As MFTs know, our field is of growing importance as an overwhelming number of individuals and families experience psychological distress rooted in relational challenges. Across the world, people are seeking help in therapy rooms and hospital emergency departments, presenting with major depression, suicidal ideation, and the effects of domestic abuse and sexual misconduct. As systemic therapists, we are uniquely equipped to address these issues holistically. Our training encompasses not only the individual aspects of psychotherapy but also the broader contextual dimensions—family of origin, life cycle stages, gender identity and expression, intimate partner violence, adult and child psychotherapy, family dynamics, as well as ethical and legal considerations. Despite this comprehensive expertise, we are too often perceived as suited only for private practice or traditional clinical settings. This raises an important question: why are systemic therapists, with such multifaceted training, not more widely integrated into mainstream hospital and mental healthcare systems?
The sharp practicality and perceived narrowness of the job market hit hard when I applied to several different jobs, including: mental health counselor, mental health therapist, community therapist, research scientist, individual family therapist, research associate, school based therapist, therapist in child care center, care manager, clinical behavioral health therapist, MST therapist, outpatient therapist, clinic based therapist, mental health clinician, research assistant, substance abuse counselor, therapist in geriatric center, senior match maker, college diversity counselor, college counselor, behavioral mental health clinician, and the list goes on.
Despite my consistent interest in hospital-based settings, I have observed significant variability in how MFTs are valued, recognized, and integrated within clinical systems. This process has raised a critical question for me as a clinician and emerging professional: how are MFTs perceived across diverse healthcare and community contexts? And what systemic or institutional factors contribute to the ongoing stereotyping and under-recognition of our professional identity in multidisciplinary environments?
With an NYSED Limited Permit and substantial clinical hours, I have encountered repeated barriers when seeking positions within well-established hospitals in New York City. Despite possessing the competencies and direct experience that align with posted job descriptions, I often receive feedback that my qualifications are insufficient due to not holding a Master’s in Social Work or Mental Health Counseling. This recurring response evokes a critical professional inquiry. What systemic or institutional biases shape the exclusion of MFTs from hospital-based roles, and why is our expertise in relational and systemic practice often confined to community or outpatient settings rather than being recognized as essential within integrated clinical care environments?
These exclusions preclude even the chance to interview, which is an essential step for candidates and employers to assess true fit. One major hospital advertised a willingness to consider MFT-LP applicants but imposed a minimum three-year hospital experience requirement, yet there appears to be no accessible pathway for newly trained MFTs to gain this foundational experience.
This pattern signals deeply rooted stereotypes and systemic oversight about the value of systemic family therapy in acute care and emergency settings. It is especially troubling given the prevalence of relational distress, domestic violence, suicidality, and sexual abuse presenting in emergency departments. While substance use and psychiatric diagnoses consistently capture institutional attention and resources, less recognition is offered to the critical relational dynamics originating in families of origin and marriage, often the source and solution for mental, emotional, and physical health challenges.
Through rigorous training as an MFT student and intern, I have learned that systemic therapy is not ancillary; it is essential. Now, MFTs can hold diagnostic privileges and demonstrable efficiency in assessment, diagnosis, and intervention for complex family and relational issues. Hospital administrators and clinical leaders need to recognize that integrating MFTs into emergency and outpatient departments is not just prudent, it is critical for improving health outcomes and supporting true recovery for the individuals and families most at risk.
It is my hope that the system will change in the near future and that hospital employers will become more aware of MFTs, providing an opportunity to build patients’ relational success with themselves and others, and thereby improve their physical health.
For those wondering what happened with my numerous job applications, at present I have a full-time job at a 150-year-old nonprofit organization and a part-time job at a 65-year-old family therapy institute, both headquartered in Manhattan. I have received other offers as well, which I pass on to others, but most importantly, I have job satisfaction. Each day, I do meaningful work that brings thoughtful change to the lives of many.
We MFTs are fit for so many things!
Deblina Jha, MFT-LP, MBA (she/her), is a student member of AAMFT and a clinical therapist at the Ackerman Institute for the Family, BSFT – The New York Foundling. lifecoachdeblina@gmail.com
AAMFT. (2022). 2022 MFT industry workforce study. https://www.aamft.org/ItemDetail?iProductCode=DL2022MIWS&Category=DR&WebsiteKey=8e8c9bd6-0b71-4cd1-a5ab-013b5f855b01
