Training in mental health is unreasonably long

2010-07-20 Black windup alarm clock faceJust as a quick thought experiment, go over to this piece at Slate discussing medical training, and every time it references “medicine” change that to “mental health.” (Accordingly, change “physicians” and “doctors” to “therapists.”) You’ll find most of it applies perfectly. To wit:

Over the past century, there have been additions to, but few subtractions from, the training process. Residency and fellowship programs became longer and longer … and longer.


The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges.


The fundamental problem here is that the argument between traditionalists and reformers [debating the appropriate length of training] is essentially theoretical — we are in an evidence vacuum.

In the time I’ve been in academia, I’ve watched as the requirements for training in mental health have increased dramatically. Family therapist training in California increased from 48 to 60 units based not on science but on workplace competitiveness. (MFTs were fighting clinical social workers for some of the same jobs, and since LCSWs need 60 units of training, MFTs couldn’t really argue that their training at 48 units was equivalent.) I’ve also watched as education in general has gotten much more expensive, and loans harder to come by. And I’ve been enlightened by learning that our 3,000-hour supervised training requirement is based entirely on tradition, and is in virtually no way linked to the science that we now have available (though admittedly, it isn’t much) on how therapist skill develops over time.

Our old apprenticeship model is broken. It’s as true in therapy as it is in medicine. It will be interesting to see how experimentation with medical training goes, as it can blaze the trail for similar efforts in other health care professions like ours. I’m just not sure we should be waiting for doctors to do it first.

# # #

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

Want to know how much that MFT degree will cost? Good luck

Many family therapy programs make it surprisingly difficult to plan for your graduate education budget.                                                                                                                                                                                                                                                                                                            

US Currency; public domain imageIn my research for California Family Therapy Program Rankings, where I offer a roundup of information and rankings on 34 of California’s biggest marriage and family therapy (MFT) graduate programs, I was determined to get readers the most objective information on cost possible. The amount of money students invest in their graduate degrees is significant, and sometimes has to be a factor in choosing programs.

I figured gathering this information wouldn’t be easy, necessarily, but that most programs would publish some way of estimating total tuition cost on their web sites. For example, I might have to multiply a per-unit tuition cost, usually given on one page of a university’s site, with the total number of units in the MFT program, which typically would be on a separate page.

If only it were that simple.

Whether by accident or by design, MFT programs in California are often less than fully transparent in letting prospective students know how much they can expect to pay for their graduate degrees.

Consider San Diego State University as an example. Theirs is a very well-regarded, COAMFTE-accredited program. They’re probably pretty inexpensive, as master’s programs go, since they’re a state school. They even advertise themselves as the most affordable MFT program in San Diego, and I suspect that’s probably true. But if you want to know how much the program actually costs, you’re out of luck. The university web site provides tuition costs for a nine-month academic year ($8,032 for California residents, if you’re wondering), which puts SDSU right in line with the other state schools. But as the program web site notes, two summers are also needed to complete their two-year program, and if you want to know how much those cost, you have to start by fishing your way here, to a 2013 summer tuition document that tells you the cost of summer tuition depends on how many units you take. And how many summer units are required for the MFT program?

I never could find that.

The information just isn’t there, or at the very least, it isn’t easy to locate. Do those two summers add up to six units, or more like 20? At up to $644 per unit in the summer, that’s a pretty big blank space in a prospective student’s budget. I know universities need to put all kinds of cautionary notes on their program plans — classes may be full, scheduling and tuition are subject to change, and on and on — but how hard would it be to tell prospective students how the program is designed, such that they can reasonably estimate how much the whole thing will cost?

My point here isn’t to single out SDSU. Again, theirs is a good program; no matter how much their summers cost, SDSU’s program will still be cheaper than private institutions; and they are hardly the only school to make cost information on their MFT program opaque. (Several programs even provide a sort of illusion of transparency in tuition cost, openly stating how much they charge per semester or per year, but not saying how many of those it takes an average student to finish the program. A $15,000-per-year program designed to be completed in two years looks a lot less attractive — and a lot less affordable — if it turns out that it takes most students four years to actually complete it.) Of the 34 programs I reviewed for the book, there were several where it was not possible to even estimate the total tuition cost of the program based on information available on the program’s web site.

My point instead is this: Prospective MFT students need more and simpler disclosure of graduate program costs. And that means more than just stating tuition and fees, especially for programs that charge by semester or by quarter: it means providing clear estimates of how long the program will take to complete. Ideally those estimates would come with graduation data to back them up; join me if you will in gasping at Phoenix’s abysmal 10% completion rate 30 months after enrollment, but at least they publish it.

Perhaps programs are concerned that making cost information too front-and-center will lead to the same kind of race to the bottom we have seen in airline fares, where consumers’ cost-driven decision-making has led to declining service, crowded planes, airline bankruptcies, and even more opaque pricing. If so, I don’t think we’re giving prospective MFT students enough credit. They’re choosing where to get years of education that will set the stage for their whole careers, not a two-hour bus-ride-in-the-sky to Toledo. Let’s give them the information they need to budget wisely, and trust that they know cost is only one of many factors to consider when choosing a graduate MFT program.

# # #

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