Can an LMFT diagnose in New York or California?

New York: what “diagnosis” means

“‘Diagnosis’ means the process of distinguishing, beyond a general assessment, between similar mental, emotional, behavioral, developmental, and addictive disorders, impairments, and disabilities within a psychosocial framework on the basis of their similar and unique characteristics consistent with accepted classification systems” (Education Law §8401).

New York: the privilege

• Licensed and registered as an LMFT
• A master's of at least 60 semester hours, with 12 semester hours of clinical courses; a degree without them can be completed with equivalent post-graduate courses
• At least 2,000 hours of supervised, direct client contact including diagnosis, psychotherapy and the development of assessment-based treatment plans
• $175 to apply, and $175 each time you renew it, with your registration every three years (Education Law §8401-a, in effect since June 24, 2024)
• Holders get a “D” before their license number on future registration certificates, and the privilege shows on NYSED's verification site

The New York LMFT diagnostic privilege: the “D”, 60 credits and 2,000 hours

Diagnosing without the privilege

“A mental health counselor, marriage and family therapist or psychoanalyst who engages in diagnosis and the development of assessment-based treatment plans without a privilege may be charged with professional misconduct” (§8401-a(2)).

Until June 24, 2027: under supervision in an approved setting

Education Law §8410(11) lets a licensed and registered LMFT without the privilege diagnose and develop assessment-based treatment plans “in a facility setting or other supervised settings approved by the department under supervision”. Chapter 140 of 2025 extended it to June 24, 2027, and NYSED says it extended the diagnostic limited permit to the same date.

Licensed before June 24, 2024

Instead of the 2,000 hours, a supervisor in a facility or other supervised setting NYSED approves can attest that you have at least three years of direct client contact that included diagnosis, psychotherapy and assessment-based treatment planning (§8401-a(1)(d)(ii)). The statute asks that the application be submitted within three years of June 24, 2024; NYSED says to “meet all requirements by June 24, 2027.” Finish everything by June 24, 2027.

What any New York LMFT may do

• Assess and treat nervous and mental disorders, whether affective, cognitive or behavioral, that result in dysfunctional interpersonal family relationships: the LMFT scope (§8403(1))
• Use accepted classifications of signs, symptoms, dysfunctions and disorders, such as the DSM, in the practice of marriage and family therapy (8 NYCRR 79-10.5); that isn't the privilege
• Without the privilege, an LMFT treating a serious mental illness on a continuous and sustained basis needs a physician's medical evaluation of the illness and consultation (§8407(1))

California: no separate privilege

California's law has no separate diagnosis credential for LMFTs. The scope of practice is to “assess, evaluate, and treat relational issues, emotional disorders, behavioral problems, mental illness, alcohol and substance use”, and it includes “Assessment, evaluation, and prognosis” (B&P §4980.02).

Does California's law use the word “diagnose”?

Not in the scope of practice, and we haven't found a Board page that says “LMFTs may diagnose” in those words. But diagnosis runs through the rest of the law: the degree must include “Diagnosis, assessment, prognosis, treatment planning, and treatment of mental disorders” (§4980.36), the required hours include “not less than 500 total hours of experience in diagnosing and treating couples, families, and children” (§4980.43(c)(8)), and 11% of the LMFT Clinical Exam is “Developing a Diagnostic Impression”.

The California LMFT Clinical Exam: format, cost, eligibility and retakes