PsyD/PhD vs MFT/MSW?

[saratoga37]

I was pretty set on applying to PsyD and PhD programs until I came across this thread: Answer to: [what degree should I get MSW/MFT/MA or PsyD]. Looking at your ROI
Now, I am not sure what to do at all. NO, I am not really interested in becoming a researcher or professor; ideally, I would like to assess and treat (using CBT) children/adolescents with anxiety disorders and OCD. I was under the impression that I could not do this with an MFT/MSW. My parents are also pushing for PsyD and PhD programs because they believe I'll make more money this way (even though they know I am not interested in becoming a researcher or professor). My parents are aware of how much PsyD programs can cost and are okay with paying for it (I, on the other hand, am not comfortable with it because I don't know if the price will be worth it in the end).
Can anyone guide me in the right direction? I am so lost and stressed right now and don't know what to do.

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[psych.meout]

In general, having a mid-level degree would allow you do therapy and would be a good choice if that is all you want to do, though there are some differences in the approaches for the different masters programs, e.g. systems in MFT. If you were more interested in assessment, then a good doctoral would probably be the better choice. Assessment is where psychologists really shine and differentiate themselves from the other mental health professions.

Yes, LCSWs do some assessment and diagnosis, depending on state-level regulations, but it's not really the same as the assessment training and practice of psychologists. Psychologists receive extensive didactic and experiential training in assessment and psychometric testing, from statistics, measurement theory, to assessment techniques, to the incorporation of clinical science into assessment and psychometrics, to specific assessment tools necessary to perform comprehensive assessments. Conversely, LCSWs don't receive this kind of training, which really limits their assessments and introduces quandaries about their scopes of practice.

It's pretty clear that more extensive psychometric tests are out of the scope of practice of LCSWs, but what about self-report measures like the BDI and BAI? Anyone can administer those, but do LCSWs have the training and skills to properly interpret them as part of case formulation and treatment planning and progress? I'm not sure, but if they don't, it introduces more issues of the quality of their evidence-based assessments and interventions. If you're doing therapy correctly, you should have pre-, intermediate, and post- intervention measures to assess responsiveness or resistance to treatment and other important variables.

Ultimately, it depends on what you actually want to be doing and what is the best and most cost-effective way of getting there. A psychologist just doing therapy is probably not going to be making more than a mid-level to the degree that it makes the difference in training worthwhile. Furthermore, your parents could a lot more with the $100K+ that most unfunded PsyD programs cost in tuition alone instead of paying for you to attend a program with dubious outcomes.

 

[deleted343839]

A very important thing for you and your parents to understand is that you do not necessarily "get what you pay for" when it comes to graduate school tuition. There are fundamental flaws with quality control in psychology doctoral programs, to the extent that some very expensive programs offer uncertain prospects for licensure and entry into the profession.

I have a strong opinion in light of what you've written about your career interests. If you are interested in primarily treating anxiety and OCD spectrum conditions, I would recommend that you attend a balanced clinical doctoral program (emphasizing both research and practice) so that you can understand in depth the empirical basis for these treatments and be able to design and carry out a competent treatment plan. An adequate assessment and conceptualization will make your work with these conditions much more efficient and effective. I say this in part because applying theories of learning and behavior has had a huge payoff for these specific disorders, and because in my own practice I've treated patients who languished unnecessarily with supportive therapy or CBT-lite.

In practice, therapy can be a very creative process, but the science should always be your guide. When your real world patients go "off script" (i.e., not textbook, i.e., the majority of people) then your deep knowledge of applying theories of learning and behavior will help keep you on course. In this regard you'll have a much better foundation as a Ph.D. (or well trained Psy.D.) and you might be able to obtain the degree with little to no debt (to you or your parents). If you are going to specialize and market yourself as the go-to person for a given population, you owe it to yourself and your patients to become an expert.

 

[foreverbull]

Assessing OCD and anxiety diagnostically (i.e. With the dsm-5) doesn't require a doctorate; I'm not sure what kind of assessment you'd be doing based on what you said, but a master's would be sufficient as long as you sought extra training for OCD because it is specialized; my doctoral program didn't even train me to work with OCD so you have to seek out true training yourself via workshops, practicum, etc. just make sure you're using best practices and science backing. A doctorate may offer more opportunities for teaching/administration/supervision/psychological assessment, but if you have no interest in that, why spend the extra money?

Do keep in mind that it's harder to transfer a master's to another state if you want to move, and some metropolitan areas (Chicago, NYC, etc.) have too many master's level graduates and not enough supervisors to get licensing hours in a paid job, so research that issue for your area before deciding so you don't end up in the same position.

 

[saratoga37]

A very important thing for you and your parents to understand is that you do not necessarily "get what you pay for" when it comes to graduate school tuition. There are fundamental flaws with quality control in psychology doctoral programs, to the extent that some very expensive programs offer uncertain prospects for licensure and entry into the profession.

I have a strong opinion in light of what you've written about your career interests. If you are interested in primarily treating anxiety and OCD spectrum conditions, I would recommend that you attend a balanced clinical doctoral program (emphasizing both research and practice) so that you can understand in depth the empirical basis for these treatments and be able to design and carry out a competent treatment plan. An adequate assessment and conceptualization will make your work with these conditions much more efficient and effective. I say this in part because applying theories of learning and behavior has had a huge payoff for these specific disorders, and because in my own practice I've treated patients who languished unnecessarily with supportive therapy or CBT-lite.

In practice, therapy can be a very creative process, but the science should always be your guide. When your real world patients go "off script" (i.e., not textbook, i.e., the majority of people) then your deep knowledge of applying theories of learning and behavior will help keep you on course. In this regard you'll have a much better foundation as a Ph.D. (or well trained Psy.D.) and you might be able to obtain the degree with little to no debt (to you or your parents). If you are going to specialize and market yourself as the go-to person for a given population, you owe it to yourself and your patients to become an expert.

Thank you! I understand people's concerns that it may be a "waste of money" (I understand and appreciate what you brought up concerning that), but I had been wondering if a master's would truly give me adequate knowledge to work with patients in the most effective manner. Thank you for assuaging my concerns, I actually had been looking at balanced doctoral programs, so I will continue doing so.
Question: does this mean I need to apply to work with professors studying these areas, or will there be opportunities for me to focus my studies on anxiety and OCD spectrum conditions in labs that may not necessarily focus on those conditions? None of my clinical/research experience has really had much to do with those conditions--my lab focused on ADHD, and few participants had OCD/anxiety for me to come up with a research question pertaining to them (I have more experience with data concerning depression).

 

[deleted343839]

Thank you! I understand people's concerns that it may be a "waste of money" (I understand and appreciate what you brought up concerning that), but I had been wondering if a master's would truly give me adequate knowledge to work with patients in the most effective manner. Thank you for assuaging my concerns, I actually had been looking at balanced doctoral programs, so I will continue doing so.
Question: does this mean I need to apply to work with professors studying these areas, or will there be opportunities for me to focus my studies on anxiety and OCD spectrum conditions in labs that may not necessarily focus on those conditions? None of my clinical/research experience has really had much to do with those conditions--my lab focused on ADHD, and few participants had OCD/anxiety for me to come up with a research question pertaining to them (I have more experience with data concerning depression).

Again, this is just one opinion, but if it is your intent to specialize in anxiety and OCD, then yes, I would apply to work with someone who does research in this or a closely related area. You can also get good training as an intern and/or a postdoc, but the more foundational training you get in grad school, the more you can leverage your later training year(s) to deepen your expertise and skill.

It's not that you can't evaluate and treat these conditions with a master's degree. You definitely can, especially if you are willing to invest in high-quality post-licensure training and consultation. But my point was that, if you want to specialize and become known as the go-to person for these disorders, a doctorate will likely serve you better.

 

[saratoga37]

Again, this is just one opinion, but if it is your intent to specialize in anxiety and OCD, then yes, I would apply to work with someone who does research in this or a closely related area. You can also get good training as an intern and/or a postdoc, but the more foundational training you get grad school the more you can leverage your later training year(s) to deepen your expertise and skill.

It's not that you can't evaluate and treat these conditions with a master's degree. You definitely can, especially if you are willing to invest in high-quality post-licensure training and consultation. But my point was that, if you want to specialize and become known as the go-to person for these disorders, a doctorate will likely serve you better.

Thank you! That is exactly what I want to do.

 

[DD214_DOC]

How are LCSW's actually trained? My institution assumes they have the ability to both diagnose and treat any behavioral health problem with the same level of competency as a psychologist or psychiatrist. In my experience working with many of them, both the psychologists and I constantly lament on an almost daily basis how none of them really seem to have a clue what they're doing -- both with diagnosis and treatment. This significantly increases our workload as we have to clean up the messes they make, or actually provide the effective treatment they seem to be incapable of.

I'm curious if we just have a bad group of them, or if this experience is shared with others.

 

[WisNeuro]

How are LCSW's actually trained? My institution assumes they have the ability to both diagnose and treat any behavioral health problem with the same level of competency as a psychologist or psychiatrist. In my experience working with many of them, both the psychologists and I constantly lament on an almost daily basis how none of them really seem to have a clue what they're doing -- both with diagnosis and treatment. This significantly increases our workload as we have to clean up the messes they make, or actually provide the effective treatment they seem to be incapable of.

I'm curious if we just have a bad group of them, or if this experience is shared with others.

Varies, IME. I have some great SWs who do case management, run some groups, and do some low level therapy type stuff. But, I've also worked with some who thought their scope was MUCH broader. This often led to misdiagnoses. This can be quite tedious to clean up, as you've said, because patients sometimes tend to get quite protective of their diagnoses, even if they aren't accurate. In the VA, we also had some problems with some of them telling their patients that they had TBIs and deserved SC even when there was no TBI, not even mild.

 

[dynamicdog]

How are LCSW's actually trained? My institution assumes they have the ability to both diagnose and treat any behavioral health problem with the same level of competency as a psychologist or psychiatrist. In my experience working with many of them, both the psychologists and I constantly lament on an almost daily basis how none of them really seem to have a clue what they're doing -- both with diagnosis and treatment. This significantly increases our workload as we have to clean up the messes they make, or actually provide the effective treatment they seem to be incapable of.

I'm curious if we just have a bad group of them, or if this experience is shared with others.

 

[dynamicdog]

IME, and of course this also varies, I've had more issues with psychiatry when it comes to diagnosis and treatment. Particularly with psychiatry residents, but also some attendings.

 

[PsychPhDone]

How are LCSW's actually trained? My institution assumes they have the ability to both diagnose and treat any behavioral health problem with the same level of competency as a psychologist or psychiatrist. In my experience working with many of them, both the psychologists and I constantly lament on an almost daily basis how none of them really seem to have a clue what they're doing -- both with diagnosis and treatment. This significantly increases our workload as we have to clean up the messes they make, or actually provide the effective treatment they seem to be incapable of.

I'm curious if we just have a bad group of them, or if this experience is shared with others.

It varies. In the last couple settings I've worked in (both VAs), social workers were not allowed to diagnose. That was left up to psychiatrists and psychologists.

 

[WisNeuro]

IME, and of course this also varies, I've had more issues with psychiatry when it comes to diagnosis and treatment. Particularly with psychiatry residents, but also some attendings.

Psychiatry has generally been ok where I've worked. My main issues with them are their proclivity to diagnose cluster B as Bipolar disorder and their misunderstanding of the TBI/CTE literature.

 

[Therapist4Chnge]

Psychiatry has generally been ok where I've worked. My main issues with them are their proclivity to diagnose cluster B as Bipolar disorder and their misunderstanding of the TBI/CTE literature.

Same.

The challenge with MSWs seems to be the wide range of training, depending on their program. IME some were much more comfortable and competent with case management and lining up community resources, while the other side of the spectrum was more traditional supportive therapy and sometimes EBTs. At my last hospital some MSWs were forced into responsibilities outside of their core training, which was hard on everyone.

Diagnostic skills and differentials tend to be the biggest weakness across the spectrum of training. In some instances it was minor, but the mTBI example above was a frequent challenge at my last hospital.

 

[WisNeuro]

Diagnostic skills and differentials tend to be the biggest weakness across the spectrum of training. In some instances it was minor, but the mTBI example above was a frequent challenge at my last hospital.

Well, my mTBI example was targeted at psychiatrists. Although, most providers do a poor job at understanding, or wanting to be educated, head injuries and the course of recovery depending on severity.

 

[Therapist4Chnge]

It definitely applies to both groups....particularly in regard to mTBI and mild complicated cases.

 

[DD214_DOC]

IME, and of course this also varies, I've had more issues with psychiatry when it comes to diagnosis and treatment. Particularly with psychiatry residents, but also some attendings.

Sadly, I cannot disagree with this. There are good and bad in every field, but some tend to have more of one than the other. I clean up messes inherited from other psychiatrists as well, and I am just as vocal with my criticism of them as anyone else. I am literally the only subspecialist of my type at my facility, so I have no choice but to rely on other professionals for the bulk of non-pharmacologic treatment. The two PsyD's are great and trusted colleagues and friends. The LCSW's, on the other hand, supply me with endless frustration. Patients we share ultimately end up coming to me more frequently than is necessary because I end up having to do the other interventions that their therapist should be doing, but isn't.

I was really just curious if this was a local phenomenon or pretty typical for LCSW (who the psychologists equally loathe for the same reasons).

 

[DD214_DOC]

Psychiatry has generally been ok where I've worked. My main issues with them are their proclivity to diagnose cluster B as Bipolar disorder and their misunderstanding of the TBI/CTE literature.

One thing to point out regarding the psychiatrists misdiagnosing things. Yes, there are crappy/lazy/idiotic psychiatrists out there -- I inherit their messes to clean up as well. However, many insurance providers will not reimburse the costs of outpatient treatment, hospitalizations, or prescriptions unless they're attached to an, "acceptable" diagnosis as determined by the insurance company. For instance, some medications are used off-label for certain symptoms in borderline PD. However, insurance will not cover the cost of medications for a personality disorder. These same medications do have indications for bipolar, and insurance will cover it for that. I have read/heard this is becoming less of a thing in the past couple of years, but since I don't work in the private sector I can't say.

 

[WisNeuro]

One thing to point out regarding the psychiatrists misdiagnosing things. Yes, there are crappy/lazy/idiotic psychiatrists out there -- I inherit their messes to clean up as well. However, many insurance providers will not reimburse the costs of outpatient treatment, hospitalizations, or prescriptions unless they're attached to an, "acceptable" diagnosis as determined by the insurance company. For instance, some medications are used off-label for certain symptoms in borderline PD. However, insurance will not cover the cost of medications for a personality disorder. These same medications do have indications for bipolar, and insurance will cover it for that. I have read/heard this is becoming less of a thing in the past couple of years, but since I don't work in the private sector I can't say.

I understand the insurance thing, to a point. Although, it was essentially similar in the VA where we didn't really need to worry about insurance. Also, the patient's become very tied to their "Bipolar" diagnoses and become very resistant to any treatment for Borderline PD. Certain behavioral interventions work far better than meds for these people, and the misdiagnosis keeps them from ever exploring those options in many cases. More harm then benefit IMO for many of these people.