What’s in a title? “Couple” versus “Marriage” and family therapists

Sarah Pflug / Burst / Used under licenseMarriage and family therapists (MFTs) work with individuals, families, and couples of all types. We assess, diagnose and treat the full range of mental and emotional disorders. So, the title “marriage and family therapist” doesn’t provide the whole picture of what we do.

Should the name of the license be changed?

Several MFT programs have changed the name of their degree or even their department to “Couple and family therapy.” This is much more reflective of the broad scope of couples with whom we are trained to work. But there would be major tradeoffs involved in changing the name of the license.

Arguments against a name change

Advocacy work for the profession relies in part on educating legislators and their staff about who MFTs are and what we do, building our reputation and their sense of MFTs’ qualifications. Changing the name of the license would set back our name recognition among those legislators, and require us to start almost from scratch on that process of educating them about what may seem to them to be a brand new profession. It also would mean that a massive number of state and federal laws and regulations would need to be updated with the new name. That process would divert resources away from other ways of advancing the profession.

Educating the public would be equally challenging. Our current title does do a nice job of differentiating our history and philosophy from other mental health licenses. For tens of thousands of clients and referral sources, the confidence they have in seeing or referring to MFTs may be undermined if the license name were to change. (However, many within mental health are quick to say that clients do not care about a therapist’s license type; they only care whether the therapist can help them in their particular circumstances.)

Arguments in favor of a name change

On the other side, there are two arguments to be made in favor of changing the name.

One is essentially the scope of practice argument I raised in the opening paragraph. MFTs do much more work with individuals, couples, and families of all kinds than the name implies. Changing the word “marriage” to “couple” does not fully resolve this, but it steps in the right direction. An even broader title, like “relational therapist,” might do even better at capturing the scope of what MFTs do.

The other argument centers on discrimination. While same-sex couples can now legally marry anywhere in the United States, it’s easy for some to forget that this was a relatively recent development. It was preceded by years of fierce debate (including within the mental health world). During that time, having the word “marriage” in our title, when same-sex couples in many states were not allowed to legally marry, appeared to many to be overtly discriminatory. That’s perhaps less of a concern now that the institution of marriage itself is not discriminatory. Even so, to this day it isn’t unusual for unmarried couples (gay or straight) to wonder whether they will be seen or even accepted by an MFT.

If we had it to do over again, I wish we had started with a different title. I like “relational therapist.” (“Systemic therapist” may be more specific to how we think and work, but the term doesn’t hold much meaning to the general public; “relational” is at least a fairly commonly understood term.) But with the title that we have, I’m not convinced that the major legislative and public-education lift involved in a title change would be worth the cost. We’ve got bigger fish to fry, so to speak. Medicare inclusion and license portability are two areas where our energy can be better spent. A title change can come later… or not. If your clients believe you can help them, they aren’t likely to much care what the letters after your name stand for.

This article was originally published July 25, 2009. Revised and republished May 9, 2018.