Psychoanalytic Psychotherapy, PhD in Counseling, Soc. Work, or Psychology?

[js1221]

I am considering further training and would like some input.

I am a master-level counselor with a CRC certification (certified rehab counselor), and I did the credits needed for mental health licensure (LPC or LMHC), but I do not have the 3000 supervised work hours needed for licensure yet. I am dissatisfied with working as a vocational rehab counselor for a state agency, which I have done for four years (the agency refuses to let supervisors sign off on hours for mental health licensure), and my goal really is to transition to work as a mental health therapist. So, how to make the transition... it has not been an easy exploration. One thought is, because I have a strong interest in psychoanalysis and psychotherapy, I have considered attending a two-year psychoan. psychotherapy training program that I could do in addition to full-time work - a few people think I am crazy for wanting to do this as it could be stressful. This first option would allow me to have training in psychotherapy, and acrue hours toward LPC. It would probably take four years to acrue the 3000 hours, on a part-time basis, and then when I'm all done, I will be able to work as a therapist from a psychoanalytic perspective with an LPC license, but I doubt it would increase my earning capacity - but it would certainly be more what I want to do. The second option I am considering is a doctoral degree. I have considred the following: PhD in Rehab Counseling/Administration, doctoral degree in Social Work, or PhD or PsyD in Psychology. I am not yet sure which degree would be best for me or allow for the greatest increase in earning capacity, but I am thinking likely that would be psychology.

Questions:

1. What are the benefits of a doctoral degree in Psychology over Counseling, or Social Work?

2. Also, would a PsyD or PhD really increase earning capacity beyond that which a mastersl-level therapist could have? I know that for psychologists who are professors, school psychologists, neuropsychologists, and psychologists working for the federal government, salaries do tend to be higher, and psychologists working in large metropolitan areas - but what about clinical counseling? For one who would like to practice as a psychotherapist, I am wondering whether it would be worth it to pursue a doctorate degree in psychology, or would doing two years for psychoanalytic psychotherapy plus another few years to accumulate hours for LPC be just as worth-it? (I do also have some interest in research and teaching).

A bit about my interests, for those who wish to respond: I am interested in practicing psychotherapy from a psychoanalytic or psychodynamic perspective. I do have some interest in teaching at the college level. I do have an interest in research. My interests are in vocational and life transition and crisis, and traumatic experiences, and how people cope through change and crises, the resources they find helpful, and how people find new purpose and meaning through crisis. I am also interested in the interrelationship between right and left brain, between emotion and language, implicit and explicit experience, felt meaning as symbolized through language, and language to access inner meaning; as Eugene Gendlin puts it, "the felt sense". I am fascinated by the work of Jill Bolte Taylor. The work of Heinz Kohut and self-psychology, and also object relations is fascinating to me. Also, I am fascinated with the work of psychoanalyst Salman Akhtar on immigration experience. My favorite (living) career theorist is Mark Savickas, PhD. And, being a rehab counselor, I still also have a strong interest in people with disabilities (especially psychology of disability, and adjustment to disabilitiy). Also, my bachelors is in music and I play a variety of instruments and I am a composer. So, that is some background.

Things I am concerned about in moving forward are: 1) the cost of further education. I already have a 60K education loan I am paying on. I may be willing to do a doctorate if I knew it could lead to more substantial and rewarding work personally and financially, and if I knew the degree could be covered with financial aid. But, it seems like a dauting task to find aid for graduate work these days. I am jealous of those who earned a psychology doctorate in the 70's when funding was ample and who had their whole degree covered by grants, stipends etc! 2) The second concern is that I make sure I choose something that will allow me to do what I really want to. I would regret gonig through a doctoral program that does not offer more in-depth training in therapy than I have now.

I would appreciate any thoughts, advice, recommendations.

Thank you!

js1221

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[Vasa Lisa]

Why not try to find a job as a licensed eligible mental health counselor to accrue hours? You may have to pay for your supervision. But you would be doing the work that you want to do. My state makes the transition from rehab counselor to clinical mental health counselor difficult. It may be easier in your state. Did you complete a mental health practicum and a mental health internship? If so, I would look for job as a counselor.

I wish you the best and suspect you will find your way.

 

[js1221]

The problem with that is actually finding a job to acrue the hours...not as easy as it may seem. I am finding many mental health settings want to hire those who aleady have licensure. Unfortunately in my masters my internships didn;t give me experience with DSM diagnosis, but I did take a psychopathology class in grad school.

 

[Vasa Lisa]

I am guessing you might have to bite the bullet and see if you can complete a *MH* clinical placement. That is where we learn how to dx. The mh training is very different from the rehab training in my state. It used to be pretty easy to become a professional counselor with the rehab background. Now it is almost impossible.

I am curious how closely your coursework aligns with CACREP.

 

[js1221]

Vasa Lisa: Thank you for your curiosity 🙂 Biting the bullet seems unfortunately what a lot of counselors are needing to do... and by counselors I mean those trained in CACREP or CORE programs, ACA-related. Counselors still have to fight harder for acceptance than social workers and psychologists.

I attended Syracuse Univ. for my master's, and the Rehab. Couns. program was CORE accredited, and all the other divisions (school, community couns., higer ed.) were CACREP accredited. I did a 60 credit master's (48 rehab, 12 community counseling).

Sadly, Syracuse closed their rehab program because enrollment was down and they lost their RSA grant; now I believe the program is solely CACREP accredited, but I may be wrong. From what I was told by a professor of a doctoral counseling program recently is that a lot of CORE programs are converting to CACREP.

 

[Vasa Lisa]

That just stinks! There has to be some way into the system from your background and training. Have you tried contacting the board of counseling in NY to see what options are available? Do you have a local counselors association? or state counseling association? ACA hasn't done a lot for me other than give me discounted liability insurance... But my state and local chapters have been great.

Other people have to be in your same situation. What have previous graduates done?

I am ignorant about the CORE requirements, but I do know that in my CACREP CMHC degree there was a lot of counseling and therapy practice and supervision before the practicum and internship. We came out prepared to be employed.

A lot of my peers work with intensive in home services (because there are $$$ there). Some work at community mental health centers. Others work at small agencies. I had a 2 semester unpaid practicum (I used my 3 credit elective for a second practicum) and a two semester unpaid internship where I commuted over 60 miles a day (one way, and it was uphill both ways <grin>). For the that was the biting the bullet time.

Now I work in a very small private practice setting where I am slowly, slowly, slowly, accruing my direct hours. I need 2000. I already have my 2000 indirect and then some! I pay for my own clinical supervision but it is totally worth it.

With your determination, I am sure you will find a way in!

 

[js1221]

I think a way in is either through continued ed...e.g. a 2-year psychotherapy program and accruing hours at the same time, or a doctorate. I will also check out state ACA divisions for resources/support...that is a good suggestion.

 

[PhDstudent1982]

I have my MSW and have had a similar experience where most agencies want someone who is licensed. It is getting more difficult for pre-licensed individuals to find employment.

 

[BlackSkirtTetra]

I have my MSW and have had a similar experience where most agencies want someone who is licensed. It is getting more difficult for pre-licensed individuals to find employment.

It's because the economy is stale and the job market (even for MSWs) is so saturated. As an employer, when there are 20 or 40 LCSWs applying for one job, you don't have to worry about offering supervision to newly-graduated MSWs.

That's another reason why it's important to have a concentration and extra training or qualification. You may be the 50th MSW who has asked them to supervise you for licensure, but if you've had extra trainings and advanced coursework, they'll more likely choose you over somebody with all the "standard" options.

 

[Isadora]

A few things:

You are not going to learn how to adequately do psychoanalysis in two years. Psychoanalysis is really freakin' complex. The schools that offer the "official" psychoanalysis program require a doctorate or a medical degree with a residency in psychiatry, as well as a 7 year commitment. Not only do you need to guide your clients, but you need to be able to analyze yourself in a psychoanalytic manner. This is not easy. Implementing psychoanalytic therapy is also difficult despite it's simplicity on the surface. I took a semester long class in psychoanalysis with a trained analyst. We didn't even take a dent out of all that is psychoanalysis.

Now, if you're interested in more psychodynamic work, that can actually be found within a few different modes of therapy. I suggest seeing if you can find some free workshops in your area on therapy topics. Interviewing therapists is also helpful. It's been in my experience that people in the field are very welcoming and happy to share their experience.

You have a lot of interests. Ultimately, it is the skill of the clinician and the therapeutic relationship that make therapy successful for a lot of people. However, you have to contend with managed care and evidence-based practice. Evidence for psychoanalysis working outside of personality disorders is in it's infancy, and you will run in to trouble getting reimbursed if you opt to utilize this therapy due to the notion that it is long-term (analysis is long-term, but psychodynamic methods aren't necessarily). Also, insurance companies rarely cover treatment for Axis II diagnoses, so you may find yourself in the quandary of tacking on a BS Axis I diagnosis so the person can get therapy and having their progress notes and treatment plans reflect the Axis I diagnosis - assuming you go the personality disorder route.

Some of your interests might be better served with different modes of therapy. Vocation, crises, and trauma are very here-and-now focused topics. However, getting to the deeper stuff is usually necessary to help folks maintain. Whatever theory works for you. It might not actually hurt to get some brief solution-focused therapy training prior to psychoanalytic training so you can take care of the immediate needs of job searching and relationship problems. Just a thought. Nothing wrong with being a little eclectic, provided you are careful.

By the way, you can get your student loans forgiven if you work for an agency that is considered to be high priority due to population. They're usually either rural or in at-risk neighborhoods. These agencies are going to require brief here-and-now type therapy, but sometimes you gotta get the bills paid before you can do what you really want. The VA also offers assistance in paying back loans. They pay very well and have great benefits.

Check with your licensure board to see who can sign off on supervision. In my state, social workers, psychologists, and psychiatrists can sign off of mine. If you're stuck going with someone outside of your workplace, you may have to pay the big bucks for your hours. Sucks, but you do what you need to.

Like it's been said, the internship is where the experience is. However, there are ways to get mental health experience without taking months off of work. Find a psychiatric hospital and volunteer there. Oftentimes hospitals will give volunteers who apply for jobs just as much priority as an internal candidate, or atleast more than an outside applicant. I'm doing that right now. It's only a couple hours a week, and it's rewarding. I get to visit a client, chat with them, and take them out of the hospital to get some exercise or coffee or whatever so long as they're doing well. The therapists and medical folks are great people to get to know.

To get mental health experience prior to graduate school, I took a low-paying part-time clerical job at a CMH agency. I pestered and pestered until they let me work with people. I ended up with an extra ten grand or so per year in pay, references for grad school, and I met a lot of awesome people. Well worth it.

As for degrees - social work and counseling doctorates are academic degrees. Master's degrees in these fields are considered terminal. It's unlikely that you'll make enough money with a doctorate to warrant taking the time out of your life to do it. But, you'll want to pick a doctoral program if you want to do research. A master's in social work has more clout with insurance and public agencies in a lot of states, but insurance companies and public agencies base their decisions to work with you on your experience. Insurance companies, believe it or not, often make decisions to add you as a provider on a case-by-case basis. Aetna is an example of this. You'll want to research the professions further to see what is a better fit for you.

Now, a doctorate in psychology is going to give you the most clout in terms of scope of practice legally, but many insurance companies are reluctant to work with doctoral psychologists because they charge more than master's level social workers and counselors. Again, it's all about how you play your cards. If you're interested in neurological stuff, clinical psychology may be the way to go. There is the option of counseling psychology, but they tend to be less brain-focused. You'd learn a lot, but you need to decide if you want to commit the time. It's still possible to get a doctorate paid for.

FYI - doctoral programs are very, very competitive in terms of admissions, even schools that aren't particularly well-known. They often expect clinical and research experience prior to admission. Research experience isn't necessarily anything elaborate - data entry duties and such is fine. They mainly want you to have solid knowledge of research protocols. Oh, and having a master's already will help you if you decide to get a doctorate.

Hope that helps. I've looked into a lot of this stuff. I came to the conclusion that getting a doctorate is not going to increase my chances of success. There are many authors of books, community college teachers, group practice owners, and supervisors who have a master's degree.

Whatever you choose, good luck!

 

[HirsuteAnthony]

To make this discussion more concrete, the LCSW insurance reimbursement rate for a 45-50 minute psychotherapy session in NYC is around $80. If you were to see 30 patients per week, 11 months out of the year, you'd earn a little more than $100 K per year.

P.S. my understanding is that LCSW's are reimbursed 75% of what psychiatrists are for psychotherapy.

 

[HirsuteAnthony]

The only question is: how difficult would it be to assemble a patient-base of 30 patients, assuming you were on multiple insurance panels? Anyone have experience with this?