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Washington Marriage & Family Therapy — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Licensed Marriage and Family Therapist

Full independent marriage and family therapy license. Status changes and the enhancement modify this underlying license rather than create an unsupported separate license identity.

Licensing authority: Washington State Department of Health, Secretary of Health · Application information

Licensure by substantially equivalent credentials under RCW 18.225.140(1)
AMFTRB Marital and Family Therapy National Examination
Application
Completed Department application, applicable fees, official transcripts, verification of other credentials, personal data questions and required state or national background checks; denial or conditional issuance remains subject to the Uniform Disciplinary Act.
Continuing Education
Applicable continuing education and suicide-prevention training requirements under WAC 246-809-630 and 246-809-615; qualifying recent suicide training may defer the first requirement for six years.
Current Experience Rule
WAC 246-809-130(1), effective October 1, 2025, deems an applicant with an active out-of-state MFT license for the past year and no disciplinary record or disqualifying criminal history to have met the supervised-experience requirement. The pinned Department page instead describes a five-year documentary exception and five years of supervisor experience; the current statute and rule govern.
Education
Master or doctoral program in marriage and family therapy or an approved allied or behavioral-science equivalent under RCW 18.225.090(1)(c)(i) and WAC 246-809-120 and 246-809-121. Equivalent coursework totals 45 semester or 60 quarter credits; at least 27 semester or 36 quarter credits in the first five specified study areas. AAMFT clinical membership satisfies the rule education standard with direct verification. Foreign degrees require translated and evaluated transcripts under WAC 246-809-096(2).
Examination Verification
Passing AMFTRB score must be verified directly to the Department. A currently offered examination already passed remains the route examination; the time of passing does not remove it.
Experience
At least 3,000 supervised hours, including 1,000 direct client hours with 500 diagnosing and treating couples and families; 200 supervision hours including 100 with an LMFT with at least two years clinical experience and 100 one-on-one. COAMFTE master program credit is 500 direct client hours and 100 qualified supervision hours. Qualifying substance use disorder practice for three of the preceding ten years reduces total hours to 2,700 while other minima remain.
Minimum Age
At least 18 years of age under RCW 18.225.010(2).
Telemedicine
Professionals providing telemedicine services must complete the required telemedicine training as stated in the Department licensing requirements.
Waiver Discretion
The Secretary may issue without examination if credentialing standards are substantially equivalent. RCW 18.225.140(1) permits a waiver; WAC 246-809-140 still identifies AMFTRB for full licensure. The examination is retained and any individual waiver is a condition.
Licensure with mandatory waiver under RCW 18.130.077
No examination is required for this applicant pathway.
Department Instructions
The Department out-of-state page requires current licensure and describes review of the original licensing jurisdiction and universal-licensure history. Its broader statement of no history of discipline is an implementation demand; the statutory two-year standard governs.
Disciplinary Eligibility
No grounds for denial or conditional issuance; no disciplinary action for unprofessional conduct or impairment in the preceding two years or while application is pending; no pending investigation or charges.
Licensure
Credentialed in substantially equivalent jurisdictions for at least two immediately preceding years; no interruption longer than 90 days.
Waiver
Education, training, experience and exam requirements shall be waived under RCW 18.130.077(1).

Official no-examination sources

Effective from 2026-09-22.

Return to active status after expiration of three years or more
No examination is required for this applicant pathway.
Activation
Comply with the applicable subsection of WAC 246-12-040(3): late penalty and renewal fees, reissuance fee and abbreviated application where required, declarations and required current or two-year continuing competency documentation.
Associate Declaration
An associate must submit an updated declaration of working toward full licensure. RCW 18.225.145(6)(b) treats a nonrenewal caused by the former six-renewal limit as expiration, allowing standard activation.
Expiration
three years or more. Do not practice until active status is restored.
Extended Lapse
For a lapse longer than three years RCW 18.225.150 requires demonstration of competence through continuing education or other Secretary-determined standards; WAC 246-12-040(3)(c) permits other competency requirements but identifies no examination.

Official no-examination sources

Effective from 2026-09-22.

Return to active status after expiration of more than one renewal cycle but less than three years
No examination is required for this applicant pathway.
Activation
Comply with the applicable subsection of WAC 246-12-040(3): late penalty and renewal fees, reissuance fee and abbreviated application where required, declarations and required current or two-year continuing competency documentation.
Associate Declaration
An associate must submit an updated declaration of working toward full licensure. RCW 18.225.145(6)(b) treats a nonrenewal caused by the former six-renewal limit as expiration, allowing standard activation.
Expiration
more than one renewal cycle but less than three years. Do not practice until active status is restored.
Extended Lapse
For a lapse longer than three years RCW 18.225.150 requires demonstration of competence through continuing education or other Secretary-determined standards; WAC 246-12-040(3)(c) permits other competency requirements but identifies no examination.

Official no-examination sources

Effective from 2026-09-22.

Return to active status after expiration of one renewal cycle or less
No examination is required for this applicant pathway.
Activation
Comply with the applicable subsection of WAC 246-12-040(3): late penalty and renewal fees, reissuance fee and abbreviated application where required, declarations and required current or two-year continuing competency documentation.
Associate Declaration
An associate must submit an updated declaration of working toward full licensure. RCW 18.225.145(6)(b) treats a nonrenewal caused by the former six-renewal limit as expiration, allowing standard activation.
Expiration
one renewal cycle or less. Do not practice until active status is restored.
Extended Lapse
For a lapse longer than three years RCW 18.225.150 requires demonstration of competence through continuing education or other Secretary-determined standards; WAC 246-12-040(3)(c) permits other competency requirements but identifies no examination.

Official no-examination sources

Effective from 2026-09-22.

Return following mandated suspension
No examination is required for this applicant pathway.
Individual Conditions
Case-specific additional requirements are conditions; the general rule identifies no offered examination.
Suspension Order
Meet all requirements in the order; required renewal or return-from-suspension fees, applicable surcharge and continuing competency declarations for the suspension; comply with specific regulatory requirements after more than three years.

Official no-examination sources

Effective from 2026-09-22.

Maintain military status for full MFT credential
No examination is required for this applicant pathway.
Renewal
No ordinary renewal or continuing education required while in military status.
Service
Submit current official service orders with maintenance request; military service continues.

Official no-examination sources

Effective from 2026-09-22.

Maintain inactive military related status for full MFT credential
No examination is required for this applicant pathway.
Eligibility
Service member continues stationed or deployed outside Washington and relationship continues; submit official orders.
Status
No continuing education while in this inactive status; no Washington practice.

Official no-examination sources

Effective from 2026-09-22.

Change to inactive military related status for full MFT credential
No examination is required for this applicant pathway.
Eligibility
Active credential in good standing; spouse or registered domestic partner of an eligible servicemember stationed or deployed outside Washington; provide orders and marriage or partnership certificate.
Status
Written request; no placement fee; no practice while inactive military-related.

Official no-examination sources

Effective from 2026-09-22.

Change to military status for full MFT credential
No examination is required for this applicant pathway.
Eligibility
Active Washington credential valid and in good standing; military or specified uniformed-service membership verified by official service orders.
Status
Written request, no fee, credential stays in force while service continues and allows practice subject to the underlying license limitations.

Official no-examination sources

Effective from 2026-09-22.

Annual full license renewal
No examination is required for this applicant pathway.
Continuing Education
32 hours every two years for full license, including six professional ethics and law hours, two separate professional roles and boundaries hours, health equity every four years and applicable six-year suicide training. Associates complete 16 hours each year, six ethics and law hours every two years, separate professional roles and boundaries training and health equity every four years.
Cycle
Annual renewal on birthday for full license; annual renewal on issue date for associate.
Declarations
Required fee and written declarations or documentation. Associates remain supervised and working toward full licensure.

Official no-examination sources

Effective from 2026-09-22.

Return from military status for full MFT credential
No examination is required for this applicant pathway.
Deadline
Request return within six months of qualifying discharge; late fees otherwise; continuing education resumes after first post-discharge renewal.
Documents
Written status-change notice, official discharge papers, current active renewal fee and any required surcharge.

Official no-examination sources

Effective from 2026-09-22.

Return from inactive military related status for full MFT credential
No examination is required for this applicant pathway.
Deadline
May return at any time; after qualifying discharge, change within six months with official discharge papers; late fees otherwise. Continuing education resumes during following renewal.
Documents
Current active renewal fee and any required surcharge; service or discharge documentation.

Official no-examination sources

Effective from 2026-09-22.

Full licensure with historical supervised experience exemption
AMFTRB Marital and Family Therapy National Examination
Application
Completed Department application, applicable fees, official transcripts, verification of other credentials, personal data questions and required state or national background checks; denial or conditional issuance remains subject to the Uniform Disciplinary Act.
Continuing Education
Applicable continuing education and suicide-prevention training requirements under WAC 246-809-630 and 246-809-615; qualifying recent suicide training may defer the first requirement for six years.
Current Experience Rule
WAC 246-809-130(1), effective October 1, 2025, deems an applicant with an active out-of-state MFT license for the past year and no disciplinary record or disqualifying criminal history to have met the supervised-experience requirement. The pinned Department page instead describes a five-year documentary exception and five years of supervisor experience; the current statute and rule govern.
Education
Master or doctoral program in marriage and family therapy or an approved allied or behavioral-science equivalent under RCW 18.225.090(1)(c)(i) and WAC 246-809-120 and 246-809-121. Equivalent coursework totals 45 semester or 60 quarter credits; at least 27 semester or 36 quarter credits in the first five specified study areas. AAMFT clinical membership satisfies the rule education standard with direct verification. Foreign degrees require translated and evaluated transcripts under WAC 246-809-096(2).
Examination Verification
Passing AMFTRB score must be verified directly to the Department. A currently offered examination already passed remains the route examination; the time of passing does not remove it.
Experience
At least 3,000 supervised hours, including 1,000 direct client hours with 500 diagnosing and treating couples and families; 200 supervision hours including 100 with an LMFT with at least two years clinical experience and 100 one-on-one. COAMFTE master program credit is 500 direct client hours and 100 qualified supervision hours. Qualifying substance use disorder practice for three of the preceding ten years reduces total hours to 2,700 while other minima remain.
Historical Application
WAC 246-809-100 applies only to an application submitted by July 1, 2010 and five consecutive years of good-standing registered counselor credentialing since obtaining the approved master degree. It deems the supervision standard met but expressly retains education and AMFTRB examination requirements. This is a historical application condition, not a currently open filing window.
Minimum Age
At least 18 years of age under RCW 18.225.010(2).
Telemedicine
Professionals providing telemedicine services must complete the required telemedicine training as stated in the Department licensing requirements.
Initial licensure by examination
AMFTRB Marital and Family Therapy National Examination
Application
Completed Department application, applicable fees, official transcripts, verification of other credentials, personal data questions and required state or national background checks; denial or conditional issuance remains subject to the Uniform Disciplinary Act.
Continuing Education
Applicable continuing education and suicide-prevention training requirements under WAC 246-809-630 and 246-809-615; qualifying recent suicide training may defer the first requirement for six years.
Current Experience Rule
WAC 246-809-130(1), effective October 1, 2025, deems an applicant with an active out-of-state MFT license for the past year and no disciplinary record or disqualifying criminal history to have met the supervised-experience requirement. The pinned Department page instead describes a five-year documentary exception and five years of supervisor experience; the current statute and rule govern.
Education
Master or doctoral program in marriage and family therapy or an approved allied or behavioral-science equivalent under RCW 18.225.090(1)(c)(i) and WAC 246-809-120 and 246-809-121. Equivalent coursework totals 45 semester or 60 quarter credits; at least 27 semester or 36 quarter credits in the first five specified study areas. AAMFT clinical membership satisfies the rule education standard with direct verification. Foreign degrees require translated and evaluated transcripts under WAC 246-809-096(2).
Examination Verification
Passing AMFTRB score must be verified directly to the Department. A currently offered examination already passed remains the route examination; the time of passing does not remove it.
Experience
At least 3,000 supervised hours, including 1,000 direct client hours with 500 diagnosing and treating couples and families; 200 supervision hours including 100 with an LMFT with at least two years clinical experience and 100 one-on-one. COAMFTE master program credit is 500 direct client hours and 100 qualified supervision hours. Qualifying substance use disorder practice for three of the preceding ten years reduces total hours to 2,700 while other minima remain.
Minimum Age
At least 18 years of age under RCW 18.225.010(2).
Telemedicine
Professionals providing telemedicine services must complete the required telemedicine training as stated in the Department licensing requirements.
Recognition of covered MFT license under military portability
No examination is required for this applicant pathway.
Covered License
Good-standing license with no revocation, imposed discipline, pending unprofessional-conduct investigation or voluntary surrender while under such investigation; comply with Washington scope and practice requirements.
Nature
The covered license is recognized as valid in Washington; this is federal recognition of an existing license, not an invented additional state license.
Relocation
Servicemember or spouse relocates residence to Washington because of military orders; submits military orders, spouse marriage certificate if applicable, and the notarized affidavit specified by 50 U.S.C. 4025a(c); background check may be conducted.
State Form Demand
DOH 670-265 March 2025 page 2 states: "Have actively used the covered license or certificate during the two years" followed by "immediately preceding the move to the state of Washington." It also says the recognition lasts for the duration of military orders. Those are demands from the state implementation form quoting the superseded statute; current 50 U.S.C. 4025a amended December 23, 2024 supplies the controlling conditions and omits those restrictions.
Temporary Federal License
If recognition cannot be completed during 30 days after application, 50 U.S.C. 4025a(b) permits a temporary license with the same rights and responsibilities; no examination is specified. A state implementation issuance of this additional license is not established here.

Official no-examination sources

Effective from 2026-09-22.

Out of state applicant satisfying ordinary full licensure requirements
AMFTRB Marital and Family Therapy National Examination
Application
Completed Department application, applicable fees, official transcripts, verification of other credentials, personal data questions and required state or national background checks; denial or conditional issuance remains subject to the Uniform Disciplinary Act.
Continuing Education
Applicable continuing education and suicide-prevention training requirements under WAC 246-809-630 and 246-809-615; qualifying recent suicide training may defer the first requirement for six years.
Current Experience Rule
WAC 246-809-130(1), effective October 1, 2025, deems an applicant with an active out-of-state MFT license for the past year and no disciplinary record or disqualifying criminal history to have met the supervised-experience requirement. The pinned Department page instead describes a five-year documentary exception and five years of supervisor experience; the current statute and rule govern.
Education
Master or doctoral program in marriage and family therapy or an approved allied or behavioral-science equivalent under RCW 18.225.090(1)(c)(i) and WAC 246-809-120 and 246-809-121. Equivalent coursework totals 45 semester or 60 quarter credits; at least 27 semester or 36 quarter credits in the first five specified study areas. AAMFT clinical membership satisfies the rule education standard with direct verification. Foreign degrees require translated and evaluated transcripts under WAC 246-809-096(2).
Examination Verification
Passing AMFTRB score must be verified directly to the Department. A currently offered examination already passed remains the route examination; the time of passing does not remove it.
Experience
At least 3,000 supervised hours, including 1,000 direct client hours with 500 diagnosing and treating couples and families; 200 supervision hours including 100 with an LMFT with at least two years clinical experience and 100 one-on-one. COAMFTE master program credit is 500 direct client hours and 100 qualified supervision hours. Qualifying substance use disorder practice for three of the preceding ten years reduces total hours to 2,700 while other minima remain.
Minimum Age
At least 18 years of age under RCW 18.225.010(2).
Out Of State License
An active MFT license held in another jurisdiction for the past year without disqualifying history meets the supervised-experience standard. This route does not invoke the mandatory two-year waiver.
Telemedicine
Professionals providing telemedicine services must complete the required telemedicine training as stated in the Department licensing requirements.
Licensure based on pre July 22, 2001 certification
No examination is required for this applicant pathway.
Prior Certification
Certified under chapter 18.19 RCW with applicable education and experience requirements met before July 22, 2001; eligible without taking the examination under RCW 18.225.130. This grandfather clause has no stated present application deadline.

Official no-examination sources

Effective from 2026-09-22.

Transition from probationary to full license
AMFTRB Marital and Family Therapy National Examination
Application
Completed Department application, applicable fees, official transcripts, verification of other credentials, personal data questions and required state or national background checks; denial or conditional issuance remains subject to the Uniform Disciplinary Act.
Continuing Education
Applicable continuing education and suicide-prevention training requirements under WAC 246-809-630 and 246-809-615; qualifying recent suicide training may defer the first requirement for six years.
Current Experience Rule
WAC 246-809-130(1), effective October 1, 2025, deems an applicant with an active out-of-state MFT license for the past year and no disciplinary record or disqualifying criminal history to have met the supervised-experience requirement. The pinned Department page instead describes a five-year documentary exception and five years of supervisor experience; the current statute and rule govern.
Education
Master or doctoral program in marriage and family therapy or an approved allied or behavioral-science equivalent under RCW 18.225.090(1)(c)(i) and WAC 246-809-120 and 246-809-121. Equivalent coursework totals 45 semester or 60 quarter credits; at least 27 semester or 36 quarter credits in the first five specified study areas. AAMFT clinical membership satisfies the rule education standard with direct verification. Foreign degrees require translated and evaluated transcripts under WAC 246-809-096(2).
Examination Verification
Passing AMFTRB score must be verified directly to the Department. A currently offered examination already passed remains the route examination; the time of passing does not remove it.
Experience
At least 3,000 supervised hours, including 1,000 direct client hours with 500 diagnosing and treating couples and families; 200 supervision hours including 100 with an LMFT with at least two years clinical experience and 100 one-on-one. COAMFTE master program credit is 500 direct client hours and 100 qualified supervision hours. Qualifying substance use disorder practice for three of the preceding ten years reduces total hours to 2,700 while other minima remain.
Minimum Age
At least 18 years of age under RCW 18.225.010(2).
Probationary Status
Holder of a probationary license must resolve education, experience and examination deficiencies identified by the Department; qualifying mandatory waiver under RCW 18.130.077 is recorded in its separate route.
Telemedicine
Professionals providing telemedicine services must complete the required telemedicine training as stated in the Department licensing requirements.
Unidentified Jurisprudential Slot
RCW 18.225.140(2)(b) allows the Department, if appropriate, to require a jurisprudential examination. No currently offered MFT state examination identity is established by that authorization or the implementing WAC 246-809-095; any such individual demand is an applicant condition.
Return from retired active status to full active status
No examination is required for this applicant pathway.
Activation
Written notice, current active renewal fee and any required surcharge; declarations on discipline, voluntary surrender or restrictions, continuing education or competency and other required documents. Satisfy other Department competency requirements if required; no particular examination is named.
Status
Currently retired active marriage and family therapist.

Official no-examination sources

Effective from 2026-09-22.

Return from retired volunteer status to full active licensure
No examination is required for this applicant pathway.
Activation
Follow expired-credential return provisions of WAC 246-12-040 as directed by WAC 246-12-450, including applicable fees, declarations and competency requirements; no particular examination is identified.

Official no-examination sources

Effective from 2026-09-22.

Marriage and Family Therapist Temporary Practice Permit

Temporary permit under the Uniform Disciplinary Act; documentation, national background check and military spouse pathways have their own conditions.

Licensing authority: Washington State Department of Health, Secretary of Health · Application information

Temporary practice permit, background check, ordinary licensure qualifications
AMFTRB Marital and Family Therapy National Examination
Application
Complete license application and fees, credential verification and permit request; supply fingerprints if required.
Background
Awaiting fingerprint-based national background check; state check reveals no Washington criminal record. Permit cannot be renewed, reissued or extended.
Duration
Permit expires on grant of license, decision notice unless explicitly extended, or 180 days after issuance.
Examination
The permit requires underlying full-license qualifications; AMFTRB passage remains identified by WAC 246-809-140 unless an applicable statutory waiver removes it.
Other License
Unrestricted active license in an equivalent jurisdiction; meet profession training, education and practice qualifications; no grounds for denial or pending discipline.
Temporary practice permit, background check, mandatory two year licensure waiver
No examination is required for this applicant pathway.
Application
Complete license application and fees, credential verification and permit request; supply fingerprints if required.
Background
Awaiting fingerprint-based national background check; state check reveals no Washington criminal record. Permit cannot be renewed, reissued or extended.
Duration
Permit expires on grant of license, decision notice unless explicitly extended, or 180 days after issuance.
Other License
Unrestricted active license in an equivalent jurisdiction; meet profession training, education and practice qualifications; no grounds for denial or pending discipline.
Waiver
The applicant also meets RCW 18.130.077(1) and (3): two years equivalent uninterrupted licensure (no interruption over 90 days) and the stated disciplinary conditions; education, training, experience and exam requirements are waived.

Official no-examination sources

Effective from 2026-09-22.

Temporary practice permit pending completion of licensing documentation
No examination is required for this applicant pathway.
Documentation
Permit pending completion of evidence of licensing eligibility and absence of denial or conditional-issuance grounds; statutory scope limitations may apply. Duration is set by regulatory rule, not inferred from an exam version.
Licensing
This permit is issued on verified existing credentials; the ordinary full-license application and any applicable exam waiver are separate routes.
Other License
Licensed in a jurisdiction with substantially equivalent licensing standards, verified as currently licensed and without charges or discipline for unprofessional conduct or impairment.

Official no-examination sources

Effective from 2026-09-22.

Temporary practice permit, military spouse, ordinary licensure qualifications
AMFTRB Marital and Family Therapy National Examination
Application
Complete license application and fees, credential verification and permit request; supply fingerprints if required.
Duration
Permit expires on grant of license, decision notice unless explicitly extended, or 180 days after issuance.
Examination
The permit requires underlying full-license qualifications; AMFTRB passage remains identified by WAC 246-809-140 unless an applicable statutory waiver removes it.
Military Relationship
Military spouse or registered domestic partner relocating on service-member transfer orders to Washington; supply orders and military identification or marriage or partnership documentation.
Other License
Unrestricted active license in an equivalent jurisdiction; meet profession training, education and practice qualifications; no grounds for denial or pending discipline.
Temporary practice permit, military spouse, mandatory two year licensure waiver
No examination is required for this applicant pathway.
Application
Complete license application and fees, credential verification and permit request; supply fingerprints if required.
Duration
Permit expires on grant of license, decision notice unless explicitly extended, or 180 days after issuance.
Military Relationship
Military spouse or registered domestic partner relocating on service-member transfer orders to Washington; supply orders and military identification or marriage or partnership documentation.
Other License
Unrestricted active license in an equivalent jurisdiction; meet profession training, education and practice qualifications; no grounds for denial or pending discipline.
Waiver
The applicant also meets RCW 18.130.077(1) and (3): two years equivalent uninterrupted licensure (no interruption over 90 days) and the stated disciplinary conditions; education, training, experience and exam requirements are waived.

Official no-examination sources

Effective from 2026-09-22.

AMFTRB Marital and Family Therapy National Examination

Provider
Association of Marital and Family Therapy Regulatory Boards (AMFTRB); administered for AMFTRB by Professional Testing Corporation (PTC) at Prometric computer-based testing centers
Format
Computer-based examination of objective multiple-choice questions, each with four alternative answers of which only one is correct; given during a one-week testing window every month; scores on the six domains and the total examination are reported after the window closes
Exam questions
180 multiple-choice items
Time limit
4 hours total testing time
Passing score
Criterion-referenced passing score set on an anchor examination by a modified Angoff method and adjusted across forms by equating; the reported score equals the total number of correct responses
Exam fee
US $370.00 examination fee (includes testing center fees)
Examination outline
  • Domain 01 — The Practice of Systemic Therapy — Tasks related to incorporating systemic theory and perspectives into practice activities, and establishing and maintaining ongoing therapeutic relationships with the client system inclusive of diverse cultural contexts. (16%; 29 items) (16%)
    • 01.01 Conceptualize therapy consistent with the philosophical perspectives of systemic theory.
    • 01.02 Maintain consistency between systemic theory and clinical practice.
    • 01.03 Integrate individual treatment approaches with systemic treatment approaches.
    • 01.04 Integrate multiple dimensions of diversity and social justice theories with systemic treatment approaches.
    • 01.05 Use a systemic perspective to co-create a safe, inclusive, and non-judgmental space.
    • 01.06 Use a systemic perspective to co-create a therapeutic relationship with the client system.
    • 01.07 Use a systemic perspective to understand the complexities inherent in therapeutic interactions (e.g., family homeostasis, self of the therapist).
  • Domain 02 — Assessing, Hypothesizing, and Diagnosing — Tasks related to assessing and conceptualizing the various dimensions of the client system inclusive of diverse cultural contexts, including forming and reformulating systemic hypotheses and diagnosing the client system to guide therapeutic activities and interventions, including use of artificial intelligence (AI) as appropriate. (16%; 29 items) (16%)
    • 02.01 Assess the client system’s verbal and non-verbal communication styles to develop hypotheses about relationship patterns, perceptions, and responses to the reciprocal influence of relational patterns and the presenting issues.
    • 02.02 Assess the mental status of clients.
    • 02.03 Assess historic and current self-injurious behavior, suicidal ideation and intent, and/or homicidal ideation and intent.
    • 02.04 Identify and assess behavioral dynamics, processes, and interactional patterns (e.g., boundaries, roles, rules, alliances, coalitions, and hierarchies) within the client system to determine systemic functioning.
    • 02.05 Formulate and continually assess hypotheses regarding the client system that consider and incorporate diverse contexts.
    • 02.06 Assess appropriateness of potential treatment and therapeutic delivery modalities for the client system.
    • 02.07 Assess environmental factors (e.g., discrimination, gang violence, migration) affecting the client system.
    • 02.08 Assess the client system’s levels of economic, social, emotional, physical, spiritual, and cognitive functioning.
    • 02.09 Assess historic and current effects of substance use disorders on the functioning of the client system.
    • 02.10 Assess historic and current effects of violence or trauma, including vicarious trauma, on the client system.
    • 02.11 Assess historic and current effects of childhood experiences and traumas on the client system.
    • 02.12 Assess historic and current effects of impact of process use disorders (e.g., gambling, internet use, technology use, shopping) on functioning of the client system.
    • 02.13 Assess historic and current effects of sexual functioning on the client system.
    • 02.14 Assess how the developmental and family life cycle stages of the client system impact problem formation, maintenance, and resolution.
    • 02.15 Assess strengths, resources, coping skills, and resilience within and available to the client system.
    • 02.16 Select, administer, review, and/or interpret results of standardized instruments within the therapist’s training, competence, and scope of practice.
    • 02.17 Assess and diagnose clients in accordance with current DSM and ICD diagnostic criteria while maintaining a systems perspective.
    • 02.18 Formulate treatment hypotheses that integrate systemic perspectives, assessment inventories, and diagnostic impressions.
    • 02.19 Assess effects of occupational issues on the client system (e.g., military personnel, workers in geographically dispersed locations, first responders).
    • 02.20 Collaborate with the client system to determine need for evaluation by other professional and community systems.
    • 02.21 Collaborate with professional and community systems as appropriate in making diagnoses and establishing treatment priorities.
    • 02.22 Collaborate with the client system to refer as appropriate based on diagnoses and treatment priorities.
  • Domain 03 — Designing and Conducting Treatment — Tasks related to developing and implementing a course of culturally responsive treatment with the client system, including identifying possible therapeutic models, implementing associated interventions, and treatment planning, including use of artificial intelligence (AI) as appropriate. (17%; 30 items) (17%)
    • 03.01 Evaluate and maintain a quality therapeutic alliance with the client system.
    • 03.02 Establish therapeutic contracts.
    • 03.03 Utilize assessment information to develop a treatment plan that reflects a contextual understanding of the presenting issue.
    • 03.04 Determine relevant short-term goals, long-term goals and objectives for treatment, as well as criteria for successful completion of treatment.
    • 03.05 Identify the client system’s previous and current attempts to resolve the presenting issues.
    • 03.06 Identify members of client and collateral systems involved in resolving issues.
    • 03.07 Develop and monitor ongoing safety plan to address identified safety risks for the client in all therapeutic delivery contexts.
    • 03.08 Engage in therapeutic interventions based on theory and current research and a shared contextual understanding of the client system and presenting issues.
    • 03.09 Clarify with the client system the rationale for selecting therapeutic interventions as appropriate.
    • 03.10 Collaborate with the client system to determine sequence of treatment and identify which members will be involved.
    • 03.11 Develop and monitor recovery-oriented systemic care for treatment of substance use disorders.
    • 03.12 Use genograms and/or family mapping as therapeutic interventions as indicated.
    • 03.13 Facilitate client system change through restructuring and reorganization.
    • 03.14 Collaborate with the client system to identify and explore competing priorities of client issues to be addressed in treatment.
    • 03.15 Assist the client system in developing decision-making, coping, and effective verbal and non-verbal communication skills in their relational contexts.
    • 03.16 Attend to the homeostatic process and its impact on the client system’s ability to attain therapeutic goals.
    • 03.17 Assist the client system in developing alternative perspectives of the presenting issues to facilitate solutions.
    • 03.18 Influence client behavior and perceptions through use of metaphor, rewriting narratives, mindfulness, etc.
    • 03.19 Integrate cultural, spiritual, social, intellectual, and biological characteristics and strengths of the client system when devising effective treatment strategies.
    • 03.20 Recognize and support client autonomy when devising effective treatment strategies.
    • 03.21 Maintain awareness of common side effects of medications, monitor client system for these within the boundaries of professional competence, and coordinate care with any relevant prescribers.
    • 03.22 Adapt therapeutic stance and interventions to accommodate the process and structure of all therapeutic delivery modalities.
  • Domain 04 — Evaluating Ongoing Process and Terminating Treatment — Tasks related to continuously evaluating the therapeutic process, incorporating feedback into the course of treatment, and planning for termination, inclusive of different cultural contexts and use of artificial intelligence (AI) as appropriate. (16%; 29 items) (16%)
    • 04.01 Use theory and current research in the ongoing evaluation of process, outcomes, and termination.
    • 04.02 Evaluate the progress of therapy in collaboration with client and collateral systems as indicated.
    • 04.03 Modify treatment plan in collaboration with client and collateral systems as indicated.
    • 04.04 Continually evaluate client system appropriateness for all therapeutic delivery modalities.
    • 04.05 Develop a termination plan in collaboration with the client and collateral systems to maintain therapeutic gains after treatment has ended.
    • 04.06 Terminate therapeutic relationship in a professional and culturally responsive manner.
  • Domain 05 — Managing Crisis Situations — Tasks related to assessing and managing emergency situations, inclusive of different cultural contexts, and intervening when clinically indicated and/or legally mandated. (16%; 29 items) (16%)
    • 05.01 Assess impairment in the client system during crisis situations to determine if and what immediate interventions may be needed.
    • 05.02 Assess for presence of suicidal ideation and determine the level of intervention.
    • 05.03 Assess for risk of violence toward the client from others to determine the need for intervention.
    • 05.04 Assess the client’s potential for self-injurious behavior to determine level of intervention.
    • 05.05 Assess the client’s potential for violence or harm toward others, including the therapist, to determine level of intervention.
    • 05.06 Assess risk of violence toward therapist from sources outside of the client system and develop a safety plan.
    • 05.07 Assess impact of community-level crisis on client system and develop interventions as they pertain to that crisis.
    • 05.08 Assess the impact of client system’s trauma history and other relevant contextual factors on current crisis.
    • 05.09 Collaborate with other relevant stakeholders in managing client system’s crisis.
    • 05.10 Respond to emerging crisis as appropriate to the therapeutic delivery modality and use relevant crisis resources.
  • Domain 06 — Maintaining Ethical, Legal, and Professional Standards — Tasks related to ongoing adherence to legal and ethical codes and treatment agreements, maintaining culturally responsive competency, upholding professional standards, and utilizing artificial intelligence (AI) in clinical practice. (19%; 34 items) (19%)
    • 06.01 Demonstrate professional responsibility and competence regarding legal issues and regulations across therapeutic delivery modalities, including use of artificial intelligence (AI).
    • 06.02 Compare agency and employment policies with relevant ethics code, statutes, case law, and regulations and privilege the higher standard.
    • 06.03 Integrate current ethical codes of licensing boards, relevant professional organizations, and associations into appropriate professional practice.
    • 06.04 Adhere to relevant business laws related to clinical practice (e.g., Stark Law, Anti-Kickback Statute, False Claims Act, etc.)
    • 06.05 Practice within therapist’s scope of competence.
    • 06.06 Maintain awareness of and effectively manage how the therapist’s personal issues, life experiences, values and morals, and previous trauma impact the therapeutic process.
    • 06.07 Maintain awareness of and effectively manage how the supervisors’ personal issues, life experiences, values and morals, and previous trauma influence the supervisory process
    • 06.08 Adhere to treatment agreements with client systems and respect the rights of clients.
    • 06.09 Provide the client system with written professional disclosures regarding fees, credentials, reporting complaints, confidentiality, privileged communication, and providing technologically assisted services, including use of artificial intelligence (AI), etc.
    • 06.10 Confirm the client system’s identities, locations, and safety levels at the beginning of each teletherapy session.
    • 06.11 Monitor and mitigate risk for potential exploitation of the client system by the therapist.
    • 06.12 Consult with colleagues and other professionals as necessary regarding ethical and legal issues, and document these consultations.
    • 06.13 Respect the roles and responsibilities of other professionals involved in the client system’s treatment process as they relate to ethical and legal issues.
    • 06.14 Maintain accurate and timely records including long-term safe and confidential storage and plan record transfer and/or disposal within timeframes specified by current statutes.
    • 06.15 Adhere to ethical and regulatory guidelines for engaging in the supervisor-supervisee relationship across modalities.
Examination sources