Many who are newly searching for psychotherapy are surprised to discover that a therapist recommended to them, or found over the internet has as the professional degree that qualifies them to practice therapy a masters degree in social work. In fact, some patients don’t discover this about their therapist until years into their therapy, if ever. I have, in fact, among others, a masters degree in social work, and I am licensed in New York State as a social worker.
While most of my patients, frankly, don’t find that fact all that interesting, some find themselves quite surprised. The practice of psychotherapy (including group psychotherapy) isn’t consistent with their image of social workers–an image no doubt shaped by the presentation in movies and on television of bureaucratic women (and aren’t they always women?), poorly dressed and alternately saintly or sinister. In accordance with this image, we’re lead to believe that social workers typically work for the government or social service agencies, find homes for displaced children, run drug treatment clinics, and provide services to the homeless. And social workers do, in fact, all of these things.
This, of course, is inconsistent with the view many have of a psychotherapist. Some assume the therapist they see is a psychologist, or perhaps a psychiatrist, but in fact this is true less-than a majority of the time. In New York City, if you’re shopping for a therapist, the odds are good you’ll find yourself in a social worker’s office. (For more on what all of these labels and titles mean, check out this blog post on finding a therapist.)
It wasn’t always like this
Social work traces its roots as a profession to the later years of the 19th Century. In response to many of the problems created (or concentrated, at least) by the Industrial Revolution, the practice of charity became revolutionized itself–it gradually became a formal profession, complete with its own science and its own university-located training programs (what is now the Columbia University School of Social Work, the oldest of such institutions in the world, was founded in New York City in 1898).
The profession grew quickly and evolved a clinical branch–one that focused increasingly on applying the new science of psychology (and, later, of psychoanalysis, especially in schools of social work in New York City and the Northeastern United States) in its practice. With the post-war advent of managed care and changing financial realities for social workers (then, as now, still primarily women), the appeal of private practice psychotherapy became too great to pass up. For many, this meant the possibility of earning more money, but with it also came increased autonomy and freedom from increasingly bureaucratic (top down, rigid) institutions that traditionally employ social workers.
In the second half of the 20th Century students sought, and schools of social work provided, better and more elaborate training in the practice of psychotherapy (often referred to as clinical social work). Additionally, post-graduate psychotherapy training institutes, which had been in many ways grown-up fraternities for psychiatrists and psychologists who shared a particular (generally psychoanalytic) persuasion began welcoming social workers into their training programs. As a result, a clinical social worker might graduate from one of these intensive training programs alongside a psychologist having developed remarkably similar skills. As the demand for psychotherapy grew, particularly in cities like New York, social workers increasingly rose to meet that demand.
What does this mean for me in my search for a great therapist?
For one thing, it certainly makes the whole process more confusing. There are a few things to note. First, don’t assume a therapist is better trained (or less-well trained) based on credentials. There are many, many paths to licensure as a psychotherapist. This is important both because you might overlook a potentially great find, but also because you might assume someone is well qualified to help you solely based on an impressive credential. Psychotherapy involves a reasonable basis of trust–much more than you’d need from a dentist or cardiologist. Giving someone the benefit of the doubt based on a particular degree could leave you more vulnerable.
It is also important to note that in New York State the practice of psychotherapy is now fully licensed. No one can call themselves a psychotherapist without a license (though that licensure process is itself quite confusing). That means that all therapists are beholden to laws and regulations governing ethical practice.
There are some important questions (and perhaps I’ll seem to contradict myself here) raised by the preponderance of social workers in private practice. While those with a degree in psychology (a PhD or PsyD) must have completed extensive training explicitly in psychotherapy in order to obtain that degree (and the subsequent license) this is actually not so for social workers! In New York State, as odd as it may seem, social workers can engage in a variety of clinical social work tasks such as diagnosis and assessment, clinical case management, treatment planning, and other activities more commonly associated with the practice of social work as part or all of the clinical experience needed to make them eligible for licensing. What that means is that you cannot assume that a social worker licensed in New York necessarily has much (or any) experience practicing psychotherapy. To be clear, many social workers (and I proudly count myself in this category) have extensive training and experience. The critical point here: Don’t assume!
And of course, beyond the critical matter of training and experience is the most critical question of all: “Can you help me?”