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Clinical Psychology vs. Social Work

Definitions:
Clinical psychology includes the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration.
Licensed clinical social worker: A social worker trained in psychotherapy who helps individuals deal with a variety of mental health and daily living problems to improve overall functioning. A social worker usually has a master's degree in social work and has studied sociology, growth and development, mental health theory and practice, human behavior/social environment, psychology, research methods. Abbreviated L.C.S.W.

Comments from Various Sources:
Clinical Social Worker vs. Clinical Psychologist

Clinical social worker and clinical psychologist. What might the functional differences in treatment be between the two professions?

"I'm suffering from suicidical depression, and finally decided I couldn't handle it alone, or even with the support of friends. As such, I went to my university's counseling services department to get a referral to a therapist. I was hoping to find a psychologist, but after the triage shrink called around to her friends, one could not be located with space in their schedule.

I've been referred to a clinical social worker at my university (although the assumption is that I will be seeing him at his private practice). I suppose this is good, since I've found somebody. But, the problem is, I read the words "social worker", and I immediately have a set of images in my head that do not at all sound like somebody I could relate to. I've set up an appointment, but I'm trying to convince myself to give him a chance (i.e. open up, tell him the truth, etc.)... but, the title/degree makes me very wary of him.

Basically, the lack of a PhD makes me seriously question his competence, in the same way that I question the competence of a chiropractor or homoeopathist. I know it's petty, but it's my mind."

More Comments:
"clinical social worker - underpaid, bachelor's degree
clinical psychologist - well paid, doctoral degree

A good clinical social worker can be just as effective as a therapist as a good clinical psychologist."

"I would be trying to emphasize to myself the fact that I have a health professional contact who will see me, over any misgivings I might have about their title. They are trained in communicating, listening and have a background in dealing with a wide cross section of medical cases."

"A PhD doesn't necessarily mean someone will be a satisfactory listener or therapist."

"Just go. Check them out. They just might be the exact type of person to help you through a rough patch."

"The most important thing you can do right now is have a little trust that people with whom you are consulting are going to do whatever they can to assist you."

"I think it's unfair to write them off (SW) based on your preconceptions. It will make it harder for you to fully relate to them, in turn hindering your initial meeting and leaving you with a negative outlook."

"Speaking as a longtime/lifetime sufferer of clinical d. I think maybe you are subconsciously trying to talk yourself out of going to the social worker. Why not wait to judge this person until you've sat through a whole session? You're making the right decision to seek help--don't sabotage yourself."

"some of my best therapists have been social workers and some of my worst have been full-fledged (expensive and prestigious) psychiatrists.

And speaking of psychiatrists, you probably know already that only they (MDs), not psychologists or MSW's, can prescribe meds."

"Based on my own experience, if you're in for "talk therapy," there will be little to no difference in treatment given an MSW or a psychologist."

"I know a number of people with social work degrees, and most of them don't fit the stereotype well."

"The hinderment of the initial meeting is exactly what I mean when I say I'm having trouble giving him a chance. My preconceptions are the problem here, and so I'm trying to educate myself out of them."

"......I don't think it's a case of 'educating yourself out of preconceptions'. It's more that you don't need to worry about them. They aren't really very important because the reality of the session will be different from what you imagine - it always is. It's what happens when you are there that's important.  Just go along to the appointment. The person you see will work out that you're not overly happy about it perhaps - talk to them then - let them speak for themselves. You just can't judge what you haven't experienced."

"The worst therapist I've ever seen was a clinical psychologist. It's been 5 years, and I'm still angry."

"The best therapist I've even seen was a clinical social worker."

"I am finishing up my PhD in Psychology. I work with social workers who are incredible clinicians. The trends in mental health professionals have changed. These days, many PhD programs are very focused on research. Licensed Clinical Social Workers are often more focused on treatment and intervention during their graduate programs than those earning PhDs. I had an excellent therapist of my own last year who was an LCSW. I can tell you that the degree itself is the last thing you need to worry about. Worry about doing what you can for yourself. With regard to the therapist, worry about a person who you feel is competent and trustworthy. The degree alone can't tell you anything about a clinician's ability to treat you. That is only something you can assess by going several times and working with a therapist.

"In my experience, psychiatrists tend to get to the issues / address "core" problems sooner, whereas psychologists want to run you in circles and figure out every problem you've ever had. For example, when I've seen a psychiatrist, I saw them once every two months or so. I was on meds, and this was basically to "check up" on my progress. Whenever I've been to a psychologist, they give me homework, question every aspect of my life, and want me to come back every week. Personally, I like the fact that psychiatrists are actual "Doctors" no offense to present or future psychology PhD's. Psychologists have never been helpful, in my experience. To answer your question directly, see someone who can give you meds, they can provide dual support and solutions, while the social worker can only counsel and refer."

"I have family and friends who are mental health professionals. My mother, in fact, has a Ph.D. in Social Work. That said, I'd like to echo the above advice: your level of comfort with the therapist means a lot more than which degree your therapist holds.

No therapist, no matter how good, is right for every client. You need someone who is right for you. Definitely see the Social Worker ASAP and find how it works out. Good luck, you're on your way to getting through this.

A clinical social worker may well have a PhD. They at the very least will have a Masters, not a Bachelors. As others have said, what matters is what the session is like."

"Many PhD Psych programs are not set up to train clinicians. I'm a Clinical Social Worker, so take this with that in mind, but I've met more clueless clinicians who were PhD Psych then MSW Social Work. Why? Because even when people went to a PhD program that did not teach clinical skills, they felt as if the PhD itself granted them some kind of authority and skill that they did not yet possess.

Broadly, Psych is more oriented to cognitive behavioral interventions because they are easy to systematize and therefore test. This does not mean they are the only effective treatment, just that they are the easiest to test without coming up with creative research scenarios (like say, asking patients to rate their care).

What we know about therapy is this:
1) The important constituents of good therapy are a good relationship with your provider, a feeling that the provider can help you, and a plan for what that help will look like.
2) The particular theory base or approach is not important and accounts for less than 1% of the change seen in treatment.
3) In addition to relationship, hope and a plan, extra therapeutic change accounts for by far the greatest perceived mood change for patients. Therapy should be helping you to make the changes in your life that will make you feel better.
4) Early change predicts later change. If you do decide to continue with a particular therapist, but you don't really feel as if anything has changed by session 8 or 10, change therapists. The average length of therapy is 8 sessions.
5) Medications are no more efficacious than therapy, and to the extent that they do work, they seem to work in the same way. In other words, what's important is the relationship with the doc, or with the idea of medication itself, and not the actual pill. This has long been demonstrated for 'mild to moderate' depression, but has now been documented and demonstrated also with 'severe' depression and more study is ongoing. In addition, there are independent analyses that indicate that taking anti-depressants is itself an independent risk factor for suicide. The Lancet recently had a long series of article and editorials on this. [I am not suggesting that you should not take medications, or that they do not work for some people, or that they have not saved some people. I am suggesting that you should make your own informed choice about medications. If they are not part of your theory of how you're going to change, then don't be forced into taking them just because they are part of someone else's theory.]"

"As a PhD psychologist who does both research and clinical practice, I second/third/and fourth the above folks who advocate going and seeing how you feel. Graduate training for social workers and psychologists differs in some important respects, but my sense is that the differences diminish over time with work and practice and continuing education.

Think of the first appointment as a time to interview a new employee - after all, you are deciding whether or not to hire this person. Ask all the questions you want, see how you feel about the answers and the person's performance, and decide
from that, not from their credential."


PhD in Clinical Psych and MSW Comparisons:
A PhD in clinical psychology is a degree in which people do lots of clinical practice (a PhD in social work -  is a research degree). Now the PhD in psych prepares you in both areas. It is true that most of the psychotherapy (though in most mental health work we don't really talk about psychotherapy - as it is actually counter indicated in some forms of mental illness) is done by social workers. To say though that a PhD in clinical psych is a wasted degree is to fail to appreciate that comparing a PhD to an MA is a bit like comparing apples to oranges. They are both fruits - but they are very different. A PhD will always give you more clout and prestige and in a multi-professional medical context with MD's your PhD will always give you a leg up on the MSW (I say this as a MSW). So if you have the interest and passion for doing a PhD in clinical psych I would do it. You could be equally competent to do therapy (if you personally would be competent I can't say) with either an MSW or PhD (possibly also with an MA in clinical psych and an MFT or LPC).
 

Clinical Psychology vs. Clinical SW??
"What I found was a greater need for the clinical social worker since health care reform (including insurance companies) are seeking "the quick fix" and will only reimburse for short term/brief therapeutic services which the SW seems more apt to provide. I.e., you find clinical social workers in psychiatric hospitals where you won't find *any* clinical psychologists. They aren't necessary, but the social worker is. Same as in DCFS - they always need social workers (to be case managers); but not psychologists.

The clinical social worker assists the client to fit in to society; whereas, the psychologist is mainly focused on trying to help the client resolve personal issues and does not have the priority of looking at how to fit that person into his/her society. I am of the belief that the individual acts/reacts based on both the micro and macro systems, not just micro.

I think you did *absolutely perfect* by following an undergrad coursework in psychology. That is so necessary in obtaining the "clinical" or "mental health" emphasis many jobs seek. I think if you look in your local newspaper, you will see many more positions available to the social worker than you will the psychologist. And, as long as you have the mental health background from psychology, you will definitely see a much greater job capability as you will have all the required background, making you a true, well-rounded professional. Make sure you take the DSM-IV courses, adult and child pathology as well as Family Systems. Those courses will be a great asset to you for future employment.

Ultimately, the choice is yours and you must feel "complete" with your choice."

The Good and the Bad of Both
MSW Good:
"Things I find applying about the MSW option includes the smaller time commitment (1 year if entertaining with a BSW), the versatility of the degree in terms of how you can use it, and the likely wider range of program options (more programs and generally much less competitive than clinical psych!)."
MSW Bad:
"The concerns I have about this option are finances (generally, MSWs are unfunded, but seeing as I am scholarship here, I should have enough money saved up to cover most of the most costs), the general trend out of burn out in many social workers (one wonders why this does not seem to be a problem in clinical psych...?), the fear of being typecast into policy/macro work (just not for me), lack of research, the lack of assessment training/ability, and the fact my general conceptualization of cases tends to fall more to the "medical model" side of things, though I'm starting to see that that isn't necessarily at odds with social work per se."
Clinical Psych Good:
"Things I find appealing about clinical psych include the extensive training in clinical work, therapy, AND research, the fact that most programs are fully funded, the use of more of a medical model perspective, and the burgeoning possibility of limited prescription rights.
Clinical Psych Bad:
"Things that worry me include the huge time commitment (I have a friend at the tail end of her program, and seeing the sheer amount of work she has had to complete [masters thesis, coursework, field placement, internship apps, internship, dissertation approval, dissertation process, dissertation writing, dissertation defense, teaching, etc, etc.] concerns me... not because I mind work but...), the EXTREME competitiveness of these programs (generally ranging from 3%-10% or 15%), the cost if one is not funded (in most cases, these wouldn't be good schools to go to anyway, though), the relative lack of versatility, worry about the degree's usefulness in rural markets, etc."
SUMMARY:
"As you can see, I've thought a lot about the relative pros and cons, but I'm still stuck. The PhD/PsyD appeals to me with the sheer depth of clinical, assessment, and research training, the funding, and the psychopathology focus, but unnerves me with the time commitment, possible money commitment, and narrow scope of practice. I love the MSW's versatility, relatively low time commitment, and broad scope of practice (I'm the strange person that doesn't mind filling out paperwork! ) but am hesitant about being forced into a policy/macro position instead of a clinical/micro/mezzo one, lack of assessment training, and lack of research training."

COMMENTS:
Either choice may be a good one - depending on what you most want to do. I wanted to point out though that I think you're mistaken to think that a Ph.D. or Psy.D. is not as versatile as a MSW. In fact one of the aspects of my career that I've enjoyed the most has been its diversity. I have a Ph.D. in psychology and have recreated my career over the years as my interests and family requirements shifted. I've worked in nonprofit agencies, in a medical hospital, on the faculty of a medical school, and now teach in a Psy.D. program. In the course of those positions my responsibilities have ranged from providing psychotherapy, psychological assessment, research, teaching medical students and graduate students to administration. There's not a bad choice here, but it might be worth taking some time out to work and really assess what you most want to do before taking the leap into graduate school.

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