President's Column

The time has come for psychologists to receive the option of training and subsequent authorization for prescription privileges. I realize there are many points of view on this matter. I would like to explain why I have come to this position and what I plan to do about it. There are several reasons why psychologists ought to have the option of prescription privileges (see also Sternberg, 2001).

  • Treating the whole person. Psychologists, like other professionals, once viewed physical and psychological disorders as relatively distinct. No longer. We now know that physical and psychological symptoms are highly interactive. Some practicing psychologists may believe, therefore, that to treat the whole person, they need to supplement psychotherapy with medications. Indeed, the biopsychosocial model adopted by many psychologists is consistent with an integration of kinds of treatments.

  • Providing "full service." Psychologists would like to help their clients in as many ways as possible. Drugs provide one way among many.

  • Dependence on medical practitioners. At the present time, psychologists may find themselves dependent on medical practitioners who have prescriptive authority. This dependence may increase costs and the time it takes to get clients drugs they may need.

  • Demonstrated success of prescriptive authority. The United States armed forces devised a successful program for training psychologists to prescribe effectively and safely.

  • Political feasibility. The passage of a prescriptive-authority bill for psychologists in New Mexico shows that efforts to obtain prescriptive authority can in fact pay off.

  • Availability of practitioners. In some locales, there are simply very few psychiatrists available. In these places it is especially important that psychologists be able to prescribe. This problem may worsen. Whereas psychology is a growing profession, psychiatry appears not to be.

  • It cuts both ways. Part of prescriptive authority may actually be a matter of psychologists taking clients off medications prescribed by other kinds of professionals that are not effective or that actually are detrimental.

  • Faith in ourselves. For whatever problems there may be with prescriptive authority, we need to have faith in ourselves--that when we are granted prescriptive authority, we will use it in a caring and responsible way.

Rebutting the arguments

I realize that many responsible psychologists are not in favor of prescriptive authority, and that they believe they have perfectly good arguments for why they believe prescriptive authority to be a mistake. I would like to respond to at least some of these arguments.

  • Psychologists cannot duplicate the thorough training of medical doctors. The goal of training for psychologists is not to create a physician but rather to tailor the training to provide sufficient training in medicine and pharmacology so that already licensed health services psychologists can prescribe safely and effectively. The Department of Defense program has shown that this is doable. And, just as doctors frequently refer patients to specialists when the problems the patients face go beyond their expertise, so can and should psychologists.

  • The drug companies will take over APA. This is a legitimate worry, and hence I support the task force initiated by Phil Zimbardo to explore and make recommendations on this issue now, before it is too late.

  • There is no time in the doctoral curriculum for such training. I agree. Such training should be postdoctoral.

As one of my presidential initiatives, I am working with the Committee for the Advancement of Professional Practice and APA's Practice Directorate to promote prescription privileges for qualified psychologists. I am also co-editing a book on the topic. I have been active in Connecticut in testifying and holding a fund-raiser, and am willing to help in any state. Prescription privileges are now APA policy. We may not agree with this policy, just as we may not agree with the laws of our land. But we abide by these laws. APA, like our country, has mechanisms in place to change policy through a vote of the Council of Representatives. But as long as prescription privileges are indeed APA policy, I hope you will all work with me to achieve APA's goal of prescriptive authority for qualified psychologists.

Further Reading

REFERENCE

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    Sternberg, R.J. (2001). Prescription privileges for psychologists: A view from academe. The California Psychologist, 34(10), 16-17.