State Leadership Conference

Psychologists trained to prescribe medication said at the 2004 State Leadership Conference that the training has changed the way they weigh treatment options for their patients.

In many cases, it's also facilitated patient treatment outcomes, said Cmdr. John Sexton, PhD, a participant in the Psychopharmacology Demonstration Project--a six-year pilot program ending in 1997 that trained 10 licensed Department of Defense (DoD) psychologists to prescribe psychotropic medications. Sexton, who has recently retired from the military, said that by combining medical and behavioral interventions, he's noticed quicker treatment results. For example, depressed patients tend to talk more during therapy and complete their homework for sessions, he said.

DoD prescribers also at the session were Lt. Col. Elaine Mantell, PhD; Cmdr. Morgan Sammons, PhD; Lt. Col. James Meredith, PhD; and Maj. Brian Pfeiffer, PhD.

Although critics have scrutinized psychology's first prescribers' ability to prescribe, proponents say the psychologists serve as models to the field and illustrate that, with intensive postdoctoral training, psychologists can prescribe safely and effectively.

In line with that argument, DoD psychologists said their training enables them to critically look at the biological and psychological components of their patients when approaching treatment options.

"We as psychologists are in such a prime position to be able to look at biological phenomena and reinterpret it," said Mantell, adding that medical conditions are often biologically labeled but can be treated more effectively with psychological interventions. For example, the DoD psychologists said, panic and anxiety disorders often are treated more effectively with behavioral interventions than with medication.

The DoD psychologists at the session cited several specific enhancements to their clinical practice since receiving prescription privileges:

  • Greater collaboration with medical colleagues.

  • More time spent on informed consent. Sammons said that he creates an ongoing dialogue with patients about their expectations and the risks and benefits of medication.

  • The ability to take patients off psychotropic medications, if necessary, to boost treatment outcomes.

  • Greater influence with underserved populations where psychiatrists are absent, such as in rural settings or prisons.

  • Improved continuity of care and convenience for patients who no longer have to consult a third party for medication.

"We prescribe very differently than our MD colleagues and we are deliberately doing that," Pfeiffer said. The prescribing psychologists follow a different model for prescribing than the conventional Western allopathic medical model, which focuses on the body's parts and organs and treating disease, the presenters said. For example, Pfeiffer follows a broader model--the biopsychosocial spiritual model, which focuses on the biological, psychological, social and spiritual aspects of a patient.

And, he says, he de-emphasizes medication in his practice. "It may give symptom relief, but it will not make the problem go away," he said, stressing the need for behavioral interventions.

Further Reading

Lt. Col. Elaine Mantell wrote about her prescription authority as part of a special section on prescription privileges in the April issue of APA's Professional Psychology: Research and Practice (Vol. 35, No. 2).