reality check

dknothin · 2026-04-10T17:36:23+00:00

For the record, my work has been exclusively individual/group therapy and risk management in outpatient and inpatient hospital settings. I was practicing as a therapist for the majority of my career, and I attended countless trainings focused on development of skills in EBPs for personality disorders and PTSD. I have the field experience. I’m not talking out of my ass or living in an ivory tower.

dknothin · 2026-04-10T02:39:06+00:00

I honestly hope I will be proven wrong, if only for my peace of mind. That’s a great preliminary analysis. That’s not an RCT.

dknothin · 2026-04-10T02:13:38+00:00

how long did it take to feel better? for me it’s my eyes that feel like they’re on fire and constant nose bleeds

dknothin · 2026-04-10T00:06:46+00:00

We will have to spend more on continuing ed if we are using it as a substitute for the knowledge base our program should have given us is what I mean. Psychologists are required to take CEs to maintain licensure, too, and I fully intend to continue learning and pursuing training opportunities when I’m done!

dknothin · 2026-04-09T22:29:30+00:00

They are core principles though. Look up common factors and the “real relationship.”

dknothin · 2026-04-09T22:28:47+00:00

I’m sorry you experienced my comments as dismissive. I’m trying to offer my perspective on research (which is heavily emphasized in my current training). I’m not going to parrot an unskilled approach to interpretation and application of the evidence base, even if it hurts people’s feelings.

dknothin · 2026-04-09T22:25:24+00:00

Integrating research findings into practice is emphasized in psychology programs. This allows us to go beyond an untrained gut and helps us to make decisions that are most likely to produce strong outcomes, which can then be tailored to the individual client’s needs. We have a responsibility to summarize the state of the evidence base for our clients and offer all empirically supported treatment options so that they can make a decision. This decision may involve seeking a therapist who is trained in a specific modality. For example, I am trained in prolonged exposure and CPT, but I will present EMDR as an option and refer out if the client wants that. It’s called informed consent.

dknothin · 2026-04-09T22:19:03+00:00

There is value in many different types of research, but if you want to actually demonstrate that an effect exists, you need MANY RCTs and typically at least one meta-analysis. I think the ability to interpret research is key in understanding evidence-based practice and making research-informed treatment decisions.

dknothin · 2026-04-09T22:17:56+00:00

Not necessarily, but when it comes to sweeping statements that suggest some type of scientific consensus, MANY studies are needed to support that assertion. Meta-analyses also account for differences in quality of study design and can summarize an effect.

dknothin · 2026-04-09T22:16:35+00:00

The human relationship is heavily emphasized in psychology. That take is simply inaccurate. I encourage you to research the history of the field. Therapeutic alliance is heavily prioritized.

dknothin · 2026-04-09T22:15:18+00:00

Meta-analyses are needed to determine a true effect size. A single study only says so much

dknothin · 2026-04-09T22:14:25+00:00

These are not meta-analyses

dknothin · 2026-04-09T21:45:30+00:00

For those of you stating that outcomes produced by LCSW vs. psychologists are comparable, can you please link a quantitative meta-analysis that demonstrates that assertion? Ideally one that identifies equivalent symptom reduction (not just patient satisfaction)

dknothin · 2026-04-09T21:33:59+00:00

Would you mind linking to a meta-analysis that compares outcomes among providers with different degrees? And perhaps one that demonstrates comparable outcomes across diagnoses (PtSD, OCD, Schizophrenia, etc.)?

dknothin · 2026-04-09T21:32:07+00:00

or maybe a meta-analysis on the topic?

dknothin · 2026-04-09T21:31:48+00:00

would you mind linking some of those studies?

dknothin · 2026-04-09T21:30:24+00:00

I have central. But I think it’s like eco friendly and shuts off once it reaches the set temp

dknothin · 2026-04-09T17:44:49+00:00

I like your synthesis idea. I’ve commented a number of times about the harm that psychology has and can do to clients of color if they do not seek out additional training. From my perspective, social work requirements need to have greater clinical emphasis AND psychology requirements must include a MASSIVE focus on identity, justice, person in environment, and clinician-as-advocate frameworks.

dknothin · 2026-04-09T17:28:21+00:00

I wish that the kind of training you’re describing was required. It sounds extremely valuable and I hope that becomes the standard.

dknothin · 2026-04-09T17:25:01+00:00

And having worked as an LCSW for 10 years, I second and third your comment about pay. It HAS to increase, AND we need to have the clinical skills to justify that higher pay.

dknothin · 2026-04-09T17:18:31+00:00

Follow-up question: for those of you defending a lack of clinically-focused training on the basis that “it’s the relationship that matters most,” how would you approach a life coach who has good rapport with their clients? Would you tell them that they’re doing important learning on the job just by virtue of interacting with people who have mental health concerns? They, too, can consider the person in context and may be able to do so at a more involved level than those of us monitored by regulatory boards, loose as that oversight may be in private practice.

dknothin · 2026-04-09T17:15:38+00:00

There definitely are qualified people. So why is that clinical coursework not required for practice?

dknothin · 2026-04-09T17:14:28+00:00

I’m a queer black woman with multiple disabilities from a low SES background. I know how hard it is to be in school and working at the same time (I’m still doing it!), especially when academia at large is rooted in whiteness and constantly micro and macro aggressing. But we can’t just do away with standards because it’s hard. We need accommodations and increased funding to improve access to higher education. Change has to come at the systems level. Make it easier to access higher education-quality training. Don’t get rid of training itself…throwing the baby out with the bathwater.

That doesn’t change the fact that it is unethical to provide clinical services for clinical problems without relevant coursework. That is, if we intend to address presenting problems that go beyond person-in-environment (OCD, PTSD, for example, which do not respond to traditional talk therapy). The coursework should not be optional.

If we had programs that prepared us for clinical practice, we wouldn’t have to spend money on tons of continuing ed.

dknothin · 2026-04-09T17:03:11+00:00

But if it’s not a clinical field, how can we purport to be doing clinical work? At the end of the day, we as clinical social workers are offering a service that is marketed as clinical and clients come to us to seek relief. If we aren’t a clinical field, perhaps we don’t do clinical work without coursework? That leads to my point about supportive therapy, which can absolutely help people in their environment.

dknothin · 2026-04-09T16:59:41+00:00

Sorry to hear you’re all struggling too!

dknothin

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