Why MFTs struggle to influence public policy

George Hodan / PublicDomainPictures.net / Licensed under Creative Commons 0As marriage and family therapists, we have a vast body of knowledge supporting our work with families and communities. Many of the pinciples and interventions from this body of knowledge could be utilized in public policy, to great positive effect. As two examples, family breakdown could be reduced, and juvenile crime recidivism decreased, both in ways that actually save taxpayers money. Politicians of all parties should be chomping at the bit for such policies.

Except that they don’t. And the April 2009 Family Relations journal helps us to understand why not.

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Proposed Ethics Code revision would remove MFTs’ social responsibility

The proposal would eliminate three sections of the AAMFT Code of Ethics that currently call for service and responsibility to larger systems. Members have until January 31 to weigh in.

Angry Talk (Comic Style)The AAMFT Board of Directors is proposing an incremental change to the marriage and family therapy profession’s Code of Ethics, the guiding document that defines professional standards in the field. At least one of the proposed changes would drastically redefine what it means to be an MFT.

Some quick background: The AAMFT Code of Ethics was last updated way back in 2001, and much has changed in the profession since then. In particular, the emergence of new technologies for both marketing and service delivery has raised concerns about how to best manage confidentiality and informed consent. The AAMFT Board has known the Code was in need of updating, but did not want to engage in a full-scale overhaul of the Code at this time; that would be about a two-year undertaking. So, they instead are looking at smaller-scale changes. (Full disclosure: I chaired a Task Force, at the Board’s request, looking at possible changes to the Code over the summer. The Task Force was just one of several sources of input for the Board as they developed the current proposal.)

One element of the proposed revised Code is shocking to me. It would change what it means to be a marriage and family therapist. The Board is proposing removing each of the following sections from the AAMFT Code of Ethics:

6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.

6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.

6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.

Together, these are the sections that place MFTs in a position of larger social responsibility and make us accountable to the communities we serve. The removal of these sections would have far-reaching implications: If MFTs no longer need to have a place at the table when laws are being developed or altered that are not in the public interest, do we simply allow others to set for us the legal standards that govern our profession? Do we now need to stay out of the same-sex marriage debate? Is it OK for us to be ignorant of major legal issues in our field, from the fight for Medicare reimbursement to the Texas lawsuit over MFTs’ ability to diagnose?

Perhaps on an even more fundamental level, we can look at the proposed removal of 6.6. Is contributing to a better community and society no longer a value of this profession? If so, I would be a lot less enthusiastic about being a part of it.

And that’s the rub. A Code of Ethics is more than just a list of behaviors that can get you in trouble in a profession; it also serves as a vital statement of what it means to be an MFT. It reflects our values and desires as a professional group. One of those values, historically, has been responsibility to the communities we serve. If nothing else, devoting some of our professional activity to services with minimal return is a clear way of demonstrating through our behavior that we truly understand systems and our role, as professionals, in those larger communities.

The Board did not provide its rationale for this proposed change (or any others). But the reasons are likely not important. These subprinciples are key to my identity as a marriage and family therapist. They set AAMFT, as an association, and MFTs as professionals apart from other professional groups. Serving the community through pro bono work and involvement in policy discussions is part and parcel to being an MFT. Isn’t it?

Members can review the full proposal of changes to the AAMFT Code of Ethics through the AAMFT web site (you will need to log in). Members can submit comments through January 31 via email; the address to send feedback can be found here. Whether you agree with me on this issue or not, if you are a member, please do weigh in on the full proposal. The more feedback AAMFT gets from members on the proposed changes (most of which are really quite good!), the better.

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If you’re wondering, the CAMFT Code of Ethics encourages (but does not require) pro bono work. It also has language nearly identical to AAMFT’s 6.7 above, about influencing laws.

Like AAMFT, I, too, appreciate your feedback. And you don’t even have to log in to give me a piece of your mind. Post a comment below, drop me an email to ben[at]bencaldwell[dot]com, or post something to me on Twitter.

CAMFT director apologies for articles opposing same-sex marriage

In a message on the organization’s web site, CAMFT Executive Director Mary Riemersma has apologized for the association’s publication of several articles opposing same-sex marriage. The apology is sincere, but the bigger issue remains: CAMFT is alone in the mental health world in its refusal to seriously address same-sex marriage.

As background, CAMFT (the California Association of Marriage and Family Therapists, which is has no affiliation with AAMFT or its California Division) has been harshly and rightly criticized by members, educational institutions, and in the media for their failure to make any kind of comment on same-sex marriage. Every other major mental health organization (APA | American Psychiatric Association | NASW | AAMFT) has taken a stand on the issue, and it is especially relevant to marriage and family therapists. The CAMFT board response has been underwhelming in the face of such criticism, issuing only a broad non-discrimination statement (members only) that sidestepped the important questions entirely.

In order to look like they were doing something on the issue without actually doing anything about it, CAMFT chose to publish a variety of articles supporting and opposing same-sex marriage in the May/June 2009 issue of its magazine, The Therapist. The sections were accompanied by a clear statement that while the articles presented a variety of viewpoints, the organization was not endorsing any of them.

The “pro” articles in the magazine were largely culled from scientific journals, as the science around the issue is quite clear. The origin of the “con” articles is unclear. Whatever their origin, their logic was horrible, and their arguments ranged from the potentially-worth-discussing to the blatantly homophobic and inflammatory.

Executive Director Mary Riemersma has now apologized for the publication of the “con” articles, and the entire issue of the magazine has been removed from their web site. (The next logical question, “Why were the ‘pro’ articles removed too, when there wasn’t a problem with them?” actually is answered in CAMFT’s non-stance on the issue. Leaving up the “pro” articles while taking down the “con” would appear to be endorsing the pro-same-sex-marriage point of view. As long as CAMFT is refusing to take a position, they were obligated to take down both sides.) The apology, which appears on the organization’s web site but is restricted to members, reads:

I am sorry that the objectionable articles appeared in the prior issue of The Therapist and that many found them offensive. I too found them distasteful and did not think they were credible. We were trying to create a balance of views and there was a paucity of articles submitted opposing marriage equality. If I had it to do over, we would have rejected the articles. Our ethics for the profession do not condone homophobia, I do not tolerate homophobia, and neither does the CAMFT Board. Let me know what we can do to overcome the unintended harm that some believe we have caused.

It’s not an outstanding apology, as apologies go (the phrase “these articles were homophobic,” or anything to that effect, is conspicuously absent, and “some believe” is a little grating), but it’s about as far as Riemersma can go. She’s responsible for the operations of the magazine, but the board determines CAMFT policies. And by staying silent on such an important issue, the CAMFT board wades father out of the mental health mainstream by the day, and harms the reputation of the profession of marriage and family therapy around the country.

Who will apologize for that?

Update: Apparently — and to their great credit — CAMFT will.