The Therapist
November/December 2008
Ann Tran, J.D. (CAMFT Staff Attorney)

I. INTRODUCTION

As of today, all fifty states and the District of Columbia have passed laws regulating marriage and family therapists. Marriage and family therapists who practice in this country are expected to do so within their “scopes of practice,” which is primarily measured by his or her licensing state’s legislative authority. A marriage and family therapist’s scope of practice varies from state to state. This article will focus solely on what is contained within the specific definition of a state’s MFT scope of practice. One must be mindful that the scope of practice for marriage and family therapists for each state is also further defined by the state’s entire licensing law, related regulations, and case law.

II. A LOOK AT THE LANGUAGE

A. “DIAGNOSIS AND TREATMENT” 1

Of the fifty states that have passed laws to regulate marriage and family therapists, twenty-four states, including the District of Columbia2 contain the language “diagnosis and treatment” in their scopes of practice for marriage and family therapists. These twenty-four states consist of Alaska3 , Arizona4 , Colorado5 , Delaware6 , Florida7 , Hawaii8 , Kansas9 , Maryland10, Missouri11, Montana12, Nevada13, New Hampshire14, New Mexico15, North Dakota16, Oklahoma17, South Carolina18, South Dakota19, Tennessee20, Utah21, Vermont22, Washington23, West Virginia24, Wisconsin25, and Wyoming26. For example, the Alaska Statute provides:

“Practice of marital and family therapy” means the diagnosis and treatment of mental and emotional disorders that are referenced in the standard diagnostic nomenclature for marital and family therapy, whether cognitive, affective, or behavioral, within the context of human relationships, particularly marital and family systems; marital and family therapy involves:

(A) the professional application of assessments and treatments of psychotherapeutic services to individuals, couples, and families for the purpose of treating the diagnosed emotional and mental disorders; (B) an applied understanding of the dynamics of marital and family interactions, along with the application of psychotherapeutic and counseling techniques for the purpose of resolving intrapersonal and interpersonal conflict and changing perceptions, attitudes, and behaviors in the area of human relationships and family life.”

Furthermore, the terms “mental and emotional disorders (or problems)” follow “diagnosis and treatment” in the scopes of practice of marriage and family therapists for sixteen states, as well as the District of Columbia. These states are Alaska, Colorado, Delaware, Florida, Hawaii, Montana, Nevada, New Hampshire, Oklahoma, South Carolina, Utah, Wyoming, North Dakota, Utah, Washington and West Virginia. Moreover, Colorado includes additional language after the terms “mental and emotional disorders,” that reads, “alcohol and substance abuse, and domestic violence, and modify intrapersonal and interpersonal dysfunctions.” Florida also adds extra language after the terms “emotional and mental dysfunctions,” which states, “sexual dysfunctions, behavioral disorders, alcoholism, and substance abuse.”

The other states have differing language after the terms “diagnosis and treatment” with regards to their MFT scopes of practice. Kansas does not include “emotional disorders,” but MFTs in this state may diagnose and treat “mental disorders.” South Dakota, New Mexico, Vermont, and Wisconsin use the terms “nervous and mental disorders.” MFTs in Tennessee may diagnose and treat “cognitive, affective, and behavioral problems and dysfunctions.” Also, Arizona authorizes MFTs in its state to use “principles and techniques to treat interpersonal relationship issues and nervous, mental and emotional disorders.”

Additionally, Maryland’s MFT scope of practice contains “the diagnosis, prevention, treatment, and amelioration of psychological problems or emotional and mental conditions of individuals or groups.” In Missouri, marriage and family therapists’ scope of practice is defined as “the diagnosis, evaluation, assessment and treatment of intrapersonal or interpersonal dysfunctions within the context of marriage and family systems.” Moreover, MFTs in Oklahoma are practicing within their scope of practice if they “assess, diagnose and treat disorders, whether cognitive, affective, or behavioral, within the context of marital and family systems.”

B. “ASSESSMENT AND TREATMENT” 27

Fourteen states utilize the terms “assessment and treatment” in their MFT scopes of practice. These states are Alabama28, Arkansas29, Arizona30, Colorado31, Kansas32, Louisiana33, Maine34, Minnesota35, Nebraska36, New York37, Ohio38, Oklahoma39, Pennsylvania40, and Virginia41. For instance, the Maine Revised Statutes provide that “marital and family therapy services mean the assessment and treatment of intrapersonal and interpersonal problems through the application of principles, methods and therapeutic techniques for the purpose of resolving emotional conflicts, modifying perceptions and behavior, enhancing communication and understanding among all family members, and preventing family and individual crises.”

Within these fourteen states, six states, Alabama, Colorado, Minnesota, Nebraska, Pennsylvania, and Virginia include the terms “mental and emotional disorders (or problems)” following “assessment and treatment.” Eight states contain varying language after “assessment and treatment” in their MFT scopes of practice. Both Arkansas and Maine use the terms “intrapersonal and interpersonal dysfunctions (or problems).” Moreover, MFTs in New York may assess and treat “nervous and mental disorders,” as well as treat “mental, emotional and behavioral disorders and ailments.”

Additionally, Louisiana’s MFT scope of practice simply states “the assessment and treatment of individuals, couples, and families.” Further, an MFT in Ohio may assess and treat “emotional disorders, whether cognitive, affective or behavioral.” The language following “assessment and treatment” of the remaining three states, Arizona, Kansas, and Oklahoma have been mentioned above (see “Diagnosis and Treatment”).

C. “EVALUATION AND TREATMENT”

Georgia42, Idaho43, Illinois44, Indiana45, and Ohio46 include “evaluation and treatment” in their MFT scopes of practice. For example, the Idaho Code provides:

“’Marriage and family therapy’ means the evaluation and treatment of mental and emotional disorders, whether cognitive, affective or behavioral, within the context of marriage and family systems. Marriage and family therapy includes the professional application of psychotherapeutic and family systems theories and techniques in the delivery of services to individuals, couples and families for the purpose of treating nervous and mental disorders.”

In Idaho, an MFT is allowed to evaluate and treat “nervous and mental disorders.” Furthermore, MFTs in the states of Georgia, Illinois, and Indiana may evaluate and treat “emotional and mental problems or conditions.” Ohio’s MFT scope of practice has been mentioned above (see “Assessment and Treatment”).

D. “IDENTIFICATION AND TREATMENT”

Two states, Kentucky47 and Oregon48 use the terms “identification and treatment” in their MFT scopes of practice. In both Kentucky and Oregon, an MFT may identify and treat “cognitive, affective, and behavioral conditions.”

E. “EVALUATION,” “ASSESSMENT,” “IDENTIFICATION”

The states of Connecticut, Iowa, and Texas do not include “treatment” anywhere in their MFT scopes of practice, but rather utilize the terms “evaluation,” “assessment,” and/or “identification.” The Connecticut General Statutes provide, “Marital and family therapy means the evaluation, assessment, counseling and management of emotional disorders, whether cognitive, affective or behavioral, within the context of marriage and family systems, through the professional application of individual psychotherapeutic and family-systems theories and techniques in the delivery of services to individuals, couples and families.”49

Furthermore, Iowa defines marital and family therapy as “the application of counseling techniques in the assessment and resolution of emotional conditions. This includes the alteration and establishment of attitudes and patterns of interaction relative to marriage, family life, and interpersonal relationships.”50 In Texas, the term “marriage and family therapy” means the “evaluation and remediation of cognitive, affective, behavioral, or relational dysfunction in the context of marriage or family systems.”51

F. VARYING LANGUAGE

California, Michigan, and Mississippi include language in their MFT scopes of practice that is unique from what has been previously discussed. For instance, California’s MFT scope of practice provides:

“The practice of marriage and family therapy shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and pre-marriage counseling. The application of marriage and family therapy principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships, and the use, application, and integration of the coursework and training required by Sections 4980.37, 4980.40, and 4980.41.”52

Moreover, Michigan’s MFT scope of practice involves “providing of guidance, testing, discussions, therapy, instruction, or advice that is intended to avoid, eliminate, relieve, manage, or resolve marital or family conflict or discord, to create, improve, or restore marital or family harmony, or to prepare couples for marriage.”53 The law in Mississippi provides that marriage and family therapy “means the rendering of professional therapy services to individuals, families or couples, singly or in groups, and involves the professional application of psychotherapeutic and family systems theories and techniques in the delivery of therapy services to those persons.”54

Additionally, Massachusetts, New Jersey, and Rhode Island do not include language previously mentioned, but all three states contain the terms “apply (or provide) therapeutic techniques for the purpose of,” “resolving,” “modifying,” and/or “enhancing” in their MFT scopes of practice. Massachusetts General Laws defines the practice of marriage and family therapy as the rendering of professional services to individuals, family, groups, couples or organizations, which include “applying principles, methods and therapeutic techniques for the purpose of resolving emotional conflicts, modifying perceptions and behavior, enhancing communications and understanding among all family members and the prevention of family and individual crisis.” 55

In New Jersey, MFTs may apply principles, methods and techniques of counseling and psychotherapy for “the purpose of resolving psychological conflict, modifying perception and behavior, altering old attitudes and establishing new ones in the area of marriage and family life.” Also, in Rhode Island, an MFT provides professional services by “applying principles, methods and therapeutic techniques for the purpose of resolving emotional conflicts, modifying perceptions and behavior, enhancing communications and understanding among all family members and the prevention of family and individual crisis.” 56

G. “PSYCHOTHERAPY” 57

A key term that is found in the MFT scopes of practice for thirty-eight states, along with the District of Columbia is the term “psychotherapy.” These states consist of Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, Wisconsin, and Wyoming. Accordingly, MFTs in these states and the District of Columbia may use applied psychotherapeutic techniques in their practice of marriage and family therapy. For example, MFTs in Massachusetts may “engage in psychotherapy of a nonmedical nature with appropriate referrals to psychiatric resources and research and teaching in the overall field of human development and interpersonal relationships.”

The states that do not explicitly include the term “psychotherapy” in their MFT scopes of practice are Alabama, Iowa, Kansas, Maine, Maryland, Michigan, New Mexico, Oklahoma, Texas, Virginia, and West Virginia. Nine of the aforementioned eleven states include the terms “diagnosis,” “assessment,” and/or “treat” in their MFT scopes of practice.58 Thus, this implies that some form of psychotherapy may be used by MFTs in these states in order to diagnose, assess, and/or treat.

The two states that do not have “psychotherapy” or the terms “diagnosis,” “assessment,” and “treatment” in their MFT scopes of practice are Michigan and Texas. Although they do not utilize these terms, Michigan and Texas both define marriage and family therapy as “providing therapy”; hence, MFTs in these two states may render some form of professional therapeutic services.

H. EXPLICIT LANGUAGE PROHIBITING OR LIMITING THE ADMINISTERING OR INTERPRETING OF PSYCHOLOGICAL TESTS

Several states utilize language in their MFT scopes of practice that explicitly prohibits or limits MFTs from administering or interpreting psychological tests. The states that make up this group are Alabama, Florida, Kentucky, Michigan, and Nevada. MFTs in Nevada are not permitted to use psychological or psychometric tests to determine intelligence, personality, aptitude, interests or addictions. Similarly, Kentucky does not allow MFTs in its state to label any test, report, or procedure as psychological.

In the states of Alabama, Florida, and Michigan, MFTs may administer, describe, or label a procedure or test as “psychological,” but to do so within their scopes of competence (which is determined by one’s education, training, and experience). An MFT in Florida may not label any test, report, or procedure as psychological, except to relate specifically to the definition of the practice of marriage and family therapy authorized in the Florida Statute. Additionally, Alabama does not allow MFTs in its state to perform any act they are not educated and trained to perform. These acts include “administering and interpreting psychological tests,” as well as describing or labeling any test, report, or procedure as psychological, or as a psychological evaluation. Michigan’s law provides that the practice of marriage and family therapy does not include “the administration and interpretation of psychological tests except for those tests that are consistent with the individual’s education and training and with the code of ethics for licensed marriage and family therapists.”

I. “INDIVIDUALS, COUPLES, AND FAMILIES”

The licensing law for forty-three states, plus the District of Columbia, clearly defines for whom an MFT may render professional services. The common language found in the scopes of practice for these states and the District of Columbia is the delivery of therapeutic services “to individuals, couples, and families.” Most states also include the terms “either alone or in a group” and “singly or in groups.”

The seven states that are not explicit in this fact are Arkansas, Indiana, Iowa, Kansas, Maine, Michigan, and New Hampshire. Although the law in these seven states do not overtly provide for whom MFTs may render professional services, one may contend, based on the broad language of the states’ scopes of practice for marriage and family therapy, that MFTs in these states may render services not only to couples and families, but to individuals as well. For instance, Arkansas provides that marriage and family therapy involves “modifying marital, family, and individual behavior within the context of marital and family systems, including the context of marital formation and dissolution.” Thus, in Arkansas, MFTs may provide services to individuals in order to modify their behavior. Furthermore, MFTs in Indiana may use individual, group, couple, sexual, family, and divorce therapy to evaluate individual, marital, relational, communicational, parent and child, and family functioning. Individual functioning is included in Indiana’s scope of practice, which clarifies that an MFT may render services to individuals.

Moreover, in Iowa, an MFT may apply counseling techniques to assess and resolve emotional conditions, as well as alter and establish “attitudes and patterns of interaction relative to marriage, family life, and interpersonal relationships.” Kansas permits MFTs to assess and treat cognitive, affective or behavioral problems within the context of marital and family systems, as well as diagnose and treat mental disorders. In Maine, an MFT may enhance communication and understanding among all family members, as well as prevent family and individual crises.

Additionally, Michigan states that an MFT may provide therapy “to avoid, eliminate, relieve, manage, or resolve marital or family conflict or discord, to create, improve, or restore marital or family harmony, or to prepare couples for marriage.” New Hampshire’s MFT scope of practice includes “the observation, description, evaluation, interpretation, diagnosis, and modification of human behavior by the application of psychological and systems principles, methods, and procedures for the purpose of preventing or eliminating symptomatic, maladapted, or undesirable behavior and of enhancing interpersonal relationships, work and life adjustments, personal effectiveness, behavioral health, and mental health, as well as the diagnosis and treatment of the psychological and social aspects of physical illness, accident, injury, or disability.”

III. CONCLUSION

The scope of practice for MFTs across the nation is comparable in some aspects, and dissimilar in others. Several states utilize similar terms in defining the scope of practice for MFTs, such as “diagnosis,” “assessment,” “treatment,” and “mental and emotional disorders.” Other states use terms such as “evaluation,” “identification,” and “intrapersonal and interpersonal dysfunctions.” Some states do not include any of the abovementioned terms to define the scope of practice for MFTs, but include varying language. Further, a number of states explicitly provide what is permitted and what is not, such as the interpretation of psychological tests. Additionally, a few states utilize the terms “including, but not limited to,” permitting MFTs to use techniques not specifically stated in the law, and still be practicing within their scope of practice. To conclude, this article discusses the specific definition of an MFT’s scope of practice as taken from the licensing laws of the fifty states and the District of Columbia. However, MFTs practicing in this country are not entirely limited to what is exclusively contained in their scopes of practice, but should also look to their state’s entire licensing law, other related regulatory authority, and case law to further define the breadth of the scope of practice for marriage and family therapists in their states.

Includes the terms “diagnosis and treatment”; “diagnose…treat”; “treat and diagnose”; “treatment and diagnosis”; “treat…diagnose.”

2 D.C. Code § 3-1207.22(19).

3 Alaska Stat. § 08.63.900(5).

4 Ariz. Rev. Stat. § 32-3251(7). Arizona also uses the terms “assessment” and “appraisal.”

5 Colo. Rev. Stat. § 12-43-503. Colorado also uses the terms “assess” and “understand.”

6 24 Del. Code § 3051(d).

7 Fla. Stat. § 491.003(8).

8 Haw. Rev. Stat. § 451J-1.

9 Kan. Stat. Ann. § 65-6402(b). Kansas also uses the terms “assessment and treatment.”

10 Md. Code § 17-3A-01(g).

11 Mo. Rev. Stat. § 337.700(7).

12 SB 271 approved by Governor on April 28, 2009.

13 Nev. Rev. Stat. § 641A.080.

14 N.H. Rev. Stat. § 330-A:2.

15 N.M. Stat. 61-9A-3. See also, N.M. Stat. 61-9A-5.

16 N.D. Cent. Code § 43-53-01.

17 59 Okla. Stat. § 1925.2. Oklahoma also uses the term “assess.”

18 S.C. Code Ann. § 40-75-20.

19 S.D. Codified Laws 36-33-1.

20 Tenn. Code Ann. 63-22-115.

21 Utah Code Ann. § 58-60-302(3).

22 26 Vt. Stat. Ann. § 4031.

23 Wash. Rev. Code § 18.225.010(7).

24 HB2532 approved by Governor on April 24, 2009.

25 Wis. Stat. § 457.01(5).

26 Wyo. Stat. § 33-38-102.

27 Includes the terms “assess and treat”; “assess…treat”; “treat and assess”; “treatment and assessment”; “treatment…assessment.”

28 Ala. Code § 34-17A-3(5).

29 Ark. Code. Ann. § 17-27-102(7)(A).

30 Ariz. Rev. Stat. § 32-3251(7).

31 Colo. Rev. Stat. § 12-43-503.

32 Kan. Stat. Ann. § 65-6402(b).

33 La. Rev. Stat. § 37:1103.

34 32 Me. Rev Stat. §13851(6).

35 Minn. Stat. § 148B.29, subd 3.

36 Neb. Rev. Stat. § 38-2114.

37 N.Y. Education Law § 8403.

38 Ohio Rev. Code § 4757.01. Ohio also uses the terms “assessment”; “counseling”; and “management.” 39 59 Okla. Stat. § 1925.2.

40 63 Pa. Consol. Stat. § § 1901-1922.

41 Va. Code Ann. § 54.1-3500.

42 Ga. Code Ann. § 43-10A-3.

43 Idaho Code § 54-3401.

44 225 Ill. Comp. Stat. § 55/10.

45 Ind. Code § 25-23.6-1-7(7).

46 Ohio Rev. Code § 4757.01.

47 Ky. Rev. Stat. § 335.300(4).

48 Or. Rev. Stat. § 675.705(5).

49 Conn. Gen. Stat. § 20-195(a)(3).

50 Iowa Code § 154D.1.

51 Tex. Occ. Code § 502.002(6).

52 Cal. Bus. & Prof. Code § 4980.02; See generally, Riemersma, Mary. “Scope of Practice.” The Therapist 13.4 (Jul./Aug. 2001): 14- 17. (This article provides a more in-depth look at the scope of practice for marriage and family therapy in California.)

53 Mich. Comp. Laws § 333.16901(c).

54 Miss. Code Ann. § 73-54-5(b). 55 Mass. Gen. Laws ch. 112 § 163.

56 R.I. Gen. Laws § 5-63.2-2(8).

57 Includes the term “psychotherapeutic techniques.”

58 Alabama, Iowa, Kansas, Maine, Maryland, New Mexico, Oklahoma, and Virginia.