Psychopharmacology/Advanced Practice Psychology

[Doctor J 216]

I agree with CGOPsych and Summit. We are all healthcare professionals and as such have an ethical standard to uphold. It isn't ethical to promote the lack of physicians and improved rural access as a political maneuver for RX privileges when it's really about money and other elements.

As for the states that have approved RX legislation, where is the data 10 years later stating that there is improved rural access or improved mental health in those states? That's right, those stats don't exist. As I've said before, safe prescribing is not necessarily effective prescribing. I'm not opposed to psychology Rx, but it needs to be done correctly for the right reasons. If a state legislator knew that years after Rx for psychologists, psychiatrists would leave the state and the condition of mental health in the state wouldn't improve...

There are too many Psy D programs that pop up and allow unqualified people to train online / long distance and feel entitled with a "doctorate." It is the fault of the APA that it cannot regulate its own entity (kind of like there being too many law schools). My psychologist colleagues agree that many elements of their training appear superfluous and profit driven (they even have to pay for supervision!).

Finally, there are some posts about years to train for doctors vs psychologists. Residency and graduate school are not the same. A year does not equal a year, not in quality of training, not in hours, not in acuity, not in depth. Let's not kid ourselves. If psychology graduate schools really had the students' best interests in mind, they would model medical residency increase the intensity and save the youngsters some financial aid.

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[psyvagabond]

So...i posted this exact message on another thread, but I think I'll receive better responses here

Until psychologists in California (and most other states) are granted prescribing privileges, wouldn't it be the smartest course of action to also become a psychiatric nurse practitioner? I have not done adequate research on this degree, but it seems to be less demanding than also becoming a psychiatrist, yet allows almost the same prescribing rights.

 

[Therapist4Chnge]

So...i posted this exact message on another thread, but I think I'll receive better responses here

Until psychologists in California (and most other states) are granted prescribing privileges, wouldn't it be the smartest course of action to also become a psychiatric nurse practitioner? I have not done adequate research on this degree, but it seems to be less demanding than also becoming a psychiatrist, yet allows almost the same prescribing rights.

If a person wants to primarily prescribe, they should go into medicine or be a mid-level (NP/PA). Psych RxP is somewhat in limbo because of political issues and (in my opinion) still has some work to do on coming up with a more comprehensive curriculum.

 

[psyvagabond]

Right. However, if someone wants to be a psychologist and have prescribing rights because it is easier on clients and (seemingly) financially worthwhile, why wouldn't a psychologist also become a NP? It may take some states forever before the Psych RxP is approved, and the option of becoming a psychiatric nurse seems the quickest route to achieve essentially the same goal.

 

[medium rare]

Right. However, if someone wants to be a psychologist and have prescribing rights because it is easier on clients and (seemingly) financially worthwhile, why wouldn't a psychologist also become a NP? It may take some states forever before the Psych RxP is approved, and the option of becoming a psychiatric nurse seems the quickest route to achieve essentially the same goal.

Spot on. This is exactly what I did, and it has been well worth it. It took a major commitment because I had to take a leave of absence from everything I was doing to go back and get the BSN and then the MSN - a process that was interesting to say the least. But the return on investment (clinically and financially) has been huge; I'm in an independent practice state and can do everything a psychiatrist can do (legally speaking) except for evaluations for involuntary court-ordered treatment. My training and expertise as a psychologist makes me appealing to a variety of employers and potential patients as I provide both psychotherapy and pharmacotherapy as my modal treatment modality along with psychological testing when indicated. I encourage anyone entertaining this option to strongly consider it, especially since the RxP movement is not really doing much at present.

 

[edieb]

http://www.thelundreport.org/resour...to_gain_prescribing_rights_in_special_session

 

[edieb]

--------------------------------------------------------------------------------

http://www.thelundreport.org/resour...to_gain_prescribing_rights_in_special_session


corrected link

 

[lamorena]

the link wont open.. what state is this??

 

[phillydave]

the link wont open.. what state is this??

Oregon

 

[Therapist4Chnge]

--------------------------------------------------------------------
Among bills during next month’s special session is one that could end a decades-long battle between psychiatrists and psychologists in Oregon over prescribing


By:
David Rosenfeld

January 28, 2010 -- Robin Henderson knows first hand that central Oregon has a shortage of psychiatrists. As the director of behavioral health at St. Charles Medical Center in Bend, Henderson and her staff regularly encounter patients who require both therapy and medication. And the only physicians who can do both are psychiatrists.

“What I see is the provider problem,” Henderson said. “There just aren’t enough doctors who want to be psychiatrists. As somebody who has worked in mental health for the past 25 years, I’ve got to look at everything I can that makes sense.”

Primary care doctors and not mental health experts prescribe an estimated 75 to 85 percent of all mental health drugs in America, said Henderson, who believes giving that ability to psychologists is a better idea. Already equipped with the training to diagnose and treat mental illness, psychologists in growing numbers support the idea.

“From where I sit, I think this is a valid part of the solution,” Henderson said. “It’s proven, it’s safe and it’s the direction we need to go.”

In the upcoming special session that starts on Monday, the Oregon legislature could finally put to rest a long-standing debate between psychologists and psychiatrists over prescribing rights. It’s a debate that’s been going on at the state capitol for as long as most longstanding Salem lobbyists can remember. But there are still differences to resolve.

If lawmakers grant psychologists the right to prescribe mental health drugs, Oregon would become the third state in the country to do so, but not without precedent going a bit further back. For the past 15 years, the Department of Defense has trained and authorized psychologists to prescribe drugs as a way to meet growing demand coupled with a physician shortage.

Sen. Laurie Monnes-Anderson spearheaded efforts to have the two professions iron out their differences in a workgroup comprised of three physicians, three psychologists and a pharmacist. The group reached consensus, which is now represented in Senate Bill 1046 pending before the legislature.

Monnes-Anderson said the process holds promise for other scope-of-practice issues that typically come before lawmakers. The work group brings clinical expertise into the discussion while the legislature still makes the final decision. No other medical specialty is currently engaged in such a process, but naturopaths earned limited prescribing rights through a similar workgroup before passing a bill last session.

“The process they took was a good one,” Monnes-Anderson said. “A citizen legislature has a responsibility of determining whether a profession has a qualification or not to expand their scope.”

The work group among psychologists and psychiatrists settled on pre-clinical training requirements and an 18-month residency training program for any psychologist that wants to prescribe drugs. Those exact recommendations became SB 1046, which the Oregon Psychological Association fully supports.

But the Oregon Psychiatric Association opposes the bill unless a few changes can be made, said John McCully, its lobbyist and executive secretary. “We are proposing amendments that if adopted would allow us to drop that opposition.”

Those amendments would allow psychologists to only prescribe drugs to adults – not children – require that any training be conducted in person and that the 18-month residency training be clearly defined as a full-time endeavor, McCully said.

“The entire medical community wants to make sure that patients are protected, that they’re provided the safest services as possible with some of the most powerful and dangerous medications that can be prescribed,” said McCully, who rejects the argument that psychiatrists are protecting their turf.

“We know there is concern from other psychologists that this is the wrong thing for their profession to do,” McCully said.

Henderson stood by the recommendations of the workgroup, which she said worded the language very carefully.

“This is a normal extension of where the field has gone,” Henderson said.

Come next week it will be up to the politicians to decide the fate of this issue.

For related articles click here.
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[phillydave]

Do you ever sleep?

 

[Therapist4Chnge]

Do you ever sleep?

I was actually napping this afternoon.

 

[maranatha]

--------------------------------------------------------------------
The work group among psychologists and psychiatrists settled on pre-clinical training requirements and an 18-month residency training program for any psychologist that wants to prescribe drugs. Those exact recommendations became SB 1046, which the Oregon Psychological Association fully supports.

But the Oregon Psychiatric Association opposes the bill unless a few changes can be made, said John McCully, its lobbyist and executive secretary. “We are proposing amendments that if adopted would allow us to drop that opposition.”

Those amendments would allow psychologists to only prescribe drugs to adults – not children – require that any training be conducted in person and that the 18-month residency training be clearly defined as a full-time endeavor, McCully said.
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I've been through 4 years of medical school and have been training in psychiatry for just over 2 and 1/2 years now. I have barely begun to feel a little comfortable prescribing medications and feel that I need more training before I'm out on my own. 18 months of "residency" seems completely inadequate to start prescribing medications. I mean no offense and have a great respect for psychologists, just my honest opinion.

 

[healthpsy]

I've been through 4 years of medical school and have been training in psychiatry for just over 2 and 1/2 years now. I have barely begun to feel a little comfortable prescribing medications and feel that I need more training before I'm out on my own. 18 months of "residency" seems completely inadequate to start prescribing medications. I mean no offense and have a great respect for psychologists, just my honest opinion.

No offense taken:

But please consider the 5 years of didactic training and research focused on psychopathology inherent in the doctorate degree before you reckon the training "inadequate." The 18 mo. is just the pharmacology, bringing the total to 6.5 years of training in mental health care. I'm not surprised that you're uncomfortable prescribing psych meds. But it's simply not an apt comparison to say that because you're not comfortable, psychologists won't be either. Compared to a clinical psychologist's training, you're simply less prepared. Your 4 years of medical school were filled with classes and rotations most of which were utterly irrelevant to the practice of mental health care. Interpret many 12 lead EKGs in your residency? How about that L&D or OR rotation-- coming in handy when you treat the mentally ill? But I exaggerate to make a point. Don't get me wrong, I applaud you: you're responsible enough to undertake residency in the psych field. Primary Care providers are in the field with no more training than they obtained in passing while in school, yet they can prescribe psychotropic meds. It's unconscionable.

RxP for psychologists is not an if, it's a when. Psychologists are just going have to fight the same fight that D.O.s, O.D.s, Podiatrists, Chiros, et al. have had to fight over the years when going up against the mighty monolith of the M.D. establishment. The AMA will continue to obstruct other professions from gaining footholds in the pharmacopeia, using any convenient pretense available to them, because they see it as an erosion of their power, but at the end of the day the people who utilize mental health services want this. For continuity of care, for access to services, we fight!
Viva la revolucion...

 

[5HT2]

No offense taken:

But please consider the 5 years of didactic training and research focused on psychopathology inherent in the doctorate degree before you reckon the training "inadequate." The 18 mo. is just the pharmacology, bringing the total to 6.5 years of training in mental health care. I'm not surprised that you're uncomfortable prescribing psych meds. But it's simply not an apt comparison to say that because you're not comfortable, psychologists won't be either. Compared to a clinical psychologist's training, you're simply less prepared. Your 4 years of medical school were filled with classes and rotations most of which were utterly irrelevant to the practice of mental health care. Interpret many 12 lead EKGs in your residency? How about that L&D or OR rotation-- coming in handy when you treat the mentally ill? But I exaggerate to make a point. Don't get me wrong, I applaud you: you're responsible enough to undertake residency in the psych field. Primary Care providers are in the field with no more training than they obtained in passing while in school, yet they can prescribe psychotropic meds. It's unconscionable.

RxP for psychologists is not an if, it's a when. Psychologists are just going have to fight the same fight that D.O.s, O.D.s, Podiatrists, Chiros, et al. have had to fight over the years when going up against the mighty monolith of the M.D. establishment. The AMA will continue to obstruct other professions from gaining footholds in the pharmacopeia, using any convenient pretense available to them, because they see it as an erosion of their power, but at the end of the day the people who utilize mental health services want this. For continuity of care, for access to services, we fight!
Viva la revolucion...

No amount of psychology classes is going to take the place of biology 101 (which psychology majors don't take) nor will it take the place of a year of anatomy and physiology as a minimum prereq (which even prenursing students take). If proponents of that bill argue that those subjects are covered within their professional training, the problem with that is that those rudimentary subjects are not graduate level work and should not be passed off as medical training. On the other hand, if they try to skip them entirely, how can they claim to have a graduate level education to treat patients with drugs if they've never taken a single biology prereq? That's like me trying to pass myself off as a structural engineer without ever taking a math class. The difference between those other professionals (chiros and O.Ds and D.O.s) is that they take science prereqs full time. If psychologists want to earn the massive responsibility of caring for patients with drugs, I've got no problem with that. But, they should join the club and take some science classes if they want to start billing for 20 minute medication consults.

 

[edieb]

No amount of psychology classes is going to take the place of biology 101 (which psychology majors don't take) nor will it take the place of a year of anatomy and physiology as a minimum prereq (which even prenursing students take). If proponents of that bill argue that those subjects are covered within their professional training, the problem with that is that those rudimentary subjects are not graduate level work and should not be passed off as medical training. On the other hand, if they try to skip them entirely, how can they claim to have a graduate level education to treat patients with drugs if they've never taken a single biology prereq? That's like me trying to pass myself off as a structural engineer without ever taking a math class. The difference between those other professionals (chiros and O.Ds and D.O.s) is that they take science prereqs full time. If psychologists want to earn the massive responsibility of caring for patients with drugs, I've got no problem with that. But, they should join the club and take some science classes if they want to start billing for 20 minute medication consults.

Do you even know the curriculum required for a psychologist to prescribe or are you speaking without any basis?? The degree is a post-doctoral master's and requires 2 additional years of study most of which involves physioi, anatomy, biochem, et cetera. After this, a residency and the passage of a national standardized exam.

As for safety, psychologists have been prescribing in other states for many years without adverse incident

 

[5HT2]

Do you even know the curriculum required for a psychologist to prescribe or are you speaking without any basis?? The degree is a post-doctoral master's and requires 2 additional years of study most of which involves physioi, anatomy, biochem, et cetera. After this, a residency and the passage of a national standardized exam.

As for safety, psychologists have been prescribing in other states for many years without adverse incident

I am very familiar with schools such as Alliant International. Their didactic training takes place in one weekend a month online. That’s 24 weekends to practice medicine. If you miss a weekend, you can just watch the CD. Are you aware of this? The head of the program is being paid to testify tomorrow in Oregon’s capital in order to boost enrollment for his program. The total length of which is less than a premed student spends on chemistry classes alone. I’d like to ask you, how might one study biochem without ever first taking biology or chemistry 101? Even at that, how many weekends would you spend on biochem? Not too many I hope or you won’t have any time left to learn how to write prescriptions. Do you take gross anatomy in one weekend or two? How about fluids and electrolytes? …. a day perhaps? Why would someone do this? Oh, they want to help patients of course! I don’t think patients really need or want that kind of help.

 

[busi26]

I am very familiar with schools such as Alliant International. Their didactic training takes place in one weekend a month online. That's 24 weekends to practice medicine. If you miss a weekend, you can just watch the CD. Are you aware of this? The head of the program is being paid to testify tomorrow in Oregon's capital in order to boost enrollment for his program. The total length of which is less than a premed student spends on chemistry classes alone. I'd like to ask you, how might one study biochem without ever first taking biology or chemistry 101? Even at that, how many weekends would you spend on biochem? Not too many I hope or you won't have any time left to learn how to write prescriptions. Do you take gross anatomy in one weekend or two? How about fluids and electrolytes? …. a day perhaps? Why would someone do this? Oh, they want to help patients of course! I don't think patients really need or want that kind of help.

News Flash. I am a clinical psychologist and I took Chemistry, Organic, Biology (multiple courses), Anatomy and physiology (1 and 2), and many other courses that "premed" students take. Thus, your premise that psychologists have no background in the "hard" sciences is faulty.

The proof is in the pudding. Psychologists have been prescribing in LA and NM for 5 years now. How many adverse events? 0.0.0.

 

[Therapist4Chnge]

I think the common concern from the medical side is that the training is not enough. I have my own reservations about quality control (online classes? ugh), but I think think the training parameters are in the ballpark. I am concerned about the proliferation of training without a more rigorous curriculum, but that will be an on-going battle.

I've gone through residential RxP training (I can't imagine doing it online), and while I believe I would be a competent prescriber if I were to practice, there is room for improvement. I'd like to see some of the basic classes covered in the first semester or two become pre-requisites, and then those "available" credits put towards more pharmacology training. I'm also not a huge fan of condensed classes for certain areas, but for others they seem to work well. I'd also like to see a higher hour limit for residency, and required collaboration. Will all of these things happen...probably not, but I think improving the training will make the idea of psychologist prescribers more paletable to the moderates in this discussion. Just like in any field, I don't think people are worried as much about the top people graduating from programs, but I think some of these improvements will address concerns about any borderline graduates.

 

[somaticpsych]

I've gone through residential RxP training

When you say "residential training", are you referring to the residency associated with a Ph.D. program?

Do _all_ APA accredited programs offer this kind of training? Or is this unique to your program?

I agree that it's only a matter of time before Psych Ph.D.'s get prescription privileges in more states. However the APA has proven time and again it is a lousy advocacy organization and I am now wondering if it might be worth my time to spend 2 years becoming a physician's assistant, which would give me prescription privileges.

Thoughts?

 

[edieb]

I am very familiar with schools such as Alliant International. Their didactic training takes place in one weekend a month online. That’s 24 weekends to practice medicine. If you miss a weekend, you can just watch the CD. Are you aware of this? The head of the program is being paid to testify tomorrow in Oregon’s capital in order to boost enrollment for his program. The total length of which is less than a premed student spends on chemistry classes alone. I’d like to ask you, how might one study biochem without ever first taking biology or chemistry 101? Even at that, how many weekends would you spend on biochem? Not too many I hope or you won’t have any time left to learn how to write prescriptions. Do you take gross anatomy in one weekend or two? How about fluids and electrolytes? …. a day perhaps? Why would someone do this? Oh, they want to help patients of course! I don’t think patients really need or want that kind of help.

I don't think the legislature allows people to present infomercials to them; he is likely testifying to help support/pass the bill

 

[5HT2]

News Flash. I am a clinical psychologist and I took Chemistry, Organic, Biology (multiple courses), Anatomy and physiology (1 and 2), and many other courses that "premed" students take. Thus, your premise that psychologists have no background in the "hard" sciences is faulty.

The proof is in the pudding. Psychologists have been prescribing in LA and NM for 5 years now. How many adverse events? 0.0.0.

If you took premed classes of your own accord and decided psychology was a better fit. That’s fine, but it's not a "news flash". It doesn’t mean that psychologists are required to take general science prerequisites to establish any kind of science foundation whatsoever. They are not. Oregon’s largest doctoral psychology program (Pacific University) requires only a college degree and 4 psychology classes for application (classes may be in progress). It’s dangerous and naïve to think that 24 weekends can prepare someone to practice medicine. That is exactly the wrong attitude to have for someone who wants to go into this line of work.

 

[busi26]

It’s dangerous and naïve to think that 24 weekends can prepare someone to practice medicine. That is exactly the wrong attitude to have for someone who wants to go into this line of work.

5HT, Whatever Louisiana and New Mexico are doing seems to be effective. Why not just look at the data and stop catastrophizing? The data suggests that the current training that medical psychologists get is adequate to prescribe psychotropics. It is really as simple as that. No one is suggesting that psychologists be allowed to do kidney surgery...

 

[edieb]

http://www.statesmanjournal.com/article/20100202/OPINION/2020317/1050

 

[Therapist4Chnge]

http://www.statesmanjournal.com/article/20100202/OPINION/2020317/1050

This was by far my favorite comment:

All any Mental Health "professional" has to do is say you are a dange to yourself or others and before you can say Hogwarts..the Sheriff has you hooked up and yer in the bug bin for "observation" until they decide it's OK to let you out. As for prescriptins. You have to let the MH Pros prescribed because regualr Docs are not trained specifically to manage MH issues.

Or so we are all led to believe. Personally I think the MH jobs were created to give "hippies" and slackers something to graduate from back in the 60's and 70's and now they hae made themselves indespensible and even acceptable to modern medicine. Kindalike LAwyyers with couches. They really are self serving and serve no real purpose in the reality of life. They give peple too weak minded to do for themselves a crutch upon wich o lean on and an excuse for bad behavior. Just an opinion...now where id my imaginary friend get off too ?? Bob..hey Bob where are ya ???

 

[maranatha]

No offense taken:

But please consider the 5 years of didactic training and research focused on psychopathology inherent in the doctorate degree before you reckon the training "inadequate." The 18 mo. is just the pharmacology, bringing the total to 6.5 years of training in mental health care. I'm not surprised that you're uncomfortable prescribing psych meds. But it's simply not an apt comparison to say that because you're not comfortable, psychologists won't be either. Compared to a clinical psychologist's training, you're simply less prepared. Your 4 years of medical school were filled with classes and rotations most of which were utterly irrelevant to the practice of mental health care. Interpret many 12 lead EKGs in your residency? How about that L&D or OR rotation-- coming in handy when you treat the mentally ill? But I exaggerate to make a point. Don't get me wrong, I applaud you: you're responsible enough to undertake residency in the psych field. Primary Care providers are in the field with no more training than they obtained in passing while in school, yet they can prescribe psychotropic meds. It's unconscionable.

RxP for psychologists is not an if, it's a when. Psychologists are just going have to fight the same fight that D.O.s, O.D.s, Podiatrists, Chiros, et al. have had to fight over the years when going up against the mighty monolith of the M.D. establishment. The AMA will continue to obstruct other professions from gaining footholds in the pharmacopeia, using any convenient pretense available to them, because they see it as an erosion of their power, but at the end of the day the people who utilize mental health services want this. For continuity of care, for access to services, we fight!
Viva la revolucion...

As I said, I'm just starting to become comfortable with the medications and should have said emphasized with "the medical side" of psychiatry. I have been learning pharmacology and medicine for almost 7 years (plus 4 years of basic biology as an undergrad) and I can tell you that having that back ground is indispensable for what I do. There are things that come up on a daily basis that utilize my back ground. I see patients everyday with complex medical backgrounds who are on multiple medications. I can tell you that knowing the difference between medical complications, drug side-effects, and psychiatric illness is something that I'm good at because of my medical training. This is experience that just can't be replaced by 18 months of pharmacology training. So, I completely disagree that I'm less prepared to handle medications in my patients and think you're beating the wrong drum if you think that's going to fly as a reason for PhD's to prescribe. Also, I'm not even done with training and will continue to be in training for the next 2 years before I even start treating on my own. I just don't understand how you can say that my background makes me less qualified. The fact that you don't recognize the importance of medical training to prescribe medications says a lot about your understanding of prescribing medications...

I know numerous well respected and nationally known psychologists who are against prescribing rights. I hope that others on this site realize that a large percentage of psychologists do not support this movement. Personally, I'm not totally against the idea and feel that a limited prescription rights might work. But once you start working with mood stabilizers, anti-psychotics, benzos, and stimulates, then I'm get a little nervous.

 

[Therapist4Chnge]

When you say "residential training", are you referring to the residency associated with a Ph.D. program?

Do _all_ APA accredited programs offer this kind of training? Or is this unique to your program?

I agree that it's only a matter of time before Psych Ph.D.'s get prescription privileges in more states. However the APA has proven time and again it is a lousy advocacy organization and I am now wondering if it might be worth my time to spend 2 years becoming a physician's assistant, which would give me prescription privileges.

Thoughts?

The psychopharm training was a separate training from the doctoral training. Residential was referencing the classes were all in person and not online. I made the distinction because I do not support online training, and I think it is a mistake for anything that isn't a 100-level undergraduate class.

As for seeking mid-level prescribing rights...if you want to prescribe as a primary part of your job, go to medical school. PA or NP training are both great paths, so it isn't so much a comment on what they lack, but more about the time/money it would take to become a clinical psychologist and then go back for another few years of school.

 

[phillydave]

No amount of psychology classes is going to take the place of biology 101 (which psychology majors don't take) nor will it take the place of a year of anatomy and physiology as a minimum prereq (which even prenursing students take). If proponents of that bill argue that those subjects are covered within their professional training, the problem with that is that those rudimentary subjects are not graduate level work and should not be passed off as medical training. On the other hand, if they try to skip them entirely, how can they claim to have a graduate level education to treat patients with drugs if they've never taken a single biology prereq? That's like me trying to pass myself off as a structural engineer without ever taking a math class. The difference between those other professionals (chiros and O.Ds and D.O.s) is that they take science prereqs full time. If psychologists want to earn the massive responsibility of caring for patients with drugs, I've got no problem with that. But, they should join the club and take some science classes if they want to start billing for 20 minute medication consults.

A B.S. in Psychology requires bio, physiology, anatomy, etc.

 

[5HT2]

A B.S. in Psychology requires bio, physiology, anatomy, etc.

Name the program. If they take the exact same courses as other healthcare professionals to get a B.S in psychology, maybe that's the answer. My 10 minute online search of BS psychology degrees revealed no such requirements of any B.S. psychology programs (not even 100 level basic science). I'm happy to eat my hat if you can come up with one though.

 

[phillydave]

Name the program. If they take the exact same courses as other healthcare professionals to get a B.S in psychology, maybe that's the answer. My 10 minute online search of BS psychology degrees revealed no such requirements of any B.S. psychology programs (not even 100 level basic science). I'm happy to eat my hat if you can come up with one though.

Hope your hungry.

Penn State University Park

Psychology

University Park, College of the Liberal Arts (PSYBS)
World Campus
Not all options are available at every campus. Contact the campus you are interested in attending to determine which options are offered.
PROFESSOR MELVIN MARK, Head
This major is designed for students who want to learn about behavior, normal and abnormal, how it is studied, and its relation to applied areas. Students are encouraged to conduct research with members of the faculty and/or take a practicum in an applied setting. Graduates are equipped for various positions in human service agencies, industrial settings, or laboratories. Others go on to professional school, e.g., medical school, law school, or to continue their training in psychology working toward a master's or a doctoral degree. Majors may elect either a Bachelor of Arts or a Bachelor of Science program.
The B.S. degree program requires more course work in the sciences than the B.A. program, and students may select courses from one of four areas--mathematics/computer science, statistics, business, or biology--which may be taken instead of a foreign language.
In order to be eligible for entrance to the PSYBS major, a student at any location must have: 1) attained at least a 2.00 cumulative grade-point average; 2) completed PSYCH 100 GS(3) with a grade of C or better; 3) completed STAT 200 GQ(4) or PSYCH 200(4), at least 3 credits of GQ courses (not including STAT 200), and at least 3 credits of GS courses (not including PSYCH 100) with a grade of C or better.
For the B.S. degree in Psychology, a minimum of 123 credits is required.
Scheduling Recommendation by Semester Standing given like (Sem: 1-2)
GENERAL EDUCATION: 45 credits
(9 of these 45 credits are included in the REQUIREMENTS FOR THE MAJOR)
(See description of General Education in this bulletin.)
FIRST-YEAR SEMINAR:
(Included in ELECTIVES or GENERAL EDUCATION course selection)
UNITED STATES CULTURES AND INTERNATIONAL CULTURES:
(Included in ELECTIVES, GENERAL EDUCATION course selection, or REQUIREMENTS FOR THE MAJOR)
WRITING ACROSS THE CURRICULUM:
(Included in REQUIREMENTS FOR THE MAJOR)
ELECTIVES: 10-13 credits
REQUIREMENTS FOR THE MAJOR: 74-77 credits[1]
(This includes 9 credits of General Education courses: 3 credits of GWS courses and 6 credits of GQ courses.)
COMMON REQUIREMENTS FOR THE MAJOR (ALL OPTIONS): 50 credits
PRESCRIBED COURSES (16 credits)
PSYCH 100 GS(3) (Sem: 1-4)
PSYCH 105(3) (Sem: 2-5)
ENGL 202A GWS(3) (Sem: 3-4)
PSYCH 301W(4) (Sem: 3-6)
PSYCH 490(3) (Sem: 7-8)
ADDITIONAL COURSES (34 credits)
Select 6 credits of GQ courses (Sem: 1-4)
PSYCH 200(4) or STAT 200 GQ(4) (Sem: 3-4)
Select 12 credits of 200-level PSY courses (not to include PSYCH 294, PSYCH 296, or PSYCH 297). At least 3 credits must be from each group a, b, and c:
a. PSYCH 253 GS(3), PSYCH 256 GS(3), PSYCH 260(3), PSYCH 261 GS(3) (Sem: 3-8)
b. PSYCH 212 GS(3), PSYCH 221 GS(3), PSYCH 231 GS;US(3), PSYCH 238 GS(3) (Sem: 3-8)
c. PSYCH 243 GS(3), PSYCH 269(3), PSYCH 270(3), PSYCH 281 GS(3) (Sem: 3-8)
Select 12 credits of PSYCH courses at the 400 level (not including PSYCH 490, and including no more than 3 credits of PSYCH 493, PSYCH 494, PSYCH 495, or PSYCH 496) (Sem: 3-8)

REQUIREMENTS FOR THE OPTION: 24-27 credits
BIOLOGICAL AND EVOLUTIONARY SCIENCE OPTION: (24 credits)
ADDITIONAL COURSES (15 credits)
Select 15 credits from groups a, b, c, and d, including at least 3 credits from each of three different groups:
--a. Genetics: ANTH 460(3), ANTH 473(3), ANTH 473W(3); BIOL 133 GN(3) or BIOL 222(3) (Sem: 3-6)
--b. Biological Anthropology: ANTH 021 GN(3), ANTH 401(3), ANTH 406W(3), BB H 410(3) (Sem: 3-6)
--c. Biobehavioral Implications: ANTH 464(3); BB H 101 GHA(3) or any higher-numbered BB H course, except BB H 310(3); HD FS 417(3), HD FS 468(3) (Sem: 3-6)
--d. Biology and Chemistry: BIOL 141 GN(3), BIOL 177 GN(3), BIOL 409(3), BIOL 421(4), BIOL 427(3), BIOL 472(3); CHEM 110 GN(3), CHEM 111 GN(1), CHEM 112 GN(3), CHEM 113 GN(1), CHEM 210(3), CHEM 212(3), CHEM 213(2) (Sem: 3-6)
SUPPORTING COURSES AND RELATED AREAS (9 credits)
Select 3 credits in natural sciences from department list (Sem: 1-8)
Select 6 credits in social and behavioral sciences from department list (Sem: 1-8)
BUSINESS OPTION: (24 credits)
ADDITIONAL COURSES (15 credits)
Select 15 credits from groups a, b, c, d, and e, including at least 3 credits from each of four different groups:
--a. ECON 002 GS(3), ECON 004 GS(3), FIN 100(3), FIN 301(3), or any FIN course numbered higher than FIN 301; ECON 302 GS(3) or higher-numbered economics course (Sem: 3-6)
--b. MGMT 100(3) or any course numbered MGMT 301(3) or higher; H P A 101(3) or any course numbered H P A 301(3) or higher (Sem: 3-6)
--c. MKTG 221(3) or any course numbered MKTG 301(3) or higher (Sem: 3-6)
--d. B LAW 243(3), SCM 301(3) (Sem: 3-6)
--e. ACCTG 211(4) (Sem: 3-6)
SUPPORTING COURSES AND RELATED AREAS (9 credits)
Select 3 credits in arts/humanities from department list (Sem: 1-8)
Select 3 credits in natural sciences from department list (Sem: 1-8)
Select 3 credits in social and behavioral sciences from department list (Sem: 1-8)
NEUROSCIENCE OPTION: (24-27 credits)
ADDITIONAL COURSES (15-18 credits)
PSYCH 260(3) (also counts in category a of COMMON REQUIREMENTS FOR THE MAJOR) (Sem: 3-6)
Select 15 credits from groups a, b, c, d, and e, including at least 3 credits from each of four different groups:
--a. Genetics: BIOL 133 GN(3), BIOL 110 GN(4), or BIOL 222(3) (Sem: 3-6)
--b. Physiology: BIOL 141 GN(3) or BIOL 472(3) (Sem: 3-6)
--c. Organic Chemistry: CHEM 202(3), CHEM 210(3), or CHEM 212(3) (Sem: 3-6)
--d. Cell Biology: BIOL 230W GN(4), BIOL 469(3), MICRB 106 GN(3), MICRB 201(3), MICRB 251(3) (Sem: 3-6)
--e. Other Topics: BIOL 240W GN(4), BIOL 177 GN(3), BIOL 409(3), BB H 470(3) (Sem: 3-6)
NOTE: Students planning to apply to medical school should select this option and choose courses to meet the following minimal requirements for most medical schools: BIOL 110 GN(4) and BIOL 230W GN(4) or BIOL 240W GN(4); CHEM 110 GN(3), CHEM 111 GN(1), CHEM 112 GN(3), CHEM 113 GN(1), CHEM 210(3), CHEM 212(3), and CHEM 213(2); PHYS 211 GN(4) and PHYS 212 GN(4), or PHYS 250 GN(4) and PHYS 251 GN(4).
SUPPORTING COURSES AND RELATED AREAS (9 credits)
Select 6 credits in natural sciences from department list (Sem: 1-8)
Select 3 credits in social and behavioral sciences from department list (Sem: 1-8)
QUANTITATIVE SKILLS OPTION: (24 credits)
ADDITIONAL COURSES (15 credits)
Select a total of 15 credits from groups a, b, c, and d:
--a. Select at least 3 credits from MATH 018 GQ(3), MATH 110 GQ(4), MATH 111 GQ(2), MATH 140 GQ(4), MATH 141 GQ(4) (Sem: 3-6)
--b. (Optional) Select 3 credits from CMPSC 101 GQ(3), CMPSC 121 GQ(3), CMPSC 201 GQ(3), CMPSC 202 GQ(3), CMPSC 203 GQ(4) (NOTE: Students may take only one of the courses in category b for credit.) (Sem: 3-6)
--c.1. Select 3 credits from STAT 318(3), STAT 414(3), STAT 418(3) (NOTE: Students may take only one of the courses in category c.1. for credit.) (Sem: 5-6)
--c.2. Select at least 3 credits from STAT 319(3), STAT 415(3), STAT 416(3), STAT 460(3), STAT 462(3), STAT 464(3) (Sem: 5-6)
--d. CAS 483(3), CMPSC 122(3), PSYCH 404(3), PSYCH 405(3) (Sem: 3-6)
NOTE: Students may fulfill the requirements of the Quantitative Skills option by completing a minor in either Statistics or Computer Science and Engineering in lieu of the course requirements listed above. Students choosing this option are encouraged to consult with an adviser designated by the Department of Psychology to determine the suitability of particular courses given their quantitative backgrounds. Other courses with advanced quantitative content may be substituted in category d with adviser's approval.
SUPPORTING COURSES AND RELATED AREAS (9 credits)
Select 3 credits in arts/humanities from department list (Sem: 1-8)
Select 6 credits in natural sciences from department list (Sem: 1-8)
[1] A student enrolled in this major must receive a grade of C or better, as specified in Senate Policy 82-44.



Here's the link. http://bulletins.psu.edu/bulletins/bluebook/college_campus_details.cfm?id=35&program=psybs.htm

 

[5HT2]

Hope your hungry.

Penn State



I stand humbled . That looks pretty good. It looks like Penn even has a Psychology major for those who wish to go to med school. If you successfully go through a program like that, then you’ve probably got the stuff. Then again, if you don’t, you don’t.

 

[edieb]

http://www.oregonlive.com/opinion/index.ssf/2010/02/oregon_shouldnt_permit_psychol.html

 

[maranatha]

Your 4 years of medical school were filled with classes and rotations most of which were utterly irrelevant to the practice of mental health care. Interpret many 12 lead EKGs in your residency? How about that L&D or OR rotation-- coming in handy when you treat the mentally ill?

Actually, I read an EKG earlier this week after placing a patient on Geodon.

Having experience with OB has been very helpful in dealing with my pregnant patients and understanding what is going on with them medically.

Having experience in the OR has come in handy multiple times when being consulted by surgeons for their patients with mental illness. I understand what goes on pre and post operatively and have a working knowledge of the different medications that anesthesiologists use, which can help me understand the etiology of depression, psychosis, anxiety, etc.. I also understand which procedures are more likely to cause post-operative psychosis and which labs to have the surgeons order to help figure out the cause. In the outpatient setting, I have an understanding of what my patients go through when they speak about their surgeries and the difficulties they experience navigating through the medical community. I can also appreciate whether the surgery they had is more or less likely to cause post surgical delirium versus a true decommensation of their primary psychiatric illness.

Also, just having experience working with other doctors and being able to "speak their language" is something that can't be under estimated. This is something that someone who is not in medicine may not appreciate.

A medical background gives me a unique perspective on mental illness and has been invaluable for the treatment of my patients. I feel that it gives me the ability to have a holistic view of my patients (of course, I'm including psychotherapy training and my background in the humanities before medical school).

Psychiatry is just one part of the puzzle of mental illness. Psychology brings its own strengths and is another critical part of patient care. My experience is that the best model is a team approach between psychiatrists, psychologists, nursing, and social workers. Each discipline contributes a unique perspective and, as a whole, is the best way to approach patients. I'm fortunate to work in a mental health care system that values this approach and I spend over 3 hours a week in multi-disciplinary meetings for our patients. We all respect each others perspectives and work together to come up with comprehensive plans for our patients.

I have yet to have a psychologist express some of your "psychiatry versus psychology" and "psychology is better then psychiatry" sentiments and I suppose I've been fortunate to work in a more collegial environment. I think that your statements are a sad reflection of a lack of understanding of what it takes to prescribe medications and this is concerning to me. I hope this isn't a shared view point.

Again, I'm not completely against psychologists gaining some prescribing rights, but I just hope that understanding of medicine in mental illness is better appreciated.

 

[edieb]

Actually, I read an EKG earlier this week after placing a patient on Geodon.

Having experience with OB has been very helpful in dealing with my pregnant patients and understanding what is going on with them medically.

Having experience in the OR has come in handy multiple times when being consulted by surgeons for their patients with mental illness. I understand what goes on pre and post operatively and have a working knowledge of the different medications that anesthesiologists use, which can help me understand the etiology of depression, psychosis, anxiety, etc.. I also understand which procedures are more likely to cause post-operative psychosis and which labs to have the surgeons order to help figure out the cause. In the outpatient setting, I have an understanding of what my patients go through when they speak about their surgeries and the difficulties they experience navigating through the medical community. I can also appreciate whether the surgery they had is more or less likely to cause post surgical delirium versus a true decommensation of their primary psychiatric illness.

Also, just having experience working with other doctors and being able to "speak their language" is something that can't be under estimated. This is something that someone who is not in medicine may not appreciate.

A medical background gives me a unique perspective on mental illness and has been invaluable for the treatment of my patients. I feel that it gives me the ability to have a holistic view of my patients (of course, I'm including psychotherapy training and my background in the humanities before medical school).

Psychiatry is just one part of the puzzle of mental illness. Psychology brings its own strengths and is another critical part of patient care. My experience is that the best model is a team approach between psychiatrists, psychologists, nursing, and social workers. Each discipline contributes a unique perspective and, as a whole, is the best way to approach patients. I'm fortunate to work in a mental health care system that values this approach and I spend over 3 hours a week in multi-disciplinary meetings for our patients. We all respect each others perspectives and work together to come up with comprehensive plans for our patients.

I have yet to have a psychologist express some of your "psychiatry versus psychology" and "psychology is better then psychiatry" sentiments and I suppose I've been fortunate to work in a more collegial environment. I think that your statements are a sad reflection of a lack of understanding of what it takes to prescribe medications and this is concerning to me. I hope this isn't a shared view point.

Again, I'm not completely against psychologists gaining some prescribing rights, but I just hope that understanding of medicine in mental illness is better appreciated.

I always chuckle when I hear psychiatrists say that they conduct psychotherapy. I have had 7 years of training in CBT and still do not feel fully competent. In fact, a recent study from Yale using randomly selected tapes from therapists who said they were cognitive behavioral in orientation, found that 99.8 percent were not adhering to CBT priniciples and/or were not praciticint cbt in a manner loyal to the model. However, you think you are a competent therapist after your cursory therapy training in medical school . Basically: you want to be a therapist without the extra training.

However, in your view, a psychologist who wishes to get an extra master's degree in psychopharm, should not be able to prescribe. Please explain the double standard.

Finally, just as your medical training gives you a unique perspective on mental illness, a psychologist's biopsychosocial training gives us a unique perspective. Psychiatrists tend to view mental illness as completely biological. Many researchers have demonstrated that patient's in the military who see a psychiatrist are very likely (>95%) to receive meds while those that saw a medical psychologist were much less likely to be given drugs (<50 percent). So much for that unique perspective psychiatrists have, huh?

 

[maranatha]

I always chuckle when I hear psychiatrists say that they conduct psychotherapy. I have had 7 years of training in CBT and still do not feel fully competent. In fact, a recent study from Yale using randomly selected tapes from therapists who said they were cognitive behavioral in orientation, found that 99.8 percent were not adhering to CBT priniciples and/or were not praciticint cbt in a manner loyal to the model. However, you think you are a competent therapist after your cursory therapy training in medical school . Basically: you want to be a therapist without the extra training.

However, in your view, a psychologist who wishes to get an extra master's degree in psychopharm, should not be able to prescribe. Please explain the double standard.

Finally, just as your medical training gives you a unique perspective on mental illness, a psychologist's biopsychosocial training gives us a unique perspective. Psychiatrists tend to view mental illness as completely biological. Many researchers have demonstrated that patient's in the military who see a psychiatrist are very likely (>95%) to receive meds while those that saw a medical psychologist were much less likely to be given drugs (<50 percent). So much for that unique perspective psychiatrists have, huh?

First, I was responding to the post that suggested that having a medical background makes me less qualified to prescribe medications.

Regarding your posts, I think your points are valid. I agree that psychiatrists tend to be too biological in their approach, but this trend is changing in the younger residents coming through. However, like I said earlier, I believe the best mental health care model is multi-disciplinary approach. Our patients get the best of all worlds--experienced psychiatrist and psychologists and their unique view points and input.

Regarding therapy, I completely agree that if a psychiatrist wants to be competent in therapy, then extra training is necessary. That is why I'm going through extra training in CBT with a psychologist to meet my hours to get certified through the Beck Institute. Do I think this well make me better then my fellow psychogists? No. But I think it will make me competent to effectively deliver some CBT. (Beck was an MD after all.) If its a difficult case, I'll refer to a psychologist. I have been very successful treating my patients with OCD, panic disorder, GAD, and depression. I assure you that I was using CBT as I always discuss my cases with experts in CBT.

 

[5HT2]

First, I was responding to the post that suggested that having a medical background makes me less qualified to prescribe medications.

Regarding your posts, I think your points are valid. I agree that psychiatrists tend to be too biological in their approach, but this trend is changing in the younger residents coming through. However, like I said earlier, I believe the best mental health care model is multi-disciplinary approach. Our patients get the best of all worlds--experienced psychiatrist and psychologists and their unique view points and input.

Regarding therapy, I completely agree that if a psychiatrist wants to be competent in therapy, then extra training is necessary. That is why I'm going through extra training in CBT with a psychologist to meet my hours to get certified through the Beck Institute. Do I think this well make me better then my fellow psychogists? No. But I think it will make me competent to effectively deliver some CBT. (Beck was an MD after all.) If its a difficult case, I'll refer to a psychologist. I have been very successful treating my patients with OCD, panic disorder, GAD, and depression. I assure you that I was using CBT as I always discuss my cases with experts in CBT.

That’s what much of this comes down to is respect for the depth and breadth of knowledge and training of other professional tracks. Nobody wants to see what they’ve spend 8+ years studying approached flippantly with an “Oh, I’ve already got all I need” attitude by another profession that wants to increase their menu of offerings. If I were desirous of attaining expertise in a psychotherapeutic modality, I would approach that only through training that was considered legitimate by providers who have the most psychotherapeutic training – psychologists.

 

[Doctor J 216]

Marantha, CBT is actually designed to be easy. Edieb is wrong as usual (and always angry, in case you didn't pick that up).

I had CBT supervision in residency, delivered CBT to my patients and was also involved in a large CBT trial. Manuals are not hard to learn, grad students could learn them. Anxiety disorders in particular look really bad but are actually pretty easy to treat. I'd put my CBT skills to the test anytime. As a part of research, you have to look over videotapes of the therapy sessions. I've seen plenty. Believe me, CBT never goes as pretty as it's supposed to. But it's highly reliant on homework and it does work (better than meds long run for less acute anxiety). There is an intuition that works for you after awhile in therapy that won't work in medicine.

Here is the problem with academic psychology. On the one hand, they need to advance their careers, so they come up with these elaborate and overly extensive manuals filled with unnecessary jargon without any attention to factor analysis. Bottom line, they need to stand out for the sake of grants.

On the other hand, they have to give lip service to public health endeavors. So they create these manuals and often intentionally use less experienced psychologists and grad students to do the therapy. Point being, anyone decent should be able to learn it.

So what is the evidence? There are computer programs that show good results for CBT. Pilot studies have been done teaching school staff aspects of CBT. Inexperienced therapists are used all the time by academia to run trials, still good results (although to be fair, in multi-site trials, the sites with more experienced clinicians have better results). There have been other studies that use relatively inexperienced therapists and even students delivering different types of therapy (I don't think CBT though).

So manuals are a double edged sword for therapists. They say therapy is so hard to learn and then they produce research that contradicts that. There is an emerging literature teaching paraprofessionals therapy skills.

You can learn DBT, CBT, MET if you have some background. Even the programs that teach will tell you that. I've known social workers that do better CBT than psychologists (not often, there is usually a talent gap to be honest in psychologys favor). I've known chemical dependency counselors do better MET than psychologists. One thing I will say is that therapy does require some natural gifts. If you don't got it, well...

So although that ridiculous military study that did not even support the additional training of psychologists for RX gets quoted partially all the time, there's more evidence to suggest that therapy can be done by many. As much as physicians feel threatened by non-physicians encroaching, psychologists feel even more threatened by social workers, life coaches...come to think of it, everyone thinks they are some kind of guru lately. That's America.

No wonder some psychologists are feeling the need to expand their horizons. Again, it's a fundamental problem of regulation. Like lawyers, too many schools, lack of standardization, inefficient training as compared to residency (similar years, not similar hours or content), for profit schools who take in people who wouldn't cut it elsewhere. I know foreign medical grads get knocked but at least they have to train in a US residency, not some mail in long distance self righteous correspondence program. I don't think anyone would hire me if I said I trained at the university of phoenix.

 

[edieb]

Marantha, CBT is actually designed to be easy. Edieb is wrong as usual (and always angry, in case you didn't pick that up).

I had CBT supervision in residency, delivered CBT to my patients and was also involved in a large CBT trial. Manuals are not hard to learn, grad students could learn them. Anxiety disorders in particular look really bad but are actually pretty easy to treat. I'd put my CBT skills to the test anytime. As a part of research, you have to look over videotapes of the therapy sessions. I've seen plenty. Believe me, CBT never goes as pretty as it's supposed to. But it's highly reliant on homework and it does work (better than meds long run for less acute anxiety). There is an intuition that works for you after awhile in therapy that won't work in medicine.

Here is the problem with academic psychology. On the one hand, they need to advance their careers, so they come up with these elaborate and overly extensive manuals filled with unnecessary jargon without any attention to factor analysis. Bottom line, they need to stand out for the sake of grants.

On the other hand, they have to give lip service to public health endeavors. So they create these manuals and often intentionally use less experienced psychologists and grad students to do the therapy. Point being, anyone decent should be able to learn it.

So what is the evidence? There are computer programs that show good results for CBT. Pilot studies have been done teaching school staff aspects of CBT. Inexperienced therapists are used all the time by academia to run trials, still good results (although to be fair, in multi-site trials, the sites with more experienced clinicians have better results). There have been other studies that use relatively inexperienced therapists and even students delivering different types of therapy (I don't think CBT though).

So manuals are a double edged sword for therapists. They say therapy is so hard to learn and then they produce research that contradicts that. There is an emerging literature teaching paraprofessionals therapy skills.

You can learn DBT, CBT, MET if you have some background. Even the programs that teach will tell you that. I've known social workers that do better CBT than psychologists (not often, there is usually a talent gap to be honest in psychologys favor). I've known chemical dependency counselors do better MET than psychologists. One thing I will say is that therapy does require some natural gifts. If you don't got it, well...

So although that ridiculous military study that did not even support the additional training of psychologists for RX gets quoted partially all the time, there's more evidence to suggest that therapy can be done by many. As much as physicians feel threatened by non-physicians encroaching, psychologists feel even more threatened by social workers, life coaches...come to think of it, everyone thinks they are some kind of guru lately. That's America.

No wonder some psychologists are feeling the need to expand their horizons. Again, it's a fundamental problem of regulation. Like lawyers, too many schools, lack of standardization, inefficient training as compared to residency (similar years, not similar hours or content), for profit schools who take in people who wouldn't cut it elsewhere. I know foreign medical grads get knocked but at least they have to train in a US residency, not some mail in long distance self righteous correspondence program. I don't think anyone would hire me if I said I trained at the university of phoenix.

I would like to see your reference citing that cbt is "meant to be easy. " It IS easy if you do a crappy job. The studies showing social workders and LPCs are skilled therapists are filled with flaws. For example, the studies failed to use standardized outcome measures and did not look at patient progress a year or two out. In addition, the studies did not even define what "better" was.

Manualized therapy is a joke. Most patients with psych disorders have schemas that make them vulnerable to certain situations in life. Manualized therapy does nothing to weaken these dysfunctional schemas and build more resilient ones that help the patient increase his/her resilience and reduce likelihood of relapse. This process takes at least a year after active symptoms are reduced.

In addition, to do good cbt you must know the most recent cognitive theories for every disorder and the cognitive underpinnings of things like rumination and worry. Otherwise, you are not able to properly hypothesize the patient's triggers and maintaining factors. Manualized therapy does nothing for this. Don't even get me started on co-morbid disorders and manualized therapy's failure to address this.

DId you conducted the schema-based portion so the patient didn't relapse? -- not if you did therapy from a manual. Did you build patient resilience? not if you did manualized therapy. I know the answer to this is "no".

Speaking to your bashing of psychology grad programs, I need to point out that you can obtain an M.D. or D.O. in many third world countries, such as Grenada. That does not speak well to standardization of the medical education system. While I do agree that some psychology programs are not good, I also know that these "pay for your M.D." programs are not any better.

You are just upset because psychiatry is a dying field: residency positions go unfilled. Nurse practitioners are replacing you. Your medical colleagues disrespect you.

 

[Msross]

I'm a licensed Oregon psychologist in private practice, and specifically, I am a Black psychologist. Those who are most affected by psychiatrist shortages are African Americans. According to the US Surgeon General "Racial and ethnic minorities have less access to mental health services than do Whites. They are less likely to receive needed care. When they receive care, it is more likely to be poor in quality." Further, Blacks, as reported by the Surgeon General, are “less likely to receive treatment – even less likely than the undertreated mainstream population." Although mental health services are available to most Americans, barriers exist for Black Americans. There is a term for this type of disparity. It is called institutional racism. For those White psychiatrists and White licensed psychologists in private practice who are unfamiliar with the term, it is defined as follows: “The institutional extension of individual racist beliefs consisting of using and manipulating duly constituted institutions so as to maintain a racist advantage over others.” “The intentional or unintentional byproduct of certain institutional practices that operate to restrict on a racial basis the choices, rights, mobility, and access of groups of individuals.” In a mental healthcare system dominated by white psychiatrists (who make up the minority of all mental healthcare practitioners), Black patients are less likely to receive treatment than the undertreated White mainstream population, more likely to be incorrectly diagnosed by psychiatrists and diagnosed more severely as schizophrenic, more likely to receive treatment via emergency rooms and inpatient care than through outpatient private practices, are more likely to be coerced or mandated into counseling than voluntary and self-referred, more likely to receive adverse treatment because of possible racial bias by the system as a whole. Funny thing is psychiatrist don't know this because they don't do any meaningful psychological research. Nor do they read any. It's not how they're trained (or any physician for that matter). Psychologist in general are trained as scientist-practitioners, psychiatrists are simply practitioners. The impact of the shortages of psychiatrists affects Black people disproportionately and is nothing less than institutional racism. You want to argue (without merit) public safety on prescribing practices? It creates a public health dilemma when Black people are underrepresented in the mental health profession, overrepresented in populations that have a high need for mental health services, and find extreme shortages of mental health practitioners who are capable of safely prescribing psychotropic medications. Disparities in accessibility, availability, and utilization of psychiatric services endure in a mental healthcare system that is dominated by White psychiatrists, whose implicit racist/racial biases overpathologize Black patients and influence their clinical decisions, and who face difficulty gaining trust of Black patients within a society where racism against Blacks is inescapable. Psychiatrists rarely do therapy, and when they do, they suck at it. Yes, suck. No behavioral interventions, poor knowledge of psychological instruments and psychometrics, poor interpersonal skills, deficient in creating cognitive strategies for patients, prescribe without understanding the cultural context in which behaviors occur by checking off symptoms like ingredients in a recipe, and treat patients as if they are on a conveyor belt – in and out of the office in 15 minutes or less, and rely on information received from drug reps than critically evaluating drug studies for themselves. Most psychiatrists don't even explain the risks and benefits of the very medications they prescribe. My patients tell me this all the time. They use their authority and prestige as physicians instead of educating patients on the medication in terms that they understand. Psychiatrists don't even set out to be psychiatrists. It is after they fail to qualify for more lucrative specialties do they consider psychiatry as a way of salvaging their overpriced medical education. You take away a psychiatrists ability to prescribe and you basically have an unemployable physician. Prescribing psychologist are not trying to be MDs, we seek to be better. We are better trained, better equipped, have more formal education than PAs and NP combined, are culturally competent, and don't arbitrarily medicate because we're smarter and spend more time with the patient than do psychiatrists. I am constantly calling psychiatrists informing them that the medication needs adjusting, need augmentation, needs to be switched; informing them of comorbid disorders they missed during their narrow-minded interview, informing of side effects that lead to noncompliance, drug on drug interactions (especially illicit/recreational use, herbal), explaining to their patients how the drug they prescribe works and why it works, helping patients with their apprehension and fears against taking drugs, debunking myths about psychotropic drugs; damn it, I'm doing everything but prescribing. Other physicians who can prescribe don't want the responsibility. They don't get extensive training in psychotropic medications. They don't know how to even diagnose most psychiatric disorders. I have seen OB/GYNs prescribe non-selective cyclic antidepressants to patients who were bipolar (which can induce manic episodes), pediatricians write prescriptions for ADHD medications that read "one and a half tablets" of a psychostimulant that cannot be cut in half because it's time-released, internal medicine physicians that prescribe antidepressants based on a one page depression inventory without suggesting concurrent psychotherapy, or who were willing to write the initial prescription with the understanding that "you need to find a psychiatrist to manage this medication." Other physicians have the ability to prescribe psychotropics, but lack the willingness and lack the training to do so. It's not how they're trained. They rather do what they specialized in and I don't blame them one bit. As a psychologist, I'm not trying to do social work with my patients even though I technically could. There are many licensed psychologists who do not want to prescribe. Ok. Then don't get a postdoctoral degree and education. Psychologist opposed to prescribing psychologists are protecting their practices and paychecks just as psychiatrists are. They are afraid that their lack of psychopharmacology knowledge and inability to prescribe will make their practices less lucrative. Why go to a professional who cannot meet all of your mental health needs? The difference is psychiatrists are the gas guzzlers of mental healthcare. Prescribing psychiatrists provide the necessary hybridization of clinical skills and psychopharmacological knowledge that bridges the gaps in patient care.

 

[maranatha]

The main reason I have written posts on this thread is because of what I consider to be gross generalizations and negative misrepresentation of psychiatrists. I realize that many of the people that I'm responding to have deep held resentments and obvious hostility to psychiatry that well likely not change through a few posts that I write. That's fine. My hope, however, is that the aspiring psychologists and other open-minded practicing psychologist who frequent this site and do not necessarily post will read a more balanced view of psychiatrists. Despite what has been said, most of us are not evil, money hungry, power craving people.

Why does that matter to me? First, I work in a multi-disciplinary environment along side psychologists, social workers, and nurse practitioners. I feel strongly that this is absolutely the best model for effective patient care. I guarantee that our patients get superb mental health care through our team approach. And, besides what some have implied about psychiatrists, I and my colleagues care deeply about patients with mental health diseases and feel that some of the views exposed on this site are counterproductive and potentially bad for patients.

 

[maranatha]

Prescribing psychiatrists provide the necessary hybridization of clinical skills and psychopharmacological knowledge that bridges the gaps in patient care.

I agree!!!

 

[Therapist4Chnge]

The main reason I have written posts on this thread is because of what I consider to be gross generalizations and negative misrepresentation of psychiatrists. I realize that many of the people that I'm responding to have deep held resentments and obvious hostility to psychiatry that well likely not change through a few posts that I write. That's fine. My hope, however, is that the aspiring psychologists and other open-minded practicing psychologist who frequent this site and do not necessarily post will read a more balanced view of psychiatrists. Despite what has been said, most of us are not evil, money hungry, power craving people.

Fair enough. I've been lucky to have worked with a number of great psychiatrists at a number of facilities, so I know where you are coming from. Unfortunately you all get dinged (much like psychologists) for the colleagues that don't provide adequate service.

I'm going to split my comments about ADD/ADHD, ethnicity, and gender out to a new thread.

 

[maranatha]

Fair enough. I've been lucky to have worked with a number of great psychiatrists at a number of facilities, so I know where you are coming from. Unfortunately you all get dinged (much like psychologists) for the colleagues that don't provide adequate service.

I'm going to split my comments about ADD/ADHD, ethnicity, and gender out to a new thread.

Yes. I have purposely avoided many stories about incompetent psychologists that I've had to work with (usually they are community psychologists that don't work at our facility). I'm not sure it is very productive to point my negative experiences with psychologists. It should go without saying that there is going to be bad clinicians in all fields. I too have been lucky enough to work with some great psychologists (some are mentors) and will not disparage the entire field because of some bad experiences.

 

[Doctor J 216]

I don't post often, and do so to get under Edieb's skin, because she's so far off center it's ridiculous. I feel bad for you (Edieb) though 1) because your oft edited response to my post was so feeble and 2) because I read between the lines and wonder about what kind of person would have such vitriol. The largest published CBT trials support my arguments and have 1 year followups.

Getting angry won't make you a better clinician, you're not the hulk. Hypervigilance is rarely a good trait. Edieb is like this bulletin's Rush Limbaugh, I'm just trying to neutralize so the gestalt is centered.

I agree with some of the arguments by Msross. But only 5% of psychologists are minorities, hardly a representation of cultural understanding. I trained in inner cities, worked at inner city schools. I understand the plight but bashing each others guilds is not the answer.

UCSF once ran a study because they have psych units that are split up by ethnicity. They found that when black patients were seen by corresponding ethnic clinicians, there was still a higher bias towards diagnosing schizophrenia. So the problem of bias is complex and is intertwined with SES and other variables.

 

[Msross]

I don't post often, and do so to get under Edieb's skin, because she's so far off center it's ridiculous. I feel bad for you (Edieb) though 1) because your oft edited response to my post was so feeble and 2) because I read between the lines and wonder about what kind of person would have such vitriol. The largest published CBT trials support my arguments and have 1 year followups.

Getting angry won't make you a better clinician, you're not the hulk. Hypervigilance is rarely a good trait. Edieb is like this bulletin's Rush Limbaugh, I'm just trying to neutralize so the gestalt is centered.

I agree with some of the arguments by Msross. But only 5% of psychologists are minorities, hardly a representation of cultural understanding. I trained in inner cities, worked at inner city schools. I understand the plight but bashing each others guilds is not the answer.

UCSF once ran a study because they have psych units that are split up by ethnicity. They found that when black patients were seen by corresponding ethnic clinicians, there was still a higher bias towards diagnosing schizophrenia. So the problem of bias is complex and is intertwined with SES and other variables.

While I don't agree with everything edieb states, your commitment to quality care of patients shows when you start talking about doing manualized therapy with patients and curing them. I highly doubt you are curing these people in the intermediate or the long term. I would think people committed to quality patient care are always trying to improve their sklls and would never say they master something as complex as therapy in a few months. I kind of feel bad for you (Dr J516) because you seem like a very angry, narcissistic person who is just in this for the money

Like edieb says, conducting quality CBT is very difficulty (see padesky's 2007 book, "Collaborative Case Conceptualization.") and isn't found in a manual. Edieb was spot on when s/he mentioned that most patients, especially the ones in the inner city, have multiple diagnoses and multiple stressors. You inadvertently admitted to the quality of cbt skills when you mentioned that most patients you saw did not d their homework. Quality cbt engenders a collaborative spirit where paitents willingly complete assignments or finish them in session

 

[Msross]

I don't post often, and do so to get under Edieb's skin, because she's so far off center it's ridiculous. I feel bad for you (Edieb) though 1) because your oft edited response to my post was so feeble and 2) because I read between the lines and wonder about what kind of person would have such vitriol. The largest published CBT trials support my arguments and have 1 year followups.

Getting angry won't make you a better clinician, you're not the hulk. Hypervigilance is rarely a good trait. Edieb is like this bulletin's Rush Limbaugh, I'm just trying to neutralize so the gestalt is centered.

I agree with some of the arguments by Msross. But only 5% of psychologists are minorities, hardly a representation of cultural understanding. I trained in inner cities, worked at inner city schools. I understand the plight but bashing each others guilds is not the answer.

UCSF once ran a study because they have psych units that are split up by ethnicity. They found that when black patients were seen by corresponding ethnic clinicians, there was still a higher bias towards diagnosing schizophrenia. So the problem of bias is complex and is intertwined with SES and other variables.

Quick note -- I searched for articles about cbt and how easy it is and found a few articles talking about the efficacy of manualized therapy in patients with a single, uncomplicated diagnosis (never happens in real life) but found a lot of articles backing what others have said about cbt and how effective BOTH psychiatry and psycholog are at providing them, and the findings support what eddieb was saying: http://www.apa.org/monitor/2009/03/substance.aspx

 

[Doctor J 216]

If you are knocking manualized therapy for only treating one condition at a time, you don't understand research. The whole point is to identify variables and treat them without confounders. It goes without saying that patients in the real world are more complicated. Naturalistic studies have hardly as robust results. Not going to get into it...

I don't do manualized CBT in practice. Very few do. Whether you are constructing fear hierarchies or creating exposure homework, no doubt that creativity is needed. I used manualized CBT as an example of CBT's accessibility.

You two have proven my main argument, however. Now your contradictions are plain to see for all.

I have been critical of some (not majority) psychologists' use of a public health argument for Rxp as being duplicitous. "There aren't enough doctors so even if we aren't as well versed medically, we need to help as many people as possible."

This is clearly a pro public health viewpoint. So when it comes to practicing medicine, greater access is paramount.

But when it comes to therapy (CBT being one), the notion of increasing its accessibility for the sake of public health is appalling. "you need 8+ years of training, and fasting, and catching flies with chopsticks..."

Hmm, all of the sudden, specialization and guild practice are paramount. How dare that social worker learn CBT!

The only conclusion that is reasonable is that Edieb and some others are only in favor of public health concerns if psychologists are the ones doing it. Guild issues, not patient care. I knew that was at the heart of it.

Checkmate.

Now I have to finish my presentation for a real academic exercise. Peace.

 

[Msross]

If you are knocking manualized therapy for only treating one condition at a time, you don't understand research. The whole point is to identify variables and treat them without confounders. It goes without saying that patients in the real world are more complicated. Naturalistic studies have hardly as robust results. Not going to get into it...

I don't do manualized CBT in practice. Very few do. Whether you are constructing fear hierarchies or creating exposure homework, no doubt that creativity is needed. I used manualized CBT as an example of CBT's accessibility.

You two have proven my main argument, however. Now your contradictions are plain to see for all.

I have been critical of some (not majority) psychologists' use of a public health argument for Rxp as being duplicitous. "There aren't enough doctors so even if we aren't as well versed medically, we need to help as many people as possible."

This is clearly a pro public health viewpoint. So when it comes to practicing medicine, greater access is paramount.

But when it comes to therapy (CBT being one), the notion of increasing its accessibility for the sake of public health is appalling. "you need 8+ years of training, and fasting, and catching flies with chopsticks..."

Hmm, all of the sudden, specialization and guild practice are paramount. How dare that social worker learn CBT!

The only conclusion that is reasonable is that Edieb and some others are only in favor of public health concerns if psychologists are the ones doing it. Guild issues, not patient care. I knew that was at the heart of it.

Checkmate.

Now I have to finish my presentation for a real academic exercise. Peace.

Your argument is predicated on the wrong foundation: Psychologists argue that PhD prescribing brings a different, biopsychosocial, paradigm to prescribing than psychiatry's medical viewpoint. I have never heard a psychologist say that s/he is inferior in that arena to an M.D. but, because we need prescribers, let us do it anyway. Can you show me where this was said? All I have heard are psychologists remarking how the evidence shows they are safe, effective prescribers. So much so that the U.S. government allows psychologists to currently prescribe.

 

[maranatha]

Your argument is predicated on the wrong foundation: Psychologists argue that PhD prescribing brings a different, biopsychosocial, paradigm to prescribing than psychiatry's medical viewpoint. I have never heard a psychologist say that s/he is inferior in that arena to an M.D. but, because we need prescribers, let us do it anyway. Can you show me where this was said? All I have heard are psychologists remarking how the evidence shows they are safe, effective prescribers. So much so that the U.S. government allows psychologists to currently prescribe.

No. But I've heard several times the argument that having a PhD makes you superior to prescribe medications and I think this is such a huge fallacy that it's hardly worth commenting on.

 

[silas2642]

I would like to see your reference citing that cbt is "meant to be easy. " It IS easy if you do a crappy job. The studies showing social workders and LPCs are skilled therapists are filled with flaws. For example, the studies failed to use standardized outcome measures and did not look at patient progress a year or two out. In addition, the studies did not even define what "better" was.

Manualized therapy is a joke. Most patients with psych disorders have schemas that make them vulnerable to certain situations in life. Manualized therapy does nothing to weaken these dysfunctional schemas and build more resilient ones that help the patient increase his/her resilience and reduce likelihood of relapse. This process takes at least a year after active symptoms are reduced.

In addition, to do good cbt you must know the most recent cognitive theories for every disorder and the cognitive underpinnings of things like rumination and worry. Otherwise, you are not able to properly hypothesize the patient's triggers and maintaining factors. Manualized therapy does nothing for this. Don't even get me started on co-morbid disorders and manualized therapy's failure to address this.

DId you conducted the schema-based portion so the patient didn't relapse? -- not if you did therapy from a manual. Did you build patient resilience? not if you did manualized therapy. I know the answer to this is "no".

Speaking to your bashing of psychology grad programs, I need to point out that you can obtain an M.D. or D.O. in many third world countries, such as Grenada. That does not speak well to standardization of the medical education system. While I do agree that some psychology programs are not good, I also know that these "pay for your M.D." programs are not any better.

You are just upset because psychiatry is a dying field: residency positions go unfilled. Nurse practitioners are replacing you. Your medical colleagues disrespect you.

No seriously, what is wrong with you? Psychiatry is about as far from a dying field as humanly possible-- try getting an appointment with one, it's impossible.