Scope Creep: How Does This Impact Clinical / Counseling Psychology

Therapist4Chnge · Dec 22, 2008

While JS can be a bit rough around the edges, I do think it is important to be able to discuss these rather controversial issues. I do agree that the scope creep that is happening is a very real area for discussion/debate. I cringe when I see a laundry list of "specialty" areas, that are rarely related.

It is always a bit of a tightrope walk when discussing these issues, but I usually err on the side of leaving a thread open as long as people can keep it professional (looks at JS 😀 ).

So back on topic.....

What is being done to support SW's expansion into primary areas of therapy/diagnosis/assessment? Curriculum changes, increased req. clinical hours, increased supervision hours? My interactions with SW are similar to Jon's (social advocacy, case management, supportive work), though I don't see where the training gets to the clinician. In the previous mentioned areas they are a great asset, and they have made my life a heck of a lot easier.

The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training. I know some programs offer more of a slant to one or another, but how can that all be done in 2 years, ethically?

In cases of expansion, the group wanting to expand should PROVE that there is competency, and it shouldn't be up to the current system to PROVE they are not. Unfortunately the MA/MS level lobbies are much more active than the doctoral level, and we are losing on sheer numbers and influence.

I'd like to have a discussion (Using emperically supported data and related information if at all possible) to talk about these issues.

WannaBeDrMe · Dec 22, 2008

I typed for 25 minutes straight and then, it said "thread closed"... I almost cried a little Christmas tear...

Good Lord, this blew up today, didn't it?

JS, while I take tremendous offense to your generalization that LCSW's as a whole are "that incompetent"... your frustrations are not unique to you. Many of my posts and private messages from this forum have detailed why I am transitioning from social work to psychology and have included similar reasoning as your own. However, I feel a bit more qualified to speak about the deficiences of social work practice/training since I have experienced it from the inside.

Social work, as a profession, is in no way intended to replace nor be compared with doctoral level psychologists. If you are experiencing something different in your state, take it up with your legislators and have your state's mental health policy clarified... Even as clusterfreaked as my state's policy is right now, the definitions of providers are VERY clear. With all of that said, your emphasis on how social workers are not trained as well as psychologists is a personal argument that really means about as much to me as arguing whether or not an apple or a banana tastes better to kitty cats.

For all of your training, and the fact that your argument is BASED UPON psychologists' greater competence based on your training, where is your evidence? Didn't you even attempt to call someone else out for their lack of evidence? I'm sure there are studies completed demonstrating the patient outcomes following treatment comparing one provider over another... I would research it, but this isn't my argument, it's your's, back it up with the rest of your argument. Show me data that can assert master's level practitioners driving a failboat of assessment/EBP/etc. Until then, it's personal... not professional.

For someone who repeatedly mentions evaluating evidence, you speak in troubling (and glaring) generalities based on assumptions. Do you have a data breakdown of curriculum for MSW programs in this country? If so, and you can show me that the standard course of study focuses more on social advocacy or whatever over theory or anything else... I'll be more likely to side with your argument. Even if I agree with some of your opinions, they hold little water given the fact that you seem to be pulling them out of the air... which is ok, we are allowed to pull opinions out of the air. Yay air.

About your googling... I can google just as many psychologist quacks... we could all google quacks all day, that proves nothing and I'm disappointed that you thought that was enough evidence to support your claims. A first year psychology undergrad major might get away with picking and choosing sources to support an opinion but you are supposed to be better... you say yourself in all of these posts that you are better... so, prove it. Stop offering fluff, if this is your argument, bring the facts that would be difficult to dispute without counter-facts.

My training was atypical for a social worker. All but one (my field supervisor, ACSW), of my successful mentor relationships have been with psychologists/psychiatrists. I get frustrated with the lower skill level of some master's level practitioners in a lot of areas... BUT I do something about it. I constantly lead in-service trainings, offer up my resouces, consult on assessments, etc. My work/research got me noticed by key personnel in the EBP methods you mention. Clearly, their offer to support me as I continue in this vein of research does not support your claim that LCSW's are incompetent when it comes to training/practice/research.

What is being done to support SW's expansion into primary areas of therapy/diagnosis/assessment? Curriculum changes, increased req. clinical hours, increased supervision hours? My interactions with SW are similar to Jon's (social advocacy, case management, supportive work), though I don't see where the training gets to the clinician. In the previous mentioned areas they are a great asset, and they have made my life a heck of a lot easier.

The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training. I know some programs offer more of a slant to one or another, but how can that all be done in 2 years, ethically?

In cases of expansion, the group wanting to expand should PROVE that there is competency, and it shouldn't be up to the current system to PROVE they are not. Unfortunately the MA/MS level lobbies are much more active than the doctoral level, and we are losing on sheer numbers and influence.

I'd like to have a discussion (Using emperically supported data and related information if at all possible) to talk about these issues.

T4C: I think the main issue here is defining therapy/assessment/diagnosis. If your state's don't do that... that is NOT the social worker's problem... you need to have those areas clearly defined so people are not being reimbursed for services outside their scope of practice. In my state, I am Medicaid reimbursed for providing comprehensive clinical assessments (not meant to be a formal diagnostic assessment, an elaborate psychosocial history with a diagnostic impression) and I can be reimbursed as a member of a TEAM that offers diagnostic assessments. In my state, not even psychologists are supposed to fill that role alone for Medicaid dollars... the diagnostic assessment MUST be signed by 5 team members (all of whom are supposed to collaborate). The truth is, the psychologists get overworked and they farm out the DA's to the master's level clinicians and blindly sign anything that is put out there... how is that the master's level clinician's fault? Or, they don't do DA's at all... assign a diagnosis and move forward... lots are great at assessment but just as many don't take the time or effort to properly assess/determine what's going on... at least in my area.

As for therapy, I don't do individual therapy other than brief therapy. I have focused the majority of my clinical work on groups. My individual interventions are much more case management/behaviorally based or has been brief interventions and crisis work. My research, however, required me to look more into the empirical side of therapeutic interventions and at least in my small niche, I found no papers speaking directly to the effect of the type/training of practitioner providing the service. Now, my niche is tiny, tiny... so I am guessing that's why I didn't see it but I'm sure it exists in other areas and I'm hoping someone who takes the other side of the argument will come forth with some data. I'd genuinely like to see it since I share a lot of the same concerns.

As for increased supervision hours, social workers in my state already have more required supervised hours in praticum and post-degree than ANY other master's level practitioner. More than psychologists, more than counselors, and more than art therapists/divinity/etc. I'm not saying we don't need more... but I think the standardization of quality of those hours would be a better use of energy than just making it more hours. My internship was 40 hrs a week for 18 months on a smaller (20-bed) inpatient psychiatric unit where I had 85% time contact with patients/families. Some in my cohort were based at an agency where they averaged 15% face time over the entire duration of their internships. Same with licensing... some of my peers counted the case management crap we had to do toward their 3000 hours... I refused and I absolutely only counted the clinical face hours I had... and when I wasn't getting them at my paid site, I sought them elsewhere...

If social work could take one thing from doctoral psychology.. it could be the internship process. The fact that internships are expected to provide standard competencies could help... With social work, some internships are competitive, some fellowships are very competitive... but there's still no set guidelines for what should occur... that's individualized between the student, the site, and the school through something called a learning contract. It's created per semester and it seems to be pretty random from what I've heard from other MSW's...

I'm not sure you guys are understanding the administration/advocacy training part... just like APA ethics... there are NASW ethics... and that code of ethics is based upon this principles... and those are just the underlying guidelines for practice... I never took a class in how to be an advocate... but in my practice classes (since I was in a clinically focused program, I had multiple practice/assessment classes)... we left from a starting point of meeting the client where they are in that moment... almost humanistic in its approach.

I agree with you wholeheartedly that 2 years is not enough time... and sadly, I've seen that few people go above and beyond to secure additional training. That is NOT, however, representative of incompetence of an entire group of practicing social workers. I'm just as guilty of bashing... I have a spectacular bias against counselors in my state for their lack of training here... it's frustrating to have spent 5 years cleaning up the messes of lesser trained or more arrogant individuals... 1 psychiatrist and 2 psychologists included. People are people and are prone to flaws regardless of their educational background...

Since my pet peeve in life is pitiful assessment/diagnosis, I don't mind taking a stand and saying that I have serious issue with anyone who sees it as a one time event. I have always learned, since my first tests/measurements class, that it's fluctuating and a living/breathing thing that should evolve as the client evolves. Unfortunately, that's not the nature of mental health in my state right now. To survive, psychologists are no longer individual practitioners, they are assessment monkeys. They might see a client once a year to pop out an assessment and that's it... and in my mind, that's a horrible ethics violation... why agree to diagnose someone based on one event without follow-up? If there's a contract for collaboration, perhaps that's one thing... but collaboration implies ongoing consultation efforts as well... which I haven't seen in my work.

I disagree with you on the system/competency issue... I think the system should be absolutely required to accurately and clearly define expectations for all of its DHHS practitioners from LPN's to janitors... without those definitions, it's left up to individual judgment... and if you have someone who already sucks... chances are they are not going to have the knowledge level to understand that they should take a step back instead of moving forward.

So, the conclusion of my 20-minute typed novella is as follows... and as it was before... social workers are no more incomptent, as a group, than other clinical professionals. I don't have data to back it up so i put it out there as an opinion, not as fact. I am seeking a doctoral degree in clinical psychology NOT because social workers are horrible... but b/c that best meets my needs and my abilitiies. There is room in this profession for everyone... if you don't like the direction your field is taking, then learn from us social workers and advocate for your rights... also learn from social workers and try not to step on others as you go after what you want.

In my state, for the kinks to work out, it's going to take change at every single level. It's going to take the consumers stepping up and raising hell. It's going to take the legislators getting their thumbs out of their asses and re-tooling their failboat. It's going to take psychologists sticking to their own ethics and NOT providing services that they are just going to bitch about later... same for social workers and counselors. I don't believe in kicking kittens... so I don't do it... how freaking hard is that??? Individual responsibility with an awareness for the needs of others... reporting irresponsible and unethical behavior to your licensing board, other licensing boards, and the DHHS immediately after an act occurs, etc, etc, etc.

Ok, as much as I love procrastination, I think I'm out of high-horse juice now... Peace. PS, no hard feelings JS, I am worried about mental health too... but your argument isn't going to win any prizes... keep it consistent and bring facts if you want to garner support. Otherwise, the people you recruit into your cause are not going to be people capable of change... only those who are unclear/unsteady are influenced by propaganda/rhetoric. Happy holidays.

biogirl215 · Dec 22, 2008

Is one year of school enough? I say one year, because many social work programs focus on social justice for one year. Important for social advocacy, but not for understanding mental illness.

I have yet to see an MSW program that spends a whole year focusing on advocacy and have seen many that spend both years focusing on clinical work. Even at my school's MSW program (which is "generalist" but still micro-focused), students are in clinical internships for both years.

This is also an issue with respect to assessment. For example, what constitutes an empirically supported assessment scale? What are psychometrics? What is a normative sample? For specific scales, how were they normed, what are the ceilings and floors, how are they most commonly used in clinical practice, what are the strengths and weaknesses of the scale?

The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training.

I agree that more training is almost always good (provided it's competent, well-supervised training) but would like to point out that MSW/LCSW's aren't trained or licensed to do assessment (anything beyond, say, a BDI) and that they shouldn't be practicing it, as it's out of scope. Also, LCSW licensure requires about twice as many post-degree hours as Psychologist licensure. Does this "make-up" for internship and so on? No, of course not. But given that LCSWs have a more limited scope of practice (no assessment) and a longer post-degree training period, it does help "level" things somewhat.

This type of empirical argument is a fallacy. . .an often repeated one. If we were to take this argument to infinite regress, it would mean no rules until there is empirical support to the contrary. In other words, I, as a psychologist, can perform neurosurgery. The local publix bagger can be a CPA. The hairdresser can be a murder trial defense attornery. . . until empirically proven incompetent. There are so many permutations to consider in this type of outcomes research that it's completely untenable. Instead, we must make logical inferences and decisions based on what we think/know is important as a knowledge-base and skillset for practice, with sprinkles of empricism. Think about outcomes research that asks the patient for example. Patients will attest to almost anything if you sell it well enough. . . *insert holistic medicine nonsense here* *insert religious babble here*. That doesn't make it correct.

Couldn't they use quantitative assessment scales (all administered by PhD Psychologists 😉 ) like they do in most outcome-based research (BDI, Y-BOCS, SENS, etc.)?

This, as a defense to using EMDR? No, that's unsatisfactory. Too big of a loophole to do whatever you want. As I said, it isn't a clear demarcation. You will find odd viewpoints from a scientific/critical thinking vantage point at all levels. It's an issue of ratio and tools to perform.

Nope. A defense of grief therapy, not EMDR. Getting to know a lot of my psych professors outside of the classroom (through research, advising, office hours, etc.), I can say that while they all respect/believe in/utilize EBM to some extent, I have yet to meet one who utilizes JUST EBM without bringing in their personal, cultural, religious, and so on experiences in the fray. One even said that he didn't believe in recommending for or against any particular treatment for depression, as he felt that was the client's judgment call, not his... (I, personally, was shocked to hear this--seemed like it should be a matter of clinical judgment--but he cited a study showing that depressed patients improved significantly more when given a treatment modality of their choosing (meds, therapy, or meds/therapy combined) regardless of what the actual modality was...

WannaBeDrMe · Dec 22, 2008

biogirl215 said:
Couldn't they use quantitative assessment scales (all administered by PhD Psychologists 😉 ) like they do in most outcome-based research (BDI, Y-BOCS, SENS, etc.)?

...

Precisely, they could and they do... program evaluation. Where did I learn that process... hmm, oh yeah, my MSW program. Granted I only had 12 hrs of research classes and a program evaluation project and a thesis so I didn't get that in depth... and I'm not even being a smart ass, there's no way masters level research training compares with doctoral level research training. Still, for what its worth, the tools are offered with the intent that social workers will use the framework to evaluate practice issues... just like everyone else.

JS, sorry if I misquoted you, I probably saw what I wanted to see during first read through... like I said, I agree with the idea in some form... just not the one I think you are expressing through these posts. I went back to the one of the first posts on the topic which I never even responded to but I feel like it has a few things I can address...

My point is that social work education is inadequate to the task with respect to informing practitioners about what is scientific and what isn't. ....Do social workers have enough theoretical/bio background to understand the explanation is complete nonsense? Nope. Does exposure therapy work just as well without the pseudoscience thrown in? Yep. Obviously, because there are plenty of psychologists/MDs that do practice things like EMDR and thought field therapy, there are inadequacies even at the doctoral level in education. We don't need to compound the problem by giving barely educated social workers free reign in mental health.

It's kind of like letting nurses practice primary care or even specialist care just because they have a few years experience. Hell, they at least get to observe a real doctor. Who do social workers get to see?

You admitted problems at your level but seem to be able to separate the good practitioners from the bad practitioners... why is it so difficult for you to tease them apart in social work? Legitimate questions for you, just to better understand your frustration, are as follows...

1. What types of research experience do you feel makes someone qualified to "understand" theory/practice issues?

2. What level of theoretical background do you think should be required of a clinician? Do you apply this across the board to psychologists/counselors/social workers/lmft's/speciality therapies (music, art, movement)?

3. Who do you think social workers get to see? To clarify, what exactly is the process by which you believe social workers are trained, in general?

As far as the social work requirements in your state, what are the psychology requirements? Yes, masters psychs have to be supervised but if we are being realistic... how many of those supervisory relationships are intensive and how many are just signing off on a log?

Neuropsych2be · Dec 22, 2008

It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep." 🙂 Interestingly, this is a trend across all health care. The coming war ... and folks I think it will be an all out war... in the medical field about the appropriate title, autonomy and clinical role of "doctoral level" nurse practitioners (with the DNP degree) mirrors this concern about "scope creep" in our field. Driving all of this is cost containment. If someone with less education (meaning cheaper) can *seemingly* do a similar job, the the prevaling economic and political forces trump any concerns about quality. My 20 years of professional work with an MS in clinical psych convinced me that the difference between a master's prepared clinician and a Ph.D. prepared psychologist was a couple years of coursework and a dissertation. Now that I am working on my Ph.D. I see how wrongheaded I was. There is an enormous difference between my knowledge base and clinical sophistication as a MS level therapist and my growing skills as a Ph.D. student. The differences are not just quantitative in terms of years of school etc... but qualitative as well. I almost feel as if I am entering another profession! 🙂 In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology. However, testing this qualitative difference empirically would be an interesting dissertation topic, if it has not been done before 🙂

WannaBeDrMe · Dec 22, 2008

Jon Snow said:
New Yorks LCSW requirement. 12 credit hours?

This is a within my own state comparison of a clinical psychology masters program with a clinical social work masters program. I am saying nothing about the quality of either program nor the quality of students it produces. Just putting two real life examples out there to ponder...

Pulled it out, too long, pm me for information if you are interested in specifics, I have it saved.

So, it looks like a clinical psychology 48 hr masters degree with <500 hr practicum will get you an LPA with 4 hrs of supervision a month if you are doing over 31 hours of clinical work per month. Is that right? I'm seriously asking, I have no idea. No independent practice but 4500 supervised hours before moving up to a more independent level of supervision.

Now for clinical social work... 62 hr masters degree with 1200 hr practicum will get you a PLCSW w/1 hr of supervision for every 30 hrs of clinical work (1 per week if you are working full-time clinical). 3000 total hrs post degree supervised practice to independent practitioner.

Both have exams, both had comprehensive exams, both had thesis projects, both had classes in theory, etc. I've compared to counselors before but never psychologists, interesting.

So, based on this (and maybe the specifics I have waiting for ya in pm) would you say that masters level psychologists are also incompetent by your definition? Again, I feel like I have to keep putting disclaimers, but I mean that with sincerity and not mockery...

As a totally unrelated aside, I just read that NC's advocacy group for masters level psychologists were actually pissed that LPA's were kept out of EMDR trainings b/c they lacked the ability to practice independently. I don't like EMDR so I don't care one way or the other... but I think it's funny that the people upset over being excluded are the ones who share at least 1/3 of your training.

WannaBeDrMe · Dec 22, 2008

Neuropsych2be said:
It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep." 🙂 Interestingly, this is a trend across all health care. The coming war ... and folks I think it will be an all out war... in the medical field about the appropriate title, autonomy and clinical role of "doctoral level" nurse practitioners (with the DNP degree) mirrors this concern about "scope creep" in our field. Driving all of this is cost containment. If someone with less education (meaning cheaper) can *seemingly* do a similar job, the the prevaling economic and political forces trump any concerns about quality. My 20 years of professional work with an MS in clinical psych convinced me that the difference between a master's prepared clinician and a Ph.D. prepared psychologist was a couple years of coursework and a dissertation. Now that I am working on my Ph.D. I see that there is an enormous difference between my knowledge base and clinical sophistication as a MS level therapist and my growing skills as a Ph.D. student. The differences are not just quantitative in terms of years of school etc... but qualitative as well. In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology. However, testing this qualitative difference empirically would be an interesting dissertation topic, if it has not been done before 🙂

yes, definitely different, no doubt about it... but necessarily better? if so, better by whose standards, the client's, the professional colleagues', the drug companies', etc. I absolutely crave that greater understanding and that's why I'm moving on but I am not willing to concede that remaining a master's level clinician would have damaged anyone beyond repair. (other than myself... ha)

I love your observation of RxP being pretty much the same bunch of grapes, different fruit basket. Pots and kettles and credentials oh my! I'm going to use this thread as my promise to myself never to bash LPC's again... the fingers wag in many directions.

biogirl215 · Dec 22, 2008

I'd to see the information you pulled WannaBeDrMe.

FWIW, I run a seminar for undergrad. students doing psych internships and had an MA Couseling student and a PhD Clinical Psych student with a previous MA in Counseling come in and talk about their programs, experiences in grad school, etc. They both said that turf wars in the field were somewhat overblown and that there is a ton of crossover between MA-level therapists, LCSW's, and PhD's in clinical practice (and interestingly enough, mentioned that one has to pick up some advocacy/social work-type skills when working with at-risk populations as a clinician). Just throwing that out there...

Therapist4Chnge · Dec 22, 2008

Neuropsych2be said:
It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep."

But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively.

Neuropsych2be said:
The differences are not just quantitative in terms of years of school etc... but qualitative as well. I almost feel as if I am entering another profession! 🙂 In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology.

Exactly.

Therapist4Chnge · Dec 22, 2008

I know some states (though not all) have "psychologist" as a protected term that required doctoral training.....so "masters level psychologist" is generally a misnomer.

WannaBeDrMe · Dec 22, 2008

Therapist4Chnge said:
I know some states (though not all) have "psychologist" as a protected term that required doctoral training.....so "masters level psychologist" is generally a misnomer.

True, sorry to generalize, my state is actually one of those... I'll try to be more respectful in future posts. I know I hate it when social worker gets tossed around to fit every person who ever worked in any helping profession.

re: the specific information, sending it your way now biogirl, since I'm posting it in pm, I'll also include links to the school's websites in case you want to look at it more, I thought it was really interesting... I've never taken the time to look and see what master's clinical programs were about... there are so few out there it seems...

Neuropsych2be · Dec 22, 2008

Therapist4Chnge said:
But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively.

Well now that you mention it. Yes there is research to support it. In fact I just coauthored an invited paper on the RxP issue that will be coming out in the Journal of Contemporary Psychotherapy in Jan 2009. 🙂🙂

Neuropsych2be · Dec 22, 2008

Jon Snow said:
I have no idea. I'm really not too familiar with this stuff. I kind of bipassed the whole masters thing. I'm learning here as we go along.

Just a nitpick, but there is no such thing as a masters level psychologist (exception: school psychologist, but the school modifier is necessary).

. . .and I would put them (masters level) on approximately equal footing to social workers in my current understanding of the situation. And, I'm not arguing that social workers are incompetent as a whole, only that some are operating outside of competencies (e.g., diagnosis) and scope creep (I like that term) promotes more and more risks of that kind of situation.

My MS degree in clinical psychology was 60 hours of graduate work, an empirical thesis, and 1400 hours of practicum! Took me three years full time (groan) and none of my credits transferred into my Ph.D. program because they were too old at > 5 years old.

biogirl215 · Dec 22, 2008

But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively

Just to play devil's advocate (not the pinball game, though you rock if you got that reference 🙂 ), isn't there a real need for mental health practitioners in general, especially in rural areas? I want to practice in a rural area with an underserved population, and in many of areas where I want to work, there's almost NO practitioners of any type (MA, MSW, PhD, PsyD, MD). Sure, NYC, CO, and Cali are saturated. The rural northwest? Not so much.

I do agree that research training is ultra-important, and, imo, should be emphasized MORE at all levels, including at some research-weak PsyD programs. No question about that... In fact, I'm applying to PhD programs because I love doing research and see a ton of value in it in regards to clinical training and practice. On the flip side, however, I know grad students in my university's Clinical PhD program who flat-out admit that they are *far* more interested in practice than research and are more than happy to do the minimal requirements of a thesis and dissertation and get out (this, of course, does not represent all the clinical students here... I also know some who are "balanced," and some who are far more interested in research).

In fact, I think it would probably be a good idea for clinical-track MSW programs to require a degree in psych or substantial post-BA psych education and place more of an emphasis on research.

Therapist4Chnge · Dec 22, 2008

biogirl215 said:
In fact, I think it would probably be a good idea for clinical-track MSW programs to require a degree in psych or substantial post-BA psych education and place more of an emphasis on research.

No way this would ever happen....as it would eliminate most of the people going for the degree, as they wouldn't want to jump through those hoops.

cara susanna · Dec 22, 2008

I gotta say, most of the people I know in MSW programs are in them because they hate research, or at least don't like it that much.

Neuropsych2be · Dec 23, 2008

Therapist4Chnge said:
No way this would ever happen....as it would eliminate most of the people going for the degree, as they wouldn't want to jump through those hoops.

Well if one wishes to argue the equivalency of an LCSW and a Ph.D. in clinical psychology, perhaps we could agree that a Ph.D. or DSW (Doctor of Social Work) degree should be the minimal educational standard for the independent practice of clinical social work 😀 One issue I see here, after my 20 years experience in mental health is an inferiority complex social work as a profession seems to have vis a vis the other professions. Yet social work is a very very honorable profession with theoretical links to sociology. psychology and anthropology. Perhaps clinical social work should be a doctoral level profession where students conduct empirical dissertation-level research with clinical training on a par with that of psychology psychology e.g. 6000 hours of supervised experience prior to licensure. Certainly with an enlarged research base to inform practice, the dissertation research generated by Ph.D. students in social work could be of immense help to all the professions given their unique perspective. Of course the NASW would never go for the transition to the doctoral level for LCSW's since they have spent so much time advocating for the viewpoint that MS level training as adequate. One problem LCSW's are going to run into are LPC's who typically have equal training as LCSW's (60 hours grad work in counseling or psych and 2000 hours of post-degree supervision) advocating for things such as Medicare reimbursement. But you are right T4C, that prospect would scare off half the student body in social work.

biogirl215 · Dec 23, 2008

Actually, I do know of at least one MSW program (Smith), which requires a fairly substantial empirical (clinical) thesis--not the same level as a dissertation, of course, but it's something.

2000 hours of post-degree supervision

Don't most states require 3,000 hours for LCSW licensure? That's what I thought, but I could be wrong...

an inferiority complex social work as a profession seems to have vis a vis the other professions

I've had professors in my social work program argue that this is due, at least in part, to the fact that "social worker" is just now becoming a protected title.

Could you elaborate on what you mean here, please? Do you think is warranted or not? I'm curious.... 🙂

Well if one wishes to argue the equivalency of an LCSW and a Ph.D. in clinical psychology, perhaps we could agree that a Ph.D. or DSW (Doctor of Social Work) degree should be the minimal educational standard for the independent practice of clinical social work

I've never seen anyone argue for equivalancy (and if they did, that would be really, really foolish, imo). All the social workers I've been around have deferred to PhDs in terms of assessment and research (as they should!)--the most I've seen argued for was the idea that they could, with training, be equally competent therapists (including therapeutic assessment and dx). FW(little)IW, I have known some clinical psychologists (professors) to recommend that students who want to do just therapy work (and have little interest in academia) consider MSW programs, as they believed MSW/LCSWs are/were competent clinicians. Just throwing that out there... Like I said, I believe there's real value in doctoral training (I wouldn't be applying otherwise), but I think it's somewhat rash to dismiss LCSWs as incompetent across the board.

Neuropsych2be · Dec 23, 2008

biogirl215 said:
I have known some clinical psychologists (professors) to recommend that students who want to do just therapy work (and have little interest in academia) consider MSW programs, as they believed MSW/LCSWs are/were competent clinicians. Just throwing that out there... Like I said, I believe there's real value in doctoral training (I wouldn't be applying otherwise), but I think it's somewhat rash to dismiss LCSWs as incompetent across the board.

I am just playing out this idea to its logical conclusion with a certain degree of tongue in cheek! I'd never ever ever say that LCSW's are incompetent. They make excellent therapists and advocates for their clients. Can anyone say Virginia Satir?? In fact, clinical psychologists can learn alot from them about advocacy and how to organize. I wish to god that someday the APA sits down with the NASW and actually learns from them how to advocate effectively in terms of public policy because the NASW puts APA to shame! However, the professions are different with a very different skill set. Clinical psychologists are in fact far more than therapists. we (both Ph.D. and Psy.D.'s) are scholars and scientists as well as clinicians. LCSW's are more than therapists, they are advocates for personal and social change and are able to work within systems and against systems to advocate for their clients. What I am saying is that each profession is very distinct with very different strengths and skill sets.

Therapist4Chnge · Dec 23, 2008

Jon Snow said:
The problem for me is social workers are not supervised. They are independent practitioners. Diagnosing mental illness/behavioral presentations requires a lot more than just knowledge of the DSM.

Agreed. I think the horse is out of the barn on this, but I think there are far too many things that could go wrong to not have supervision. The Dx piece in particular. Many times once a label is written down....it sticks.

Jon Snow said:
I don't see how a license that requires "at least 12 hours" or clinical coursework can possibly be adequate.

12 hours of pure clinical coursework is a drop in the bucket when it comes to training. Reading Gray's Anatomy (the book) does not make someone competent to effectively diagnose, and the same can be said about the DSM. There are SO many other things that go into a Dx: Cog, neuro, behavioral, projective, objective, etc. Those assessments provide the differentials that can't be had from strictly a clinical interview.

Jon Snow said:
In my opinion, doctoral level psychology also needs to beef up their biological/neuropsych educations.

I didn't know what I didn't know until I started my MS in Pharma. I had to take orgo, A&P, biochem, pathophys, etc. It isn't that I am advocating for all of that, but taking single courses in Pharmacology, Psychobiology, and maybe Neuroanatomy is hardly sufficient nowadays. I think more neuro-based courses need to be required.

biogirl215 · Dec 23, 2008

I disagree that LCSW's (and other master's level practitioners) can't acquire the skills to effectively dx and treat psychological disorders. In fact, I would argue that they need to be able to because clients will present with those d/o's or at least symptoms of them. Clients may present with a chief complaint of "anxiety" that is actually OCD or a specific phobia or "sadness" that is actually MDD and/or part of bipolar. A good clinician needs to be able to recognize this and handle it and then make appropriate referrals if necessary (to clinical psychologists for additional testing, MD's for meds or medical rule-outs)

For example, I work in substance abuse (undergrad intern) where all our clients are mandated for MIPs, dorm write-up's, etc. One of my fellow interns (an MA Counseling student) had a difficult client who she suspected may be bipolar based on his bx in the group. She obviously couldn't dx him without an individual session, but recognizing that possibility changed the way she handled the situation--being trained in diagnosis kept her "antenna up," so to speak, even in a situation where we weren't necessarily expecting to see psychopathology.

Are all MSW's trained to diagnose and treat disorders? No. But many have had the courses, training, supervision, etc. (and passed a state licensing exam) to allow them to do so. They aren't just getting the MSW curriculum--they're also getting supervision, etc., in the area.

I agree that medical rule-out's need to be done carefully, and that this is something that needs to be improved, even among clinical psychologists. I think it's a bias of the fields (clinical psych, counseling, lcsw's, etc.) to approach and treat behavioral/emotional issues in a psychological manner, and that this can sometimes "blind" practitioners to the possibility of strictly organic causes (poor wording but hopefully you can follow me) of these issues.

Neuropsych2be · Dec 23, 2008

I didn't know what I didn't know until I started my MS in Pharma. I had to take orgo, A&P, biochem, pathophys, etc. It isn't that I am advocating for all of that, but taking single courses in Pharmacology, Psychobiology, and maybe Neuroanatomy is hardly sufficient nowadays. I think more neuro-based courses need to be required.

I just took a look at the MS in pharmacology at Nova. The courses seem far superior to what a typical mid-level NP or PA might get in the sense that the coursework seems very focused. The only concern about such a curriculum is the whole issue of psychotropic drugs interacting with other pathological condition outside the central nervous system. But the curriculum looks impressive. If this is scope creep then it is very nice and very comprehensive scope creep :laugh:

I'd love to take a course sequence like that but organic chem and biochem for your typical psychologist with a liberal art background would be challenging to say the least.

BohuMSW · Dec 23, 2008

This thread should (and the closed ones that precede it) should be required reading for prospective clinical social work students. It highlights a few of the joys of being a social worker.

1)you'll get to work mostly with two types of psychologists. One type will be like Jon Snow, and be openly condescending and dismissive of your abilities. The other type will also generally think you're an idiot, but will be too nice to talk like this around you.

2)expect plenty of backhanded praise from other disciplines such as "social workers do have excellent skills in providing support and advocacy," i.e. they are good at things any reasonably intelligent person could have figured out how to do without getting a masters degree.

3)Despite the complaints about social workers assessing and diagnosing, don't expect your psychologist co-workers to be leaping to accept your referrals for testing and assessment.

4)Do expect your psychologist co-workers to refer every single task that might be related to one's "social" functioning to you. Expect calls asking things like what are the local bus routes home from the clinic, or my favorite "the patient I have been seeing for two years asked me to fill out a form for his work, can you do it?" Or, "my patient with depression is depressed because he is in bankruptcy, could you see him, I only treat his depression?"

5)Everyone thinks you're an idiot. If you work extra hard, keep up with current literature/research, have a track record of success, take a leadership position, etc. they might rethink that. Now they'll both think you're an idiot and resent you.

On the other hand there are some valid reasons why people see us this way. A few that come to mind:

1)we accept anybody. anybody with a pulse can get an MSW. Regardless of what it says in other threads, our programs aren't selective, and they are incredibly easy. Garbage in, garbage out.

2)Our curriculum is filled with 60's/70's platitudes. Expect liberal indoctrination about how "western" culture is individualistic and shallow, whereas "eastern" cultures live in harmony and joy. Jon Snow is wrong about there being a "social justice year." I'm not sure where he got that, but learning absurd "facts" like "dangerous radicalism almost always rises from the right wing" and "Husserl was the first existentialist" made it into my "human behavior" classes.

3)our professional organization, the NASW is extremely obnoxious. Expect to hear their views on how you should vote, what you should believe, and I better stop before the black maria arrives at my door to carry me off for re-education.

I try to not get hung up on this stuff. You learn solid clinical skills in MSW programs that can help a lot of people. I'm sure the same is true for clinical psych. There will always be total tools who get a lot of satisfaction out of hating on each others disciplines sort of like i did in the first part of the post. It's amusing yes, but ultimately pretty stupid. I'm sure I could walk on water, cure severe TBI with my touch, and end world poverty tomorrow, and someone like Dr. snow would still have a "yes but" to disparage social work.

I think "scope creep" is dangerous, but I don't really think that's what this thread was about at all. It started as a "are social workers incompetent? Why yes they are!!" thread, and changed to a "make a few valid points about scope, then say social workers are incompetent" thread.

psychmama · Dec 23, 2008

BohuMSW said:
This thread should (and the closed ones that precede it) should be required reading for prospective clinical social work students. It highlights a few of the joys of being a social worker.

1)you'll get to work mostly with two types of psychologists. One type will be like Jon Snow, and be openly condescending and dismissive of your abilities. The other type will also generally think you're an idiot, but will be too nice to talk like this around you.

2)expect plenty of backhanded praise from other disciplines such as "social workers do have excellent skills in providing support and advocacy," i.e. they are good at things any reasonably intelligent person could have figured out how to do without getting a masters degree.

3)Despite the complaints about social workers assessing and diagnosing, don't expect your psychologist co-workers to be leaping to accept your referrals for testing and assessment.

4)Do expect your psychologist co-workers to refer every single task that might be related to one's "social" functioning to you. Expect calls asking things like what are the local bus routes home from the clinic, or my favorite "the patient I have been seeing for two years asked me to fill out a form for his work, can you do it?" Or, "my patient with depression is depressed because he is in bankruptcy, could you see him, I only treat his depression?"

5)Everyone thinks you're an idiot. If you work extra hard, keep up with current literature/research, have a track record of success, take a leadership position, etc. they might rethink that. Now they'll both think you're an idiot and resent you.

On the other hand there are some valid reasons why people see us this way. A few that come to mind:

1)we accept anybody. anybody with a pulse can get an MSW. Regardless of what it says in other threads, our programs aren't selective, and they are incredibly easy. Garbage in, garbage out.

2)Our curriculum is filled with 60's/70's platitudes. Expect liberal indoctrination about how "western" culture is individualistic and shallow, whereas "eastern" cultures live in harmony and joy. Jon Snow is wrong about there being a "social justice year." I'm not sure where he got that, but learning absurd "facts" like "dangerous radicalism almost always rises from the right wing" and "Husserl was the first existentialist" made it into my "human behavior" classes.

3)our professional organization, the NASW is extremely obnoxious. Expect to hear their views on how you should vote, what you should believe, and I better stop before the black maria arrives at my door to carry me off for re-education.

I try to not get hung up on this stuff. You learn solid clinical skills in MSW programs that can help a lot of people. I'm sure the same is true for clinical psych. There will always be total tools who get a lot of satisfaction out of hating on each others disciplines sort of like i did in the first part of the post. It's amusing yes, but ultimately pretty stupid. I'm sure I could walk on water, cure severe TBI with my touch, and end world poverty tomorrow, and someone like Dr. snow would still have a "yes but" to disparage social work.

I think "scope creep" is dangerous, but I don't really think that's what this thread was about at all. It started as a "are social workers incompetent? Why yes they are!!" thread, and changed to a "make a few valid points about scope, then say social workers are incompetent" thread.

As someone who made the difficult decision to start over in a new career as a psychologist in part to escape the obnoxious elitism and smugness of my former profession (lawyer), all I can say is that I'm embarrassed. I do not agree with the tone of most posts on this thread, and it makes me ashamed to call myself a psychologist in training. Maybe it's the fact that I come to this field with more life experience, but the idea that any profession has cornered the market on competence and intelligence is just ridiculous!

psychmama · Dec 23, 2008

Jon Snow said:
No doubt, who claimed that?

Jon, go ahead and pick apart arguments sentence by sentence. More telling, IMHO at least, is the overall gist and tone of your posts. Your points are sometimes well-taken, for instance about the need for better training of psychologists and the problems with professional schools. Honestly though, are you planning a career in clinical work? Because I have to say that your manner of expression is quite off-putting and sanctimonious.

I know this is not the well-reasoned, evidence based response you would prefer. It's just a gut reaction from a fellow human. Sheesh!

BohuMSW · Dec 23, 2008

psychmama said:
As someone who made the difficult decision to start over in a new career as a psychologist in part to escape the obnoxious elitism and smugness of my former profession (lawyer), all I can say is that I'm embarrassed. I do not agree with the tone of most posts on this thread, and it makes me ashamed to call myself a psychologist in training. Maybe it's the fact that I come to this field with more life experience, but the idea that any profession has cornered the market on competence and intelligence is just ridiculous!

I wouldn't take it too seriously, it's just the internet. Plus, i don't begrudge psychologists some griping. If you complete a doctorate you should be at least entitled to get all "Dey took 'er jobs!!!" now and again with those of us who swooped in with merely a masters. Like snakes in the grass if one is fond of mixing metaphors which i am. I'm also fond of all the psychologists I work with.

psychmama · Dec 23, 2008

BohuMSW said:
I wouldn't take it too seriously, it's just the internet. Plus, i don't begrudge psychologists some griping. If you complete a doctorate you should be at least entitled to get all "Dey took 'er jobs!!!" now and again with those of us who swooped in with merely a masters. Like snakes in the grass if one is fond of mixing metaphors which i am. I'm personally fond of all the psychologists I work with.

You're right, of course. It's just the internet. I find it scary that the anonymity of the forum allows people to show a side of themselves that I gather they hide rather well in "real life". 🙂

Of course, I could be wrong...

psychmama · Dec 23, 2008

Jon Snow said:
Heh. I've seen this style of response before. Notice, I haven't attacked anyone, but I'm sanctimonious and a *implied* poor clinician because of my style of posting on a messageboard and because I support high standards and worry about the product mental health providers represent to the public and other professionals. But instead, this constantly is interpreted as if I'm playing turf war and being elitist. Right, right. In case you haven't noticed, mental health as a collective enitity has taken major hits in reputation in the public eye because of a lot of the things that I rant about. And yes, I'm pissed about it. I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto. It's annoying. . . . as if this has anything to do with my ability to establish rapport or show compassion for a patient. . . or anything to do with whether or not I'm a nice guy. Yeah, I care about the field.

You may be a nice guy. I have no way of telling that except by what you present on these boards. And yes, I can tell you're passionate about the field and want to promote its standing and reputation. I've been around the block a bit, and I would simply point out that (as Grandma used to say) "You catch more flies with honey than you can with vinegar." Like it or not, people will be much more inclined to listen to your arguments if you deliver them with humility and good will. You probably think this makes me a mushy thinker, one of those undisciplined "feel good" types. Maybe I am. I'm also a pragmatist and trained in the art of persuasion (law school and 11 years of practice). Think about it. Reject as you will. It's just my viewpoint.

TMS@1987 · Dec 23, 2008

Jon Snow said:
Heh. I've seen this style of response before. Notice, I haven't attacked anyone, but I'm sanctimonious and a *implied* poor clinician because of my style of posting on a messageboard and because I support high standards and worry about the product mental health providers represent to the public and other professionals. But instead, this constantly is interpreted as if I'm playing turf war and being elitist. Right, right. This is self-serving. In case you haven't noticed, mental health as a collective enitity has taken major hits in reputation in the public eye because of a lot of the things that I rant about. And yes, I'm pissed about it. I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto. It's annoying. . . . as if this has anything to do with my ability to establish rapport or show compassion for a patient. . . or anything to do with whether or not I'm a nice guy. Yeah, I care about the field.

Heres a thought, which you can take with a grain of salt since I'm only a junior in undergrad, but could it be that social workers tend to collect more "fluff non-thinkers" due to the shere size of their group? This is kinda my "the bigger the village, the more idiots you get" theory. I bring this up simply because I have heard from a few professors of mine that social workers are the largest providers of menta health services in the country, and as such they porbably have a bigger number of quacks to match their bigger number overall. Just a theory, be gentle with me *cowers from JS*

cara susanna · Dec 23, 2008

Jon Snow said:
I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto.

Sorry, would you mind listing some examples? I'm curious. Or does this tie in with the complaint that the APA is constantly releasing statements on government policies without providing scientific evidence to back them up?

biogirl215 · Dec 23, 2008

But, I don't think social work corners the market for fluff non-thinkers.

Wait. I'm confused here--is the argument that social work (LCSW) has a disproportionate number of "non-thinkers" or that mental health in general (PhD, PsyD, LCSW, MA/MS, MD) has a disproportionate number of "non-thinkers"?

And maybe I'm reading this wrong, but I really don't see how you can support social workers has clinicians without giving them some of sort of diagnostic scope. Isn't that a necessity for working with clients?

The problem for me is social workers are not supervised. They are independent practitioners. Diagnosing mental illness/behavioral presentations requires a lot more than just knowledge of the DSM.

I agree that LCSW's should have supervision and that all mental health clinicians should have or could benefit from supervision. I think (in my very limited opinion/experience) that there's A LOT of value in supervision.

PsyDr · Dec 23, 2008

my 2 cents:

i am not really concerned with any of this for a few reasons:

1) imo, ppl who can afford it will always pay more for a high quality service. i will always pay for a dr. over a nurse practitioner much as i will pay more for a mercedes over a kia. those that want to take shortcuts will end up getting worse service. let the buyer beware.

2) insurers will always reimburse at a higher rate for higher levels of care. it is simply too far ingrained into the system to be undone.

3) there is more than enough business to go around if you have some basic business skills.

4) i believe that crap tx providers attract terrible patients. happens across all levels and areas of practice.

TMS@1987 · Dec 23, 2008

Question! What is "supportive therapy"? I'm sure my obscene ignorance is glaring through in this post but I'm just trying to understand the lingo.

biogirl215 · Dec 23, 2008

So, you essentially believe social workers should do *nothing* clinical...? Wow.

apumic · Dec 24, 2008

biogirl215 said:
So, you essentially believe social workers should do *nothing* clinical...? Wow.

I think to some degree, one could argue that SWs are, in some sense, a case coordinator in many cases -- that is, their function could be seen to be as similar to a primary care doc in medicine in that they are able to do the most basic work in each area in which they work (mental health, advocacy/law, etc.) and act as a coordinator of the treatment team for a given client in many cases but are not specialists in any one area. If we consider SWs in that sense then JS's accusations would be quite appropriate since we don't let SWs represent their clients in the same way a lawyer does (therefore, why should they be able to do all of the work of a clinical psychologist?)

biogirl215 · Dec 24, 2008

^
But social workers DON'T do all the work of clinical psychologists--they do therapy but not assessment.

apumic · Dec 24, 2008

^ From what I've seen/heard, masters-level practitioners are able to perform some assessments now (primarily administration of certain objective measures). I haven't done any real research in this area since my goal is to pursue my doctorate but I know that even the BA-level practitioners at the place I worked recently were able to administer some behavioral analysis measures and write up reports that went in clients' files and were later filed with DMHS.

WannaBeDrMe · Dec 24, 2008

apumic said:
^ From what I've seen/heard, masters-level practitioners are able to perform some assessments now (primarily administration of certain objective measures). I haven't done any real research in this area since my goal is to pursue my doctorate but I know that even the BA-level practitioners at the place I worked recently were able to administer some behavioral analysis measures and write up reports that went in clients' files and were later filed with DMHS.

What social workers do is legally determined by state policy and carried out through licensing boards. If you feel any practitioner is practicing outside of their scope, it is your ethical duty (at least as a social worker, I don't remember APA ethics) to report that as a professional violation. Reporting across disciplines is tricky but it didn't stop me, as an intern, from reported a board certified child/adolescent psychiatrist. I didn't make any friends but I could sleep at night.

JS's clarifications on lots of mental health being fluff is much more easily digested, by me, than just holding social workers accountable for the downfall of civilization as we know it. I don't know if anyone has ever tried to make the case that social workers feel that thy are as thoroughly trained as doctoral level psychs... so attacking with that argument is non-sensical and made my head hurt.

There are ALL types of mental health workers at every skill level with various degrees who are great... and ones who suck in stinky ways.

BohoMSW, I'm sorry you've had that experience with psychologists. I have had very positive experiences with professional clinical psychologists, academic psychologists, etc both before and after my MSW/LCSW. If they have any qualms about social workers, they keep it quiet around me and I've always felt respected, included, and appreciated. In fact, psychologists have downright empowered me to move forward in my field in a few areas.

I'm not a name dropper, but I could drop some names of people who don't hate me... people who have offered me work, research, collaboration, opportunities, grant-funded positions (got a call today for another in my masters-level research area-- different from my current research), etc. Have I missed out on any opportunities because I chose an MSW first?? Maybe... I can't rule it out... but I can definitely say that my frustrations with the field have NOT been b/c of any issues where I felt discriminated against by psychologists.

My issues spoke to the fluff of my training, the poor professionalism of our department staff, the failed mental health policy in my state, the plethora of under-qualified practitioners in my area (including doctoral level individuals), etc... Scope creep issues generally involved me BEGGING someone else to do their job but them refusing to do it... I can honestly say that I don't believe I've overstepped my knowledge-boundaries (and definitely not my job description agency/state-wise) since my internship. I work hard to build relationships with professionals in other disciplines.

I know the original thread directed this conversation toward LCSWs and I appreciate that it has been clarified that it's under-qualified professionals in all disciplines, at all levels of training who practice outside of their ability/training. As long as this stays in that realm of thinking, I think this is a very helpful discussion. Knowledge shouldn't become exclusionary... knowing more should open up the world... not close it off... I have sympathy for people who set limits on what they are willing to learn... and obviously, that goes beyond academia.

Happy holidays... and ps, if you think NASW is bad, NAMI is way worse. They have action alerts for everything... someone did a Law and Order about a person w/schizophrenia being a murder suspect, oh noes, write 4 billion letters to NBC... someone did a song with the word "suicide"... oh noes, boycott radio stations...

I hope it isn't too much self-disclosure to offer my fave quote on the boards... I think it applies to that paragraph... and the thread in general... very well... take care guys.

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."
~ C.S. Lewis, God In The Dock

biogirl215 · Dec 24, 2008

Wanna,

Have the psychologists you've worked with had issues against you practicing clinically (as a therapist)?

WannaBeDrMe · Dec 24, 2008

biogirl215 said:
Wanna,

Have the psychologists you've worked with had issues against you practicing clinically (as a therapist)?

Someone mentioned quality of service and cost of service... and while I don't support the idea that social workers provide a lower quality of service than psychologists (perhaps less thorough if anything)... that statement sort of applies to my answer.

I see a totally different caseload than the psychologists in my area. Community mental health (indigent, medicaid, medicare, sliding scale) practitioners are almost entirely licensed psychological associates, provisional clinical social workers, and licensed professional counselors.

My paid job-based interaction with psychologists has been strictly in 15 minute intervals for their contract services. The psychologists I've worked with tend to ask me 5-6 questions about a client and then offer their signature as endorsement on whatever I need to submit to Medicaid. For this, the agencies pay them a reimbursement rate. (In my state, some enhanced services require approval of a team of clinicians including 2 doctoral level clinicians ... designed to encourage collaboration but is a big old boat of fail).

I didn't agree with it (and many other things) and got fed up after I saw that not much was changing so I left earlier this year. There are many great clinical psychologists in my area including my 2 current supervisors... but they don't work with the same population. They see insured individuals or private pay. Their medicaid/medicare cases might be a complex disability, like TBI w/my neuro mentor, but otherwise, their clients are much more SES stable.

To my knowledge, none of the clinical psychologists have taken issue with my practice. Even in internship, a psychologist and an MD served in equal roles as teachers to me alongside my ACSW supervisor. I never took interest in ongoing therapy as a focus, though, so perhaps I just didn't flash on their radars in that way. I have worked with at least 25 different psychologists over the last 5 years (just tried to count, that's as far as I got, might be more) and most of them have always asked me to summarize my assessment for them and that, not client contact, is how they based their decision on whether or not to endorse a service order.

There's not a lot of intra-"species" competition in my area because of how mental health reform has outlined our system. For those who are able to step outside of it and form independent private practices (licensed clinical social workers included), their world is very, very, very, very, very different from what my world has been over the last few years. It's just been two different worlds completely.

My situation is atypical and if you ever get bored and want to read a trainwreck in progress... I'll refer you to a news paper in our state that has conveniently sectioned off all of the mental health articles into one section called Mental Disorder: The Failure of Reform.

If you scroll beyond the initial articles from Feb, you'll get to see how something new and devastating hits the press a few times a week. You can't imagine how disappointed I was to work so hard to get a point where I could enter the field only to be tossed into this dismal abyss of douchebaggery... I know there are problems everywhere but the main problem here is that legislators turned back around on clinicians and blamed us and agencies for the failure.... I wrote SEVERAL nasty letters to politicians I'd previously volunteered with... for one, I had been a paid member of her staff... but her decision to go on television and say it was our fault was just shady and disgusting. Ok, end rant... as you can see, in my area, I have bigger things to worry about than whether or not Dr. Awesome thinks I suck at diagnosing people... ha. It's good to get to talk it out on the board though... helps me process those things I don't get to discuss with others in real life. Be well and happy holidays.

http://www.newsobserver.com/2771/index.html

psychometric · Jan 3, 2009

WannaBeDrMe said:
yes, definitely different, no doubt about it... but necessarily better? if so, better by whose standards, the client's, the professional colleagues', the drug companies', etc. I absolutely crave that greater understanding and that's why I'm moving on but I am not willing to concede that remaining a master's level clinician would have damaged anyone beyond repair. (other than myself... ha)

I love your observation of RxP being pretty much the same bunch of grapes, different fruit basket. Pots and kettles and credentials oh my! I'm going to use this thread as my promise to myself never to bash LPC's again... the fingers wag in many directions.

How about Master's level physicians? Does this explain why Doctoral level mental health might be desired AND better than Master's level ones. I don't think you would feel comfortable seeing Eli Bart, M.S. to do your spleen surgery, or would you?

WannaBeDrMe · Jan 3, 2009

psychometric said:
How about Master's level physicians? Does this explain why Doctoral level mental health might be desired AND better than Master's level ones. I don't think you would feel comfortable seeing Eli Bart, M.S. to do your spleen surgery, or would you?

You can't compare clinicians who are offering differing services. That was my point. Spleen surgery... I probably want the entire team to be experienced and good at their particular job... (which, by the way, it takes a team to perform a surgery and may include people with only certificates from a community college as well as janitors with no degree to keep things clean)

Physician's Assistants only have master's degrees and perform essentially the same services as physicians in multiple settings. Should we bash them too? I have had positive experiences with many PA's and didn't feel like they damaged me because their academic training was 2 years and not 4 years...

I don't really care what people's opinions are of master's level clinicians... I'm far more troubled by several people's inability to adjust their conflicting statements to form some cohesive set of views... It's like nails on a chalkboard to me.

docjohng · Jan 4, 2009

Jon Snow said:
Well see, that's the thing. You go to a PA because you can't get into see a doc, you think you only have a cold or whatever, and it's cheaper. You don't go to a PA if you really think something is wrong. That's how social work and other masters level folks should be used with respect to therapy in my opinion. But, that's not the case.

Which is great, but so what? You can't change a profession's focus by ranting about it online, and you're unlikely to change people's minds by making empty arguments that have little outcome research support.

I also think the basis for your argument is questionable. Is there a finite economy for mental health professionals, or is it an ever-expanding profession comprised mostly of various types of professionals who mostly work together, get along, and respect one another's professional perspectives?

If it's a finite, closed economy, then yes, professionals will have to scratch and claw amongst themselves for competition and to rally against each group from infringing on what they view as their rightful areas of expertise.

But I'd argue we don't live in such a closed system, that instead we live in a very dynamic and ever-changing system. This could be evidenced by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges. Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).

We don't need to make this a battle between professions and I think that's the exact opposite direction that the rest of the world is going in, especially as patients themselves become better educated and informed not only about their disorders, but possible treatment and treatment techniques. It's becoming an increasingly collaborative environment amongst clients and their therapists, and I'd suggest it's far more productive for professions to also collaborate rather than to raise the drawbridge and declare some sort of silly war.

Unlike some who've posted to this thread, experience has taught me that each profession brings something valuable and unique to the table. And if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them. Time and research will tell whether this is a good thing or not.

Psychoanalysts frowned upon the explosion of behaviorists in the 1950s and the 1960s in America, suggesting that because they didn't have the extensive training (sometimes 10+ years postdoc) that analysts had, they were less qualified to diagnose and treat mental disorders. I see this kind of argument being no different than what is being argued here, simple turf wars that have been repeated for decades and will likely continue for decades to come.

John

psychmama · Jan 4, 2009

docjohng said:
Which is great, but so what? You can't change a profession's focus by ranting about it online, and you're unlikely to change people's minds by making empty arguments that have little outcome research support.

I also think the basis for your argument is questionable. Is there a finite economy for mental health professionals, or is it an ever-expanding profession comprised mostly of various types of professionals who mostly work together, get along, and respect one another's professional perspectives?

If it's a finite, closed economy, then yes, professionals will have to scratch and claw amongst themselves for competition and to rally against each group from infringing on what they view as their rightful areas of expertise.

But I'd argue we don't live in such a closed system, that instead we live in a very dynamic and ever-changing system. This could be evidenced by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges. Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).

We don't need to make this a battle between professions and I think that's the exact opposite direction that the rest of the world is going in, especially as patients themselves become better educated and informed not only about their disorders, but possible treatment and treatment techniques. It's becoming an increasingly collaborative environment amongst clients and their therapists, and I'd suggest it's far more productive for professions to also collaborate rather than to raise the drawbridge and declare some sort of silly war.

Unlike some who've posted to this thread, experience has taught me that each profession brings something valuable and unique to the table. And if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them. Time and research will tell whether this is a good thing or not.

Psychoanalysts frowned upon the explosion of behaviorists in the 1950s and the 1960s in America, suggesting that because they didn't have the extensive training (sometimes 10+ years postdoc) that analysts had, they were less qualified to diagnose and treat mental disorders. I see this kind of argument being no different than what is being argued here, simple turf wars that have been repeated for decades and will likely continue for decades to come.

John

Thank you for your post. I agree wholeheartedly with it, and I think you put it more eloquently than I could have.

Therapist4Chnge · Jan 4, 2009

docjohng said:
....by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges.

From my understanding, there has been an increase in applicants for psych positions. It still isn't at the level of more lucrative areas, but it is far from a decline in the field.

docjohng said:
Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).

This is most likely more in reaction to dwindling reimbursement and economic viability decisions.....and not because it is menial. I personally wouldn't want to constantly give assessments, but many clinicians prefer to do their own assessments when possible.

docjohng said:
....if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them.

Has there been an equal increase in training to meet their "branching out"? If not, their branching out is not ethical, and possibly harmful.

Time and research will tell whether this is a good thing or not.

You don't fill a plane full of people, send it up, and see if it flies or not.....so why put the cart before the horse in this instance?

Neuropsych2be · Jan 5, 2009

Therapist4Chnge said:
From my understanding, there has been an increase in applicants for psych positions. It still isn't at the level of more lucrative areas, but it is far from a decline in the field.

T4C

I just co-authored an invited review article on psychopharm training for psychologists in the January issue of the Journal of Contemporary Psychotherapy. One of the points we made in the article is that there is declining interest in psychiatry as a speciality among medical student. The irony s that the "Decade of the Brain" and the explosion of empirical data in neuroscience has not led to a concomitant increase in interest interest in psychiatry as a career track. Usually when a research area is "hot" it leads to an interest in applied practice. This has not happened with psychiatry. You may want to look at the following cited in our paper:

Fenton, W., James, R., & Insel, T. (2004). Psychiatry residency
training, the physician-scientist, and the future of psychiatry.
Academic Psychiatry, 28(4), 263–266. doi:10.1176/appi.ap.
28.4.263.

Moran, M. (2006). Physician shortage concerns AAMC's next
president. Psychiatric News, 41(1), 2–37.

Tamaskar, P., & McGinnis, R. A. (2002). Declining student interest in
psychiatry. Journal of the American Medical Association, 287,
1859. doi:10.1001/jama.287.14.1859.

Yakeley, J., Shoenberg, P., & Heady, A. (2004). Who wants to do
psychiatry? The influence of a student psychotherapy scheme—
A 10-year retrospective study. Psychiatric Bulletin, 28, 208–212.
doi:10.1192/pb.28.6.208.

docjohng · Jan 5, 2009

Therapist4Chnge said:
This is most likely more in reaction to dwindling reimbursement and economic viability decisions.....and not because it is menial. I personally wouldn't want to constantly give assessments, but many clinicians prefer to do their own assessments when possible.

Which is the exact same argument one could use to argue for branching out into more insurance-reimbursable areas. "Well, this CPT code for individual psychotherapy is far more lucrative than this billing code for individual social work appt/psychological testing appt."

Has there been an equal increase in training to meet their "branching out"? If not, their branching out is not ethical, and possibly harmful.

You don't fill a plane full of people, send it up, and see if it flies or not.....so why put the cart before the horse in this instance?

Go look at the research literature and show me all the studies that demonstrate solid data, across dozens of studies, that a Master's degree providers better client outcomes than a doctorate. That list is much smaller than you can imagine.

And yet, the doctoral degree was decreed in the 1970s as "the" degree that denotes a "psychologist." But the decision wasn't based upon any research, it was simply a political decision made for political reasons.

So if our own field can't meet this criterion, why would you hold other fields to it?

John

PsyDr · Jan 5, 2009

in support of snow,

just wait until the the AMA files an injunction against various master's level professions for diagnosing.

oh wait, that was filed against MFTs the other month in one state.

i guess we'll wait to see what the legal system has to say about it.

(snow, i am amused that i am supporting you with the same appeal to legal decisions that you and i have so often disagreed about)

docjohng · Jan 5, 2009

Jon Snow said:
Are you sure you're a psychologist?

Unacceptable, we shouldn't experiment on the public.

Outcome studies are important, but exceedingly difficult on the level of analyses necessary to measure comptence across training backgrounds. As a profession, we have a responsibility to establish what is necessary to practice ethically and competently. The designation of a doctoral degree in psychology was not political or arbitrary. It's about what educated and experienced individuals thought was necessary to practice competently. We can say without doing an outcome study comparing neuropsychologists that know neuroanatomy and psychometrics to neuropsychologists with no knowledge of neuroanatomy and psychometrics that neuroanatomy and psychometrics are necessary knowledge areas to practice competently. But, you are arguing the opposite. Basically, from your perspective, we are engaging in silly turf wars by establishing any standard before we empirically demonstrate its necessity on the public. What happened to logic? E.g., a pilot needs specific training to know how to fly an airplane? Recently, a pilot that was certified at one level to land an airplane in fog conditions, but not another, turned the plane around and landed somewhere else. He was applauded for the decision; recognizing his limits. He might have been able to land the plane safely, but we don't know and he didn't experiment on the public. I find your position unethical, but I'm sure the insurance companies love you.

So apparently your method for debate is personal insult, calling the other side "unethical," and using homey anecdotes in lieu of any actual data.

Since nobody can say with any certainty the actual requirements that result in positive outcomes in psychotherapy (outside of "common factors" or manual-guided treatment -- manuals written in such a way that a 1st year grad student could give such treatment [and sometimes do in research studies]), I find it hard to believe there exists some sort of logical minimum educational requirements similar to that of a pilot. It's perhaps comforting to think there is, but research simply hasn't backed up that assertion, despite having decades to perform such research showing the necessity.

Otherwise, one might argue that it's unethical to throw 2nd year grad students into doing individual psychotherapy, since they've only had 1 year's worth of educational training. And yet, there they are, first thing 2nd year, in their first practicum. Yes, it's under supervision, but it's not like the supervisor is sitting there in the room with you.

If you want to continue replying to me, please stick with trying to argue the points of discussion and refrain from the personal/ad hominem attacks, thanks.

John

Scope Creep: How Does This Impact Clinical / Counseling Psychology

deleted75966

Neuropsych Ninja

Full Member

Full Member

Full Member

Full Member

Full Member

Full Member

Full Member

Neuropsych Ninja

Neuropsych Ninja

Full Member

Full Member

Full Member

Full Member

Neuropsych Ninja

Full Member

Full Member

Full Member

Full Member

Neuropsych Ninja

Full Member

Full Member

New Member

Full Member

Full Member

New Member

Full Member

Full Member

Full Member

Full Member

Full Member

Psychologist

Full Member

Full Member

Oracle of the Sheet

Full Member

Oracle of the Sheet

Full Member

Full Member

Full Member

Full Member

Full Member

Founder & CEO, PsychCentral.com

Full Member

Neuropsych Ninja

Full Member

Founder & CEO, PsychCentral.com

Psychologist

Founder & CEO, PsychCentral.com

Similar threads