Can MFT interns pay for supervision?

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.

California LPCC law passes; should MFTs dually license?

Late in the evening of October 11, Governor Schwarzenegger signed California Senate Bill 788, adding Licensed Professional Clinical Counselors (LPCCs) to the state’s masters-level mental health professions, alongside MFTs and LCSWs. Licensure by grandparenting will take place over a six-month period in 2011, with routine licensure starting January 1, 2012. Should MFTs dually license?

For most, there would be no benefit, and significant added expense. Since licensure is inherently a state-based activity, there is no reason to believe that licensing as an LPCC will make one’s license more portable; in fact, a license obtained through grandparenting may have greater trouble getting recognized in another state. Add to that the still-unclear question of whether California will recognize national exams in counseling (national exams in MFT and Clinical Social Work are not recognized in the state), and the likelihood of a portability benefit grows even slimmer. The added expense of two renewal fees could be little more than wasted money.

There is, however, a legitimate reason why some MFTs may want to dually license: They want to reflect what their professional orientation has been all along. California was the first state in the US to license MFTs, and the last in the country to license LPCCs. As a result, some who work under the MFT license do so because that was the masters-level entry point into a career in mental health, and not because they particularly identify with systemic concepts. For those therapists, the Clinical Counselor license is probably a better fit.

They will not, however, want to switch over entirely. Counselors will enter the mental health marketplace in California more than four decades after MFTs did, and will need to fight for themselves every battle MFTs waged and won for recognition in hiring and reimbursement. They’ll be able to make up ground, but it will be many years before counselors can claim the kind of recognition and stature in the state that MFTs claim today, thanks to decades of good work by CAMFT and AAMFT.

50 states of MFT licensure: Reflections

The news that Montana enacted MFT licensure law put me in a reflecting mood last week. The profession of marriage and family therapy now is distinctly licensed in all 50 states and the District of Columbia. This is a major milestone in the development of MFT as a profession. At the same time, it is just that — a milestone. Not a beginning, and not an end.

As I try to make meaning of having nationwide licensure, I’ve compiled a few reactions below. I’m sure this list is by no means complete, and I would welcome your reactions in the comments.

The progress in MFT science and regulation is only accelerating. It is these very areas of progress which this blog aims to review, and yet, they are advancing so quickly that my highlighting of some specific areas is necessarily incomplete. Consider this: Today, MFT licensure laws have been enacted in 50 states. In 1986, only 11 states had MFT licensure laws. And in 1963, just one did (California was the first). So, in one 23-year span, we went from having licensure in one state up to 11. In the 23 years since, we’ve made it to 50.

The research base in the field seems to be growing at a similarly exponential rate: There are now five family therapy-specific journals listed in the ISI index (formally, the Thomson ISI Web of Science, which evaluates the scientific impact of various publications), and another 23 in family science. There are also a number of MFT-specific journals not listed in ISI but still publishing relevant and useful articles, including the Journal of Systemic Therapies, the Journal of Couple and Relationship Therapy, and many more. When the next edition of Effectiveness Research in Marriage and Family Therapy comes out, it is likely to show that in a short time frame (probably about a decade, by the time it is published), MFT research has advanced in leaps and bounds.

A national name does not mean a national license. Of course, there is still much work to be done. (I’ll return focus to the regulatory side.) While the profession is now licensed everywhere in the nation, those licensing requirements continue to hold significant differences from state to state. As a result, it is often difficult for MFTs licensed in one state to move and obtain licensure in their new home. (That is, unless they are adequately prepared.) This is a particular issue in California, where about half the country’s MFTs live — and where licensure requirements are most out of sync with other states. There is now a license title recognized in all 50 states: “Marriage and Family Therapist.” There is much work to be done in having that mean the same thing from one state to the next.

This issue is not unique to marriage and family therapy — there is simply no such thing as a “national license” in any mental health profession, as licensing is accomplished through state regulatory bodies. However, improvements in license portability are often a goal of the national associations for mental health professions.

We can now work on a national scale like never before. While licensure is a state-by-state activity, there are some benefits to having licensure in every state. It certainly helps in making the case for MFT inclusion in federal programs, like Medicare and No Child Left Behind. It also makes partnerships with other national organizations much more feasible. One example of AAMFT’s work with a federal government organization is the Minority Fellowship Program, cooperatively developed with the Substance Abuse and Mental Health Services Administration. Such opportunities will only grow with licensure now available nationwide.

Associations matter. Neither MFT licensure nor the rapidly-growing research base for the field would be progressing at the rate they have in the absence of a strong national association working closely with state divisions. I initially got involved with AAMFT because I was proud of the work of the association and wanted to be a part of it. I’m glad I did. There is great power in professionals organizing themselves in the dual interest of advancing the profession and improving care for the clients we serve. With MFT licensure one that is now recognized across the US, that power appears more visible than ever.

Those are my initial reactions. It is inspiring and humbling to be part of, and hopefully in some small way a contributor to, an advancing profession that improves people’s lives and communities.

I’d be curious to hear your thoughts on 50 states of licensure. What does it mean to you?

Montana becomes 50th state to license MFTs

Montana governor Brian Schweitzer made his state the 50th to enact marriage and family therapist licensure last week, when he signed SB271 creating the MFT license there.

Congratulations, Montana MFTs! With a nation of MFT licensure laws complete, this should add great momentum to the push for MFTs to be included in federal programs, including Medicare and No Child Left Behind.

It is also worth pausing to reflect on just what an accomplishment this is — I’ll post more on this later in the week.

Montana could complete nation of MFT licensure

The state legislatures in Montana and West Virginia have each now passed bills (Montana bill | West Virginia bill) that would create Marriage and Family Therapist licensure in those states. If Montana’s bill is signed by the governor, the country could be complete: MFT licensure would exist in each of the 50 states, and the District of Columbia.

The governor of West Virginia has formally approved the MFT bill there. It is unclear when the state will actually begin issuing MFT licenses, because the board has some rulemaking to do, but it may happen as early as next year.

The Montana bill was sent to the governor April 22; he has 10 days to sign or veto it, or it becomes law automatically. It’s not fully clear, at least from what I can find, whether the governor will sign it; the Montana chapter of NASW has opposed MFT licensure there, and the governor has been busy with his veto pen. Still, improving public safety in mental health services, as well as access to care, through MFT licensure would be a good way to demonstrate to Montana residents that mental health issues are important, even when budget limitations prevent expanding services.

Stay tuned…