Masters v PsyD v PhD

[DocEspana]

I can basically guarantee that other people have asked about this, but I can't seem to find a clear enough answer (or one not from like 2011) that makes me feel like I fully understand what the best advice would be. I understand the medical world, but I know so little about the world of psychology and therapy.

My wife recently got her masters in marriage and family therapy. Because we live in Florida, she's actually currently doing her two-year internship (not certain if this is a thing in every). And right as she just starting to do her first year of internship, she states that she doesn't feel that she is sufficiently skilled/qualified (despite going to a great/elite school for her MFT masters) and is thinking of the extra education and more-or-less guaranteed extra income the PhD/PsyD people can request. Her entire goal is to be a good clinician and stay in clinical psychology/therapy.

I tried to convince her that she can simply use continuing medical education and the numerous (extremely overpriced) credentialing programs to expand her education and that her income is largely dictated by how much she hustles and advertises for herself. Basically her net worth will be whatever the market states she can charge.

She is somewhat skeptical of my view on this and has been inquiring with schools in the area about their PhD and PsyD programs. The problem we keep running into is that the PhD programs all keep saying that they are really not meant to train you to be a better clinician, and that they are not thrilled at people getting a PhD just to be a "doctor" psychologist for more pay since their education is really more research focused and more leadership (of organizations) focused. And the PsyD programs all say that they are exactly what she is requesting, but that they will essentially not respect that she already has a master's and is a licensed therapist and requires her to take 5 years off from paid therapy work in order to complete the program.

What is the thought of the community on this. She has plenty of friends she graduated with already demanding and getting $300 an hour for therapy in our area with just masters degrees, but she really doesn't think she has "it" to request that amount and wants the degree. But all the PhD programs say they're not meant to give her what she is requesting and the PsyD programs want to her stop what she is doing for 5 years for essentially more acronyms after her name and the ability to charge 33% more to insurance customers?

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[R. Matey]

Ugh, post-graduate training for the mid-level psychotherapy providers is such a vulnerable time in their career. I sympathize. I was in the same position as your wife ten years ago when I made the decision to back for my Ph.D. and I am definitely much more comfortable (and competent according to my evaluators) in psychotherapy than I was back then. But, it's not the really point of the Ph.D. That is definitely true. It's because students are trained in a lot of other skills that are related, but distinctly not psychotherapy.

But could a master's level clinician get reach that same level of skill without a Ph.D.? Sure they can, Ph.Ds. don't have the market cornered on repeated supervised practice. To get there, M.A. level folks train at private institutes, pay for CMEs, or do their post-graduate internship somewhere that offers them access to quality supervision in a niche area. I wouldn't pay that amount for someone fresh out of school, personally, but I could be convinced if that person had demonstrable skill in a specific area.

Also, is your wife working with individuals or with families? MFT training doesn't really prepare people well to work with individuals so I can imagine that feeding feelings of incompetence.

 

[Neuromed13]

I'm in a completely different area of psychology and not yet graduated (intern) but I have actually felt that master level clinicians actually have better training in psychotherapy as at the doctorate level there are so many other required competencies that don't necessarily make you a better therapist. My main recommendation would be, if you're looking at South Florida PsyDs don't do it (from someone who is getting one). While my area of focus is neuropsychology and my interest in psychotherapy is more limited, I truly do not think my program prepared me super well to go out there and provide amazing therapy so in comparison to an elite MFT program I would say it is definitely not better and absolutely not worth the money and time. I agree with you about the PhD, if she is not really interested in the research and academic side of things, probably not a good fit. However, if she tends to be an ambitious person, she might just feel that she needs the degree to feel she has achieved the ultimate milestone in her field. Nonetheless, she can absolutely and likely already is an amazing clinician doing better work than some doctorate level clinicians who might have a different focus and lack advanced therapy training. Lastly, like you said, finding a niche to specialise in might be a good way to make more money. I wish your wife the best of luck!

 

[Sanman]

OP, your instincts are generally correct.

Your wife either has a bit or imposter syndrome or really has no interest in working. IMO, A two year internship doing clinical work will teach you more than all the academic classes in the world. Therapy is a trade and like any other it requires a sound basis in theory and a lot of practice. That said, the answers to your questions:

There is not much more guaranteed income and the differential is mostly attributed to a larger scope of practice. If she is unwilling to do those things, then she will not make more money.

PhDs - Make you pretend that you are interested in research and academia even though most of their graduates go on to become clinicians as there are not enough academic positions for all the grads. You better be okay with research and writing even if you don't plan on making it your life's work. The pro is that you go to school for free or low cost in most cases.

PsyDs - Some are good, some are not so good and most of them cost an arm and two legs. The few affordable/free ones are just as difficult to get into as PhD programs.

None of these will give you credit for schooling because they are governed by different professional boards, like finishing an NP program and then applying to med school.

If your wife is going this route, you both should be willing to relocate nationally for internship and post-doc (similar to med school). Not doing so is effectively throwing away all your hard work unless you are lucky. It much like acing medical school and boards, then taking a 3rd rate internal med residency with mostly FMGs because it happens to be around the corner from where you live.

Good luck!

 

[WisNeuro]

Probably going to vary depending on program, even our neuro people had to get hundreds of hours of therapy in prior to internship.

But as for OP, I agree with others, midlevels can learn therapy just fine with adequate training and supervision. The biggest downfall for midlevels in my experience though, is that they just don't know what they don't know. As we've talked about before, midlevels are especially prone to buying into pseudoscientific "treatments" that sound good, but don't do anything beyond a temporary placebo effect. That's one of the extras that teh doctoral education buys you. There are still some doctoral level psychologists, who tend to be from diploma mills, who also buy into the junk science, but a far lower ratio.

 

[R. Matey]

Therapy is a trade and like any other it requires a sound basis in theory and a lot of practice.

Indeed, and the trade culture among the master's level postgraduate training experiences is at least partially responsible for the pseudoscience that we like to complain about. It's only worth commenting on to emphasize how important on where a trainee does their internship since that probably matters just as much, if not more, than the degree.

 

[Sanman]

Indeed, and the trade culture among the master's level postgraduate training experiences is at least partially responsible for the pseudoscience that we like to complain about. It's only worth commenting on to emphasize how important on where a trainee does their internship since that probably matters just as much, if not more, than the degree.

Of course, the issue is that sound training and accessible training are not always the same. This is true of many fields.

 

[smalltownpsych]

The doctoral path is extremely challenging, often expensive, and requires geographic flexibility. Practitioners that don’t fully invest in that often don’t make it to licensure and are at the bottom end of our distribution of skills and salaries. She might want to shoot for the top end of her current degree by seeking the training opportunities. I have helped train many midlevels in all stages of education even well past licensure as many of them recognize the value of learning from an experienced well trained psychologist.

 

[R. Matey]

Of course, the issue is that sound training and accessible training are not always the same. This is true of many fields.

I just think it's a shame that CACREP, NASW, COAMFTE et al puts such few resources into training their clinicians beyond an extremely minimal level of competence. At least in psych, we have organizations that regulate internships and, to a lesser extent, postdocs. It's just the wild west for mid-level psychotherapy providers post-degree, pre-licensure hence the cottage industry of post-degree training CMEs. It matters because the talking point of "oh, but they do two years of internship before independent licensure" falls flat when that two years can be spent "doing stuff" with incredibly minimal oversight.

 

[DocEspana]

This is all been awesome. Thank you.

 

[Sanman]

I just think it's a shame that CACREP, NASW, COAMFTE et al puts such few resources into training their clinicians beyond an extremely minimal level of competence. At least in psych, we have organizations that regulate internships and, to a lesser extent, postdocs. It's just the wild west for mid-level psychotherapy providers post-degree, pre-licensure hence the cottage industry of post-degree training CMEs. It matters because the talking point of "oh, but they do two years of internship before independent licensure" falls flat when that two years can be spent "doing stuff" with incredibly minimal oversight.

Their scope is too wide and APA missed the boat to have midlevel extenders under its control. Most social work is not psychotherapy. CRACREP accredits career counselors and school counselors. I don't know about you, but my HS guidance counselor was an idiot who once suggested I become a mechanic because of the results of a vocational test. I don't trust one body to keep on top of all of these various jobs.

 

[DocEspana]

Ugh, post-graduate training for the mid-level psychotherapy providers is such a vulnerable time in their career. I sympathize. I was in the same position as your wife ten years ago when I made the decision to back for my Ph.D. and I am definitely much more comfortable (and competent according to my evaluators) in psychotherapy than I was back then. But, it's not the really point of the Ph.D. That is definitely true. It's because students are trained in a lot of other skills that are related, but distinctly not psychotherapy.

But could a master's level clinician get reach that same level of skill without a Ph.D.? Sure they can, Ph.Ds. don't have the market cornered on repeated supervised practice. To get there, M.A. level folks train at private institutes, pay for CMEs, or do their post-graduate internship somewhere that offers them access to quality supervision in a niche area. I wouldn't pay that amount for someone fresh out of school, personally, but I could be convinced if that person had demonstrable skill in a specific area.

Also, is your wife working with individuals or with families? MFT training doesn't really prepare people well to work with individuals so I can imagine that feeding feelings of incompetence.

Wife is probably going to primarily be doing individual therapy. She has said a few times that she seems to have a much stronger affinity for individual therapy. Also, her internship a mixture of individual and couples/marriage therapy (It's actually particularly focused on couples/marriage therapy). That stuff that is specifically family is probably going to be the stuff she does the least of from her original training.

 

[WisNeuro]

Wife is probably going to primarily be doing individual therapy. She has said a few times that she seems to have a much stronger affinity for individual therapy. Also, her internship a mixture of individual and couples/marriage therapy (It's actually particularly focused on couples/marriage therapy). That stuff that is specifically family is probably going to be the stuff she does the least of from her original training.

Just make sure you have a spray bottle handy to nail her in the face in case she ever comes to you and says "Hey, I'm going to do an EMDR/Somatic Experiencing/other pseudoscience workshop!"

 

[Sanman]

Just make sure you have a spray bottle handy to nail her in the face in case she ever comes to you and says "Hey, I'm going to do an EMDR/Somatic Experiencing/other pseudoscience workshop!"

Careful, in some climates that may actually be a reinforcer.

 

[WisNeuro]

Careful, in some climates that may actually be a reinforcer.

Fill the spray bottle with cat pee. This sort of thing needs to be dealt with seriously.

 

[Sanman]

Fill the spray bottle with cat pee. This sort of thing needs to be dealt with seriously.

Fine, but you are supplying the cat pee.

 

[R. Matey]

Their scope is too wide and APA missed the boat to have midlevel extenders under its control. Most social work is not psychotherapy. CRACREP accredits career counselors and school counselors. I don't know about you, but my HS guidance counselor was an idiot who once suggested I become a mechanic because of the results of a vocational test. I don't trust one body to keep on top of all of these various jobs.

This is factually wrong. CACREP accredits mental health counseling also, and I wasn't just talking about CACREP.

 

[Sanman]

This is factually wrong. CACREP accredits mental health counseling also, and I wasn't just talking about CACREP.

I never said they didn't accredit mental health counseling as well. I was trying to imply they accredit both and those are two very different jobs. Just like facility social worker and psychotherapist are two different jobs. My point was that there should be a single body accrediting mental health programs and it should have been the APA. Then you have tighter control over the education received.

 

[R. Matey]

Wife is probably going to primarily be doing individual therapy. She has said a few times that she seems to have a much stronger affinity for individual therapy. Also, her internship a mixture of individual and couples/marriage therapy (It's actually particularly focused on couples/marriage therapy). That stuff that is specifically family is probably going to be the stuff she does the least of from her original training.

GTK, that's the other side of the MFT equation. When I did my post-graduate licensing hours, I took a lot of trainings from ACBT. I just looked quickly to see what was available and this looks like a useful launchpad to start getting info on EBTs: https://ebbp.org/.

 

[R. Matey]

I never said they didn't accredit mental health counseling as well. I was trying to imply they accredit both and those are two very different jobs. Just like facility social worker and psychotherapist are two different jobs. My point was that there should be a single body accrediting mental health programs and it should have been the APA. Then you have tighter control over the education received.

I know there are efforts now within APA (or at least there were) to credential M.A. level providers. Horse may have left the barn though.