Licensed Marriage and Family Therapists (LMFT) vs. Licensed Mental Health Counselors (LMHC)

As a mental health professional, you have a variety of licensure options to pursue depending on your skills and interests. A Licensed Marriage and Family Therapist (LMFT) and a Licensed Mental Health Counselor (LMHC) both practice within the realm of mental health, but have different areas and populations of focus in providing services. Below is a review of the similarities and differences between the two licensures. 

What Is an LMFT?

Licensed Marriage and Family Therapists (LMFTs) are mental health professionals at a master’s level licensure that specialize in treating individuals and families for various psychological and interrelationship issues. They take the lead on the assessment of the presenting issues, diagnosis, treatment planning, and providing appropriate psychological interventions that best fit the presenting problem. LMFTs can work in a variety of clinical settings including hospitals, private practices, in-patient and out-patient settings, and schools. Typically LMFTs enter a treatment relationship with a collaborative treatment goal in mind which is solution-focused, lasting about ten to twelve sessions. The modality of treatment is often approached from a systems perspective and the LMFT and client work collaboratively towards set goals.

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What Is an LMHC?

Licensed Mental Health Counselors (LMHCs) are mental health clinicians that focus on providing psychological therapies to individuals in one-on-one sessions. Treatment focuses are based on clinical and developmental principles that address incongruencies and barriers to healthy personal and social functioning. They are trained in psychological approaches of assessment, diagnosis, treatment planning, and interventions within various therapeutic settings. LMHCs can practice in various settings similar to LMFTs including private practice, hospitals, in-patient and outpatient treatment centers, schools, and rehabilitation centers. The main difference between an LMFT and an LMHC is that LMHCs focus on the individuals’ mental health and functioning, and in order to provide other services (e.g. couples/family therapy) they would have to earn additional training and certification.

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Differences and Similarities Between LMFTs and LMHCs

What does an LMFT do?

LMFTs provide psychological interventions to individuals, couples, and families as they influence each other within a family unit. The goal is to improve the relationships within the unit and help all members find a state of homeostasis within the family, promoting adaptive functioning. The most common work environments of LMFTs according to the Bureau of Labor Statistics (BLS):

• Individual and family services (29%)
• Offices of other health practitioners (24%)
• Self-employed workers/private practice (13%)
• Outpatient care centers (11%)
• State government (excluding education and hospitals) (7%)

What does an LMHC do?

LMHCs have the ability to work with individuals of diverse demographics and primarily focus on clinical treatment centered around an individual’s needs and optimizing mental and emotional health. LMHCs are trained in handling general counseling needs across a variety of issues including trauma, interrelationship issues, substance abuse, and comorbid mental health problems. The specialty is highly clinically based which means LMHCs rarely deal with populations that do not need diagnosis and assessment. Highlighted below are the most common work environments of LMHCs according to the Bureau of Labor Statistics (BLS):

• Outpatient mental health and substance abuse centers (19%)
• Individual and family services (15%)
• Hospitals (10%)
• Residential mental health and substance abuse facilities (9%)
• Government (8%)

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Job Outlook and Salary

With a higher demand for mental health professionals, there has been a growing demand for LMFTs and there is a projected growth of 16% in the next decade according to the Department of Labor Statistics. As of 2021, the median annual pay for MFTs nationally is $49,880, with hourly rates at an average of $24.00 and salaries ranging from $37,050 to $96,520.  

LMHCs have also seen steady growth over the last few years which is projected to increase by 22% over the next decade, much faster than other occupations in the United States. The median annual wage as of 2021 was $48,520 (higher than the national average) with a range of $30,870 – $79,000. 

How to Become an LMFT

The first step to becoming an LMFT is choosing the right program. It is advantageous to look for programs that are accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) or the Council for Accreditation of Counseling & Related Educational Programs (CACREP). This accreditation ensures you would receive the necessary coursework and training while in school, to prepare you for licensure upon graduation. Along with successfully completing the graduate degree, you would also have to pass the state or national licensing examination set by the Association of Marital and Family Therapy Regulatory Boards (AMFTRB). 

As a part of the graduate program, you will be required to complete clinical practicum training. Accruing the required supervised hours is a requirement for licensure and provides you with insight into what sort of work environment you would want to pursue after graduation. The clinical practicum is generally during the final year of your degree. Initial licensure upon graduation will be probationary licensure as an LMFT Associate (LMFT-A). Licensure in this status will last about 18 months or until you accrue 3000 supervised clinical hours, where 1500 would be direct clinical services to patients, and 1500 will be indirect services. 

Upon accruing the 3000 supervised clinical hours, you would then reapply for your final upgraded licensure as an LMFT, at which point you could practice independently without the need for clinical supervision. The AAMFT council is the national entity that governs state boards overseeing MFTs in their specific states. The AAMFT sets the standards and guidelines for licensure, accreditation, ethical guidelines, and information for licensure renewal and maintenance. 

How to Become an LMHC

A Licensed Mental Health Counselor is a licensed individual that has graduated from an accredited institution, completed approximately 3500 hours of supervised clinical experience (depending on the state of licensure) post-graduation, and successfully pass the National Clinical Mental Health Counseling Examination (NCMHCE) to qualify for an LMHC licensure. The National Board for Certified Counselors (NBCC) is the governing body that regulates graduate accreditation, and clinician competence, and sets the guidelines and regulations for licensure-related activities.

The first step in becoming an LMHC is obtaining a bachelor’s degree. While a bachelor’s degree in psychology is not a requirement to pursue a graduate degree in the field, it may provide a good foundation of what to expect in graduate school. Upon obtaining a bachelor’s degree, you would then seek further education with a graduate degree in psychology or clinical mental health (sometimes referred to as an LMHC Degree). It is important that the program is accredited by the CACREP, as it is a requirement for licensure upon graduation.

Upon successful graduation from a master’s program, you would have to accrue approximately 3500 supervised clinical hours to qualify for an LMHC. Then, you would then have to complete the NBCC licensure examination and apply through your state board for initial licensure as an LMHC. Of these supervised clinical hours, at least 1500 would have to be direct clinical treatment hours.

The NBCC provides information on examinations, the procedure for licensure, and resources for state, educational, and supervisory requirements.

Which Suits Me Better?

Practicing as a Licensed Marriage and Family Therapist requires a special skill set that other generally focused specializations do not require. You would enter into a therapeutic relationship with several individuals in the family system and assist with the growth of the family unit and its members simultaneously. An LMFT has the freedom of choosing a work environment that best suits their work style. Further, if you do not wish to have a career in a clinical setting, you have the option of contributing to the field through academia, research, handling judicial cases (such as divorce proceedings and custody assessments), or even taking on a supervisory/training role to other professionals. Professional and personal development opportunities continue to expand within the specialization of MFT, and a career in the field provides significant versatility and flexibility.

A career in counseling offers a generalized approach to assessing, diagnosing, and treating mental health issues across a variety of populations. An LMHC has the flexibility of choosing a work environment similar to the choices of an LMFT. However, LMHCs have a narrower focus on treating individuals with clinical issues and assessments rather than general counseling and mental health needs. 

The biggest difference between an LMFT and an LMHC is that LMFTs have a wider approach and demographic base of treatment focus in comparison to an LMHC which tends to be more clinically focused. The license you pursue will ultimately depend on your skills and academic and career interests.

Resources

American Association of Marriage and Family Therapists
https://www.aamft.org/

Association of Marital and Family Therapy Regulatory Boards
https://amftrb.org/

Bureau of Labor Statistics
https://www.bls.gov/

Commission on Accreditation for Marriage and Family Therapy Education
https://www.coamfte.org/

Council for the Accreditation of Counseling and Related Educational Programs
https://www.cacrep.org/

National Board of Certified Counselors
https://www.nbcc.org/

National Clinical Mental Health Counseling Examination
https://www.nbcc.org/exams/ncmhce

O*Net
https://www.onetonline.org/