As landmark California law heads to court, few support reparative therapy for minors

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SB1172 would prevent licensed therapists from trying to change the sexual orientation of minors.                                                                                                                                                                                                                                                                                                            

JudgesTools IconTwo lawsuits (Pickup v Brown and Welch v Brown) have sought to stop the implementation of SB1172, California’s landmark bill passed last year that outlaws the practice of reparative therapy on minors. Though one of these suits did lead to an injunction preventing 1172 from taking effect until the legal challenges could be sorted out, things aren’t looking good for those who would like it to remain legal for licensed therapists to try to turn gay kids straight.

Here is a list of all those who have filed amicus (“friend of the court”) briefs in support of SB1172, as of the February 10 listing on the federal appeals court’s web page for this case. I’ve put the major professional mental health associations in bold. (Full disclosure: I’m on the AAMFT-CA Board of Directors, and represented the organization in a lot of work on SB1172 and the brief onto which AAMFT-CA signed.)

American Association for Marriage and Family Therapy – California Division
American Civil Liberties Union of Northern California
Rt. Rev. Marc Handley Andrus, Episcopal Bishop of California
California Council of Churches
California Faith for Equality
California Network of Metropolitan Community Churches
California Psychological Association
Children’s Law Center of California
City and County of San Francisco
Dependency Legal Group of San Diego
Dr. Jack Drescher
East Bay Children’s Law Offices
Equality California
First Amendment Scholars
Gaylesta
Health Law Scholars
Justice and Witness Ministries
The LGBTQ-Affirmative Therapist Guild of Utah
Legal Advocates for Children and Youth
Legal Services for Children
Los Angeles Gay & Lesbian Center
Los Angeles Youth Network
National Association of Social Workers
National Association of Social Workers – California Chapter
Parents, Family and Friends of Lesbians and Gays
Public Counsel
St. Paul’s Foundation for International Reconciliation
Survivors of Sexual Orientation Change Efforts
The Trevor Project
Truth Wins Out
Unitarian Universalist Legislative Ministry California
United Church of Christ

Quite a list, eh? Lawyers, scholars, local government, mental health professionals, churches, and advocacy groups, all on the same side. And here is a list of all those who have filed amicus briefs in support of using therapy to try to turn gay kids straight, and asking that the law be struck down:

National Legal Foundation

While the points of emphasis are a bit different from one brief to the next, those briefs in support of SB1172 make a number of compelling arguments. The restriction on reparative therapy isn’t unique, as California already restricts a variety of health care practices; the legislature made a well-informed decision in rejecting the practice of reparative therapy among minors; reparative therapists can’t claim free speech as a defense here, since many professional restrictions are by their nature restrictions on speech (like the rules requiring therapists to maintain confidentiality for their clients); and on and on. Basically every argument made by those who support reparative therapy gets demolished. They’re interesting reading, and a good preview of the legal arguments on both sides.

The two cases will be heard together in April at the US Ninth Circuit Court of Appeals. Obviously, the number of groups on either side of the issue will not decide the case, but the level of consensus here at least says something about just how far on the fringes reparative therapy has become.

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Your comments are welcome, either in the comments below, via email to ben[at]bencaldwell[dot]com, or to my Twitter feed.

The upside of overdiagnosis

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Yes, we’re pathologizing everyday life. But that also makes it easier to ask for — and get — help.                                                                                                                                                                                                                                                                                                            

DepressionThere’s a nice column on PsychCentral today asking the question, “Are we over-diagnosed and over-medicated?” Author Linda Sapadin isn’t asking whether we are diagnosing people who fail to actually meet diagnostic criteria; that’s also worth debating, but not the point here. She’s challenging the diagnostic criteria themselves. Her voice adds to the chorus of those concerned about changes coming in the DSM-5 this May, particularly those that will make it easier to diagnose a grieving person as having major depressive disorder.

There are clear downsides to broadening the diagnostic criteria for any mental health disorder. Such a shift means that more people who are functioning within normal ranges (which is not to say they are functioning well, mind you; we’re talking about people who are still suffering, it is just that the suffering is common) will qualify for a diagnosis and then receive treatment. This adds to our growing healthcare costs. It arouses skepticism of the overall legitimacy of mental health care, leading some to wonder whether these changes are driven (at least in part) by pharmaceutical companies looking for new people to sell drugs to. It also risks sending the message to more people that they are mentally ill, that there is something wrong with them, when in actuality their functioning is quite normal and their suffering would possibly resolve on its own without treatment.

But such discussion is incomplete unless we also look at the upside of broadening diagnostic criteria. Just because a person’s suffering is within normal ranges does not mean we should refuse, as a mental health field, to make help available. Bereavement is a prime example. Not everyone who is grieving the loss of a loved one needs medication. But for those who cannot seem to resolve their grief, those who feel genuine struggle and suffering, those who want treatment to help them function better — broader diagnostic criteria makes it more likely that they will be able to get treatment and have it paid for through their insurance.

It’s also possible that having broader diagnostic criteria can help reduce the stigma of a mental health diagnosis. If we looked at these diagnoses as more like colds (almost everyone gets them sometimes) and less like the plague (rare and frightening), it would be easier to publicly discuss one’s mental health struggles without shame.

I realize there is more to this, and I’ll confess I’m not yet sure where I land on many of the DSM-5 changes. There are reasonable questions to be asked about whether someone should be able to receive mental health treatment (particularly on someone else’s dime, whether that someone else is the taxpayer or other members of their health plan) simply because they feel they need it. Widespread use of psychotropic medications has serious public health and environmental consequences. And the national shortage of well-trained mental health workers means our system is already strained by current diagnostic criteria. But anyone who presumes that broader diagnostic criteria are automatically bad is failing to consider the whole picture. There are some potential benefits of allowing more people who at the edges of normal functioning to qualify for diagnoses.

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The DSM-5 comes out in May; you can learn more about it here. Your comments are welcome. You can email me at ben[at]bencaldwell[dot]com, post a comment below, or find me on Twitter @benjamincaldwel.

Northcentral University becomes first mostly-online program to earn COAMFTE accreditation

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Their masters program uses practicum site supervisors as co-instructors, meeting COAMFTE’s requirement for in-person education.                                                                                                                                                                                                                                                                                                            

Books-aj.svg aj ashton 01The Commission on Accreditation for Marriage and Family Therapy Education announced just before the holiday that Northcentral University, one of five online programs (or in their case, mostly-online programs) I discussed in this recent post, has become the first such program to earn COAMFTE accreditation. (Here’s why COAMFTE accreditation matters to students.)

As I mentioned previously, they appear to use practicum site supervisors as co-instructors for the practicum class, thus meeting the COAMFTE requirement (page 8) that at least some instruction in any accredited program be provided in person.

This is a milestone for graduate education in MFT, though I will confess I am not quite sure what meaning to put to it. That’s a longer discussion I’ll put in another post. For now, my hearty congratulations to the faculty, staff and students at Northcentral for a significant achievement!

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In the interest of full disclosure, I have served in the past as a COAMFTE Site Visitor, but I had no involvement with the accreditation process for Northcentral and have no affiliation with that university.

Your comments are welcome. You can email me at ben[at]bencaldwell[dot]com, post a comment below, or find me on Twitter @benjamincaldwel.

Happy holidays!

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ChristmasThe blog is taking a little hiatus over the holidays. Back in January with a report on the first mostly-online program to win COAMFTE accreditation, the latest on the court challenges to California’s SB1172 (the ban on conversion therapy for minors), a discussion about the importance of cultural competence for MFTs, and much more! I hope you and your family have a wonderful holiday season. -bc

Online MFT programs

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Are you interested in getting your marriage and family therapy degree through an online program? Here are five MFT programs that are mostly or fully online.                                                                                                                                                                                                                                                                                                            

Computer and screenOnline education holds the promise of extending the reach of marriage and family therapy training. Champions of these programs argue that they make advanced education available to those who otherwise might not have access to it, due to scheduling, geographic, or other barriers. It is possible that the growth of online MFT programs will particularly help bring cultural diversity and rural practitioners into our community of licensees.

Of course, there are also general concerns about online education, including dropout rates, profit motives (as many online schools are for-profit), and overall effectiveness.

In the MFT field, online education seems to be an especially challenging proposition: We need to train practitioners in the art and science of relating, face-to-face, in a way that will heal clients and their family relationships. That is a skill set, and one that would seem to require a fair amount of face-to-face interaction to be best developed, shaped, and observed.

Online graduate programs in MFT are experimenting with a number of creative ways to resolve this dilemma — and also keep themselves eligible for COAMFTE accreditation. COAMFTE has tried to walk a difficult middle ground in its educational standards, saying that MFT programs can employ some distance education but not be fully online; since “fully” means “fully,” it would seem a program could get around the letter of this requirement simply by requiring a one-hour meeting on campus at some point during the educational process. But many of the online MFT programs appear to be genuinely interested in maximizing the potential benefits of online education alongside a recognition of the need for in-person work to develop relational skills. As such, many have integrated in-person events and coursework into their online curricula.

Below you will find a list of five MFT programs that are mostly or fully online. Some things to know about all of these programs: 1, As of early December 2012, none of them have yet earned COAMFTE accreditation. (Here’s why COAMFTE accreditation matters to you.) That is only one consideration in choosing the right MFT program, but it is worth considering. [Update 2013: Northcentral is now COAMFTE-accredited.] 2, The information here is drawn from the universities’ web sites. Information can change quickly. 3, Any cost statements do not include books, supplies, living expenses, or the cost of travel or lodging for any required in-person events. 4, It is always the responsibility of the student to ensure their academic program will meet the requirements for licensure in the state where they wish to be licensed; check with your state’s licensing board before choosing a program and remain up-to-date as state requirements change. 5, States typically require hours of supervised experience in a clinic setting as part of the graduate degree; the schools also have this requirement, and offer varying levels of assistance in locating placements. 6, And of course, requirements and costs can change quickly; the information here is as of December 2012, and you should check with the schools for current information.

  • Touro University Worldwide is based in Woodland Hills, CA and has been rapidly growing their Master of Arts in Marriage and Family Therapy program. Part of this is due to cost; at $500 per unit, Touro’s program is less expensive than some of their competitors. Their 60-semester-unit program is delivered in eight-week terms (six of them per year). This program is fully online.

  • Northcentral University is widely considered a pioneer in online MFT education. Members of their faculty have spoken at past AAMFT Annual Conferences about their efforts to comply with COAMFTE standards [Update 2013: Northcentral is now COAMFTE-accredited]; it looks to me like they do so by utilizing site supervisors as co-instructors with university mentors for the practicum courses, which would then be considered in-person instruction. The Northcentral MA in MFT program is a 45-semester-unit program that can be bumped to 48 or 60 units for those living in states requiring more units for licensure. They also offer a PhD in MFT that requires an additional 72 semester units.

  • Capella University offers a Master of Science degree in Marriage and Family Counseling/Therapy. They have quickly grown this program to national prominence and notably earned CACREP accreditation. To their credit, they list cost information plainly and prominently on their site: Their 92-quarter-unit degree, at $458 per credit, will run about $40,000 in total tuition. The program requires two six-day colloquia in to accompany the online instruction. Like many online schools, Capella is for-profit, which may or may not matter to you. (I’ll do a separate post in the next few months on non-profit versus for-profit schools.)

  • Liberty University promises an affordable online MFT masters degree with a Christian perspective. They advertise themselves as the nation’s largest private, nonprofit online university. Their MFT program requires four one-week intensives to accompany the online instruction. Unfortunately, the information on their web site is surprisingly thin — I could not locate a program plan (curriculum) or specific cost information anywhere on their site.

  • Cal Southern University offers a Marriage and Family Therapy concentration within its Master of Arts in Psychology program. This 63-semester-unit program is entirely online.

There are other online programs out there as well, I’m sure. Feel free to share info on them in the comments, and I’ll update this post every once in a while with more recent additions.

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Your comments are welcomed; you can email me at ben[at]bencaldwell[dot]com, post a comment below, or find me on Twitter @bcmft. I regret that I cannot answer every comment personally, but I do chime in on the comments when I can!