Book Review: The Making of a Therapist, by Louis Cozolino

Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

The full title of this book is The Making of a Therapist: A Practical Guide for the Inner Journey, which should give you a pretty good idea about what's inside. The permission to "start off by not knowing a single thing about psychotherapy" (p. xxi) is given because this book is intended for beginning psychotherapists who...well...probably don't know a single thing about psychotherapy. And may be feeling boatloads of anxiety about it. Not that I know anything about that.

Cozolino articulates that "a basic goal of this book is to give beginning therapists permission to feel what they inevitably will feel--uncertainty, confusion, and fear--while also offering some strategies and advice for dealing with common situations that all therapists face" (p. xx). He's big on giving permission, which somewhat allays the fear that whispers, "if you're prepared to start seeing clients, why do you feel like you've got no idea what you're doing??"

He believes that graduate training for psychotherapists focuses on the what rather than the how of therapy, and there's not enough room for exploring and developing the inner world of the new therapist. So while we may be armed with theory and interventions and even some good idea of what questions we should be asking clients, we're not as well prepared for the interpersonal nature of therapy. To assist in nurturing this critical part of training, Cozolino has structured this book somewhat chronologically. He begins the journey with "Getting Through Your First Sessions" before moving on to "Getting to Know Your Clients" and finally guiding the reader to "Getting to Know Yourself." If you're not doing your own personal therapy as you begin seeing clients, you may find this last part especially helpful and supportive.

The Making of a Therapist a wonderful balance of Cozolino's anecdotal personal experiences as a beginning therapist, his observations of students and supervisees over the years, and advice that somehow manages to be both pragmatic and inspirational. It's an easy read, and something I'll imagine I'll find myself coming back to as I hit rough patches in fieldwork. But the lasting lesson of this book is to give yourself permission to be open to and aware of all you don't know--it seems it's in those moments where the real making happens.

 

Points of Interest:

My Favorite Therapy Podcasts - UPDATED!

Caroline wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

I spend an unreasonable amount of time in my car, so podcasts have been my saving grace. There are several great therapy podcasts I have stumbled across that have really broadened my understanding of the mental health field and introduced me to the huge variety of different paths you can take as a practitioner. Most podcasts release new episodes regularly, so I feel like they help me stay current even though my studying for school has been more focused on theoretical foundations, but I also recommend diving into the archives!


The Modern Therapist's Survival Guide, Curt Widhalm and Katie Vernoy
Medium format (25-35 minutes). One of my very favorite podcasts, especially because there are frequently new episodes. Curt and Katie are very involved in the accompanying Facebook group, which is awesome for when you've got questions about episodes or anything in general! Recommended to add to your playlist!


Psychotherapy Notes Podcast, Ben Caldwell, PhD, LMFT
Very short format (under 10 minutes). Part of how I decided to become an MFT was by reading every single thing posted by Dr. Caldwell on his excellent blog, Psychotherapy Notes. Dr. Caldwell is a passionate advocate for the profession with a clear and engaging style that's both easy and invigorating to read--he really wants the reader to understand what he's saying. He just launched his podcast, and I'm really excited to see where it goes from here.


Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

Psychology in Seattle (Premium)Dr. Kirk Honda
Long to extremely-long format (30 minutes - 2+ hours). I only recently became a patron at Patreon so I could access some of the full episodes that were interesting to me. Try the free podcast first and if you enjoy the format, I recommend upgrading. I have gotten my money's worth listening to the therapist development episodes--I would say this podcast has been the most relevant to my experience as a student/trainee.


Talking Therapy, RJ Thomas, MFT & John Webber, MFT
Long-format (each episode is around an hour). This is one of my favorite ones but it doesn't get updated frequently.The hosts' media/entertainment industry experience shows--it's not overly-scripted but the interviews always flow. They also aren't selling anything, so you just get a lot of great information. They cover a wide variety of topics and always have quality guests. I appreciate how the hosts are mindful of explaining terms that "future therapists of America" might not understand yet. My only complaint is that I wish there were more episodes!


Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

Starting a Counseling Practice, Kelly Higdon LMFT & Miranda Palmer LMFT
Medium format (25-40 minutes). These ladies are a wellspring of great information about becoming a therapist and developing a private practice. They've got episodes going back to 2015 available on iTunes, and if you've got a question, chances are they've covered it!


Itunes_3000x3000.jpg

The Private Practice StartupDr. Kate Campbell & Katie Lemieux
Medium format (30-45 minutes). I really like the style and energy of these hosts. The pace of each episode really keeps up, so they cover a ton of information in a short amount of time. Covers a lot of great business building information.


Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

The Abundant Practice Podcast, Allison Puryear
Medium format (20-30 minutes). Very focused on practice-building if you're looking for the nitty-gritty. Occasionally Allison does episodes where she coaches a clinician about their specific issues and the we get to listen in--I really enjoy these episodes! Episode #67, "All About GDPR" was especially helpful.


YouTube LecturesDr. Diane Gehart, LMFT
OK this is not actually a podcast, but still I think the sooner you check these out, the better off you'll be. Dr. Gehart has several lectures posted on YouTube that cover various orientations and also more nuts-and-bolts things like APA style and BBS hour logging (for California trainees/associates). They're very popular with people studying for the licensing exam, but I found them to be an invaluable adjunct to my introductory counseling theories course in my first semester of grad school.


Hidden Brain, Shankar Vedantam
Medium format (25-50 minutes). Not strictly about psychotherapy, but it is so fascinating! And really, really well done (it comes from NPR). I can't explain it any better than they do on their website: "Hidden Brain links research from psychology and neurobiology with findings from economics, anthropology, and sociology, among other fields. The goal of Hidden Brain isn't merely to entertain, but to give you insights to apply at work, at home and throughout your life."


Invisibilia, Alix Spiegel, Hanna Rosin, & Lulu Miller
Long format (1 hour). Another NPR/not-strictly-psychotherapy podcast, but a must-listen: "We weave incredible human stories with fascinating new psychological and brain science, in the hopes that after listening, you will come to see new possibilities for how to think, behave and live."


The Radical Therapist, Chris Hoff, PhD(c), LMFT
Long format (40-60+ minutes). Admittedly, I believe I personally am leaning towards a postmodern orientation, and this podcast has a heavy dose of that. As a new graduate student, I find the "Therapist Roundtable" episodes particularly helpful (I think I've listened to episodes 28 and 38 three times each). He's also had big-time guests like Scott Miller, Ph.D. and Harlene Anderson, Ph.D.


The Psychology Podcast, Dr. Scott Barry Kaufman
Medium format (30-50 minutes). Dr. Kaufman is an acquired taste, I think--though his enthusiasm is delightful, he can sometimes seem a little pushy. That being said, I always get so much out of his podcast. He gets great guests and engages them in deep, thoughtful, yet briskly-paced dialogue.


Where Should We Begin?, Esther Perel
Medium format (35-40 minutes). As someone who's nowhere near actually being in a room with a client yet, this podcast feels a little like field observation meets television drama. I'm absolutely obsessed with it, but at this point I find it more entertaining than instructional. The focus is definitely on the couples rather than on Perel's techniques.


Selling the Couch, Melvin Varghese, Ph.D.
Medium format (30-40 minutes). One of the biggest complaints I heard when I was researching graduate programs was that no school prepares you for the business aspects of running a private practice. There are several podcasts that seek to fill this void, and honestly they do a great job. If you listen to all of them, you will start to hear the same themes surface over and over, but for me I hope that's just helping me learn it better. Melvin seems like a genuinely nice person and I enjoy his honesty/vulnerability in discussing his own struggles.


Practice of the Practice, Joe Sanok
Usually medium format (30-40 minutes) but sometimes he does a short format series (15 minutes). Joe Sank is the private practice guru. He does consulting on starting and growing a private practice, so a lot of the guests are clients of his and he does frequently pitch his services. However, it's a TON of free useful information, and he's very encouraging of private pay services.


The Therapist Experience, Perry Rosenbloom
Medium format (20-40 minutes). This podcast is produced by Brighter Vision, a therapist website company, and the guests are generally clients who have had success with their website. A lot of great nuts and bolts info on running a private practice--another one that advocates private pay. Perry, the host, is kind of hilarious because he sticks to a very structured script every episode, but it's clear that sometimes his guests aren't familiar with the format, so they get blindsided by the questions even though regular listeners are waiting for them. Makes me giggle.


Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

The John ClarkcastJohn Clarke
Short to medium format (5-40 minutes). Another one on building and marketing a private practice. Lot of different approaches--interviews, series focused on particular aspects of marketing, more general business systems stuff, etc. A great one to add to the playlist!


Therapist Club House, Annie Schuessler, MFT
Medium format (30-40 minutes). The host is a business coach, so as with the two previous podcasts, many guests are clients. I like how in-depth she gets with her clients' experiences--I particularly enjoyed the 12/25/17 episode with Jennie Steinberg.


Businesses in Bloom, Juliet Austin
Medium format (40-45 minutes). A former therapist, the host is now a marketing consultant for private practitioners. There's a wide variety of guests so you can become acquainted with the different options in the field, and there is a focus on marketing.


Therapist Uncensored, Dr. Ann Kelley and Sue Marriott
Long format (40-60 minutes).  More content-oriented than focused on business aspects.


Therapy Chat, Laura Reagan, LCSW-C
Long format (40-60 minutes). Another more content-oriented podcast, but she does really get into what it's like to practice from different orientations and some early episodes focus on more practical issues (#39, Designing a Website with Empathy).


Shrink Rap Radio, David Van Nuys, Ph.D.
Long format (60-75 minutes). Content-oriented and with a VERY deep archive--episodes go back to 2005, so there's lots to browse through.


 

Points of Interest:

What is the medical model? And why do people seem to hate it so much?

Caroline wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate
 

"Raise your hand if you believe in the medical model!"

This challenge was issued by a professor on the second day of my MFT graduate program. Hesitantly, I and about half of my class sort of raised our hands.

You ever have the feeling where you are on-the-fly asked to give a definition of a word you've been using with confidence forever, and you instantly start to question whether you have any idea what the word actually means?

Yeah. That.

If someone had asked me to define "the medical model," I would have said, "um...like...hospitals? And doctors? And it's a model, so like...the idea that we go to the doctor when we're sick?" So, yeah. I believe in that, I guess? Which is why I raised my hand. I like doctors. I go to them frequently. My brother even is one.

But as my professor surveyed the room with a judgey raised eyebrow, I started to wonder what I had just committed to.

"So you believe all of your clients should get a diagnosis?" he questioned in an admonitory tone (admonitory: giving or conveying a warning or reprimand).

I was embarrassed. I didn't have much experience in the mental health field, wasn't super-educated about current theory, and felt that clearly everyone else knew what this was all about and I was the only one raising my hand in total ignorance.

And instead of elaborating on the medical model and what it had to do with diagnosis, he moved on to ask whether it was ethical or unethical to assign a diagnosis to a client just so they could get treatment covered by insurance.

I was left feeling like I'd just missed the bus. My inner monologue was scream-whispering inside my head: "Wait so but what is the medical model also why wouldn't you give a diagnosis WHAT'S WRONG WITH DIAGNOSIS??"

After all, I'd been diagnosed with an egg allergy when I was a toddler. Without that diagnosis, I would have spent many years wondering why breakfast foods made me feel like I was dying.

This kept happening. Someone would say something obliquely critical of "the medical model," like if you were in favor of the medical model then you were not going to be a good therapist and you were probably a terrible person to boot. And it always happened in a hush-hush sort of way. Like, "well I know I shouldn't be saying this BUT..." And then there was never any further discussion.

One of my professors suggested clients don't need medication as much as they need unconditional positive regard. Another professor warned that doctors don't treat their patients like people. Another begged/demanded that "you must never refer to your clients as a diagnosis!" 

Apparently, there was something wrong with "the medical model." I had to find out what the hell this thing was, and why it was so bad.

So I started asking around. My classmates' definitions varied. Some thought "the medical model" referred to  using medication to treat things. Others believed "the medical model" was responsible for stigmatizing disability. Still others believed it was somehow connected to science and psychotherapy in general. And we were all aware it had a negative connotation.

Finally, this summer, I decided to do some real reading.

Me, realizing what I'd gotten myself into:

Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

But it was too late.

I'd lifted the lid on what seems to be a Great Debate in the field of mental health. Many authors identify that the term "the medical model" is used as an epithet "with denigration, suggesting that its methods are paternalistic, inhumane and reductionist" (Pies, 2017; Shah & Mountain, 2007, p. 375). I found lots of reasons why this is the case, but I also found many authors arguing that this is unfair. Mostly, I realized there are a lot of things to be confused about.

At this point, I've done a good amount of research, but trust me that I've only just scratched the surface.  I make no claims to having figured this all out. But I'm going to share what I've learned thus far--I feel much less confused now than when I started this project. Still, if you think I've wrongly interpreted something or am just in general way off the mark, I welcome feedback, clarification, and edification! Seriously. 


What I think is going on is this:

  • "The medical model" is a term for how we conceptualize illness, and the definition has changed over time.
  • It's a concept that came about during the Scientific Revolution, began to be applied to mental health and psychotherapy in the 20th century, and was successfully challenged starting in the 1960's.
  • At that point, people were pointing out a bunch of things that were seriously problematic about the model, and "the medical model" got a really bad reputation.
  • (I think it was also around this time that "the medical model" and all its oppressiveness got conflated with "applying scientific principles to psychotherapy." I'll be addressing this in a later post.)
  • In the latter half of the 20th-century, people started trying to address all the problems raised by critics, and "the medical model" shifted from a biomedical emphasis to a biopsychosocial emphasis as a result.
  • The "new" (and improved) medical model as used today by clinicians is--or should be--quite different from the "old" medical model, though people still call it just "the medical model."

Now here's why I think this is such an important issue:

Poisoning the well against "the medical model" without defining the term and explaining the debate is dangerous, because it unfairly prejudices new clinicians against whatever they decide "the medical model" means to them--diagnosing, giving clients a medication referral, reading published studies to inform their practice, etc. This results in clinicians more likely to justify opting out of evidence-based practice as the taking of a principled stand against "the medical model," when in reality it is simply unethical practice

Part 2 of this article will address this argument, and I'll include some things I think we can do as ethical psychotherapists instead of sitting around demonizing the medical model.

In the meantime, let's start with figuring out what the hell it really is.


    I've included a list of references at the end of this article in case you're interested in following me down this insane rabbit hole. And even if this is not the most interesting thing you've ever learned about, I hope you'll at least hear me out to the end of this post, because I do think this is really important and I'm not sure why it's not covered more in-depth in school.

    Ready to learn more than you ever wanted to know about the medical model?

    HERE WE GO!

     

    The Classic Medical Model

     Image: Paul K.,  Le Docteur Alchimiste (18th cent.) , bibliodyssey.blogspot.com/2008/10/alchemy-laboratories.html

    Image: Paul K., Le Docteur Alchimiste (18th cent.), bibliodyssey.blogspot.com/2008/10/alchemy-laboratories.html

    Once upon a time (starting in the 1500s), the Scientific Revolution happened. People started trying to figure out what was going on when other people developed pustules or hacked up blood. They started taking dead people apart like cars. Displeased, the Church, who had previously cornered the market on "why do people get pustules?" (because God), wasn't real happy about this infringement on its philosophical territory. But it agreed to a compromise and said, "hey you know what, you can take apart bodies as long as you leave us the mind, by which we really mean soul" (Engel, 1977). The proto-doctors decided this was fine, so they started trying to find biological reasons for biological symptoms like pustules--and the medical model was born (Wade & Halligan, 2017). But they stayed away from the mind/soul because that was the Church's turf, which resulted in the mind/body division that existed in the Western world for hundreds of years (Engel, 1977).

    So, simply put, the classic medical model "is characterized by a reductionist approach that attributes illness to a single cause located within the body" (Wade & Halligan, 2017). This is the medical model that, in general, most people are referring to when they say "medical model" in a derogatory way.

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    A Tiny Bit More History

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    However, after the Industrial Revolution, some folks started to think that maybe people shouldn't be thought of as machines made out of meat, while the rise of democracy was fueled by the idea that individual humans are more equal than not (we're just gonna gloss over that historical hypocrisy for now). The backlash against the medical model happened shoulder-to-shoulder with the rise of humanism and postmodernism. Humanism emphasized the value and agency of people, while postmodernism in part challenged notions of power--including the power of knowledge.

    At the same time, the medical model had been identifying and curing diseases like gangbusters, but a bewildering paradox came to light: sometimes, people felt ill but had no physiologically identifiable disease, while others with an identified disease did not feel ill at all.

    Also by this point, the Church had lost a lot of ground and couldn't really tell doctors to stay out of people's minds anymore. So naturally, the field of medicine came to incorporate the "mental" as well as the "physical," and they began to apply the tried-and-true medical model that had worked for hundreds of years to the human mind--resulting in the new discipline of psychiatry.

    Considering the chronological context, it was a relatively short amount of time before people realized this wasn't gonna work out so great.


    The Anti-Medical Model Movement and the New (Medical) Model(s)

    The conceptualization of illness as biological resulted in "great advances in the diagnosis and treatment of some life-threatening and debilitating diseases " (Wade & Halligan, p. 996). In fact, even treating some mental disorders, like schizophrenia, "in a medical sense has led to significant benefits for a segment of the population" (Corrigan & Ralph, 2005, p. 8), and "biological explanations have helped reduce fear, superstition, and stigma and increase understanding, hope, and humane methods of treatment" (Shah & Mountain, 2007, p. 375).

    However, the medical model has a lot of drawbacks that caused significant debate, which we'll explore in a moment. For the most part, when people hate on the medical model, they do so because they believe it's ultimately harmful to the people it was designed to help.

    In large part, the consensus seemed to be that taking a strictly physiological approach to issues of illness/wellness was too narrow.

    In a series of articles published from the 1960s through the 1980s, George Engel sought to identify the shortcomings of the classic medical model and replace it with something new; his landmark article was, in fact, titled The Need for a New  Medical Model: A Challenge for Biomedicine. His suggestion was to replace the classic medical model (what he called the biomedical model) with the biopsychosocial model:

    The existing medical model does not suffice. To provide a basis for understanding the determinants of disease and arriving at rational treatments and patterns of health care, a medical model must also take into account the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of illness, that is, the physician role and the health care system. This requires a biopsychosocial model.

    This does not do away with the "bio" part of medicine, but it does incorporate entire domains of human existence that had been neglected, like interpersonal relationships, intergenerational trauma, adverse childhood experiences, minority stress, etc. 


    The Biopsychosocial Model

    Many authors I read suggested that the ideology of the classic medical model is no longer reflected in actual current clinical practice. Today, the biopsychosocial approach is the prevailing perspective in both the medical and mental health fields:

    • In 1981, an article in The Journal of Marital and Family Therapy declared that "recent developments in the understanding and treatment of mental disorder have resurrected the medical model--no longer the narrow, reductionistic model of the past but one that encompasses biological, psychological, social, and even moral-existential parameters" (Abroms, 1981, p. 385).
       
    • In 2009The Australian and New Zealand Journal of Family Therapy, stated that "case formulation, with a strong biospychosocial emphasis, is considered a key task in the training of psychiatrists and psychologists" (McDonald & Mikes-Liu, 2009). 
       
    • In 2014, Bolton said the biopsychosocial model "has become part of the ideology of medicine" (p. 180).
       
    • In 2016, Searight described the biopsychosocial model as "a mainstay of North American medical school curricula and postgraduate psychiatric education" (p. 289).
       
    • In 2017, Wade and Halligan argued that "the model has been used to structure guidelines, is used clinically, and is discussed in relation to person-centered care and in other contexts" (p. 997). 

    Many people seem to believe the biopsychosocial approach has overhauled "the medical model" rather than done away with it, so they still use the term "medical model" to describe how we conceptualize mental health in this more expanded way--hence my desire to clearly identify whether we're talking about the "classic" or the "new" medical model.

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    The Biopsychosocial Model and the Field of Medicine

    Because nothing can ever be easy, there is, of course, criticism of the biopsychosocial model. I'll refer you to Farre and Rapley (2017) and Searight (2016)  for a fuller exploration of the critiques and the various models proposed to address those critiques, because honestly this post is turning into a Complete History of Medical Philosophy. For you and me, I think the most relevant critique is that the biopsychosocial approach requires clinicians to collect an unreasonable amount of data on each patient before being in a position to diagnose and treat. It's from this context that some mental health professionals feel medical professionals "don't spend enough time with their patients." The field of medicine has offered solutions such as patient-centered clinical care, which attempts to narrow the medical scope while still honoring biopsychosocial principles (Searight, 2016; Weston, 2005).

    The Biopsychosocial Model, Mental Health, and Psychiatry

    With his biopsychosocial model, Engel waded into a heated debate within the field of psychiatry during the latter half of of the 20th century. On the one side, "psychosocial extremists such as Thomas Szasz ...argued that mental illness was not 'real illness' but instead a medicalization of 'problems in living.' On the other side, ... [the] biologically oriented psychiatrists [who developed the DSM] sought to reunite their specialty with medicine... Psychiatry eagerly adopted the [biopsychosocial model] because it provided a 'big tent' and prevented a split in the psychiatric community. Thanks to Engel, the molecular biologists investigating serotonergic synaptic activity and the anti-psychiatrists attributing mental illness to a sick society could be at home with one another" (Searight, 2016, p. 291).

     
     

    This fundamental debate--whether mental health should fall under the purview of medicine--is still alive and well today. 

    Psychology ≠ Biology, Psychotherapy ≠ Medicine

    This camp believes that "problems of living" for which people seek mental health care are not illnesses at all. Depression (as far as we know now) isn't caused by a virus. Therefore, the argument goes, mental "abnormalities" shouldn't be treated like illnesses, and psychotherapy isn't an "intervention" as much as it is "an interpersonal process" (Elkins, 2009). Elkins seems to really believe we as therapists should opt out of the medical model in its entirety and cast our lot with "alternative practitioners" like psychics.

    Going even further, some people believe the "medicalization" of the mental health field has cultivated a mindset of "low-efficacy," where people who aren't doctors feel like they are not in a position to effect mental-health change precisely because they are not doctors--and therefore, must be powerless to "fix" anything (Gutkin, 2012). They believe the medical model perpetuates this power dynamic in the mental health field, and we would be better off without it, because then everyone would feel empowered to "fix" mental health.

    I completely understand why these folks hate the medical model. And for the conspiracy theorists in the back--no, I don't think these therapists are just afraid they're losing all their income to Big Pharma so they want to position themselves as a totally separate alternative.  Like the Church, this group believes the mind and body should be separate disciplines entirely. If you believe this, then I can understand how frustrating it must be to have to  learn stuff you don't believe in so you can get licensed and practice as a psychotherapist.

    The truth, I suspect, is that this group is a minority. 


    The Recovery Model

    Perhaps most relevant to MFTs is the rise of the recovery model in mental healthcare in America. It seems to me that this approach is a significant way that the field of marriage and family therapy has incorporated biopsychosocial values into mental health care. It came from the world of substance abuse treatment but has been applied more broadly to treatment of chronic illnesses such as hypertension, diabetes, HIV, and cancer (Barber, 2012; Gehart, 2012a).

    In 2004, the Department of Health and Human Services (HHS) issued a recommendation for a shift to recovery approaches in treating mental illness. HHS defines "recovery" as "a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential" (Gehart, 2012a, p. 430).

    Unlike the classic medical model, full symptom remission is no longer the ONLY metric of recovery from illness. Essentially, it moves the goal line, and the person with the illness decides where the goal line is.


    YouTube Break

    Because if you're not taking every possible opportunity to watch Debbie Reynolds as a dancing football, what are you even doing with your life? With bonus Donald O'Connor!


    The recovery approach was created and promoted by "consumers"--the individuals more commonly called "clients" or patients, a marked difference from both the biomedical and biopsychosocial approaches which were conceived of and implemented by providers. "Consumer" is used to reflect that the person receiving treatment is more actively choosing to "consume" an available option (much as we "consume" entertainment or news) rather than passively get treatment applied to them by a clinician (Gehart, 2012a).

    One framework of the model outlines three types of recovery:

    1. Cure, or clinical recovery: The consumer is symptom free and does not need further treatment.
    2. Illness management: The consumer and healthcare professionals are collaboratively involved in symptom control and monitoring of the illness over time. Treatment can help minimize impact of the illness.
    3. Personal recovery: The consumer is functioning at their best even in the face of ongoing symptoms. It can be thought of as living a fulfilling life while having an illness. (Barber, 2012)

    Since I think this is the model that will most likely affect practicing MFTs now and in the near future, I'm going to highly recommend you read two articles from The Journal of Marital and Family Therapy on the topic: Gehart (2012a) and Gehart (2012b). For now, the most important thing to know is that Gehart describes the recovery approach as "in dialogue with" the medical model, not fundamentally opposed to it:

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    Now that we've more or less (less, trust me) covered the historical shift from the classic medical model to wherever the hell we are now, it's time to figure out what my professor was so upset about when I admitted that I did, in fact, believe in the medical model.


    The Great Debate - So What's Wrong with the Medical Model?

    I think it's really important to take a look at the charges leveled against the classic medical model and consider how the biopsychosocial approach and the recovery model have attempted to address these concerns.

     

    As I understand it, the classic medical model has some fundamental assumptions:

    1. There is "normal," and then there's "abnormal."
    2. It's better to be "normal."
    3. When things are abnormal in a person, getting back to normal is the highest priority.
    4. Abnormal things in people are caused by something physical/biological.
    5. Experts are the best people to identify what's abnormal, who has an abnormality, what's causing it, and how it needs to be fixed.
     

    No one tends to argue when this approach is applied to a broken arm. Yes, we generally agree it is better to have a non-broken arm than a broken arm. Yes, this problematic arm has a physical/biological source of abnormality--that bone is broken. Yes, we can get this arm back to "normal" by putting a cast on it so the bone can grow back together, and yes, we all think a doctor is a better person to set that bone than my UPS guy.

    As Engel puts it:

    The biomedical model was devised by medical scientists for the study of disease. As such, it was a scientific model; that is, it involved a shared set of assumptions and rules of conduct based on the scientific method and constituted a blueprint for research. (p. 319)

    Boy, did this work out great for awhile. They found cures for all sorts of things this way. Like broken arms! And tuberculosis! And the plague! It worked so well for bodily ailments that people started applying it to the nascent field of psychiatry.

    It's when this approach started expanding to "abnormalities" less obvious than broken arms--like mental health--that things really started to go off the rails.


    Normal and Abnormal: Which is Which, and What to Do About It

    Let's begin with the very first assumption of the medical model--there is "normal" and there is "abnormal." You can't get around to fixing anything unless you know what something looks like when it's "fixed" and you can tell the difference when it's "broken," right?

    Critics of the medical model raise some important questions:

    • Who, exactly, gets to define what is "normal" and what is "abnormal?"
    • Why is it better to be normal??
    • Who gets to decide someone needs to "fixed" if the "abnormal" person doesn't agree that they're "broken?"

    I'm sure you can see how the concept of normal/abnormal is going to start getting fuzzy when we look at mental health issues. But we're already at fuzzy just talking about physical issues. For example, if that broken arm doesn't heal entirely straight, is it normal? Does it need to be straight? If it's your arm and you'd rather not have a surgery to straighten it out, does the doctor have the right to knock you out and do it anyway 'cause it's in your best interests?


    The Medical Model of Disability

    Click to enlarge! Image: Taxi Driver Starter Pack

    These hypothetical questions carry real-life weight when it comes to issues of disability. The medical model of disability dictates that there is a "normal" way the body should function, and if it doesn't function that way, the body should be "fixed" until it gets as close to "normal" as possible. Ableism, or "the idea that those who are 'more able' are 'more includable'" (Shyman, 2016, p. 367), is the natural outgrowth of this way of looking at disability--it locates the "problem" in the person with the disability. This is a very valid critique of the classic medical model's fundamental assumptions, and disability advocates argue there's an alternative to this perspective (Laner, 1976; Shah & Mountain, 2007; Shyman, 2016 ).

    The Social Model of Disability

    Informed by the biopsychosocial perspective, they argue that problems of inclusion for people with disabilities are not only caused by the physical disability--rather, barriers to inclusion exist in the psychological (such as minority stress) and sociocultural (stigma, abled-centered design, etc.) domains as well. Shifting the locus of responsibility from the person with disabilities to the greater context also shifts the understanding of where change should come from. Rather than people with disabilities being expected to conform to "normal" functioning, society needs to make changes to accommodate people with disabilities. This is called the "social model" of disability, and is what the recovery model is based on (Gehart, 2012a).


    The Medical Model, Diagnosis, and the DSM

    Similarly, when the medical model is applied to mental health, it identifies psychopathology within individuals as the reason they can't get along with the world at large. Therefore, the solution is to identify these psychopathologies and discover effective treatments so everyone can function optimally in society. This has resulted in the Diagnostic and Statistical Manual, or DSM, a catalog of mental "disorders," each with its own suite of signs and symptoms and each with its own diagnostic label (like Major Depressive Disorder). Because this manual is the manifestation of the power to define normality/abnormality, some people find it intrinsically problematic.

    Diagnosis is Dehumanizing

    Some make the humanistic argument that diagnosis reduces a human being to a label, stripping them of their humanity (this is why some of your professors may vehemently exhort you to say "my client with borderline personality disorder," not "my borderline client"). The act of assigning such a label to a person makes them vulnerable to social stigmatization and may even insidiously alter the person's self-concept to the point where they take on an "illness identity." Receiving a diagnosis could also lead to a "self-fulfilling prophecy," where the diagnosed resigns themselves to never living without the diagnosis and may give up on recovery (Byrne, Happell, & Reid-Searle, 2015; Kvaale, Haslam, & Gottdiener, 2013; Scott, 2010).

    Diagnosis as an Instrument of Power

    Others make the postmodernist argument that the act of diagnosing is how those in power classify as "deviant" those whose behavior "annoys or offends" them--diagnosis, therefore, is an oppressive act. We're not talking about "my roommate annoys me when they don't pick up their socks, therefore they must have a disorder." It's more like "my roommate's sadness annoys me, and I want to change their behavior so I'm not bummed out, therefore they have a disorder that needs to be fixed, I shouldn't have to learn how to cope with their sadness." Some even suggest diagnosis is "an attempt by professionals to distance themselves from the consumer by creating difference" (Byrne et al., 2015, p. 221). And if you've ever heard the phrase "the myth of mental illness," it's referring to the mind-bending idea that something like "depression" isn't really an illness like "influenza" (you can't see a depression germ under a microscope) and we just use the word "illness" metaphorically. In this conceptual framework, the concept of "mental illness" is semantically dismantled and reduced to a turn of phrase, or story--thus, myth (Laner, 1976).

    Mental gymnastics aside, the idea that diagnosis could be dehumanizing and/or oppressive is another completely valid critique of the medical model.

    The Biopsychosocial/Recovery Approach to Diagnosis and the DSM

    If you're of the mind that there's nothing medical about mental "illness," then diagnosis is bad and that is that. However, if you believe that mental health deserves to be researched and treated according to the best available evidence, but you also don't like dehumanizing or oppressing people, you're in luck--the biopsychosocial and recovery approaches to diagnosis should appeal to you.

    Wong (2010) states that the clinicians he knows "use the DSM as one of several assessment tools within the context of interpersonal therapeutic conversations" and that "to diagnose someone as 'depressed' does not necessarily mean that the client is apathologized as long as the client is treated with empathy, unconditional positive regard, and genuineness as a unique human being" (p. 251). From that standpoint, the DSM is a tool that can be used to empower clients as much as to oppress.

    And this is how Gehart (2012b) describes the recovery approach to diagnosis: "Similar to the medical model, mental health diagnosis is an important step in the recovery process; however, in contrast to the medical model, the diagnosis does not drive the recovery process" (p. 449). Diagnosis, Gehart argues, helps the clinician to better understand the consumer and identify resource options for treatment. However, the clinician does not tick off symptoms in the DSM like a checklist counting down to zero. There may be recovery goals, for example, articulated by the consumer that are unrelated to an official "symptom," and the consumer is not considered to be "in recovery" until those goals are met. In this way, the recovery approach resolves the paradox of the medical model in which a patient has no symptoms and yet still feels "ill."

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    Diagnosis as Taxonomy

    According to postmodern principles, there is no objective "true" definition of any word. What I mean when I say "depression" may not mean exactly what you think when you hear "depression." Before we can meaningfully communicate about what's going on with me that I'm using the word "depression," we need to agree on a definition.

    This is, in part, what the DSM is designed to do--provide a common language and the basis for an organized body of knowledge about what is effective in treating various problems (Kane, 1982). Without operationalizing variables, there is no scientific method, and no way to identify common risk factors, which are crucial to prevention, or develop screening tools, which can help make sure the people who really need care are the ones who are getting it (Kane, 1982).


    Semiotics Break

    Almost nothing makes me happier than semiotics. These are quick little primer videos if  you want to understand why it's a big deal that "depression" doesn't mean the same thing to both you and me:

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    Diagnosis for Reimbursement

    The ethical debate my professor raised in class after challenging us about our beliefs in the medical model springs from fact that the institutions of healthcare administration and funding ("the entities and individuals who control the levers of power in our mental health system" [Deacon, 2013, p. 856]) have been slow to respond to the biopsychosocial approach. Indeed, the entire third-party payer reimbursement system is firmly entrenched in the classic medical model where diagnosis drives treatment. In order to get treatment covered by insurance, a diagnosis is almost always (ok always) required.

    This puts the clinician in the difficult position of having to assign a diagnosis in order for the client to access affordable treatment--often before the clinician is confident of the diagnosis, and sometimes in violation of ethical principles if the clinician believes no diagnosis in fact applies.

    Wade & Halligan (2017) make an eloquent case for the "political and managerial arenas" of mental healthcare to catch up to the clinical arena; they argue that using a biopsychosocial approach, especially within records-keeping and information systems would streamline healthcare, increasing efficiency and lowering costs. I know I'm probably preaching to the choir here, but take a look at pages 1000-1001 if you're interested.

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    The Medical Model and the Expert Clinician

    None of these critiques would exist if there wasn't also a fundamental assumption that certain experts deservedly have the power to define normality and they also get to decide what to do with people who are "abnormal." As a society, when it comes to issues of health, we decided those experts would be doctors. We had the option of saying psychics have that power, or fishermen! We also had the option of letting the Church keep that power. But we didn't. We, as a society, decided to invest that power in doctors.

    I mean...they do spend a ridiculous amount of time in medical school. They have to take some really hard tests, get really good grades in classes you couldn't pay me to take, and then work for like 18 hours straight in the ER. The societal hope is that, through all of that, they end up knowing more about "health" (what is normal/abnormal) than the rest of us.

    But at the end of the day, doctors wield the power society invests in them, and some people take exception to the idea that these expert clinicians are privileged above the very people they're supposed to be helping (Byrne et al., 2016). Even with all that education and training, why do they get to stand around and tell other people they're defective? It is a question, ultimately, about who gets to be in power and why.

    The Biopsychsocial/Recovery Approach to the Role of the Clinician

    In the "new" medical model, the clinician is envisioned more as a collaborator rather than an authority. However, an important critique of the biopsychosocial approach from the postmodern/constructivist perspective is that "it still positions the clinician as being best equipped [rather than the client] to appraise a clinical scenario by applying theoretical and technical knowledge. The therapist’s version, while aiming to be collaborative, may be privileged above that of the client" (MacDonald & Mikes-Liu, 2009, p. 276).

    So, if you're a postmodern purist, you may believe the relationship between clinician and client must be 100% egalitarian, and maybe the "new" medical model doesn't go far enough. I think this is tough to achieve in practice, because of what Engel refers to as our "folk model of disease" in the Western world, wherein "the historic function of the physician [is] to establish whether a person soliciting help is ‘sick’ or ‘well;’ and if sick, why sick and in which ways sick; and then to develop a rational program to treat the illness and restore and maintain health" (Engel, 1977, p. 386).

    The biopsychosocial and recovery approaches have redefined the clinician's relationship to and with the client while bearing in mind this societal context. When incorporating a biopsychosocial perspective into treatment, MacDonald and Mikes-Liu (2009) suggest that, "we live in a society that values certain ideas about health...[and clients] will have developed certain formulations and expectations of treatment based on the medical ideas currently dominant in society's thinking...As clinicians, we need to be able to join with clients around their current formulation before inviting them to consider other ideas that might expand their thinking" (p. 279).

    These "other ideas" include the concept of the clinician as collaborator rather than authority. The recovery approach "does not privilege the therapist with 'expert' knowledge whose role is to identify irrational beliefs, dysfunctional dynamics, or other areas of pathology" (Gehart, 2012a, p. 437). Instead, the client is in the driver's seat of their own care. Gehart suggests that clinicians working in the medical model provide goals, while clinicians working from a recovery approach remove barriers to consumer's identified desires and goals (Gehart, 2012b, p. 449).


    The Medical Model and Medication

    From what I can tell, the broadest consensus is that the classic medical model, which assumes that there is a physical explanation for every ailment and which extends this idea to mental health problems when applied to the mental health field, is too narrow in focus. This was Engel's point when he argued in 1977 that the medical "model of disease [was] no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry" (p. 129).

    The classic medical model only considers biological factors that may be contributing to disease or dysfunction and ignores other factors that may be critically important in a given person's context--like their personal psychology, or living environment, or relationships, etc.

    Many also argue that this emphasis on a biological foundation for mental health problems has resulted in an emphasis on treating mental illness with medication, following the logic that biological/chemical therapies are best for biological/chemical problems.  Some see medication as oppressive because it is "prescribed" by a power-invested expert clinician; some think that the biological foundations of the medical model result in a glorification of biological therapies that overshadows non-biological therapies (Byrne et al., 2016; Scott, 2010). Some also argue that those on public assistance are deprived access to "better" treatments and are only offered medication because it's the cheapest treatment option (Byrne et al., 2016). And some have argued that the founding theorists of family therapy, writing and practicing at the height of the debate over the classic medical model, "expressed negative feelings about the appropriateness of medication" that came to define the field (Springer & Harris, 2010, p. 361). 

    The Biopsychocial and Recovery Approaches to Medication

    FFS Brenda.

    As discussed above, the biopsychosocial approach does not ignore biological determinants of disease--it just also takes into consideration other dimensions, as well. In Pies's (2017) "real" medical model that incorporates biopsychosocial values, biological explanations of behavior do not negate valid psychosocial/cultural explanations and vice versa, and "biological factors are part of a comprehensive differential diagnosis, even if psychological or cultural factors prove more relevant or informative" (p. 30).

    In the biopsychosocial approach, therefore, pharmaceutical treatments are one in an arsenal of available options for mental illness. This is echoed in the recovery model, which is not "against interventions such as diagnosis or medication; such medical interventions are valued yet secondary to psychosocial needs, such as autonomy, which are considered primary needs for successful recovery" (Gehart, 2012a, p. 431).

    Gehart describes a consumer in recovery from severe mental illness who articulated a recovery goal as being able to work a job; however, though she experienced hallucinations, she no longer wanted to take medication. The recovery-oriented therapist did not insist she remain on medication and instead helped the consumer work towards the goal of employment. Ultimately, however, the consumer determined that not being on medication was getting in the way of successful employment, and she decided to start taking them again: "Thus, medication was used as a resource when the consumer determined it was most beneficial to help her live a meaningful life" (Gehart, 2012a, p. 431).


    Now You Know More About the Medical Model Than When You Started

    Congratulations! You made it through the longest blog post I've ever written.

    Hopefully you have a basic understanding of how the medical model came about, the major problems with the model, and how the newer approaches to mental healthcare have attempted to address these problems. 

    Just in case it takes me a really long time to get around to writing Part 2...

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    THIS IS ME GETTING ON MY SOAPBOX. It's a little soapbox, because I'm just a grad student with a blog. But after having to do way too much work to find out why people hated the medical model so goddamn much, I think I have a right to a little soapboxing.

    Don't throw the baby out with the bathwater. Yes, the medical model is the scientific basis for evidence-based practice (Karam & Sprenkle, 2010; Lilienfeld et al., 2013; Patterson, Miller, Carnes, & Wilson, 2004). But just because you take issue with some parts of the medical model doesn't mean you should dismiss out of hand anything that smacks of medicine and/or science. If you hate the medical model because there used to be a heavy emphasis on a biological basis for mental illness, and you think that's why pharmacological treatments are privileged in research and practice over psychological treatments, FINE! But don't disregard the literature that suggests pharmacological treatments are helpful--like the overwhelming evidence that suggests depression is best treated by a combination of psychotherapy and antidepressants. Please read Dr. Ben Caldwell's excellent book Saving Psychotherapy for many compelling arguments about how and why psychotherapists should be embracing science, not denying it.

    And if you're a teacher, I think it would be really great if you bring up this debate in class instead of just snarking on the medical model. In my humble opinion, it elucidates a lot of the theory and philosophy of the field and makes it much easier to understand the current state of affairs. And just one class discussion would have saved me so much Googling.


    Resources

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    Barber, M. (2012). Recovery as the new medical model for psychiatry. Psychiatric Services, 63(3), 277-279.

    Bolton, J. (2014). Case formulation after Engel—the 4p model: A philosophical case conference. Philosophy, Psychiatry, & Psychology, 21(3), 179-189.

    Bott, N., Radke, A., Kiely, T., & Brown, Ronald T. (2016). Ethical issues surrounding psychologists’ use of neuroscience in the promotion and practice of psychotherapy. Professional Psychology: Research and Practice, 47(5), 321-329.

    Byrne, L., Happell, B., & Reid-Searl, K. (2016). Lived experience practitioners and the medical model: World’s colliding? Journal of Mental Health, 25(3), 217-223.

    Carpenter, W. (2017). Organizing knowledge in the biopsychosocial medical model. Psychiatry, 80(4), 318-321.

    Corrigan, P.W., & Ralph, R.O. (2005). Recovery as consumer vision and research paradigm. In L Davidson, C. Harding, & L. Spaniol (Eds.) Recovery from severe mental illnesses: Research evidence and implications for practice, Vol. 1 (pp.3-18).  Washington, D.C.: American Psychological Association.

    Deacon, B. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846-861.

    Dutch, M., Ratanasiripong, P., & Callahan, Jennifer L. (2017). Marriage family therapist’s attitudes toward evidence-based treatments and readiness for change. Journal of Psychotherapy Integration, 27(4), 540-547.

    Elkins, D. (2009). The medical model in psychotherapy: Its limitations and failures. Journal of Humanistic Psychology, 49(1), 66-84.

    Elkins, D. (2010). David Elkins responds. Journal of Humanistic Psychology, 50(2), 256-263.

    Engel, George L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-36.

    Farre, A., & Rapley, T. (2017). The new old (and old new) medical model: Four decades navigating the biomedical and psychosocial understandings of health and illness. Healthcare, 5(4), Healthcare, 2017, Vol.5(4).

    Flaherty, M. (2012). A medical model for today. Psychiatric Services, 63(5), 510.

    Gaudiano, & Miller. (2013). The evidence-based practice of psychotherapy: Facing the challenges that lie ahead. Clinical Psychology Review, 33(7), 813-824.

    Gehart, Diane R. (2012). The mental health recovery movement and family therapy, part I: Consumer-led reform of services to persons diagnosed with severe mental illness. Journal of Marital and Family Therapy, 38(3), 429-442.

    Gehart, Diane R. (2012). The mental health recovery movement and family therapy, part II: A collaborative, appreciative approach for supporting mental health recovery. Journal of Marital and Family Therapy, 38(3), 443-457.

    Goldfried, M. (2013). What should we expect from psychotherapy? Clinical Psychology Review, 33(7), 862-869.

    Gutkin, T. (2012). Ecological Psychology: Replacing the medical model paradigm for school-based psychological and psychoeducational services. Journal of Educational and Psychological Consultation, 22(1-2), 1-20.

    Henningsen, P. (2015). Still modern? Developing the biopsychosocial model for the 21st century. Journal of Psychosomatic Research, 79(5), 362-363.

    Hernandez, Barbara Couden, & Doherty, William J. (2005). marriage and family therapists and psychotropic medications: Practice patterns from a national study. Journal of Marital and Family Therapy, 31(3), 177-189.

    Kane, R. (1982). Lessons for social work from the medical model: A viewpoint for practice. Social Work, 27(4), 315-321.

    Karam, Eli A., & Sprenkle, Douglas H. (2010). The research-informed clinician: A guide to training the next-generation MFT. Journal of Marital and Family Therapy, 36(3), 307-319.

    Kvaale, Haslam, & Gottdiener. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33(6), 782-794.

    Laner, M. (1976). The medical model, mental illness, and metaphoric mystification among marriage and family counselors. The Family Coordinator, 25(2), 175-181.

    Lilienfeld, Ritschel, Lynn, Cautin, & Latzman. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33(7), 883-900.

    MacDonald, C., & Mikes‐Liu, K. (2009). is there a place for biopsychosocial formulation in a systemic practice? Australian and New Zealand Journal of Family Therapy, 30(4), 269-283.

    Meyer, A., Bowden Templeton, G., Stinson, M., & Codone, S. (2016). teaching research methods to mft master's students: A comparison between scientist-practitioner and research-informed approaches. 38(3), 295-306.

    Patil, Tejas, & Giordano, James. (2010). On the ontological assumptions of the medical model of psychiatry: Philosophical considerations and pragmatic tasks. (Editorial). Philosophy, Ethics, and Humanities in Medicine, 5, 3.

    Patterson, J., Miller, R., Carnes, S., & Wilson, S. (2004). Evidence‐based practice for marriage and family therapists. Journal of Marital and Family Therapy, 30(2), 183-195.

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    Pies, R.W.. (2017). Hearing voices and psychiatry’s (real) medical model. Psychiatric Times. 34.

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    Book Review: Deliberate Practice for Psychotherapists, by Tony Rousmaniere

     ~ Tony Rousmaniere,  Deliberate Practice for Psychotherapists

    ~ Tony Rousmaniere, Deliberate Practice for Psychotherapists

    In Dr. Benjamin Caldwell's book Saving Psychotherapy, he outlines four tasks that psychotherapists must embrace to help "save" the field of psychotherapy. If you've read my review of the book, you know how much it resonated with me. However, the final task (accepting accountability for the quality of our work by deliberately working to better our skills) has haunted me.

    I do want to be the best therapist I can be, but I've felt a little lost about how exactly I'm supposed to work on my skills to get there. The unarticulated message I've received during my first year of graduate training has been that "getting good" just happens through some alchemy of learning theory, being congruent, asking circular questions, avoiding microaggressions, and seeing clients. Lots of clients. (I'm obviously being reductive for the lulz--I think my program is doing the best they can within the current paradigm of therapist training. Even so...) 

    It's this last bit, simply seeing lots of clients, that really hasn't been sitting well with me. Learn by doing just seems like a cop-out, like no one was able to figure out how to teach something so they presumed the best way to learn must be the way they learned, which is by muddling through until it gets easier. That's all fine and good when we're talking about needlepoint or something. But I'm being asked to help people who are having serious life problems. Needlepoint this is not.

    And y'know what, since you bring up needlepoint . . . there's actually a deliberate way to work on getting better at needlepoint. Samplers. Young girls used to work on them to perfect their skills before they were married off and had to work on their husbands' socks or waistcoats or whatever.

     
     A sampler! Click to enlarge.

    A sampler! Click to enlarge.

     

    Where's the sampler for psychotherapy??

    <<MUCH FANFARE>> Meet Tony Rousmaniere, author of Deliberate Practice for Psychotherapists: A Guide to Improving Clinical EffectivenessY'all, I'm a little frustrated I haven't been assigned this book in any one of my classes yet. Why wouldn't you assign a beginning graduate student a step-by-step guide to becoming an effective clinician? I am forever grateful to my friend and colleague, Ben Fineman, who recommended this book to me and lent me his copy. Because what Rousmaniere has to offer is, in fact, a sampler for psychotherapy.

    Rousmaniere begins with his own experience as a clinician in training, despairing about the fact that no matter how hard he tried, about half of his clients were not benefiting from therapy. As it turns out, this is not an outlier--in fact, this rate is about average. Which seems to directly contradict the research presented by Caldwell as a beacon of hope in Saving Psychotherapy--that therapy is effective. How can half of clients not benefit from therapy if therapy itself is effective? The problem, Rousmaniere and Caldwell seem to agree, lies with therapists.

    Rousmaniere argues that the current model of clinician training is a "path to competence." That is, the end goal of the current system of training and licensing therapists is simply to produce competent therapists, who have a decent success rate. But the truth is, some clinicians are better than others--and those that are better have better success rates. What makes some clinicians better than others? Rousmaniere argues these clinicians take the "path to expertise."

    This path is the harder path. The research presented by Rousmaniere demonstrates that the only way to get to expertise is through deliberate practice. He takes issue with the misconception popularized by Malcolm Gladwell that it simply takes 10,000 hours of doing something repetitively to achieve mastery--what it actually takes, he says, is repeatedly and deliberately working at a level just beyond your current skill level. Simply playing tennis matches over and over will only incidentally improve your serve, but spending an hour every day drilling serves will deliberately improve your serve. This, Rousmaniere argues, is the faster and more effective path to mastery than simply muddling through a learn-by-doing process.

    So how can psychotherapists deliberately practice? We can't conjure up a fake patient to do therapy with when we're off the clock (yet). The good news is--we don't need to. Rousmaniere has created a curriculum of sorts composed of several exercises designed to isolate specific psychotherapeutic skills, and the cornerstone of all of them is the humble video camera. He recommends video-taping as many of your actual sessions as possible, then using the taped sessions--both alone and with a coach--for the prescribed exercises.

    For those of us in COAMFTE-accredited programs, we're already familiar with the idea of video-taping sessions; it's a requirement for our fieldwork and we can't accept a placement that won't allow recording of at least some sessions. But most other graduate programs do not require recording of sessions, and the whole idea might seem crazy. What client would be ok with this?? But apparently, clients seem to be pretty ok with the idea of their therapist recording the session both as a quality-control measure as well as a way to get more (maybe better) input.

    Now, I hate watching myself on camera. But Rousmaniere points out that this very reaction is standing between me and becoming a better therapist. So while I have been dreading having to record my sessions, I'm now looking forward to it (at least I'm telling myself I am). Rousmaniere has even created an exercise specifically targeted towards working with this reaction and I can see how it would really be effective.

    After reading this book, I'm now planning to make recording sessions standard in my personal practice once I'm a licensed clinician, and I'm going to try to implement deliberate practice as soon as possible.

    I know what you may be thinking, because I thought it, too--what graduate student has time to do MORE practice outside of everything else?? Rousmaniere beat us to this punch, though, and he addresses the issue of not having a lot of extra time to dedicate to practice outside of work by encouraging us to start small--just a few minutes per day at first. This goes for students as well as already-practicing clinicians who are interested in upping their game. No matter who you are or what your schedule is, you can make some room in your life to work towards expertise.

    And when I step back and think about it . . . a lot of Olympic athletes aren't superstars with lucrative sponsorship deals and personal assistants. They're regular people with normal jobs who happen to also have a crazy passion for shot-put or sprinting or skiing. They manage to put in the extra time and effort to become world-class athletes in order to represent their country at the Olympic Games. The least I can do to help my clients is put in the time and effort to become a world-class therapist. Now, with Rousmaniere's guide, I feel like I finally know how to get started.

     

    Points of Interest:

      Listen to Dr. Caldwell's podcast on iTunes!

    Listen to Dr. Caldwell's podcast on iTunes!

    3 Things You Can Do as a Pre-Licensee to Set Yourself Up for Success

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate
     

    This post originally appeared in the AAMFT Emerging Professionals newsletter. Join the network and subscribe to the newsletter here!

    As a first-year student in a master’s program, I’ve only just set out on the road to becoming a marriage and family therapist. When I stop and think about the distance I have yet to travel, I can get a little demoralized. However, I’ve found some things I can focus on now to make sure I’m ready to hit the ground running once I get that license. Focusing on each step makes me feel a little better about how far away that finish line is, and maybe it can do the same for you! 

    #1 – Start Thinking About a Specialty

    First, I’m using this time in graduate school to narrow down my future area of focus. There are a lot of papers to write, and I’m trying to use them for the greater purpose of determining what I may want my specialty to be. So when I’m given the chance to choose a topic, I tend to choose something that may help inform that decision rather than researching exotic diagnoses or very specific populations I’m unlikely to encounter in practice. I see these papers as great opportunities to learn about what I do (and do not) enjoy under the guidance of professors who can help me decide whether something might be a good fit for me. For example, I studied family-based treatments for adolescents with depression in my Clinical Research class; I enjoyed it and my professor gave me encouraging feedback, so when it came time to pick a paper topic in my Diagnosis class, I chose Major Depressive Disorder. I got to use some of the research I’d done for the first paper, and I discovered that I’m still not sick of studying it, so I think that’s a good sign! The same logic could work as you consider elective, fieldwork, and continuing education workshop options (especially if you’ve already graduated).

    #2 – Build a Professional Network

    It’s never too early to start making contacts! I’m cultivating relationships with professors and peers now to start building my professional network. I don’t mean this in a fake, shallow, or inauthentic way. I recognize that this network will be key to scaffolding my career in the future, so I want to set a good foundation. This means that in class, I try to be an active participant; not only is this good for participation points towards my final grade, but I’m able to demonstrate to the professors that I am an engaged and motivated future therapist. I want to make sure they are familiar with me and my work, because I will be needing letters of recommendation and I want to help them both remember me and feel confident vouching for me. I also reach out for guidance on assignments and attend office hours where necessary. Again, this isn’t about sucking up or making a nuisance out of myself—it’s about recognizing that professors are often so overwhelmed that it can be hard to form individual relationships with students. I want to make it as easy as possible.

    This also goes for my classmates, who are my future colleagues in addition to being good friends. The relationship network we forge now will be a critical source of client referrals, word-of-mouth job opportunities, and much-needed emotional support as we enter the field. Which brings me to…

    #3 – Join Groups and Organizations to Broaden Your Experiences

    That professional network will also include colleagues I meet outside of school, which is why I feel it’s important to be active in groups and organizations. This kind of involvement can expand both your contacts and your experience in the field, and you can start at any stage of your career! I’ve found that informal groups—like those found on social media—can be a great place to get peer support as well as to ask questions in a low-pressure environment. Professional organizations like AAMFT foster both collaboration and advocacy, and membership demonstrates to potential employers that you’re serious about your profession. Personally, I’m really looking forward to getting involved with AAMFT’s Topical Interest Networks!

    Ready, Set, Go!

    I’ve found that focusing on these steps now keeps me engaged in the present moment and reminds me that I’m making progress towards my goal every day. I hope some of these ideas can help you, too, as you keep putting one foot in front of the other towards that finish line!

    Points of Interest:

    Learn about the many benefits of membership in California's largest Marriage and Family Therapy Association, from unlimited access to our on-staff legal team, to our enriching educational and networking opportunities, and so much more. Become a CAMFT member and enjoy the many benefits that await you.

    Full-Time? Part-Time? Online? Or...?

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    The decision to go to graduate school involves, at least in my experience, a realistic evaluation of how much time you have on a daily basis to dedicate to a program. The nice thing about master's programs in general, and marriage and family therapy programs in particular, is there tends to be more of an awareness that master's-level students are more likely than undergraduates to have very busy lives--often involving full-time employment and/or families.

    This means that master's programs are offered in a wide variety of format options. Whatever schedule you want, there is a program for you. Want to get in and out in the least amount of time? You can pick a full-time program with a daytime schedule that will most likely get you graduated in two years. You could also pick a full-time program with a choose-your-own schedule and just pile on as many classes as you can handle. 

    A caveat here--when I first realized that CSUN's schedule involved classes from 4pm-10pm two days per week, and was still somehow a full-time program, I felt like I was getting away with something. I thought it would be so easy to work during the days and just go to school a couple nights a week. LOL. Let me just say, a full-time class load means a full-time workload, even if you're not PHYSICALLY in class every day. You've been warned. (If you want to read more about what my classes were like in my first semester, check out my post on that here.)

    If you're trying to juggle a master's program with other life commitments, like work or family, you may want to consider a truly part-time program. These programs can often get you graduated in 4-6 years (be careful, though, because this generally increases your overall tuition amount). You may only take one or two classes at a time. A evenings/weekends-only program may give you the flexibility to maintain your day job while still getting your master's.

    Finally, there are always online programs to consider. There's, of course, wild debate about online programs. Some people think they're every bit as good as brick-and-mortar programs, but others make the (well-made, IMO) point that if you're trying to get training in a profession that is ALL ABOUT FACE-TO-FACE INTERACTION, why would you choose training that's online? It's truly hard to tell what the reputation of online schools is--I don't have much evidence to show, unfortunately, but like all careers, it seems there is some sort of stigma attached to degrees from online universities. And bear in mind, even with an online program, you MUST conduct in-person direct client-contact hours; these field placements are usually obtained in the student's local community.

    From my personal experience, I want to say that perhaps the most invaluable part of my education so far has been getting to know my classmates. They are truly wonderful people who will be friends and colleagues for life. I feel like I'm building a very important professional (and personal) network that will be critical for my success in the future. I honestly don't think I'd have this opportunity in an online program. For more of my thoughts on why I think program location is an important factor to take into consideration when deciding on an MFT program, check out my longer post about that.

     

    On MFT California, the site I created that catalogs MFT master's programs across the state of California, I've made an effort to make each program's format options clear. Let's take a look at some examples of the different formats you can choose from:

    San Diego State University
    At one end of the spectrum, you can attend a full-time program like SDSU. You can be finished with this program in only TWO YEARS, but it will need to be your main life priority while you're there. The program begins with online courses during the first part of summer, followed by day-long classes during the second part of summer. Then, they jump right into fieldwork (in addition to all other classes) in the fall. It's intense, but it also means you spend less time overall in a program. At a program that is affordable to begin with, that makes this program a pretty good deal--if you can afford to spend two years focused solely on school.

    Antioch University - Santa Barbara
    This program is much more amenable to the needs to working students. If you want a full-time course load, the AUSB full-time option involves class one day per week over 24 months of full-time study. Students can also opt to go at their own pace, taking as many or as few units as they desire--as long as they complete the degree in five years.

    Northcentral University
    If you're interested in an online program, NU makes it very easy to start. Students can enroll and begin classes almost any time (start dates occur several times per month). NU is COAMFTE-accredited (read my post on accreditation to find out why--and if--that should matter to you). The only thing students need to do in-person are their client contact hours, and the thing I appreciate about NU is that they make sure students understand how this works at the point of applying to the school; this ensures that students are not caught off-guard when they realize they will be responsible for procuring their own fieldwork site (read more about how that works in my post on fieldwork).

    Pepperdine University
    This program exemplifies all possible format options. On the one hand, Pepperdine offers a full-time format--students attend the Malibu campus during the day and the course schedule is lockstep and predetermined. A flexible part-time program is also available; not only are classes offered during evenings and weekends, but they are offered at three different campuses across the Los Angeles area, and students are allowed to take courses at any or all of these locations. Finally, Pepperdine even offers an online-only option. The drawback, however, is cost. Estimated total program tuition for the online-only option is $92,690 - $101,660, roughly the same as that of the full-time program tuition. The evening-format estimated total program tuition, however, is only $71,700 - $78,870.

    Hope this post has helped clear up what sort of format options you have as an MFT graduate student. 

    Points of Interest:

    Learn about the many benefits of membership in California's largest Marriage and Family Therapy Association, from unlimited access to our on-staff legal team, to our enriching educational and networking opportunities, and so much more. Become a CAMFT member and enjoy the many benefits that await you.

    What is "Fieldwork" and Why Does It Matter?

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    Oh man. You have no idea how hard I laughed when I uploaded this photo. Fieldwork. HA! I'm still laughing.

    Annnnyyywaaaaayyy...

    If you're researching MFT programs, you've probably heard the term "fieldwork" and gathered that it is a requirement for graduation. Your "fieldwork placement" is where you gain direct client contact hours ("practicum" is the class you're enrolled in while you are working at a fieldwork site). You actually counsel clients while you're in graduate school.

    Full disclosure: I am in the middle of the fieldwork process. I've applied to some sites and am waiting for interviews. I'm basing much of the following info on research instead of personal experience, but I will update as I learn new and exciting things!

    So, what is fieldwork, exactly?

    During your program, you will need to get supervised direct client-contact experience in order to graduate (the specifics of this are laid out on the BBS website). Some schools have an on-campus clinic and guarantee you that you can meet this requirement at their clinic. Others, however, require you to "go out into the field" (the community) and find your own placement--this is also called a traineeship, as you are considered a "trainee" when you are enrolled in a graduate program and seeing clients. Many schools frame their approach to traineeships in terms of "support"--programs who funnel students into an on-campus clinic or who provide lists of university-approved field sites typically refer to themselves as "very supportive." The programs that leave the process entirely up to students normally don't mention it...

    If you're at the point where you're trying to decide which graduate program to enroll in, you may want to take each program's fieldwork situation into account. As a conscious consumer, here are some things that you should be aware of when it comes to an MFT program's traineeship process:

    Total Hours

    First of all, you should know that the state of California requires at least 225 hours of direct client contact in order for you to graduate. If that's what a program requires, they are requiring the bare minimum. That could be good or bad--on the one hand, you'll get out sooner, but on the other hand, you'll have less experience than other graduates. The maximum number of direct client contact hours you're allowed to log while in graduate school is 1300. You could log more, of course, no one will stop you as long as you're following all the rules, but you won't be able to count more than 1300 hours towards the 3000 hours you need for licensure.

    On-Campus Clinics

    Some programs have on-campus clinics, and many who do guarantee that students can meet all their hours at the on-campus clinic. For example, at CSUN, you can apply for the Mitchell Family Clinic/Strength United cohort--this track of the MFT program completes all of their fieldwork hours through these two university-affiliated programs. This situation has both pros and cons. On the pro side, you would not need to worry about finding a placement and the whole process will be pretty convenient. You'll avoid the application and interview process entirely (apart from applying for the program itself). On the con side, you probably won't have a ton of say in what sorts of populations you work with or what kind of supervision you'll get.

    Fieldwork Programs

    The alternative are programs where you find a placement out in the community. At CSUN, the school provides students with a list of approved community sites, but it's up to the student to apply and get accepted. This approach ALSO has pros and cons. The pros? You get to find a placement that interests you--but there's no guarantee they'll take you on as a trainee (you have to apply like you're applying for a job). You also have an opportunity during the interview to get hopefully get a sense of what supervision will be like, and if it rubs you the wrong way, you can try somewhere else. Some sites will train you  in specific evidence-based treatments, which are proprietary modalities that can cost thousands of dollars to become certified in, at no cost to you. But the cons are real. It can be confusing and stressful trying to find a placement in the community. Personally, I didn't find the process overwhelming because I've applied for jobs before; some of my classmates, though, found the process incredibly trying--many were putting together resumés and cover letters for the first time, and interviews were intimidating. 

    You should also know that it seems like there's a non-zero number of graduate students who continue working at their fieldwork site post-graduation. Either they continue to do it for free to earn the rest of their 3000 hours towards licensure, or some even get hired by the site. My school has low-key suggested that you shouldn't really stress about what site you end up at, but I think if you have a long-term goal of being hired at a site post-graduation, it's something you should keep in mind when you're applying to schools. For example, if you're applying to a program that requires you to work at the on-campus clinic, I doubt you would be able to stay on there post-graduation.

    If You Currently Work in Mental Healthcare

    If you're currently working in mental healthcare, and you think it will be easy-peasy to log your hours at the site you're currently employed at, you may want to clear this with the program before applying. Other schools seem to be fine with this arrangement, but my program "encourages" students to seek another placement to gain broader experience. 

    If you currently work in a private practice, you should know that in California, trainees cannot log hours in a private practice (though they can once they become Associates).

    Does It Matter?

    Ultimately, I don't know if the fieldwork placement situation would be a dealbreaker for any program, but you'll probably want to know a bit about what you're agreeing to when you enroll.

    Personally, I'm glad I made the choice to attend a program where I could choose my own field site. Friends of mine, however, have said they wish they'd chosen the other CSUN cohort where you are placed into the on-campus clinic. Now that I have met several CSUN professors who serve as supervisors at that clinic, I think I also would have enjoyed that, but I don't regret my decision.

    Again, in my own opinion, I would be wary of programs that offer NO support to their students in terms of finding a fieldwork placement. It seems that these students need to take on the extra work of researching agencies in their area with traineeship programs and vetting them to ensure the site meets the school's criteria. It's extra work that I'm very glad I don't need to worry about, on top of everything else I have due!

    On my site, MFT California, I tried to include any information programs make available about how supportive they are when it comes to fieldwork. I hope it helps you in your hunt for the right grad program!

     

     

    Points of Interest:

    Learn about the many benefits of membership in California's largest Marriage and Family Therapy Association, from unlimited access to our on-staff legal team, to our enriching educational and networking opportunities, and so much more. Become a CAMFT member and enjoy the many benefits that await you.

    Location, Location, Location

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    If you're trying to decide where to go to graduate school for marriage and family therapy, one of your primary concerns will most likely be location.

    It seems like most people select an MFT program that is close to where they live--I know that's what I did. But I do know some people who were willing to relocate for school. Why would anyone uproot their life for school, when chances are pretty good there's at least one program within driving distance??

    Let's take a look at some of the reasons physical location of a graduate program is important, and then maybe you'll have a better idea of how important location is to you--and whether you're willing to uproot yourself.

    Fieldwork

    During your program, you will need to get direct client-contact experience in order to graduate (the specifics of this are laid out on the BBS website). Some schools have an on-campus clinic and guarantee you that you can meet this requirement at their clinic. Others, however, require you to "go out into the field" (the community) and find your own placement--this is also called a traineeship, as you are considered a "trainee" when you are enrolled in a graduate program and seeing clients (check out my post on fieldwork for a more thorough look at the differences between those options).

    If you're in an area like Los Angeles, you will have absolutely no problem finding such a placement--your challenge becomes deciding which one you want.

    If, however, you're in a more rural part of California, your opportunities for field placement sites may be limited. Trainees are not allowed to earn hours in private practices, so you will need to find some sort of local non-profit or agency that can meet the requirements (including supervision) of the BBS.

    As I've gleaned from some forum discussions online, this can be really hard. I have no personal experience with what you do if you're in a rural program and you can't find a traineeship, but it seems like a real problem, and one of the reasons I suggest attending a program in an area with robust mental health services options.

    Networking

    Hopefully, during your time in graduate school, you'll be building the foundations of your professional network. The mental healthcare field is largely a community-oriented profession, and while the internet provides opportunities for you to connect with other therapists anywhere in the world, the most important contacts will probably be the ones you make in real life. If you attend a graduate program in an area you are not considering practicing in, you are depriving yourself of a head-start on building that important professional network.

    Where You Want to Practice

    This kind of goes along with networking. If you want to practice in San Diego, but you go to school in San Francisco, once you get to San Diego you will need to begin at square one in building your professional network. To some extent, this goes for whether you're looking for an agency job or thinking about opening a private practice. But if you begin practicing in the same area where you went to school, chances are a little better that your network can help boost you as you're starting out.

    Of course, there's a flip side. If you live in an area that's low on mental health resources, you may benefit from attending school somewhere else for a couple reasons. First, you personally may benefit training-wise from having fieldwork opportunities in a higher-density area. And second, when you return to your home base, your credentials of having attended school and worked in a more metropolitan area may give you an advantage in getting work.

    And finally, if you're planning on going to school in California but think there's a chance you may want to practice in another state, you will definitely want to investigate the accreditation of any school you're attending. The MFT is not a very "portable" license, meaning that it's hard to qualify for licenses in other states just by virtue of having qualified for an MFT license in California. Part of this is because of the graduate programs that qualify for licensure here versus other states. Some states (not California) require that a licensee's graduate degree be granted by a COAMFTE-accredited program, but there are only nine programs in California that currently have that accreditation status. If license portability is important to you, you may want to think about making attending a COAMFTE program a priority.

    Personally, I had no intention of practicing out of state, and I hope to practice in the city I'm currently living in--Los Angeles. And there are plenty of MFT programs in Los Angeles to choose from. However...I didn't know about MANY of them. Some simply don't show up when you Google "MFT program Los Angeles."

    I wanted to make things easier for you, if you're looking to narrow down your choices by location. So on my website, MFT California, I created a map that plots the locations of every MFT program approved by the BBS in California. 

    I hope you'll find it a handy resource as you hunt down the perfect program for you!

     

     

    Points of Interest:

    Learn about the many benefits of membership in California's largest Marriage and Family Therapy Association, from unlimited access to our on-staff legal team, to our enriching educational and networking opportunities, and so much more. Become a CAMFT member and enjoy the many benefits that await you.

    If You Want to Be an MFT, You Don't Want a Master's in Psychology (Probably)

    Caroline Wiita Marriage and family therapy therapist psychotherapist graduate student masters degree doctorate phd MFT licensed prelicensed clinical social worker trainee intern associate

    One of the horror stories I came across as I was researching MFT programs was the tale told by a young woman who had almost completed her master's program in psychology when she realized that the program did not qualify her to sit for the MFT licensing exam (which was her goal). She believed that to become an MFT, she just needed to get a master's in psychology! Unfortunately, this is only partly true.

    This is critical: If, like me, you want to eventually qualify for the "marriage and family therapy" license in California, you need to attend a program that meets the requirements set forth by the licensing body, the Board of Behavioral Services (BBS). 

    See, there's a broad spectrum of master's degrees in psychology. 

    There are some schools that offer a masters in psychology that is intended to prepare students to pursue a doctorate (this is also sometimes the program that students drop down into when they are kicked out of the school's doctorate program). Most of the time, this program DOES NOT meet the requirements you would need to get your MFT license! They offer different classes, don't require the right direct client contact hours, etc. 

    Let me make this super clear: If you accidentally enroll in a masters program like this, you WILL NOT be able to become a marriage and family therapist! You would need to RE-ENROLL in a qualifying program. So...do it right from the beginning, yeah?

    If you want to become an MFT in California, you need to make sure you're enrolling in a qualifying program. Unfortunately, they come with a variety of different names:

    M.A. in Marital & Family Therapy
    M.A. in Clinical Psychology
    M.S. in Counseling, Option in Marriage, Family and Child Counseling

    M.A. in Psychology - Marriage and Family Therapy
    M.A. in Counseling
    M.A. in Marriage & Family Therapy

    You get the point. Hilarious, right? Those are all very different names for essentially the same degree.

    Luckily, almost every qualifying program declaratively says so somewhere on the website. So it should be pretty clear. Let's look at example.

    The school I currently attend is California State University, Northridge (CSUN). CSUN has a College of Social and Behavioral Sciences, and this college has a Department of Psychology that offers an master's in Psychology with two different options--Clinical Psychology and General Experimental Psychology.

    Click to enlarge!

    Click to enlarge!

    NEITHER OF THESE PROGRAMS QUALIFY. If you attend these programs, you are not qualified to get your MFT license. You would have to attend this program:

    That is, the M.S. in Counseling, Option in Marriage & Family Therapy, offered through the College of Education.

    So, at CSUN, a master's degree in Clinical Psychology does NOT qualify you to become an MFT, but at Antioch, it DOES. It just has to do with how each school picks its degree names.

    There is, of course, an exception that exists simply to screw with you.

    At San Francisco State University, both the MS in Clinical Psychology, Concentration in Clinical Psychology degree (offered through the Psychology Department in the College of Science & Engineering) AND the MS in Marriage, Family, and Child Counseling degree (offered through the Department of Counseling in the College of Health & Social Sciences) meet the BBS requirements for MFT education.

    Because sure, why not.

    I wanted to make it easier to figure out which program at a given school was in fact an MFT-qualifying program. The site I created, MFT California, lists every single program in California that meets the BBS degree requirements--you can clearly see the name of the qualifying degree at the top of every profile page, and I've included links to the specific degree's program page.

    I hope you find it helpful, and that it saves you the horror of enrolling in the wrong kind of master's program!