One of my greatest frustrations as president of APA is that I am not able to wave a magic wand and heal the science/practice divide. Once upon a time, long, long ago, in a kingdom by the sea, this divide did not exist. And then things changed. There are many stories told about why and how this divide took place. No doubt there were many causes. For some, this history is irrelevant; for others, it still sparks strong feelings. From my perspective, the divide is both a blessing and a curse.
The blessing is that the original split within APA-which I gather was quite contentious and very upsetting to many people-laid the groundwork for the creation of a new organization, the Association for Psychological Science, that has proven to be an effective advocate for psychological science. Because I found APA to be a congenial home for my interests, I never joined APS, though I have many friends and colleagues who are APS members. What I do lament, however, is the split between science and practice, which was intensified by having an alternative all-scientist organization and which continues within APA.
But why do I yearn for less divide and more collaboration? In large part, this desire for unity is based on my own experience in a wide range of settings, both clinical and academic. I have always enjoyed talking with and learning from practitioners and scientists, some of whom have expertise in both enterprises. However, my desire for narrowing the current divide is driven by far more than my own comfort level. It stems primarily from my belief that more contact between scientists and practitioners would benefit both.
As it turns out, there has never been a better time for such contact. The rise of neuroscience among psychological scientists as well among scientists in many other disciplines has probably been the most significant scientific development in-take your choice: the last decade, the last generation, the last century. Whatever the timeline, neuroscience is a thriving multidisciplinary enterprise that attracts increasing numbers of scientists and marks a profound increase in the emphasis on biology in general and the brain in particular.
This scientific shift has also affected the practice of psychology. There are now significant numbers of clinical neuropsychologists who engage in various types of professional work focusing on rehabilitation,health, and forensics. Perhaps, however, the most dramatic biologically related emphasis in the practice of psychology is the effort to secure prescriptive authority for psychologists. I am well aware that many psychological scientists are not supportive of this expansion of psychological practitioners' scope of practice. However, I firmly believe that if my scientific colleagues knew more about the need for this addition to psychological practice they would better understand its value for the patients who would be served.
The fact of the matter is that the vast majority of individuals receiving psychotropic medication do not receive it from a psychiatrist. There are simply not enough psychiatrists to meet the need, and in many places, especially rural areas, there are no psychiatrists available. Instead, general practitioners and nurse practitioners are the major sources of prescriptions for psychotropic medication.
In other words, the real issue here isn't a debate about whether psychologists, nurse practitioners, or psychiatrists should prescribe, but whether it's possible to train psychologists to be highly proficient in offering an integrated approach that provides both psychological care and, when appropriate, medication. I believe we can meet this training goal. This is a postdoctoral program, combining didactic instruction and supervised clinical experience; it also requires maintenance of competencies through lifelong learning.
Perhaps, then, this increasing emphasis on biology by both scientists and practitioners could offer at least one bridge that would span the current divide. For example, I hope that APA will sponsor some invited conferences addressing topics such as "the contributions of neuroscience to psychological treatment," "the neuroscience of psychotropic medication," and so forth. We could even invite APS to participate. Of course, I know that not everybody will get along and that we all have turf that we defend vigorously. Nevertheless, psychologists and neuroscientists, science and practice, APAers and APSers have far more in common than we seem to recognize. And if we would work together, we would all be much more powerful advocates for our scientific and professional concerns. Surely we are smart enough to figure out how to unite in behalf of our own self-interests. Think about it.
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