Making sense of the 2010 CAMFT “Typical MFT” survey

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CAMFT came out last month with their biannual “Who Is the Typical California MFT?” article, summarizing a survey of hundreds of members about themselves and their careers. The article is presented largely as narrative, without much in the way of interpretation – the way a good summary of results should be. To me, three things stood out in this year’s numbers. Bear in mind with all of these that, because it is just a survey of California folks, when I say “MFTs” I am really referring to “California MFTs.”

1. The economic news is not great, but it is not as bad as it sometimes seems. The average income among survey participants[*] is down almost 6% from the 2008 survey, to $52,886 from $55,890. But the news could be a lot worse. For one thing, CAMFT does not explain what they mean by “average” – that is, whether are reporting the mean or the median. If they are using the mean, it is entirely possible that some of this downturn is explained by the highest outliers making a bit less money. They do note that both “tails” of the frequency distribution – those making above $80,000 and those making below $20,000 – have increased in frequency over 2008.

2. The increase in MFT incomes over the last eight years is almost fully accounted for by those with doctoral degrees. The incomes of MFTs at the masters level have been effectively flat since 2002, rising only from $47,851 to $50,689. This increase is less than what would be expected from inflation alone. Doctoral-level MFTs, however, have seen their incomes grow significantly – including in the current economic downturn. I’ve turned CAMFT’s data since 2004 into a graphic to show the difference:

Since 2004, while masters-level MFTs have seen little to no increase in income from the profession, those with doctoral degrees have seen their incomes rise by almost $10,000 a year, from $62,885 in 2004 to $72,165 in 2010. Still wondering whether to get that doctorate? I’m speculating here, but there are a couple of reasons why the doctoral-level MFTs are continuing to see rising incomes: 1, those with doctoral degrees are able to teach in academic institutions, where they may have more job and income stability than those in private practice; 2, many of those licensed MFTs who have doctoral degrees may also be licensed as Psychologists, who are reimbursed at higher rates than MFTs when paid by most insurance plans.

3. Your web presence is not as important as your physical presence. For all of the excitement surrounding clients’ abilities to find therapists through internet searches, most clients still are not coming to therapy that way. Respondents noted that referrals came most often from other clients and from colleagues. Managed care companies were third on the list, followed by physicians, and (in a single choice) family/friends/neighbors. Internet searches were eighth on the list. So rather than spending your next Friday tinkering with your web site, you may be better off attending a local meeting of your CAMFT Chapter or AAMFT district. There’s no apparent substitute for real-world networking.

* A number of cautionary notes seem important here. For one thing, we’re talking about a survey with a 16% response rate – that, in and of itself, makes the numbers a bit dubious. That said, they’re pretty consistent with past surveys, both demographically and in the other data. So, there may be some response bias (and it seems especially likely that those at the low end of the income spectrum would be less willing to talk about it), but it’s difficult to know how that plays out. As mentioned above, CAMFT does not specify whether they are talking about a mean or a median in their income numbers; the median would probably be a better metric, but it seems more likely that the mean is what’s being reported. Finally, with all of the income numbers, CAMFT asked participants to state their pre-tax income specifically from the practice of the profession. That may or may not include supplemental activities like teaching courses as an adjunct faculty member, selling workbooks or other study materials, and so forth. Other surveys ask for total income, which has its own pitfalls. The difference in how the question is asked may account for differences from other surveys of the profession.

Reference:
Riemersma, M. (2010). The typical California MFT: 2010 CAMFT member practice and demographic survey. The Therapist, 22(4), 28-36.

From the AAMFT Research Conference: The one question that can improve depression treatment outcomes

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A large number of clients who seek treatment for depression also are having difficulty in their marriages. New data suggests that one question can dramatically improve patient outcomes on both problems: Which came first?

That’s the finding Steven Beach, a professor at the University of Georgia, discussed at this weekend’s AAMFT Research Conference in Alexandria, VA. Research has shown for many years (1, 2) that marital satisfaction and depression can be greatly improved at the same time through couples treatment, regardless of which problem came first. However, new data from Beach and his colleagues suggests that when women are struggling with both depression and marital problems, individual therapy for depression will have negative effects on the relationship if the marital discord came first — suggesting worse outcomes for the depression as well.

Why should this matter to MFTs, who are eminently qualified to identify and treat both issues? Because most depressed people don’t start by seeking treatment from a family therapist. According to a 2009 NAMI survey on depression, people with depression usually receive treatment from their primary care physicians. Just 38% receive their primary depression treatment through a mental health professional of any kind. Physicians tend to treat depression with medication and/or referral for individual therapy. They rarely refer for couples therapy, in spite of the research supporting such referrals. The list of possible reasons for this disconnect is long, but some reasonable guesses include that physicians may not know the research, may not have a trusted marriage therapist to whom they can send clients, or simply may not think to ask depressed patients about relationship difficulties (an area of struggle patients may not bring up on their own).

Beach and his colleagues believe that the link between depression and relationship difficulty is so strong that physicians ought to screen for relationship problems whenever they are diagnosing a patient with depression and considering treatment options. They developed a simple 10-item screening measure for relationship problems, with an 11th question for those who show relationship difficulty: Which came first?

Notes: Two quick things about the research base here: 1, the studies of marital therapy to treat depression have universally, as best as I can tell, looked at depressed women. Whether the suggested treatment course and likely outcomes would be the same with depressed men is open to question. 2, while studies have looked at marital therapy and marital satisfaction, there is no reason to believe that non-married people in committed relationships have a different kind of link between depression and relationship difficulty. The screening instrument can be used for married and nonmarried couples alike.

UNLV’s MFT program will survive

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This post was originally posted on June 5, 2010 under the headline “UNLV MFT program to close.” The original post follows. It is updated below. -bc

The Las Vegas Sun is reporting that the state’s Board of Regents has approved the closing of UNLV’s marriage and family therapy program. The decision was based on state budget cuts, which also have forced the closing of five other UNLV programs. This appears to be the first COAMFTE-accredited program to be shuttered due to state budget cuts.

Update 7-17-2010: As noted in the comments, the program has been saved thanks to some thoughtful maneuvering by its faculty. Though the MFT program will no longer have its own department, the program will continue under a new administrative structure. This is wonderful news to students, faculty, and colleagues alike. The UNLV program is the only COAMFTE-accredited program in the state and is vital to the region.

From the AAMFT Research Conference: Does marriage education work?

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Marriage education (also known as relationship enhancement or RE) has gotten a big, warm spotlight lately. A recent big-deal writeup in the Washington Post hit on the high points: Marriage education programs are big business, they have a lot of federal money supporting them, and there’s not a lot of research on them. Do they work?

That was the basic question tackled yesterday by Howard Markman at the AAMFT Research Conference in Alexandria, VA. In general, it looks like the research base for such programs is growing but still fairly small relative to the number of RE programs in existence. Markman and his colleagues located 30 studies examining 21 different programs since 2002 — meaning that a large number of programs offered at the annual SmartMarriages conference have not been researched at all. The research that does exist is usually promising, but not definitive: programs are generally shown to produce short-term improvements in couple satisfaction and communication skills. However, there have not been studies addressing whether these programs actually do what they set out to do, reducing the risk that couples will eventually divorce over the long term.

The federal government has been running a huge study that should be able to offer clearer answers. Involving eight sites and more than 5,000 couples around the country, the Building Strong Families (BSF) project sponsored by the Administration for Children and Families is testing voluntary RE programs offered to unmarried couples who are expecting or recently had a baby. The project just released its 15-month follow-up data, and the news is not good:

When results are averaged across all programs, RE did not make couples more likely to stay together or get married. In addition, it did not improve couples’ relationship quality.

As Markman was quick to note, the news was not all bleak. It would be more accurate to say that couples didn’t finish the programs than it would be to say that the programs didn’t work; with the exception of the project’s Oklahoma site (which performed much better than other sites in a variety of ways), only 9% of couples completed at least 80% of the relationship enhancement curriculum offered to them. That’s a big problem. Where couples did tend to finish their program — at the Oklahoma site — they were more likely to still be together at the 15-month follow-up, and experienced a number of other measurable improvements as well. Furthermore, only the Oklahoma site used a program that included most of PREP, one of the best-known and more well-researched relationship enhancement programs around. Other sites used less established curricula.

The study will be releasing its 3-year follow-up data in 2012. As Markman noted, the 15-month followup may simply be too early to see the hoped-for impact on marriage that these programs would offer; by definition, preventing marriage breakup is a long-term goal. It is possible that changes will emerge over time. Until they do, however, RE programs will continue to face skepticism. Which is good, if it drives more research that will develop programs that really do ultimately meet their preventive goals.

San Diego County to get MFT stipend program

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The San Diego MFT Consortium has been awarded a $350,000 grant to launch a stipend program for marriage and family therapy interns working in public mental health. The program will largely mirror the highly successful Los Angeles County MFT stipend program, which awards $18,500 stipends to MFT Interns who agree to work for at least one year in public mental health in an underserved area. More than half of the awardees in the LA program have been bilingual, helping meet a major need in the county’s mental health workforce.

I’ll add detail about the San Diego County program as it becomes available.