Is it possible/common to get sufficient training in EBT without a PhD?

[Wherther]

I’m thinking about a career change and am trying to decide between pursuing a PhD in clinical psychology or an MSW. I‘m primarily interested in doing therapy (and learning about research), rather than assessments or conducting research, which makes me think the MSW might be the better option. However, I’m fascinated by and respect psychological science, and I’m afraid that I won’t get a good grounding in research based practices such as EBT, how to diagnose, and when to use which EBTs for which clients in an MSW program. I’ve heard that you would need a lot of good training and supervision after graduating and I’m wondering what type of supervision and/or training you would need and whether that would be difficult for most MSW grads to get? If I knew I could just do a X fellowship or Y practicum after the MSW to get trained, I would definitely go that route. But I would be very unsatisfied if I ended up just doing whatever talk therapy I happened to pick up without any real grounding in the scientific evidence.

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[cara susanna]

It is possible to be a good EBT provider without a PhD, but IMO you'll always be at a disadvantage because you won't be as skilled at interpreting the research studies behind them.

 

[WisNeuro]

Possible? Yes. Common? No.

 

[PsyDr]

I would highly encourage anyone to look at the msw curriculum, and separate the social work theory coursework from the clinical coursework. It might surprise you.

 

[Wherther]

Thank you all so much for the feedback!! What would you recommend for someone like me then, who wants to be a good clinician but doesn't want a career in research or assessment? It feels like there should be some middle option (that doesn't put you in massive debt like the PsyD).

@PsyDr When I've done that, the clinical curriculum has seemed very, very sparse. Is that what you're referring to? That's a lot of where my hesitation is coming from. Do you think most MSW grads would have access to additional/sufficient training after graduating if they wanted it?

@WisNeuro Do you know why that is? Are MSW grads not interested in seeking out such training or is it difficult for them to acquire?

 

[PsyDr]

@Wherther It seems to me that most MSW programs have one year of overall social work theory, followed by one year of coursework related to mental health specific material (e.g., DSM5, psychotherapy, etc) that co-occurs with practica.

I don't see how one year can cover such factors as the entire DSM5, how to conduct a diagnostic interview, become familiar with the predominant psychotherapies modalities, learn how to provide psychotherapy for a range of mental illnesses, learn how to provide group psychotherapy, learn biological presentations that need immediate referral to medicine, etc.

As to whether people will seek more education when they don't have to... I don't know. I've never seen an MSW do that, but that's not exactly a great sample.

 

[Sanman]

So, here is what I will say on the subject. How far do you want to go? Most MSWs will not pay for extra training (beyond required CEs) once they are licensed because you get paid either way. The same can be said for many psychologists. I think the question is how much training do you want and how far are you willing to go to get it. I knew an MSW that completed the 5 year psychoanalytic training from one of the institutes. I know one that spent years working at the Beck institute as well. Erik Erikson never even had a bachelors degree and is in our textbooks. If you get a VA therapy/clinical job, they will often push you to learn EBTs and pay for it. I recently completed an EBT workshop with an MSW in our training cohort. The question is how committed are you to learning when you don't have to and there is not clear fianancial gain.

 

[AcronymAllergy]

My take: you're more likely to get higher-quality, in-depth EBT training in a psychology doctoral program than an MSW program. Some of this just relates to time in program, but training philosophy and environments, required accreditation competencies, and future career goals and scopes of practice also come into play. Purely anecdotal: I've known multiple new/recent MSW graduates who had little to no therapy experience; I've never met a doctoral psychologist who has little to none (even in research-intensive programs or assessment-heavy specialties like neuropsych).

All that being said, I do know MSWs who went on to receive solid training in EBTs. They had to do this on their own via formal (e.g., fellowship, VA-sponsored certification training) and informal (e.g., on-the-job training and mentorship) methods. If use of EBTs is a career goal and you go the MSW route, I'd say it seems more likely than not you'll need to line up additional post-graduate training.

 

[cara susanna]

Just FYI, if you work in the VA you have access to pretty great EBT trainings. I know a lot of MSWs who've participated in them.

 

[DynamicDidactic]

This is a nuanced question without a simple answer.

The slightly less simple answer is most trainees don’t get training in EBPs, regardless of degree.

https://www.researchgate.net/profile/Helen_Verdeli/publication/6893167_National_Survey_of_Psychotherapy_Training_in_Psychiatry_Psychology_and_Social_Work/links/0a85e52ec83719fc95000000.pdf

You also have to think that the quality of training in EBPs isn't being empirically examined. So, the state of EBP training is likely dismal across fields. PsyD and MSW are particularly concerning.

Let us stick to masters-level programs. There is a recent article in the Behavior Therapist about competencies in masters-level programs.
www.abct.org/docs/PastIssue/43n4.pdf
At the moment, no competencies are being systematically measured or used across training programs. No one requires training, assessment of the training, and measurement of training outcomes in EBTs. Not accrediting bodies, licensing boards, or accreditors.

If you want quality training in EBTs, you are going to have to be your own advocate. The degree or licensure isn't going to provide that. There are some generalities about programs:
MSW - more interested in social justice, theory-driven, less emphasis on empiricism
PhD - equal emphasis on science and practice
PsyD - lower emphasis on science (notice that no greater emphasis on practice)
LPC - kind of all over the place

HOWEVER, you wont know about any of this for each individual program. One has to do their research and find the program that works best for your goals. My recommendation is to find the program that emphasizes the importance of science in understanding etiologies and treatments of psychopathology. If you have those tools then you can seek the additional training after schooling.

Anecdotally, I knew someone that joined an MSW program at a prestigious PNW university. They were seeking to get training in CBT and DBT. However, the program was extremely psychodynamic and did not want to provide the sort of training this person was seeking. A quality program will be flexible to the interests of their students.

 

[erg923]

Yep. Agree with above.

The Ph.D., certainly on average, will do this better (as it very well should and is suppose to...whether its a scientist-practitioner model program or a clinical science model program) but this continues to be a gamble. The amount of junk requests and thinking that comes from the Ph.Ds I see if astonishing as well.

But certainly, on average, training with just a masters degree (sans many years of experience and/or proper training/mentorship) is EXTREMELY prone to innumerable errors in scientific thinking and clinical judgment that leads one to believe (and subsequently recommend) that generic "individual and/or family therapy" is the best or only treatment available for pretty much any psychological malady (child, adolescent or adult). This kind of thinking is so scientifically sloppy and so generic that it borders on the ridiculous and sad.

 

[clausewitz2]

My partner is an LCSW who I greatly respect and trust to interpret empirical literature. They have had to seek out quite a lot of trainings on EBP post-degree. However they are also a refugee from a developmental psych PhD program and are published in Journal of Animal Behavior so maybe not typical of the average masters-level cohort.

 

[erg923]

My partner is an LCSW who I greatly respect and trust to interpret empirical literature. They have had to seek out quite a lot of trainings on EBP post-degree. However they are also a refugee from a developmental psych PhD program and are published in Journal of Animal Behavior so maybe not typical of the average masters-level cohort.

I don't know how these are run today, but so much rich knowledge and literature have come from animal models of learning.

I am somewhat jealous that I was not around when the clinical psychology PhD involved so much "rat-running" (1940-1955?) to inform our knowledge and thinking about learning and psychological science. Ok. well, rats are pretty gross. So, whatever.

 

[clausewitz2]

I don't know how these are run today, but so much rich knowledge and literature have come from animal models of learning.

I am somewhat jealous that I was not around when the clinical psychology PhD involved so much "rat-running" (1940-1955?) to inform our knowledge and thinking about learning and psychological science. Ok. well, rats are pretty gross. So, whatever.

Born too late to explore the globe and too soon to voyage amongst the stars etc.

 

[MAClinician]

I don't know how these are run today, but so much rich knowledge and literature have come from animal models of learning.

I am somewhat jealous that I was not around when the clinical psychology PhD involved so much "rat-running" (1940-1955?) to inform our knowledge and thinking about learning and psychological science. Ok. well, rats are pretty gross. So, whatever.

One of my craziest memories of undergrad was my Theories of Learning class and the rat lab we had to do. One time I was transferring the rat from his box to the learning cage and I accidentally dropped that f**ker on the floor. My lab partner had to shut the door quick so he didn’t get out of the room. And then there was the time the rat had to push the lever (which really looked like a pole from the top of the cage) to get food and that rat started shaking that lever in anger and frustration

To the OP, doctoral study will give you the most in-depth training over masters. But NASW lists common specialties in MSW programs. And CSWE let’s you search by concentration so you can find programs with courses related to clinical practice. You will want to choose a program that is micro focused rather than macro focused. Good luck in your decision.

 

[NoDodoBird]

I admit I am not sure how much this varies across programs. I finished my MSW with a focus in mental/behavioral health last year (2019). We had two "direct practice" courses that covered the absolute basics of therapy practice and three courses that covered the research side. Most of the clinical/field placements that people in my class involved them providing group psychoeducation and charting. There was no specific training on modalities or specialized treatments. All of that is (hopefully) done during the job you get after you graduate.

 

[AcronymAllergy]

I admit I am not sure how much this varies across programs. I finished my MSW with a focus in mental/behavioral health last year (2019). We had two "direct practice" courses that covered the absolute basics of therapy practice and three courses that covered the research side. Most of the clinical/field placements that people in my class involved them providing group psychoeducation and charting. There was no specific training on modalities or specialized treatments. All of that is (hopefully) done during the job you get after you graduate.

This is the part that could be troubling. If an MSW goes straight into, say, VA in a Mental Health job (as opposed to a formal fellowship), odds are they'll be expected to start seeing patients from day one. With very limited time for any type of additional in-depth therapy training (other than someone nominally signing off on their notes).

 

[WisNeuro]

This is the part that could be troubling. If an MSW goes straight into, say, VA in a Mental Health job (as opposed to a formal fellowship), odds are they'll be expected to start seeing patients from day one. With very limited time for any type of additional in-depth therapy training (other than someone nominally signing off on their notes).

That would be the same in our healthcare system. On-boarding is 2 weeks, and is all admin/technical. After that, you get your first caseload. In most institutional settings, there is no "on-the -job" training in therapy as you are expected to have that as part of your professional training.

 

[Fan_of_Meehl]

I’m thinking about a career change and am trying to decide between pursuing a PhD in clinical psychology or an MSW. I‘m primarily interested in doing therapy (and learning about research), rather than assessments or conducting research, which makes me think the MSW might be the better option. However, I’m fascinated by and respect psychological science, and I’m afraid that I won’t get a good grounding in research based practices such as EBT, how to diagnose, and when to use which EBTs for which clients in an MSW program. I’ve heard that you would need a lot of good training and supervision after graduating and I’m wondering what type of supervision and/or training you would need and whether that would be difficult for most MSW grads to get? If I knew I could just do a X fellowship or Y practicum after the MSW to get trained, I would definitely go that route. But I would be very unsatisfied if I ended up just doing whatever talk therapy I happened to pick up without any real grounding in the scientific evidence.

It's also important--in my probably controversial opinion--not to define evidence-based psychotherapy solely with reference to a maximally structured, fixed length, single syndrome protocol in which the agenda and assignments for each and every session are prescripted before the first session even occurs. In certain open clinic populations (e.g., VA post-deployment clinic or a community MH clinic) the proportion of your caseload who will agree to and dutifully complete/cooperate with such an approach and be thereby treated to remission in 12 weeks will likely be a distinct minority of your caseload). So...what u gonna do with all those other folks? That's what you need the PhD/PsyD for. The downside is that lesser trained manager types and administrators will rule over you and won't be able to follow your reasoning. Makes for an interesting career.

 

[Sanman]

It's also important--in my probably controversial opinion--not to define evidence-based psychotherapy solely with reference to a maximally structured, fixed length, single syndrome protocol in which the agenda and assignments for each and every session are prescripted before the first session even occurs. In certain open clinic populations (e.g., VA post-deployment clinic or a community MH clinic) the proportion of your caseload who will agree to and dutifully complete/cooperate with such an approach and be thereby treated to remission in 12 weeks will likely be a distinct minority of your caseload). So...what u gonna do with all those other folks? That's what you need the PhD/PsyD for. The downside is that lesser trained manager types and administrators will rule over you and won't be able to follow your reasoning. Makes for an interesting career.

There is what happens in session and what gets put down on paper.

 

[Fan_of_Meehl]

Right

There is what happens in session and what gets put down on paper.

Right, and unfortunately I don't have the time and logistical resources to author a several paragraph progress note amounting to half a book chapter in a comprehensive clinical casebook of CBT. A lot can happen within session that isn't fully explicated in the chart note. Which is why the default VA method of "quality assurance" for psychotherapy sessions (just reviewing chart notes) is so pathetic and lacking in reliability/validity. There is no valid cheap and easy shortcut to providing quality psychotherapy supervision and training.

 

[Sanman]

Right
Right, and unfortunately I don't have the time and logistical resources to author a several paragraph progress note amounting to half a book chapter in a comprehensive clinical casebook of CBT. A lot can happen within session that isn't fully explicated in the chart note. Which is why the default VA method of "quality assurance" for psychotherapy sessions (just reviewing chart notes) is so pathetic and lacking in reliability/validity. There is no valid cheap and easy shortcut to providing quality psychotherapy supervision and training.

Why would you ever want to write that much? Quality assurance is basic CYA and not supervision or training. I used to do chart audits and it is about stupid stuff like billing a 90834 for 35 min session.

 

[Fan_of_Meehl]

Why would you ever want to write that much? Quality assurance is basic CYA and not supervision or training. I used to do chart audits and it is about stupid stuff like billing a 90834 for 35 min session.

Things are changing. Joint Commission will be upping the scrutiny on chart notes, MH Suite treatment plans, and demanding justification for why you don't have 'measurable, specific time-limited goals' developed on which you make steady progress until the patient is symptom-free (but, of course, his 100% service connection for PTSD and associated disability income will be safe). There is a major and inevitable collision coming soon between the likes of administrators and Joint Commission surveyors and clinical reality.

 

[Sanman]

Things are changing. Joint Commission will be upping the scrutiny on chart notes, MH Suite treatment plans, and demanding justification for why you don't have 'measurable, specific time-limited goals' developed on which you make steady progress until the patient is symptom-free (but, of course, his 100% service connection for PTSD and associated disability income will be safe). There is a major and inevitable collision coming soon between the likes of administrators and Joint Commission surveyors and clinical reality.

You can have a treatment plan for a time-limited goal that the patient does not meet. The question for administrators and JC is what is an acceptable response if the patient does not meet the goal. This will be just like the GAF score games we used to play.

 

[AbnormalPsych]

GAF score

**triggered**

 

[BuckeyeLove]

It's also important--in my probably controversial opinion--not to define evidence-based psychotherapy solely with reference to a maximally structured, fixed length, single syndrome protocol in which the agenda and assignments for each and every session are prescripted before the first session even occurs. In certain open clinic populations (e.g., VA post-deployment clinic or a community MH clinic) the proportion of your caseload who will agree to and dutifully complete/cooperate with such an approach and be thereby treated to remission in 12 weeks will likely be a distinct minority of your caseload). So...what u gonna do with all those other folks? That's what you need the PhD/PsyD for. The downside is that lesser trained manager types and administrators will rule over you and won't be able to follow your reasoning. Makes for an interesting career.

I'm really happy that you said this and legit provides some validation over feelings of unease I've had practicing the last few years in my state psychiatric hospital system. I've had to bend so many times and be flexible with patients solely because of this, and I know the staunch empiricists would be looking down on me from the literature clouds above. My older colleagues appeared to just not care, but maybe after 10-15 years dealing with bureaucracy it has sucked their soul to the point of having to "not" care as a means of getting through the day.

 

[Fan_of_Meehl]

I'm really happy that you said this and legit provides some validation over feelings of unease I've had practicing the last few years in my state psychiatric hospital system. I've had to bend so many times and be flexible with patients solely because of this, and I know the staunch empiricists would be looking down on me from the literature clouds above. My older colleagues appeared to just not care, but maybe after 10-15 years dealing with bureaucracy it has sucked their soul to the point of having to "not" care as a means of getting through the day.

Confession and full disclosure time. I'll admit it. Prior to spending the past 6 years on the 'front lines' in an outpatient post-deployment/polytrauma setting, I had some notions of superiority and I bought the kool-aid propaganda that those providers just weren't trying hard enough and that was the reason for the lack of utilization/uptake of the EBT protocols. However, endless practical experience showed me that, 9 times out of 10, the barriers to EBP implementation (protocols) lie on the client-side, not the therapist side.

Quick anecdote. Had a recent session with a 'high-risk suicide flag' veteran (however, with no intent/plan, some recent (and chronic) SI, no hx of preparatory behaviors or attempts). Still HR sui flag though. He was assessed with full CSRE < 1wk prior to my appt, re-assessed a few days later with CSRE update (one day prior to my appt). I asked the sui prev coordinator (who is actually a good, sophisticated person) if there was any flexibility in not re-administering the CSRE for a THIRD time in a week (but opting for, say, the Columbia) so that I could have some time for actual therapy with the veteran and re-establish rapport (hadn't seen him in 2 years). She said Joint Commission mandates an updated CSRE every single appt for HR flagged veterans for the duration they have the flag. I also needed to do a safety plan with him cause no one else did. He also had no leave time and had to come during lunch break (30 min appt). So I had to spend the near entirety of the appt updating the CSRE and doing the safety plan in a relatively inflexible manner. He reported no problems with ideation or anything for the past week or so, but we still have to go through the motions (as if that is going to change either his answer or the outcome or further 'reduce risk' in any meaningful way). You know what WOULD have been useful in actually reducing risk? Me having more time to work with him directly on rapport and cognitive restructuring around hopeless cognitions and/or schemas of being 'worthless.' However, due to the power that the cult/church of suicide prevention and Joint Commission commissars hold in the organization, I was not allowed the latitude to decide with my patient how best to utilize the 30 mins I had with him in context in order to 'reduce risk.'
The bull**** philosophy that increased structure/detail that is mandated inflexibly for each and every clinical encounter necessarily increases quality of said encounter needs to end. Yesterday.

 

[PsyDr]

Things are changing. Joint Commission will be upping the scrutiny on chart notes, MH Suite treatment plans, and demanding justification for why you don't have 'measurable, specific time-limited goals' developed on which you make steady progress until the patient is symptom-free (but, of course, his 100% service connection for PTSD and associated disability income will be safe). There is a major and inevitable collision coming soon between the likes of administrators and Joint Commission surveyors and clinical reality.

Amazing how the system rates coma victims the same as the married guy who works part time and drives himself to treatment once a month.

 

[AbnormalPsych]

Amazing how the system rates coma victims the same as the married guy who works part time and drives himself to treatment once a month.

I'm surprised coma patients are treated that well. Only one of those can go to the media/make a complaint against you/be used by politicians for an emotional response from their base to get $ and/or re-elected.

 

[cara susanna]

Confession and full disclosure time. I'll admit it. Prior to spending the past 6 years on the 'front lines' in an outpatient post-deployment/polytrauma setting, I had some notions of superiority and I bought the kool-aid propaganda that those providers just weren't trying hard enough and that was the reason for the lack of utilization/uptake of the EBT protocols. However, endless practical experience showed me that, 9 times out of 10, the barriers to EBP implementation (protocols) lie on the client-side, not the therapist side.

Quick anecdote. Had a recent session with a 'high-risk suicide flag' veteran (however, with no intent/plan, some recent (and chronic) SI, no hx of preparatory behaviors or attempts). Still HR sui flag though. He was assessed with full CSRE < 1wk prior to my appt, re-assessed a few days later with CSRE update (one day prior to my appt). I asked the sui prev coordinator (who is actually a good, sophisticated person) if there was any flexibility in not re-administering the CSRE for a THIRD time in a week (but opting for, say, the Columbia) so that I could have some time for actual therapy with the veteran and re-establish rapport (hadn't seen him in 2 years). She said Joint Commission mandates an updated CSRE every single appt for HR flagged veterans for the duration they have the flag. I also needed to do a safety plan with him cause no one else did. He also had no leave time and had to come during lunch break (30 min appt). So I had to spend the near entirety of the appt updating the CSRE and doing the safety plan in a relatively inflexible manner. He reported no problems with ideation or anything for the past week or so, but we still have to go through the motions (as if that is going to change either his answer or the outcome or further 'reduce risk' in any meaningful way). You know what WOULD have been useful in actually reducing risk? Me having more time to work with him directly on rapport and cognitive restructuring around hopeless cognitions and/or schemas of being 'worthless.' However, due to the power that the cult/church of suicide prevention and Joint Commission commissars hold in the organization, I was not allowed the latitude to decide with my patient how best to utilize the 30 mins I had with him in context in order to 'reduce risk.'
The bull**** philosophy that increased structure/detail that is mandated inflexibly for each and every clinical encounter necessarily increases quality of said encounter needs to end. Yesterday.

That was a huge complaint about the CSRE when it first hit clinical practice, especially in the PCMHI side where you only have 20-30 min. By the time you're done with the CSRE, safety planning, etc., you don't have time to actually give the patient skills or actually address the underlying causes of the SI itself.

 

[Sanman]

Confession and full disclosure time. I'll admit it. Prior to spending the past 6 years on the 'front lines' in an outpatient post-deployment/polytrauma setting, I had some notions of superiority and I bought the kool-aid propaganda that those providers just weren't trying hard enough and that was the reason for the lack of utilization/uptake of the EBT protocols. However, endless practical experience showed me that, 9 times out of 10, the barriers to EBP implementation (protocols) lie on the client-side, not the therapist side.

Quick anecdote. Had a recent session with a 'high-risk suicide flag' veteran (however, with no intent/plan, some recent (and chronic) SI, no hx of preparatory behaviors or attempts). Still HR sui flag though. He was assessed with full CSRE < 1wk prior to my appt, re-assessed a few days later with CSRE update (one day prior to my appt). I asked the sui prev coordinator (who is actually a good, sophisticated person) if there was any flexibility in not re-administering the CSRE for a THIRD time in a week (but opting for, say, the Columbia) so that I could have some time for actual therapy with the veteran and re-establish rapport (hadn't seen him in 2 years). She said Joint Commission mandates an updated CSRE every single appt for HR flagged veterans for the duration they have the flag. I also needed to do a safety plan with him cause no one else did. He also had no leave time and had to come during lunch break (30 min appt). So I had to spend the near entirety of the appt updating the CSRE and doing the safety plan in a relatively inflexible manner. He reported no problems with ideation or anything for the past week or so, but we still have to go through the motions (as if that is going to change either his answer or the outcome or further 'reduce risk' in any meaningful way). You know what WOULD have been useful in actually reducing risk? Me having more time to work with him directly on rapport and cognitive restructuring around hopeless cognitions and/or schemas of being 'worthless.' However, due to the power that the cult/church of suicide prevention and Joint Commission commissars hold in the organization, I was not allowed the latitude to decide with my patient how best to utilize the 30 mins I had with him in context in order to 'reduce risk.'
The bull**** philosophy that increased structure/detail that is mandated inflexibly for each and every clinical encounter necessarily increases quality of said encounter needs to end. Yesterday.

I had not heard about the CSRE being required every time a veteran with a high risk flag is seen. I know that we (MH professionals) are being required to administer the Columbia every time as the PHQ2+I9 or PHQ9 are not sufficient per JC.

This is where it helps that my veterans are often bed bound and not in the system as much. Less frequency of dealing with this nuttiness.

 

[beginner2011]

Confession and full disclosure time. I'll admit it. Prior to spending the past 6 years on the 'front lines' in an outpatient post-deployment/polytrauma setting, I had some notions of superiority and I bought the kool-aid propaganda that those providers just weren't trying hard enough and that was the reason for the lack of utilization/uptake of the EBT protocols. However, endless practical experience showed me that, 9 times out of 10, the barriers to EBP implementation (protocols) lie on the client-side, not the therapist side.

Quick anecdote. Had a recent session with a 'high-risk suicide flag' veteran (however, with no intent/plan, some recent (and chronic) SI, no hx of preparatory behaviors or attempts). Still HR sui flag though. He was assessed with full CSRE < 1wk prior to my appt, re-assessed a few days later with CSRE update (one day prior to my appt). I asked the sui prev coordinator (who is actually a good, sophisticated person) if there was any flexibility in not re-administering the CSRE for a THIRD time in a week (but opting for, say, the Columbia) so that I could have some time for actual therapy with the veteran and re-establish rapport (hadn't seen him in 2 years). She said Joint Commission mandates an updated CSRE every single appt for HR flagged veterans for the duration they have the flag. I also needed to do a safety plan with him cause no one else did. He also had no leave time and had to come during lunch break (30 min appt). So I had to spend the near entirety of the appt updating the CSRE and doing the safety plan in a relatively inflexible manner. He reported no problems with ideation or anything for the past week or so, but we still have to go through the motions (as if that is going to change either his answer or the outcome or further 'reduce risk' in any meaningful way). You know what WOULD have been useful in actually reducing risk? Me having more time to work with him directly on rapport and cognitive restructuring around hopeless cognitions and/or schemas of being 'worthless.' However, due to the power that the cult/church of suicide prevention and Joint Commission commissars hold in the organization, I was not allowed the latitude to decide with my patient how best to utilize the 30 mins I had with him in context in order to 'reduce risk.'
The bull**** philosophy that increased structure/detail that is mandated inflexibly for each and every clinical encounter necessarily increases quality of said encounter needs to end. Yesterday.

This is the kind of thing that makes me think a career in the VA system would not work for me, which I think is a damn shame in many ways.

 

[Fan_of_Meehl]

The top-down administrative micromanagement and proliferation of rigid practices/documentation has been accelerating in the past 5 years or so. My impression is that most rank and file MH providers on the front lines are near their breaking point (but VERY few speak up due to fear of retaliation by corrupt/arrogant parts of the system). I suspect that a collision between increasingly unrealistic micromanagement practices and clinical reality will have to occur at some point, preferably within the next 3-5 years.

 

[Sanman]

The top-down administrative micromanagement and proliferation of rigid practices/documentation has been accelerating in the past 5 years or so. My impression is that most rank and file MH providers on the front lines are near their breaking point (but VERY few speak up due to fear of retaliation by corrupt/arrogant parts of the system). I suspect that a collision between increasingly unrealistic micromanagement practices and clinical reality will have to occur at some point, preferably within the next 3-5 years.

Yes and no, IMO. The traditional mental health wings of most departments (general MHC, Trauma, inpatient, and SUDS) seem to get hit with more stuff than us folks that provide ancillary services to medical clinics and service areas (health psych, HBPC, PCMHI, CLC, etc). I find the former to be a much more stressful and shorter term gig than the latter in many cases.