Advertising Guidelines for Therapists By Bonnie R. Benitez, Attorney Previously employed with CAMFT The Therapist (September/October 2001)

"Advertise" defined
The word "advertise" is defined as a "public communication" and includes, but is not limited to, communication by means of mail, television, radio, motion picture, newspaper, book, list or directory, Internet or other electronic communication of healing arts practitioners. It also includes the issuance of any card, sign, or device to any person, or the causing, permitting, or allowing of any sign or marking on, or in, any building or structure, or in any newspaper or magazine or in any directory, or any printed matter whatsoever, with or without any limiting qualifications.

Advertising Laws Protect you and your License
Business and Professions Code section 4980(b) prohibits any person from engaging in the practice of marriage, family, and child counseling absent a valid license as a marriage and family therapist, unless he or she is exempted from the licensing requirements.¹ Moreover, no person may advertise him or herself as performing the services of a marriage, family, child, domestic, or marital consultant, or in any way use these or any similar titles, including the letters "M.F.T." or "M.F.C.C.," or other name, word initial, or symbol in connection with or following his or her name to imply that he or she performs these services without a license as provided by this chapter.²

Prohibited Advertisements
All of your advertisements must be true and accurate (not false, misleading, or deceptive). Business and Professions Code section 4982(p) defines as unprofessional conduct "advertising in a manner which is false, misleading, or deceptive."

For example, you may be an experienced therapist who has practiced using a behavioral model for twenty years. However, you cannot advertise as "Beth F. Skinner, licensed behaviorist." There is no such license, so that ad would be false. In the State of California, there are no "licensed psychotherapists," "licensed therapists," or "licensed (name of your school of thought)." Psychotherapists are either LMFTs, LCSWs, Licensed Psychologists, or Psychiatrists (licensed as Physicians).

Business and Professions Code section 651 includes an extensive list of statements, claims, and images that would be considered false, fraudulent, misleading or deceptive including a statement or claim that does any of the following:

• Contains a misrepresentation of fact.
• Is likely to mislead or deceive because of a failure to disclose material facts.
• Is intended or is likely to create false or unjustified expectations of favorable results, including the use of any photograph or other image that does not accurately depict the results of the procedure being advertised or that has been altered in any manner from the image of the actual subject depicted in the photograph or image.
• Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors.
• Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived.
• Makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant to the service being performed and can be substantiated with objective scientific evidence.
• Makes a scientific claim that cannot be substantiated by reliable, peer reviewed, published scientific studies.
• Includes any statement, endorsement, or testimonial that is likely to mislead or deceive because of a failure to disclose material facts. *Note: The CAMFT Ethical Standard 10.6 prohibits the solicitation of testimonials from patients (see below).

Acceptable Advertisement Material
In addition to the list of prohibited advertising, Business and Professions Code section 651 includes a list of advertisement content that is acceptable, including, but not limited to the following:

• A statement of the name of the practitioner.
• A statement of addresses and telephone numbers of the offices maintained by the practitioner.
• A statement of office hours regularly maintained by the practitioner.
• A statement of languages, other than English, fluently spoken by the practitioner or a person in the practitioner's office.
• A statement that the practitioner provides services under a specified private or public insurance plan or health care plan.
  
• A statement of names of schools and postgraduate clinical training programs from which the practitioner has graduated, together with the degrees received.
  
• A statement of publications authored by the practitioner.
  
• A statement of teaching positions currently or formerly held by the practitioner, together with pertinent dates.
  
• A statement of his or her affiliations with hospitals or clinics.
  
• A statement of the charges or fees for services or commodities offered by the practitioner.
  
• A statement that the practitioner regularly accepts installment payments of fees.
  
• Otherwise lawful images of a practitioner, his or her physical facilities, or of a commodity to be advertised.
  
• A statement, or statements, providing public health information encouraging preventative or corrective care.
  
• Any other item of factual information that is not false, fraudulent, misleading, or likely to deceive.

Advertising the License
On July 1, 1999 the name of the profession changed from Licensed Marriage Family and Child Counselor (LMFCC or MFCC) to Licensed Marriage and Family Therapist (LMFT or MFT). Since that date, marriage, family and child therapists can lawfully advertise as Licensed Marriage and Family Therapists. The law does not prohibit you from referring to yourself as an MFCC, but doing so sets a limitation on you advertisements. In particular, the law is specific as to when you can use the words psychotherapy or psychotherapist.

The name change has caused much confusion around the use of certain acronyms. Can a marriage and family therapist continue to advertise as an MFCC? Yes, although many therapists have abandoned the use of MFCC in an effort to keep current with the times.

What about the use of MFT or LMFT? Technically, the full title of the license is Licensed Marriage and Family Therapist, thus LMFT seems to be appropriate. Licensed Clinical Social Workers, for example, call themselves LCSWs, not CSWs.

Given the fact that the name change took place just two years ago, perhaps the best thing to do is to use words, not acronyms. The use of the words, "licensed marriage and family therapist" serves multiple purposes. First, it clearly tells the consumer exactly what license the therapist holds. Second, if a therapist uses the words "licensed marriage and family therapist," he or she is not required to include his or her license number in the advertisement. Third, if a therapist uses the words "licensed marriage and family therapist," he or she is permitted to use the words "psychotherapy" and "psychotherapist" in the advertisement (as discussed below).

Use of the words "Psychotherapy" or "Psychotherapist"
In order to use the words "psychotherapy" or "psychotherapist" in an advertisement, a therapist must spell out the full title of his or her license (i.e. "licensed marriage and family therapist"), and the therapist must be competent by reason of his/her education, training, and/or experience, to perform the professional services advertised or to act in a manner or professional capacity advertised. Therefore, if a therapist desires to use the words "psychotherapy" or "psychotherapist" the use of an acronym such as MFT, absent the full title of the license, would be prohibited.³

Marriage and Family Therapist Registered Interns and Trainees
A marriage and family therapist registered intern may advertise so long as he/she informs each client or patient prior to performing any professional services that he or she is unlicensed and under the supervision of an LMFT, LCSW, Licensed Psychologist, or Licensed Physician certified in Psychiatry.⁴

Unlicensed MFT interns and trainees should clearly identify themselves as unlicensed by using the words "registered intern" or "trainee," and indicate that they are supervised by using the words, "supervised by," or in a private practice setting, "employed and supervised by," followed by the name and license of the supervisor. Or, at a minimum, when working in a setting where the supervisor changes frequently, use the words, "working under supervision."

Like a licensee, an intern does not need to include his or her intern registration number when the full title of the registration is spelled out (e.g., "marriage and family therapist registered intern"). If an abbreviation, such as "MFT Registered Intern" is used, then the registration number must also be used.

The use of the initial "I" (such as "MFTI") for "Intern" is inappropriate; spell out the word(s), registered intern or trainee, whichever is applicable. Also, there is no such license as a "licensed" intern, MFT interns are "registered."

Interns who work in private practice settings generally should not pay for advertising expenses, or most other business expenses.⁵ However, if an intern wants to create a flyer, or wishes to have a business cards and the employer/supervisor refuses to pay for them, the intern is not be prohibited by law from using his or her personal funds to pay for the advertising. Any advertising by an intern should, nevertheless be approved by the intern's employer/supervisor prior to its publication or printing. However, any advertising including information about an intern should serve as an advertisement for the practice or agency itself, even though it highlights the services of the intern. Even though it is not expressly prohibited for an intern or trainee to pay for advertising, it would be better for the employer to pay for all costs of advertising and promotion, and if necessary, pay the supervisee a lower wage to be able to do so. When an intern or trainee pays directly for advertising, it gives the impression that the intern or trainee may have a proprietary interest in the employer's business, which is expressly prohibited.

CAMFT Ethical Standards
While the law sets a minimum standard for advertisement, CAMFT seeks to further the profession and patient care by setting a higher standard and providing clearer guidelines on ethical conduct. The CAMFT Ethical Standard 10 addresses ethical advertising.

Marriage and family therapists engage in appropriate informational activities, including those that enable laypersons to choose professional services on an informed basis.

10.1 Marriage and family therapists accurately represent their competence, education, training, and experience relevant to their professional practice.

10.2 Marriage and family therapists assure that advertisements and publications, whether in directories, announcement cards, newspapers, or on radio or television, are formulated to accurately convey information that is necessary for the public to make an appropriate selection.

10.3 Marriage and family therapists do not use a name which could mislead the public concerning the identity, responsibility, source, and status of those practicing under that name and do not hold themselves out as being partners or associates of a firm if they are not.

10.4 Marriage and family therapists do not use any professional identification (such as a business card, office sign, letterhead, or telephone or association directory listing) if it includes a statement or claim that is false, fraudulent, misleading, or deceptive. A statement is false, fraudulent, misleading, or deceptive if it a) contains a material misrepresentation of fact; b) fails to state any material fact necessary to make the statement, in light of all circumstances, not misleading; or c) is intended to or is likely to create an unjustified expectation.

10.5 Marriage and family therapists correct, wherever possible, false, misleading, or inaccurate information and representations made by others concerning the therapist's qualifications, services, or products.

10.6 Marriage and family therapists do not solicit testimonials from patients.

10.7 Marriage and family therapists make certain that the qualifications of persons in their employ are represented in a manner that is not false, misleading, or deceptive.

10.8 Marriage and family therapists may represent themselves as specializing within a limited area of marriage and family therapy, but only if they have the education, training, and experience which meet recognized professional standards to practice in that specialty area.

10.9 CAMFT clinical, associate and prelicensed members may identify such membership in CAMFT in public information or advertising materials, but they must clearly and accurately represent whether they are clinical, associate, or prelicensed members.

10.10 Marriage and family therapists may not use the initials CAMFT following their name in the manner of an academic degree.

10.11 Marriage and family therapists may use the CAMFT logo only after receiving permission in writing from the Association. Permission will be granted by the Association to CAMFT members in good standing in accordance with Association policy on use of CAMFT logo. The Association (which is the sole owner of its name, logo, and the abbreviated initials CAMFT) may grant permission to CAMFT committees and chartered chapters in good standing, operating as such, to use the CAMFT logo. Such permission will be granted in accordance with Association policy on use of the CAMFT logo.

10.12 Marriage and family therapists use their membership in CAMFT only in connection with their clinical and professional activities.

BBS Advertising Guidelines
The Board of Behavioral Sciences has set forth specific guidelines with regard to advertising. These guidelines are reproduced below.

California law prohibits any advertising which is false, misleading or deceptive. In addition, any professional advertising must clearly indicate the licensure status as a Marriage and Family Therapist, Licensed Clinical Social Worker or Licensed Educational Psychologist.

Licensure status must be shown either by including the complete name of the license OR by including the initials of the appropriate license AND the license number. Any UNLICENSED person practicing under supervision MUST also include the name and correct licensure status of the supervisor.

It is also permissible to include academic credentials (i.e., M.A., M.S.W., Ph.D.) so long as the degree is earned and relevant to the license. The use of the academic qualification must not imply the provision of services which would be beyond the scope of the license.

Marriage and Family Therapists, Licensed Clinical Social Workers and Registrants/Associates MAY NOT ADVERTISE AS PSYCHOLOGISTS OR AS PROVIDERS OF PSYCHOLOGICAL SERVICES UNLESS THEY ALSO HOLD A PSYCHOLOGY LICENSE. Licensed Educational Psychologists MAY ADVERTISE AS EDUCATIONAL PSYCHOLOGISTS.

Referral Service Advertising
An MFT referral service is defined as a group advertising and referral service for MFTs. The BBS issues registrations for MFT referral services upon receiving the appropriate application and accompanying documentation.⁶

A licensee may participate in or operate an MFT referral service so long as all of the following conditions are met:

• The patient referrals by the service are the result of patient-initiated responses to service advertising.
  
• The service advertises in conformity with Business and Professions Code sections 651 and 4982(p) (as discussed above).
  
• The service does not employ a solicitor to solicit prospective patients or clients.
  
• The service does not impose a fee on the member marriage, family, and child counselors that is dependent upon the number of referrals or amount of professional fees paid by the patient to the marriage, family, and child counselor.
  
• Participating marriage, family, and child counselors charge no more than their usual and customary fees to any patient referred.
  
• The service registers with the Board of Behavioral Science Examiners, providing its name, street address, and telephone number.
  
• The service files with the Board of Behavioral Science Examiners a copy of the standard form contract that regulates its relationship with member marriage, family, and child counselors, which contract shall be confidential and not open to public inspection.
  
• If more than 50 percent of its referrals are made to one individual, association, partnership, corporation, or group of three or more marriage, family, and child counselors, the service discloses that fact in all public communications, including, but not limited to, communications by means of television, radio, motion picture, newspaper, book, list, or directory of healing arts practitioners.
  
• When member marriage, family, and child counselors pay any fee to the service, any advertisement by the service shall clearly and conspicuously disclose that fact by including a statement as follows: "Paid for by participating marriage, family, and child counselors." In print advertisements, the required statement shall be in at least 9-point type. Radio advertisements, the required statement shall be articulated so as to be clearly audible and understandable by the radio audience. Television advertisements, the required statement shall be either clearly audible and understandable to the television audience, or displayed in a written form that remains clearly visible to the television audience for at least five seconds.

The BBS has the authority to adopt regulations necessary to enforce and administer the laws pertaining to MFT Referral Services.

Also, it is unlawful and shall constitute a misdemeanor for a person to operate a group advertising and referral service for marriage, family, and child counselors without providing its name, address, and
telephone number to the Board of Behavioral Sciences.

Following these basic guidelines can help therapists create effective advertisements, while avoiding the possibility of disciplinary action by the BBS. Members who have questions about the content of their advertisements may contact CAMFT for review.
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¹Business and Professions Code section 4980.01 exempts the following individuals from the licensing requirements: a priest, rabbi, or minister of the gospel of any religious denomination when performing counseling services as part of his or her pastoral or professional duties, or to any person who is admitted to practice law in the state, or who is licensed to practice medicine, when providing counseling services as part of his or her professional practice, an employee of a governmental entity or of a school, college, or university, or of an institution both nonprofit and charitable if his or her practice is performed solely under the supervision of the entity, school, or organization by which he or she is employed, and if he or she performs those functions as part of the position for which he or she is employed.

²However, persons licensed as psychologists or clinical social workers may engage in the practice of marriage and family therapy or advertise that they practice marriage and family therapy, but may not advertise that they hold the marriage and family therapist'slicense. Business and Professions Code section 4980.

³See the BBS Policy on Advertising for sample formats of advertising for BBS licensees.

⁴Business and Professions Code section 4980.44(a)(4).

⁵Interns who work in private practice typically carry their own malpractice insurance.

⁶MFT Referral Services regulations can be obtained through the BBS.

⁷ California Business & Professions Code, Sec. 650.4