I’m a licensed marriage and family therapist, which is a surprisingly confusing job title.
People sometimes assume I spend my days helping married couples stop arguing about the dishwasher. And while I do work with couples (and the dishwasher does occasionally make an appearance), much of my practice involves people who come to therapy entirely on their own.
Some are struggling with depression or anxiety. Some are processing trauma. Some are trying to figure out why they keep repeating patterns they swore they’d never repeat. Others are young adults trying to make sense of themselves and their place in the world.
And about half the couples I work with aren’t married at all.
So what exactly is a marriage and family therapist? How is an LMFT different from a psychologist, a licensed professional counselor, or a clinical social worker? And why might you choose one if you’re not having any particular problems with your marriage or family?
I’m glad you asked.
First, what does LMFT actually mean?
LMFT stands for Licensed Marriage and Family Therapist. We’re licensed mental health professionals trained to assess, diagnose, and treat mental health conditions. We provide psychotherapy to individuals, couples, and families.
The name is a little unfortunate, because it makes it sound as though we specialize in a particular kind of client when, in fact, our training emphasizes a particular way of understanding people.
Marriage and family therapy is rooted in something called systems thinking. This means we recognize that people are part of relationships and families in which everyone influences one another.
Sometimes a behavior that’s causing one person considerable distress is also helping keep things running smoothly for everyone else. For example, someone who has always been the peacemaker in their family may struggle with anxiety and resentment, but when they finally begin speaking up for themselves, everyone else may become uncomfortable. The old pattern wasn’t healthy for that person, but it was familiar and worked for the family in certain ways.
Understanding these dynamics can help us recognize why change is sometimes so difficult, even when it’s good for us.
This doesn’t mean we believe everything is your mother’s fault. (Although I understand why you might have wondered.)
It means we’re interested in understanding not only what’s happening inside you, but also the relationships and patterns that may be shaping your experience.
But what if I’m just depressed? Do I really need a family therapist?
You absolutely might.
Let’s imagine you’ve come to therapy because you’re depressed. You’re exhausted, you’ve lost interest in things you used to enjoy, and you spend a remarkable amount of time telling yourself you’re not doing enough.
An LMFT is trained to assess and treat depression. Depending on their additional training and therapeutic approach, they might use cognitive behavioral therapy, EMDR, Internal Family Systems, or any number of other therapeutic approaches.
But their relational training might also lead them to wonder about some other things.
What did you learn growing up about being successful? What happened when you disappointed someone? Was there room in your family for sadness, anger, or vulnerability? Did you learn that being loved meant being useful, agreeable, or exceptionally good at everything?
And what about your relationships now? Do you feel responsible for everyone else’s happiness? Do you find it difficult to ask for help? Do you withdraw when you’re struggling because you don’t want to burden anyone?
None of these questions requires your family to come to therapy.
And none of them assumes that your depression was caused by your relationships. Depression is complicated. Biology, genetics, life circumstances, physical health, and many other factors can contribute.
But our relationships often influence how we experience distress, what we believe about ourselves, and how we respond when life becomes difficult.
You can come to therapy entirely by yourself and still bring a lifetime of relationships into the room.
That’s something marriage and family therapists are particularly trained to notice.
Wait. My friend’s marriage and family therapist does EMDR. Isn’t that something different?
Yes! And no.
One of the confusing things about psychotherapy is that we have professional licenses, theoretical orientations, and treatment methods, and they’re not all the same thing.
Your license tells people something about your graduate education, supervised clinical training, and professional qualifications.
Your theoretical orientation describes how you understand psychological difficulties and what helps people change.
And your treatment methods are the specific approaches you use to help people.
For example, I’m an LMFT, but much of my individual work draws from Internal Family Systems (IFS), a therapeutic approach that helps people understand and relate differently to the various parts of themselves. I also use EMDR to help people process trauma.
Other marriage and family therapists might primarily practice cognitive behavioral therapy (CBT), psychodynamic therapy, emotionally focused therapy, or other approaches.
These aren’t contradictions.
My MFT training helps me remain curious about the relationships and experiences that have shaped someone’s internal world, even when we’re doing work that focuses primarily on their thoughts, emotions, memories, or nervous system.
And this works in the other direction, too. Psychologists, professional counselors, and clinical social workers can all have extensive training in family systems, attachment, and relational therapy.
There’s a great deal of overlap between the professions.
So how is an LMFT different from other therapists?
There are several paths to becoming a licensed psychotherapist, and they come with somewhat different educational traditions.
Marriage and family therapists receive specialized training in relationships and family systems. Licensed professional counselors (LPCs) have a strong foundation in mental health counseling and human development. Licensed clinical social workers (LCSWs) are trained to consider how people’s lives are affected by their social environments, communities, and access to resources. Clinical psychologists generally complete doctoral programs with additional training in psychological science, research, and assessment.
These are meaningful differences, but there’s also a tremendous amount of overlap. Therapists from all four professions can treat depression, anxiety, trauma, and other mental health concerns. And all four can specialize in individual, couples, or family therapy.
You might reasonably wonder whether a psychologist, with all those additional years of education, would automatically be a better therapist.
Not necessarily. That additional training can be especially valuable if you need comprehensive psychological testing or a specialized diagnostic evaluation. But when it comes to psychotherapy, years of schooling are only part of the picture. Experience, specialized training, clinical skill, and the relationship you develop with your therapist matter enormously.
I’ve known extraordinary therapists from all these professions. I’ve also known therapists whose impressive credentials didn’t necessarily translate into being the right fit for every client.
The letters after someone’s name tell you something about how they were trained. They don’t tell you everything about how they’ll work with you.
So how do I actually choose a therapist?
I wouldn’t recommend choosing a therapist based solely on the letters after their name.
If you’re drawn to the idea of understanding yourself in the context of your relationships, an LMFT might be a wonderful fit. But plenty of therapists with other licenses work from a similar perspective, just as plenty of LMFTs have developed expertise in other therapeutic approaches.
The more important question is whether a particular therapist is a good fit for you.
Have they worked extensively with the issues you’re bringing to therapy? What approaches do they use, and how do they understand the process of change? Do they have additional training in the kind of treatment you might need?
And perhaps most importantly, how do you feel when you talk with them?
Do you feel listened to? Are they curious about your experience rather than quick to tell you what’s wrong with you? Can they help you notice things you hadn’t considered before? Do you feel comfortable enough to disagree, ask questions, or tell them when something isn’t working?
Therapy isn’t always comfortable, of course. Sometimes the most important conversations are the ones we’d rather avoid. But a good therapeutic relationship should make it possible to approach difficult things with increasing honesty, curiosity, and compassion.
The goal isn’t to find the person with the most letters after their name. It’s to find someone whose training, experience, and way of working can help you understand yourself and make meaningful changes in your life.
And if that person happens to be a marriage and family therapist, don’t worry.
You don’t have to be married.
You don’t have to bring your family.
And I promise we don’t have to talk about the dishwasher.
