The Building of a Profession
A Profession Created, Crafted and Adapted Through Legislation
Many marriage and family therapists are unaware of the profession’s humble beginnings in the State of California. Marriage and family therapy or marriage, family and child counseling as it was known in the early years, was initiated and crafted by years of legislative initiatives.
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, co-authored 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 of 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 disorder.
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 is too fierce, or maybe the timing is not right, or other factors 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, 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 psychotherapist-patient 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 by 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 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, CAMFT-sponsored 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.