MFT Clinical Training Handbook

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Loma Linda University

Counseling & Family Sciences
(909) 558-4547 extension 47001
www.llu.edu

2012 2013
Student Clinical Handbook
Mast e rs i n Mari t al andFami l y T he rapy
and Fami l yCounse l i ng Ce rt i f i cat e
Prog rams

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ACKNOWLEDGMENT

I, ________________________________________, hereby acknowledge the receipt of
the 2012-2013 Counseling and Family Sciences Masters in Marital and Family Therapy
and Program Counseling Certificate Student and Clinical Handbook. I realize that I am
responsible for reading and understanding the CFS Student Handbook and the MFT
clinical handbook, which contains many of the policies, procedures, rules and regulations
to which I will be subject. I further acknowledge that this Handbook supersedes and
replaces any and all prior Student Policy Handbooks. I also understand that it is the
intent of the Student Handbooks to give me some idea as to the policies to which I will be
subject and that it is not a complete manual. Except as provided in this
acknowledgment, I realize the policies may change from time to time.

Date: , 2012

Program:________________________________________

Student Signature

Student Name (please print)

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II. WELCOME to the Department of Counseling and Family Sciences. You will be
spending the next two years with faculty who are committed to collaborative education.
The work entrusted to mental health professionals is that of caring for relationships, and
we believe this work begins among ourselves. The greatest gifts your professors have to
share with you are their collegial spirit of working together and their respect for the
individuality of one another. We anticipate your contact with faculty, staff and students
at Loma Linda University will be positive and respectful as well, for these relationships
will become the foundation upon which you build new and ever more nurturing ways of
being with others.

With our rich cultural heritage, which spans the globe from India to Japan, Scandinavia,
Western Europe, and the Caribbean, your faculty cherishes the rich diversity you bring to
the program. You will be encouraged and supported in your sharing of the journey,
which has brought you to this place. It will be in the intimate associations of graduate
education that you will come to understand more fully experiences which may at this
time be foreign to you, experiences such as the depths of extreme poverty or privilege
and other uncommon ground. It is important to the faculty that we do not judge or
discriminate on the basis of differences in ethnicity, ideology, religion, gender, or
lifestyle. Please follow this example of inclusion by respecting individual differences and
the university mission that unites us from all parts of the earth.

Your status as a professional-in-training should set the standard for your behavior. In the
event you find yourself in conflict with the department over ideas, policies or individuals,
we ask that you maintain a code of conduct that conforms to the expectations set forth in
this handbook.

Marital and family therapists-in-training are expected to adhere to ethical guidelines of
the American Association for Marriage and Family Therapists (AAMFT).

Respect and professionalism are to be nurtured in all interactions. It is through these
relationships with faculty mentors, your classmates, and clients that you will grow and
ultimately be presented to the professional community upon graduation as the best and
brightest Loma Linda University has to offer.

Welcome.

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III. Loma Linda University
Mission

A Seventh-day Adventist Christian health-sciences institution, seeks to further the
healing and teaching ministry of Jesus Christ to make man whole by:

Educating ethical and proficient Christian health professionals and scholars through
instruction, example and the pursuit of truth;

Expanding knowledge through research in the biological, physical, environmental
sciences and applying this knowledge to health and disease;

Providing comprehensive, competent, and compassionate health care for the whole
person through faculty, students, and alumni.

Department of Counseling and Family Sciences
Mission Statement

Our mission is to facilitate wholeness by promoting health, healing, and hope to
individuals, families, and communities through education, research, professional training,
community service, and global outreach.

Program Goals, Mission, Vision and Values

Program and Goals:

The M.S. degree in marital and family therapy is designed to give students a broad
academic background as well as professional practice for working with individuals,
couples, and families in a variety of settings. These include, but are not limited to,
medical, legal, educational, community mental health, managed care, church settings and
private practice. Education and training is offered with the purpose of preparing students
to be effective with a variety of mental health problems such as co-occurring disorders,
serious emotional disorders, crisis care, chronic and/or serious mental illness, child and
elder abuse, emancipation issues, and homelessness and complex relational issues. Great
care is taken to include training that addresses issues of cross-cultural awareness,
diversity, law and ethics, systemic approaches to treatment along with other evidence
based modalities, life-span development, family and community systems, community
integration for support and resources, collaborative case coordination, and a focus on
elimination of discrimination and stigma of mental illness.

Program Mission and Philosophy:
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The programs is to prepare practitioners who will promote the health, hope, healing and
well-being of diverse individuals, couples, families, and communities. The masters
mission, vision and values reflect the mission, vision and values of the University and
Department.

Program Vision:
The programs vision is congruent with the university and department mission and states,
MFT students will learn how to make diverse families whole. Families include
different family structures such as; single parent, families headed by grandparents, bi-
racial couples, and families with special needs. This vision supports the notion that
transforming relationships in diverse families is essential. Diversity being a key concept
in training graduate students to work effectively with diverse populations,

Values
The program adopted five values as central to its view of education. These values reflect
many of the University values and include:
Compassionthe sympathetic willingness to be engaged with the needs and
sufferings of others. Among the most memorable depictions of compassion in
Scripture is the story of the Good Samaritan.
Integritythe quality of living a unified life in which one's convictions are well-
considered and match one's actions. Integrity encompasses honesty, authenticity,
and trustworthiness.
Excellencethe commitment to exceed minimum standards and expectations.
Freedomthe competency and privilege to make informed and accountable
choices and to respect the freedom of others. God has called us not to slavery but
to freedom.
Justicethe commitment to equality and to treat others fairly, renouncing all
forms of unfair discrimination.

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IV. CONTENTS OF THIS HANDBOOK

I. Acknowledgment 2
II. Welcome 3
III. Loma Linda University Mission 4
Department Mission
Program Goals,
Mission, Philosophy, Vision and Values 5
IV. Contents 6
V. Program and Student Learning Outcomes 8
VI: Review of Progress 10
VII. Phases of the Program: Academic and Clinical 11
VIII. Professional Licensure 14
VIV. Clinical Requirements for MFT Program 14
X. Board of Behavioral Science Examiners (BBS) 15
-LMl1 Lxperlence lnformaLlon for Pours Calned on or afLer 13
!anuary 1, 2012
-LMFT Experience Information for Hours Gained on or after 16
January 1, 2012
XI. Educational Requirements for MFT by the Board of Behavioral Sciences 18
XII. What is a Marriage and Family Therapist (MFT)?
XIII. AAMFT Code of Ethics 19
XIV. APPENDICES: PROGRAM CLINIC FORMS AND REQUIREMENTS 27

A. MFT 2 YEAR -AND THREE YEAR PROGRAMS CURRICULUMS 27
B. FAMILY COUNSELING CERTIFICATE REQUIREMENTS 31
C. INTERIM DOCTORATE (Ph.D/DMFT) PROGRAM OF STUDY 32
D. 18 UNIT EVALUATION: STUDENT ADVANCEMENT EVALUATION 35
E. MFT CLINICAL TRAINING CONTRACT 36
F. WHEN CLINICAL FORMS ARE DUE 37
G. PROGRAM CLINICAL HOUR REQUIREMENTS 38
H. YOUR RESPONSIBILITIES FOR SUPERVISION 39
I. LIST OF APPROVED CLINICAL SITES 40
J. FOUR WAYINTERNSHIP/TRAINEE CONTRACT 47
K. AAMFT SUPERVISION QUALIFICATION STATEMENT 51
L. EVALUATION BY SUPERVISOR OF STUDENTS PERFORMANCE 58
`CLINICAL COMPETENCY
M. QUARTERLY SUPERVISOR EVALUATION BY STUDENT 59
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N. AAMFT TRAINEE CLINICAL LOG SHEET (GREEN SHEET) 57
O. BBS AND LLU CLINICAL HOURS FORM 65
P. BBS EXPERIENCE ERIFICATION 66
Q. BBS RESPONSIBILITY STATEMENT FOR SUPERVISORS 68
R. FINAL CASE COMMITTEE APPROVAL 71
S. CONSENT TO USE PHI 72
T. FINAL ORAL EXAM PART I EVALUATION 75
U. FINAL ORAL EXAM PART II EVALUATION 82
V. GRADUATION SURVEY 90
W. CFS CLINIC 94

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V. MS MFT Program and Student Learning Outcomes

There are four overall program outcomes. The MFT program outcomes integrate our
Universitys commitment to diversity, the California State licensure requirements, the
American Association for Marriage and Family Therapy (AAMFT) MFT Educational
Guidelines and Core Competencies.

1. To prepare students to engage in the MFT profession by being eligible for MFT
licensure in California with a greater than 70% pass rate for students who sit for
the exam and additionally maintain membership in AAMFT.
2. The program will maintain a greater than 75% graduation rate.
3. The program will provide a learning environment and resources that allow
students to collaborate with other health care providers and multiple community
services (or contexts). (At least 80% of the students will be in a learning
environment where they are collaborating with other health care providers and
multiple community services.
4. The program will graduate a diverse student population whom are prepared to
practice in the field of marriage and family therapy. (At least 40% of graduates
will be members of a minority group; i.e., Asian, Black, Hispanic, low income.

MS MFT Student Learning Outcomes
Each of the seven student learning outcomes (below) for the program supports the whole
person care mission of the University. The program specifically addresses this whole
person care mission with a specific emphasis on advancing systems/relational theory
and practice in diverse societal context.
In addition, the student learning outcomes reflect AAMFT core competencies as students
learn to promote the emotional health and well-being of individuals, couples, families,
organizations, and communities. The student outcomes also reflect the California Board
of Behavioral Science (BBS) objectives for the profession of MFT is for students to be
trained in psychotherapeutic orientations directly related to marriage and family therapy
and marital and family systems approaches to treatment and how these theories can be
applied therapeutically with individuals, couples, families, adults, including elder adults,
children, adolescents, and groups to improve, restore, or maintain healthy relationships
(BBS code: 4980.36). It is also the programs responsibility to ensure that students learn
how to practice this service with integrity, compassion, sensitivity, flexibility, insight,
and personal presence (BBS code 4980.37).

The following are the programs student learning outcomes with the associated
measures used to track student performance:

1. Students will be able to apply a systemic framework to their clinical practice as a
martial and family therapist:
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A. Use systems/relational theories to guide practice and service delivery
across interpersonal, family, organizational, and/or community contexts
B. Integrate program knowledge and skills into a clinical setting.
C. Demonstrate a systems/relational epistemology in their final oral exam.

2. Student will be able to identify themselves as a systemic marital and family
therapy trainee.

A. Complete at least six case practicums with a satisfactory grade.
B. Complete their final oral exam successfully as evaluated by their three
member panel of experts.
C. Complete MFT theory courses (MFAM 551, MFAM 553, and MFAM
564) with a passing grade

3. *Students will be familiar with a variety of MFT therapy theories and demonstrate
clinical language and practices that enable them to work with diverse populations
within a multidisciplinary context.
A. Complete clinical traineeship with satisfactory supervisor evaluations.
Complete 500 hour clinical requirements.
B. Complete at least six practicums (**MFAM 535, 536, 537, 635, 636, 637
with a satisfactory grade of B or better grade. **MFAM 535, 536 and 537
are pass/fail courses

4. Students will be able to demonstrate the ability to analyze and present a clinical
case using one of the major MFT models:

A. Demonstrate the use of a MFT model with one of their clinical cased in
both their case write up and video presentation for their final oral exam.
B. Demonstrate knowledge of a major MFT model in their epistemology
paper for the final oral exam.
C. Receive a panel rating of 75% or better for their final clinical oral exam.

5. Students will demonstrate awareness of contextual issues in therapy such as
gender, religion/spirituality, sexual orientation, age, and socioeconomic status:
A. Completing MFAM 528 Culture and Socio-Economic Status in Therapy
with a B or better
B. Completing MFAM 604 Gender, Class and Race: Social Context in
Clinical Practice with a B or better.

6. Students will be knowledgeable of the legal and ethical standards relevant to the
field of marital and family therapy and apply their knowledge to their clinical
practice:
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A. Demonstrate knowledge of legal and ethical standards relevant to the field
of marital and family therapy by receiving a grade of B or better in
MFAM 614: Law and Ethics.

7. Students will be qualified to apply for internship status and subsequent licensure
as an MFT and aligned with practice standards.
A. Receive a 75% or better rating on their Final Oral Exam.
B. Receive a 70% or better rating on their comprehensive exam.

VI. Review of Progress

1.Regular Review. Students academic and professional progress is regularly reviewed
throughout the program. The faculty is committed to helping all students develop their
knowledge and skills. If concerns arise regarding professional or academic
performance, the faculty will discuss the issues with the student and determine an
appropriate plan for addressing them. Continued enrollment in the program, however, is
contingent on successful performance in both academic and professional areas.

2. Review for MFT Clinical Practice. MFT masters students must complete at least 18
units of course work before beginning their clinical placements. Admittance to the
program does not automatically mean students are ready for clinical practice. All
students, even those with previous experience, are reviewed by the faculty prior to
enrollment in case and practicum classes. In most cases, students are reviewed at the
end of fall quarter and begin clinical work winter quarter.

3.Transfer from MFT Masters Case to Doctoral Practicum. Students working on an
interim masters degree may petition to waive MFAM 636 and 637 (the last two quarters
of case presentation class) and begin MFTH 634 (Doctoral Practicum). To determine if
they are making sufficient clinical progress to transfer into the doctoral practicum,
students will be evaluated by their clinical supervisors and the faculty. Typically this
evaluation will occur at the end of fall quarter of the students second year. To transfer
into the doctoral practicum, interim students must also have attained at least 200 hours
of clinical experience.

Students who waive the last two quarters of masters case and transfer into the doctoral
practicum do not need to complete the masters final case presentation.

4. Comprehensive Exam: Masters and interim masters degree students must take the
Comprehensive Exam after the first year of masters level courses. This exam is
program-specific and is taken prior to the fall quarter during the second year. The exam
contains approximately 200 questions and is multiple choice or true/false. If a student
fails the first time, he/she will be allowed to take a second exam prior to their winter
quarter. If the student fails the second exam, he/she will be evaluated and will be
required to retake courses or take extra course work to strengthen areas not passed. If a
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student does not receive a B or better on the course retake he/she may be dismissed from
the program.

If the student is part-time or off tract they must consult with the Program Director as to
when this exam is to be taken, either the first or second time and if necessary when the
extra course work will be taken.

VII. Programs Four Phases

Overview
The MS program is divided into four phases of study. Phase I includes 21quarter units of
coursework. Student must complete these units and pass a faculty evaluation (Student
Advancement Evaluation (pg. 48) in order to enter clinical training. Phase II includes all
first year courses following the 21 unit (Phase I). After completing Phase I and II
students take a comprehensive exam. If they pass this exam, they are awarded Candidacy
and enter Phase III of the program which is essentially the second year of coursework.
During this phase, students must have completed all of their previous coursework with a
B or better, complete 500 clinical hours and pass the final oral exam. Phase IV is post
masters where the expected outcome is that all students will obtain a job in the field and
become a licensed MFT. To be licensed in the State of California one must complete
3000 clinical hours and pass the California MFT license exam.

PHASE ONE: COMPLETION OF 21 UNITS AND CLINICAL SITE
TRAINEESHIP
When entering the program students are required to complete 21 units of course work on
introductory or foundational issues for mental health providers. Such as Basic counseling
skills (MFAM 535), Writing (SCTJ 515), Crisis Intervention (MFAM 515), Social
Ecology, (MFAM 547), Family Therapy foundational theories and practice (MFAM
551), Psychopathology and diagnostic procedures (MFAM 556) and Law and Ethics
(MFAM 614). Once the student has completed these courses (with an average grade of B
or better) they are evaluated with the Student Advancement Evaluation (Appendix H)
which determines the students eligibility to be placed in an approved clinical site. While
the program requires the completion of 21 units prior to being placed in a clinical site the
California BBS only requires 18 units.

Phase One: Ready for a Clinical Site and Traineeship
Curriculum Student Learning
Outcomes
Outcome Evaluations
MFAM 535
BHTJ 515
MFAM 515
MFAM 547 MFAM 551
MFAM 556 MFAM 614
SLO #2, #5 and #6 Student Advancement
Evaluation stored in
Program Directors office
Grades for MFAM 614 in
student files (Required B or
better)
Average grade of B or better
in all Phase I courses
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PHASE TWO. COMPLETION OF FIRST YEAR COURSES AND
COMPREHENSIVE EXAM
Students begin phase II with an approved clinical placement. During this phase students
build onto their introduction training from phase I and integrate their clinical experiences
with advanced curriculum. At the conclusion of this phase students will have completed
48 units (including the 21 units from phase I). At the conclusion of this phase students
take the comprehensive exam (Available of site). The exam is a 200 item exam. Each
question is a multiple choice question and the questions are written and evaluated each
year by all faculty whom have taught the courses within Phase I and II. Students who
pass the exam move to candidacy status (Phase III). Those who do not pass, retake the
exam. If they do not pass the exam the second time, they are required to take a course
that focuses on the areas that seemed to present them with the most challenge. The
program director makes these recommendations. In addition to the academic
requirements, students must maintain a satisfactory score from the placement site
supervisor. These evaluations are collected through the Quarterly Trainee Evaluation
Form (Appendix L and Appendix T). The program director evaluates students each
quarter and determines whether the student has maintained a satisfactory rating. The
benchmarking for this rating is presented in Table III.6 below. Students must maintain a
score of 75% or higher on the total assessment to continue on to Phase III. Students not
meeting this benchmark may be placed on clinical probation. Students with two quarters
of probation are removed from the program. Often times a less than satisfactory score
will result in the student being placed in the departments clinic (BHI) so that facility are
able to mentor these students into a passing score the following quarter.

Phase Two: Completion of Phase Two Move Student to Candidacy Status
Outcomes
Outcome Evaluations
MFAM 528 (FMST ,
MFAM 536 MFAM
553,MFAM 644 MFAM
604, MFAM 501 MFAM
537, MFAM 564 MFAM
584

SLO#1, 2, 3, 4, 5, and 6

75% or higher on
Comprehensive Exam
Results:- (Located in
Department Office
Managers Files)
Average of B or higher for
all course in Phase II course
(located in student files)

2010 Supervisor Student
evaluations located in the
Assistant to the Director of
Clinical Trainings office

Receive a Grade B or better
in MFAM 528 Culture and
Socio-Economic Status in
Therapy
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Receive grades B or better
in MFAM 604 Gender,
Class, & Race: Social
Context in Clinical Practice.

PHASE THREE: FROM CANDIDACY TO GRADUATION
During this phase students will finish their course work, complete their clinical
requirements and take a final oral exam to determine if they have reached the high
standards we require of all graduates. Student will complete the remaining 45 units of
coursework prior to their final oral exam. The student must demonstrate they have
integrated a systemic approach to working with a couple or family. The student must
complete 500 clinical hours in an approved site in order to graduate. The final oral exam
has four parts: 1. an epistemology paper, 2. a thorough write up of the clinical case
(minimum of 6 sessions videotaped), 3. clinic case presentation (must be a couple or
family), and 4. a response to a clinical case vignette. This exam integrates all student
learning outcomes and many AAMFT core competencies. The exam is evaluated by the
three licensed clinicians who are faculty, supervisors or experts on the type of case
presented. (See standard IV for a more detailed discussion of the final oral exam process).
Students, who do not meet the 75% cutoff for any one of the four sections, are asked to
rewrite or retake the section in which they did not pass. This is termed a pass with
revisions. Failure to pass during a revision could result in removal from the program.
See table III.8 for the summary of 2010 and 2011 pass rate with the 75% cut off
benchmarks. On average only 5.6% percent of students will not pass one or more of these
sections (as seen on Table III.8 below).

Phase Three: Complete Program and Graduate
Outcomes
Outcome Evaluations
MFAM 502, MFAM 567,
MFAM 568, MFAM 552,
MFAM 635 MFAM 524,
MFAM 624 MFAM 636,
MFAM 638 MFAM 637,
MFAM 674, COUN 675
RELR 564, 8 units of
Electives

SLO # 1, #2, #3, #4, # 5,
#6, and #7
MFAM 635, 636 and 637
receive a B or better.

75% or better rating on
Final Oral Exam

Completion of 500 clinical
hours

PHASE FOUR. POST MASTERS JOB AND MFT LICENSE
Student in Phase IV have graduated and during this phase seek post masters employment
or education, as well as licensure. required by the accrediting body of your program in
the department.

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Phase Four: Post Graduation: Job and MFT License
Clinical Hours Student Learning
Outcomes
Outcome Evaluations
Completion of 3000
approved clinical hours.
SLO #7

90% of students from class
of 2010 acquired a job in the
mental/behavioral health or
related field (Alumni
Survey)

More than 70% of student
pass the CA license exam

VIII. Professional Licensure

Licensed Marriage and Family Therapist
In most cases the masters degree will be the qualifying clinical degree students use to
obtain licensure as a Marital and Family Therapist in California. Students will be
allowed to count up to 1,250 hours of clinical work before completion of the program.
The remaining 1,750 hours are to be accumulated post-masters. Students are encouraged
to work toward and obtain licensure while completing their doctoral degree. Information
regarding licensure is included in the Clinic Handbook.

Students should also directly contact: Department of Consumer Affairs
Board of Behavioral Sciences
1625 N. Market Street, Suite S-200
Sacramento, CA 95834
916-445-4933
http://www.bbs.ca.gov

VIV. Clinical Requirements for MFT Program

1. Background Check
Loma Linda University requires that all students entering a clinical program obtain a
backgound check at least two weeks prior to beginning clinical work or before starting
their programs Students are required to request their own background check from
www.MyBackgroundCheck.com, use order code (C8S90) payable by the student. The
check must include a minimum of the past 7 years, past five counties, Office
of Inspector General (OIG), Social Security numbers, other names (maiden, married,etc.),
addresses, and sex offender database. The check will be valid for the duration of the
program unless you are suspended or discontinue the program, in which case a new check
is required to reenter.

2. AAMFT Membership.
MFT Masters degree students are required to become members of the American
Association for Marriage and Family Therapy (AAMFT). The AAMFT is a professional
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association dedicated to the interests of marital and family therapists. It promotes
research, theory development and education in the field of marital and family therapy and
develops standards for graduate education and training, clinical supervision, professional
ethics, and the clinical practice of marriage and family therapy. To join, go to
www.aamft.org and click on join.

3. AAMFT Ethical Code.
Students are expected to become familiar with and abide by the AAMFT code of ethics.
(A copy is included in the appendix). Violation of the ethical code may result in
disciplinary action and possible dismissal from the program.

4. COAMFTE Accreditation.
The masters program in MFT has been accredited by the Commission on Accreditation
for Marriage and Family Therapy Education (COAMFTE) since 1975. COAMFTE
accredited programs adhere to the highest standards of education and training in family
therapy. Graduating from candidacy programs carries the full benefits of accreditation.
In 2O11 both the doctoral (Ph.D. and DMFT) and masters in Marital and Family
Therapy received full accreditation without stipulation for the next 6 years.

5. Personal Therapy.
Students are encouraged to seek therapy for personal growth to gain a deeper
understanding of the client-therapist relationship and processes. The student does not
need to inform the faculty that they have entered into this relationship. However, if
during the course of therapy, the student and/or therapist come to realize that the
students current situation interferes with being able to appropriately handle clinical or
academic assignments, it is the students professional responsibility to inform his/her
advisor in order to determine the best course of action for the student and the program.

Students may also be required to participate in therapy if personal issues appear to be
interfering with the ability to develop and practice good therapy skills.

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1. Individual Counseling or Psychotherapy (performed by you)
No Minimum or Maximum
No pre- or post-degree hours are required performing individual psychotherapy, though
many people gain hundreds of hours in this area due to the limitations of other categories.

2. Couples, Family and Child Psychotherapy (performed by you)
Minimum 500 hours May be completed pre- or post-degree or a combination of both. Up
to 150 hours of conjoint couples and family therapy may be double-counted

3. Group Therapy or Counseling (performed by you)Maximum 500 hours
May be completed pre- or post-degree or a combination of both.
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4. Telehealth Counseling (performed by you)Maximum 375 hours
NOTE - PRE-DEGREE HOURS: A maximum of 750 hours of clinical experience
(1-4 above), including direct supervisor contact (7, 8, next page), can be counted
pre-degree. EXAMPLE: A trainee earns 625 hours of clinical experience comprising a
combination of categories 1, 2, 3 and

5. In addition, the trainee earns 125 hours of individual supervision pre-degree, for a total
of750 hours.

6. Non-Counseling Experience (A-C below) Maximum 1,000 hours combined
Categories 5A and 5B have their own maximums within the 1,000 combined maximum.

A. Attending Workshops, Seminars, Training Sessions or Conferences
Maximum 250 hours

B. Personal Psychotherapy (received by you)
Maximum 100 hours X 3
Up to 100 hours may be earned. These hours are triple-counted by the Board for a
total of 300. Hours may be completed pre- or post-degree or a combination of both.

C. Direct Supervisor Contact
Maximum 1,000 hours Minimum 52 weeks/hours
Completed both pre- and post-degree. For more information see Supervision
section.

7. Administering and Evaluating Psychological Tests, Writing Clinical Reports, Progress
Notes, or Process Notes, and Client Centered Advocacy
Maximum 500 hours
Revised 1/12

LMFT Experience Information for Hours Gained on or after January 1, 2012
The information provided in this publication is general and intended to serve as a quick
answer guide for common questions. The Statutes and Regulations Relating to the
Practice of Professional Clinical Counseling, Marriage and Family Therapy,
Educational Psychology, and Clinical Social Work contains the official legal code
sections and language. The Board of Behavioral Sciences encourages you to thoroughly
read the Statutes and Regulations and refer to it in cases that require official legal
language.
EXPERIENCE TYPE
8. Supervision, Individual (One-on-One)
Minimum 52 Weeks/Hours
May be completed pre- or post-degree or a combination of both. Note: These may be
non-consecutive weeks.
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9. Supervision, Group
No Minimum or Maximum
No pre- or post-degree hours are required in this area. Not more than eight (8)
supervisees are permitted per group. Must be provided in one two-hour session or two
one-hour segments.

NOTE: A TOTAL MINIMUM of 104 hours/weeks of supervision is required.
Persons gaining hours pre- or post-degree must have a minimum of one (1) hour of
individual supervision, OR
two (2) hours of group supervision during each week in which experience is claimed,
for each work setting (see ratios required below). A maximum of five (5) hours of
supervision may be
credited per week.

SUPERVISION RATIOS REQUIRED FOR DIRECT COUNSELING
For trainees, ratios can be calculated based on the average number of hours

Trainees: Minimum one (1) unit of supervision for every five (5) hours of
EXPERIENCE gained over the entire period of time a trainee works in a particular
setting.

client contact in each setting
Supervision ratios cannot be averaged for persons gaining hours post-degree.

Ratio - Hours of Clinical Experience to Units of Supervision
(One unit of supervision is equal to one (1) hour of individual ortwo (2) hours of group
supervision)

Post-degree: Minimum one (1) unit of supervision each week in each setting;
AND one additional unit during any week
in which more than ten (10) hours of client
contact is gained in each setting

WEEKS OF EXPERIENCE REQUIRED
Minimum 104 weeks
Completed pre and post degree.

TOTAL HOURS OF EXPERIENCE REQUIRED
PRE-DEGREE Maximum 1,300 hrs
POST-DEGREE Minimum 1,700 hrs
1,300 maximum pre-degree hours = 750 maximum counseling and supervision
(categories 1-4, 7, 8) + all remaining hours categories

TOTAL Minimum 3,00 hrs

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X.The MFT masters program adheres to the following educational objectives as
outlined by the Board of Behavioral Sciences:

Degree Program Requirements
The degree program must contain no less than 60 semester or 90
quarter units of instruction.
The degree program does the following:
1. Throughout its curriculum, integrates marriage and family therapy
principles, the principles of mental health recovery-oriented care and
methods of service delivery in recovery-oriented practice environments,
and an understanding of various cultures and the social and
psychological implications of socioeconomic position, and an
understanding of how poverty and social stress impact an individuals
mental health and recovery;
2. Allows for innovation and individuality in the education of marriage and
family therapists;
3. Encourages students to develop the personal qualities that are intimately
related to effective practice;
4. Permits an emphasis or specialization that may address any one or more
of the unique and complex array of human problems, symptoms, and
needs of Californians served by marriage and family therapists; and
5. Provides students with the opportunity to meet with various consumers
and family members of consumers of mental health services to enhance
understanding of their experience of mental illness, treatment, and
recovery.

The degree program includes no less than 12 semester or 18 quarter
units of coursework in theories, principles, and methods of a variety of
psychotherapeutic orientations directly related to marriage and family
therapy and marital and family symptoms approaches to treatment and
how these theories can be applied therapeutically with individuals, couples,
families, adults, including elder adults, children, adolescents, and groups to
improve, restore, or maintain healthy relationships, as stipulated in BPC
Section 4980.36(d)(1)(A).
The degree program includes no less than six semester or nine quarter
units of practicum that involves direct client contact in a supervised clinical
placement that provides supervised fieldwork experience, and adheres to
the requirements stipulated in BPC Section 4980.36(d)(1)(B)(iv).
19
The practicum in the degree program includes a minimum of 150
hours of face-to-face experience counseling individuals, couples,
families, or groups (BPC Section 4980.36(d)(1)(B)(ii)).
In addition to the 150 hours of face-to-face experience, the
practicum must include 75 hours of either of the following:
Client-centered advocacy, as defined in Section 4980.03; or
Face-to-face experience counseling individuals, couples, families,
or groups (BPC Section 4980.36(d)(1)(vi)).
The degree program includes instruction in diagnosis, assessment,
prognosis, and treatment of mental disorders (Psychopathology), as
specified in BPC Section 4980.36(d)(2)(A).
The degree program includes instruction in developmental issues
from infancy to old age and all areas of study specified in BPC
Section 4980.36(d)(2)(B).
The degree program includes instruction in the broad range of
matters and life events that may arise within marriage and family
relationships and within a variety of California cultures and includes
instruction in all areas of study specified in BPC Section
4980.36(d)(2)(C).
The degree program includes instruction in cultural competency and
sensitivity and the areas of study specified in BPC Section
4980.36(d)(2)(D).
The degree program includes instruction in multicultural
development, cross-cultural interaction, and the areas of study
specified in BPC Section 4980.36(d)(2)(E).
The degree program includes instruction in the effects of
socioeconomic status on treatment and available resources, as
specified in BPC Section 4980.36(d)(2)(F).
The degree program includes instruction in resilience and the areas
of study specified in BPC Section 4980.36(d)(2)(G).
The degree program includes instruction in human sexuality and the
areas of study specified in BPC Section 4980.36(d)(2)(H).
20
The degree program includes instruction in substance use disorders,
co-occurring disorders, addiction, and the areas of study specified in
BPC Section 4980.36(d)(2)(I).
The degree program includes instruction in California law and
professional ethics for marriage and family therapists and the areas
of study specified in BPC Section 4980.36(d)(2)(J).
The degree program includes instruction in case management,
systems of care for the severely mentally ill, public and private
services and supports available for the severely mentally ill,
community resources for persons with mental illness and for victims
of abuse, disaster and trauma response, advocacy for the severely
mentally ill, and collaborative treatment, as specified in BPC Section
4980.36(e).
Please refer to BPC Section 4980.36 for the exact education requirements
effective August 1, 2012.
How Are the Education Requirements Changing August 1, 2012?
The main difference in the requirements that go into effect August 1, 2012,
is the separation of the additional coursework requirements, such as
human sexuality and psychopharmacology. The new requirements
integrate these areas into the degree program requirements, rather than
treating them as separate courses that may be completed outside of the
degree program. Applicants that fall under the requirements effective
August 1, 2012, must meet the qualifying degree program requirements in
order to be registered as an MFT Intern. Under the previous requirements,
some of the additional coursework could be completed outside of the
degree program and after being issued an intern registration number.\

XI. Educational Requirements for MFTs by the Board of Behavioral Sciences (BBS)
Marital and Family Therapy is an inter-disciplinary program leading to the Master of
Science degree. It is designed to give the student a broad academic background for
understanding the individual, couple or family and their problems and to prepare the
graduate to assist individuals, couples and families in working through their problems.
Marriage, family and child therapy has been established in California by law as a
professional requiring state licensure. Persons who desire to enter the profession must
have the proper academic and clinical preparation and must pass the written and oral
licensing examinations. Persons previously practicing as licensed marriage, family and
child therapists must update their credentials by approved continuing education
programs. Other states than California have enacted or plan to enact similar legislation.
The master's program at this University meets California licensing standards according to
Business and Professions Code 4980.36 and Code 4980.37.
21
X1I. What is a Marriage and Family Therapist (MFT)?
Sect i on: 4980. 02. PRACTl CE OF MARRl AGE, FAMl LY, AND CHl LD
COUNSELl NG; APPLl CATl ON OF PRl NCl PLES AND METHODS
For the purposes of this chapter, the practice of marriage and family therapy shall mean
that service performed with individuals, couples, or groups wherein interpersonal
relationships are examined for the purpose of achieving more adequate, satisfying, and
productive marriage and family adjustments. This practice includes relationship and
premarriage counseling.
The application of marriage and family therapy principles and methods includes, but is
not limited to, the use of applied psychotherapeutic techniques, to enable individuals to
mature and grow within marriage and the family, the provision of explanations and
interpretations of the psychosexual and psychosocial aspects of relationships, and the use,
application, and integration of the coursework and training required by Sections 4980.37,
4980.40, and 4980.41.
Pursuant to Business and Professions Code Section 4980.08, effective July 1,
1999, the title "licensed marriage, family and child counselor" or "marriage, family
and child counselor" is hereby renamed "licensed marriage and family therapist"
or "marriage and family therapist," respectively. Any reference in any statute or
regulation to a "licensed marriage, family and child counselor" or "marriage,
family and child counselor" shall be deemed a reference to a "licensed marriage
and family therapist" or "marriage and family therapist." Nothing in this section
shall be construed to expand or constrict the scope of practice of a person
licensed pursuant to this chapter

XIII. AAMFT Code of Ethics

CODE OF ETHICS Effective July 1, 2012
Preamble The Board of Directors of the American Association for Marriage and
Family Therapy (AAMFT) hereby promulgates, pursuant to Article 2, Section
2.01.3 of the Association's Bylaws, the Revised AAMFT Code of Ethics, effective
July 1, 2012.
The AAMFT strives to honor the public trust in marriage and family therapists by
setting standards for ethical practice as described in this Code. The ethical
standards define professional expectations and are enforced by the AAMFT
Ethics Committee. The absence of an explicit reference to a specific behavior or
22
situation in the Code does not mean that the behavior is ethical or unethical. The
standards are not exhaustive. Marriage and family therapists who are uncertain
about the ethics of a particular course of action are encouraged to seek counsel
from consultants, attorneys, supervisors, colleagues, or other appropriate
authorities.
Both law and ethics govern the practice of marriage and family therapy. When
making decisions regarding professional behavior, marriage and family therapists
must consider the AAMFT Code of Ethics and applicable laws and regulations. If
the AAMFT Code of Ethics prescribes a standard higher than that required by
law, marriage and family therapists must meet the higher standard of the AAMFT
Code of Ethics. Marriage and family therapists comply with the mandates of law,
but make known their commitment to the AAMFT Code of Ethics and take steps
to resolve the conflict in a responsible manner. The AAMFT supports legal
mandates for reporting of alleged unethical conduct.
The AAMFT Code of Ethics is binding on members of AAMFT in all membership
categories, all AAMFT Approved Supervisors and all applicants for membership
or the Approved Supervisor designation. AAMFT members have an obligation to
be familiar with the AAMFT Code of Ethics and its application to their
professional services. Lack of awareness or misunderstanding of an ethical
standard is not a defense to a charge of unethical conduct.
The process for filing, investigating, and resolving complaints of unethical
conduct is described in the current AAMFT Procedures for Handling Ethical
Matters. Persons accused are considered innocent by the Ethics Committee until
proven guilty, except as otherwise provided, and are entitled to due process. If an
AAMFT member resigns in anticipation of, or during the course of, an ethics
investigation, the Ethics Committee will complete its investigation. Any
publication of action taken by the Association will include the fact that the
member attempted to resign during the investigation.
Principle I Responsibility to Clients Marriage and family therapists advance
the welfare of families and individuals. They respect the rights of those persons
seeking their assistance, and make reasonable efforts to ensure that their
services are used appropriately.
1.1 Non-Discrimination. Marriage and family therapists provide professional
assistance to persons without discrimination on the basis of race, age, ethnicity,
socioeconomic status, disability, gender, health status, religion, national origin,
sexual orientation, gender identity or relationship status.
1.2 Informed Consent. Marriage and family therapists obtain appropriate
informed consent to therapy or related procedures and use language that is
reasonably understandable to clients. The content of informed consent may vary
depending upon the client and treatment plan; however, informed consent
generally necessitates that the client: (a) has the capacity to consent; (b) has
23
been adequately informed of significant information concerning treatment
processes and procedures; (c) has been adequately informed of potential risks
and benefits of treatments for which generally recognized standards do not yet
exist; (d) has freely and without undue influence expressed consent; and (e) has
provided consent that is appropriately documented. When persons, due to age or
mental status, are legally incapable of giving informed consent, marriage and
family therapists obtain informed permission from a legally authorized person, if
such substitute consent is legally permissible.
1.3 Multiple Relationships. Marriage and family therapists are aware of their
influential positions with respect to clients, and they avoid exploiting the trust and
dependency of such persons. Therapists, therefore, make every effort to avoid
conditions and multiple relationships with clients that could impair professional
judgment or increase the risk of exploitation. Such relationships include, but are
not limited to, business or close personal relationships with a client or the clients
immediate family. When the risk of impairment or exploitation exists due to
conditions or multiple roles, therapists document the appropriate precautions
taken.
1.4 Sexual Intimacy with Current Clients and Others. Sexual intimacy with
current clients, or their spouses or partners is prohibited. Engaging in sexual
intimacy with individuals who are known to be close relatives, guardians or
significant others of current clients is prohibited.
1.5 Sexual Intimacy with Former Clients and Others. Sexual intimacy with
former clients, their spouses or partners, or individuals who are known to be
close relatives, guardians or significant others of clients is likely to be harmful
and is therefore prohibited for two years following the termination of therapy or
last professional contact. After the two years following the last professional
contact or termination, in an effort to avoid exploiting the trust and dependency of
clients, marriage and family therapists should not engage in sexual intimacy with
former clients, or their spouses or partners. If therapists engage in sexual
intimacy with former clients, or their spouses or partners, more than two years
after termination or last professional contact, the burden shifts to the therapist to
demonstrate that there has been no exploitation or injury to the former client, or
their spouse or partner.
1.6 Reports of Unethical Conduct. Marriage and family therapists comply with
applicable laws regarding the reporting of alleged unethical conduct.
1.7 No Furthering of Own Interests. Marriage and family therapists do not use
their professional relationships with clients to further their own interests.
1.8 Client Autonomy in Decision Making. Marriage and family therapists
respect the rights of clients to make decisions and help them to understand the
consequences of these decisions. Therapists clearly advise clients that clients
have the responsibility to make decisions regarding relationships such as
24
cohabitation, marriage, divorce, separation, reconciliation, custody, and visitation.
1.9 Relationship Beneficial to Client. Marriage and family therapists continue
therapeutic relationships only so long as it is reasonably clear that clients are
benefiting from the relationship.
1.10 Referrals. Marriage and family therapists assist persons in obtaining other
therapeutic services if the therapist is unable or unwilling, for appropriate
reasons, to provide professional help.
1.11 Non-Abandonment. Marriage and family therapists do not abandon or
neglect clients in treatment without making reasonable arrangements for the
continuation of treatment.
1.12 Written Consent to Record. Marriage and family therapists obtain written
informed consent from clients before videotaping, audio recording, or permitting
third-party observation.
1.13 Relationships with Third Parties. Marriage and family therapists, upon
agreeing to provide services to a person or entity at the request of a third party,
clarify, to the extent feasible and at the outset of the service, the nature of the
relationship with each party and the limits of confidentiality.
1.14 Electronic Therapy. Prior to commencing therapy services through
electronic means (including but not limited to phone and Internet), marriage and
family therapists ensure that they are compliant with all relevant laws for the
delivery of such services. Additionally, marriage and family therapists must: (a)
determine that electronic therapy is appropriate for clients, taking into account
the clients intellectual, emotional, and physical needs; (b) inform clients of the
potential risks and benefits associated with electronic therapy; (c) ensure the
security of their communication medium; and (d) only commence electronic
therapy after appropriate education, training, or supervised experience using the
relevant technology.

Principle II Confidentiality Marriage and family therapists have unique
confidentiality concerns because the client in a therapeutic relationship may be
more than one person. Therapists respect and guard the confidences of each
individual client.
2.1 Disclosing Limits of Confidentiality. Marriage and family therapists
disclose to clients and other interested parties, as early as feasible in their
professional contacts, the nature of confidentiality and possible limitations of the
clients right to confidentiality. Therapists review with clients the circumstances
where confidential information may be requested and where disclosure of
confidential information may be legally required. Circumstances may necessitate
repeated disclosures.
25
2.2 Written Authorization to Release Client Information. Marriage and family
therapists do not disclose client confidences except by written authorization or
waiver, or where mandated or permitted by law. Verbal authorization will not be
sufficient except in emergency situations, unless prohibited by law. When
providing couple, family or group treatment, the therapist does not disclose
information outside the treatment context without a written authorization from
each individual competent to execute a waiver. In the context of couple, family or
group treatment, the therapist may not reveal any individuals confidences to
others in the client unit without the prior written permission of that individual.
2.3 Confidentiality in Non-Clinical Activities. Marriage and family therapists
use client and/or clinical materials in teaching, writing, consulting, research, and
public presentations only if a written waiver has been obtained in accordance
with Subprinciple 2.2, or when appropriate steps have been taken to protect
client identity and confidentiality.
2.4 Protection of Records. Marriage and family therapists store, safeguard, and
dispose of client records in ways that maintain confidentiality and in accord with
applicable laws and professional standards.
2.5 Preparation for Practice Changes. In preparation for moving from the area,
closing a practice, or death, marriage and family therapists arrange for the
storage, transfer, or disposal of client records in conformance with applicable
laws and in ways that maintain confidentiality and safeguard the welfare of
clients.
2.6 Confidentiality in Consultations. Marriage and family therapists, when
consulting with colleagues or referral sources, do not share confidential
information that could reasonably lead to the identification of a client, research
participant, supervisee, or other person with whom they have a confidential
relationship unless they have obtained the prior written consent of the client,
research participant, supervisee, or other person with whom they have a
confidential relationship. Information may be shared only to the extent necessary
to achieve the purposes of the consultation.
2.7 Protection of Electronic Information. When using electronic methods for
communication, billing, recordkeeping, or other elements of client care, marriage
and family therapists ensure that their electronic data storage and
communications are privacy protected consistent with all applicable law.
Principle III Professional Competence and Integrity Marriage and family
therapists maintain high standards of professional competence and integrity.
3.1 Maintenance of Competency. Marriage and family therapists pursue
knowledge of new developments and maintain their competence in marriage and
family therapy through education, training, or supervised experience.
3.2 Knowledge of Regulatory Standards. Marriage and family therapists
26
maintain adequate knowledge of and adhere to applicable laws, ethics, and
professional standards.
3.3 Seek Assistance. Marriage and family therapists seek appropriate
professional assistance for their personal problems or conflicts that may impair
work performance or clinical judgment.
3.4 Conflicts of Interest. Marriage and family therapists do not provide services
that create a conflict of interest that may impair work performance or clinical
judgment.
3.5 Veracity of Scholarship. Marriage and family therapists, as presenters,
teachers, supervisors, consultants and researchers, are dedicated to high
standards of scholarship, present accurate information, and disclose potential
conflicts of interest.
3.6 Maintenance of Records. Marriage and family therapists maintain accurate
and adequate clinical and financial records in accordance with applicable law.
3.7 Development of New Skills. While developing new skills in specialty areas,
marriage and family therapists take steps to ensure the competence of their work
and to protect clients from possible harm. Marriage and family therapists practice
in specialty areas new to them only after appropriate education, training, or
supervised experience.
3.8 Harassment. Marriage and family therapists do not engage in sexual or other
forms of harassment of clients, students, trainees, supervisees, employees,
colleagues, or research subjects.
3.9 Exploitation. Marriage and family therapists do not engage in the
exploitation of clients, students, trainees, supervisees, employees, colleagues, or
research subjects.
3.10 Gifts. Marriage and family therapists do not give to or receive from clients
(a) gifts of substantial value or (b) gifts that impair the integrity or efficacy of the
therapeutic relationship.
3.11 Scope of Competence. Marriage and family therapists do not diagnose,
treat, or advise on problems outside the recognized boundaries of their
competencies.
3.12 Accurate Presentation of Findings. Marriage and family therapists make
efforts to prevent the distortion or misuse of their clinical and research findings.
3.13 Public Statements. Marriage and family therapists, because of their ability
to influence and alter the lives of others, exercise special care when making
public their professional recommendations and opinions through testimony or
other public statements.
27
3.14 Separation of Custody Evaluation from Therapy. To avoid a conflict of
interest, marriage and family therapists who treat minors or adults involved in
custody or visitation actions may not also perform forensic evaluations for
custody, residence, or visitation of the minor. Marriage and family therapists who
treat minors may provide the court or mental health professional performing the
evaluation with information about the minor from the marriage and family
therapists perspective as a treating marriage and family therapist, so long as the
marriage and family therapist does not violate confidentiality.
3.15 Professional Misconduct. Marriage and family therapists are in violation of
this Code and subject to termination of membership or other appropriate action if
they: (a) are convicted of any felony; (b) are convicted of a misdemeanor related
to their qualifications or functions; (c) engage in conduct which could lead to
conviction of a felony, or a misdemeanor related to their qualifications or
functions; (d) are expelled from or disciplined by other professional organizations;
(e) have their licenses or certificates suspended or revoked or are otherwise
disciplined by regulatory bodies; (f) continue to practice marriage and family
therapy while no longer competent to do so because they are impaired by
physical or mental causes or the abuse of alcohol or other substances; or (g) fail
to cooperate with the Association at any point from the inception of an ethical
complaint through the completion of all proceedings regarding that complaint.

Principle IV Responsibility to Students and Supervisees Marriage and
family therapists do not exploit the trust and dependency of students and
supervisees.
4.1 Exploitation. Marriage and family therapists who are in a supervisory role
are aware of their influential positions with respect to students and supervisees,
and they avoid exploiting the trust and dependency of such persons. Therapists,
therefore, make every effort to avoid conditions and multiple relationships that
could impair professional objectivity or increase the risk of exploitation. When the
risk of impairment or exploitation exists due to conditions or multiple roles,
therapists take appropriate precautions.
4.2 Therapy with Students or Supervisees. Marriage and family therapists do
not provide therapy to current students or supervisees.
4.3 Sexual Intimacy with Students or Supervisees. Marriage and family
therapists do not engage in sexual intimacy with students or supervisees during
the evaluative or training relationship between the therapist and student or
supervisee. If a supervisor engages in sexual activity with a former supervisee,
the burden of proof shifts to the supervisor to demonstrate that there has been no
exploitation or injury to the supervisee.
4.4 Oversight of Supervisee Competence. Marriage and family therapists do
not permit students or supervisees to perform or to hold themselves out as
28
competent to perform professional services beyond their training, level of
experience, and competence.
4.5 Oversight of Supervisee Professionalism. Marriage and family therapists
take reasonable measures to ensure that services provided by supervisees are
professional.
4.6 Existing Relationship with Students or Supervisees. Marriage and family
therapists avoid accepting as supervisees or students those individuals with
whom a prior or existing relationship could compromise the therapists objectivity.
When such situations cannot be avoided, therapists take appropriate precautions
to maintain objectivity. Examples of such relationships include, but are not limited
to, those individuals with whom the therapist has a current or prior sexual, close
personal, immediate familial, or therapeutic relationship.
4.7 Confidentiality with Supervisees. Marriage and family therapists do not
disclose supervisee confidences except by written authorization or waiver, or
when mandated or permitted by law. In educational or training settings where
there are multiple supervisors, disclosures are permitted only to other
professional colleagues, administrators, or employers who share responsibility
for training of the supervisee. Verbal authorization will not be sufficient except in
emergency situations, unless prohibited by law.

Principle V Responsibility to Research Participants Investigators respect
the dignity and protect the welfare of research participants, and are aware of
applicable laws, regulations, and professional standards governing the conduct
of research.
5. 1 Protection of Research Participants. Investigators are responsible for
making careful examinations of ethical acceptability in planning studies. To the
extent that services to research participants may be compromised by
participation in research, investigators seek the ethical advice of qualified
professionals not directly involved in the investigation and observe safeguards to
protect the rights of research participants.
5. 2 Informed Consent. Investigators requesting participant involvement in
research inform participants of the aspects of the research that might reasonably
be expected to influence willingness to participate. Investigators are especially
sensitive to the possibility of diminished consent when participants are also
receiving clinical services, or have impairments which limit understanding and/or
communication, or when participants are children.
5.3 Right to Decline or Withdraw Participation. Investigators respect each
participants freedom to decline participation in or to withdraw from a research
study at any time. This obligation requires special thought and consideration
when investigators or other members of the research team are in positions of
29
authority or influence over participants. Marriage and family therapists, therefore,
make every effort to avoid multiple relationships with research participants that
could impair professional judgment or increase the risk of exploitation.
5.4 Confidentiality of Research Data. Information obtained about a research
participant during the course of an investigation is confidential unless there is a
waiver previously obtained in writing. When the possibility exists that others,
including family members, may obtain access to such information, this possibility,
together with the plan for protecting confidentiality, is explained as part of the
procedure for obtaining informed consent.

Principle VI Responsibility to the Profession Marriage and family therapists
respect the rights and responsibilities of professional colleagues and participate
in activities that advance the goals of the profession.
6.1 Conflicts Between Code and Organizational Policies. Marriage and family
therapists remain accountable to the AAMFT Code of Ethics when acting as
members or employees of organizations. If the mandates of an organization with
which a marriage and family therapist is affiliated, through employment, contract
or otherwise, conflict with the AAMFT Code of Ethics, marriage and family
therapists make known to the organization their commitment to the AAMFT Code
of Ethics and attempt to resolve the conflict in a way that allows the fullest
adherence to the Code of Ethics.
6.2 Publication Authorship. Marriage and family therapists assign publication
credit to those who have contributed to a publication in proportion to their
contributions and in accordance with customary professional publication
practices.
6.3 Authorship of Student Work. Marriage and family therapists do not accept
or require authorship credit for a publication based on research from a students
program, unless the therapist made a substantial contribution beyond being a
faculty advisor or research committee member. Co-authorship on a student
thesis, dissertation, or project should be determined in accordance with principles
of fairness and justice.
6.4 Plagiarism. Marriage and family therapists who are the authors of books or
other materials that are published or distributed do not plagiarize or fail to cite
persons to whom credit for original ideas or work is due.
6.5 Accuracy in Publication and Advertising. Marriage and family therapists
who are the authors of books or other materials published or distributed by an
organization take reasonable precautions to ensure that the organization
promotes and advertises the materials accurately and factually.
6.6 Pro Bono. Marriage and family therapists participate in activities that
contribute to a better community and society, including devoting a portion of their
30
professional activity to services for which there is little or no financial return.
6.7 Advocacy. Marriage and family therapists are concerned with developing
laws and regulations pertaining to marriage and family therapy that serve the
public interest, and with altering such laws and regulations that are not in the
public interest.
6.8 Public Participation. Marriage and family therapists encourage public
participation in the design and delivery of professional services and in the
regulation of practitioners.
Principle VII Financial Arrangements Marriage and family therapists make
financial arrangements with clients, third-party payors, and supervisees that are
reasonably understandable and conform to accepted professional practices.
7.1 Financial Integrity. Marriage and family therapists do not offer or accept
kickbacks, rebates, bonuses, or other remuneration for referrals; fee-for-service
arrangements are not prohibited.
7.2 Disclosure of Financial Policies. Prior to entering into the therapeutic or
supervisory relationship, marriage and family therapists clearly disclose and
explain to clients and supervisees: (a) all financial arrangements and fees related
to professional services, including charges for canceled or missed appointments;
(b) the use of collection agencies or legal measures for nonpayment; and (c) the
procedure for obtaining payment from the client, to the extent allowed by law, if
payment is denied by the third-party payor. Once services have begun, therapists
provide reasonable notice of any changes in fees or other charges.
7.3 Notice of Payment Recovery Procedures. Marriage and family therapists
give reasonable notice to clients with unpaid balances of their intent to seek
collection by agency or legal recourse. When such action is taken, therapists will
not disclose clinical information.
7.4 Truthful Representation of Services. Marriage and family therapists
represent facts truthfully to clients, third-party payors, and supervisees regarding
services rendered.
7.5 Bartering. Marriage and family therapists ordinarily refrain from accepting
goods and services from clients in return for services rendered. Bartering for
professional services may be conducted only if: (a) the supervisee or client
requests it; (b) the relationship is not exploitative; (c) the professional relationship
is not distorted; and (d) a clear written contract is established.
7.6 Withholding Records for Non-Payment. Marriage and family therapists
may not withhold records under their immediate control that are requested and
needed for a clients treatment solely because payment has not been received
for past services, except as otherwise provided by law.
31
Principle VIII Advertising Marriage and family therapists engage in
appropriate informational activities, including those that enable the public, referral
sources, or others to choose professional services on an informed basis.
8.1 Accurate Professional Representation. Marriage and family therapists
accurately represent their competencies, education, training, and experience
relevant to their practice of marriage and family therapy.
8.2 Promotional Materials. Marriage and family therapists ensure that
advertisements and publications in any media (such as directories,
announcements, business cards, newspapers, radio, television, Internet, and
facsimiles) convey information that is necessary for the public to make an
appropriate selection of professional services and consistent with applicable law.
8.3 Professional Affiliations. Marriage and family therapists do not use names
that could mislead the public concerning the identity, responsibility, source, and
status of those practicing under that name, and do not hold themselves out as
being partners or associates of a firm if they are not.
8.4 Professional Identification. Marriage and family therapists do not use any
professional identification (such as a business card, office sign, letterhead,
Internet, or telephone or association directory listing) if it includes a statement or
claim that is false, fraudulent, misleading, or deceptive.
8.5 Educational Credentials. In representing their educational qualifications,
marriage and family therapists list and claim as evidence only those earned
degrees: (a) from institutions accredited by regional accreditation sources; (b)
from institutions recognized by states or provinces that license or certify marriage
and family therapists; or (c) from equivalent foreign institutions.
8.6 Correction of Misinformation. Marriage and family therapists correct,
wherever possible, false, misleading, or inaccurate information and
representations made by others concerning the therapist's qualifications,
services, or products.
8.7 Employee or Supervisee Qualifications. Marriage and family therapists
make certain that the qualifications of their employees or supervisees are
represented in a manner that is not false, misleading, or deceptive.
8.8 Specialization. Marriage and family therapists do not represent themselves
as providing specialized services unless they have the appropriate education,
training, or supervised experience.
Violations of this Code should be submitted in writing to the attention of: AAMFT
Ethics Committee 112 South Alfred Street, Alexandria, VA 22314 Phone: (703)
838-9808 Fax: (703) 838-9805 email: ethics@aamft.org

32
XIV. APPENDICES

APPENDIX A

MARITAL AND FAMILY THERAPY PROGRAM
2 YEAR 2012/2013

Pre FALL QUARTER 1
st
YEAR: (6 units)

MFAM 535 Case Presentation and Professional Studies (4)
BHCJ 515 Research/Writing Grad Level Papers (2)

FALL QUARTER 1
st
YEAR: (15 units)
MFAM 515 Crisis Intervention & Client-Centered Advocacy (3)
MFAM 547 Social Ecology of Individual and Family Development (3)
MFAM 551 Family Therapy: Foundational Theories and Practice (3)
MFAM 556 Psychopathology and Diagnostic Procedures (3)
MFAM 614 Law and Ethics (3)

WINTER QUARTER 1
st
YEAR: (12 units)
MFAM 528 Culture& Socio-Economic Status in Therapy (3)
MFAM 536 Case Presentation and Documentation (3)
MFAM 553 Family Systems Theory (3)
MFAM 644 Child Abuse and Family Violence (3)
MFAM 731 Professional Clinical Training (200 hrs.) (6
clinical units IP until Student finishes 200 clinical hours)

SPRING QUARTER 1
st
YEAR: (15 units)
MFAM 604 Gender, Class & Race: Social Context in Cl. Practice (3)
MFAM 501 Research Tools and Methodology: Quantitative (3)
MFAM 537 Case Presentation Seminar (3)
MFAM 564 Family Therapy: Adv. Foundational Theories and Practice (3)
MFAM 584 Advanced Child and Adolescent Development (3)

SUMMER QUARTER 2
nd
YEAR: (11 units)
MFAM 568/COUN Groups: Process and Practice (3)
MFAM 732 Professional Clinical Training (300 hrs IP until they reach
500 hour - )

ELECTIVES (8 units)
MFAM one required theory elective (2):
MFAM 539 Solution-focused Family Therapy ` (2)
MFAM 555 Narrative Family Therapy (2)
MFAM 557 Object-Relations Family Therapy (2)
MFAM 559 Cognitive Behavioral Couples Therapy (2)
MFAM 565 Advanced Bowen Theory and Practice (2)
MFAM 605 Gestalt Family Therapy (2)
33
MFAM 606 Emotionally Focused Couples Therapy (2)
MFAM 665 Structural & Multi-Dimensional Family Therapy (2)
MFAM 664 Experiential Family Therapy (2)

Additional Electives Offered:
MFAM 516 Play Therapy (2)
COUN 577 Assessment in Counseling (3)
MFAM 538 Theory and Practice of Conflict Resolution (2)
MFAM 544 Family and Divorce Mediation (4)
MFAM 549 Christian Counseling and Family Therapy (2)
MFAM 585 Internship in Family Mediation (4)

SECOND YEAR

FALL QUARTER 2
nd
YEAR: (14 units)

MFAM 502 Research Tools and Methodology: Qualitative (3)
MFAM 567 Treating the Severely and Persistently Mentally Ill
& The Recovery Model (3)
MFAM 552 Couples Therapy: Theory and Practice (3)
RELR 564 Religion, Marriage and the Family (3)

WINTER QUARTER 2
nd
YEAR: (11 units)

MFAM 524 Psychopharmacology and Medical Issues (3)
MFAM 624 Individual and Systems Assessment (3)
MFAM 638 Family Therapy and Chemical Abuse (3)

SPRING QUARTER 2
nd
YEAR: (6 units)

COUN 675 Dynamics of Aging (1)
MFAM 674/COUN Human Sexual Behavior (3)

Additional Electives Offered TBA:
FMST 524 Family Resource Management (2)
FMST 528 Parenting (2)
FMST 529 Family Life Education (3)
COUN578 College and Career Counseling (2)
MFAM 548 Men and Families (2)
MFAM 615 Reflective Practice (2)
MFAM 659 Current Trends in The Field of Family Therapy (2)
MFAM 670 Seminar in Sex Therapy (2)
MFAM 695 Research Problems: Marriage and Family (1-4)

1
st
year core = 59 units
34
2
nd
year core = 31 units
Electives = 8 units
Total: (90 units)

MARITAL AND FAMILY THERAPY PROGRAM
3 YR PROGRAM 2012/2013

FALL QUARTER 1
st
YEAR: (12 units)

STCJ 515 Research/Writing Grad-Level Papers (2)
MFAM 515 Crisis Intervention Counseling (3)
MFAM 535 Case Presentation and Professional Studies (4)
MFAM 551 Family Therapy: Foundational Theories & Practice (3)

WINTER QUARTER - 1
st
YEAR: (9 units)

MFAM 528 Culture and Socio-Economic Status in Therapy (3)
MFAM 553 Family Systems Theory (3)
MFAM 644 Child Abuse & Family Violence (3)

SPRING QUARTER - 1
st
YEAR: (9 units)

MFAM 501 Research Tools and Methodology: Quantitative (3)
MFAM 604 Gender, Class, & Race: Social Context in Clinical
Practice (3)
MFAM 731 Professional Clinical Training (6 clinical units)

SUMMER QUARTER 1
st
YEAR: (8 units)

MFAM 568 Groups: Process and Practice (3)
MFAM 731 Professional Clinical Training (IP)

MFAM one required theory elective (2):
MFAM 539 Solution-focused Family Therapy (2)
MFAM 555 Narrative Family Therapy (2)
MFAM 557 Object-Relations Family Therapy (2)
MFAM 559 Cognitive Behavioral Couples Therapy (2)
MFAM 565 Advanced Bowen Theory and Practice (2)
MFAM 665 Structural and Multi-dimentional
Family Therapy (2)
MFAM 605 Gestalt Family Therapy (2)
MFAM 606 Emotionally Focused Couples Therapy (2)

FALL QUARTER - 2
nd
YEAR: (12 units)

MFAM 547 Social Ecology of Individual and Family Development (3)
MFAM 552 Couples Therapy: Theory & Practice (3)
35
MFAM 556 Psychopathology & Diagnostic Procedures (3)
MFAM 614 Law & Ethics (3)

WINTER QUARTER - 2
nd
YEAR: (6 units)

MFAM 524 Psychopharmacology and Medical Issues (3)
MFAM 624 Individual and Systems Assessment (3)
MFAM 732 Professional Clinical Training (9 clinical units)

SPRING QUARTER - 2
nd
YEAR: (7 units)

MFAM 564 Family Therapy: Adv. Foundational Theories & Practice (3)
MFAM 584 Advanced Child and Adolescent Development (3)
COUN 675 Dynamics of Aging (1)

Comprehensive Examination (End of August)

SUMMER QUARTER - 2
nd
YEAR: (8 units)

MFAM Elective (2)
MFAM Elective (2)
MFAM Elective (2)

FALL QUARTER 3
rd
YEAR: (9 units)

MFAM 502 Research Tools & Methodology: Qualitative (3)
MFAM 567 Treating the Severely Mentally Ill and Recovery Process (3)
RELR 564 Religion, Marriage and the Family (3)

WINTER QUARTER 3
rd
YEAR: (5 units)

MFAM 638 Family Therapy & Chemical Abuse (3)

Additional Electives Offered:
FMST 524 Family Resource Management (2)
FMST 528 Parenting (2)
FMST 529 Family Life Education (3)
MFAM 522 Family and Career Counseling (2)
MFAM 548 Men and Families (2)
MFAM 615 Reflective Practice (2)
MFAM 659 Current Trends in The Field of Family Therapy (2)
36
MFAM 675 Clinical Problems in Marriage and Family Therapy (1-2)
MFAM 694 Directed Study: Marriage and Family (1-4)
MFAM 695 Research Problems: Marriage and Family (1-4)

SPRING QUARTER 3
rd
YEAR: (5 units)

MFAM 674 Human Sexual Behavior (3)
MFAM 732 Professional Clinical Training (IP and finish)

Final Case Presentation (during last quarter)

90 Quarter Units Program
36 core units first year
27 core units second year
19 core units third year

82 core units
8 elective units
9O unit total

Students who are completing an interim masters degree in tandem with the doctoral
degree in Marital and Family Therapy must submit the appropriate graduation forms for
the masters degree according to University deadlines. Requirements include:
The 60 units of masters courses outlined on the interim checklist (see
appendix)
A total of at least 90 completed units (including at least 30 doctoral courses)
500 hours of direct client contact in systems/relational therapy (at least 250
with couples and families)
passing the masters level comprehensive exam

The Interim Masters degree will typically be awarded during the third year of study.
You must file Form C more than two quarters prior to earning the Masters degree. See
the Doctoral Administrative Assistant for assistance.

37
APPENDIX B

Family Counseling Certificate Requirements
To earn the certificate, students must successfully complete 27 quarter units, including 19 core
units and 8 units of electives. It is possible to complete the certificate in two academic quarters.
No clinical experience is required, but students may use their electives to become exposed to
clinical modalities. This certificate does not assist the student in applying for or obtaining a
clinical license.
Learning outcomes
1. Students will demonstrate awareness of contextual issues in the field of marital and
family therapy,
2. Students will gain an understanding of how to apply their knowledge of contextual issues
to their field of study/work.
Required Courses Units
MFAM 528 Culture and Socio-Economic Status in Therapy 3 units
MFAM 515 Crisis Intervention and Client Centered Advocacy (3 ) 3 units
MFAM 535 Case Presentation and Professional Studies (4) 4 units
MFAM 551 Family Therapy: Foundational Theories and Practice 3 units
MFAM 553 Family Systems Theory 3 units
Total 16 units

Electives (8 units)
As approved by Advisor
MFAM____ Select a Marital and Family Therapy Course 8 units
Total 8 units

Religion
RELR 5___ (3 units)

RELR 564
Graduate-level Relational
Religon, Marriage and the Family

Choose one course
3 units
Total 3 units
Overall Total 27 units

38
APPENDIX C
Interim Doctorate (Ph.D./D.M.F.T.) Program of Study and Advising
Students are required to meet with their advisors each quarter. Students must pick up an
advising form from the Doctoral office prior to meeting with their advisor.

Overviews outlining a suggested course sequencing of the doctoral programs are included
in the appendix. Checklists of required courses are also included in the appendix.

Students who wish to finish more quickly, extend their programs, or study part-time must
consult with their advisor to develop an appropriate plan.

Most courses are offered once per year. Some are offered on alternate years only.
MFTH designates doctoral courses.
FMST may be masters or doctoral level

The following courses are to be taken in sequence:
1) MFTH 606 Research in MFT (for PhD in MFT and DMFT)
2) MFTH/FMST 604 Advanced Qualitative Methods
3) MFTH/FMST 605 Advanced Quantitative Methods
4) MFTH/FMST 668 Qualitative Research Practicum
5) MFTH/FMST 608 Analysis and Presentation of Research

Students who do not take these courses each quarter as offered will delay their
graduation.

Concentrations:
All doctoral students must complete a 12 unit concentration in an area of study. Students
may choose any concentration based on approval of the students advisor and the faculty.
The concentration must focus around a specific area for study.

Students should submit a concentration approval form by the end of the first year of study
for review by the doctoral committee.

Pre-approved 12-units course sequences are available in:
Family Studies (for MFT students)
Families, Systems, and Health
School Consultation
Systems Consultation and Professional Relations

Students are strongly encouraged to complete one of the above concentrations. However,
in consultation with their program advisor, students may propose a concentration that
meets their specialized interests. Such concentrations must be approved by the CFS
doctoral committee.

Supervision Courses:
PhD in MFT and DMFT students must complete the doctoral practicum and at least 500
39
hours of clinical contact before taking the supervision courses: MFTH 501 and 502.
These courses require an advanced knowledge and skill in MFT. Readiness depends on
your level of experience. Unless already a licensed MFT most students take it as late in
their programs as possible

Clinical Courses (PhD in MFT and DMFT):
Clinical 1, 2, & 3 do not need to be taken sequentially. Clinical 4 should be your last
clinical course.

Electives:
Electives should be selected to meet specific student interests. A number of doctoral
electives are offered regularly. Others may be offered when there is significant demand.
MFAM courses and courses from other departments may be used as electives.

Certificates:
The department offers a variety of certificates. Students wishing to complete one of these
certificates must make a separate application for admittance to the certificate program
and should contact the Director of the certificate program. Available certificates and their
Directors are:
Child Life Specialist Michelle Minyard-Widmann
Clinical MediationIan Chand
Drug and Alcohol CounselingRandall Walker
Family Counseling Mary Moline
Family Life EducationCurtis Fox
School CounselingCheryl Simpson
Interim masters degree:
Students who are completing an interim masters degree in tandem with the doctoral
degree in Marital and Family Therapy must submit the appropriate graduation forms for
the masters degree according to University deadlines. Requirements include:
The 60 units of masters courses outlined on the interim checklist (see
appendix)
A total of at least 90 completed units (including at least 30 doctoral courses)
500 hours of direct client contact in systems/relational therapy (at least 250
with couples and families)
passing the masters level comprehensive exam

The Interim Masters degree will typically be awarded during the third year of study.
You must file Form C more than two quarters prior to earning the Masters degree. See
the Doctoral Administrative Assistant for assistance.
Research and Professional Presentations:
In addition to the required course work, students are expected to engage in research
and/or program development throughout their programs of study. Professional
presentations at conferences and the development of journal articles are an important
aspect of doctoral study. Students are encouraged to collaborate with faculty and other
students in these activities. All student research MUST be supervised by a faculty
member and approved by the University IRB. Submissions for presentations should also
be approved by a faculty mentor before submission.
40
APPENDIX D
18 unit Evaluation: Student Advancement Evaluation

LOMA LINDA UNIVERSITY
Marital and Family Therapy
STUDENT ADVANCEMENT EVALUATION
RATIONALE:
During the first terms of the MFT program, while students are completing a minimum of 18 units,
the MFT program evaluates students for academic and clinical readiness, professional, personal
development and writing skill. While we understand that these evaluations are conducted very
early in the program and cannot be a perfect assessment, it is important to consider the personal,
professional, academic, clinical readiness and writing aptitude of students as early as possible.

Please consider each student in your class and respond as best you can to the items below. One
form must be completed for each student. Using your class enrollment sheet, please enter the
student=s name and student number. Circle the number that best describes your student. If you
circle a 1 or 2 please
Make a comment regarding your evaluation. Thank you for your time and consideration in this
important process.

Student Name: ______________________________________ Date: ________________

Student Number: ____________________________________

Please circle the number that best suits that student. The scale is from 1 to 5. 1 = unacceptable,
3=acceptable and 5 is Proficient. Academic refers to grades and the ability to complete graduate
work
and demonstrate a potential to strive for excellence. Personal refers to their personhood
That they demonstrate they are compassionate, stable, humble, have self-control and a good
attitude.
Professional refers to integrity, striving for excellent and a commitment to the field of Marriage
and
Family Therapy. Clinical refers to a student that has the potential to do proficient work as a
clinician,
strives for justice, and is compassionate toward others. Writing is in reference to their ability to
write well
and is the category that will decide if they are to attend the SST writing course.

Category Unacceptable Acceptable Proficient Comment
Academic 1 2 3 4 5
Personal 1 2 3 4 5
Professional 1 2 3 4 5
Clinical 1 2 3 4 5
Writing: 1 2 3 4 5

Check those that apply: ___ Case Instructor_______ Academic Instructor___ Graduate Assistant
41

CLINICAL TRAINING CONTRACT
(ForMS. inMFTStudents)
This is to state that I, , have carefully read all the clinical
training requirements stated below and clearly understandthe program clinical expectations of me. I do hereby agree to
follow these requirements faithfully. I am aware that failure to do so may influence my grades and/or standing in the
program.
PRIOR TO SEEItJG CLIENTS REQUIREMENTS:
. Background check (see Clinical Training Handbook)
. Completion of 19 units of coursework (see Clinical Training Handbook)
CLINICAL HOURS:
. 500 client contact hours (only face to face therapist client & therapeutic meetings)
. 250 hours of the 500 hours with couples and families
SUPERVISION HOURS:
. 100 individual and group supervision hours
. 1hour of individual supervision for every week in which clients are seen.
. 50 of the 100hours should consist of live, audio or video supervision.
. 1:5 ratio must be maintained between supervision and client contact hours.
CLINICAL COURSES:
. 6 quarters of Professional Clinical Training: MFAM 734
. A trainee who is seeing clients must be registered for MFAM 734 at all times.
. 6 quarters of Case Presentation: MFAM 535, 536, 537, and MFAM 635, 636, 637
CLINICAL EXAMINATIONS:
. Exam for Clinical Placement Preparedness in conjunction with MFAM 535
. Final oral examination at the end of the first year
. Final oral examination at the end of the program
CLINICAL REPORTING:
. Trainee hours log sheet must be submitted by the Friday prior to finals weekof each quarter for each placement
site.
. Quarterly trainee evaluation forms must be submittedby the Friday prior to finals weekof eachquarter for each
placement site.
. Quarterly supervisor evaluation formmust be submitted by the Friday prior to finals week of each quarter for
each individual supervisor.
. Clinical paperwork between LLU and placement site and paperwork associated with case management at the
placement site must be kept up-to-date at all times.
Universitv Dolicvstates: That if an '1p. (in progress) grade in MFAM 734 (Professional Clinical Training) is not
cleared by the end of 5th quarter, student will receive a 'V. grade, has to re-registerfor Clinical Training, and loses
the clinical hours.
CLINICAL LAWS AND ETHICS:
. Abide by the AAMFT Code of Ethics, 2001.
. Abide by the laws and regulations issued by BBS, 2010.
. Abide by the CAMFT Code of Ethics, 2009.
Trainee
Director ofM.S./MFT Clinical Training
Date
9/14/2010
- --
42
APPENDIX F

Department of Counseling and Family Sciences
Clinical Training

CHECKLIST AND TIMELINE FOR REQUIRED CLINICAL DOCUMENTS

MS/MFT students who are registered for MFAM 731 (Prof. Clinical Training) are
required to turn in the following forms:

1. Before you can start collecting hours for your practicum:
(Forms are to be filled out, signed, and turned in when starting your placement
site.)

LLU Forms: State Forms:
! Clinical Training Contract (original) ! BBS Responsibility
Statement for Supervisor
! Four-Way Internship Agreement (original)

! Supervisor Qualification Statement (original)

! Supervisor CV/Resume (original)

! Supervisor State License/s (copy)

! Supervisor Information Sheet (original)

2. Forms due the Friday before Finals week each quarter (see page 2 for the
schedule of turning in forms):

! Trainee Hour Log (green) Sheet (original) ! BBS Weekly Summary of
Hours of Experience (copy)
! Quarterly CLINICAL COMPETENCY Trainee
Evaluation (original)
(to be filled out by supervisor)

! Quarterly Supervisor Evaluation (original)
(to be filled out by student/trainee)

3. Other Forms

! Multiple Clinical Placement Form (copy) ! BBS Marriage and Family
Therapist Experience
Verification (copy)
43

APPENDIX G

CLINCIAL HOUR REQUIREMENTS
FOR
MASTERS IN MARITAL AND FAMILY THERAPY

Family and Couples and Family and
Couple Group Hours
125 double counted = 250 hours total
Individual, Individual Group, and Family
and Couple not double counted
150 hours
Alternative Hours: documentation, client
centered advocacy (case management) and
Personal Therapy

100 hours maximum
Documentation: maximum 75 hrs.
Personal Therapy: Maximum 9 hours
(times 2=27 hours
Student can count all 500 hours as clinical
hours
SUPERVISION HOURS: Will be a
minimum of 100 hours with a minimum
of 50 live supervision hours.

Total clinical hours required: 500 hours
Student must collect all 500 hours in
Order to march in graduation or
graduate
Total supervision hours: 100
TOTAL: 600 Hours

44

!"#$%"& "() *"+$&, -./#"0, 1#23#"+
42+" 4$()" 5($6/#7$%,

895: :;<19=<>?>4>->;< *9: <51;:@><>9=

1. Your supervisor should:
! be enthusiastic about working with you.
! have experience with or be supportive oI the Iamily systems approach.
! be someone you Ieel comIortable with.

2. All supervisors are aware that they must provide one hour per week oI Iace-to-Iace one-
on-one supervision with trainees:
! Provide supervisor with a copy oI a signed supervision agreement Iorm
! Find out who will provide supervision or help in urgent situations iI your
supervisor is not available.
! Do not hesitate to prompt your supervisor to provide the agreed upon supervision
should scheduling become lax or your needs are not met.

3. Options Ior supervision are:
! use oI a one-way mirror.
! co-therapy with supervisor.
! audio or videotape review oI sessions.
! case reports.

4. It is ethically inappropriate Ior a trainee to receive therapy Irom a supervisor. It is
appropriate to:
! become aware oI personal issues which impact delivery oI therapy.
! Iocus on proIessional competence development.
! obtain a reIerral Ior personal therapy elsewhere.

5. Items to cover during weekly supervision:
! all documentation/correspondence should be co-signed by the supervisor.
! discussion oI urgent client issues such as suicidal ideation, homicidal intent,
ongoing substance abuse, litigation involvement or illegal practices oI the client,
etc.
! outline treatment goals Ior each client.
! explore integration oI theory and practice in your therapy sessions.

!"#"#$"! &'(& )*+, -+./,01-*,! !! !- 213/4-/ 1- 14 5/*.(,6) -'*+26 )*+ 7(12 &* 8//. '19:'/,
147*,9/6 *7 321/4& *, &'/,(.1-&;321/4& 1--+/-<

**It is your responsibility to contact the Director oI Clinical Training iI there are diIIiculties with
supervision that cannot be worked out between you and your supervisor.

10/2/2008
45
APPENDIX H.

LIST OF APPROVED CLINICAL PLACEMENT SITES
Marital and Family Therapy Program
2012-2013

ASIAN AMERICAN CHRISTIAN COUNSELING (www.AACCS.Org)
Address: 2550 W. Main Street, #202
Alhambra, CA 91801
Phone #: (626) 457-2900 ext. 372
Fax #: (626) 457-2904
Contact & supervisor: June Sano, LMFT, Clinical Director
Services:Individual, couple, and family
counseling; premarital counseling; marriage
enrichment programs, parent education; general
counseling; psychotherapy.
Trainees/Interns: accepting applications
Stipend: none

BILINGUAL FAMILY COUNSELING SERVICE
Address: 317 West F Street
Ontario, CA 91762
Phone #: (909) 986-7111
Fax #: (909) 986-0941
Contact: Olivia Sevilla, LCSW, Agency Director
Services: Family counseling, child abuse treatment program,
Prevention/education program, school-based
counseling
Trainees/Interns: Apply early in Winter & Summer for acceptance in
the Fall. Bilingual (Spanish) preferred
Stipend: $200.00/mo.

CARITAS COUNSELING OF CATHOLIC CHARITIES
Address: 1441 N. D Street
San Bernardino, CA 92405
Phone #: (909) 763-4970
Fax #: (909) 763-4977
Contact: Lena Lopez-Bradley, Ph.D.,
Clinical Services Coordinator
46
(909) 763-4970
Services: Agency serves a wide-ranged population and a
wide-range of presenting problems, including cases
of depression, child abuse, family issues, marital
anxiety. Has 14 different clinical placement sites in
both San Bernardino and Riverside County.
Stipend: depends on qualifications, hourly client contact pay

CHINO COMMUNITY SERVICES
Address: 13271 Central Avenue
Chino, CA 91710
Phone #: (909) 591-9822
Fax #: (909) 628-4093
Contact: Dan McGetrick, LMFT, Clinical Specialist
Wed & Thurs. 7 a.m.-4 p.m.
Services: Adolescent, elementary school, and senior citizen
programs. Child abuse education, alcohol treatment
and education. Individual, child, family, multiple
family & group therapy.
Stipend: none to start, depends on qualifications

COMMUNITY ACCESS NETWORK
Address: 2791 Green River Road
Corona, CA 92882
Phone #: (951) 279-3222
Fax #: (951) 279-5222
Contact: Rafik Philobos, MSW, Executive Director
Services: Therapeutic foster family agency;
outpatient mental health program provides
individual/family therapy.
Supervisor: Gary Bell, Ed.D., LMFT
Stipend: depends on qualifications

HOPE HOUSE
Address: 10777 Civic Center Drive. Rancho Cucamonga, CA
91730
Email: www.HopeCounselingTherapist.com
47
Phone: (909) 948-3536 (909) 561-5466
Fax : (909) 989-0456
Director: Jamie Lynn Juarez, LMFT (President
Contact : Matthew Janse
Services: Improving Relationships affected by:
Anxiety, ADHD, Autism, OCD, PTSD,
Bipolar, Migraines, Depressive Disorders, in
both Children and Adults
Trainee Coordinator: Matthew Janse.
Email: matthewhopeinc@gmail.com
INLAND BEHAVIORAL AND HEALTH SERVICES, INC.
Address: 1963 N. E Street
Phone #: (909) 881-6146
Fax: (909) 881-0111
Contact & Supervisor Frank Andrews, Ph.D., LMFT
Services: Individual therapy sessions, group
education/counseling, and psychological testing are
offered to children, teens, adults, couples and
families. Assists clients to improve their lifestyle,
health and well-being and to help them to realize
their personal goals.
Stipend none

INLAND TEMPORARY HOMES
Address: 26300 Mission Street
Redlands, CA 92373
Maling Address: P.O. Box 239
Loma Linda, CA 92354
Phone #: (909) 771-9696
Contact & Supervisor: Ebrahim Sadeghi, PsyD
Services: Provides individual, couple, and family counseling;
variety of cases such as depression, anxiety, drug
and alcohol issues.
Stipend: none

INLAND VALLEY DRUG AND ALCOHOL RECOVERY SERVICES
Address: 934 N. Mountain Ave.
Upland, CA 91786
Phone #: (909) 949-4667
Contact & Supervisor: Roberta Reid, LMFT
48
Services: Outpatient substance abuse counseling, drinking
driver programs, domestic violence batterers
treatment programs, anger management, parenting
programs, drug testing, AIDS awareness.
Stipend: none
LDS FAMILY SERVICES
Address: 17350 Mount Hermann St., #A
Fountain Valley, CA 92708
Phone #: (714) 444-3463
Fax #:
Contact & Supervisor: Todd Huisken, LMFT
Services: Individual, couple, family & group counseling,
marital & relationship counseling; work with adult
victims of abuse, child welfare agency.
Stipend: None

LLU BEHAVIORAL HEALTH INSTITUTE COUNSELING AND
FAMILY SCIENCES CLINIC
Address: 1686 Barton Road
Redlands, CA 92373
Phone #: (909) 558-9552
Fax #: (909)
Contact: Randall Walker, M.S., LMFT, Director
Robin Lanham, Clinic Coordinator
Services: Individual, couple, family, and group counseling;
Parenting; anger management.
Trainees/Interns: accepting applications in the Fall & Spring
Stipend: $8.00 - $20.00 per client-contact hour, depends

LLU BEHAVIORAL MEDICINE CENTER
Address: 1710 Barton Road
Redlands, CA 92373
Phone #: (909) 558-9200
Fax #: (909) 558-9262
Contact: Jill Pollock, Administrator
(909) 558-9204
Supervisor: Jennifer Weniger, PhD, LMFT
Lead Clinical Therapist II
Services: Comprehensive psychiatric, nursing and
psychosocial assessments; individual, family, and
49
group therapy sessions;
Stipend: None

LLU SACHS NORTON CLINIC
Address: 1455 E. Third Street
Phone #: (909) 382-7130
Fax #: (909) 382-7166
Contact: Donna Smith-Burgess, LMFT
Director of Behavioral Health
Supervisor: Jack Johnson, LMFT
Services: Individual, couple, and family counseling;
psychological testing and psychiatric services;
Provides services under OADP (alcohol and drug
treatment). Various contracts with San Bernardino
and Riverside counties.
Stipend: Through work study or as funds are available.
MFI RECOVERY CENTER
Address: 5870 Arlington
Riverside, CA 92504
Phone #: (951) 683-6596
Fax #: (951) 341-5316
Contact: Craig Lambdin, LMFT, Executive Director
CraigLambdin@mfirecovery.com
Services: Provides a spectrum of residential, day-treatment
and outpatient drug and alcohol services with
specialized services for women and their children.
Stipend: $10.00/hr., after 3 months - $12.00/hr.

NOW I SEE A PERSON INSTITUTE: MUST TALK TO MARY
MOLINE BEFORE CHOOSEING THIS SITE.
Address: 299 e. Foothill Blvd.
San Dimas, CA 91773
Phone #: (626) 487-9305
Fax #:
Contact & Supervisor: Susan Swim, Ph.D., Executive Director
Services: Problems can range from symptoms of depression,
anxiety, grief, family and couple conflict, phase of
life issues, as well as organizational issues;
individual, couple and group therapy; schools, at
50
risk youth, adults.
Stipend: $10.00/hr.

POMONA UNIFIED SCHOOL DISTRICT
Address: 800 S. Garey Ave. .
Pomona, CA 91767
Phone #: (909) 397-4711
Fax #:
Contact & Supervisor: Bridget Earl, Clinical Supervisor
Services: Counseling students n individual/group settings
during school days.
Stipend:

RIVERSIDE COUNTY DEPARTMENT OF MENTAL HEALTH
Address: 3801 University Ave., Ste. 400
Riverside, CA
Phone #: (951) 955-7198
Contact: Sheree Summers, LMFT
University and School Liaison Workforce Education and
Training
David Schoelen, MHSA Education and Training Coordinator,
at (951) 358-7729 Coordinator for Student Placement
email address: JLehman@co.riverside.ca.us
Supervisors: Department has several supervisors with
professional clinical licenses including MFTs,
MSWs & Ph.D.s in the Riverside County.
Services: Department has several clinics that provide variety
of services.
Stipend: $9.01/hr. actual work hours

SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL
HEALTH
Address: 268 West Hospitality Lane Suite 400
Phone #: (909) 382-3037
Fax #: (909) 382-3105
Contact: Susan Davis, M.S., LMFT
MFT Intern Program Supervisor
51
Email: sdavis@dbh.sbcounty.gov
Supervisors: Department has several supervisors with
professional clinical licenses including MFTs,
MSWs and Ph.D.s in the San Bernardino County.
Services: Department has several clinics that provides
outpatient mental health services to mentally ill
adults, children, adolescents. Services may include
assessment, crisis intervention, individual and group
counseling, medication, case management referral.
Trainees & Interns: accepting applications
Stipend: $15.25/hr. work for trainees

SAN BERNARDINO COUNTY SUPERINTENDENT OF SCHOOLS
Address: 1060 East Cooley Drive
Colton, CA 92324-3924
www.sbcss.k12.ca.us
Phone #: (909) 777-0912
Fax #: (909) 777-4781
Contact: K. Jane Russell, LMFT
Manager of Clinical Service
Student Service Division
jane_russell@sbcss.k12.ca.us
Services: Provides counseling to students who had been
expelled, and those who experience psychological,
behavioral and/or learning difficulties.
Stipend: Trainees: $10.00/hr.; Interns: $15.00/hr.

52
APPENDIX J
FOUR-WAY MASTERS INTERNSHIP AGREEMENT
(Between LLU, internship site, site supervisor, and student)

Student: _______________________________________________Phone:
______
______
_____

Site:
________________________________________________________________________
_

Address: _________________________________________________Phone:
______
______
__

Site Supervisor: ___________________________________________Phone:
______
______
___

Time Frame: The terms of this agreement extend from _________________
to______________
(The duration of this agreement will be up to two years unless terminated by either party within 30 days written
notice.)

Purpose: Signatures on this form indicate agreement between LLU Department of Counseling
and Family Sciences, Marital and Family Therapy program, the internship site named above, the
site supervisor named above, and the student named above to cooperate in a clinical internship for
the student. Signatures also indicate that all parties have read and are agreed to the provisions
detailed here.

Termination: This agreement may be terminated by the site or by LLU for any breach of its
contents which is left uncorrected for fifteen continuous days, following notification of the
breach. The agreement may be terminated by the site or by LLU without cause at the end of the
designated time frame or by either party giving the other at least thirty days written notice of
intent to terminate.

Staff Status: A student or LLU supervisor will at no time be considered or represented as an
53
employee or agent of the site. While the University supervisors are guests of the site and the
student carries out staff functions, the University maintains ultimate authority over student
activities performed under the purview of the site supervisor. Site staff members will at no time
be considered or represented as employees or agents of the University. While site supervisors
cooperate with the University to further the education of student-interns, the site supervises
students in activities approved by the Internship Coordinator. With the prior approval of the
Director of Clinical Training and appropriate documentation from site supervisors, a student may
be able to count clinical hours worked for his or her employer toward the educational requirement
of 1000 hours.

Decision power. Neither the site nor the University grants or delegates any of its power of
decision-making to the other. Such power may be statutory, administrative, policy, practice,
implied, or otherwise.

Internship Modifications. Either the site or the University may request modifications to the
internship for the purpose of enhancing its educational quality. Both parties agree to give
reasonable consideration to any such requests. Any modifications will be agreed upon in writing,
signed by the Internship Coordinator for the University and an official representative of the site
and attached to this agreement. Modifications that vary from this internship agreement as written
must be signed by the Internship Coordinator and initialed by the University Vice-President for
Business and Finance (University office responsible for legal matters) or designate.

Student Discipline. The site may require a student to leave site practices or premises if the
student fails to abide by site policies and practices. A conference between an authorized
representative(s) of the site and the Internship Coordinator will be held at the soonest time of
mutual convenience. The conference participants will reach a mutual written agreement to
terminate the students internship at the site or to allow continued internship participation. The
student will be informed of and must agree to conditions for continuation

University Insurance and Indemnification: The university shall at its sole cost and expense,
provide coverage for its activities in connection with this Agreement by maintaining in full force
and effect programs of insurance and/or self-insurance as follows:
1. Professional liability coverage with limits of one million dollars
($1,000,000) per occurrence and an aggregate of three million
dollars ($3,000,000).
2. General liability coverage with a limit of one million dollars
dollars ($3,000,000).
3. Workers Compensation coverage covering Universitys full
liability as required under state law.
4. Such other insurance in such amounts which from time to time
may be reasonably required by the mutual consent of the parties,
against other insurable risks relating to this Agreement.

It should be expressly understood, however, that the coverage required under this
paragraph shall not in any way limit the liability of University.

The University, upon the execution of this Agreement, shall furnish site with certificates
evidencing compliance with these insurance requirements. Certificates shall further
54
provide for thirty (30) days advance written notice to site of any cancellation of the above
coverage.

The University hereby agrees to defend, indemnify, and save harmless the site from any
liability or damages the site may suffer as a result of claims, demands, costs, or
judgments against it arising out of the operation of the program covered by this
Agreement resulting from the negligence of the University, its employees, faculty,
students, or authorized agents. The site agrees to give the University notice in writing
within thirty (30) days of any claim made against it on the obligations covered hereby.

Site Insurance and Indemnification: The site shall provide at its sole cost and expense,
coverage for its activities in connection with this Agreement by maintaining in full force
and effect programs of insurance and/or self-insurance as follows:
1. Professional liability coverage with limits of one million dollars
dollars ($3,000,000).
2. General liability coverage with a limit of one million dollars
dollars ($3,000,000).
3. Workers Compensation coverage covering sites full liability as
required under state law.
4. Such other insurance in such amounts which from time to time
may be reasonably required by the mutual consent of the parties,
against other insurable risks relating to this Agreement.

It should be expressly understood, however, that the coverage required under this
paragraph shall not in any way limit the liability of site.

The site, upon the execution of this agreement, shall furnish University with certificates
evidencing compliance with these insurance requirements. Certificates shall further
provide for thirty (30) days advance written notice to University of any cancellation of
the above coverage.

The site hereby agrees to defend, indemnify, and save harmless the University from any
liability or damage the University may suffer as a result of claims, demands, costs, or
judgments against it arising out of the operation of the program covered by this
Agreement resulting from the negligence of the site, its employees, or authorized agents.
The University agrees to give the site notice in writing within thirty (30) days of any
claim made against it on the obligations covered hereby.

Agreement Administration. The official representatives who administer this agreement
will be the Internship Coordinator for the University and an official representative of the
internship site.

Determination of Participation. The site and the Internship Coordinator will mutually
determine (1) the number of students who will undertake an internship at the site and (2)
55
the length and duration of time each student will participate under internship auspices.

Agreement Scope. This written document constitutes the entire agreement between the
site and the University. It supersedes any prior or contemporary agreements,
representations, or warranties.

The LLU INTERNSHIP COORDINATOR understands and agrees to:
1. coordinate all internship activities, including student placement at internship sites.
2. identify, evaluate, and review appropriate internship sites and supervisors.
3. inform students of internship requirements.
4. review student evaluations of sites and supervisors.
5. maintain files on internship sites and internship supervisors.
6. act as a liaison between students, supervisors, and faculty.
7. coordinate with LLU insurance representative to maintain student malpractice
insurance.
8. supports video taping of clients with client consent

The INTERNSHIP SITE understands and agrees to provide:
1. appropriate facilities and clients for the student.
2. clinical experiences that total at least 500 clock hours of client contact.
3. clinical experiences that total at least 250 clock hours of client contact with
couples and families.
4. appropriate supervision.
5. as culturally diverse a clientele as possible is such respects as culture, race,
religion, socioeconomic status, ethnicity, and family configuration.
6. client assessment opportunities.
7. site orientation to students, including relevant paperwork.
8. site policies and practices information to the LLU Internship Coordinator.
9. one or more supervisors to attend MFT meetings for site supervisors.

The SITE SUPERVISOR understands and agrees to:
1. guide the student-interns on-site clinical activities.
2. meet with each assigned student at least one hour per week for individual
supervision for each week the student has direct contact with clients.
3. evaluate the students clinical performances over all clinical cases and give them
appropriate feedback.
4. provide feedback about students and internship site to the LLU Internship
Coordinator.
5. interact as appropriate with MFT supervisors.
6. participate in MFT meetings for supervisors.
7. evaluate the intern in writing using the Quarterly Student Evaluation form.

The STUDENT understands and agrees to:
1. conduct therapy in ways that are as therapeutically adept, ethically appropriate,
56
and legally appropriate as possible for a student.
2. abide by MFT and site policies and practices. Failure to comply with urgent
directives (e.g., how to work with a potentially suicidal client) may be a basis for
suspension from the internship and/or MFT program.
3. maintain records of all internship activities
4. file relevant forms with the Internship Coordinator, including routine forms (e.g.
quarterly logs) and special or idiosyncratic forms (e.g. request for brief leave-of-
absence).
5. .provide clinical services according to site schedules, not LLU academic term
schedules.
6. complete at least 500 clock hours of direct client contact
7. complete at least 250 clock hours of direct client contact (500 hours) with couples
and families
8. complete at least 100 hours of individual and group supervision , 50 hours of the
100 hours should consist of live, audio or video supervision.
9. maintain openness to feedback from supervisors and peers.
10. evaluate the site supervisor in writing using the Quarterly Supervisor Rating Scale

____________________________________________ ___________________________
LLU Director of Clinical Training Date

Internship Site Representative Date

Site Supervisor Date

________________________________________________________________________
Student Date

57
APPENDIX K
SUPERVISOR QUALIFICATION STATEMENT
Marriage and Family Therapy Programs

This is to certify that I, __________________________________, meet the following
criteria to be a supervisor:
(Please check all that apply to you and attach copies of certificates and current licenses):

1. I am an AAMFT-Approved Supervisor as of __________________________
I am an AAMFT-Approved Supervisor in Training as of _________________
I am a CAMFT-Approved Supervisor as of ___________________________
I am a BBS-Approved Supervisor as of ______________________________
I am a BBS-Approved Supervisor in Training as of _____________________
2. I have been licensed for at least two years in one of the following professions:
MFT LCSW Psychologist Psychiatrist
License No. ________________ Date of initial licensure ________________
Date of Board Certification (psychiatrist) _______________________________
3. I have completed six hours of continuing education in Supervision
Date of completion: __________________________________
4. I am willing to meet at least one hour per week with trainees for supervision
5. I am knowledgeable and supportive of the Marriage and Family Therapy
profession
6. I have taken a course in MFT supervision
Dates taken: ________________________________________
7. I have taken a course in marital and family therapy
Dates taken: ________________________________________
8. I will attend the supervisory inservices offered prior to the Placement Fair.
9. I will attend the AAMFT Approved Supervisor Training or its equivalent.
______________________________________________
Signature of Supervisor

Name of Supervisor _____________________________________________
Address _____________________________________________
_____________________________________________
Telephone _____________________________________________
58
APPENDIX L

Clinical Supervisors Form to Evaluate
Student Trainees Progress in Clinical Site

Clinical Supervisors evaluate students at the end of each quarter. The following is the
new supervisors form starting Winter quarter, 2012.

1>A?67A J7<L7>= 89 1>78?>M >9C (>=8ME 3N67>5E
)O>M@>?8<9 <; /M898:>M /<=56?69:86A 89 .EA?6=AP&6M>?8<9>M 3N67>5E

Directions: Each of the competencies below is described on a developmental continuum
with 1 representing basic proficiency expected of incoming masters students and 5 as
expert, able to show other professionals how to develop this skill.
Please circle the number that most closely approximates the students level of current
development,
!
Basic
proficiency
expected of
incoming
masters
students
"
Expert: shows
other
professionals
how
to develop this
skill

Term ___________summer/fall/winter/spring ____________________ year

Student ________________________________________________________________
Print Name Date

Student _________________________________________________________________
Signature Date

Supervisor
_______________________________________________________________
Print Name Date

Signature
________________________________________________________________
Signature Date
59
CASE CONCEPTUALIZATION
Competency 1: Use of Systems/Relational Framework
1
ls able Lo
concepLuallze a case
from a model
2
ls able Lo
concepLuallze a case
from a sysLemlc
perspecLlve

3
ls able Lo lnLegraLe
mulLlple cllenL
perspecLlves Lo
creaLe sysLemlc
hypoLheses
4
8egularly lnLegraLes
mulLlple cllenL
perspecLlves Lo
creaLe sysLemlc
hypoLheses
3
LvaluaLes mulLlple
cllenL perspecLlves
Lhrough
sysLems/relaLlonal
Lheorles and research

Competency 2: Assessment
1
Can recognlze uSM
caLegorles and
relevanL sympLoms
wlLhouL clear
undersLandlng of
Lhe sysLemlc conLexL
2
ls able Lo ldenLlfy
key relaLlonal
dynamlcs Lhrough
use of such
lnformal and
formal sysLemlc
assessmenLs as
genograms and
famlly maps
3
ls able Lo formulaLe
several sysLemlc
hypoLheses LhaL
connecL Lo goals,
dlagnoses, and
lnLervenLlons
4
ls able Lo ldenLlfy uSM-
lv-18 and
relaLlonal/sysLemlc
dlagnoses for cllenL's
presenLlng lssue(s)
3
lormulaLes sysLemlc
hypoLheses (lndlvldual
and famlly
developmenL/llfe
cycle lssues,
lnLeracLlon paLLerns,
soclal conLexL, eLc.)
and dlfferenLlal
dlagnosls (uSM-lv-18)
by conducLlng an
approprlaLe cllnlcal
lnLervlew

Competency 3: Integrating Research into Practice
1
ls able Lo arLlculaLe
how Lhey can [udge
cllenL progress and
Lhe ouLcome of
Lherapy
2
lnLegraLes research
relaLed Lo Lhe
effecLlveness of
famlly Lherapy lnLo
cllnlcal pracLlce

3
undersLands Lhe
slgnlflcance of
sLaylng abreasL of
currenL research ln
marrlage and famlly
Lherapy and
lnLegraLlng lL lnLo
cllnlcal pracLlce
4
undersLands Lhe
relevance of research
regardlng
effecLlveness ln Lhelr
pracLlce of famlly
Lherapy
3
ClLes research
regardlng
effecLlveness ln
famlly Lherapy and
beglns Lo apply Lo
cllnlcal pracLlce

Competency 4: Maintains a Clear Overall Treatment Plan
1
Can obLaln
measurable goals ln
collaboraLlon wlLh
cllenL(s)
2
Coals are relaLed Lo
dlagnoses,
hypoLheses, and
lnLervenLlons
3
LlsLens Lo lndlvldual
lssues and works
wlLh cllenLs Lo
develop relevanL
sysLemlc LreaLmenL
goals.
4
Lnvlslons how
Lherapy may
affecL/be affecLed
by larger relaLlonal
sysLems and
conslders who besL
Lo lnvolve and
develops a plan Lo
aLLaln goals
3
Manages
progresslon of
Lherapy Loward
LreaLmenL goals
Comments:

60
IN SESSION SKILLS
Competency 5: Socio-Cultural Attunement
1
Identifies own
cultural biases
2
Is able to conduct an
assessment of
cultural factors that
may affect process
between therapist
and client
3
Is able to conduct an
assessment of
cultural factors that
may affect treatment
and outcome
4
Sessions show that
clients belong to a
particular cultural
context but dont
display how they are
organized by culture
or their relationship
to it.

5
Sessions expand
awareness of cultural
contexts to include
intersections with
gender, class, race,
religion, and other
significant personal
contexts such as
prison experience and
work environment

Competency 6: Therapeutic Alliance
1
Seeks Lo undersLand
and empaLhlze wlLh
each person's
perspecLlve.
2
!olns and malnLalns
connecLlon wlLh all
members ln Lhe
relaLlonshlp sysLem,
lncludlng Lhose who
may noL be presenL.
3
8ecognlzes socleLal
lnfluences on
LherapeuLlc alllance
and seeks Lo engage
sllenced or
overlooked volces
and perspecLlves.
4
names dlfflculL
lssues such as power
lmbalances and
confllcL ln ways LhaL
all famlly members
feel valldaLed and
malnLalns a
collaboraLlve
worklng alllance wlLh
cllenLs.
3
Sklllfully manages
relaLlonshlp wlLh
famlly members Lo
counLeracL socleLal
power lmbalances
and faclllLaLe Lhelr
engagemenL wlLh
each oLher.

Competency 7: Management of Clinical Sessions
1
ls able Lo sLarL on
Llme, end on Llme,
and documenL
lnLeracLlons
approprlaLely
2
lollows baslc cllnlcal
and professlonal
procedures (explaln
lnformed consenL
and cllnlc pollcles,
requlred lnLake,
noLlflcaLlon of
Lralnee sLaLus, eLc.)
3
Crganlzes Lhe flow of
Lhe sesslon ln order
Lo creaLe a safe
envlronmenL so
mulLlple volces are
heard
4
laclllLaLes
engagemenL
beLween cllenLs ln
face of dlfflculL
lssues such as
confllcL or
dlsLanclng.
3
ALLends Lo lssues of
physlcal and
emoLlonal safely
and avolds causlng
cllenLs addlLlonal
dlsLress

Competency 8: Use of systems/relational intervention skills
1
ls able Lo descrlbe
Lechnlques from one
sysLemlc/relaLlonal
Lherapy approach
2
uescrlbes Lechnlques
from a varleLy of
sysLemlc/relaLlonal
approaches
3
uses a varleLy of
cllnlcal
Lechnlques, buL
wlLhouL a clear
overall focus or
sysLemlc/
relaLlonal
raLlonale
4
uses a varleLy of
lnLervenLlon skllls
Lo respond ln Lhe
momenL, buL
someLlmes lacks a
clearly arLlculaLed
raLlonale for
speclflc cllnlcal
declslons
3
uses a varleLy of skllls
Lo achleve speclflc
sysLemlc/relaLlonal
goals
Comments:

61
RECOVERY ORIENTATION
Competency 9: Client Advocacy
1
ldenLlfles cllenL llfe
lssues LhaL warranL
case managemenL,
cllenL advocacy, or
8ecovery Model
appllcaLlon.
2
Can ldenLlfy
relevanL menLal
healLh and
communlLy
resources
3
ConnecLs cllenL(s) Lo
relevanL communlLy
resources
4
laclllLaLes
collaboraLlon
beLween cllenL(s)
and communlLy
resources
3
ArLlculaLes and
applles sysLemlc
prlnclples LhaL
supporL recovery-
orlenLed case
managemenL LhaL
supporLs cllenL
sLrengLhs

Competency 10: Embodies a Strengths-based Approach
1
Approaches work
wlLh cllenLs wlLh an
expecLaLlon LhaL
cllenLs have a varleLy
of sLrengLhs

2
Able Lo ldenLlfy
sLrengLhs of each
member of Lhe
sysLem

3.
ls able Lo ldenLlfy
sLrengLhs wlLhln Lhe
sysLem as a whole

4.
ldenLlfles cllenL
sLrengLhs and how
Lhese have been
helpful Lo promoLe
change ln Lhe pasL
3.
Crganlzes sesslons so
LhaL cllenL resources
are a ma[or focus of
Lhe LherapeuLlc
conversaLlon

CommenLs:

PROFESSIONALISM
Competency 11 Ethics
1
knows Lhe
dlfference
beLween eLhlcal
and legal lssues
2
knows legal, eLhlcal,
and professlonal
sLandards of
pracLlce LhaL apply
Lo Ml1
3
Can apply eLhlcal and
legal sLandards of
pracLlce
approprlaLely ln
Lherapy
4
Lxpands eLhlcal
awareness Lo
lnclude gender,
culLure, SLS,
power, and
prlvllege
3
Pas developed a
process for addresslng
eLhlcal lssues ln case
concepLuallzaLlon and
managemenL

Competency 12: Self Reflexivity
1
8ecognlzes self as an
lnLegral parL of Lhe
Lherapy process.
2
8ecognlzes how
cllenL lssues
reclprocally
lnfluences Lhe
LheraplsL.
3
Cpen Lo feedback
from oLhers
sLudenLs, cllenLs, and
supervlsors and uses
lL poslLlvely.
4
ls aware of how
own values, ldeas,
and soclal poslLlon
lnfluence Lherapy.
3
AcLlvely sollclLs
feedback from oLher
sLudenLs, cllenLs and
supervlsors and uses
lL poslLlvely.

Competency 13: Interdisciplinary Consciousness
1
Aware of scope of
pracLlce of Ml1s
2
Aware of roles and
scope of pracLlce of
oLher dlsclpllnes.
3
racLlces wlLhln
scope of Ml1 and
makes approprlaLe
referrals.
4
8ecognlzes own
cllnlcal conLrlbuLlons
wlLhln a sysLem of
care.
3
uemonsLraLes respecL
for oLher dlsclpllnes as
Lhey lnLersecL wlLh
sysLems/relaLlonal
pracLlce.

62
Competency 14: Professional Engagement
1
Lngages ln
professlonal
manner wlLhln
cllnlcal seLLlng.
2
Lngages ln
professlonal
manner wlLh
cllenLs.
3
Cverall presence,
dress, and
communlcaLlon sLyle
reflecLs enLry-level
sLandards of Lhe fleld.
4
uemonsLraLes
lnlLlaLlve ln carrylng
ouL responslblllLles
assoclaLed wlLh role
as LheraplsL.
3
LffecLlvely engages
wlLh oLher
sLakeholders, famlly
members,
professlonals, or
slgnlflcanL persons ln
Lhe LreaLmenL
process.
Comments:

63

MARITAL AND FAMILY THERAPY
MASTERS PROGRAM

Trainee Hours Log Sheet

Name: ________________________________________ Quarter: ____________________Year _______________

Placement: ____________________________________________________________________________________

Supervisor! !! !s Signature: _________________________________________________________________________

Total Direct Counseling Hours: _____________________ Total Direct Supervision Hours: _________________

DIRECT COUNSELING HOURS

DIRECT SUPERVISION HOURS
(1:5 ratio)
1

Individual

Couple

Family

Individual
2

Group
3

DATE
(Daily)

Indv

Group

Indv

Group

Indv

Group

Verbal
Report

Video

Audio

Live
Observ

Verbal
Report

Video

Audio

Live
Observ

Total
Hours

1
A ratio of 1:5 (supervision to client contact hours) is to be maintained on a weekly basis.
2
A minimum of one (1) hour of individual supervision is required for each week in which clients are seen.
3
Group supervision does not exceed eight (8) supervisees per group.
!"#$"%&&'
64
APPENDIX M

QUARTERLY SUPERVISOR EVALUATION
(To be filled out by Trainee)

Name of Trainee: _____________________________________________ Quarter
&Year:_________________________

Name of Supervisor: ______________________________ Site:
_____________________________________________

Please answer the following questions as honestly as you can. Your responses will be utilized in the
continuing development of the clinical training experience. In answering the questions, please use the
following scale and circle the appropriate response. Space for written clarification of answers is provided
at the end of this form. Trainees must discuss this evaluation with their supervisor and have him/her sign
this form.

NA = Not applicable
1 = POOR, well below an acceptable level 4 = GOOD, better than an acceptable
level
2 = FAIR, below an acceptable level 5 = VERY GOOD, significantly better
than an acceptable level
3 = ADEQUATE, at an acceptable level 6 = EXCELLENT, far exceeding an
acceptable level

1. The supervisor met with me for one hour per week (other than vacations) for
supervision. NA 1 2 3 4 5 6
2. The supervisor offered useful suggestions to me in improving my skills as a
therapist. NA 1 2 3 4 5 6
3. The supervisor contributed to and encouraged my learning about my theory.
NA 1 2 3 4 5 6
4. The supervisor clearly articulated (verbally or written) his/her expectations for
my traineeship. NA 1 2 3 4 5 6
5. The supervisor encouraged me to discuss my expectations of supervision.
NA 1 2 3 4 5 6
6. The supervisor clearly articulated (verbally or written) his/her expectations for
supervision. NA 1 2 3 4 5 6
7. The supervisor assisted me in learning methods for writing case notes and
treatment plans. NA 1 2 3 4 5 6
8. The supervisor contributed to my understanding and application of DSM-IV
diagnoses. NA 1 2 3 4 5 6
9. The supervisor contributed to my understanding and application of systems
diagnoses. NA 1 2 3 4 5 6
10. The supervisor enhanced my assessment of interactions between couples
and families. NA 1 2 3 4 5 6
11. The supervisor treated me with respect by conveying understanding,
cceptance, and support.NA 1 2 3 4 5 6
12. The supervisor encouraged my ideas and opinions, and listened attentively to
my suggestions. NA 1 2 3 4 5 6
65
13. The supervisor displayed knowledge of and adherence to ethical and legal
guidelines. NA 1 2 3 4 5 6
14. The supervisor was aware of and showed sensitivity to cultural and ethnic
issues in therapy. NA 1 2 3 4 5 6
15. The supervisor was aware of and showed sensitivity to cultural and ethnic
issues in supervision. NA 1 2 3 4 5 6
16. The supervisor displayed awareness of and sensitivity to gender issues and
roles in therapy. NA 1 2 3 4 5 6
17. The supervisor displayed sensitivity to spiritual issues
NA 1 2 3 4 5 6
18. The supervisor displayed awareness of and sensitivity to gender issues and
roles in supervision. NA 1 2 3 4 5 6
19. The supervisor assisted my understanding of abuse issues in therapy.
NA 1 2 3 4 5 6
20. The supervisor contributed to my understanding of sexual behavior issues in
treating clients. NA 1 2 3 4 5 6
21. The supervisor recognized and commented upon my strengths as a therapist.
NA 1 2 3 4 5 6
22. The supervisor enhanced my understanding of areas in which I desire to grow
as a therapist. NA 1 2 3 4 5 6
23. How safe was the environment in supervision to allow you to discuss your cases and
your own development?
NA 1 2 3 4 5 6
- What specific factors contributed to the safety or lack of it in supervision?
_____________________________________________________________________
________________________________

- What did the supervisor do to facilitate a safe environment?
_____________________________________________________________________
_ _______________________________

- What, if anything, could the supervisor have done to increase your sense of safety in
supervision.___________________________________________________________
________________________________________________________________________
24. Overall, how well did your supervisor contribute to your learning this quarter?
NA 1 2 3 4 5 6
- What are his/her strengths in this area?
_____________________________________________________________________

- Is there anything he/she could have done to make the internship a better experience for you?
____________________________________________________________________

25. How valuable was the feedback you received from your supervisor?
NA 1 2 3 4 5 6
- What specifically was helpful about the feedback?
_________________________________________________________________
66
-Were there any ways the feedback could have been more helpful?
_____________________________________________________________________
________________________________
26. How would you describe the support you received from your supervisor this quarter
in your journey of being atherapist?
NA 1 2 3 4 5 6

- What, if anything, could the supervisor have done to be more supportive?
_____________________________________________________________________

27. Overall, how has the experience of meeting with your supervisor been for you this
quarter?
NA 1 2 3 4 5 6

Please use the space below to clarify answers or provide additional comments about the supervisor. When
clarifying answers, please refer to answer number.

ADDITIONAL COMMENTS/CLARIFICATION:
______________________________________________________________________________________
______________________________________________________________________________________
__________________________________________

____________________________________ _____________________________________ ____________________
Signature of Trainee Signature of Supervisor Date

67
APPENDIX O

3TATE 0F CALlF0RNlA - 3TATE AN0 C0N3uVER 3ERvlCE3 A0ENCY 0overror Edrurd 0. 8roWr Jr.

125 Norlr Var|el 8|vd., 3u|le 3200, 3acrarerlo, CA 95831
Te|eprore: (91) 5Z1-Z830 TTY: (800) 32-229Z
WWW.oos.ca.gov

MARRIAGE AND FAMILY THERAPIST
WEEKLY SUMMARY OF HOURS OF EXPERIENCE

FOR HOURS GAINED ON OR AFTER January 1, 2010

THIS FORM SHALL BE COMPLETED PURSUANT TO TITLE 16, CALIFORNIA CODE OF REGULATIONS SECTION 1833(e). use a separale |og lor eacr
superv|sed Wor| sell|rg ard lor eacr slalus |rd|caled oe|oW.

(Please type or print clearly in ink)
Nare ol VFT Tra|ree/lrlerr: Lasl

F|rsl

V|dd|e

Nare ol 3uperv|sor: 0ale erro||ed |r graduale degree prograr: 883 F||e No (|l |roWr)

Nare ol wor| 3ell|rg: Address ol wor| 3ell|rg: Nuroer ard 3lreel C|ly, 3lale, Z|p
lrd|cale lre slalus ol lre rours |ogged:
Tra|ree Tra|ree |r Pracl|cur Reg|slered lrlerr (VFT lrlerr No. __________)
3uperv|s|or v|a v|deo corlererc|rg |s rol a||oWed as a lra|ree

Posl-0egree W|lr App||cal|or Perd|rg lor
lrlerr Reg|slral|or
[8 & P Code 3ecl|or 1980.13(r)|
Note: Child counseling can be logged in any appropriate category as specified by your supervisor
YEAR: WEEK OF:
Tola|
lours
lrd|v|dua| Psycrolrerapy (perlorred oy you)
Coup|es, Far|||es, ard Cr||drer (r|r. 500 rrs.)
0l lre aoove CFC rours, roW rary aclua| rours Were
ga|red v|a corjo|rl coup|es ard lar||y lrerapy?

0roup Trerapy or Course||rg (rax. 500)
Te|ered|c|re (rax. 3Z5)
Adr|r|sler|rg & eva|ual|rg psycr. lesls, Wr|l|rg c||r|ca| reporls,
Wr|l|rg progress or process roles (rax. 250)

wor|srops, ser|rars, lra|r|rg sess|ors, or corlererces d|recl|y
re|aled lo rarr|age, lar||y, ard cr||d course||rg (rax. 250)

C||erl Cerlered Advocacy (CCA)
3uperv|s|or, lrd|v|dua| Face-lo-Face
3uperv|s|or, 0roup
Tola| Per wee|

3 | g r a l u r e o l 3 u p e r v | s o r

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* Please see the FAQs for instructions on how to report the Conjoint Couples and Families Therapy Incentive hours gained.
**These categories when combined with credited Personal Psychotherapy shall not exceed 1250 hours of experience.

3ZA-521a (Rev. 1/11) Tr|s lorr ray oe reproduced
68

APPENDIX P

3ZA-301a (Rev. 1/11) 1 Tr|s lorr ray oe reproduced

Te|eprore: (91) 5Z1-Z830 TTY: (800) 32-229Z
WWW.oos.ca.gov

MARRIAGE AND FAMILY THERAPIST
EXPERIENCE VERIFICATION

FOR HOURS GAINED ON OR AFTER JANUARY 1, 2010

Tre superv|sor rusl corp|ele lr|s lorr. use a separale lorr lor eacr persor ver|ly|rg rours ol superv|sed exper|erce lor ||cersure as a rarr|age ard lar||y
lrerap|sl ard lor eacr erp|oyrerl sell|rg. Corp|ele a separale lorr lor pre-degree ard posl-degree rours. Make certain that the form is complete and
correct prior to signing. Any change should be initialed by the supervisor and is subject to verification. Exper|erce ver|l|cal|or lorrs are lo oe
suor|lled oy lre app||carl W|lr r|s or rer app||cal|or lor exar|ral|or e||g|o|||ly.
(Please type or print clearly in ink)
App||carl:

Lasl

F|rsl

V|dd|e

SUPERVISOR: (Please type or print clearly in ink)
1. 3uperv|sor Nare: Lasl F|rsl V|dd|e 2. 8us|ress Prore:
3. Address: Nuroer ard 3lreel C|ly 3lale Z|p Code
1. Nare ol App||carl's Erp|oyer: 5. 8us|ress Prore:
. Erp|oyer's Address: Nuroer ard 3lreel C|ly 3lale Z|p Code
Z. a was lr|s exper|erce ga|red |r a sell|rg lral |aWlu||y ard regu|ar|y prov|des rerla| rea|lr course||rg or psycrolrerapy?
Yes No
o. was lr|s exper|erce ga|red |r a pr|vale pracl|ce sell|rg? Yes No
8 Exper|erce Was ga|red |r a sell|rg lral prov|ded overs|grl lo ersure lral lre app||carl's Wor| reels lre exper|erce ard
superv|s|or requ|rererls ard |s W|lr|r lre scope ol pracl|ce lor lre proless|or?

Yes No
9. For |rlerrs or|y

, was lre app||carl rece|v|rg pay lor lre erp|oyrerl? ll yes, allacr a copy ol lre app||carl's w-2
slalererl lor eacr year exper|erce |s c|a|red. For lre currerl year |r Wr|cr a w-2 ras rol oeer |ssued, suor|l a copy ol a
currerl paysluo.
ll app||carl vo|urleered, a |eller lror lre erp|oyer ver|ly|rg vo|urleer slalus |s requ|red.

Yes No
10. 0ales ol lre exper|erce |s oe|rg c|a|red

Fror:
rr/dd/yyyy

To:
rr/dd/yyyy

11. loW rary Wee|s ol superv|sed exper|erce are oe|rg c|a|red?
12. 3roW or|y lrose rours ol exper|erce as ver|l|ed or lre Wee||y surrary ol rours lorr. Logged lours
a. lrd|v|dua| Psycrolrerapy (No r|r|rur or rax|rur rours requ|red)

o. Coup|es, lar|||es, ard cr||drer (r|r|rur 500 rours)
0l lre rours recorded or ||re 12. o., roW rary aclua| rours Were ga|red v|a corjo|rl coup|es ard lar||y lrerapy.

c. 0roup Trerapy or Course||rg (rax|rur 500 rours)

d. Te|ered|c|re (rax|rur 3Z5 rours)

e. Adr|r|sler|rg ard eva|ual|rg psycro|og|ca| lesls ol course|ees, Wr|l|rg c||r|ca| reporls ard progress or process roles
(rax|rur 250 rours)

l. wor|srops, ser|rars, lra|r|rg sess|ors, or corlererces d|recl|y re|aled lo rarr|age, lar||y,
ard cr||d course||rg (rax|rur 250 rours)

g. C||erl Cerlered Advocacy (CCA)

Continue on next page.

69

3ZA-301a (Rev. 2/10) 2 Tr|s lorr ray oe reproduced

App||carl: Lasl

F|rsl

V|dd|e

1. Face-lo-lace superv|s|or: lours per Wee| Logged lours
a. lrd|v|dua|

o. 0roup (0roup superv|s|or corla|red ro rore lrar 8 persors)

1. 3uperv|sor L|cerse lrlorral|or:
Type ol L|cerse L|cerse Nuroer 3lale ol L|cerse 0ale 0r|g|ra||y L|cersed
ll V.0., Were you cerl|l|ed |r Psycr|alry oy lre Arer|car 8oard ol Psycr|alry ard Neuro|ogy dur|rg lre erl|re per|od ol
superv|s|or?

0ale 8oard cerl|l|ed: _________________________

Yes No

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct

3|gralure ol 3uperv|sor: 0ale:

*These categories when combined with credited Personal Psychotherapy shall not exceed 1250 hours of experience.
70
APPENDIX Q

Te|eprore: (91) 5Z1-Z830 TTY: (800) 32-229Z
WWW.oos.ca.gov
RESPONSIBILITY STATEMENT FOR SUPERVISORS
OF A MARRIAGE AND FAMILY THERAPIST TRAINEE OR INTERN
Title 16, California Code of Regulations (16 CCR) Section 1833.1 requires any qualified licensed mental health professional who assumes responsibility for
providing supervision to those working toward a Marriage and Family Therapist license to complete and sign, under penalty of perjury, the following statement
prior to the commencement of any counseling or supervision.
Nare ol VFT Tra|ree/lrlerr: Lasl F|rsl V|dd|e
Nare ol 0ua||l|ed 3uperv|sor: 0ua||l|ed 3uperv|sor's 0ayl|re Te|eprore Nuroer:
As lre superv|sor:
1) l ar ||cersed |r Ca||lorr|a ard rave oeer so ||cersed lor al |easl lWo years pr|or lo correrc|rg lr|s superv|s|or.
(1 CCR 1833.1(a)(1) ard 8us|ress ard Proless|ors Code (8PC) 1980.03(g)(1))
A.Tre ||cerse l ro|d |s:
Varr|age ard Far||y Trerap|sl
License # Issue Date
L|cersed C||r|ca| 3oc|a| wor|er
*Psycro|og|sl
*Prys|c|ar cerl|l|ed |r psycr|alry oy lre Arer|car 8oard ol Psycr|alry ard
Neuro|ogy
**8. l rave rad sull|c|erl exper|erce, lra|r|rg, ard educal|or |r rarr|age ard lar||y lrerapy lo corpelerl|y pracl|ce rarr|age ard lar||y
lrerapy |r Ca||lorr|a. (1 CCR 1833.1(a)(2))
C. l W||| |eep ryse|l |rlorred aooul deve|oprerls |r rarr|age ard lar||y lrerapy ard |r Ca||lorr|a |aW goverr|rg lre pracl|ce ol
rarr|age ard lar||y lrerapy. (1 CCR 1833.1(a)(3))
2) l rave ard ra|rla|r a currerl ard va||d ||cerse |r good slard|rg ard W||| |rred|ale|y rol|ly ary lra|ree or |rlerr urder ry superv|s|or ol ary
d|sc|p||rary acl|or la|er aga|rsl ry ||cerse, |rc|ud|rg revocal|or or suspers|or, ever |l slayed, prooal|or lerrs, |racl|ve ||cerse slalus, or
ary |apse |r ||cersure, lral allecls ry ao|||ly or r|grl lo superv|se. (1 CCR 1833.1(a)(1), (a)(1))
3) l rave pracl|ced psycrolrerapy or prov|ded d|recl superv|s|or ol lra|rees, |rlerrs, or assoc|ale c||r|ca| soc|a| Wor|ers Wro perlorr
psycrolrerapy lor al |easl lWo (2) years W|lr|r lre l|ve (5) year per|od |rred|ale|y preced|rg lr|s superv|s|or. (1 CCR 1833.1(a)(5))
1) l rave rad sull|c|erl exper|erce, lra|r|rg, ard educal|or |r lre area ol c||r|ca| superv|s|or lo corpelerl|y superv|se lra|rees or |rlerrs. (1
CCR 1833.1(a)())
5) l rave corp|eled s|x () rours ol superv|s|or lra|r|rg or courseWor| W|lr|r lre rereWa| per|od |rred|ale|y preced|rg lr|s superv|s|or, ard
rusl corp|ele sucr courseWor| |r eacr rereWa| per|od Wr||e superv|s|rg. ll l rave rol corp|eled sucr lra|r|rg or courseWor|, l W|||
corp|ele a r|r|rur ol s|x () rours ol superv|s|or lra|r|rg or courseWor| W|lr|r s|xly (0) days ol lre corrercererl ol lr|s superv|s|or,
ard |r eacr rereWa| per|od Wr||e prov|d|rg superv|s|or. (1 CCR 1833.1(a)()(A)&(8))
) l |roW ard urderslard lre |aWs ard regu|al|ors perla|r|rg lo oolr lre superv|s|or ol lra|rees ard |rlerrs ard lre exper|erce requ|red lor
||cersure as a rarr|age ard lar||y lrerap|sl. (1 CCR 1833.1(a)(Z))
Z) l sra|| ersure lral lre exlerl, ||rd, ard qua||ly ol course||rg perlorred |s cors|slerl W|lr lre educal|or, lra|r|rg, ard exper|erce ol lre
lra|ree or |rlerr. (1 CCR 1833.1(a)(8))
37A-523 (Rev. 1/11) 1
71

_______________________________________ _____________________________________________ _______________

____________________________________________________________________________________________________________________________________________

8) l sra|| ror|lor ard eva|uale lre exlerl, ||rd, ard qua||ly ol course||rg perlorred oy lre lra|ree or |rlerr oy d|recl ooserval|or, rev|eW ol
aud|o or v|deo lapes ol lrerapy, rev|eW ol progress ard process roles ard olrer lrealrerl records, or oy ary olrer rears deered
appropr|ale. (1 CCR 1833.1(a)(9))
9) l sra|| address W|lr lre lra|ree or |rlerr lre rarrer |r Wr|cr erergerc|es W||| oe rard|ed. (1 CCR 1833.1(a)(10))
10) l agree rol lo prov|de superv|s|or lo a TRAlNEE ur|ess lre lra|ree |s a vo|urleer or erp|oyed |r a sell|rg lral reels a|| ol lre lo||oW|rg: (A)
|aWlu||y ard regu|ar|y prov|des rerla| rea|lr course||rg or psycrolrerapy; (8) prov|des overs|grl lo ersure lral lre lra|ree's Wor| al lre
sell|rg reels lre exper|erce ard superv|s|or requ|rererls ard |s W|lr|r lre scope ol pracl|ce lor lre proless|or as del|red |r 8PC 3ecl|or
1980.02; (C) |s rol a pr|vale pracl|ce oWred oy a ||cersed rarr|age ard lar||y lrerap|sl, a ||cersed psycro|og|sl, a ||cersed c||r|ca| soc|a|
Wor|er, a ||cersed prys|c|ar ard surgeor, or a proless|ora| corporal|or ol ary ol lrose ||cersed proless|ors. (8PC 1980.13(d)(1))
11) l agree rol lo prov|de superv|s|or lo ar lNTERN ur|ess lre |rlerr |s a vo|urleer or erp|oyed |r a sell|rg lral reels oolr ol lre lo||oW|rg: (A)
|aWlu||y ard regu|ar|y prov|des rerla| rea|lr course||rg or psycrolrerapy; (8) prov|des overs|grl lo ersure lral lre |rlerr's Wor| al lre
sell|rg reels lre exper|erce ard superv|s|or requ|rererls ard |s W|lr|r lre scope ol pracl|ce lor lre proless|or as del|red |r 8PC 3ecl|or
1980.02. (8PC 1980.13(e)(1))
12) ll l ar lo prov|de superv|s|or or a vo|urlary oas|s |r a sell|rg Wr|cr |s rol a pr|vale pracl|ce, a Wr|ller agreererl W||| oe execuled oelWeer
ryse|l ard lre orgar|zal|or |r Wr|cr lre erp|oyer ac|roW|edges lral lrey are aWare ol lre ||cers|rg requ|rererls lral rusl oe rel oy lre
|rlerr or lra|ree, lrey agree rol lo |rlerlere W|lr ry |ega| ard elr|ca| oo||gal|ors lo ersure corp||arce W|lr lrese requ|rererls, ard lrey
agree lo prov|de re W|lr access lo c||r|ca| records ol lre c||erls course|ed oy lre |rlerr or lra|ree. (1 CCR 1833(o)(1))
13) l sra|| g|ve al |easl (1) ore Wee|'s pr|or Wr|ller rol|ce lo a lra|ree or |rlerr ol ry |rlerl rol lo s|gr lor ary lurlrer rours ol exper|erce lor
sucr persor. ll l rave rol prov|ded sucr rol|ce, l sra|| s|gr lor rours ol exper|erce oola|red |r good la|lr Wrere l aclua||y prov|ded lre
requ|red superv|s|or. (1 CCR 1833.1(c))
11) l sra|| oola|r lror eacr lra|ree or |rlerr lor Wror superv|s|or W||| oe prov|ded, lre rare, address, ard le|eprore ruroer ol lre lra|ree's
or |rlerr's rosl recerl superv|sor ard erp|oyer. (1 CCR 1833.1(d))
15) lr ary sell|rg lral |s rol a pr|vale pracl|ce, l sra|| eva|uale lre s|le(s) Wrere a lra|ree or |rlerr W||| oe ga|r|rg rours ol exper|erce loWard
||cersure ard sra|| delerr|re lral: (1) lre s|le(s) prov|des exper|erce Wr|cr |s W|lr|r lre scope ol pracl|ce ol a rarr|age ard lar||y lrerap|sl;
ard (2) lre exper|erce |s |r corp||arce W|lr lre requ|rererls sel lorlr |r 1 CCR 3ecl|or 1833 ard 3ecl|or 1980.13 ol lre Code. (1 CCR
1833.1(e))
1) upor Wr|ller requesl ol lre 8oard, l sra|| prov|de lo lre ooard ary docurerlal|or Wr|cr ver|l|es ry corp||arce W|lr lre requ|rererls sel
lorlr |r 1 CCR 3ecl|or 1833.1. (1 CCR 1833.1(l))
1Z) l sra|| prov|de lre |rlerr or lra|ree W|lr lre or|g|ra| ol lr|s s|gred slalererl pr|or lo lre corrercererl ol ary course||rg or
superv|s|or. (1 CCR 1833.1(o))
I declare under penalty of perjury under the laws of the State of California that I have read and understand the foregoing and that I meet
all criteria stated herein and that the information submitted on this form is true and correct.
Pr|rled Nare ol 0ua||l|ed 3uperv|sor 3|gralure ol 0ua||l|ed 3uperv|sor Date
Va|||rg Address: Nuroer ard 3lreel C|ly 3lale Z|p Code
The supervisor shall provide the intern or trainee being supervised with the original of this signed statement prior to the commencement of any
counseling or supervision.
The trainee or intern shall submit this form to the board upon application for examination eligibility.
* Psycro|og|sls ard Prys|c|ars cerl|l|ed |r psycr|alry are rol requ|red lo corp|y W|lr #5.
App||es or|y lo superv|sors N0T ||cersed as a Varr|age ard Far||y Trerap|sl.
37A-523 (Rev. 1/11) 2
72
APPENDIX R

FINAL CASE COMMITTEE APPROVAL
Student name Date
Proposed committee members:
1.
2.
3.
Final case information:
Date
Time
Place
o I have obtained consent from the couple/family for videotaping
o I have obtained consent from the couple/family to serve as my final case
o I understand that my committee must be provided with my final case paper one week
before my final presentation
o Two of the three committee members are from the following list:
*Jennifer Andrews, Ph.D. *Doug Huenergardt, Ph.D.
*Ian Chand, Ph.D. *Carmen Knudson-Martin, Ph.D.
Craig Lambdin, M.S. *Randall Walker, M.S.
*Curtis Fox, Ph.D. *Mary Moline, Ph.D.
*Suzanne Hanna, Ph.D. Cheryl Simpson, Ph.D.
*Pam Hart, M.S. *Susan Swim, Ph.D.
*Barbara Hernandez, Ph.D.
*Eligible to serve as committee chair
The signature below indicates approval for the committee panel listed above.
-
Barbara Couden Hernandez, PhD
Director of Clinical Training
Date
Lama Linda University Final Case Panel Approval Form 4/2/07
73
APPENDIX S

DEPARTMENT OF COUNSELING AND FAMILY SCIENCE
CONSENT TO PARTICIPATE IN PROFESSIONAL PRESENTATION

PRESENTATION: __________________________________________
Presentation title, venue, topic, or description

AUTHOR/CO-AUTHOR: __________________________________________
Therapists name
__________________________________________
Therapists name

From time to time therapist trainees and interns have the opportunity to make educational
presentations at state and national conferences about therapeutic, relational, or cutting
edge issues in marriage and family therapy. These presentations may consist of
discussions about the process of therapy, portions of therapy session transcripts, or
videotape clips. It is our expectation that such presentations will both help improve the
skills of mental health clinicians and therapists in training, and will also forward our
profession by the dissemination of helpful information.

Additionally, a graduate student requirement is to present a series of video clips of their
work with clients to classmates and faculty. This presentation, called a qualifying clinical
demonstration, or final case presentation, is held under the direct auspices of the faculty
in the Department of counseling and Family Science and occurs once during the students
course of study. You may be asked for permission to include a portion of videotape of
you and your therapist working together for this presentation.

The professional report named above may be performed only by using personal
information relating to your mental health treatment. National data protection regulations
give you the right to control the use and disclosure of your mental health information.
Therefore, by signing this form, you specifically authorize your mental health
information to be used or disclosed as described below.
Use of your personal information
The following personal information, considered Protected Health Information (PHI) is
needed to conduct this report and may include, but is not limited to: your reason for
seeking therapy services; course of treatment; discussion about your participation in
therapy. Additionally, PHI may be shared with individuals designated to assist in
conducting this study as well as with accreditation bodies. PHI may also be reviewed to
ensure that the study meets legal and institutional standards.
Disclosure of your personal information
The main reason for sharing this information is to be able to analyze clinical processes
and present or publish the results to other mental health professionals. The results may be
presented in educational venues, professional conferences, or in publications. Although
74
information obtained from your mental health record will be disclosed in the publication,
we will not publish identifiers such as your name, address, telephone number or
government-issued identification number.

Safeguards to protect PHI
All media or printed matter containing any information pertaining to you shall be carried
in a locked briefcase to and from the presentation venue and will be in the possession of
the abovementioned presenter at all times. If video clips are used, only a portion of the
entire recorded session will be selected and transferred onto a CD or DVD for the
presentation. Your name, age, and other identifying information will be changed for the
presentation. An announcement will be made at the beginning of the presentation
requesting that if anyone recognizes individuals in the video to excuse themselves from
the presentation immediately.

Risks
Although every precaution will be taken to protect your PHI, risk of theft, destruction of
materials, or the possibility that someone at the presentation may recognize you, cannot
be entirely eliminated. We will do all in our power to protect your information while it is
transported and used at the chosen presentation venue. All privileged information will be
returned to the agency immediately after the therapist returns from the presentation.

I hereby give authorization for the use or disclosure of my personal information for the
professional report based on my understanding of the following (please initial or
designate N/A for each item below):

_____ I understand that you may use my personal information to prepare this report. The
scope of the report, however, is limited to the case description indicated above.

_____ I understand that the authorization to use my personal information to conduct this
report will expire at the end of the presentation or study. However, I understand
that following publication, full articles or abstracts of or from the initial report
may be published and continue to be published for an indefinite period of time.

_____ I understand that this authorization does not authorize the use or disclosure of
personal information created or obtained after initial publication.

_____ I understand that I do not need to sign this authorization in order to receive health
care.

_____ I understand that I may revoke this authorization at any time. However, the
revocation will not apply to information that has already been released in response
to this authorization.

_____ I agree that my personal mental health information may be used for:

75

student qualifying examination presentation

final case presentation

professional/educational conference presentation

future presentations and other educational purposes at dates and times yet to
be determined

______ I have had the opportunity to ask questions about the purpose and use of the
presentation at which my PHI will be used

___________________________________ ________________________
Client name Date & time

___________________________________
Client signature

___________________________________ ________________________

___________________________________
Client signature

___________________________________________________ __________________________________

__________________________________________________
Client signature

___________________________________ ________________________
Therapist name Date & time

___________________________________
Therapist signature

___________________________________________________ ___________________________________
Co-therapists name Date & time

___________________________________________________
Co-therapists signature

___________________________________ ________________________
Clinical supervisor Date & time

___________________________________ __________________
Director Clinical Training, Loma Linda University Date & Time

76
APPENDIX T

1. Evaluator's Name
2. What is the name of the student being evaluated?
3. Please enter the date you are taking this survey
4. The student's case study is an example of:

2.
*
Your Name
*
Student's Name
Placement Site
MM DD YYYY
Today's Date / /

A Family Case

nmlkj
A Couple Case

nmlkj
Other (please specify)
77

Please answer the questions below in reference to the student's professional paper.
1. The following questions ask you to rate the student's professional paper

3. Professional Paper
Excellent Above Average Average Fair Poor Quality Unacceptable N/A
Organization
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
Clarity
Thorough discussion of
theory
Incorporates self into paper
Understands systems
concepts, theory, techniques
(1.1.1)
Understands risks & benefits
of relational therapy (1.1.4.)
Recognizes contextual &
systemic dynamics (1.2.1)
Systemic & contextual
assessment & diagnosis
(2.1.5.)
Discusses strengths &
limitations of model (2.1.6.)
Considers extra-therapeutic
relationships (2.2.4.)
Assesses dynamics with
genogram/comparable
measures (2.3.6.)
Demonstrates model's
effectiveness for determined
outcomes (3.1.1.)
Demonstrates an appropriate
level of critical thinking skills

Comments of feedback in reference to the student's professional paper
5 5
6 6
78

The following questions refer to the student's written case
1. Quality of Written Case

4. Written Case
Organization
Clarity
Use of theory
Explained intervention and
how they relate to treatment
plan
Appropriateness of
intervention and treatment
plan
Understands systems
concepts, theories &
techniques (1.1.1.)
Understands risk & benefits of
relational therapy (1.1.4.)
systemic dynamics (1.2.1.)
Considers health, MSE, &
biological factors (1.2.2.)
Understands who needs to
attend sessions (1.3.2.)
Facilitates involvement of all
who attends sessions (1.3.3.)
Maintains therapeutic
alliance with participants
(1.3.6.)
Maintains working
relationship with referral
sources & other practitioners
(1.3.8.)
Evaluates for professional
scope of practice (1.4.1.)
Understands legal issues for
vulnerable populations
(1.5.1.)
Understands human gender
& sexual development, &
DSM, meds & processes
(2.1.1)
Understands systemic impact
of health disorders (2.1.2.)
Understands clinical needs &
implications of persons with
comorbid disorders (2.1.3.)
Assesses each client's
engagement in the process
(2.2.1.)
Integrates client reports,
referrals, tests to guide
assessment process ( 2.2.2.)
Identifies client's strengths,
79

resilience, & resources
(2.3.8.)
Develops hypotheses
regarding patterns, problem,
& influence of extra-
therapeutic factors on client
systems (2.2.3.)
Considers influence of
treatment on extra-
therapeutic relationships
(2.2.4.)
Comments of feedback in reference to the student's written case
5 5
6 6
80
APPENDIX U

1. Your name
2. What is name of student being evaluated?
3. Date of presentation

2.
Evaluator's Name
Student's Name
Placement Site
MM DD YYYY
Enter today's date / /

81

The following questions refer to the vignette portion of the case presentation
4. Quality of Vignette

3. Vignette
Demonstrates ability to
exercise counseling
judgment "on the spot"
Demonstrates understanding
of systems concepts (1.1.1.)
systemic dynamics (1.2.1.)
(2.1.1)
Understands current models
for assessment & diagnosis of
mental health & substance
use disorders & relational
functioning (2.1.5.)
Considers influence of
treatment on extra-
therapeutic relationships
(2.2.4.)
Develops safety plans to
address abuse/harm to self &
others (2.3.5.)

Feedback or comments about the student's vignette presentation
5 5
6 6
82

The follow questions refer to the student's demonstrated level of compentency during the oral preentation
5. Quality of Oral Presentation

4. Oral Presentation
*
Use of Video Tapes
Use of Audio Tapes
Presented theoretical
orientation
Presents self competently &
professionally
Demonstrates sense of
direction in counseling
Understands legal & ethical
issues
Demonstrates professional
ethics
Assesses nonverbals of client
& self
Demonstrates self as effective
change agent
Identifies & assesses
interactive patterns
Recognizes strengths of
clients
Demonstrates Client
Advocacy Techniques
Demonstrates awareness of
self and use of self in
counseling relationship
Understands systems
concepts, theory, techniques
(1.1.1)
systemic dynamics (1.2.1)
Maintains working
relationship with referral
sources & other practitioners
(1.3.8.)
(2.1.1)
Discusses strengths &
limitations of model (2.1.6.)
Assesses each client's
engagement in process
(2.2.1.)
Develops hypotheses
regarding patterns, problem,
& influence of extra-
83

therapeutic factors on client
systems (2.2.3.)
Considers extra-therapeutic
relationships (2.2.4.)
Considers contextual &
systemic impact of
organic/physical problems on
symptoms (2.2.5.)
Assesses & diagnose
behavioral & relational issues
systemically/contextually
(2.3.1.)
Comments about the oral presentation
5 5
6 6
84
APPENDIX V

SURVEY OF GRADUATING MARITAL & FAMILY THERAPY STUDENTS

The Department of Counseling and Family Sciences is conducting a survey of students
who are graduates of the program. This is to help us evaluate the program and to provide
data for accreditation purposes. It will be very helpful if you can complete this survey
and return it to our office as soon as possible.

Length of time to complete program (quarters):
______________________________________

What is your primary employment status after
graduation:______________________________

Will be employed/continuing current employment (check all settings that apply)
Private Practice College/University Mental Health Setting
Elementary School Community Agency Hospital Setting
Jr./Middle School Group Therapy Rehabilitation Agency
High School Individual Therapy Group Home
Court Community College Other, please specify
Unemployed
Continuing training/education (e.g., unpaid internship, doctoral studies) at:

How would you say your training/education prepared you for your current employment?

Not at all adequately extremely well somewhat very well

What is /will be the nature of your work?

What are your plans with respect to MFT Licensing?
Plan to pursue : Not pursuing at this time:
Plan to pursue license in another state
Yes No If so,
what state: _____________

Will you pursue another type of license or certification? Yes No
If yes, what type? :
If so, what state: ________________

What is your AAMFT membership
status?__________________________________________

How long have you been
member?_______________________________________________
85
Will you seek membership in other organizations?
Yes If yes, which organization? _________________________ No

How would you say the program prepared you as a therapist?
1
Not at all
2
Somewhat
3
Adequately

4
Very well

5
Extremely well

How do you think the program prepared you to work with clients from various ethnic
backgrounds and cultural differences?
1
Not at all
2
Somewhat
3
Adequately

4
Very well

5
Extremely well

How well do you think the program prepared you to apply personal and professional
valuesof LLU to the practice of psychotherapy?

1
Very weak
2
Weak
3
Adequately
4
Strong
5
Very strong

How do you think the program prepared you to understand current issues and trends in
your profession, as well as the probable impact of those issues and trends on human
relationship and professional practice?

1
Very weak
2
Weak
3
Adequately
4
Strong
5
Very strong

How would you say the program prepared you to apply methods of decision making and
interventions with the following categories of clients?

INDIVIDUALS
1
Very week

2
Weak

3
Adequately

4
Strong

5
Very strong

COUPLES
1
Very weak
2
Weak

3
Adequately

4
Strong

5
Very Strong

FAMILIES

1
Very weak
2
Weak

3
Adequately

4
Strong
5
Very Strong

86
The mission of the Department of Counseling and Family Sciences embodied wholeness
of care and respect for human diversity.

Do you feel that the mission was addressed throughout the program?
1
Very weak
2
Weak
3
Adequately
4
Strong
5
Very strong

How would you say it has been for you to have the mission of the department interweave
throughtout the curricula?

1
Very weak
2
Weak
3
Adequately
4
Strong
5
Very strong

How do you rate the overall strength of the Counseling and Family Therapy program?

1
Very weak
2
Weak
3
Adequate

4
Strong

5
Very Strong

Please make any suggestions that you believe could improve the program.

Would you be interested in joining the Department of Counseling and Family Sciences
Alumni Association?
# Yes: # No:

Would you like information regarding on-campus workshops/seminars? Yes: No:

The following information is voluntary, but would be helpful for accreditation purposes
or sending the information you requested above.

Age:________________ Gender:_________________ Marital
Status:__________________

Ehnicity: Native American Black/Non-Hispanic Hispanic
Alaskan Native White/Non-Hispanic Asian/Pacific
Islander
Other (Please specify): ______

Name:

87
Address:

Home Phone: Work Phone:
__________________________

Employer:
________________________________________________________________

Employer Address:
_________________________________________________________

Thank you very much for your cooperation in completing this survey.

88
APPENDIX W

Counseling and Family Sciences Clinic

1686 Barton Road
Redlands, California 92373
Phone: (909) 558-9500
About the CFS Clinic

Loma Linda University Counseling and Family Sciences (CFS) Clinic, formerly known as
the Marriage and Family Therapy (MFAM) Clinic, is operated by the Department of
Counseling and Family Sciences, a program within School of Behavioral Health. The
marriage and family therapy program is accredited by the Commission on Accreditation of
Marriage and Family Therapy Education (COAMFTE), a division of the American
Association for Marriage and Family Therapy (AAMFT).

The Clinic is located on the second floor of the Loma Linda University Behavioral Health
Institute (BHI) as one of the participating academic clinics. The BHI is an innovative
endeavor undertaken by Loma Linda University to offer community members easy access
to all behavioral health disciplines in one location. The second floor is the location for an
integrated, interdisciplinary clinic staffed by students and residents from the psychiatry,
psychology, social work, and counseling and family sciences programs.
The Clinic is staffed by master's- and doctoral-level therapists, interns, and trainees.
Appointments with faculty are available on a limited basis. Therapists at the Clinic
89
are supervised by licensed marriage and family therapists, who have qualified as
AAMFT-approved supervisors and most of whom teach in the marriage and family
therapy program.
Clinic Mission Statement
The Loma Linda University Counseling and Family Sciences Clinic is a team of
professionals in mental health functioning within the mission of the University, "To
Make Man Whole." A holistic approach refers to relating to complete systems
rather than to the analysis of, treatment of, and disse ction into parts. Therefore, we
are concerned with understanding people at the micro level (biological,
physiological) and macro level (family, social, spiritual). Included in our endeavors
of holistic care are professors, administrators, supervisors, medical personnel,
credentialed family therapists, and therapists in training.
Our Focus
1. To provide high quality individual, group, marital, couple, and family therapy to the
people of the greater Inland Empire.
2. To commit to excellent training for students within the disciplines of counseling and
family sciences.
3. To act collaboratively with community professionals to provide the most
comprehensive understanding and care for clients.
4. To develop research methods and findings which will contribute to the field of family
therapy, mental health, and intersections of holistic care.
Clinic fees
Clients at the Loma Linda University Counseling and Family Sciences Clinic pay for
services on a sliding-scale fee basis. You fee is based on your income and ability to pay.
The Clinic does accept Risk Management for those employed by Loma Linda University.

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