RN's facilitating group therapy

Zookeeper44, RN · Mar 18, 2009

I was a social worker in a community mental health facility (I will also be going to nursing school this fall) and we had an RN who mostly did med mgmt. and part of this was running a couple of groups, were technically med mgmt. groups but they were still group therapy and she was excellent. I have a master's degree in counseling and we only took one quarter on group therapy so you are probably as qualified as any counselor to do it.

sanctuary18 · Mar 18, 2009

Thank you so much for this info. Interestingly enough, I considered going back to school to be a clinical social worker! Nursing is frustrating in that there is not enough time to be with your patients to address their emotional needs. Medical models typically ignore emotional/spiritual needs of pts. Thanks again and good luck in your pursuits.

Zookeeper44, RN · Mar 18, 2009

Well...I worked for the CSB in my region and you might be surprised how much paperwork/administrative duties social workers have as well...I'd say EASILY my paperwork took at least 50-75% of my time spent at work. There were salaried counselors who literally slept at the clinic to keep their paperwork caught up (and even at that, it was still not ever caught up). We were threatened constantly with being fired if it was not done but it was an insurmountable goal that was set for us and understandably, counselors never stayed there more than a year. Even the RN I referred to in my other post left shortly after I did...she had the worst of it. The patient contact there was also very medically focused, although they did do groups...but one reason I wanted to get out of it was that Medicaid and other insurance co.'s cut funding more and more every year for group therapy.

Now a fully licensed LCSW has a few more options but of course it takes years to get to that level, and even then...unless you can somehow find a clientele who is totally private pay, you still have to submit to many of those same paperwork guidelines set by Medicaid, etc.

Did you decide not to pursue the LSCW route? I'm curious...what direction do you think you'll go in now? I am also thinking about what my options are going to be. I am getting into nursing because of the versatility of it and because I think I'll always be able to find work *somewhere* in a pinch, but I really love psychiatry.

sanctuary18 · Mar 18, 2009

I never did pursue a MSW. I was interested in working directly with clients, either psychotherapy and groups, but as you said, it takes yrs to become a LCSW. I seriously considered going the route of a Psychiatric Mental Health Nurse Practitioner (I'm in PA and PMH-NP's can practice psychotherapy and have prescriptive authority). However, the PMH-NP programs offer little in comparison with programs in clinical SW. The NP programs mainly include core nursing courses, regardless of specialty, and very limited focus on MH. Therefore, this path would still necessitate further training/supervision. I'm not saying post graduate training and supervision is not a good thing. In fact, it is essential to help ensure effective and safe relationships between practitioner and client. It's just that I do not wish to spend so much time to get to my destination.

I have facilitated support groups for trauma/abuse survivors and for individuals/couples experiencing miscarriage, stillbirths, and infant death. Also, I started a support group for parents of children with Down syndrome (I have a son with DS). I am frustrated because I've been told repeatedly and believe that I have strengths in the MH area and am committed to helping others receive quality MH care. Working as an RN in a psych facility is mostly about meds (and paperwork - but that's with any field today). I am not interested in this role.

Currently, I am not working as I've been raising 3 kids, 2 with significant chronic medical conditions requiring frequent hospitalizations. I am going back to nursing but before jumping back I am considering my options. I've worked in Med-Surg, Oncology, Critical Care, Infusion Home Care and Psych. I really do not want to return to hospital nursing (hrs and awful nurse-pt ratios). So, not sure where I'll end up but am researching doing some group therapy on the side to fulfill that interest. I guess anyone can put up a shingle but I would not want to do it if it wasn't legal or if it wasn't in the best interest of the clients. Let me know if you have any thoughts or ideas.

I still think you might want to research other avenues utilizing your SW education and background.

Thanks and take good care.

Zookeeper44, RN · Mar 19, 2009

Just curious...but did you mean other avenues as in not nursing? Or other areas in nursing besides psych?

Any specific ideas you think might be a good fit, that I could look into? I have worked in home health (administrative positions) and I am very interested in that field. Also case managment, but really not quite sure where that fits in yet.

Whispera, MSN, RN · Mar 19, 2009

I'm a psych CNS, and have done group therapy and prescribed and had my own practice. I did group therapy before I got my MSN too. I think it all depends on where you live, what you can do. Different state laws and such. I do know that often RNs earn more than social workers in the same facility, so that's worth consideration too.

sanctuary18 · Mar 19, 2009

I was referring to other avenues in SW. If you're interested in administrative or case management, would you consider working in a non-psychiatric hospital? I don't know about salary comparison to nurses working in same setting but it's been my experience that SW's do a lot of D/C placements and case management type work.

Zookeeper44, RN · Mar 19, 2009

That takes me back to the issue of not being licensed...the only positions I have seen in my area require an LCSW. My thinking was that in less time than it would take me to get licensed (and I would be an LPC, not an LCSW) I can become an RN, and even new grad RN positions pay more than most SW positions I am aware of, and then there seem to be many more options for moving up or moving around as an RN. The only positions I have held or have been offered as a non-licensed SW have been in the upper-20,000's. I have looked into hospital SW jobs and they either do not have openings or they are just telling me they don't since I'm not licensed...I don't know...but there never seem to be any open. And I am pretty sure that what Whispera said is true here too about RN's making more in the same type positions as SW's. I am in a rural area and I'm sure there are many more opportunities in bigger cities.

In terms of it being "illegal" to open a practice, my understanding is that anyone can call themselves a counselor/therapist legally, at least here in GA...you just can not call yourself a "psychologist." The main issue is I'm not sure whether or not insurance co's will pay you if you stand on your own...I know there was an RN in our town who opened her own counseling practice, but not sure if she was private pay only or what. That would be something to look into in your state...I suppose you'd have to work with a psychiatrist for prescribing?

Can I ask for what kind of facility you did your group facilitation in the past? Just curious as it sounds like you had the opportunity to do what you enjoy but wondering if it was a limited opportunity or if maybe it is something you could do again in a similar setting?

Lots to think about :wink2:

Thunderwolf, MSN, RN · Mar 20, 2009

In terms of it being "illegal" to open a practice, my understanding is that anyone can call themselves a counselor/therapist legally, at least here in GA...you just can not call yourself a "psychologist."

Not necessarily true.

Counselor is a protected title in some states, like RN, LPN, Psychologist, Social Worker, et cetera....you have to check with your state if the term Counselor is protected.

The term Therapist is not protected...because it is a catch-all title.

Knowing this about THIS term...buyer beware.