diagnosis w/ MSD or Psy.D/Ph.D?

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So I am looking for more information on Masters in Social Work, mainly in clinical focus (LCSW?) I need some clarification on the difference in the ability to diagnose mental health betwen LCSW and Psy.D/Ph.D psychologist. I heard that LCSW can only do diagnosis, but not psychological tests? I am not even sure what the difference means.

titanz7 - mental health diagnosis is part of our work as clinicians. If I can't diagnose, how can I create a treatment plan and assess whether the client is improving? BA/BS/BSW mental health workers don't dx that I know of. And I think there are MSW tracks that don't prepare people to be clinicians - but the SW folks will have to speak to that.

I am not a clinical psychologist or an LCSW. I am working toward an LPC - licensed professional counseling.

As part of my 60 credit CACREP program, I took one class in assessment. It was an overview of several standard intelligence, personality, career, achievement and other assessments and tests - and included a brief overview of the MSE (mental status exam) and SCID - structured clinical interview. From that class, I felt qualified to administer nothing other than the MSE and some of the light weight career assessments.

About 1/3 of my other classes required that I be competent in clinical interviewing, DSM diagnosis, and assessment.

My colleagues who were in the PsyD program took several classes in assessment and several classes in statistics. We shared a practicum site. The counseling clinicians were responsible for diagnostic interviewing and we did dx our clients. The PsyD clients did all the formal testing. Their clients went through a battery (and it was a battery!) of testing. The PsyD clinicians then spent hours and hours learning how to write useful assessment reports.

Many of these clinical psych folks went on to hospitals, the VA, college counseling centers and other large clinical settings where the bulk of their work is assessing and writing reports. They also do therapy but testing and assessment is what sets them apart from the LPCs and LCSWs.

The doc students that I admired most and who got great outcomes had the best of the counseling skills with the addition of assessment skills. They worked with the "sickest" clients. They also worked with clients with brain injuries, autism, ADHD, personality disorders, psychosis, etc.

As a counselor, I assess and diagnose everyday. I am not qualified to do the battery of assessments that a Licensed Clinical Psychologist does - nor do I want to be. There are handful of talented LCP in my town - and they are who I refer out to for formal testing.

Because my passion is therapy, I knew I wanted the training that prepared me to do what I am now doing - individual, group, family, and couples therapy.

YMMV,

VL

Thanks for your post, VL. Learned alot from it.

Originally Posted by titanz7

So I am looking for more information on Masters in Social Work, mainly in clinical focus (LCSW?) I need some clarification on the difference in the ability to diagnose mental health betwen LCSW and Psy.D/Ph.D psychologist. I heard that LCSW can only do diagnosis, but not psychological tests? I am not even sure what the difference means.

I am in a clinical psychology program, have an MSW, and am working toward my LCSW. I am not a licensed psychologist or an LCSW as of yet. Psychological testing refers to interpreting tests such as intelligence tests, achievement tests, personality tests, and other psychometric measures. Social workers cannot do testing. Only psychologists with a PsyD or PhD in clinical, counseling, or school psychology can interpret psychological tests. As for diagnosis and therapy, LCSWs can put a diagnosis on an insurance claim form and in intake reports for therapy, but cannot make diagnoses for learning disorders, developmental delays, ADHD, etc because these diagnoses require psychological testing. LCSWs can do therapy, while psychologists can do therapy and testing. Some agencies will have a psychologist diagnose a problem, write a treatment plan, and the LCSW will carry out the treatment plan.

I went back to psychology because I want to interpret psychological tests in addition to therapy. If all you want to do is therapy, then an LCSW will get you there in less time, for less money, and with less grief. MSW programs are very different from psychology programs though and train social workers in topics that have nothing to do with therapy.

Originally Posted by PsyDLICSW

MSW programs are very different from psychology programs though and train social workers in topics that have nothing to do with therapy.

And if you want a MA/MS/EdS level degree - not the PhD/PsyD - a CACREP counseling program will train you have to do therapy with very little extraneous coursework.

The MSW is a very different degree - and from what I understand only the clinical track prepares you to do therapy. From my experience, it is easier to get a job - just about any job with an LCSW (two years experience post masters) than with the LPC but in my experience, counseling grads are often better trained to do counseling and psychotherapy than MSW grads. My experience is limited to the MSW grads I have worked with - so it is VERY limited.

There are lots of MSW/LCSW proponents here - so hopefully they will chime in with their experiences.

VL


VL

Originally Posted by PsyDLICSW

MSW programs are very different from psychology programs though and train social workers in topics that have nothing to do with therapy.

Not so true anymore. Yes, some schools require courses that don't have anything to do directly with therapy (such as casework), but plenty of schools have clinical tracks that do prepare students exclusively for careers in psychotherapy and related professions. Like Vasa Lisa said, it depends on the program and on your concentration within the program. All of the courses I'm taking now as an M.S.W. are geared toward clinical practice.

Originally Posted by Qwerk

. All of the courses I'm taking now as an M.S.W. are geared toward clinical practice.

Qwerk!
Great to have your voice hear to speak to the clinical side of the MSW. I look forward to hearing more about your journey.

Originally Posted by Qwerk

Not so true anymore. Yes, some schools require courses that don't have anything to do directly with therapy (such as casework), but plenty of schools have clinical tracks that do prepare students exclusively for careers in psychotherapy and related professions. Like Vasa Lisa said, it depends on the program and on your concentration within the program. All of the courses I'm taking now as an M.S.W. are geared toward clinical practice.

That's awesome! which program are you in?
Also, does the clinical concentrated MSW still do fieldwork jobs such as casework and stuff?

Originally Posted by titanz7

That's awesome! which program are you in?
Also, does the clinical concentrated MSW still do fieldwork jobs such as casework and stuff?

I'm in the accelerated full-time clinical program. The first-year field practicum is generally not chosen by the student, and some people do end up doing casework. I'm doing a mixture of casework, counseling, and group work. The second-year practicum is more student-directed, and if you want to get therapy experience, that's the time to do it. They generally let you pick your population and problem focus.

Originally Posted by Qwerk

I'm in the accelerated full-time clinical program. The first-year field practicum is generally not chosen by the student, and some people do end up doing casework. I'm doing a mixture of casework, counseling, and group work. The second-year practicum is more student-directed, and if you want to get therapy experience, that's the time to do it. They generally let you pick your population and problem focus.

In your opinion, do you think that the MSW gives enough courses/training in the psychology and clinical aspect of therapy? I have been looking around different schools that claim to have strong clinical emphasis (NYU, Hunter, etc) but the course catalog listed about three or four courses that would be relevant to therapy. I'm wondering how that would be sufficient to perform therapy.

Originally Posted by titanz7

In your opinion, do you think that the MSW gives enough courses/training in the psychology and clinical aspect of therapy? I have been looking around different schools that claim to have strong clinical emphasis (NYU, Hunter, etc) but the course catalog listed about three or four courses that would be relevant to therapy. I'm wondering how that would be sufficient to perform therapy.

Aside from just the courses about therapy you will also want to find out how good the supervision because that nearly equals the importance of coursework. Do you record yourself? Do you have regular weekly meetings with at least one clinical supervisor? Do they critique those videos of you? Do you develop your own counseling theoretical orientation or do you have to subscribe to your supervisors? Do you get exposure to people who actually regularly practice, and if so, do those people represent a range of theoretical orientations? You can't learn therapy from just reading a book or sitting in a class . . . it's like learning how to ride a bike or swim by sitting through a class. The best way to learn is through actual experience.

Originally Posted by titanz7

So I am looking for more information on Masters in Social Work, mainly in clinical focus (LCSW?) I need some clarification on the difference in the ability to diagnose mental health betwen LCSW and Psy.D/Ph.D psychologist. I heard that LCSW can only do diagnosis, but not psychological tests? I am not even sure what the difference means.

The answer to your question depends on what state the LCSW is practicing in. Most states grant an LCSW the right to diagnose psychological and psychiatric disorders. Some states even permit an LCSW to do psychological testing. Granted, I don't know of a single MSW program that trains in psychological testing, but there are a few states that permit it. Personally, I haven't met an LCSW that does testing.

So, to answer your question, it depends on what state you plan on practicing in. Look up the codes for a clinical social worker and see if the term diagnose is included, implicitly excluded, or exclusively excluded (i.e. this does not include diagnosis as defined by....). Most states will explicitly state that the definition of clinical social work includes the diagnosis of mental disorders, however, a few state that an LCSW can "assess" but not diagnose. This had more to do with the lobbying efforts of psychologists and psychiatrists than the ability of an LCSW to actually diagnose. Even in the few states that prohibit diagnosis, LCSW's still diagnose everyday when they submit insurance claims, etc.

Originally Posted by titanz7

In your opinion, do you think that the MSW gives enough courses/training in the psychology and clinical aspect of therapy?

No. That's why I dropped out of my MSW. My friend completed her program at another school and said the same thing: the training was insufficient. A lot of the folks who came to the MSW from undergrad disciplines other than psych didn't know what they were missing (sociology is a typical feeder undergrad major), but trust me, those of us who studied psych at a good UG institution knew better. Compare curriculums between the MSW programs you are considering and MFT/LPC. The MSW is a more employable degree and leads to a more portable license, but you receive less counseling training. Social work is not the same as psychology/counseling. Don't assume that an MSW program with a strong clinical reputation is equivalent to a masters in MFT or counseling.

Originally Posted by wigflip

Don't assume that an MSW program with a strong clinical reputation is equivalent to a masters in MFT or counseling.

Amen sistah! Counselors are new to the mental health arena - in my state - they began to practice independently in 1976 - pretty recent compared to the LCSW. I sometimes get tired of explaining and defending and describing what it means to be in Clinical Mental Health Counseling. But that is part of my obligation to my profession.

Counseling sure isn't social work. And it isn't psychiatry or clinical psychology. And I am grateful for the MH professionals in those fields. We *each* have an important role and contribution - and we are different.

Some of the stellar PsyDs that went through at the same time I did my CMHC are kick ass therapists - and they are so much more - and I am just not interested in the stats, assessment, teaching, report writing, severe pathology, developmental issues, testing etc. And I value that there are highly trained, sensitive colleagues who do that work - and do it well.

I often hear the research comparison in reference to the different degrees. I did independent research for my first MS in addition to teaching undergrads, and doing research for my advisor that was totally unrelated to my work. It was ok - but not my thing. I actually had one semester in my counseling grad school where I got a tuition waiver to work in a psychology research lab. After the semester was over, I decided I would rather pay tuition than work in a lab. Lesson learned - for sure.

In my current setting, I *read* research all the time, I have journal articles all over the house, in my car, I go to intensives to learn new things. I deeply value the scientist/researcher contributions. Where would I be without Marsha Linehan?

And I am content to do the slow, patient, steady, work of sitting with people - 50 minute hour after 50 minute hour with the occasional 90 minute intake, and the even more occasional all day art retreat.

And I am also skilled to do brief, solution focused work to help people who are temporarily stuck or overwhelmed.

My residency has been a period of learning to balance working with "higher functioning" folks - the worried well - who have lots of resources and are using therapy in an intentional way to improve their lives and relationships and taking on just enough - but not too many clients who have fewer resources, larger obstacles, less support, more isolation, inefficient interpersonal skills, and just plain bad luck on top of everything else.

My 60 credit CACREP program prepared me to be a therapist. Being in my sixth decade helps too.

I completely agree that it's a mistake to view counselors, MFTs, and social workers as interchangeable. We come from different philosophical bases and practice methods, and differ tremendously in our coursework and fieldwork. It's frustrating that many employers view our degrees as another box to check rather than sharply divergent practice focuses, even within the same degree. Students who are interested in becoming therapists should look at all three types of program (with the possible addition of psychiatric nursing), but none of these programs are for everyone.

Originally Posted by Qwerk

I completely agree that it's a mistake to view counselors, MFTs, and social workers as interchangeable. We come from different philosophical bases and practice methods, and differ tremendously in our coursework and fieldwork. It's frustrating that many employers view our degrees as another box to check rather than sharply divergent practice focuses, even within the same degree. Students who are interested in becoming therapists should look at all three types of program (with the possible addition of psychiatric nursing), but none of these programs are for everyone.

in all honestly, it is more about what program you attended than what profession you are affiliated with. I know MSW programs that would knock most other masters programs out of the water, and vice versa. Also, remember, being a good therapist is 20% what you learned in school and 80% what you will learn in the filed. Nothing can surpass excellent practice experiences and good supervision.

I think all the degrees mentioned so far are legitimate career choices, and are right for different people, for different reasons. I am biased toward social work, however.

Originally Posted by PsyDLICSW

MSW programs are very different from psychology programs though and train social workers in topics that have nothing to do with therapy.

I get what you're saying but in a way, this is not true. You're right that MSW programs train students in policy, nonprofit management, advocacy/activism, social role analysis, and other fields that psychology doesn't necessarily, but these things have A LOT to do with therapy insofar as they affect how therapy is carried out, when, where, and how it is offered, how it is funded or de-funded, which insurances are acceptable, why therapy is needed in the first place...the list goes on.

I look at the MSW as the broadest of the degrees that have been mentioned. You can do therapy and any given MSW graduate may be perfectly well-equipped to do therapy, but you can also do supervision, case management, urban development, political activism, nonprofit management...

I tend to think of the whole situation like this. Once you're graduated and in the field, you can take a broad degree (like the MSW) and focus it in one direction much easier than you can take an already more focused degree (like the PsyD) and broaden it. I have thought about this a lot as I've struggled whether or not to leave my particular MSW program, and I would choose the latter type of degree only in the situation that I knew with certainty that I wanted to do therapy and therapy-only for the rest of my life/career. I don't know where I will be in 20 years, so the MSW allows more potential doors to be opened.

Originally Posted by PhDstudent1982

Some states even permit an LCSW to do psychological testing. Granted, I don't know of a single MSW program that trains in psychological testing, but there are a few states that permit it.

Just curious--do you know which states?

Double post, sorry. I guess I'm incompetent today... :P

Originally Posted by BlackSkirtTetra

I get what you're saying but in a way, this is not true. You're right that MSW programs train students in policy, nonprofit management, advocacy/activism, social role analysis, and other fields that psychology doesn't necessarily, but these things have A LOT to do with therapy insofar as they affect how therapy is carried out, when, where, and how it is offered, how it is funded or de-funded, which insurances are acceptable, why therapy is needed in the first place...the list goes on.

Good post -- I'd also add that most programs allow students to declare specific tracks or majors. So clinical students aren't learning too much about administration, and community organizers aren't poring over the DSM-IV.

Even with unlimited time and money, I'd pick my M.S.W. program every time. I like the balance that clinical social work offers between learning about the individual and the environment. This year, I'll be taking a seminar in psychodynamics and completing an internship at a counseling program, but I'll also be taking courses in policy. Policy affects practice, period, especially with my clients, who are mostly poor and of color, and have plenty of experience with unfair policing and bureaucracy nightmares.

Your state defines your scope of practice, in a way. Despite what you do and do not learn in school, and despite what your accrediting body says you should be able to do, the state licensure board is who ultimately determines your practice. Legal protection is definitely a good thing, but it ends up a mess of politics instead of things that benefit our professions and our clients.

Check with the state. They'll have a website.

My state actually doesn't address testing for my credential at all. Probably not a good thing for a lot of people.

I personally found my testing class to be painfully boring. You stare at someone taking a test. You go through the test. You right up a report. You talk to the client. The process is time consuming. Plus you have to pay for the tests, which sucks.

I'm going to try to get some personality testing training at some point since I'm interested in personality issues, but even then I'm not sure. For my intents and purposes, I can get plenty of diagnostic information out of someone by just talking to them for an hour about their life.

That said, testing definitely has a role in mental health. I don't think I'm going to be in a position where I'm going to need to utilize much besides a Beck Depression Inventory, but who knows.

Originally Posted by Isadora

Your state defines your scope of practice, in a way. Despite what you do and do not learn in school, and despite what your accrediting body says you should be able to do, the state licensure board is who ultimately determines your practice. Legal protection is definitely a good thing, but it ends up a mess of politics instead of things that benefit our professions and our clients.

Check with the state. They'll have a website.

My state actually doesn't address testing for my credential at all. Probably not a good thing for a lot of people.

I personally found my testing class to be painfully boring. You stare at someone taking a test. You go through the test. You right up a report. You talk to the client. The process is time consuming. Plus you have to pay for the tests, which sucks.

I'm going to try to get some personality testing training at some point since I'm interested in personality issues, but even then I'm not sure. For my intents and purposes, I can get plenty of diagnostic information out of someone by just talking to them for an hour about their life.

That said, testing definitely has a role in mental health. I don't think I'm going to be in a position where I'm going to need to utilize much besides a Beck Depression Inventory, but who knows.

It's definitely going to vary by state, but I believe psychological testing in general is a "protected category" reserved for licensed psychologists (and perhaps physicians) in most/all states and situations. The one exception I can think of off-hand would be testing conducted by master's-level school psychologists in a school setting (which is a whole 'nother can of worms).

I used to live in Kansas, and MA-level practitioners definitely do testing and assessment. I don't know if it's allowed as per the state boards, but they definitely do it all the time.

I've heard rumblings that they also do it in Colorado (I think), Virginia (or West Virginia?), and somewhere else, but I don't remember where. In my head it seems like there are 3 or 4 states where people other than doctoral-level practitioners do assessments and testing. You'd have to pore over all 50 states' rules to know for sure and I wouldn't know how to even do that, some of their websites are so confusing...

I think assessment and testing may be one of those areas that is slowly being chipped away at as the exclusive domain of PhDs. I don't think this is necessarily a good thing, either...

Originally Posted by BlackSkirtTetra

I used to live in Kansas, and MA-level practitioners definitely do testing and assessment. I don't know if it's allowed as per the state boards, but they definitely do it all the time.

I've heard rumblings that they also do it in Colorado (I think), Virginia (or West Virginia?), and somewhere else, but I don't remember where. In my head it seems like there are 3 or 4 states where people other than doctoral-level practitioners do assessments and testing. You'd have to pore over all 50 states' rules to know for sure and I wouldn't know how to even do that, some of their websites are so confusing...

I think assessment and testing may be one of those areas that is slowly being chipped away at as the exclusive domain of PhDs. I don't think this is necessarily a good thing, either...

Do you know if, in Kansas, this testing/assessment is conducted independently, or if it's under the supervision of a psychologist? If the former, that's not much different than testing being administered by a psychometrist, and I'm fine with it. If the latter, then that (in my opinion) is a serious issue and would reflect instances of individuals practicing outside the bounds of their training and competence.

Do you know if, in Kansas, this testing/assessment is conducted independently, or if it's under the supervision of a psychologist?

Well, some Masters level practitioners ARE psychologists in Kansas (it's a state where MA-level practitioners are called "psychologists" in addition to PhD-level practitioners also being called "psychologists").

The instances that I remember, I am honestly not sure if they were under the supervision of someone else or not but I know that it happens. I haven't lived there in a long time so I might ask somebody else who works there currently. I've tried to read through the laws but to be honest they're pretty confusing...

The answer isn't as clear as testing vs. no testing.

Psychological tests are restricted by the training of the individual purchasing the test. If you review the publishers distributing the tests, you will see how they label each test as Level A, Level B, or Level C. Highly sophisticated tests that require advanced training in statistics will be restricted to the highest level, while other tests may be appropriate for masters level practitioners. One has to show their training to be able to purchase certain psychological tests.

An LCSW should be able to administer a simple inventory such as the Beck Depression Inventory, while only a PhD can administer and interpret the MMPI.

One side note, I believe Psychologists attempted (and failed) to restrict the use of certain "psychological assessment instruments" in Indiana and Kentucky. So, I'm not sure the line is very clear sometimes.

Originally Posted by DrPablo

One side note, I believe Psychologists attempted (and failed) to restrict the use of certain "psychological assessment instruments" in Indiana and Kentucky. So, I'm not sure the line is very clear sometimes.

That's what I'm learning! I also found out that our friends to the North in Canada deal with a similar province-to-province issue, but even more varied than we have it. In some provinces (such as Alberta) an MA/M.Ed is a psychologist, whereas in other provinces (such as Ontario), only PhD-level folks are psychologists, and in other areas (such as the Yukon) anyone--with any degree of education whatsoever--can practice as a psychologist.