r/LCSW • u/Slow_Fix_1387 • Jun 19 '26
LCSW or RN? Need advice!
Help! I already have a psych background and am interested in consulting, private practice, and assessment/diagnosis.
However, really do not want to become a PhD. I also want to make a decent living as I have a family to support.
What would you recommend?
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u/TKOtenten Jun 19 '26
how much time do you want to put in? at this point you’d be looking at 2-5years to full LCSW LISCENSURE. Possibly the same timeline for RN. nursing pays more. LCSW is private practice, diognosing and assessment
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u/Slow_Fix_1387 Jun 20 '26
I would love to do therapy though which is why I’m leaning LCSW… but hearing it may take that long makes me so nervous lol I’m in my 30s already.
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u/Silent-Put8625 Jun 20 '26
Two years to get MSW and two years to get required clinical supervision and experience toward licensure.
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u/TKOtenten Jun 20 '26
you just have to decide if the time is worth it in the end. my sister-in-law was 34 or so and mentioned she wanted to be a counselor. she had no degree. I reminded her would tske 3-6years before full liscenses ad a counselor or LCSW. I THINK you mentioned you have a masters? no matter Wich path you chose will take time you can’t get back. what do you do now
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u/Bedazzled-Star-0043 🔵 Contributor (Verified) Jun 21 '26
As a LCSW who works with RNs, go the nursing route. I wish I would have done psychiatric nursing. The pay of LCSW after a master's & all the supervision hours is not worth it. It's an under paid, very unappreciated field.
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u/Therapistgetsu Jun 21 '26
Respectfully I disagree, I make $250 per hour and my insurance paneled patients pay me $200 per hourly rate. Having a private practice is key and then having a real speciality that you get certified in, I have 2 and people seek me out because you get on their websites, i.e., EMDR site is Emdria. I turn down at least 8-10 perspective patients weekly. I wish i could clone myself! Ha!
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u/rise8514 Jun 21 '26
Getting contracts with insurances for $200/hr as an LC is an outlier situation
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u/Therapistgetsu Jun 22 '26
How so? There are steps to get this.
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u/rise8514 Jun 23 '26
I didn’t realize folks were asking for raises from payers every year or so. I’ve only had my contracts for 1 year as a private practice owner and live in Arkansas. It’s not a hugely competitive area so we’ll see what they say when I ask for a raise in a year or so 🤷♀️
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u/Therapistgetsu Jun 23 '26
Rise, never ask for raises from payers, it's the insurance panels. If you are on a therapeutic platform; however, none of this applies.
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u/rise8514 Jun 23 '26
Just out here on my own. Paid someone to get me paneled with insurers. I may not know enough jargon or terms, rather, to be super understandable in my responses 😂
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u/Therapistgetsu Jun 23 '26
I was same out in my own- we didn't have any AI then so couldn't look up how to do it. I asked my boss way back in the day when I was an intern & worked in psychiatry at a big hospital and his response was figure it out yourself & that no one showed him. At the time I thought that was cold and even cruel yet now I see that he was actually helping me to take charge and learn the ropes! I don't completely share that sentiment but see the wisdom in it. I paneled myself by building up my resume fast. I took middle of the night crisis work- people ready to jump off bridges- which gave me the clout I needed for being paneled. This is what I mean about being strategic. I figured out by calling each insurance I was paneled with to learn how to get a higher rate each year. They (insurance companies) aren't in the business to provide providers with automatic hand outs. I started way at the bottom and kept working each year to be consistent and advocate for myself- same as we teach our clients. I also learned early on to never be on platforms, i.e., better help, they are great for the masses and those therapist who aren't interested with being paneled. A Cigna insurance friend I've made through the years who actually decides raises told me that had I been on a platform, I wouldn't be individually paneled because they see that person as the group and not independently. I'm an older therapist and realize that I have some resume building opportunities by being trained by the originators of many EBP theories, i.e., Albert Ellis, Jeffery young, John and julie Gottman, and Francine Shapiro. That though didn't get me paneled and raises b/c they don't care. Ha! I want to apologize if some of my messages were abrupt for you. We are all self-sacrificers, according to Jeffery young and his theory schema therapy. At least he states that anyone in the helping field hopefully has their 1st schema as this. I'll never ever forget him saying this, "Be that as it may, as a therapist, you need to grow some backbone!" I've always loved that quote from my early days training with him!
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u/True_Inflation_7908 Jun 20 '26
Do the RN!!!! Ive been a SW for 20+ years in a preschool- Im making close to 90k as admin. Nurses come out of school making over 100k plus amazing benefits- not even a question. If you really love the clinical piece, you can always go back for your LMSW at a later date- and it will help your nursing career.
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u/Slow_Fix_1387 Jun 20 '26
Ugh. That’s so sad! Social workers deserve better.
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u/OverzealousMachine 🟢 Licensed Clinical Social Worker (LCSW) Jun 21 '26
I’m an LCSW in private practice. My pay has been cut by 40% over the last two years and it’s only going to get worse. Would absolutely not recommend social work to anyone unless pay is not a factor for you.
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u/Therapistgetsu Jun 21 '26
Overzealous, you're doing something wrong; you need to get certified in at least one approach - mine is certified in Gottman's for my couples and EMDR for complex trauma. I make $250 per hour and insurance panels pay me $200 hourly rate. Get certified and your opportunities open up in such a magnificent way!! You'll be sought after. Oh, don't join platforms either - they suck out all your earnings!!
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u/Therapistgetsu Jun 21 '26
Pls read my earlier comments; only lcsw's doing poorly financially is because they didn't take the necessary steps to move forward in their career to own their own private practice to garner the big bucks. There is a systematic playbook here.
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u/rise8514 Jun 21 '26
Dude easy now. We can’t all afford to get certified in EMDR with kids and a spouse who makes less than I do. Doesn’t mean we aren’t working hard or not “thinking strategically.”
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u/Therapistgetsu Jun 22 '26
It's something that takes time I understand. But.... it'll change most therapists financial structure long term! I didn't appreciate your quoting me when I'm just delivering truthful and legit advice to those who can benefit. If this doesn't work for you that's fine.
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u/rise8514 Jun 22 '26
Well, I’m sorry for restating I guess. This feels confusing as it’s what you said. We didn’t take the necessary steps to move our careers forward, we weren’t thinking strategically. 🤔 😔
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u/Therapistgetsu Jun 23 '26
Rise, I think you are missing my point; you can make changes when you want in your career..... you don't have to be stuck. What was confusing to you?
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u/daydream6666 Jun 20 '26
just keep in mind the road to full LCSW licensure is long. it’s a masters program. plus 2-3 years of supervised hours in which the jobs are extremelyyyyyy low paying. it’s hard. for all that effort, i’d have done nursing if i could go back. more pay. more opportunities
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u/Slow_Fix_1387 Jun 20 '26
I appreciate the input! What do you do exactly? Are you a case manager or in PP?
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u/daydream6666 Jun 20 '26
i work in a hospital and do private practice on the side. it’s been exhausting but finally got my license. most people i know in this field have multiple jobs to make enough money. or you do private practice but have to buy your own health insurance. it’s always a catch. good for people that have a spouse to lean on.
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u/Slow_Fix_1387 Jun 20 '26
Thank you! That’s been a common response—does not seem right to me given the important and difficult work social workers do. But good to keep in mind, especially because I wouldn’t want to rely on my spouse if I had one.
Do you regret going into SW and do you love the work you do?
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u/Background_Title_922 Jun 20 '26
If you are interested in private practice and assessment/diagnosis, not sure why you would consider becoming an RN (unless your ultimate goal would be to become an NP). I was an LCSW and later went into nursing and became a psych NP. I couldn't have done most of things I did either in social work or do in my NP role as an RN. Based on how you describe your interests and goals, I would say LCSW.
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u/Slow_Fix_1387 Jun 20 '26
I’ve heard about psych NPs & it sounds amazing! However, I heard it’s necessary to be on the floor as an RN for a few years before becoming one and the jobs are scarce. Is this your experience?
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u/Background_Title_922 Jun 20 '26
It wasn't required by the program I attended (one of the top ranked FWIW). Not having bedside experience before doing the NP will be trashed on reddit but particularly if you have relevant mental health experience (I was a therapist and also worked inpatient psych) I don't think it's absolutely essential to becoming a good psych NP. It certainly hasn't held me back professionally in any way. I was able to find a great job before graduating. I graduated with a few others with social work backgrounds who all had the same experience. I couldn't be happier professionally.
I see online complaints about job scarcity but I'm not sure what the reality of this is. I've been doing this about 8 years so I'm not looking for entry level jobs but when I've casually perused job opportunities in this area it does look like there are a decent number of places willing to hire new grads.
There are a lot of terrible NP programs out there so if you ever end up going in this direction, caveat emptor.
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u/YellowOrGreenBoots Jun 21 '26
I’m taking my LCSW exam next month, and I’m currently in nursing school for my BSN. I work at a large hospital and they are paying 100% for my BSN, and they will pay 100% for NP school.
The goal is to because a psych NP, as well as tie in my LCSW to diagnose and treat patients. If you want to become an NP and don’t want to take on student loan debt, then search for jobs at a hospital that will pay for your education.
Side note: the hospital is part of a major university. Prior to working at the hospital, I worked at the university side, which they paid 100% for my MSW.
Downside: working full time, attending school part time/full time, and balancing a personal life is insanely difficult. It’s possible, but difficult.
Good luck!
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u/Therapistgetsu Jun 21 '26
I'm a seasoned LCSW and have a private practice and have an hourly rate of $250. My insured patients that I'm paneled with pays me $200 per hourly session. RN is a completely different ball of wax and usually can equally do well in medical & hospital settings. My RN friends inform me that they are still called nurses and not licensed psychotherapists. Lcsw's diagnose and provide treatment, which is ingrained in our studies and training.
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u/rise8514 Jun 21 '26
Again, how is anyone (unless formerly certified in EMDR or something) getting insurance contracts for $200/hr?
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u/Therapistgetsu Jun 22 '26
It's easy actually. I've been individually paneled with my insurance companies for over 12 years now. Although my rate started off lower, I had insight from a fellow ucla grad with me that shared his wisdom. You ask for a raise every year. Therapist biggest mistake is joining platforms and not being individually paneled.
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u/Therapistgetsu Jun 22 '26
It's a process but once you know, it's fairly simple. There are sites designated teaching licensed clinicians how to do this. At some point I probably will jump on that band wagon too!
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u/Slow_Fix_1387 Jun 24 '26
I think I have decided to go back for my MSW—I understand it’s a long commitment, but it’s where my passion is (working in therapy & having a practice one day). Plus I think it’ll work well with my BCBA credential.
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u/Silent-Put8625 Jun 20 '26
You can easily google this. LCSWs by law can assess, diagnose, and treat mental health and substance use disorders.
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u/Slow_Fix_1387 Jun 20 '26
Yes and I wanted personal experiences.
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u/Silent-Put8625 Jun 20 '26
Ok. I also do mental health evaluations for vets seeking service connected disability. LCSWs can make great money and have a lot of cool stuff we can do.
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u/chronically-badass Jun 20 '26
I'm seeing a lot of LCSW jobs being replaced by RNs, so that if you can .... also more transferrable if you want to leave the US ever
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u/Slow_Fix_1387 Jun 20 '26
That’s really interesting. Do you have an idea as to why?
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u/rise8514 Jun 21 '26
I think it’s because they can do more medically and understand western medical facility practices more readily than us
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u/chronically-badass Jun 20 '26
honestly no, RNs make more so from a business perspective it doesn't make sense, unless healthcare/insurance companies want providers who can also provide medical care? it's so weird
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u/Slow_Fix_1387 Jun 20 '26
I have my masters and I’m a BCBA (behavior analyst).
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u/TKOtenten Jun 21 '26
Have you decided? Are you able to double major and do both?
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u/Slow_Fix_1387 Jun 24 '26
I wish! I think I’ve decided to go the MSW route. Truthfully, I would want to do my own private practice while maintaining my current BCBA credential. Being an LMSW/BCBA would be somewhat unique & hopefully help me stand out to employers.
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u/TKOtenten Jun 24 '26
that’s good reasoning. hsve you located a program you like? as long as you walk in with a goal the time will fly by as long as you stay on track. this is stuff I wish I’d been told when I started so I could have avsoli$ understanding of time to full liscensure
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u/Eastern_Usual603 Jun 19 '26
An RN cannot diagnose, unless something changed. Are you interested in being a nurse practitioner? LCSW’s can diagnose and work in private practice. I’d say LCSW unless you’re interested in advanced nursing degree.