Professional Issues in Pharmacotherapy for Psychologists

Professional Psychology: Research and Practice Copyright 2004 by the American Psychological Association 2004, Vol. 35, No. 2, 158–163 0735-7028/04/$12.00 DOI: 10.1037/0735-7028.35.2.158 Professional Issues in Pharmacotherapy for Psychologists Robert E. McGrath Jack G. Wiggins Fairleigh Dickinson University Missouri Institute of Mental Health Morgan T. Sammons Ronald F. Levant U.S. Navy Bureau of Medicine and Surgery Nova Southeastern University Anita Brown Wendy Stock Hampton University Alliant International University Much of the critical discussion of prescriptive authority for psychologists has focused on the question of whether this is the right direction for the profession. The authors contend that discourse on prescriptive authority should progress to identification of the challenges that lie ahead for psychology as a prescribing profession, with the goal of anticipating and addressing those challenges as early in the process as possible. The authors identify a number of such potential challenges, including both general issues of professional identity and more practical concerns. In some cases, the authors express their opinions on these matters, but more generally their intention is to spur reasoned discussion of the issues psychologists will face. In 1995, the American Psychological Association (APA) critical analysis of APA’s decision should move beyond the Council of Representatives formally endorsed the pursuit of question of whether it is the right choice to an evaluation of the prescriptive authority for appropriately trained psychologists. professional challenges created by adding prescriptive authority This resolution has sparked a great deal of debate, with strong to psychologists’ scope of practice. opinions voiced on both sides (e.g., DeNelsky, 1996; Hayes & Fortunately, the experiences of other prescribing professions, Heiby, 1996; Heiby, 2002; Hines, 1997; Norfleet, 2002). Ob- as well as psychologists, in response to the development of a jections have been remarkably similar to those raised over 50 therapeutic role, help us identify what some of those challenges years ago when APA began encouraging the development of will be. The purpose of the present article is to discuss training programs in psychotherapy for psychologists (Shakow, some of the key issues to be addressed. The goal here is not to 1965; Sward, 1950). The recent enactment of legislation award- reach closure on these issues but to begin an internal dialogue ing prescriptive authority to psychologists in New Mexico about the best means to ensure that we consciously guide the increases the likelihood that the outcome for the current agenda evolving character of psychology as a profession and a will also mirror that of 50 years ago. In light of these events, the discipline. ROBERT E. MCGRATH received his PhD in clinical psychology from Auburn ANITA BROWN received her PhD in clinical psychology from the University University and is currently professor and training director of the Psycho- of Pittsburgh and completed her postdoctoral training in psychopharma- pharmacology Postdoctoral Training Program in the School of Psychology, cology through the Psychopharmacology Demonstration Project sponsored Fairleigh Dickinson University. The bulk of his research is in the area of by the U.S. Department of Defense. She is now working in the Community personality assessment. Mental Health Service at Fort Eustis, Virginia. Her research areas include JACK G. WIGGINS received his PhD in clinical psychology from Purdue psychopharmacotherapy and cultural issues in mental health. University. He is currently affiliated with the Missouri Institute of Mental WENDY STOCK received her PhD in clinical psychology from the State Health, St. Louis, MO. His primary area of research is psychopharmaco- University of New York at Stony Brook. She currently is a faculty member therapy. at Alliant International University, San Francisco Bay Campus. Her pri- MORGAN T. SAMMONS received his PhD in counseling psychology from mary areas of research include psychopharmacology training issues, human Arizona State University. He is currently deputy director for clinical sexuality, sex therapy, and feminist approaches. operations at the U.S. Navy Bureau of Medicine and Surgery. His areas of interest include combined treatments for mental disorders and prescriptive ALTHOUGH SOME OF THE AUTHORS of this article are involved in the authority for psychologists. The opinions expressed by Morgan T. Sam- governance of APA or APA’s Division 55 (the American Society for the mons are wholly his own and do not represent the official views of the U.S. Advancement of Pharmacotherapy), the opinions expressed here are those Navy or the U.S. Department of Defense. of the authors and are not intended to reflect the official position of the RONALD F. LEVANT received his EdD in clinical psychology and public association. practice from Harvard University and is dean and professor of psychology CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Robert at Nova Southeastern University in Ft. Lauderdale. His research interests E. McGrath, School of Psychology, Fairleigh Dickinson University, Tea- are in advancing professional psychology and the new psychology of men. neck, NJ 07666. E-mail: [email protected] 158 SPECIAL SECTION: ISSUES IN PHARMACOTHERAPY 159 General Issues psychologists, it is important to clarify the degree to which pharmacotherapy should be incorporated into predoctoral training. Maintaining Our Identity Though APA’s (1996) model curriculum for training psychologists There is perhaps no objection to prescriptive authority more in preparation for prescriptive authority is entitled Recommended serious than that it can lead to the loss of our identity as psychol- Postdoctoral Training in Psychopharmacology for Prescription ogists. The importance of this objection is not necessarily predi- Privileges, the preamble states cated on its being a particularly likely outcome of obtaining prescriptive authority, but rather on its being the most potentially the same curriculum and practicum experiences could be incorporated damaging outcome to psychology both as a discipline and a into an expanded predoctoral curriculum in programs that so wish. These programs could then accept students who would enter their profession. The fear is that psychologists will follow the path of graduate education with the goal of a professional practice that in- psychiatrists, many of whom have surrendered the psychological cludes prescription privileges. (p. 1) approach to the understanding and amelioration of mental disorders for a largely medical approach, resulting in the deterioration We believe that widespread expansion of the standard predoc- of traditional psychotherapy and assessment skills. Such an out- toral curriculum in this way would be potentially dangerous for the come could hurt the discipline in that it would deepen existing rifts future of the profession. A basic knowledge of pharmacotherapy between professional and research psychologists, and it would hurt should be expected of all practitioners but should not comprise a the profession in that it would reduce rather than expand the substantial portion of their predoctoral training. For the majority of variety of treatment options we can offer our patients. practitioners, pharmacotherapy is best treated as a proficiency to It is essential that psychology learn from psychiatry’s error, an be mastered subsequent to the integration of basic knowledge, error that resulted in large-scale abandonment of psychotherapy as skills, and abilities that make up health care psychology as tradi- a treatment option and, in many cases, resulted in the restriction of tionally practiced. Accordingly, it is our position that training for treatment options to medication alone.1 To avoid this outcome, we prescriptive authority should remain a largely postdoctoral recommend that prescriptive authority remain a proficiency for a endeavor. select few, rather than becoming a basic clinical skill for all, with Over time, we are likely to find some students who aspire to a the bulk of training occurring after completion of doctoral-level career focusing on basic or applied psychopharmacology, poten- training as a psychologist health care provider. In this way, the tially justifying the development of curricula that accommodate trainee in pharmacotherapy has already committed at least 5 to 7 this interest. However, even in these instances, APA educational years to learning a largely psychosocial model of diagnosis and policy must be designed to ensure that predoctoral training in treatment. psychopharmacology does not occur at the expense of an educa- The advanced practice nurse (APN), a term that encompasses tion in the psychosocial fundamentals that continue to define our nurse practitioners and several other advanced training options in field. Furthermore, it is important that such programs remain a nursing, offers a good model for the appropriate role of the relatively small portion of training opportunities in psychology. prescriber within psychology. The emergence of the APN as an Doctoral training programs specializing in neuropsychology or independent practitioner with some form of prescriptive authority health psychology offer a good prototype for the appropriate level in all 50 states has enhanced the image of nursing among consum- of specialization in predoctoral training experiences. ers and other health professionals and has created opportunities for nurses

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