Prospects for Clinical Social Work Education

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This manuscript was one of the four chapters of my doctoral qualifying paper in social work. The middle section of this version has been expanded from the submitted version, to clarify material that was too concise in its original form. There have also been a few other minor changes from the version included in my qualifying paper.

The manuscript may appear very long. Note, however, that a large portion of this post is devoted to the list of references.

I submitted this article to reviewers at two separate journals of social work education. Their reactions are the topic of another post. Readers may find it interesting to compare their own views of this manuscript against the views of those reviewers, and also against the reactions of my qualifying paper reviewers at the Indiana University School of Social Work.

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Reflections on Reid & Edwards:
Prospects for Clinical Social Work Education

Ray Woodcock, MSW, JD, MBA (2010)

This article responds to certain views expressed in an article by Reid and Edwards (2006) on the purpose of a school of social work. Several years have passed since that article’s publi­cation. There have been changes in the economic environment and developments in related areas. Some views that may have seemed reasonable at that time may now be less tenable.

Reid and Edwards (2006) (referred to here, briefly, as R&E) provide a considerable amount of information that is helpful and uncontroverted, including a review of certain aspects of the history of the social work profession. The present article is concerned with statements, favoring a clinical emphasis, that appear primarily in their concluding pages. The several points of critique support a suggestion for a different direction in social work education.

The vision of social work education provided by R&E turns upon the impression that perhaps 85-90% of social work students want training for direct practice (p. 480). Students generally want that form of training because they are “interested in provid­ing counseling or psycho­therapy on a private or independent practice basis” (p. 481). Many choose the MSW because it facilitates that goal “faster and with less expense . . . than a PhD in psychology” (p. 481). With so many students taking this route, R&E say, social work practice has been transformed into “something akin to medical services,” with services being “delivered and financed in organiza­tions modeled on the US health system” (p. 482). But there is “some discrepancy between what a high proportion of social work students want and what many social work faculty members are prepared to provide” (p. 480). This is because the profession “has maintained an intellectual and ideological stream derived from its origins” in social justice movements (p. 479). As a result, social work programs are not “adequately preparing their students to perform jobs that agencies and organizations are willing to pay to have done” (p. 482). If social work programs persist in failing to meet this demand and generally to “become more nimble and flexible in recognizing and responding to the rapidly changing realities of social work practice,” they say, graduates will struggle to find jobs; appli­cants will shift toward other kinds of academic programs; social work programs will shrink; and that “will precipitate a downward spiral” (p. 482). But R&E believe the situation will improve, as the older generations of social work professors, oriented toward social justice, are replaced by younger faculty who are “closer to contemporary social work practice” (p. 482).

Narrowing the Focus

R&E emphasize that they are looking specifically at American schools of social work (SSWs). This article does likewise, noting however that social work elsewhere (e.g., IFSW, n.d.) is typically oriented toward social justice. In a study of social work students in ten countries by Dixon, Weiss, and Gal (2003, p. 219), students from only two other countries[1] shared Americans’ prioritization of individual well-being over social justice. Diffusion of an American concept of the profession may displace local educational innova­tions (e.g., Cwikel, Savaya, Munford, & Desai, 2010) and have other undesirable effects (Hegar, 2008, p. 718; Tang, 1996, p. 52). Imposing a clinical orientation and an American conceptual­ization of mental illness (Watters, 2010) abroad can be imperialist – even though, far from being classically capitalist (see Lenin, 1916/1999), it tends to be socially liberal in nature (Beecher, Reeves, Eggertsen, & Furoto, 2010, pp. 205, 212).

R&E (p. 462) treat social work education as something that is found exclusively in approximately 475 baccalaureate (BSW) and 200 master’s (MSW) programs accredited by the Council on Social Work Education (CSWE). While social workers may consider that treatment unremarkable, it bears noting that countless other American college and university programs do provide education in subjects and practice areas overlapping with social work education (e.g., Harvard University, 2010; Ivy Tech, 2010). (Following the lead of R&E, this article uses “university” as shorthand for the gamut of institutions of higher education.) Perhaps not everyone realizes that a focus on accredited programs also rules out social work Ph.D. programs, which the CSWE does not accredit (see R&E, pp. 463, 480). (This article generally speaks of social work “programs” rather than “schools” because, in many universities, social work degrees are granted by departments or other academic units in which social work is combined with other fields, ranging from sociology (e.g., Manchester College, n.d.) to physical education (e.g., Indiana State University, 2010).)

A third narrowing distinction comes into view when R&E note that students want credentials to qualify for third-party reimburse­ment (pp. 480-481). Such reimbursement tends to imply master’s-level education (Dyeson, 2004, p. 409; see Whitaker, Weismiller, & Clark, 2006, p. 6). Hence, it would not be unreasonable to interpret their article as being particularly oriented toward the purpose of a CSWE-accredited MSW program. The present article likewise focuses especially on MSW programs.

Social Work Education and Other Semi-Professions

R&E seem to take two incompatible positions on the question of MSW competence. They want social work programs to enroll as many students as possible; but they also want those programs’ graduates to have skills comparable to those of psychologists and other clinicians. Enrolling more students – accommodating the sharp rise in the numbers of social work programs in recent decades – has meant lowering admissions standards (Sowers & Dulmus, 2009, p. 115; see Stoesz, Karger, & Carrilio, 2010, p. 62). The acceptance rate at CSWE-accredited MSW programs is 67% (Kirk, Kil, & Corcoran, 2009, p. 74). As noted by Kindle and Colby (2008), most applicants apply to more than one school, and thus are likely to be admitted somewhere.

That high average rate of acceptance has predictable effects on the quality of social work education. The Educa­tional Testing Service (ETS, 2010, pp. 17-19) places the average combined verbal and quantitative GRE score for test-takers who intend to major in social work in 50th place of the 50 fields reported. That score (896 out of a possible 1600) would probably be even lower, but for the fact that many social work programs do not require the GRE. When R&E (p. 482) allude to a downward spiral that would be precipitated by enrolling fewer students, they seem to be speaking of a budgetary matter; they surely are not suggesting that more selective admissions would impair academic quality. The concept is, in short, that social work programs will want to keep their doors open to as many students as possible, so as to keep money coming in, even if doing so damages the reputations and competitiveness of graduates, schools, and the profession.

In their discussion of professional education, R&E say that social work seeks “to emulate the recognized and established professions of medicine and law” (p. 464). But it would be inaccurate if not unethical to give incoming students the idea that their educations and career prospects will resemble those of doctors and lawyers. Since R&E characterize the MSW as a quick alternative to a psychology PhD, clearly they are not suggesting that MSW programs emulate the educational processes of these other profes­sions. Law school is three hard years of study. Med school is that and more, requiring considerable prior study in addition. Acceptance rates run as low as 22% for DO (as distinct from MD) medical programs and 11% for PhD (as distinct from PsyD) clinical psych programs (Fauber, 2006, pp. 227-228; Becker, 2007, pp. 97-99). The average clinical psych applicant’s combined verbal and math GRE score is 1039 (Stoesz & Karger, 2009, p. 107). Finally, presumably R&E are not suggesting that social work education produces licensed practitioners in a manner reminiscent of these other professions. While the monopolies on medical and legal practice have historically put a substantial majority of their graduates into high-paying positions, that is not the case in social work.

R&E (pp. 463-464) indicate that social work is joined, in its putative emulation of law and medicine, by other semi-professions (see Etzioni, 1969). They cite engineering as an example. But despite being a semi-profession, engineering is another extreme contrast. The average engineering GRE is 1181 (ETS, 2010). A master’s in engineering is undeniably chal­lenging, and requires years of prior study. Engin­eering licensure typically requires at least four years of supervised full-time experience after graduation (NCEES, n.d.). R&E claim nursing as another fellow semi-profession but here, again, there is no comparison. In nursing, many programs “are so competitive that there are three applicants for every acceptance” (Buchbinder & Buchbinder, 2007, p. 244). Rather than unload incompetents upon the public, “tens of thousands of future nurses are being turned away . . . each year because nursing schools are stretched beyond their capabilities” (Cleary, McBride, McClure, & Reinhard, 2009, p. w634). Students do not waltz into master’s-level nursing study without preparation. Even “direct entry” master’s programs for those who lack a BSN require a prior year of intensive preparatory study (DeBasio, 2005; e.g., University of Vermont, 2010). In short, when R&E suggest that the licensing of social work emulates that of law or medicine, perhaps the message is just that law and medicine originated the notion of professional licensure (see Polelle, 1998, p. 212). In that sense, licensure in law and medicine is also emulated by licensure in hairstyling and telemarketing (e.g., Samuelson, 2009, p. 17; Burt, 2010, pp. 20-21).

If the MSW parallels anything, it is not nursing or engineering; it is the MBA, though applicants to top MSW and MBA programs tend not to be on the same level (e.g., Anonymous, 2007). The MBA can be helpful, but is rarely if ever considered the only route of entry into a profession (see Wier, Stone, & Hunton, 2005; Miller, Hopkins, & Greif, 2008, p. 38).

MSW Quality Improvement via the Advent of Practitioners

Social work education is often not much of an education. Numerous observers have criticized it for being anti-intellectual, vague, outdated, doctrinaire, and even incoherent (e.g., Singh & Cowden, 2009; Green, 2006; Stone & Gambrill, 2007; Karger & Hernández, 2004; Khinduka, 2007; Pardeck, 2005; Neal, 2008; Saleebey & Scanlon, 2005; Hodge, 2002; Harrison, 2009, p. 751; Galambos, 2009; Stoesz et al., 2010, p. 53). As noted above, R&E seem to concur with some of these criticisms. In particular, in the terms just listed, they apparently detect anti-intellectual and doctrinaire tendencies in those social work academics who disparage contemporary quantitative research methods; and they evidently find current social work education vague, outdated, and potentially incoherent insofar as it continues to try to do too many things – which was essentially Flexner’s (1915, pp. 588-590) criticism, nearly a century ago.

R&E are nonetheless “optimistic” (p. 482) about the future of social work education. Their optimism is based partly upon external developments (especially at the university level) that, they believe, will result in “self-searching and renewal processes” (p. 483). Some external considerations are addressed below – with the caveat that, as R&E themselves admit, “Universities tend to be slow to incorporate contextual change” (p. 480). Here, the focus is on the other source of R&E’s optimism. They believe change will come from the replacement of older faculty with a new generation “who both are closer to contemporary social work practice and skilled in sophisticated research methods” (p. 482). There is no doubt some validity to this hope. Yet it calls for significant caveats.

For one thing, as R&E themselves note, the newcomers may not be both closer to contemporary practice and skilled in research methods. The newcomers who are closer to contemporary practice tend to be those who hold “part-time teaching roles, clinical professorships, and other ‘non-tenure track’ positions” (p. 481). While it is possible for someone to be both an active and/or experienced clinician and a skilled researcher, those tend to be different career paths, each typically requiring years of focus and experience. Hence, R&E appear to be saying that the new generation will constitute an improvement on the old in two relatively distinct ways: some will bring the realism of clinical experience into the academy, while the advanced research skills of others will instigate change at more conceptual levels.

Let it be observed that there is something ironic, if not pathetic, in what may be a correct assessment that social work, a putatively change-oriented profession, can itself be changed only through the inordinately slow passage of generations. R&E are addressing a situation in which people who obtained their degrees 30 to 40 years ago are only now yielding the reins. A process of this nature could be expected to involve many stakeholders and to play out very gradually (see Thyer, 2009, pp. 127-128). Changes in the CSWE’s (2010) Educational Policy and Accredit­ation Standards also make it likely that programs will vary considerably in their willingness to move toward a heavily clinical model (see Petracchi & Zastrow, 2010, p. 132).

In addition, some skepticism may be appropriate, with respect to the notion that non-tenure-track faculty will bring about significant change. Professors of that nature tend to lack the power. Often, these are mere PhD students themselves. Some readers may also be puzzled at the notion that it would be novel to employ people who are in touch with contemporary practice. Probably the better way of phrasing the point here is not to link it to a particular generation, but rather to suggest simply that practitioners have always operated in tension with the ivory tower, and that perhaps they will have relatively more weight, in some matters, as academia becomes a less secure bastion of tenured abstractionists. While that prospect may be justified, this phrasing does not yield profound support for the practice-related aspect of R&E’s hopes.

Clinicians may be inclined to promote clinical social work education, but they will surely continue to encounter opposition, not only from old and young faculty of a social justice bent, but also from clinical researchers who view clinical practice skeptically. There would be significant drawbacks in a proposal that clinical practice should steer academia.

To make that clear, it may be worth reflecting upon the training of clinicians. Perhaps due to the ease of entry into MSW programs, social work education is in many ways a dumbed-down kind of learning designed for people who do not necessarily belong in graduate school. The discrepancies in GRE scores noted above are reflected in professors’ complaints that it tends to be difficult to engage social work students in critical or abstract reasoning (e.g.,Weaver & Nackerud, 2005; Johnston, 2009; Deal & Pittman, 2009). This writer’s observations in three different MSW programs suggest a broad, usually tacit understanding that instructors generally will not probe too deeply into the assigned reading and will not test on it very stringently – if, indeed, there are any tests at all. This is not to denigrate the hard work and significant education that a motivated learner might achieve even in adverse circumstances. It is, rather, a recognition that some who should have succeeded will instead be suffocated by material that, as many complain, is bland, redundant, and/or tangential to their life or career plans. An MSW, in itself, is simply not an assurance that its holder is qualified to opine on what counts as good social work education.

The reply may be that the practitioners who become adjunct faculty tend to be among the most accomplished of all practitioners. In some cases, that is undoubtedly true. In others, it is apparently not. University politics aside, conversations with some faculty have suggested that some practitioners who tend toward faculty roles may actually be hoping to get away from practice. Further, the variable caliber of clinical instruction demonstrates that thriving clinicians are not generally demanding opportunities to lose remunerative daytime hours, or to work into the evening, for purposes of providing poorly compensated instruction to beginners. To the extent that superior practitioners do crave a teaching role, many may correctly conclude that they can undertake it most effectively as mentors to practicing therapists under their supervision.

Thankfully, the training of social work practitioners does not end at graduation. People learn on the job, though what they learn may or may not be particularly effective and ethical. For clinical practitioners seeking licensure, mentoring is formalized in mandatory weekly supervision. There again, though, the quality and effect are uncertain. The required weekly hour of supervision may entail little more than indifferent group meetings from which the supervisor learns almost nothing about what supervisees have been doing. In some situations, supervision can even be harmful to supervisees and clients (Ellis, Siembor, Swords, Morere, & Blanco, 2008; Hall, Macvaugh, Merideth, & Montgomery, 2007). Supervisors typically have little training in supervision and make scant adjustment in their styles to adapt to supervisee needs (Spence, Wilson, Kavanagh, Strong, & Worrall, 2001, p. 151). As Raskin, Wayne, and Bogo (2008, pp. 176, 182) say about MSW field placements, supervisory requirements exist, not because of solid research into what works, but because of “compromises . . . assumptions . . . [and] opinions.”

Indeed, there are few checks upon the risk that bad supervisors will perpetuate the worst myths and practices. For one thing, supervision apparently fails to emphasize and inculcate appreciation for relevant knowledge. To the contrary, “[R]esearch demon­strates that clinicians rarely read the scientific liter­ature or rationalize their practice decisions by direct reference to scientific findings” (Howard, Himle, Jenson, & Vaughn, 2009, p. 264). Instead, regrettably, direct practice seems to provide many social workers with a veritable candy store, containing hundreds of mental health frameworks and therapies (see Turner, 1996; Cocker­ham, 2003, p. 23; Kazdin, 2007, p. 196). Numerous reports indicate that many social workers (including licensed ones) dabble freely in these possibilities, experimenting with folk remedies and quack interventions (see Barrio-Minton & Myers, 2008, pp. 330-331; Weiss­man et al., 2006; compare e.g., Bell, 1995 with van Emmerik, Kamphuis, Hulsbosch, & Emmel­kamp, 2002 and Roberts, 2009, pp. 297-298; compare Howard, Himle, Jenson, & Vaughn, 2009, p. 259 with Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010, p. 636; Thyer, 2007, p. 28; Specht & Courtney, 1995, pp. 1-2; Black, Weisz, & Bennett, 2010, p. 181; Collins & Dressler, 2008, p. 66).

MSW Quality Improvement via a Generation of Researchers

As noted above, R&E also hope that social work education will be improved by the arrival of a new generation of more sophisticated researchers. Here, again, the sentiment is worthy – every generation does bring change, sooner or later – but it is apt to be freighted with a number of qualifications.

Some of the caveats expressed above apply here as well. There is, for instance,, a question as to whether these new researchers, like their clinical peers, will be tenure-track, and how long it will be before they can overrule not only the outgoing Baby Boomers but also the middle-aged Generation X professors who will have moved into controlling positions. Also, like clinicians, researchers are not exactly a new phenomenon. The profession has had skilled researchers for decades, especially but not only at places like Columbia, Michigan, and Berkeley. As some such researchers have demonstrated, technical skill is not necessarily incompatible with dogmatism. Skilled researchers can labor on behalf of absurd or dangerous ideologies.

The arrival of a generation of markedly superior social work researchers, were it to happen, would raise important questions about the future of social work graduate education. SSWs are not generally known as powerhouses of research sophistication. Those newcomers’ technological edge would presumably demonstrate the benefit that SSWs might derive by hiring more people trained in departments of psychology, sociology, education, and wherever else a given university’s research methods experts reside. Indeed, SSWs do acknowledge as much, now and then, by hiring PhDs in sociology and other fields. It is not immediately obvious why SSWs are not rolled back to a certificate-granting role – attesting, perhaps, that a person who has acquired micro or macro practice competence (via e.g., a master’s in counseling psychology or public administration) has also completed additional coursework intended to inculcate a social work perspective.

Contrary to R&E’s hope, it is not immediately apparent that social work PhD programs have become markedly better with respect to research capabilities (see Thyer & Arnold, 2003). The present writer’s years as a student, continuing to the present, do not compel the conclusion that there is a distinct new generation of researchers, nor that the researchers now in training generally possess dizzying technological prowess, or are inclined to use it to exert revolutionary pressure upon the ancien régime. To the contrary, research-driven change seems likely to continue to be steered by such questions as who becomes a social work researcher, which social work researchers are hired, and what kinds of research (and outcomes) will be tolerated or encouraged. One may reasonably expect that conformist pressures in academia generally, and in social work particularly, will continue as always to groom newcomers to take over, very gradually, in ways that cause scarcely a ripple.

In short, the renaissance that R&E hope for seems to be philosophical, not technological. They are looking ahead to a time when social work education uses its research and other capabilities sensibly. This desire overlooks the likelihood that social work education is already doing so. That is, whatever the current arrangement may be, there are probably reasons for it, and there are probably incentives to keep it that way, and barriers to change.

R&E themselves seem to recognize, and approve, some of the factors that make the current arrangement seem sensible from a certain perspective. On one hand, they want MSW programs to continue to enjoy high enrollments. Given the limited supply of superstar applicants and the advantages enjoyed by competing fields, this desire results in the lowered standards noted above. On the other hand, R&E want the social work profession to compete successfully with those other fields. Achievement of this wish requires a substantial percentage of MSW graduates to become successful practitioners. It does not require, however, that all or even a majority of them will do so.

In other words, R&E appear to be hoping for an enhanced version of the status quo. In their vision, MSW programs will continue to function as systems that take money from students and give them degrees, so that they can move ahead in their quest for clinical licensure, and neither the university nor the accreditors will pay much attention (Stoesz & Karger, 2009, pp. 109-110; Thyer, 2009). This means that those crackerjack researchers and clinical experts of the future social work faculty will still be stuck with teaching classrooms full of students who are not necessarily qualified to be there. Among other things, these new faculty will still have to be careful not to flunk more than the rare student, if they hope to keep their student ratings up and qualify for tenure or contract renewal. None of this sounds like a formula for dramatic change. In this regard, R&E may be summed up as expressing a hope for improvements whose purpose is to enhance the permanence of today’s MSW programs.

It appears, in other words, that social work education does not subscribe to the customary paradigm in higher education – where, to some greater or lesser degree, students tend not to be offered admission if they appear unlikely to succeed in their chosen career path. The approach taken in schools of social work is to admit very high percentages of applicants despite the fact that those applicants are, on average, among the least suited of all would-be graduate students. In the name of making higher education available to the widest possible variety of students, SSWs maximize their enrollments, their faculty rosters, and their faculty’s salaries. There is the risk, in such an arrangement, that an untold number of students will become saddled with student loans, will waste years on an ultimately unsuited and unproductive pursuit, and will have to explain to themselves, and to future employers, why they did not prove particularly successful in their foray into social work. And students, it seems, will typically fail to understand this in real time. It may seem fortunate, to a busy student, that the professor does not seriously require much reading and imposes few if any exams. The student’s noncompetitiveness may not become evident until well after graduation.

Problems of MSW Positioning

As R&E observe, social work education has become overwhelmingly oriented toward individual services, especially in the realm of mental health. In that realm, several other professions – notably marriage and family therapy and counseling psychology, but also clinical psychology, psychiatry and psychiatric nursing, pastoral counseling, and numerous others to varying degrees (e.g., occupational therapy, therapeutic recreation) – work on similar or related problems, often using similar concepts, guidelines, and interventions (Thyer, 2002; compare e.g., Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2010 with e.g., Brown & Lent, 2008). There has long been a question of why the U.S. has multiple overlapping mental health professions (Specht & Courtney, 1994, p. 127). Abroad, others could be added to the list. In the UK, for example, nursing in the UK plays much the same role as social work in the U.S. (Beinecke & Huxley, 2009, p. 221).

It certainly seems that, if social work does intend to follow R&E’s advice and define itself more precisely as a narrowly clinical profession – making a deliberate break, that is, from the social justice branch of its roots – then it must focus its MSW curriculum. At present, MSW programs require far more non-clinical coursework than one finds in social work’s more targeted competitors (see Petracchi & Zastrow, 2010, p. 132; Simpson, Williams, & Segall, 2007, p. 6; Crane, Shaw, Christen­son, Larson, Harper, & Fein­auer, n.d., pp. 20-21; Weissman et al., 2006; Thyer, 2007, p. 29; ASPPB, n.d.). In Indiana, for example, clinically oriented MSW students must spend almost a year in introductory courses on the welfare system, the foundation of social work practice, communi­ties and institutions, the social context of human behavior, and social policy (e.g., IUPUI, 2010; USI, 2010; see e.g., Taylor, Mulroy, & Auston, 2004). Meanwhile, marriage and family therapy master’s students in Indiana will be focusing almost entirely on therapy (e.g., Purdue, 2010; see Crane et al., 2010), as will students in other core mental health fields (see HRSA, n.d.) such as psychiatric nursing (e.g., Indiana University, 2010). Oddly, then, while producing the greatest number of mental health clinicians, social work provides the least mental health training.

Logically speaking, society should hope that its least trained professionals would also be its least numerous. Over the longer term, progress in that direction seems to call for the improvement of social work education or its elimination as a trainer of mental health professionals. Some elimination does appear likely. University programs may be trimmed, perhaps with the guidance of cost-cutting criteria like those recommended by Dickeson (2010, p. 66), which look at such things as the public demand for a particular degree program, its costs, its quality, its productivity (i.e., graduation rate), its indispens­ability, and its opportunities.

Applying such criteria, social work pro­grams are arguably dispensable if there are several in the same geographical area (Vedder, Denhart, & Ruchti, 2008, p. 63). They have demand problems if they produce MSWs whose training leaves them barely desirable for low-paying jobs. They will not offer promising opportunities if they are unresponsive to developments (see Stoesz et al., 2010, ch. 5). For instance, business schools have taken the leading role in the area of social entrepren­eurship (e.g., Germak & Singh, 2010), and neuroscience (a subject barely broached in social work clinical classes) is on the cutting edge of future approaches to therapy (e.g., Farmer, 2009, pp. 113-115). Over time, one may expect that an unresponsive discipline to see pieces of its domain pared away and handed elsewhere, and that some social work programs will be aggregated into other university depart­ments (above) or eliminated altogether (Stoesz et al., 2010, p. 77). In short, forced weeding-out by policymakers and the market seems to be the most likely long-term mechanism by which what remains of social work education may develop sharper attention to its best faculty, students, ideas, and market niches.

There is, however, another way in which social work education could develop a stronger quality orientation. Rich and Nugent (2010) say that clinical nursing PhD programs are being prepared “to bring nursing into line with programs offered to other health care professionals” in fields like “physical therapy, pharmacy, occupa­tional therapy, and speech-language pathology, [which] have already or are fast approaching a clinical doctorate as the entry-into-practice level” (p. 230; see BLS, 2010; Rosseter, 2010). In a future professional landscape oriented toward measurable outcomes, one cannot reasonably hope that master’s-level practitioners with minimal clinical training will compete well against cutting-edge technologies steered by clinical PhDs who are eager and able to keep up with relevant research.

What is more likely is that MSWs will be relegated to more patently restricted and inferior roles. Conceivably social work education could escape that scenario by developing its own clinical doctorate. Doing so would require a marked departure from most of the academically oriented social work PhDs now offered (see Thyer & Arnold, 2003; Stoesz et al., 2010, pp. 112-115; Anastas, 2006, p. 204). Those existing programs typically have relatively few applicants and limited resources (Freeden­thal, Potter, & Grinstein-Weiss, 2008; Stoesz et al., 2010, pp. 108, 112).

This is not to suggest that clinical social work PhD programs seeking to compete against those of e.g., clinical psychology would necessarily fare well in the intellectual atmos­phere of typical schools of social work. Such concerns might be ameliorated by structuring such programs as essentially remedial joint efforts with cross-training in psychology or other related fields (e.g., University of Michi­gan, 2010). Such programs could produce clinical social work PhDs who would articulate and develop a rationale for a distinctively social work approach to direct service in clinical practice. Conceivably the MSW could yet emerge as somehow indispensable within that perspective.

The Private Practice Chimera

The preceding pages discuss R&E’s perspectives on a relatively global level. It may be useful to consider relevant matters from a viewpoint closer to that of the individual MSW student and graduate.

R&E estimate that up to 90% of social work students “want to be prepared to provide clinical or direct practice services to clients” (p. 480). This is supported by Han and Chow (2010, p. 215), whose report on a large survey at California MSW programs in the mid-1990s found that 86% of first-year MSW students chose micro-level field placements (see also Whitaker, 2008a, p. 4; Perry, 2009, p. 58; D’Aprix, Dunlap, Abel, & Edwards, 2004, p. 274; Santangelo, 1992; Weaver & Nackerud, 2005, p. 107).

Some students move away from that clinical orientation during their MSW studies. For those who retain it through graduation, the typical next steps on the road to independent private practice (as determined by varying state laws) are to pay about $200 and take the Master’s licensing exam administered by the Association of Social Work Boards (ASWB, 2008); to accumu­late around 3,000 hours of supervised clinical experience over a period of two or more years (see ASWB, n.d.); and then to pay a similar fee to take the ASWB’s Clinical exam. Each of these steps has the potential to delay or defeat the MSW’s progress toward licensure.

First, in what could seem to be a determination to protect educational mediocrity, the ASWB refuses to publish the Master’s exam pass rates for graduates of different schools (Thyer, 2010). That is, an applicant who plans to pursue a clinical career cannot find out which schools do the best job of preparing students to pass the exam. Absent such informa­tion, students must guess whether to pay, as many do, for post-MSW exam prep courses (see Goldstein, 2007, p. 20). Thyer reports that some state laws overrule the ASWB on that; hence, he discovered that, in Florida in 2007, 78% of ASWB test-takers from one accredited MSW program passed, as compared to only 42% from another. Substantial divergences might be expected even among programs of comparable quality but differing focus, given Thyer’s (p. 5) observation:

The MSW curriculum is centered on the CSWE accreditation standards. The LCSW examination is centered on the ASWB task analysis. There have been no formal investigations on the extent to which these two driving forces governing the profession overlap, supplement, or contradict each other.

In a poignant commentary on the quality of such exams, Albright and Thyer (2010) gave the ASWB’s four-answer multiple-choice practice test to students with the questions blanked out. In other words, students were looking at only the four possible answers to each question. Without knowing what the questions were, they were able to guess the right answer 52% (i.e., not 25%) of the time. It has apparently not yet been possible to test whether random college graduates, with and without the benefit of an exam prep course, might do just as well on those exams as the gradu­ates of a given MSW program, though there have been indications that MSW programs may not, in fact, be very educational at all (see Pardeck, 2005, pp. 125-126; Lacasse & Gomory, 2003).

The other major prelicensure requirement, often involving 3,000 hours of supervised clinical practice, brings its own challenges. The first is the simple quest for a position in which the MSW graduate can put in those hours. Even in mid-decade, when the economy was doing well, R&E had to admit, MSWs “increas­ingly find it harder to get jobs” (p. 479), and those jobs offered “far less job security, more changes in work site and focus, and more competition than at any point in the past” (p. 480; e.g., Kang & Krysik, 2010). Reflecting the essentially vocational nature of social work education, MSW salaries are sharply lower than those in nursing and other health-related professions (see Basham & Buchanan, 2009; Buchanan, Kim, & Basham, 2007, p. 295; BLS, 2010; Whitaker, 2008c, p. 11); indeed, they are often inferior even to the salaries of dental hygienists and radiation therapists (BLS, 2010).

If the MSW graduate does land a job, or decides to take a volunteer position (which, at least in principle, could be anywhere in the world) for purposes of accumulating the required number of hours, s/he will then have to arrange for an LCSW, there or elsewhere, to provide the requisite supervision. Supervision typically involves about one hour of face-to-face consultation per week of practice (ASWB, 2010). In the circumstances encountered by some MSWs, there is no charge for this supervision; it comes along with one’s employment. If the MSW has to pay an LCSW to provide it, however, rates commonly range from $25 to $100 per hour (e.g., NASW Connecticut, n.d.). At the latter rate, two years’ worth of supervision would cost about $10,000. Since states vary in what kinds of work count, and in other requirements, some MSWs who complicate things (e.g., moving to a different state partway through the process) may encounter additional issues.

Assuming the MSW progresses through these requirements, passes the Clinical exam, and becomes an LCSW (or whatever it is called in the particular state), the next question is what s/he will be doing. In a national survey of licensed social workers (including some who had only bachelor’s degrees, but were considered to be licensed within the laws of their state), Wing, McGinnis, Cohen, Whitaker, and Weismiller (2006, ch. 3, pp. 9, 11) found that their top roles were direct services (61% of partici­pants), adminis­tration and manage­ment (20%), and supervision (7%). In response to a separate question, the top four tasks on which they reported spending at least half their time were counseling (31%), psychotherapy (28%), case management (11%), and screening and assessment (10%). These figures suggest that perhaps two-thirds of MSWs who achieve licensure spend significant amounts of time in face-to-face direct practice with individuals (see Whitaker, 2008c, p. 7).

Wing et al. (2006, ch. 4, p. 5) also asked about pay. They found that by far the primary factor that would influence licensed social workers to change jobs was the prospect of a higher salary (73% of participants). Part of the problem was that student loans have become a worrisome and in many cases untenable burden upon social work graduates (Karger & Lonne, 2009; NASW Iowa, 2006). In Illinois, according to Boland-Prom (2009, p. 357), non­payment of state student loans is now the most frequent reason for sanctions levied upon social workers by the state licensing board. Whitaker (2008b) reports that, even among NASW members earning over $50,000 (presumably with family expenses and/or other debts), many report “unreasonable” or “unmanage­able” levels of educational debt (pp. 13, 17).

Direct practice, or whatever it is that the LCSW tends to be doing, is not always what MSW applicants visualize. Burnout is common among social workers (e.g., Kim & Stoner, 2008; Siebert, 2005), though levels vary among specialties (Kim, 2010). Wing et al. (2006, ch. 4, pp. 1, 9) found that 44% of licensed social workers reported safety concerns at their jobs, and roughly one-third of those felt that their employers did not respond adequately. Participants in that study named lifestyle/family concerns, (lack of) interesting work, and job stress as drawbacks of their present positions, for purposes of contemplating a change of jobs. They also tended to report that demands upon them (in terms of e.g., paperwork, severity of client problems, non-social work tasks, caseload) had increased significantly in the past two years (ch. 4, p. 9). It appears likely that financial and economic forces pushing toward workplace distress will not have been reduced during the years since those data were collected.

As for the dream of private practice, Wing et al. (2006, ch. 3, p. 5 & ch. 4, p. 1) indicate that more than 40% of licensed social workers under age 35 did not plan to be in their current jobs two years later, and 30% intended to go back to school for a degree in some field other than social work. Among licensed social workers under age 50, fewer than 20% were working in anything other than government or not-for-profit settings.

The remarks in this section have been intended, again, to provide some insight from the perspective of the individual student or graduate. They demonstrate that only a fraction of first-year MSWs become licensed, and only a fraction of those wind up in full-time clinical practice, and only a fraction of those make it into independent private practice before their kids are grown. It appears unlikely that most MSW program applicants are aware of these outcomes. Hence, R&E leave out an important dimension: what happens to all those students who pay the fees and spend the years in MSW programs?

In net terms, R&E seem to say that social work educators should flood society with what the job market considers an excessive number of practitioners who have opted for the “lite” version of mental health training. Applicants take this career path for the sake of a dream of private practice, despite what many will find to be relatively unrewarding practice environments accompanied by potentially unrepayable levels of student loan debt. It appears that this arrangement is able to continue because, as social work administrators can readily ascertain, a substantial number of people who go through this process will abandon it after graduation, thereby making room for more. Such considerations suggest that many SSWs may fail – that some may fail egregiously – to incorporate ethicality, appropriate disclosure, and career outcome data into the structuring and operation of their MSW programs.

Conclusion

R&E have put forth a concept of social work education and the social work profession in which clinical practice predominates. This article has refined and/or critiqued certain aspects of that concept.

The first point of attention has to do with the claim that social work education emulates professional education in law or medicine, or that at least it is similar to education in other semi-professions. A look at some professions prominently named by R&E suggests that, in fact, social work education differs from them rather profoundly.

A second point of attention suggests that social work has boxed itself in by depicting the MSW as though it were a peer of a PhD in clinical psychology, and by complacently relying upon that depiction. In so doing, the profession has left itself virtually bereft of an intellectual infrastructure that would support a transition to its own clinical doctorate, so as to improve its competitiveness with other professions that are making such a transition.

The third point of attention in this article examines the troubling discrepancy between the promoted dream of private practice and the adverse odds confronting those who pursue it. It appears that the purpose of a SSW is best discussed with considerable attention to the best interests of students, extending well beyond what they think they want when they are deprived of key information.

* * * * *

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[1] The two sharing the American outlook were Israel and Hungary (see Weiss-Gal & Gal, 2009, p. 285). The others were Australia, Brazil, Canada, Germany, Hong Kong, the United Kingdom, and Zimbabwe.

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Comments

  • unnamed  On October 22, 2014 at 8:15 AM

    wow! super!

  • Jay  On August 1, 2012 at 1:32 AM

    Interesting paper. I’ve been looking at social work PhD programs, and I found that I don’t really like what I see. There’s so much focus on research and acquisition of technical skills. One school offered so many statistics courses that you wonder what the students learn in terms of social work. I’ve wondered why most social work PhD curricula are almost completely disconnected from the reality that most BSW’s and MSW’s work in service settings. In the MSW program that I attended, the worst practice classes were conducted by PhD’s. Thank goodness for the adjunct LCSW’s, because without them, we probably wouldn’t have learned the little bit of practice that we did. It befuddles me why SSW’s do not start to train PhD’s in clinical social work practice in order to teach MSW’s and BSW’s so that the social work field does not continue to flood the market with graduates who have barely any awareness about themselves, much less awareness about the people they’re working with. My comments may be misconstrued as anti-intellectual. To the contrary, I value research and theory and how it can inform practice and maintain our focus on social justice and advocacy. Why can’t social work PhD programs simply incorporate more practice courses along with research components, much like clinical psychology doctoral programs? Could it be that even at the doctoral level, we don’t have enough social work faculty that can teach clinical social work practice?

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