On Friday, February 24, 2017, the Texas Supreme Court reversed a lower court decision and affirmed the validity of a Texas MFT licensure board rule authorizing marriage and family therapists to diagnose. As a program director of a marriage and family therapy program for over fifteen years, I have witnessed the critical importance of the legal authority of MFTs to be able to diagnose. Graduates venturing into states that did not specifically authorize MFTs to diagnose often found a challenging environment. The opinion offered by Justice Jeffrey S. Boyd highlights the central role of the definition of diagnosis in the Texas ruling. Had the lower court ruling held, Texas would have been the only state specifically excluding MFTs from diagnosing mental and behavioral disorders and the impact would undoubtedly have been felt well beyond the borders of Texas.
The authority to diagnose is a lynch pin for the success of the profession. I have observed a number of challenges in states that did authorize MFTs to diagnose. Graduates of our training program seeking employment would repeatedly be turned away from positions primarily because of the restriction about diagnosing. With fewer avenues for employment as an MFT, university and other training programs in such environments are reluctant or even able to maintain a program when potential students recognize the limits of the MFT license. With limited training programs, research and innovation of the field are further compromised. Professional groups, associations and lobby efforts purposed to advance the profession and practice of MFT are equally compromised by fewer members. When opportunities for MFTs are limited, other mental and behavioral health professions have greater opportunity for expansion further diminishing the value of the MFT. Such an environment delegitimizes the profession of marriage and family therapy as a whole.
Specifically excluding MFTs from diagnosing would undoubtedly cripple the practice of marriage and family therapy in Texas, but far beyond as well. If marriage and family therapy is progressively devalued, recent gains for MFTs in venues such as the Veteran's Affairs may be impacted. Federal efforts for inclusion of MFTs as Medicare providers are hampered if practice in one of largest states is minimized. Perhaps most profoundly, a successful effort in Texas to deny MFTs the privilege to diagnose, sets the stage for such similar argument in other states.
Many may fairly criticize the DSM 5 as a contrast to systemic thinking, but the ability to meaningfully diagnose is critical not only to effective care and treatment, but a privilege absolutely critical to the long term advancement of the profession. Without a doubt, the ruling in February upholding the validity of MFTs in Texas to diagnosis is a central to practitioners everywhere and the professional as a whole. This ruling by the Texas supreme court may well be the single most important case thus far for the profession of marriage and family therapy.
Chris Habben, PhD, LMFT is president of AAMFT. He is a Professor of Marriage and Family Therapy and Program Director of a COAMFTE accredited Master's Degree Program at Friends University. Dr. Habben has served as a clinician in hospital, non-profit and private practice settings, as well as an AAMFT Approved Supervisor actively training students and post graduate supervisees. He has served in various local and national leadership positions in the field of Marriage and Family Therapy.