State MFT Licensure Requirements

I found a very useful chart of all the requirements for MFT licensure by state from the mftprogress blog that I follow.  He linked this pdf with the information (it's on page 258).  It is several years old, however.  But offers the best state to state comparison that I've come across.  If I get really ambitious I might type it out so it's more easily accessible.

Update:  I found myself in a very productive mood yesterday and this morning, so I transferred the data from the pictures into the following chart.  If you click on link that is the name of the state it will take you to that state's licensing webpage.  While this is proving to be a very time consuming task, I like the resource of seeing the comparison between states of the hours required for a Marriage and Family Therapy license.  I'm not really satisfied with the education requirements as listed on the chart, so I plan to update it...someday.  I know California has quite a few additional courses that are not included in the COAMFTE coursework.  I believe there is a psychopharmacology class among others.  I believe Idaho also required two courses in diagnosis.

State	Education	Direct Client Contact Hours	Direct Hours that must be MFT	Indirect or Other Hours	Supervision	Post Graduate Years of Experience	Other Requirements	Specified Master's degree Credit Hours	Practicum
Alabama	COAMFTE Master's degree or equivalent	1000	250		200 (1:5 ratio) at least 100 hours must be individual	2 years experience post master's degree	Good Moral Character		500
Alaska	Graduate degree in MFT or allied field	1500	1500		200 (100 individual and 100 group)	4 years	Training in domestic violence		One year
Arizona	COAMFTE Master's degree or equivalent	1600	1000		200 hours	2 years			300 hours
Arkansas	COAMFTE Master's or equivalent	3 years with 1000 hours of client contact per years			Year 1=1000 hour with 100 supervision hours; Year 2=1000/50; Year3=1000/25	3 years 30 post master's credit hours may be substituted for one year	Oral exam after passing written exam. Approval of therapy tape. Criminal background check.	60 hour Master's degree	500 hours
California	Master's degree in MFT or equivalent	1700	500	1300	1 to 10 ratio for the duration of supervised post master's experience (1 to 5 during graduate program)	2-6 years	Additional training- Check website for specifics	48 hour Master's degree	500 hours
Colorado	COAMFTE Master's degree or equivalent	1500		500 (0 if a Ph.D)	100, 50 must be individual, 75/37.5 if a Ph.D	2 years for Masters degree, 1 year Ph.D	Jurispreudence Exam	45 hour Master's degree	300 hours
Connecticut		1000 in at least 12 months			100 hours, 50 must be individual	1 year		45 hour Master's degree	500 hours completed in 1-2 years
Delaware	COAMFTE Master's or equivalent	1600	500		100 hours 60 must be individual	2 years			Not specified
District of Columbia	COAMFTE Master's or equivalent	1500	1500		300 (1 to 5 ratio) at least 100 must be individual	2 years	Good Moral Character	60 hours Master's degree	Not Specified
Florida	MFT Master's degree					2 years supervised experience	8 hour law & rules course, 2 hour prevention of medical errors course		PDF of requirements
Georgia	COAMFTE Master's or equivalent	2000	2000		200, 100 with an approved supervisor, 50 must be individual	2-5 years	Criminal Background check		1 year, 500 hours
Hawaii	MFT Master's degree	1000	1000		200 hours	2 years			1 year 300 hours
Idaho	COAMFTE CACREP Master's or equivalent	2000	1000		200 hours, 100 hours must be individual	2 years		60 hour Master's degree	1 year 300 hours 150 MFT hours
Illinois	COAMFTE Master's degree or equivalent	2000	1000		200 (1 to 5 ratio) at least 100 must be individual	2 years	Good Moral Character	48 hour Master's degree	300 hours
Indiana	COAMFTE Master's degree or equivalent	1000	500		200 (1 to 5 ratio)	3 years	Good Moral Character		500 hours
Iowa	COAMFTE Master's or equivalent	1000	1000		200 hours 100 must be individual, 1 hour per week must be face to face individual	2 years		45 hour Master's degree	300 hours
Kansas	COAMFTE Master's degree or equivalent	4000			1 to 15 ratio				500 hours
Kentucky	COAMFTE Master's degree or equivalent	1000	1000		200 hours	2 years	N/A		300 hours
Louisiana	COAMFTE Master's or equivalent, CACREP Master's with MFT coursework	3000, 2000 must be direct client contact		1000	200 hours 100 must be individual face to face (100 if graduate of COAMFTE program)	2 years	Good Moral Character	48 hour Master's degree	500, 250 must be with couples and families
Maryland	MFT Master's or equivalent from an accredited university	1000			100 at least 50 must be face to face individual	2 years	N/A	60 hour Master's degree	300 hours
Massachusetts	COAMFTE Master's degree or equivalent	1000	500		200 at least 100 must be face to face individual	2 years	N/A	60 hour Master's degree	300 hours
Michigan	COAMFTE Master's degree or equivalent	1000	1000		200(1 to 5 ratio) at least 100 hours individual	Not specified	Good Moral Character		300 hours
Minnesota	COAMFTE Master's degree or equivalent	1000	500		200 at least 100 must be individual face to face	2 years	Good Moral Character		300 hours
Mississippi	COAMFTE Master's degree	1000 hours			200 at least 100 must be individual face to face	2 years	N/A		500 hours
Missouri	COAMFTE Master's degree or equivalent	1500	1500		200 face to face supervision hours	2 years (no more than 4 years)	N/A	45 hours Master's degree	500 hours
Montana
Nebraska (Licensed Mental Health provider)	COAMFTE Master's degree or equivalent	1500		1500	2 face to face hours per 15 hours of direct client contact	2-5 years	N/A		300
Nevada	MFT Master's degree or equivalent	1500		A maximum of 300 hours as a group facilitator, a maximum of 150 of personal therapy, a maximum of 200 hours of psychoeducation, a maximum of 50 hours of trainings, and a maximum of 500 hours of direct client contact hours from a graduate program.	300 hours, 160 must be provided by an approved supervisor other can be by secondary supervisor	Not specified	N/A	45 hour Master's degree	Not specified
New Hampshire	COAMFTE Master's degree or equivalent	1000	1000		200 hours face-to-face supervision	2 years	N/A		Not specified
New Jersey	COAMFTE Master's degree or equivalent	Full time practice for 5 years, at least 20 hours of client contact per week		11 hours per week for 5 years	5 years, 2 of which must be in supervised MFT practice. 4 hours of supervision per week, 2 must be face-to-face (1 to 5 ratio)	5 years	Good Moral Character		3 credit hour practicum
New Mexico	MFT Master's degree from a regionally accredited university		1000		200 (100 must be individual face-to-face)	2 years		45 hours Master's degree	300
New York	Accredited MFT Master's degree or equivalent	1500			1 hour per week	Not Specified	Good Moral Character, complete training in child abuse reporting	45 hour Master's degree	300 hours
North Carolina	MFT Master's degree or equivalent	1500 hours	1500		200 hours	3 years	Good Moral Character	45 hour Master's degree	500 hours
North Dakota
Ohio	MFT master's degree or related master's with required coursework	1000	1000		200 (1 to 5 ratio) at least 100 hours individual	2 years	Good Moral Character	60 hour Master's degree	300 hours
Oklahoma	MFT Master's degree or equivalent	1000			150 face to face (75 may be group). Supervisor must ovserve live or on tape 2 times ever 6 months	2 years	Criminal background check		300 hours
Oregon	COAMFTE Master's degree or equivalent	2000	1000		At least 2 hours per month for every 45 client contact hours. 3 hours per month when 46 or more client client contact hours.	3 years	Law and rules examination	48 hour Master's degree	Not Specified
Pennsylvania	COAMFTE Master's degree or equivalent	1800		1800	2 hours for every 40 of the 3600	3 years	Good Moral Character	48 hour master's degree or 60 hours of graduate credit in a planned program	300 hours
Rhode Island	COAMFTE Master's degree or equivalent	2000			100 hours of supervision spread across 2 years	2 years	Good Moral Character	60 hour Master's degree	12 semester hours of practicum and internship
South Carolina	MFT Master's degree or equivalent	1500			150 hours, 100 must be individual face-to-face	5 years of practice, 2 of the 5 years must be under the supervision of an MFT supervision		48 hours Master's degree	300 hours
South Dakota	COAMFTE or CACREP Master's degree or equivalent	1700			200	3 years		48 hours Master's degree	1 year
Tennessee	MFT Master's degree or equivalent	1000			200	2 years	Criminal background check, good moral character		300 hours
Texas	MFT Master's degree or equivalent	1500	750		200, 100 must be face-to-face individual	2 years	Jurisprudence exam	45 hour Master's degree	12 months 9 credit hours
Utah	COAMFTE Master's degree or equivalent	4000 hours must include 1000 hours of mental health therapy	500		100 individual face-to-face hours	2 years			500 hours
Vermont	MFT Master's degree or equivalent	2 years experience under the supervision of a licensed MFT				2 years
Virginia	CACREP or COAMFTE degree or equivalent	2000/w 4000 hours experience	1000		200 (1 to 5 ratio) at least 100 individual	2 years	Good Moral Character	60 hour Master's degree	600 hours
Washington	COAMFTE Master's degree or equivalent	3000, 1000 must be direct contact with clients	500		200, 100 must be face-to-face	2 years	AIDS Education and Training		1 year 9 credit hours
West Virginia
Wisconsin	COAMFTE Master's degree or equivalent	1000 w/3000 hours experience			Not Specified	2 years	N/A		Not Specified
Wyoming	MFT Master's degree or equivalent	3000			100 hours face-to-face supervision

Functional Family Therapy

In my first couples case, my supervisor recommended switching the model of treatment to Functional Family Therapy.  Being another model that we have not covered in our program, I have been struggling to develop a method of approaching treatment with this model.

The concept that I like the most, and have since implemented it almost every couples case, is that there are three outcomes from any interaction between couples.  An action can either create distance between partners, maintain the relationship as is, or bring the couple closer together.  While there is no hard-fast rule of what actions fall into these categories the theorists of Functional Family Therapy have provided some standard examples.

Distancing

Work (especially working another job on the side)

School (especially when only one partner is attending)

A teen learning to drive.

Arguing

Perhaps the most insightful concept of distancing is the consideration of working, learning to drive, or going to school as distancing activities.  It is common to think of only *bad* or *negative* activities, such as arguing, as distancing, but any time spent apart creates a distance.  Working and going to school, or learning to drive, certainly are *good* and many times necessary to have in a relationship.  However, they each create experiences that are not shared between couples.  I'm sure any graduate student that is in a committed relationship would be willing to testify of this truth.  I know it is the case with me and my wife, and all the people in committed relationships in my cohort.  The amount of time spent studying and at school, as well as the rethinking of our own relationships, certainly brings a large amount of stress to our relationships.  It really was an interesting perspective to realize that my work and school (which are both good) created strains on our relationships.

Regulating

Group date outings

Going to a movie (my wife and I find this a little more intimate than regulation, but we do both acknowledge that the movie itself is more regulation.  We enjoy cuddling during the movie and talking about the movie, which are both creating intimacy)

Eating together

Coming closer (creating intimacy)

Sexual intimacy (I am hesitant to just write it as sex, because not all sexual encounters even between loving couples are intimate)

Having deep conversations

After being able to identify, and explicitly doing so, a couple is (hopefully) better able to increase the number of regulation and intimacy activities to balance the distancing ones.

Genograms

As part of the program here at UNLV we meet with a supervisor twice a week for our practicum.  The practicum in which I am currently assigned requires that we make a "case presentation" every few weeks.  As part of this presentation we are required to have a basic genogram (which is basically a family tree).  While genograms are an integral part of Bowenian or Multigenerational Family Therapy, I have really found the technique to be very helpful in early session to bring out more information about the family--especially patterns and interplay between members.  Below is the cheat sheet I use for making genograms.

I Statements (and how to use/teach them) AND Reflective listening

In the early 1970s Thomas Gordon introduced a concept to the family sciences called "I statements: (Gordon, 1970).  It has since become a common and early starting point for couples/group therapy.  It's commonly taught as a way to improved communication and I've used it with my wife as well as clients with great success.  However, I was tricked this week.

We began by briefly introducing the concept of I-statements to a family while helping a family to structure a conversation.  First, the family members began by using I-statements to speak to each other through us (the co-therapists).  As this was progressing well, we then asked the family to move their chairs to face each other, and begin to use these I-statements to speak to each other.  The child then made a statement about his feelings about a disagreement.  The parent then responded with, "I thought I made it clear..."  It was about here that I jumped back in and mentioned the implications behind the statement.  (Being that if the child misunderstood differently the child is dumb because the parent made it easy to understand) It was at this point I realized that I needed to improved my teaching about using I-statements because all my rules had been followed...  So I'm going to work to improve that.



Burr, W.S., (1990).  Beyond i-statements in family communication.  Family Relations, 39(3), 266-273.


Gordon, T. (1970). Parent Effectiveness Training.  New York: Wyden.

Update:

It's been almost a year now since my first attempt get a family to use I statements in session.  They still try to trick me--but I expect it now.  I pretty much always provide people with a template:

"When ______________________________  I feel __________________________."
"When you stay at work until 10pm I feel like I'm not important."


"When you flirt with other women I feel like you don't care about me."
"When you ask me why I didn't take out the trash I feel like I'm never going to be good enough for you."



This exercise pairs very well with reflective listening:

First, one partner says how they feel. Then the other reflects it back.
A to B: "When you work until 10pm it makes me feel like you care more about work than me!"
B to A:"When I work until 10pm it makes you feel like I care more about work than you."
If it was not reflected back correctly, A corrects.

Once A has expressed his/her feelings entirely and B has reflected them, B begins to reflect feelings to A and A reflects them back

Reflective listening is really the ONLY way to ensure that communication and actual understanding is taking place.  Usually we listen to respond/defend.  Which really means we are not listening for understanding.  Why listen at all if not for understanding?

The 5 Love Languages

I've found (not like it was really a surprise my wife would say, I'm sure) that I like having very structured sessions in therapy.  I like lists and structuring just about everything--even if that means I plan to have no plan or structure a session to have no structure.  Does that even make sense?  

So cut to yesterday, a fellow student and I are preparing to go into a session with a couple (it's fairly standard practice here to go co-therapy with couples and families--we like the dynamics and also all need the relational hours) and we make an outline for things to cover in session.  We begin session and start with our list--but it just felt off to us.  We ask a few questions and we get down to an issue of communication and how each partner understands love.

So we began a brief psychoeducation process about the 5 Love Languages developed by Dr. Gary Chapman.    While it can be said that the 5 Love Languages are "pop-psychology", I believe there is a lot of truth to them.

 The basic gist of the 5 Love Languages is that people have different ways of expressing and understand emotions (love).  By this I mean that partner 1 may use a different method than partner 2, but also that partner 1 may express emotion in one way and understand it differently.  Though it seems pretty common that it is both expressed and understood the same way.  These five love languages are:

1. Words of Affirmation
1. Actions don't always speak louder than words.  If this is your love language, unsolicited compliments mean the world to you.  Hearing the words, "I love you," are important--hearing the reasons behind that love sends your spirits skyward.  Insults can leave you shattered and are not easily forgotten.
2. Quality Time
1. For those whose love language is spoken with Quality Time, nothing says, "I love you,:" like full, undivided attention.  Being there for this type of person is critical, but really being there--with the TV off, fork and knife down, and all chores and tasks on standby--makes you significant others feel truly special and loved.  Distractions, postponed dates, or the failure to listen can be especially hurtful.
3. Receiving Gifts
1. Don't mistake this love language for materialism; the receiver of gifts thrives on the love, thoughtfulness, and effort behind the gift.  If you speak this language, the perfect gift or gesture shows that you are known, you are cared for, and you are prized above whatever was sacrificed to bring the gift to you.  A missed birthday, anniversary, or a hasty, thoughtless gift would be disastrous--so would the absence of everyday gestures.
4. Acts of Service
1. Can vacuuming the floors really be an expression of love?  Absolutely!  Anything you do to easy the burden of responsibilities weighing on an "Acts of Service" person will speak volumes. The words he or she most want to hear: "Let me do that for you."  Laziness, broken commitments, and making more work for them tell speakers of this language their feelings don't matter.
5. Physical Touch
1. This language isn't all about the bedroom.  A person whose primary language is Physical Touch is, not surprisingly, very touchy.  Hugs, pats on the back, holding hands, and thoughtful touches on the arm, shoulder, or face--they can all be ways to show excitement, concern, care, and love.  Physical presence and accessibility are crucial, while neglect or abuse can be unforgivable  and destructive.

Discernment Counseling (working with couples who are leaning different ways on divorce)

Common Therapist Mistakes:

1. Pursue the distance to get them to try therapy
2. Hold back meaningful help unless they both want therapy
3. Launching half-hearted couples therapy

Overview of Discernment Counseling with Mixed Agenda Couples

1. Goal:  greater clarity and confidence in their decision making about divorcing, and better equipped to understand their prospects for reconciliation.
2. Make a clear distinction between discernment counseling and marital therapy.
3. Short term:  1-5 sessions.  Preferably weekly, but sometimes biweekly (makes it more intense)
4. Structure:  after assessment and agreement on doing discernment counseling, sessions consist of three parts:
1. brief check in with couple
2. separate conversations with each partner
3. brief summary/check-out at the end
5. Frame three paths:
1. stay married as it has been
2. move towards divorce
3. agree on a six-month reconciliation period with all-out effort in therapy (and using other resources) with divorce off the table--and then make a decision about the long term future.
6. Use different approaches with leaning-in and leaning-out partners (adapted by Doherty from Betty Carter)
1. Leaning out:  help them make a decision based on a more complex understanding of the marriage and own role in its problems
2. Leaning in: help them bring best self to the crisis, not making things worse, using it as a wake-up call to work on self.
7. Outcomes:  launching couples therapy and other help for six months, move towards divorce with better understanding and acceptance, or stay on hold for now.

Medical Family Therapy

My very first client was a transfer who had been coming into therapy for about a year.  It appeared that the client had been previously treated using a Solution-Focused framework.  While I very much subscribe to a Solution-focused ideology--it seemed less appropriate for this case.  One of the biggest critiques of Solution-Focused therapy is that it does not seem to appropriate address real and permanent problems--such as what my client is facing.  Upon discussing this with my practicum, my supervisor suggested (instructed) switching the model to a Medical Family Therapy model.  This was very exciting to me because it is a model we have not studied in our program and because it is something that I find very interesting and would like to go on to a PhD program that has some sort of MedFT program.  These are my findings in my dabblings with Medical Family Therapy.

What is Medical Family Therapy?

The following outline comes from lecture notes by Dr. Katherine Hertilein.

Medical Family Therapy refers to biopsychosocial (biological, psychological, social) treatment of individuals and families who are dealing with medical problems.  It actively encourages collaboration between therapists and other health professions.  It recognizes that there is a relationship with biology and family therapy.

Goals of MedFT

The two primary goals of Medical Family Therapy are increasing agency and communion.

1. Agency

Agency refers to the active involvement in and commitment to one's own care.  A sense of making personal choices in dealing with the illness and the health care system, both of which often contribute to a patient's feeling of passivity and lack of control.  This can involve:

         a. Helping a patient and family set limits on the amount of control an illness or disability has over their lives.  E.g. deciding to proceed with holiday celebrations despite the patients limited participation.

         b. Helping the family to negotiate for more information or better care arrangements with health professionals, hospitals, or insurance providers.

         c.  The therapist can promote agency of the patient in relation to other family members

                     1. Setting boundaries on family members' helpfulness

                     2. Teaching a family member to ask assertively for help

2. Communion

Emotional bonds are often frayed by illness, disability, and contact with the healthcare system.  There needs to be a sense of being cared for, loved, and supported by a community of family members, friends, and professionals.  Serious illness or disability is an existential crisis that can isolate people from those that who care for them, but the quality of the patient's social relationships appears to be the most powerful psychosocial factor in health and illness. One of the reasons for emphasizing medical "family" therapy is that serious illness and disability provide opportunities for resolving old conflicts and for forging new levels of health family bonding.  During the acute phase of an illness, family members may be emotionally available to each other in unaccustomed ways, but during the chronic phase, many families find that their sense of common purpose and common feeling deteriorates. One of the MedFT's important tasks is to help family members join together to cope with an illness, and to do so within the context of allowing the patient maximum feasibility and autonomy.  

Techniques

There are seven major themes to techniques in the MedFT model: 1. Recognize the biological dimension; 2. Solicit the illness story; 3. Respect defenses, remove blame, and accept unacceptable feelings; 4. Maintain communication; 5. Attend to developmental issues; 6. Increase a sense of agency in the patient & family; 7. Leave the door open for future contact.

1. Recognize the biological dimension

• Start with a focus on the patient
• The word "patient" has its own implications and depersonalization issues
• Use a psychoeducational approach to explain the difference between psychotherapy and other medical encounters
• Ask the physician to explain the patient's illness, its prognosis, and its possible course
• When there is ambiguity or disagreement about the diagnosis, maintain an open, exploratory stance
• Maintain humility about the possibility of biological change

2. Solicit the illness story

• Listen empathetically
• Taking a genogram to trace the course of their particular history with illness and loss
• As part of soliciting the illness story I have asked clients to first write a eulogy of their pre-loss life, and then second to write a birth announcement celebrating the new life.
• I suggested a rule to maintain a 3-1 positive to negative ratio (I wanted to keep the 5-1 Gottman ratio, but I wanted it to be hard not damn-near impossible)

3. Respect defenses, remove blame, and accept unacceptable feelings

• Accept Denial
• A common goal that I have seen from clients is to find a way to grieve the old self and accept the new self.  The eulogy/birth announcement previously mentioned helped to work towards this--however it was not enough.  
• After this I created (compiled) a handout about grief--largely from Kubler-Ross's 5 stages of grief.  After this psychoeducation I assigned an art therapy assignment.  At some point  I'll provide an example/template of some sort of this assignment but it consisted of an instruction to take a large sheet of paper (or 4 regular ones taped together) and draw a visual representation of all the things that have been lost as a result of the illness.  (This works well with any loss).  
• It can be a very challenged and powerful assignment.
• Externalize the illness
• I found this to combine very well with soliciting the illness story.  I've found that my client has a lot to say--and it seems of therapeutic importance that there is a chance provided to allow this to happen.  I'm skeptical of pushing clients beyond telling their story and venting frustrations--but this allow a refocus of these discussions into an externalized discussion.  Once the story is told, I believe they move on.
• Remove blame
• Normalize negative feelings

4. Maintain communication

• Between families and medical providers
• Among family members

5. Attend to developmental issues

• Out the illness in its place
• This means acknowledging the demands placed on a family by an illness, but not letting it run your life

6. Increase a sense of agency in the patient/family

• Emphasize the patient's input
• Bracket patient's unhealthy decisions
• Facilitate rather than advise

7. Leave the door open for future contact 

• Recognize the physician's ongoing involvement
• Provide patient follow-up

Along with these 7 techniques, these 9 steps from Patterson (1991) have proven to be very beneficial to me in working with Medical Family Therapy and chronic illness.

1. Balance illness with other family needs
2. Maintain clear boundaries
3. Develop communication and competence
4. Attributing positive meaning to situation
5. Maintaining flexibility
6. Maintaining family cohesiveness
7. Engaging in active coping efforts
8. Maintaining social supports
9. Developing collaborative relationships with professions