Comparison of Training Programs (e.g., psychologist vs. LPC, psychiatrists, etc.)

[texanpsychdoc]

I thought there was a post somewhere on the forum that provided a decent breakdown of the hours and quality of training across various mental health programs such as for psychologists, LCSWs, LPCs, LMFTs, psychiatrists? Or am I making that up?

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[psych.meout]

Or am I making that up?

 

[texanpsychdoc]

Fair enough....well darn.

 

[psych.meout]

Fair enough....well darn.

Actually, I have no clue. I just thought it was funny.

 

[MAClinician]

For LPC/LMHC programs, the practicum hours are typically 100 hours in a semester with at least 40 hours being direct F2F contact. Internship is typically 600 hours with at least 240 hours being direct F2F contact. Post masters experience hours required ranges between 2000 and 4000 hours, depending on the state I believe, and direct F2F hours also vary.

 

[DynamicDidactic]

For LPC/LMHC programs, the practicum hours are typically 100 hours in a semester with at least 40 hours being direct F2F contact. Internship is typically 600 hours with at least 240 hours being direct F2F contact. Post masters experience hours required ranges between 2000 and 4000 hours, depending on the state I believe, and direct F2F hours also vary.

I would say the F2F hours vary wildly between states. But generally the 100/600/3000 hours is a rough estimate at each stage of master's-level training for licensure.

 

[smalltownpsych]

Psychologist: three years of 20 hour per week practicum at typically a different placement each year, then a year of full time intensive internship training, and then another year of supervised post doc training. In the middle of that we have to do our dissertation research so a little more experience with balancing high stress/work demands. Also, since our training is usually in many different sites along the way and they tend to be in fairly intense settings.

 

[PsyDr]

The LCSW curricula is terrifying. Two years. First year is general social work theory. If you choose to be a clinical social worker, the second year is diagnosis, and therapy.

 

[WisNeuro]

The LCSW curricula is terrifying. Two years. First year is general social work theory. If you choose to be a clinical social worker, the second year is diagnosis, and therapy.

Yeah, this tracks along with my direct experience of clinical "acumen" in therapy and diagnosis.

 

[texanpsychdoc]

The LCSW curricula is terrifying. Two years. First year is general social work theory. If you choose to be a clinical social worker, the second year is diagnosis, and therapy.

Indeed - I actually supervised a clinical social work intern at a previous VA in Ohio and their knowledge of the DSM, pathology, and therapy was horrendous. And they even told me that their knowledge was on par with what their curriculum sequence taught them. Let's just say the program in question is at a big 10 university.

 

[BuckeyeLove]

Just found out in my state they are now allowing other degrees to become social workers. Like...you don't have to have a social work degree.

 

[WisNeuro]

Just found out in my state they are now allowing other degrees to become social workers. Like...you don't have to have a social work degree.

Are college degrees also just a social construct these days? Do they at least have to stay at a Holiday Inn last night?

 

[texanpsychdoc]

Just found out in my state they are now allowing other degrees to become social workers. Like...you don't have to have a social work degree.

Yeah I saw that on LinkedIn and spoke about that with folks on there. It's my understanding that it's (HB 509) been proposed but not yet law.

 

[BuckeyeLove]

Yeah I saw that on LinkedIn and spoke about that with folks on there. It's my understanding that it's (HB 509) been proposed but not yet law.

Yeah hasnt passed yet. If it does, I legit worry for mental health consumers even more than i already do. Licensing board attorneys will be happy though i have a feeling.

 

[texanpsychdoc]

Yeah hasnt passed yet. If it does, I legit worry for mental health consumers even more than i already do. Licensing board attorneys will be happy though i have a feeling.

Indeed - I am very much for protecting turf. I made a post which has gained several thousand views and many comments regarding how psychologists are not just "therapists." Most of the responses were positive and supportive, but like 2-3 were from mid-level folks who somehow managed to frame it in a way that they perceived it as offensive. I told them I stand by what I said, and that I do not apologize for setting boundaries and advocating for our profession. Too many people want to be friendly with all the other licensing boards to a point where being a psychologist has lost it's luster and identity. I've literally seen some folks say "I became a psychologist to do program management." And I am sitting there thinking "you don't need a damn Ph.D./Psy.D. for that, go get a damn MBA or MPA if that's your goal. So...silly me for trying to preserve and protect our profession. I even told them "don't think for a second physicians aren't doing the same with NPs and PAs. And they do a very good at it for the most part. We suck at advocating for ourselves...usually I hear folks say "oh, we don't want to be divisive and drive a wedge between us and LCSWs or LPCs," and I'm like "sometimes people need to be told NO, that they can't have what they want." Some of those folks wanted to attempt to claim to be better trained than psychologists at which point I just opted not to engage in that BS line of thinking. Instead, I just stated "at least in Texas, and most other jurisdictions I know of, to be qualified as a forensic EXPERT witness pertaining to competency and insanity evaluations, one must be a psychiatrist or a psychologist."

 

[texanpsychdoc]

To be clear about my original intent of this thread, it's because I for some reason thought there was some source where I saw someone compare and contrast psychologists vs. LPC/LMHC vs. LCSW vs. psychiatrist in terms of depth and scope of practice, as well as total hours acquired throughout their mental health training. I vaguely recall that psychologists (by leaps and bounds) had the most hours across mental health professions, from the beginning of their doctoral program through internship and post-doc (like at least 8000 + hours). Not to mention the amount of coursework. My program alone was 136 credit hours. That's a lot of classes across 5 years vs. a 2 year master's degree with 60ish credit hours.

 

[PikminOC]

Indeed - I am very much for protecting turf. I made a post which has gained several thousand views and many comments regarding how psychologists are not just "therapists." Most of the responses were positive and supportive, but like 2-3 were from mid-level folks who somehow managed to frame it in a way that they perceived it as offensive. I told them I stand by what I said, and that I do not apologize for setting boundaries and advocating for our profession. Too many people want to be friendly with all the other licensing boards to a point where being a psychologist has lost it's luster and identity. I've literally seen some folks say "I became a psychologist to do program management." And I am sitting there thinking "you don't need a damn Ph.D./Psy.D. for that, go get a damn MBA or MPA if that's your goal. So...silly me for trying to preserve and protect our profession. I even told them "don't think for a second physicians aren't doing the same with NPs and PAs. And they do a very good at it for the most part. We suck at advocating for ourselves...usually I hear folks say "oh, we don't want to be divisive and drive a wedge between us and LCSWs or LPCs," and I'm like "sometimes people need to be told NO, that they can't have what they want." Some of those folks wanted to attempt to claim to be better trained than psychologists at which point I just opted not to engage in that BS line of thinking. Instead, I just stated "at least in Texas, and most other jurisdictions I know of, to be qualified as a forensic EXPERT witness pertaining to competency and insanity evaluations, one must be a psychiatrist or a psychologist."

Funny because when a Psychiatrist says the same thing about their training, psychologists say it's a turf war.

 

[texanpsychdoc]

Funny because when a Psychiatrist says the same thing about their training, psychologists say it's a turf war.

Could you expand on that please? As a side note, I can certainly see how a turf war would play out between psychologists and psychiatrists, especially more-so with the RxP movement.

 

[Dazen]

Just found out in my state they are now allowing other degrees to become social workers. Like...you don't have to have a social work degree.

Seems like another example of the wild reactivity to lack of mental health providers. Increasing the number of incompetent providers will likely cause more harm than good, despite intentions.

 

[WisNeuro]

Funny because when a Psychiatrist says the same thing about their training, psychologists say it's a turf war.

It is a turf war, in both situations. It's not mutually exclusive. In both instances, there is something of a paucity of outcome data. But, as far as RxP goes, there are decades of data out there for the prescribing psychs.

 

[texanpsychdoc]

It is a turf war, in both situations. It's not mutually exclusive. In both instances, there is something of a paucity of outcome data. But, as far as RxP goes, there are decades of data out there for the prescribing psychs.

This is me being vulnerable and transparent on RxP - as you may (or may not) know, I serve on a state psychological association RxP committee as well as on a national-level RxP committee. I've also been enrolled (but not matriculated) into a clinical psychopharmacology post-doc master's program. My reasoning and opinions on the matter tend to vary, especially as of late. I can certainly appreciate psychiatrists being apprehensive and defending their turf with respect to psychologists prescribing. I get it. And I am unsure if the whole "well the genie is out of the bottle because NPs and PAs prescribe" is a justified reason for further encroachment on another field. I have no doubt that psychologists can and do prescribe ethically and competently (I work with several of them that do). The whole notion of "just because you can, should you?" comes to mind. We as psychologists have equally been facing encroachment from others on our turf with LPCs, LPAs, LCSWs, even NPs and PAs who took up psychotherapy as a part-time hobby. Psychologists I fear are growing increasingly irrelevant. Now you have folks that don't even want to admit and acknowledge that we are experts in human behavior, psychotherapy, assessments. They want the spotlight as well and don't like being told "no, your master's is not equal to my doctorate and fellowship training." Sometimes, difficult decisions need to be made and lines drawn in the sand. It's a tough pill to swallow, but not everybody can have the same seat at the same table. Certain chairs are reserved for some folks while other chairs are meant for others. I think Wise or someone else had brought up in a previous thread that we as psychologists have other pressing matters that should likely become the focus of our collective attention, and I think preserving and protecting the individuality, scope, and purpose of our profession has to be on the top 3 list.

 

[MAClinician]

Yeah hasnt passed yet. If it does, I legit worry for mental health consumers even more than i already do. Licensing board attorneys will be happy though i have a feeling.

Looks like the OH NASW chapter opposes the bill.

https://search-prod.lis.state.oh.us/cm_pub_api/api/unwrap/chamber/134th_ga/ready_for_publication/committee_docs/cmte_s_workforce_higher_ed_1/testimony/cmte_s_workforce_higher_ed_1_2022-11-30-0300_1552/hb509smith.nationalassociationofsocialworkersohiochapter.pdf

And it’s not just SW licenses being addressed. There are a lot of occupational titles affected by the bill? I didn’t read everything but the “interested/opposed” parties are many lol

 

[texanpsychdoc]

Yeah....people like to demean others for advocating for their profession until it finally hits them on their own doorstep. I'm sure they will start throwing out things like "these non-MSW people are unqualified, incompetent, not trained in XYZ." And all the while I will be watching and thinking "we've been there....join the club."

 

[WisNeuro]

Yeah....people like to demean others for advocating for their profession until it finally hits them on their own doorstep. I'm sure they will start throwing out things like "these non-MSW people are unqualified, incompetent, not trained in XYZ." And all the while I will be watching and thinking "we've been there....join the club."

I'll just continue beating the drum of "healthcare needs better outcomes research" when it comes to all of the turf wars.

 

[counselor2b]

I live in a state where you can become a certified social worker CSW at the bachelors level without having a bachelors in social work. You just have to have a human services like degree, such as psychology, sociology etc and complete a few extra classes and a practicum before you can sit for the CSW exam. There is no parallel to this at the masters level in my state and being a CSW from a non BSW program will not get you advanced standing in a MSW Program.

 

[smalltownpsych]

100% agree with supporting our profession and advocating that we are the best! Is there something wrong with having a turf war? I think the MDs should protect there profession just as I think we should protect ours and the Social Workers and NPs are going to do that too and try to say they are the same as us and we have to push back or we diminish our professions. Not all restaurants and all cooks are the same as a highly trained chef at a nice restaurant and nobody expects that, why do we need to apologize for being better trained and having more skill and expertise?

 

[Doctor Eliza]

My state psychological association’s slogan is “Psychologists do it better.” I get what they were going for, but clearly they did not run it past any teenage boys.

 

[texanpsychdoc]

100% agree with supporting our profession and advocating that we are the best! Is there something wrong with having a turf war? I think the MDs should protect there profession just as I think we should protect ours and the Social Workers and NPs are going to do that too and try to say they are the same as us and we have to push back or we diminish our professions. Not all restaurants and all cooks are the same as a highly trained chef at a nice restaurant and nobody expects that, why do we need to apologize for being better trained and having more skill and expertise?

This. This is basically what I posted on my LinkedIn "wall." I basically said "not everybody gets to have the same seat at the same table." Doesn't mean they aren't at the table, but some chairs are for different folks.

 

[PsyDr]

100% agree with supporting our profession and advocating that we are the best! Is there something wrong with having a turf war?

The problem is that curricula is not empirically derived. Curricula is historically derived. We don't know the ideal training for treatment outcomes. There are things that psychiatrists know more about, there are things that psychologists know more about. There are research PhDs that teach medical school courses that know more about things than any of us.

Psychiatrists and psychologists had it GOOD for a long time. They made a LOT of money. Sometime in the 80s, this income decreased relative to inflation, and continues to do so. And it's not a free market. It's a command economy because the federal government, through CMS's price setting and resident funding, controls prices and number of providers. Because we don't understand economics, we believe that other people are taking our income. You could eliminate every midlevel psychiatric provider in the USA, and insurance based positions would not substantially change in income.

 

[smalltownpsych]

The problem is that curricula is not empirically derived. Curricula is historically derived. We don't know the ideal training for treatment outcomes. There are things that psychiatrists know more about, there are things that psychologists know more about. There are research PhDs that teach medical school courses that know more about things than any of us.

Psychiatrists and psychologists had it GOOD for a long time. They made a LOT of money. Sometime in the 80s, this income decreased relative to inflation, and continues to do so. And it's not a free market. It's a command economy because the federal government, through CMS's price setting and resident funding, controls prices and number of providers. Because we don't understand economics, we believe that other people are taking our income. You could eliminate every midlevel psychiatric provider in the USA, and insurance based positions would not substantially change in income.

I didn’t say that our training is better because it has been demonstrated to be the optimal curricula. I do think that psychologists have good training and that we should focus on what those strengths are and communicate those. To me standing up for your profession is all I really mean about turf war. Also, if we don’t fight for our profession, won’t we lose?

One more point is that critiquing concepts and perspectives that are not empirically derived is something we appear to be really good at. Probably derived from our emphasis on research. Obviously, I can’t empirically prove this so should I just not talk about the strength of critical thinking that we have over those who don’t know as much about research? Sometimes our greatest strength seems to be our greatest weakness.

 

[cara susanna]

My state psychological association’s slogan is “Psychologists do it better.” I get what they were going for, but clearly they did not run it past any teenage boys.

Or maybe they wanted to catch people's attention

 

[texanpsychdoc]

I think our curriculum sequence is far superior to other mid-level providers, aka "advanced-practice providers." The proof is in the pudding.

 

[PikminOC]

The problem is that curricula is not empirically derived. Curricula is historically derived. We don't know the ideal training for treatment outcomes. There are things that psychiatrists know more about, there are things that psychologists know more about. There are research PhDs that teach medical school courses that know more about things than any of us.

Psychiatrists and psychologists had it GOOD for a long time. They made a LOT of money. Sometime in the 80s, this income decreased relative to inflation, and continues to do so. And it's not a free market. It's a command economy because the federal government, through CMS's price setting and resident funding, controls prices and number of providers. Because we don't understand economics, we believe that other people are taking our income. You could eliminate every midlevel psychiatric provider in the USA, and insurance based positions would not substantially change in income.

I'm not referring to insurance based practices.

 

[PikminOC]

I think our curriculum sequence is far superior to other mid-level providers, aka "advanced-practice providers." The proof is in the pudding.

Medical residency has requirements from the ACGME.

 

[texanpsychdoc]

Medical residency has requirements from the ACGME.

In what way?

 

[PikminOC]

In what way?

They set the requirements for each residency that have to be met for residency to be accredited. This is how medical education and residency are standardized.

 

[PsyDr]

I'm not referring to insurance based practices.

Sorry, I wasn't directing my comments at you or smalltownpsych. I didn't make that more clear. I was speaking more broadly. But the general principle applies: as AGME residencies are partially funded by CMS through DGME, which caps the number of resident spots.

 

[texanpsychdoc]

They set the requirements for each residency that have to be met for residency to be accredited. This is how medical education and residency are standardized.

The same is true for psychology. I guess my question is, how would residency which focuses almost exclusively on pharmacology equate to the training received by psychologists regarding diagnoses, case conceptualization, knowledge of prevailing theories and sciences in psychology, testing, and the use of EB therapies (aside from just CBT)? I used to teach some psychiatry residents back in Miami and like 15 of them took the course I was co-teaching which basically provided a very cursory overview of CBT. By no means did it equate to what psychologists learn about CBT in grad school. Notwithstanding that, CBT is not the only therapy we are trained in, and oftentimes I tend to see psychiatrists who do use therapy, will offer CBT or psychodynamic. Again....there are more than just two flavors out there.

 

[PikminOC]

The same is true for psychology. I guess my question is, how would residency which focuses almost exclusively on pharmacology equate to the training received by psychologists regarding diagnoses, case conceptualization, knowledge of prevailing theories and sciences in psychology, testing, and the use of EB therapies (aside from just CBT)? I used to teach some psychiatry residents back in Miami and like 15 of them took the course I was co-teaching which basically provided a very cursory overview of CBT. By no means did it equate to what psychologists learn about CBT in grad school. Notwithstanding that, CBT is not the only therapy we are trained in, and oftentimes I tend to see psychiatrists who do use therapy, will offer CBT or psychodynamic. Again....there are more than just two flavors out there.

4 years of residency does not focus mainly on pharmacology. Lots of therapy as well.

 

[PikminOC]

I see many unaccredited and diploma mill psychology programs which is very different from the standardized process of medical school and residency training.

 

[Sanman]

I see many unaccredited and diploma mill psychology programs which is very different from the standardized process of medical school and residency training.

Students from unaccredited programs are ineligible for APA accredited internships or fellowships. It really is not that different than a Caribbean school grad that might take a non ACGME accredited residency or fellowship.

 

[PikminOC]

Students from unaccredited programs are ineligible for APA accredited internships or fellowships. It really is not that different than a Caribbean school grad that might take a non ACGME accredited residency or fellowship.

Pls show me a non ACGME accredited residency.

 

[WisNeuro]

Non ACGME open residency & fellowship positions

Find currently vacant positions in non ACGME-accredited programs.

www.ama-assn.org

 

[Sanman]

Pls show me a non ACGME accredited residency.

Non ACGME open residency & fellowship positions

Here is the link to the AMA page that lists openings for Non-ACGME residencies and fellowships.

 

[Therapist4Chnge]

4 years of residency does not focus mainly on pharmacology. Lots of therapy as well.

...in certain programs, not across the board, correct? Whenever I read over in the psychiatry forum, this is brought up and most of the time it is people not getting the kind of therapy training they wanted, as opposed to receiving "lots of therapy" training.

 

[WisNeuro]

...in certain programs, not across the board, correct?

I think the definition of "lots" may be the issue.

 

[Therapist4Chnge]

I think the definition of "lots" may be the issue.

Exposure to therapy, maybe some didactics and some cases, but the complaints I see on here and in real life, talk therapy training is difficult to find, and even harder to find quality talk therapy training. I'm not saying it doesn't exist in psychiatry programs, but it sure isn't "lots" of therapy and it certain isn't easily available.

 

[PikminOC]

...in certain programs, not across the board, correct? Whenever I read over in the psychiatry forum, this is brought up and most of the time it is people not getting the kind of therapy training they wanted, as opposed to receiving "lots of therapy" training.

The ACGME requirements at minimum. It doesn't take four years of 60 to 80 hour weeks to just learn meds.

 

[PikminOC]

Non ACGME open residency & fellowship positions

Here is the link to the AMA page that lists openings for Non-ACGME residencies and fellowships.

Now do the percentages of that to all the residencies versus the psychology diploma mills number students to all the psychology school number of students.

 

[WisNeuro]

no need to move the goalpoats. I think we can agree that ill-trained providers abound in both professions.