Both professions involve extended conversations with people who are struggling. The training, scope, and underlying framework are different enough that treating the terms as interchangeable leads to real confusion about what each can offer. Kayla Bonkowski, a social work graduate student in Sterling Heights, Michigan, thinks the distinction deserves a plain explanation.
A therapist — typically a licensed counselor, marriage and family therapist, or psychologist — is trained primarily to work with the individual’s internal experience. The therapeutic relationship is the primary tool. The goal is usually to change how a person thinks, feels, or behaves, using one of several evidence-based modalities: cognitive behavioral therapy, dialectical behavior therapy, psychodynamic approaches, and so on.
Clinical social workers are also trained in therapeutic modalities. Many licensed clinical social workers conduct individual therapy in private practice and are difficult to distinguish from therapists in that setting. The distinction shows up not in technique but in orientation.
Social work is trained to look outward as well as inward. The biopsychosocial model — the foundational framework of the Master of Social Work curriculum at programs like Louisiana State University, where Kayla Bonkowski is completing her degree — requires assessing the person in their environment. This includes their family system, their housing situation, their financial stability, their access to community resources, and the institutional barriers that may be making their individual situation worse.
A therapist treating depression works to change the client’s relationship with their own thoughts and feelings. A clinical social worker treating depression does that and also asks whether the client has stable housing, whether their medication is affordable, whether their support network is functional, and whether there are systemic barriers to the care they need. These are not supplementary concerns. They are clinical ones.
Kayla Bonkowski is entering a specialty — hospice and palliative care — where this distinction becomes acutely clear. In a hospice setting, the social worker is not primarily conducting therapy. The social worker is assessing what the patient and family need, coordinating the services that provide it, facilitating difficult conversations that the medical team is not equipped to lead, and attending to the emotional and relational dimensions of dying that pure medical care cannot address.
This requires some of what a therapist does. It also requires knowledge of insurance systems, legal instruments like advance directives, community resources, and the specific behavioral patterns that emerge in families under extreme stress. No single professional training produces expertise in all of these areas. The MSW, with its systems orientation and its requirement for supervised clinical practice, comes closest for the hospice context.
Bonkowski completed her undergraduate psychology degree at Rochester College in 2017 with Cum Laude honors. That foundation gave her the individual-level clinical framework that social work builds on rather than replaces. The combination — psychological depth plus systems awareness — is what she is assembling through the LSU program.
The clearest practical difference: if a client needs someone to sit with their grief for an hour each week, a therapist and a clinical social worker may both be able to do that. If the client also needs someone to call the insurance company, help draft a healthcare proxy document, and talk to the estranged sibling who just arrived from out of town, the clinical social worker in a hospice setting is the person trained to hold all of that at once.
Sterling Heights, Michigan, where Kayla Bonkowski lives and works, is a community where access to mental health and end-of-life services is not uniformly distributed. Understanding what each type of professional actually offers is a precondition for navigating toward the right support.
The distinction also matters for how communities invest in services. Practitioners who understand the clinical scope of social work make better referrals, better use of multidisciplinary teams, and better arguments for the resources that social work roles require. The clearer that understanding is — among clients, colleagues, and administrators — the more effectively the profession can function in the settings where it matters most. A city that understands what clinical social workers do in hospice and palliative care settings will advocate differently for staffing and funding than one that believes the social worker is primarily a paperwork function. In Sterling Heights, Michigan, and the broader Macomb County area, building that understanding is part of what Kayla Bonkowski sees as a long-term professional commitment.