My frustration with the profession

[PsychGraduate]

I am in total agreement wiht erg923. The role of science and research in practice *IS* one of the biggest differences in training between different professions, and sadly it is an issue within our profession. I've written before about the "stats/research is icky" crowd, so I won't repeat that, though there is definitely a threat to the overall profession when people discount/devalue the role research plays in clinical practice. Science/Research/Statistics inform our work, yet people seem to be pulling away from it instead of embracing it.



I have become more conservative with my views as I've spent more time interacting with othe professionals. While I am not in the "no therapy should be provided by an MSW" camp, I do have some concerns about MSWs diagnosing and treating severe pathology. A good portion of my time is spent doing differential dx assessment (mostly neuro, though also personality, mood, capacity, etc), so I review medical records in much more detail than the average clinician. I have seen issues across disciplines, which includes social work, psychiatry, PA/NP, and GP/FP/EM, etc. I am a stickler for differential Dx, but in some cases it makes a HUGE difference.

I believe supportive therapy, which I think is appropriate for MSW-trained therapists, is quite different than a more in-depth therapeutic approach. I am much more supportive of LCSWs doing traditional therapy, and MSWs doing more supportive therapy and case management. I believe the extra training and supervision an LCSW receives better prepares them to handle more Dx's, though it still isn't ideal.

Quality control is certainly an issue, but my concern is that some who are not competent at the upper echelons in psychiatry and psychology are suppressing those who are competent with "just" master's degrees or who are social workers with PhD's.

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[Therapist4Chnge]

First, coursework it not what the ph.d is about. I would also bet that the courses were more geared towards theory and underlying mechanisms of change rather than teaching techniques. That is a good thing frankly, a ph.d program is not a trade a school! Moreover, 4 years of practica has given me plenty of outlets to learn specific techniques.

This is one of the biggest misnombers when it comes to training. A middle of the pack doctoral student (from a balanced program) probably spends 20-30% of his/her time with classwork (including reading time outside of class). The classes are there to provide a theoretical foundation, as the technical application means little if the underlying theory and research is not adequately understood. The other 70-80% of the time is spent sythesizing and integrating information that is then applied in practice. The training is as much about being a scientist as it is about being a practioner (thus the term scientist-practitioner), though without the former the latter cannot work. Science informs practice, and without science we are rudderless as a professional.

Second, two years of MSW program vs 5-6 years of doctoral program (4 of which have practicum training). You do the math.

The total number of hours, and how the hours are spent is quite different. It isn't that one is better than the other, but the requirements are different. By design, classroom time is a small fraction of the overall learning in a doctoral program. In many programs B = Ph.D. / Psy.D. because the class grade really isn't the point.

Damn straight my scientific training (yes, even mutivariate statistics courses) has informed my clinical decision making!

This becomes more and more applicable as each day goes by. I see it in team meetings, I see it in co-lead groups, and I see it in every day practice. It is the difference between a mechanic and a tech. Both work on cars, but they evaluate the car quite differently. They each serve a role, though they are distinct of each other, even though some of the content crosses over.

Your education and training are what you decide to get out of it.

I disagree. There are milestones put in place to address competency. They aren't perfect, but there is a certain level that must be attained to move through each.

 

[zzzz2]

I am new here so I do not want to continue in a manner not conducive to productive conversation.

Your productivity here on this forum is admirable! Welcome.

 

[Therapist4Chnge]

I'm not necessarily saying that I disagree with you, but I wonder... if you're correct, then why have there been no published, peer-reviewed studies indicating that therapy with psychologists produces better clinical outcomes than therapy with, say, a social worker.

Quantifying "better" is very difficult, thus measuring it becomes much much more challenging, and putting forth a study without adequately accounting for this issue is irresponsible. I still would like to see it, but it is a tall mountain to climb.

 

[Therapist4Chnge]

It seems as though there are some posts on the clin psych sdn that tend to repeatedly stray into a defense of one particular training model etc. It's incredible how minimally related threads have drifted over to the first factor of debates here: pro schools, onlines, for profits. Lets not let this one do that.

Unfortunately a lot of these issues are intertwined. I try the best I can to keep threads on topic, as it does no one any good to devolve into petty arguments. This topic is particularly problematic because it cuts to the center of a major difference in training approaches (the level and role science plays in training). With that being said, let's...as a group....try and keep this thread away from a pro/online/etc discussion.

Others may have a different experience, but mine is that the discussions in this forum are much more contentious than the real world.

Yes and no. I think there is a sampling error on here, in that there are not as many contentions out in the real world, but many of the issues are alive and well. I am thankful that I am part of multiple treatment teams that value my input, though this has not always been the case.

I have a MA in clinical right now. I am not qualified to provide independent therapy with my MA in clinical...why should someone with a masters in social work be granted access to therapy?

Their political support was better. Honestly, that is how a bill makes it through all of the necessary votes to make it a law. I'm sorry if I come off as a tad bitter, but I've been in the trenches with political action committees (PACs....the driving force behind 99.8% of legislation), and right/wrong almost never trumps win/lose for your group. The vast majority of people involved in influencing legislation often understand very little about the implications, though they were hired to win and not to evaluate their cause.

One of the challenges with scope creep is the lack of emperical support. In some places the research is there, and in others it is not...but politicians don't much care for science and statistics.

 

[Therapist4Chnge]

Quality control is certainly an issue, but my concern is that some who are not competent at the upper echelons in psychiatry and psychology are suppressing those who are competent with "just" master's degrees or who are social workers with PhD's.

The battle is never fought for the over-achievers, instead it is fought for the <50%, as they are the ones most likely to cause problems. I don't agree that the top few are trying to hold down the masses, though I do concede that no one likes scope creep, so they will actively fight it. The response should not be brute force, but instead science and outcome studies. Many professionals object to the "there are more of us than you" tactics, which is not a sound reason for making change.

 

[ClinPsycMasters]

I am in total agreement wiht erg923. The role of science and research in practice *IS* one of the biggest differences in training between different professions, and sadly it is an issue within our profession. I've written before about the "stats/research is icky" crowd, so I won't repeat that, though there is definitely a threat to the overall profession when people discount/devalue the role research plays in clinical practice. Science/Research/Statistics inform our work, yet people seem to be pulling away from it instead of embracing it.

I think research is extremely important but I know that I am not made for it. If I wanted to do stats all day I would have majored in stats or math or something like that. I wanted to deal with people not computers, grant applications, etc. Then again, therapists don't deal with people all day either, spending too much time dealing with paperwork and insurance crap.

 

[docjohng]

The fact remains that a wealth of empirical data simply do not exist to confirm our own personal prejudices about whether or not more training = better patient outcomes. Yes, there are some studies that are suggestive of a trend along these lines, but there are also studies that dispute this trend.

It remains completely astounding that 20 years after I first entered grad school and realized that these studies had not been done, they still haven't been done. If you want to shut up critics of whether you need a doctoral degree in order to do good therapy (and there are tens of thousands of master's degree-level therapists nationwide who would vigorously disagree with you right now), then simply do some good, robust research into the issue. (Robust meaning more than a few dozen therapists studied.)

Until you have the empirical data, it's just a bunch of anecdotes from people who have invested self-interests in mind when arguing their points. Entertaining, for sure, but not really going to make any difference in the field in the long run.

John

 

[ClinPsycMasters]

And who with what kind of agenda is going to fund this big study? We rely on findings from quality studies, but there is bias in what gets researched, what gets funded, what gets published, and what gets cited. I'm a Kuhnian at heart though have great respect for Popper.

 

[teo3099]

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[PsychGraduate]

The fact remains that a wealth of empirical data simply do not exist to confirm our own personal prejudices about whether or not more training = better patient outcomes. Yes, there are some studies that are suggestive of a trend along these lines, but there are also studies that dispute this trend.

It remains completely astounding that 20 years after I first entered grad school and realized that these studies had not been done, they still haven't been done. If you want to shut up critics of whether you need a doctoral degree in order to do good therapy (and there are tens of thousands of master's degree-level therapists nationwide who would vigorously disagree with you right now), then simply do some good, robust research into the issue. (Robust meaning more than a few dozen therapists studied.)

Until you have the empirical data, it's just a bunch of anecdotes from people who have invested self-interests in mind when arguing their points. Entertaining, for sure, but not really going to make any difference in the field in the long run.

John

There are many with master's with relevant high quality training who are published and working. Besides the politics which is a shame, the research should be done.

 

[PsychGraduate]

The battle is never fought for the over-achievers, instead it is fought for the <50%, as they are the ones most likely to cause problems. I don't agree that the top few are trying to hold down the masses, though I do concede that no one likes scope creep, so they will actively fight it. The response should not be brute force, but instead science and outcome studies. Many professionals object to the "there are more of us than you" tactics, which is not a sound reason for making change.

How do you qualify your first sentence? Matter of fact how do you defend your choice of word never? Is there empirical evidence the claim or a general consensus amongst the majority of overachievers that there is no battle? I do not share this optimism based upon my own experiences and peer reviewed data on racially motivated practices, ethnocentricism, socioeconomic status, and false interpretations of affirmative action which I WILL NOT GET INTO DETAIL IN THIS THREAD

There are whole courses and PhD theses based upon the psychology of class, race, ethnicity and the workplace.... nuff said.

Change should be based upon results. Outcomes based analysis and some more research into the actual methods employed is probably helpful. However, all one has to do is look in their college library website or on google scholar to see some robust data on those who hold master's degrees doing ethical, practical and beneficial work in diagnostic assessment, intense therapeutic interventions, high quality peer reviewed research, and writing manuals that PhD's learn from. I am not pointing any fingers but some in our profession are making very large assumptions and not looking at the wealth of scientific data that already does exist.

 

[ClinPsycMasters]

The idea that research is simply "do[ing] stats all day" surprises me. Research encompasses critical thinking, problem solving, literature analysis, research design, statistics, interpretation of results, undergoing peer-review, collaborating with other researchers, writing skills, etc etc etc.

Research has forced me to become far more intimate with a subject than taking a class or teaching a class was ever able to do. And I'm a relative research novice, but I know that without my experience so far I would be lacking severely in my ability to approach psychology scientifically. Practice creating my own research has increased my ability to understand, critique, and integrate other people's research as well.

I'm not saying that all research has to be strict double-blind clinical trials (try some qualitative approaches if you hate numbers--or collaborate with a statistician. Or write a theory paper) but I truly don't believe that someone is fully capable of understanding their chosen field unless they take part in at least a moderate level of research and contribution.

FWIW, I agree that many aspects of research can be somewhat painful. Grants, IRB approvals, participant scheduling, stats, and more can be pretty draining, no doubt.

Ah, I'm just in a bad mood TBH. I spent a good deal of time working on my supervisor's projects which I did not find interesting at all. If I find something that really really interests me and is well funded, I don't mind doing the mind-numbing stats. But it has to be MY project. That means I get to do the critical thinking and problem solving. I also love doing lit search. My favorite part is study design. I absolutely love it.

But I really rather leave the rest ("grants, IRB approvals, participant scheduling, stats" which you mentioned) to someone who has more patience, better writing skills, and greater mastery of stats.

 

[Manicsleep]

I decided to write this in hopes that it might bring some of us closer together vs. further apart.

I have become increasingly disappointed in the lack of respect we, as mental health professionals, have for one another. I have read numerous threads where individuals argue about the differences between PhD vs. PsyD; look down upon master level therapists; MD's arguing with PhD's about "who's more qualified" or "who had the most rigorous training". I have read complaints that social work is stealing the frontline from psychology; I have also read that psychologists are infringing on psychiatrists' rights to prescribe. Many psychologists look down at social workers, while many social workers consider psychologists to be pompous and arrogant.

What the heck is happening here? Don't we realize that we are all more similar than different. Hopefully, we all entered this profession in order to help others by utilizing our own unique backgrounds and trainings. How dare we belittle each other in order to make ourselves feel superior.

I would like each of you to answer and respond to this one simple question: Why did you decide to become the professional that you are today?

I think a lot of it has to do with money.
Professionals want to make more money while those in the health care business want to pay less money.
If you can get a PA to do a psychiatrists job, do it. If you can get an LCSW/MFT/Psych Tech to do the job of a psychologist, why not. It's all about getting the best productivity for the least amount of money.

When people lose jobs they get angry.

I became a psychiatrist because: It allows me to do all of the above in the mental health field. I chose mental health because I find it fascinating. I chose sleep because I wanted to go beyond psychiatry...although technically its still psychiatry.

 

[teo3099]

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[KillerDiller]

How do you qualify your first sentence? Matter of fact how do you defend your choice of word never? Is there empirical evidence the claim or a general consensus amongst the majority of overachievers that there is no battle? I do not share this optimism based upon my own experiences and peer reviewed data on racially motivated practices, ethnocentricism, socioeconomic status, and false interpretations of affirmative action which I WILL NOT GET INTO DETAIL IN THIS THREAD

There are whole courses and PhD theses based upon the psychology of class, race, ethnicity and the workplace.... nuff said.

I read T4C's original post much differently. I read it as saying that nobody is fighting a battle over the over-achievers, meaning that nobody is concerned about the top representatives from each profession who are doing their jobs competently and well. However, there is concern about quality control in each profession with regard to students who fall below the average level in meeting training goals and who may be practicing beyond their scope of competence.

I guess I'm not sure what this has to do with ethnocentricity and class. Are you suggesting that all over-achievers are going to come from a privileged background? I'm honestly not sure.

 

[Therapist4Chnge]

I read T4C's original post much differently. I read it as saying that nobody is fighting a battle over the over-achievers, meaning that nobody is concerned about the top representatives from each profession who are doing their jobs competently and well. However, there is concern about quality control in each profession with regard to students who fall below the average level in meeting training goals and who may be practicing beyond their scope of competence.

That was my intended message.

 

[PsychGraduate]

I read T4C's original post much differently. I read it as saying that nobody is fighting a battle over the over-achievers, meaning that nobody is concerned about the top representatives from each profession who are doing their jobs competently and well. However, there is concern about quality control in each profession with regard to students who fall below the average level in meeting training goals and who may be practicing beyond their scope of competence.

I guess I'm not sure what this has to do with ethnocentricity and class. Are you suggesting that all over-achievers are going to come from a privileged background? I'm honestly not sure.

Not at all. My point was that many overachievers will come from the underclass and some from all different racial and ethnic groups. I was not accusing T4C of being racist or prejudice either; I was reacting to a post that I obviously in retrospect misread.

 

[PsychGraduate]

That was my intended message.

I simply misread your post

 

[TenaciousGirl]

I would like each of you to answer and respond to this one simple question: Why did you decide to become the professional that you are today?

It seems like people are ignoring this question. I'll answer it. Initially, I got into this area of study because I was fascinated with the brain, how it processes, and how it learns. As a rookie, I developed the desire to "help people." I quickly learned, thanks to a mentor of mine, that "people need to help themselves." So, I stayed in this line of work because I enjoy the fact that every single person is different and what we do requires a lot of critical thinking/evaluation about the uniqueness of each client's circumstances. And... I'm still fascinated with the brain

 

[Therapist4Chnge]

I enjoyed research and I liked the flexibility the profession offers. Teaching, researching, assessment, consultation, etc. I didn't plan on a mostly assessment and consultation career, but it fits now that I look back.

 

[psychmama]

I was working as an employment attorney and realized I was way more interested in the underlying personality issues and dysfunctional organizational systems than I was in the law part. Also, I hated fighting over right/wrong -- was always more interested in integrating and understanding rather than winning/losing on behalf of my clients.

Once I realized all of this, it was just a matter of time until I drifted into psychology. The field has problems, but I've never looked back. I'm very happy with my decision despite all of the headaches, because I love the subject matter. It's just never dull.

 

[Neuropsych2be]

I decided to write this in hopes that it might bring some of us closer together vs. further apart.

I have become increasingly disappointed in the lack of respect we, as mental health professionals, have for one another. I have read numerous threads where individuals argue about the differences between PhD vs. PsyD; look down upon master level therapists; MD's arguing with PhD's about "who's more qualified" or "who had the most rigorous training". I have read complaints that social work is stealing the frontline from psychology; I have also read that psychologists are infringing on psychiatrists' rights to prescribe. Many psychologists look down at social workers, while many social workers consider psychologists to be pompous and arrogant.

What the heck is happening here? Don't we realize that we are all more similar than different. Hopefully, we all entered this profession in order to help others by utilizing our own unique backgrounds and trainings. How dare we belittle each other in order to make ourselves feel superior.

I would like each of you to answer and respond to this one simple question: Why did you decide to become the professional that you are today?

David

I wish to gently remind you that this is primarily a forum for students not seasoned professionals and the behaviors and attitudes you see reflected here are not what one finds among working professionals. This is also a very limited sample wand what yoou observe here may noy be representative.This is also the internet, where primary process thinking emerges in all its glory. The negative intra-professional attitudes often expressed on a forum like this would never be tolerated in a real work setting. Entitlement is one of the quickest route to professional ruin after boundary violations with clients. Why did I get into this field?? Good question! I suppose its because I am just plain nosy!

 

[Therapist4Chnge]

David

I wish to gently remind you that this is primarily a forum for students not seasoned professionals and the behaviors and attitudes you see reflected here are not what one finds among working professionals. This is also a very limited sample wand what yoou observe here may noy be representative.This is also the internet, where primary process thinking emerges in all its glory. The negative intra-professional attitudes often expressed on a forum like this would never be tolerated in a real work setting. Entitlement is one of the quickest route to professional ruin after boundary violations with clients. Why did I get into this field?? Good question! I suppose its because I am just plain nosy!

I disagree.

While some of the views on here can be a bit myopic at times, you will definitely see similar views expressed out amongst working professionals. Certain settings tend to bring out more vitrol than others, so it is always YMMV.

 

[stigmata]

David

I wish to gently remind you that this is primarily a forum for students not seasoned professionals and the behaviors and attitudes you see reflected here are not what one finds among working professionals. This is also a very limited sample wand what yoou observe here may noy be representative.This is also the internet, where primary process thinking emerges in all its glory. The negative intra-professional attitudes often expressed on a forum like this would never be tolerated in a real work setting. Entitlement is one of the quickest route to professional ruin after boundary violations with clients. Why did I get into this field?? Good question! I suppose its because I am just plain nosy!

This is so very true. Also, in real-life people are too busy with their own work and family to get involved in this level of abstraction and analysis of the field.

 

[erg923]

David

I wish to gently remind you that this is primarily a forum for students not seasoned professionals and the behaviors and attitudes you see reflected here are not what one finds among working professionals. This is also a very limited sample wand what yoou observe here may noy be representative.This is also the internet, where primary process thinking emerges in all its glory. The negative intra-professional attitudes often expressed on a forum like this would never be tolerated in a real work setting. Entitlement is one of the quickest route to professional ruin after boundary violations with clients. Why did I get into this field?? Good question! I suppose its because I am just plain nosy!

I have also heard this stated before and am often confused by it. The opinions actually come from the professionals, superviosrs, professors and other students around us. The board is an outlet for peoples opinions. They came from somewhere. They came from the world we are emersed in everyday!

I also feel that this board is actually quite representative of clinical psych. We might be more vocal about our opnion, but in general, this board is a good mix of scientist-practioners ph.d people and practioner-scholar psy.d folks.

 

[erg923]

This is so very true. Also, in real-life people are too busy with their own work and family to get involved in this level of abstraction and analysis of the field.

I guess you've never been to an APS conference.....

 

[Therapist4Chnge]

The members farther along in the process will soon be in hiring positions, so it can matter. I know I'll probably be looking for a couple of grad students this winter/next spring for research help, and I definitely have my preferences. It will be interesting though, since I think I am the only Psy.D. in the entire hospital and medical school.

Some of the Pre-grad posters, much like the pre-med gunners, can get colorful at times, but that is part of the process.

Very true about APS!

 

[stigmata]

I guess you've never been to an APS conference.....

LOL..No I have not. However in general conferences are a mix of students and academics and not a good representation of the average working environment.

 

[PsychGraduate]

LOL..No I have not. However in general conferences are a mix of students and academics and not a good representation of the average working environment.

Averages aside it is good to get some exposure to all sorts of environments.