Book Review: Letters to a Young Therapist, by Mary Pipher, Ph.D.
I start my second semester of my marriage and family therapy master's program this month. This is the semester we must find our "fieldwork placement," the community site where will be seeing our very first clients. It is, of course, an intimidating proposition.
I'm not afraid of seeing my first clients--coming to this career later in life has afforded me the advantage of being already familiar, through 35 years of life experience, with much of what we're learning in our classes. However, I am still wandering into uncharted territory, and I have to admit to feeling nervous and slightly unmoored. I have such reverence for the science and craft of therapy, and I want to honor my clients' courage in seeking help by doing my best work.
We've been getting a lot of warnings about how everyone feels trepidation as they begin to see clients and that it's easy to feel overwhelmed by the process, especially in the early sessions. Recently, I stumbled across this blog post which simultaneously relieved and agitated me. On the one hand, it is written so bluntly and honestly that I feel like the author is sharing their honest truth without trying to spare my feelings, so I have a more fuller understanding of what is waiting for me on the other side of the office door. On the other hand...it makes the experience of a beginning therapist seem dire indeed. It certainly increased my anxiety level.
Which is why it was such a relief to read Mary Pipher's warm and generous Letters to a Young Therapist. This is a memoir and manifesto in the form of a series of letters from the author to her favorite graduate student, who she describes as "like most young therapists, a funny mix of scared and overconfident" (p. 44 of the ebook). That she described the exact combination of emotions I was feeling as "a funny mix" instantly soothed me a little.
Pipher shares her experience of being a therapist as well as lessons she has learned over the years. Most encouragingly, she writes of her love of being a therapist--even after so much time and so many clients. When asked if it's depressing to listen to people talk about their problems all day, she responds, "I am not listening to problems. I am listening for solutions" (p. 2). The optimistic reframe inspired me, as did her follow-up assertion that it has been her experience that clients generally want help, are ready for change, and do, in fact, make positive changes in their lives as a result of the therapy process. It's worth it, she seems to be saying.
She does not shy away from how difficult and complicated the work can be. She shares wisdom on deep topics (family dynamics, pain, happiness, and handling failures, to name a few) as well as more practical matters, like protecting one's own safety and attention to self-care. It's a thoughtful, nuanced, and detailed account of how the author's experiences have shaped her, and reveals the myriad ways we new therapists may well be shaped by the work before us.
If you're feeling a little overwhelmed about beginning to see clients--or even if you're feeling a bit of burnout and need a fresh perspective on the practice of therapy--I would definitely recommend reading this book. It may even inspire you to write some letters of your own (or a blog).
This person is in Los Angeles. There are more training sites in this city than you can shake a stick at. So I wonder if this person is not getting interviews because these sites are “full”…in that they are holding spots for students from in-person programs with which the site has a preexisting relationship. This person elsewhere in the thread also mentioned they couldn’t take a traineeship at a school because they need to get relational hours (this is a requirement of COAMFTE programs only)…but schools are perfect places to get relational hours. In fact, most students at CSUN specifically chose school-based programs because they knocked out their relational hours in a matter of months. What was going on at this person’s program that they didn’t know that?!?! Also, most programs see supporting students in getting a field site as the bare minimum—one Cadillac program has a dedicated staff member who counsels students on which site might be best for them, then helps shepherd them through the application process.
I really don’t know what’s going on. But I know I often find people from online programs frantically trying to find a field site in Facebook groups, which suggests a serious lack of support from the program.
If, due to your unique circumstances, you’ve already got a fieldwork situation guaranteed? Then you can ignore this whole part.
I am also concerned that online students may miss out on networking opportunities.
In my experience, this field is a very word-of-mouth kind of place. The good jobs don’t seem to get posted on Indeed—you’re lucky if they even make it to Facebook groups. Typically, people ask their colleagues for recommendations, or if someone is leaving a particularly great position, they’ll let their friends know so they can apply. And client referrals are very much word-of-mouth, whether it’s clients referring their friends, other health professionals referring their patients, or other therapists referring clients they can’t see themselves (for a million reasons).
Additionally, a lot of the hiring—especially if you’re wanting to go into private practice—can happen because someone supervised you while you were in school and they really liked working with you so they want to take you on when you graduate. I noticed things like this happening a lot at my field site. Most of my colleagues were from a different MFT program than mine, and a lot of the professors who taught at that program were also supervisors (or friends with supervisors, or worked with supervisors) at my field site. A lot of connections were made in this web that ultimately led to jobs and referrals after graduation.
Networking happens everywhere—in the classroom, at the field site, in all the parking lots in between. If online programs don’t provide support for you to build connections while you’re in school, it’s going to be very hard to hit the ground running when you graduate.
UNLESS…you’ve already got a network. Totally possible! If you’re already friends with some therapists, or you are super outgoing and you’re ready to hit all the conferences and join all the professional organizations in your area, you’ll probably be just fine!! You can ignore this part too.
I am concerned because I personally know a lot of trainees, Associates, and licensed MFT’s…and I don’t know anyone who graduated from an online program.
Like…why is that?? I’m talking about professionals I’ve actually formed working relationships with, not randos in Facebook groups. It’s totally possible that, because I live in Los Angeles, and there are lots of in-person MFT program options in this area, maybe most people who are interested in MFT programs in LA opt for an in-person program!
But it’s also possible that not as many online program students actually make it to the point in their career where I would meet them through my network, by working at the same place, or at a conference or training, etc. I wonder how many online program students finish their academic classes, hit the stone wall of trying to find a field site, get overwhelmed, and give up on the whole endeavor. I wonder if online program students have a tough time overcoming the stigma of an “online MFT degree,” and can’t get hired when they graduate. I honestly don’t know. But I do know that I can’t think of a single person I would refer clients to or recommend for a job that got their degree from an online program.
I can’t tell you what to conclude from this information, but I felt like it was important for you to know.
Diploma Mills
If you’re not familiar with this term, it refers to schools that aren’t super rigorous—if you pay tuition on time and at least go through the motions of being a student, they’ll hand you a diploma on the agreed-upon date and time. There’s also the implication that the education they provide is not of good quality.
So listen…I used to work in for-profit education marketing. I’ve seen how the sausage is made. And when I started researching MFT programs, I was sickened to notice a lot of the same tactics that worked at my former place of employment at work on me.
For example, if you go to a program’s website and in order to get any real, in-depth information about the program, you have to hand them your email address? Congratulations, you’ve just entered a click funnel. You’ve been assigned to a sales representative and they will get a commission if they can enroll you.
Often, you will be contacted by an “admissions advisor.” Ask this admissions advisor what theoretical orientation the program emphasizes, or how much experiential training you’ll get and what it looks like. If they balk and try to change the subject before telling you they’ll put you in touch with “the head of the department” or a professor, they don’t know shit about the program, they’re just trying to enroll you. For the commission.
If you just HAPPEN to be calling right before a new cohort starts, or if your “admissions advisor” is really glad you called because they can waive your application fee for you, or if you get a lifetime tuition discount if you enroll by the end of the week…you will earn your “advisor” a commission if you enroll.
Does this affect the quality of the education that program provides???
I honestly can’t tell you that. Some schools use some of these tactics but I wouldn’t consider them diploma mills (cough, cough, lookin’ at you, USC and Pepperdine). These programs are among the more selective/competitive programs, and I have known both students and faculty at these programs that gives me an indication that the quality of the education is high. There is an institutional reputation to uphold that I imagine buoys standards. They also charge an obscene amount for tuition, so it makes sense that they’d have extra money to throw at a marketing department—and not a lot of people are looking to drop $100k+ on a master’s degree, so it makes sense to me that they have to work harder than most programs to fill their seats.
But what about these other programs? The ones that don’t cost an arm and a leg, that are either online or have multiple locations throughout the state (usually where there aren’t many other in-person programs)? Why are THEY working so hard to get your email address?
At my former place of employment, money was poured into improving products where stiff competition was eating away at our market share. Products (courses) where there was NO competition? That shit hadn’t been updated in years.
There are a lot of MFT programs in California, but (as I’m sure you’ve noticed) there aren’t a LOT of options for affordable programs with flexible formats, and even fewer that are conveniently located (unless you’re in LA, San Diego, or the Bay Area).
So I’m not sure what would incentivize some of these programs to commit to improving the quality of their curricula. They’re gonna get enrollees anyway.
HOWEVER…this is a gripe I have with the entire MFT graduate educational complex. I know that the professors at my own program were genuinely dedicated to delivering the absolute best education they could provide—but the truth is, the research seems to show that the field has no actual idea how to train a great therapist. There are debates about what “great therapist” even means, so figuring out how to turn a grad student into one is a stab in the dark at best. For the most part, programs do what they’ve been doing for decades to train therapists…and clinical outcomes haven’t improved. There’s a cutting edge of the field that’s really challenging the status quo and trying to develop a better way to train therapists (I’ll be writing a blog post about that soon), but they don’t have a school (just a website with lots of free resources go check it out, tell your friends). But for now, you will be told by therapists already in the field that it “doesn’t matter what program you go to, you learn how to be a therapist after you graduate.” I theoretically agree that graduate programs haven’t cracked the code about how to make therapy work better and turn grad students into great therapists, but I’m not sure that means it doesn’t matter what program you go to.
So. If there’s debate about what even constitutes a quality MFT education, how can you tell if a given program is a “good program” or not?
How to Pick a Good Program (for You)
Do these things:
Decide what is important to you in your education. As I’ve laid out above, I think there is some evidence to suggest that it might matter, to some people under some circumstances, what program you attend. But, a diploma from a diploma mill works the same as a diploma from the most selective, most rigorous MFT program in the state—it allows you to sit for the licensing exam. And no, generally clients don’t ask where you went to school. So, if you want the quickest cheapest path from reading this blog post to being a licensed MFT, and you’re not worried about finding a field site, and you’re not worried about developing a professional network, and you don’t believe that what you get taught in graduate school has a lot to do with whether you can be a successful and/or good therapist, then you have a whole lot of program options. My personal priority list went: 1) cost, 2), location, 3) quality of academics, 4) quality of training. That resulted in me selecting CSUN, and only CSUN. I would make the same choice again. What is your priority list?
Do some research on programs that interest you. Can you find the names of any faculty, or will the program provide some? Google them. See what they’re up to. Are they publishing academic articles, or books, or even a blog? Do they have a private practice? Maybe you don’t care how accomplished the faculty is! In that case, does the program offer some specialized training that is appealing to you? Will you graduate with a certification in anything, or will you be able to take unique classes not available at other programs? See if you can find a list of training sites associated with the program (or ask the program for such a list), then Google those sites and see if they look like places you’d like to earn your hours. Or, you can find training sites in your area that look interesting, and see if they have any therapist bios that mention what school they attended, or call the site and ask what schools they tend to get trainees from. If you’re trying to get a sense of how successful a given program’s graduates are, start looking up therapists in your area (or the area you want to practice) on Psychology Today—where did they all go to school?
Remember that program accreditation (CACREP or COAMFTE) does not necessarily mean you’ll be a better therapist when you graduate. COAMFTE is an organization associated with AAMFT, the national professional organization for MFTs. The mandate of AAMFT is to preserve and defend the profession of marriage and family therapy. There are turf wars amongst MFTs, clinical counselors, and social workers, because all three licenses do more or less the same thing. There’s lots of speculative talk about those licenses being combined under one license someday—which would be the end of the individual professional organizations. So one way they can keep the licenses separate (and the individual professions alive, and AAMFT alive) is by convincing everybody that these three licenses really do totally different things. They do THAT by doubling-down on what are called “core competencies”—these “skills” that are “unique” to marriage and family therapists. They like to say MFTs think differently (and treat differently) than other master’s-level license-holders, by emphasizing that MFTs all have the same core competencies. Well…they can only prove THAT…if all MFTs are taught the same core competencies, and tested on the same core competencies. Qualifying for COAMFTE accreditation means a program has jumped through a series of hoops—among them that the program is delivering these core competencies. The real cherry on top is when a state requires you to have graduated from a COAMFTE-accredited program to get your license…which California does not. Some states do! You will have an easier time transferring your license to some states, under some conditions, if you’ve graduated from a COAMFTE program. But as far as quality…in an arcane, turf-war-y way, you could say that COAMFTE programs provide better (purer?) MFT education (as defined by AAMFT). A COAMFTE program might make you more MFT-y? But it’s not necessarily designed to make you a better therapist. I know this doesn’t make a ton of sense to you right now. It will, eventually. I guess all I’m saying is, when you’re making your priority list, if “quality of education” is first on your list, COAMFTE isn’t necessary. BUT, if “being able to transfer my license to any state with the least amount of angst” is high on your priority list, so should be COAMFTE-accreditation.
You’ll notice how I elegantly got through this entire blog post without mentioning by name any schools of which I have a negative opinion. That’s because I don’t know that they are “bad” schools for you. I don’t know your priorities, or that you value the same things about an education that I do. Also, I don’t want to get harassed. In 2018, I started getting threatening emails from a program and I didn’t even say anything shitty about them (though I did have a pretty negative opinion of them)—they were just mad that I posted how much their program cost on MFT California. But that’s a red flag, right? If a program doesn’t want prospective students to have all the information they need in order to make an informed decision, I would venture to say that the student experience is not high on their list of priorities. And, in fact, the following year, Argosy University imploded, leaving many students up a creek without a paddle.
Not saying I was right but…
