Allow me to introduce myself; my name is Spencer Fox and I get to sign my name Spencer Fox, LMFT on all sorts of documents. That little LMFT after my name stands for Licensed Marriage and Family Therapist. This describes what I get to do every day, but often confuses people as to the exact nature of my work.

My hope is that this article will demystify those four little letters and help you to understand how I or another licensed marriage and family therapist could help you navigate life’s challenges and curve balls.

Perhaps we should zoom in on the last word first, “therapist.” People often wonder, “What’s the difference between counseling and therapy?” For me, the words are almost entirely interchangeable. Sometimes I say I’m a counselor, but usually, I say I am a therapist.

Broadly speaking, there isn’t much of a differenc between (psycho) therapy and counseling, but the distinction lies in who gets to use the title. Many counseling positions in the mental health field which are available to individuals holding bachelor degrees are called.

I held the position of “house counselor” right after my undergraduate studies. These positions usually involve some monitoring of and talking through current situations that clients and /or patients are experiencing. However, traditional counseling and therapy are usually done by individuals holding a master’s level degree.

This is where I fit in now. I have a Master’s of Science in Marriage and Family Therapy. This means I get to call myself a therapist, but I really don’t mind if you call me your counselor, too. Beyond just finishing the degree, however, there is a process of licensure.

In most states, there is a three-step process to licensure. First, you participate in a clinical internship providing therapy under close supervision while you are still in your program. After your education, you can begin your licensure process.

Here in Washington, you are eligible to be a Licensed Marriage and Family Therapy Associate (LMFTA) right out of your MA or MS program. This means you get to provide therapy but are still responsible and accountable to a supervisor.

After a minimum of two years and a lot of hours of therapy and work, you can take the national exam (think of “passing the bar” for lawyers), and upon completion of the time and passing the test you get to move into full licensure. This is what I hold as an LMFT. At all of these levels, therapy and counseling are provided.

So what about those other words? Do I only work with married couples and families? In short, no. Licensed marriage and family therapists provide a type of counseling that is actually much broader than the name implies. Licensed marriage and family therapists are concerned with what we call “systems,” which are any groupings of people.

Even if you have been completely cut off from all family, you are still in some ways connected to them through your history. Everyone is a part of such a system! I believe it would be more appropriate to call ourselves “System Therapists,” but that sounds much less inviting than marriage and family therapists.

We work with couples, families, and individuals. Usually, about three quarters of my caseload at any point is comprised of just individuals. What is different is how we think and connect things to larger systems. Further, we are also very comfortable engaging with your family as well! For many, change in life patterns is solidified when the larger family or system can be involved. It’s hard to stay an ice cube when you’re sitting out in the sun, so we need to change your environment!

So call it counseling, call it therapy, call me whatever you want to, but get the ball rolling and start the process! You might be wondering what the process of working with a licensed marriage and family therapist looks like. For many, just starting the process of therapy can be daunting and produce anxiety of its own.

It might seem a strange place to be. You may think, “Is it like the movies? Will he have a clipboard? Will he wear a cardigan? Will I lay down on a couch? What am I supposed to do once I get there? Will he smell weird?” These are all perfectly legitimate questions!

Every therapist is going to have their own bent. Most won’t have you lay down while the therapist is out of view (a la Freud), but will probably have a fairly comfortable place for you to sit and just talk. The initial session is more like an interview, where the therapist will lead the conversation and just work towards getting to know you.

Obviously they will ask what is going on that brought you in, but they will probably look to explore what your strengths are and what is already going well. In some ways, it’s like a first date just trying to get to know each other and see how each other thinks!

Also like a date, if you don’t like the therapist you are in no way obligated to continue. It should feel comfortable and be a good fit, so it may take sitting with a couple therapists to find one that you feel you can trust and get the help and support you need.

After the initial interview, you will begin more of the actual “treatment” phase. Usually, this begins with setting goals, maybe figuring out some smaller steps, then working through how to get you there. Perhaps there are things from your past that need to be worked through, so a lot of this will feel like a conversation.

Over time, you will begin to develop a relationship with your therapist and they can help you through whatever comes up and any new goals you may set for yourself. For many, the thought of engaging in a long process seems daunting and overwhelming.

However, there is a lot of research out there that suggests that most people make significant progress toward their goals in just the first four sessions! Since most people come weekly, that’s just a month of therapy to significantly improve your life!

When working with a licensed marriage and family therapist, there are no right or wrong goals. Perhaps you are coming in with your spouse to work on communication. That is one of the most common things I hear in couple’s counseling! Perhaps there has been infidelity or just a lack of relationship in general; both of these often bring couples in. While this hurts so much, the sooner you can begin working on healing the better.

For families, often major dysfunction exists and I see them come in when they feel the fabric of the family simply falling apart. Working on this will mean bringing everyone in and learning to listen and work with each other. Licensed marriage and family therapists are trained to de-escalate shouting matches and direct those towards more positive communication. In short, there is no wrong reason to reach out to a marriage and family therapist.

So if you’re considering therapy, for any reason, I encourage you to reach out soon. The time commitment is not large, the risk is small, and the benefits are huge. Licensed marriage and family therapists can help you through any sort of life predicament you have found yourself in, or learn to cope with any potential mental health problem you are experiencing.

If after reading this you still have reservations, ask a friend who has been through counseling what it is like. I’m sure you can find someone, and hearing from firsthand experience can really help you to feel more comfortable. Start your process today!

“Chat”, Courtesy of Mentatdgt,, CC0 License; “Lovers”, Courtesy of Luizclas,, CC0 License; “Jumping”, Courtesy of Agung Pandit Wiguna,, CC0 License; “Bound by Light”, Courtesy of Anastasiya Lobanovskaya,, CC0 License


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