education

Why cultural competence matters in MFT – and how to build yours

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Mental health professionals need to understand a variety of cultures (and, ideally, languages) to assess and diagnose properly.                                                                                                                                                                                                                                                                                                            

Globe image [public domain] via Wikimedia CommonsIf you are a mental health professional (or are in the process of becoming one), developing cultural competence will help ensure that you don’t mistakenly diagnose a culturally-appropriate behavior as some kind of mental illness. It will enable you to recognize the difference between a client who is ashamed and one who was simply taught to avoid eye contact. And most importantly, it will enable you to provide treatment within a client’s cultural context without imposing your own values, either intentionally or by mistake.

Cultural competence — that is, the ability to provide effective services to people from a wide variety of cultural backgrounds — gets built in a variety of ways. It is important to understand traditions and practices across a wide range of cultural groups, and you can’t possibly go to every single one of the places your clients will be from. In short, whether you ever travel or not, you need to internationalize your thinking.

But to really develop your cultural competence, you need to experience different cultures, both within and outside of your local area. To this end, many universities are ramping up their offerings (and their requirements) when it comes to truly experiencing the diversity of our world.

I teach in the Couple and Family Therapy Programs at Alliant International University in Los Angeles. To be sure, we are in one of the most diverse cities in the nation. Our student body reflects that, with students from a wide range of cultural, national, religious, and other traits that allow them to learn a great deal from one another when they share a classroom. Many of the benefits of study abroad can be achieved in classrooms just like ours. But a classroom is a controlled environment, and Alliant’s mission centers largely on both multiculturalism and internationalism, so we offer much more than just the classroom experience. We also offer cultural immersion experiences for our students in Mexico City, China, and India; we also have had students and faculty take part in a past Cambodia immersion.

The students who take advantage of these opportunities describe them as much more than professional development. They often describe them as life-changing.

Naturally, it is tough for faculty to teach from a fully-informed perspective if they have not travelled themselves. The need for cultural immersion is not limited to students, nor is it limited to a certain phase of one’s career. Times change and cultures change, and as professionals we need to stay in contact with these changes to best serve the clients with whom we work. In the past several years, I’ve been to Mexico City, Hong Kong, Costa Rica, and Europe, and many in our Alliant faculty have their own long list of recent travels. (As a group, we rack up a lot of frequent-flyer miles.) I can happily say that on each trip, I’ve learned far more about the local cultures than I ever could have understood from a book.

If you’re considering a career working in mental health, and are interested in developing your international and multicultural competence, I would strongly encourage you to check out Alliant’s programs. We have programs in six cities around California and in Mexico City, Tokyo, and Hong Kong. And many programs — including mine — are still accepting applications for this fall.

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Your comments are welcomed. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.

Eastern Michigan settles Julea Ward case

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The university settled in December and will pay Ward $75,000, according to AnnArbor.com.

JudgesTools IconJulea Ward’s lawsuit against her graduate program in counseling at Eastern Michigan University took several interesting turns last year. The case started when Ward refused to counsel a gay client as part of her training; the university determined this was discrimination, and expelled Ward from the program. She sued, claiming she was being singled out for her religious beliefs. I’ve previously discussed the case here and here.

Ward’s case is often discussed in the same breath as Jennifer Keeton’s. Keeton sued Augusta State University, where she had been a graduate student in counseling, after the university expelled her for clearly stating her refusal to counsel gay and lesbian clients and her unwillingness to complete a university-mandated remediation plan.

While Keeton lost her case, Ward appeared to at least have some chance of winning hers. In a footnote within his ruling in favor of Augusta State University in the Keeton case, United States District Judge J. Randal Hall made it clear that the two cases had similar themes but very different specifics (citations removed, and paragraph breaks and emphasis added, for clarity):

This case is distinguishable. In Ward, the plaintiff, a student enrolled in Eastern Michigan University’s graduate counseling program, asked to refer a gay client during her practicum course because she claimed that her faith prevented her from affirming a client’s same-sex relationships. No remediation plan was issued; instead, the plaintiff was promptly dismissed from the program following a formal review. […] The plaintiff in Ward was disciplined after she asked to refer a client, but evidence showed that the university may not have had a policy prohibiting such referrals; indeed, there was evidence that referrals had been permitted for others in the past. […] The Sixth Circuit held that a juror could find that the plaintiff was dismissed because of her religious views.

This case presents a stark contrast: Keeton was cited by faculty for statements which evinced an intent to clearly violate program policies, i.e., according to the remediation plan, faculty believed that Keeton had expressed an interest in conversion therapy. Moreover, Keeton later stated definitively, and without mention of referral, that she would not withhold open judgment of a client’s sexual choices in a counseling session, action also in violation of program policies. One final set of facts serves to
distinguish the two cases – Keeton was not, like the plaintiff in Ward, summarily dismissed. Instead, she was subjected to a remediation plan, the details and import of which was painstakingly explained by faculty members through meetings, written plans, emails, and face-to-face discussions. […]

In sum, the patience and measure exhibited by faculty members during the course of Keeton’s protracted remediation proceedings, coupled with the nature and content of their efforts to ensure that Keeton understood how her actions violated professional ethics and could harm future clients, mark this case as different from Ward.

Eastern Michigan, apparently seeing the writing on the wall, chose to settle with Ward and has agreed to pay her $75,000. Notably, the university is neither admitting any wrongdoing nor changing any of its policies as a result of the ruling, according to AnnArbor.com. In the meantime, Michigan’s legislature debated the “Julea Ward Freedom of Conscience Act” — which would have allowed graduate students in mental health to refuse to treat gay and lesbian clients if providing treatment would conflict with the student’s religious beliefs.

I’ve written about that and a similar “conscience clause” bill that did become law in Arizona. A similar bill has now been proposed in Tennessee, which I’ll tackle in a separate post.

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Your comments are welcomed in the comments section below, by email at ben[at]bencaldwell[dot]com, or in the conversation on my Twitter feed.

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!

Money for MFTs

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Stipend and loan reimbursement programs for family therapists, updated for 2012 with current links, updated amounts, and additional programs.
                                                                                                                                                                                                                                                                                                           

A number of state and federal programs offer tens of thousands of dollars in stipends and loan reimbursements for marriage and family therapists to advance their careers. Generally, these programs aim to help bring mental health services to underserved areas and to reward therapists who dedicate themselves to such communities. Here are just a few of the programs MFTs may find enriching.

The federal National Health Service Corps program offers a whopping $60,000 in loan reimbursement, on top of the salary one would already make in an eligible position, for two years of service. Continue working in an NHSC-eligible position over time, and you can get as much as $360,000 in loan reimbursement for 16 years of full-time service. NHSC-eligible jobs can be found at the NHSC Jobs web site.

Also on the federal level, the Indian Health Service (IHS; www.ihs.gov) offers a similar program, awarding $20,000 per year for two years of service at an IHS site. (A cautionary note: MFTs are legally recognized for employment within IHS, but appear to fall within “other professions as determined by need” in the loan repayment program.)

The American Association for Marriage and Family Therapy (AAMFT) / US Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program awards stipends to cover education, plus funding to conduct research and travel to conferences and trainings, to doctoral students in MFT programs. These awards can be worth tens of thousands of dollars and are renewable for multiple years.

In California, there are additional state-based stipend and loan reimbursement programs. The awards offered by each of these programs are in addition to the salary one would already earn in an eligible position.

The California State MFT Stipend Program provides awards of $18,500 per year to MFT Interns who agree to work in public mental health positions in underserved areas for at least one year. In 2010 and again in 2011, 60 of these stipends were awarded through the statewide MFT Consortium, which covers most of the state; Loma Linda University and CSU-Chico each administered a handful of additional stipends through the same state fund. For 2012, Alliant International University (where I teach) also is administering its own stipend program, awarding 15 stipends per year of $18,500 each, distributed across our four CFT campuses.

There are separate stipend programs at the county level. The Los Angeles County MFT Stipend Program has awarded more than 300 stipends of up to $18,500 since 2005, with recipients committing to similar service requirements. San Diego County and Orange County have more recently launched similar programs.

Finally, the state offers MFTs and MFT Interns its Mental Health Services Provider Education Program, which awards up to $15,000 in loan reimbursement for two years of service in an underserved area, and its Mental Health Loan Assumption Program, which offers $10,000 in loan reimbursement for a one-year commitment. Though these programs are both run by the same state agency, their separate amounts and selection processes are because their funding comes through two distinct streams (license renewal fees, and the Mental Health Services Act). They have different application forms and run on different deadline cycles. The next MHLAP deadline is in August; the next MHSPEP deadline is in September.

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To put in a plug for my program: Alliant students are eligible for our own stipend program, the county programs in San Diego and Los Angeles, and the state and federal programs. Some campuses are still accepting applications for fall 2012; more information is available here: Alliant Couple and Family Therapy programs.

Are you aware of other federal or state-based programs that should be added to this list? Email me at ben[at]bencaldwell[dot]com and let me know, and I’ll be happy to expand this post.