From Public Service to Private Practice: The Collapse of the Social Work Profession

The social work profession was historically rooted in a mission of improving the lives of the vulnerable, the oppressed, and those living in poverty. Yet, the modern use of the social work license and degree as a quick path to private practice serving middle to upper-middle-class communities is oddly not questioned. This use of a social work master’s degree for private practice, primarily serving privileged communities, contradicts the profession’s code of ethics.

Social work is indeed a profession in collapse. This is due to broader social and economic changes, namely the shift away from welfarism towards neoliberal privatization, but also because of how social workers increasingly utilize the license.

Social work originated with the Settlement House movement as a response to the increasing poverty brought about by industrialization. By the mid to late 20th century, neoliberal policies led to cuts in social programs, shifting social responsibility from the state to mostly nonprofits and privatized services. The social services that remain government-funded are often outsourced to private entities. This shift towards privatization has not only weakened public programs but also pushed many social workers into either nonprofit organizations or private practice businesses (as social work embraced psychotherapy into the profession).

During this market-driven transition, deinstitutionalization (i.e. closure of public institutions for individuals with serious mental illness) took place, as well as the rise of psychopharmacology after the 1980 DSM III update. Around this time there was a simultaneous increase of markets for private practice psychotherapy that catered to mostly middle to upper-class patients. In Unfaithful Angels: How Social Work Has Abandoned Its Mission, Harry Specht and Mark Courtney warned that the profession would face collapse as it increasingly prioritized psychotherapy over its broader mission for social equity. They seem to have been onto something.

The COVID-19 pandemic and the increased popularity of “mental health” services solidified a new era of social work, which may be more adequately referred to as the “private practice social work industrial complex.” A report to the National Association for Social Workers (NASW) found that approximately 65% of social workers work in private practice.

It appears that fewer social workers are entering the field to serve marginalized communities (yet there is limited quantitative data available on this trend as of now). Nonetheless, I have observed that recent social work graduates seem to be increasingly prioritizing private practice psychotherapy to serve the upper and middle classes. Many social work students go into the field often without any interest in working with the underserved. This has been common in elite social work schools like Columbia or New York University for quite some time, however, it’s happening more openly now in public universities. We are witnessing a strange turn of events where it seems that psychologists, psychiatrists, and other mental health professionals are more interested in engaging in social work or “community health” than actual social workers these days and no one is blinking an eye.

The use of a social work degree for private practice psychotherapy started in the 1970s and ‘80s; however, social workers historically provided services in community health clinics or other social programs for many years before transitioning into private practice. This no longer appears to be the case today. I’ve observed that some of the younger and recently graduated social workers go directly into private practice, even doing their student internships at a private group or individual practice within affluent white communities. This means that some social work students don’t even serve or come into contact with low-income or other marginalized communities during their master’s programs.

Even new psychotherapists (often Licensed Master Social Workers [LMSW], who cannot even practice as clinicians independently yet, as opposed to the Licensed Clinical Social Worker [LCSW]) often do not take insurance nor offer sliding scale fees. And when they do take sliding fees, it tends to be aimed at individuals in temporary financial hardship, such as students or other low-income earners, but seldom those in chronic poverty.

How is this not a significant issue in our profession? And why is this being overlooked and normalized? To echo Specht and Courtney, why isn’t this considered a scandal that is being addressed in our licensing boards and educational institutions?

We all know the dire working conditions in the public and nonprofit social service sectors these days—poorly managed and exploitative, to say the least. Even in the best environments, the work is grueling, and the dynamics are toxic, bringing out the worst in all of us. The psychological and emotional toll of working in these settings is something only those who’ve experienced it can truly understand.

These programs, agencies, and departments are increasingly run by number-driven administrators who care little for the quality of services and only about their metrics. Take, for example, Article 31s (community mental health clinics regulated by the Department of Health), which, in social work circles, are half-jokingly, half-seriously referred to as “psychotherapy sweatshops” given the exorbitant workload. In these places, given the impossibility of the workload, most therapists last six months to a year at most.

In addition, Master of Social Work (MSW) graduates have an average student debt of $67,000 (as of 2019; it has likely only increased in the intervening six years). This type of debt is nearly impossible to pay off on the low salaries typical in social work, especially with high interest rates on these loans. While a student loan forgiveness program exists and offers debt relief after 10 years of full-time work (which the Trump administration is actively trying to dismantle), the reality of workplace environments in the social service sector makes it difficult to complete a decade of full-time service.

Another contributing factor to high debt is the unpaid internship required for the social work master’s program, which limits students’ ability to work during their two-year degrees. As a result, students accumulate loans not only for tuition but also for living expenses. The cycle of exploitation is deeply embedded in every stage of the social work profession. This economic reality further pushes many social workers toward private practice, where they can charge higher rates.

After 15 years in the trenches of social work, I can only conclude that social service institutions are designed to be overwhelming and dysfunctional (i.e. traumatizing)—creating unbearable and overwhelming emotional states for both workers and service recipients, thus rendering them semi-functional and ineffective. Marginalized communities (and the workers meant to service these communities) are given just enough resources to fail. This is systemic oppression 101. By restricting access or providing subpar services (by underfunding them), the so-called “failures” of marginalized groups are weaponized against them, reinforcing shame rather than acknowledging that systemic conditions are responsible. This functions, in part, as a mechanism for the psychological internalization of oppression, with shame serving as a crucial yet invisible component.

Paul Kivel, in his 2000 essay Social Service or Social Change? Who Benefits from Your Work?, critiques the social work profession and similar social service professions by claiming they function as a “buffer zone” to protect the elite from the consequences of social injustice, while offering only temporary relief to the working classes and poor. In her essay Age, Race, Class, and Sex: Women Redefining Difference, Audre Lorde states:

“In a society where the good is defined in terms of profit rather than in terms of human need, there must always be some group of people who, through systematized oppression, can be made to feel surplus, to occupy the place of the dehumanized inferior. Within this society, that group is made up of Black and Third World people, working-class people, older people, and women.” [Italics added]

Following Lorde’s idea of surplus, we could say that social services are designed to under-function because they exist to manage and regulate the lives of what I would call the surplus other in society. As such, social work remains a low-paying, undervalued profession because it is largely composed of a female workforce serving the “dehumanized inferior” or “surplus other” (children, BIPOC individuals, women, third-world peoples, LGBTQIA, seniors, poor, etc.). The underfunding of agencies and institutional settings ensures that workers and those they serve remain trapped in cycles of instability and crisis. This reinforces the very conditions social services claim to address. It’s no surprise social workers aren’t thrilled to work in community social service programs and agencies and often actively avoid these environments by going into private practice—but that’s only part of the story.

This bigger issue is one of systemic institutional abandonment by professionals, which occurs when systems, funding, and professionals withdraw from marginalized communities, leaving them with inadequate resources. In this process, the burden of care is shifted to underpaid paraprofessionals and/or the communities themselves. With many social workers moving to private practice, it is the underpaid and exploited paraprofessionals who are left to manage the profession’s collapse with limited alternatives for their career advancement.

We often fail to recognize or support the many workers who engage in the same work as social workers without formal degrees or licensing in social work: meaning case managers, care managers, counselors, etc. Many of these paraprofessionals are working-class BIPOC women, of which a majority of whom belong to the communities they serve. They often earn a fraction of what someone with an MSW, LMSW, or LCSW does. This means that this issue isn’t just about the understandable avoidance of difficult and exploitative work environments—it’s also about who is left behind to endure the fallout.

When social workers leave community practice for private practices or move from direct practice to managerial roles in community agencies or programs, they unintentionally engage in professional stratification (i.e. occupational segregation). One sociological understanding of social stratification is that as the nature of work becomes stratified by occupation, so does the potential for meaning that can be derived from the work. Social workers with professional degrees who leave community settings (or never set foot in them at all) to work in private practice exacerbate occupational segregation and economic privatization trends.

The social work profession should ideally be a public service with particular attention to serving the poor, yet as stated before it has become not only a privatized service but also a clinical service for those of the privileged classes. After all, serving the “surplus other” in an underfunded social service agency isn’t “sexy,” but being a psychotherapist or better yet a “radical” or “decolonial” psychotherapist in private practice is. This brings into question the contemporary curious phenomenon of the co-option or extraction of the ethos and professional mission of the social work profession by private practice therapists to market their private group or individual businesses.

This trend may help explain the rise of the “anti-oppressive” or “decolonial” private practice therapist. By framing their private psychotherapy work in social justice rhetoric, these practitioners market themselves as ethically progressive while remaining mostly financially inaccessible to the very communities social work was meant to serve. This could be seen as a way to manage cognitive dissonance—individual social workers, driven by these systemic factors to serve only the privileged, are able to use this language to convince themselves that they are still doing the advocacy work that perhaps motivated them into the profession in the first place.

However, this blatant appropriation of the core ethical values of social work—once centered on serving the poor—has been repurposed for a predominantly middle-class audience and consumer base. This practice by private therapists with social work degrees has gone unchallenged due to its normalization, with little self-critique from social workers or NASW.

It’s important to note that my aim is not to shame individuals for their professional decisions but to spark dialogue on the overall systemic issues impacting social work in addition to the “social justice” branding that is reshaping our profession.

Meanwhile, according to ProPublica, the former CEO of NASW, Dr. Anthony McClain, made $458,334 in 2022. But please, by all means, continue to pay your $236 NASW yearly professional membership fee for two CEU online credits, some online published surveys, and a monthly happy hour at your local bar, on your $47,100 yearly salary (the median income for social workers in 2019). NASW is a hollow, performative organization that makes money by propping up the illusion of advocacy while it ignores real systemic issues taking place in the United States and the profession. NASW should be leading these discussions and organizing for change. Instead, it dresses itself up in empty “social justice” rhetoric while ignoring the systemic exploitation and collapse of the profession, failing to push for real structural reforms for the provision of services, union organizing, and living wages for social workers, among other necessary advocacy.

The growth of the private practice industry seems to have given rise to various specialty markets. I have noticed many clinical social workers—mostly young social workers, though not exclusively—treat psychotherapy as a business product, rather than a service or social practice. I have seen young professionals, increasingly with minimal clinical experience, obtain their master’s degrees and immediately open private practices, stating on the web that they charge $150-250 per session, and are not on health insurance panels. It may be a generalization, but many seem unwilling to serve lower-income clients at all. It also seems that newer psychotherapists (who are technically still in training) set their fees based on perceived “market rates” rather than ethical considerations like experience, years of practice, and accessibility, which traditionally guided pricing for psychotherapists in the past.

My brain nearly short-circuited when I saw a young white woman who was a psychotherapist (perhaps in her late 20s), with an LMSW—meaning she was still unable to practice independently—charging $400 per session in her Upper East Side private practice. This recent graduate had just two years experience after her MSW degree from Columbia University’s School of Social Work, according to her Psychotherapy Today profile. In addition, there was no indication of prior experience (license abroad or similar field experience, etc.) nor specialized training to justify that rate, aside from offering EMDR—even though full certification by EMDRIA requires years of training, which there is no way she could already have accomplished beyond the initial week-long intensive. Somehow this is normalized in the contemporary psychotherapy “markets” for social workers and I can’t seem to wrap my head around it.

Instead of proper mentorship, entry-level clinicians—often young white cis women—are urged to disregard their “imposter syndrome” with a corporate feminist mindset of “breaking the glass ceiling” and “you got this, girl,” pushing them toward entrepreneurship rather than skill development. I have observed that these social workers new to the profession are encouraged to build their private businesses no matter their actual preparedness, but not to even consider what the original purpose of a master’s degree in social work was intended for—to serve the poor.

Another phenomenon of serious concern related to this is the increasing acceptance in the field of the “online side hustle therapist.” These therapists often lack clinical training, but due to the versatile nature of the social work degree, they can engage in virtual “gig work” as therapists to supplement their income on the weekends. Market expansion is becoming the key force behind the commodification of mental health care, which raises ethical concerns. However, very few people in the field are talking about this.

On a related note, cultural influences (no doubly impacted by the market) discourage professionals from identifying as “beginners” and instead often frame this identification in terms of “imposter syndrome.” But maybe some of us aren’t imposters, but rather not yet seasoned professionals. This should be viewed as a normal part of professional development. Whereas professions like psychoanalysis, law, and medicine historically embraced apprenticeship models that focus on confidence growing with experience and mastery of skills, the present focus on mentorship in the mental health field has shifted to building early confidence and “branding” rather than gradual skill-building. This influences young professionals to go into private practice to “brand” themselves quickly (often with their identities and increasingly common personal psychiatric diagnoses!) rather than develop a professional identity over time. This impact on the provision of mental health services cannot be overlooked.

The shift towards “support” over “challenge” in mentorship/ supervision means that some newer professionals to the field may not be getting the rigorous feedback and reality checks they need to truly develop their skills, nor does it seem many want to be challenged. Ethically, shouldn’t new therapists in private practice acknowledge their inexperience by charging corresponding rates (and/or accepting insurance to ensure accessibility) given that they are not even attempting to work in community health settings before transitioning to private practice?

In psychoanalytic circles, it’s often said that it takes 10 years to become an analyst, reflecting the profession’s serious apprenticeship-like nature. Psychotherapy is a discipline that demands years of serious, long-term development, not merely business branding. We must not forget that it involves working with highly sensitive issues related to mental health. A two-year MSW (and some clinical supervision) is not adequate to prepare someone for providing psychotherapy, especially not without rigorous post-graduate training and supervision. Have we forgotten that an MSW is not a clinical degree, but rather a degree in social work? What is going on here?

While I do not intend to place blame or shame, I do believe that clinicians who are social workers (by degree) have an ethical responsibility to reflect on and critically assess their professional choices, and to reconsider how they can actively promote the core values of the social work profession in ways that go beyond simply marketing “social justice.”

In The End of Social Work, Chris Maylea states that social work has “achieved no great social change, universal human rights or social justice. Despite our rhetoric, social work is not a term that most people associate with movements for social justice, human rights, environmental sustainability, or significant social reforms. Social work has not held back the flood of oppression, inequality, neo-liberalism, or managerialism. Social work is stuck and it has failed.”

Maylea advocates for the abolition of the social work profession. He argues that due to the profession’s lack of a coherent theoretical foundation, professionalization, historical abuses, and inability to address contemporary challenges, it cannot be reformed. I happen to agree with him–in an ideal world, but practically I am not sure what that would look like given that it is already collapsing. He recognizes that: “Social work has already been successfully depoliticized. It has, as a political force, already been abolished.”

Social work is not only being dismantled, largely due to systemic issues, namely neoliberal and conservative efforts to depoliticize and undermine the profession and the systems/ institutions that provide stated services. But also, we must admit that clinical licensing in the social work degree and its widespread use for private practice have also significantly contributed to this decline.

Right now, the Trump administration poses an unprecedented threat to both social services and the social work profession. Policy changes affecting healthcare, including but not limited to attacks on LGBTQIA+ and women’s rights, the undermining of equity, cuts to federal funding, Medicaid/Medicare, SNAP, and Social Security benefits, as well as restrictive/ racist immigration policies and other government downsizing, further exacerbate this threat. We need comprehensive social work leadership now more than ever. As a profession, we must engage in deep self-critique and gain a better understanding of the developmental history of our profession. This must include an analysis of the trends that promote the social work license to be used for private practice purposes, as well as the exploitation of the “social justice ethos” of social work for the benefit of private practice businesses that cater to the middle class.

Amid the collapse of the social work profession, rising authoritarianism, administrative attacks on democracy, and expanding austerity, I hope we resist turning to private practices that are masked in social justice rhetoric as a substitute for genuine movement building and advocacy for social workers and the communities we serve. Instead, for those of us drawn to social work out of a commitment to its core values of justice and solidarity with the working classes/ poor, as well as other marginalized communities, let us strive to reignite and reshape our engagement with its mission. The collapse of social work is not just an end, but a call—a call to redefine it as a practice of genuine solidarity with the individuals and communities it was always meant to serve.