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Curious Becca

Need Help Understanding

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Hello, 

I'm writing this in order to help understand something that's currently dumbfounding me - how can it be that Social Workers are prepared to practice counseling and therapy? 

I'm currently attending grad school in order to obtain my LMFT, and I have a bacholers in Psychology. My grandpa was a Psychologist, so I grew up understanding the depths of psychoanalysis,  psychometry, and CBT. 

I've worked in several agencies that offer therapy by people who have social work degrees, and have found that many people who are receiving therapy by social workers often don't get the psychological treatment and cognitive/behavioral change seen with people that hold degrees with a Psychological and Therapeutic/Counseling background. 

In fact, while researching several Masters level programs in Social Work, I have yet to run across any programs that offer in depth classes that promote therapeutic approaches - such as  Theories of Psychology, or Basic Counseling classes...

It was shocking to find out that Oklahoma allows Social Workers to practice therapy on someone, when I don't feel they're adequately trained! 

Please help me understand what I'm missing here... 

 

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Sadly, most MSW programs don't even require a Master's Thesis! What's more disturbing is, the whole field seems to operate based on personal feelings and experiences rather than evidence and research. Where I live, Social Workers conduct group therapy sessions, even though they have no formal training. Unfortunately, this is probably the case due to the need and lack of trained professional. Furthermore, I suspect that this is a way of "cutting corners" in terms of saving money. 
 

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This strikes me as taking an elitist "my discipline is the best discipline" approach to thinking about who conducts therapy. Would you say that only those with training in psychology are qualified or could those with a background in nursing or other medical areas be qualified? Ultimately, why is it that you think only specific courses can prepare someone to counsel others? (And also, what good is writing a master's thesis for someone who wants to be doing therapy, counseling, or other hands-on work? What would they gain from devoting extensive time to research, rather than to field experiences?)

Because your question made me curious, I googled the MSW curricula for two schools: Florida State University and the University of Georgia. I won't link to FSU because, for whatever reason, the link isn't secure. But the UGA revised curriculum requires courses on human behavior, working with individuals, working with groups, and psychopathology. Even their old clinical curriculum required those courses. Are there specific course requirements you take issue with? Is there really only one "proper" way to be trained to be a counselor?

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Therapy is a very broad field - if you are saying that people with MSWs don't have a background in CBT and therefore can not administer the most efficacious and scientifically sound form of therapy, yes it is true they have less experience in CBT than someone with a clinical psychology PhD would, because they have internships and placements and are supervised through these encounters to ensure they are adequately executing the therapy type.

However, if someone did a philosophy degree and then was doing psychoanalysis, which is obviously not empirically supported through randomized clinical trials and is basically pseudoscience, then they are still doing "therapy", they are just not doing scientific therapy as you're describing.

So yes, not everyone is doing the same therapy. As well, people with an MSW do not cost as much as someone with a clinical psych PhD, for a reason. But there are many different ways of administering community health programs, most of which do not use the best scientific methods we have available, and improving that so that people can have better outcomes would obviously be ideal. This movement towards evidence-based therapies, policymaking, governance, and business is slow, but it's gaining a lot of momentum.

To summarize, yes @rising_star, there is a "right" and "proper" way to be trained to be a counselor, if we define counselor as someone who administers scientifically-based therapies that are more effective than controls and placebos, just like there is a right way to be trained to be a medical doctor or a scientist. If we define counselor as someone who talks to people, then of course anyone with any background can talk to people. But that won't necessarily be empirically supported. I'm sure you understand, being a scientist yourself.

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@eternallyephemeral, have you actually evaluated the content of the training MSW students receive? Can you say with certainty that the training they receive isn't scientifically based? MSW programs have an accrediting agency. Students are supervised by trained professionals and complete internships and placements, just like clinical psychology PhD students do. Is the root of this that you think that social sciences which aren't psychology aren't rooted in science, don't use empirically derived evidence, etc.? If so, again, that's someone being an elitist about their discipline. Yes, the training MSW students receive is different but that doesn't automatically make it lesser than something else. 

This is a really old post but it has some good information on the various degree options. It's probably worth noting that, in most states, MSWs can and do provide therapy and receive insurance reimbursement for doing so (see here for more). This page offers a comparison between MFT and MSW degrees, just in case you're interested. Does anyone arguing that MSWs are less qualified or unqualified to engage in evidence-based counseling/therapy have actual evidence to cite in support of this claim? Or is just posturing, blustering, and ideas based on what you think happens in a degree program you aren't in?

Please don't make any assumptions about my own training, which includes the notion that different people can approach a problem from different perspectives and still have valuable insight.

P.S. If you really want to know about the training MSW students receive, you might try posting on the MSW subforum here and asking folks about it.

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1 hour ago, eternallyephemeral said:

To summarize, yes @rising_star, there is a "right" and "proper" way to be trained to be a counselor, if we define counselor as someone who administers scientifically-based therapies that are more effective than controls and placebos, just like there is a right way to be trained to be a medical doctor or a scientist. If we define counselor as someone who talks to people, then of course anyone with any background can talk to people. But that won't necessarily be empirically supported. I'm sure you understand, being a scientist yourself.

To clarify, we don't think there's only one "right" way to train a doctor or a scientist. There are lots of competing approaches. 

For one small example, take a look at, say, DO vs MD for training. You also have eastern medicine gaining more acceptance in the US, and a (slow) growth of programs following that mindset. 

Even within the MD pool, different schools take different approaches to training- there is no one, unified "right" way. 

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On 5/16/2017 at 11:08 PM, rising_star said:

 (And also, what good is writing a master's thesis for someone who wants to be doing therapy, counseling, or other hands-on work? What would they gain from devoting extensive time to research, rather than to field experiences?)

According to a colleague of mine (and in my experience as a dilettante studying pseudoscience in mental health treatment), MA-level therapists who lack the research experience that a PhD brings tend to be more taken in by faddish treatments, e.g., rebirthing therapy, recovered memories, EMDR.

Clinical psychologists also tend to take on more complex case presentations (e.g., schizophrenia, anxiety, major depression) but that level of training isn't needed for every person seeking therapy, e.g., a nurse practitioner can treat many 'family doctor' conditions that don't require a medical doctor.

I'm blanking on the source but I recall reading that efficacy studies show that newly trained PhDs are more effective practitioners than MAs initially--because they get more training hours--but the difference disappears after something like five years (when equating the type of case being treated).

 

 

 

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On 5/16/2017 at 6:35 PM, HigherEdPsych said:

Furthermore, I suspect that this is a way of "cutting corners" in terms of saving money. 
 

I think this is really at the bottom of it. If you check on the U.S. Bureau of Labor Statistics you'll see the median hourly wage for a Social Worker is about $10-$15 cheaper than that of a Clinical Psychologist. I can see how people (or insurance companies) would be swayed by this. 

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On 5/17/2017 at 6:37 AM, rising_star said:

@eternallyephemeral, have you actually evaluated the content of the training MSW students receive? Can you say with certainty that the training they receive isn't scientifically based? MSW programs have an accrediting agency. Students are supervised by trained professionals and complete internships and placements, just like clinical psychology PhD students do. Is the root of this that you think that social sciences which aren't psychology aren't rooted in science, don't use empirically derived evidence, etc.? If so, again, that's someone being an elitist about their discipline. Yes, the training MSW students receive is different but that doesn't automatically make it lesser than something else. 

I can say with absolute certainty that the MSW students in my area do not get enough training that is science based nor are they prepared for the myriad of consequential job responsibilities. Working with local state organizations (e.g., Child Welfare Services, Department of Human Service, etc.), I've seen many Social Workers make assessments, recommendations, or suggest interventions based on past/personal experiences. When asked how decisions were made and if they had a set of procedures (specific to situations or populations), I learned that decisions were commonly based on other cases or personal beliefs and no such procedure existed. Which worries me deeply - how do we know Social Workers are not influenced by biases in making their decisions? I've also witnessed Social Workers who categorize individuals into a immutable mold: "Oh, they've experienced sexual trauma? Well, then you can expect to see [X, Y, and Z] from them. They will not like [X, Y, and Z], so be sure not to do any of those things. Only [X, Y, and Z] will help in this situation." Perhaps, this is only my experience. To improve practice and service, attention needs to be focused on the ways that Social Workers form judgements and make decisions with an aim to have the most efficacious outcome. And, that's where research comes in, how do we train competent Social Workers - who are expected to make crucial assessments or provide counseling - when they simply do not know/implement the science? To be absolutely clear, I am not saying a MSW is lesser than a PhD. I am saying that a MSW should not be tasked with responsibilities nor make crucial, lasting decisions that are above their training level. 

Edited by HigherEdPsych

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On 5/19/2017 at 11:04 PM, HigherEdPsych said:

I can say with absolute certainty that the MSW students in my area do not get enough training that is science based nor are they prepared for the myriad of consequential job responsibilities. Working with local state organizations (e.g., Child Welfare Services, Department of Human Service, etc.), I've seen many Social Workers make assessments, recommendations, or suggest interventions based on past/personal experiences. When asked how decisions were made and if they had a set of procedures (specific to situations or populations), I learned that decisions were commonly based on other cases or personal beliefs and no such procedure existed. Which worries me deeply - how do we know Social Workers are not influenced by biases in making their decisions? I've also witnessed Social Workers who categorize individuals into a immutable mold: "Oh, they've experienced sexual trauma? Well, then you can expect to see [X, Y, and Z] from them. They will not like [X, Y, and Z], so be sure not to do any of those things. Only [X, Y, and Z] will help in this situation." Perhaps, this is only my experience. To improve practice and service, attention needs to be focused on the ways that Social Workers form judgements and make decisions with an aim to have the most efficacious outcome. And, that's where research comes in, how do we train competent Social Workers - who are expected to make crucial assessments or provide counseling - when they simply do not know/implement the science? To be absolutely clear, I am not saying a MSW is lesser than a PhD. I am saying that a MSW should not be tasked with responsibilities nor make crucial, lasting decisions that are above their training level. 

Sorry for the delayed response. I've been traveling with no internet access for 2+ weeks. I'm only going to respond to this because you're doing a common thing, which is taking anecdotal evidence based on your experiences and extrapolating from that to denigrate an entire discipline and draw conclusions about how that field should be changed, without actually informing yourself about the training MSW students receive. I've interacted with clinical psychologists who tell LGBT persons that the issues are all in their head but that doesn't mean that I think all clinical psychologists are that way. Have you conducted a systematic evaluation of the social workers you've met, which includes factoring in their training? If not, then I'd suggest that you avoid making such broad, sweeping statements.

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On 6/3/2017 at 5:50 AM, rising_star said:

Sorry for the delayed response. I've been traveling with no internet access for 2+ weeks. I'm only going to respond to this because you're doing a common thing, which is taking anecdotal evidence based on your experiences and extrapolating from that to denigrate an entire discipline and draw conclusions about how that field should be changed, without actually informing yourself about the training MSW students receive. I've interacted with clinical psychologists who tell LGBT persons that the issues are all in their head but that doesn't mean that I think all clinical psychologists are that way. Have you conducted a systematic evaluation of the social workers you've met, which includes factoring in their training? If not, then I'd suggest that you avoid making such broad, sweeping statements.

Thank you for the reply. A quick lit search bolsters my original claim and further conveys the disconnect between social work and evidence based practice/science. It seems that a large body of evidence exists, which attempts to bridge the gap between the practice of social work and empirical evidence - suggesting that this is no new argument. And, frankly, I don't think it matters much whether it is one MSW program or one thousand MSW programs that lack a science based curricula. All training programs should be evidence based, especially if they aim to produce practitioners who heavily influence others' lives.

1) The Scientific View of Social Work: http://socialwelfare.library.vcu.edu/social-work/the-scientific-view-of-social-work/

2) The Science of Social Work and Its Relationship to Social Work Practice: https://www.researchgate.net/publication/274647142_The_Science_of_Social_Work_and_Its_Relationship_to_Social_Work_Practice

3) Philosophy of Science and Social Work: http://www.oxfordbibliographies.com/view/document/obo-9780195389678/obo-9780195389678-0100.xml

4) Science and Social Work: A Critical Appraisal: https://books.google.com/books?hl=en&lr=&id=ikusAgAAQBAJ&oi=fnd&pg=PR9&dq=social+work+science+&ots=7d_40pVGag&sig=UEnCfRSq-SmngPNB7Vdzc15Qugw#v=onepage&q=social work science&f=false

Edited by HigherEdPsych

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Apparently, most - but not all - states mandate CSWE (Council of Social Work Education) accreditation as part of the educational requirement for licensing to become a Social Worker. The immediate question, then, is what constitutes CSWE accreditation? Taken directly from Social Work Licensure.org: "CSWE Accreditation means: Graduates will know how to apply ethical principles and critical thinking to social work practice." As I mentioned above, "critical thinking" is a far departure from evidence based practice and is prone to biases. Moreover, there appears to be exceptions where this most basic standard is not even necessary for CSWE accreditation (e.g., for new programs going through candidacy and programs which are state approved [for example, programs in Oregon]). 

Are these the same accreditation standards you were mentioning? 

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@HigherEdPsych, no, I was thinking of the standards required for licensing in various states. But, a quick lit search does not equal a systematic review, as I'm sure you already know. I'll just reiterate my earlier point that you might be better served by having this conversation with social work faculty, graduate students, and practitioners so that you're not just speaking into an echo chamber.

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7 hours ago, rising_star said:

@HigherEdPsych, no, I was thinking of the standards required for licensing in various states. But, a quick lit search does not equal a systematic review, as I'm sure you already know. I'll just reiterate my earlier point that you might be better served by having this conversation with social work faculty, graduate students, and practitioners so that you're not just speaking into an echo chamber.

Thanks for the advice, but it's pretty clear (to me at least) that I've found all the information I need. 

Cheers!

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