TRANSCRIPT
I want to challenge the idea that having a fancier degree makes you a better therapist. When I first became a therapist, I was a social worker. I noticed in the staff lounge at different clinics where I worked that the psychologists often had a superior attitude toward the social workers. I wondered, were they better?
Then I started realizing, just by looking at them and listening to them, and having been a client with people with all sorts of different degrees, I realized I didn’t see any connection between the quality of their work as a therapist and the degree they had. As time went on, I even speculated—I wouldn’t say this is necessarily true—but I speculated that for some of them, being in school for longer, having gone to all that extra school to become a psychiatrist, let’s say, to become an MD, or training to become an analyst on top of everything else, sometimes made them an even worse therapist. Because sometimes they were trained in different schools of thought that I think were not helpful or simply incorrect. They had all sorts of theoretically incorrect ideas, or they had spent so many years in school that they were actually more distanced from humans and human problems. They weren’t actually out there living their lives and going through their own transitions and learning life lessons. Instead, they were learning how to survive in an academic environment.
What I found is sometimes people who were in school for a long, long time felt at some level that it made them superior. What I found, as time went on for myself, is just it wasn’t true. There was not necessarily a superiority by having been in school for longer or having a fancy degree. I felt actually what made someone a better therapist was their ability to empathize, their ability to have compassion, their intelligence, their life experience. And sometimes, yes, people who had a fancier degree were smarter. Sometimes they knew more, sometimes they’d read more, sometimes they did have life experience than people who had lesser degrees. But sometimes they didn’t. And sometimes there were people who were 50 years old who went back to school to become social workers, and they got what’s one of the lower degrees to become a therapist. And yes, they were fantastic right from the beginning, just because they had so much wonderful life experience, and the degree they had didn’t reflect that at all.
Now, as I contemplate it, I also think, well, sometimes I had clients who did buy into this idea that having a better degree would have made me a better therapist. I had sometimes clients who said to me, “Oh, you’re just a social worker. Well, I don’t think you can help me at all. I don’t think you have the ability to help me with these problems. My problems are too serious.” On the other hand, I had other clients who came in and said, “Oh, I’ve had so many bad experiences with these arrogant psychologists. I don’t want any more psychologists. The only people who can help me are social workers because they really understand about social problems.” And I thought, well, I know some social workers that really actually are pretty terrible. I know some psychologists who I think actually are very, very insightful and are wonderful therapists.
So for me, what I’ve found is I actually really don’t care what some of these degrees are. Often, actually, I don’t even care if they have a degree at all. I want to look at their personal qualities and their life experience, and I think that is what really counts.
Interestingly, some years back, I was at a conference—I believe it was in Sweden—and there was a guy named Bruce Wompold. I’ve never heard of him before, but he got up and he gave a talk about this very subject, and I found it fascinating. He had actually done quantitative research on it. I don’t remember exactly how he did his research, but what I remember he came up with as his results—and I think I will try to link it in the description box below if I can find it—is that there wasn’t a connection between the quality of the therapist and the degree that they had. It just wasn’t a correlation. And that actually there were personal qualities that a therapist had that were more correlated with their ability to help people.
Also, as a client in therapy myself, I think, let me see, I’ve had two or three therapists who were social workers. I had a therapist for a short while who was a psychologist, and I had a therapist who was a pastoral counselor for a while. What I found is they were all terrible, actually. It didn’t make any difference what their degree was. They were all kind of arrogant. They were all kind of withdrawn. They all had an attitude of superiority. It really didn’t matter what their degree was; they were all pretty much equally bad, and I wouldn’t have chosen one over the other. I think really what I would have loved is someone who was humble. I didn’t care what their degree was. It didn’t really make any difference to me personally when I was a client.
And then there’s another thing, though—this is sort of contrary to it. I remember it’s happened many times to me when I was a therapist, and I always introduce myself: “This is my name, this is what my degree was, this is my license. I was a licensed clinical social worker,” etc., etc. When I was working as a therapist, now what would happen—and this happened many times—there’s a year, two years later in therapy, six months later, sometimes I would have a client of mine say to me, “You know, I’m so glad I got you as my psychologist.” And I remember thinking, well, and then I’d say, “Actually, I’m not a psychologist. I’m actually a social worker.” And they look at me and go, “Oh, well, I thought you were a psychologist.” I said, “No, I’m a social worker.” And they say, “Oh, okay.” And then like three months later, they say, you know, they say it again sometimes, “You know, I’m really glad you’re a very good psychologist.” Then I realize, why argue? Sometimes people just—they have an idea of what a psychologist is.
And even in Europe, I think in Europe with a master’s degree, you can call yourself a psychologist. In the United States, you can’t really call yourself a psychologist unless you have a doctorate, an PsyD, or a PhD. Or another thing that happened, I remember one time early on when I was working for three years at a clinic after I’d graduated from school and I was getting a higher level of licensure, there was a guy there, a therapist who was older than me who was a psychologist. He said, “Daniel, you know, you’re a really good psychologist.” And I remember thinking, uh-oh, he mistook me. And I said, “Actually, no, I’m not a psychologist at all. I’m a social worker.” He said, “Oh, come on. It’s all the same. Haven’t you figured that out by now?” And I remember thinking, well, actually, yeah, we kind of have figured that out by now. I said, “But don’t you think it’s important at least that I say what I really am?” Because Daniel, all these degrees and licenses, does that really matter? You’re a therapist, I’m a therapist. Once we get in a room with a client and we close the door, it’s our personality that allows us to do what we do.
And so psychologist, you are dealing with their psychology. You are a psychologist. I said, “But I don’t feel comfortable calling myself a psychologist because that’s not my degree.” He says, “Yeah, but when we’re talking informally, that’s really what you are. You’re a psychologist.” And I said, “Well, maybe a more fair thing to say is all of these ideas and all these labels are just kind of silly in a way. They really don’t tell that much about how we really are as people and the quality of our work.” The other thing, and I think I’d like to close with this, is in the mental health field for professionals—speaking as a former mental health professional—there is such a hierarchy of what degree you have, what license you have, etc., etc. And nowhere is it more extreme than inside of a mental hospital. I did a very short stint working in a mental hospital, and there everybody knew what your license was, what your degree was, your ward, and a little tag on you and clients.
Knew it. And people who had fancier degrees had more power and more responsibility. It really was a top-down hierarchy, with psychiatrists at the top, then psychologists, then social workers. Maybe occupational therapists were around the same level or maybe a little bit lower.
But what I found is that hierarchy actually had a very strange parallel elsewhere in the mental health field. And that parallel was with clients. And that clients had their own hierarchy. The hierarchy that clients had was their diagnosis. And what was considered to be more extreme diagnoses were like schizophrenia and bipolar, these so-called biological diagnoses. And then there were milder diagnoses, maybe like post-traumatic stress disorder, obsessive-compulsive disorder, and maybe personality disorders were a little bit less extreme than the psychosis. And then down near the milder end of the spectrum were like anxiety disorders, generalized anxiety disorder, and depression. Some of the adjustment disorders were below that. But it was a strict hierarchy.
And it was like when therapists would talk about clients, especially in mental hospitals, but even in the mental health field in general, it was sort of like this idea that if you had a more extreme diagnosis, it was harder to solve your problem. If you had a less extreme diagnosis, it was easier to solve your problem. I often saw this with therapists too at clinics. They didn’t want to work with people with more extreme diagnoses. Often, they just wanted to work with lesser people because they were supposedly easier to help.
And I thought also clients’ status, in terms of their view from the mental health field, was often based on their diagnosis. And often if people had more extreme diagnoses, they were considered to be of lower status. And at some point, it hit me: this is kind of parallel to how it is for mental health professionals. It’s like this whole field is hierarchical in a way that when I came to think about it, I’m like, you know, I think it’s all a false hierarchy. I don’t think it really means anything.
So what does that mean when it comes to the clients in these diagnoses? Well, sometimes what I saw is people with these supposedly really extreme diagnoses, for instance, like psychosis, could bounce out of it pretty quickly. Sometimes they really were very amenable to talking about their problems and could work it out. And sometimes could resolve it more easily than someone who, let’s say, had a supposedly lesser diagnosis. And that this hierarchy didn’t really say that much about the character of the client. It didn’t say that much about their inherent goodness or their nastiness or their generosity or their caring or their respect or their ability to change. Or it didn’t say anything necessarily about their motivation or their insight or their intelligence.
And I think in that way, the fact that you really can’t tell that much about a person just by their so-called mental health label, this diagnosis, it really is parallel to you really can’t tell that much about a clinician just by their label that they have, their degree, and their license.