For many Marriage and Family Therapists (MFTs), accepting insurance is a critical way to make therapy accessible to clients who might not otherwise be able to receive care. But while insurance participation can expand access, it also brings a host of challenges that increasingly strain MFTs and their practices. 
The 2025 MFT Workforce Study reveals the depth of this tension. Seventy-three percent of MFTs report that current insurance reimbursement rates are too low to sustainably support their practice. Yet low rates are only the beginning.
Many clinicians describe inconsistent reimbursement—payments that are delayed, denied, or unpredictable. This instability makes it difficult for practices to plan, grow, or even remain viable, especially for early-career therapists who are already navigating substantial financial pressures.
Layered on top of financial strain is the administrative burden required to stay in compliance with insurance panel expectations. Seventy-four percent of MFTs say the paperwork alone—billing, resubmissions, follow-up calls, and evolving documentation requirements—deters them from joining or remaining on insurance panels. Every hour spent wrestling with paperwork is an hour taken away from direct client care.
Compounding the problem is a structural imbalance: while MFTs are uniquely trained in systemic therapy, couples and family work, and relational dynamics, insurance companies often reimburse individual sessions at higher rates than couple or family sessions. Therapists are left with a difficult choice—provide the relational services they were trained to deliver, or shift their caseloads toward sessions that are more financially feasible.
This misalignment doesn’t only burden therapists. It also limits clients’ access to the forms of systemic care that strengthen relationships, support families, and prevent future mental health crises.
AAMFT is committed to addressing these challenges through policy advocacy, research, and systemic solutions aimed at strengthening the mental health workforce.
Download the full 2025 MFT Workforce Study for additional data insights and to explore the solutions AAMFT is advancing to improve reimbursement, reduce administrative strain, and expand access to systemic care.
