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  1. Altus permalink

    “… it is unlikely that the social work profession will be taken very seriously.” IMHO it is taken too seriously by insurance companies. Therapists with no medical training are using the DSM to diagnosis Dissociative Identity Disorder and PTSD, among other things. In some states these folks work with with nurse practitioners who prescribe the social worker’s patients drugs based largely on the social worker’s non-medical DSM assessment.

    Social workers might be nice folk but they are the people who flock to weekend workshops at places like Omega in NY and get the info on the latest treatment fads such as past lives regression therapy. Many, as you point out, lack basic critical thinking skills and are easily swayed to try someone’s theory based on a book or lecture which they then turn around and use on their patients. Vulnerable patients can then start playing right into these unproven half-baked theories like repressed memory and we have a mess on our hands.

    Letting someone with social worker degree do what is essentially a medical diagnosis without having medical training really needs to be examined in this country.

    • True, but without the psychiatric profession’s endorsement of Dissociative Identity Disorder, the social work profession would not have such power. As disillusioned as I am with the social work profession, I have to admit that the psychiatric profession is primarily to blame for this bogus disorder and its insistence on keeping it in their DSM. It matters not whether someone has a medical degree and treats DID because DID has no valid medical basis and there is no such thing as “valid” training in DID because there is no evidence to support that DID treatment, whether administered by a psychiatrist, a social worker, a psychologist or anyone else does anyone any good. Just have a look at all the court cases of the 1990s involving the damage done by DID therapy. Most involved psychiatrists and psychologists. I am sure that for every case of malpractice involving social workers I could show you at least one or more cases that involved psychiatrists or psychologists (particularly those that did not go through a good PhD program with a solid grounding in research and there are many more of those than there are good PhD programs).

      Even in the states you mention, the social workers could do nothing without at least the approval of the nurse practitioners, so when it comes to the DID problem, the power is in the hands of the psychiatrists and nurse practitioners. Unfortunately, as Carol Tavris and Eliot Aronson have pointed out, much of a psychiatrist’s training is authority, rather than evidence-based and therein lies the root of the problem. Getting rid of all social workers would still not solve the problem of the ignorance that many psychiatrists have of the scientific literature.

      I am very well aware of the high prevalence of social worker’s use of novel unsupported therapies. I did my dissertation on that topic and have since published research showing that in my sample, 75% had used at least one such therapy within the year that the survey was given.

      In my opinion, the root of the problem in the social work profession lies with the post-modernist philosophy taught by a number of social work faculty that maintain that there is no objective reality and that one way of knowing is as good as the next, hence psychics are just as welcome as people who advocate evidence-based practice and sometimes more so, if my own experience of rejection is any indication.

      I would also take issue with the notion that one needs a medical degree to do competent mental health practice and that the medical model is the best way to treat mental health problems. The fact is that the non-drug, cognitive behavior therapies have been shown in numerous randomized clinical trials to be as or more effective than drugs for a variety of different conditions and numerous studies have shown that these are therapies that masters level therapists such as licensed clinical social workers or marriage and family therapists can be trained to administer quite competently. The problem is not with the lack of medical training, but rather with the flawed philosophical stance taken by many within the profession who are anti-science and anti-evidence based practice.

      • Altus permalink

        Your points are well-taken. But going back to my premise: there is evidence the social work profession is taken very seriously when it comes to psychotherapy. In fact I would go as far as to state it IS the reality of therapeutic experience for the majority of people in the United States. The reason for this is insurance. It costs less to pay a social worker than it does someone with a medical degree so psychiatrists are no longer the reality of psychotherapeutic experience for most of the population. Jeanette Bartha just discussed this item on her blog about Cedars Sinai closing their psych facilities.

        Quality mental health care is simply evaporating.
        Yes, let’s take DID. Indeed, people with a medical degree accounted for some high profile court cases in the 1990s, but the reality is the vast majority of people with medical degrees don’t believe in DID. (Cedars does not even list it.) In a 1999 survey of psychiatrists, only about one-quarter of respondents felt that diagnoses of dissociative amnesia and dissociative identity disorder were supported by strong evidence of scientific validity.

        In the past decade or two I would wager, given the insurance realities the shift has increased at an alarming rate away from psychiatrists toward social workers in the field of psychotherapy.
        Purely statistically speaking, if I walk into a “therapist’s” office today I am less likely to be diagnosed by somebody with any medical training and more likely to be diagnosed by someone who is a social worker, by your estimates 75% of whose members use “novel unsupported therapies.”

        I am agreeing with your assessment of social workers. I am just trying to make the point that they indeed are taken very seriously by virtue of the fact that they are the face of psychotherapy. You and I might agree that psychics should be doing psychotherapy, but there is really nothing to stop them. This, I find, very concerning.

      • In that context, I agree with you. When I wrote “taken seriously” I meant to be referring to the context of knowledgeable clinical scientists. Thanks for pointing this out. I will edit what I wrote so that this is clear. Indeed, the average person often doesn’t know the difference, nor how to distinguish mental health professionals on any level who are engaging in evidence-based practice versus those who use whatever form of therapy strikes their fancy, based on testimonials and anecdotes, rather than rigorous scientific testing.

        Yes, I realize that the majority of psychiatrists do not believe in DID, but that is a separate issue. The small percentage of psychiatrists who do believe in DID can still be and are the ring leaders in the DID industry. The two are not mutually exclusive. The vast majority of licensed clinical social workers also do not deal with DID in any way. It is a very small percentage of mental health professionals from any discipline that are involved in this form of therapy. The larger issue, however, is that a much larger percentage of mental health professionals do not appear to be knowledgeable about how to evaluate a given intervention for efficacy and instead, base their choices on either testimonials and anecdotes or authority and psychiatrists are also, unfortunately, often included in that problem. Although the majority do not believe in DID, may are involved in all kinds of other less than evidence-based practices.

        I think what may be getting confused here in our discussion is within groups vs. between groups comparisons. There are indeed many more practicing clinical social workers than clinical psychologists or psychiatrists. It is well documented that social workers outnumber both of these groups. However, within each of those professions, a serious problem exists and psychiatrists, although smaller in number, have more power within any kind of formalized institutional structure, such as a hospital setting. If psychiatrists were better educated, they would not be writing bogus prescriptions for so-called DID patients. So really, the problem is pervasive in all mental health professionals. If social workers were completely stopped from any kind of clinical practice, the problem would still exist. That is highly unlikely to happen, but if it did, others would step in to fill the gap, I am sure. The only solution is to change the entire educational system and in my experience, this is an uphill battle, although the profession that has come the closest to being successful is the clinical psychologists who run Boulder Model PhD programs, although they, even within the psychology profession, are in the minority given the proliferation of less rigorous PsyD programs that accept many more applicants.

      • If you look at how many people with a medical degree still promote harmful or questionable practices (not even psychological ones – look at some of the doctors that claim to cure cancer or other serious conditions) it makes me think that medical training is not the answer to weeding out those practices. In general there needs to be more training in critical thinking in any level of education.

    • jeanettebartha permalink

      I am not at all surprised to learn about psychic powers and its acceptance by social workers. I have found several continuing education credit classes for the treatment of multiple personalities. I told several social worker friends and they were outraged – although I don’t know that their outrage led to proactively having a discussion with the National Assoc of Soc Workers.

      Social workers used to be a down-to-earth group. I find them going the way of most of the psychology industry that is down the drain.

      Thanks for the post.

  2. WML permalink

    Well said! Bravo!

  3. Altus permalink

    “In general there needs to be more training in critical thinking in any level of education.” Indeed! Scott Lilienfeld is one of the most vocal advocates of this approach. There need to be more like him at every university.

    • Philosophy is often dismissed as a subject, but classes in basic logic should be mandatory. I minored in biology at school, and it was stunning how many of my classmates, even ones who wanted to be doctors, bought into pseudoscientific beliefs.

      Skepticism frightens some people, I think, because in doing so you have to accept you might be wrong about something.

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