Alan Montgomery, JD, Staff Attorney
The Therapist
November/December 2017

INTRODUCTION
For those just beginning the journey of becoming a Licensed Marriage and Family Therapist in California, the road may seem long. There are new many paths to navigate as you begin your academic course of study and enter the field of practice. This article focuses on some of the more practical educational and experience requirements specifically applicable to trainees and how those requirements change when a trainee graduates and becomes an MFT Registered Intern,1 such as supervision ratios.

When can a trainee begin counting pre-degree hours?
A trainee can count hours of experience after they have completed either a minimum of 12 semester or 18 quarter units of coursework in a qualifying marriage and family therapist degree program.2 However, a trainee may count personal psychotherapy hours from the date they began a degree program (must still be within the six years). Please note, effective January 1, 2016, obtaining and tracking supervised work experience hours became less complicated. Senate Bill 620, streamlined options to gain supervised work experience hours. After January 1, 2016, individuals may gain hours in two categories—clinical and nonclinical experience (“Option 1”). The existing option of multiple categories (“Option 2”) will remain available, and allows registrants to count personal psychotherapy hours, but individuals are required to submit an Application for Licensure and Examination postmarked no later than December 31, 2020.

What types of hours can a trainee count towards supervised experience?
A trainee is permitted to earn a maximum of 1,300 hours of experience prior to the degree being awarded. Up to 750 hours of counseling and supervision are permitted within the 1,300-hour maximum.3

Can a trainee provide services through Telehealth? If so, where can information about the telehealth guidelines and regulations be obtained, and what special considerations should be considered.
Yes. Trainees working under licensed supervision may provide services via telehealth as long as the provision of services is in accordance with the regulations governing the use of telehealth promulgated by the board.4 Originally, the statute that defined telehealth and set provisions for the practice of telehealth was written only for licensed individuals (a definition which included interns/associates, but not trainees, who are not yet under the jurisdiction of the Board.) Thanks to CAMFT’s advocacy efforts, an amendment was added to the LMFT statute (BPC §4980.43) clarifying that MFT trainees are permitted to perform telehealth.

The telehealth regulations are available on the Board of Behavioral Science’s website at: http://www.bbs.ca.gov/licensees/psych_online. shtml. For further reading about the new telehealth regulations, read the article titled, “Regulatory and Legal Considerations for Telehealth: What Therapists Need to Know” by Ann-Tran Lien, JD.

In cases where continuity of care is crucial, work collaboratively with the patient—to the extent that you can—to ensure support services will be readily accessible to the patient in that other state.

Where can a trainee work to gain hours of experience?
A trainee may obtain supervised experience a setting that: 1) lawfully and regularly provides mental health counseling or psychotherapy, 2) provides oversight to ensure that the trainee’s work satisfies experience and supervision requirements as prescribed by the licensing statutes and regulations, and 3) exempt settings (not a private practice or a professional corporation owned by a Licensed Marriage and Family Therapist, a Licensed Professional Clinical counselor, a Licensed Psychologist, a Licensed Clinical Social Worker, or a Licensed Physician and Surgeon.)

Exactly what types of settings are exempt settings?
The type of settings which are “exempt” from mental health professional licensure laws include:

1. 501(c)(3) Non-Profit/Charitable organizations
2. Governmental entities such as federal, state, city, and county governments
3. Schools, colleges, or universities which can be either non-profit or for-profit
4. Churches with tax exempt status
5. Alcohol and drug treatment programs regulated and licensed by the CA Department of Alcohol and Drug Treatment Programs which can be either non-profit or for profit
6. State licensed skilled nursing facilities that provide mental health services
7. State licensed residential health care facilities
8. State licensed intermediate/in-patient care facilities that provide behavioral health care services
9. State correctional treatment centers
10. State licensed social rehabilitation or community treatment facilities
11. Hospitals which can be either non-profit or for-profit

Does a trainee have to be enrolled in a practicum in order to count hours of experience?
Generally, the law requires that a trainee must be enrolled in practicum in order to counsel clients. However, there are two exceptions. The first exception is as follows: a trainee who began graduate study before August 1, 2012, and graduates before December 31, 2018, may count hours of experience and counsel clients outside of the required practicum as long as hours were earned on and after January 1, 2012.

The other exception to this requirement is as follows: a trainee who began graduate study after August 1, 2012, and graduates after December 31, 2018, may gain hours of experience and counsel clients while not enrolled in practicum course if 1) there is a period of lapsed enrollment less than 90 calendar days, and 2) that period is immediately preceded by enrollment in a practicum course and immediately followed by enrollment in a practicum course; or, immediately followed by completion of the degree program.5

For example, if a trainee’s practicum course ended on May 29, and the trainee is not taking a summer practicum course, the trainee may see clients for the next 90 days provided the trainee is enrolled in another practicum course that starts by August 27, or graduates by August 27.

What is the required ratio of supervision to client contact hours for a trainee and how does that differ from the supervision ratio requirements registered interns?
Trainees must receive at least one unit of supervision for every five (5) hours of psychotherapy or counseling performed, and in each setting. “One unit” of supervision = one (1) hour of individual OR two (2) hours of group. A trainee is required to receive supervision in each week he/she is gaining hours of experience, but is not required to satisfy the ratio on a weekly basis and can average their supervision ratios over the course of their employment at a particular site.6 To illustrate, consider the following examples:

EXAMPLE #1: John, an MFT Trainee, works in a residential treatment program and provides 16 hours of direct counseling experience during a single week. John must have four (4) units of supervision during that week.

EXAMPLE #2: Harry, an MFT Trainee, works at two different sites. During a single week, Harry provides four hours of direct counseling experience at Job A, and seven hours direct counseling experience at Job B during a single week. Harry must obtain three (3) units of supervision during that week—one unit for each work setting—1 unit for Job A and 2 units for Job B.

EXAMPLE #3: During one week, Brenda an MFT Trainee, accumulates ten (10) hours of direct counseling experience and had one (1) hour of individual supervision and two (2) hours of group supervision (two units). The second week Brenda accumulated fifteen (15) hours of direct counseling experience and had two (2) hours of individual supervision and two (2) hours of group supervision (three units). In the third week, she accumulated ten (10) hours of direct counseling experience and had two (2) hours of individual supervision and two (2) hours of group supervision (three units). Over the course of three (3) weeks of MFT Trainee experience, Jennifer accumulated thirty-five (35) hours of direct counseling work experience and eight (8) hours of supervision. Brenda has met her supervision requirement over this three-week period.

Once a Trainee is registered as a Registered Intern, the ratio for client to supervision changes. The supervision requirement for an MFT Registered Intern and Post-Graduate Intern Applicant is as follows: Interns and Applicants must receive one unit of supervision for the first 10 hours of counseling experience performed in any week in each setting. Interns must receive one additional unit of supervision during any week in which more than 10 hours of psychotherapy or counseling are performed in each setting. However, unlike a trainee, a registered intern may not average their supervision hours.

Can a trainee receive supervision through video conferencing?
Trainees are not permitted to receive supervision in this manner. Only, an MFT Registered Intern who works in a governmental entity; school, college, or university; or an institution that is both nonprofit and charitable may obtain supervision via live two-way videoconferencing. The supervisor is responsible for ensuring that the client confidentiality is preserved.

Individual or group supervision may not be provided over the telephone, as supervision must consist of face-to-face contact.

How must a trainee advertise while in school, and after graduating, but before obtaining an intern registration number?

A trainee is an unlicensed person currently enrolled in a masters or doctor degree program designed to qualify him or her for licensure. As discussed above, the BBS does not register or have jurisdiction over MFT Trainees. However, the licensing statutes and regulations do prescribe advertising guidelines for any person or entity that advertises services performed by an MFT Trainee. Under Business and Professions Code, Section 4880.48, “any person that advertises services performed by a trainee shall include the following:

Any person that advertises services performed by a trainee shall include the trainee’s name, the supervisor’s license designation or abbreviation, and the supervisor’s license number.

Any advertisement by or on behalf of a marriage and family therapist trainee shall include, at a minimum, all of the following information:

That he or she is a marriage and family therapist trainee.

The name of his or her employer.

That he or she is supervised by a licensed person.”

As such, a trainee may appropriately refer to him or herself as a graduate student or as an “MFT Trainee.”

An applicant who has graduated from school, and has not yet received an intern registration number, can use a title that is not deceptive or misleading that substantially complies with the BBS advertising laws. The BBS has indicated the titles “MFT Intern Registration Applicant,” or “Post-graduate MFT Intern Registration Applicant,” are appropriate titles to use in advertisements.

Can a graduate count hours of experience after he/she graduates but before he/she receives an Intern Registration?

Whether a graduate may count hour of experience towards licensure after graduation depends on the following: (1) the time frame during which the intern application is submitted to the Board; and, (2) the type of setting in which the graduate works during that time. For example, a graduate who works in an “exempt” setting and applies for an intern registration number within ninety (90) days of their degree conferral date, and is subsequently issued an intern registration number, may count those post-degree hours toward licensure. However, a graduate is not permitted to work in, and/or count hours earned at, a private practice setting until he/ she actually receives an Intern Registration number.7 An intern applicant can count hours using the registered intern ratio as explained above.

If an applicant for MFT licensure earned hours as a trainee more than six years from the date he/she applies for licensure, will all of those hours be lost?
Under the “Six-Year Rule,” hours of experience must be gained no more than six (6) years immediately preceding the date on which the applicant applies for LMFT examination eligibility. However, a maximum of 500 hours of experience earned as a trainee (i.e., direct counseling and supervision) older than six years may be counted toward licensure.

To illustrate, consider the following example:

Cynthia applies for LMFT examination eligibility and the BBS receives her application on 4/27/2012. All of the hours gained by Cynthia between 4/27/2006 and 4/27/2012 will be acceptable. However, if required, she could count up to 500 hours of direct counseling and supervision hours gained as a trainee that are older than 4/27/2006.

Trainees and Minors Consent
Under Health and Safety Code section 124260 and Family Code section 6924, a therapist can provide services to a minor, 12 years or older, without parental consent, in certain circumstances. The Health and Safety Code was amended so that MFT Trainees, like LMFTs and Registered Interns, can see clients 12 and older without parent consent. The law requires that an MFT Trainee must notify his or her supervisor or, if the supervisor is unavailable, an on-call supervisor at the site where the Trainee volunteers or is employed within 24 hours of treating or counseling a minor. If upon the initial assessment of the minor the Trainee believes that the minor is a danger to self or to others, the Trainee must notify the supervisor or, if the supervisor is unavailable, the on-call supervisor immediately after the treatment or counseling session.

CONCLUSION
Thoroughly understanding what requirements have to be fulfilled at each stage in the process of becoming licensed is no doubt overwhelming. The more information you have at your fingertips, and knowing where the resources are with the information you need, the more prepared and confident you will be.

Alain Montgomery, is a paralegal for CAMFT. Alain is available to answer member calls regarding ethical and licensure issues.