MH Counseling vs. MSW in relation to PTSD/Military

[jhunsanger]

Hi everyone,

I searched around and looked at the counseling vs MSW threads, but I wanted advice more fitting to what I'm hoping to do.

I am in my last few semesters for my bachelors in Psychology. At first I had decided on the MSW program at USC with the concentration on Veterans and the military. But now I'm overthinking it, starting to think that it may not get me where I want, so I started looking into counseling programs.

I'm hoping to work in a VA or on a base (I'm near Nellis AFB), with returning veterans with PTSD, doing assessments and working with more of a clinical aspect. That is why I think I'm so confused, I've heard MSWs can't do assessments, but I have also heard they in some situations they can.

So anyone have any pointers? Thank you!!

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[Vasa Lisa]

At my university - there were clinical psych folks who did lots of assessments. They were deeply trained in something I had no interest in. Assessing and testing and comparing against norms. All good stuff. I do believe this - good stuff.

And as a Jungian - not my "way in" to what most matters. My way in is through the archetypal encounter, dream work, mandalas, expressive arts, sand tray. Do I use EBT/EVT/CBT/DBT etc? yes but does it define who I am as a clinician? no.

And in my counseling program, I was deeply trained in something I have a great interest in - how to sit with people who are suffering and to have the patience to be with them in that place of uncertainty.

Do I refer for assessment - yes - but is it my primary way of interacting? no.

Until you have a chance to "be" in your setting - it is hard to know what will resonate with your way of being. Counselors may not have the "status" that other mental health professionals have - but when properly trained and mentored - we can be immensely effective.

YMMV,

Vasa Lisa

 

[Qwerk]

I wouldn't count on a counseling program necessarily giving you more clinical experience than a social work program. Of course, this will depend on what electives you take and what field placements you choose (as well as whether your particular program has a clinical focus), but many social work programs are heavily clinical and will allow you to get the mental health experience that you'll need as a therapist.

As it stands today, an M.S.W. will typically allow you to do as much as, or more than, a mental health counselor, especially when it comes to taking insurance and qualifying for government employment. In other words, you're unlikely to see a job posting for a counselor that an M.S.W. won't also qualify for. See here, for instance: http://www.usajobs.gov/GetJob/ViewDetails/307076800

No comment on the fairness of this situation to counselors, of course. This situation will likely change in the next decade or so as their legal status as practitioners improves.

USAJobs.gov is actually a great resource if you're looking to see what qualifications you'll need to work with veterans, by the way.

 

[BlackSkirtTetra]

Every state has different regulations, and what's on the books in terms of law (re: who can do assessments) is often not what actually happens in practice. I know a social worker who does assessments all the time, because in her practice the PhD is only there one day a week. When the PhD comes in, she signs off on that week's assessments, but the social worker is the one who actually does them (they have a PhD, an LCSW, and two MAs). Of course, many would say this is unethical or unprofessional (and that may be true), but it's the reality of the field in a lot of places, especially in private practices.

I agree with the above poster that the MSW (and then LCSW, or whatever your state calls it) will be more versatile than the MH Counselor. Does the school you're looking at have an MSW with a Mental Health focus? Some schools have this, and it sounds like it might be a good fit for you...

 

[Padinn]

I recently completed my counseling program. I can say that breaking into the VA system right now as a counselor is extremely difficult. They only authorized the hiring of professional counselors last July and job postings have been very limited. That said, things are changing slowly. I see more and more counselor positions each month, but still lagging far behind MSW positions.

For what its worth, I don't regret my choice. I was able to do an internship with the VA and had a wonderful time working with Vets. However, it is a difficult system because you will find yourself vastly outnumbered professionally. At times, that can lead to not feeling valued...but that is changing slowly as well.

Counselors do bring a unique skill set to the table. Though anecdotal, my clinical ability was advanced in comparison to the social work interns I worked with. Our training emphasizes therapy in our all classes and settings. I also felt my program did very well in terms of addressing culture and diversity...there were definitely some cringe worthy moments I had when working with some MSW students.

Honestly, if you want the easier route, social work will get you to the Veterans and military quicker. There are many more job opportunities due to its recognition. However, I would also consider other factors that are important to you. Counseling programs place a very high emphasis on your own personal growth and development. Counseling is growing as a profession and recognition is increasing, at this rate it will be only another 5-10 years before the remaining barriers are taken down.

 

[Schooled]

My sense is that an MSW better facilitate a career in the VA system. Social workers have a longstanding history in the military (and in general) than counselors who are not psychologists or psychiatrists. As mentioned above, as an LCSW you have a lot more options and elbow room.

As far as assessment (I'm assuming you mean formal testing beyond rating scales), I don't think there's really a difference at the masters level. Neither an LPC or LCSW is qualified to do formal psychological testing in my opinion. Clinical, counseling, and school psych doctoral students often take several courses in assessment (intelligence, academic, neuropsychological, etc.) as well as supervision in assessment. How can a masters level practitioner be qualified to do assessment when the length of core assessment course work for PhDs is about as long as a masters program?! The only exception to this would be masters level school psychologists because.. well, testing is primarily what they do! Now this doesn't mean that LCSWs don't do assessment. I've also heard that they do. Other than stating my opinion on the matter, I'm saying that LPCs probably don't have a leg up on assessment.

Finally, as far as counseling skills, it will vary from program to program and supervisor to supervisor. I don't think one can say that LPCs are generally better at counseling than LCSWs. In fact, they often are at the same prac sites and doing the same things!

Your decision, in my opinion, should be driven by what setting you want to work in. Since, in my opinion, social workers and counselors are on equal footing in terms of counseling skills and (lack of) assessment skills, it's more about which professional is traditionally employed in that setting. In military/VA settings its social workers, phd psychologists, and psychiatrists. In residential healthcare settings you might see more counselors. In schools, social workers typically don't do counseling. In prisons, a counselor is more of what you want.

Try and ask some social workers and counselors in the area you want to work. In some states, one profession is held in higher esteem than the other for historical reasons. That will also play into securing the job you want!

 

[Padinn]

Just wanted to give you some more input about how PTSD treatment works through the VA system. Where I did my internship there were several dedicated mental health teams. Mental Health Intensive Case Management for individuals with severe mental illness. Substance Treatment Services for SUDs. PTSD was handled by the PCT (PTSD Clinical Team). We also had a Psychosocial Rehabilitation and Recovery program. In addition, we had several outpatient clinics. It's worth noting that due to the prevalence of PTSD in the military you will likely work with trauma in any of the above programs in some way.

In general, my assessment class focused on how to learn to properly utilize and research which assessment tools to use. We learned the skills necessary to find and learn the ethical use of assessments, rather than focusing on learning lots of different tests. Diagnosis is something that is typically done by psychiatrist / psychologists in the VA. It's worth noting that assessment is an ongoing part of a therapeutic relationship, not always necessarily through the use of formal testing, but as a part of sound therapeutic practice.

For counselors, assessment coursework is part of our CACREP requirements. I strongly recommend if you go into counseling that you choose a CACREP accredited program. It will just make life easier and it is a requirement to get a VA position as a counselor.

However, please know that in the VA system you will have substantial advantages (at least for the near future) with an MSW over a Mental Health Counseling degree. There is an "old guard" mentality in many VA hospitals that is making it very difficult for counselors to bust in...not to mention some very powerful lobbying against the hiring of LPCs by the NBSW and APA. I experienced this first hand during my internship experiences with the VA. Several positions opened up on the team I was serving for an I was ineligible for employment simply because I was a counselor and not a social worker. Despite receiving a lot of praise and advocacy from team members, I simply wasn't able to get even to the interview phase.

I suspect in the next five to ten years LPCs will become a regular staple in the VA. For what it's worth, I've noticed that many of the higher tier supervisor (GS-12+) positions are beginning to be posted for LMHCs. That is an encouraging sign.

 

[Vasa Lisa]

Padinn - well said and well articulated! I appreciate the information and the clarity. The VA outpatient clinics in my rural area will only take LCSWs for jobs - there are opportunities for LPC interns (pre-masters). I don't know anyone who has gone on to do a paid LPC/CMHC residency at the VA - for the reasons you list and others.

 

[Padinn]

Padinn - well said and well articulated! I appreciate the information and the clarity. The VA outpatient clinics in my rural area will only take LCSWs for jobs - there are opportunities for LPC interns (pre-masters). I don't know anyone who has gone on to do a paid LPC/CMHC residency at the VA - for the reasons you list and others.

Yea, it's an unfortunate part of the system right now. I definitely recommend that LPC/CMHCs looking to get into the VA apply for social work positions and contact local VA HR boards. You will often be stonewalled, but you can at least hear what the reasons are. It's then best to contact the local Congressional representative and ask them to investigate why qualified mental health professionals are being excluded from positions. This is basically what the American Counseling Association advocates that we do for the time being.

 

[Vasa Lisa]

Excellent advice and guidance. I will pass this along to my colleagues.