AUSTIN, Texas (CN) – The Texas Occupations Code permits licensed marriage and family therapists to diagnose a client’s emotional, mental and behavioral problems within their expertise, the state’s high court ruled, reversing a lower court.
Justice Jeffrey S. Boyd delivered the court’s Feb. 24 opinion, which reversed an earlier judgment by the Third District Appeals Court in favor of the Texas Medical Association.
The dispute originated with a rule passed by the Texas State Board of Examiners of Marriage and Family Therapists in 1994. According to court records, the rule allowed marriage and family therapists, or MFTs, to provide “[d]iagnostic 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.”
The DSM, which is published by the American Psychiatric Association, is considered the universal system for diagnosing mental health disorders in the United States and much of the rest of the world.
The Therapists Board said the ability to provide diagnostic assessments using the DSM is essential to an MFT’s practice. For instance, the assessments allow MFTs to identify a client’s mental disorder, develop a proper treatment plan, determine eligibility for various services, consult with other health professionals and obtain insurance payments for their services.
However, the Medical Association disagreed, and in 2008 it sued the Therapists Board and its directors in Travis County District Court. It sought declaratory judgment invalidating the rule, claiming that, by permitting MFTs to provide diagnostic assessments, it unlawfully authorized MFTs to practice medicine without a license.
The Therapists Board countered that, while the rule does not permit MFTs to provide a medical diagnosis or any diagnosis beyond their area of expertise, it does authorize them to diagnose some “nonmedical” disorders caused by psychological and social experiences.
These include disorders such as relational dysfunction, adjustment disorder, mood disorder, anxiety disorder, behavioral dysfunction, sexual dysfunction, anorexia, depression, personality disorder and addiction.
In the trial court phase, the sides filed cross-motions for summary judgment on the Medical Association’s declaratory judgment claim. The court ruled in favor of the association and declared the diagnostic-assessment rule invalid because it exceeded the scope of the Therapists Act. The court of appeals then affirmed the ruling 2-1.
In determining the validity of the diagnostic-assessment rule, Justice Boyd first looked at the arguments of the Therapists Board. It claimed 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.”
“Accepting all of that as true, however, we must decide this case based on the relevant Texas statutes, not on whether MFTs are qualified to make DSM diagnoses or whether the DSM or other states’ laws allow them to,” Boyd wrote in a 21-page opinion.
However, since the courts generally presume that agency rules are valid, it is the challenging parties who have the burden of proving invalidity, he said.
The Medical Association did not dispute that MFTs are allowed to make “assessments,” but it disagreed with the addition of the term “diagnostic.”