A question for those in the mental health field - LMHC or LCSW to work as counselor in private...

[dbsam]

I am considering a new career and have a question for those of you in the mental health field.   I am debating between a Master’s in Clinical Mental Health Counseling or a Master’s in Social Work.  I am interested specifically in private practice counseling. 

A couple of thoughts:

·         The curriculum for the CMHC looks as though it would better prepare me for counseling than the MSW.

·         I am concerned about insurance reimbursements.  One of the therapists in the practice I am considering suggested I look into insurance reimbursement - they are LCSW’s so they are not too familiar with the insurance reimb for LMHC.

·         The therapist I could possibly work with (although much can change in the time it takes to get the degree) said either program is fine.  Her first response was ‘get the MSW, it will be fine’ changed a little.  After looking at the CMHC program she said she liked the program and felt it would be more relevant to the job.    She w/h considered the CMHC program if it was available when she was in school.   Her main concern was insurance reimbursement.

·         The CMHC is offered at a private school and costs twice as much as the MSW at an extension of a state school.

So, if I find the insurance is not an issue, it seems to me the CMHC/LMHC is the way to go but I am wondering if there is something I am overlooking.

Thanks!

I am really nervous about going back to school.  I was an accountant in my first career and have been a SAHM for seven years – so this is a big change.  It has been a long time since I was in school.     

[Marska]

I have an LCSW and I'm in NY. It might vary by state. Here you have to first get your LMSW, then work in the field for a number of years (I think 3) and get supervision by an LCSW or a PhD or MD, then take a test to get your LCSW, then work in the field some more, then you can get your "R number" which means you can get reimbursement from insurance companies. At some agencies you might be able to work with your LMSW or LCSW (without the R number) and bill under another practitioner. 

I don't know about billing with LMHCs.

[SpiralChrissy]

I'm an LISW-S in Ohio. I got my MSW to do counseling. Like NY, I had to practice under supervision for 2 years before I could practice independently. I think that the social work degree is the way to go...but of course, I'm a bit biased:).  I went to school to do counseling myself and I really feel like my program prepared me well to do that. What I like about social work, though, is that the degree allows you do so many different things. For me, I did private practice work for awhile but I got burnt out. It was too intense. But, with the social work degree I could work in so many different settings. There's more room to take your career off in a totally different direction than there would be with counseling. You can do hospital social work, or case mgmt in a host of different settings, or work at the VA  and you can work with lots of different populations. I think it's a wider major than counseling. I feel like counseling might be more limited, but I can't speak for that profession. I can only tell you that I've never regretted social work and I've loved the jobs I've had. Good luck to you!

[dbsam]

Thank you both for the replies.  It is my understanding that in my state I would also need to work under supervision for three years prior to licensure – for both the LMHC and LCSW.   You both brought up good points.  Although I believe I would remain in private practice, I cannot be sure and being a LCSW would offer more diverse career opportunities.  Thanks!

[Drummer's Wife]

Hi, dbsam.  I would recommend going for an MSW (I am thinking about it, too).  My understanding is that having a LCSW - or LISW, as they use where I live - is easier to get insurance reimbursement vs. a LMHC.  Also, and I know you plan to open a private practice, there are more jobs for MSW's over those with a masters in counseling.  I think that's worth considering, b/c starting your own business as a therapist may be expensive and risky - though, of course, it could end up being very profitable in the long run.  I've just heard that it can be hard in the beginning to make a liveable wage, and if being a LCSW makes it easier to bill insurance, I'd say go that route.  I have also heard, however, that some feel like a LMHC receives a better education to counsel clients.  Really, though, I think with either degree, you will learn the most while working, yk?  If you are going all the way to become a psychologist, that is when I would say it makes more sense to skip the MSW.  But I don't think the hourly rate, even in private practice, would justify the cost of a doctorate, but that's just me. 

Best of luck figuring it out!

[dbsam]

Drummer's Wife, Thanks for the reply.  Actually I wouldn't be starting a practice.  Someone who already has a practice is encouraging me to go back to school and work with her and her partner.  They specialize in areas that would fit nicely with the type of counseling I would like to do.

But overall, I think you and the pp's are correct - a MSW will allow me to do what I want and more.

[kmddmk]

dbsam, did you make a decision?  i am in the same boat as you.  really wish i could get clarification on the insurance reimbursement issue b/c that is the only thing that i think cuts in favor of the msw if you want to do straight up private practice therapy.

[insidevoice]

The most flexible here- with a good number of supervised hours, is the LCPC.  It often will take an additional year to complete, but there is no problem with getting approval for any insurance.  Particularly with a private practice setting, supervised hours for state licensure may be very important. 

[hxcmama]

Hi there, I'm bringing this older thread back since I found it google-ing "licsw vs lhmc" - you asked EXACTLY the question I wanted to know. Several people I asked (my college advisor, my therapist who is a LICSW for example) think SW is "the quickest way to licensure" but both require about two years internship after graduating an approximately 60-62 credit master's degree. I looked at the detailed coursework for the MSW versus the MA-Psych (which prepares to sit for the LMHC designation) at one school, in this case Bridgewater State here in Massachusetts and the SW curriculum has literally nothing to do with counseling people. The MA-Psych degree however is all about counseling and different psychological theories etc so I feel like I would be really unhappy in the actual SW program (since I don't want to do traditional social work after graduating) and I feel I would be woefully unprepared to be a therapist. SO that just leaves the insurance coverage or reimbursement question. I still don't have a solid answer to this, however I looked at the coverage of my two policies (I have a PPO and medicare) and the licensure of the covered therapists was about 65% LICSW and 35% LMHC (those that aren't holding doctorates, that is). So this leads me to believe that LMHC do get insurance coverage. I'm leaning towards the UMass program which is MS-mental Health Counseling right now.
 

I do intend to look more into this (meeting with my undergrad advisor next week), and I would love to know what you have learned too!

Michelle