Marriage and family therapists (MFTs) work with individuals, families, and couples of all types. We assess, diagnose and treat the full range of mental and emotional disorders. So, the title “marriage and family therapist” doesn’t provide the whole picture of what we do.
If you’re considering a career in mental health, there’s some good news on the economic front. After stagnation associated with the larger economy’s downturn, salaries in mental health professions appear to be back on the rise.
According to the federal Bureau of Labor Statistics, salaries are improving for all of the mental health professions except Psychology, which has been effectively flat since 2009. There are several cautionary notes that go with this data (more on those below), but if you’re considering a master’s degree in counseling, clinical social work, or family therapy, overall it’s promising:
Source data: Bureau of Labor Statistics
Note that the y-axis there starts at $40k, so it’s a little misleading as to proportionality but shows year-over-year changes more clearly.
The news seems to be especially good for MFTs in California (I’m one of them, so I’m incredibly biased on this): From 2012 to 2013, the mean annual wage for MFTs here went from $47,230 to $54,470. That’s an increase of more than 15% in just a year.
As I said, some pesky cautionary notes: First, the BLS data assumes full-time work, calculating the average annual wage by multiplying the mean hourly wage by 2,080. There are benefits and drawbacks to that approach; it keeps the mean from being dragged down by part-time workers, but also arguably overestimates what the average worker actually makes, since many do work part-time. Second, there is significant state-by-state variability in the numbers. Even if the national means are improving, it can be worth checking to see what the trend is within your state. Third, especially in states with smaller populations of mental health professionals, it isn’t unusual to see big gains or drops in a year simply due to small sample sizes. Data for larger states is more reliable. Finally, the BLS data isn’t perfectly broken down by license; the data shown here uses the BLS categories of Mental Health Counselors (21-1014); Clinical, Counseling, and School Psychologists (19-3031); Marriage and Family Therapists (21-1013); and Mental Health and Substance Abuse Social Workers (21-1023). These are the categories most focused on mental health services and thus the closest parallels to licensure.
There should be a new data set for 2014 out within a couple of months; I’ll update this post once that data is available.
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Of course salary numbers in mental health look bad when you leave out people with the graduate degrees necessary to practice.
NPR ran a story last month punctuated by a graph of the highest- and lowest-earning college majors. The worst on the list, by far, was Counseling Psychology. Those who majored in Counseling Psych brought in a median income of under $30,000 per year.
No one gets into mental health care for the money, but the numbers were a black eye for the Counseling field — the American Counseling Association has even responded by commissioning its own study of salaries among its members.
But there was a big problem with that original chart, one that the researchers themselves had noted but which was often ignored in discussions of their findings: It didn’t include people with graduate degrees.
In just about any mental health field, you need at least a master’s degree to practice. Those who don’t take that extra step are often limited to very basic, entry-level jobs with little hope for advancement.
So NPR is back this week with another chart, one that includes graduate-degree earners. And Counseling Psychology no longer shows up on the list of the 10 lowest-earning undergraduate majors. Counseling Psych majors get a big bump in median incomes when you include those who go on to advanced degrees, as should be expected.
Notably, social work stayed in the bottom 10, even when those who get their graduate degrees are included. Their median incomes went from just under $40,000 a year (with graduate degree earners excluded) to about $45,000 a year (with graduate degree earners included).
It’s hard to place family therapy here, since MFTs come from a wide variety of undergraduate majors, most commonly (but by no means exclusively) psychology or family studies. For MFT salary data, the best place to start is this Bureau of Labor Statistics page.
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Okay, a bit of a rant today. In the family therapy world, I often hear criticism of the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic guide published by the American Psychiatric Association and currently on its fifth edition (DSM-5). This usually comes from students first learning about the DSM and its history, and in those students the criticism is often based more on anxiety than on any real substantive problem with the book.
Students are understandably anxious when confronted with the complexity of diagnosis and the power that comes with being able to diagnose a client as mentally ill. Unfortunately, I see too many MFTs who never get past that initial anxiety, and use it as an excuse for avoiding the DSM well into their professional careers. I don’t begrudge anyone their anxiety, I just wish people would own it for what it is (kind of like with licensing exams), instead of making up or latching onto an easily-refuted argument against learning and using the DSM appropriately.
The arguments against DSM use that I hear in the MFT world tend to reflect poor understanding of both the DSM and family therapy. Those arguments typically fall into three groups, listed here with their easy counters:
“The DSM is based on individuals, and I work with families.” The DSM offers labels for common sets of symptoms. That is, it gives you a quick name for sets of problematic behaviors that often occur together. It is agnostic about the source of those symptoms. It does not, contrary to some therapists’ opinions, make a presumption that the source of suffering lies within the individual. The way the DSM is written, depression could be caused by something within an individual, by problems in couple or family functioning, or by aliens. You’re free to maintain your systemic ideas about how depression often originates and is sustained (ideas I agree with, just so we’re clear) without any concern that these ideas conflict with the DSM. They don’t. Furthermore, a good systemic therapist does not ignore individual functioning; indeed, one needs to be keenly aware of how individuals are functioning within a system in order to understand the system itself.
“A diagnosis is just a label, and I don’t like labeling people.” Nonsense. Any time you call someone by their name, you are using a label for them. Labeling is a good and healthy and awesome thing that we do in human societies to keep language relatively efficient. If you really hate labels, and prefer to capture the whole essence of things (many of those I have heard say they avoid the DSM say that they do so to better capture the “whole person”), then when you go home tonight I want you to announce to whomever is close by that for dinner you will be having semolina, flour, eggs, and water, all formed, cut into long needle shapes, and dried, and then resoftened in boiling water for a few minutes, topped with pulverized tomatoes that have themselves been heated and mixed with spices and possibly some kind of meat or cut mushrooms. Served steaming hot! Then you can take pride, when they tell you “um, that’s spaghetti,” that you have captured the entire essence of the pasta. You’ve also needlessly wasted everyone’s time.
Listen, use of a label doesn’t constrain you to only using that label, nor does it mean the label is all there is of someone. I hope that when doing therapy, you really do maintain a thorough sense of your clients’ strengths and resources and personalities far beyond what you can gather from a simple diagnosis. But use the label too. It is essential for other health care providers, who may need to know the nature of someone’s symptoms very quickly (like in an emergency), that you know enough about symptoms and diagnoses that you can tell them, without taking the next 15 minutes to describe someone’s essence as a human being.
“The DSM is pathologizing, and I try to focus in therapy on depathologizing behavior.” I have the most empathy for this argument, as family therapists are particularly inclined to see even diagnosable behaviors as adaptive to their context. But it still falls pretty flat. Yes, the DSM is pathologizing, insofar as it describes symptom clusters as mental disorders. Expanding criteria for mental illness contributes to what Szasz labels the medicalization of everyday life. And there is much to be said about the misuse of DSM diagnoses across cultures.
But go back to the first argument here. Remember, the DSM is agnostic as to the source of symptoms. The fact that the behaviors that together add up to a diagnosis of, say, depression are actually adaptive responses to family dysfunction does not make the diagnostic label incorrect — the individual really is displaying those symptoms — and it doesn’t mean that the individual should not receive treatment. Indeed, one of the upsides of broadening diagnostic criteria is that they allow people to receive treatment, often paid for by their insurance company, when they previously could not have. In other words, that individual diagnostic label (which, again, is just a description for a symptom set, not a theory about the cause of the symptoms) is often the very thing that allows you to treat the system.
There are larger debates to be had about the role of the DSM in mental health care, and even more broadly, how our entire health care system is structured around diagnosis and dysfunction rather than a foundation of keeping people well. And there certainly is plenty to criticize about the DSM. But for where we are now, let’s all agree that (1) diagnosing is important enough that it’s okay to be anxious about it, and (2) the act of assessing and diagnosing an accordance with the DSM is in no way inconsistent with family systems work. In fact, it’s a requirement for doing that work well.
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I’ve been lamenting over the past few months that as the dynamic first-generation leaders in the family therapy profession have been passing on, there really haven’t been loud, passionate voices ready to take their places. Kahn, however, is just such a voice. She offers a full-throated defense of family-based treatment for most cases of self-injury. The crowded rooms and warm receptions she has received at conferences put on by NAMI, AAMFT-CA, and AAMFT show just how much of a hunger there is for her work and her insight.
Based in Los Angeles, SII was born partly out of necessity. There are few places in the country specializing in self-injury treatment, and few if any of them seem to offer what Kahn does: An understanding and treatment of self-injury based in family dynamics. As word of her family-based treatment has spread, she has found herself with more clients than she can take on — and no one who provides similar local services who she could refer clients to.
The Institute is starting with trainings and treatment. KISI offers family-based, outpatient therapy for self-injury through Kahn and several registered MFT interns. The first official KISI training for mental health professionals will be July 12 in Los Angeles, with Kahn herself as the instructor. Complete information and registration is at www.selfinjuryinstitute.com.
In the interest of full disclosure, I’ve been assisting the Institute in getting started, and hold the title of Fellow there. But it’s a volunteer role, and I would be happily cheering SII on even if I weren’t directly involved. This institute will be great for the family therapy profession, and more importantly, for the many families struggling with self-harm who have spent far too much time with diagnoses that don’t really match their problems, and in treatments that, far too often, don’t work.
Welcome to the world, SII. We need you.
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Your comments are welcomed. You can post them in the comments below, or email me at ben[at]bencaldwell[dot]com.