Marriage and family therapists

Type of Psychology: Clinical; Counseling; Consulting; Developmental; Family; Psychotherapy; Social

Marriage and family therapy is a specific profession in the mental health field which focuses on understanding problems based on a relational and systemic worldview. Marriage and family therapists are licensed professionals who do clinical psychotherapy with individuals, couples, and families. They help to mediate family conflicts and address mental health issues.

What is a Marriage and Family Therapist?

Most people are familiar with the applied psychology and social work professions, however marriage and family therapy is not as well known. This is probably because the marriage and family therapy (MFT) field is still relatively new. MFT is unique in its focus on working with clients in a relational manner. This means that often MFT's will see more than one person at a time for therapy, either a couple or an entire family. The MFT profession holds a belief that no one operates alone. Everyone is affected by their relationship with others, and it is not possible to assist people in addressing their problems without considering these relationships. MFT takes a systemic approach that explores the interactions, feedback loops, and circular impact of problems.

History

The family therapy movement began in the 1950s, when psychologists started to gain insight into the impact of family dynamics on psychological disorders and struggles. Prior to this, all therapy and mental health was focused solely on the individual. It was believed that an individual may have a personal defect or internal flaws specific to them until child psychologists began to recognize the profound impact parents, families, and other relationships have on an individual's mental health. Following World War II, researchers found evidence that families were greatly influenced by those coming home from the war. The "schizophrenogenic mother" was a now-debunked theory developed in the beginning of the creation of marriage and family therapy; this described how a mother was thought to create confused and inadequate children leading to schizophrenia through her passive and cold interactions. Although this was later discredited, it did begin the thought process of family impact on mental health disorders. Family therapy progressed looking deeper into relational dynamics, feedback loops, and explored ideas of how to create healing in people's lives. Among others, the originators of family therapy include Gregory Batson (double binds), Murray Bowen (intergenerational), Jay Haley and Don Jackson (furthered resesarch on schizophrenia), John Bowlby (attachment), Nathan Ackerman, Carl Whitaker, Virginia Satir (experiential), and Salvador Minuchin (structural family therapy).

Underlying Philosophy

The overall philosophy of the marriage and family therapy field revolves around the emphasis put on people as relational beings. All humans are influenced by the relationships in their lives or even the absence of relationships. Marriage and family therapy views problems as a systemic collection of experiences that have influenced a person's way of functioning. This worldview is different from other mental health professions, as problems and people are often viewed through a more individualistic and possibly deficit-based perspective. Clients may notice the difference in the questions, focus, and interventions marriage and family therapists will use to create goals, process information, and help create change.

Marriage and family therapists often utilize different theories than other helping professions, which have all been created in reaction to the original family systems theory. Family systems theory was expanded into intergenerational family therapy created by psychiatrist Murray Bowen in the 1960s while working with patients suffering from schizophrenia and their families. He changed his approach from focusing on internalized issues of the patient to explore the relational impact of their families. Bowen focused his theory on understand the family of origin impact on people in which the goal of therapy was to increase awareness of patterns in order to help clients increase functioning. Following the family systems theory, many other theories have emerged either expanding this belief or introducing a new perspective. These theories include the following: structural family therapy, strategic family therapy, humanistic (experiential/Gestalt therapy), object relations (attachment), narrative therapy, emotional focused therapy, and solution focused therapy. All of these theories originate from a systemic approach. They vary in how they understand how change happens. For example, structural family therapy focuses on the relationships and patterns in the family and believes that change happens through altering the structure of the family. Narrative therapy focuses on how meaning is developed through experiences in our lives creating a problem storyline and believes that change happens through insight around the meanings and working to find alternative and preferred meaning in one's life.

Cognitive behavioral therapy and psychodynamic theory are also used by MFTs; however, they were not originally developed as a systemic theory. MFTs also incorporate approaches that reflect the most current, evidence-based approaches to therapy such as eye movement desensitization reprocessing (EMDR) and trauma-focused cognitive behavioral therapy.

Education and Training

Marriage and family therapy is a specific form of psychotherapy involving viewing clients and their problems through a relational perspective. MFTs begin with entering a master's level program, which is generally two to three years in length. To be accepted into a graduate program, the individual must already have a bachelor's degree. This degree may be in psychology, nursing, social work, education, or other counseling-related fields. If the applicant does not have a bachelor's degree in a helping profession, they may be required to complete additional coursework before being considered. They will have the option to go to marriage and family therapy doctorate programs or may choose to go clinical psychology or counseling doctorate programs. However, unlike some other mental health professions, having a master's degree in MFT will allow for licensure, owning a private practice, and affords the ability to supervise others. Marriage and family therapy has been recognized as a core mental health profession. Other mental health professions in this category include psychiatry, psychology, social work, and psychiatric nursing.

After completing a MFT graduate program students go into an intern or trainee phase of their learning. This is regulated on a state to state basis. During the intern phase the professional is required to work in the field seeing clients and needs to keep track of their own clinical, supervision, client advocacy and other professional development hours. All fifty US states recognize the MFT profession and administer the licensure according to their own state regulations. For example, in California, registered interns are required to have three thousand clinically supervised hours. The supervisor is a licensed professional (at least two years) who has completed the approved supervisor requirements and is responsible for overseeing the cases and signing documentation. In New York State graduates have a limited permit and are required to do 1,500 clinically supervised hours before they are eligible to sit for the licensing exam. The American Association of Marriage and Family Therapy provides standards of the profession that all of the state licensure aim to meet. This association accredits universities that meet the high standards of the profession. Often it will take approximately two to four years after the degree to complete the requirements to sit for the licensing exam.

All of the states require interns to complete relational hours which are distinctive to this specialty. Interns must see a large number of couples and families to get their hours. Due to the emphasis on the relational and systemic approach of MFT these hours are very important. Working relationally can be a challenge for mental health professionals since the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which serves as the guideline for understanding mental health disorders is individual based. Marriage and family therapists see problems as less within the individual client or patient and more as resulting from the system of relationships that has become dysfunctional, causing stress and conflict. Since this is not the norm in how American culture explains and understands personal issues, learning to think systemically requires a learning curve for MFTs. In more recent years there has been some shift in this viewpoint, as the DSM now includes some relational disorders and other mental health professionals are opening up their theories and interventions to include some systems ideas.

Supervision

Perhaps more than other clinical specialties, the MFT profession focuses on supervision. Supervisors are expected to fill a combination of roles that includes supportive, didactic, and therapeutic, as well as serving as the gatekeepers of the profession. Although supervisors cannot act as the trainee's actual therapist, there is often a therapeutic-like relationship of support and learning. Supervisors have a large impact on the philosophy and the practice of their interns. They must share their supervision philosophy to provide transparency in their approach. Supervision may be provided for the interns at their place of employment or on some occasions interns are responsible for seeking out and paying for their own supervision. The intern must be in supervision the entire time they are counting hours toward their licensure. The supervisor is the one who is overseeing all of the clinical cases and it is their job to ensure clients are receiving the appropriate care. Supervisors are also seen as the gatekeepers for the profession, as it is their responsibility to make sure that the intern's follow the main ethical standard of doing no harm. They provide feedback for the intern on their abilities, successes, and areas for improvement. It is also possible for a supervisor to provide feedback that an intern may not be appropriate for the profession.

Live supervision is also common to the MFT profession and highly prized. A supervisor either watches the intern's therapy sessions on video, through a one-way mirror or by actually sitting in on the sessions. Although this can be a stressful experience for interns, it also yields a large amount of feedback. Supervision in other fields such as social work or psychology often is done through case consultations. The professional reports back to the supervisor about what happened in the session and what they feel worked and what did not. Case consultations are also used by MFT supervisors; however, live supervision provides all the details of the session that can be left out or overlooked in the session. For example, if a supervisor is watching a session they have the ability to pick up on nonverbal cues such as eye contact, body language, and tone. Since nonverbal communication represents a huge portion of expression, these elements are extremely important in understanding clients. Therefore the added value of live supervision is that it provides much more information for the supervisor than simply being told about the therapeutic process.

Law and Ethics

The practice of marriage and family therapy is governed through state laws and the ethics code of the profession. There is an ethical code written by the American Association of Marriage and Family Therapy which includes all the expectations of how therapists should behave and how to ensure that they do no harm to their clients. The code of ethics is not only taught in training programs but is highly tested on the licensing exams and is also required to be part of a continuing education post licensure. The laws of marriage and family therapy vary slightly from state to state. These laws include information of mandated reporting, where clinicians are required to break confidentiality to report suspected abuse, suicidality and homicidally. Licensed professionals are required to keep current on the changing legal and ethical codes of the field.

Practice

Marriage and family therapists have the ability to practice in many different settings. Among these include private practice, hospitals, community clinics, substance abuse treatment centers, residential facilities, or nursing homes. Most of the agencies that hire mental health professionals will consider MFTs for the position. There are a few agencies that may be behind on this since MFT is still seen as a newer field than social work and psychology. Marriage and family therapists who possess a doctoral degree will also be considered for academic jobs at universities. On a rare occasion even MFTs with only a master's degree may be able to do some adjunct teaching at most universities. Marriage and family therapists at a master's level are also able to own their own private practice. This is different from psychology, since psychologists must have a doctorate to own a practice.

Salaries for marriage and family therapists will vary depending on the state and the setting of where they work. Community-based agencies often pay the lowest salary while MFTs in private practice or private facilities will tend to make the most. It is also very common to find MFTs who work at a combination of these settings. Lower income for MFTs is around $30,000 annually while higher incomes reach $80,000 or more. The median income for marriage and family therapists continues to grow in the United States.

Choosing a Professional

When looking to choose a mental health professional there a few things to keep in mind to help you make an educated decision. Psychologists, marriage and family therapists, and social workers all provide therapy and counseling. Psychologists are often the professionals that will do psychological testing and will all have their doctoral degrees. This means that they can offer an expertise in the testing profession and may also be more expensive to see in a private practice. Social workers often work in mental health care agencies and have more of a focus on case management and obtaining resources. Social workers can also advance their degrees to get a doctorate or become licensed clinical social workers, which you will also find in working in private practice. Marriage and family therapists will most likely be master's level clinicians, and their entire training and education experience is around doing therapy therefore they often have more experience in seeing clients right out of school. Whereas psychologists and social workers can focus on other avenues of mental health in their training, such as case management or testing, MFTs focus primarily on doing therapy. Again, this will vary based on the individual as some psychologists will focus their training mostly on doing therapy. There will be a difference in the theoretical approach these professionals take based on their education, training, and also their personality. Overall, regardless of which helping professional you choose to see it is very important to find a person who will be a good fit with you and your needs. Therapists are just people and you will not get along with all of them solely because they are therapists. If you do not feel that the therapist's style is a good fit for you, try another.

Bibliography

Corey, Gerald, et al. Issues and Ethics In the Helping Professions. 9th ed. Belmont: BrooksCole, 2014. Print. This book covers all of the ethical codes that are held by the American Association of Marriage and Family Therapists, discussing in detail the understanding and intention of each code.

Goldenberg, Herbert, and Irene Goldenberg. Family Therapy: An Overview. 8th ed. Belmont: BrooksCole, 2013. Print. This book provides an overview of the history of marriage and family therapy and information of all the systemic theories this field utilizes.

Nichols, Michael P. Family Therapy: Concepts and Methods. 10th ed. Boston: Pearson, 2012. Print. This book offers an introduction to the practice of family therapy.

Todd, Thomas C., and Cheryl L. Strom. The Complete Systemic Supervisor: Context, Philosophy, and Pragmatics. 2nd ed. Chichester: Wiley, 2014. Print. This source covers the meaning behind systems theory and the importance of supervision on the MFT field. It provides information about the role, focus and responsibility of supervisors.