Are Social Workers better therapists than psychologists?

[annel]

Hey all,
I'm currently in the first year of a Psy.D. program. Twice so far, once via a TA and once via a lecturer, I've heard people around me say that in their experience, social workers are the best/most talented therapists they’ve encountered(one of these people was making a point that the only thing that differentiates psychologists from other professionals is our ability to do assessment).
This statement irks me, because I got into this field because I have a passion for therapy, and this seemed like the best degree to get in order to do so. Do you all agree with the above statement? Why/why not?
I imagine responses here might be a little bit skewed towards the psychologist side, but I’d like to hear any/all responses to this important question.

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[Therapist4Chnge]

This should be fun.

Let me start off by saying that I have a great deal of respect for the social workers I have previously worked with and correct work with now. There are aspects of their job that I neither understand nor would want to deal with on a dail basis, but in the areas in which there is some crossover, I'd take my training experience every time. Supportive therapy and similar areas are probably a wash because patient outcome is most strongly correlated with the therapuetic relationship, though I think the average psychologist's training in clinical interviewing, assessment, EBT training, and intervention work is far superior.

 

[erg923]

Come on man...you didnt really expect a response on the order of "Why yes, social wokers are always the best therapist and a there is rich history of literature supporting that." ...did you?
There are plenty of existing threads (mostly in the BA/BS, MA/MS section) where people have debated scope of practice issues of masters level providers. I suggest you look there.

http://forums.studentdoctor.net/showthread.php?t=801884

http://forums.studentdoctor.net/showthread.php?t=622242

http://forums.studentdoctor.net/showthread.php?t=776803

http://forums.studentdoctor.net/showthread.php?t=778309

http://forums.studentdoctor.net/showthread.php?t=744628

 

[MNGradToBe12]

For someone in the eye field, I liken this to a comparison of optometrists vs. ophthalmologists. For many things, an optometrist is a terrific choice, but I wouldn't want one reattaching my retina.

 

[annel]

Thanks for the replies so far.

I obviously would like to think psychologists were as good/better than social workers in terms of therapy.

I wonder, though, if part of the reason I've heard this statement is because MSW's seem to have less theoretical training, and so are perhaps more in the room with the client, rather than thinking theoretically as a psychologist might?

Just an idea. I imagine most of the differences are due to individual differences, not the degree itself. But I'm open to other ideas...

 

[erg923]

Read over the threads I provided, as the debate has been played out in each one to some degree.

PS: Theoretical constructs/orientations may be helpful for guiding treatments, but mostly, I think they just help us (psychologists) feel better/more confident in our views and treatment choices. However, It is important to understand the fundamantal principles behind psychopathology (ie., development), as well as the principles underlying behavior change in your chosen method of treatment. In theory, psychologists are trained more extensively in both of these, but does it help? Maybe, maybe not.

 

[annel]

Read over the threads I provided, as the dedbate has been played out in each one to some degree.

PS: Theoretical constructs/orientations may be help for guiding treatments, but mostly, I think they just help us (psychologists) feel better/more confident in our views and treatment choices. However, It is important to understand the fundamantal principles behind psychopathology (ie., development), as well as the principles underlying behavior change in your chosen method of treatment. In therpry psychologists are trained more in both, but does it help? Maybe, maybe not.

Thanks, I'll read it over and write up any thoughts.

I'd agree with you, I'd hope that would be the case too.

 

[paramour]

I . . .

Um, yeah. I'm just going to leave it at "I concur" with these guys. ^^

 

[paramour]

Hey all,
I'm currently in the first year of a Psy.D. program. Twice so far, once via a TA and once via a lecturer, I've heard people around me say that in their experience, social workers are the best/most talented therapists they’ve encountered(one of these people was making a point that the only thing that differentiates psychologists from other professionals is our ability to do assessment).
This statement irks me, because I got into this field because I have a passion for therapy, and this seemed like the best degree to get in order to do so. Do you all agree with the above statement? Why/why not?
I imagine responses here might be a little bit skewed towards the psychologist side, but I’d like to hear any/all responses to this important question.

NOT to say that I agree with any part of the bolded segment above... But even IF the "only thing" that differentiated psychologists from other mental health care professionals was their ability to do assessment, this would not imply that "social workers are the best/most talented therapists."

 

[BSWdavid]

NOT to say that I agree with any part of the bolded segment above... But even IF the "only thing" that differentiated psychologists from other mental health care professionals was their ability to do assessment, this would not imply that "social workers are the best/most talented therapists."

I think there are a lot of characteristics that contribute to being a good therapist, and probably at the end of the day, a lot has to do with the qualities of the individual therapist, their passion for the work that they do, their commitment to helping people, and their ability to balance being a professional and being a person. You can be a highly educated individual and still suck as a therapist if you cannot connect well or empathize with your clients. Similarly, a therapist may have the best of intentions, but if the appropriate training isn't there, their effectiveness will be diminished.

The research doesn't support the idea that professional affiliation is indicative of therapeutic outcome. In my opinion, the best therapists I have known have been the ones that have valued their clients and have generally wanted to help them; have implemented appropriate boundaries; have been emotionally mature; have strived to provide excellent services; have kept up on the literature; have sought continued supervision; and have had solid training in their theoretical orientation.

Please understand that labeling someone as "best" is always going to be biased, as the term suggests an opinion not a fact.

 

[Student4Life0]

I think there are a lot of characteristics that contribute to being a good therapist, and probably at the end of the day, a lot has to do with the qualities of the individual therapist, their passion for the work that they do, their commitment to helping people, and their ability to balance being a professional and being a person. You can be a highly educated individual and still suck as a therapist if you cannot connect well or empathize with your clients. Similarly, a therapist may have the best of intentions, but if the appropriate training isn't there, their effectiveness will be diminished.

The research doesn't support the idea that professional affiliation is indicative of therapeutic outcome. In my opinion, the best therapists I have known have been the ones that have valued their clients and have generally wanted to help them; have implemented appropriate boundaries; have been emotionally mature; have strived to provide excellent services; have kept up on the literature; have sought continued supervision; and have had solid training in their theoretical orientation.

Please understand that labeling someone as "best" is always going to be biased, as the term suggests an opinion not a fact.

I think there is a lot of validity to what you said here. Individual therapist qualities are very important, in my opinion. However, (as previously stated on this board, and discussed to death), there is a large difference in the training models.

 

[stigmata]

I had a supervisor who taught me this, "There is a big difference between helping someone feel better and helping someone get better".

 

[Shatani]

I had a supervisor who taught me this, "There is a big difference between helping someone feel better and helping someone get better".

i like that.

 

[hope4change23]

I had a supervisor who taught me this, "There is a big difference between helping someone feel better and helping someone get better".

I like that too

 

[docjohng]

Which most people won't care about or get the differentiation being made here. Professionals will, but clients don't.

I hear there's a scientific profession that has a lot of background in doing research about client outcomes. Surprisingly, that profession still hasn't done a lot of research into this particular area. I can't help but wonder why...

John

 

[stigmata]

Yes indeed, but I see former "clients" every day who are so relieved that someone actually knows something about their diagnosis and how to treat it....and that it usually is not all done by one person.

 

[Therapist4Chnge]

I hear there's a scientific profession that has a lot of background in doing research about client outcomes. Surprisingly, that profession still hasn't done a lot of research into this particular area. I can't help but wonder why...

John

1. Too busy helping severely impaired folks?*
2. There is no funding to prove the more expensive option is better?
3. Too busy fending off mid-level providers with a fraction of the training that are pushing for a broader scope of practice without any additional training?

*It's 11:17pm on St. Patty's Day...and I'm still in the office. While I wish I had the time to design a proper study to prove clinical psychologists provide superior interventions and outcomes, but I'm still digging out from the mounds of notes I have to write to justify our work to the insurance companies, drafting a letter of necessity for a patient, and make some quick neuro recommendations. The glamorous life of a clinical/neuropsychologist....

 

[PhDToBe]

I just learned about this in my psychotherapy research course, and currently, the research has not found a difference among psychologists, social workers, and other master's level therapists, with the exception of marriage and family therapists. the research shows MFTs are not as effective as the others, but this is probably due to the types of clients they work with. I am in an R1 clinical psych Ph.D. program, too.

 

[DrGero]

The studies that I have seen generally indicate that if trained in evidence-based therapy (and actually adhering to that therapy) there is no difference between various experience levels.

I of course don't know the particular studies you're referring to, but overwhelmingly, when people talk about EPTs used in clinical trials, we're talking about manualized treatment. Which, pardon my saying so, any second-year clinical trainee (or monkey) can administer.

However, we all know that it is not the case that everyone gets evidence-based therapy training. As variable as it is at the Ph.D. level, my sense is that it is even more sketchy at the master's level.

Probably true. Moreover, my personal take is that master's level therapists are more apt to blindly administer their therapy modality of choice and not do any particularly sophisticated assessment of the patient initially, or in any ongoing way. For a lot of master's level folks (just my experience) they are folks with hammers, and so everything looks like a nail. The really quality masters-level therapists are the ones gifted with intuition and sensitivity, which doesn't come from training. Scientist-practitioners are a different bag.

 

[berlin81]

I of course don't know the particular studies you're referring to, but overwhelmingly, when people talk about EPTs used in clinical trials, we're talking about manualized treatment. Which, pardon my saying so, any second-year clinical trainee (or monkey) can administer.

I think this statement brings on a big issue of how therapy is conducted, whether it be in a clinical trial or in a work environment that requires "manualized treatment". I work at a skilled nursing home that requires that both individual therapy and our psycho-social groups adhere to a so-called skills training model. What makes me angry is that there is no examination of how a given client might not be receptive of such an approach. For example, a client might be required to attend an anger management group by their therapist. Although I (as the clinician) believe it would be helpful for the client, he/she might not see it that way and refuse to attend. Therefore, I feel its my responsibility to understand that client's reasons for not attending the group while gently helping them see how various triggers and circumstances manifest negative behavior.

So here's my point, I believe the real danger is having clinicians who disgustingly strict towards a specific treatment approach and are not willing to mix-in a few other techniques when faced with challenging individuals. Sadly, I am seeing this a lot from a lot of clinicians (bachelor, masters, and doctorate) and they refuse to apply some degree of creativity in order to increase the client's insight. Obviously many work environments have various methods/approaches that are required for a clinician to apply, which is absolutely fine. But again, if the approach does not examine the clients lack of motivation, non-compliance, or comprehension, its a problem.

 

[PsyDetective]

What a useful debate (again). That is, of course, provided you're not the person who needs help.

I'm speechless (again) regarding the 'there's no time for research to help the impaired people because there are too many impaired people taking up our time in therapy' argument.

 

[stigmata]

It is like comparing an osteopath to a physical therapist; both can do similar things to treat conditions but only one is trained to figure out what is actually wrong.

 

[O Gurl]

So here's my point, I believe the real danger is having clinicians who disgustingly strict towards a specific treatment approach and are not willing to mix-in a few other techniques when faced with challenging individuals. Sadly, I am seeing this a lot from a lot of clinicians (bachelor, masters, and doctorate) and they refuse to apply some degree of creativity in order to increase the client's insight. Obviously many work environments have various methods/approaches that are required for a clinician to apply, which is absolutely fine. But again, if the approach does not examine the clients lack of motivation, non-compliance, or comprehension, its a problem.

I absolutely agree. But how does one ascertain these things? Through assessment. That often requires:

1. A solid and comprehensive fund of knowledge about things like psychopathology, learning, human development, and physiology of behavior
2. Testing (psych/cognitive/personality)

This has to be in place before the therapy skills, which are useless if you don't know what the problem is. So I am not sure if asking which discipline has better therapists is a useful question. It is highly subjective and as Stigmata pointed out, there is a big difference between helping someone feel better and helping them get better. A "good therapist" as described by a depressed person with poor social skills could just be a kind person to talk to. Is that really dealing with their depression? Not sure.

As for the research in the area, most of it that I have seen (admittedly not much) has looked at EBTs (CBT and such) applied to a sanitized sample (no characterological issues or comorbidities) with presentations that should respond well to CBT, like garden-variety depression and anxiety. Great. that is why we have manualized treatments.

There is no logical way to test this across more diverse and complex cases. Those of you repeatedly calling for such a study should describe how you would design and execute it. Using pure logic, one can deduce that having more tools with which to understand and approach a case is a positive thing. Thus, if I had to entrust my mental health to a provider, I would go with the doctoral level clinician.

 

[berlin81]

I absolutely agree. But how does one ascertain these things? Through assessment. That often requires:

1. A solid and comprehensive fund of knowledge about things like psychopathology, learning, human development, and physiology of behavior
2. Testing (psych/cognitive/personality)

This has to be in place before the therapy skills, which are useless if you don't know what the problem is. So I am not sure if asking which discipline has better therapists is a useful question. It is highly subjective and as Stigmata pointed out, there is a big difference between helping someone feel better and helping them get better. A "good therapist" as described by a depressed person with poor social skills could just be a kind person to talk to. Is that really dealing with their depression? Not sure.

As for the research in the area, most of it that I have seen (admittedly not much) has looked at EBTs (CBT and such) applied to a sanitized sample (no characterological issues or comorbidities) with presentations that should respond well to CBT, like garden-variety depression and anxiety. Great. that is why we have manualized treatments.

There is no logical way to test this across more diverse and complex cases. Those of you repeatedly calling for such a study should describe how you would design and execute it. Using pure logic, one can deduce that having more tools with which to understand and approach a case is a positive thing. Thus, if I had to entrust my mental health to a provider, I would go with the doctoral level clinician.

Excellent point O Gurl, and essentially the lack of real assessment is what concerns me about manualized treatment. Moreover, the type of treatment that I described is intended to be used my bachelor level clinicians, which of course have no experience in doing comprehensive testing or assessment. At my current job I am the only one with a master's degree and has the experience to do real assessments. However because I cannot get licensed in the state I am now living in (I'm licensed in another state), my only choice is to work in this type of setting, it sucks big time.

Obviously there is much debate on who is generally more skilled and experienced at doing assessment and therapy (MSW's, MA/MS Clinicians, PsyD/PhD's). However when a work-site employs approaches that are solely based on "educating" the client and not assessing his or her's motivation or response to treatment, its not going to be very effective in more difficult cases. And as much I like to defend those who do not have doctorates and but have substantial work experience, those with bachelor level training is simply not enough.

 

[Student4Life0]

Again?

This is getting nauseating.

 

[Jegg]

Why is a raven like a writing desk?

 

[PsyDLICSW]

Hey all,
I'm currently in the first year of a Psy.D. program. Twice so far, once via a TA and once via a lecturer, I've heard people around me say that in their experience, social workers are the best/most talented therapists they've encountered(one of these people was making a point that the only thing that differentiates psychologists from other professionals is our ability to do assessment).
This statement irks me, because I got into this field because I have a passion for therapy, and this seemed like the best degree to get in order to do so. Do you all agree with the above statement? Why/why not?
I imagine responses here might be a little bit skewed towards the psychologist side, but I'd like to hear any/all responses to this important question.

It really depends on programs and experience. I am also in a PsyD program, but before this, I got an MSW, because I wanted to do therapy and was encouraged to pursue an MSW after getting rejected from PhD and PsyD programs. There are some MSW programs that provide great clinical experience and coursework in psychotherapy and there are other MSW programs that are generalist programs that require courses in crap that have nothing to do with therapy. My MSW program lacked adequate clinical classes. My classes were basically "this is what a social worker is and this is what a social worker does..." I had a great internship as a therapist at a medical school with a great supervisor, but not everyone in the program got that experience. Social workers are trained in systems theory and look for strengths in a person before pathology. Pathology is also considered in the contect of SES more often in social work. Maybe some interpret this as "better therapist." I cannot speak for everyone, but in my experience, my MSW courses were a waste of time and the practicum I had was lucky. I learned more about psychotherapy and mental health in my clinical psych program than social work. The "best therapist" question may also depend on the individual giving therapy.