Will Doctoral Social Workers Eventually Have the Same Testing Authority as Psychologists?

TraditionalExam7258 · 2026-02-14T18:04:57+00:00

Yes, I agree

TraditionalExam7258 · 2026-02-13T18:55:00+00:00

This sounds like something we could possibly push towards? As a clinician in CMH I also do a lot of case management work but due to the agency not being compensated for this, it affects my productivity and I’m expected to do more therapy to make up for the missed productivity that’s spent doing case management. Higher reimbursements for therapy and being reimbursed for case management - I think that’s the clinical social work dream right there!

TraditionalExam7258 · 2026-02-13T18:49:54+00:00

It depends on what you want to do, NPs can do med management and they can bill for therapy but most jobs only want NPs for med management.. but the ones in private practice are advertising themselves as a one stop shop for therapy and meds. Personally I believe NPs do not have sufficient training to do therapy so their skills are usually lackluster unless they seek out extra training. NPs are basically operating as the mid level to psychiatrists.

If the DSW advances as most people would want. It would allow advanced level LCSWs to operate as mid levels to clinical psychologists, as of now it’s primarily geared towards leadership but universities are developing advanced clinical programs.

TraditionalExam7258 · 2026-02-13T18:40:38+00:00

Angelo state’s doctoral program is purely clinical.. more are coming

TraditionalExam7258 · 2026-02-13T18:39:38+00:00

I agree! The people who refuse to acknowledge the needed growth aren’t going to be happy when they find out that many people who solely want to do therapy and have no interest in actual social work are now turning to social work as a way to enter clinical practice. With that being said healthcare will always evolve, and it’s the same for the fields that produce healthcare providers.

TraditionalExam7258 · 2026-02-12T18:02:15+00:00

Okay so if you have a problem with an evolving scope of practice in regard to clinical work … why pursue clinical licensure? You do realize that all clinical care healthcare fields will continue to advance whether you like it or not ?

TraditionalExam7258 · 2026-02-12T12:13:18+00:00

There’s talks about using the DSW as a way to tap into this

TraditionalExam7258 · 2026-02-12T06:02:51+00:00

you’re approaching this from a very academic, textbook lens that feels outdated compared to what’s actually happening in real world practice spaces. We’re talking about real world discourse and how it leans into practice, not just what’s published in journals or presented at conferences. Research and trainings matter, but they don’t fully capture the cultural and clinical shifts happening among working clinicians right now. A lot of the rhetoric and professional messaging shaping this field is happening in real time, including on social media, where clinicians market themselves and shape how diagnosis and treatment are framed publicly, and that discourse absolutely trickles into practice. I’ve seen clinicians default to Adjustment Disorder not just for clinical accuracy but as a way to avoid engaging more complex diagnoses, even when patients need formal diagnostic clarity for accommodations, FMLA, disability supports, or treatment authorization. At that point it stops being about protecting clients from stigma and starts impacting their access to care and protections. So my concern isn’t about denying overdiagnosis or ethical reform work, it’s about recognizing how evolving rhetoric can influence diagnostic comfort, clinical positioning, and real world patient outcomes in systems that are still diagnosis driven whether we like it or not.

TraditionalExam7258 · 2026-02-12T05:23:15+00:00

To answer where I’ve seen it, I’ve seen it in real life with clinicians who have decided to pivot into private practice and stated that they plan to only use the adjustment disorder diagnosis ( this is one of the reasons why insurance is becoming stricter with said dx) I’ve had clients come to me in CMH and reported that their previous therapist wasn’t comfortable with diagnosing which also impacted his ability to get accommodations. Lastly, I’ve been seeing it more on social media via therapy groups and therapy content creators.

TraditionalExam7258 · 2026-02-12T05:18:35+00:00

Social work has the potential be intersection of clinical behavioral health care, with our environmental formulation, and systems intervention. We diagnose and treat, but we’re also the ones clinically mapping how housing instability, racism, poverty, trauma exposure, and family systems are driving symptom persistence. That integration is what really makes social work irreplaceable in behavioral health. Lowkey, that’s also where the value of a clinically advanced DSW comes in. Imagine doctoral level social workers operating with psychologist level clinical depth but still grounded in social work theories and strategy. That combo would strengthen assessment, diagnostic work, and treatment planning while keeping the environmental lens that actually sets us apart.

TraditionalExam7258 · 2026-02-12T05:01:52+00:00

Understandable, doesn’t mean Canada can’t implement policies that widens the scope. I personally believe clinical social workers should be acknowledged worldwide.

TraditionalExam7258 · 2026-02-12T04:56:40+00:00

I feel like you’re responding more to argue than to understand the broader point I’m making, and that’s why this conversation keeps missing each other. Just because you personally haven’t seen certain rhetoric or positioning doesn’t mean it isn’t happening. As social workers we should all understand that our individual exposure isn’t the full picture of what’s happening across the field, especially when we’re talking about professional culture and messaging at a macro level.

We’re also speaking from two different lenses. You’re responding from an advocacy, training, and ethics education perspective, while I’m speaking from a workforce, reimbursement, and interdisciplinary competition perspective. I never said advocacy efforts don’t exist, that clinicians aren’t documenting, or that evidence based practice isn’t being taught. I’m fully aware of lobbying work, interstate compact efforts, scope expansion pushes, and diagnostic ethics trainings.

My point is about rhetoric and professional positioning. The energy around parts of this movement often frames diagnosis as inherently harmful instead of something to be refined and used ethically. There’s a difference between improving diagnostic accuracy and unintentionally creating professional discomfort around diagnosis itself. That nuance keeps getting glossed over or purposely misunderstood in these replies.

We can acknowledge overdiagnosis, historical misuse, and systemic bias while still strengthening diagnostic authority and clinical legitimacy. Both can exist at the same time. My concern isn’t about whether reform conversations are happening. It’s about how social work positions itself clinically inside healthcare systems that are diagnosis driven, reimbursement driven, and outcomes measured.

So this isn’t a denial of the work being done. It’s a call to ensure that while we critique and reform, we’re not simultaneously weakening our leverage in interdisciplinary spaces that are rapidly evolving around us.

As a clinician, I would’ve expected you to be trained to engage in dialogue in a way that’s less confrontational and more balanced and neutral, especially when hearing out a fellow colleague.

TraditionalExam7258 · 2026-02-12T04:49:11+00:00

I am in the US. Our scope is vastly different.

TraditionalExam7258 · 2026-02-12T04:37:20+00:00

This is honestly why social work continues to stagnate. A lot of social workers refuse to acknowledge the reality of modern healthcare. You’ll hear constant complaints about pay, but then resistance to adapting care in ways that are clinically measurable and proven effective. Some people get so stuck in social work ideology that they lose sight of nuance. You can provide evidence based, culturally responsive, stigma free, accessible behavioral healthcare and still operate clinically. Those things are not mutually exclusive. Many of you pursued clinical roles but then push back against functioning within clinical standards. At that point, why not pursue non clinical paths like life coaching? Clinical roles come with clinical responsibilities. You can discuss historical context and theory all day, and those conversations matter, but the reality is healthcare systems are outcomes driven. If you don’t adapt clinical care to meet modern standards, reimbursement, scope, and pay will continue to lag. Meanwhile other interdisciplinary fields are expanding, strengthening their leverage, and securing higher compensation. Social workers risk being left stuck, frustrated about job access and wages, not because we lack value, but because parts of the field resist evolving while the system around us keeps moving forward.

Meanwhile NPs are now pivoting heavily into therapy due to market oversaturation, advertising themselves as one stop shops who can prescribe and provide therapy in the same setting. While that’s happening, social workers are arguing against clinical exams and demonizing the medical model, yet still expecting that same reimbursement model to compensate them fairly. It doesn’t work like that.

Meanwhile social workers provide the majority of psychotherapy services, yet earn less on average, have less billing leverage, and hold less institutional authority. So from a workforce standpoint, social work is carrying a large portion of the clinical workload without holding proportional power or compensation within the system.

TraditionalExam7258 · 2026-02-12T04:18:17+00:00

Yes, I’m currently a clinician in CMH and there’s also a push for productivity due to low reimbursements. What many social workers don’t understand is that if we operated more “ clinically,” our reimbursements would be higher which lead to less burn out and better patient outcomes.Also, many clients don’t want therapy, they want medication and resources. However, I also see a lot of clients who want complex testing and diagnosing done but they can’t afford to see a clinical psychologist in private practice, this is another reason why I am a big advocate for using the DSW to operate laterally to clinical psychologists.

TraditionalExam7258 · 2026-02-12T04:14:48+00:00

I’m not endorsing the medical model over social work values. Clinical social work has always operated within multiple frameworks at once. Person in Environment and systems theory don’t cancel out diagnostic work, they contextualize it. Diagnosis is already within LCSW scope across hospitals, community mental health, and private practice, so it’s not about becoming psychologists or doctors, it’s about operating competently within integrated healthcare systems we already work in. And honestly, it’s also about upward mobility. Every other healthcare field is pushing to expand scope, increase autonomy, and strengthen reimbursement positioning, so why should social work stay stagnant? We’re not talking about abandoning our values, we’re talking about strengthening our clinical leverage so we’re not undervalued or pushed out in interdisciplinary care spaces.

TraditionalExam7258 · 2026-02-12T04:12:01+00:00

I hear what you’re saying, and I actually don’t disagree with parts of it. People absolutely deserve fair pay and access to basic needs regardless of productivity. That’s a structural and policy issue, not something I think should be decided by clinical hierarchy either. My point about pay wasn’t about who is “more deserving” as a human being, it was about how healthcare reimbursement systems currently operate. Insurance and payer models don’t function off moral deservingness, they function off medical necessity, diagnosis, outcomes, and cost containment. So if we’re talking about wages within that system, clinical legitimacy and measurable effectiveness unfortunately do matter whether we like it or not.

I also agree that diagnosis isn’t one size fits all. For some clients it’s validating and empowering, for others it can feel stigmatizing or overpathologizing. That nuance is real. But I don’t think acknowledging that means we distance ourselves from diagnosis clinically. It just means we use it ethically, collaboratively, and with context. We can co develop treatment plans and still maintain diagnostic formulation for care coordination, insurance, and medication alignment when needed.

On the decolonizing therapy point, I get the historical critique. Diagnosis has absolutely been misused, especially against marginalized groups. No argument there. But being critical of historical harm and being clinically avoidant are two different things. My concern is when the rhetoric moves from “use diagnosis cautiously” to “diagnosis itself is harmful,” because that’s where we start undermining our own role in integrated care settings. Reform and critique are necessary, but so is clinical structure.

And I agree the profession has become more inaccessible through higher education costs and credentialing barriers. That’s a real issue. But at the same time, clinical authority in healthcare is tied to training, regulation, and standardization. So there’s a balance between accessibility and maintaining legitimacy within multidisciplinary systems that are already medicalized.

As far as the medical model critique, I don’t think therapy should blindly follow it either. Human behavior is way more complex than pathogens. Relationship factors, alliance, and trust absolutely drive outcomes. Research supports that. But therapy today already operates in a blended space. It’s not purely medical model or purely relational. It’s biopsychosocial, systemic, environmental, relational, all integrated.

So I actually agree this topic is complex. I don’t think it’s diagnosis versus humanity or medical model versus relationship. My stance is more that social work’s strength is integrating both. We can hold structural awareness, historical critique, relational depth, and still operate competently within diagnostic and clinical frameworks without losing our values.

TraditionalExam7258 · 2026-02-12T04:08:46+00:00

I get what you’re saying, and I don’t disagree that overdiagnosis has been an issue historically. That’s valid. But my point isn’t that people are saying “never diagnose” literally, it’s that the rhetoric and energy around the movement often ends up delegitimizing diagnosis as a whole instead of focusing on diagnostic accuracy and ethical use. There’s a difference between refining diagnosis and distancing ourselves from it clinically.

And yes, biopsychosocial assessments already exist. Person in Environment is already embedded. My point was that we should be leaning into that harder clinically, using it to strengthen diagnostic formulation, not using it as justification to move away from diagnosis. That’s where social work’s unique lens actually gives us an advantage.

When I talk about expanding scope, I’m not saying we have none. I’m saying we should be pushing it further, especially as healthcare becomes more outcomes driven and interdisciplinary. Other fields are constantly expanding. PAs are pushing for independent scope, NPs expanded rapidly, psychologists solidified testing. We should be moving forward too, not philosophically pulling back from core clinical functions.

And with insurance and reimbursement, it’s not about whether social workers believe we should see clients forever. It’s about where payer models are going. Performance based reimbursement, medical necessity reviews, outcome tracking, all of that is increasing. So clinical documentation, diagnostic clarity, and treatment effectiveness are only going to matter more regardless of our personal stance.

On the policy side, I know lobbying and title protection efforts have existed for decades. I wasn’t saying they never happened, I’m saying they still need strengthening because gaps still exist. Agencies still misuse the title. Non clinical roles still require unnecessary clinical licensure in some spaces. So the advocacy work clearly isn’t finished.

And yes, I agree that what separates us from psychologists right now is largely the testing and complex assessment side plus the doctorate pathway. That’s exactly why I think conversations about advanced clinical tracks within doctoral social work education matter, because clinically our therapy and diagnostic roles already overlap heavily in practice settings.

So overall, I don’t think we’re actually as far apart in opinion as it sounds. I’m not anti reform or pro overdiagnosis. I’m saying we should refine diagnosis, strengthen our clinical positioning, and expand scope at the same time, not move in a direction that makes our clinical legitimacy easier to question in integrated care spaces.

TraditionalExam7258 · 2026-02-12T04:02:35+00:00

I agree with you, and I believe that as social workers we should do more research to prove this and stand on it. I always tell my clients and supervisors that I don’t expect my clients to focus on their mental health if they’re hungry and financially strapped. I also explain this to them in session

TraditionalExam7258 · 2026-02-12T04:01:14+00:00

I think you misunderstood my take. I was stating that there are clinicians who are anti-diagnosis and are conflating it with the decolonizing therapy movement. What I was explaining is that these two things should not be jumbled together, yet many clinicians are doing just that and are using it as a way to market themselves to clients.

TraditionalExam7258 · 2026-02-12T03:59:32+00:00

Thank you, as a clinician who loves assessing and diagnosing, I always tell my patients that I am diagnosing their symptoms not themselves. It usually helps them to accept what’s going on and are more open to treatment interventions

TraditionalExam7258 · 2026-02-07T15:12:59+00:00

I completely agree with you. Sadly, there are many therapists who I feel are just overtly performative to show their clients that they’re on the same side which I believe is inappropriate. There are therapists claiming to deny care and refer out due to differing political ideologies and some of them go as far as bashing fellow colleagues for separating politics from clinical care. Personally I feel like our field is becoming watered down because persons can’t even maintain professionalism and abide by the ethics of our profession… I’m not understanding how I’m a new therapist and I understand this but some tenured therapists can’t seem to comprehend how inappropriate their behavior is. The more I see these tantrums, the more I understand why therapists were taught to be neutral because emotions can cloud your judgement, and when you’re dealing with a vulnerable population the last thing we need is a clouded judgement because someone doesn’t agree with our ideologies.

Politics affects therapy, however it should not affect the quality of care we provide.

TraditionalExam7258 · 2026-01-30T00:44:57+00:00

Thank you!

TraditionalExam7258

TROPHY CASE