BBS

Quitting CAMFT

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CAMFT’s LPCC “gap exam” lawsuit against the BBS is a waste of resources that, if CAMFT “wins,” would eliminate California’s legal recognition of the distinctiveness of the MFT license. I refuse to let my member dues support it.

As I reported here recently, the California Association of Marriage and Family Therapists (CAMFT, which is independent of AAMFT and its California Division) has filed suit against the Board of Behavioral Sciences, alleging that their decision to require a “gap exam” for MFTs seeking grandparenting into LPCC licensure amounts to an illegal restraint of trade.

If CAMFT loses, it would mean they wasted thousands of dollars of member dues on outside counsel and court fees.

But if they “win,” the outcome would be far worse: It would eliminate legal recognition of any distinction between the practices of MFT and professional clinical counseling — and pave the way for the MFT license to disappear completely. (Here’s why.)

And either way, CAMFT’s conduct around the issue has already damaged the organization’s ability to work collaboratively with the BBS. [Page 50, item III on the linked PDF.]

Why CAMFT would want to win this argument, I do not know. But I know my member dues cannot support it.

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I have been an active and supportive member of CAMFT for several years. As I have talked with students and colleagues around the state, I have been able to honestly say that there is much to be proud of in the work CAMFT has done — even this year, legislation CAMFT sponsored to clarify MFTs’ roles and responsibilities around child abuse reporting has been good for the profession. Their in-house attorneys are wonderful resources, available any time. And at the chapter level, the overwhelming majority of CAMFT members simply want to be able to make a living providing providing the most effective services possible to their clients. They’re great people and often outstanding therapists.

The organizational decisions CAMFT has made, though, have too often been in direct conflict with the best interests of the profession. CAMFT’s struggle around same-sex marriage is well-worn territory here, and it speaks to larger structural problems that were apparently never meaningfully addressed. CAMFT has stopped publicly advocating for the complete elimination of the MFT license, but they continue to make decisions that lead in that direction — like this lawsuit — and I do not believe most members know just how close they have come to making it happen.

This lawsuit over a gap exam, if successful, would put the state on the record as determining there are no differences in practice between MFT and LPCC. Not only is that fundamentally wrong, but it also would virtually force the BBS to consolidate the MFT and LPCC licenses. (If there is no difference in practice, there is no need for independent licensure.) It would not happen immediately — the process would take years — but with a CAMFT “victory” in this case, it would be almost impossible to prevent.

I am a marriage and family therapist. Not a professional clinical counselor. There is a difference. Even the counselors say so. [See currently-third item, “AMHCA lauds…”] I should never have to remind a professional association of MFTs that this is true. And I cannot support one more dime of my money being used to chip away at what makes this profession unique and valuable.

So I am, with a great deal of disappointment, resigning my membership in CAMFT. I hope they get back on the right track at some point in the future. My letter resigning my membership, which largely repeats these same points, follows in its entirety.

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November 1, 2010

Dear CAMFT,

Effective immediately, please cancel my membership.

Over the past several years, I have gradually lost my faith that the organization’s goals and actions are truly in the best interest of the MFT profession. Your lawsuit against the BBS over the “gap exam” for MFTs seeking grandparenting into LPCC licensure only confirms that you are actively working against what is best for the field of marriage and family therapy.

If unsuccessful, this lawsuit will be a massive waste of members’ dues in a misguided cause. If successful, the outcome would be even worse: A legal determination that there is no difference in practice between MFT and LPCC (and perhaps LCSW as well) would pave the way for license consolidation. While this may be in the best interest of CAMFT as an organization (you could add LPCC members under one umbrella), it is quite clearly not in the best interest of marriage and family therapy as a profession. Independent licensure provides valuable legal recognition of the distinctiveness of our skill set and body of knowledge. A short “gap exam” for grandparenting appropriately balances the need to recognize this distinctiveness with the desire among some experienced MFTs who are otherwise prepared for LPCC licensure to obtain that distinct license.

Regardless of its outcome, the lawsuit has harmed CAMFT’s ability to effectively work collaboratively with the BBS. This was made clear when, at the September BBS meeting, several board members openly and publicly expressed their disappointment with CAMFT’s conduct.

I cannot in good conscience allow my dues money to be used for efforts that work against the best interests of the profession of marriage and family therapy. I will happily rejoin if and when CAMFT (1) drops this misguided lawsuit; (2) makes a clear and public statement that it recognizes the practice of marriage and family therapy is distinct from other mental health professions; and (3) outlines and follows through on clear steps to protect, preserve and advance the distinctiveness of our profession.

Sincerely,

 
Benjamin Caldwell, PsyD

CAMFT sues California licensing board

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CAMFT is suing the Board of Behavioral Sciences (BBS), demanding a ruling that the practice of marriage and family therapy has nothing unique to offer.

See updates below: The court sided with the BBS on two out of three legal questions and CAMFT on the other. The ruling required the BBS to consult with the state’s Office of Professional Examination Services prior to determining whether a gap exam was necessary. OPES recommended doing the exam, and the BBS voted unanimously to do a gap exam.

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The California Association of Marriage and Family Therapists (CAMFT) followed through on an earlier threat and filed suit this week against the state’s licensing board, the Board of Behavioral Sciences (BBS). CAMFT is seeking a ruling that marriage and family therapists who wish to be grandparented into licensure as Professional Clinical Counselors (LPCCs) will not need to take an exam on the differences in practice between those professions. But the issue is bigger than it may sound: Such a ruling would require the BBS to first determine that there are no differences in practice between the professions, a ruling that would have major implications for the future of professional licensing in mental health.

But let’s start with where this is now. The law that brings the LPCC license into the state is quite clear (emphasis mine):

The board and the Office of Professional Examination Services shall jointly develop an examination on the differences, if any differences exist, between the following:
   (A) The practice of professional clinical counseling and the practice of marriage and family therapy.
   (B) The practice of professional clinical counseling and the practice of clinical social work.
– California Business & Professions Code section 4999.54(b)(1)

CAMFT argues in its suit, as it has in BBS meetings, that there may be differences between the professions, but that these do not amount to differences in practice. So they do not believe that an exam on differences between MFT and LPCC (a “gap exam”) is necessary. That argument has now lost twice: The BBS ruled on July 28 that there should be a gap exam, based on the language of the law. CAMFT threatened to sue (page 6), and the BBS vacated all earlier discussion and took the issue up again on September 9. Again they ruled that there must be a test. In a suit filed on Monday, CAMFT argues that requiring a gap exam amounts to an unlawful restraint of trade for MFTs seeking LPCC licensure. They ask to have the BBS decision again vacated, and an injunction issued preventing the BBS from requiring a gap exam.

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While I am trying to present these facts as neutrally as possible, I am hardly an objective observer. I co-signed AAMFT-CA’s letter to the BBS encouraging them to revisit their initial decision in May that no gap exam would be needed. And, fundamentally, I believe there are significant differences between the professions — that’s why we have distinct educational programs and are distinctly licensed. Arguing that the professions may be different but their practices — the doing of the professions — is the same is a giant leap of both language and logic. Indeed, as Dean Porter, head of the California Coalition for Counselor Licensure, has said, proving LPCCs’ distinctiveness [currently-third item, “AMHCA lauds…”] was one of their biggest challenges in achieving licensure in California.

There is no need for a separate license if the professional group in question has nothing new or different to offer. That is why this is such a concern for me — if CAMFT gets their way, and the BBS or a court rules that there are no differences in practice between the professions, it is an extremely short logical walk to an argument that MFTs and LPCCs (and even LCSWs) should not be separately licensed. I worry that that’s the idea. CAMFT has stopped publicly advocating such a shift (they openly projected such a “one-license future” to members and to the California legislature in 2007), but they still seem to be walking down that road. Having earlier removed their opposition to LPCC licensing legislation, they appear to have taken no action when a 2008 version of the LPCC bill proposed to study eliminating the MFT license entirely (see Section 6, at the bottom of the next-to-last page; that version of the bill, thankfully, failed). This week’s legal action seems to be a continuation of the “we have nothing unique to offer, so let’s all combine licenses” philosophy. Why an association of marriage and family therapists would continue taking stances that appear to act against keeping the MFT license distinct is beyond my understanding.

I would love a different explanation, but cannot seem to come up with one.

The legal complaint and related documents can be downloaded here *. They are referenced by case number (34-2010-80000689).

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I know I say this over to the right, but it bears repeating: On this blog, I speak strictly for myself, and not my employers or contractors or anyone else. It also bears repeating, for those of you from outside California, that CAMFT is an independent organization with no ties to the American Association for Marriage and Family Therapy (AAMFT) or its California Division (AAMFT-CA).

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* Updated 1-11-2011: Updated link.

Updated 2-3-2011: The court has issued its ruling, which sides with the BBS on two out of three legal questions and CAMFT on the other. See this post for details: Ruling mixed on CAMFT-BBS “gap exam” lawsuit.

Updated 2-27-2011: OPES recommended doing the exam, and the BBS has voted unanimously to do a gap exam.

Insights from 5 1/2 years of California MFT license exam data: Part I

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California’s 80-ish degree-granting MFT programs are hard to compare. While there are minimum curriculum standards every program must meet, each has its own personality, its own goals, and its own structure. For prospective students, it can be difficult to figure out which programs offer them the best chances of success in the field. There’s really only one common yardstick that every student, from every program, ultimately gets measured on: Licensing exams.

California’s Board of Behavioral Sciences routinely publishes licensing exam success rates for each program in the state, in six-month increments. The most recent data can be viewed on their web site for the Standard Written Exam and the Written Clinical Vignette Exam. However, the small sample sizes that result from using six-month intervals make meaningful comparison difficult; smaller programs are particularly prone to large swings in their graduates’ exam pass rates from one six-month period to the next.

I gathered the BBS data going all the way back to 2004 to see whether bigger sample sizes might allow for some more solid conclusions — or at least better-informed guesses — about how MFT programs around the state compare to one another.

Before we dive in, some pretty major caveats need to be put forward. (1) My student assistants and I did the best we could to cross-check and validate the data, but we cannot guarantee that we did a perfect job. You are cordially invited to check our work (details at the end of this post). (2) Lots of factors influence the exam pass rates of a particular school’s graduates, separate from the quality of education. There are the program’s choices about whom to admit; graduates’ experiences in supervision; decisions by students about whether to pursue MFT licensure; and on and on. So if a program’s graduates performed especially well or poorly, that does not necessarily mean that the program itself performs that way. (3) To whatever degree exam passing-or-failing does reflect on a program itself, it reflects on that program’s performance several years prior to the exam. When you’re looking at data going back to 2004, as we are here, we’re considering the impact of an education received as far back as around 2000, possibly even earlier. Programs change. (4) If you’re a prospective MFT student, exam pass rates are certainly not the only things to consider when choosing an MFT program. They can be useful to include in your decision-making, but please do not let them be a powerful factor.

Got all that? Great! With those cautionary notes in mind, let’s dive in. We’ll focus here on the first licensing exam, the Standard Written Exam.

I’ve had student assistants input and cross-check the data, and we’ve done some analysis using Excel and SPSS (now PASW, for statistical-software purists) programs. The data shows some clear trends.

  • There are big differences between programs. Don’t let anyone tell you that graduate programs are basically interchangeable. They may all be subject to the same MFT curriculum requirements, but some appear to be far more effective than others in preparing their students for the licensing exams. (Education is not the only influence on exam preparedness, of course, but this data does suggest that it is a meaningful one.)

    Note: Try as I might, I could not get the tables to display well inline here. So they’ve been shifted over to the MFTEducation.com server, where they display properly. -bc

    Table 1: Best and worst performing programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009 (Minimum 50 first-time examinees)

  • Accreditation matters. Graduates of COAMFTE-accredited programs were more successful on licensing exams than graduates of non-COAMFTE programs. While my own program at Alliant International University did better than the state average, much of the COAMFTE benefit seems to come from the strength of the University of San Diego. (I have a more detailed exploration of the link between program accreditation and licensing exam success in press at the Journal of Marital and Family Therapy.)

    Table 2: COAMFTE-accredited programs*, California MFT Standard Written Exam, 1/1/2004-6/30/2009
    * – Accredited as of 1/1/2004.

  • Size doesn’t matter. Graduates of smaller programs did no better or worse overall than graduates of bigger programs. And the biggest programs were not necessarily the best. Far from it, in fact. Graduates of National University, the state’s largest MFT program by number of examinees, performed well below state averages on the Standard Written Exam:

    Table 3: Most first-time examinees, California MFT Standard Written Exam, 1/1/2004-6/30/2009

These are only the beginning, of course. There is a lot to be gleaned from the available data, for programs and prospective students alike. I’ll be doing some additional posts with more comparisons here in the coming weeks to illustrate some more of the interesting (I hope!) things we found.

One big plus about working with BBS data is that it’s all public information. So I feel an obligation to make sure others can review it, call out any errors you find, and do additional research with it as you see fit. All of the information on which these tables were based is available now at www.MFTeducation.com. There you will find the BBS source documents that we put together, as well as a searchable database so you can compare your program with others around the state. Your comments and suggestions are always welcome; I hope this is a useful resource!

Coming in Part II: Comparing for-profit programs with not-for-profit.

Can MFT interns pay for supervision?

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Aaron Feldman is frustrated. He’s spent several months telling the BBS, AAMFT-CA, CAMFT, and anyone else who will listen that he can’t run a therapy business legally and be successful in the state of California. No one has told him he’s wrong.

The problem, which Aaron is trying to conquer while others mostly ignore, is California’s Labor Law. Depending on whom you ask, it might prohibit marriage and family therapist interns from paying their employers for supervision; if it actually does (CAMFT argues otherwise), then a significant number of clinics around the state would be in violation.

But the supervision issue could be only the beginning. Mental health clinics are no different from any other business in the eyes of state labor law. But when was the last time a clinic required its therapists to take at least a 10-minute break every two hours, or mandated a lunch break for shifts lasting beyond six hours? Each of those is a labor law requirement.

At the October 2009 meeting of the Board of Behavioral Sciences (BBS), the licensing board’s counsel was clear: Those who employ MFT interns are subject to labor laws just like any other employer, and “there is no scenario under which it would be appropriate for a supervisee to pay an employer for supervision.” The BBS has since elaborated on that position here. CAMFT has since put forth its contrasting interpretation of the law, arguing that it is perfectly legal for an intern to pay their employer for supervision, as long as the terms of the arrangement are agreed to by both parties, in writing, in advance.

It is the Labor Board‘s opinion — or perhaps ultimately a judge’s — that matters. And so far, the Labor Board has chosen to stay away from the issue, politely rebuffing requests to attend BBS meetings or issue any written statement on the question. For the Labor Board to address this issue directly, it appears, they will have to face a complaint from a disgruntled supervisee.

And that has been Aaron’s frustration. He doesn’t want to run his clinic in constant fear of becoming the test case. CAMFT has hinted that they might try to clear up the issue through legislation, but the odds of getting a bill passed if it looks in any way like a weakening of, or exemption from, state labor laws is slim.

Without a clear set of guidelines, what is an employer or agency to do? The lowest-risk approach appears to be to abide by the BBS stated opinion: Assume MFT interns, when they are employed (as opposed to volunteering), are subject to all labor laws, and act accordingly. In practical terms, this would require an employer to go the extra mile to make sure that interns are taking adequate breaks. Do not have interns pay for supervision. Ensure that, however interns’ pay is computed, it amounts to at least minimum wage once all the intern’s time (including time spent on supervision, marketing, administrative tasks, etc.) is taken into account. (Of course, I’m not a lawyer, so please do not construe this as legal advice; any employer with questions about labor law or its application should consult an attorney.)

The problem for Aaron, and anyone else trying to run a therapy business honestly, is that even if he chooses to play by all of the labor law rules, plenty of other employers are not. If Aaron abides by the labor law, he will need to either pay his employees less, or charge his clients more, than similar clinics. The extra burden could be enough to make his clinic, as a business, unsustainable. Until at least one disgruntled intern makes a test case out of it, those who disregard the labor law appear to be at a competitive advantage.