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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I'll play...out of network psychologist, additional training after, practice out of my home (virtual & in person), a bit under $200 per hour, patients range from those who started last month to my longest at 13 years, network of dc colleagues, in practice about 15 years.

1. It took many years to get here. Top of the line training, supervision and my own long (expensive) but deep psychotherapy. I estimate training and my  therapy at over 500 k during my lifetime. Since age 22 when I was a psych major and popped into therapy sporadically to ongoing, deep treatment into my midlife. 
2. You can take someone only as far as you yourself have gone. No shortcuts. You can't ask patients to do work you yourself have not done. They sense if you walk the walk and have the depth. That comes over time with experience and expensive training and supervision. 
2. People who pay out of pocket expect a lot and rightly so.  Deliver something of deep value, something meaningful to them, something helpful or they will go. Understandably. And that differs for each person and you have to work intellectually and emotionally to truly understand who they are and what they are saying on multiple levels. Then you must decide how to intervene, your technique, which takes years to explore and never ends. But the level of listening is active and at times, by the end of some days, exhausting.
3. It's demanding, gratifying, sometimes deeply sad, sometimes deeply enjoyable and everything in between, hour by hour, day by day, week by week. 
4. You learn to plunge the depths and love your patients and then you bear the goodbye. You work with loss, fear, pain,  suffering and existential dread. You do this with your own therapist too. You learn to bear pain and grief, personally and professionally. 
5. Whatever inner issue or family issue at play, you must show up for your patients. Which means keeping your personal life as stable as possible, to the best of your ability. Over years.

I love what I do, I'm grateful to have had this rewarding career and I hope I can continue to do it for several more years. But it was and is at times still a hard road and there are much, much easier ways to make money. [/quote]

You sound wonderful! And remind me of my own psychologist. FWIW I will only see psychologists (for trauma, family issues, and life generally) and I think their training is dramatically different than that of an LSW and it matters. Seems like there is so much need that LSWs can make money, too. [/quote]

Thank you. A colleague just sent a link to the Jonah Hill /Washington post article on therapists who rarely challenge patients. It was interesting. Gratifying patients is almost always very gratifying for the therapist as well, including for psychologists especially early  in your career. Learning to identify resistances, defenses, ongoing life themes, self defeating behavior and the presence of pathology if it is there (among other tasks) and working technically with these issues within a strong therapeutic bond takes a long time to learn but is the work of a psychologist (with a dynamic/analytic bent) and the heart of the work and why you can feel entitled to the big money quite honestly and why people stay to work on them selves.  Patients who stay get something potentially life changing ideally. (And I do too as their psychologist). But what I wanted to add was that doing a dissertation often involves so much received criticism, humility, perseverance and tears that you sort of learn to say hard things because many hard things have been said to you in the process! Same in your own therapy....you heard hard sh*t sometimes, often from a psychologist, a future colleague, but you learn how it helped and healed you too. Writing a dissertation also teaches you to critically evaluate research and hones your analytical thinking skills. Which establishes a clinical underpinning to your style. This was just my experience but something about the dissertation process informs the differences. Plus psychologists tend to see other psychologists so we learn that language. I have colleagues who are clinical social workers and they do excellent work...it just tended to not be rooted in clinical theory, psych testing, doing research and abnormal psych. And not everyone wants that anyway nor is it necessary for everyone. Or necessarily better. But yes there are differences. Would be interested in the social worker's perspective as well. Psychiatry would likely have their issues with psychologist training. And so it goes.[/quote]

Social worker here.

To me, the main differences in training seemed to be in "academic" and "community" realms. Psychology at a professional level is still fairly academic in that it seems to be less community mental health. Private practice in general is a much lower intensity setting than community mental health or in-patient care or child welfare, and I think that psychologists, by virtue of the longer training and stronger academic background, have an easier entry into private practice. I lucked into a group private practice that hired masters level clinicians to work under supervision, but most of my peers from my MSW program spent all or almost all of their training years in CPS, in hospitals, at care agencies in the community, at jails, etc. The psychologists they worked with there were always in a more supervisory role. I think social work is also more geared toward community organizing and engagement by virtue of its origins. There is certainly plenty of direct service work to be done with marginalized communities, but there are also a lot of social workers in policy roles doing advocacy but not direct service. When I went to grad school, that was a major selling point for me - I was coming from nonprofit admin and had some small concerns that I wouldn't like direct service. A MSW seemed like a decent thing to bring to a DC policy job as well (my undergrad degree is in political science, like everyone else).

One of my best friends is a clinical psychologist. We have been in practice for the same amount of time, but she went to school for 6 years and I went to school for 2 years. [/quote]

Very well said, thank you. Community settings sound so demanding. In private practice you can hone in on who you like to see and refer out if necessary, you don't have to answer to anyone. Very different experience.[/quote]

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