MFT Core Competencies

AMERICAN ASSOCIATION FOR MARRIAGE AND FAMILY THERAPY (AAMFT)
MFT CORE COMPETENCIES

Creating competencies for MFTs and improving the quality of mental health services was considered in the context of the broader behavioral health system. The AAMFT relied on three important reports to provide the framework within which the competencies would be developed: Mental Health: A Report of the Surgeon General; the President’s New Freedom Commission on Mental Health’s Achieving the Promise: Transforming Mental Health Care in America; and the Institute of Medicine’s Crossing the Quality Chasm. The AAMFT mapped the competencies to critical elements of these reports, including IOM’s 6 Core Values that are seen as the foundation for a better health care system: 1) Safe, 2) Person-Centered, 3) Efficient, 4) Effective, 5) Timely, and 6) Equitable. The committee also considered how social, political, historical, and economic forces affect individual and relational problems and decisions about seeking and obtaining treatment.

The core competencies are organized around 6 primary domains and 5 secondary domains. The primary domains are:
1) Admission to Treatment – All interactions between clients and therapist up to the point when a therapeutic contract is established.
2) Clinical Assessment and Diagnosis – Activities focused on the identification of the issues to be addressed in therapy.
3) Treatment Planning and Case Management – All activities focused on directing the course of therapy and extra-therapeutic activities.
4) Therapeutic Interventions – All activities designed to ameliorate the clinical issues identified.
5) Legal Issues, Ethics, and Standards – All aspects of therapy that involve statutes, regulations, principles, values, and mores of MFTs.
6) Research and Program Evaluation – All aspects of therapy that involve the systematic analysis of therapy and how it is conducted effectively.

The subsidiary domains are focused on the types of skills or knowledge that MFTs must develop. These are: a) Conceptual, b) Perceptual, c) Executive, d) Evaluative, and e) Professional.

Although not expressly written for each competency, the stem “Marriage and family therapists…” should begin each. Additionally, the term “client” is used broadly and refers to the therapeutic system of the client/s served, which includes, but is not limited to individuals, couples, families, and others with a vested interest in helping clients change. Similarly, the term “family” is used generically to refer to all people identified by clients as part of their “family system,” this would include fictive kin and relationships of choice. Finally, the core competencies encompass behaviors, skills, attitudes, and policies that promote awareness, acceptance, and respect for differences, enhance services that meet the needs of diverse populations, and promote resiliency and recovery.

Domain 1: Admission to Treatment
Number Subdomain Competence
1.1.1 Conceptual Understand systems concepts, theories, and techniques that are foundational to the practice of marriage and family therapy
1.1.2 Conceptual Understand theories and techniques of individual, marital, couple, family, and group psychotherapy
1.1.3 Conceptual Understand the behavioral health care delivery system, its impact on the services provided, and the barriers and disparities in the system.
1.1.4 Conceptual Understand the risks and benefits of individual, marital, couple, family, and group psychotherapy.
1.2.1 Perceptual Recognize contextual and systemic dynamics (e.g., gender, age, socioeconomic status, culture/race/ethnicity, sexual orientation, spirituality, religion, larger systems, social context).
1.2.2 Perceptual Consider health status, mental status, other therapy, and other systems involved in the clients’ lives (e.g., courts, social services).
1.2.3 Perceptual Recognize issues that might suggest referral for specialized evaluation, assessment, or care.
1.3.1 Executive Gather and review intake information, giving balanced attention to individual, family, community, cultural, and contextual factors.
1.3.2 Executive Determine who should attend therapy and in what configuration (e.g., individual, couple, family, extrafamilial resources).
1.3.3 Executive Facilitate therapeutic involvement of all necessary participants in treatment.
1.3.4 Executive Explain practice setting rules, fees, rights, and responsibilities of each party, including privacy, confidentiality policies, and duty to care to client or legal guardian.
1.3.5 Executive Obtain consent to treatment from all responsible persons.
1.3.6 Executive Establish and maintain appropriate and productive therapeutic alliances with the clients.
1.3.7 Executive Solicit and use client feedback throughout the therapeutic process.
1.3.8 Executive Develop and maintain collaborative working relationships with referral resources, other practitioners involved in the clients’ care, and payers.
1.3.9 Executive Manage session interactions with individuals, couples, families, and groups.
1.4.1 Evaluative Evaluate case for appropriateness for treatment within professional scope of practice and competence.
1.5.1 Professional Understand the legal requirements and limitations for working with vulnerable populations (e.g., minors).
1.5.2 Professional Complete case documentation in a timely manner and in accordance with relevant laws and policies.
1.5.3 Professional Develop, establish, and maintain policies for fees, payment, record keeping, and confidentiality.

Domain 2: Clinical Assessment and Diagnosis
Number Subdomain Competence
2.1.1 Conceptual Understand principles of human development; human sexuality; gender development; psychopathology; psychopharmacology; couple processes; and family development and processes (e.g., family, relational, and system dynamics).
2.1.2 Conceptual Understand the major behavioral health disorders, including the epidemiology, etiology, phenomenology, effective treatments, course, and prognosis.
2.1.3 Conceptual Understand the clinical needs and implications of persons with comorbid disorders (e.g., substance abuse and mental health; heart disease and depression).
2.1.4 Conceptual Comprehend individual, marital, couple and family assessment instruments appropriate to presenting problem, practice setting, and cultural context.
2.1.5 Conceptual Understand the current models for assessment and diagnosis of mental health disorders, substance use disorders, and relational functioning.
2.1.6 Conceptual Understand the strengths and limitations of the models of assessment and diagnosis, especially as they relate to different cultural, economic, and ethnic groups.
2.1.7 Conceptual Understand the concepts of reliability and validity, their relationship to assessment instruments, and how they influence therapeutic decision making.
2.2.1 Perceptual Assess each clients’ engagement in the change process.
2.2.2 Perceptual Systematically integrate client reports, observations of client behaviors, client relationship patterns, reports from other professionals, results from testing procedures, and interactions with client to guide the assessment process.
2.2.3 Perceptual Develop hypotheses regarding relationship patterns, their bearing on the presenting problem, and the influence of extra-therapeutic factors on client systems.
2.2.4 Perceptual Consider the influence of treatment on extra-therapeutic relationships.
2.2.5 Perceptual Consider physical/organic problems that can cause or exacerbate emotional/interpersonal symptoms.
2.3.1 Executive Diagnose and assess client behavioral and relational health problems systemically and contextually.
2.3.2 Executive Provide assessments and deliver developmentally appropriate services to clients, such as children, adolescents, elders, and persons with special needs.
2.3.3 Executive Apply effective and systemic interviewing techniques and strategies.
2.3.4 Executive Administer and interpret results of assessment instruments.
2.3.5 Executive Screen and develop adequate safety plans for substance abuse, child and elder maltreatment, domestic violence, physical violence, suicide potential, and dangerousness to self and others.
2.3.6 Executive Assess family history and dynamics using a genogram or other assessment instruments.
2.3.7 Executive Elicit a relevant and accurate biopsychosocial history to understand the context of the clients’ problems.
2.3.8 Executive Identify clients’ strengths, resilience, and resources.
2.3.9 Executive Elucidate presenting problem from the perspective of each member of the therapeutic system.
2.4.1 Evaluative Evaluate assessment methods for relevance to clients’ needs.
2.4.2 Evaluative Assess ability to view issues and therapeutic processes systemically.
2.4.3 Evaluative Evaluate the accuracy and cultural relevance of behavioral health and relational diagnoses.
2.4.4 Evaluative Assess the therapist-client agreement of therapeutic goals and diagnosis.
2.5.1 Professional Utilize consultation and supervision effectively.

Domain 3: Treatment Planning and Case Management
Number Subdomain Competence
3.1.1 Conceptual Know which models, modalities, and/or techniques are most effective for presenting problems.
3.1.2 Conceptual Understand the liabilities incurred when billing third parties, the codes necessary for reimbursement, and how to use them correctly.
3.1.3 Conceptual Understand the effects that psychotropic and other medications have on clients and the treatment process.
3.1.4 Conceptual Understand recovery-oriented behavioral health services (e.g., self-help groups, 12-step programs, peer-to-peer services, supported employment).
3.2.1 Perceptual Integrate client feedback, assessment, contextual information, and diagnosis with treatment goals and plan.
3.3.1 Executive Develop, with client input, measurable outcomes, treatment goals, treatment plans, and after-care plans with clients utilizing a systemic perspective.
3.3.2 Executive Prioritize treatment goals.
3.3.3 Executive Develop a clear plan of how sessions will be conducted.
3.3.4 Executive Structure treatment to meet clients’ needs and to facilitate systemic change.
3.3.5 Executive Manage progression of therapy toward treatment goals.
3.3.6 Executive Manage risks, crises, and emergencies.
3.3.7 Executive Work collaboratively with other stakeholders, including family members, other significant persons, and professionals not present.
3.3.8 Executive Assist clients in obtaining needed care while navigating complex systems of care.
3.3.9 Executive Develop termination and aftercare plans.
3.4.1 Evaluative Evaluate progress of sessions toward treatment goals.
3.4.2 Evaluative Recognize when treatment goals and plan require modification.
3.4.3 Evaluative Evaluate level of risks, management of risks, crises, and emergencies.
3.4.4 Evaluative Assess session process for compliance with policies and procedures of practice setting.
3.4.5 Professional Monitor personal reactions to clients and treatment process, especially in terms of therapeutic behavior, relationship with clients, process for explaining procedures, and outcomes.
3.5.1 Professional Advocate with clients in obtaining quality care, appropriate resources, and services in their community.
3.5.2 Professional Participate in case-related forensic and legal processes.
3.5.3 Professional Write plans and complete other case documentation in accordance with practice setting policies, professional standards, and state/provincial laws.
3.5.4 Professional Utilize time management skills in therapy sessions and other professional meetings.

Domain 4: Therapeutic Interventions
Number Subdomain Competence
4.1.1 Conceptual Comprehend a variety of individual and systemic therapeutic models and their application, including evidence-based therapies and culturally sensitive approaches.
4.1.2 Conceptual Recognize strengths, limitations, and contraindications of specific therapy models, including the risk of harm associated with models that incorporate assumptions of family dysfunction, pathogenesis, or cultural deficit.
4.2.1 Perceptual Recognize how different techniques may impact the treatment process.
4.2.2 Perceptual Distinguish differences between content and process issues, their role in therapy, and their potential impact on therapeutic outcomes.
4.3.1 Executive Match treatment modalities and techniques to clients’ needs, goals, and values.
4.3.2 Executive Deliver interventions in a way that is sensitive to special needs of clients (e.g., gender, age, socioeconomic status, culture/race/ethnicity, sexual orientation, disability, personal history, larger systems issues of the client).
4.3.3 Executive Reframe problems and recursive interaction patterns.
4.3.4 Executive Generate relational questions and reflexive comments in the therapy room.
4.3.5 Executive Engage each family member in the treatment process as appropriate.
4.3.6 Executive Facilitate clients developing and integrating solutions to problems.
4.3.7 Executive Defuse intense and chaotic situations to enhance the safety of all participants.
4.3.8 Executive Empower clients and their relational systems to establish effective relationships with each other and larger systems.
4.3.9 Executive Provide psychoeducation to families whose members have serious mental illness or other disorders.
4.3.10 Executive Modify interventions that are not working to better fit treatment goals.
4.3.11 Executive Move to constructive termination when treatment goals have been accomplished.
4.3.12 Executive Integrate supervisor/team communications into treatment.
4.4.1 Evaluative Evaluate interventions for consistency, congruency with model of therapy and theory of change, cultural and contextual relevance, and goals of the treatment plan.
4.4.2 Evaluative Evaluate ability to deliver interventions effectively.
4.4.3 Evaluative Evaluate treatment outcomes as treatment progresses.
4.4.4 Evaluative Evaluate clients’ reactions or responses to interventions.
4.4.5 Evaluative Evaluate clients’ outcomes for the need to continue, refer, or terminate therapy.
4.4.6 Evaluative Evaluate reactions to the treatment process (e.g., transference, family of origin, current stress level, current life situation, cultural context) and their impact on effective intervention and clinical outcomes.
4.5.1 Professional Respect multiple perspectives (e.g., clients, team, supervisor, practitioners from other disciplines who are involved in the case).
4.5.2 Professional Set appropriate boundaries, manage issues of triangulation, and develop collaborative working relationships.
4.5.3 Professional Articulate rationales for interventions related to treatment goals and plan, assessment information, and systemic understanding of clients’ context and dynamics.

Domain 5: Legal Issues, Ethics, and Standards
Number Subdomain Competence
5.1.1 Conceptual Know state, federal, and provincial laws and regulations that apply to the practice of marriage and family therapy.
5.1.2 Conceptual Know professional ethics and standards of practice that apply to the practice of marriage and family therapy.
5.1.3 Conceptual Know policies and procedures of the practice setting.
5.1.4 Conceptual Understand the process of making an ethical decision.
5.2.1 Perceptual Recognize situations in which ethics, laws, professional liability, and standards of practice apply.
5.2.2 Perceptual Recognize ethical dilemmas in practice setting.
5.2.3 Perceptual Recognize when a legal consultation is necessary.
5.2.4 Perceptual Recognize when clinical supervision or consultation is necessary.
5.3.1 Executive Monitor issues related to ethics, laws, regulations, and professional standards.
5.3.2 Executive Develop and assess policies, procedures, and forms for consistency with standards of practice to protect client confidentiality and to comply with relevant laws and regulations.
5.3.3 Executive Inform clients and legal guardian of limitations to confidentiality and parameters of mandatory reporting.
5.3.4 Executive Develop safety plans for clients who present with potential self-harm, suicide, abuse, or violence.
5.3.5 Executive Take appropriate action when ethical and legal dilemmas emerge.
5.3.6 Executive Report information to appropriate authorities as required by law.
5.3.7 Executive Practice within defined scope of practice and competence.
5.3.8 Executive Obtain knowledge of advances and theory regarding effective clinical practice.
5.3.9 Executive Obtain license(s) and specialty credentials.
5.3.10 Executive Implement a personal program to maintain professional competence.
5.4.1 Evaluative Evaluate activities related to ethics, legal issues, and practice standards.
5.4.2 Evaluative Monitor attitudes, personal well-being, personal issues, and personal problems to insure they do not impact the therapy process adversely or create vulnerability for misconduct.
5.5.1 Professional Maintain client records with timely and accurate notes.
5.5.2 Professional Consult with peers and/or supervisors if personal issues, attitudes, or beliefs threaten to adversely impact clinical work.
5.5.3 Professional Pursue professional development through self-supervision, collegial consultation, professional reading, and continuing educational activities.
5.5.4 Professional Bill clients and third-party payers in accordance with professional ethics, relevant laws and polices, and seek reimbursement only for covered services.

Domain 6: Research and Program Evaluation
Number Subdomain Competence
6.1.1 Conceptual Know the extant MFT literature, research, and evidence-based practice.
6.1.2 Conceptual Understand research and program evaluation methodologies, both quantitative and qualitative, relevant to MFT and mental health services.
6.1.3 Conceptual Understand the legal, ethical, and contextual issues involved in the conduct of clinical research and program evaluation.
6.2.1 Perceptual Recognize opportunities for therapists and clients to participate in clinical research.
6.3.1 Executive Read current MFT and other professional literature.
6.3.2 Executive Use current MFT and other research to inform clinical practice.
6.3.3 Executive Critique professional research and assess the quality of research studies and program evaluation in the literature.
6.3.4 Executive Determine the effectiveness of clinical practice and techniques.
6.4.1 Evaluative Evaluate knowledge of current clinical literature and its application.
6.5.1 Professional Contribute to the development of new knowledge.