Reversing the previous decision of a lower court, the Texas Supreme Court ruled that under the Texas Occupations Code, licensed family and marriage therapists can diagnose the mental, behavioral, and emotional problems of their clients, provided their assessment falls under their expertise. Among other things, the decision allows family and marriage therapists to provide diagnostic assessments to couples going through a divorce, or spouses with troubled marriages.
Justice Jeffrey S. Boyd delivered the High Court’s decision on February 24, reversing an earlier ruling by the Third District Appeals Court done in favor of the Texas Medical Association.
The decision originates from a 1994 rule passed by the Texas State Board of Examiners of Marriage and Family Therapists, which permitted marriage and family therapists (MFTs) to offer “diagnostic assessment which utilizes the knowledge organized in the Diagnostic and Statistical Manual of Mental Disorders (DSM)…as part of their therapeutic role to help individuals identify their emotional, mental, and behavioral problems when necessary.”
Curated and published by the American Psychiatric Association, the DSM is the universal reference system for diagnosing mental health disorders in the U.S. and in many countries around the world. According to the Therapists Board, the ability to conduct diagnostic analyses through the DSM is at the heart of an MFT’s practice and services.
For example, diagnostic assessments play a crucial role in an MFT’s ability to:
Diagnose a client’s mental health problems
Develop a plan of treatment
Determine suitable treatment services
Provide recommendations to treatments with other health professionals
In 2008, the Medical Association disagreed with the rule and sued the Therapists Board and its directors. In its push for a court to invalidate the rule, the Association argued that allowing MFTs to conduct diagnostic assessments also allowed them to practice medicine without a medical license.
But the Board argued the rule specifically prohibits MFTs to provide medical diagnoses, or any other kind of diagnoses, outside their expertise. Rather, it permits MFTs to diagnose a number of nonmedical mental disorders related to psychological issues and experiences, such as, but not limited to:
The Travis County District Court ruled in favor of the Medical Association, invalidating the diagnostic-assessment rule on the grounds of exceeding the scope of the Therapists Act.
The Texas Supreme Court, however, saw otherwise. Justice Boyd considered the arguments raised by the Therapists Board, particularly the claim that the appeals court decision “makes Texas the only state to prohibit Licensed MFTs from performing an integral part of their profession that is essential to their ability to properly treat their clients.”
Boyd also refuted the Medical Association’s claim that the rule allowed MFTs to diagnose all kinds of mental disorders with no limits.
“(T)he rule itself specifically states that MFTs may only make diagnostic assessments ‘as part of their therapeutic role to help individuals identify their emotional, mental, and behavioral problems when necessary.’ Another Therapists Board rule explicitly limits an MFT to services ‘within his or her professional competency,’” the ruling reads.