Therapy outcomes and type of degree

[deleted820760]

Hi guys,

I’m considering a career change, so I’ve been lurking a lot on your forum. I have a question, so I hope you guys don’t mind me posting here even though I’m not a psychologist.

I value science and research, but I’m having difficulty believing research that says masters-level practitioners and clinical psychologists achieve similar outcomes in therapy. I have even more issues with research claiming similar outcomes between physicians and nurse practitioners. I have worked very closely with both, and I am more familiar with their training. There is no way they can even be compared. I’m thinking the research must be biased and lack good methodology.

So on to my questions, how is it possible for social workers to be as effective as PhD clinical psychologists? What is even the point of going through all the additional years of training and education if, in the end, it doesn’t even matter? I know therapy is not all psychologists do. They do assessments and research, too, but is that the only difference in the education? So the training in psychotherapy is the same for LPC, LMFT, LCSW, and psychologist?

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[counselor2b]

I don’t really find it that hard to believe. Manualized treatments aren’t really that difficult to follow. So when looking at outcomes for a specific condition using a specific treatment protocol, you will likely not find any real clinical difference if both are following the treatments as prescribed. However, even though there is some overlap in what we do on a day to day basis,we are distinct professions. Generally speaking, a psychologist can do what we do but can’t do everything a psychologist does. You will have more options going the psychologist route. However, that does not mean that masters level therapist are incompetent. We have a specific skill set and if we stay in our lane we can be effective and offer a much needed service. You ultimately need to decide what you want long term and what options you may want available to you in the future. Best of luck.

 

[R. Matey]

This issue has been discussed at length in a few threads. I'd encourage you to look around. @counselor2b is right when they say that the studies comparing professions usually rely on a form of manualized treatment so the ecological validity is such an approach is questionable. I haven't seen too many studies on it, but my clinical experience with many master's level trainees is an over-reliance on pseudoscientific treatments and supportive listening skills as well as poor diagnostics leading to inappropriate or ineffective treatment.

 

[deleted820760]

This issue has been discussed at length in a few threads. I'd encourage you to look around. @counselor2b is right when they say that the studies comparing professions usually rely on a form of manualized treatment so the ecological validity is such an approach is questionable. I haven't seen too many studies on it, but my clinical experience with many master's level trainees is an over-reliance on pseudoscientific treatments and supportive listening skills as well as poor diagnostics leading to inappropriate or ineffective treatment.

I searched, but I couldn’t find the other threads. Perhaps I used the wrong words. What is the name or keywords for these other threads?

 

[BuckeyeLove]

I know the notion that they're commensurate gets pontificated on a lot on here, and I know I'm not supposed to say this given it's all anecdotal, but....I just don't see it. I've yet to meet a master's level provider that is on par from a conceptualization and critical thinking standpoint. Not to say they are poor clinicians, far from it, but there just seems to be a layer of nuance and sophistication that is absent. And I'm not just talking about how they do manualized treatments and analysis and appreciation of empiricism. I'm talking in terms of overall interviewing skills, ability to think on the spot in session, appreciation of interpersonal process, etc. I have met a handful of docs who previously practiced as master's level clinicians, and they have across the board said that their doctoral training provided an avenue for more comprehensive supervision and training, and they've all said they were better for it. Now that I'm done projecting, outcome data probably indicates otherwise I imagine. (I also have been called to do a lot of 2nd opinion forensic work in another state where master's level people are allowed to do psycho-legal assessment work, so I imagine that is also shading my opinion.)

 

[tr]

I searched, but I couldn’t find the other threads. Perhaps I used the wrong words. What is the name or keywords for these other threads?

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[DynamicDidactic]

Yes, there is not a large literature on differences in degrees and therapy outcomes. The studies out there do not indicate a difference.

However, I have not seen well designed studies examining this question. Here are my thoughts about the topic:

• Generally speaking, treatment outcomes are not great across the allied mental health fields.
• I think the range is probably similar across degrees. There are ****ty and amazing clinicians across the field. The real question is whether there is a smaller variability in some segment.
• Asking about differences between degrees is less useful than differences between types of treatments (or treatment approaches). I cannot imagine a difference between a masters-level, doctoral, or MD in outcomes when treating eating disorders using psychoanalytic treatment. It does not matter since the treatment is crap (for that disorder). In an RCT with well-trained and supervised therapists that often have to go through compliance/adherence checks, I doubt one would see a difference between degree types.
• The placebo effect is strong. To demonstrate differences in outcomes across therapist it needs to be a treatment that is above and beyond placebo.
• So, the real question to me is whether outcomes of behaviorally-orientated (or whatever approach one is studying) clinicians treating a disorder where a behavioral treatment should be the frontline treatment (e.g., panic, phobia) in an ecologically valid manner (e.g., an effectiveness study design) will differ based on degree type.
• HOWEVER, that is separate from a different yet important question. Is there a difference in masters-level training vs. doctoral in competence, views on evidence-based practice, belief in science, understanding of health science, and use of pseudoscience.
• Basically, it is a two-part question. How well can masters-level practitioners be trained and what kind of training does the typical masters-level practitioner usually receive. I am sure a conscientious, bright, and motivated student in a good program will get fine training and become an effective clinician. I am also sure a poor student in a crappy doctoral program will be a less effective clinician. However, what is the likelihood of getting that training based on degree.

I am actually working on a study (early stage) about the latter topic. Not treatment outcomes but other important aspects of training (e.g., EBP views, pseudoscience).

 

[Sanman]

I think that the issue at hand is really one of internal validity vs external validity. Research studies on the topic tend toward internal validity (manualized therapy, proper training in the manualized therapy for all participants , higher homogeneity in the patients being treated). However, in the real world, how many therapists are reaching for the manualized therapy? What do you do when the client does not want that? How about when the initial diagnosis is incorrect?

The problem with testing this is that there are too many individual factors. Even doctoral training is not homogenous. I would venture to guess that Judith Beck is better at implementing a CBT protocol than I am despite holding the same degree. Same can be said for any degree really. Add to that, you have the general bias of the smartest usually opting for the highest degree available. Then there is patient perception of what is better.

I doubt there will be a straight answer to this other than to say that a variety of factors will lead to the cliché being true in any field.

 

[PsyDr]

1) Training is NOWHERE near the same.

a. If you look at most MSW curricula, you'll see that the first year is mostly theory about nonclinical stuff. Then the second year is diagnosis, treatment, and practica/clinical rotations. Then their residency whatever stuff for like a year. That's right, they have about 1 year of actual mental health coursework.

b. Counselors have like 2 years of coursework, with concurrent part time clinical practica, followed by a year of supervised clinical practice. You will notice that many of these programs are or were housed in the educational department. This is a throwback from when psychology decided to start helping people without formal disorders. (e.g., vague life dissatisfaction). So you'll notice that the coursework is much more vague. These people are intolerable in professional discussions, where instead of admitting , "I don't know about X", they revert to feelings about whatever. And their feelings always support whatever they want.

c. Psychologists are usually 4 years of class work that encompasses more broad things, 2-3 years of part time practica/clinical rotations, followed by 1-3 years of full time supervised clinical practice. In regards to the coursework, the requirement calls for a much more broad training in scope, and much more in depth training in more particular areas. This may seem silly, but it's important.

Example: Let's say you're a middle aged woman, who goes to therapy for some anxiety disorder. In the course of treatment, you express concerns about how your kids are developing or behaving, how your husband is behaving, about your sex life, your concerns about your aging parents behavior, etc.

Do you want someone who knows that X behavior in kids is developmentally appropriate or not? What about someone who has advanced coursework about gender differences in middle age? Or someone who knows that based upon the ridge of your brow and the tip of your nose that maybe you're a higher sexual drive person, and that maybe your spouse's libido is going down because statistically testosterone reduces by like 10% every decade after 30/40 whatever, and that the leading cause of marital sexual dissatisfaction is the male partner's preference for masturbation, which recursively affects testosterone? Or maybe someone who knows some signs of healthy vs pathological aging to include affective disorders and dementias?

2) Easier explanation:

a. Outcome studies are based upon aggregate data. To do this correctly, you require standardization of both diagnosis and treatment. That doesn't require a lot of skill. However, the methods of diagnosis and the method of delivery of treatment require considerable skill.

Example i.
A lot of people could probably perform a simple appendectomy's with a few weeks of training, and a trained support staff. But what if it is not appendicitis? Or what if there are extreme anatomical variations that make the surgery extremely complicated? A surgeon is going to outshine every untrained person, every time. They'll do it with more finesse, more skill, less complications, better looking scars, etc.

Example ii.
Going back to a mental health example, a truly skilled psychologist can do psychotherapy in such a way that you don't even realize it's happening. If you look at the one of the Skinner vs Rogers debates, you'll notice that Skinner actually reinforces a behavior in Rogers, and he doesn't even know it.

 

[AcronymAllergy]

Agree with everything above, particularly RE: the limitations of extant studies, and the ability of a skilled psychologist (amongst whom I would probably not count myself) to perform psychotherapy. On the converse, I've been very surprised by the number of MSW post-graduate trainees and practitioners who've had little formal training (i.e., one class) and little to no supervised experience in psychotherapy.

I'm also at times disheartened by the numbers of psychologists I see ascribing to pseudoscientific principles and treatments, but it's at least not ubiquitous.

 

[Therapist4Chnge]

A challenge with social work programs is that there seems to be a wide spectrum of foci, with one end being administrative / social justice........therapy and direct intervention is on the other end. Some programs are balanced, but others lean more one way than the other, which all impacts training. This isn't meant to pick on SW, but it's important to understand the skills of a SW can really range, depending upon their actual training and work experience.

 

[deleted820760]

Thank you guys for the helpful responses.

 

[foreverbull]

Should we actually conduct a real-world ecological study that compares master’s level therapists to psychologists seeing complex cases, it would immediately get criticized for methodology/internal validity issues, so it’s tricky with so many variables to control for.

Some people go into master’s programs with high emotional intelligence and are just far more sharp and interpersonally skilled than others, same for doctoral students although they are more closely monitored for extra years. I think we can at least say that doctoral trainees who are poor practitioners are more likely to be weeded out if there are more years of supervised training, perhaps? But as someone mentioned before, all therapists and psychologists are on a spectrum of skill. I just wonder if the curve for psychologists is a bit higher/farther right in the direction of effectiveness in terms of looking at the overlapping bell curves between the two? Or if the baseline of effective practice ends up being a bit higher for psychologists starting out vs. master’s level practitioners starting out for the average graduate? I personally believe this, but we still need evidence to support it. For now, we rely on indirect ways of looking at it, like anecdotal info and the general belief that more years of training tends to be more conducive to developing expertise across various professions.

Much respect to anyone who tries to tackle this research topic; you have your work cut out for you.

 

[bookwormpsych]

Hi,

I can offer some input regarding master's level training. As was said above, there is waaaay too much variation in training among master's level programs. I attended a "clinical psychology" master's program housed within the university's psychology department. However, our university also offers a "clinical counseling" master's program that is housed in the education department. There is very little overlap between the two based off of looking at the coursework. My program, for example, had specific courses for assessment (i.e., IQ and personality assessments), a couple of specific courses for treatment modalities (i.e., I took a course just over CBT), had specifically clinical courses (e.g., over diagnoses/psychopathology, how to diagnose, etc.), and we had much more practica/internship time, individual supervision, and group supervision. The other program's course work appears to be more centered around theory and non-clinical stuff. My program was set up for 1 semester of in-house practica (at the university "psychology clinic") and then 1 year of outside internship, all of which we received individual and group supervision for. The other program only had a 1 year practica/internship/whatever at the university "counseling center." Don't ask me the difference between the "psychology clinic" and "counseling center" because, man, I just don't know LOL. Our program was set up to allow for licensure as an LPC or an LPA in my state, the other only allowed for licensure as an LPC. So, different criteria had to be met.

On another note, as a bit of personal opinion, do I feel competent to provide therapy effectively?.... NOPE. Not to say my training wasn't great, because I think it was. I received AWESOME supervision (I highly respect my supervisors - amazing people), I had an awesome internship, and experienced and learned amazing things. However, the depth of what is taught to a person in just a measly 2 years is not that great. I don't think master's programs timeframes allow for appropriate training to actually do the things they tell you that you can do after graduation. Does that make sense? I learned a lot of broad and general knowledge, but I don't feel like I know how to actually apply that to specific populations, or how to use specific interventions, or whatever (well, except maybe CBT, to some degree. Strong orientation amongst faculty at the university). I think what my program did for me - other than provide me a graduate degree and set me up to get my license - was set me up for further training. This cycle I am applying to doctoral programs so that I CAN feel that I can be an effective therapist, and not just a "good listener." I value my training, I do, but it isn't enough for me to feel comfortable to try and help peoples' mental health. Even seeking outside training (e.g., attending conferences for CEUs for my license, supervision under my current supervisor), I just don't feel this has been enough.

I hope this provides a useful perspective from a current master's level person!

*Note: I speak from a perspective of a psychology degree - I know nothing about social work degrees lol

 

[R. Matey]

Should we actually conduct a real-world ecological study that compares master’s level therapists to psychologists seeing complex cases, it would immediately get criticized for methodology/internal validity issues, so it’s tricky with so many variables to control for.

Just because something would be criticized, doesn't mean it's not worth doing. I think an observational study would add to a body of evidence. It might help research conducting theoretical lab studies to choose different methods, for instance. I'd read that study.

 

[foreverbull]

Just because something would be criticized, doesn't mean it's not worth doing. I think an observational study would add to a body of evidence. It might help research conducting theoretical lab studies to choose different methods, for instance. I'd read that study.

I’d read it too. I wasn’t saying it’s a completely lost cause, just very challenging to study given the factors involved. I agree that we could benefit from a larger body of research on the topic, regardless.

 

[deleted820760]

Hi,

I can offer some input regarding master's level training. As was said above, there is waaaay too much variation in training among master's level programs. I attended a "clinical psychology" master's program housed within the university's psychology department. However, our university also offers a "clinical counseling" master's program that is housed in the education department. There is very little overlap between the two based off of looking at the coursework. My program, for example, had specific courses for assessment (i.e., IQ and personality assessments), a couple of specific courses for treatment modalities (i.e., I took a course just over CBT), had specifically clinical courses (e.g., over diagnoses/psychopathology, how to diagnose, etc.), and we had much more practica/internship time, individual supervision, and group supervision. The other program's course work appears to be more centered around theory and non-clinical stuff. My program was set up for 1 semester of in-house practica (at the university "psychology clinic") and then 1 year of outside internship, all of which we received individual and group supervision for. The other program only had a 1 year practica/internship/whatever at the university "counseling center." Don't ask me the difference between the "psychology clinic" and "counseling center" because, man, I just don't know LOL. Our program was set up to allow for licensure as an LPC or an LPA in my state, the other only allowed for licensure as an LPC. So, different criteria had to be met.

On another note, as a bit of personal opinion, do I feel competent to provide therapy effectively?.... NOPE. Not to say my training wasn't great, because I think it was. I received AWESOME supervision (I highly respect my supervisors - amazing people), I had an awesome internship, and experienced and learned amazing things. However, the depth of what is taught to a person in just a measly 2 years is not that great. I don't think master's programs timeframes allow for appropriate training to actually do the things they tell you that you can do after graduation. Does that make sense? I learned a lot of broad and general knowledge, but I don't feel like I know how to actually apply that to specific populations, or how to use specific interventions, or whatever (well, except maybe CBT, to some degree. Strong orientation amongst faculty at the university). I think what my program did for me - other than provide me a graduate degree and set me up to get my license - was set me up for further training. This cycle I am applying to doctoral programs so that I CAN feel that I can be an effective therapist, and not just a "good listener." I value my training, I do, but it isn't enough for me to feel comfortable to try and help peoples' mental health. Even seeking outside training (e.g., attending conferences for CEUs for my license, supervision under my current supervisor), I just don't feel this has been enough.

I hope this provides a useful perspective from a current master's level person!

*Note: I speak from a perspective of a psychology degree - I know nothing about social work degrees lol

Thank you! This was very helpful. I considered going the masters route since it takes less time, and I’ve already spent 8 years for my current degrees. However, I don’t want to be unprepared after graduating from a masters program. I’d be scared I’d end up getting burned out, or accidentally harm patients because I don’t know what I’m doing. Bring great at my job, and not harming patients is really important to me.

I lurk on Reddit, and masters-level therapists are constantly talking about how burned out, depressed, and anxious they are, and that concerns me. I also don’t have another 10 years to spend on becoming a licensed clinical psychologist. I’d be old as dirt by the end of it.

Back to the drawing board.

I will say, a PhD clinical psychologist I know said the PhD is a research degree. It didn’t teach her how to do effective therapy. She thinks masters level clinicians can be just as effective, because most of what anyone learns happens after they’re already in practice.

 

[WisNeuro]

I will say, a PhD clinical psychologist I know said the PhD is a research degree. It didn’t teach her how to do effective therapy. She thinks masters level clinicians can be just as effective, because most of what anyone learns happens after they’re already in practice.

This person was either trained WAY back in the day, or went to a very heavily research focused program. This is not the case in most clinical psych PhDs. This is why it's important to properly look into where you are applying and think about these things beforehand.

 

[R. Matey]

The other program's course work appears to be more centered around theory and non-clinical stuff. My program was set up for 1 semester of in-house practica (at the university "psychology clinic") and then 1 year of outside internship, all of which we received individual and group supervision for. The other program only had a 1 year practica/internship/whatever at the university "counseling center." Don't ask me the difference between the "psychology clinic" and "counseling center" because, man, I just don't know LOL. Our program was set up to allow for licensure as an LPC or an LPA in my state, the other only allowed for licensure as an LPC. So, different criteria had to be met.

Some clarifications....

It's not uncommon for university psychology departments to have an assessment and psychotherapy clinic for training their students, which is separate from the university counseling center--the primary source for student mental health services on a given campus. Many psychologists complete their predoctoral internships at such places. It's also important to note here that the coursework for master's degrees in counseling, while insufficient in my opinion, is clinical coursework aimed at training people to practice psychotherapy independently at the master's level. Usually the training is more humanistic rather than CBT.

Agree that this is probably less common than it used to be. The necessary coursework to be licensed at the master's level changed a little over ten years ago from a 48 to a 60 credit master's degree in nearly every state with very specific coursework that is typically only offered in counseling programs. It's not impossible to go to a clinical psychology master's program and get licensed as an LPC, but it's becoming more difficult especially with accrediting bodies looking to close ranks. I wouldn't advise this path to anyone looking to train as a therapist today.

 

[bookwormpsych]

Agree that this is probably less common than it used to be. The necessary coursework to be licensed at the master's level changed a little over ten years ago from a 48 to a 60 credit master's degree in nearly every state with very specific coursework that is typically only offered in counseling programs. It's not impossible to go to a clinical psychology master's program and get licensed as an LPC, but it's becoming more difficult especially with accrediting bodies looking to close ranks. I wouldn't advise this path to anyone looking to train as a therapist today.

Definitely agree here. For me, I also attended a master's for other reasons (i.e., my undergrad GPA was TRASH, my grad GPA was a 3.95 - dang ol stats got me a B). Took the long.... senseless path around.... but, I needed to. Fortunately, for those of us in TX going this route truly doesn't make a different as TX is literally the wild west and I'm not entirely sure even the boards (for psychologists, or for counselors) really know what's going on right now. It's a sad fact, but true.

To the OP,

I lurk on Reddit, and masters-level therapists are constantly talking about how burned out, depressed, and anxious they are, and that concerns me.

Back to the drawing board.

I will say, a PhD clinical psychologist I know said the PhD is a research degree. It didn’t teach her how to do effective therapy. She thinks masters level clinicians can be just as effective, because most of what anyone learns happens after they’re already in practice.

The first part can absolutely happen no matter the degree. It depends on your work environment, case load, personal characteristics, etc.
The last point - some PhD programs are absolutely research powerhouses. But, that is not the norm. Most programs emphasize the integration of practice and research, as research is important to understand what the frick we are practicing, right? There are your research-mills out there, but generally speaking, most programs are well-balanced (1/2 research, 1/2 clinical training - something like that).

 

[AbnormalPsych]

Don't ask me the difference between the "psychology clinic" and "counseling center" because, man, I just don't know LOL.

One is probably for psychotherapy for psychiatric disorders and psychological assessment while the other is for time-limited/capped counseling services (adjustment to college, unspecified psychosocial stressors, romantic breakups, etc).

 

[bookwormpsych]

One is probably for psychotherapy for psychiatric disorders and psychological assessment while the other is for time-limited/capped counseling services (adjustment to college, unspecified psychosocial stressors, romantic breakups, etc).

That's what I thought at first, too. But, the clients that I had (not sure about other students) were for the exact problems you just listed. Well, with the exception of 2 or so of them. I THINK, the difference is price and preference. I know the psychology clinic is also open to the public at a very low cost (since it is students that see clients), but the counseling center is only for students. And definitely the types of services offered as you said. I just never understood the point in having 2 centers. I guess it is good to have one with students trained for psychotherapy for psychiatric disorders and assessment as you said, just in case lol

 

[R. Matey]

That's what I thought at first, too. But, the clients that I had (not sure about other students) were for the exact problems you just listed. Well, with the exception of 2 or so of them. I THINK, the difference is price and preference. I know the psychology clinic is also open to the public at a very low cost (since it is students that see clients), but the counseling center is only for students. And definitely the types of services offered as you said. I just never understood the point in having 2 centers. I guess it is good to have one with students trained for psychotherapy for psychiatric disorders and assessment as you said, just in case lol

It's simple. There are two clinics because the serve different purposes. The services offered are mostly the same, but it widely depends on the campus (e.g.: LD/ADHD assessments are done by either the training clinic or the UCC).

Psychotherapy and assessment clinics in psychology departments exist to predominantly for training psychology students. They're funded by offering low-cost services to the community to recruit patients for their students to practice on.

University counseling centers are usually funded via student fees and offer full range services to college students including psychotherapy, psychological assessment, and psychiatric medication management. The idea that UCCs only treat adjustment concerns might've been true twenty years ago, but isn't true today. I saw everything from break-ups to suicide and psychosis on my UCC internship and my time on the ACCA listserv tells me that my experience is reflective of a national demand for wide range mental health services in college counseling centers.