licensing

Psychotherapy’s dirty little secrets

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wooden-chestAs tremendously effective as psychotherapy is, and as much as we try to help out students and new professionals, there are some things about working in this field that we don’t eagerly share. It’s not that we don’t want you to know, necessarily, it’s just… these things don’t look so good.

Here are three secrets we keep about the world of therapy. Each one is true, even if we don’t talk about them much.

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Counselor and therapist licensure: Does testing raise quality?

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Whenever I get into conversations about the licensing process, a number of the same questions keep coming up. Many of these questions revolve around the value of having a license exam. It’s perhaps the most pesky, the-answer-should-be-obvious-but-isn’t question: Do licensure examinations make for better therapists?

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How long does it take to get an MFT license?

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State laws vary, but typically, you need a two-year masters degree and two more years of full-time, supervised experience. Here are the steps to becoming a licensed family therapist.

                                                                                                                                                                                                                                                                                                           

2010-07-20 Black windup alarm clock faceIf you are planning or considering a career as a marriage and family therapist, it is important to give thought to the time and money it will take to work your way to licensure. The timing of steps along the way could impact your choices for when to get married, have children, or maintain employment in another field.

Presented here are the typical steps to an MFT license and some common timeframes. The steps and timeframes listed here do not account for individual circumstances or the many state-to-state differences in licensure laws. You should check the web site of your state MFT licensing board (AAMFT offers a handy directory of state MFT licensing boards) to learn the specific requirements of the state where you want to license. I have some emphasis on California in this post because it is the state I call home, and because about half the MFTs in the country are here.

Note that a “typical timeframe” here means a common amount of time needed for those who are accomplishing that step through full-time work or study. If you build your career in MFT through part-time work or study, to allow you to balance family responsibilities, maintain outside employment, or for any other reason, naturally your timeframe will be longer.

Progression to licensure as a marriage and family therapist usually follows these steps:

  1. Complete a bachelor’s degree in psychology, family studies, or a related field. Many schools will be OK with a major in a different field if you can demonstrate adequate base knowledge in psychology and family development, through specific prerequisite classes, GRE subject test scores, or other means. Typical timeframe: 4 years.
     
  2. Complete a master’s degree in marriage and family therapy, counseling psychology with an emphasis in MFT, or a closely related field. Note that some states, like California, have specific requirements for what degree titles will make you eligible for MFT licensure. In most states, you will need to demonstrate that your master’s degree program was accredited by COAMFTE (the accrediting body for MFT programs), or is equivalent to COAMFTE standards. I’ve written in the past about the benefits of attending a COAMFTE-accredited program, and I’ve also offered tips for admissions interviews at MFT programs. You might want to consider a doctorate in MFT, though it will take longer. Typical timeframe (masters degree): 2-3 years.
     
  3. Complete additional supervised experience under a licensed MFT. In some states, including California, other licensed mental health professionals can supervise you as well; check with your state to see what their supervision standards are. Note that some states require your pre-licensed experience to be under an AAMFT Approved Supervisor. (A directory can be found here: Find an AAMFT Approved Supervisor.) During the time between graduation and licensure, while you are working under supervision, your state may call you an “intern” or an “associate” depending on the state. A few states use other titles. Most states require a total of 3,000 hours of supervised experience for you to be eligible to sit for licensing exams; there is some variability here, too, however. (Pennsylvania’s governor just signed a bill reducing that state’s requirement to 3,000 hours from 3,600.) Some states simply phrase this as two years full-time experience or the equivalent. Also note that in California, some hours gained within the master’s degree program can count toward the 3,000 total needed for licensure. (Other states tend not to allow this.) Typical timeframe: 2 years.
     
  4. Pass your state’s licensing exam(s). California is the only state that uses its own exams rather than the National MFT Exam. Many states require a state law and ethics exam in addition to the national exam, since state laws vary in key areas like child abuse reporting requirements. While an exam itself is over in a day, the licensing board needs time to process your MFT exam eligibility application, you need time to prepare, and you will need to schedule an appointment with a nearby testing facility. I’ve previously offered tips for preparing for MFT licensing exams, four myths about MFT licensing exams, and some discussion about whether MFT exam prep courses are worth the money. Typical timeframe: 6 months – 1 year. Longer if you need multiple attempts to pass.

Once you make it through that last step, congratulations! The state can now make you fully licensed as a marriage and family therapist, able to work independently in a private practice if you choose.

Overall, it’s good to plan for a total of at least 4-5 years from the start of your masters degree all the way through to licensure. Your time may be longer based on your circumstances; it would be possible (at least in CA) but unusual for your time to be any shorter.

In most states, the timelines for masters-level licensure are similar among clinical social workers, counselors, and MFTs. California is a noteworthy exception there: Only MFTs can count pre-degree hours of experience toward the 3,000 hours required for licensure, so it tends to be faster to get an MFT license in California than the other masters-level licenses. Licensing as a Psychologist requires a doctoral degree (typically 5 years, sometimes as short as 4) plus a postdoctoral internship (in California, 1,500 more hours, or about another year of full-time work) for a total of 5-6 years. Again, though, your individual circumstances may make your time longer.

Ed. note: This post originally published March 26, 2012. Some links updated June 11, 2018.

The myth of the portable license

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California’s new LPCC isn’t any more of a “national license” than the MFT license is: not at all. Why do rumors persist that it is?                                                                                                                                                                                                                                                                                                            

Cloth SuitcaseHere in California, we’re currently in the middle of the grandparenting period for licensed MFTs and LCSWs who want the state’s new Licensed Professional Clinical Counselor (LPCC) license. One of the most common reasons I hear from MFTs for wanting the LPCC is the notion that it, unlike the MFT, is a “national license.”

Except it isn’t.

For clarity: An LPCC license is no more of a national license than an MFT license, which is to say, neither is a national license at all. Both are state licenses only. Both professions now have licensure laws in all of the 50 United States (and DC), but for both, the licensing laws from state to state differ. How portable your license is — that is, how easily you could get licensed in a new state once you move — depends on a number of factors, including which state you move to. (For more on this, see my earlier post on MFTs and license portability.) But neither license has true reciprocity, which is automatic recognition of another state’s license.

The only reason I know of that could explain the myth of a portable LPCC license is that California’s Board of Behavioral Sciences is recognizing the National Clinical Mental Health Counselor Exam for LPCCs, while for MFTs, we use state-based exams. Admittedly, that can make moving into or out of California with an MFT license slightly more challenging: If you move into California, even if you have been licensed elsewhere for decades, you will need to take California’s MFT licensing exams. And if you move out of California, even if you have been licensed here for decades, you will need to take the National MFT Exam (many states also require a state-based law and ethics exam) to get licensed in your new home state. But the BBS has already gotten legislative approval to restructure the MFT license exam process, and is working with the folks who develop the National MFT Exam to have that exam offered and recognized in California. So that difference between the professions will hopefully be vanishing in the not-too-distant future.

There are good reasons for some MFTs to pursue the California LPCC license. Unfortunately, the ones I hear most often from MFTs as their motivators are falsehoods, and this portability issue is a great example.

If you are interested in hearing more about the LPCC license (including debunking of more myths!), differences between the philosophies of MFT and LPCC, scopes of practice, legal and workplace recognition, and much, much more, please consider attending “The California LPCC,” a presentation I’m giving with Angela Kahn, MA. Angela has helped develop the LPCC curriculum for Antioch University in Los Angeles, and is going through the grandparenting process; I helped AAMFT-CA negotiate what became the LPCC licensing bill, and I’m probably not going to go through grandparenting. So we present an informed perspective from both sides of that question. We’re giving the talk at Antioch in LA this Saturday, November 19 (that one’s just for Antioch students, faculty and alumni, so contact the school for more info or to RSVP). We’re also giving the talk in San Diego on December 3. Use this link for more information or to register: The California LPCC, Dec. 3, San Diego.

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Your comments are always free to cross state lines. Offer them here, by email to ben[at]bencaldwell[dot]com, or through my easily-portable Twitter feed.

Four myths about MFT licensing exams

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Go ahead and be anxious about your licensing exam process — it’s a big deal! But don’t buy into grumbling falsehoods about it. Test items are written by actual MFTs, and there are no trick questions.

Every person who becomes a licensed marriage and family therapist has to go through an examination process. In most states, that means passing the National MFT Exam. Many states also supplement the national exam with a second exam covering areas of state law (for example, ensuring that therapists are familiar with that state’s requirements for child abuse reporting). In California, the exam process is a bit different; California MFTs must pass two state-run exams, the MFT Standard Written Exam and the MFT Written Clinical Vignette Exam. [Update: The California MFT licensing exams change structure on January 1, 2016.] The overall content and structure of California’s exams are similar to the National MFT Exam — they’re multiple-choice tests that use a combination of factual questions and case-vignette-based questions.

Regardless of what state you’re in, if you haven’t taken the exam(s) yet, you may be dreading them. Even if you have gone through the exam process, you may not have fond memories of it. I hear complaints about the licensing exam process on a regular basis — most of them based on total mythology. It’s as if we (quite understandably) have anxiety-based associations with our testing process, past or future, and then (far less understandably) conjure up rational-sounding but totally baseless complaints about the process in an attempt to justify those fears.

It’s okay to be anxious about the process on its own merits. The exams are high-stakes; if you fail, you typically have to wait several months to try again. That impacts your standing among your peers, your employment options, and potentially your income. I still remember completing California’s Written Clinical Vignette exam and feeling certain I had failed. In a matter of moments, I was mentally planning how I would explain the failure to my employer, and how I would plan to do better next time. It turned out I had passed, but the memory of those anxious moments before getting my results stays with me.

If I had failed, I wanted to blame someone else: How dare that test be too hard for me! It must be the test’s fault! I’m glad I didn’t take much of a walk down that road, but if I had, I would have had plenty of company. Once a rumor has started that serves to explain why the tests feel so frightening and why we feel so unsure of ourselves going into them, it is easy for that rumor to be perpetuated. Such stories are factually wrong, and ultimately do more of a disservice to future test-takers by making the exams look cruel and unpredictable. But to someone who has failed a test (or is worried they might), the stories offer comfort — and someone else to blame. So they live on each year.

Here are the four myths I hear about MFT licensing exams the most:

  1. There are trick questions. Simply put, a licensing exam that uses trick questions would not be legally defensible. Test developers go to tremendous lengths to make sure any potential exam item works well, through several layers of review and pilot testing. If too many people are missing a question, it gets flagged for even more review. If a question appears to be tricking people, either by design or by accident, it is removed.
  2. There is secret knowledge. Test-prep companies make a lot of money perpetuating the mythology that they can provide you with “secrets” or other insider knowledge to help you pass the tests. Nonsense. Both California and AMFTRB (developers of the national exam) offer study guides that say what will be covered on the exams, and they ultimately draw their questions from the same textbooks and journal articles that graduate programs use to teach their students.
  3. They are meant to assess whether you are a good therapist. If I may be blunt, your licensing board does not care whether you are a great therapist or a lousy one. They only care about whether you can practice marriage and family therapy competently enough so as to not be a danger to the public. That’s what the exams are meant to assess. Yes, it is sometimes true that ineffective therapists pass their licensing exams, and effective therapists fail. But effectiveness and potential dangerousness are two different things. If you want an outside evaluation of your quality as a therapist, look elsewhere. (Back in 2008, I examined in more detail the question of whether licensing exams lead to better quality therapists.)
  4. They are written by people who aren’t therapists. Both California and the AMFTRB use licensed therapists to write their test items. In California, you can apply to be a subject matter expert involved in writing the exams. Elsewhere in the country, AMFTRB intermittently recruits MFTs with relevant expertise. Every test item on both the California and National MFT Exams is written by one or more practicing MFTs.

If you’re anxious about your own upcoming exams, instead of buying into the falsehoods above, you’ll likely be better off to do something about that anxiety. Maybe that means simply more studying, or maybe it means more directly addressing the anxiety through meditation, therapy, or other means. (Test-prep programs may be of questionable value overall, but if they can help you feel more knowledgeable and less anxious as you take the tests, they may well be worth your time and money.) Rest assured the exam process, and those who designed it, are not out to get you or to trick you. With the right preparation, you can do well on exam day.

If you know someone else who is anxious about their exams, or even who has failed an exam, by all means, comfort them and empathize with them. Sometimes we just have bad days. But please don’t support any of the mythology above — those ideas just make the testing process look bigger, scarier, and less under your control than it really is.