In April, I wrote about AAMFT’s decision not to pursue an interstate compact for MFTs. You can see them discuss the issue and their rationale in this video. Their logic came down to two things: 1) since more than half of MFTs are in California and New York, and these states would almost certainly not join such a compact, the benefits to the MFT profession would be limited; and 2) the cost of such an effort, which would require resources to be pulled away from other initiatives, would not be worth it, especially given #1.
I think they’re wrong on both counts.
Who would benefit
It’s true that the distribution of MFTs around the country doesn’t look like other mental health professions. More than half of the licensed MFTs in the country are in California and New York. That’s largely an artifact of California being the first in the nation to license MFTs, and the last in the nation to license counselors. Both of these states have historically not participated in interstate compacts in health care. AAMFT took that to mean that the clinicians already in these states, and those who would want to practice with clients there, would not benefit from an interstate compact for MFTs.
That’s not right, though. Many California and New York MFTs have the same desires for license portability and multi-state licensure shared by MFTs elsewhere. And these MFTs in California and New York would benefit from an interstate compact, even if it would require them to take an extra step: They would have to first get a license in a compact state, and then use the compact’s provisions to gain practice privileges in other compact states. While there’s no hard data to draw from, based on my conversations with MFTs at all career stages in California, it seems quite likely that many would do exactly that, if given the opportunity.
In May, I asked a Facebook group of California prelicensees what they would do if there were an interstate compact for MFTs but California didn’t participate. It’s a small sample, and not necessarily representative, but the results are consistent with what I’ve heard (and polled) elsewhere:
In other words, MFTs in California and New York wishing to practice in multiple states would still benefit from the existence of a compact, even if their home states don’t participate.
Weighing the costs
As AAMFT noted, pursuing an interstate compact is an expensive endeavor. AAMFT is smaller, in both people and budget, than its sister organizations ACA and NASW. AAMFT has to be particularly thoughtful about where they’re going to invest their resources. Sometimes they’re called upon to act quickly to respond to licensure threats at the state level.
But it’s worth asking: What big strategic task is AAMFT working on? They completed licensure across the country in 2009, and achieved Medicare recognition for MFTs last year. These have been decades-long, profession- and association-defining projects. So what’s next? What big project could draw MFTs to the association in support of something big that we all could benefit from?
AAMFT’s approach to portability is a state-by-state one. They plan to encourage individual states to offer a framework for licensure by endorsement that is similar to what California offers now. If you’ve been licensed in good standing in your home state for two years, you can get licensed in California with some additional CE and California’s Law and Ethics Exam. The state will not re-evaluate your degree or experience. You will not need to take another Clinical Exam.
I get the logic. From a business perspective, perhaps it’s the smarter path. But it’s sure uninspired, and uninspiring. It positions MFTs far behind social workers and counselors, as those professions are actively pursuing compacts.
Responding to MFTs’ needs
In considering its portability efforts, AAMFT did research on current MFTs’ desires and struggles. An overwhelming majority — more than 70% — want to practice in more states. AAMFT looked at the flaws in compacts, and decided that pathway wasn’t worth the effort. Taking a state-by-state approach looks like punting, especially for an organization that dissolved its state divisions several years ago.
AAMFT also noted that MFTs express struggles in other areas, like reimbursement rates and the cost of education. Fair enough. It doesn’t appear from the outside that AAMFT is rallying to do anything substantial about those issues, either.
Membership organizations frequently misunderstand how especially young professionals — their prospective members — perceive the value proposition of membership. For many, it isn’t just “What can membership do for me.” It’s “What can I help us do together, that we couldn’t do apart.” Young MFTs want to contribute to important work that has substantive impact.
Pursuing an interstate compact would be one way for AAMFT to show new therapists that it still engages in big, tough, important, collective work. Failing to pursue a compact based on a flawed rationale — especially in the absence of other defining projects — suggests that big, tough, important, collective work on behalf of the MFT profession isn’t AAMFT’s purpose.
And if that’s not its purpose, what is?