How to Write an Application Essay or Personal Statement

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

I have been doing a ton of essay editing and coaching lately, which I have really enjoyed. I love working with you guys as you reframe your life experiences into a narrative about how you’ve ended up at the decision to become a mental health professional!

While the process is VERY unique to every individual, I’ve noticed some themes that keep coming up. I thought it might be helpful to lay those out for those of you tackling the task of trying to answer these HUGE life-and-career questions in 2-4 double-spaced pages. 😂

Your Essay Is Only Part of the Picture

Whether you’re writing an essay as part of a school application, a job application, or a scholarship application, the essay is ONE piece of the application. All the parts should work together to create an entire picture of you as an applicant. That means a few things:

  • You don’t need to waste precious real estate in your essay listing out ALL your work and volunteer experience. Some things are definitely critical to expand upon! But let your resume/CV speak for itself.

  • Your essay is the place to explain some of the “problematic” parts of the rest of your application. Does the job description say you need to have three years of experience, and you only have two? The essay or statement is the place to explain why you think your two years of experience is the equivalent of someone else’s three. Are there some troubling grades on your transcript? In your essay, you can explain what happened there.

  • Remember that your letters of recommendation can be their own essays. If you get to read your letters of recommendation before submitting them, AWESOME. You know what other people have said about you! You don’t need to waste any essay time making the same exact points! But more likely, you WON’T get to read those letters—they’re usually sent directly to the school, or sealed in an envelope so you can’t read what’s been written about you. That’s ok though! The truth is, you’ve got SOME idea of what a recommender would say about you, otherwise you wouldn’t have asked them for a letter. Try to keep what you think they’ll say in mind as you write your essay, and make sure your own narrative reflects what they’re likely to say. You just want to make sure you don’t CONTRADICT what your recommenders have said!

Frame Yourself for the Specific Application

Everything you’re applying for is looking for something slightly different—even though they may all be looking for YOU! For example, say you’re applying to three different graduate programs. Each program has slightly different requirements of their applicants, and each program has a different personality. One program might emphasize research, while another emphasizes social justice, while still another emphasizes preparing you for private practice. If you’re applying to all three, there are aspects of each program that appeal to you! Your job as a an applicant is to highlight the parts of your story that fit the personality of each program. The same is true when you’re applying to jobs. If a job is customer-facing, you’ll want to highlight how much you love working with people. If a job is teamwork-oriented, you’ll want to emphasize your experience working successfully with others. The trick, of course, is trying to gauge what each program, organization, or scholarship committee is looking for!

Sound Like You, But Professional

Please, please, please—don’t try to sound erudite in your essays and personal statements! If you’ve got an expansive vocabulary, by all means use it, just make sure you don’t veer into the realm of the pretentious. It must sound natural. Especially when you’re being asked for a personal statement, they are looking for WHO YOU ARE. This goes double if you’re applying to MFT programs!! The whole point of being a therapist is bringing your authentic self to the work. You don’t need to impress admissions committees with an essay that sounds like Austen or Dickens. They are evaluating your essay to make sure you can write well, but more importantly that you can communicate well.

Be Mentally Healthy

There is a fine, fine line between being authentic and TMI (too much information). Especially if you’re applying for something in the field of psychotherapy, you need to share personal stuff without coming across like you’re the one who needs therapy!! It’s tough, and this is one of the areas that I work on the most in coaching, because it’s so different for every person.

  • Be honest about why you want to go into this field, but make sure you communicate that you’re not still in crisis. So many essays ask about formative experiences that have made you want to be a therapist. For many applicants, this may mean relaying experiences of trauma where a therapist really helped (or where a therapist could have helped…). Remember that you’re not trying to communicate the depths of your trauma—save that for your own therapist! You’re trying to communicate how your experiences have inspired you to want to help others.

  • When in doubt, use neutral everyday language. Try to stay away from diagnostic language unless your experience with mental health services specifically involved diagnoses. You’ll learn in graduate school not to talk about people as their diagnoses (“my sister has schizophrenia” instead of “my sister is a schizophrenic”) and you’ll also learn that diagnostic language can be kind of controversial. So instead of saying “I had a codependent relationship with my husband and seeing a couples counselor really helped,” you may want to say “our couples counselor helped my husband and I develop healthy boundaries that saved our marriage.”

  • Think about how you’re coming across from a total stranger’s point of view. This is where having an objective editor (like me!) really comes in handy. As you read your essay back, remember that this is your first introduction to someone who doesn’t know you at all—and the reason they are reading your essay is to determine your suitability to help others. There’s a middle ground between revealing all your personal struggles diary-style and revealing absolutely nothing, and sometimes that can be hard for you to gauge. If you grew up in a family where it was absolutely normal to talk about very personal things, a reader might find your essay over-share-y and lacking professionalism. If you grew up in a family where it was NOT ok to talk about personal things, however, a reader might find your essay cold and detached—not desirable qualities for a future therapist! So it’s really important to find that balance between honesty and…too much honesty.

How I Can Help You

I hope this has helped give you a better idea of what exactly you should be trying to accomplish with your essay or personal statement. If you need some more help, I’m available for editing and coaching. I enjoy helping applicants from the very beginning of the process all the way to the final polished product. I offer an Essay Coaching package (where I interview you and review application materials to help you decide what to write about), a Coaching + Editing package (where we work together through three revisions to craft your essay or statement), an Editing package (if you just need some feedback/proofreading on your essay but don’t need my advice on WHAT you should write about), and phone consultations on any part of the process. If you need something more specialized, I’m happy to work with you to put together a custom package!

I hope this post has taken some of the mystery out of the essay-writing process. I know when I wrote my application essay for my master’s program, it took me a solid two months of revising before I felt confident! I really hope the process is smoother for you!

Good luck!!


Points of Interest:

Phone Consultation
from 25.00

Phone or Skype advising session--ask me any questions you have on the process!

Email Follow-up:
Add To Cart
Personal Statement or Essay Editing
from 75.00

I can help you craft an outstanding personal statement or essay (up to 1,250 words) for your graduate school, scholarship, or job application.

Add To Cart
Essay Coaching
from 100.00

I will coach, guide, and advise you through brainstorming what to write for your essay or personal statement.

With 15-minute Phone Call:
Add To Cart

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, " 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?



    The Classic Medical Model

    Image: Paul K.,  Le Docteur Alchimiste (18th cent.) ,

    Image: Paul K., Le Docteur Alchimiste (18th cent.),

    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.


    Adler, R. (2009). Engel's biopsychosocial model is still relevant today. Journal of Psychosomatic Research, 67(6), 607-611.

    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.

    Penttila, M., Jaaskelainen, E., Hirvonen, N., Isohanni, J., & Miettunen, M. (2014). Are we reinforcing the anti-medical model? Reply. British Journal Of Psychiatry, 205(6), 499-500.

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

    Scott, Helen. (2010). The medical model: The right approach to service provision? Helen Scott questions the medicalisation of mental distress, along with the use of labels to define illness, and argues that lip service is paid to service-user choice. Mental Health Practice, 13(5), 27-30.

    Schwartz, S., Lilienfeld, S., Meca, A., Sauvigné, K., & Kazak, Anne E. (2016). Psychology and Neuroscience: how close are we to an integrative perspective? Reply to Staats (2016) and Tryon (2016), 71(9), 898-899.

    Searight, H. (2016). The biopsychosocial model: "Reports of my death have been greatly exaggerated". Culture, Medicine and Psychiatry, 40(2), 289-298.

    Shah, P., & Mountain, D. (2007). The medical model is dead – long live the medical model. British Journal of Psychiatry, 191(5), 375-377.

    Shyman, Eric. (2016). The reinforcement of ableism: Normality, the medical model of disability, and humanism in applied behavior analysis and ASD. Intellectual and Developmental Disabilities, 54(5), 366-376.

    Sprenkle, D. (2003). Effectiveness research in marriage and family therapy: Introduction. Journal of Marital and Family Therapy, 29(1), 85-96.

    Springer, Paul R., & Harris, Steven M. (2010). Attitudes and beliefs of marriage and family therapists regarding psychotropic drugs and therapy. Journal of Marital and Family Therapy, 36(3), 361-375.

    Thyer, B., & Pignotti, A. (2011). Evidence-based practices do not exist. Clinical Social Work Journal, 39(4), 328-333.

    Van Dyke, David J., & Hovis, Ryan. (2014). Systemic critique of the DSM-5: A medical model for human problems and suffering. Journal of Psychology and Christianity, 33(1), 84-89.

    Wade, D., & Halligan, P. (2017). The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation, 31(8), 995-1004.

    Wakefield, J. (2013). The DSM-5 debate over the bereavement exclusion: Psychiatric diagnosis and the future of empirically supported treatment. Clinical Psychology Review, 33(7), 825-845.

    Weston, W. Wayne. (2005). Patient-centered medicine: A guide to the biopsychosocial model. Families, Systems & Health, 23(4), 387.

    Wickramasekera, Ian, Davies, Terence E., Davies, S. Margaret, Deleon, Patrick H., & Kenkel, Mary Beth. (1996). Applied Psychophysiology: A bridge between the biomedical model and the biopsychosocial model in family medicine. Professional Psychology: Research and Practice, 27(3), 221-233.

    Wong, P. (2010). the future of humanistic/existential psychology: A commentary on david Elkins’s (2009a) critique of the medical model. Journal of Humanistic Psychology, 50(2), 248-255.

    Yakeley, J., Hale, R., Johnston, J., Kirtchuk, G., & Shoenberg, P. (2014). Psychiatry, subjectivity and emotion - deepening the medical model. The Psychiatric Bulletin, 38(3), 97-101.

    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.


    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.


    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.


    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. 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!


    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 Grad School Like?

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

    When I first started researching MFT master's programs, one of the questions that kept gnawing at me was, "what is it really like to be in one of these programs?" Each program seemed so different, and I didn't have a great idea of what "perks" I should be prioritizing over others. Should a flexible schedule at multiple campuses be the deciding factor? Or should I shoot for a rigorous "lockstep" program that would get me out in the least amount of time? Would I be missing anything if I did an online program? And what's the deal with "fieldwork sites," anyway??

    I've successfully completed my first semester in graduate school and have begun my second--which includes the fieldwork/traineeship process. I wanted to give you a breakdown of what I've experienced so far. Bear in mind, this is one experience, and I'm basing all of my judgments on my one experience. I'll be honest about what I think, but you may think and feel differently from me, and ultimately come to different conclusions, and that's ok! I just wanted to illuminate the whole thing a little.

    For many reasons, I decided to attend California State University, Northridge (CSUN) in Los Angeles, CA. First, I'm going to address the various factors that influenced this decision so you can see my thought process and how it panned out. Then, I'll give you a look inside what my classes were like.

    Deciding Factors

    Location was the most important part of the decision for me . The school I attended had to be in Los Angeles, because I couldn't relocate. That being said, I didn't feel like I needed to attend the closest campus to my place--I didn't mind driving under an hour, but I couldn't attend school in Santa Barbara or anything. I wrote a whole post on why location of your grad program is important if you'd like some more information.

    After that, cost was an enormous factor. I'm still paying off student loans from my undergraduate years, so I didn't want to take on another huge chunk of debt. It seems like you can make a solid living as a marriage and family therapist, but you're probably not going to be a millionaire, so it didn't make sense to me to take on $100,000 of debt just for a master's degree. That ruled out programs like Pepperdine and USC. The CSU schools, however, were remarkably affordable.

    Once I narrowed down my choices based on location and cost, I started to consider the less-easily-quantifiable factors. I wanted to get a good education, be taught by good professors, have exposure to diverse populations, and have some flexibility to make my experience personal to me.

    Trying to determine the quality of the education and professors at different programs was difficult. What worked best for me was doing some Google and library research on whatever professor names I could find. Some were easy--CSUN, for example, lists its full-time faculty on its website. Others, like Alliant, don't have a full list of faculty members, just a sampling of professors in the program (and information was scant on the Los Angeles ones).

    Once I had some names, I could see if they were actively practicing, researching, publishing, presenting at conferences, speaking on panels, etc. Quickly I determined that the faculty at CSUN was very active in all those activities, which gave me a sense that the program was probably academically rigorous rather than geared simply towards meeting accreditation requirements.

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

    Accreditation was another thing I considered but was far from the deciding factor. The only Los Angeles-area COAMFTE school while I was applying was Alliant; CSUN had CACREP accreditation, which seemed to be not as "great" as COAMFTE but better than nothing. However, I found out after I applied that CSUN had in fact been actively pursuing COAMFTE accreditation and was awarded it right before I enrolled--by the time I started, CSUN's program was, in fact, COAMFTE-accredited. You can read about why that is (sort of) important in my blog post on accreditation and why it matters.

    Finally, the program format was important to me. CSUN's MFT program meets two days per week in the evenings. You are placed in either the Monday/Wednesday cohort or the Tuesday/Thursday cohort, and for the entirety of the program you stay in those groups. I figured this would give me the flexibility to work during the days and go to school in the evenings (I will get to how that worked out in just a second).

    The program has been described as a "lockstep" program--the cohort moves through the program together, and all classes and the order in which they are taken is prescribed. So first semester, everyone takes the same classes, though you may have different professors; the second semester, you all move on to the next set of classes as a group. This differs from a program like Pepperdine's evening format program, where they tell you what classes you need to graduate, and then you figure out what order you want to take them (and where). If you would like to know more about different program format options, check out my blog post on that subject.

    So, how did it all work out?

    What Grad School is Really Like

    Honestly, I feel like I made the perfect decision for me. The commute to CSUN is not bad, and parking isn't that great a challenge for evening classes. It costs a good chunk of change to go to grad school, but my program is significantly more affordable than most other programs in the area so every time I have to pay my tuition I remind myself it could be lots worse!

    The professors are, as I'd hoped, incredible. For the most part, each is brilliant and on the cutting edge of his or her particular area of expertise, and every single one is so supportive and caring--they truly do want students to succeed.

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

    But the x-factor in my experience has been my classmates. I'd hoped that by going to a cohort-model program, I would be able to form stronger bonds with classmates (my future colleagues) than I might be able to attending a program where you have different classmates for every class, and I definitely think that is true. Within the first few weeks of class, I'd met and formed friendships with some really amazing people, and as the semester went on, those bonds deepened and even more bonds were made. Even this semester, I'm still making new friends and adding to this incredible support system that I'm not sure I would have found elsewhere. It is for this reason alone--my classmates--that I would urge anyone considering an online program to take a look at on-campus programs one more time. I'm sure you can probably learn a fair amount of material via online delivery, but I think my experience would have been far less valuable without hearing my classmates' perspectives during in-class discussions or being able to engage with them outside of class. It really is the thing that will push your grad school experience from sufficient to transformative.

    My Classes

    First semester, our cohort had to take Counseling Theories, Practicum, Law & Ethics, and Clinical Research Methods. There were two different instructors for Theories, four for Practicum, and then the same instructor taught two different sections of Law & Ethics, and another instructor taught two different sections of Clinical Research. 

    I had Dr. Stan Charnofsky for Counseling Theories, and there were about 20 students in the class. On the first day, he gave us an overview of what we would be doing in class--every week, a group would present on a specific psychotherapeutic theory for about an hour, and then after than Dr. Charnofsky would add a little bit of information from his own perspective. A sign-up sheet was passed around and we signed up for whichever theory we wanted to present on (I picked postmodernism). We had one textbook, and every week our assignment was just to read the chapter out of the book that applied to the upcoming presentation.

    The class was an interesting overview of all the theories that make up the field of psychotherapy. We covered everything from Freud to gestalt to person-centered to choice theory to an overview of family systems. It was really easy, which was a nice way to ease into graduate school (because my other classes were not easy). We had no exams during the semester, and the final was a group discussion with Dr. Charnofsky--he presented a case vignette, then we brainstormed different ways we could approach the case from different theoretical perspectives. Dr. Charnofsky was always very supportive and very kind, and he really encouraged us to do our presentations in whatever way we felt inspired to do (most of us did PowerPoints but he was open to anything if you wanted to be more creative).

    This class is where I made the strongest bonds with my classmates. I had Dr. Mark Stevens and I don't think I've made a luckier choice in my entire life--I just randomly chose to be in his practicum because I'd seen him speak at orientation and he seemed nice. He's great. He really got a feel for our class's comfort level, didn't let preconceived class structure get in the way of us getting to know each other, and was just a gentle supportive presence at every turn.

    In this class, we began doing role-plays, which is a mainstay of therapist training. GET USED TO THIS IDEA NOW! It seems to be a go-to tool in training beginning therapists. One student plays "the therapist," and the other plays "the client." Sometimes you do the role-plays privately, but you will also be expected to do them with the whole class watching.

    Dr. Stevens made a really great choice in letting us create a character when we played the client at first--I think this gave us all time to get comfortable with each other. Then, after awhile, if we wanted to bring in personal issues during role-plays (like friend drama or family problems etc), we could. 

    I cannot stress enough how important it is that you go into this class with an open mind and a collaborative spirit. Try your best to set a tone that encourages the rest of your class to approach this as a team. You really don't want it to descend into a competition, where you're trying to win the title of Best Therapist when you're in the therapist seat or trying to trip up your classmates by playing Problem Client when you're in the client seat. This is a class for introspection and muddling through the newness of it all, not for trying to demonstrate how amazing you are. You should also get in the frame of mind to receive feedback, because you'll get a lot. I highly recommend Brené Brown's book Daring Greatly, and you can read my review for my thoughts on what she has to say about giving and receiving feedback--it should be required reading before Practicum!

    There were no exams in my practicum class; instead, we had some writing assignments, turned in weekly journals, and had a couple role-play projects where we paired up and filmed role-plays for submission, and for one of them we had to write out a transcript of the session. There was also a final PowerPoint presentation about our experience over the semester.

    This may seem like a dry, boring class, but I promise you, it's really important with a lot of real-world applications. I had Dr. Ian Russ, who used to be Chair of the Board of Behavioral Sciences (the MFT licensing board in California) and has also been involved in CAMFT, one of the main professional organizations for MFTs in California. He has extensive personal experience with many of the issues covered in this course.

    Most of each class is taken up with a lecture by Dr. Russ; he uses the Socratic method, so he'll pause his lectures frequently to ask the class a question (and he will wait for an answer, so don't think he'll move on if no one says anything!). In almost every class there is also a group presentation on a specific theme--you'll sign up in the first couple weeks of class. These cover things like Tarasoff situations as well more broad categories like eating disorders and child abuse; each group is expected to cover both the legal and ethical issues associated with their topic and present with a PowerPoint. There were two quizzes during the semester that were pretty hard (you really need to learn everything, so try to listen for the details that Dr. Russ thinks are especially important), but the final was really based on the quizzes so it wasn't brutal.

    I feel like this class did a great job preparing me for the gray areas of this profession, but it was definitely designed more to encourage critical thinking and evaluating your personal ethics rather than preparing students for the Law & Ethics licensing exam that must be taken in order to practice. Dr. Ben Caldwell also teaches this class, and he has written a prep textbook for that exam, Preparing for the California MFT Law and Ethics Exam, that I highly recommend. I bought it the first week of class and followed along as we moved through the semester, so I feel like I learned the material with an eye towards the exam.


    I was not a psychology major as an undergraduate (I studied English literature), so this class was the most challenging but also my favorite. I learned so much! I had Dr. Deborah Buttitta, who is really smart and kind. I loved her teaching style--mostly she lectures, but she's very open to questions and discussion if anyone is confused about anything. Her PowerPoint slides were crucial for preparing for the quizzes during the semester.

    The course, as its name implies, covers research methods used in the field of family therapy. Dr. Buttitta emphasized that even if you have no intention of doing research yourself, it's very important that as a clinician you understand research (and what makes research good), as one of our ethical obligations as therapists is to be up-to-date on the latest research that can help our clients.

    The major component of this class was the literature review. I had never done one before--my classmates who were psych majors were familiar with this project so I don't think it was as intimidating to them. But even though it was intense, I do think this was an excellent assignment to practice coming up with a question, finding literature that could help answer the question, and synthesizing all the material into a usable form. I would definitely take another class with Dr. Buttitta.

    What I Have Learned

    The biggest lesson I learned about graduate school is that even though my classes only meet two evenings per week, it is in fact a full-time class load. There is SO MUCH reading, and there really are a lot of group presentations and projects that take up a lot of time. So while it was possible for me to continue to work part-time while I was in school, it was a delicate balancing act. My classmates who have full-time jobs were much more stressed, so I would really say that if you must continue working a full-time job while you're in school, you may want to only consider programs that allow you to go part-time (CSUN is a full-time program).

    The other major lesson I have already addressed above--I think my classmates are an integral part of why my experience so far has been so incredible. I simply cannot imagine doing these classes online and not having my classmates to discuss things with. Also, hearing my classmates' perspectives in class discussions but also outside of class has truly expanded my experience and understanding of the world, which I think is vital both as a therapist-in-training as well as a person in general. I feel so lucky to have met such compassionate, inspiring, funny, smart people. I hope your experience is as transformative!!

    If you have any questions about the grad school experience, don't hesitate to contact me