Clinical Social Worker vs. Clinical Psychologist
April 22, 2005 12:16 PM   Subscribe

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 homeopathist. I know it's petty, but it's my mind.
posted by Netzapper to Health & Fitness (25 answers total) 1 user marked this as a favorite
Response by poster: Sorry for not properly stating the question. I misused the "title" line. The "two professions" in question are clinical social worker and clinical psychologist.
posted by Netzapper at 12:18 PM on April 22, 2005

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.
posted by caddis at 12:26 PM on April 22, 2005

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 this 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.

See how it goes. It's the first step.
posted by peacay at 12:29 PM on April 22, 2005

I think it's unfair to write them off 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. Best wishes.
posted by prostyle at 12:34 PM on April 22, 2005

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.

BTW and FWIW, 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.
posted by scratch at 12:38 PM on April 22, 2005

(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.)

/forgot to answer the question
posted by scratch at 12:41 PM on April 22, 2005

Psychologists or MSWs can work with MDs to prescribe meds, however. At least, I've seen it done.

I know a number of people with social work degrees, and most of them don't fit the stereotype well. Your mileage may vary.
posted by weston at 12:44 PM on April 22, 2005

Response by poster: prostyle: 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.

scratch: You're probably right about me trying to talk myself out of seeing somebody.

re: meds: I'm trying to avoid medication, actually. Mind you, I have no problem with drugs in general, but I don't personally know anybody who hasn't described the side effects as being as bad or worse than the depression itself. "Numb" is the term I've heard from every one of them.
posted by Netzapper at 12:46 PM on April 22, 2005

Mod note: fixed the question error so it reads as intended
posted by jessamyn (staff) at 12:55 PM on April 22, 2005

Netzapper.......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.

Just go. It's the best thing.
posted by peacay at 12:56 PM on April 22, 2005

And when is the appointment by the way?
posted by peacay at 12:57 PM on April 22, 2005

Is this your first visit to a "professional"? I agree that you should definitely give this person a try, if for no other reason than the fact that no one else is available to see you at the moment. Taking that initial action is the most important thing, even if you ultimately find the clinical social worker unhelpful or inept.

Speaking as someone who has tried numerous medications and equally numerous therapists, let me just tell you that it could take a few attempts before you find the right person you can connect with. I didn't know any better as a young kid and I stayed with the same therapist (and in the same miserable condition) for years. Looking back, this man should have his credentials revoked, or at the very least, get his ass kicked. He told me absolutely nothing. All I remember is listening to myself talk. I don't think he ever said anything to me other than a question here and there to prompt/extend my running monologue. Another psychologist blatantly ignored my very direct plea for help. Maybe I am overexplaining because you sound like an intelligent individual, but...don't settle for just anyone, even if they do have a Ph.D. You want someone who is going to interact intelligently and creatively with you--someone who makes you question your perceptions and subtly illustrates or suggests ways to improve your outlook on life. I really hope you find that person. Soon. Hang in there and good luck.
posted by crapulent at 1:03 PM on April 22, 2005 [1 favorite]

re: meds: I'm trying to avoid medication, actually. Mind you, I have no problem with drugs in general, but I don't personally know anybody who hasn't described the side effects as being as bad or worse than the depression itself. "Numb" is the term I've heard from every one of them.

Hi there, pleased to meetcha ... with me it's exactly the other way around. I'm numb without 'em. Every single person responds differently to every medication there is. "Newer" (SSRI) antidepressants generally have much fewer and less severe side effects than "first-generation" ones such as tricyclics. As usual, of course, YMMV. I can't take Wellbutrin, for instance, b/c of the side effects, but Zoloft and Serzone, now that's the ticket. (Wellbutrin isn't an SSRI, actually, but whatever.)
posted by scratch at 1:06 PM on April 22, 2005

The worst therapist I've ever seen was a clinical psychologist. It's been 5 years, and I'm still angry at the Svengali asshole. [lots of ranting deleted due to irrelevancy]

The best therapist I've even seen was a clinical social worker. [lots of fawning deleted due to irrelevancy]

Mostly, I agree with what several others have said here: go. If it sucks, you can stop going.
posted by MrMoonPie at 1:14 PM on April 22, 2005

Response by poster: crapulent: No, it's not my first time. It is, however, my first time doing it because I think I need to.

When I was very young, I was being a "bad kid", and was taken into a child psychologist for a while. The end result of that was a diagnoses of Authority Disrespect and Defiance Disorder, and a suggestion that I be put inpatient somewhere at the age of five. My parents, bless their souls, realized that was bullshit, terminated treatment, and went on with life.

I also saw a psychologist when I was in middle school because I was fucking up in school. However, it was again my parents' idea, and it was hellish and irritating... the guy was a Skinnerian behaviorist with a tiny bit of emotive-rational thrown in for flavor, and kept telling me to reward myself concretely when I completed assignments, controlled impulses, etc. I thought it was bullshit and didn't think I needed to be seeing somebody at all. He ended the process, telling my parents that I, for whatever reason, was capable of "recognizing and consciously short-circuiting operant conditioning". I was sort of proud of that, actually.

You might say that I don't have the greatest trust in health care professionals as it stands. Not that I think they're all incompetent, by any means. Just that I've never had one who matched well with me.
posted by Netzapper at 1:21 PM on April 22, 2005

Hee hee. Sorry for giving you a bunch of useless information. You are an old hand at this. Perhaps you can get recommendations from friends or find a website that rates shrinks in your area.
posted by crapulent at 1:34 PM on April 22, 2005

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 trustwirthy. 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.
posted by abbyladybug at 1:49 PM on April 22, 2005 [1 favorite]

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. FWIW, 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. YMMV; 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.
posted by AllesKlar at 2:03 PM on April 22, 2005

Response by poster: Thanks, ya'll. Between you guys, and my roommate's* advice, I'll give the guy a shot.

*She's a reintegration worker, trained as a (non-clinical) psychologist.
posted by Netzapper at 2:32 PM on April 22, 2005

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.
posted by Eamon at 6:39 PM on April 22, 2005

Think of appt. #1 as an interview. Ask some questions about the person's approach and phoilosophy. Competent practioners come with a variety of degrees; so do incompetent ones.

I've had good luck with SSRI's, and minimal side effects with the right med/dose combination. I use a pretty low dose, and it doesn't entirely get rid of the depression, but I don't feel numb, either.

Suicidal depression. I recommend How not to commit suicide by Art Kleiner. There are resources available if suicide starts looking appealing. My email's in my profile.
posted by theora55 at 8:01 PM on April 22, 2005

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.

As abbyladybug points out, 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) All decent therapy is basically decent. In other words, the particular theory base or approach is not important and accounts for less than 1% (Wampold, 2001) of the change seen in treatment.
3) In addition to relationship, hope and a plan, extratherapuetic 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.]

Best of luck, take care of yourself, get yourself to an ER if you feel like you can't take it anymore.

Feel free to email me via my profile if you would like, and if you can overcome my lack of credentials ; )
posted by OmieWise at 6:45 AM on April 23, 2005 [2 favorites]

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.

Good for you for making an appointment! Keep us posted, and good luck!
posted by jasper411 at 3:13 PM on April 23, 2005

I'm not sure when the appointment was supposed to be, but how did it go? We're all rooting for you, and I know that many of us here wouldn't mind at all if you contacted us, and we hope that you go to this one appointment. But the thing to keep in mind AFTER the appointment is that there is NO shame in realizing that the particular person's approach isn't going to work for you. Know that you can find someone else that will be just right.
posted by fionab at 3:56 PM on April 23, 2005

> clinical social worker - underpaid, bachelor's degree

Not true. Few clinical social workers do not have an MSW.
posted by Raspberry at 7:35 PM on April 27, 2005

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