Supervision

Can a religious therapist refuse to treat gay and lesbian clients?

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Homosexuality symbolsIn 2009, Julea Ward, a counseling student at Eastern Michigan University, was in her school-assigned practicum when she was assigned a same-sex couple for treatment. She went to her supervisor and said she could not provide treatment to the couple, citing a conflict with her religious beliefs. The couple ultimately was assigned to a different counselor at the same agency, who did not have the same conflict. Ward thought she had handled the issue appropriately, as the clients received the treatment they had sought and she was not put in a position of needing to hide or compromise her beliefs. She understood the issue to have been successfully resolved.

Her graduate program, however, did not.

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MFT licensure: Why 3,000 hours?

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Whenever I get into conversations about the MFT licensure process, and how it differs from one state to another, similar questions come up. Earlier I addressed the fundamental question of whether license examinations make for better therapists. Another common question I hear: Why do we require 3,000 hours of supervised, prelicensed experience for MFT licensure?

(Making things more complicated, why do some states require more? California uses the 3,000-hour standard. Arizona, like a handful of other states, requires 3,200 hours. Some other states simply say “two years of full-time supervised experience or the equivalent.”)

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Senioritis: The last stretch of hours before licensure

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Brodie Vissers / Burst / Used under licenseWe all remember the last semester of high school. A new life chapter was approaching. Our childhood was ending. We would soon experience the freedom of the college world.

It was scary to know that we would be on our own, but we were itching to leave. We knew the quality of our work did not reflect what we were capable of, we just wanted it out of the way. I even remember calculating how much I had to do to just barely pass my classes and coast through the rest of my school year. It did not matter that more difficult times and more responsibility were imminently ahead of us, we just wanted to be done with high school. We called it “senioritis.”

Nearing the end of your 3,000 hours towards licensure can be eerily similar.

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Boundaries, apps, and dispensaries: Seeing clients in public

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Brodie Vissers / Burst / Used under licenseAs mental health clinicians, we all know the importance of setting and maintaining boundaries with clients. We have several posts on this blog about setting boundaries online, specifically in regards to social media use (1 2 3). One boundary that we have not discussed is how to manage situations when you see a client outside of the regular therapy setting.

Therapists generally agree that we do not to approach clients outside of therapy, out of respect for the client’s confidentiality. If someone else knows that you are a therapist, they may make the connection that the person you are interacting with is a client. If a client approaches the therapist first, however, engaging is often considered appropriate. Even so, many therapists agree that it is difficult to maintain professional boundaries while also engaging clients socially.

Legal and technological changes are further complicating the potentially uncomfortable situations where we might encounter clients outside of the office. More specifically, we may see clients in settings that were not previously socially acceptable or accessible. Therapists today are at risk of seeing clients on dating apps, at meet-up groups, and at marijuana dispensaries. The potential for seeing clients in social situations has always been present, but there is added risk that those interactions will reveal private details about your personal life.

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Podcast episode 9: Measurement with Casey Meinster

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Psychotherapy Notes podcastCasey Meinster is the Director of Evidence Based Practices at Hathaway-Sycamores Child and Family Services, a major mental health services provider in Los Angeles. In that role, she wrangles a lot of information. But one piece of information I learned from her changed how I think about the importance of measurement in psychotherapy.

Hathway-Sycamores serves thousands of clients a year through more than a dozen programs. They fund those programs through a variety of sources, including government contracts, grants, and other sources. And it is now the case that every single program they run now has to produce outcome data on its clients. Their payors demand it.

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