The discipline of marriage and family therapy (MFT) has been established around the world. Inspired by theories and models developed in Western countries, professionals in East Asian countries over the last two decades have been dedicated to introducing the concepts of MFT to local mental health professionals. This paper presents an overview of the cultural background of East Asian cultures, a summary of MFT development in East Asia, and a discussion of key challenges to advancing MFT in East Asia. We provide recommendations to overcome these obstacles, including bridging the gap between MFTs in the West and East Asia, developing country-specific MFT development plans, establishing accreditation and licensing regulation, increasing the public awareness of MFT, increasing collaboration among training institutes and the number of qualified MFT trainers and training locations, and developing culturally attuned MFT training and practices. Practitioner points • Direct application of Western approaches to the East Asian context can be detrimental if therapists do not carefully examine the cultural differences and adapt accordingly • A critical step in developing MFT in East Asia is to develop country/ region-specific plans including the recognition of the history, values, and distinctive features of Asian families Keywords: culturally attuned marriage and family therapy practices; development of marriage and family therapy; East Asia; marriage and family therapy