Last edited by a moderator:
What is being done to support SW's expansion into primary areas of therapy/diagnosis/assessment? Curriculum changes, increased req. clinical hours, increased supervision hours? My interactions with SW are similar to Jon's (social advocacy, case management, supportive work), though I don't see where the training gets to the clinician. In the previous mentioned areas they are a great asset, and they have made my life a heck of a lot easier.
The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training. I know some programs offer more of a slant to one or another, but how can that all be done in 2 years, ethically?
In cases of expansion, the group wanting to expand should PROVE that there is competency, and it shouldn't be up to the current system to PROVE they are not. Unfortunately the MA/MS level lobbies are much more active than the doctoral level, and we are losing on sheer numbers and influence.
I'd like to have a discussion (Using emperically supported data and related information if at all possible) to talk about these issues.
Is one year of school enough? I say one year, because many social work programs focus on social justice for one year. Important for social advocacy, but not for understanding mental illness.
This is also an issue with respect to assessment. For example, what constitutes an empirically supported assessment scale? What are psychometrics? What is a normative sample? For specific scales, how were they normed, what are the ceilings and floors, how are they most commonly used in clinical practice, what are the strengths and weaknesses of the scale?
The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training.
This type of empirical argument is a fallacy. . .an often repeated one. If we were to take this argument to infinite regress, it would mean no rules until there is empirical support to the contrary. In other words, I, as a psychologist, can perform neurosurgery. The local publix bagger can be a CPA. The hairdresser can be a murder trial defense attornery. . . until empirically proven incompetent. There are so many permutations to consider in this type of outcomes research that it's completely untenable. Instead, we must make logical inferences and decisions based on what we think/know is important as a knowledge-base and skillset for practice, with sprinkles of empricism. Think about outcomes research that asks the patient for example. Patients will attest to almost anything if you sell it well enough. . . *insert holistic medicine nonsense here* *insert religious babble here*. That doesn't make it correct.
This, as a defense to using EMDR? No, that's unsatisfactory. Too big of a loophole to do whatever you want. As I said, it isn't a clear demarcation. You will find odd viewpoints from a scientific/critical thinking vantage point at all levels. It's an issue of ratio and tools to perform.
Couldn't they use quantitative assessment scales (all administered by PhD Psychologists ) like they do in most outcome-based research (BDI, Y-BOCS, SENS, etc.)?
My point is that social work education is inadequate to the task with respect to informing practitioners about what is scientific and what isn't. ....Do social workers have enough theoretical/bio background to understand the explanation is complete nonsense? Nope. Does exposure therapy work just as well without the pseudoscience thrown in? Yep. Obviously, because there are plenty of psychologists/MDs that do practice things like EMDR and thought field therapy, there are inadequacies even at the doctoral level in education. We don't need to compound the problem by giving barely educated social workers free reign in mental health.
It's kind of like letting nurses practice primary care or even specialist care just because they have a few years experience. Hell, they at least get to observe a real doctor. Who do social workers get to see?
New Yorks LCSW requirement. 12 credit hours?
It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep." Interestingly, this is a trend across all health care. The coming war ... and folks I think it will be an all out war... in the medical field about the appropriate title, autonomy and clinical role of "doctoral level" nurse practitioners (with the DNP degree) mirrors this concern about "scope creep" in our field. Driving all of this is cost containment. If someone with less education (meaning cheaper) can *seemingly* do a similar job, the the prevaling economic and political forces trump any concerns about quality. My 20 years of professional work with an MS in clinical psych convinced me that the difference between a master's prepared clinician and a Ph.D. prepared psychologist was a couple years of coursework and a dissertation. Now that I am working on my Ph.D. I see that there is an enormous difference between my knowledge base and clinical sophistication as a MS level therapist and my growing skills as a Ph.D. student. The differences are not just quantitative in terms of years of school etc... but qualitative as well. In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology. However, testing this qualitative difference empirically would be an interesting dissertation topic, if it has not been done before
It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep."
The differences are not just quantitative in terms of years of school etc... but qualitative as well. I almost feel as if I am entering another profession! In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology.
I know some states (though not all) have "psychologist" as a protected term that required doctoral training.....so "masters level psychologist" is generally a misnomer.
But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively.
I have no idea. I'm really not too familiar with this stuff. I kind of bipassed the whole masters thing. I'm learning here as we go along.
Just a nitpick, but there is no such thing as a masters level psychologist (exception: school psychologist, but the school modifier is necessary).
. . .and I would put them (masters level) on approximately equal footing to social workers in my current understanding of the situation. And, I'm not arguing that social workers are incompetent as a whole, only that some are operating outside of competencies (e.g., diagnosis) and scope creep (I like that term) promotes more and more risks of that kind of situation.
Just to play devil's advocate (not the pinball game, though you rock if you got that reference ), isn't there a real need for mental health practitioners in general, especially in rural areas? I want to practice in a rural area with an underserved population, and in many of areas where I want to work, there's almost NO practitioners of any type (MA, MSW, PhD, PsyD, MD). Sure, NYC, CO, and Cali are saturated. The rural northwest? Not so much.But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively
In fact, I think it would probably be a good idea for clinical-track MSW programs to require a degree in psych or substantial post-BA psych education and place more of an emphasis on research.
No way this would ever happen....as it would eliminate most of the people going for the degree, as they wouldn't want to jump through those hoops.
2000 hours of post-degree supervision
an inferiority complex social work as a profession seems to have vis a vis the other professions
Well if one wishes to argue the equivalency of an LCSW and a Ph.D. in clinical psychology, perhaps we could agree that a Ph.D. or DSW (Doctor of Social Work) degree should be the minimal educational standard for the independent practice of clinical social work
I have known some clinical psychologists (professors) to recommend that students who want to do just therapy work (and have little interest in academia) consider MSW programs, as they believed MSW/LCSWs are/were competent clinicians. Just throwing that out there... Like I said, I believe there's real value in doctoral training (I wouldn't be applying otherwise), but I think it's somewhat rash to dismiss LCSWs as incompetent across the board.
The problem for me is social workers are not supervised. They are independent practitioners. Diagnosing mental illness/behavioral presentations requires a lot more than just knowledge of the DSM.
I don't see how a license that requires "at least 12 hours" or clinical coursework can possibly be adequate.
In my opinion, doctoral level psychology also needs to beef up their biological/neuropsych educations.
I didn't know what I didn't know until I started my MS in Pharma. I had to take orgo, A&P, biochem, pathophys, etc. It isn't that I am advocating for all of that, but taking single courses in Pharmacology, Psychobiology, and maybe Neuroanatomy is hardly sufficient nowadays. I think more neuro-based courses need to be required.
This thread should (and the closed ones that precede it) should be required reading for prospective clinical social work students. It highlights a few of the joys of being a social worker.
1)you'll get to work mostly with two types of psychologists. One type will be like Jon Snow, and be openly condescending and dismissive of your abilities. The other type will also generally think you're an idiot, but will be too nice to talk like this around you.
2)expect plenty of backhanded praise from other disciplines such as "social workers do have excellent skills in providing support and advocacy," i.e. they are good at things any reasonably intelligent person could have figured out how to do without getting a masters degree.
3)Despite the complaints about social workers assessing and diagnosing, don't expect your psychologist co-workers to be leaping to accept your referrals for testing and assessment.
4)Do expect your psychologist co-workers to refer every single task that might be related to one's "social" functioning to you. Expect calls asking things like what are the local bus routes home from the clinic, or my favorite "the patient I have been seeing for two years asked me to fill out a form for his work, can you do it?" Or, "my patient with depression is depressed because he is in bankruptcy, could you see him, I only treat his depression?"
5)Everyone thinks you're an idiot. If you work extra hard, keep up with current literature/research, have a track record of success, take a leadership position, etc. they might rethink that. Now they'll both think you're an idiot and resent you.
On the other hand there are some valid reasons why people see us this way. A few that come to mind:
1)we accept anybody. anybody with a pulse can get an MSW. Regardless of what it says in other threads, our programs aren't selective, and they are incredibly easy. Garbage in, garbage out.
2)Our curriculum is filled with 60's/70's platitudes. Expect liberal indoctrination about how "western" culture is individualistic and shallow, whereas "eastern" cultures live in harmony and joy. Jon Snow is wrong about there being a "social justice year." I'm not sure where he got that, but learning absurd "facts" like "dangerous radicalism almost always rises from the right wing" and "Husserl was the first existentialist" made it into my "human behavior" classes.
3)our professional organization, the NASW is extremely obnoxious. Expect to hear their views on how you should vote, what you should believe, and I better stop before the black maria arrives at my door to carry me off for re-education.
I try to not get hung up on this stuff. You learn solid clinical skills in MSW programs that can help a lot of people. I'm sure the same is true for clinical psych. There will always be total tools who get a lot of satisfaction out of hating on each others disciplines sort of like i did in the first part of the post. It's amusing yes, but ultimately pretty stupid. I'm sure I could walk on water, cure severe TBI with my touch, and end world poverty tomorrow, and someone like Dr. snow would still have a "yes but" to disparage social work.
I think "scope creep" is dangerous, but I don't really think that's what this thread was about at all. It started as a "are social workers incompetent? Why yes they are!!" thread, and changed to a "make a few valid points about scope, then say social workers are incompetent" thread.
No doubt, who claimed that?
As someone who made the difficult decision to start over in a new career as a psychologist in part to escape the obnoxious elitism and smugness of my former profession (lawyer), all I can say is that I'm embarrassed. I do not agree with the tone of most posts on this thread, and it makes me ashamed to call myself a psychologist in training. Maybe it's the fact that I come to this field with more life experience, but the idea that any profession has cornered the market on competence and intelligence is just ridiculous!
I wouldn't take it too seriously, it's just the internet. Plus, i don't begrudge psychologists some griping. If you complete a doctorate you should be at least entitled to get all "Dey took 'er jobs!!!" now and again with those of us who swooped in with merely a masters. Like snakes in the grass if one is fond of mixing metaphors which i am. I'm personally fond of all the psychologists I work with.
Heh. I've seen this style of response before. Notice, I haven't attacked anyone, but I'm sanctimonious and a *implied* poor clinician because of my style of posting on a messageboard and because I support high standards and worry about the product mental health providers represent to the public and other professionals. But instead, this constantly is interpreted as if I'm playing turf war and being elitist. Right, right. In case you haven't noticed, mental health as a collective enitity has taken major hits in reputation in the public eye because of a lot of the things that I rant about. And yes, I'm pissed about it. I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto. It's annoying. . . . as if this has anything to do with my ability to establish rapport or show compassion for a patient. . . or anything to do with whether or not I'm a nice guy. Yeah, I care about the field.
Heh. I've seen this style of response before. Notice, I haven't attacked anyone, but I'm sanctimonious and a *implied* poor clinician because of my style of posting on a messageboard and because I support high standards and worry about the product mental health providers represent to the public and other professionals. But instead, this constantly is interpreted as if I'm playing turf war and being elitist. Right, right. This is self-serving. In case you haven't noticed, mental health as a collective enitity has taken major hits in reputation in the public eye because of a lot of the things that I rant about. And yes, I'm pissed about it. I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto. It's annoying. . . . as if this has anything to do with my ability to establish rapport or show compassion for a patient. . . or anything to do with whether or not I'm a nice guy. Yeah, I care about the field.
I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto.
Wait. I'm confused here--is the argument that social work (LCSW) has a disproportionate number of "non-thinkers" or that mental health in general (PhD, PsyD, LCSW, MA/MS, MD) has a disproportionate number of "non-thinkers"?But, I don't think social work corners the market for fluff non-thinkers.
The problem for me is social workers are not supervised. They are independent practitioners. Diagnosing mental illness/behavioral presentations requires a lot more than just knowledge of the DSM.
So, you essentially believe social workers should do *nothing* clinical...? Wow.
^ From what I've seen/heard, masters-level practitioners are able to perform some assessments now (primarily administration of certain objective measures). I haven't done any real research in this area since my goal is to pursue my doctorate but I know that even the BA-level practitioners at the place I worked recently were able to administer some behavioral analysis measures and write up reports that went in clients' files and were later filed with DMHS.
Have the psychologists you've worked with had issues against you practicing clinically (as a therapist)?
yes, definitely different, no doubt about it... but necessarily better? if so, better by whose standards, the client's, the professional colleagues', the drug companies', etc. I absolutely crave that greater understanding and that's why I'm moving on but I am not willing to concede that remaining a master's level clinician would have damaged anyone beyond repair. (other than myself... ha)
I love your observation of RxP being pretty much the same bunch of grapes, different fruit basket. Pots and kettles and credentials oh my! I'm going to use this thread as my promise to myself never to bash LPC's again... the fingers wag in many directions.
How about Master's level physicians? Does this explain why Doctoral level mental health might be desired AND better than Master's level ones. I don't think you would feel comfortable seeing Eli Bart, M.S. to do your spleen surgery, or would you?
Well see, that's the thing. You go to a PA because you can't get into see a doc, you think you only have a cold or whatever, and it's cheaper. You don't go to a PA if you really think something is wrong. That's how social work and other masters level folks should be used with respect to therapy in my opinion. But, that's not the case.
Which is great, but so what? You can't change a profession's focus by ranting about it online, and you're unlikely to change people's minds by making empty arguments that have little outcome research support.
I also think the basis for your argument is questionable. Is there a finite economy for mental health professionals, or is it an ever-expanding profession comprised mostly of various types of professionals who mostly work together, get along, and respect one another's professional perspectives?
If it's a finite, closed economy, then yes, professionals will have to scratch and claw amongst themselves for competition and to rally against each group from infringing on what they view as their rightful areas of expertise.
But I'd argue we don't live in such a closed system, that instead we live in a very dynamic and ever-changing system. This could be evidenced by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges. Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).
We don't need to make this a battle between professions and I think that's the exact opposite direction that the rest of the world is going in, especially as patients themselves become better educated and informed not only about their disorders, but possible treatment and treatment techniques. It's becoming an increasingly collaborative environment amongst clients and their therapists, and I'd suggest it's far more productive for professions to also collaborate rather than to raise the drawbridge and declare some sort of silly war.
Unlike some who've posted to this thread, experience has taught me that each profession brings something valuable and unique to the table. And if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them. Time and research will tell whether this is a good thing or not.
Psychoanalysts frowned upon the explosion of behaviorists in the 1950s and the 1960s in America, suggesting that because they didn't have the extensive training (sometimes 10+ years postdoc) that analysts had, they were less qualified to diagnose and treat mental disorders. I see this kind of argument being no different than what is being argued here, simple turf wars that have been repeated for decades and will likely continue for decades to come.
....by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges.
Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).
....if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them.
Time and research will tell whether this is a good thing or not.
From my understanding, there has been an increase in applicants for psych positions. It still isn't at the level of more lucrative areas, but it is far from a decline in the field.
This is most likely more in reaction to dwindling reimbursement and economic viability decisions.....and not because it is menial. I personally wouldn't want to constantly give assessments, but many clinicians prefer to do their own assessments when possible.
Has there been an equal increase in training to meet their "branching out"? If not, their branching out is not ethical, and possibly harmful.
You don't fill a plane full of people, send it up, and see if it flies or not.....so why put the cart before the horse in this instance?
Are you sure you're a psychologist?
Unacceptable, we shouldn't experiment on the public.
Outcome studies are important, but exceedingly difficult on the level of analyses necessary to measure comptence across training backgrounds. As a profession, we have a responsibility to establish what is necessary to practice ethically and competently. The designation of a doctoral degree in psychology was not political or arbitrary. It's about what educated and experienced individuals thought was necessary to practice competently. We can say without doing an outcome study comparing neuropsychologists that know neuroanatomy and psychometrics to neuropsychologists with no knowledge of neuroanatomy and psychometrics that neuroanatomy and psychometrics are necessary knowledge areas to practice competently. But, you are arguing the opposite. Basically, from your perspective, we are engaging in silly turf wars by establishing any standard before we empirically demonstrate its necessity on the public. What happened to logic? E.g., a pilot needs specific training to know how to fly an airplane? Recently, a pilot that was certified at one level to land an airplane in fog conditions, but not another, turned the plane around and landed somewhere else. He was applauded for the decision; recognizing his limits. He might have been able to land the plane safely, but we don't know and he didn't experiment on the public. I find your position unethical, but I'm sure the insurance companies love you.