Clinical Social Worker Education and Training

[deleted176373]

What I think is interesting about the Becks is that Aaron Beck is a psychiatrist, Judith Beck a psychologist, and Dan Beck a clinical social worker. I wonder if they fight over who should be assessing and treating mental health.

Ask the Beck's this next time they invite you over to dinner...

Does Psychiatrist = Psychologist = Clinical Social Worker?

Just because one can be trained to do CBT as a clinical social worker does not mean that one is qualified as a clinical social worker to diagnose and treat mental illness. I can teach a janitor to do CBT, does that mean he should be a therapist?

When one seeks to be in nearly all ways to be practicing in a field that is not the one that you are formally trained in, you are circumventing the process in becoming any one of those professions.

It's true that some notable people have in the process blurred the lines between disciplines. There is a big difference between finding a niche in which one becomes an expert (e.g. Yalom, Matarazzo, Beck) and one where the aim is to circumvent the training needed to go into the field that one is planning to practice in. You keep talking about how social workers are being "pigeon holed" but in reality these individuals are choosing to join the social work field for a reason, and that reason shouldn't be to be clinical psychologists without the training to be a clinical psychologist.

The reason that many potential clinical psychologists go train as MSW's is that they know the following is in general true.

1. Easier admission requirements
2. Lower opportunity costs.
3. Ability to bill insurance directly.
4. Less training required.
5. Ability to practice independently with only a Masters.

( Sayette, Mayne, & Norcross, 2010)


However if you read the introduction in Wittenberg's Opportunities in Social Work Careers (2003) it's quite clear that the focus of social work is NOT mental health treatment, but rather it states that social workers "are people specially trained to provide counseling, support, and guidance to people in need. Their help allows people to understand themselves and their living conditions and to attain their full potential."

Nowhere in the introduction does it suggest that the appropriate role of the clinical social worker is to treat mental illness. Clinical social work is important and it's a great field, but if one is doing it to operate as a clinical psychologist without the appropriate training, then they are acting unethically.

Mark

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[BSWdavid]

Ask the Beck's this next time they invite you over to dinner...

Does Psychiatrist = Psychologist = Clinical Social Worker?

Just because one can be trained to do CBT as a clinical social worker does not mean that one is qualified as a clinical social worker to diagnose and treat mental illness. I can teach a janitor to do CBT, does that mean he should be a therapist?

When one seeks to be in nearly all ways to be practicing in a field that is not the one that you are formally trained in, you are circumventing the process in becoming any one of those professions.

It's true that some notable people have in the process blurred the lines between disciplines. There is a big difference between finding a niche in which one becomes an expert (e.g. Yalom, Matarazzo, Beck) and one where the aim is to circumvent the training needed to go into the field that one is planning to practice in. You keep talking about how social workers are being "pigeon holed" but in reality these individuals are choosing to join the social work field for a reason, and that reason shouldn't be to be clinical psychologists without the training to be a clinical psychologist.

The reason that many potential clinical psychologists go train as MSW's is that they know the following is in general true.

1. Easier admission requirements
2. Lower opportunity costs.
3. Ability to bill insurance directly.
4. Less training required.
5. Ability to practice independently with only a Masters.

( Sayette, Mayne, & Norcross, 2010)


However if you read the introduction in Wittenberg's Opportunities in Social Work Careers (2003) it's quite clear that the focus of social work is NOT mental health treatment, but rather it states that social workers "are people specially trained to provide counseling, support, and guidance to people in need. Their help allows people to understand themselves and their living conditions and to attain their full potential."

Nowhere in the introduction does it suggest that the appropriate role of the clinical social worker is to treat mental illness. Clinical social work is important and it's a great field, but if one is doing it to operate as a clinical psychologist without the appropriate training, then they are acting unethically.

Mark

Each respective profession that treats mental illness didn't necessarily begin with that focus. Medical doctors didn't originally treat mental illness; psychologists didn't originally treat mental illness. Professions evolve, and within them, so do specialties. The issue I see in your post is that you equate mental health treatment with psychology. Mental health treatment is not and has never been the exclusive domain of psychology.

Consider the overlap between psychology and psychiatry. A similar argument by a psychiatrist might be, if psychologists want to prescribe psychotropic medications, they should have become psychiatrists. You use the argument that social workers shouldn't attempt to blur the line between psychology and social work but support the argument that this is acceptable between psychiatry and psychology. Getting additional training in pharmacology in order to prescribe medication - a medical practice - is ok for psychologists, but social workers should not attempt to practice in any realm that is considered to be "psychological" in nature - I don't get it!

The reality is that psychologists will never be happy with social workers treating and assessing mental illness, regardless of our training. We could spend six years in grad school and the argument would be "If you wanted to be a psychologist, you should have become one." Yet, psychologists are the first ones to want prescription rights, even though that is beyond the scope of the practice of clinical psychology. I read a post recently where psychology is making the argument that psychologists should be considered physicians under medicare. A physician is a medical doctor yet psychologists are attempting to redefine what physician means. You can't complain about encroachment of other professions on your perceived turf and then turn around and do the same thing to another profession.

 

[BSWdavid]

Clinical social work is the professional application of social work theory and methods to the diagnosis, treatment, and prevention of psychosocial dysfunction, disability, or impairment, including emotional, mental, and behavioral disorders (Barker, 2003).

 

[erg923]

Clinical social work is the professional application of social work theory and methods to the diagnosis, treatment, and prevention of psychosocial dysfunction, disability, or impairment, including emotional, mental, and behavioral disorders (Barker, 2003).

What is Lake Wobegon like? Is it magical?

 

[BSWdavid]

From the NYS Office of Professions:

"Licensed Clinical Social Worker: The practice of clinical social work encompasses the scope of practice of licensed master social work and, in addition, includes the diagnosis of mental, emotional, behavioral, addictive and developmental disorders and disabilities and of the psychosocial aspects of illness, injury, disability and impairment undertaken within a psychosocial framework; administration and interpretation of tests and measures of psychosocial functioning; development and implementation of appropriate assessment-based treatment plans; and the provision of crisis oriented psychotherapy and brief, short-term and long-term psychotherapy and psychotherapeutic treatment to individuals, couples, families and groups, habilitation, psychoanalysis and behavior therapy; all undertaken for the purpose of preventing, assessing, treating, ameliorating and resolving psychosocial dysfunction with the goal of maintaining and enhancing the mental, emotional, behavioral and social functioning and well-being of individuals, couples, families, small groups, organizations, communities and society.

Diagnosis: Diagnosis in the context of licensed clinical social work practice is the process of distinguishing, beyond general social work 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.

Psychotherapy: Psychotherapy in the content of licensed clinical social work practice is the use of verbal methods in interpersonal relationships with the intent of assisting a person or persons to modify attitudes and behavior which are intellectually, socially, or emotionally maladaptive.

Assessment-based treatment plans: Development of assessment-based treatment plans in the context of licensed clinical social work practice refers to the development of an integrated plan of prioritized interventions, that is based on the diagnosis and psychosocial assessment of the client, to address mental, emotional, behavioral, developmental and addictive disorders, impairments and disabilities, reactions to illnesses, injuries, disabilities and impairments, and social problems."

 

[Student4Life0]

My goodness, with the time that you've wasted trying to prove yourself to a group of people that will never fully agree with you, you couldve completed your PhD!

 

[Therapist4Chnge]

The reality is that psychologists will never be happy with social workers treating and assessing mental illness, regardless of our training.

Do you believe there is sufficient training in MSW programs to adequate prepare social workers to handle the host of mental health diagnoses out there? How about programs that are evenly split between non-clinical/mental health related training? How about those that offer little training in mental health?

I read a post recently where psychology is making the argument that psychologists should be considered physicians under medicare. A physician is a medical doctor yet psychologists are attempting to redefine what physician means. You can't complain about encroachment of other professions on your perceived turf and then turn around and do the same thing to another profession.

This is clearly not what was meant. Per the APA:

HR 6147 does not reconstitute clinical psychologists as physicians, and inclusion in the physician definition will not expand a psychologist’s scope of practice. Instead, as with other non-physician providers already in the Medicare “physician” definition, psychologists will be able to provide services to Medicare beneficiaries to the full extent of their licensure as permitted under state law. Psychologists are the only doctoral-trained Medicare providers not already included in the “physician” definition.

 

[BSWdavid]

First off, it is insulting to compare clinical social work to janitorial work. Second, it is about as fair to say that social workers who wish to assess and treat mental illness desire to be psychologists as it is to say that psychologists who wish to prescribe medication wish to be psychiatrists.

I hoped, in starting this thread, that we could develop civilized discourse. Ultimately, I have realized that there is much anger and resentment amongst many of the posters here that has made this impossible. You assume that clinical social workers wish to be psychologists, therefore increasing your own self-worth and stroking your fragile egos. I am disheartened by the lack of respect and cooperation amongst the various mental health professions, but realize this exists regardless of the profession. I hope that one day we can set aside our differences and come together to help the individuals that we set out to help; after all, shouldn't this be the tie that binds?

I'm done!

 

[Student4Life0]

Hooray!

 

[BSWdavid]

Do you believe there is sufficient training in MSW programs to adequate prepare social workers to handle the host of mental health diagnoses out there? How about programs that are evenly split between non-clinical/mental health related training? How about those that offer little training in mental health?



This is clearly not what was meant. Per the APA:

Unfortunately, this is a difficult answer to give because programs very greatly in their clinical training, exposure, and emphasis. Partially, this has to do with the extreme variations in state licensing laws for clinical social workers. In psychology, all 50 states license clinical psychologists in a similar manner; however, clinical social work licensure has been in the implementation process for nearly 50 years, and the result is quite a mess.

That said, I believe that there needs to be better standards set in place to ensure that MSW students are getting the training and exposure they need to properly assess and treat mental disorders. Individual states are doing this as we speak (some obviously better than others), but it is getting down. ONe of the main reasons I am attending a clinical PhD program is to gain the experience and knowledge that I feel I didn't get in the MSW program. The additional doctoral level coursework will allow me to refine my research skills, develop a strong psychodynamic foundation, and ultimately write and defend a dissertation.

 

[erg923]

Similar to your inaccurate (not to mention irrelevant) post about who pioneered assessment, please know what your talking about before throwing out accusations: Please see below.

HR 6147 does not reconstitute clinical psychologists as physicians, and inclusion in the physician definition will not expand a psychologist's scope of practice. Instead, as with other non-physician providers already in the Medicare "physician" definition, psychologists will be able to provide services to Medicare beneficiaries to the full extent of their licensure as permitted under state law. Psychologists are the only doctoral-trained Medicare providers not already included in the "physician" definition.

It is obvious that you are trying to prove something about your field. Thats admirable. However, as other have noted, your thinking is superficial (probably because you obviously have limited experience), and you appear preseverative on the fact that you feel psychology is trying to take over psychiatry. Not only is this incorrect, its not even relevant to the original proposition that started this thread regarding assessment by social workers. Psychologists who are intending to prescribe obtain an actual degree in that area (Master's degree in psychopharmacology and appropriate practicum training with supervision oversight) as well as pass a national exam. Social workers who want to do testing do not want any of this, they simply want to informally tailor their training and be granted this privileged. Big differences here and I suggest you comprehend it.

Continue living in Lake Wobegone if you wish, but the rest of the world will continue to delineate between the professional roles of the disciplines as they currently exist. Unless you want to reinforce the unfortunate stereotypes that often exist about social workers, I would suggest you just stop now before you put forth more inaccurate arguments in an attempt to tout your profession's "competence"

 

[Born2rumble1st]

I've been following this thread and I've found the points raised to be interesting. However, I'm not sure I understand exactly what you intend on getting out of your Ph.D in Clinical Social Work. What, precisely, do you want to use it for? If you had the opportunity to write your ideal job description, what would it be? And if that job description could also be used to advertise for a clinical psychologist, why are you getting a Ph.D. in social work? I'm honestly curious.

 

[BSWdavid]

Similar to your inaccurate (not to mention irrelevant) post about who pioneered assessment, please know what your talking about before throwing out accusations: Please see below.

HR 6147 does not reconstitute clinical psychologists as physicians, and inclusion in the physician definition will not expand a psychologist’s scope of practice. Instead, as with other non-physician providers already in the Medicare “physician” definition, psychologists will be able to provide services to Medicare beneficiaries to the full extent of their licensure as permitted under state law. Psychologists are the only doctoral-trained Medicare providers not already included in the “physician” definition.

It is obvious that you are trying to prove something about your field. Thats admirable. However, as other have noted, your thinking is superficial (probably because you obviously have limited experience), and you appear preseverative on the fact that you feel psychology is trying to take over psychiatry. Not only is this incorrect, its not evenrelevant to the original proposition that started this thread regarding assessment by social workers. Psychologists who are intending to prescribe obtain an actual degree in that area (Master's degree in psychopharmacology and appropriate practicum training with supervision oversight) ad well as pass an exam. Social workers who want to do testing want any of this, they simply want to informally tailor their training and be granted this privileged. Big differences here and I suggest you comprehend it.

Continue living in Lake Wobegone if you wish, but the rest of the world will continue to delineate between the professional roles of the disciplines as they currently exist. Unless you want to reinforce the unfortunate stereotypes that often exist about social workers, I would suggest you just stop now before you put forth more inaccurate arguments in an attempt to tout your profession's "competence"

Man, your arrogance really shows!

 

[BSWdavid]

I've been following this thread and I've found the points raised to be interesting. However, I'm not sure I understand exactly what you intend on getting out of your Ph.D in Clinical Social Work. What, precisely, do you want to use it for? If you had the opportunity to write your ideal job description, what would it be? And if that job description could also be used to advertise for a clinical psychologist, why are you getting a Ph.D. in social work? I'm honestly curious.

I am not interested in testing. I am interested in treating mental, behavioral, and emotional problems from an integrative-psychodynamic perspective.

 

[erg923]

yes, I guess thats why you dont want to actually be a psychologist, but apparently want to play one on tv, right?

If you can spot an actual factual error in the information I provided, point it out.

 

[Born2rumble1st]

I am not interested in testing. I am interested in treating mental, behavioral, and emotional problems from an integrative-psychodynamic perspective.

So, if I understand this correctly, the only thing that you think should be the exclusive domain of psychologists is testing?

 

[BSWdavid]

So, if I understand this correctly, the only thing that you think should be the exclusive domain of psychologists is testing?

Yes, that sounds about right

 

[BSWdavid]

yes, I guess thats why you dont want to actually be a psychologist, but apparently want to play one on tv, right?

If you can spot an actual factual error in the information I provided, point it out.

Again, the arrogance is unnecessary!

 

[deleted176373]

Each respective profession that treats mental illness didn't necessarily begin with that focus. Medical doctors didn't originally treat mental illness; psychologists didn't originally treat mental illness. Professions evolve, and within them, so do specialties. The issue I see in your post is that you equate mental health treatment with psychology. Mental health treatment is not and has never been the exclusive domain of psychology.

I never said that, what I did say was that the focus of each discipline was very different and that social work is not primarily concerned with the issue of mental health treatment although it may certainly be one area that social workers may have some experience with. Clinical social work training does not prepare one to be a competent psychologist. Obviously with additional training, clinical social workers can be effective at providing mental health care, but like psychologists prescribing, that practice should be limited to the area of competence demonstrated by the practitioner.

Consider the overlap between psychology and psychiatry. A similar argument by a psychiatrist might be, if psychologists want to prescribe psychotropic medications, they should have become psychiatrists.

And to a great extent, I agree with that. Psychiatrists are primarily experts in the medical model of mental health treatment, this does not mean with additional training that psychologists cannot gain the competency to prescribe in a limited manner. Once again, competence needs to be demonstrated and practice limited to that area of competence.

You use the argument that social workers shouldn't attempt to blur the line between psychology and social work but support the argument that this is acceptable between psychiatry and psychology. Getting additional training in pharmacology in order to prescribe medication - a medical practice - is ok for psychologists, but social workers should not attempt to practice in any realm that is considered to be "psychological" in nature - I don't get it!

What additional clinical training are you talking about that MSW's is sufficient to practice as a Psychologist or competent mental health care provider in anything more than a very limited role (e.g. with a specific population or area of competence)? I have no problem with Social Workers getting additional training to raise their level of competence and to practice within that level of competence. To suggest that Social Worker = Psychiatrist = Psychologist is inane though.

Even though I took several classes (including physiology and pharmacology) with the M.D. students at my school, I will not and should not, practice medicine. It helps me communicate effectively with psychiatrists and other medical doctors, but it is not the same as medical school training. If I wanted to prescribe medication as my primary modality of practice, I should have become a psychiatrist. So I am not being hypocritical here. The training to get prescription privileges is extensive and takes 2 years plus an internship. I don't see Clinical Social Workers gaining this level of additional training. Psychiatry residency is 4 years if I remember correctly, along with a number of years in medical school. Ph.D. Clinical psychologists average 5-6 years of schooling and at least a 1 year internship. MSW's have a fraction of this training when they are eligible for licensure.

The reality is that psychologists will never be happy with social workers treating and assessing mental illness, regardless of our training. We could spend six years in grad school and the argument would be "If you wanted to be a psychologist, you should have become one." Yet, psychologists are the first ones to want prescription rights, even though that is beyond the scope of the practice of clinical psychology.

Stop generalizing all psychologists as desiring prescription privileges.

Even if all psychologists were pushing for prescription privileges, the additional training is sufficient to put psychologists in a position where they have the competence to practice in a narrow area of medicine. This is quite different than the Clinical Social Worker who wishes to play Psychologist and pretend that they have the same qualifications with a fraction of the training in psychology. If one is attending a "clinical social work" program that is 6 years long and focuses almost exclusively on psychological content, then you could make the argument that clinical social workers are well qualified to practice psychology (but I would argue that they would not be well qualified as clinical social workers.)

I read a post recently where psychology is making the argument that psychologists should be considered physicians under medicare. A physician is a medical doctor yet psychologists are attempting to redefine what physician means. You can't complain about encroachment of other professions on your perceived turf and then turn around and do the same thing to another profession.

Not hardly, that clearly was not the aim at seeking parity of mental health treatment for psychologists. Others have addressed this.

Mark

 

[deleted176373]

I am not interested in testing. I am interested in treating mental, behavioral, and emotional problems from an integrative-psychodynamic perspective.

If this is what you want to do, a Ph.D. in clinical social work is NOT the right degree. The training that is most aligned with that description is a professional degree in psychology.

Mark

 

[erg923]

Either refute the facts of my post and stop whining about how the board is against you/psychologist are arrogant, blah blah blah, OR drop out. You brought this topic up (for reasons that no one is quite clear about), no one picked a fight with you...

 

[deleted176373]

First off, it is insulting to compare clinical social work to janitorial work. Second, it is about as fair to say that social workers who wish to assess and treat mental illness desire to be psychologists as it is to say that psychologists who wish to prescribe medication wish to be psychiatrists.

Really, think about this... A janitorial supervisor in my zip code makes $48,000 on average and an LCSW makes $54,000 a year. I would not be throwing stones at the janitors just yet... It is the height of arrogance to think you're above the "lowly" janitor who cleans the offices... Janitorial staff work a great deal harder for their money than most people do.

As to point two, if you got a degree in psychology and you wanted to practice medicine from the beginning, you picked the wrong degree. It seems pretty rare though, maybe because most Ph.D. clinical psychologists would have little trouble getting accepted to a medical school... I don't know if the same can be said for many pursuing MSW programs.

I hoped, in starting this thread, that we could develop civilized discourse. Ultimately, I have realized that there is much anger and resentment amongst many of the posters here that has made this impossible. You assume that clinical social workers wish to be psychologists, therefore increasing your own self-worth and stroking your fragile egos.

Yes, blame us for the problem. We are simply incapable of accepting that others are our equals. I have no anger or resentment, but I believe that the type of training you have should guide the type of practice you pursue. It has nothing to do with self-worth or a fragile ego.

I am disheartened by the lack of respect and cooperation amongst the various mental health professions, but realize this exists regardless of the profession. I hope that one day we can set aside our differences and come together to help the individuals that we set out to help; after all, shouldn't this be the tie that binds?

You've done the equivalent of walking into our living room and peeing on the carpet and then you are confused by your perceived lack of respect and cooperation?

As far as setting aside our "differences" for the common good, this false olive branch is insulting... "can't we all get along so that I can get my way..." Umm, no. Stop trying to set up straw men arguments about psychiatry and psychology which have nothing to do with the practice of social work and the encroachment of social work on what is clearly the practice of psychology.

I'm done!

I only wish this was true...

Mark

 

[psich]

Yes, that sounds about right

But...psychologists do not do practica and internships exclusively in testing. Doctoral students in clinical psychology undergo training in psychotherapy; more training than any other mental health profession in the field.

You are asserting that some members on this board are arrogant for wanting to maintain appropriate boundaries between the professions. But don’t you think it takes some hubris to claim that there is no distinction - in terms of providing psychotherapy - between a social worker and psychologist? I think the duration and intensity of educational training for the latter speaks for itself, at the very least.

 

[Neuropsych2be]

I have read several posts that suggest LCSWs don't have the training and education to provide therapy and diagnostic assessments. I am finishing up my MSW program and will say that I do understand some of what has been said. It is very difficult to reach competency in a two year program. However, course work has been evidence based, focused mostly on CBT. The DSM course was presented from a differential diagnosis perspective, and practicum has consisted of two semesters of working with clients while applying CBT techniques and differential diagnostic assessments. Furthermore, our assessments are signed off by an LCSW and again by a psychiatrist. Rarely is something questioned in the assessment.

I think it is unfortunate that social workers are pigeoned holed into the category of "case manager, supportive therapist, etc." when our education does prepare us for much more. However, I desire more depth in my training which is why I will be beginning a 4-year clinical social work PhD program that will allow me to establish the depth of knowledge and strong clinical skill set that I didn't get in the MSW program. I still wonder how I will be looked at even after I have my PhD? Sometimes I think it has more to do with looking down on another profession than anything.

I thinks its wonderful that you wish to get training at the Ph.D. level in social work. I am also always perturbed by some of the negativity exhibited online towards social workers and the social work profession. Such attitudes are more typically an expression of the ignorance and infantile narcissism of the opinion maker than anything else. Having worked in mental health for 20 years I worked with some wonderful therapists and clinicians who were LCSW's. I have the utmost respect for social work as a profession and the clinical skills and perspective that it brings to the table. Anyone in a "real world" context expressing these opinions would quickly find themselves a professional pariah.

I think my doctoral work has so vastly expanded my understanding of this field that I often think that the Ph.D. should be the entry level degree for clinical social work rather than the master's degree. I think doctoral training has given me the capacity to explore the literature more comprehensively and to think more deeply about psychological processes and constructs. I think clinical social workers could gain similar advantages from doctoral-level training. I remember that there used to be a doctoral degree in social work called the D.S.W. that was more practice oriented than the Ph.D. but its been years since I have heard of it. I think you will find your Ph.D. to be a great professional and personal choice.

 

[jdawgg]

If anyone has evidence demonstrating that psychologists produce better psychotherapeutic outcomes than, say, social workers - I'd love to see it... because all I'm seeing here is a lot of conjecture and chest beating on both sides.

 

[jdawgg]

Show me that an MD specialization is surgery is necessary to do surgery, that an architecture degree is better than a mechanical engineering degree for designing houses, etc. . .


Some outcome studies show this, some don't. It depends on the measures and it's very challenging research. I think this argument is better played out in a construct validity/field direction manner.

I don't see other health professions (nursing, for instance) training people to do surgery, or other design professions training people to design houses. The professions of social work, counseling, and psychology, however, all train people to do psychotherapy. You may or may not consider master's level training sufficient, but it's a valid question to ask whether the additional training provided in a PhD program is actually improving clinical outcomes. What I'm hearing from you is that determining this is difficult and that we don't know at this time... and that's fine, but let's not pretend otherwise.

 

[edieb]

I don't see other health professions (nursing, for instance) training people to do surgery, or other design professions training people to design houses. The professions of social work, counseling, and psychology, however, all train people to do psychotherapy. You may or may not consider master's level training sufficient, but it's a valid question to ask whether the additional training provided in a PhD program is actually improving clinical outcomes. What I'm hearing from you is that determining this is difficult and that we don't know at this time... and that's fine, but let's not pretend otherwise.

Other than the poorly designed Seligman study, it is insane to think social workers can compete clinically with a clinical psychologist. It would be like saying someone with a bachelor's in human physiology is equivalent to a surgeon. Yes, the person with the bachelor's degree has some background knowledge that the M.D. has, but knows little about the theory and practice of medicine.

Similarly, social workers may have a superficial understanding of psychopathology but do not have knowledge of psychological THEORY: psychometrics, cognitive theory of different psychiatric disorders, theory of behavior change, cognitive psychotherapeutic theory.

Thus, it is a foregone conclusion that a person with an MSW is not equivalent to someone with a Ph.D./Psy.D. in clinical psychology. Arguments otherwise are just Trojan horse attempts to give the illusion of equivalence between professions where none exists

 

[jdawgg]

Other than the poorly designed Seligman study, it is insane to think social workers can compete clinically with a clinical psychologist. It would be like saying someone with a bachelor's in human physiology is equivalent to a surgeon. Yes, the person with the bachelor's degree has some background knowledge that the M.D. has, but knows little about the theory and practice of medicine.

Similarly, social workers may have a superficial understanding of psychopathology but do not have knowledge of psychological THEORY: psychometrics, cognitive theory of different psychiatric disorders, theory of behavior change, cognitive psychotherapeutic theory.

Thus, it is a foregone conclusion that a person with an MSW is not equivalent to someone with a Ph.D./Psy.D. in clinical psychology. Arguments otherwise are just Trojan horse attempts to give the illusion of equivalence between professions where none exists

Please... help me understand why it is so insane to suggest that social workers can produce therapeutic outcomes equivalent to psychologists when there is no convincing evidence either way. While theory is clearly imporant (and I'd argue that social workers DO have some, though not equivalent, knowledge of psychological theory), proficiency in psychotherapy comes primarily from actual practice.

Formal training to become a psychotherapist could be extended by 10 or 20 years... more theory the better, right? But does it make any sense from a cost/benefit standpoint? That is my point here. Psychotherapy is challenging, but it isn't rocket science. Clearly, those of you who are already psychologists or are working toward that path have a strong psychological incentive to advocate for your own position, but that doesn't mean that it makes practical sense or is based in evidence.

 

[erg923]

Please... help me understand why it is so insane to suggest that social workers can produce therapeutic outcomes equivalent to psychologists when there is no convincing evidence either way. While theory is clearly imporant (and I'd argue that social workers DO have some, though not equivalent, knowledge of psychological theory), proficiency in psychotherapy comes primarily from actual practice.

Formal training to become a psychotherapist could be extended by 10 or 20 years... more theory the better, right? But does it make any sense from a cost/benefit standpoint? That is my point here. Psychotherapy is challenging, but it isn't rocket science. Clearly, those of you who are already psychologists or are working toward that path have a strong psychological incentive to advocate for your own position, but that doesn't mean that it makes practical sense or is based in evidence.

JS makes good points. I would just add that what I think edieb was saying is that all those things are needed in order to make the best therapist possible. It makes for a better rounded, better informed therapist. IMHO, it does NOT mean that people without that training are necessarily going to make bad therapists. I think it means they are probably more likely to misdiagnose and probably more likely to fumble around without a clear conceptual organization to what they are doing though. They can still get good outcomes though, and they can still be adequate therapists much of the time.

However, that is really side-tracked from what this thread started as and what this thread it is really about. The overarching motif that the OP brought is a common downfall of modern day entitlement and an unfortunate feature of the current educational system. That being, that everyone is the same, all are equal, let's get rid of professional roles and all practice the same thing for the good of patients (i.e., I can do your job, because all i need is to learn a little bit of this and incorporate it into my training paradigm). This is a very naive, undergraduate-like mentality to have, because during this stage all one has in the ambition to apply their knowledge. Unfortunately, these people do not yet have the working knowledge regarding how this mentality results in disorganized care with no clear standards that actually ends up hurting patients, as well as the well-being and reputation of both professions. What? My social worker is also doing my neuropsych eval and my cog rehab? I dont think so. If I go to a brain surgeon, he should be a brain surgeon and I would generally prefer that he specialized in brain surgery, not IM/Peds/oncology/radiology/brain surgery.

Given that that OP continually states that we (the posters and the profession in general) are simply "arrogant", rather than actually challenging the facts we state suggests that he cant argue himself out of a wet paper bag. Thus, I hope this thread can now die a peaceful death.

.

 

[stigmata]

I would like to say that I do think this group has been a little harsh with BSWDavid, who was simply trying to make a point which seemed legitimate to him. We need to keep in mind that MSW schools are teaching students that the only thing separating them from psychologists is, and I quote "a few statistics classes". His perspective is skewed by the very nature of where he is in training and experience; I feel the same way about some of the dogmatic, unrealistic and naive drivel I see many students profess about on this forum. I agree that his premise is full of holes, but the holier-than-thou stuff from a group who are mainly still students themselves is hard to watch and not comment on.

The fact of the matter is that every group in behavioral health is trying to expand its scope of practice, including psychiatry, psychology, social work and even psych techs. Is this bad, better for one group than another, or just the nature of healthcare in this country? I have technicians for testing; testing is easy. It takes quite a bit more knowledge, training and experience to take that data, mix it with other forms of data, and come up with a plausible diagnosis (not 72 rule-outs), and treatment plan or decision. LCSWs could be trained to do this, but like prescribing psychology it will take both a paradigm shift and a comprehensive, graduate level training program with practica, supervision and lots of repetition. Believe it or not PhD/Psy.D. students when you make it out into the workforce with your new Capital D degree/title, and license you ARE NOT good at assessment. You will be if you pursue it and do a lot of it. A new psychologist, like a new physician will often vastly over-rate their skill level, and will only realize how much they did not know with the benefit of experience and hindsight.

 

[Ollie123]

Don't have much time but a couple quick points:
1) For the love of god STOP assuming all psychologists favor RxP. Many do not. I do not, and largely for the reasons you are stating. I don't believe appropriate steps have been put in place to guarantee it is being done safely and effectively. The push is politically driven, not patient-care driven. That is perhaps a naive and overly idealistic view, but its how I feel. Even if some do support it, are you really arguing on the grounds that "Well other professions are engaging in bad behavior, so we should too"? I happen to agree with most of what you are saying about RxP, so am I therefore "allowed" to think poorly of social workers expanding too far into therapy/assessment settings? Actually, I don't have nearly as strong an opinion on the matter as many people here since I actually think there is plenty of room for master's level providers of all types and that PhD-level psychologists roles will be shifting away from direct care over time.

2) When on earth did the educational standard become "We're going to start doing this until you can prove we are worse at it". How on earth is that respectful of patients lives? How would you feel if your doctor told you "Well, I'm not sure I have the training to do the procedure safely, but no one has shown that I can't" would you really be okay with that? Yes, standards have been set and I agree there is not always a definitive rationale for why they exist and this should certainly be examined. I think if new people want to enter the field the onus should be on them to prove they are just as capable, not the established field. This attitude really seems to expand far beyond the current discussion though and into a number of other common arguments on this board, and I think is a symptom of a flawed society in general. Unfortunately, politics is all about "winning" and not about being correct.

3) Agree that the post (forget whose) about the roles of different professions was quite amusing, but not helpful or even reasonable in the context of this discussion.


Personally, I think the devil is in the details. I have no doubts that any of the Becks are much better therapists than I am (or ever will be) regardless of their degree. That seems tangential to the point though. I'm quite certain somewhere out there is a person with enough drive, IQ, and interpersonal skills they could become a good therapist through self-study and practice, with no formal education beyond high school. That does not mean we should allow it. You have a fair point with regards to the overlap of the professions, but I'm not convinced it is as strong as you think it is, and others have mentioned that having some overlap does not equate to competence with just "some" additional training. I think the analogy to surgery is quite perfect...a cardiac surgeon who maybe did a rotation in neurosurgery and did some workshops at neurosurgery conferences is not the person I want operating on my brain even if there is a fair bit of overlap in their training...I want the neurosurgeon.

As an aside, Jon touched on something I think should be reiterated. What does social work add to the therapy field? Does social work training provide something unique in the world of therapy? You have stated several times you don't want to be a psychologist, but I'm still rather unclear on why not if your primary goal is to do therapy. What does social work offer in terms of therapy training that psychology does not? I'm not arguing that there isn't anything it can add...I actually think there may be, particularly for certain types of interventions with components that may draw on aspects that are within the domain of social work...for example, contingency management and other similar behavioral interventions may very well benefit from someone with a strong background in case management, used to helping facilitate changes to someone's environment, etc. I would be very interested in providing additional training in that area to social workers, and suspect that has the potential to be a highly effective team-based model. Just an example - its clearly not well thought out and I'm surer there are problems, as well as other areas there is room to work with it. I'm not sure I see as strong a connection to psychodynamic treatments, but I'd be interested to hear what the rationale is for choosing social work over psychology if that is the goal.

 

[DrGero]

I don't have much to add (particularly data or citations) except that I've worked with plenty of Social Workers in my time and they are incredibly useful people to have around in an integrated mental health practice - particularly when they are bringing what I think of as traditional social work skills to bear, which to me is expertise in, yes, case management (which is not something I find myself particularly good at), family counselling, and caregiver support. I find that traditional clinical psychology practice and traditional social work practice tends to complement each other incredibly well.

Also, personally one of the best personal psychotherapy experiences I've ever had was with a social worker.

On the negative side, the idea of social workers being considered legitimate practicioners of psychological assessment, particularly without any additional focused training and education (similar to what psychology is proposing for RxP), is ridiculous.

Quality social work training certainly can produce great psychotherapists, but quality clinical psychology training can produce great psychotherapists who also inform their psychotherapy practice with research skills and complement it with rigorous psychological assessment techniques.

 

[BSWdavid]

I think it is about as fair to equate social workers = case managers as it is to equate psychiatrists = med pushers. Certainly, case management is a strong aspect of social work, but it certainly isn't the only thing we are trained to do. In fact, case mgmt. training typically comes at the BSW level, not MSW. I actually have virtually no case mgmt. training and have no desire to be a case manager. Just as the psychology profession has expanded (i.e. developmental, social, I.O, etc.) so too has the social work profession - there are many different specializations.

I have the utmost respect for psychology and I have worked with many psychologists that have been superior clinicians. Perhaps my arguments aren't as sound as some of those on here. No doubt that much of what has been posted here has also been emotionally driven - by both sides. Until I entered this profession, I had no idea that this amount of animosity existed between social workers and psychologists. To be honest, it has been quite disheartening.

My question to many of you is this: is it really that you believe social workers receive inferior training, or do you simply not want social workers to exist on the same level as you? I wonder how much of the concern is for the good of the patients and how much of it is aimed at elevating your own status? How many of you would want to be psychologists if you couldn't put the "Dr." in front of your name? Would you be comfortable with social workers having similar status and job description, even if we spent 5 years in grad school? I can't help be feel that much of this has to do with prestige, and little has to do with actuality. Perhaps some of you don't want to be considered equal to social workers because your own egos would suffer. I see the same thing between physicians and nurses.

i entered social work instead of psychology because I was advised, at the masters level, it was more practical, and in my state, tends to be preferred over MA in psych. I assumed that if 70% of the therapists in the state were MSW's that MSW programs provided training in psychotherapy. However, I do realize that any masters program is limited which is why I have decided to attend a clinical swk PhD program. Why not psychology? I can't move to another state to attend a program, I can't move for internship, etc. I think one of the reasons that swk has become a popular route for thearapists is because its practical. No matter how well qualified most individuals are, psych programs can only accept a small percentage of applicants. Social work has filled the void simply because psychology is out of reach for most. Psychology has remained a highly selective profession, and as a result, has lost its weight to other professions willing to pick of the slack.

I looked into psych programs and couldn't make it work. Too many hoops to jump through that made it impractical. I am not implying that high standards are a bad thing. On the contrary, I think social work could learn a few things from psychology, however, most of us can't pick up and move half-way around the country for grad school and internship. As an increasing number of individuals seek out services, someone is going to have to provide said services. I wonder if psychology could keep up with the demand of therapists. I wish it could, and perhaps if psychology becomes more practical and attainable for more individuals, it will again become the dominant force in mental health treatment.

I think the discrimination between both profession is sad.

Example: As I petitioned to take graduate level psychology courses to augment my MSW degree, I received a lot of snickering and cold shoulders from psych graduate students. Even though I was able to do very well in said courses, and maintained a 4.0 psych GPA, I had to fight tooth and nail to earn their respect. I got the feeling that they were insulted that a social work student could take their courses and actually do well in them. Was this fair? If you believe you have superior training, why not welcome a social worker that you feel has inferior training? Towards the end, things began to change, but in the beginning, it was really rough. Even the instructors were a bit hesitant to let me into their courses, but I managed to do well and hopefully changed a few minds. It really did feel as though I was a minority attempting to enter into an elite group.

 

[BSWdavid]

I assume I am dealing with a fairly intelligent group of individuals, therefore, I continue to consider your arguments. The one argument that tends to stand out the most is that even if social worker can receive appropriate training in mental health treatment and assessment, they shouldn't because a) it doesn't fit with the traditional view of social workers as case managers, and b) clinical psychologists already provide these services, therefore social worker-therapists aren't needed. I think the first point is moot and represents an immature and uniformed understanding of the social work profession. The second point appears to focus more on maintaing the status quo than anything else. As I have mentioned before, mental health treatment has never been exclusive to psychology. In fact, psychiatrists were once the sole providers of psychological treatment, yet psychology fought to earn its respective place in mental health treatment. Additionally, at one time, psychoanalytic training institutes were open only to psychiatrists, and psychologists also challenged psychiatry's dominance in the psychoanalytic field. Based on this argument, psychology shouldn't have sought the right to provide mental health treatment as this was already provided by another discipline (psychiatry). Similarly, psychologists should not have sought acceptance into psychoanalytic institutes because, again, this was the sole domain of psychiatry. Do you not see my point? Just as today, many psychologists are fighting for prescription rights; are they not again challenging the status quo? Don't we have enough med providers already?

I can't get past the hypocrisy. Psychology is defined as the scientific study of human thought and behavior - which is just as far removed from mental health treatment as social work is - so why is ok for psychology to challenge the status quo but not ok for other professions, such as social work?

 

[stigmata]

Don't we have enough med providers already?



Are you serious? NO, not even close! Read my past post on your posts.

 

[docjohng]

- Because no difference has been shown is not a good reason to continue to expand services. That's putting the cart before the horse.

Is it? Just because one profession "got there first" -- with no research demonstrating its education model is the best or most ideal for creating professionals that can help people with mental illness -- isn't really much of a foundation to base an argument.

Especially not a field that prides itself on its scientific achievements and its deep research roots.

Medicine is actually having to deal with this right now in their own house. Their training model is taking some hits, especially the practice of how residents are trained and the ridiculous hours they keep while on call. But of course, they didn't change this on their own -- they changed it only after studies demonstrated not only is such a model bad for learning, it's also not great for patient care or safety.

- The current studies comparing outcomes by degree are few and poorly designed. So, we are allowing expansion/practice with no evidence to support it.

Psychologists made their bed and now they have to lie in it. They've had decades -- literally -- to design and implement gold-standard research demonstrating their training methods result in superior professionals to treat mental illness. The lack of studies demonstrates the complete lack of motivation for the profession to take the task on.

You can't expect economic and market forces to just take a nap waiting for one profession to produce the research that may signal its own demise. It's no wonder it hasn't been done for so long -- the results we've had to date are neither very overwhelming nor supportive of psychologists and their training model.

But the reality is that the market has already largely decided this issue and has moved on to reimbursing masters-level therapists across the board for psychotherapy services. Without the data demonstrating any differences in outcomes, there's been little that the profession can do to stop these sorts of things. Insurance companies, instead of researchers, are making the decisions, because researchers dropped the ball.

John

 

[FadedC]

I assume I am dealing with a fairly intelligent group of individuals, therefore, I continue to consider your arguments. The one argument that tends to stand out the most is that even if social worker can receive appropriate training in mental health treatment and assessment, they shouldn't because a) it doesn't fit with the traditional view of social workers as case managers, and b) clinical psychologists already provide these services, therefore social worker-therapists aren't needed.

Well I could be wrong (and other posters can tell me if I'm misinterpreting them) but I think that's not quite what people are saying. They aren't saying that there is anything wrong with a social worker who decides they want to spend some time getting extra training in work traditionally done by psychologists. But they are saying that if your only goal is to do work traditionally done by psychologists, and you have no interest in doing work traditionally done by social workers, then you should become a psychologist and not a social worker.

To put it in different terms using my own field, I'm studying to become a school psychologist. As a school psychologist my training will be focused around working in schools but I still have the potential to work doing the same things that a traditional clinical psychologist would do if I decide that's what I want to do and if I make sure I get the apropriate experience and training. And I may well choose to do that. But because the focus of my training is on working within a school, it would have been inapropriate for me to go into school psychology if I knew for sure that I wanted to work somewhere else.

Finally regarding the whole psychologists and meds thing, I think it is important to note that there is a shortage of medical providers which leads to a high demand for other people being given the right to prescribe, whether they are pyschologists or nurses or any other field. On the other hand there is an oversupply of clinical psychologists so there is no demand based reason that can be given for loosening the requirements to practice as one.

 

[erg923]

Based on this argument, psychology shouldn't have sought the right to provide mental health treatment as this was already provided by another discipline (psychiatry). Similarly, psychologists should not have sought acceptance into psychoanalytic institutes because, again, this was the sole domain of psychiatry. Do you not see my point? Just as today, many psychologists are fighting for prescription rights; are they not again challenging the status quo? Don't we have enough med providers already?

I can't get past the hypocrisy. Psychology is defined as the scientific study of human thought and behavior - which is just as far removed from mental health treatment as social work is - so why is ok for psychology to challenge the status quo but not ok for other professions, such as social work?

BSWdavid: You need to stop looking at the past as the end-all be-all guide for future practice. Moreover, although psychologists providing mental health treatment didnt go over very well with psychiatrists in the first decade or so follOwing WWII, we didn't fight or steal anything from them. At that time, it was needed (not enough psychiatrists to provide treatment for the veterans coming back) and the government provided ample financial resources and sponsorship for this to occur. Further, we didn't replace anything or anyone. 1.) We filled a gap as psychiatry moved into its more biologic/med prescribing role 2.) We carved out a unique paradigm/approach and advanced the field through research and developing/expanding new treatments and creating new subdisciplines (eg., b-med, neuropsychology, etc). Professions will expand and change over time, that is a given. However, at the current time, there is no need for SW to expand/morph into the same role that doctoral level psychologists currently provide-especially when they do not want to change their curriculum significantly in order to do so. As been said time and again, the Rx movement is spearheaded by a small group of psychologists who are willing to get a specialized degree in that subject matter, get appopriate training and practicum supervision, and pass a national exam in order to meet the needs of patients, because NO, there is NOT enough psychiatrists to meet the need in many areas. They are not emulating physicians and they are not taking over their role as equals (as you propose SW should do with psychology).

PS: You provided the definition for psychology, not the subdicipline of clinical psychology. Which is, "an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and personal development.

 

[deleted176373]

is it really that you believe social workers receive inferior training, or do you simply not want social workers to exist on the same level as you?

Contrary to what you said, like a bad penny, you're back!!!

I can only speak for myself... but here it goes!

I just put janitors on the same level as me... I don't pretend to place myself above others because of education, brilliant people exist in all occupations and at all levels. Education doesn't replace intellect, it only enhances it. My grandfather was a facilities person, and perhaps the most brilliant man I have yet met, he was also a "mechanic" but this was back in the early 1900's when that meant something. As an immigrant, he also had nothing past an 8th grade education.

I wonder how much of the concern is for the good of the patients and how much of it is aimed at elevating your own status?

Are you serious? I really don't care about my status... I didn't get into this to stroke my own ego... If I was, then perhaps I would have not settled for a career as a lowly psychologist... I would have aimed for a far more prestigious career.

How many of you would want to be psychologists if you couldn't put the "Dr." in front of your name?

Once again, WTF. Who cares??? I don't care if you call me Dr., Lieutenant, Mr., Mark, or Hey You. My worth is not determined by my educational accomplishments.

Would you be comfortable with social workers having similar status and job description, even if we spent 5 years in grad school?

If you spend 5 years or even 20 years in school, it doesn't matter if you aren't getting training in the right area. If you are aiming to practice psychology then all the training in the world as a physicist won't help you!!!

I can't help be feel that much of this has to do with prestige, and little has to do with actuality. Perhaps some of you don't want to be considered equal to social workers because your own egos would suffer. I see the same thing between physicians and nurses.

You really need to get past this. You have to consider that your projections here might not have anything to do with what others are feeling. I am sorry that you feel that you are being marginalized... are you now suggesting that Physicians and Nurses are equatable training for medical practice? Really?!?

Doctors and Nurses are NOT the same, and while they are both important to the comprehensive and competent care of patients, equating M.D.'s and R.N.'s is about as sensible as comparing Psychologists, Psychiatrists, and Social Workers!

i entered social work instead of psychology because I was advised, at the masters level, it was more practical, and in my state, tends to be preferred over MA in psych. I assumed that if 70% of the therapists in the state were MSW's that MSW programs provided training in psychotherapy.

So you were given advice and the perseverance on that advice seems to be all consuming. Keywords: "I assumed" that if 70% of therapists in the state were MSW's, then MSW programs provided [comprehensive] training in psychotherapy.... Now only to find out that your MSW training (as you admit yourself in posts above) was insufficient to practice at a level you felt comfortable with.

However, I do realize that any masters program is limited which is why I have decided to attend a clinical swk PhD program. Why not psychology? I can't move to another state to attend a program, I can't move for internship, etc. I think one of the reasons that swk has become a popular route for thearapists is because its practical.

So now you make excuses as to why you cannot pursue the appropriate degree. You are geographically limited. So practicality wins out over the ethical concerns of practicing outside your scope of competence. Be a therapist at any cost (save those that might require you to move.)

No matter how well qualified most individuals are, psych programs can only accept a small percentage of applicants. Social work has filled the void simply because psychology is out of reach for most. Psychology has remained a highly selective profession, and as a result, has lost its weight to other professions willing to pick of the slack.

Wait... No matter how well qualified most individuals are psych programs can only accept a small percentage of applicants... and as a result of this highly selective process psychology has missed out on a large pool of qualified applicants.... You are assuming that this selectivity is arbitrary and without merit. Got any data to back that up?

It sounds like you are saying that social work programs are filled by people who didn't have the ability to gain admittance to psychology programs and that these people would have picked psychology training if they would have only been able to gain admittance. I hope not, if this is the case, then you are saying that those who pursue Clinical Social Work training are essentially the ******ed cousins of psychologists and psychiatrists that could not gain admission to medical or psychology programs. I soundly reject that thesis. I believe that most people going into social work, don't wish to be psychologists but wish to work as social workers. These social workers are committed to fostering systematic changes that are beneficial for communities and are invested in improving the outcomes of their clients.

I looked into psych programs and couldn't make it work. Too many hoops to jump through that made it impractical. I am not implying that high standards are a bad thing. On the contrary, I think social work could learn a few things from psychology, however, most of us can't pick up and move half-way around the country for grad school and internship. As an increasing number of individuals seek out services, someone is going to have to provide said services. I wonder if psychology could keep up with the demand of therapists. I wish it could, and perhaps if psychology becomes more practical and attainable for more individuals, it will again become the dominant force in mental health treatment.

You are admitting that you were looking to be a psychologist but simply were unable to make it work. How much more can you paint a picture of back door psychologist than this admission. Pathetic.

Of course social workers can inform psychologists. Social workers are not beneath psychologists, but they are different!!! It is important to not only celebrate these differences but to allow each profession to operate within it's sphere of competence to bring the highest quality care to the clients who need the services of psychologists and social workers alike.

The idea that psychology is neither practical or attainable is ludicrous, further the thought that psychology is not a dominant force in mental health treatment is equally laughable. Sure, I will concede that Psychiatry is the highest prestige segment of the mental health care community, and perhaps the most dominant force in mental health treatment, but psychologists have a great deal of importance as well. Comparing the impact of psychology and social work in the arena of mental health treatment is pretty laughable though. Social work is not a dominant force in mental health treatment and honestly shouldn't be.

I think the discrimination between both profession is sad.

Example: As I petitioned to take graduate level psychology courses to augment my MSW degree, I received a lot of snickering and cold shoulders from psych graduate students. Even though I was able to do very well in said courses, and maintained a 4.0 psych GPA, I had to fight tooth and nail to earn their respect. I got the feeling that they were insulted that a social work student could take their courses and actually do well in them.

I think you're just pissed off that you're not a psychologist... get over it dude.

Was this fair? If you believe you have superior training, why not welcome a social worker that you feel has inferior training? Towards the end, things began to change, but in the beginning, it was really rough. Even the instructors were a bit hesitant to let me into their courses, but I managed to do well and hopefully changed a few minds. It really did feel as though I was a minority attempting to enter into an elite group.

I've taken medical school courses, I did just fine... doesn't make me a physician though. Do Psychiatrists have superior training??? No.. they don't. Do they have different training, why yes, they do. I am NOT a psychiatrist, I don't want to be one either. It doesn't matter how much I know about drug interactions, biology, or pharmacology. I AM NOT A PHYSICIAN. So when people ask if I am a Doctor, how will I respond when they say, "You're not a real doctor, are you?"

I don't care... I have a Ph.D. and I am happy practicing in my area of expertise.

Mark

 

[deleted176373]

I assume I am dealing with a fairly intelligent group of individuals.

Really, you're making an assumption... don't have much else to go on, do you?

This is really sad....

Mark

 

[BSWdavid]

Contrary to what you said, like a bad penny, you're back!!!

I can only speak for myself... but here it goes!

I just put janitors on the same level as me... I don't pretend to place myself above others because of education, brilliant people exist in all occupations and at all levels. Education doesn't replace intellect, it only enhances it. My grandfather was a facilities person, and perhaps the most brilliant man I have yet met, he was also a "mechanic" but this was back in the early 1900's when that meant something. As an immigrant, he also had nothing past an 8th grade education.

Are you serious? I really don't care about my status... I didn't get into this to stroke my own ego... If I was, then perhaps I would have not settled for a career as a lowly psychologist... I would have aimed for a far more prestigious career.

Once again, WTF. Who cares??? I don't care if you call me Dr., Lieutenant, Mr., Mark, or Hey You. My worth is not determined by my educational accomplishments.

If you spend 5 years or even 20 years in school, it doesn't matter if you aren't getting training in the right area. If you are aiming to practice psychology then all the training in the world as a physicist won't help you!!!

You really need to get past this. You have to consider that your projections here might not have anything to do with what others are feeling. I am sorry that you feel that you are being marginalized... are you now suggesting that Physicians and Nurses are equatable training for medical practice? Really?!?

Doctors and Nurses are NOT the same, and while they are both important to the comprehensive and competent care of patients, equating M.D.'s and R.N.'s is about as sensible as comparing Psychologists, Psychiatrists, and Social Workers!


So you were given advice and the perseverance on that advice seems to be all consuming. Keywords: "I assumed" that if 70% of therapists in the state were MSW's, then MSW programs provided [comprehensive] training in psychotherapy.... Now only to find out that your MSW training (as you admit yourself in posts above) was insufficient to practice at a level you felt comfortable with.

So now you make excuses as to why you cannot pursue the appropriate degree. You are geographically limited. So practicality wins out over the ethical concerns of practicing outside your scope of competence. Be a therapist at any cost (save those that might require you to move.)

Wait... No matter how well qualified most individuals are psych programs can only accept a small percentage of applicants... and as a result of this highly selective process psychology has missed out on a large pool of qualified applicants.... You are assuming that this selectivity is arbitrary and without merit. Got any data to back that up?

It sounds like you are saying that social work programs are filled by people who didn't have the ability to gain admittance to psychology programs and that these people would have picked psychology training if they would have only been able to gain admittance. I hope not, if this is the case, then you are saying that those who pursue Clinical Social Work training are essentially the ******ed cousins of psychologists and psychiatrists that could not gain admission to medical or psychology programs. I soundly reject that thesis. I believe that most people going into social work, don't wish to be psychologists but wish to work as social workers. These social workers are committed to fostering systematic changes that are beneficial for communities and are invested in improving the outcomes of their clients.



You are admitting that you were looking to be a psychologist but simply were unable to make it work. How much more can you paint a picture of back door psychologist than this admission. Pathetic.

Of course social workers can inform psychologists. Social workers are not beneath psychologists, but they are different!!! It is important to not only celebrate these differences but to allow each profession to operate within it's sphere of competence to bring the highest quality care to the clients who need the services of psychologists and social workers alike.

The idea that psychology is neither practical or attainable is ludicrous, further the thought that psychology is not a dominant force in mental health treatment is equally laughable. Sure, I will concede that Psychiatry is the highest prestige segment of the mental health care community, and perhaps the most dominant force in mental health treatment, but psychologists have a great deal of importance as well. Comparing the impact of psychology and social work in the arena of mental health treatment is pretty laughable though. Social work is not a dominant force in mental health treatment and honestly shouldn't be.

I think you're just pissed off that you're not a psychologist... get over it dude.

I've taken medical school courses, I did just fine... doesn't make me a physician though. Do Psychiatrists have superior training??? No.. they don't. Do they have different training, why yes, they do. I am NOT a psychiatrist, I don't want to be one either. It doesn't matter how much I know about drug interactions, biology, or pharmacology. I AM NOT A PHYSICIAN. So when people ask if I am a Doctor, how will I respond when they say, "You're not a real doctor, are you?"

I don't care... I have a Ph.D. and I am happy practicing in my area of expertise.

Mark

It sounds like you are saying that social work programs are filled by people who didn't have the ability to gain admittance to psychology programs and that these people would have picked psychology training if they would have only been able to gain admittance. I hope not, if this is the case, then you are saying that those who pursue Clinical Social Work training are essentially the ******ed cousins of psychologists and psychiatrists that could not gain admission to medical or psychology programs.

Not what I am saying at all. My point is that psychology cannot meet the demand for therapists so other professions have stepped in.

I don't agree. Just because social workers aren't psychologists doesn't mean their training is inferior. You are assuming that by default, clinical psychology education is superior, but as has been noted, it has yet to be proven the the psychology education model is superior to any other model.

Social work is not a dominant force in mental health treatment and honestly shouldn't be.

70% of therapists are clinical social workers, yet social work isn't a dominant force in mental health treatment?

I live in a state with 6 million residents, yet we only have a handful of clinical psych. programs. How are they to meet the growing demand for services? Should we turn clients away because we believe that clinical psychology is the only relevant paradigm?

 

[BSWdavid]

BSWdavid: You need to stop looking at the past as the end-all be-all guide for future practice. Moreover, although psychologists providing mental health treatment didnt go over very well with psychiatrists in the first decade or so follOwing WWII, we didn't fight or steal anything from them. At that time, it was needed (not enough psychiatrists to provide treatment for the veterans coming back) and the government provided ample financial resources and sponsorship for this to occur. Further, we didn't replace anything or anyone. 1.) We filled a gap as psychiatry moved into its more biologic/med prescribing role 2.) We carved out a unique paradigm/approach and advanced the field through research and developing/expanding new treatments and creating new subdisciplines (eg., b-med, neuropsychology, etc). Professions will expand and change over time, that is a given. However, at the current time, there is no need for SW to expand/morph into the same role that doctoral level psychologists currently provide-especially when they do not want to change their curriculum significantly in order to do so. As been said time and again, the Rx movement is spearheaded by a small group of psychologists who are willing to get a specialized degree in that subject matter, get appopriate training and practicum supervision, and pass a national exam in order to meet the needs of patients, because NO, there is NOT enough psychiatrists to meet the need in many areas. They are not emulating physicians and they are not taking over their role as equals (as you propose SW should do with psychology).

PS: You provided the definition for psychology, not the subdicipline of clinical psychology. Which is, "an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and personal development.

PS: You provided the definition for psychology, not the subdicipline of clinical psychology. Which is, "an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and personal development.

My point in doing so is that most have referred to social work in the same general terms while ignoring the subspecialty of clinical social work.

However, at the current time, there is no need for SW to expand/morph into the same role that doctoral level psychologists currently provide-especially when they do not want to change their curriculum significantly in order to do so.

With clinical psychology programs shrinking (at least in my state) and more clients desiring services, it seems that is a great need for social work-therapists. In fact, social workers have been providing mental health services since about WWII - the same as clinical psychologists.

 

[BSWdavid]

Mark P - If you don't want to participate in the discussion, then don't!! No one is twisting your arm, forcing you to read or post. Perhaps you are the one that is pathetic!

 

[BSWdavid]

Well I could be wrong (and other posters can tell me if I'm misinterpreting them) but I think that's not quite what people are saying. They aren't saying that there is anything wrong with a social worker who decides they want to spend some time getting extra training in work traditionally done by psychologists. But they are saying that if your only goal is to do work traditionally done by psychologists, and you have no interest in doing work traditionally done by social workers, then you should become a psychologist and not a social worker.

To put it in different terms using my own field, I'm studying to become a school psychologist. As a school psychologist my training will be focused around working in schools but I still have the potential to work doing the same things that a traditional clinical psychologist would do if I decide that's what I want to do and if I make sure I get the apropriate experience and training. And I may well choose to do that. But because the focus of my training is on working within a school, it would have been inapropriate for me to go into school psychology if I knew for sure that I wanted to work somewhere else.

Finally regarding the whole psychologists and meds thing, I think it is important to note that there is a shortage of medical providers which leads to a high demand for other people being given the right to prescribe, whether they are pyschologists or nurses or any other field. On the other hand there is an oversupply of clinical psychologists so there is no demand based reason that can be given for loosening the requirements to practice as one.

Perhaps you need to read about the history of social work. Social workers have been providing mental health services since WWII.

 

[DrGero]

My question to many of you is this: is it really that you believe social workers receive inferior training, or do you simply not want social workers to exist on the same level as you?

Social workers don't receive "inferior" training, they receive *different* training. And it seems like you're the one really obsessing about the heirarchy of mental health professions, here - for my part, I'm surprised that social workers get paid so little compared to their PhD and MD counterparts - although they do receive somewhat less training overall, they tend to work in very demanding roles and are compensated very little for the work they do in many cases.

I wonder how much of the concern is for the good of the patients and how much of it is aimed at elevating your own status? How many of you would want to be psychologists if you couldn't put the "Dr." in front of your name? Would you be comfortable with social workers having similar status and job description, even if we spent 5 years in grad school?

Oh my goodness you have such a chip on your shoulder. It's really quite obvious.

 

[loveoforganic]

This thread started heading off a cliff, saw a glimmer of light and thought about turning around, then said **** it and jumped.

 

[erg923]

BSWdavid: The only one really talking about this subject in terms of "hierarchy," "inferiority," and "animosity" is YOU. What you construe as these nasty things is what everyone else on this board (and in the actual world of clinical practice) views as different training, different specializations/strengths, and different professional roles. Notice that not one person in this thread has ever said or even hinted that LCSWs are inferior or that their jobs are secondary or useless. They are different from ours, don't you get that? Its a different dicipline (that has some overlapping commonalities, obviously), thats why it has a different name!

The feuding between mental health disciplines gets exaggerated on here because people like you make comments about how they (you) should be to do my profession under a different name and with less training. Our response has been simply "no, your not...and here's are the reasons why." In turn, you set up poorly constructed straw men arguments about topics that are essentially irrelevant (we have thoroughly explained how the Rx movement is much different than what you are proposing, both in structure and in premise, and have explain how and why disciplines change focus over time), and play the "oh, you guys are just arrogant" card. Its a intellectually sloppy way to debate, and that why you have gotten some snide comments-however, I feel the vast majority have been cogent, albeit blunt arguments on why your initial proposition was 1.) not reasonable 2.) not needed at this time.

Again, I think YOU are the one caught up in the perceived ivory tower hierarchy. Maybe you have had some bad experiences, but I really don't think that the acrimony between SW and clinical psych is present much in the day-to-day operations of the real world. Sure, there are scope of practice issues and petty BS that comes up from time to time, but I really don't think its anything to get all "sad" about. Its just human nature. If you are going to work in the mental healthcare system you are going to have to get in through your head the we dont hold hands and do the Kumbayah for our patients by all doing the same job. We do the Kumbayah by working together within our training so we can utilize our respective strengths. And for goodness sake, you need to respect the training strengths of those other professions and not trample all over them with informal versions of your own and learn to admit that "you don't know what you dont know" or you are gonna piss alot of people off. There is nothing surprising about any of this to me. Its people squabbling over how to become the best clinicians and researchers so patients can get the best care/treatment. We all have a vested interest in it. I think its cool actually.

 

[BSWdavid]

I guess at some point we have to agree to disagree.

However, I do thank those of you who have been willing participate in civilized discourse. The rest, well..I imagine they will move on to some other unsuspecting post.

David

 

[Neuropsych2be]

Reading through this debate,one things strikes me. Psychologists are actually inferior to social workers in one very important way. Psychologists seem to be incapable of concerted, organized, advocacy for our profession and our clients. I just wish APA would look at the NASW and see how a professional advocacy organization is supposed to work!

 

[DrGachet]

Reading through this debate,one things strikes me. Psychologists are actually inferior to social workers in one very important way. Psychologists seem to be incapable of concerted, organized, advocacy for our profession and our clients. I just wish APA would look at the NASW and see how a professional advocacy organization is supposed to work!

Actually psychologists are capable of organized advocacy. I think we have our fair share of politically minded people in the field. And they will get more support from the rest, once the threat of being overtaken or marginalized by other fields becomes more palpable for larger number of members.