Times Are Changing


Tracy Todd

It has been 12 years since Montana, as the last state, obtained licensure (literally days behind West Virginia). Since that time, AAMFT has worked with divisions and more recently, Family TEAM, to strengthen the license throughout the United States. We won a hard-fought battle with the Texas Medical Association over our ability to diagnose. Last year, AAMFT had a record number of cosponsors for the MFTs in Medicare bill.

Fast forward to 2020, and add in a global pandemic no one saw coming, and suddenly, behavioral health made a massive shift from in-person to telehealth, literally, overnight. The pandemic acted both as a disruptor and an accelerator of change. Fortunately, AAMFT had recently published Best Practices in the Online Practice of Couple and Family Therapy (2017) aiding MFTs and other mental health professions, but we needed more. AAMFT and our members were literally tasked with creating resources overnight, lobbying for executive orders to extend MFTs’ right to practice in new circumstances, and providing much needed connection and support in our suddenly disconnected world.

Amidst these challenges, achievements, and opportunities, LMFTs have quietly increased in numbers. Now, with an estimated 62,000+ licensees, and often cited by U.S. News and World Report as one of the top social service jobs, we are in a better place than ever before. MFTs are employed in a wide variety of agency settings, and many are doing very innovative and creative work. Some good examples are housed within the AAMFT Research and Education Foundation:  Ben Erwin and Damir Utrzan will soon release a webinar, Developmental Impact of Displacement-Induced Trauma, and Amy Morgan’s study, Developing a Redemptive Identity: A Mixed Methods Study Exploring Post-incarceration Resiliency, is underway.

These successes have increased the profession’s recognition. In 2020 and 2021, the Mental Health Liaison Group (MHLG), an advocacy group of over 70 mental health organizations, for the first time ever, wrote a letter in support of LMFTs inclusion in Medicare Part B. Another key recognition of the profession’s growing influence involves the University of Michigan Behavioral Workforce Research Center, whose mission is to conduct research on the behavioral health workforce to strengthen it. AAMFT has partnered on research projects and has a staff member participating in the Center’s Advisory Group. Earlier this year, AAMFT partnered with the Center on a workforce study and surveyed 5,000 members and 866 members responded—AAMFT sincerely thanks those members for taking time to participate.

These shifts and areas of growth strongly suggest that AAMFT has evolved to a place where it must begin to better understand workforce issues impacting LMFTs and how we as an association can continue to support those, while removing unnecessary barriers:

  • What are the entry points to the field?
  • What are barriers to completion from germination of the idea to license “in hand?”
  • How has the pandemic altered the practice and profession permanently moving forward?

These are just a sampling of the topics needing better understanding. Immediately, however, we must focus on how to improve portability of the license and continue to pressure Members of Congress to include LMFTs in Medicare Part B.

To assist in accomplishing these goals, AAMFT has commissioned two research projects. The first is to study seniors’ attitudes towards mental healthcare as well as access issues such as barriers to access and entry paths (i.e., primary care physicians, family members, senior living centers). The second area of study will involve focus on the MFT industry at large to examine three main areas of interest:

  • Entry points to the MFT field being utilized
  • The current working environments and characteristics of employment of LMFTs
  • Shifts from the COVID-19 pandemic and their potential long-term impacts on the industry at large in areas such as adoption of telehealth or interest in licensure law adaptations and changes such as portability

The outcomes of these two research projects will enable AAMFT to more engage in advocacy efforts and workforce development initiative that will strengthen the position of LMFTs within the overall mental health employment arena. Member participation is vital as we look to understand these complex shifts. So please watch for more information, and if you are invited, I sincerely hope you will take a few minutes to participate. Your input can help to shape the future of our profession.

It is very likely that these efforts will reveal changing needs in everything from standards of education and training to the Code of Ethics. This issue of FTM typifies the work settings and ethical challenges facing today’s LMFTs. I trust you will see both the ethical difficulties and the workforce development areas of concern contained within the important contributions highlighted through the authors’ discussion of the following:

  • Client generated prejudice
  • Military issues
  • Queer MFTs
  • Professional competence and integrity

While we are currently exploring numerous options for increasing portability of the license, AAMFT will continue to pursue Medicare inclusion as our highest federal advocacy priority. Improving employment opportunities within the Veterans Administration will certainly remain a focal point. State licensure laws must continue to stay on par with other mental health professions.

Not only is it evident that AAMFT must remain diligent in its efforts to advance the profession, but it is also clear that AAMFT must take the next step of expanding its own scope to include workforce development information, resources and initiatives. Over the next several years, AAMFT will embark on projects that will help inform us about the challenges and opportunities facing the profession. We must better understand and formulate strategies challenging the LMFT, as well as position LMFTs as a strongly desired mental health discipline within all possible work environments.

To quote Bob Dylan, “The Times They are A-Changin” and AAMFT will remain steadfast in its commitment to protecting and advancing the practice and profession.

AAMFT. (2017). Best practices in the online practice of couple and family therapy. Alexandria, VA: Author.

University of Michigan Behavioral Workforce Research Center

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