Career As a Marriage and Family Therapist

A CAREER AS A

MARRIAGE AND FAMILY THERAPIST

Institute Research Number 869 ISBN 1-58511-869-9 O*Net SOC Code 21-1013.00

A CAREER AS A

MARRIAGE AND FAMILY THERAPIST Mental Health Professionals Who Assess and Treat Couples, Families and Individuals MARRIAGE AND FAMILY THERAPISTS ARE TRAINED TO HELP FAMILIES, COUPLES AND

individuals – at all ages and from all walks of life – confront and cope with their personal problems. In a single day, they might be presented with the following caseload: A gay teenager and his parents, who are having a difficult time accepting his homosexuality.

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An unhappily married couple who are trying to decide if their marriage is worth saving. A father, already burdened with financial difficulties, who has recently suffered a job loss. A young couple struggling to help their adopted daughter who has a history of prior sexual abuse. A blended family – with a baby on the way and four children from prior marriages – who are stressed to the limit. Marriage and family therapists differ from other mental health professionals in that they practice solution-focused, family-centered treatment. The course of treatment is generally brief and is designed with an end in mind. Twelve sessions is the average, according to a recent survey of therapists. Marriage and family therapists believe that individuals and their problems must be seen in context, and that the most important context is the family. They address a wide range of relationship issues within the context of the family system. Their goal is to help their clients achieve more satisfying and productive relationships. Marriage and family therapists also treat individuals in one-on-one sessions and, in fact, about half of the treatment provided by marriage and family therapists is one-on-one, with the other half divided between marital/couple and family therapy, or a combination. Marriage and family therapy is recognized by the US federal government as the fifth core mental health profession, along with psychiatrists, psychologists, social workers and psychiatric nurses. Currently, 48 states and the District of Columbia regulate the profession, requiring a license or certification to practice. It takes many years of education and hard work to become a licensed marriage and family therapist. You need, at a minimum, a master’s degree, which requires about two or three years to complete, after you graduate from college. Some go on to earn a doctoral degree, which typically requires another three to five years. Moreover, many hours of supervised clinical practice are required both during the course of your studies and after graduation, in order to be eligible to sit for the licensing examination.

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The majority of marriage and family therapists eventually go into private practice. This provides them with flexible work hours, the freedom to be selective about their clientele, and the option to specialize. But it also requires business and marketing skills, as well as covering the expenses of running an office. Alternative work settings include hospitals, hospice programs, inpatient facilities, employee assistance programs, community mental health centers, schools, rural clinics, business and consulting companies, health maintenance organizations, social service agencies, prisons, universities and research centers. A career as a marriage and family therapist is both satisfying and demanding, and not everyone is well suited for it. It takes a special kind of person who can spend every day listening and responding to people’s problems with the right mix of compassion and detachment. Distance yourself too much and your clients won’t believe that you really care about them; become too emotionally involved in their problems and you’ll burn out very quickly. Read on to see if you’ve got what it takes to make it in this field.

WHAT YOU CAN DO NOW AFTER READING THIS REPORT, THE NEXT STEP YOU SHOULD TAKE IN EXPLORING

and preparing for this career is to visit the website of the American Association of Marriage and Family Therapy (AAMFT) at www.aamft.org. The AAMFT is the main professional association for marriage and family therapists in the US, and its website is filled with all kinds of information about this career, including a listing of accredited educational programs. Another way to learn more about this profession is to meet with and interview several marriage and family therapists. To locate professionals in your area, click on the Therapist Locator link that appears on the AAMFT website. Type in your zip code and you will see a listing of local marriage and family therapists nearby along with contact information. You can ask them why they like to work in this field and what advice they may have for you. But, of course, you will be unable to sit in on therapy sessions due to privacy concerns. Some therapists recommend that anybody who wants to work as a therapist should first go into therapy themselves, mainly to work out their own issues, but also to experience what it is like to be a client. If this is not a viable option for you, try writing down your thoughts and 4

feelings in a daily journal as a way to get in touch with your inner struggles and to tackle any problems that you are dealing with in your own life. While you are at it, it would be a good idea to examine closely your motivations for wanting to work in the field of mental health. Make sure that it’s not just to learn how to deal with the mental wounds you sustained while growing up but that you also genuinely want to help others. If your school has a peer counseling program, by all means get involved. That would provide you with valuable experience in the mental health field. Alternatively, look for volunteer or paid work opportunities at a university, special needs center, school, camp, teen home, women’s shelter, or crisis hotline. In college, be sure to take psychology and sociology courses. While you don’t need to major in a specific field as an undergraduate, you should contact some of the marriage and family therapy graduate programs that you might be interested in attending to see if there are any prerequisites. If possible, also get some research experience since doctoral programs typically require students to conduct original research. Finally, be sure to explore all of the other mental health professions as well so that you end up choosing the one that best matches your needs and desires. This includes social work, psychology, counseling, psychiatry, and psychiatric nursing.

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HISTORY OF THIS CAREER MARRIAGE AND FAMILY THERAPY IS ONE OF THE NEWER METHODS OF TREATING

psychological problems. It only started to take root back in the mid-1950s. Historically, people with marriage and family problems either attempted to handle their own issues or sought counsel with clergy, lawyers or doctors, rather than with mental health professionals. In the first half of the 20th century, psychoanalysis and behaviorism were the predominant psychological theories in the US. These approaches to psychotherapy focused on individual therapy and the patient-therapist relationship. Several factors combined to make family therapy accepted and eventually popular during the latter half of the 20th century. The first was the growth in the number of women enrolled in colleges, and their demand for courses in family life education. Another influence was the establishment of marriage counseling. The founding of the National Council on Family Relations in 1938, and the establishment of its journal, Marriage and Family Living, in 1939, also affected the field. County home extension agents began working with families in the 1920s and 1930s to help them better understand the dynamics of their family situations. In 1942, the American Association of Marriage Counselors (AAMC) was formed by Ernest Groves and others. Its purpose was to help professionals network, and to devise standards for the practice of marriage counseling. The 1940s saw a major focus on the study of families with a schizophrenic member. One of the early pioneers in this area was Theodore Lidz, who published a survey of 50 families. He found that the majority of schizophrenics came from broken homes and/or had seriously disturbed family relationships. Lidz later introduced the concept of “schism,” which means the division of the family into two antagonistic and competing groups, and “skew,” whereby one partner in the marriage dominates the family to a strong degree as a result of s serious personality disorder. The events of World War II brought considerable stress to millions of families in the US. To help meet their mental health needs, the National Mental Health Act of 1946 was passed by Congress. Mental health workers who aided families were eventually funded under this act.

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The 1950s is considered to be the genesis of the family therapy movement. Nathan Ackerman is one of the most important personalities of this decade. In his book, The Psychodynamics of Family Life, he urged psychiatrists to begin treating clients’ mental disorders in light of family process dynamics. Gregory Bateson, a researcher in California, obtained several government grants for study and, with Jay Haley, John Weakland and eventually Don Jackson, formulated a novel, controversial and influential therapy of dysfunctional communication called the double-bind. This theory states that two seemingly contradictory messages may exist on different levels and lead to confusion, if not schizophrenic behavior, on the part of some individuals. Bateson left the field of family research in the early 1960s, and the Bateson group disbanded in 1962. However, much of the work of this original group was expanded by the Mental Research Institute (MRI), which Don Jackson established in California in 1958. Jackson helped lead the family therapy field away from a pathology-oriented, individual illness concept of problems to one that was relationship oriented. In the late 1960s, Jay Haley joined the Child Guidance Clinic, which was under the direction of the psychiatrist Salvador Minuchin. Minuchin first began his work with families at the Wiltwyck School for Boys in New York State in the early 1960s. He used his own form of family therapy to treat urban slum families. Founded in 1942, the American Association for Marriage and Family Therapy (AAMFT) enjoyed a huge growth in membership in the 1970s, due in part to the recognition by the Department of Health, Education, and Welfare in 1977, as an accrediting body for programs granting degrees in marriage and family therapy. In 1974, the AAMFT began publishing its own professional periodical, The Journal of Marital & Family Therapy. The American Family Therapy Academy (AFTA) was founded in 1977 by a small group of mental health professionals who were active during the early years when the field of family therapy was emerging. The AFTA has focused almost exclusively on family therapy clinical and research issues.

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Until the 1980s, research techniques and solid research in family therapy were scarce. A breakthrough in research in the 1980s came when studies indicated that certain forms of family therapy were effective in working with families. There was also a growth in the number of publications and periodicals in this area. Some major publishing houses began to specialize in books on marriage and family therapy. In the 1980s, the profession was listed as one of the core mental health professions eligible for mental health traineeships as part of the Public Health Service Act. It placed the profession in the eyes of the US federal government on the same level as psychology, psychiatry and other professions that were all receiving federal training grants. In the 1990s, marriage and family therapy became a more global phenomenon, and new theories and specialty areas emerged. Emerging theories during this time included the feminist family therapy; the reflecting team approach; the therapeutic conversations model; the psychoeducational model; and the internal family systems model. In this decade, there was a redirection of the family therapy education field from a focus on producing narrowly trained, theory-specific clinicians to a focus on training practitioners who know how to work with special types of families. In the 21st century, more contemporary influences such as managed health care are influencing the course of this profession. Managed care is requiring marriage and family therapists to justify their procedures before therapy may begin, and case reviewers employed by the insurance companies are now making decisions that had previously been made by the therapist. They are now more constrained not only by the types of problems considered to be reimbursable but also by the number of sessions allotted for treatment.

In this new century, where the September 2001 terrorist

attacks and the Iraq war have disturbed the national equilibrium, the need for marriage and family therapists may be greater than ever. Researchers have projected some of the more important trends that will have an impact on this profession in the coming years. They include dealing with the grieving process, family violence, interfacing with the legal system, aging and end-of-life system, and religious and spiritual issues. 8

WHERE YOU MIGHT WORK ABOUT HALF OF ALL MARRIAGE AND FAMILY THERAPISTS WORK IN PRIVATE

practice. Some work by themselves in an office that they rent or own. Others share office space with colleagues in order to share the overhead expenses. Therapists in private practice may choose to specialize in certain areas, such as treating those with eating disorders; divorce or stepfamily adjustment issues; or child behavioral problems. About one-quarter of all marriage and family therapists work in an organizational or agency setting. The remaining 25 percent split their time between working in a private practice and at another job setting. Different settings tend to service different types of client populations. Traditional outpatient settings of community-based mental health centers funded by county and state resources typically attract a wide range of clients. Outpatient settings that are hospital-based and affiliated with either the psychiatric department of the hospital or a private corporation also employ marriage and family therapists. These clinics are subcontracted to provide mental health services to clients referred from within and outside the hospital. Some charitable organizations set up facilities to provide similar outpatient services, along with related family services such as adoption and foster care. Also, religiously affiliated social service organizations employ marriage and family therapists, some of whom may practice spiritually-based therapy. In addition to outpatient settings, marriage and family therapists also work in traditional hospital inpatient units. A growing trend is toward home-based family therapy services, particularly for at-risk families in need of short-term, high-intensity treatment. Other settings where marriage and family therapists are employed are residential facilities for children and adolescents with severe behavioral and legal problems related to violent behavior, sexual offenses or chemical dependency that require either temporary or permanent removal from their home. Marriage and family therapists also find employment with hospice programs, employee assistance programs, rural clinics, and business and consulting companies. They also work for programs affiliated with the criminal justice system that provide required mental health services for various offenses, such as shoplifting, domestic violence, sexual abuse, and driving under the influence of alcohol. They can also be 9

found working in schools. There are now many grants and programs that incorporate into schools a variety of mental health services for children and adolescents. In fact, marriage and family therapists can be found almost anywhere that healthcare is delivered or practiced. Those marriage and family therapists with a doctoral degree have additional opportunities available to them. They may work at a university to teach and conduct research, or find employment at a research or public policy center.

DESCRIPTION OF WORK DUTIES WHEN AN INDIVIDUAL, COUPLE OR FAMILY SEEKS OUT THERAPY, THE FIRST TASK FOR

the marriage and family therapist is to conduct an intake session. During the intake session, many questions are asked, and careful listening is required. The therapist looks for signs of any mental disorders, takes a psychosocial history, and makes a tentative diagnosis. Immediately following the intake session, the therapist needs to document what occurred. This information is used to develop a preliminary treatment plan. According to a recent survey of marriage and family therapists, the most common presenting problems are mood disorders, couple relationship problems, family relationship problems, anxiety disorders, and adjustment disorders. Presenting problems are those concerns that have motivated the client to seek treatment in the first place. Of course, as the therapy progresses, other underlying problems will usually be uncovered. Marriage and family therapists typically take a systemic approach rather than an individual approach when treating their clients. With the idea that people do not live in a vacuum, a systemic approach sees individuals within the context of their close relationships, and patterns of communication and relating with others are evaluated. A frequent challenge for marriage and family therapists is how to get family members to participate in therapy sessions along with the individual client. Not all family members will see the value in therapy, or recognize that they play a role in problems that another family member may be experiencing. Therapists use a range of strategies to encourage other family members to participate. If they still refuse to participate, all hope is not lost since much can be accomplished in individual sessions. In fact, marriage and family therapists actually spend a significant percentage of their time working with individuals rather than directly with couples or families. 10

During the course of therapy sessions, the therapist must challenge old perceptions, help clients define their problems, and develop various possible solutions. The therapist needs to assess what changes can or should be made in order to help the family function better. They encourage clients to develop and use skills and strategies for confronting their problems in a constructive manner. They may push family members and the family as a whole to make changes and breakthroughs. Asking carefully constructed questions will help clients identify their feelings and behaviors. Sometimes, the therapist will assign homework. As an example, family members might be asked to practice listening to one another at home and then each member will have to paraphrase what another said before making his/her own statement. Therapists spend a great deal of time documenting their work. Documentation is not only for the benefit of the therapists and their clients, but is also a necessary step for legal reasons and for insurance reimbursement purposes. Self-employed therapists who accept insurance will have to do extra work. They will need to fill out forms, provide proper documentation and follow up on any problems that arise. Even for those who do not accept insurance, collecting payment can be a big job. Notes should be written as soon as possible after each session so that the information is fresh in the therapist’s mind. The specific record of each session is called a case note or a progress note. Many formats for case notes exist, and an increasing number of computer software packages for producing complete clinical records are becoming available. Still, it is quite a challenge to capture in words the essence of the complex dynamics of a session. Therapy sessions typically last 50 to 60 minutes. According to the research on marriage and family therapy, the first few sessions are the most critical. During these early sessions, the therapist needs to establish a sense of trust, which is a crucial component of family therapy. A number of different types of therapies have been developed over the years by various theorists, and you will learn about and study many of them in school. Therapists may choose to specialize in one or several techniques and treatment methods. Despite outward appearances, however, many of these various family therapy theories are more alike than different in practice. For instance, all kinds of family therapies are concerned with processes involved in clarifying 11

communications among family members, overcoming resistance, and rectifying dysfunctional behaviors. Most see the relationship and not the individuals within the relationship, as the focus of therapy. Consequently, marriage and family therapists have many common concerns and procedures that transcend their different theoretical systems. According to a recent survey of marriage and family therapists, the most popular theoretical approaches are cognitive-behavioral; multi-systemic/systems; psychodynamic; Bowen family systems; and solution focused. The most prevalent and empirically validated treatment models for working with couples in or outside of marriage are behavioral couple therapy (BCT), cognitive-behavioral couple therapy (CBCT), and emotionally focused therapy. With behavioral couple therapy, the underlying assumption is that all behavior is learned and that people, including families, act according to how they have been previously reinforced. Behavior is maintained by its consequences and will continue unless more rewarding consequences result from new behaviors. A second major principle of this approach is that maladaptive behaviors, and not underlying causes, should be the targets of change. A third premise is the belief that not everyone in the family needs to be treated for change to occur. In cognitive-behavioral family therapy, the idea is that there are health-promoting, relationship-related cognitions that promote growth, and negative relationship-related cognitions that lead to distress and conflict. Three prevalent forms of behavioral and cognitive-behavioral family therapy are behavioral parent training, functional family therapy, and behavioral treatment of sexual dysfunction. Therapy is not always smooth sailing, even for a highly experienced therapist. Treatment impasses, or getting stuck or stalled, can occur at any point in therapy. This is to be expected. Fortunately, there are a number of strategies available to overcome this situation, and most of the time it will not lead to the necessity of referring the case to another professional or terminating treatment. Marriage and family therapy does eventually reach a point when it is time to end the treatment. Termination must be carried out in a planned and systematic way, rather than in an abrupt manner. The process of wrapping up a case successfully must begin long before you have a final session. In fact, at the start the therapist should begin 12

with an eye towards the end, and clients should be informed that therapy is not forever. Of course, it can be difficult to predict just how long treatment may take, however, an honest effort must be made to give the client a reliable estimate. Therapists have to be very conscious of making ethical decisions. Some common ethical concerns include the issue of confidentiality. Confidentiality means that the information revealed during therapy will be protected from unauthorized disclosure. A breach of confidentiality could also cause the therapist some legal jeopardy. Of course, a sexual or even close personal relationship between a therapist and a client is absolutely forbidden. There are times, however, when confidentiality cannot be maintained – in cases of child abuse, for example, when therapists are mandated to report such situations. As a family therapist, you might be subpoenaed to appear before a court to testify on behalf of or against a family or family member. Therapists must be accepting of people whose beliefs, morals and values may differ from their own. They will also be working with people from diverse cultural and religious backgrounds, and therefore it is important for therapists to examine and confront any biases they may be harboring so that it does not affect their work. Peer supervision and consultation are an important part of a marriage and family therapist’s professional life. Supervision is a requirement to obtain a degree in this field, and then to become licensed. Supervision may also be required by the agency you work for. Those who are self-employed may choose to continue with supervision for guidance and a sense of security. Many go on to become approved to do supervision for others. Along with face-to-face supervision, other options include videotape review and case consultation.

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THERAPISTS TELL THEIR OWN STORIES I Am a Clinical Supervisor at a Nonprofit Agency and I Have My Own Private Practice “I’ve been working at a nonprofit agency through the county of Los Angeles for the past eight years. I started as an intern and eventually became a supervisor, and then worked my way up to the director of an intake department. Now I just do clinical supervision for students and interns. Right now I am only working part time because I have a young child at home. I work two days a week for a total of about 20 hours. I also have my own private practice where I see six clients each week. When I worked in the field full time – in the director position and doing private practice on the side – I was making a six figure income, but I was working 65-plus hours a week. I have a bachelor’s degree in psychology with a minor in sociology focusing on marriage and the family. I also have a Master of Science degree in marital and family therapy. I went straight from my bachelor’s degree to a master’s degree, which I received 10 years ago. When I was in the master’s program, I started what is called a trainee program, where I saw clients under the supervision of a licensed professional. I had to get 500 face-to-face client hours before I could graduate. Once you’re finished with your master’s degree in the State of California you become an intern, and you have to gain many more hours before you can sit for your license. Usually as an intern, it takes about two to three years working full time in the field at low pay seeing clients, in order to get that experience, until you can sit for your licensing exam. After I left graduate school, I worked in a residential treatment facility for kids ages six to 12 with severe mental illnesses. I was there for about a year. Then I moved on to a small group home setting with teens who weren’t going to be adopted but were going to go into transitional living when they turned 18. 14

Now, in my private practice, I see everybody from a four-year-old child to a geriatric client. I have a colleague who is a child psychiatrist, and we share office space so we’re always referring clients to each other. I’ve also marketed to the private schools in the area because I only accept cash-paying clients. I don’t bill insurance so I market to an affluent community that can afford the full fee every week. In private practice, if your client doesn’t show up you don’t get paid but you still have the expenses of being a business owner. Also, in private practice it’s very lonely. I have colleagues that share my rented space but we have different hours so it’s just me and nobody else except my clients. You have to pick up the phone and talk to somebody if you want to consult about a case. What I like best about this career is the flexibility. I also really like working with my clients. I have high-functioning clients that are struggling with typical life issues, and I find it rewarding working with people at all different developmental stages and ages. Then I can go to my clinic and do clinical supervision and guide students through their training. There’s never a day that gets boring for me.”

I Started My Own Private Practice “My bachelor’s degree is in chemistry, but I always loved psychology and read many books in that area, so I eventually decided to pursue a career in therapy. I received a master’s degree in marriage and family therapy at a university in Connecticut. I did my internship at an agency, and when it came time to work to accumulate hours for my license, I was hired by that same agency as sort of a subcontractor. They provided the supervision, and I earned my required hours there. While working toward my license I focused mostly on children, so two other therapists and I eventually left to form a group practice specializing in children. We did that for four years until one of the members retired. Then I opened my own private practice.

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I mainly get referrals. When I was with the group practice I was on what they call insurance panels where you’re on their list as a provider and you get a reduced fee, but in exchange you tend to get more volume. So in the group practice I gained clients that way, and through referrals from psychologists, psychiatrists, school counselors, school principals and special education people that knew me in the community. In my own private practice I also continued the relationships that I had built at the group practice. I’ve done some advertising but it really hasn’t been productive. I’ve also made speeches, and that gets my name out there and builds awareness, but I don’t know if it builds clients. I find that the best way to get new clients is through referrals and word of mouth. I work three days a week. I have two small children so I’m doing a family balancing act. I see adults and children. I see adults in the early afternoon or late morning starting at 11, and then I go until 8 at night. On the days that I’m off I’m not really off because I’m returning phone calls and emails, working on scheduling, and working on cognitive-behavioral therapy handouts for the children. It’s fulfilling and gratifying to watch people grow and change, and knowing that I am the agent of that change. I don’t tell people what to do – I can just take people through that process. It’s very interesting and always changing. I work with kids so it can be fun just watching them go through the process. And it’s a very creative career. You have to really think about different ways to approach a problem and try what works. You cannot be rigid.”

I Use Some Nontraditional Therapies in My Practice “Part of my ongoing effort is to help people in a broader context. Let’s say a couple comes in and they’ve had trouble communicating for years. I find out why that is, and if it’s partly due to a person’s inability to think clearly and therefore they can’t articulate or listen well, then I might very well help with what’s called neurofeedback. It helps the person calm down and clear up foggy thinking. Some people walk around in a 16

bit of a fog, and others may have had an injury to their head that interferes with their ability to really process well and think clearly. Or they may have attention deficit problems as adults, so I might do neurofeedback to help them. They do become better listeners and have better communication skills and become better spouses. The same holds true for a child who’s having difficulty at school or at home. Maybe the whole family needs to have help, and I might do family therapy to help structure some of the chaos that is going on and making it hard for the child. But I might also do neurofeedback or biofeedback sessions with the child to help him/her pay attention more effectively and become more successful at home and at school, while at the same time I will help the family structure itself better. Another nontraditional method that I use is guided Eye Movement Desensitization and Reprocessing, which helps people who’ve had trauma in their past and might have some of the symptoms of post-traumatic stress disorder creating havoc in their lives. Eye Movement Desensitization and Reprocessing helps people get past the emotional reactivity that they still might have in certain situations. I was one of the first to be licensed as a marriage and family therapist in New York State. I was on the licensing board and was involved in writing the regulations for licensure. I had my first experience as a therapist working for an agency where I had an internship doing marriage and family therapy. It wasn’t for credit but I ended up being fascinated by the idea that I could treat somebody and help them in a much larger context than simply as an individual. I knew that people were coming to see me and getting help, but then they were going back to the same environment where they were living, which wasn’t changing, and so I thought: What if we could change the family, including the parents as well as the child? Or, what if we could change the spouse as well as the partner? Indeed, I have learned to see things much more as a whole when I look at a problem. I love to work with couples because I know that a problem is never one sided, and I get to hear both sides.

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Since I have a private practice, I have the flexibility to schedule my time the way I want. However, I do need to schedule sessions at times convenient for my clients. Because I choose to work with families and couples, there might be some evening hours. It always gets more complicated when you have to get more than one person in a room because of their different schedules. My typical workweek by my own choice is to start at 8:30 or 9, depending on the day, or maybe 10. I might have some days where I’m busy every hour from 8:30 until 6:30. And then another day I’ll have a lighter schedule. I don’t do very well when I have to work a really intense schedule, one person after another, day in and day out. What I like about my schedule is that it’s varied. Today I had supervision this morning, where I sat down with a psychiatrist who went over my cases with me, and that was a nice break from doing sessions all day. Another thing I do is a radio talk show, so I’m actually helping people that way, too. I’ve always sought to have my office be as much like a living room as possible – a comfortable, warm, and safe environment where you have privacy, where people feel that what they say is going to stay there, and that they’re not going to be judged. I don’t like working in a cramped environment. I like order in my office. I don’t commute very far. I have a duplex and I see people out of one side of it. I really like the fact that the people who come to me by and large don’t have serious mental illnesses. What they typically have is an adjustment disorder. There is something going on in their lives that they are having difficulty adjusting to. I really like teaching people how to communicate about issues that they’ve gotten stuck on in the past, and I like to see the restoration of some balance in a person’s life or relationship. I believe that there will always be a market for this service so I think that it’s a good investment in the future. I also think that anybody who gets enough training and who has the gift of being a good therapist can go far in this profession and make good money. I don’t like telling people that they have to sacrifice a high salary because they are working in a profession that has more emotional satisfaction. I don’t like that tradeoff, because you can go into business for yourself if you’re a good businessperson and you can make a good living.” 18

I Work Three Nights a Week in My Own Private Practice “I am the mother of two young girls so besides loving therapy and wanting to do it and work on my own, one of my main reasons for a private practice is so I can be home with my children. During the day I stay with them, and then my husband gets home three days out of the week at 5:30, and on those evenings I get right in the car and go to my office. I work three nights a week and see three clients a night maximum. Probably what I like least about my job is that I have to work at night. My goal is that once my children are in school I can shift to daytime. But right now it’s just a very long day, and I don’t like it when my family is sitting down for dinner and I have to be walking out the door. What I like best about my job is the rush that I feel when people have been helped, and knowing that I’ve made a difference. They feel happier and have the tools to know how to help themselves. People come in with pain that is very real and very intense, and it’s a privilege to be a witness to that and be able to help them. It’s also a huge responsibility. It’s not something I take lightly. It’s very, very gratifying when people tell me that they don’t know what they would have done had they not come to therapy, and that it really changed their lives. I’ve known that I wanted to be a therapist of some sort since I was fairly young. I was the kind of kid who others would talk to about their problems. I went to college and majored in psychology and minored in child and family studies. In fulfilling the minor I became familiar with the marriage and family therapy department at my university. Every course that I took in my minor fascinated me, and it just seemed to click, and I discovered that I had a passion for it. I didn’t really know about marriage and family therapy until I started taking the classes, and when I did, I realized that it was what I wanted to do. We have more training hours required in marriage and family work than most healthcare professions. We have to complete 500 client contact hours in the school program, and then we have to complete another 1,000 for licensure. That also includes supervision. To my knowledge, we have more thorough and 19

complete supervision than any other profession does. Everything is supervised. Every week included three hours of supervision while I was an intern, and then while working toward licensure I had to have 100 supervision hours. So you’re really closely monitored. It was extremely helpful always having someone watching over my shoulder. It was also a little nerve-wracking at times, but I see how it really helped my education to be first rate. In my program we had an in-house clinic where we interned, and clients came from the community and received a reduced fee. It’s a very rigorous process to become a marriage and family therapist. When you’re in a program, you are the tool so your trigger buttons are all going to be fair game in the pursuit of being a good therapist. A lot of people go through the program and it sort of cures them of the urge to do therapy. I met my husband in the program, and he is still interested in it but it’s not his passion and not what he ended up wanting to do. So he now works in another field. Just be prepared to work hard, and if it is something that you want to do then the rewards will be great. I graduated in 1999 and got my license in 2001. When I got my degree, I worked with an agency working with children and families. I worked to gain hours towards licensure there. I worked at one agency for that, and after I became licensed I worked at another agency. As is fairly typical for the first job out of school, I was at an agency where I was working with very high-risk populations and working long hours and seeing many clients. The good thing about that is you complete your hours for licensure quickly. I started my own private practice in 2002 on a very part-time basis. I quit my job at the agency very soon after I started my practice and devoted my time to it all the way. I’ve been doing it ever since. In order to be successful in this profession you have to be comfortable with yourself. You have to be facile with language. It’s all about being able to communicate well. And I think you have to be honest, because clients will pick up insincerity very, very quickly, and that can destroy the whole process. You really have nothing unless you have a good relationship with the clients and they trust you and believe that you are there to help them, and that you really care.” 20

PERSONAL QUALIFICATIONS IF YOU’RE CONSIDERING A CAREER AS A MARRIAGE AND FAMILY THERAPIST,

chances are excellent that you like interacting with people on an emotional level and that others feel comfortable sharing their problems with you. But what other personal qualities will you need in order to be successful in this field? Emotional stability is crucial. This means that you can express compassion without allowing the problems of others to weigh you down. You must be able to separate your feelings from those of your clients. And, of course, you can’t bring your own problems into the office. It is easy to get burned out in this career if you can’t appropriately manage your own feelings and problems. Marriage and family therapists must have exceptional communication skills, which includes both the ability to speak well and to listen well. Good written communication skills are also important because you will frequently be writing notes about your sessions. You must be nonjudgmental and accepting of people from different backgrounds and beliefs. You have to act ethically at all times in your professional life and can’t be rigid in your thinking. Good analytical skills are also important. A good therapist will not become unsettled when dealing with ambiguity. There are usually no black-and-white answers when it comes to mental health and there will be many times when the right path to take is not clear. You will need to be able to accept this fact without becoming frustrated or confused. Other important characteristics include empathy, warmth, trustworthiness, and the ability to set boundaries with your clients. Successful marriage and family therapists also tend to be creative and intuitive.

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ATTRACTIVE FEATURES OF THIS CAREER THE PERSONAL SATISFACTION THAT GOES ALONG WITH HELPING PEOPLE IMPROVE

their relationships and better their lives is perhaps the greatest reward of being a marriage and family therapist. It’s a great feeling to know that you have made a real difference in the lives of others. You will play a substantial role in keeping marriages intact, preventing suicides, helping children succeed in school, lifting individuals out of depression, and so much more. Another attractive feature of this career, especially for those trying to balance their work and home lives, is the flexibility it affords therapists to plan their own work schedule around personal needs. It is also appealing to have the option of either being self-employed or working as an employee. Through their education and work, marriage and family therapists often develop an increased ability to solve their own family problems and a deeper appreciation of their family. They are also able to hone their communication skills. Marriage and family therapists report that their days are varied and challenging. Consequently, there is rarely a dull moment in this profession.

UNATTRACTIVE FEATURES WHILE CERTAINLY REWARDING, SPENDING YOUR DAYS HELPING OTHERS DEAL WITH

their problems can also be stressful and emotionally draining. It requires skill to be able to demonstrate sympathy and compassion to your clients while at the same time maintaining a comfortable professional distance from them. If you bring your clients’ problems home with you, you’re likely to burn out at some point in your career. Setting boundaries with your clients can also be a challenge. Some expect you to be available to them 24 hours a day, seven days a week, but that is neither professional nor prudent. Also, because many agencies are understaffed, resulting in heavy caseloads for therapists, a high level of emotional and mental energy is required to keep up with the work. If you want to have your own private practice, you will need to be business savvy in order to be successful. Keep in mind that with a private practice you will have the expense of renting or purchasing 22

office space and all of the overhead costs that go along with that. Moreover, therapists in private practice often report feelings of isolation and loneliness while at work. The unfortunate reality is that an investment in malpractice insurance is necessary in order to protect yourself from a client who may want to sue you. Even if the agency or institution that you work for has comprehensive malpractice insurance to cover its staff, it is recommended that you still obtain your own insurance to protect yourself in case of any loopholes. This career requires you to spend considerable time doing paperwork. You must keep careful records of each session. If you accept insurance, that requires an additional layer of paperwork. While this career offers you some flexibility in planning your weekly schedule, you may need to work night and weekend hours to accommodate those clients who are in school or at work during the weekday.

EDUCATION AND TRAINING YOU WILL NEED THERE ARE THREE EDUCATIONAL PATHS AVAILABLE TO THOSE SEEKING TO BECOME

a marriage and family therapist. Individuals may attend a master’s degree program, a doctoral degree program, or a post-graduate clinical training program. Whichever path you choose, you will be trained in the diagnosis and treatment of mental disorders and learn about human growth and development, behavioral patterns, marital and family interaction, sexual dysfunction, parent-child relationships, and the dynamics of family systems. You will also be taught a variety of therapeutic techniques and processes. Master of Arts or Master of Science programs typically require two to three years to complete. These programs cover broad areas of theory and practice in marriage and family therapy. Students take clinical courses in the first year and start seeing clients during the second semester of the first year. Students are required to complete 500 hours of supervised clinical practice. Courses may have such titles as: introduction to marriage and family therapy practice; system dynamics in a group setting; introduction to family systems; couples therapy and techniques; marriage and family therapy ethics and issues; assessment in marriage and family therapy; introduction to cultural diversity; sexual issues for 23

the helping professional; family theories in family therapy; applied research in social work; statistical thinking; child development theory and family therapy interventions; marriage family therapy practice in substance abuse. Doctoral degree programs generally require three to five years to complete. Students need a minimum of 1,000 clinical hours providing therapy and 200 hours of supervision to graduate with a doctoral degree, some of which may be transferred from their master’s programs. The doctoral program in marriage and family therapy is designed to provide students with an understanding of advanced theory and expertise in process and outcome research methodology. This training provides advanced instruction in marriage and family therapy research, theory construction and supervision. It is preparation for teaching, research, advanced clinical practice, and supervision. Students are trained in advanced theory, research, and teaching in the field of marriage and family therapy. The third educational path that can lead to a career in marriage and family therapy is available to those who have already earned a graduate degree in another mental health field, such as psychiatry, psychology, clinical social work, or psychiatric nursing. They may attend an accredited post-graduate degree clinical training program that provides clinical education in marriage and family therapy. Programs may provide specialized training in a particular modality or treatment population and generally require two to four years to complete. The American Association for Marriage and Family Therapy’s (AMFT) Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) is the national accrediting body for graduate and post-graduate educational and training programs in the field of marriage and family therapy. For a listing of accredited programs, visit the AAMFT website at www.aamft.org. Currently, 48 states and the District of Columbia support and regulate this profession by licensing or certifying marriage and family therapists. The regulatory requirements in most states are substantially equivalent to the American Association of Marriage and Family Therapists Clinical Membership standards. After graduation from an accredited program, a period, usually two years, of post-degree supervised clinical experience is necessary before licensure or certification. When the supervision period is completed, the therapist can take a state licensing exam, or the national examination for 24

marriage and family therapists conducted by the AAMFT Regulatory Boards. This exam is used as a licensure requirement in most states. You should check with the licensure board in your state for its licensure or certification requirements. Licensure or certification laws for marriage and family therapists provide a mechanism for the public and third-party payers to identify qualified practitioners. Marriage and family therapists who obtain this license or certificate have met high educational and clinical experience criteria. All states require a master’s or doctoral degree and supervised clinical experience. The most common titles used for this license are Marriage and Family Therapist or Marital and Family Therapist. License renewal requires the completion of continuing education credits. These can be earned by taking workshops and seminars periodically.

EARNINGS THE AVERAGE ANNUAL SALARY FOR MARRIAGE AND FAMILY THERAPISTS

nationwide is about $45,000. Most earn between $35,000 and $55,000. A few earn $25,000, and some earn as much as $75,000. Most marriage and family therapists do not work full time. The average is 15 to 20 hours per week. Charges per session can range from approximately $65 to $125 or more per hour. Many of those in private practice have supplementary sources of income, such as a part-time clinical affiliation. Self-employed marriage and family therapists with well-established practices usually have the highest earnings, however, they do not receive the fringe benefits that full-time employees typically receive. The top paying states for this occupation are Wisconsin, New Jersey, Oregon, Nevada, and Hawaii.

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OUTLOOK FOR THIS CAREER EMPLOYMENT OF MARRIAGE AND FAMILY THERAPISTS IS EXPECTED TO GROW

rapidly over the coming decade. There are many reasons for this. One is that therapy has become a widely accepted way to get help with everyday problems, not just serious mental illnesses. Therefore, it is becoming increasingly common for people to turn to a mental health professional for help with relationship issues and marriage, and family therapists are realizing the rewards of this growing enlightenment. Health maintenance organizations (HMOs) have become increasingly accepting of marriage and family therapists, although they are motivated by the bottom line. Because their services generally cost less than those of psychiatrists and psychologists, it’s not surprising that HMOs would prefer their members to seek them out. Another contributing factor to the optimistic outlook for employment of marriage and family therapists in the coming years is the proliferation of employee assistance programs. These programs provide mental health services to employees of participating companies, and more than half of all employee assistance programs employ marriage and family therapists as staff members or contracted providers. Marriage and family therapy is also increasingly in demand because of its relatively brief, solution-focused, family-centered approach, and its demonstrated effectiveness. In fact, research indicates that marriage and family therapy is at least as effective as individual treatment for many mental health problems such as adult schizophrenia, mood disorders, adult alcoholism and drug abuse, children’s conduct disorders, adolescent drug abuse, anorexia in young adult women, childhood autism, chronic physical illness in adults and children, and marital distress and conflict. Recognition of marriage and family therapists by the federal government and the 48 states that require licensure or certification has also helped this profession to grow.

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STARTING YOUR CAREER AS A STUDENT IN A MARRIAGE AND FAMILY THERAPY PROGRAM, YOU WILL BE

required to complete many hours of clinical practice. For some students, this can become an entry into their first job if they are lucky enough to work at a place that is hiring, and they did an outstanding job. Others can use the resources available at their school to make connections, polish their résumés, and learn about job openings. You will find that most accredited programs offer comprehensive career guidance services. After graduation from an accredited program, a period of usually two years of post-degree supervised clinical experience is necessary before you are eligible for licensure or certification in most states. When the supervision period is completed, you may have to take a state licensing exam conducted by The Association of Marriage and Family Therapy Regulatory Boards (AMFTRB). Be sure to familiarize yourself with the laws of the state where you intend to practice regarding licensure or certification requirements. Obtaining your license should be a primary goal as you go about selecting your first job. To do so, you will almost certainly have to work under a licensed professional for a period of time until you meet the supervised experience criteria for a license in your state. You will want to work somewhere that provides the type and scope of supervision required by the board of the license that you are working toward. When starting your career, turn to the professional associations, particularly the American Association for Marriage and Family Therapy (AAMFT). The AAMFT has a very useful Job Connection service on its website at www.aaft.org. If you become a member of the AAMFT, you can search for a job and post your résumé on this site. If your goal is to have your own private practice, you first need to get some experience at an agency or institution and try to build up a client base as well as professional contacts. Once you have your license and several years of experience, you are well on your way to establishing a successful career in this field.

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ASSOCIATIONS  American Association for Marriage and Family Therapy

www.aamft.org  American Family Therapy Academy

www.afta.org  International Association of Marriage and Family

Counselors www.iamfc.com  National Council on Family Relations

www.ncfr.com

PERIODICALS  American Journal of Family Therapy

www.tandf.co.uk/journals/pp/01926187.html  The Family Journal

www.iamfc.com/family_journal.htm  Family Process

www.familyprocess.org  Family Therapy Magazine

http://www.aamft.org/resources/Product_Events/FTMPage /FTM_Online.asp  Journal of Consulting and Clinical Psychology

www.apa.org/journals/ccp  Journal of Marital & Family Therapy

www.jmft.net  The Journal of Marriage and the Family

www.ncfr.org/journals/marriage_family/home.asp

COPYRIGHT Institute For Career Research 2009 CAREERS INTERNET DATABASE www.careers-internet.org

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