[thesnowqueen]

Hi all - I haven't checked in for a long time but my situation with my new therapist (from about February) has hit a bit of a bumper. It seems like our medical aid will only pay for psychotherapy from a psychologist and not from a social worker. I am going to try speak to someone more senior to check if its impossible for them to substitute -

Meanwhile I am looking up the difference online and it does seem quite large. Since my psychologist-of-8-years passed away in April last year I have seen 4 different people. The three before were all men and psychologists, but she, a social worker, is definitely better. I have some concerns about not having cultural touch-stones in common; also her seeming to be without a daffy/alternative side (sorry not sure how to articulate that better). I suspect I am struggling with NOT being infatuated with her (I have a long history of infatuation and my long term therapist was able to take that on so it didn't manifest in my actual life and destroy it...)

Anyway - sorry about long essay with so many details. I originally just wanted to ask the difference between social worker and psychologist...?

It is hard to say for certain as your country may have different standards than the US. Can you find a site that speaks specifically about this for your country?

[thesnowqueen]

Yeah, the academic qualifications for a psychologist take twice as long. A social worker can take on many more roles than a psychologist etc. I have an idea of this kind of thing but I was wondering more if anyone had experienced both and noticed any pros and cons from the point of view of a patient rather than just research. My first therapist was actually a social worker and there were a number of problems with the therapy that I later largely attributed to her being a social worker rather than a psychologist. However, now I am thinking that it probably had a lot more to do with her particular personality than with her training...

I've had three different excellent therapists with three very different training backgrounds. I personally don't think quality has so much to do with training and degree as it has to do with experience and personal/professional skill.

[atisketatasket]

I have had an MS/LPC, two MSWs (one of whom was also had a DBH online from U-Phoenix), an MA/LMFT, and a clinical psychologist/PhD.

Oh, and I've done both insurance/private pay, too, but just females.

I have found very little difference in quality among the degrees. I got on with the MS and MA best, plus they were the most effective, and with the PhD the worst (she struck me as arrogant, plus, it was like she felt we were in an intellectual competition - I have a PhD in the humanities; she was not a researcher). I left almost every session with the PhD feeling worse.

Not sure what you mean by cultural touchstones, but the PhD was the worst in how I define that category too. Didn't understand allusions to Hamlet because she hadn't read it. Didn't know major historical events, even recent ones. So that added to the whole intellectual competition vibe. She was only a couple years older than me, while the rest were all at least ten years older, so we did both remember the 80s and 90s from similar perspectives.

Whereas the MS was easily the most intellectual of the lot. Sometimes I want to go back to finish a conversation about St. John the Divine we started once. And she had a daffy side.

So I'm winding up to the personality matters most. I would imagine different degrees and specialties might well attract one type of personality over another, but then you have to factor in the client's own personality too.

Eta: it sounds to me like there is no significant difference between SA and the US in terms of graduate training, given that both were influenced by the European and British systems.. A PhD will take 6-7 years here, requiring a research dissertation, and a master's 2-3, possibly requiring a thesis, but maybe not.

[thesnowqueen]

Thanks Lolagrace and Atisketa-
Seems we pretty much all agree that formal qualifications are about the least relevant factor!
Apologies for my ignorance but I don't actually know what most of those acronyms stand for (other than PHD...)

I can certainly see how an undercurrent of rivalry would spoil the entire process. Also seems this is something she SHOULD have been aware of and thus changed the tone?

By touchstones I mean more or less the same thing - though also she is from a different culture/ethnic group to my own as well (which might be a good thing). I think she is very widely aware but I don't think she shares many of my own interests - unless she is just expert at keeping any details about herself to herself. I think she would get a general reference to Hamlet but doubt she would engage on The Cloud of Unknowing.

Also difficult because obviously I miss my original T - especially the things I disliked the most like his frequent groan-worthy puns! I guess one needs much longer to suss out the oddities of any individual, but why does a dry sense of humor have to be so scarce?

ETA - I couldn't engage on The C of Unknowing either!

[toomanycats]

I was seeing a psychologist with a PsyD for 3 years and am now seeing a LCSW.
The LCSW is a much...much better fit for me.
And, honestly, he may even just be a better therapist overall...
I'm not sure if he's got any plans to go beyond LCSW -- he's young, so he totally could. But, regardless... he's good. Really good.

[atisketatasket]

MS, master of science
MA, master of arts
LPC, licensed professional counselor
LMFT, licensed marriage and family therapist
MSW, master of social work
LCSW, licensed clinical social worker
DBH, doctor of behavioral health (it's a new education fad here)

Dry senses of humor usually require intelligence, imo. I'd settle for someone who could appreciate mine (which most of them have).

DBC (the PhD, I nicknamed her Dr. Biker Chick) was definitely not self-aware.

[thesnowqueen]

toomanycats - it's interesting how so many have received BETTER treatment from people with LOWER qualifications.

Wow, thanks for the breakdown, Atisket. I doubt South Africa has all of those!

I think dry humor requires intelligence, but there are many intelligent people who are still without. Personally I most like humor when it's dry and dark! I agree - if someone really didn't appreciate mine I don't think we would get along at all.

As for therapists who are not self aware...? Like I would assume that is the most basic basic prerequisite. No wonder the profession is so problematic!

[Bluesday]

I have an art therapist for a counselor. I'm still shocked that my psychiatrist does meds only and very little if any actual therapy.

[thesnowqueen]

Originally Posted by Bluesday

I have an art therapist for a counselor. I'm still shocked that my psychiatrist does meds only and very little if any actual therapy.

I've found that psychiatrists can be quite odd and out of their depth when giving psychotherapy!

[atisketatasket]

Originally Posted by thesnowqueen

I've found that psychiatrists can be quite odd and out of their depth when giving psychotherapy!

Yes. When my former psychiatrist tried what she called therapy, it felt like nothing so much as being beaten around the head and shoulders with a brick in a sock.

Some are good at it. But generally I don't think the MD mindset is conducive to giving therapy.

Eta: I suppose dry senses of humor tend to require a sense of the ridiculous as well, of not taking yourself too seriously.

Agree that the degree is likely not relevant to treatment outcomes. I've had therapists with several varieties of degrees over the years. One PhDs was meh, and one was fairly good. One psychiatrist was very good for therapy, another ok, and others terrible for both medications and therapy. Etc.

These are the traits that stand out:

- natural interpersonal skills
Some have this and some don't. Analogous to giving a speech-although speech giving is a developed skill in a sense, some people are just good at it naturally. Because they can give an effective speech does not equate to being more or less knowledgeable about the content of the speech. And those good at speech can deliver good speeches no matter what the topic. Similarly, Ts with good interpersonal skills can deliver good therapy for multiple types of clients.

- ability to apply knowledge
Self explanatory but underrated. I also think good ones will study beyond their school and self-teach from different orientations or schools of thought, and keep abreast of new research and apply it in practice.

- compassion
This is opposed to being primarily needs driven. After some time, I can tell when relating to someone who is driven more by their own needs vs driven by compassion. Everyone is driven by their own needs to an extent, but I think the ones who have balance are better. When the scale is tipped to far to the self need fulfillment, it rubs off too much and can't be hidden.

-motivations to be a therapist
A psychiatrist may have wanted to be in the field or ended up in the field because they couldn't rank high enough to get their preferred medical specialty. A social worker may choose the career or it could be someone who wanted a less demanding/less intellectually challenge degree. I don't mean to imply that those who chose the field will always be good, but I think it makes a difference.

- ability to not get entangled with client (solid sense of self)
Too many issues to get into here.

I'm probably in the minority here because I think the concept of 'the match' is overrated and gauge a therapist's abilities through these big picture issues. In my opinion, the nuts and bolts of things that drive many conversations here (eg, boundaries) are under the umbrella of these concepts, which are discussed less often.

[thesnowqueen]

Originally Posted by atisketatasket

Yes. When my former psychiatrist tried what she called therapy, it felt like nothing so much as being beaten around the head and shoulders with a brick in a sock.

Some are good at it. But generally I don't think the MD mindset is conducive to giving therapy.

Eta: I suppose dry senses of humor tend to require a sense of the ridiculous as well, of not taking yourself too seriously.

The docs I've had haven't been quite that bad, lol!

I agree that those with that form of humor have those traits, but think it might be hasty to infer that those without it are either not-as-intelligent or that they tend to be pompous. Perhaps it also involves personality style, quirky perspective or something else!

Both of my therapists had their initial degree in social work, one with a masters and the other with a PhD. They also have other qualifications and training. I know many psychologists via my own work, some do research, others purely clinical practice, and some both. I never really saw a correlation between their qualities and their degrees. Perhaps there is in a younger population that just completed degrees, but for people that have been working for >15 years, I think what primarily matters is their individual quality, skill set, and ability to self-train and learn from their experiences. I've experienced some power struggle with the PhD, which was coming from both of us, I think. I've been doing academic research in my whole career so far (close to 20 years) and have high quality standards when it comes to assessing and interpreting, and presenting things. Subjectively, I often found my Ts approaches sloppy and more self referential than looking at the "material" out there. So we would get into arguments around these things. Never happened with the other T that has a MA degree and some background in academic research similar to mine, but I don't think it has to do with his training per se, much more personal qualities, a more open mind, and respectfulness. And I find some of the psychologists I know via my work quite arrogant and not so good with people at all.

So, in general, what makes a real difference IMO is not formal training but individual qualities and experience. For me, that is the basis of trustworthiness and competency, not degrees and schools. Looking at credential is good as a first impression but I want to evaluate them based on my own experience. I also met people without any formal degree that knew more about human nature and were more able to understand and work with diverse sets of people than anyone else I've known with elite degrees and education.

As for the off-beat, dry and dark sense of humor, I also appreciate that and can connect with people that way when I choose to. But I don't always see it as a sign of higher level of intelligence when it comes to self-awareness and confidence. I think often it's a defense and avoidance strategy for many that have the knowledge and intellectual confidence to twist things in interesting ways, it can be applied to cover up insecurities. I personally learned to appreciate more a style when someone will openly say when they don't know or are unsure about something, have the courage to admit failure etc. It's not mutually exclusive of course, just saying that I would see it more as a red flag of a therapist used dark humor too much with clients, however enjoyable.

[thesnowqueen]

Thanks Xynesthesia!

I'm not one to idealize high degrees - having encountered far too many problematic people holding them (as well as some awesome people, of course!) I had assumed it would make a significant difference to the approach the therapist took, but a therapist once told me that the longer therapists practiced, the more alike their approach was!

It sounds like you had some similar dynamics to the ones Atisket had with a PHD therapist! In my opinion it is the therapist's duty to be aware and manage this, but I guess some are prone to competition. The only T I have seen with a PHD was not at all like that. In fact, I got irritated with his word choices being inexact and somewhat careless. He was also a bit prone to cliches and had a strangely naive way of looking at things. On the other hand he was quite centered, professional, compassionate and steady.

Regarding humor and off-beat-ness, I can see how this COULD manifest in ways that are problematic, and be a sign of traits that are not desirable in a T. With the long term T that I had, this was not the case - but I do think a T could be really good without having such traits and so...I probably shouldn't think of it as a deal breaker...

[reb569]

Many insurance companies in the US require a LCSW to reimburse. There is also a LCSW-R (I think, or maybe -S) designation that designates a higher level of training.

In my opinion, as someone who went through part of the training to become a Social Worker, the Social Work training concentrates less on theory and more on actually working with and understanding people than a Psychologist. Only a couple years less or training too.

I don't think it matters if you get the help you need. Personally, I'm getting tired of educating them. If I know more than they do, it's not a good sign..... .

[cucumbercat1]

I've seen a clinical psychologist/PhD, a MA level (clinical psych), a master's level LPC, and now a MSW. Honestly, my best experience has been with the social worker and MA psych. It really all depends on training, what treatment orientation works for you, personality, etc. I don't care how much schooling someone has as long as their training meets my needs and our personalities mesh.

[Erebos]

In the UK social workers only work with adults/cjildren/,families, in need. They have no PhD, no doctorate and are not required to have a university level education. Until recently didn't require anything more than a high school diploma (equivalent)
They certainly don't counsel, and the alot aren't fit for purpose. They are meant to help, with day to day organising and helping to support you to claim your entitlements.

Sounds like very different thing to where you are.

[thesnowqueen]

Originally Posted by Erebos

In the UK social workers only work with adults/cjildren/,families, in need. They have no PhD, no doctorate and are not required to have a university level education. Until recently didn't require anything more than a high school diploma (equivalent)
They certainly don't counsel, and the alot aren't fit for purpose. They are meant to help, with day to day organising and helping to support you to claim your entitlements.

Sounds like very different thing to where you are.

Hi there - yes, it's definitely quite different. In South Africa they do need a university degree but it does take less time than a psychologist. And I know this one also has clinical qualifications.

[thesnowqueen]

I just wanted to say thank you to everyone for their input on this. I am planning on fighting the medical aid for coverage on this as it turns out that almost all other medical aids do cover it...

[HowDoYouFeelMeow?]

My PhD and PsyD are/were wonderful, but my LCSW was a nightmare. It had nothing to do with her degree, though. She was just a monster.