This is the third entry in a series on the implications of psychologists pursuing prescription privileges. What those implications are exactly, is far from clear — they ought to be examined very closely. Others in the series include:
Some stronger arguments:
Here’s an outline of Dr. John Norcross’ examination of some of the more legitimately compelling arguments for presciption authority for psychologists (RxP).
- 1. Public Accessibility
2. To Prescribe or Not Prescribe: A Choice
3. Integrated Treatment
4. Evidence-Based Treatment
Dr. Norcross asserts that the main prescribers — physicians and psychiatrists — are not meeting the “public need”.
First, general practitioners prescribe about 70 – 75% of psychotropic medications, but these professionals have little training in psychopharmacology and virtually none in the diagnosis and treatment of mental disorders (Fowler, 1999). General practitioners’ education in psychopathology, psychotherapy, and psychoactive medications is significantly less than psychologists’.
Further supporting this argument: The recent trend of physicians, as they become more aware of the liabilities involved in prescribing psychotropics, to back away from prescribing this class of medications.
Dr. Norcross also cites the steady decline in number of psychiatrists being trained in this country. And psychologists’ “wider accessibility and specialized training.” He couches this not just in terms of an opportunity for psychology, but perhaps even a responsibility.
Choice: Prescribe or not prescribe:
Simply put, psychologists might be more apt to not prescribe — since prescribing is not central to our professional identity. Basically, the argument goes that psychologists are trained to view people in a much broader context. Psychological training
…assumes [that] medication, when appropriate, is but one aspect of treatment and will be employed as an adjunctive measure. The psychological model is more likely to empower clients to engage in active collaboration, as opposed to a largely passive recipient of care.
Norcross states: “Our historical and distinctive strengths in assessment, psychotherapy, relationships, consultation, and research methods will compliment our use of medications and the evaluation of medication effects.” Beyond this, the implication of this is psychologists have an opportunity to substantially alter the way medications are prescribed. If true, this would indeed be promising. There is little doubt (in my mind) that currently psychotropic medications are being overprescribed, and that this is not in the best interest of the public.
Basically, psychologists will also have the chance to take people off medications. This seems like a rehash of the earlier prescribe-or-not-prescribe argument, but emphasizes that psychologists’ research training has been useful in “the sobering reanalyses of medication effectiveness, for example, the negligible effect of SSRIs for children and the high placebo rates for antidepressants.”
Norcross views psychologists’ services as potentially comprehensive, able to provide both therapeutic as well as psychopharmacological interventions. He also points out that this service could be more cost effective, enabling people to receive their care from a single practitioner.
Prescribing psychologists are more likely to understand, adhere, and apply the scientific literature. As both a science and a profession, psychology pulls “double duty” in our training and activities. Both academic – research courses and practical – clinical training. For this reason, psychologists are known as the “scientists among the professionals and the professionals among the scientists.”
Psychologists, Dr. Norcross asserts tentatively, are arguably more competent with statistical matters, research methods, evaluation strategies, and critical thinking than other prescribers. However, we must demonstrate a willingness to apply this same “empirical scrutiny” to our own work, pharmacological or otherwise.
Next post, some comments on the “strong” v. “weak” arguments, as well as looking at some of the persuasive strategies employed by pro RxP exponents. I may continue with the prescriptive authority issue in another venue, as there are so many issues to address. It seems like they are outside the scope of this blog.
Kalea Chapman, Psy.D.
This is one entry in a series on the implications of psychologists pursuing prescription privileges. Other articles in the series include: