LCSW = Psychologist?

[positivepsych]

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It seems the public portrayal of psychologists is further degrading...

FYI: Money Magazine has a Cutting Health Care Costs article in their November 2006 issue (just came out). They say:

(point 9) "Seek Smart Counsel. If you're seeing a mental-health therapist every week, you're probably footing much of the bill. Most Health plans limit coverage to 30 visits a year. You can cut the cost by going to a certified counselor or clinical social worker (average fee: $90 an hour) instead of a psychologist (around $120). A recent survey found no difference in effectiveness."

 

[Therapist4Chnge]

Negatory Ghost Rider!

I know there are no conclusive studies either way, but the training is vastly different, and the range is also much different. Psychology really could use a facelift in the public eye. Large companies pay PR firms large amounts of money (in addition to lobbyists), Psychology needs that....PRONTO.

 

[50960]

I agree, where is the APA in this?? They are busy blowing their money on PC pseudoscience. I am not threatened much by this stuff as I can outperform any LCSW when it comes to anything but social work, but it still makes me angry.😎

 

[pingouin]

another error in that statement is the idea of the patient saving money, as they're assuming that the patient is using insurance. whether you see a LCSW or a psychologist, your out of pocket cost is going to be the same no matter what- just your specialist copay. doesn't matter the credentials of provider.

the increased cost is incurred by the insurance companies (contracted rate- copay= what they have to pay out) since psychologists are contracted at a higher rate.

if we're talking patients paying out of pocket, then it's true- a psychologist will cost the patient quite a bit more. but what's written is misleading.

 

[PsiKo]

"Seek Smart Counsel. If you're seeing a mental-health therapist every week, you're probably footing much of the bill. Most Health plans limit coverage to 30 visits a year. You can cut the cost by going to a certified counselor or clinical social worker (average fee: $90 an hour) instead of a psychologist (around $120). A recent survey found no difference in effectiveness."

When it comes to treating the "walking well," this survey is probably spot on.

I'm in a PhD program, so, obviously, I have no inherent bias against psychologists. But I've been on the client side of the couch of more than a few utterly clueless licensed clinical psychologists and now know better than to assume that having a PhD correlates to being a superior clinician.

A friend of mine is an interventional cardiologist. When going through the roster of cardio-thoracic surgeons at his affiliated MAJOR metropolitan hospital to select a surgeon to operate on my father, he eliminated more than half as being incompetent. One surgeon with very impressive paper credentials is apparently (and unknowingly) referred to by his peers as "The Assassin." And please, resist temptation in asking if my father would have been better off being treated by a cardiac nurse instead of "The Assassin." That would be a specious argument.

The further into my graduate education I go, the more I feel like I'm in a sausage factory. And everyone knows that no one should have to witness how sausage is made.

Psychotherapy is not brain surgery or heart surgery. And I am under no illusions that doctoral level therapists are any better equipped than well-trained master's level therapists when it comes to working with garden variety patients. And to hear psychologists talk about how weird their colleagues are (read: socially inept), you begin to understand why.

And speaking as a consumer too, I'm amazed by how many PhD frogs you have to kiss before you find someone who's truly gifted. To a not so neglible extent, great psychologists and psychotherapists are born, not made.

 

[50960]

Spoken like a true consumer. I cannot disagree more on more levels than I have energy to write about. I will say this from true experience; you will learn 100 times more in your first 2 years post licensure out there doing clinical psychology than you ever did at school. If your training is that bad I really feel bad for the students at your school.👎 👎

 

[PsychevalIII]

Social Workers are far more likely to engage in on going, long term, supportive counseling, without a direction. Psychologist, while costing more / hr, end up costing less than mid levels due to a greater probability of providing targeted, time limited, goal directed treatment interventions.

 

[MeghanHF]

Sausages, assasins, and frogs...oh my, PsiKo! While there are certainly excellent MA level therapists out there, the training and expertise of clinical psychologists is vastly different. Unfortunately, in my experience, those most in need of the services of a clinical psychologist are also those without the knowledge or money to do so. I'm not sure how you are defining 'walking well' or 'garden variety' or your own needs but in gerneral, I would suggest forking over the extra $30...

 

[Logic Prevails]

I think the issue here is getting across to consumers what the difference is. It is very misleading to suggest to consumers that "there is no difference in effectiveness" based on a survey. As tough as it may be, we need some advocation to express to the general public that social workers may be the more economical route for couples counseling, but not when it comes to treating severe anxiety, depression, etc.

 

[50960]

As I have said before, there is a big difference between counselling and evidence-based tx of mental disorders; apples and oranges. However the public generally does not know this, and statements like LCSW=Psychologist are preying on the public's ignornace for one's own purposes which is highly unethical...and sorta pathetic.

 

[Pterion]

As I have said before, there is a big difference between counselling and evidence-based tx of mental disorders; apples and oranges. However the public generally does not know this, and statements like LCSW=Psychologist are preying on the public's ignornace for one's own purposes which is highly unethical...and sorta pathetic.

Yes. Absolutely. Brilliant business strategy on the LCSW's part. Now psychology is in the position of trying to play defense. Guess we know how that will go. And where is the much esteemed APA during this PR disaster? Focused on pursuing RxP, which serves to further endorse the field's irrelevance compared to strict medical treatment.

People, and here I also include third party payors, are convinced that psychologists are all apologists, tweed coat-wearing hand-holders who make lots of money 😱 talking 😱 to people? Well of course they will go to the less expensive alternative. For that matter, if you're just basically talking - I can do that with Smitty the bartender. And get drunk. Why do we not get outraged enough to actually fix these misperceptions? Do we fear offending someone?

Meanwhile, outside the hallowed halls of the DC HQ, practitioners and researchers are doing nothing to ameliorate this dissolution of clinical psychology. How do we evaluate our own effectiveness? Follow up monthly with a BDI II for half a year? How do we administer quality control in our own ranks? The very field that is master of test construction can't do better than the E-triple-flipping-P? I'll not even touch the PhD vs PsyD papermill debate, but you see how it may fit in here.

When this science adequately stands up for itself and shows patient groups, physicians, congress, Pharma, Blue Cross ad infinitum the true value and cost savings it already provides, perhaps the pay and respect long due to this profession will finally become manifest. Or maybe in 15 years LCSW's will have prescription privileges, too.

End of rant. Resuming normal duties.

 

[doctorpsych]

no psiko... great psychologist are not born... the practice of psychology is based on the application of science... great psychologist have to learn and integrate scientific methodologies, evidenced-based treatment, learn and understand from scientific studies, continue their education in order to be a good psychologist... great speakers, public charm and socially skilled individuals are 'born'. Just because you can be a good listener does not make you a good psychologist... a good listener may be able to engage a person, but have no knowledge how to treat a person's disorder...

just one example among the many that I have... one social worker attempted to conduct couple's therapy just from watching Dr. Phil... then this person thought that they knew what they were doing... for the love of God, this person kept quoting Dr. Phil!

APA or maybe the newly formed NAPPP needs to do something about this... let's see which is more dedicated to us... what recent survey are they referring to? any scientific merit to this survey?

 

[QPublic]

Unfortunately, the data aren't there (at least not yet) to indicate that psychologists are more effective psychotherapists than LCSWs (or LPCs, LMHCs and all the other counselor-types out there). As a licensed clinical psychologist, of course, I feel that we have a more stronger background in diagnosis and treatment, and particularly in medical settings, are more qualified with regard to differential dx, etc. That said, the data still aren't there with regard to psychotherapy, though it pains me to say it.
That can be a strong incentive for some to specialize (e.g, neuropsychology, behavioral medicine, etc.). Then again, given how impotent the APA is, I wouldn't be shocked if sooner or later MSWs are trying to practice in these areas too. The fact that the average person cannot distinguish a psychologist from a psychiatrist from a social worker from a counselor from [fill in the blank] is discouraging. I often hear people refer to their 'psychologist', when it turns out the person is a masters-level clinician of some sort. Blech.

 

[50960]

As a psychologist I have never thought of myself or referred to myself as a therapist. I saw a pt today with acute onset of psychotic symptoms at 40, and I ordered an EEG...guess what...she has TLE, would an MSW know what that is without googling it? have a clue how to diagnose it, or be able to order the test........NO.

 

[doctorpsych]

yes, there are no direct studies, at least that I'm aware of that has compared treatment efficacy btwn psychologist and others...(although I recall a study that compared psychological treatment for depression over community based referrals-->largely social work providers, that resulted in significantly better outcomes ...sorry I can't seem to find the ref... I would have posted it) however, there are many studies that demonstrate the effectiveness of treatments that have been emperically demonstrated to work for specific disorders (for a list, just look at Barlow's articles...) and by far, most these treatments are conceptualized, applied, and studied by psychologists... most MSW, LCSW, LCSW-R, or whatever have no training with these treatment modalities, if they do, they are mostly over 1-2 day workshops and some badly photocopied handouts that they received... but then feel well-equipted to performed ERT, PCT, B-mod, Beck's CT, REBT or you name it... who gets hurt at the end, sure partially us and our well earned egos... but all pride a side, at the end, the patients get the short end of the stick... they end up putting their trust on anybody who is simply willing to listen, give them a tissue and allow them to vent while their sx's continue to deteriorate... now, don't get me wrong, there are good social workers out there that will match well with pts. who may not be suffering from serious problems... I have no beef with that...

Once, a very 'seasoned' social worker said this to me "what's a BDI... is that a self-report?... how's that useful? they can just lie!... you just need to ask them if they are still depressed?!?!?!?" This is the mentality that I have a problem with...

Unfortunately, the data aren't there (at least not yet) to indicate that psychologists are more effective psychotherapists than LCSWs (or LPCs, LMHCs and all the other counselor-types out there). As a licensed clinical psychologist, of course, I feel that we have a more stronger background in diagnosis and treatment, and particularly in medical settings, are more qualified with regard to differential dx, etc. That said, the data still aren't there with regard to psychotherapy, though it pains me to say it.
That can be a strong incentive for some to specialize (e.g, neuropsychology, behavioral medicine, etc.). Then again, given how impotent the APA is, I wouldn't be shocked if sooner or later MSWs are trying to practice in these areas too. The fact that the average person cannot distinguish a psychologist from a psychiatrist from a social worker from a counselor from [fill in the blank] is discouraging. I often hear people refer to their 'psychologist', when it turns out the person is a masters-level clinician of some sort. Blech.

 

[Therapist4Chnge]

...... most MSW, LCSW, LCSW-R, or whatever have no training with these treatment modalities, if they do, they are mostly over 1-2 day workshops and some badly photocopied handouts that they received... but then feel well-equipted to performed ERT, PCT, B-mod, Beck's CT, REBT or you name it...

Unfortunately, this mirrors my interactions with most LCSWs. I think the most common problem I've seen is trying to use a round peg to fill every type of "hole"....round, square, etc. It speaks to the limited range of modalities they are taught.

For an example, last year I had an LCSW swear that HER way of doing things was right, bc that was what she was taught, and she has used it for 10 years, so obviously since it worked previously...it should work now. Not only was it not working, but it was negatively effecting my work with the patient. I suggested a couple different (empirically validated) methods that could also work, and she quickly dismissed them. What was problematic was that her dismissal was more based on her limited knowledge, instead of an informed clinical opinion.

In the end, the patient did not receive the same standard of care that he should have had. What was ironic, was her implementation of her modality wasn't even done right. It was a very vanilla behavior mod implementation, and while she hit the basic areas, she missed the boat on some of the more subtle areas. I had to share the patient with her, and needless to say....it was frustrating.

Once, a very 'seasoned' social worker said this to me "what's a BDI... is that a self-report?... how's that useful? they can just lie!... you just need to ask them if they are still depressed?!?!?!?" This is the mentality that I have a problem with...

Crystal clear example of why only clinicians should administer, score, and interpret assessments. Self-Reports are some of the easiest assessments to give. In contrast, I've seen counselors use projective tests, and then REALLY miss the boat on the interpretation. I think they can be great in therapy, but if you are going to use them.....please please please have a solid understanding of the assessment! I'm still pre-licensure, so I am far from a well-seasoned professional, but I know that if I'm going to use a method or measure, that I better darn well know what i'm doing before I use it on a patient, be able to competently explain the reasoning behind why the assessment was administered, what the scores actually mean, etc.

These are only my personal opinions, and I know there are great LCSWs out there, but I've had some very poor experiences with most of the ones i've met.

-t

 

[edieb]

You've seen counselors interpret tests??? I thought that was illegal...

Unfortunately, this mirrors my interactions with most LCSWs. I think the most common problem I've seen is trying to use a round peg to fill every type of "hole"....round, square, etc. It speaks to the limited range of modalities they are taught.

For an example, last year I had an LCSW swear that HER way of doing things was right, bc that was what she was taught, and she has used it for 10 years, so obviously since it worked previously...it should work now. Not only was it not working, but it was negatively effecting my work with the patient. I suggested a couple different (empirically validated) methods that could also work, and she quickly dismissed them. What was problematic was that her dismissal was more based on her limited knowledge, instead of an informed clinical opinion.

In the end, the patient did not receive the same standard of care that he should have had. What was ironic, was her implementation of her modality wasn't even done right. It was a very vanilla behavior mod implementation, and while she hit the basic areas, she missed the boat on some of the more subtle areas. I had to share the patient with her, and needless to say....it was frustrating.



Crystal clear example of why only clinicians should administer, score, and interpret assessments. Self-Reports are some of the easiest assessments to give. In contrast, I've seen counselors use projective tests, and then REALLY miss the boat on the interpretation. I think they can be great in therapy, but if you are going to use them.....please please please have a solid understanding of the assessment! I'm still pre-licensure, so I am far from a well-seasoned professional, but I know that if I'm going to use a method or measure, that I better darn well know what i'm doing before I use it on a patient, be able to competently explain the reasoning behind why the assessment was administered, what the scores actually mean, etc.

These are only my personal opinions, and I know there are great LCSWs out there, but I've had some very poor experiences with most of the ones i've met.

-t

 

[50960]

It happens all the time...

 

[Therapist4Chnge]

You've seen counselors interpret tests??? I thought that was illegal...

They would try and do stuff like "House Tree Person", and then use it in the session. Thankfully it wasn't a common occurance, but people go flip through assessments and say some really off the wall stuff.

-t

 

[doctorpsych]

it is outragious that some social workers would actually attempt to interpret tests... but in my example, that social worker had a reaction toward me using the BDI!

 

[QPublic]

I just happened to see my previous posting and noticed the grammatical error in my post -- it was actually a typo ;-)

>psychologist, of course, I feel that we have a more stronger background in >diagnosis and treatment, and particularly in medical settings, are more >qualified with regard to differential dx, etc. That said, the data still aren't

Now back to the topic at hand. On one hand, I feel like we're shooting ourselves in the feet here. I am strongly of the opinion that we are much better trained in assessment, of course research methodology, etc, than are LCSWs, "counselors", etc. But no one outside of clinical psychology will give a damn if we can't show any data to support this. It really irks me to see LCSWs doing presurgical assessments, etc. When it comes to psychotherapy, I don't think it is fair, however, to say that LCSWs do not receive any training in CBT or other empirically supported treatments. Some do, some don't. But unfortunately, I've met many clinical psychologists, including relatively new ones, who don't have that background either.
I think that we can continue to tell each other that "they can't do it; we can", but THEY ARE doing it. And of course, psychologists as a whole in turn receive lower reimbursement on average.
PsiCi, you mentioned that you don't view or refer to yourself as a "therapist". Actually, I don't either. But what I realize is that insurance companies, the general public, and many in the mental health field will continue to assume that psychologists = therapists. It sounds as if you are in a more enlightened locale... it sounds good to me!

 

[doctorpsych]

yes, some lcsw's do get appropriate training, some enroll into analytical institutes, never met any that actually did get specialized training in CBT... but, any lcsw who did not get additional training (post grad), they are innapropriately trained, take a look at their curriculum and school requirement, no GRE needed, very very breath courses on psychopath and tx, only an overview, no training... and that's how they are ok with accepting the low reimbursement rates by insurance... sure there are psychologist who do not have the appriopriate knowledge, but as a whole, psychologist are more prepared, better exposed to the necessary tools... there is no direct comparative research because people are too afraid of the political consequences of the results, but by in large, most of the efficacy studies on tx are conducted by psychologist and tx carried out by psychologists... this is the message that needs to go out of our circle, the public should know this, apa should freakin do something about that money magazine article, psychology should get a backbone and not just be all touchy feely...or hide behind the ivery tower... in my opinion, that is the mentality behind shooting ourselves on the feet...

I just happened to see my previous posting and noticed the grammatical error in my post -- it was actually a typo ;-)

>psychologist, of course, I feel that we have a more stronger background in >diagnosis and treatment, and particularly in medical settings, are more >qualified with regard to differential dx, etc. That said, the data still aren't

Now back to the topic at hand. On one hand, I feel like we're shooting ourselves in the feet here. I am strongly of the opinion that we are much better trained in assessment, of course research methodology, etc, than are LCSWs, "counselors", etc. But no one outside of clinical psychology will give a damn if we can't show any data to support this. It really irks me to see LCSWs doing presurgical assessments, etc. When it comes to psychotherapy, I don't think it is fair, however, to say that LCSWs do not receive any training in CBT or other empirically supported treatments. Some do, some don't. But unfortunately, I've met many clinical psychologists, including relatively new ones, who don't have that background either.
I think that we can continue to tell each other that "they can't do it; we can", but THEY ARE doing it. And of course, psychologists as a whole in turn receive lower reimbursement on average.
PsiCi, you mentioned that you don't view or refer to yourself as a "therapist". Actually, I don't either. But what I realize is that insurance companies, the general public, and many in the mental health field will continue to assume that psychologists = therapists. It sounds as if you are in a more enlightened locale... it sounds good to me!

 

[50960]

Indeed, that is why I donot give my $ to APA. I am happy so far with NAPPP.

 

[QPublic]

I agree. APA is impotent, as far as I'm concerned. I had checked out the NAPPP site some time ago (I think it was brand new), and you just reminded me to check back into it.

Indeed, that is why I donot give my $ to APA. I am happy so far with NAPPP.

 

[Therapist4Chnge]

I agree. APA is impotent, as far as I'm concerned. I had checked out the NAPPP site some time ago (I think it was brand new), and you just reminded me to check back into it.

I too checked it out early on. Ironically I think I was at APA and was talking to some people about the NAPPP (and their stance on RxP). I haven't re-upped with APA, and i'm not a member of NAPPP currently.....so it looks like I have some reading to do to figure out if either (or both) are worth joining.

-t