New APA guidelines address psychologists’ expanding role in prescribing medication

The number of psychologists who can prescribe medication is growing rapidly. Since New Mexico became the first state to allow licensed psychologists to prescribe in 2002, the field has grown from a few dozen to more than 300 today, with another 1,500 psychologists also holding master’s degrees in clinical psychopharmacology.

This growth prompted APA’s Council of Representatives to pass an update to the professional practice guidelines to help all psychologists—whether they prescribe, collaborate on medication decisions, or field questions about antidepressants and stimulants—navigate conversations around psychotropic drugs. In 25 jurisdictions in the United States, a role in medication management is part of a psychologist’s scope of practice.

“We are at a place where there is an expectation that psychologists will know and understand a lot more about medication” than they used to, said David Shearer, PhD, a clinical and prescribing psychologist for the Department of the Army at Madigan Army Medical Center (MAMC) in Washington state. Shearer cochaired the working group that developed the guidelines along with Bret Moore, PhD, a clinical psychologist and prescribing psychologist in San Antonio. (Shearer said his views are his own and do not represent official Department of the Army or U.S. government policy.)

The professional practice guideline document contains 14 specific guidelines, aspirational in nature, that highlight the importance of knowing one’s scope of practice as a clinician, as well as building trust with patients for shared decision-making about medications. Psychologists, with their strengths in rapport-building and understanding of biological, psychological, and social factors in a patient’s life, tend to be well positioned for these discussions, Shearer said. Prescribing psychologists are also in a unique position to monitor medication side effects and adherence because of how regularly they see their patients.

“We have become more than just another prescriber,” Shearer said. “We really are psychologists first and prescribers second.”

When APA passed its first Guidelines for Psychologists’ Involvement in Pharmacological Issues in 2011, there were only two states, two federal agencies, and portions of the military that allowed prescribing psychologists. Today, seven states allow appropriately trained and licensed psychologists to prescribe, as do Guam, all federal military services, the Indian Health Service, and the U.S. Public Health Service. Clinical psychopharmacology became a new APA specialty in 2020, and the American Board of Professional Psychology voted this year to recognize psychopharmacological psychology as a board specialty.

A step along the path toward becoming a prescribing psychologist is a master’s degree in clinical psychopharmacology, a credential that can allow the practitioner to take a substantive role in medical decision-making. Meanwhile, even those without advanced credentials often find that patients ask them about medications or side effects, meaning a baseline knowledge—as well as an understanding of where to refer the patient for specialty help—is important.

The guideline document categorizes psychologists into three levels: Level 1 are general practitioners who may offer relevant information to medical decision-makers. Level 2 psychologists have completed a master’s degree in clinical psychopharmacology and can take on a collaborative role in decision-making. Level 3 are prescribing psychologists. Some of the individual guidelines are intended specifically for prescribers, some for prescribers and collaborating psychologists, and some for psychologists at any level of practice.

Guideline 1 encourages psychologists at all levels to objectively consider the scope of their own competence before making prescribing decisions or recommending prescriptions to patients. This might include considering whether one has reliable knowledge of a particular drug class or patient population. In some cases, they may need to decline to offer an opinion, even under pressure.

“A strength of this document is that it speaks to different levels of training—the psychologist who is a general practitioner, one who has the academic training, and one who has also had supervised practice and has a license to prescribe,” said Elaine LeVine, PhD, a member of the guidelines working group and a prescribing psychologist in private practice who holds the first license of that kind issued in New Mexico. “It’s very important that all of this stay within the boundaries of our expertise,” she said.

Guideline 2 recommends that psychologists at all levels of practice evaluate their own beliefs about and attitudes toward medication for behavioral or mental health disorders. Psychologists who understand their own opinions and the origin of those opinions can better approach conversations with patients with transparency and balance.

Guideline 3 focuses on the patient’s individuality. Practitioners are advised to be sensitive to the patient’s developmental stage, age, disability status, sexual and gender identity, educational experience, and cultural and ethnicity factors that might influence their beliefs and communication style around medications and symptoms.

“One of the things psychologists can do really well is emphasize the cultural and personal, religious and other variables, including things like disability, into this decision-making process,” Shearer said. “It’s not just us paternalistically telling people to take this medication.”

Guidelines 4 through 6 emphasize the importance of psychopharmacology education for psychologists who will be prescribing or making recommendations about medications. Psychologists are encouraged to know what level of knowledge they need for their desired role and to seek out educational opportunities to stay current.

Psychologists often see their patients more frequently than physicians do and may be the first health care professional to hear about adverse effects from a new medication. Resources on adverse effects include standard pharmacological texts as well as online repositories such as Drugs.comopens in new window, Cochrane.orgopens in new window, or Psychiatry.orgopens in new window (see “Further reading” for more recommendations).

Psychologists may also consider staying abreast of the electronic resources designed for prescribers. This includes informational resources as well as software for e-prescribing and telehealth platforms. AI is beginning to play a larger role in the practice of psychology, and big data has massive potential to help guide treatment options, but Shearer warns that AI is not always accurate and needs human oversight. “You have to know enough to know [when] it’s not right,” he said.

Even a psychologist without higher-level training in psychopharmacology might consider asking patients about their medications and being aware of potential side effects, Shearer said. Otherwise, they may misattribute symptoms to psychological issues when they are actually medication effects. For example, a common side effect of bupropion (Wellbutrin) is insomnia, and if a patient has not been given this information, they might seek psychological help for their sleeplessness. The psychologist might first recommend they consult with their prescriber about ways to reduce that side effect.

Some of the guidelines are specific to psychologists with prescriptive authority.

Guidelines 7 and 8 focus on assessment and are aimed at prescribing psychologists who are recommended to regularly monitor effects of a medication, both desired and undesired. This may include conducting physical exams, interpreting laboratory results, and using feedback from psychological tests or questionnaires. They also need to be aware of comorbid conditions that can affect how a patient responds to a medication or whether they experience adverse reactions.

When conducting interventions and consultations, psychologists at all practice levels are encouraged to build trust and practice shared decision-making with their patients. Shared decision-making, the focus of Guideline 9, involves getting the patient’s opinions on treatment options, providing information about potential risks and benefits, and deliberating together on the best course of action. Because adherence to psychotropic medications can be low, the goal is to improve the patient’s engagement with the process, address concerns or stigma, and build a treatment plan together. Guideline 10 notes that psychologists with prescriptive authority can help improve cooperation by patients by following up regularly, especially within the first month, checking in on patient satisfaction and working to minimize side effects.

Guideline 11 urges a biopsychosocial approach for psychologists, regardless of prescriptive authority. This model recognizes the importance of psychosocial factors in medical conditions and coping or recovery. A prescribing or collaborating psychologist might consider how behavioral treatments and medication can complement each other. For example, research on attention-deficit/hyperactivity disorder suggests that psychosocial interventions alongside medication are more effective than either one alone (Ojinna, B. T., et al., Cureus, Vol. 14, No. 12, 2022opens in new window). Taking a biopsychosocial approach can also reduce overreliance on medication, where different options are available.

“When we see patients on too many medications, inappropriate medications, or medications that have problematic drug interactions, we’re able to stop those medications and help patients reduce the risks,” Shearer said.

Prescribing psychologists are also primed to understand a person’s relationship with medication via the lens of their individual psychology, said Beth Rom-Rymer, PhD, the founder, president, and CEO of the Illinois Association of Prescribing Psychologists and a coauthor of the guidelines. Are they resistant to change? Do they put undue faith in new treatments? Are there cultural or family beliefs around medicine that might influence their decisions?

“That’s a very exciting part of what we do as prescribing psychologists—we have this holistic understanding of the patient and how we manage both psychological treatment and psychopharmacological therapeutic treatment,” said Rom-Rymer, a past president of APA Division 55 (Society for Prescribing Psychology).

Guideline 12 highlights an expanded informed consent process that can enable shared decision-making and a deep relationship with patients. Psychologists are bound by APA’s Ethics Code and federal and state law to obtain informed consent before all professional interactions. But a collaborative decision around medication may need to go beyond the basics and into the gritty details. Psychologists might need to go in depth on the rationale for choosing one treatment over other options; explain why medications are being switched, reduced, or discontinued; and educate patients on why pharmacological treatments are often combined with psychotherapy. This can involve explaining the dual role of a prescribing psychologist in prescribing medications and providing other therapeutic interventions. It might also involve being open to patient concerns such as financial costs or access, as well as assessing their likelihood to adhere to the treatment plan.

“I view my role as a prescriber is to give the patient options for treatment that are consistent with the literature, and then we talk about what fits for them, considering their time, circumstances, and preferences for treatment,” said guideline document coauthor Lynette Pujol, PhD, MCSP, the deputy director of the master’s in clinical psychopharmacology program at Fairleigh Dickinson University and the president of Division 55.

Psychologists with a role in medication management are not only concerned with the psychologist-patient relationship; they also work in collaboration with other professionals. Guidelines 13 and 14 suggest that psychologists with prescriptive authority strive to maintain appropriate relationships with other providers, both psychologists and nonpsychologists, on their patients’ care team. Nonprescribing psychologists may sometimes refer to prescribing psychologists for medication consultation only. In some cases, the two psychologists may have differing opinions on the optimal treatment plan. The guidelines urge prescribing psychologists to avoid competition if the patient has another psychologist, aligning with the APA Ethics Code Standard 10.04, which emphasizes the importance of centering patient welfare in such cases. Successful collaborative care is linked to better patient outcomes and reduced wait time for treatment (Reist, C., et al., Medicine, Vol. 101, No. 52, 2022opens in new window).

The guidelines provide some guidance on how to interact with nonpsychologists on the team. One advantage of a master’s degree in clinical psychopharmacology, Shearer said, is a shared language with the medical team. “For psychologists who are not prescribers, I think one of our challenges is to be brief,” he said. Shearer said he finds that primary-care physicians tend to value concise communication, so it is important to find ways to spotlight crucial information quickly.

The reach of prescribing psychologists is growing. In 2019, APA’s Council of Representatives adopted a revision of the designation criteria that allows psychologists to start their training in psychopharmacology at the graduate level rather than at the postgraduate level. This streamlines the career path and enables more psychologists to get this additional training, Rom-Rymer said. The Canadian province of Ontario announced in September 2025opens in new window that it is considering expanding the scope of psychologists with psychopharmacological training to include prescription privileges.

As the number of prescribing psychologists grows, so do the data on their impact. Research suggests that prescribing psychologists have similar safety outcomes as psychiatrists and primary-care physicians (Hughes, P. M., et al., American Psychologist, Vol. 80, No. 7, 2025). Policies allowing prescribing psychologists are also associated with reductions in suicide on a state level (Hughes, P. M., et al., Professional Psychology: Research and Practice, Vol. 54, No. 4, 2023).

There are currently about a dozen U.S. states with active efforts to expand the scope of practice to include prescribing for appropriately trained psychologists. The goal, Rom-Rymer said, is to increase access for patients.

“There is a dire need for mental health prescribers who are extraordinarily well trained,” she said. “And prescribing psychologists certainly fit that criteria.”