Are Phd therapist better than Masters level?

[psychMDhopefully]

And are they trained differently as far as THERAPY is concerned? I know the different degrees focus on different stuff but do they take similar approaches to things like CBT? Our school provides mental health services that are really marginal. For a university of its size it should offer more. There is 1 psychiatrist, and 2 master level therapist, and I have seen both therapist and didn't like either of them. In undergrad I had a Phd therapist, and she just seemed better and more able to get me to change my thought patterns, while the LCSWs and LPCs tended to talk more from an emotional stand point.

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[bcliff]

social work, counseling, psychiatry, and psychology all approach mental health differently -- working with a licensed clinical social worker (LCSW) will be different than working with a licensed professional counselor (LPC) and still different from working with a licensed psychologist (LP), which is also different from working with a psychiatrist (MD). Between all fields, I would say that within-group differences are likely larger than between-group differences, meaning that you're more likely to find "good" and "bad" clinicians within each training model, as opposed to finding all the "good" clinicians in psychology and all the "bad" in psychiatry.

A clinical psychologist with a PhD (as opposed to a PsyD) is typically trained as a scientist-practitioner, which, in my own work, translates to me approaching clinical presentations as a scientist (e.g., how can I isolate the variables that may be contributing to the presenting problem?) and research questions as a clinician (e.g., what clinical utility could these data have?). I like to think that the individuals I work with benefit because of my specific theoretical orientation, clinical skills, and scientist-practitioner perspective, but it may be the case that they would have benefitted from working with any of the previously described clinicians and in any number of different therapy styles.

The mods will probably post shortly that SDN should not be used to seek specific medical or treatment-related advice.


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[Fan_of_Meehl]

I served as a protocol therapist when I was in graduate school for an NIMH funded treatment outcome study involving the delivery of cognitive therapy and 'computer-assisted' cognitive therapy as treatment conditions. At the time (while working on my doctorate), I would have been considered a 'masters-level' therapist (as would a social worker (LCSW) involved in the study). Importantly, we were all trained to deliver exactly the same protocol treatment (an abbreviated nine session protocol to treat depression using Beckian cognitive therapy). It was, essentially, a 'manualized' protocol with close supervision, review of our tapes, ratings on session content as well as 'quality' of the session (rated via the Cognitive Therapy Scale). Each therapy session was 'mapped out' in terms of what we were supposed to cover with the client, how we were supposed to cover it, and in what sequence. Also, because it was a treatment outcome study, it had stringent exclusion criteria for participants (e.g., couldn't be on psychotropic meds, couldn't have had a prior course of psychotherapy, couldn't suffer from major comorbidities--e.g., personality disorders, substance abuse).

In the vast majority of treatment outcome studies, there is a tendency to utilize (a) manualized/homogenized treatment protocols, and (b) shall we say, 'simplified' clientele (as described above) to be treated.

It's not surprising that post hoc analyses (by therapist degree, that is, 'masters vs. doctoral') tend to show no differences in outcome related to therapist degree.

However, I don't know that this necessarily 'proves' that it 'makes no difference' whether the treating clinician has a doctorate or a masters degree. One of the biggest differences I see (anecdotally) in practice is a difference in differential diagnostic acumen between the average clinician with a doctorate vs. the average clinician with a masters degree. And the importance of proper differential diagnosis and case formulation in promoting better outcomes seems paramount in clinical practice.

I admit that I haven't looked at the empirical literature that purports to address this question of 'equivalence' in outcome in therapy between doctoral and master's-level therapists, but I think that the methodological realities (that tend toward 'homogenization' of delivered treatments) that are prevalent in psychotherapy treatment outcome studies (that I have described above) are quite pertinent to the interpretation of any such research data.

 

[ClinicalABA]

In the vast majority of treatment outcome studies, there is a tendency to utilize (a) manualized/homogenized treatment protocols, and (b) shall we say, 'simplified' clientele (as described above) to be treated.

It's not surprising that post hoc analyses (by therapist degree, that is, 'masters vs. doctoral') tend to show no differences in outcome related to therapist degree.

The old internal validity vs. external validity trade-off- "yep, it's because of what we did, but what we did and where we did it may not look a whole lot like what you CAN do and WHERE you'll be doing it." I think you'll find that the research in this area is difficult to do and tricky to interpret. There's a tendency to look at it as a parametric analysis that compares different amounts of what is presumed to be the same types of training (i.e. Masters vs. doctoral). As others have alluded to, it might be more appropriate to look at it as a component analysis (e.g. how do client outcomes change when we add in or drop out the components of doctoral training). Not an easy study to do.

 

[smalltownpsych]

I think that the training in science and legal and ethical issues and emphasis on effective supervision and high standards of training provides an edge for psychologists in a lot of aspects of mental health, but that doesn't necessarily transfer to an individual therapist or individual relating to a therapist. All of the above (excellent) posts explain some of the reasons for this. Those posts are also great examples of the perspective and approach that psychologists use. When I was hiring, I had a clinical team with a mix of degrees and I found this to be best. Social worker, psychologist, MFT, LPC, LAC. Each one brought something different to the team. However, if I could only choose one degree, then I'm going with the psychologist.

 

[psychMDhopefully]

So do you guys think if someone has severe depression or treatment resistant depression, they should probably see a psychologist? Like I said before psychologist just seem better at getting me to change my thought patterns, while with LCSW (what our school provides) it's just more of a conversation where they try to comfort and offer advice, but does little to actually help me correct my thinking.

 

[AcronymAllergy]

Mod Note: This thread appears to now relate to querying personal mental health advice/assistance, which is not appropriate for SDN. Please seek assistance from a qualified professional in your area.