What do social workers do in private practice?

[DrGachet]

What do psychologists do? Often, they do assessment and provide psychotherapy, typically for the more wealthy clientele. What about social workers? And why would anyone go to see a private social worker as opposed to hospital one? Social workers don't do psychological assessments but I believe they can provide psychotherapy. They also help their clients access various social services and resources available in the community (disability, health, etc). What am I missing? I know very little about social workers in private practice and I would appreciate some info. What does your typical day look like? Do you spend a lot of time on the phone trying to get people connected with the right organization? Though I have great respect for the kind of work social workers do for our society and the poor and marginalized, I wonder if it--based on my limited knowledge of the field--is intellectually challenging and satisfying. My training in psychology provided me with more than enough intellectual stimulation and I would like to hear from the other side.

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[BSWdavid]

Clinical social workers in private practice are licensed to provide mental health and behavioral services for a broad range of issues, disorders, and individuals. The work that a clinical social worker in private practice does is quite similar to that of a psychologist in private practice (besides psychological testing). Licensed clinical social workers are qualified to bill insurance and medicare for treatment (provided the services are covered and the LCSW is paneled), and are reimbursed at the same rates as LPCs, LHMCs, etc. A typical day might consist of performing diagnostic assessments, providing individual and/or group therapy, and consultation work (when applicable). I think you would be hard pressed to find a clinical social worker in private practice that provides direct resource connection or case mgmt., as the scope of clinical social work reaches beyond case management.

Clinical social work is the professional application of social work theory and methods to the diagnosis, treatment, and prevention of psychosocial dysfunction, disability, or impairment, including emotional, mental, and behavioral disorders (Barker, 2003).

 

[stigmata]

"The work that a clinical social worker in private practice does is quite similar to that of a psychologist in private practice (besides psychological testing)."

Not true at all.

 

[erg923]

BSWdavid has rep for fact checking similar to that of Bill O'Reilly...

I think the issue here is not so mich a distortion of what LCSWs do in PP, as they do alot of the traditional therapeutic hour im sure, but a misunderstanding of the modal PP psychologists job description.

 

[loveoforganic]

I know my dad supplements his administrative job with pp counseling. Not sure what population he works with though, and dunno how he bills.

 

[BSWdavid]

BSWdavid has rep for fact checking similar to that of Bill O'Reilly...

I think the issue here is not so mich a distortion of what LCSWs do in PP, as they do alot of the traditional therapeutic hour im sure, but a misunderstanding of the modal PP psychologists job description.

Man, you are rude. Comparing someone to Bill O'Reilly is just wrong!

 

[DrGachet]

I hope this does not turn into one of those BSWDavid vs psych students political debates. There was no conscious malicious intention behind my question. I do not interact with social workers regularly. In fact, the one I meet with in the hospital once in a while, churns out these short reports about patients' ADL, living arrangement, etc, which I find quite tedious. Don't get me wrong, she provide extremely important services to the patients and is quite happy with her job, but doing psychological assessment and psychotherapy is intellectually demanding and one of the reasons I put up with the other crap (low pay, stress, office politics). I'm trying to find out more about what a social worker would do in his private practice and if she finds it quite as enjoyable and stimulating.

 

[BSWdavid]

I didn't read any malicious intent behind your post. I think it is a great question. Social work has many specialties (i.e. health, child welfare, school social work, clinical social work). Clinical social workers are the only specialists that go into private practice, as you are correct to point out, other types of social work practices don't make sense from a private practice stand point. Also, licensed clinical social workers are the only social workers eligible to bill third party payers. Clinical social workers in private practice mainly provide individual and group psychotherapy, while those employed by organizations might provide more comprehensive services (case mgmt.); however, this has little to do with the "social work" title and more to do with the cost savings of mental health centers. LHMC's, LMFT's, would also provide exactly the same services in these settings.

I am completing my practicum at a medical school psychiatric clinic. I am supervised primarily by an LCSW, while also working closely with a clinical psychologist and psychiatrist. In our office, the LCSW and Psychologist have the same responsibilities. The intake assessments are the same, they both provide individual therapy. The only difference is that the psychologist is a CBT therapist while the LCSW is a psychodynamic therapist. Psychological testing is not performed in our office but is referred out when needed.

 

[erg923]

The only difference is that the psychologist is a CBT therapist while the LCSW is a psychodynamic therapist. Psychological testing is not performed in our office but is referred out when needed.

Why is that?

 

[BSWdavid]

Why is this do you think?

Why is what?

 

[erg923]

Why is what?

Do you think its odd that a person with 2-3 years post-bac education and one year of clinical practicum training practices the form of psychotherapy that is 1.)the most complicated and convulted 2.) generaly takes the longest to become proficent in. 3).According to its cult-like following, necessitates many years of formal training (preferably in training institute) in order to practice competently 4.) Generally, has the least amount of empirical support for many of the most common diagnosis one is likely to see in an outpatient psychiatric setting?

 

[BSWdavid]

Do you think its odd that a person with 2 years post-bac education and one year of clinical practicum training practices the form of psychotherapy that is 1.)the most complicated and convulted 2.) generaly takes the longest to become proficent in. 3).According to its cult-like following, necessitates many years of formal training (preferably in training institute) in order to practice competently 4.) Generally, has the least amount of empirical support for many of the most common diagnosis one is likely to see in an outpatient PP?

I should note that we also have several psychiatrists that practice from a psychodynamic perspective, and several that practice from a CBT perspective. We have two other clinics as well, and there are a few psychologists that are psychodynamically oriented. In the midwest, social workers tend to be more CBT oriented, however, my supervisor is from NY and attended a psychodynamic program.

 

[BSWdavid]

I should note that we also have several psychiatrists that practice from a psychodynamic perspective, and several that practice from a CBT perspective. We have two other clinics as well, and there are a few psychologists that are psychodynamically oriented. In the midwest, social workers tend to be more CBT oriented, however, my supervisor is from NY and attended a psychodynamic program.

Well, she seems to be good at what she does. She has been there for 13 years and has a top notch reputation within the department and university (one of the reasons I chose this particular placement), and has earned a lot of respect from her fellow psychology and psychiatry colleagues.

 

[stigmata]

Ok so nobody feels the need to actually answer the original question?? I will. LCSWs in private practice do psychotherapy...period. That is all they will get paid/reimbursed to do and that is what they are trained to do, so that is what they do. Are there psychologists who do the same thing...of course, but we are not limited to that. I do zero therapy..in private practice as a psychologist. I do a wide array of assessment from military, fitness for duty, disability, vocational rehab, DD to psychopharm consults (50% of my clinical time). I have active hospital privileges, teach primary care medical residents, and a variety of other things. After the last time I wrote "psychotherapy" this is a simple, yet not exhaustive list, of things psychologist can do in private practice that an LCSW cannot.

 

[MKE88]

That sounds like a dream job! 🙂
Maybe you can help steer me in the right direction - I've been wondering for a while whether psychologists who teach residents/medical students are usually also involved in some kind of research at the hospital (or elsewhere)? Is teaching without being heavily involved in research a possibility?

 

[stigmata]

Yes I am pretty sure they are. I am not, but may do so in the future. This is mainly because I am not an employee of the University who owns the residency program or the hospital, but contract independently with both.

 

[Therapist4Chnge]

That sounds like a dream job! 🙂
Maybe you can help steer me in the right direction - I've been wondering for a while whether psychologists who teach residents/medical students are usually also involved in some kind of research at the hospital (or elsewhere)? Is teaching without being heavily involved in research a possibility?

It depends on the university and the classification of the position. In academic medicine I have found the following types of positions:

100/0: You are a clinician. You may do research, but it is on your own time and you are responsible for the funding. Some people teach on the side, but it is not counted as part of your contribution to your department (the people who pay your salary). Some people can negotiate a decrease in their billing requirements if they teach, while others do it as a side gig like someone having a private practice on the weekends. Some places may allot a % of your clinical time for supervision/teaching within a department. I interviewed at a place where 20% of my time would have been spent mentoring medical students who rotated on to my service. I'm not sure how common this is at other places, so YMMV.

80/20: The majority of your time is clinical, but you also have research and/or teaching responsibilities. This time can be protected or not protected, which often depends on the funding source. "Protected" time means you have an assigned number of hours away from your core job to fulfill other duties. This is often dictated by who is paying for your time (is a research grant paying a % of your salary? Is the university paying for your teaching time out of a different pot of money?). The other key factor is your billing requirements (are you responsible for 100% of the set billing or less because you are doing things outside of your core work?). Some psychologists prefer a formal delineation of their time, while others like the flexibility of not having set times for things.

50/50: Similar to the above, but your teaching/research responsibilities are more. You may also have mentoring/supervision responsibilities on the academic side, in addition to your teaching. Assistant or Associate Professors often fall into this category. It very much depends on where you are teaching (medical school v. undergraduate v. graduate), liberal arts v. public, R1 v. Less research focused university.

20/80: You are primarily are researcher, though you see patients for about 1 day per week and/or supervise people.

 

[slinger]

I get a little confused as to why professionals are so fixated on focusing on one modality of therapy. Does best practice principles not promote individualizing treatment and care to the needs of the patient/client? This is pscyhotherapy 101 for any profession; whether you are a pscyhiatrist, psychologist, or clinical social worker. CBT is very prevalent in the mid-west, typically because of the Menninger influence (which the reason they used it was because of their specific clientele).

Social Workers in private practice, whether with a group or just by themselves need to have a License as a Clinical Social Worker. They are considered licensed clinicans, psychotherapists, and for all intent and purpose considered to be direct mental health care providers.

To resonate what stigmata has already stated, they do psychotherapy. We are not qualified to do formal psych testing. For all intent and purpose, this is the primary difference between an LSCSW and a Psychologist. We could sit here all day and talk about the difference between philosophies, and who is better. In the end, there are Psychologists who are horrible therapists and Social Workers who are horrible therapists.

 

[stigmata]

Yes indeed....

 

[BSWdavid]

I get a little confused as to why professionals are so fixated on focusing on one modality of therapy. Does best practice principles not promote individualizing treatment and care to the needs of the patient/client? This is pscyhotherapy 101 for any profession; whether you are a pscyhiatrist, psychologist, or clinical social worker. CBT is very prevalent in the mid-west, typically because of the Menninger influence (which the reason they used it was because of their specific clientele).

Social Workers in private practice, whether with a group or just by themselves need to have a License as a Clinical Social Worker. They are considered licensed clinicans, psychotherapists, and for all intent and purpose considered to be direct mental health care providers.

To resonate what stigmata has already stated, they do psychotherapy. We are not qualified to do formal psych testing. For all intent and purpose, this is the primary difference between an LSCSW and a Psychologist. We could sit here all day and talk about the difference between philosophies, and who is better. In the end, there are Psychologists who are horrible therapists and Social Workers who are horrible therapists.

I thought Menninger was psychodynamic

 

[slinger]

Menninger had a plethora of Psychoanalysts working there, and there was a Psychoanalytic training facility in Topeka, KS. The cool thing about Menninger, is that it wasn't limited to one form of therapy. Psychodynamic was typically used in treating a lot of the personality disorders, such as someone with Borderline P.D. indulges in splitting with staff, modern psychoanalysts would create scenarios that could help the patient be more conducive to other therapy approaches, and sometimes Psychodynamic for that matter.