Addressing Racism in Clinical Licensing Exams: An Interview with Ben Caldwell and Tony Rousmaniere
Curt and Katie interview Dr. Ben Caldwell and Dr. Tony Rousmaniere about the problems with the Clinical Licensing exams for therapists. We discuss the recent report from ASWB on their pass rates as well as the concerns about the EPPP2 implementation, the poor predictive validity and utility of these licensing exams, and suggestions for what to do with our licensing processes given these concerns.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
An Interview with Dr. Ben Caldwell, LMFT, PsyD and Dr. Tony Rousmaniere
Benjamin E. Caldwell, PsyD is a California Licensed Marriage and Family Therapist focusing on ethics, policy, and professional development. He serves as Adjunct Faculty for California State University Northridge. You can learn more about Ben’s work at BenCaldwellLabs.com.
Tony Rousmaniere is Executive Director of the Sentio Counseling Center. He is the author/co-editor of many books on deliberate practice and psychotherapy training and two series of clinical training books: “The Essentials of Deliberate Practice” (APA Press) and “Advanced Therapeutics, Clinical and Interpersonal Skills” (Elsevier). More about Dr. Rousmaniere can be found at DrTonyR.com.
In this podcast episode, we talk about recent data that licensing exams are racist
Friends of the show, Dr. Ben Caldwell and Dr. Tony Rousmaniere wrote a white paper in response to a recent report from the ASWB that shows their licensing exams appear to be racist. We wanted to talk with them about their calls to discontinue these exams.
How are the clinical exams racist?
“To be sure there are existing [racial] disparities in the professional pipeline. But it seems like the clinical exams add their own unique layer of disparity in the process of getting licensed as a mental health professional.” – Dr. Ben Caldwell
- The number one predictor of whether you pass the exam is your race
- The structure of the exam seems to advantage those with more affinity to these types of tests (i.e., those who are educationally privileged)
- There may also be content or language concerns leading to these disparities
What is the purpose of the clinical exams for therapists?
“[The clinical licensing] test has nothing to do with training. And the test has nothing to do with qualifications except your qualification of passing a standardized test.” Dr. Tony Rousmaniere
- Said that it is to be an assessment of knowledge and training, consumer protection, etc.
- Little predictive validity (of competence or consumer safety) for these tests
- The test is an unfair hurdle for folks without academic privilege
- There does not seem to be a need for this test (due to the rigor of training and supervised experience)
What would be better alternatives to requiring a clinical exam?
- Alternate pathways that some states have taken
- Addressing workforce shortages by allowing folks who have gotten through every other requirement (aside from the clinical exam) to be licensed
- Just don’t require a clinical exam
What can therapists do to try to get rid of licensing exams?
- Advocacy to state boards to not implement EPPP2
- Other advocacy related to master’s level clinical exams
- Organizations to #StopASWB and address the EPPP2
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
White Paper: Clinical Licensing Exams in Mental Health Care by Benjamin E. Caldwell, PsyD and Tony Rousmaniere, PsyD
ASWB Report on Social Work Licensing Exam Pass Rates
Stop the Adoption of EPPP2 Website
ASWB: End Discriminatory Social Work Licensing Exams
A sample letter you can send to your licensing board: Board Advocacy Against Clinical Exam for Masters Level Clinicians
Relevant Episodes of MTSG Podcast:
Fixing Mental Healthcare in America
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast where we talk about things going on in the therapist world, the things that are happening behind the scenes and affect people. And we’re here to talk today about licensing tests might be racist. And we’ve got the co authors of a paper that came out recently, really good friend of the show, Ben Caldwell and Dr. Tony Rousmaniere, somebody that we’ve been watching from a distance through a lot of our careers as well. And they are here to talk about the white paper that they wrote ‘Clinical Licensing Exams in Mental Health Care’ and some of the stuff that they’re finding emerge across some of the licensing exams here. So thank you very much for joining us, and helping to expose what is going on behind the scenes.
Dr. Ben Caldwell 1:12
Thank you for having us. It’s a pleasure to be with you.
Dr. Tony Rousmaniere 1:15
Thank you. Sure.
Katie Vernoy 1:16
So we’re so excited to have you. And Ben, you know, the first question we ask of you. I ask you, please just very short, tell us who you are, because we want to meet the new guy, Tony, it’s great to have you here. But the first question we ask is, who are you? And what are you putting out to the world?
Dr. Ben Caldwell 1:32
I’m Ben Caldwell, I’m a licensed MFT in California, and I am putting advocacy out into the world on behalf of therapists who are trying diligently to achieve licensure.
Dr. Tony Rousmaniere 1:44
Hi, I’m the new guy. My name is Tony, very nice to be here. I am a licensed psychologist in California. I’m executive director of the Sentio Counseling Center.
Curt Widhalm 1:55
A lot ofour longtime listeners have heard Ben talking about some of the things going on behind the scenes. We’re, you know, we’re constantly borrowing and attributing content that Ben has written or expressed someplace else before. I have a lot of conversations behind the scenes with Ben about things. And I know that the first parts of my conversations with him around this really started around ASWB releasing some passing scores that showed that what was it the most, the number one predictor of whether or not somebody would be able to pass the exam is whether or not that they were black. And this becoming very problematic. And in looking at things like interstate reciprocity and licensing exams, and some of the board discussions around this kind of stuff that these issues are becoming not only as problematic as they were before, but potentially we’re positioned at a unique time to actually do something with this. So my first question to the two of you is, you guys seem like stand up, guys. But how did you really get into this issue in the first place?
Dr. Ben Caldwell 3:02
I think that’s a great question. So I saw the ASWB report this summer, the same time everybody else did. And, on one hand credit to ASWB for at least releasing this data, because the other test developing organizations don’t tend to. And that’s part of the reason why there’s a real information vacuum, about whether these tests actually do what they are intended to do. So ASWB after what seems to be some infighting within the organization, they released this report over the summer. And the report very clearly shows major racial and ethnic disparities in exam performance on all of the ASWB exams. Now here in California, we use the ASWB clinical exam as the exam for licensure as an LCSW. And that level of exams used around the country for LCSW licensure. But ASWB produces other exams as well for other levels of social workers, and these disparities were seen on all of their exams. And just as an example, for the clinical exam, if you are taking the test for the first time, and you’re white, your chances of passing the exam are something like 83-84%, somewhere in that neighborhood. If you’re taking the test for the first time, and you’re black, your chance of passing was less than 50%, with other racial and ethnic groups landing somewhere in between. That is a major, major difference between groups. And ASWB has argued, since the report came out that hey, we’re just we’re sort of passively reflecting disparities that already exist in the world around us. But their report, along with some other data that we can get into as we go here, suggests that that actually probably isn’t true. To be sure there are existing disparities in the professional pipeline. But it seems like the clinical exams add their own unique layer of disparity in the process of getting licensed as a mental health professional. And it’s not just ASWB, we’ve seen similar kinds of data, similar disparities on the EPPP in psychology. And we’re just seeing some data start to emerge about the clinical exams for marriage and family therapists as well showing very similar disparities.
Katie Vernoy 5:33
So you’re saying that their argument is that we’re just reflecting the systemic inequities? And you’re saying, no, no, no, they’re actually adding to it.
Curt Widhalm 5:43
This? Is that principle Skinner meme of am I the problem? No, it’s the test takers, who are the problem.
Katie Vernoy 5:50
So how does that work? I mean, how can a bunch of questions about therapy be racist? How does it actually contribute to it versus their argument that it’s reflecting it?
Dr. Ben Caldwell 6:01
Some of this gets down to really sort of testing philosophy, about what does it mean to possess and demonstrate knowledge. And while we all tend to just sort of accept this four option, multiple choice structure as an acceptable way of demonstrating knowledge, it is a particular skill set to demonstrate, quote, unquote, knowledge, to perform knowledge in this way. And we see throughout the world of standardized testing, differences based on race and ethnicity, because of this exam structure. So even if the content of the exam the topics being tested on, even if there were no sort of disparate content, and that’s probably not the case, there is some disparate. But even if the content was totally equitable, the structure itself, this four option, multiple choice, computer based, timed, no resources available to you, structure, that by the way, it looks nothing like the actual clinical practice of therapy, that structure seems to advantage those who have a particular logic in their thinking, who are attuned to test taking skill in this particular format. And so, you know, ASWB and others will say, Well, we examine the content very closely. And I believe that they do, there is evidence that the kinds of committees that they use to look at content for disparity actually don’t work very well, that they they will miss disparity where it exists. But even if they were doing their job perfectly, we’re not just talking about content, we’re talking about underlying structure.
Curt Widhalm 7:50
I will point out that I have written questions for some of the California exams here. So I have some of…
Dr. Ben Caldwell 7:58
You are the problem.
Curt Widhalm 8:00
I have some…
Katie Vernoy 8:01
Curt is the problem.
Curt Widhalm 8:03
I have some NDA issues that I’m not going to be able to fully bring into this conversation. But I knew I do notice some of the questions to ask in this process. And one of the things that you are talking about here, Ben is do you see any evidence in any of these boards of how they go about training test writers to look at culture, to look at race topics in some of the content that they’re writing? Or are you solely just talking about just the structure of this sets this up to where even that might be, despite everybody’s best intentions here, maybe even a little bit irrelevant?
Dr. Ben Caldwell 8:48
I think there’s truth to both of those things. So on one hand, the structure in and of itself appears to be problematic. On the other hand, while the exam developers sometimes talk about training their item writers, their item developers in issues of bias, disparity, equity in language and that kind of thing. The actual training seems to vary quite a bit in terms of its length, depth, quality, that kind of thing. And the proof is in the data. At the end of the day, we look at the scoreboard and when these disparities in performance exist, then sort of definitionally whatever processes are in place on the developer side to try to minimize those disparities clearly aren’t working.
Dr. Tony Rousmaniere 9:39
I think it’s valuable to just take a step back to and consider, you know, Ben has raised the point, you know, previously that these tasks are for people who have already graduated a graduate program. So they’ve been through, you know, countless papers, countless tests, they’ve been through their practicum. You know, they’ve gone through their, you know, internship in order to, you know, get to the point of licensure test, you know, 1000s of hours of supervised experience. And we’re in the context of a real shortage, a workforce shortage of mental health providers, especially a shortage of providers from diverse communities. And so, you know, I think it’s really worth taking a step back and saying, you know, what, what is the goal of having another hoop? An expensive time consuming hoop, that these people who are right on the cusp of being able to join the workforce and serve communities, of preventing them. You know, why are we putting another hoop in their way? And first of all, there should be a really high bar for that. There should be a really good rationale. And I don’t know, I have yet to hear what that rationale is. Because, you know, our our industry does not suffer from a major, you know, outsize problem of providers acting, you know, unethically. There is not a major outsized problem of providers getting, you know, discipline for this or that or whatever. I mean, sure things happen. But if there is, so first of all, let’s, let’s set the rationale for yet another hoop. And second of all, if there is a rationale, we should customize a test focused on that rationale. For example, let’s say providers were having ethical lapses related to, I don’t know, healthcare related things, let’s just totally pick that out of a hat, right? Then why why not develop a test very specifically targeted at that. You know, something, Ben, I’ve heard you say previously, is, someone can take this test, and fail 100% of the ethical questions on the test, and they’ll still pass the test.
Katie Vernoy 11:53
Dr. Tony Rousmaniere 11:53
Yeah, these guys…
Dr. Ben Caldwell 11:54
If they get the content right, elsewhere. If they if they do well enough in like assessment and treatment planning kinds of questions, they could get every question wrong that is related to legal and ethical compliance. And in some cases, they could also get every question wrong, related to crisis intervention, those issues that are most clearly tied to public safety. And they could still pass the test if they show enough knowledge in other areas.
Katie Vernoy 12:20
So the question I have is, we’re looking at what is the rationale? So going back to what you were Tony, talking about, Tony, I think my understanding of the rationale is for consumer protection and protecting the quality of the profession. And you’re saying that doesn’t, tt doesn’t work that way?
Dr. Tony Rousmaniere 12:39
Katie Vernoy 12:40
We’re not actually solving the problem of consumer protections, and, and protecting the quality or the prestige of the profession, by making sure we have highly trained, highly qualified therapists that come out the other side,
Dr. Tony Rousmaniere 12:54
Well, or this test has nothing to do with training. And the test has nothing to do with qualifications except your qualification of passing a standardized test. There’s the students have already gone through graduate program, which has to be accredited in 100 different ways. And so there’s that. And they’ve already gone through practicum, internship 1000s of hours of supervised experience. So there’s all those qualifications. So that’s all very well documented. And there’s lots of supervision and all that kind of stuff. So all that is already done. Now, if there is a rationale to to have continuing education, if there’s a rationale to have continuing supervision or feedback on professional work, I can definitely see rationales for that. I’m very open to that conversation. I encourage a professionals to get, you know, to engage in supervision, deliberate practice throughout their entire career. You know, 50 years into their work. But standardized tests a lack of what’s called predictive validity. In terms of, dude, if someone fails the test, does that mean they were more likely to have somehow endangered the public? Or if someone passes the test? Does that mean they’re less likely to endanger the public. And that has never been conclusively shown or really shown in any way, by any of the people who are making the test or supporting the test?
Curt Widhalm 12:55
This almost seems reactionary, of the people that are already licensed are missing some of this information. So we should make new test takers have to cover this content, that they’re most likely to have gotten in an ever expanding number of required credits in grad school.
Dr. Tony Rousmaniere 14:30
I mean, I don’t know. I mean, they’re, you know, every few years, the legislature decides there’s a new topic that they want new therapists or therapists to be competent in. Like, there was a new topic on AIDS education or there can be a new topic on various, you know, various things like that, and they can add that as a continuing education course. You know, and that’s okay. Could be five hours of this or six hours of this. But that is not designed to exclude people from the profession. It’s they’re relatively accessible in terms of the cost and the burden for providers. So it’s really quite different.
Katie Vernoy 15:06
So are you saying that the clinical exam has no actual utility? And really is just a hurdle for folks to enter the profession and get licensed?
Dr. Tony Rousmaniere 15:17
It’s, no, no, no, no, no? Well, first of all, yes, it has no clinical utility. And B, it is a hurdle for some people. It was not a hurdle for me. I grew up with a fair amount of you could say academic privilege, meaning my family was very academically oriented. And from a very young age, I was given the message that I was going to succeed academically, I had no choice. And I was given financial resources, and family resources to really do that. Not everyone is provided with that privilege. And so for them, this can really be a major hurdle that can exclude them from the profession.
Dr. Ben Caldwell 15:51
And I would say the same for me. I had a fair amount of resources, academic privilege. I’m a native English speaker, which we know makes a difference in performance on these exams. I don’t have a lot of test taking anxiety, which we also know that there is some evidence to suggest that that impacts performance on these exams. And so you know, for folks who are in Tony’s position, in my position, I think we feel a particular moral obligation to speak out on this issue to say, hey, we benefited in a way that is not fair, that is not equitable. And we don’t want those coming into the profession to continue to experience this. I don’t think, I don’t want to speak for you, Tony, but I don’t think either one of us have, like a moral problem with a clinical exam for licensure, so long as it showed some kind of utility. And so long as it showed equity. You know, we’re not opposed to high standards. We are opposed to clinical exams that have never shown predictive validity for anything. And that also are inequitable.
Dr. Tony Rousmaniere 17:05
Curt Widhalm 17:06
Getting a little bit into kind of the history of how some of these exams have looked in, you know, building a better future out of this. I can speak to at least California’s history, where at least our clinical exam used to be an oral exam in front of judges, that probably moved to this multiple choice thing to take out any sort of variability with it enters subjective judging and you know, potential biases that happen.
Katie Vernoy 17:31
Curt Widhalm 17:31
Yes. And moving to this more standardized sort of thing was supposed to probably take care of any of these kinds of problems. But if we’re imagining an opportunity here to actually do something predictive with clinical exams, what might that look like?
Dr. Tony Rousmaniere 17:51
I would suggest, we don’t presume there has to be yet another exam, before someone joins a career after they finish graduate school, which necessarily involves many exams. And of course, that requires College, which also involves many exams. So we’ve already got a stack of a thousand of exams. And by the way, the research connecting any academic exam to clinical skills is just about zero. So we’ve already got typically eight plus years of, you know, very expensive academic training, that itself has a hard time to, you know, justify. But But leaving that aside, I, I think it’s, it’s, I think it’s upon us who are already in the profession, to think how can we increase the accessibility of the profession, while there’s a workforce shortage, particularly, for people from diverse communities who, you know, might otherwise be excluded for academic reasons that have nothing to do with clinical skills?
Katie Vernoy 19:00
You’re saying get rid of the clinical exam?
Dr. Tony Rousmaniere 19:03
Katie Vernoy 19:04
Huh. Okay. Well, Ben you’d have to do something else, then I guess you can still do the law and ethics exam prep, right?
Dr. Ben Caldwell 19:10
Yeah, you’re right, in the like, I sell a test prep program for the California MFT clinical exam. And so I’ve had people ask me, Why are you advocating for getting rid of an exam that you benefit from? And? I, I get that question. That’s a totally fair question. I think that I’m waiting for the day that my wife or somebody in my family comes to me and says, Hey, Ben, maybe just a little quieter on this clinical exam thing. But this is this is a moral issue for me.
Katie Vernoy 19:52
Dr. Ben Caldwell 19:53
You know, if the clinical exams were to go away tomorrow, as I think they should, quite frankly, they’re They don’t have any utility that we know of that’s been proven. And they are inequitable. They’re, they’re probably not necessary, really, as Tony was saying. If that exam went away tomorrow, then, okay, great. I’ll do other stuff. I’ll train on other topics, like Tony was saying there’s, you know, new CE requirements that licensing boards come out with all the time. Lately, a lot of states have done things around suicide prevention and telehealth and the like. I’m happy to talk with people about those kinds of topics. And, you know, if if I can’t train people anymore for a clinical exam, because the clinical exam no longer exists, that’s a win in my book. I will not lose sleep over the lost revenue.
Curt Widhalm 20:45
And there’s also precedent that exams aren’t the only pathway to licensure in every jurisdiction.
Dr. Ben Caldwell 20:52
Yeah, we talked about that in the white paper. And other states have done, other states outside of California, where we are now, they’ve done some different things that are really interesting. Texas for a while had a sort of secondary pathway to licensure for people who were struggling to pass their license exam, but we’re close to passing. Illinois, not long ago, got rid of their exam entirely for Bachelors level social workers. They did this over the objections of ASWB and others. And what they found was that when they got rid of that exam, there’s suddenly this burst of new people into the profession, because you had a group of disproportionately clinicians of color, who had been bottlenecked, in clinical exam or license exam, Purgatory, because they completed everything else that Tony was talking about, and they just hadn’t passed their exam for licensure. This group, suddenly they get through to licensure, they’re able to provide services to the public at a time of very high demand. And it’s not like opening the floodgates on a permanent basis. There’s no evidence to suggest that this lowers the safety or quality of the care that people are providing. And if you look at the overall pipeline into the mental health professions, that’s constricted on the front end, by people’s resources, how much money they have, the long road that it takes to get to licensure, and on and on and on. So we are in a moment right now, as you said, of very high demand for mental health services. We have a group of well qualified clinicians who have been through the gauntlet of graduate education, and 3000 hours of supervised experience, and the only thing they’ve not been able to get through is their clinical exam, which has never been shown to be predictive of anything. If we let those folks who are disproportionately clinicians of color, have licensure, what a great way to meet this moment of very high demand to diversify the mental health workforce, and to do it without opening floodgates on a permanent basis, because the overall pipeline into the profession is going to remain about the same. We don’t need clinical exams.
Katie Vernoy 23:22
Practically what you’re describing is you get through everything, you take your law and ethics exam, if that’s part of your state’s process, and then your licensed. Like there’s not a replacement to the clinical exam or something that’s more effective than the clinical exam.
Dr. Ben Caldwell 23:36
Katie Vernoy 23:37
It’s just gone, just remove it.
Dr. Ben Caldwell 23:39
Correct. And there are other processes that folks have developed to assess competence in what they hope is a more meaningful way. There’s what’s called an objective structured clinical exam, that you could do a portfolio process, you could look at people’s imagine this actual clinical outcomes from therapy. You know, all of those things are possibilities. But to what Tony was saying earlier, we would want a process that is equitable, and effective. And right now, we don’t have this massive problem of people behaving in unsafe ways as clinicians. It’s not to say it never happens. You know, there is a whole podcast about Very Bad Therapy that includes many examples of clinicians behaving badly. But if you look at at statistics, it’s just not a large number. Here in California, for the third quarter of 2022, our Board of Behavioral Sciences, which governs the Master’s level professions, they had jurisdiction over about 120,000 licensed and registered mental health professionals, and in that three months span, they issued seven disciplinary orders. Seven. For 120,000 clinicians. And so when we look at clinical exams, and especially when you when you look at psychology and what they’re trying to do with the E triple P two (EPPP 2), there’s a great question of what problem are we actually solving here? What public protection need is being served when, number one, there aren’t a lot of issues of bad behavior in the first place. Number two, there’s no evidence that the clinical exams actually serve to reduce issues of bad behavior.
Dr. Tony Rousmaniere 25:33
Yeah, the the I saw a Tweet quite recently by the Association of Behavioral and Cognitive Therapies, ABCT, where they took a very strong stand against the E triple P 2 for exactly these reasons, because it doesn’t have any predictive validity in terms of helping, and it can just reinforce the problems of structural racism in terms of the workforce in the field.
Curt Widhalm 25:56
Now, for a little bit of background for our audience here. Can you fill us in and a little bit on the controversy behind the E triple P 2 that’s coming out here?
Dr. Tony Rousmaniere 26:05
Yeah, it’s so this the E Triple P is a exam, thelicensure exam, the psychologists have to take. The organization that created the ASPPB decided that they wanted to have a second one. And there were, you know, many scholars who and organizations that suggested that they take more time and consider it and they put a bunch of money into developing it. And they said, No, we’re going to do it. And they just said, no matter what, in fact, we’re going to recommend that states require this by I think 2025 is the year. I could be wrong.
Dr. Ben Caldwell 26:26
26 I think.
Dr. Tony Rousmaniere 26:33
Sorry, 26. And so and it’s just very opaque. They’re not really giving any kind of academic peer reviewed, you know, support or rationale for why they’re doing this. It just seems that, you know, these organizations unfortunately, make money off these exams. They’re funded through the use of the exams. And so there’s a fair amount of conflict of interest in terms of them. And so there’s been a lot of pushback within the field from a variety of different organizations, for example, ABCT, that are encouraging clinicians to contact their state licensing boards, and encourage the state licensing board to say no to these additional licensing exams, because the state licensing boards are kind of the final line, they get to decide whether the licensure exams are going to be required or not.
Dr. Ben Caldwell 27:34
And I would just add, those boards are in something of an awkward position, because the boards are members of the associations like ASPPB, that develop these exams. So the board and that way acts as kind of both the buyer and the seller of the test, which is a pretty meaningful conflict of interests. However, there have been boards, particularly around the E Triple P two that have stepped up and said, We’re going to need more evidence before we move in the direction of implementing this exam. And it puts them in this awkward position of fighting with an organization that they’re actually a part of.
Curt Widhalm 28:18
It sounds like there’s a whole lot of pearls that are still just going to need to be clutched, even with all of this evidence that they don’t actually do anything. So part of this is addressing the board’s themselves. But going back to these alternative pathways to licensure, you’re talking about seven out of 120,000, licensees or registrants actually getting in trouble. I’m sure certainly, if I’m, you know, putting myself in a pearl clutching capacity here, that with all of these alternative pathways that we saw an exponential number of citations and enforcement’s in these other states.
Dr. Ben Caldwell 28:56
No, we did not.
Curt Widhalm 28:58
Dr. Tony Rousmaniere 29:01
Can I Can I jump in here for a second is, here’s the thing is, you know, I have made many clinical mistakessince I got licensed. And I you know, I’m not proud of this, but I’m human. And so I tried to be self compassionate about it. I’ve made a range of clinical mistakes with a range of clients. Now, zero of those clinical mistakes would have been prevented if somehow I got a higher score on my Licensure Exam, or if I crammed more or paid more for test prep to pass my licensure exam. Those clinical mistakes would have been prevented by me getting more consultation, more supervision, you know, on my cases. Because because therapy is complex. Therapy is hard and it’s incredibly nuanced. And it’s you know, it’s infinitely complex and so, it you know, if our goal is to reduce the quantity of episodes of very bad therapy, if we want that podcast to come to an end and for Ben and Carrie to say, you know, we hit that we hit the end, we hit the limit There’s no more very bad therapy to talk about. If that is our goal, then there are ways to kind of head in that direction, but a standardized test at the beginning, you know, you know of your career is not it.
Curt Widhalm 30:13
So is there a call to action, a core place for people to go to really get their voices behind things? Or are we just encouraging everybody to go to their licensing boards armed with this podcast and your white paper and saying, Ben and Tony say, This is bad.
Dr. Ben Caldwell 30:34
There are organizations that are forming and active, particularly around the ASWB exams, if you go on to any of the socials and you look for hashtag stop ASWB (#stopaswb), you will find organizations that are springing up on the topic. And also around the E Triple P two, there are organizations as Tony was talking about that are organizing and mobilizing to talk with state boards, not just on an individual practitioner basis, but on a on a collective organized basis to try to have some impact here. Certainly going to your licensing board as an individual can have an impact. I know that our BBS here in California, is going to be looking at these exam issues through the course of the next year or so. But getting involved in organizations can raise your voice exponentially.
Curt Widhalm 31:31
Are we seeing any of the professional organizations getting behind this? Or are they all just kind of cautiously maintaining status quo?
Katie Vernoy 31:40
They’re just watching.
Dr. Ben Caldwell 31:41
I think it depends on the organization. So in MFT world, because I’m a licensed MFT, we have AMFT and CAMFT, and they have expressed concern about what’s come out in relation to clinical exam data. But we are only in the very beginning stages of seeing data on the MFT exams, because here in California, they don’t even gather demographic data on examinees to be able to tell whether there are these disparities and the National MFT exam, they don’t publish their data. So there’s a group of researchers led by Diane Gehart and Kevin Linus, who have started examining the topic and what they are finding is horrifying. But they haven’t formally published their findings yet. So we’re in the early stages with with MFTs. When it comes to social workers NASW and its chapters are kind of in listening mode right now. They’re they’re wanting to know how concerned their members are and what their members want from them on this issue. So NASW California, did a town hall meeting not long ago, and to the great credit of social workers here in our state, the ones who attended wasn’t a huge number. But they pushed hard for the organization to take a firmer stance, to get involved, to say that these exams for social workers need to be either wholesale changed or eliminated. And I think that’s kind of where the associations in general tend to be right now is. They’re waiting to hear. They know that this issue exists. And they are waiting to hear from their members to know, hey, how much energy should we devote to this? So for everybody listening, if you’re a member of a professional organization, you can impact the stance that your organization is going to take and how active the organization is going to get on these exam issues by letting them know, Hey, this is important to me. And I want you to act in this way. And I’m willing to be involved.
Katie Vernoy 33:52
It seems to me with all of our good intentions, that there may be a challenge with us, each composing our own letter to write to our professional association and to our boards. And so Curt, is this something that we can put together and maybe put on our website so people can find some templates that they can send off to appropriate folks?
Curt Widhalm 34:13
Katie Vernoy 34:14
Let’s do it. Let’s do it. We’ll put that in the show notes.
Curt Widhalm 34:17
So speaking of our show notes, we want to be able to highlight Ben and Tony’s work. Where can other people our listeners find you and the work that you’re doing.
Dr. Ben Caldwell 34:27
Both can find me at BenCaldwellLabs.com And there’s a lot more on these license exam issues at my blog psychotherapynotes.com.
Dr. Tony Rousmaniere 34:36
And you can find me at the Sentio Counseling Center which is SentioCC.org. The Sentio Counseling Center is an 100% online practicum site where we have counselor trainees providing therapy at very low fee sliding scale from $30 a session to individuals and couples. And we have openings for online therapy, so please consider us at www.SentioCC.org.
Curt Widhalm 35:05
And we’ll include links to those in our show notes over at mtsgpodcast.com. Follow us on our social media, join our Facebook group, the Modern Therapist Group to continue this discussion. And if you want to continue supporting Katie and myself, please consider becoming a patron. That’s another way that you can help support us in our advocacy for better changes for the profession and the delivery of therapy. And you can also support us through Buy Me a Coffee. And until next time, I’m Curt Widhalm, with Katie Vernoy, Dr. Ben Caldwell and Dr. Tony Rousmaniere.
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.
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