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APRN (psychiatry) versus MSW: pros and cons

elijah elijah (New) New


I'm making a career transition in order to become a therapist. I'm considering three tracks:

1) APRN with a speciality in psych counseling.

2) A masters in social work (MSW).

3) MFT certificate.

I'm mainly motivated to work with mostly functional adults, children, or couples. In my dream scenario I'd like to hang my own "shingle," and work independently as a therapist in a West coast city (e.g., San Francisco, Santa Barbara, Portland, OR). I might even want to move to New Zealand or somewhere where Dubya doesn't show up on the radar screen.

I have been told that I shouldn't pursue an APRN because I'm mainly interested in providing therapy--not full body health care.

However, the APRN track attracts me for the following reasons:

1) It is easier to find work in the city of your choice.

2) The pay is higher (I have worked in non-profits my whole life...and I'd like to start a family before I'm 40...I'm now 30).

3) There are many more tracks to pursue than an MSW or MFT (for example, suppose I can't hang my own shingle so easily...I'd have to find a job job).

4) It seems like it would be easier to build a group of clients as APRN than as an independent MSW or as an MFT.

Any advice would be very appreciated! For example, would I have a lot of discretion over the kinds of clients that I would treat as an APRN? I'm not opposed to the idea of working in a hospital for my first few years...but not long term. I would like to be an independent practioner ASAP.





Hi Elijah,

I took the MFT route and I would do things differently knowing what I know now. I have not been in practice for over a decade, and what has changed the most since I left is the integration of medical management into mental health care. I regard this as an wonderful development and often reflect on my clients from years past who would have benefited so greatly from some of the newer meds. (Or older ones! )

If I had it to do over again I would be sure to be credentialed to prescribe or to work in a practice of well-recognized MDs/APRNs who have MSWs on board and work collaboratively. If I were your age I'd become a psychiatrist or APRN with the mission of destimatizing mental illness! Then the world is your oyster *and* you are providing comprehensive care!

The MSW is sought after in hospitals, so if that's what you are after, I think its as nearly as good as a nursing degree.

It's very difficult to make a living strictly through private practice given the HMO climate. If you live in a *very* expensive area and specialize in problems unique to that area, you will likely get enough private pay patients to float your boat.

Feel free to PM me if you wish!


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