Couples and Family Therapy


I wanted to call this post “advice for taking and passing the LMFT exam” but it turns out, having passed last week, that I don’t have much advice to give. The problem is that the ways the exam is hard are not things you can prepare for. I’ll describe that situation, for what it’s worth, then describe the process of taking the test, and give the few pieces of advice I can offer. Take that advice with several grains of salt, though, because when you pass, they don’t tell you your score. I have no idea if I passed with flying colors or barely scraped by. For reasons I’m about to get into, I wouldn’t be surprised either way. I really can’t say if I over-prepared and rocked it or underprepared and got lucky.

The material you have to know is not that hard. With a few exceptions, it’s the same stuff you learned in your grad school program, the same stuff you’ve been drilling in your internship. The test is hard mostly because the writing is terrible. Have you ever read something that has been passed through several languages in a translator program, then back into English? That is how the questions, and especially the answers, read. Most of them. They often barely make sense and some of it is complete nonsense. I doubt they used the translator trick, so it may be that they looked up the most obscure synonym for each word and then garbled up the grammar a bit to top it off. I would be ashamed to be associated with the writing of that exam. I do not consider it an ethical way to make an exam difficult. Unfortunately, that is the situation.

The second reason it is hard is that you have to read and comprehend all of that garble at lightning speed. I read at a slightly above average speed with high comprehension and I had twelve minutes left at the end to review my marked questions. Twelve minutes left at the end of a four hour test.

So that’s my first piece of advice: If you’re a slower than average reader, see what you can do for special accommodations on time, and definitely if English is your second language. I don’t know what’s available in that way, but look into it and take what you can get.

The third reason is that it’s just difficult to sit and concentrate that hard for four hours without stopping. Your body will hurt, if it has that tendency. If you have body or pain issues I would look into what accommodations they have to offer.

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The process of taking the test: I took mine in Riverside, so this may vary, and because you have to take the ethics exam right away now, you probably know all of this stuff already. You can skip this and the next paragraphs. PSI, the testing company has a suite in an office building. You walk into their lobby and the staff signs you in, takes your photo, and you wait a bit. The staff is very nice and professional. There is a rack to hang your coat and you can get a locker. (The PSI materials say that you don’t get a locker, but you can.) They let me take my migraine meds in on a tissue, but you can’t take anything else. I wished I’d worn a long sleeve shirt because it was a bit cool for me and I couldn’t take my sweatshirt in. They provide a pencil and scratch paper. You sit in one of fifteen or twenty cubicles with a PC computer, mouse, and keyboard. It’s pretty quiet. They offer you earplugs but I didn’t need them, and I’m pretty sensitive to noise. You run through some instructions and practice questions to get the hang of it. It’s pretty easy. Then you start the test and have four hours to finish 170 questions. That’s less than 90 seconds per question. There are three or four counters at the top of your screen, counting questions, up and down, and time. I can’t remember if the timer counted up or down or both, but I remember it being pretty easy to use. I would occasionally multiply my number of questions answered by 1.5 to make sure I was on track to get through every question. For example, after answering question 40, I could check that I was well under one hour into the exam. You can take breaks whenever you want, but the clock won’t stop. I took two breaks. The first was about a minute, to eat a few bites of a date bar I left in my coat pocket, about an hour and a half into the exam. The second was to pee, at about three hours in. That took five or six minutes, because the bathroom is down the hall and the staff has to escort you. I’m glad I took the breaks. I imagine that seven or eight extra minutes at the end of the exam would not have been very useful after hours of low blood sugar and holding pee.

If you have any time left, you can go back and look at questions you marked. I had time to look at a few and changed one answer. Then you finish. They make you click “yes” on a few versions of “Yes, I understand this will end my test and I can’t go back” before ending, so you can’t end the test accidentally. You walk back out into the lobby, grab your stuff, and get your results. I think if you fail they tell you your score, but I’m not sure. There is also the possibility that the BBS is re-analyzing how the exam is performing and you won’t find out if you passed for another month or so. That happened to me for my ethics exam, and it’s much nicer to know immediately how you did. I was in a bit of a daze after the exam and walked around the roads near the test center for a while before I felt like driving.

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To prepare for the exam, I bought the Therapist Development Center’s MFT Clinical Exam package and did their 65 hour (versus 110 hour) track. I can’t say how it compares to Grossman or AATBS because I’ve never seen those packages. I can say that I used a Grossman practice-test package to study for the ethics exam and passed, but I’m pretty sure that I spent too much time studying that way. I basically tried to reverse-engineer the test using the practice tests plus the legal statutes and CAMFT Code of Ethics, which took a long time—a little over 70 hours of dedicated studying. The TDC package helped me avoid rabbit holes and working too long. TDC’s 65-hour track took me 68 hours to complete, plus I did an extra eight hours of study on the DSM-5, having been trained exclusively on the DSM-IV-TR. I made two outlines of the DSM-5, one of timeline information, like how long you need symptoms for each diagnosis, and one for age limit information. (I put those up here and here.) I also spent about four hours reading (and rereading) the CAMFT Code of Ethics, California statutes, and legal/ethics articles from CAMFT’s Therapist magazine archives.

Again, I have no idea how I would have done without studying that way, but I went in feeling as well-prepared as I could have. I barely studied the last couple days before the test because I felt like I knew the material. I remember thinking, “If I don’t pass, I’m not sure what I will do for the next four months, because I already know this stuff.”

So I can recommend the Therapist Development Center material. The extra DSM study didn’t help me that I remember on the exam—the TDC coverage would have been enough. I could probably say the same for the Code of Ethics and statutes reading. I don’t recall the test getting very nit-picky about any of that stuff. That’s not how they made the exam difficult, though I would have preferred it that way. Even if it was extra studying, I feel good about having done it. We MFTs should know that stuff cold.

That was likely the last multi-hour multiple choice exam I’ll ever have to take. I’m fine with that. Now it’s time to focus on setting up my private practice!

This is a long post, so first the short version. In the last year: I started working full time and am adjusting to that. I’m glad to be working towards my MFT licensure, but uncomfortable about how it pushes my relationships and other projects onto the back burner. My marriage gets better and better, despite this. The company I work for goes out of business so I get part of the summer off, and I get the exact same job (family therapist for US Marines & their families) with a new company.

And for the year ahead: I plan to continue this work, taking good care of myself, dance with Reanna every night, as promised to my friend, Tilke, in her “How to be a Real Artist” workshop, get in best shape in 5 years, and learn how to treat myself and Reanna really really well while working full time.

October: I started my year out at Farm & Wilderness, VT, staffing and teaching a really fun psychology project at Not Back to School Camp. As is traditional, I got really sick, but this time it was from a waitress in Rutland, not someone at NBTSC. I recuperated while visiting Ethan & Susannah, also in Vermont. Back in Joshua Tree, I started working out again (SERIOUS style), planted my first winter garden, fixed some electrical and plumbing problems in my trailer, and started setting up a private practice. In the process of hiring a supervisor, I found out that in California, unlike in Oregon, I cannot do my internship in a private practice. So I started looking for work in a local clinic.

Looking out over Woodward Reservoir from my cabin at Farm & Wilderness

Ethan, cataloging NBTSC lost & found in his library

The famous Quodlibetarian tub

Reanna

Reanna at Playa Del Rey

Ollie, a year ago

Ollie & Pap

Gabe, Damian & Maya on the Hwy 62 Art Tour

Trailer at sunset, looking south

November: I move into a new computer, archive my years of audio journal entries, and learn Sketchup while applying for and getting a job at Morongo Basin Mental Health: providing free, confidential therapy for US Marines, veterans, and their families. In what would become a series of small-town coincidences, a high school friend I hadn’t seen in decades worked there, saw my name on the interview list and sat in on my interview, interjecting stuff like, “Oh, yeah, good answer!” Nice way to interview. The manager of the military program assured me that the our contract was solid for at least two years. That’s about how long I need to get my hours for licensure, so the job sounded good–no chance of having to ditch my clients like I had to in grad school! I spent the rest of the month getting in as much time with Reanna and my family before starting full time work.

Rainbow over the Bartlet Mts

Maya & Ollie in hammock

Ollie helps Nana Honey cook

Me & Reanna

December:  My 93 year old Grandpa Bob gets really sick, and I get really sick taking care of him. I was pretty sure he was going to die. He had pneumonia and had to go on antibiotics for the first time in his life. It took me weeks to fully recover. He eventually recovered, too, but I’m not sure he’ll ever fully recover. He’s been on antibiotics off and on ever since and is progressively less mobile. It’s got me thinking a lot about dying–how I can support the people I love when they start having a hard time taking care of themselves, and how I want to die when my time comes.

I start at MBMH, reading 40 hours a week of protocols. I have Christmas with family in Joshua Tree. My brother Damian starts a weekly evening with family, listening to an integral Christianity lecture and meditation that turns out to be a presentation of integral theory to Christians, rather than Christianity to integral thinkers, but valuable nonetheless.

Reanna & Christina, Xmas

Reanna & Maya, Xmas

Ely, Christina, Pap, Ben, Rebeca, Xmas

Gabe, Ely, Ollie, Christina, Xmas

Reanna, ukulele, heater

Ollie, bundled up

January: I get my first paid vacation ever–one week off, fully paid by MBMH. Weird, pretty nice. I write my first attempt at a comprehensive political statement. Reanna and I start a three-month experiment with a strict “paleo” diet, which mostly means we cut out sugar and grains from our diet. The theory is that human adaptation to grains and refined anything is shallow at best. I also start cooking Mexican food (the paleo-friendly recipes) from Rick Bayless’ Authentic Mexican. I love it. And Reanna loves eating it. I start learning to play Reanna’s ukulele. I play and sing “Amazing Grace” most nights for a month. Fun!

I’m working full time, which I’ve never done. It’s not my favorite schedule. I had to let go of most of my projects. I started building a solar batch water heater in the fall, for example, that is still not finished. The schedule has simplified my life quite a bit. Work all day, spend the evening with Reanna. I gained more respect for my friends who’ve been working full time for decades and still manage to write some music or read books. I’m ramping into a caseload, though, and am seeing seven clients a week by the end of the month.

My endurance training is going great by this point. Mid month I got my heart rate up to 179 bpm without hurting myself. Very exciting.

Smiley and Gallant visit

Reanna in our clean, cold kitchen

Dinner’s almost ready. (Photo by Reanna.)

Grandpa Bob turns 94

Me in therapist costume, with Ollie. (Photo by Reanna.)

February: Full time work continues. I get trained in the Trauma Resiliency Model, which I find very cool and useful. I re-up the trademark on Abandon Ship. I feel sad that I can’t write music with my brothers right now, but have plenty of optimistic plans to do so… Reanna starts designing our future house, another exciting project that I have to watch from the sidelines. I love watching her get super deep into a topic like this, though. She is now the resident expert in passive-solar-optimized-very-small-house design. We start car shopping, too. We need to be independently mobile in Joshua Tree.

Trench. Hose feeding trailer finally to be buried.

Reanna & treehouse near the Mexican border

Ollie, Damian

March: I’m up to 16 clients at MBMH and I’m fighting for mastery of the intense paperwork load. The clinical work is going great. My supervisor is good, I am fully engaged by my clients, and I get to see a good variety of folks–kids, adults, families, couples. The paperwork is fairly unpleasant, though. Mental health providers that get government funding spend a huge amount of time and energy creating and maintaining a paper trail for their work. These clinics get paid based on the work they claim to have done and then various agencies can audit their files and take that money back if a box wasn’t checked or a T wasn’t crossed. I spend my first very late day at work in March, trying to catch up on paperwork. Reanna is not happy.

Highlights: A great lecture by Bruce Perry, planting my first spring/summer garden, endurance training going great (I work out during my lunches at MBMH), meeting the Transition Joshua Tree folks. And Reanna. Reanna is wonderful.

Lowlights: My truck fails smog and I begin what becomes an expensive debacle trying to get it to pass.  I start having sync problems with my Mac that I am still dealing with as I write. I start working on our taxes on weekends. Reanna is Canadian and that makes our taxes super complicated and somehow even though we hired a professional we ended up owing big fines.

Abandon Ship cover art, for the TM folks. Art by Tilke.

Damian & Ollie in old billy goat pen, future garden

Me, just having sunk the garden beds. (Photo by Reanna)

Reanna planting pepper starts

Ollie

Ollie & Reanna take the trash out

Ollie & Reanna rest in the hammock

April: I find out that Morongo Basin Mental Health has decided to go out of business after more than 40 years, at the end of June. That’s quite a shock and less for me than for the many decade-plus employees I work with. At home, our three months of paleo is up and I feel fine, as I have on just about every diet I’ve tried, but it clearly had not solved any of the problems we’d been tracking for the experiment. And I am sick in bed for a week for a third time this year. Reanna’s parents arrive for a month long visit. I don’t get to see them as much as I’d like, but we get in some fun events (like the Morongo Basin Conservation Association’s “Desertwise Landscape Tour” and Transition Joshua Tree’s Water Catchment Workshop), good talks, good swimming.  I get trained in sand-tray therapy by my supervisor, Richard Gray, which I find quite useful.

Reanna preps cholla buds for dinner

Family dinner at Damian & Maya’s (Damian with Bugzooka)

Doug & Kathryn up San Jacinto

May: We get a great little car, a gift from Reanna’s parents. It gets 38 mpg unless we use the AC.  At work, emotions are high and rumors are flying around. I try to avoid it as much as possible. My coworkers are mostly looking for work with great intensity. I decide that I will chill instead, concentrate on my clients, and do what I can to get my job back with whatever company picks up the military contract in the summer.  Meanwhile,  something is eating my garden. My weekends and after work time is often spent critter-proofing.

The highlight of the month by far is meeting my new nephew, Julian.

Julian in sling

Ollie in work gloves

First scorpion of a scorpion-rich year

June: I’m at 21 clients at the beginning of my last month at MBMH. The management has had me continue taking new clients but I’m starting to get nervous about it. It’s starting to look like my clients will have a significant lapse in services, and it pisses me off. I write people in charge at the county and local journalists but no-one can say how long it will take to get the military program back up and running. I know I’m fine. I can look forward to a full season working at NBTSC if things go badly. It sucks, though, that my clients are just getting dumped. It’s screwed up. I just have to set them up as best I can for the lapse and do the tons of paperwork to close their charts. Meanwhile, my co-worker, Jackie, introduces me to Candy Crush, which starts sucking up the cracks in my schedule.

Highlights: Jonathan & Ayako’s wedding in Idaho. Motorcycle safety class with Reanna. And being married to Reanna, of course.

Living room pano: Ely, Christina, Julian, Ben, Rebeca visit

Ben & Julian

North end pano from on top of Reanna’s sewing RV

Ayako & Jonathan, getting married

July: I’m unemployed again, but within two weeks I get interviewed by Pacific Clinics, the company who got the military contract that I’d been working for at MBMH. It looks like I’ll get the job based on the reputation I’d made for myself in that position. That feels good! It means I’ll miss most of NBTSC this year, too, for the first time in 14 years.

Reanna leaves for OR to do prep work for NBTSC and I delete Candy Crush from my phone so I can get some things done: install AC in our trailer, create an outside pantry, build a greywater cistern, make a front step for the trailer, get my motorcycle license, and a few other things. Satisfying. Then I fly up to OR to work the Camp Latgawa session of NBTSC.

Reanna hangs our laundry while I goof off with the camera

Cistern in progress

Julian & me

August: Finish at NBTSC (wonderful, as usual), and spend a few short days in Eugene at an NBTSC leadership summit, then back to Joshua Tree for my last week of unemployment. I completed some last-minute landscaping and plumbing projects, built a dry toilet and installed a weather station, then started training at Pacific Clinics in Arcadia.

At the end of August, Reanna got back from her travels, and we started shutting down all lights and electronics at 8pm and just hanging out until going to bed. This was lovely. We usually laid in the hammock outside, talking and looking at stars. The desert summer evenings are really, really nice. Especially with Reanna.

My advisee group, NBTSC Camp Latgawa

Ely & Julian before dinner

Reanna & Ollie, downtown Joshua Tree

September: I start making contact with clients and by the end of the month I’m back up to 7 clients. This is exciting, and it’s nice to be working with some of my old co-workers from MBMH, and the new crew at Pacific Clinics is an entertaining bunch. Working full time again limits what I can do in terms of projects, but I manage to put a new roof on the old goat pen/the new outside pantry, go visit Quail Springs permaculture farm, and start building a new composter with my 2-year-old nephew, Ollie.

At the end of the month, I have my first birthday at home in many years. Usually I’m at camp. It’s nice. My family threw me a little party and I’m glad to be here, even though I miss my people at Farm & Wilderness.

Yes, Ollie wants to help build the composter!

Rain Event, 29 Palms

With Reanna & ocotillo, on my 42nd birthday.

When I find myself in the presence of a new very smart person, my favorite question to ask is,”What is the most interesting question in your field?”* It both makes for great conversation and expands my sense of the envelope of human inquiry.

If you have an idea about the most interesting question in your field, I’d love to hear about it in a comment below. If you are the kind of person who creates and publicizes websites, though, what I’d like even more is for you to create a wiki-style site where folks can go, create a forum for their field or sub-discipline, and propose and vote on most interesting questions. This could generate what I want to look at: a home page that is a self-updating outline of what professionals believe are the most interesting questions in their field. If you want to go whole-hog, you could also let them vote on and link to what they believe are the best pieces of research on their question to date.

And since I posed the question, I should probably tackle it for my own field… I am a couples and family therapist, and I propose that the most interesting question in my field is, “What are the precise mechanisms of therapeutic change in couple and family systems?” In other words, how does therapy work? We know that it is helpful in most cases, and we have endless models and speculations about how it works, but virtually no evidence about the mechanisms of change. The best research I know about on the topic is the qualitative, two-part, “What Clients of Couple Therapy Model Developers and Their Former Students Say About Change,” by Davis & PiercyEdging into that territory from another angle is the research summarized in Gottman’s The Science of Trust.

*I stole this question from very-smart-person Ethan Mitchell.

I am moving away from Eugene after more than ten years, and that means saying a lot of goodbyes to close friends and family. Last night I had dinner with my experiential support group from my couples & family therapy grad school cohort, Ryan and Debra. In family therapy, “experiential” means very generally that you take a humanistic stance in your therapy and believe that emotions are as important as behavior and thinking. (I wrote a piece on it here if you want more details.) We called ourselves “Experiential Lunch” because we met every week for lunch for a year and a half, to discuss how our understanding and application of family theory was evolving throughout the program. It was super helpful and we came to feel quite close and supported each other through some difficult times. I am going to miss them.

Nathen, Ryan, Debra: Experiential Lunch, 10/27/2011

Debra is a Zen meditation teacher and a farmer as well as now a therapist in private practice, and I can highly recommend her in all capacities. If you need a therapist for individual, couple, or family work, you can reach her at (541) 844-4917.

Ryan is working with at-risk children and families at the Oregon Social Learning Center. When he starts a private practice, I will recommend him to you as well.

I biked around the University of Oregon campus yesterday for the first time in months, getting some stuff done in preparation for my upcoming move to Joshua Tree. I was thinking about how familiar the ride was, how many hundreds of times I had done it in the last several years. I know each building, each stop sign, each crack in the pavement on my commute.

Suddenly it hit me: I am not biking to class! All the signs pointed to school. The leaves are turning, the college kids are out in force, there is no parking within a half mile of campus, but I am done with all that.

I loved school. I loved the two years finishing my Bachelor’s degree in psychology, I loved my couples and family therapy Master’s program, I loved my classes and most of my professors, I loved the community of learners, I loved all the reading and writing, I loved the density and the pace of the learning. There is just no chance that I would have learned all that I did in the last four years without all the school, deadlines, tests, and papers.

My academically-minded friends all say that I have to do a Ph.D, that I should do a Ph.D, that I would love to do a Ph.D. And maybe they are right–I probably would love to do a Ph.D. But right now, I am glad to be done. I am excited about having a more relaxed lifestyle, moving to my small town, spending time with my family, starting my own family, starting my own practice, writing some books, writing some music. That sounds great.

It has been four years of sitting in hundreds of hours of lectures, reading thousands of pages of theory and research, writing hundreds of pages, and seeing clients for hundreds of hours. It has been long weeks, late nights, steep learning curves, and lots and lots of thinking. It is amazing how much learning you can do in four years of 60-80 hour weeks!  In 2009 I finished a Bachelor of Science degree in psychology, with a research assistant position in Sara Hodges’ social cognition lab, a practicum position at a residential treatment facility for teenage sex offenders, an honors thesis entitled “Differentiating the Effects of Social and Personal Power,” and a GPA of 4.23. Yesterday I graduated with a Master of Education degree, Couples and Family Therapy specialization, 455 client-contact hours at the Center for Family Therapy and Looking Glass Counseling Services, one term as a counselor for the University of Oregon Crisis Line, four terms volunteering for the UO Men’s Center, a GPA of 4.19, and a “Pass With Distinction” on my final Formal Client Presentation. It has been a wonderful, exhilarating, exhausting four years.

It has also taken a bit of a toll on my health, but the major loss was in community. If you do not live in Eugene and we have not made a point of a regular visit, I probably have not spoken or even written to you much, if anything, since 2007. For that I sincerely apologize. It is not how I prefer to live but I could not seem to do this any other way. Know that I miss you. Let’s reconnect. Call me up, write, send me your unfinished song, your idea for a book, something to read and talk about. Let’s go for a walk, go swimming, have lunch, see a show. I am looking forward to it.

Couples & Family Therapy 2011 Cohort

Me & My Dad, June 14, 2011

One of the ways that John Gottman says people talk themselves out of their marriages is “rehearsing distress-maintaining attributions” in between arguments. That is, instead of making up stories about how their troubles are passing and circumstantial, they make up stories about how their troubles have to do with permanent flaws in their partner’s character. Over time, this version of the story solidifies and they reinterpret the entire history of the relationship using that filter.

This is another of Gottman’s gendered findings; it is mostly a problem because the men (in heterosexual marriages, at least) do it. It’s a problem when women do it, too, they just don’t tend to as much.

The alternative to rehearsing distress-maintaining attributions is rehearsing relationship-enhancing attributions, and this is exactly what Gottman found that the people in marriages that ended up happy and stable did. It’s probably a good idea, then, to practice rehearsing relationship-enhancing attributions if you can. Try thinking about the strengths of your relationship, good times, things you are proud of, ways that current conflict is passing and circumstantial. If that is difficult to do, think instead about couples counseling.  If you want to keep your relationship, you probably need help.

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