THE GREAT PSYCHOLOGY PRESCRIPTION DEBATE
It's About Money, Not Patient Care
John M. Grohol, Psy.D.
July 14, 1998
Why do psychologists want to prescribe medications?
Because there is more money in it.
That may seem like an overwhelmingly simplistic answer to a complex topic of debate, yet that is largely what it boils down to. A psychologist right now can provide the same quality of care working closely with a psychiatrist within the same facility or office, as thousands of psychologists have been doing for years. Additionally, there already is a legitimate and time-proven method to obtaining prescription privileges -- go to medical school and become a medical doctor.
All other debate is largely noise in this discussion. Whether psychologists can actually prescribe just as well as other medical professionals is missing the point. The point is that psychologists (my profession!) are trying to steal the ground and marketplace from underneath psychiatry. They did so with psychotherapy earlier this century, and are now trying to take away the last vestige which makes psychiatry a unique medical field.
Some of my colleagues argue that psychologists should be allowed to prescribe because of the complex and not-well-understood interactions between biology and psychology. This is a straw-man argument. Since we are in the infancy of any real understanding of the biological processes of the brain, it makes no sense to suggest that psychologists, with no history of prescribing or medical background could do a better job than psychiatrists. Certainly a balanced treatment approach emphasizing the biopsychosocial model of mental disorders is the ideal one to take. It does not follow, however, that that approach can only be obtained through a single practitioner administering all the treatments available. In fact, it likely does a client much good to have different perspectives and approaches available to them in their treatment now.
Another flimsy argument used to support prescription privileges is to suggest that somehow psychiatric research is in need of psychologists to prop it up. While I admit that some medical research in this area is not of the same quality as that of the behavioral sciences, I believe it is a minority. Even if it were larger than I believe it to be, there is not a single reason why psychologists and psychiatrists cannot, right now collaborate more thoroughly and cooperatively on biobehavioral research studies. In fact, there are some studies in the literature where such cooperation has occurred. Psychologists don't need to obtain prescription privileges in order to help our psychiatric colleagues, or in order to better understand brain chemistry. They can gain that knowledge in the traditional fashion -- via medical school training.
The economics of the situation are pretty clear to anyone. Managed care has taken its toll on the behavioral healthcare field. It seems that most Americans prefer to receive medication for a mental health problem first, with psychotherapy offered almost as an afterthought. (Even though, as I constantly emphasize, the best treatment for nearly any disorder is a combined psychotherapy/medication approach.) HMOs pay for medications ad infinitum, while psychotherapy benefits are still limited in scope for most people.
Pharmaceutical companies are chomping at the bit to be able to tap into the market of prescribing psychologists. But for now, they have to keep a low profile in this debate so as to not upset their current customer base, the psychiatrists. Some psychologists even see pharmaceutical companies as psychology's saviors. They believe that the income generated by prescribing medication, and the huge "donations" pharmaceutical companies can make to the cause via advertising revenues, free continuing education seminars, etc., will give a much-needed boost to psychology's image.
Psychologists are experts in human behavior, not the body's physiology. If you're a psychologist and want the ability to prescribe, do it through the traditional route already available to you -- medical school to become a physician's assistant, psychiatric nurse, or medical doctor. There is nothing stopping you. There is no need to spend psychology's precious efforts and time in so useless a battle, so obvious a grab at another profession's livelihood.
Let's concentrate on what we do best and informing the public about psychology's unique contributions to the world. Psychologists conduct assessments and are the "general practitioners" of mental health problems today. Their unique training based in empirical study and research ensures that their therapeutic techniques are grounded and helpful to their clients.
If psychologists want to help their clients in the best way possible, they should seek to educate themselves about the basic interactions of human physiology and become close working partners with an experienced and open-minded psychopharmacologist or psychiatrist. This teamwork approach offers the best choice for clients today and in the future, since it carefully balances the biological aspects with the psychological aspects of the disorder. A clinical social workers should also be a part of a comprehensive treatment team, although such cohesive and organized teams are a rarity outside of large treatment centers or facilities. Psychologists should work harder to emphasize this balanced treatment approach, rather than working to try and put another profession out of business.
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Last reviewed: By John M. Grohol, Psy.D. on 27 Jan 2007
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