View of the MFT field on the internet vs in reality

[jay73sun]

I am seriously considering accepting my offer of admission at a COAMFTE accredited MFT program at a public institution in Texas. I reside in a big metro area (Dallas). Whenever I look at forums or threads, I often see discouraging sentiments with the most common ones being "the LCSW is much more versatile" or even "you may not find a job as an MFT." Although eager to get started, I would personally prefer not to invest time and resources to pursue the license I want, if it is really going to be as tough and near-impossible as the Internet has generally made it seem like it's going to be, post-graduation.

I have researched and am aware of the fees associated with licensing, continuing education credits, the need to accrue hours to become fully licensed and pay for supervision (once every week?), etc. Putting this out there to see if anyone who has gone through it and is currently in the field can speak to the environment for new grads -- from any part of the country.

For someone who attempts to complete the steps to get licensed, wouldn't it be more likely than not that they will be able to practice professionally? Curious as to whether I am missing something major about the current state of this field and with this thread being one of the only primary, direct sources of knowledge, I'd be thankful for your time in responding.

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[summerbabe]

Although eager to get started, I would personally prefer not to invest time and resources to pursue the license I want, if it is really going to be as tough and near-impossible as the Internet has generally made it seem like it's going to be, post-graduation.

It depends on what you want to do professionally. I know plenty of MFTs who are happily employed, including some who are likely doing pretty well for themselves.

Where you will see limitations are the types of agency-based jobs that hire MFTs. For example, hospitals, VAs, and community mental health settings are much more likely to hire social workers and even LPCs. That's not to say there aren't jobs in these settings (I work in the VA and we seem to be hiring more MFTs as we expand couples counseling options and I've trained in hospital settings that had MFTs employed in residential programs) but for the most part, a lot of MFTs seem to end up in private practice since all you need is a license.

There is some variability in what LCSW can bill Medicare/Medicaid that MFTs cannot but more importantly, MFTs take a systems approach to treatment whereas other professions are more aligned with the medical model.

I can't speak to licensing directly since I'm a psychologist but given that the MFT is very popular in some states and probably barely existent in other states, portability could be an issue. But if you plan to stay in Texas, you should be fine. There are definitely predatory for profit Master's level programs out there but something in the UT/Tx St system is a great bet. Good luck!

 

[R. Matey]

Yeah, the issue with MFT training can be (in some programs) the emphasis on the family systems training at the expense of diagnostic training, which makes it's difficult sometimes to compete for certain agency jobs against LCSWs and/or LPCs. That being said, you want what you want and it is possible. I've worked with MFTs in agency jobs who were doing more family therapy and/or couples. A lot of folks I've known who went this way took an agency positions at a child/family oriented CMHC and then moved into PP afterwards. But, is it more restrictive than the LCSW or even the LPC? From what I've seen? Yep.

Another thought would be to start with a more versatile degree and then specialize during your licensing hours or post-licensure.

 

[jay73sun]

Yeah, the issue with MFT training can be (in some programs) the emphasis on the family systems training at the expense of diagnostic training, which makes it's difficult sometimes to compete for certain agency jobs against LCSWs and/or LPCs. That being said, you want what you want and it is possible. I've worked with MFTs in agency jobs who were doing more family therapy and/or couples. A lot of folks I've known who went this way took an agency positions at a child/family oriented CMHC and then moved into PP afterwards. But, is it more restrictive than the LCSW or even the LPC? From what I've seen? Yep.

Another thought would be to start with a more versatile degree and then specialize during your licensing hours or post-licensure.

Thank you for your insight R. matey. Do you happen to know if those who are in the process of accruing hours for full licensure after graduation are able to make a living to support themselves? Or is it more common to see people work another job?

 

[jay73sun]

It depends on what you want to do professionally. I know plenty of MFTs who are happily employed, including some who are likely doing pretty well for themselves.

Where you will see limitations are the types of agency-based jobs that hire MFTs. For example, hospitals, VAs, and community mental health settings are much more likely to hire social workers and even LPCs. That's not to say there aren't jobs in these settings (I work in the VA and we seem to be hiring more MFTs as we expand couples counseling options and I've trained in hospital settings that had MFTs employed in residential programs) but for the most part, a lot of MFTs seem to end up in private practice since all you need is a license.

There is some variability in what LCSW can bill Medicare/Medicaid that MFTs cannot but more importantly, MFTs take a systems approach to treatment whereas other professions are more aligned with the medical model.

I can't speak to licensing directly since I'm a psychologist but given that the MFT is very popular in some states and probably barely existent in other states, portability could be an issue. But if you plan to stay in Texas, you should be fine. There are definitely predatory for profit Master's level programs out there but something in the UT/Tx St system is a great bet. Good luck!

Thank you for your response and support, summerbabe - it is much appreciated!

 

[summerbabe]

Do you happen to know if those who are in the process of accruing hours for full licensure after graduation are able to make a living to support themselves? Or is it more common to see people work another job?

I live in a poor state in the South and there are licensed Master’s level therapists in my state making $35,000 a year working full-time in a community mental health setting. I also know people in private practice who probably gross more than I do as a VA psychologist (but are on the hook for their own health insurance, retirement, etc).

Basically, there’s gonna be a wide range and factors such as where you can/want to work and what type of clientele you want to work with (e.g., Highland Park Dallas with steady cash pay referrals versus community mental health agency in the Rio Grande Valley) and business acumen if you go into private practice will influence what you end up making. If the private practice ‘hustle’ and its unpredictability doesn’t seem appealing, you’re more likely to hit a ceiling on your earning potential working an agency or in somebody else’s practice.

You can also take a look at online therapy startups as a floor for private practice earnings. Doctor’s on Demand pays $60 for each hour long session with a psychologist. It’s probably significantly less for a Master’s level therapist and don’t forget about taxes and whether the company provides benefits or not.

 

[R. Matey]

Thank you for your insight R. matey. Do you happen to know if those who are in the process of accruing hours for full licensure after graduation are able to make a living to support themselves? Or is it more common to see people work another job?

You can expect to make around ~35-40k depending on where you're living at some CMHC job right after graduation. There are also postmaster's fellowships now for licensing hours, which I think is a significant improvement on how the system used to operate because training is a dedicated part of the work experience. I think the pay might be the same though.

Some folks attempted PP right after graduation and had a second job outside the field. I don't recommend doing that.

 

[Lukewarm Counselor]

the issue with MFT training can be (in some programs) the emphasis on the family systems training at the expense of diagnostic training

True. But this is also true with some LPC programs, as well. Even CACREP does not mandate diagnostics as one of their core areas of training. The program I did (MA Counseling) had two 3-credit courses in diagnostics, which, sadly, is on the higher end for these programs. (Only so much a program can squeeze into a 60-hour program, though.)

To anybody considering a masters program in counseling or MFT: Look for a program with a strong curriculum in [consuming] research, assessments, psychopathology, and diagnostics. The "art" of counseling is very much a science first and foremost. I cannot even imagine treating clients without having a foundational understanding of research or in assessments/diagnostics.

Even with a stronger background in diagnostics than many of my mid-level peers, I still much prefer to have a doctoral-level clinician (psychologist or PhD counselor) do the diagnosing and the treatment-planning. Many folks forget this was the original plan for us mid-levels. In a perfect world, we will have a psychologist do the intake, assessments, diagnosing, and treatment-planning, and then just hand us the client along with the treatment plan. The problem is there are so few psychologists in my area. So, us mid-levels must often do the diagnosing. (And don't even get me started on the unsubstantiated diagnoses I have came across from other mid-level clinicians.)

 

[R. Matey]

True. But this is also true with some LPC programs, as well. Even CACREP does not mandate diagnostics as one of their core areas of training. The program I did (MA Counseling) had two 3-credit courses in diagnostics, which, sadly, is on the higher end for these programs. (Only so much a program can squeeze into a 60-hour program, though.)

Take a closer look at CACREP standards. Specialization programs in CMHC and MFT both require some level of training in diagnostics (See Section 5).

Even with a stronger background in diagnostics than many of my mid-level peers, I still much prefer to have a doctoral-level clinician (psychologist or PhD counselor) do the diagnosing and the treatment-planning. Many folks forget this was the original plan for us mid-levels. In a perfect world, we will have a psychologist do the intake, assessments, diagnosing, and treatment-planning, and then just hand us the client along with the treatment plan. The problem is there are so few psychologists in my area. So, us mid-levels must often do the diagnosing. (And don't even get me started on the unsubstantiated diagnoses I have came across from other mid-level clinicians.)

I don't know if it was the original plan, but I used to see that in practice much more than I do now. Speaking as a psychologist, I would much prefer a MD-PA relationship with counselors and social workers where I could oversee their treatment plans. Part of the problem though is master's level clinicians are often expected to function as generalists in applied settings and psychologists, generally speaking, ending up specializing in a few areas. In that respect, you could view midlevels as a form of secondary prevention and psychologists as providing specialized intervention. It's complicated because psychologists don't necessarily the position of only seeing the most difficult patients nor do firms necessarily want to pay for it.

 

[Lukewarm Counselor]

Take a closer look at CACREP standards. Specialization programs in CMHC and MFT both require some level of training in diagnostics (See Section 5).

Fair enough, it is indeed there in the fine print. I just meant that diagnostics is not one of their eight core areas of curriculum. See "What subject areas comprise the counseling curriculum?" at:

Program FAQs - CACREP

www.cacrep.org