Social Workers?

[pschmom1]

I am interested in everyone's opinion of social workers, mainly MSWs or CLSWs. For those who are in practice now, or have their own practice (or have knowlege on this matter), do you have social workers that work w/you to provide therapy to your patients when you can not? How about psychiatric social workers? I know that in the final year of graduate school for social work you choose your specialty and one of the specialties is psychiatric social work. Do you refer your patients to specific therapists or psychologists for therapy when you don't provide the therapy? Of what benifit do you think social workers that specialize in psychiatric care provide, as opposed to one that specializes in family or short term crisis counseling? I know these are a lot of questions all at once, but I am very interested because my friend plans on getting her MSW and she is also very interested in psychiatric disorders and such, and would rather be associated with that type of therapy as opposed to couple counseling ect. Her mom whom is an MSW specialized in substance abuse receintly told her that psychiatric social workers have limited resources and that b/c the patients have psychiatric disorders or conditions and are so "messed up" that the therapy would be unsuccessful and she would get "nowhere" with her clients. I personally have read several books, mainly on schizophrenia and dissociative personality disorder in which a social worker (masters level) works side by side with the psychiatrist and provides most of the therapy. Sorry so long, I appreciate your professional (or non professional) opinion on this. Thanks

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[OldPsychDoc]

There are a lot of levels at which SWs intervene. On inpatient, my SW is my lifeblood--handling d/c planning, family communication, etc. The inpt SWs also do some therapy, though it would probably be characterized by your friend's mother (who is sounding a bit burned out if you don't mind me saying!) as "psychoeducation"--e.g. life skills, basic CBT & DBT, etc.
Outpt SWs might be doing case managment type stuff with the severe mental
illness population, or they might be doing depression & adjustment disorders in a clinic. Whether or not you"get anywhere" depends very much on what your expectations are for the intervention you are providing. I would argue that the county case manager that sees a schizophrenic almost daily on an ACT team is "getting somewhere" just as much as is the outpatient MSW therapist who helps somewone cope with their depression and family problems.

I am interested in everyone's opinion of social workers, mainly MSWs or CLSWs. For those who are in practice now, or have their own practice (or have knowlege on this matter), do you have social workers that work w/you to provide therapy to your patients when you can not? How about psychiatric social workers? I know that in the final year of graduate school for social work you choose your specialty and one of the specialties is psychiatric social work. Do you refer your patients to specific therapists or psychologists for therapy when you don't provide the therapy? Of what benifit do you think social workers that specialize in psychiatric care provide, as opposed to one that specializes in family or short term crisis counseling? I know these are a lot of questions all at once, but I am very interested because my friend plans on getting her MSW and she is also very interested in psychiatric disorders and such, and would rather be associated with that type of therapy as opposed to couple counseling ect. Her mom whom is an MSW specialized in substance abuse receintly told her that psychiatric social workers have limited resources and that b/c the patients have psychiatric disorders or conditions and are so "messed up" that the therapy would be unsuccessful and she would get "nowhere" with her clients. I personally have read several books, mainly on schizophrenia and dissociative personality disorder in which a social worker (masters level) works side by side with the psychiatrist and provides most of the therapy. Sorry so long, I appreciate your professional (or non professional) opinion on this. Thanks

 

[pschmom1]

Thanks OPD, I do agree that my friends mom may be a little burn out. She sometimes seems a bit negative about social work. Thanks again for the information.

 

[pingouin]

I am interested in everyone's opinion of social workers, mainly MSWs or LCSWs.

They're wonderful! But I might be a little biased since I'm both. Currently I have a private practice, and I also work PRN at a local children's hospital on the med floors. And I'm doing prereqs to prep for the MCAT.

For those who are in practice now, or have their own practice (or have knowlege on this matter), do you have social workers that work w/you to provide therapy to your patients when you can not?

My own practice has 5 clinicians, 3 LCSWs and 2 LPCs (acronyms may vary depending on your state). We have several psychiatrists who refer to us frequently for therapy, and in exchange will usually see our clients who need a medication evaluation. Of the three I'm thinking of, one has a cash-only practice and sees his patients for 1/2 to a full hour per session, one combines cash and insurance clients and tries to spend 20-30 minutes, and the third has told us "you went to school to do therapy, I went to school to do medication" and usually only does 15 minute med checks. She's the only one who has a therapist within her group's practice, but said she hasn't gotten good feedback, therefore refers most clients elsewhere.

How about psychiatric social workers? I know that in the final year of graduate school for social work you choose your specialty and one of the specialties is psychiatric social work. Do you refer your patients to specific therapists or psychologists for therapy when you don't provide the therapy?

I'm going to say that most specialization actually occurs after graduation, mostly because since MSW programs are only two years (if you go full time), it's just not enough time to truly "specialize". My school's only offering was "clinical" social work, by which they meant psychodynamic theory and self-psychology. Had I been older and wiser and done more investigative work, I probably would have chosen another school which fit my personality and style better. My school mandated a class which was basically psychopathology, but not all of my friends who were at other programs had something so intense; our textbook was Kaplan and Sadock's Synopsis of Psychiatry. There is also a mandatory two-semester practicum which can be done in a variety of settings (I was at an EAP- quite the dichotomy from the psychodynamic classroom stuff) with various levels and types of therapy experience over the minimum 900 hours. It's been in the jobs I've had since graduation that I've been able to "specialize", along with 3000 hours of supervised clinical experience in order to get my license, the continuing ed seminars, the consultation with colleagues, the consultation with psychiatrists.... and on and on.

Of what benifit do you think social workers that specialize in psychiatric care provide, as opposed to one that specializes in family or short term crisis counseling? I know these are a lot of questions all at once, but I am very interested because my friend plans on getting her MSW and she is also very interested in psychiatric disorders and such, and would rather be associated with that type of therapy as opposed to couple counseling ect.

I'm a bit confused by your statements, as short-term crisis counseling usually does have a psychiatric component to it (often acute anxiety), as does family counseling (a behavioral disorder? a personality disorder creating family conflict? many others..). And couples counseling........ was it OPD who once said something like "I'd rather claw my eyes out"? Whoever it was, I echo that sentiment.

Her mom whom is an MSW specialized in substance abuse receintly told her that psychiatric social workers have limited resources and that b/c the patients have psychiatric disorders or conditions and are so "messed up" that the therapy would be unsuccessful and she would get "nowhere" with her clients.

I'm a little surprised a substance abuse social worker feels comfortable commenting on mental health consumers being "messed up" and going "nowhere", given the spotty track record of most substance abusers' roads to sobriety and the comorbidity of substance abuse and psychiatric disorders. It's all about perspective. For a substance abuse client, perhaps the goal is permanent sobriety. For my clients? Well, I saw two women yesterday diagnosed with borderline PD. One hasn't had an extreme emotional outburst in almost two months, and the other, for the first time in the 6 months I've been seeing her weekly or twice weekly, reported that she had NO thoughts of self-harm, suicide, or wishes for death. To me, that's huge progress.

Could you please clarify the "limited resources" comment? Social workers are usually known as the resource kings/queens. I will grant that resources are becoming a bit more scarce due to government budget cutbacks, etc., which is scary.

I personally have read several books, mainly on schizophrenia and dissociative personality disorder in which a social worker (masters level) works side by side with the psychiatrist and provides most of the therapy. Sorry so long, I appreciate your professional (or non professional) opinion on this. Thanks

Coordination of care is crucial in for the patient, IMHO. Psychiatrist and therapist need to be on the same page, sending the same messages, or else the patient may get very confused and get worse. Coordination of care also helps prevent manipulation and triangulation.

All that having been said, I'd also like it on the record that I believe many MSW programs have become degree factories. Caveat emptor, and do your homework before referring.

 

[MDgonnabe]

Thanks OPD, I do agree that my friends mom may be a little burn out. She sometimes seems a bit negative about social work. Thanks again for the information.

just "a bit negative???" that's amazing in this day and age! the social worker who handles all of the psych consults at my school refused to allow her daughter to go into social work. she said the profession, at least in the philly area, has largely become glorified secretarial work and she openly loathes it.

 

[pschmom1]

Hello jlw.

I'm going to say that most specialization actually occurs after graduation, mostly because since MSW programs are only two years (if you go full time), it's just not enough time to truly "specialize". My school's only offering was "clinical" social work, by which they meant psychodynamic theory and self-psychology. Had I been older and wiser and done more investigative work, I probably would have chosen another school which fit my personality and style better. My school mandated a class which was basically psychopathology, but not all of my friends who were at other programs had something so intense; our textbook was Kaplan and Sadock's Synopsis of Psychiatry. There is also a mandatory two-semester practicum which can be done in a variety of settings (I was at an EAP- quite the dichotomy from the psychodynamic classroom stuff) with various levels and types of therapy experience over the minimum 900 hours. It's been in the jobs I've had since graduation that I've been able to "specialize", along with 3000 hours of supervised clinical experience in order to get my license, the continuing ed seminars, the consultation with colleagues, the consultation with psychiatrists.... and on and on.

Thanks for that info. I think, if I can remember clearly, that the school I was going to attend and that my friend is going to attend has you choose your specialty in your second year in which you do your internship in that feild for the second year, and upon graduation you can take the test and be licensed and be specialized in that feild. There were several fields from substance abuse to family counseling. From what I understand in this state and from this degree is that you had to work 2 years after graduation/licensing to open your own practice. I am not 100% positive on this, but I've read a lot about the MSW program for this peticular school and that is what I have understood about the practice in this state.

I'm a bit confused by your statements, as short-term crisis counseling usually does have a psychiatric component to it (often acute anxiety), as does family counseling (a behavioral disorder? a personality disorder creating family conflict? many others..). And couples counseling........ was it OPD who once said something like "I'd rather claw my eyes out"? Whoever it was, I echo that sentiment.

I agree that most if not all types of therapy will have some psychiatric components to it. However, when one prefers more of the psychiatric aspect of therapy as opposed to depression, grief, couple, family, ect, than it might be a benificial choice to specialize in psychiatric social work as offered at this school.

I'm a little surprised a substance abuse social worker feels comfortable commenting on mental health consumers being "messed up" and going "nowhere", given the spotty track record of most substance abusers' roads to sobriety and the comorbidity of substance abuse and psychiatric disorders. It's all about perspective. For a substance abuse client, perhaps the goal is permanent sobriety.

I absolutely agree and I really don't have any idea how she can comment on something else being pointless or "getting nowhere". I think there is a big difference between an addict as opposed to someone with a psychiatric condition. I would assume that it would be much more frustrating and complicated to counsel someone addicted to alcohol or heroin as opposed to someone with PTSD, BPD, or schizophrenia, ect (although schizophrenics could be complicated to someone not fully educated on the matter). Especially concidering that a lot of psychiatric illness/disorders are not controllable or self induced. Yes I do understand that people have certian predispositions to drug or alcohol addictions and that alcoholism is concidered a disease. This being said, how does one justify what is "getting somewhere" when every person is different and every situation is different in these types of cases?

Could you please clarify the "limited resources" comment? Social workers are usually known as the resource kings/queens. I will grant that resources are becoming a bit more scarce due to government budget cutbacks, etc., which is scary.

I again am not to sure what she meant by "limited resourses". I have also thought that social workers are the power house throughout treatment, concidering they often provide much of the therapy that is extremely important and works in accordance with psychotropics (my personal opinion).

I have the utmost respect for MSWs and such, and I would like to one day have my own practice in which I hope to work closely with one or a few MSWs throughout the treatment of my patients. I really appreciate your responce and you have made my prior understanding on this subject more valuable. By the way, what type of specialty are you interested in once in med school? ( I will guess psychiatry but ya never know)

 

[pschmom1]

just "a bit negative???" that's amazing in this day and age! the social worker who handles all of the psych consults at my school refused to allow her daughter to go into social work. she said the profession, at least in the philly area, has largely become glorified secretarial work and she openly loathes it.

I guess I am a little confused to what you mean by "glorified secretarial work"? Could you please clarify your statement

 

[MDgonnabe]

I guess I am a little confused to what you mean by "glorified secretarial work"? Could you please clarify your statement

i guess when she did her training she was under the impression that she'd actually be seeing patients a lot more than she actually does. the vast majority of her time is spent on the phone getting disposition established.

 

[Poety]

I'd rather stab my eyes out than spend all day getting dispositions. Why is there soooo much scut in some programs and not others? What a turn off.

 

[pingouin]

Thanks for that info. I think, if I can remember clearly, that the school I was going to attend and that my friend is going to attend has you choose your specialty in your second year in which you do your internship in that feild for the second year, and upon graduation you can take the test and be licensed and be specialized in that feild. There were several fields from substance abuse to family counseling. From what I understand in this state and from this degree is that you had to work 2 years after graduation/licensing to open your own practice. I am not 100% positive on this, but I've read a lot about the MSW program for this peticular school and that is what I have understood about the practice in this state.

Some states (mine included) may offer a license available immediately upon getting a MSW, but it's not a clinical license to practice independently. "The Test" (standardized, computer-based) has 4 levels- basic, intermediate, advanced, clinical, and most states require clinical to get your LCSW or equivalent. After you've done minimum 3000 supervised hours (may vary by state) over minimum 24 months AND passed the test, you can apply for a clinical license. If the plan is to go into program administration/policy development/community organizing, then the advanced test may suffice if there's a non-clinical masters-level license available in that state.

I agree that most if not all types of therapy will have some psychiatric components to it. However, when one prefers more of the psychiatric aspect of therapy as opposed to depression, grief, couple, family, ect, than it might be a benificial choice to specialize in psychiatric social work as offered at this school.

You lost me here. What's the difference? Are you referring to case management vs. therapy? They really are two different things.

I absolutely agree and I really don't have any idea how she can comment on something else being pointless or "getting nowhere". I think there is a big difference between an addict as opposed to someone with a psychiatric condition. I would assume that it would be much more frustrating and complicated to counsel someone addicted to alcohol or heroin as opposed to someone with PTSD, BPD, or schizophrenia, ect (although schizophrenics could be complicated to someone not fully educated on the matter). Especially concidering that a lot of psychiatric illness/disorders are not controllable or self induced. Yes I do understand that people have certian predispositions to drug or alcohol addictions and that alcoholism is concidered a disease. This being said, how does one justify what is "getting somewhere" when every person is different and every situation is different in these types of cases?

This is why I love what I do- because "success" is measured differently for everyone, and it really is the little stuff. When I talk with my clients about progress, I sometimes refer to "What About Bob?" and the idea of the book, called Baby Steps- because that's what it takes. Treatment plans MUST be individualized, and they're great to measure progress since ideally (I admit, I'm a slacker) they should be reviewed every 3-6 months, and the client should be actively involved in reviewing progress and giving feedback on what goals are next. It's his/her life, after all- not mine. There are only 2 things that I routinely put on a treatment plan- if there's a psychiatrist involved, then the patient "Will take all medications as prescribed and report any benefits or side effects" to the doctor, and the patient "Will attend all appointments as scheduled" with me and the doctor because if they don't show up, there's nothing much we can do.

I have the utmost respect for MSWs and such, and I would like to one day have my own practice in which I hope to work closely with one or a few MSWs throughout the treatment of my patients. I really appreciate your responce and you have made my prior understanding on this subject more valuable. By the way, what type of specialty are you interested in once in med school? ( I will guess psychiatry but ya never know)

Psych is certainly on the radar, but we'll see. Speaking of baby steps- I'm just concentrating on trying to get in before I can worry about what I'm going to do after!

 

[pingouin]

I'd rather stab my eyes out than spend all day getting dispositions. Why is there soooo much scut in some programs and not others? What a turn off.

Some SWs seem to love discharge planning, but to many it is the bane of our existence.