September Membership Meeting Write-Up — Kirstin Carl, MS, LMFT

The State of the Profession
presented by
Nabil El-Ghoroury, PhD
Executive Director of CAMFT

As practitioners within a system of ever-evolving laws and regulations governing our work, today’s topic is vitally relevant. What we’ll talk about today is The State of the Profession — the state of Marriage and Family Therapy in California.

Let’s start with CAMFT. CAMFT Connects was held this year with the topic of The MFT Scope of Practice in the 21st Century. California was the first state to define scope of practice, which according to Dr. El-Ghoroury, is by far the worst scope of practice in the nation. Lots of states have better scope-of-practice definitions.

One of the biggest challenges for Marriage and Family Therapy is that the right to diagnose and treat is not explicitly written in the code that describes our scope of practice. The code references other laws and codes that give it that right; however, what’s not included is the language of, “Marriage and Family Therapists can diagnose and treat.” Other states do that. CAMFT is planning to look at that scope of practice and potentially open it up for revision, which is a big deal. Once that scope of practice is opened, Dr. El-Ghoroury expects other professions to quickly try to block our efforts to include it explicitly in the scope of practice. So we have to develop a thoughtful, strategic process. The CAMFT Connects meeting was a great first step, and a task force is going to meet to continue that process and dialogue. The process is intended to make the scope clearer and more relevant to MFT practice.

The other thing we need to work on is the perception of what MFTs do. Everyone thinks that an MFT only conducts marriage and family counseling, and you have to constantly explain that to people.

CAMFT has an on-demand learning library. You can get online CEs, law and ethics workshops, and many topics that were held at the April conference. CAMFT is including a 6-hour session on HIV and AIDS, which is required for new licensees. There is also an online member directory known as Counseling California, which has a great search tool that can be use to potentially gain clients. Additionally, CAMFT is working on revising its ethics code.

Next, Dr. El-Ghoroury discussed the CAMFT Political Action Committee. The PAC is how we develop relationships with our state and federal legislators. At the state level, CAMFT is taken very seriously. CAMFT is the largest mental health association in the state. When we have concerns, state legislators and aides listen.

What do we know about CAMFT demographics? The demographic survey is on the CAMFT website. The average age of LMFTs in California is between 58 and 67. Eighty percent of MFTs are women. The most common online advertising is through Psychology Today. About 2/3, or 68 percent, are in private practice, which is the most common setting. The average number of sessions that MFTs have is 13 to 24 sessions. Their usual billing is between $120 and $140. Billing for insurance is about one-half of that, between $60 and $75.

Only 18 percent of MFTs have a professional will. There are some materials on the CAMFT website about wills. Should something happen, you want a plan for continuity of care for your clients, and for the records of those clients. Who contacts your clients? How do they get referred? And who has access to those records?

There are also online legal resources on the CAMFT website, as well as a lot of tools for starting a private practice. There are sample practice forms in both English and Spanish. If you are ever doing background research, CAMFT has EBSCO as a member benefit. CAMFT is providing a lot of public education, both to those entering the profession, and to the general public.

Now we’ll talk about the BBS. The first change is creating confusion everywhere — the transition from the word “intern” to the word “associate.” We are now calling interns “Associate Marriage and Family Therapists” or “Registered Associate Marriage and Family Therapists.” For pre-licensees, make it very clear that you are a “Registered Associate.” Do not say or use “Marriage and Family Therapist” without the word “Associate” somewhere. Another confusing part of this is that CAMFT has a membership category called “Associate,” which is meant for non-MFT colleagues.

Dr. El-Ghoroury then discussed topics that CAMFT is advocating for at the BBS. CAMFT is working on license portability. The biggest barrier is that California doesn’t offer the national exam for MFTs. Getting the BBS to offer the national exam is a big deal. The second is low exam, pass rates. California revised its exam a few years ago, when the pass rate dropped from 75% to 50%.

Telehealth is a big issue that all regulatory boards are working on, as well. It is a very complicated issue, as the laws were written from a 1970s perspective. The real issue is, which jurisdiction owns the client? Within California, it is very clear. The purpose of regulation is to protect the client. With interstate practice, who owns the client? States are very reluctant to give that up. All BBS meetings are live-streamed.

So let’s talk about federal advocacy. The biggest catch is getting MFTs into Medicare. This is a challenge that will require continued work. In the VA, there has been some improvement. They have added some verbiage about hiring MFTs. Oregon has recognized the CA exam. This means if you move there, you don’t have to take another test.

Next, Dr. El-Ghoroury discussed departmental Issues. Pertaining to the Department of Homeland Security, it is possible for mental health experts to give testimony for trauma in immigration cases. However, ICE is not accepting LMFT evaluations. With the federal tax plan, there is a possibility that those who own their own businesses could benefit from recent tax reform.

In regards to association healthcare plans, the federal administration made a change in healthcare law that could potentially allow associations to offer healthcare plans. Due to some systemic challenges, CAMFT won’t be offering association healthcare plans at this time. However, CAMFT may soon be able to offer dental and vision plans.

Regarding California legislation, there is a new law allowing minors 12 years and older who consent for treatment to addend their records. The other bill is from the BBS regarding supervision. It has lots of changes, including requiring supervisors to monitor clinical dynamics like counter-transference. One big change is to drop the 90-day rule connected to accruing associate hours in agency settings. The 90-day rule has never applied to private practice. Furthermore, CAMFT is advocating for MFTs in federally-qualified health centers.

CAMFT priorities include Medicare reimbursement, promoting and protecting LMFT practice in California, pre-licensed issues, and communication with members.

Lastly, Dr. El-Ghoroury discussed legal resources offered by CAMFT. Subpoenas are a big reason to consult with CAMFT. Child abuse reporting is another big reason for calling, as the legal requirement to report can impair the therapeutic alliance. Treating minors is a big issue, including consent for treatment, divorced parents, and custody evaluations. Ethical issues and requirements for licensure are other topics addressed during CAMFT legal consultation. Pre-licensed therapists should always verify their supervisor’s license, so that they don’t lose hours because their supervisor’s license has lapsed. He reminded us that CAMFT provides legal consultation, not legal advice.

As you can see, Dr. El-Ghoroury provided us with immensely important information which we all need for our clinical practices.

Kirstin Carl, M.S., LMFT, has a private practice in Encino, specializing in trauma, faith-based therapy, and adolescents. Practicing for over 10 years, she is passionate about her work. Currently seeking certification in Emotionally Focused Couples Therapy, as well as participating in training on Voice Dialogue Therapy, she remains strongly committed to her development. You can reach her through her website kcarlmft.com, or at 818.593.9047.