VAMFT Newsletter (v. 4, no. 1)

March 1999

• A Letter from the President
• Families Thriving in the 21st Century!
• Elections Committee Report
• The Development of a Profession
• Recent LMFT Regulations Change: Implications for Non-Licensed Members
• Legislative Committee Report
• A Letter from the President

Spring of 1999 is beginning to bloom and I hope this season of rebirth and beauty inspires all of us to renew our pledges to those people, ideas and projects that we value. I hope everyone has visited our Web Page. You can reach it via either www.therapy.org or www.vamft.org.

The VAMFT Board had an extremely productive retreat in December, and as a result has voted to realign our priorities in order to focus our energy and resources toward 1) third party reimbursement and 2) the 2000 conference.

In the spirit of wrapping up old business, we have put the current Virginia LMFT regulations on the VAMFT Web page and we will continue to alert you as to what we endorse within these regulations and our concerns with them. Although these regulations do not meet AAMFT clinical membership requirements, we believe them to represent training equivalent to the Virginia LPC. (The current LMFT regulations are virtually the same as the LPC with a few course adjustments; a residency providing therapy to couples and families; and the National MFT exam, unless you¹ve earned a Virginia LPC.) The licensing board has recently raised the therapy hour requirement for both the LPC and the LMFT to 2,000 hours out of the 4,000 work hours required. This is a national average and is the same as several neighboring states¹ requirements. Please note that a COAMFTE accredited internships hours can be used toward these hours and ALL RESIDENT MFTs MUST register their supervision with the Licensing Board for their work and therapy hours to count toward the license. Please obtain a copy of the current LMFT regulations and please read the regulations carefully. Please also note: AAMFT has a new Code of Ethics that went into effect July 1, 1998.

In keeping with the members' requests, the VAMFT Board has now turned its focus and energy to obtaining third party reimbursement and professional parity. Here is the Board¹s parity action plan. We know our members have many hidden talents, skills, and connections. Please share with us your wisdom and experience toward any of these objectives or to expand our list.

1. Task forces being built to go to third party payers and potential employers (in progress)
2. Virginia Clinical Member Referral Directory - May 1, 1999 (see Article 7)
3. MFT Marketing Brochure - Summer 1999, watch the VAMFT webpage for ordering information
4. Regional Town meetings on Parity - Fall 1999

Get out your calendars and get excited!!!! The next VAMFT Conference: "Families Thriving in the 21st Century" is scheduled for April 28 &29, 2000 in Williamsburg, Virginia. We, as Marriage and Family Therapists, believe in the human spirit, community initiative and the power of compassion. We will be sharing these ideals and ideas with each other as we strive to do our very best to help Virginia's families thrive in the 21st century. In the spirit of collaboration, we will be inviting a wide variety of both mental health professionals and other volunteers and professionals who work with individuals, couples and families. We are calling for family therapists to share their work helping people to prevail when faced with a wide range issues such as: violence, mental illness, drug addiction, trauma, chronic illness, poverty, divorce and death. We are encouraging a broad definition of family, and attention to working with people with respect and cultural sensitivity.

Currently we have the following people as having volunteered for the conference committee: Yvonne Barry, Jeanne B. Burger, Mark Bodwalk, Melba D. Hendrix, and Kelly McCracken. Please check the conference committee box on the enclosed survey if you¹d like to join this committee. If you¹ve already turned in your survey, you can write or e-mail Anne Prouty to join this committee. The call for presentation submissions is enclosed in this newsletter. Please feel free to copy it for colleagues. Submissions are due to the VAMFT office in Blacksburg, Virginia by July 1, 1999.

Fall 1999 is fast approaching and we will be electing several new VAMFT board positions. However, prior to this election the current VAMFT Board will be proposing a VAMFT Bylaw change. The Board has found it difficult to learn its many functions with so many new members. Hence, this summer it will be proposing that the officers' terms be staggered to allow for memory retention and consistency across elections. We want to put our energy toward VAMFT issues, not reinventing the wheel every two years. Please think on this. Ballots for this vote, along with a more detailed explanation, will go out in early summer.

In the last 14 years, I've had discussions with many of our members about the development of the profession of marriage and family therapy, and how that compares and/or contrasts with human developmental stages and cycles. Roughly, we have tried to correlate different stages of human development with the emergence and maturation of the profession. While those analogies have proven interesting, at this point, at least, I'm not sure how relevant or useful they are. Here is why: human development is a natural thing--once set in motion, barring disaster or disease, humans will progress through different developmental stages--physically, mentally, and emotionally. This seems to be true across culture, race, and ethnicity.

Professions, on the other hand, are not natural organisms. In many ways, all professions are socially constructed realities; things we create out of will, force, and persistence. If the professionals who comprise the profession do not invest in its continued development and success--"give something back" in common parlance--the profession will wither, or be subsumed by some group which is investing will and energy (physical, mental, and emotional force).

Granted, a profession still has to fill a societal need in order to be considered valid, and to be valued. Some professions, despite the investment of the professionals, are overtaken by time and/or technology. For better or worse, though, that will never happen to the profession of marriage and family therapy. There will never be technology to help us build families, and as long as there are humans, there will be family groupings. We are by definition skilled but "low tech" and timeless, as a profession.

Perhaps a better analogy to our emergence and maturation as a profession is a small redwood sapling in an old growth forest. Yes, it has the potential to become a mighty tree of stature. But, there are many other larger trees blocking the light, and taking nutrients from the soil. Without care and feeding, the tree may die. And, in many respects, its up to someone besides the tree to make sure that it prospers over time. While the tree can do some things on its own, it is environmentally dependent, particularly early in life, on the environment, or human hands, to provide optimal conditions for growth. Marriage and family therapy is emerging. We have made tremendous strides, despite the other, larger trees, and the forest fire of managed care. Despite that progress, though, we are not fully viable without every member contributing to the well-being of the profession.

The Board of Directors, to further the development of the profession, has established a bold and ambitious strategic plan. It will require effort from all of us if we are to accomplish the objectives outlined in the plan. And, there is much you can do. Certainly, in this era where demands outstrip resources, giving time is difficult. However, if every member gave one hour a week back to their profession, doing public education, lobbying letters, or other work defined by your division, think how much impact that would have. Giving to your division's PAC or legislative fund is important. Contributing, even small amounts, to the AAMFT Research and Education Foundation furthers important "nutrient enriching activities" for the profession. Whatever each of us can give, we need to find the will to give. Of course, many other things insist on attention. I'm reminded of Steven Covey's quadrant of busyness and activities the urgent but unimportant, the urgent and important, the unimportant and non-urgent, and the important but non-urgent. He emphasizes the vital need to spend more time in the last category--the things that are important, but not demanding our immediate attention. His assertion is that if we invest there, we will receive a longer term and much greater beneficial return. I have found that to be true in my personal life. Think how much more so it would be for the profession if we all acted in that way.

This time of the year is about renewal and action! My hope is that we all take the time to appreciate what the profession has given to us, and the opportunities we have because of it. Further, I hope we can all make a resolution this year to give back to the profession. Not only will the profession be better for it--I believe we will personally be better as well.

Changes in the LMFT regulations were adopted in the Fall of 1998. One of the changes involved an increase in client contact hours for licensure. Although the total hours of supervised work experience (client contact, case notes, consults, meetings, conferences, etc.) remains the same at 4,000, the number of client contact hours has increased from 1,000 to 2,000 (half of which are to be with couples or families). The ratio of client contact to supervision remains the same at 5 to 1.

Prior to this change, AAMFT did not recognize the sub-minimal Virginia LMFT as client contact hours fell below the National standard of 2,000 (some states require 3,000). Furthermore, with the increase, insurance companies in Virginia can consider the LMFT a reimbursable license; prior to the increase, they did not. Although this increase will extend the time required to accrue the necessary contact hours by a year or so, the increase is important for our Virginia LMFT. We have a stronger license that can now allow us to be minimally recognized by AAMFT, insurance companies, and other states. We all benefit from having higher standards!

As a reminder, for supervised work hours obtained in Virginia, all non-licensed members need to register their supervisor with the Licensing Board for the hours to count toward licensure. If you have any questions, please contact me at sedwards@vt.edu.

The 1999 General Assembly session is winding down. A number of bills involving families, and mental health (bills of interest to marriage and family therapists) were introduced, debated and acted upon. I would invite and encourage you to visit the General Assembly¹s web site (http://legis.state.va.us/) and familiarize yourself with the legislative process and the pertinent bills. (There is not enough room in this column to fully inform you of key legislation, but we may be able to find other ways to review this material, possibly by utilizing our web site). Most members of the VAMFT Board are on a VAMFT ListServ, while the VAMFT President and President-Elect are on the AAMFT DivList. Both electronic mail (e-mail) discussion groups have helped increase and improve communication with the central office while sharing and discussing information with VAMFT Board Members between board meetings. Again, I would like to share a few lessons learned from this legislative session and a few thoughts about key issues facing us in the present and in the future.

First, it was much easier to track legislation using the electronic medium of the web. A problem that emerged was that when we (VAMFT) identified a bill on which we needed to take action, we struggled to follow through with the desired action. We learned that we need to have VAMFT membership in the Richmond area on standby, informed and ready to represent us at meetings. We also need these folks for our Regulatory Board meetings. WE NEED YOUR HELP! We need to schedule frequent meetings, maybe monthly, leading up to and during the legislative session so that the Board can collaborate on position statements. At this time, we have a volunteer Board. Due to the complexity of pushing for parity in the present environment, it may be necessary for our organization to consider having staff. Additionally we need to better organize our Board and our membership through the regions. We are doing an adequate job of staying informed, and responding to the most necessary issues, but we need major infrastructure work so that we can be more responsive and action oriented. As the Director of Counseling at Family Service of Roanoke Valley, I receive electronic messages from the social work and counselor organizations and am aware of their higher level of organization and how this organization helps with their legislative efforts.

Second, since being placed under the purview of the Board of Licensed Professional Counselors, Marriage and Family Therapists, and Substance Abuse Professionals, as a counselor and an MFT, I have been thinking a lot about the tension between counselors and MFTs, especially over licensing regulations. It is as if we, (MFTs) have been trying to get out from under the shadow of the counselors in order to have our own identity as the counselors have attempted to get out from under the shadow of the clinical psychologists and the social workers. The clinical psychologists and social workers must find it amusing as the counselors and MFTs struggle with one another.

Having worked in the social work field and taught social work classes, I am aware that social workers embrace the biopsychosocial model which leads them to focus on different size systems (the individual is part of this ecosystemic frame). MFTs have been criticized for not looking at smaller systems (individual psychology) and for not looking at larger systems (community and culture). Counselors have been criticized for being too narrowly focused on individual issues and ignoring larger systems issues. We, MFTs, have both expanded our focus to look at community and culture, and narrowed our focus to look at individual issues, while the counselors are expanding their focus to look at systems. Historically, counselor¹s and MFTs have held lower status in Virginia (as compared to the social workers and clinical psychologists). It may be time for us, counselors and MFTs, to let go of our either/or orientation and adopt a both/and approach.

A reason that we, counselors and MFTs, have found it difficult to form a healthier relationship with each other can be found in Bowenian theory‹both MFTs and counselors continue to struggle with differentiation. Both disciplines need to be fully differentiated before we can have a closer, more intimate relationship (Schnarch, 1991). So, the need by MFTs to make distinctions between counselors and MFTs (as has played out in the regulatory process) is not to reject the counselors and what they believe, but to avoid becoming an "undifferentiated ego mass" with them. We need to explain this to the counselors--that we need to be distinct before we can come together, and to invite them to stop worrying. We need to tell our own people to be more clear about what we believe so that we can learn the counselor's paradigm, just as the counselors need to learn ours, so that with these multiple perspectives we have a better understanding of the bigger picture.

As we become more successful in taking stands, and communicating our positions on issues (as indicated in the first part of this column), we will better define ourselves and facilitate the process of differentiation. If we can maintain our identity while in relationship with other professional groups, without being emotionally reactive, we will also further this process. We need not be angry with the Regulatory Board which is fashioning our regulations, but help them better understand who we are. In doing this we can establish closer relationships, partner with others and achieve a true parity by occupying the same space while still being differentiated. We may also find, in a closer relationship with counselor¹s, that we are more similar to the social workers and have much common ground. Would this be a bad thing? I believe in this way, at a future time, we will be better positioned to lobby for needed mental health services for our clients.

Finally, in response to a question and/or concern regarding the 2,000 face-to-face client contact hour requirement: "Why hasn¹t the Board taken a position against this increase? And, does VAMFT really want to see the experiential requirements for a license in Virginia to be the same as the experiential requirements to be an Approved Supervisor?"

The license in Virginia allows one to establish an independent practice, find some space, put out a shingle, see clients and bill for the service (in the old days). To become licensed, there is need for course work, and supervised clinical experience. The current requirement is for 2,000 hours of direct client contact. There is an assumption that the experience requirements for the license can be attained in approximately 2 years of full-time practice that is predominantly therapy oriented. This requirement is not necessarily for a beginning mental health practitioner, but a beginning mental health practitioner who is able to establish an independent practice of therapy. The two years of full-time clinical practice is what is considered a minimum for the development of the professional maturity to establish such a practice.

The Licensed Counselors used to have this requirement, 2,000 hours of direct client contact, but they dropped it and shifted to 4,000 hours of work that is predominantly counseling oriented. This shift was because there were significant numbers of counselors in contexts where they were not doing sessions (like counselors who were working in residential type settings) but were doing predominantly counseling. The standard (and this seems pretty universal) is a ratio of 2 to 1, i.e., for every 2 hours on the job there is an expectation of 1 hour of therapy. So for someone working full-time (40 hours per week) in a therapy position they would have approximately 20 sessions. It is also pretty standard in the field that to get 20 sessions per week you have to schedule about 25 clients, because about 5 of those will "no show", or cancel. Now if you do this over the course of 2 years, with a 2 week vacation each year you will get the 2,000 hours (20 session hours/week X 50 weeks/year = 1,000 direct client hours X 2 years = 2,000 hours of direct client contact).

Family Service America (the parent organization for Family Service agencies across the country) conducted a survey in the last 5 years to find out what the "productivity" standard was across Family Service agencies (where a lot of family therapy is conducted) and they found it was about 20 something per week. When I worked at a CSB (Community Service Board/Mental Health Services) the productivity standard was 20, but the demand for services and caseload led to between 25-30 hours of direct client contact. In many private, for-profit clinics, they begin to have incentive clauses in their contracts for direct client contact over about 25 hours per week. I have found that 20 client contact hours per week over a career is reasonable, especially starting out, and that as you go along you may provide related services to balance out that 20 per week, like supervision and consultation, but there is still a productivity expectation of about 20 "bill-able" hours per week. It seems like we spend so much of our time "jumping through the necessary hoops" to get to where we want to be only to find another set of hoops. The experiential hours are part of the licensing "hoops" that are part of cost of establishing a professional identity. Through understanding of this relationship, these requirements are no less tiring, and these words are little consolation to a person trying to get to that place.

Schnarch, D. M. (1991). Constructing the sexual crucible: An integration of sexual and marital therapy. NY: W. W. Norton &Company.

We are almost ready to print the first VAMFT Referral Directory. We have heard from about half of the clinical members either by telephone or from the survey in the November 1998 newsletter (the one that came wrapped around your Membership Directory). Thank you for sending those in! Below are two clinical member lists of whom we have verified their business addresses. The first list are those members who DO wish to be in the directory and have given us a business address and telephone number. The second list are those who do Not wish to be included in the referral directory. If your name is NOT on either list, then we have not heard from you. Please know that we have called twice and that this is the second provision of the membership survey. If you are a clinical member we will ONLY include your name and city because we do not want to risk printing your home address and phone number. So, if you have not already done so, please fill out the attached survey. For inclusion in the Referral directory, please return the survey no later than April 1, 199. Print date is May 1, 1999.

All VAMFT members will receive one free copy of the Referral Directory. All clinical members will receive two additional copies for free. If you would like to order more, please send your check for $ 1.75 per directory to VAMFT in Blacksburg by April 15, 1999. After May 1,1999 VAMFT will only print more referral directories in batches of 500 in order to keep costs down.

Confirmed for Referral Directory