Do you feel the clinical MSW prepares you well?

[avila87]

A question for current MSW students and/or seasoned LCSWs: do you/did you feel well prepared by your programs to work in therapy/counseling immediately after graduation?

Although I was an undergrad psych major, part of the reason I was attracted to the MSW was the attraction to the social justice philosophy (helping at the micro level but also studying the mezzo and macro levels that affect the client). Also, I was always more interested in direct practice than research and couldn't justify entering the work force in my late 20s by going for a Phd when a two year degree and adequate fieldwork experiences/supervision would lead me to what I wanted to do.

Still, I wonder [am nervous about] if two years (with one year focused on general SW alone and the second devoted to clinical track classes) is really enough to make someone a really competent clinician by the time they graduate, especially looking at the more rigorous expectations and time commitment put on the clinical psych Phd candidates in my same school.

Though the core clinical track classes seem solid, I'm looking at my school's list of electives and feel it's unfortunate I won't have space to take many ones I feel are important or almost just as essential as the core clinical track classes (classes ranging from a CBT course to crisis intervention and substance abuse counseling).

I know no one's thrown blindly into the field since there's post-grad supervision and that you're not meant to be a jack of all trades and instead tend to focus on a specialization/population (re: my electives concern), but how good do you feel your clinical training is in comparison to a PsyD, Phd, or fellow master's level LPC? Have you experienced equal or different treatment in a clinical setting made up of people with different masters and doctoral level degrees?

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[psich]

I think your concerns are sound. Have you thought about applying to an applied MA program?

 

[Therapist4Chnge]

I know no one's thrown blindly into the field since there's post-grad supervision and that you're not meant to be a jack of all trades and instead tend to focus on a specialization/population (re: my electives concern), but how good do you feel your clinical training is in comparison to a PsyD, Phd, or fellow master's level LPC? Have you experienced equal or different treatment in a clinical setting made up of people with different masters and doctoral level degrees?

This is actually my major concern with MSW's doing in-depth therapy. I have worked with some great LCSW's, but they all pursued additional training and supervision after their graduate program and post-grad supervision. There just isn't enough time and supervision to get everything in for an MSW, particularly when a % of the 2 years is dedicated to non-Tx training. Many great clinicians are MSWs and/or LCSWs, though I think that additional pursuit of training is a major contributor to that.

 

[specialk962]

I am currently a first summer student at Smith's MSW program. Its program is strongly focused on clinical social work. A lot of our classes my first year are focused on theory and clinical work. The program also does 2 full time internships during the school year. For 3 summers I'm in Massachusetts and for 2 academic years September-April I'm doing a full time internship.

 

[avila87]

psich: I thought about an MA program in counseling before (LPC/LMHC) but instead will be starting an MSW program this fall.

Therapist4Change: I agree about the importance of additional training and supervision. Although the school I will be attending has a clinical track with a good reputation, when a % of those two years is spent in non Tx-training as you say, it feels like there's barely time to scratch the surface of working in a clinical setting and gaining in depth knowledge about things like psycho-pathology and different schools of thought re: treatment. I'm not against the non-Tx classes because I'm also attracted to and like the general social work aspect, but would still feel nervous about my "clinical toolbox" upon graduation without additional training/close post-grad supervision.

P.S. What do you mean re: MSWs doing in-depth therapy? Do you mean something like long term psychoanalysis, or do you mean in-depth therapy such as dealing with serious psycho-pathology?


specialk962: The program I'm starting in the fall is also heavily clinical and has its own dedicated clinical track. The first year focuses on generalist practice and the second on the clinical track, with two different full year internships to reflect that. It's good to know that you seem to be getting a lot of clinical coursework in your first year as well, thanks for sharing!

 

[BSWdavid]

psich: I thought about an MA program in counseling before (LPC/LMHC) but instead will be starting an MSW program this fall.

Therapist4Change: I agree about the importance of additional training and supervision. Although the school I will be attending has a clinical track with a good reputation, when a % of those two years is spent in non Tx-training as you say, it feels like there's barely time to scratch the surface of working in a clinical setting and gaining in depth knowledge about things like psycho-pathology and different schools of thought re: treatment. I'm not against the non-Tx classes because I'm also attracted to and like the general social work aspect, but would still feel nervous about my "clinical toolbox" upon graduation without additional training/close post-grad supervision.

P.S. What do you mean re: MSWs doing in-depth therapy? Do you mean something like long term psychoanalysis, or do you mean in-depth therapy such as dealing with serious psycho-pathology?


specialk962: The program I'm starting in the fall is also heavily clinical and has its own dedicated clinical track. The first year focuses on generalist practice and the second on the clinical track, with two different full year internships to reflect that. It's good to know that you seem to be getting a lot of clinical coursework in your first year as well, thanks for sharing!

In my opinion, this can really be a problem, not only with MSW programs, but all master level programs. Can you really train to be a therapist in two-years? At this point, the evidence doesn't suggest that master level therapists are less effective than doctoral level clinicians. However, that doesn't mean it still isn't a problem.

Pertaining to MSW programs, it is a difficult judgement call as no two programs are created equal, and even two clinical programs that offer similar courses may be worlds apart in their actual clinical emphasis. I think one large problem of MSW programs is that the CSWE mandates a unified curriculum; that means an MSW program in Idaho and an MSW program in New York will have to conform to CSWE standards and offer a similar curriculum, which includes courses in social policy, macro practice, etc. Obviously, this takes away from the opportunity to lean direct practice skills.

It is important to understand that in the social work profession, "clinical work" is a broad term that can be interpreted in many different ways. In fact, anything that involves micro work (case management, for example), may fit the definition as clinical. Is this appropriate? No, I don't think so, but unfortunately, because clinical work can be defined from such a broad perspective, an MSW student can go two years without ever learning about therapy, practice in a hospital setting as a healthcare social worker, and still receive their clinical license. Other programs define clinical work as indeed "psychotherapy" and will focus exclusively on training MSW students to be therapists. Point is, just because a program is clinical doesn't mean it teaches its students to be therapists. I would look more closely at the specific programs versus just assuming all clinical programs train their students to be therapists.

Even though MSW programs have similar course offerings, the content of those courses varies greatly from program to program. I think some programs are better at training therapists than others, but can you really learn to be a competent therapist in two years? Probably not. I think additional supervision and training is necessary in order to combat the time constraints of MSW programs. Some programs can offer a solid foundation to build upon, but it will be up to the practitioner to develop their clinical skills post-masters.

In regards to "in-depth therapy" I think that this depends more on program characteristics and theoretical orientation than MSW vs. PhD. I know numerous PhD programs that offer little training in long-term psychotherapy and others that exclusively focus on such training. I don't buy into the idea that just because a program is doctoral or takes longer to complete automatically ensures its graduates are capable of providing long-term services. If this is in fact the case, I would like to see the data supporting this hypothesis. I also don't buy into the idea that a program that spends five years providing research training produces better clinicians, capable of providing in-depth therapy. Research training is very important, but doesn't necessarily equate to a superior ability to practice psychotherapy. Again, if I am wrong, please show me the evidence to support this position.

 

[BSWdavid]

While the below text isn't from a journal article, I think it may provide the basis of thinking critically about training.

Is Professional Training a Waste of Time?
Every year, thousands of students graduate from professional programs with degrees enabling them to work in the field of behavioral health. Many more who have already graduated and are working as a social worker, psychologist, counselor, or marriage and family therapist attend—often by legal mandate—continuing education events. The costs of such training in terms of time and money are not insignificant.

Most graduates enter the professional world in significant debt, taking years to pay back student loans and recoup income that was lost during the years they were out of the job market attending school. Continuing professional education is also costly for agencies and individuals in practice, having to arrange time off from work and pay for training.

To most, the need for training seems self-evident. And yet, in the field of behavioral health the evidence is at best discouraging. While in traveling in New Zealand this week, my long-time colleague and friend, Dr. Bob Bertolino forwarded an article on the subject appearing in the latest issue of the Journal of Counseling and Development (volume 88, number 2, pages 204-209). In it, researchers Nyman and Nafziger reported results of their study on the relationship between therapist effectiveness and level of training.

First, the good news: “clients who obtained services…experienced moderate symptom relief over the course of six sessions.” Now the bad news: it didn’t matter if the client was “seen by a licensed doctoral –level counselor, a pre-doctoral intern, or a practicum student” (p. 206, emphasis added). The authors conclude, “It may be that researchers are loathe to face the possibility that the extensive efforts involved in educating graduate students to become licensed professionals result in no observable differences in client outcome” (p. 208, emphasis added).

In case you were wondering, such findings are not an anomaly. Not long ago, Atkins and Christensen (2001) reviewed the available evidence in an article published in the Australian Psychologist and concluded much the same (volume 36, pages 122-130); to wit, professional training has little if any impact on outcome. As for continuing professional education, you know if you’ve been reading my blog that there is not a single supportive study in the literature.

“How,” you may wonder, “could this be?” The answer is: content and methods. First of all, training at both the graduate and professional level continues to focus on the weakest link in the outcome chain—that is, model and technique. Recall, available evidence indicates that the approach used accounts for 1% or less of the variance in treatment outcome (see Wampold’s chapter in the latest edition of the Heart and Soul of Change). As just one example, consider workshops being conduced around the United States using precious resources to train clinicians in the methods studied in the “Cannabis Youth Treatment” (CYT) project–a study which found that the treatment methods used contributed zero to the variance in treatment outcome. Let me just say, where I come from zero is really close to nothing!

Second, and even more important, traditional methods of training (i.e., classroom lecture, reading, attending conferences) simply do not work. And sadly, behavioral health is one of the few professions that continue to rely on such outdated and ineffective training methods.

The literature on expertise and expert performance provides clear, compelling, and evidence-based guidelines about the qualities of effective training. I’ve highlighted such data in a number of recent blogposts. The information has already had a profound impact on the way I and ICCE Associates conduct training. Thanks to Cynthia Maeschalck, Rob Axsen, and Bob, the entire curriculum and methods used for the annual “Training of Trainers” event have been entirely revamped. Suffice it to say, agencies and individuals who invest precious time and resources attending the training will not only learn but be able to document the impact of the training on performance.

http://centerforclinicalexcellence..../18/is-professional-training-a-waste-of-time/

 

[socwrkr]

As a recent MSW graduate, this is also a concern for me. I graduated from a generalist program, and I don't feel qualified to do in-depth therapy.

Even LCSW's whom I've worked with are not skilled at doing therapy, but are great at community organizing, advocacy, program management, etc. OTOH, there are many MSW's and LCSW's who are very good in doing therapy, but only after intensive training postgrad.

Psychotherapy is not a focus of many social work programs; this is why it's called social work and not counseling or counseling psychology. I'm always perturbed by recent MSW graduates who said that they are now doing "therapy" or "psychotherapy" when this was not the focus of the programs that they attended. Taking one or two classes in CBT does not make us therapists.