Differences in Careers Between LCSW's and Psychologists?

[TMS@1987]

I keep hearing conflicting stories from different people. Some tell me LCSW's have almost identical careers to psychologists, and others tell me that LCSW's are essentially at the bottom of the totem pole in regards to respect and opportunities.

I don't want to be under a psychologists my whole life unless I'm in private practice. I want to treat serious mental illness with real treatments (not just supportive counseling). Some people tell me that you can do this with an LCSW, and that with this license you are PRACTICALLY equal to a psychologist with the exception of testing (I use the term "practically" because I understand the training models are very different).

Can any of you guys help me with this? I don't wanna be an inferior just because I like the idea of learning about both psychology and social systems. I don't want people to be constantly assuming that I went for my MSW just because I didn't have it in me to get a PhD.

P.s. This is kind of an emotional rant, so I'm sorry if its nonsensical and if you need clarification I will be glad to clarify.

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[WannaBeDrMe]

I can only speak personally about the career of an LCSW though I have friends/colleagues who are clinical psychologists and many friends/colleagues who hold masters level credentials as psychological associates, professional counselors, and marriage and family therapists. I'm also at an age (30, whoa) where some of my friends have settled into academia with clinical backgrounds/training.

Biggest rule here... the state in which you work will dictate licensing guidelines for each profession. Those can vary from state to state. The responsibilities of an LCSW in my state might vary from the responsibilities of an LCSW in your state. If you are concerned with your legal scope of practice in a potential field... use your friend google to refer to licensing statutes for each field and compare the notes.

As far as inferiority stuff... that's a feeling unique to the individual and you can only feel that way if you get caught up in the hype. In my state, psychologists aren't necessarily the "top dogs"... psychiatrists love to pull rank with the mental health clients and talk trash about the psychologists. The psychologists might talk crap about the social workers. The social workers might talk crap about the counselors. The counselors might talk crap about the family therapists and the family therapists will talk crap about the masters level psych associates. The clients might talk crap about all of them... regardless of training/credential.

Personally, I've experienced very little of the smack talk. I feel I've been respected by all levels of clinicians and academicians... but I've worked my arse off too. I've made myself present for research opportunities. I sucked it up and worked horrid community health jobs during a mental health reform in crisis. I KNEW my stuff and went above and beyond the MSW curriculum to learn about theory and application. I have met some jerk providers... but I went toe to toe with a psychiatrist my first year because I needed the client info to be heard, it had a good result, and I never looked back...

Now, all of that being said, I'm not in private practice full time. I prefer only brief interventions/crisis/assessment or group treatments. Even in my psychology-goaled life, I don't ever see myself becoming a star individual therapist. That isn't my interest. I know some truly talented LCSW private practitioners... who use "real" treatments as you mentioned below... I also know some horrible LCSW's who pretty much read from "Seeking Safety" for 9 out of 10 clients.

I wouldn't say that LCSW's are "practically" equal to psychologists in training or function. The roles are defined differently and the approach is different. Despite what I hear a lot on these boards, I've never experienced LCSW's trying to take responsibility from psychologists... in fact, I've seen much more of us begging psychologists to be more thorough in their part of the process so we can focus on our roles. I hope that has more to do with our failing mental health reform than an overall trend.

Similarities... both can practice indepedently, both can sit on insurance panels, both can join national membership/advocacy organizations with state/local chapters, both have to attend continuing education, both serve in academic settings in research/teaching, both can train interns, hmm... I don't know what else, I tend to only visit the board when I have a cold these days and my brain is fuzzy.

Differences... the testing part is huge because of the amount of effort that goes into understanding testing/assessment. Social workers are taught biopsychosocial assessment techniques where basically, you are just gathering information that someone else will use to medically diagnose the client (with your desired population, the severe and persistently mentally ill, they will almost always be on psychopharms). Psychologists (and/or psychiatrists), in my experience, will fine tune that broad assessment, picking out the important parts, testing and evaluating specifically as needing, and settling on a diagnosis that makes sense.

The pay is also different. Though you likely will have a hard time finding insurance reimbursements... Medicaid and Medicare reimbursement rates should be posted somewhere on your state dept of health and human services website. You'll likely see $20 - $100 difference per session as well as the psychologists have a greater "menu" of services they can provide for each client (and bill there after)...

I'm not sure what you mean by "real" treatments and might ask you to clarify... both psychologists and social workers will work in various settings and the treatments you will use vary upon site location.

I think you nailed it on the head with your disclaimer that this is an emotional rant. In the end, getting a degree because of what people might think... that's probably not the right reason to choose one over another. Neither program is going to be easy for sure... both difficult for their own reasons... and neither will be worth it if you aren't able to fully commit to this as a career.

Good luck to you. If you have any other questions, feel free to message me... I just got sick so I should be around at least a few more times before I'm well again. I don't like to publicly speak about my specific experience/training for privacy reasons but I'd be glad to share some in pm if it would help with your decision. For what it's worth, the MSW will not be my terminal clinical degree... I will be going farther with my formal education. Be well.

 

[AryaStark]

Great post.
I think what he/ she meant was: do they use empirically supported treatments, like CBT, or do MSW's mostly use counseling? At least that is what I assume the question was. The only MSW I ever encountered mainly performed everyday counseling (more just shooting the shi* than actually attempting to modify behavior). I have always been under the impression that that is what most MSW's do, however I think I am wrong. I'm not too familiar with that particular degree, so I'd be interested to hear this answer as well.

I'm not sure what you mean by "real" treatments and might ask you to clarify... both psychologists and social workers will work in various settings and the treatments you will use vary upon site location.

 

[simpler2]

Social Work as a field traditionally involves many roles other than that of therapist. You can find these in the code of ethics for Social Work here:
http://www.socialworkers.org/pubs/Code/code.asp
If you aren't interested in the other aspects of social work (policy, social justice, case management...) you might find yourself constantly fighting to define/defend yourself to others. Sounds like you are more interested in the therapy...in that case the psychology approach seems like the better fit.

 

[psychanxiety]

I work at a Hospital where a number of patients with severe mental illness come for treatment. These patients are always seen by a psychiatrist, who is their primary doctor and prescribes medications, and a therapist of some sort- either MSW, mental health nurse (which is an awesome and ofter overlooked degree), or a PsyD/PhD. If you're dealing with severe mental illness, unless you have an MD you're never going to be "top dog". Only MDs can prescribe or admit to the inpatient unit. The social workers tend to check in subjectively on how the patient is doing and hook them up with the neccessary resources, like supportive employment or shelters. MSWs also run groups and day treatment programs (it's like adult daycare for the severely mentally ill) at our hospital is directed by a social worker. I don't know of any MSWs working on the inpatient unit. It seems like the PhDs do more CBT-style stuff. So an MSW will be somewhat limiting if you're working with severe mental illness, but there still a lot of diverse options.

 

[socialcog]

I work at a VA Hospital where a number of patients with severe mental illness come for treatment (schizophrenia, chronic and psychotic PTSD, bipolar, chronic and psychotic MDD).

MSWs also run groups and the day treatment program (it's like adult daycare for the severely mentally ill) at our hospital is directed by a social worker. I don't know of any MSWs working on the inpatient unit. It seems like the PhDs do more CBT-style stuff. So an MSW will be somewhat limiting if you're working with severe mental illness, but there still a lot of diverse options.

Adding to your post, I think there are clearer job delineations when working at a hospital or any setting where there is a multi-disciplinary treatment team. MSWs have a clear job focus in those settings with the thrust on case management and not so much on treatment.

**To clarify, I am speaking for acute facilities that, of course, treat the 'severely mentally ill' that you mentioned in your post. That descriptor may also often include populations with illnesses more chronic in nature and that may require longer hospital stays at facilities akin to state hospitals. Having never worked in those, I cannot speak for them.

 

[PsyDr]

You are asking the difference between a 2 year degree and a 6 year degree. The easy answer is 3-4 years of actual learning in the field.


of course there is a different level of respect for degree of education.