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Form 08-4252 - Application To Become An Approved Marital And Family Therapy Supervisor

State of Alaska

Department of Commerce, Community and Economic Development

Division of Corporations, Business and Professional Licensing

BOARD OF MARITAL AND FAMILY THERAPY

State Office Building, 333 Willoughby Avenue, 9

Floor

PO Box 110806, Juneau, AK 99811-0806

Phone: (907) 465-5470  Fax: (907) 465-2974  E-mail: license@alaska.gov

Website:

APPLICATION TO BECOME AN APPROVED

MARITAL AND FAMILY THERAPY SUPERVISOR

In accordance with AS 08.63.120, a person may not supervise an associate marital and family therapist unless approved

by the board to be a supervisor.

If you have questions concerning the admission requirements, please contact the licensing examiner at (907) 465-2551.

The board will approve a licensed marital and family therapist to provide supervision to an associate marital and family

therapist upon submission of the following information.

1. A complete notarized application.

2. Proof that you are currently licensed to practice marital and family therapy in this state.

3. Proof that you have practiced marital and family therapy for at least five continuous years. In accordance with

AS 08.63.900(5), the practice of marital and family therapy means:

the diagnosis and treatment of mental and emotional disorders that are referenced in the standard diagnostic

nomenclature for marital and family therapy, whether cognitive, affective, or behavioral, with the context of

human relationships, particularly marital and family systems, marital and family therapy involves:

(A) the professional application of assessments and treatments of psychotherapeutic services to

individuals, couples, and families for the purpose of treating the diagnosed emotional and mental

disorders; and

(B) an applied understanding of the dynamics and marital and family interactions, along with the

application of psychotherapeutic and counseling techniques for the purpose of resolving intrapersonal

and interpersonal conflict and changing perceptions, attitudes, and behaviors in the area of human

relationships and family life.

4. Documentation of having completed at least six contact hours of education related to the practice of supervising a

marital and family therapist within the last two years.

GENERAL INFORMATION

Licensees must adhere to the requirements for license renewal and continuing education found under Article 2 of 12 AAC

19.210(b) and Article 3 of 12 AAC 19.300-.340.

08-4252 (Rev. 04/10/13)

Form 08-4252 - Application To Become An Approved Marital And Family Therapy Supervisor