Independent practice for LPAs?

[KayJay85]

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I'm not quite sure of your point here - since manualized CBT doesn't fit real world practice situations, we can't learn anything from looking at how much training in a manualized therapy actually helps lead to competency and efficacy in that manualized therapy? That's your argument? Ignore any actual research on the topic? Just go with heated shouting?

I'm starting to feel like the only one actually reading the literature in this argument and not shouting from my pulpit.

No. I am saying that training in a manualized therapy only leads to competency and efficacy in that manualized therapy. Which no one here has questioned. That is in no way grounds to argue that people at varied training levels, in this particular case LPAs who may really only be trained in one modality, should practice independently. Especially without some restrictions or designation on their license. Such as licensed CBT therapist.

 

[KayJay85]

I never said that more=better. There are certainly incompetent psychologists out there, no doubt! I said the depth, breadth, and model of training is different. FWIW and in my limited experience, I do think the psychology *model* is better *for clinical work*, esp. diagnosis. For things like working with disenfranchised populations, social work probably has the edge. Prior to grad school, I worked in an area (DV/IPV in a socially disenfranchised group) where social justice plays a HUGE role and having someone with a social work background is INVALUABLE. A mentor/colleague of mine has a PhD in social work, and I have nothing but the utmost respect for her as a researcher and as a social justice professional (our work is entirely research, so I can't speak to her skills as a clinician, but I trust they're probably very good).

My clinical supervisor in undergrad, an MSW, was a very, very good clinician, and again, I have nothing but respect for her. My other clinical supervisor was an LPC--again, same thing. But their training is still fundamentally different from that of psychologists--in the population they were working with (lots of phase of life issues), that very well may have been to their advantage or at least given them a good background for that population. So, I'm not knocking social work at all. In fact, I have a BSW!

You seem to think anyone who advocates for psychology or our training model is either (a) bashing social work, (b) has a fragile ego and needs to puff it up by getting a PhD, (c) disregards all social workers and Masters level clinicians, or (d) has no exposure to social work. On the same hand, you same to be denying that the psychology training model has ANY good to it and that the little good it does have simply duplicates social work.

👍👍👍👍

Thanks for bringing civility back. I, too, have had EXCELLENT experiences with LCSWs and LPCs. However, I do agree with the sentiment of the OP, that continuing to grant free license for psychotherapy across disciplines and training models without any checks is not a smart move.

 

[BSWdavid]

You seem to think anyone who advocates for psychology or our training model is either (a) bashing social work, (b) has a fragile ego and needs to puff it up by getting a PhD, (c) disregards all social workers and Masters level clinicians, or (d) has no exposure to social work. On the same hand, you same to be denying that the psychology training model has ANY good to it and that the little good it does have simply duplicates social work.

(a) many posters have bashed social work. In fact, I have been quite surprised at the vast amount of bashing in general that happens on SDN. I was actually surprised and relieved to find out this isn't the case in real life; (b) I don't think that individuals who pursue a PhD have a fragile ego. I think there is a lot of merit in such an endeavor; (c) again, similar to what I have already stated, many do disregard social work as simply "social justice work or case management"; and (d) much of what I have read has suggested that most posters have a perceived notion of social workers as case managers, "do-gooders", or "baby snatchers". Let me make it clear that I think there is a lot of good to the psychology training model and I have the utmost respect for psychologists. I work with many psychiatrists, social workers, and psychologists, and my psychology colleagues have been some of the most well trained and knowledgeable; however, my point has been and remains that psychologists promoting the superiority of psychology is like white supremacists promoting white supremacy. At the end of the day, it is difficult to take someone seriously when they have a biased and vested interest in their argument.

I suppose it is easy to get defensive on this board being in the minority. Honestly, I have been quite impressed with the level of professional input and civility most posters have displayed (besides a couple of posters; I even received a few less than respectful PMs). I suppose that if I wasn't impressed I wouldn't try so hard to defend my profession. If I have implied any disrespect or have devalued the psychology profession in any way, I am sorry as this was not my intent. Being in the minority really does suck on so many levels. I wish there were more social workers here to support the profession.

 

[KayJay85]

(c) again, similar to what I have already stated, many do disregard social work as simply "social justice work or case management"; and (d) most of what I have read has suggested that most posters have a perceived notion of social workers as case managers, "do-gooders", or "baby snatchers".

With all due respect, there is something in your attempts to distance clinical social workers from traditionally trained social workers that makes me wonder what misperceptions or negative views you have toward the field. BTW, I have not encountered anyone here throwing around terms like "do-gooders" or "baby snatchers."

my point has been and remains that psychologists promoting the superiority of psychology is like white supremacists promoting white supremacy.

C'mon. Seriously? WTF?

 

[BSWdavid]

With all due respect, there is something in your attempts to distance clinical social workers from traditionally trained social workers that makes me wonder what misperceptions or negative views you have toward the field. BTW, I have not encountered anyone here throwing around terms like "do-gooders" or "baby snatchers."





C'mon. Seriously? WTF?

Ok, bad example. I didn't mean to compare psychologist to white supremacists, which is how this reads. My point was that it is difficult to remain objective when one is too close to the argument. I suppose I will get a lot of heat for this one. I chose such a strong analogy in order to make my point more clear, not to compare the two as I don't equate psychologists to racists.

 

[BSWdavid]

With all due respect, there is something in your attempts to distance clinical social workers from traditionally trained social workers that makes me wonder what misperceptions or negative views you have toward the field. BTW, I have not encountered anyone here throwing around terms like "do-gooders" or "baby snatchers."

My point is that what some view as "traditional social work" isn't necessarily social work at all. Yes, social justice, case management, and welfare have been strong components of the social work profession, but they don't necessarily define the profession. Clinical social work is a specialty of social work, just as clinical psychology is a specialty of psychology. There are many hats that social workers wear and the same is true for psychologist. I remember my social psych professor telling the story of a neighbor who when she told the neighbor she was a psychologist responded with, "Oh, can you analyze me"? The professor went on to explain to her neighbor that she was not that kind of psychologist. The mental image that is evoked when someone hears the term psychologist isn't necessarily true, which is the same for social workers as well. While there are many psychologists that do perform psychoanalysis, there are also many that are social, developmental, I/O, etc. who have nothing to do with analysis. Similarly, although many social workers do work in case management, social justice, etc., clinical social work has become the largest speciality in our profession; however, consumers and other various professionals don't always understand the distinction.

 

[KayJay85]

Ok, bad example. I didn't mean to compare psychologist to white supremacists, which is how this reads. My point was that it is difficult to remain objective when one is too close to the argument.

Fair enough. I can't speak for others, because I am sure there is an element of snobbiness to some psychologists. For me, though, it has never been an issue of supremacy. I can honestly say that some of the best gains I have made with patients has involved referrals or consultation with traditionally trained, social justice-oriented social workers. When I have someone sitting across from me who is unsure of where he/she is going to sleep, I am totally handicapped in what I am able to do to address their mood. Maslow's theory. There is value in what all of us as professionals bring to the table. It is off putting though to have social workers come into a psychology-oriented practice and react defensively when someone raises concerns about psychology theories and practice in their work. Even going back to the point you (I think?) made about the APA overseeing regulations for therapist and how it would be unfair to non-psychology providers. That really chaps my ass when psychotherapy as we know it today has been largely shaped, defined, and established from psychology. And when psychology leaves the building (which happens with some, just some, clinical social workers) one cannot claim to be providing psychotherapy.

 

[BSWdavid]

Fair enough. I can't speak for others, because I am sure there is an element of snobbiness to some psychologists. For me, though, it has never been an issue of supremacy. I can honestly say that some of the best gains I have made with patients has involved referrals or consultation with traditionally trained, social justice-oriented social workers. When I have someone sitting across from me who is unsure of where he/she is going to sleep, I am totally handicapped in what I am able to do to address their mood. Maslow's theory. There is value in what all of us as professionals bring to the table. It is off putting though to have social workers come into a psychology-oriented practice and react defensively when someone raises concerns about psychology theories and practice in their work. Even going back to the point you (I think?) made about the APA overseeing regulations for therapist and how it would be unfair to non-psychology providers. That really chaps my ass when psychotherapy as we know it today has been largely shaped, defined, and established from psychology. And when psychology leaves the building (which happens with some, just some, clinical social workers) one cannot claim to be providing psychotherapy.

No doubt that psychology cannot leave the building in order for true psychotherapy to pursue, but I don't think you have to be a psychologist in order to incorporate psychology into practice. Just as physicians aren't biologists but do rely heavily on the discoveries gained from that science.

And I agree that resource connection is very important, but not all social workers specialize or are even trained in it. Also, one doesn't really need a masters degree in order to connect clients with resources. So, I guess the part that frustrates me the most is that we, as social workers, tend to get pigeon holed into that arena when we aren't necessarily trained in it. The extent of my abilities as a resource connector is how to dial 2-1-1.

You would probably be surprised how similar some of the content of our coursework is to psychology. For example, I chose to take an elective psychology CBT course through the psychology department, as our program didn't explicitly offer the course. The following semester I was surprised to find that the first mental health interventions course was essentially the same course that I had taken through the psych dept. While certainly there were some differences in the teaching philosophies of the professors, overall, it was the same material I had already learned; evidence based mental health practice. It would be interesting if we could switch roles for a week and psych students could spend a week as social work students and vice versa. I bet we would all learn a lot!

One other thing I will note. I was quite impressed with the balanced approach that the psych class took with teaching clinical skills and research skills. Although I believe my social work courses have done a very good job at teaching clinical skills, they have lacked in promoting an understanding of the science behind interventions. I really prefer the former approach as it tends to promote a deeper understanding of the material (plus, I really like science in general).

 

[AcronymAllergy]

One other thing I will note. I was quite impressed with the balanced approach that the psych class took with teaching clinical skills and research skills. Although I believe my social work courses have done a very good job at teaching clinical skills, they have lacked in promoting an understanding of the science behind interventions. I really prefer the former approach as it tends to promote a deeper understanding of the material (plus, I really like science in general).

My guess is that statement right there would sum up a large chunk of what many of the posters here (in perhaps less-than-neutral terms) have been saying is the key difference between most psychology doctoral programs and most master's-level programs.

It's not at all to say that psychologists, as people, are superior to social workers, LPAs, or anyone else. Rather, it's just that by virtue of the fact that the majority of our classes and practica work are like what you mentioned and experienced, and due to simple logistics (e.g., we hide away in school for a longer period of time), psychology doctoral programs will impart a greater depth of knowledge regarding the science and theory behind mental health assessment, diagnosis, and treatment. This occurs in much the same way that MD/DO training imparts a greater breadth and depth of knowledge in medicine than that received by an RN, NP, or PA; again, in part because of a theoretical difference in training model, but also due to logistics--physicians simply spend more time "in school."

 

[StrangeVision]

You seem to think anyone who advocates for psychology or our training model is either (a) bashing social work, (b) has a fragile ego and needs to puff it up by getting a PhD, (c) disregards all social workers and Masters level clinicians, or (d) has no exposure to social work.

Chiming in a bit late here, but I just had to say that this was EXACTLY what I was thinking, futureapppsy2. Reading this thread started to become pretty exasperating. Many are still sticking to logical arguments, but it was disappointing to start seeing some straw man arguments from you, BSWdavid, especially in regards to polarizing others’ statements and running with them, picking and choosing the views of the most extreme members on here, or just generally interpreting things through a defensive lens. I can give examples if needed, but I think you may already know what I mean.

I was too tired to respond to this last night, so it was really refreshing to see that after I went to sleep the conversation got a bit more civil on here. I wanted to add though, that I totally know where you’re coming from, BSWdavid, since I agree it looks like you’ve gotten some emotional bashing from a few psychology students on here, especially in some of the older threads. But that doesn’t mean all psych students or practicing psychologists share those extreme views or have an ego-protecting motive for their arguments in this thread. Please try to keep that in mind. And I’m not trying to attack you or further any self-serving motive here. My current training is only at the master’s level (in counseling psychology), so I don’t yet have a 6 year investment to protect, and social justice advocacy is also very close to my heart. 😀

 

[StrangeVision]

My guess is that statement right there would sum up a large chunk of what many of the posters here (in perhaps less-than-neutral terms) have been saying is the key difference between most psychology doctoral programs and most master's-level programs.

It's not at all to say that psychologists, as people, are superior to social workers, LPAs, or anyone else. Rather, it's just that by virtue of the fact that the majority of our classes and practica work are like what you mentioned and experienced, and due to simple logistics (e.g., we hide away in school for a longer period of time), psychology doctoral programs will impart a greater depth of knowledge regarding the science and theory behind mental health assessment, diagnosis, and treatment. This occurs in much the same way that MD/DO training imparts a greater breadth and depth of knowledge in medicine than that received by an RN, NP, or PA; again, in part because of a theoretical difference in training model, but also due to logistics--physicians simply spend more time "in school."

👍 I agree with this.

 

[PsyDetective]

Instead of bashing one another, let's find some commonality. I think we can (generally) agree that the doctoral degree in clinical/counseling psychology provides additional training beyond the MA/MS level in fundamental areas of practice (e.g. psychotherapy, assessment, etc.), and also provides a unique and critical expertise in research, supervision, and teaching. These areas of training and expertise are the bedrock of clinical/counseling psychology. How we doin' so far?

As individuals trained in psychology, do we not all believe in the core tenants of our profession? We believe that a fundamental understanding of human behavior (broadly) is paramount to addressing issues whose core represent distress or dysfunction in some area(s) of functioning (behavior, again broadly).

The mental health system is a mess. We sadly have no debate there. And where does the garbage of an increasingly cluttered, poorly organized, poorly regulated, profit-driven mental health system go? It falls on the people. It falls on the people WE are supposed to be dedicated to helping. We can lament and b*** about whose training is this or that, or we can mobilize to serve the people, the consensus from which all others derive. Who would disagree?

Some here may be future leaders (AMA, NASW, ACA, APA). What will YOU do? How do we bring uniformity to mental health? How do we also allow people to help others from their own unique backgrounds and orientations? Is it really psychology versus everyone else? Is this necessary? We desperately need to focus our energies on organizing a more efficient, effective mental health system. We need to be advocates of our clients, not adversaries of our counterparts.

So I ask you, if we agree on our purpose, can we not now say what we would like to do or petition our leaders to do to bring us together for the sake of the people we ALL serve? Let's have that discussion.

 

[futureapppsy2]

With all due respect, BSWDavid, your posts continually read to me like you want to become a psychologist but, for whatever reason, don't want to get a doctoral degree in psychology. You speak, for example, of wanting to get a PhD, presumably in Social Work, to shore up your (clinical?) training, but a PhD in social work isn't designed or intended as a clinical degree, though they can provide EXCELLENT research training given the right program, student, and fit (I actually briefly considered going the social work PhD route simply because the social work PhD students and faculty with whom I worked are all such strong researchers-I mean that sincerely). A PhD in social work won't provide you with the clinical skills that a PhD in psychology would, nor the scope of practice (you'd still be licensed at the LCSW level). The additional research training *could* indirectly benefit your clinical skills, but that's not--or shouldn't be--the stated purpose of the degree. Also, you seem rather intent to assert that your clinical training is just like that received by psychologists. Are there a great many similarities in regards to therapeutic, intake, and other techniques? Yes, I hope so. Is a PhD just a masters with more stats classes and a few testing classes thrown in? IMO, no, as others have discussed. Again, there are plenty of excellent masters-level clinicians out there, so this isn't meant to put down masters-level clinicians. The thing is, you don't seem like you really *want* to be a masters-level clinician or really recognize the difference between a purely research PhD and a research/clinical PhD (even the most die-hard clinical science clinical psychology programs out there have a substantial clinical training component).

Also, as an aside not intended for BSWDavid, it sort of bothers me from an ethical POV to see clinicians who are licensed at the masters level but have a non-clinical PhD advertise heavily under the auspices of PhD and Dr. but obsecure their level of license or field of doctoral study. In no way saying you will do this, but I have seen it done. They certainly have the right to call themselves Dr. and put PhD after their name but should also be clear wrt to the scope of their license and training, as not to mislead or confuse clients.

 

[O Gurl]

Some here may be future leaders (AMA, NASW, ACA, APA). What will YOU do? How do we bring uniformity to mental health? How do we also allow people to help others from their own unique backgrounds and orientations? Is it really psychology versus everyone else? Is this necessary? We desperately need to focus our energies on organizing a more efficient, effective mental health system. We need to be advocates of our clients, not adversaries of our counterparts.

I think we were getting to this point in the conversation somewhere in the 1st page of this thread. Calling for some increased regulation or streamlinining in mental health quickly spiraled into a career pissing match. I'm guilty of that, too. I do not think anyone here is positioning psychology versus others. All throughout I have read comments acknowledging that social work and psychiatry are critical and they have said the same about psychology. I have noticed a few key misinterpretations:
1) only doctoral level professionals should provide therapy- to the best of my knowledge, no one said this. Ever. Rather that we are concerned about the varied forms of training that occurs across master's degrees. We can't assume that an LSCW = MFT = LPC = LPA or so on. In particular, for this thread, I am concerned that LPAs receive their practice in the field with very loose requirements. So after only 2 years of course study, an LPA in my state can work in a private practice under one supervising psychologist, do whatever tasks are assigned (e.g. run psychoeducational groups), have no requirements to stay abreast of or contribute to the literature, and have no didactics or continuing education. Then this person can leave this specific setting and set up shop claiming to be able to do all the things a psychologist or LCSW can do for whoever comes their way,
2) social workers cannot be competent therapists- no one has said this. Rather, that we'd like to see some safeguards for the actual quality, breadth, and depth of psychotherapy training received. It may not be fair, but observations of the those few bad apples that provide pseudotherapy (supportive check-ins) or show gross incompetence (see Dr.Gero's thread about a social worker claiming to be able to provide behavioral management for a patient with vascular dementia) should be concerning to everyone, including competent clinical social workers. So why not have some accreditation of programs from a psychology perspective? Other than pride, what is the reason for resisting this? Why not have specialized licenses?
3) psychologists are exempt from these concnerns- hardly. I have said and will say again, that board certification for psychologists is a step in the right direction. At my current internship, a large number of staff psychologists hold one or more certification. One of my key supervisors is a certified clinical neuropsychologist (ABBP-CN) and is on my ass (already) to factor in certification standards for whichever post doc path I pursue (health psych or rehab psych). The same is impressed upon the trauma-focused interns here.

So I say raise the standards for everyone in clinical practice (boards and specialized licenses). The only people who will balk at having to prove they know what they are doing are those who do not know what they are doing.

 

[nitemagi]

1) only doctoral level professionals should provide therapy- to the best of my knowledge, no one said this. Ever.

Unfortunately O Gurl if you go back to page 1 you say:

Psychiatrists need to accept the fact that they are not qualified to provide therapy or conduct research without pursuing at least a 2-year fellowship in that area.
...
Social workers should stick to just that--social work (e.g. helping link people with community resources). Which is EXTREMELY valuable. If they want to be therapists they should pursue the route described above.
...
That is the ideal clinical world according to O Gurl 😀

 

[PsyDetective]

...I am concerned that LPAs receive their practice in the field with very loose requirements. So after only 2 years of course study, an LPA in my state can work in a private practice under one supervising psychologist, do whatever tasks are assigned (e.g. run psychoeducational groups), have no requirements to stay abreast of or contribute to the literature, and have no didactics or continuing education. Then this person can leave this specific setting and set up shop claiming to be able to do all the things a psychologist or LCSW can do for whoever comes their way...

I did not realize this was the case in Texas. That is very different from my state. To be able to perform anything under the "Practice of Psychology," one must document graduate training and practicum/internship experience in those activities, which falls under "Health Services Provider." Furthermore, the program must be openly identified as a clinical/counseling psychology program with the express purpose of preparing graduates to perform those duties. We also are required to maintain the same number of CE credits as doctoral-level psychologists. In fact, there is a provision in our law that states that LPA's cannot be "trained" in "new" techniques/therapies/measures, etc. by their supervising psychologist.

I love the idea of boarding. I would love to see a similar system at the master's level. I think having a national organization with regulatory authority in place to issue credentials based upon a basic minimum background appropriate for conducting psychotherapy, assessment, etc. would be a great start for clinicians and clients alike.

I think no matter what, a minimum background in psychology is necessary, if for no other reason than to be able to adequately assess if the client's presenting problem(s) is outside the scope (credential?) of one's training and experience, availability of supervision, etc. (based on science, not blind confidence). Then, one could come from any orientation they wish, and the public could be more or less assured of some level of uniformity and oversight of competence. In the end, I think psychology is just the foundation, and each different profession brings it's own unique "furniture" to fill the office that will appeal to the preferences of different clients.

Now, who will undertake the arduous task of establishing a sound (empirically supported) argument for these recommendations? Wait, I know. Who has the unique training and expertise in such matters? (and should be paid far more than they current are for it)

 

[O Gurl]

1) only doctoral level professionals should provide therapy- to the best of my knowledge, no one said this. Ever.

In response to the question of how I would fix MH care I said:

Let me start by saying that I believe mental health care should be delivered through interdisciplary teams and that things have gotten so far out of hand that everyone involved in MH care will have to re-brand.

Psychiatrists need to accept the fact that they are not qualified to provide therapy or conduct research without pursuing at least a 2-year fellowship in that area.

Psychologists need to dwindle in numbers and define our identity. I believe our defining criteria is our scientist-practitioner approach. Thus programs that diminish this aspect of our training should be de-accredited if admissions and training standards are not raised, enrollment caps are not adopted, and scientific training is not incorporated. Then I could see psychologists functioning primarily as PIs, administrators, psychotherapy supervisors (for trainees and master's level clinicians) and in specialty assessment roles (e.g. neuropsych, bariatric/surgery, developmental disorders, learning disabilities, and forensic evaluations). Along these lines, I think that psychologists who wish to perform primarily clinical duties should be required to seek board certification in their area of interest.

Persons interested in providing therapy without all the hassle of research, administrative, or specialty duties should pursue a streamlined master's level therapy degree. This is where I see a lot of people who would have gone the professional school/PsyD route landing. I believe that there should be options toward independent licensure including PRE-degree practicum experiences followed by post-degree supervised experiences in specialty areas so that there can be a similar board-comparable designation to the license (e.g. licensed marriage and family therapist, licensed child and adolescent therapist, licensed addictions therapist, licensed cognitive behavioral therapist, licensed psychodynamic therapist).

Social workers should stick to just that--social work (e.g. helping link people with community resources). Which is EXTREMELY valuable. If they want to be therapists they should pursue the route described above.

And then for people who majored in psychology in undergrad and don't even want to bother with all of this specialty licensing rigamorol, there should be non-license-eligible assistant positions (research assistant, psychometrist, psychological assistant, etc.)

That is the ideal clinical world according to O Gurl 😀

Now, nitemagi, did you miss that entire middle section where I described a master's level therapist route?

If you want to have a discussion, let's have one. But continuing with what Strange Vision so adequately described as "straw man arguments" is not helping.

 

[O Gurl]

I did not realize this was the case in Texas. That is very different from my state. To be able to perform anything under the "Practice of Psychology," one must document graduate training and practicum/internship experience in those activities, which falls under "Health Services Provider." Furthermore, the program must be openly identified as a clinical/counseling psychology program with the express purpose of preparing graduates to perform those duties. We also are required to maintain the same number of CE credits as doctoral-level psychologists. In fact, there is a provision in our law that states that LPA's cannot be "trained" in "new" techniques/therapies/measures, etc. by their supervising psychologist.

Hence the original bee in my bonnet. How in the heck does a consumer navigate through all of this when the person treating them could be trained in the manner described above or could have had training from one supervisor in one setting?

 

[BSWdavid]

Chiming in a bit late here, but I just had to say that this was EXACTLY what I was thinking, futureapppsy2. Reading this thread started to become pretty exasperating. Many are still sticking to logical arguments, but it was disappointing to start seeing some straw man arguments from you, BSWdavid, especially in regards to polarizing others’ statements and running with them, picking and choosing the views of the most extreme members on here, or just generally interpreting things through a defensive lens. I can give examples if needed, but I think you may already know what I mean.

I was too tired to respond to this last night, so it was really refreshing to see that after I went to sleep the conversation got a bit more civil on here. I wanted to add though, that I totally know where you’re coming from, BSWdavid, since I agree it looks like you’ve gotten some emotional bashing from a few psychology students on here, especially in some of the older threads. But that doesn’t mean all psych students or practicing psychologists share those extreme views or have an ego-protecting motive for their arguments in this thread. Please try to keep that in mind. And I’m not trying to attack you or further any self-serving motive here. My current training is only at the master’s level (in counseling psychology), so I don’t yet have a 6 year investment to protect, and social justice advocacy is also very close to my heart. 😀

If it appears that I have deflected the argument with an "unequivalent position" that wasn't my intent.

The

 

[BSWdavid]

With all due respect, BSWDavid, your posts continually read to me like you want to become a psychologist but, for whatever reason, don't want to get a doctoral degree in psychology. You speak, for example, of wanting to get a PhD, presumably in Social Work, to shore up your (clinical?) training, but a PhD in social work isn't designed or intended as a clinical degree, though they can provide EXCELLENT research training given the right program, student, and fit (I actually briefly considered going the social work PhD route simply because the social work PhD students and faculty with whom I worked are all such strong researchers-I mean that sincerely). A PhD in social work won't provide you with the clinical skills that a PhD in psychology would, nor the scope of practice (you'd still be licensed at the LCSW level). The additional research training *could* indirectly benefit your clinical skills, but that's not--or shouldn't be--the stated purpose of the degree. Also, you seem rather intent to assert that your clinical training is just like that received by psychologists. Are there a great many similarities in regards to therapeutic, intake, and other techniques? Yes, I hope so. Is a PhD just a masters with more stats classes and a few testing classes thrown in? IMO, no, as others have discussed. Again, there are plenty of excellent masters-level clinicians out there, so this isn't meant to put down masters-level clinicians. The thing is, you don't seem like you really *want* to be a masters-level clinician or really recognize the difference between a purely research PhD and a research/clinical PhD (even the most die-hard clinical science clinical psychology programs out there have a substantial clinical training component).

Also, as an aside not intended for BSWDavid, it sort of bothers me from an ethical POV to see clinicians who are licensed at the masters level but have a non-clinical PhD advertise heavily under the auspices of PhD and Dr. but obsecure their level of license or field of doctoral study. In no way saying you will do this, but I have seen it done. They certainly have the right to call themselves Dr. and put PhD after their name but should also be clear wrt to the scope of their license and training, as not to mislead or confuse clients.

I don't wish to become a psychologist. The program I am attending is a clinical social work PhD program that is designed to increase clinical skills in psychodynamic therapy. While it does have a strong research component, it is primarily a practice degree. Yes, my license won't change as social work doesn't provide a higher level license for doctoral practitioners, but there is talk about creating a special license for doctorally trained clinical social workers.

 

[nitemagi]

Now, nitemagi, did you miss that entire middle section where I described a master's level therapist route?

If you want to have a discussion, let's have one.

O Gurl, I did not miss the middle section.

Your statement which I had quoted appeared to disavow any appearance of impropriety in placing psychologists above others in therapy, and in telling other mental health providers they shouldn't provide therapy since they don't do an equivalent # of therapy hours to a Ph.D. psychologist. Therefore I was pointing out statements you had made which I believe did stir the pot, in that others could take your original statements as inflammatory. Even in the full post your proposal was the only viable alternative to Ph.D. was a masters specializing in therapy. If you can't see how your statements are inflammatory, I'm sorry to hear that.

Your original points may have been "Straw Man Proposals," though.

 

[BSWdavid]

Chiming in a bit late here, but I just had to say that this was EXACTLY what I was thinking, futureapppsy2. Reading this thread started to become pretty exasperating. Many are still sticking to logical arguments, but it was disappointing to start seeing some straw man arguments from you, BSWdavid, especially in regards to polarizing others’ statements and running with them, picking and choosing the views of the most extreme members on here, or just generally interpreting things through a defensive lens. I can give examples if needed, but I think you may already know what I mean.

I was too tired to respond to this last night, so it was really refreshing to see that after I went to sleep the conversation got a bit more civil on here. I wanted to add though, that I totally know where you’re coming from, BSWdavid, since I agree it looks like you’ve gotten some emotional bashing from a few psychology students on here, especially in some of the older threads. But that doesn’t mean all psych students or practicing psychologists share those extreme views or have an ego-protecting motive for their arguments in this thread. Please try to keep that in mind. And I’m not trying to attack you or further any self-serving motive here. My current training is only at the master’s level (in counseling psychology), so I don’t yet have a 6 year investment to protect, and social justice advocacy is also very close to my heart. 😀

It is easy for a group of psychologists and psychology students to defend an argument in a logical and non-defensive manner, but it gets a bit more complicated when you are virtually the only one defending your position.

 

[BSWdavid]

O Gurl, I did not miss the middle section.

Your statement which I had quoted appeared to disavow any appearance of impropriety in placing psychologists above others in therapy, and in telling other mental health providers they shouldn't provide therapy since they don't do an equivalent # of therapy hours to a Ph.D. psychologist. Therefore I was pointing out statements you had made which I believe did stir the pot, in that others could take your original statements as inflammatory. Even in the full post your proposal was the only viable alternative to Ph.D. was a masters specializing in therapy. If you can't see how your statements are inflammatory, I'm sorry to hear that.

Your original points may have been "Straw Man Proposals," though.

Yet I am the one creating straw man arguments?

 

[KayJay85]

It is funny that every time this thread seems to be moving toward a productive discussion about what could be done to fix matters, someone derails it back to a superiority argument- most recently, Nitemagi. Sorry, but you are clearly cherry-picking peoples comments, extrapolating things that no one is saying, and taking things out of context.

O Gurl, I did not miss the middle section.

Your statement which I had quoted appeared to disavow any appearance of impropriety in placing psychologists above others in therapy, and in telling other mental health providers they shouldn't provide therapy since they don't do an equivalent # of therapy hours to a Ph.D. psychologist. Therefore I was pointing out statements you had made which I believe did stir the pot, in that others could take your original statements as inflammatory. Even in the full post your proposal was the only viable alternative to Ph.D. was a masters specializing in therapy. If you can't see how your statements are inflammatory, I'm sorry to hear that.

Your original points may have been "Straw Man Proposals," though.

I re-read O Gurl's comment and no where does she "tell other mental health providers they shouldn't provide therapy since they don't do an equivalent # of therapy hours to a Ph.D. psychologist." You are just making things up at this point. What is "inflammatory" about calling for clearer training standards for people who want to provide psychotherapy? Perhaps the following is more appropriate than you are willing to admit:

The only people who will balk at having to prove they know what they are doing are those who do not know what they are doing.

 

[nitemagi]

Yet I am the one creating straw man arguments?

I think it was the white supremacist comment that jumped the shark on that one. 😀

 

[nitemagi]

I wouldn't say that other professions shouldn't provide therapy. But is it really unreasonable to say that the scope of practice should be limited for professions that don't have as much therapy training (or that professions that don't have this training naturally in their degree program should seek extra training to demonstrate competency)?

Depends. There's a presumption that a Ph.D. psychologist is the gold standard for all therapies, whereas there isn't clear regulation/standardization as to how much training and in what form Ph.D.'s get for any specific therapy. Furthermore there isn't research to clearly show how much training really equates to a level of competency in a particular therapy, especially in terms of mapping out to actual outcomes.

So at this phase I do think it is unreasonable to limit non-Ph.D.'s from being able to practice therapy. Introduce standardization of number of hours of training in a particular therapy, and show that those hours correlate with an agreed upon level of "competency" in a therapy that has been shown to lead to expected outcomes, and I'll be very in favor of it. But that's not here. Yet.

 

[Therapist4Chnge]

Depends. There's a presumption that a Ph.D. psychologist is the gold standard for all therapies, whereas there isn't clear regulation/standardization as to how much training and in what form Ph.D.'s get for any specific therapy. Furthermore there isn't research to clearly show how much training really equates to a level of competency in a particular therapy, especially in terms of mapping out to actual outcomes.

So at this phase I do think it is unreasonable to limit non-Ph.D.'s from being able to practice therapy. Introduce standardization of number of hours of training in a particular therapy, and show that those hours correlate with an agreed upon level of "competency" in a therapy that has been shown to lead to expected outcomes, and I'll be very in favor of it. But that's not here. Yet.

So you would be fine with....

Depends. There's a presumption that MD/DO is the gold standard for med management, whereas there isn't clear regulation/standardization as to how much training and in what form MD/DOs get for any specific medication management. Furthermore there isn't research to clearly show how much training really equates to a level of competency for medication management, especially in terms of mapping out to actual outcomes.

So at this phase I do think it is unreasonable to limit non-MD/DOs from being able to practice medication management. Introduce standardization of number of hours of training for medication management, and show that those hours correlate with an agreed upon level of "competency" in medication management that has been shown to lead to expected outcomes, and I'll be very in favor of it.

?

 

[BSWdavid]

I think it was the white supremacist comment that jumped the shark on that one. 😀

Yes, that was an ouch on my part. But hey, it was really late and I wanted to make a point.

 

[KayJay85]

Nitemagi and BSWDavid, if you will pardon my asking, what is your area and stage of training?

Edit: Also PsyDetective

I feel like this could help all of us understand each other a little better.

 

[nitemagi]

So you would be fine with....
?

Touche'.

The difference is one involves the narrowing of scope of practice for those that already have it, whereas the other is an expansion of scope of practice outside of what they already have.

There already is a minimum standard for med management, called a state medical board. But I actually agree, there is no standard for good med management. I have plenty of gripes about many of my own colleagues in medicine 🙂

 

[nitemagi]

Nitemagi and BSWDavid, if you will pardon my asking, what is your area and stage of training?

Edit: Also PsyDetective

I feel like this could help all of us understand each other a little better.

I am a chief resident in psychiatry. That means I'm finishing my 4th year of residency.

MD's do 4 years of medical school, after 1-3 years of pre-med classes, followed by 4 years of specialization training in residency.

 

[KayJay85]

Touche'.

The difference is one involves the narrowing of scope of practice for those that already have it, whereas the other is an expansion of scope of practice outside of what they already have.

There already is a minimum standard for med management, called a state medical board. But I actually agree, there is no standard for good med management. I have plenty of gripes about many of my own colleagues in medicine 🙂

So given your appreciation of medical boards, why would you not be in favor of board certification for psychotherapy specialties? It doesn't have to involve narrowing the scope of practice for any professional who is actually competent at what they are doing. The only people who may find their license restricted would be those who could not demonstrate competency in the areas in which they are practicing.

 

[BSWdavid]

Nitemagi and BSWDavid, if you will pardon my asking, what is your area and stage of training?

Edit: Also PsyDetective

I feel like this could help all of us understand each other a little better.

I am finishing my masters of social work degree this semester and will be entering a PhD clinical social work program in psychodynamic psychotherapy in the fall. I also has a BS in psychology and BSW. Additionally, I am a clinical intern at a medical school dept of psychiatry clinic. I was also trained in CBT at the Beck Institute.

 

[nitemagi]

So given your appreciation of medical boards, why would you not be in favor of board certification for psychotherapy specialties? It doesn't have to involve narrowing the scope of practice for any professional who is actually competent at what they are doing. The only people who may find their license restricted would be those who could not demonstrate competency in the areas in which they are practicing.

I'm not opposed to it.

The problem is that you're talking about an additional regulatory body outside of the state level. Which is fine. But I would be suspect of who actually organizes such a board. Each camp wants to protect themselves, sadly too often at the exclusion of others. Furthermore a national board might be able to certify competency, but won't have authority to limit practice of those without it, which I think is what you would really like. The authority to practice still comes down to state regulation.

 

[cara susanna]

BSWdavid, I find it funny that you're questioning our objectivity when your personal interests in this topic are just as vested as ours.

 

[Therapist4Chnge]

Touche'.

The difference is one involves the narrowing of scope of practice for those that already have it, whereas the other is an expansion of scope of practice outside of what they already have.

There already is a minimum standard for med management, called a state medical board. But I actually agree, there is no standard for good med management. I have plenty of gripes about many of my own colleagues in medicine 🙂

It lined up too well to not at last inquire. I actually don't support RxP in its current form, as I believe it falls short in some of the "minimum standards" you referenced above. For the record, I'm a neuropsychology fellow at a top academic medical center.

 

[KayJay85]

I'm not opposed to it.

The problem is that you're talking about an additional regulatory body outside of the state level. Which is fine. But I would be suspect of who actually organizes such a board. Each camp wants to protect themselves, sadly too often at the exclusion of others. Furthermore a national board might be able to certify competency, but won't have authority to limit practice of those without it, which I think is what you would really like. The authority to practice still comes down to state regulation.

Are you not suspicious of those who sit on medical boards? I would imagine people who have established expertise in an area would sit on the boards. And I agree that it would not restrict anyone's practice who couldn't pass the board or refused to sit for it (which I would like). At least not under the current system. Over time, though, it would weed out those who have passed and demonstrated competency from those who couldn't or wouldn't. This would give employers, insurers, and consumers a lot of information.

 

[nitemagi]

Are you not suspicious of those who sit on medical boards? I would imagine people who have established expertise in an area would sit on the boards. And I agree that it would not restrict anyone's practice who couldn't pass the board or refused to sit for it (which I would like). At least not under the current system. Over time, though, it would weed out those who have passed and demonstrated competency from those who couldn't or wouldn't. This would give employers, insurers, and consumers a lot of information.

Well there's two tiers of regulation. There's state medical boards, which licenses you to perform "medicine and surgery." So legally I could go do a surgery, though no one in their right mind would let me run an OR.

Then there's the Specialty Board Certification in Psychiatry by the ABPN. They don't control my ability to practice psychiatry, but I might get paid a little better at certain jobs if I am board certified.

I'm not "suspicious" of those at the ABPN, but I do recognize that there are political and financial interests at work in all of healthcare and science. Anyone who's ever tried to publish a negative trial should be able to recognize that.

Your idea would be fine, or even good, if it actually mapped out to better clinical outcomes for patients. Otherwise it's just another piece of paper on the wall to make us feel like we know what we're doing.

 

[BSWdavid]

BSWdavid, I find it funny that you're questioning our objectivity when your personal interests in this topic are just as vested as ours.

True, but I'm not claiming superiority either.

 

[BSWdavid]

Are you certified by the ACT or did you attend a workshop? There is a difference - just clarifying.

Workshop

 

[nitemagi]

It lined up too well to not at last inquire. I actually don't support RxP in its current form, as I believe it falls short in some of the "minimum standards" you referenced above. For the record, I'm a neuropsychology fellow at a top academic medical center.

There's a lot of crap being practiced out there in psychopharm. An artifact IMO of multiple factors -
1) Biased science (pharma sponsored)
2) Unnaturalistic science (patients and methods that just don't fit our usual population)
3) That many meds don't work as well as we wish they did
4) Miseducating patients about the "chemical imbalance" model - which removes responsibility/culpability, and pushes meds as the only viable intervention in the patients' mind

This all leads to excessive polypharmacy as the only intervention, much of which is off-label, and often delves into 5th line meds because 1-4 have failed.

I think overall the psychology prescribing movement is misguided. Some (physicians) think of it as a power grab, or a manifestation of the flooding of psychologists into the field and needing new practice opportunities.

I just don't see recruiting MORE prescribers as solving the mental health problem. We need better science, better studies, better and more therapy, and a philosophical turn away from the narcissistic entitlement of the individual in our society.
[end rant]

 

[O Gurl]

There's a lot of crap being practiced out there in psychopharm. An artifact IMO of multiple factors -
1) Biased science (pharma sponsored)
2) Unnaturalistic science (patients and methods that just don't fit our usual population)
3) That many meds don't work as well as we wish they did
4) Miseducating patients about the "chemical imbalance" model - which removes responsibility/culpability, and pushes meds as the only viable intervention in the patients' mind

This all leads to excessive polypharmacy as the only intervention, much of which is off-label, and often delves into 5th line meds because 1-4 have failed.

I think overall the psychology prescribing movement is misguided. Some (physicians) think of it as a power grab, or a manifestation of the flooding of psychologists into the field and needing new practice opportunities.

I just don't see recruiting MORE prescribers as solving the mental health problem. We need better science, better studies, better and more therapy, and a philosophical turn away from the narcissistic entitlement of the individual in our society.
[end rant]

😱

It has to be magic. The moment you start to speak your own language, you make the exact same arguments that we are making. And I agree with everything you said. Likewise, we do not need to keep expanding the number of people delivering whatever the hell they are calling therapy without even the basic clearances that it takes for people on your side to be deemed competent enough dole out psychotropic meds--which is a board comparable review.

 

[Therapist4Chnge]

We need better science, better studies, better and more therapy, and a philosophical turn away from the narcissistic entitlement of the individual in our society.

Well said.

The focus should be on better science, which can then be implemented to provide better treatment, but each guild is caught fighting over scope. My issue in regard to LPAs is the clear push to expand score without ANY attempt to pursue additional training or provide data in support of their position. Science gets lost and/or bastardized by the politics, and we all lose.

 

[KayJay85]

There's a lot of crap being practiced out there in psychopharm. An artifact IMO of multiple factors -
1) Biased science (pharma sponsored)
2) Unnaturalistic science (patients and methods that just don't fit our usual population)
3) That many meds don't work as well as we wish they did
4) Miseducating patients about the "chemical imbalance" model - which removes responsibility/culpability, and pushes meds as the only viable intervention in the patients' mind

This all leads to excessive polypharmacy as the only intervention, much of which is off-label, and often delves into 5th line meds because 1-4 have failed.

I think overall the psychology prescribing movement is misguided. Some (physicians) think of it as a power grab, or a manifestation of the flooding of psychologists into the field and needing new practice opportunities.

I just don't see recruiting MORE prescribers as solving the mental health problem. We need better science, better studies, better and more therapy, and a philosophical turn away from the narcissistic entitlement of the individual in our society.
[end rant]

VS

Your idea would be fine, or even good, if it actually mapped out to better clinical outcomes for patients. Otherwise it's just another piece of paper on the wall to make us feel like we know what we're doing.

You make a lot more sense to me when you rant.

But yet you are not asking for studies demonstrating that psychiatrists are capable of producing better clinical outcomes. You simply accept the standards in place that are supposed to guarantee this (psych residency, medical boarding, followed by specialty certification by ABPN). When it comes to psychotherapy, though, you won't even support putting similar standards in place without evidence that people are being harmed first. I simply do not get it. 😕

 

[KayJay85]

With all due respect, BSWDavid, your posts continually read to me like you want to become a psychologist but, for whatever reason, don't want to get a doctoral degree in psychology. You speak, for example, of wanting to get a PhD, presumably in Social Work, to shore up your (clinical?) training, but a PhD in social work isn't designed or intended as a clinical degree, though they can provide EXCELLENT research training given the right program, student, and fit (I actually briefly considered going the social work PhD route simply because the social work PhD students and faculty with whom I worked are all such strong researchers-I mean that sincerely). A PhD in social work won't provide you with the clinical skills that a PhD in psychology would, nor the scope of practice (you'd still be licensed at the LCSW level). The additional research training *could* indirectly benefit your clinical skills, but that's not--or shouldn't be--the stated purpose of the degree. Also, you seem rather intent to assert that your clinical training is just like that received by psychologists. Are there a great many similarities in regards to therapeutic, intake, and other techniques? Yes, I hope so. Is a PhD just a masters with more stats classes and a few testing classes thrown in? IMO, no, as others have discussed. Again, there are plenty of excellent masters-level clinicians out there, so this isn't meant to put down masters-level clinicians. The thing is, you don't seem like you really *want* to be a masters-level clinician or really recognize the difference between a purely research PhD and a research/clinical PhD (even the most die-hard clinical science clinical psychology programs out there have a substantial clinical training component).

I am finishing my masters of social work degree this semester and will be entering a PhD clinical social work program in psychodynamic psychotherapy in the fall. I also has a BS in psychology and BSW. Additionally, I am a clinical intern at a medical school dept of psychiatry clinic. I was also trained in CBT at the Beck Institute.

With all due respect from me as well, it really does sound like your ideal career path is more in line with a psychologist. I just learned of a clinical social work PhD today when I saw your thread on the Institute of Clinical Social Work (http://www.icsw.edu/) in the other forum. Which, without bringing that discussion here, just reeks of the diploma mill type programs that rely upon those who want to circumvent the traditional route to a doctorate in psychology (online training, no GRE required,etc.).

 

[BSWdavid]

With all due respect from me as well, it really does sound like your ideal career path is more in line with a psychologist. I just learned of a clinical social work PhD today when I saw your thread on the Institute of Clinical Social Work (http://www.icsw.edu/) in the other forum. Which, without bringing that discussion here, just reeks of the diploma mill type programs that rely upon those who want to circumvent the traditional route to a doctorate in psychology (online training, no GRE required,etc.).

Certainly not a diploma mill. Many of the faculty are well respected in the psychoanalytic field. Also, several of their faculty members were on a PDM task force. I inquired extensively into the program before applying and even Nancy McWilliams spoke highly of the program. Additionally, I am familiar with the PsyD program director at the University of Indianapolis who also recommended the program. This has NOTHING to do with circumventing the route to a clinical psych program as it doesn't lead to psych licensure. The individual remains licensed as an LCSW; the point of the program is to increase psychodynamic therapy skills - what's wrong with that? Many of you have already stated you don't believe a masters degree is enough training, so why would you disapprove of an individual attending a PhD program just because it is different than your own? You continue to criticize social work training and masters programs in general, and then proceed to continue to criticize an attempt to increase clinical competence. I don't get it! It really does appear that in general, many posters believe that the psychology training model is the golden standard, and that anything different is unacceptable. As of this may, my education will be considered sufficient, by the State of Indiana, to apply for the LCSW once I have completed 2 years of supervised practice. So if I want to receive additional training in psychodynamic therapy, what's the big deal? I am not asking to become licensed as a clinical psychologist. Wouldn't any additional training only enhance my clinical skill set? BTW - the ICSW program is modeled after the psychoanalytic training institutes, with an added research component.

 

[KayJay85]

Very well. Perhaps I spoke out of turn. I just saw several concerning issues from the outset such as the distance learning approach and vague/low admissions standards. However, if you feel that this program will benefit your training and career beyond simply providing the grounds for a "Dr." before your name, then best of wishes with it

 

[BSWdavid]

Very well. Perhaps I spoke out of turn. I just saw several concerning issues from the outset such as the distance learning approach and vague/low admissions standards. However, if you feel that this program will benefit your training and career beyond simply providing the grounds for a Dr. before your name, then best of wishes with it

I'm really not sure why someone would spend 4+ years in a program just to place Dr. before their name. Heck, if that is the only reason, there are much easier and quicker ways of doing so. I understand that California Southern University offers a PsyD program that is completely online, takes only 2 years, and costs less than $20k. Probably would be a quicker way to earn the Dr title.

 

[nitemagi]

VS
You make a lot more sense to me when you rant.

But yet you are not asking for studies demonstrating that psychiatrists are capable of producing better clinical outcomes. You simply accept the standards in place that are supposed to guarantee this (psych residency, medical boarding, followed by specialty certification by ABPN). When it comes to psychotherapy, though, you won't even support putting similar standards in place without evidence that people are being harmed first. I simply do not get it. 😕

That's a fair point. I guess it's somewhat of a semantic issue. Opening up scope of practice I don't like (RxP, LPA's), but what I have taken issue with in this thread, which was brought up early, was the idea of restricting scope of practice away from those that already have it. The path of discussion in this thread involved a reaction to the expansion of LPA's in texas, and then proposing at a point that psychologists are the only one who have enough training to be therapists (that was unfortunately what I took from it). So I became reactionary, but also turned to the literature. While I agree that psychologists usually have the most training in therapy at baseline, if we're going to restrict practice we'd better damn well have evidence that the way we're restricting it has benefit for patient outcome, as opposed to being part of a turf war.

 

[BSWdavid]

That's a fair point. I guess it's somewhat of a semantic issue. Opening up scope of practice I don't like (RxP, LPA's), but what I have taken issue with in this thread, which was brought up early, was the idea of restricting scope of practice away from those that already have it. The path of discussion in this thread involved a reaction to the expansion of LPA's in texas, and then proposing at a point that psychologists are the only one who have enough training to be therapists (that was unfortunately what I took from it). So I became reactionary, but also turned to the literature. While I agree that psychologists usually have the most training in therapy at baseline, if we're going to restrict practice we'd better damn well have evidence that the way we're restricting it has benefit for patient outcome, as opposed to being part of a turf war.

Agreed!