Getting a LCSW, then a PsyD/PhD?

[BX1959]

First, thanks to everyone who has given me advice on the whole psychiatry/psychology/clinical social work debate. It's been very helpful, especially because I hadn't given much critical thought to these distinctions beforehand.

I'd like to know how people feel about the idea of getting a MSW/LCSW first, and then going back for a PsyD or a PhD at a later period if it seems necessary/desirable. I ask this both in general (for the sake of other readers) and with regards to my situation.

If it helps, here's where I am now:
--BA in Psychology ('13), 169V/160Q/5.0W GRE, but no clinical volunteer/research experience.
--My chief interest is in diagnosing and treating mental disorders -- but I also realize that I won't know if that's truly what I want to do for a career until I have significant experience in the field.
--Accepted to the MSSW program at UT-Austin, and I will be able to attend for free (thanks to my awfully generous parents). Deferred until 2016 so that I could gain in-state status; I want to live in Texas my whole life, so it made sense to come a year early.
--My parents will not foot the bill for a 4-year program, be it a PsyD, PhD, MD, or whatever.
--Am I in it for the money? Let me put it this way: I'm in it to support a large family, maybe 5+ kids, on a single income. No wife/family to speak of yet, so I'm more flexible and 'free' at this stage than I'll ever be.

I've been doing a lot of soul searching/career searching, and it does seem that the consensus is that if you're mainly interested in therapy, it's really a toss-up between the LCSW and PsyD, since both can charge/receive about the same amount from insurers. (That being said, it sounds like some psychologists make a lot more than social workers in private practice -- even $100,000 more per year. why would that be?)

The other element is that while I've been interested in clinical mental health work since my freshman year of college, I don't have the experience to confirm that this is what I want to do. That's why I hesitate to pursue a PsyD or PhD right now, since even if I emerged debt-free, I'll be a lot older, and there's the opportunity cost issue.

So, it occurred to me that I could go ahead and pursue the MSSW/LCSW now. It would be a relatively short and debt-free degree. Afterwards:

1. If I was earning enough from the LCSW to support a family, then great -- end of story.
2. If I wasn't earning enough but enjoyed therapy, I could make the transition to a PsyD or clinical PhD. I'd have plenty of clinical experience, but perhaps no research experience. But I would know that I enjoy the field enough to dedicate an extra 5+ years of education to it. Needless to say, I would choose either a debt-free option or a very low-debt option -- not a professional school.
3. If I disliked therapy, or the PsyD/PhD route wasn't feasible, I could pursue an MBA or some other route.

The main problem is that entering a doctorate would be difficult enough now; it would be extremely difficult if a spouse and family is involved. But people do seem to find a way, even if it puts a big strain on the relationship. I also realize that I'm just kicking the 'no research experience' can down the road, but this appears to be less of a problem for the PsyD -- and at least one poster said that his/her MSW opened the doors to a lot of PsyD programs.

So keeping in mind my interest in therapy, but also the need to support a lot of hungry mouths down the road, should I go ahead with the MSSW, or dedicate myself to the PsyD/PhD route?

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[wesleysmith]

Search the forum for PsyD/PhD talks -- if you're interested in clinical psychology you certainly don't want to limit your applications to the PsyD, but rather, you should look for program fit (research interests with faculty, program orientation, APA match rates, clinical training) things psychologists on this forum would be much more capable of explaining .

"MSSW/LCSW now. It would be a relatively short and debt-free degree"

Unless you got a free-ride (or dang near) this will be nowhere approaching the truth. From the sounds of it, although you would put off earning money for longer, you may have better financial aid options with a good PhD program - I read "fully funded" fairly often. I've never heard of this for the MSW. There are scholarships available, but just like the six-figure PP salary, aim for it but don't expect it.

It is certainly wise to consider potential incomes before jumping into any degree, but in the end, you can make a respectable salary with hard work with either degree (yes, even the MSW). What you should strongly consider now is what you want to do, and what training/education resonates with you.

 

[erg923]

First, thanks to everyone who has given me advice on the whole psychiatry/psychology/clinical social work debate. It's been very helpful, especially because I hadn't given much critical thought to these distinctions beforehand.

I'd like to know how people feel about the idea of getting a MSW/LCSW first, and then going back for a PsyD or a PhD at a later period if it seems necessary/desirable. I ask this both in general (for the sake of other readers) and with regards to my situation.

If it helps, here's where I am now:
--BA in Psychology ('13), 169V/160Q/5.0W GRE, but no clinical volunteer/research experience.
--My chief interest is in diagnosing and treating mental disorders -- but I also realize that I won't know if that's truly what I want to do for a career until I have significant experience in the field.
--Accepted to the MSSW program at UT-Austin, and I will be able to attend for free (thanks to my awfully generous parents). Deferred until 2016 so that I could gain in-state status; I want to live in Texas my whole life, so it made sense to come a year early.
--My parents will not foot the bill for a 4-year program, be it a PsyD, PhD, MD, or whatever.
--Am I in it for the money? Let me put it this way: I'm in it to support a large family, maybe 5+ kids, on a single income. No wife/family to speak of yet, so I'm more flexible and 'free' at this stage than I'll ever be.

I've been doing a lot of soul searching/career searching, and it does seem that the consensus is that if you're mainly interested in therapy, it's really a toss-up between the LCSW and PsyD, since both can charge/receive about the same amount from insurers. (That being said, it sounds like some psychologists make a lot more than social workers in private practice -- even $100,000 more per year. why would that be?)

The other element is that while I've been interested in clinical mental health work since my freshman year of college, I don't have the experience to confirm that this is what I want to do. That's why I hesitate to pursue a PsyD or PhD right now, since even if I emerged debt-free, I'll be a lot older, and there's the opportunity cost issue.

So, it occurred to me that I could go ahead and pursue the MSSW/LCSW now. It would be a relatively short and debt-free degree. Afterwards:

1. If I was earning enough from the LCSW to support a family, then great -- end of story.
2. If I wasn't earning enough but enjoyed therapy, I could make the transition to a PsyD or clinical PhD. I'd have plenty of clinical experience, but perhaps no research experience. But I would know that I enjoy the field enough to dedicate an extra 5+ years of education to it. Needless to say, I would choose either a debt-free option or a very low-debt option -- not a professional school.
3. If I disliked therapy, or the PsyD/PhD route wasn't feasible, I could pursue an MBA or some other route.

The main problem is that entering a doctorate would be difficult enough now; it would be extremely difficult if a spouse and family is involved. But people do seem to find a way, even if it puts a big strain on the relationship. I also realize that I'm just kicking the 'no research experience' can down the road, but this appears to be less of a problem for the PsyD -- and at least one poster said that his/her MSW opened the doors to a lot of PsyD programs.

So keeping in mind my interest in therapy, but also the need to support a lot of hungry mouths down the road, should I go ahead with the MSSW, or dedicate myself to the PsyD/PhD route?

This is all predicated on the assumption that one can make meaningfully more money doing therapy as a Psy.D.

 

[Peacemaker36]

If you decide to take insurance, you will make considerably more money as a psychologist. You just have to weigh the increased income against the years of opportunity cost and possible student loan debt. I would recommend looking into the reimbursement rates for the major insurers where you live and then running the numbers.

 

[erg923]

If you decide to take insurance, you will make considerably more money as a psychologist. You just have to weigh the increased income against the years of opportunity cost and possible student loan debt. I would recommend looking into the reimbursement rates for the major insurers where you live and then running the numbers.

No. You have the potential to make more as psychologist. Efficencey, work hours, overhead, demand, buisness model, taxes, etc. all factor in here.

 

[Peacemaker36]

Insurance companies pay psychologists more. So, assuming everything is equal, you make more as a psychologist in private practice than you would as a social worker in private practice.

 

[erg923]

Insurance companies pay psychologists more. So, assuming everything is equal, you make more as a psychologist in private practice than you would as a social worker in private practice.

But everything isn't equal, is it?

 

[WisNeuro]

Oh, let's clear up this semantic argument. How about using the phrase "will most likely" make more?

 

[smalltownpsych]

Oh, let's clear up this semantic argument. How about using the phrase "will most likely" make more?

lol ...but that ruins the classic "I knew a social worker who makes X dollars more than a psychologist I know" type of argument or even better "I knew someone that went to a school with a 25% match rate and they got an internship so I'll be fine". My research methods prof back in undergrad used to call these Uncle Ernie arguments because of arguments like "but my Uncle Ernie was a high school dropout and he owns a Fortune 500 company so why should I go to school?"

 

[WisNeuro]

My research methods prof back in undergrad used to call these Uncle Ernie arguments because of arguments like "but my Uncle Ernie was a high school dropout and he owns a Fortune 500 company so why should I go to school?"

He stole that from Meehl, "Uncle George's Pancake Fallacy."

 

[bcliff]

Often I saw insurance reimbursement rates (lets say per hour of generic psychotherapy) at ~$130/hour for MD/DO, ~$80/hour for PhD/PsyD, and ~$75/hour for LCSW/LPC/MFT/etc. - If PP is your ultimate goal, I don't think you *need* to become a doctoral level provider.

If I was not interested in the flexibility offered by a clinical psych PhD (training in stats, methods, practice, and teaching), I wouldn't have pursued a PhD/PsyD - I would have either pursued an MPH, so I could stay involved in research/stats, or an MSW, so I could pursue licensure as an LCSW.

 

[smalltownpsych]

A big part of private practice is bringing in the business and many successful people who want to pay for treatment are going to prefer a psychologist over a social worker. I also feel that the training we receive as psychologists gives us an edge and we can do assessments and some of the well-compensated business I get from the local court is because of my degree. I am in somewhat of a private practice setting currently and eventually want to start my own group practice or treatment center and I don't believe that I, as an individual, would be nearly as effective if I didn't develop the skills and confidence that a solid APA doctorate program and internship provided. Bottom line though is that I never wanted to be a social worker, I wanted to be a psychologist. To me, they are two distinct fields and this was especially the case when I was in undergrad as I thought of a social worker as a case worker at an agency more than a psychotherapist in private practice. When I eventually found out that social workers did work in private practice, I still didn't want to be one for a lot of reasons including the fact that I doubted that I would be only in private practice, but even if I had thought that, I still believe that I was better served becoming a psychologist.

 

[BuckeyeLove]

180/therapy hour for psyd/phd's on the plans my supervisors accept in their side practices.

 

[deleted343839]

So keeping in mind my interest in therapy, but also the need to support a lot of hungry mouths down the road, should I go ahead with the MSSW, or dedicate myself to the PsyD/PhD route?

To answer that question with anything other than "none of the above," you'd need to be in a geographical sweet spot where (1) reimbursement rates and self-pay rates are relatively high; (2) the market is not already oversaturated with therapists, and (3) the cost of living is relatively low. Not saying it can't be done, but... you would most likely have to live pretty modestly to pull that off.

 

[LAPsyGuy]

No. You have the potential to make more as psychologist. Efficencey, work hours, overhead, demand, buisness model, taxes, etc. all factor in here.

Well, definitely ignores some of the facts in order to keep things real. It's key to make career decision based on the worst case scenario.

 

[BX1959]

Looks like I got a good discussion going -- thanks everyone for your input.

WesleySmith, I am lucky enough to have parents who are willing to pay for the in-state MSSW at UT Austin. Along with my AmeriCorps education stipend, the total cost of the MSSW should be around $18,000. So I'm looking at a cost of $0 for the MSSW, versus anywhere from $0 to a lot of debt with a PsyD or PhD.

Now, often people say, "if you're just doing therapy, there won't be a difference between the LCSW and the doctorate." Pardon my ignorance, but what are the things that a PsyD/PhD offers above "just therapy" that are also more lucrative than therapy? From my perspective, reimbursement rates of $75 an hour sound pretty good. What would be ways that a psychologist can 'top' that? I would certainly be willing to commit myself to the research involved in a PsyD or a PhD, but I don't envision a career in teaching and/or research.

I recognize that insurance will reimburse psychologists at least slightly more. And I think the point about people preferring a psychologist is a good one. But can't you largely cancel out the differences with a copay, and still find people who are willing to pay the extra $10 or $20 that would make up for a smaller reimbursement? I ask this because there was some hearsay that LCSWs and psychologists were largely charging the same hourly rate (copay + reimbursement). I'm living in Houston, where the cost of living is awfully low -- and certainly lower than NYC, SF, Boston, etc.

I also admit that, beyond a 'gut feeling' and a sense of interest, I don't know for sure that I want to pursue a career in therapy. That's one of the reasons why I'm hesitant to launch directly into a 5+ year doctorate, especially if any debt is involved.

Part of me wants to push myself to my intellectual limits and pursue the doctorate. But I owe it to myself (and yes, to anyone else in my household) to make a wise decision about what degree to get at this point.

 

[AcronymAllergy]

Looks like I got a good discussion going -- thanks everyone for your input.

WesleySmith, I am lucky enough to have parents who are willing to pay for the in-state MSSW at UT Austin. Along with my AmeriCorps education stipend, the total cost of the MSSW should be around $18,000. So I'm looking at a cost of $0 for the MSSW, versus anywhere from $0 to a lot of debt with a PsyD or PhD.

Now, often people say, "if you're just doing therapy, there won't be a difference between the LCSW and the doctorate." Pardon my ignorance, but what are the things that a PsyD/PhD offers above "just therapy" that are also more lucrative than therapy? From my perspective, reimbursement rates of $75 an hour sound pretty good. What would be ways that a psychologist can 'top' that? I would certainly be willing to commit myself to the research involved in a PsyD or a PhD, but I don't envision a career in teaching and/or research.

I recognize that insurance will reimburse psychologists at least slightly more. And I think the point about people preferring a psychologist is a good one. But can't you largely cancel out the differences with a copay, and still find people who are willing to pay the extra $10 or $20 that would make up for a smaller reimbursement? I ask this because there was some hearsay that LCSWs and psychologists were largely charging the same hourly rate (copay + reimbursement). I'm living in Houston, where the cost of living is awfully low -- and certainly lower than NYC, SF, Boston, etc.

I also admit that, beyond a 'gut feeling' and a sense of interest, I don't know for sure that I want to pursue a career in therapy. That's one of the reasons why I'm hesitant to launch directly into a 5+ year doctorate, especially if any debt is involved.

Part of me wants to push myself to my intellectual limits and pursue the doctorate. But I owe it to myself (and yes, to anyone else in my household) to make a wise decision about what degree to get at this point.

RE: the bolded points, keep in mind that often, that $75/hour is before practice-related overheard is taken out, which is likely to be somewhere around (IIRC) 30-ish%. Or, if you're practicing in an existing PP office, then they're going to take a portion "off the top" to help offset their overhead. Again, this usually seems to be anywhere from 30-50%, depending on your contract. Also, remember that you're not going to be billing for all of your time at work. There's time spent prepping for clients, writing notes, eating lunch, and various other tasks. Also, there will be no-shows, cancellations, and the like.

Secondly, I could be wrong, but (again, IIRC) I believe it's generally prohibited to bill any extra amount of money on top of the insurance reimbursement rate. If you want more than a particular insurance company offers, then you'd need to just go private pay (and, I believe, not be on that ins co's panel); the clients can then request reimbursement from their insurance company after the fact.

 

[smalltownpsych]

Looks like I got a good discussion going -- thanks everyone for your input.

WesleySmith, I am lucky enough to have parents who are willing to pay for the in-state MSSW at UT Austin. Along with my AmeriCorps education stipend, the total cost of the MSSW should be around $18,000. So I'm looking at a cost of $0 for the MSSW, versus anywhere from $0 to a lot of debt with a PsyD or PhD.

Now, often people say, "if you're just doing therapy, there won't be a difference between the LCSW and the doctorate." Pardon my ignorance, but what are the things that a PsyD/PhD offers above "just therapy" that are also more lucrative than therapy? From my perspective, reimbursement rates of $75 an hour sound pretty good. What would be ways that a psychologist can 'top' that? I would certainly be willing to commit myself to the research involved in a PsyD or a PhD, but I don't envision a career in teaching and/or research.

I recognize that insurance will reimburse psychologists at least slightly more. And I think the point about people preferring a psychologist is a good one. But can't you largely cancel out the differences with a copay, and still find people who are willing to pay the extra $10 or $20 that would make up for a smaller reimbursement? I ask this because there was some hearsay that LCSWs and psychologists were largely charging the same hourly rate (copay + reimbursement). I'm living in Houston, where the cost of living is awfully low -- and certainly lower than NYC, SF, Boston, etc.

I also admit that, beyond a 'gut feeling' and a sense of interest, I don't know for sure that I want to pursue a career in therapy. That's one of the reasons why I'm hesitant to launch directly into a 5+ year doctorate, especially if any debt is involved.

Part of me wants to push myself to my intellectual limits and pursue the doctorate. But I owe it to myself (and yes, to anyone else in my household) to make a wise decision about what degree to get at this point.

We do psychological testing and we we can bill for the scoring and report writing which I only do when other patients don't show. We can give expert testimony and that is usually very well compensated and everything is billable when involved in a legal case. We usually make a lot more in salary jobs such as the VA for example where licensed psychologists make about 100k and I am not sure what the MA level people make. When I taught a few classes at a college, I made 20% more as a doctoral level instructor. I was a clinical director of a treatment facility and supervised a number of clinicians and was able to supervise post-docs which is something that gave us an edge over the competition who didn't have as many doctoral level people and the marketing people loved to introduce me as Dr for obvious reasons. There is also professional consulting which can also be quite lucrative.

Ultimately though, this choice is not a mathematical formula. I wanted to be a psychologist, not a social worker or counselor. That was the main emotional basis that made the decision for me. It obviously wasn't purely emotional, but to steal a bit from Linehan, the wise mind occurs at the intersection of the rational mind and the emotional mind.

 

[Kb1234]

I typically see social work as someone who likes to work on a more issues regarding family problems, school related work, etc. It's not purely mental health related. Clinical psychology Ph.D. is what it is, you work with an individuals regarding mental health.

Ph.D. definitely opens more avenues rather than a Psy.D. Psy.D programs are most of the time not funded so you can end up with at least 80,000+ in debt by the end of it all. Ph.D. programs are often partially or fully funded.

I've also heard that regarding obtaining internship positions, Ph.D. students are more favored that Psy.D. students, so its harder for Psy.D students to find places.

For me, Psy.D programs are very risky, open very little avenue, and you acquire a substantial amount of debt. But if you are not interested in research at all, then doing a Ph.D. will be difficult for you.

 

[olayak]

A big part of private practice is bringing in the business and many successful people who want to pay for treatment are going to prefer a psychologist over a social worker. I also feel that the training we receive as psychologists gives us an edge and we can do assessments and some of the well-compensated business I get from the local court is because of my degree. I am in somewhat of a private practice setting currently and eventually want to start my own group practice or treatment center and I don't believe that I, as an individual, would be nearly as effective if I didn't develop the skills and confidence that a solid APA doctorate program and internship provided. Bottom line though is that I never wanted to be a social worker, I wanted to be a psychologist. To me, they are two distinct fields and this was especially the case when I was in undergrad as I thought of a social worker as a case worker at an agency more than a psychotherapist in private practice. When I eventually found out that social workers did work in private practice, I still didn't want to be one for a lot of reasons including the fact that I doubted that I would be only in private practice, but even if I had thought that, I still believe that I was better served becoming a psychologist.

Sorry, I have to disagree. I think that people will pick a LCSW or Psychologist based on experience and reputation, rather than just the title of their degree. And, in fact, some people don't want to go to a psychologist because they feel that it means that they are "damaged". But they'll go to a psychotherapist instead because they feel that it's for people who just need a little help, rather than being seriously mentally ill. And my own friends, who are all old money, will go to whoever is the best, not who has what degree. When Hilary Swank won her Oscar, she forgot to thank her husband. But she whole heartedly thanked her therapist. Her therapist is a licensed social worker.

Licensed social workers are not case workers, that's usually for BSW s or other people who want to be caseworkers but don't have the MSW. The majority of clinical social workers do not want to be caseworkers. That's not what we went to school for. You don't need a MSW to be a caseworker. Clinical social workers are psychotherapists and social workers training involves an extensive study of therapeutic techniques, as well as utilizing community resources to help the client and a study of public policy and administration of organizations. Psychologists are trained in testing (social workers are not) and therapeutic techniques, but ones that have a different focus than social workers. An experienced social worker will probably be a better therapist than a novice psychologist, and vice versa. However, a few things that you have to consider:

1. Where you live determines your fees. In NYC, most clinical social workers charge anywhere from $100-$200 per session without taking insurance. However, that's with an advanced license. Entry level social workers may make as little as $25 per session. Yes, psychologists may (or may not) charge more, but they have a different focus and approach. You have to figure out what style of therapy suits you.

2. An advanced social work license, the kind that you need to have a private practice, often requires 3,000 hours of clinical work after the masters degree. In NYC, after you finish the license you get a LMSW and then, after 3,000 more hours, you get a LCSW. You can only have a private practice with a LCSW. So, school may be only 2 years, but they are an intense 2 years and then you have to work 2 to 3 more years to get your advanced license. So it ends up being a 3-5 yr path.

3. Social work school is intense. Psychologists do their 1 yr internship after they finish classes. Social workers do it WHILE taking classes. At NYU we had a 21 hour internship per week, each year, while also taking 4 classes per semester. That totaled 6,000 hours of internship WHILE going to school full time. It's intense. But worth it! You learn SO much!

4. Social work school can be very expensive. At NYU it's $60,000 per year. Despite the fact that some entry level SW jobs are $40,000 per year (or less). The real money is after you get that private license. Then you can make your own hours and take as many clients as you want. In NYC, for example, if you saw just 20 clients per week (which is part time) you could make anywhere from $100,000 to $200,000 per year, depending on what you charge. Of course, you could also make less.

5. A lot of SW also teach classes as adjunct professors, which supplements their income. So, you have the $100,000 PLUS teaching salary. In NYC it starts at $65 per hour and then goes up (depending on the university). Of course, you can decide that you love casework and you love being deep in the trenches and helping people. Which is wonderful. But then your salary is less. Still, I've seen public, government social worker jobs that are $75,000 and up.

6. Don't assume that you'll be forever poor. Sure, you may make less, the starting salary can be crap. But there's also room to go up. And, yes, psychologists will make a lot more in a similar position at a hospital. But, as someone on this forum reminded me, you may see the head of a psych ward as a psychologist but rarely a SW. But it's more likely to see the head of a hospital as a SW (because we're taught administration/policy classes, too) and it's rarely a psychologist. Again, it depends on what your end goal is.

7. A lot of MSW programs offer joint degrees. So, MSW/MPH or MSW/JD etc. This makes you even more marketable!

For SW, it really depends on what you specialize in and what your interests are. Many social workers go on to high level administrative positions in hospitals or other agencies. That salary can be quite high.

I'm a SW, if you haven't guessed yet I actually left a school psych phd program (which lead to licensure) in order to get a MSW instead. Have I considered going back for a PsyD or PhD Psych? Sure. But I'm not sure if I need to. I may just go for the DSW instead.

So what's the difference between the LCSW and the PsyD/PhD Psych? It's a different approach and a different focus. They're just different degrees but with a lot of overlap.

BTW, Suze Orman has a social work degree. So does Stedman Graham (Oprah's boyfriend). It helps you in any field. It's really up to you and what you want to do. Both psychology and SW are great degrees with a different focus. Feel free to ask me any questions.

 

[smalltownpsych]

Psychologists dress better than social workers.

Social Worker ^

Psychologist^

It seems like an obvious choice to me.

 

[olayak]

Oh, and SW are also trained in assessment. And psychologists don't "have an edge". That's shows a complete lack of understanding about the clinical social work field. They are different degrees with a different focus. Would you say that a PhD in Classics has an edge over a PhD in Romance Languages? Nope. Both are PhDs in languages, but they are different. Neither has an edge over the other.

 

[olayak]

SOCIAL WORKERS.

The attached file is a picture of me. Clearly not disheveled.

 

[WisNeuro]

Oh, and SW are also trained in assessment.

Depends on what you mean by assessment, really. Like clinical interviewing? Sure. Neuropsych or psychological assessment, not so much.

 

[olayak]

Hilary Swank's Therapist (Social Worker!) http://drhollyhein.com/html/bio.html

 

[olayak]

Depends on what you mean by assessment, really. Like clinical interviewing? Sure. Neuropsych or psychological assessment, not so much.

Clinical assessment. To diagnose mental illness. You're right, we're not trained in neuropsych testing. We don't do IQ tests, projective tests, personality tests, etc. As I said, the SW and the Psych degree overlap quite a bit but each has a different approach and different focus. One is not better than the other, they are just different.
It's really sad, actually, that people on this forum feel the need to put down social workers. Not funny. Not cool. Our field is just as valid. THEY ARE DIFFERENT DEGREES. One is not better than the other. I was just trying to give the person who originally posted insight into the social work field.

 

[WisNeuro]

Oh, I wasn't putting anything down. Just making a distinction between "assessment." It's an umbrella term, of which people often conflate the things falling under it.

 

[olayak]

Oh, I wasn't putting anything down. Just making a distinction between "assessment." It's an umbrella term, of which people often conflate the things falling under it.

Oh, not you! You've been very respectful. I meant the poster called "small town psych" who posted a picture of a disheveled man and called him a social worker and then the pic of the professional man and called him a psychologist. How you dress is about the person, not about their career choice. His post was rude and disrespectful and not helpful for this conversation.

I'll continue to say that neither profession is better or more sophisticated. It's all about which path you take. There's a lot of misconception about social workers. Clinical social workers aren't caseworkers. We're clinical psychotherapists, administrators, policy makers and, occasionally have joint JD or MPH degrees. I personally have also a MSEd and MA in Biopsych. I'm an educator, researcher, chairman of a non-profit and a clinical psychotherapist. You make your own path in life. Psychologists have a different focus than social workers. Different degrees with some overlap. They aren't the same degree and one isn't better than the other. They are just different.

Remember the Dr. Seuss book about the Snitches with stars on their bellies and those without stars? Neither was better than the other. They were just different. In the end they learned to get along and respect either other's differences.

 

[psych844]

One question about Psychologists that only do therapy. So beyond getting clients through other providers (i guess it make sense to have relationships with psychologist who do assessments in the area that you provide therapy), but if random people want to come in for therapy, is a Psychologist who really understands only therapy equipped to know if the client has the issue they think they have?

 

[WisNeuro]

^^I'm with you. Depends on what you want out of your career. I've definitely steered students down both paths based on their career goals. And, I have definitely worked with some SW's who were better clinicians than some of the psychologists I've worked with. I'd say the only real clear edge that is usually there is in research, if we're talking about the PhD, anyway. I've seen some SW programs with that component, but it's usually small if it is there.

 

[olayak]

I totally agree. Although, they do have Social Work PhDs I think I'd say that the social work degree may have more of a focus on policy, while psychology may have more of a focus on testing. Although both equally focus on providing therapy. And, you're right, I do research but most people with MSWs do not.

 

[olayak]

One question about Psychologists that only do therapy. So beyond getting clients through other providers (i guess it make sense to have relationships with psychologist who do assessments in the area that you provide therapy), but if random people want to come in for therapy, is a Psychologist who really understands only therapy equipped to know if the client has the issue they think they have?

I don't think we quite understand the question. Psychologist, Psychiatrists and Clinical Social Workers are all able to do an initial assessment and diagnose a mental illness (if there is one). Although it usually takes more than one session to fully understand a client's problem. Clients often come with a previous diagnosis or they self diagnose (thanks to the Internet). It's a psych or therapists job to assess the clients mental health based on what is observed and discussed. "what the client thinks they have" is one of many factors that are taken into account.

Not sure about psychologists, but sockets workers consider biological, psychological and environmental (social) factors. It's called the biopsychosocial model. No therapist /psych will blindly accept what a client says they have. We sometimes review previous charts but we also do our own assessment.
I hope that answered your question!

 

[psych844]

I don't think we quite understand the question. Psychologist, Psychiatrists and Clinical Social Workers are all able to do an initial assessment and diagnose a mental illness (if there is one). Although it usually takes more than one session to fully understand a client's problem. Clients often come with a previous diagnosis or they self diagnose (thanks to the Internet). It's a psych or therapists job to assess the clients mental health based on what is observed and discussed. "what the client thinks they have" is one of many factors that are taken into account.

Not sure about psychologists, but sockets workers consider biological, psychological and environmental (social) factors. It's called the biopsychosocial model. No therapist /psych will blindly accept what a client says they have. We sometimes review previous charts but we also do our own assessment.
I hope that answered your question!

I guess I was looking for clarification for what people mean when they say "if you only intend on doing therapy, you don't need a Phd". I was asking if a person who has a Masters (Psychologists included), have enough assessment training to understand who they can help and who they can't.

 

[olayak]

I guess I was looking for clarification for what people mean when they say "if you only intend on doing therapy, you don't need a Phd". I was asking if a person who has a Masters (Psychologists included), have enough assessment training to understand who they can help and who they can't.

Yes, LCSW are trained in clinical assessment. However LCSW, LMSW, LMFTs all do not do psychological testing. So, for example, a clinical social work is more than qualified to diagnose a pervasive developmental disorder (like Autism). But the same social worker does not do IQ testing, so he/she might send the client to a psychologist for further testing.

A clinical social worker is definitely qualified to diagnose a mood disorder, a personality disorder, etc. Again, tho, we do not do testing. But these clients may not need testing. If the client needs testing we will refer them to a psychologist and if they need medication we will work with a psychiatrist. But often we all work together. However, if a client need access to special services, such as a day treatment program, a LCSW will assess the illness, provide the therapy, and also help the client get access to those services. Some psychologists and psychiatrist are also involved in research whild most LCSW are not.

So, the short answer to your question is that LCSW and Psychologist both are trained in clinical mental health assessment. We are all good at assessing. We are all good at therapy. The difference is what we do beyond the therapy. And it is required of all of us that we refer the client somewhere else if we are not able to help them and/or if they have special needs that we cannot help them with. That's why you'll see psychiatrists, psychologists and psychiatric social workers all working together in a hospital. Since we wear different hats, we often collaborate on a client's treatment plan.

 

[psych844]

Yes, LCSW are trained in clinical assessment. However LCSW, LMSW, LMFTs all do not do psychological testing. So, for example, a clinical social work is more than qualified to diagnose a pervasive developmental disorder (like Autism). But the same social worker does not do IQ testing, so he/she might send the client to a psychologist for further testing.

A clinical social worker is definitely qualified to diagnose a mood disorder, a personality disorder, etc. Again, tho, we do not do testing. But these clients may not need testing. If the client needs testing we will refer them to a psychologist and if they need medication we will work with a psychiatrist. But often we all work together. However, if a client need access to special services, such as a day treatment program, a LCSW will assess the illness, provide the therapy, and also help the client get access to those services. Some psychologists and psychiatrist are also involved in research whild most LCSW are not.

So, the short answer to your question is that LCSW and Psychologist both are trained in clinical mental health assessment. We are all good at assessing. We are all good at therapy. The difference is what we do beyond the therapy.

Ah, thanks for the clarification. So most Master level people have enough training to diagnose/assess (LCSW, LMSW, LMFT's), but the difference is if testing is needed, they need to be sent to a Psychologist?

 

[olayak]

I guess I was looking for clarification for what people mean when they say "if you only intend on doing therapy, you don't need a Phd". I was asking if a person who has a Masters (Psychologists included), have enough assessment training to understand who they can help and who they can't.

I think that when people say that what they mostly mean is that psychologists must do a dissertation as part of their PhD. So if you're not interested in research, don't do a PhD. If you want to do therapy, but you're not interested in research, do a LCSW or LMFT or LMHC. Although, for the MSW we did need to learn how to do research and we did have a "capstone project", it wasn't anywhere near as intense a project as a PhD dissertation.

 

[olayak]

Ah, thanks for the clarification. So most Master level people have enough training to diagnose/assess (LCSW, LMSW, LMFT's), but the difference is if testing is needed, they need to be sent to a Psychologist?

Pretty much, yes. But that's formal testing. You don't always need formal testing. Some people prefer to start off at a psychologist, some don't.

Another difference is that SW use a strengths based perspective. We start off by looking at what is right in the person and how we can use that to help them improve. Psychologists and Psychiatrists use a psychopathological focus, they start off by looking what is wrong with the client (what their illness is) and then seeing how they can help them improve.

So, same therapy, different focus. Whether you paint a room blue or green, it's still painted. It's just painted a different color.

 

[Therapist4Chnge]

Yes, LCSW are trained in clinical assessment. However LCSW, LMSW, LMFTs all do not do psychological testing. So, for example, a clinical social work is more than qualified to diagnose a pervasive developmental disorder (like Autism). But the same social worker does not do IQ testing, so he/she might send the client to a psychologist for further testing.

100% disagree. A pediatric neuropsychologist is needed in this example. There are a plethora of DX's that could be masquerading as autism, present in addition to autism, etc. Half of my training was in Peds and I know enough to know that a TON of things can be missed in regard to DDs if a sub-specialist isn't consulted.

A clinical social worker is definitely qualified to diagnose a mood disorder, a personality disorder, etc. Again, tho, we do not do testing. But these clients may not need testing.

Again, I think you are overstating expertise. There is far more considerations developmentally than just mood disorders.

For instance...a kid consistently acts out in class, he becomes really upset during different academic exercises, he displays a range of aggressive behaviors, he's socially inappropriate, his mood goes from quiet to incredibly labile, etc

Attempting to diagnosis a kid in such a scenario would be wildly inaccurate w/o formal evaluation. Schools struggle constantly w these cases and regularly jack up the diagnosis.

Not every discipline can accurately do differential diagnosis, conduct therapy, etc the same. Heck, I would feel ill prepared to do couples therapy because that was such a small part of my training and it's been a decade since I studied it. I refer to our social worker in these instances. Knowing limits of competency is hugely important.

The "you're the same, we're the same...except for testing and research" is really an inaccurate portrayal between the different professions. For instance, Psychologists will know little to nothing about care management, setting up social services, etc. The professions are vastly different w a handful of areas of crossover.

For context, over the years I've lectured in a range of programs: clinical psych, mental health counseling, marriage & family, school psych, med school, and residency...and diagnostic understanding across training programs is HUGELY different. The landscape is far more niche than ppl realize.

 

[smalltownpsych]

Another difference is that SW use a strengths based perspective. We start off by looking at what is right in the person and how we can use that to help them improve. Psychologists and Psychiatrists use a psychopathological focus, they start off by looking what is wrong with the client (what their illness is) and then seeing how they can help them improve.

This is inaccurate. Have you ever heard of Humanistic Psychology? FYI Carl Rogers was a psychologist. Also, helping a patient access their own coping resources and strengths is at the heart of much CBT.

You also said something earlier about social workers getting more clinical experience during the course of their degree program. This is not accurate either. The amount of supervised clinical experience that is obtained during a clinical PhD or PsyD program is extensive and far exceeds the amount of experience of any of the recent MSW grads that I have supervised.

 

[BuckeyeLove]

The amount of supervised clinical experience that is obtained during a clinical PhD or PsyD program is extensive and far exceeds the amount of experience of any of the recent MSW grads that I have supervised

This ^^^

 

[psych844]

100% disagree. A pediatric neuropsychologist is needed in this example. There are a plethora of DX's that could be masquerading as autism, present in addition to autism, etc. Half of my training was in Peds and I know enough to know that a TON of things can be missed in regard to DDs if a sub-specialist isn't consulted.



Again, I think you are overstating expertise. There is far more considerations developmentally than just mood disorders.

For instance...a kid consistently acts out in class, he becomes really upset during different academic exercises, he displays a range of aggressive behaviors, he's socially inappropriate, his mood goes from quiet to incredibly labile, etc

Attempting to diagnosis a kid in such a scenario would be wildly inaccurate w/o formal evaluation. Schools struggle constantly w these cases and regularly jack up the diagnosis.

Not every discipline can accurately do differential diagnosis, conduct therapy, etc the same. Heck, I would feel ill prepared to do couples therapy because that was such a small part of my training and it's been a decade since I studied it. I refer to our social worker in these instances. Knowing limits of competency is hugely important.

The "you're the same, we're the same...except for testing and research" is really an inaccurate portrayal between the different professions. For instance, Psychologists will know little to nothing about care management, setting up social services, etc. The professions are vastly different w a handful of areas of crossover.

For context, over the years I've lectured in a range of programs: clinical psych, mental health counseling, marriage & family, school psych, med school, and residency...and diagnostic understanding across training programs is HUGELY different. The landscape is far more niche than ppl realize.

Any idea how common misdiagnosis is from providers not respecting or even understanding their scope of practice/competence?

 

[Therapist4Chnge]

Any idea how common misdiagnosis is from providers not respecting or even understanding their scope of practice/competence?

Incredibly common…and this includes psychologists.

 

[psych844]

Incredibly common…and this includes psychologists.

Beyond emphasizing ethics in practice, and urging providers to stay within their scope of practice and expertise, are there any ramifications (legal), about someone practicing outside their area?

 

[olayak]

As I stated, clinical social workers are qualified and licensed to diagnose mental illness. With limited knowledge about the field, it's not fair to say that we are not able nor competent when it comes to diagnosis. I wasn't specifically talking about children but you're right that ODD or CD can initially be confused with other disorders or illnesses. School social workers are quite adept at working with children with a variety of disorders.
We still are very qualified to diagnose. We are legally qualified to diagnose. Clinical social workers are not caseworker. Those are usually people with a BSW or basic BA. Sure, we'll sometimes help with services, but most LCSWs focus on the therapy. If it's out of our area of expertise, we refer it out. That's in our code of ethics. In the case of the child with PDD, we would refer to a psychologist for further assessment. We would probably focus more on providing supportive counseling for the parents. For a mood disorder, a LCSW is more than qualified to diagnose and provide therapy.
For the record, I have 3 masters degrees and ABD in school psych phd. I also lecture, research, write and teach University classes. I do know the difference between psychology and social work and there is a lot more overlap than you think. Again, they are different but have overlap. Social workers are much more advanced and competent than you may realize.

 

[olayak]

X

 

[Therapist4Chnge]

Beyond emphasizing ethics in practice, and urging providers to stay within their scope of practice and expertise, are there any ramifications (legal), about someone practicing outside their area?

Sure…but it's hard to actually get addressed. Notification of the applicable licensing board is probably the most common method. I've seen people be reported to their employer. If they are out in the community, it seems near impossible to actually get someone to change w/o egregious behavior that is able to be documented and proven.

In general I warn other providers if a name comes up where I've had problems, but there always seems to be plenty of work out there.

 

[olayak]

This is inaccurate. Have you ever heard of Humanistic Psychology? FYI Carl Rogers was a psychologist. Also, helping a patient access their own coping resources and strengths is at the heart of much CBT.

You also said something earlier about social workers getting more clinical experience during the course of their degree program. This is not accurate either. The amount of supervised clinical experience that is obtained during a clinical PhD or PsyD program is extensive and far exceeds the amount of experience of any of the recent MSW grads that I have supervised.

Recent MSW grads are required to have 6,000 hours of clinical practice but they don't get an advanced (clinical) license until they get an additional 3,000 hours of clinical practice. For a total of 9,000 hours over 4-5 years. That's pretty extensive.

 

[Lurking Oracle]

As I stated, clinical social workers are qualified and licensed to diagnose mental illness. With limited knowledge about the field, it's not fair to say that we are not able nor competent when it comes to diagnosis. I wasn't specifically talking about children but you're right that ODD or CD can initially be confused with other disorders or illnesses. School social workers are quite adept at working with children with a variety of disorders.
We still are very qualified to diagnose. We are legally qualified to diagnose. Clinical social workers are not caseworker. Those are usually people with a BSW or basic BA. Sure, we'll sometimes help with services, but most LCSWs focus on the therapy. If it's out of our area of expertise, we refer it out. That's in our code of ethics. In the case of the child with PDD, we would refer to a psychologist for further assessment. We would probably focus more on providing supportive counseling for the parents. For a mood disorder, a LCSW is more than qualified to diagnose and provide therapy.
For the record, I have 3 masters degrees and ABD in school psych phd. I also lecture, research, write and teach University classes. I do know the difference between psychology and social work and there is a lot more overlap than you think. Again, they are different but have overlap. Social workers are much more advanced and competent than you may realize.

Didn't you initially post that you had "half a PhD" (or words to that effect), but have now changed it to "ABD"? ABD, for those universities that recognize the term (not all do, BTW), is well beyond "half" (whatever that means) and has very specific requirements for use and maintenance of the term.

 

[Ollie123]

Recent MSW grads are required to have 6,000 hours of clinical practice but they don't get an advanced (clinical) license until they get an additional 3,000 hours of clinical practice. For a total of 9,000 hours over 4-5 years. That's pretty extensive.

I'm not sure the math even works out on that. 6000 hours of clinical practice while getting an MSW is equivalent to doing nothing but clinical work 40 hours/week, 50 weeks per year for 3 years. I don't know a single MSW grad who put in those kinds of hours on top of a full-time courseload, etc. If you are counting everything education-related as "clinical practice" that is different, but that's not how we typically define it in psychology.

 

[Lurking Oracle]

And while we're at it, let's redirect our replies on this thread back to the OP's actual questions/concerns. While it is true that there are social workers and psychologists that make nice salaries (usually those with full-pay, non-insurance, or forensic niches), it is basically guaranteed that one will NOT walk into a six-figure salary right out of training. Some psychologists, and fewer social workers, will, eventually, reach the $100-200K range in private practice in certain cities, but guess what?... that will be after MANY years. You will NOT walk into that right after putting in 18-24 months for an MSW, or a 5+ year PhD/PsyD. Also... to address an earlier assertion, while there are LCSWs here in NYC that make that kind of money (and not the majority, ever, at any point in one's career), $100K in NYC is, frankly, barely getting by with one-bedroom apartments going for $1.5M. If you have two people pulling in that amount, well, then the calculus changes (a bit), but with a large family... not so much. Ultimately, the issue is about one's own professional goals, abilities, and what one is will to commit/delay/sacrifice/expect. But the various options are NOT interchangeable.