Marriage and Family Therapy was birthed as marriage counseling in
the 1920s. It was initiated as a part of the routine work of physicians,
especially as a part of obstetrics and gynecology, which was itself
just becoming a recognized medical specialty. By the 1930s marriage
counseling was a recognized specialty. After several false starts,
an organizational meeting of the American Association of Marriage Counselors
(now AAMFT) was held in June of 1942. At its inception, it was widely
multidisciplinary including the professions of medicine, psychology,
social work, law, ministry, and teaching. Approximately half of the
early constituents were physicians. But AAMFT had no role in the early
days with defining or developing state licensing laws.
California was actually, in many respects, at the core of the development
of the profession. Many of the pioneers of the marriage counseling
profession originated in California or moved to California once established.
AAMFT was originally located in California. The Southern California
Division of AAMFT was established in 1961 and soon thereafter the Northern
California Division came into existence. These two Divisions were among
the first dozen Divisions created by AAMFT.
A statewide association of marriage counselors was founded in 1964,
known as the California State Marriage Counseling Association (CSMCA).
It later became the California Association of Marriage and Family Counselors
(1971), and ultimately became the California Association of Marriage
and Family Therapists (1979). It was one of only three professional
associations of marriage and family counselors that were established
independent of AAMFT. The other two organizations were later absorbed
into AAMFT. As has been described by those knowledgeable about the
development of the profession, the history of marriage and family therapy
in California is the history of CAMFT.
When marriage and
family counseling came to the attention of California legislators
in the early 1960s, the state had already a history of
regulating the mental health disciplines. In 1928, the legislature
passed the country’s first social work certification bill
that resulted in a voluntary registration of social workers. After
numerous
failed attempts to regulate the practice of psychology, the legislature
passed a registration act for psychologists in 1957 and a certification
act in 1958. California was the first state to license marriage
and family counselors with the passage of legislation in 1963 that
took
effect in 1964. In 1967, psychologist and clinical social work
licenses were initiated by the passage of legislation in California.
By the early 1960s, a wide range of professionals advertised themselves
as offering marriage and family counseling services, some were psychiatrists,
psychologists, social workers, clergy, and others were more unconventional
and some utilized unorthodox techniques.
Interest was great
amongst many in private practice who saw the need to establish
legitimacy for the profession. But, the desire to regulate
the profession came from a multitude of directions. A number of individuals
claim partial or full credit for the passage of legislation to regulate
the profession. At least two early marriage counselors individually
claimed that they were each singly responsible for the passage of
the
legislation— even at the individual’s own cost.
But, according
to Judith Richlin-Klonsky (JRK), who as part of a dissertation,
completed in-depth research into the sociology of the MFT profession
in California, concluded that Don Mulford, Republican Assemblyman
from Alameda County, coauthored the bill (Assembly Bill 2374) to
regulate marriage counselors. According to JRK, Mulford had
a good friend
and
neighbor who suggested the need for legislation because his wife
had gotten bad advice from a marriage counselor. Because Mulford
was distressed
by the break-up of his friend’s marriage, he persuaded Lester
McMillan, Democratic Chair of the Assembly Interim Committee on
Government Efficiency and Economy to co-sponsor the bill. According
to JRK,
Mulford did not recall any involvement from persons within the profession.
Prior to the introduction of the legislation in 1963, hearings were
held on House Resolution 81, introduced by Mulford in March of 1962.
The purpose of the Resolution was to study all facts and circumstances
relating to the subject of regulating marriage counseling.
The following quotes
are in JRK’s research:
“Self-styled spiritual advisors, pseudo-psychologists and psycho-analysts,
pseudo-clergymen, mystic readers, and others advertising themselves
as offering help on marital problems for a price will be invited to
describe their qualifications and services. . .before the Assembly
Interim Committee on Governmental Efficiency and Economy.” (McMillan,
11/15/62)
“The committee will investigate allegations that some charlatans
and quacks have invited in this field resulting in a number of marriages
being unwarrantedly disrupted or broken up. The committee will consider
whether licensing is needed and if so, whether the licensees should
be placed under an existing board or a new board to be created for
this purpose.” (McMillan, 10/17/62)
A large contingent
attempting to influence the consideration of licensure were
of the opinion that a marriage counselor should be a professional
qualified in another profession, i.e., psychiatry, psychology,
social
work. With this view, licensing of MFCCs would have become a specialty
within existing licensing structures and not a separate license.
Yet, when AB 2374 was introduced on April 11, 1963, it provided for
a marriage
counseling license based on a master’s degree in one of the
behavioral sciences and at least two years of supervised experience
under the
direction of a person with a similar degree, and approved by the
Director of Professional and Vocational Standards. Apparently,
Mulford, the
author of the bill, became so annoyed with those who appeared to
be seeking a monopoly on marriage counseling that he devised a
bill for
an independent MFCC license.
Opposition to independent
licensing of MFCCs was tremendous. According to JRK and her
research, psychiatrists did not want it because they
wanted the work for themselves, psychologists cited standards and
competence or the lack thereof, social workers wanted to be able
to continue to
advertise as marriage counselors, and clergy and others saw it
as excessive and unnecessary regulation. The Director of
the Department
of Professional
and Vocational Standards objected to the bill because he believed
it did not adequately protect the public—that the grounds for
denial, suspension, or revocation of the license were inadequate.
For example,
there were, at that time, no grounds for denial based on incompetence,
dishonesty, violation of confidentiality, or fraud.
AB 2374 was signed into law in July 1963. By all accounts, the bill,
in its final form, did not please its supporters or its opponents.
The history of the creation of this license is clearly illustrative
of the role that legislative action has played on the carving out of
a separate occupational identity. This bill, and the various bills
that followed, created and crafted a unique, yet evolving, profession
in California.
In 1967, the profession faced a major challenge. The Little Hoover
Commission, established to streamline the efficiency of state government,
recommended that the MFCC license be abolished. To counteract the Little
Hoover Commission, CAMFT launched a massive lobbying effort to save
the license. This successful campaign focused the profession on a common
goal and strengthened the organization, which impressed upon MFCCs
the need to be members of their professional association.
AAMFT, until the early 70s, was not an option to most California licensed
MFCCs as membership required a doctoral level degree. AAMFT was also,
at that time, not inclined to get involved in licensing issues or for
that matter, legislative issues. By the time their membership requirements
were changed, CAMFT already had an established identity and voice.
One of the first
efforts of the CSMCA (the predecessor to CAMFT) was to purge
its ranks of members whose academic credentials were “mail-order” degrees
and who engaged in questionable ethical and clinical practices. Soon
after, membership standards were developed and a code of ethical
standards was created. Apparently, there was much chaos in
those early years,
with expulsions and attempted expulsions of CAMFT members deemed
unfit. Regardless of the turmoil, skill in addressing legislative
matters
became a part of the early CAMFT heritage. CSMCA established itself
as the legislative voice for the profession in California. Even those
who were more invested in AAMFT, began to join CSMCA to have a voice
for the profession in Sacramento.
Between 1964 and up to 1980 and beyond, CAMFT was involved in sponsoring
several bills that revised the criteria for MFCC licensing, by better
defining the educational and supervision requirements.
A major barrier
for the profession, however, was the lack of reimbursement
by insurance companies. In light of these difficulties, CAMFT contracted
with Richard S. Leslie, Attorney, in 1976 to work with the profession
to attain the ability to be reimbursed by insurance. Between 1977
and 1979, he wrote a series of advisory letters for members,
giving guidance
as to how to submit insurance claims and appeal denials. While his
arguments worked some of the time, they did not work consistently.
Thus, the only worthwhile solution appeared to be to seek legislation
to mandate that insurance companies reimburse marriage, family and
child counselors. Such legislation was introduced and passed in 1980,
and became known as the “freedom of choice” bill (AB
2211, Bruce Young, author).
The passage of
this piece of legislation was likely the single greatest accomplishment
that moved the profession forward. Of course, the opposition
to this effort was overwhelming. It was anticipated that insurers
would
balk, but the competing disciplines, already reimbursed by insurance,
were unrelenting. Once again, this effort resulted in a pulling together
of the profession to rally for support of this measure. The opposition
claimed that MFCCs were not qualified as psychotherapists and could
not practice psychotherapy or diagnose and treat mental disorders.
Ironically, at the same time as these arguments were launched against
MFCCs, California psychologists, along with their colleagues throughout
the country, were battling psychiatrists over the same issue. Psychologists,
like MFCCs, were also demanding “freedom of choice” for
reimbursement of mental health services. It was argued by the social
work organizations that the services rendered by MFCCs were not considered
mental disorders and that they were not trained to provide psychotherapy.
It is true that up until this time, possession of one of twenty-three
different degrees were considered equivalent to qualify a person for
the license. The education may not have consistently prepared one to
diagnose and treat mental disorders.
AB 2211 was characterized
as a consumer bill. It was devised to protect the consumer’s right to choose the type of professional desired
to provide mental health care. CAMFT also argued that MFCCs were both
qualified and entitled to practice psychotherapy. Richard Leslie’s
arguments in support of this contention were taken from the law where
MFCCs were specifically mentioned along with other psychotherapists,
e.g., the psychotherapist patient privilege. The insurance industry,
of course, argued that passage of AB 2211 would increase health care
costs. Their arguments were that greater availability of mental health
services would increase demand for mental health care and the fear
that even though MFCC fees were lower, they would raise their fees
when they gained the right to be reimbursed.
Like most any piece
of legislation that successfully moves through the process,
it was necessary to take amendments to make the legislation
more palatable to the opponents. At the top of the list was the
fact
that some MFCCs were admittedly not competent to diagnose according
to the medical model. To set aside this concern, an amendment was
accepted to require physician referral. The acceptance of this amendment
satisfied
some of the opposition, while at the same time created additional
opposition within the Association’s own ranks. One chapter
of CAMFT expressed their displeasure and one member of the chapter
actually
urged her
assemblyperson to vote against the bill.
However, without physician referral, the bill would not have moved
forward. . .and it was the foot in the door. Besides, social workers
also had physician referral, and it would have been an insurmountable
battle to argue that MFCCs should not be similarly required. Realistically,
there were, at the time, MFCCs who had no training in diagnosing mental
disorders and it was a time when many grandparented MFCCs were still
amongst the ranks of the licensees.
To create an image
of what the profession was confronting, the metaphor of “David and Goliath” was
adopted. Once again, this rally to move the profession forward
was uniting, and MFCCs joined the Association
to add strength to the effort. A fundraising effort was initiated
and CAMFT created a political action fund (CAMFT-PAC) to
aid the effort.
With much effort,
much opposition, and a grassroots rally of communication
to legislators, AB 2211 was signed into law on September
18, 1980 and
took effect January 1, 1981. The lobbyists for opposing entities
like the California Medical Association (CMA) and California
State Psychological
Association (CSPA) were instructed to spare no effort to kill the
bill. Interesting, as researched by JRK, when the CMA did
not endorse the
bill following the physician referral amendment, “one senator
challenged the CMA representative, asking, ‘Will the physicians
make appropriate referrals?’ To say ‘no’ would have
been a public acknowledgement that physicians generally make these
referrals simply upon a patient’s request, without any direct
knowledge of the situation, the patient’s problem, or the psychotherapist
to whom they are referring. When the CMA representative indicated his
belief that, of course, physicians would make appropriate referrals,
the senator asked why the CMA needed to oppose the amendment, if not
out of self-interest.” One legislator was particularly angry
at the social workers speaking in opposition, who themselves had
recently lobbied for reimbursement. The legislator allegedly scolded
the social
worker for now opposing the MFCCs. According to Richard Leslie, the
legislator was so angry that he told him he would support the bill
only if it included a proposal to do away with the clinical social
work license.
It was believed
that the bill was achieved on two counts: The grassroots
efforts of CAMFT members contacting their legislators in
great numbers.
So much so that they were asked to stop. And, they were so annoyed
with the attitudes and arguments of the opposition—at the heart
of the opposition was economics, in other words, “protecting
turf.” The reason for the bill’s success was likely not
because legislators had any passion for the bill or for MFCCs.
In 1984, CAMFT-sponsored AB 1153, extended the reimbursement rights
to policies written outside of California and issued for delivery within
California. California was the first state to obtain mandatory freedom
of choice for marriage and family therapists, also referred to as third
party reimbursement or vendorship.
In 1967, CSMCA
began to reach out to AAMFT to attempt a working relationship.
A committee was even formed for that purpose. While AAMFT
was generally
uninvolved in legislative endeavors, there were, at times, contributions
given to the early CAMFT by AAMFT and SCAMFT to assist with the profession’s
legislative strategy. Further, there was significant mutual support
with the organization’s having many of the same members. Since
the organizations served differing purposes, they were, in many respects,
complementary. On the other hand, due to the early doctoral level education
requirement necessary for membership, early CAMFT members viewed the
AAMFT as “elitist” and “uppity.” Further, because
AAMFT membership criteria was considerably more stringent than CAMFT’s,
AAMFT appeared uninterested in the typical California licensee. On
the other hand, many affiliated with AAMFT considered CAMFT too accessible.
Consequently, these feelings led to tension between the organizations.
By 1970, with declining
numbers of members and the fact that most marriage counseling
was being done by masters’ level professionals,
AAMFT relaxed its membership standards and began to accept persons
with masters’ degrees as clinical members. Also in the 1970s,
AAMFT began to see the value of legislation and was becoming active
at the Federal level. CAMFT was also becoming more involved legislatively
and otherwise in attempting to improve the clinical interests and
qualification of its constituents.
With more similarity between the standards for membership in the two
organizations, discussions led to merging the organizations. Needless
to say, however, the views about merger within each organization were
disparate. Even the CAMFT Board was split on the issue. While there
were considerable discussions, and two separate votes were taken to
merge the organizations, CAMFT Members narrowly voted down the proposals
to merge in 1973 and 1976.
While CAMFT leadership
watched and reacted to legislation that related to marriage
and family relations in order to fulfill a perceived
responsibility to be involved in such matters, the organization was
most active on
issues to gain parity with the other mental health disciplines.
Early issues in which the organization took an interest,
outside those
issues that affected MFCC rights to practice, included: marriage
dissolution, rape, incest, domestic violence, child abuse
reporting, custody,
child
pornography, and some other societal issues. These interests were
both perceived as having an impact upon the profession and by demonstrating
an interest in these relevant issues, it helped to counterbalance
the
appearance of self-interest. Primarily, the organization’s
focus was for the MFCC profession to attain full professional recognition
with the other mental health professions in all areas of practice
including
employment, third party reimbursement, psychotherapist patient
privilege, and other relevant practice-related concerns. Parity
was the main
goal of most all CAMFT-sponsored legislation.
In the same year as insurance reimbursement was achieved (1980), CAMFT-sponsored
AB 2210 was signed into law, which allowed for marriage, family, and
child counselors to be employed in the County Mental Health System.
In other words, the intent was to prohibit discrimination on the basis
of the license held. Prior to 1980, licensed marriage, family and child
counselors were almost exclusively in private practice.
The Association
has not always been successful in its attempts to pass laws
to move the profession forward. Sometimes the opposition
was too fierce, or maybe the timing was not right, or other factors
may have deterred success. One such attempt was in 1981, AB 1762,
with the intent to change the name of the professional from
Marriage, Family
and Child Counselor to Marriage and Family Therapist. The bill was
framed as an effort to clarify the name of the profession and to
remove confusion as to the public’s perception of the education, training,
and experience of licentiates—to bring it into conformity with
the licensing law, to more realistically describe who the profession
is and what it does, and to clarify the right to practice psychotherapy.
Needless to say, the competing professional groups heatedly opposed
the bill, claiming that referring to MFCCs as therapists would allow
them to make claims to competence outside their scope of practice.
At this time, all of the other disciplines argued that MFCCs were
not competent to practice therapy. This effort was killed in its
first
committee.
In 1982, CAMFT-sponsored AB 2701 was signed into law permitting marriage
and family therapists, like other health care professionals, to form
marriage, family and child counseling corporations. What was significant
about this legislation is it created the opportunity for MFCCs, when
incorporated, to have as shareholders and/or employees, other types
of health care professionals and permitted the other professionals
to perform the services that they are licensed to perform while working
in the MFCC professional corporation.
When the license
was first created, the law was placed in Division 7 of the
Business and Professions Code, a residual category of the
Code that addressed a myriad of other regulated businesses. It
took
until 1983, but after several years’ effort, CAMFT-sponsored
AB 1856 was passed, moving the MFCC licensing law into Division
2 of the Business and Professions Code, thus classifying MFCCs
under
the
healing arts division of the law along with other health care professionals.
This bill was significant for several reasons, but the most significant
was that it presented the profession as healing arts practitioners.
Regularly, in attempting
to pass legislation, either due to opposition and negotiation,
or an attempt to avoid excessive opposition and have
the bills killed, CAMFT’s successes were incremental. The strategy
was, at a minimum, to get a “foot” in the door and return
to reach the ultimate goal piece-by-piece. Such was the case with protecting
patient’s confidentiality and privilege when seeing MFCCs. According
to the research of JRK, the sections of the Evidence Code related to
psychotherapistpatient privilege were enacted in 1965, and were applicable
only to psychiatrists and psychologists. It was recommended by the
Law Revision Commission in 1969 that the privilege be expanded to other
types of professions recognized as “psychotherapists.” While
the privilege was expanded to include MFCCs and clinical social workers,
the expansion was limited to only civil cases. In the late 1970s,
CAMFT began a series of efforts to expand the privilege to include
criminal
cases, which at the time was only applicable to psychiatrists and
psychologists. Bills were attempted unsuccessfully in 1978, 1982,
and 1983. In 1985,
with the passage of CAMFT-sponsored SB 1044, the psychotherapist-patient
privilege for MFCCs was extended to criminal proceedings. In 1987,
with the passage of CAMFT-sponsored AB 2402, the psychotherapist-
patient privilege was extended to MFCC registered interns in both
civil and
criminal proceedings. In 1988, with the passage of CAMFT-sponsored
AB 4168, the privilege was extended to MFCC trainees in civil proceedings
when the trainees are engaged in meeting their practicum requirements.
In 1990, with the passage of CAMFT-sponsored SB 2245, the psychotherapist-
patient privilege was extended to MFCC professional corporations.
In 1984, CAMFT-sponsored AB 2881 was signed into law bringing clarity
to patient access to records by making MFCCs subject to the same laws
as psychiatrists. While it did not expand the MFCC scope of practice,
it was a bill to gain parity for the profession by imposing on MFCCs
the same standards imposed on other mental health professionals. This
section of the Health and Safety Code was initiated in 1982 and provided
patients the right to access their health care records under certain
circumstances. CAMFT amended clinical social workers into its bill,
which was becoming a relatively common practice when CAMFT sought legislation
they found equally beneficial. Psychologists were also amended into
the bill.
In 1985, CAMFT-sponsored
SB 587 was passed permitting MFCCs to treat claimants in
workers’ compensation cases and to be eligible for
reimbursement from self and private insurers and the State Compensation
Insurance Fund. Like other pieces of legislation, this bill was negotiated
to include the requirements of physician referral and employer approval
for the MFCC to be eligible for reimbursement. Also in 1985, CAMFT-sponsored
SB 1331 was passed extending full reimbursement rights to licensed
MFCCs under the California’s Victims of Crime Program. Prior
to this legislation, MFCCs’ reimbursement was significantly
lower than other mental health professionals.
In 1986, CAMFT was instrumental in the passage of AB 3657, a bill
that substantially revised the MFCC licensing law with respect to the
educational and experiential requirements for licensure, registration
of interns, employment of interns in private practice, as well as addressed
a variety of concerns to upgrade the standards of the profession. While
technically not a bill sponsored by CAMFT (CAMFT had its bill this
same year addressing related issues), the CAMFT-sponsored bill was
amended into this legislation. AB 3657 was initiated and authored by
then Assemblyman John Vasconcellos. Vasconcellos, a proponent of mental
health care and a supporter of MFCCs, had his own ideas about the makeup
of the profession and introduced and negotiated the many issues addressed
by his legislation and the CAMFT-sponsored bill.
In 1987, CAMFT-sponsored
AB 661, expanded upon the changes in the prior year’s legislation by providing additional protections
for MFCC interns and trainees. And, even further changes were made
in 1989 with the passage of CAMFT-sponsored SB 649. In 1990, CAMFT-sponsored
SB 2214 deregulated hypnosis for MFCCs (MFCCs, contrary to the other
disciplines, were previously required to have certificates in hypnosis
in order to use hypnosis), clarified and expanded work settings, and
limited the BBS’ power to prevent an applicant for licensure
from taking examinations due to the receipt of a complaint. In 1997,
CAMFT-sponsored SB 650 expanded the work settings for MFCC interns
and trainees.
Several CAMFT-sponsored bills, SB 545 (1987), SB 272 (1988), AB 2858
(1996) amended MFCCs into sections of law providing for immunity from
liability for professional societies who maintain the professional
standards of the society (ethics committees) or who provide referral
services or telephone information libraries.
In 1987, CAMFT-sponsored AB 878 was passed, permitting MFCCs to be
certification review hearing officers and to preside over hearings
to involuntarily commit persons for fourteen days following the initial
72 hours of confinement. Also in 1987, CAMFT-sponsored SB 879 prevented
the exclusion of certain evidence in a criminal proceeding solely because
the practitioner who conducted hypnosis was an MFCC. And, in 1987,
CAMFT-sponsored AB 880 changed the law permitting MFCC registered interns
to provide mental health services as employees in County Departments
of Mental Health.
In 1988, CAMFT-sponsored AB 4617 permitted MFCC professional corporations
to use fictitious business names as long as the names are not false,
misleading, or deceptive and as long as certain prescribed disclosures
are made. Also in 1988, CAMFT-sponsored 2658 permitted MFCCs to supervise
up to 1,000 hours of experience for registered associate clinical social
workers. This number was subsequently expanded beyond 1,000 hours.
In 1989, CAMFT sponsored landmark legislation (SB 1004), whereby a
psychotherapist could be criminally prosecuted and convicted for engaging
in sexual activity with a patient. California became the first state
in the country to pass such legislation. Also in 1989, CAMFT-sponsored
AB 1074 permitting MFCC registered interns and trainees to be employed
in state and other governmental health facilities.
In 1990, CAMFT-sponsored
AB 3470 permitted MFCCs and other licensed psychotherapists
to sign applications for restricted driver’s
licenses on behalf of their patients so that the patients could
drive to obtain mental health treatment.
In 1991, CAMFT-sponsored
SB 902 corrected an ambiguity in law and paved the way for
MFCCs to more readily obtain reimbursement for
treating injured workers under the workers’ compensation system.
In 1992, CAMFT-sponsored SB 1394 amended the MFCC licensing law on
a number of counts including, but not limited to, permitting an MFCC
professional corporation to employ up to ten interns and defining as
unprofessional conduct when a therapist engages in a sexual relationship
with a patient up to two years following termination.
In 1994, CAMFT-sponsored AB 2659 clarified that the patient is the
holder of the privilege, rather than the psychotherapist, which was
prior law, when appropriately treating minors. Also in 1994, CAMFT-sponsored
SB 133 clarified that interns who volunteer in private practice will
not be denied hours of experience due to being a volunteer (the position
taken at the time by the BBS).
In 1995, CAMFT-sponsored SB 675 permitted MFCCs to participate in
and operate group advertising and referral services for MFCCs when
specific conditions are met.
In 1996, CAMFT-sponsored SB 2027 authorized the court, pursuant to
the Family Code, to call an MFCC who meets certain criteria, to testify
as an expert witness in proceedings to permanently terminate parental
rights, when the court determines that the testimony would be in the
best interests of the child or children. Also in 1996, CAMFT-sponsored
AB 3073 permitted the BBS to issue a license to any person who, at
the time of application, held a valid license for at least two years
as a marriage and family therapist in another state, as long as the
applicant met the California education and experiential requirements
and passed the required examinations. And, in 1996 as well, CAMFT-sponsored
SB 195 clarified that MFCCs are psychotherapists for the purpose of
civil actions regarding sexual harassment.
In 1997, CAMFT-sponsored SB 1121 permitted MFCCs with specified experience
to act as independent adoption service providers. Also in 1997, CAMFT-sponsored
SB 1295 permitted patients to designate a licensed MFCC as the therapist
to whom records should be sent when the prior therapist refused to
provide the patient with either a copy or a summary of the records.
Prior law permitted the patient to designate only a psychiatrist or
psychologist.
In 1998, CAMFT-sponsored
AB 1449 changed the license title from “marriage,
family and child counselor” to “marriage and family therapist” bringing
the license title in line with the name used throughout the rest
of the country. Also in 1998, CAMFT-sponsored AB 1290 corrected ambiguities
in existing law regarding the reporting duties of mandated reporters
of child abuse. And, in 1998, CAMFT-sponsored AB 1094, among other
things, corrected an error in the Child Abuse and Neglect Reporting
Act regarding the classification of MFTs.
In 1999, CAMFT-sponsored AB 253 added to the educational requirements
for MFTs survey courses in psychological testing and psychopharmacology.
Also in 1999, CAMFT-sponsored AB 352 provided licensees of the BBS
with inspection and copying rights with respect to their individual
files. And, in 1999, CAMFT-sponsored SB 809 provided for a statute
of limitations on the initiation of disciplinary actions against licensees
and registrants of the BBS.
In 2000, CAMFT-sponsored
AB 2374 provided immunity from discovery for the records
and testimony of CAMFT’s Ethics Committee.
Also in 2000, CAMFT-sponsored AB 2524 permitted MFTs to be hired
in regional
facilities to treat seriously emotionally disturbed wards.
In 2001, CAMFT-sponsored
AB 213 added marriage and family therapists to the list of
providers who may approve the disclosure of information
and records relating to services provided to mentally disordered
and developmentally disabled patients in instances where the provider’s
patient designates persons to whom such information or records
may be released. Also in 2001, AB 1503 provides that health care
service
plans and disability insurers will be required to have a policy
to enable enrollees and subscribers with acute, serious, or chronic
mental health conditions to continue, for a limited period of time,
treatment
with their providers when plans are changed by employers.
In 2002, CAMFT-sponsored
AB 2672 was signed into law restoring a penalty for supervisors/
administrators who retaliate against employees who
report child abuse as mandated. Also in 2002, CAMFT-sponsored AB
2723 was signed into law making apologies rendered by professionals
to patients
inadmissible in disciplinary actions. And, signed into law was CAMFT-sponsored
AB 2551, which provided “clean-up” to CAMFT’s continuity
of care bill from 2001.
In 2003, CAMFT-sponsored
AB 116 clarified in the MFT licensing law that MFTs are covered
by the Telemedicine Act—an act contained
within the Medical Practice Act and applicable to MFTs. Also in
2003, CAMFT-sponsored AB 652 provided for interns to be able
to carry over
hours of experience from one intern registration period to another.
Prior to this legislation, the intern who had gained insufficient
hours during his/her initial six-year intern registration period
would have
lost all hours previously gained. This measure was ultimately moved
into another bill (AB 1077) and was signed into law.
In 2004, CAMFT-sponsored
SB 598, addressing a major concern with the Confidentiality
of Medical Information Act was finally signed by the
Governor after several attempts to correct previously passed problematic
law. The bill restored law permitting mental health professionals
to communicate, without authorization or any other communication,
with
other health care professionals for the purposes of diagnosis and
treatment of patients. Also in 2004, CAMFT-sponsored AB 2182
was signed into
law, which addresses the treatment of minors by interns in Alcohol
and Drug Programs. This change in law permits marriage and family
therapist registered interns, social work associates, and
psychology assistants,
when appropriately employed and supervised in Alcohol and Drug Programs,
to treat minors without parental consent under the same terms and
conditions as licensees. And, in 2004, CAMFTsponsored AB
2552 was signed into
law. It addressed various issues in the MFT licensing law. The most
significant of these amendments was to the scope of practice section
of the licensing law, which by referencing another section, clarifies
that MFTs “diagnose.”
In 2005, CAMFT-sponsored AB 776 was signed into law and addresses
the difficulties many mandated reporters experience when attempting
to make child abuse reports where the reporting agencies refuse to
take the reports or are inaccessible.
In 2006, CAMFT-sponsored
AB 733 was signed into law and clarifies that a psychotherapist
is only required to warn the intended victim
and notify the police in order to have immunity from liability. It
corrected language that led to a faulty interpretation by the Judicial
Council that both acts were mandatory to avoid being deemed negligent.
Also in 2006, CAMFT-sponsored AB 525 corrects/clarifies concerns
in the Child Abuse and Neglect Reporting Act (CANRA) with
regard to emotional
abuse. It clarifies that the confidentiality protections for mandated
reporters who make required reports of child abuse or neglect also
apply to mandated reporters who make permissive reports of “emotional
abuse.” It also clarifies that mandated reporters who report “emotional
abuse” are entitled to receive the same feedback at the end of
the investigation or upon a final disposition of the matter as they
are supposed to get when making a mandated report. And, in 2006, CAMFT-sponsored
AB 1994 clarified that the limitation of liability applicable to the
therapist in denying a parent’s request to inspect a minor patient’s
records, also applies to a therapist’s decision to deny a parent’s
request for a copy of the minor’s records. Such a denial is permissible
when access to the records would have a detrimental effect on the provider’s
relationship with the child or would jeopardize the physical safety
or well-being of the child. CAMFT-sponsored AB 3013 corrected a provision
in the Confidentiality of Medical Information Act. It previously provided
that a therapist, unless there was a specific written request to the
contrary, could release the patient’s name, address, age, sex,
a general description of the reason for treatment, the general nature
of the injury, the general condition of the patient, and any information
that is not medical information as specifically defined. CAMFT-sponsored
AB 1907 amended a section of the Welfare and Institutions Code to specifically
name marriage and family therapists as “multidisciplinary personnel.” Previously,
MFTs had been referred to as “other trained counseling personnel.”
This article highlights
many bills, but not all, of the legislation that CAMFT sponsored
and was instrumental in the bills’ success.
Not addressed here are the myriad bills that CAMFT was instrumental
in amending to either be beneficial to the profession or to at
least not be detrimental. Nor does this article address the
bills that
CAMFT was instrumental in assuring that they did not pass. Likewise,
this
article does not address, generally speaking, the many bills that
may have died at the hand of the Governor or the action, or lack
of action,
in the legislature.
As one can see by a quick overview of the history, the profession
was built piece by piece by legislative action. It has been tweaked,
molded, and crafted by legislation and has risen from a budding profession
tinged by the questionable practices and reputations of those that
led to its beginning into a profession that has grown to be deservedly
respected. Further, the profession will continue to evolve, and this
evolution will be driven largely by legislative action.