SHARED PERSPECTIVES

One academic's viewpoint on prescription privileges

By M. Marlyne Kilbey, PhD Wayne State University

Initially, my excitement in discovering psychology as a college freshman was generated by the power of the basic proposition that human behavior could be studied scientifically. The notion

that it is reasonable to approach the study of human behavior through scientific investigation of its biological properties as they are expressed in a social and physical environment was compelling. When I entered graduate school, the least understood of these biological properties were the then newly discovered neurotransmitters. In the early 1960s, psychologists and life scientists were just discovering how drugs acted upon these amines and how their characteristics, in fact, help explain the psychoactive properties of the drugs. I was hooked and, for three decades, it has seemed evident to me that drugs are an important tool by which we can learn more about nervous system function. Furthermore, that knowledge has helped develop drugs to treat behavior/mental disorders, and increased knowledge will continue to inform drug development. In fact, increased understanding of drug function and development of psychotherapeutic drugs truly has been a bootstrap operation with each informing the other every step of the way over the past 30 years.

So when in 1990 I received a call from someone at APA's Central Office asking me to serve on a Board of Directors task force on psychopharmacology, I enthusiastically agreed. It seemed possible that psychology was undergoing a sea of change and practitioners were becoming interested in the very topic that had engaged me for so long--that is, how drugs affect behavior. By participating in that task force, I learned that some practicing psychologists had acquired in-depth knowledge of psychotherapeutic drug action through study outside a traditional academic setting. They had gained expertise in determining the likelihood that a particular drug could assist a patient with a particular disorder. The task force weighed all sorts of evidence offered by all kinds of experts and sought to define a training model that would build on the strengths of psychology's extant training models. The goal was to provide psychology practitioners with a curriculum with which to acquire basic psychopharmacological knowledge during the course of their graduate training and expert knowledge postdoctorally or through continuing education while practicing. I also served on two APA Board of Educational Affairs working groups that fleshed out these recommendations. Most recently, I have co-chaired an interdivisional committee--composed of Div. 28 (Psychopharmacology and Substance Abuse), Div. 31 (State Psychological Association Affairs), Div. 42 (Independent Practice) and Div. 50 (Addictions)--that applied to have psychopharmacology recognized as a proficiency in psychology.

Thus, a majority of my service to the profession over a decade has centered on the issue of psychopharmacology training for counseling, clinical and applied developmental psychologists. Over that period, training models have changed somewhat. The Department of Defense (DoD) training program showed convincingly that licensed psychologists could be trained to prescribe medications safely and effectively. Psychopharmacology course work and practical experience appear to have been incorporated increasingly into doctoral training programs. A few postdoctoral training programs have emerged in different forms, including consortia between universities and psychological associations. A large number (the exact figure seems unknown) of psychologists have enrolled in continuing-education programs in psychopharmacology. However, the very real problem of expanding opportunities for psychologists to receive comprehensive practical training through continuing education remains to be settled, as does the issue of how the experience of psychologists so trained can be marshaled to inform research efforts designed to improve psychotherapeutics.

While a large number of practitioners have shown their interest in prescribing by enrolling in one or another type of educational program focusing on psychopharmacotherapy, academic training programs, especially the PhD programs, have been slow to change. Furthermore, it is not clear how many training programs are providing the in-depth fundamental knowledge of basic medical sciences relevant to psychopharmacology.

At this point, it seems to me that real progress depends upon amending the scope of practice legislation in some state or states to include prescriptive authority for psychologists trained in the DoD program and other appropriate training programs. Once this major step is accomplished and some state recognizes prescribing within the scope of practice of appropriately trained psychologists, I believe our discipline will see increasing emphasis on psychopharmacology research and training, as well as improved integration of pharmacological and psychological therapies.

M. Marlyne Kilbey, PhD, is a psychology professor at Wayne State University.



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