The California School of Professional Psychology was the country’s first free-standing professional school of psychology. It was one once known for radically transforming the training mental health professionals. And at the 2013 Evolution of Psychotherapy Conference in Anaheim, its founding President said the school made a major mistake by choosing to pursue APA accreditation for its Clinical Psychology programs.
We can’t say we didn’t see this coming. In the first edition of The Heart and Soul of Change: What Works in Therapy, published in 1999, authors Mark Hubble, Barry Duncan, and Scott Miller predicted that psychotherapists would soon be facing a new era of accountability for their work. Clients, payors, and policymakers would all demand hard evidence that psychotherapy was effective. That era is well underway, and so far we have provided a wealth of the kind of information these parties have demanded.
We can demonstrate that therapy works as an overall conclusion, and within the contexts of specific problems and populations. Proving the effectiveness of specific models has been helpful in many ways (showing that model-based treatment is superior to no treatment) and enlightening in others (showing that, for most problems, the model of therapy has little to no impact on outcome). The brain research discussed by Siegel, Cozolino, and others explains why therapy works. Psychotherapy in general is being held accountable, and it is passing the test with flying colors.
The same cannot be said of specific therapists, or of therapy training programs – yet.
Ah, to be a medical doctor. To only have to pass the boards once, and then be done with it. MFT license portability isn’t so easy.
Marriage and family therapists — who, at least in theory, practice the same profession no matter where they roam — are subject to a mishmash of licensure laws around the 50 states, with similar-but-different requirements for education, experience, and examinations. Taking your MFT license to a new state can be a challenge, as you may be forced to provide transcripts and even syllabi from classes taken decades ago, register as an intern or associate even if you’ve been fully licensed, and in some states, go through another testing process.
If adopted, the draft COAMFTE standards would require all programs to teach LGBTQ-affirmative practices.The public comment period closes Wednesday on the draft version of new accreditation standards for graduate programs in marriage and family therapy. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) is proposing some major changes from current standards:
- The draft standards would restore the 500-client-contact-hour requirement for practicum. Under the current, version 11.0 standards, programs can require fewer hours as long as they have evidence to show that their practicum results in students being competent to practice at the master’s level. This vague standard has left different accredited programs using different experience requirements, which can be confusing to state licensing boards who want to know how much practical experience they can reasonably expect to be included in graduate degrees.
- The draft standards separate accreditation requirements into “eligibility standards” and “accreditation standards.” As it is now, the Commission makes its decisions based on the full scope of information presented to them. Programs that meet most but not all standards may still be granted accreditation, with stipulations — requirements that the program comes into full compliance with the standards within a year. This proposed split into eligibility and accreditation standards arguably makes the accreditation bar a bit higher: Programs that fail to meet even one of the eligibility standards would not be eligible for accreditation, regardless of their performance on the other standards.
- The draft standards would go back to a singular, mandatory core curriculum for all accredited programs. Of course, programs would remain free to add on to this core curriculum as they see fit, but all accredited programs would be required to have the same core set of coursework.
- Perhaps what is most notable in the draft standards is what is missing: The draft standards remove COAMFTE’s current vague, blanket exemption for religious programs. The exemption, present in the current COAMFTE standards (p. 3), says
Religiously affiliated institutions that have core beliefs directed toward conduct within their communities are entitled to protect those beliefs.
It has never been clear to me what that is supposed to mean in practice, but the way I read it, any religious-based program that wants COAMFTE accreditation but isn’t in tune with any part of the standards was free to ignore that part of the standards, as long as they could tie their objection to their religious beliefs. Under the proposed new standards, not only would that clause go away, but the required curriculum would include at least three semester units on
diversity, power, privilege and oppression as they relate to race, age, gender, ethnicity, sexual orientation, gender identity, socioeconomic status, disability, health status, religious and spiritual practices, nation of origin or other relevant social categories throughout the curriculum. It includes practice with diverse, international, multicultural, marginalized, and/or underserved communities, including LGTBQ affirmative practices. [emphasis in original]
It is much clearer what the new standards would mean: Every COAMFTE-accredited program would need to teach its students how to work with LGBTQ clients in a positive, affirming way, and an appreciation for the harm such clients suffer from living in a heterosexist society.
To me, these are all good and necessary changes. First, as to the hours and curriculum changes: I hear chatter among MFTs around the country that licensing boards haven’t known what to do with the current COAMFTE standards. Those current standards are so flexible that licensing boards don’t necessarily know what they’re getting when someone comes to them with a COAMFTE-accredited degree. The draft standards, if adopted, would bring back greater consistency in content across programs and could restore state boards’ confidence in maintaining COAMFTE accreditation as the standard educational requirement for licensure.Second, as to the removal of the religious exception: I’ve written previously about the struggles some religious therapists face when trying to work with LGBT clients, and the debate there is far from settled. But accredited programs can and should teach affirmative practices. The debate here should be restricted to how a therapist balances their values with client needs in the therapy room, not about whether the therapist can be exempted from exposure to affirmative techniques or to the suffering LGBTQ clients genuinely experience. There’s only one thing COAMFTE didn’t included that I wish they would: Require MFT programs to be more transparent about cost. COAMFTE will be reviewing comments on the proposed changes this fall. If adopted, the new standards would likely take effect in 2014 for new accreditations and be phased in for those programs already accredited.
Their masters program uses practicum site supervisors as co-instructors, meeting COAMFTE’s requirement for in-person education.The 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! # # # 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.