Would anyone buy stock in a future therapist?

CurrencyThere’s an interesting alternative to the student loan model of financing education floating around: In essence, sell stock in yourself.

On Wednesday, Senator Marco Rubio and Representative Tom Petri introduced legislation defining “income share agreements” (ISAs), which are basically contracts where investors could fund your education in exchange for a percentage of your future earnings. Under such agreements, which are expressly not loans, an investor could lay claim to a limit of 15 percent of your future income under a contract that could last no more than 30 years. (Those are just upper limits. Presumably most contracts would be shorter and have lower percentages of income involved.)

The idea is interesting, and worthy of consideration insofar as it transfers the risk associated with education funding away from the student and their family. One of the worst possible outcomes of taking out tens of thousands of dollars in student loans is then not being able to pay it back, either because you failed to finish your degree or, once you did, there simply weren’t enough well-paying jobs in your field. Changes in bankruptcy law have made it much more difficult to get out of student loan debt even in difficult circumstances. Under the proposed ISA rules, on the other hand, it would be the investor who would be out of luck, not the student.

Unfortunately, that doesn’t mean that selling stock in yourself is a good idea for a prospective student in the mental health professions of psychology, counseling, clinical social work, and family therapy. For one thing, private investors may simply not be willing to fund education that is long and expensive when they look at salary data in mental health. It seems much more likely that such investors would flock to students in more lucrative fields like business, engineering, technology, and medicine.

And even if some enterprising therapy students could attract investors willing to fund their education, the kind of system envisioned with ISAs holds the potential to be rather exploitive. Let’s say, for example, that you are unable to secure enough in student loans, so you turn to a private investor to fund your education. And — lucky you! — you find one willing to take on the risk. In exchange for $50,000 to fund your education, they ask for 10% of your income per year for the next 25 years.

To a hopeful student with no other options to fund schooling, that may be an attractive offer. From the outside, though, it just looks like a classier form of indentured servitude. It’s true that if you don’t complete your degree, you would not need to pay the money back. However, because these agreements define the investment as being in the individual, and not the specific career for which you received education funding, you would still owe a portion of what you make for the term of the agreement no matter what kind of work you wind up doing. Worse, if you do complete your degree, and you do find a well-paying job after graduation, you could easily wind up paying back four or five times the amount of the initial investment. Investors, after all, would understandably want their good investments to pay off bigger if they are taking all the risk for the bad investments.

If nothing else, I admire the creative thinking on Rubio’s and Petri’s part. (In fairness, it isn’t their original idea; startups like Upstart and Pave have been working on this model for some time.) There is certainly some merit in having the most successful students end up paying the most for their education, rather than further financially punishing those who struggle the most to find work or finish their degrees. However, as it applies in mental health, this kind of a funding vehicle seems like a band-aid at best. It would keep a supply of students coming in to overly long and expensive training programs, with primarily investors and universities profiting. We still need a viable long-term solution that makes graduate training in mental health accessible and affordable for those who prove they are capable of doing the work.

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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.

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Proposed new MFT accreditation standards eliminate vague religious exemption

If adopted, the draft COAMFTE standards would require all programs to teach LGBTQ-affirmative practices.

W-classroomThe public comment period closes Wednesday on the draft version of new accreditation standards for graduate programs in marriage and family therapy. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) is proposing some major changes from current standards:

  • The draft standards would restore the 500-client-contact-hour requirement for practicum. Under the current, version 11.0 standards, programs can require fewer hours as long as they have evidence to show that their practicum results in students being competent to practice at the master’s level. This vague standard has left different accredited programs using different experience requirements, which can be confusing to state licensing boards who want to know how much practical experience they can reasonably expect to be included in graduate degrees.

  • The draft standards separate accreditation requirements into “eligibility standards” and “accreditation standards.” As it is now, the Commission makes its decisions based on the full scope of information presented to them. Programs that meet most but not all standards may still be granted accreditation, with stipulations — requirements that the program comes into full compliance with the standards within a year. This proposed split into eligibility and accreditation standards arguably makes the accreditation bar a bit higher: Programs that fail to meet even one of the eligibility standards would not be eligible for accreditation, regardless of their performance on the other standards.

  • The draft standards would go back to a singular, mandatory core curriculum for all accredited programs. Of course, programs would remain free to add on to this core curriculum as they see fit, but all accredited programs would be required to have the same core set of coursework.

  • Perhaps what is most notable in the draft standards is what is missing: The draft standards remove COAMFTE’s current vague, blanket exemption for religious programs. The exemption, present in the current COAMFTE standards (p. 3), says

    Religiously affiliated institutions that have core beliefs directed toward conduct within their communities are entitled to protect those beliefs.

    It has never been clear to me what that is supposed to mean in practice, but the way I read it, any religious-based program that wants COAMFTE accreditation but isn’t in tune with any part of the standards was free to ignore that part of the standards, as long as they could tie their objection to their religious beliefs. Under the proposed new standards, not only would that clause go away, but the required curriculum would include at least three semester units on

    diversity, power, privilege and oppression as they relate to race, age, gender, ethnicity, sexual orientation, gender identity, socioeconomic status, disability, health status, religious and spiritual practices, nation of origin or other relevant social categories throughout the curriculum. It includes practice with diverse, international, multicultural, marginalized, and/or underserved communities, including LGTBQ affirmative practices. [emphasis in original]

    It is much clearer what the new standards would mean: Every COAMFTE-accredited program would need to teach its students how to work with LGBTQ clients in a positive, affirming way, and an appreciation for the harm such clients suffer from living in a heterosexist society.

To me, these are all good and necessary changes. First, as to the hours and curriculum changes: I hear chatter among MFTs around the country that licensing boards haven’t known what to do with the current COAMFTE standards. Those current standards are so flexible that licensing boards don’t necessarily know what they’re getting when someone comes to them with a COAMFTE-accredited degree. The draft standards, if adopted, would bring back greater consistency in content across programs and could restore state boards’ confidence in maintaining COAMFTE accreditation as the standard educational requirement for licensure.

Second, as to the removal of the religious exception: I’ve written previously about the struggles some religious therapists face when trying to work with LGBT clients, and the debate there is far from settled. But accredited programs can and should teach affirmative practices. The debate here should be restricted to how a therapist balances their values with client needs in the therapy room, not about whether the therapist can be exempted from exposure to affirmative techniques or to the suffering LGBTQ clients genuinely experience.

There’s only one thing COAMFTE didn’t included that I wish they would: Require MFT programs to be more transparent about cost.

COAMFTE will be reviewing comments on the proposed changes this fall. If adopted, the new standards would likely take effect in 2014 for new accreditations and be phased in for those programs already accredited.

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.

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