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I have to admit I am getting a little bit annoyed with psychologists saying the are anti-RxP, or that psychologists should not deal with meds etc... What planet are you practicing in? If you don't want to prescribe then don't get the further training to do so; you have that choice. I have never heard a nurse say they do not think there should be NPs!!
My belief is that people are intimidated by the prospect of seemingly not knowing anything about the bio part of the bio-psycho-social model we are all supposedly adhering to. So if they don't want to learn it then nobody should because it will make them look bad. Why be against something that is at best optional?? It is like being against neuropsych because you don't know anything about it..........sigh.
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Yes, but most people operate and take stances on things based on how they will effect them not for the greater good. Most people won't admit they do this. Psychology has to grow and evolve to even be protectable.
 
psisci said:
I have to admit I am getting a little bit annoyed with psychologists saying the are anti-RxP, or that psychologists should not deal with meds etc... What planet are you practicing in? If you don't want to prescribe then don't get the further training to do so; you have that choice. I have never heard a nurse say they do not think there should be NPs!!
My belief is that people are intimidated by the prospect of seemingly not knowing anything about the bio part of the bio-psycho-social model we are all supposedly adhering to. So if they don't want to learn it then nobody should because it will make them look bad. Why be against something that is at best optional?? It is like being against neuropsych because you don't know anything about it..........sigh.
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Have you considered writing a letter describing your thoughts to your state psychological association? Perhaps they'll run it in the next newsletter? I agree that psychology as a profession has failed to keep up with the explosion of knowledge from the neurosciences in general and psychopharmacology in particular. Most of the psychologists who say they are "anti-RxP" are either dinosaurs deeply rooted in their Freudian or Skinnerian traditions or students/interns/post-docs/psychologists who fear the added responsibility that comes with RxP. Why these folks are trying to put a stick in the RxP legislative wheel is ignorant and just plain stupid.

Clinical psychology programs adhere to an antiquated training model and teach solely psychosocial treatments. Neurosciences, psychopharmacology, and courses on biological bases of behavior are heavily neglected in most training programs. Sadly, clinical psychology PhD programs, in all their ivory tower glory, have failed to recognize that what they are teaching their students is outdated and last resort in today's managed care environment. Oddly, PsyDs seem to be uniquely poised to lead the RxP movement for psychology, as they have played a major role in getting RxP legislation passed in NM and LA, and tend to be more concerned about the practitioner aspect of clinical psychology training.

People in favor of RxP need to be heard. Write letters to your state association, government officials, etc. Psychology needs RxP to remain viable in today's healthcare system. Otherwise, psychologists will be nothing more than overtrained social workers.
 
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Exactly!! Thank you. I just joined my state association because they are very pro RxP and training improvements!!

:)
 
I am in complete agreement with Jon Snow.

My graduate department placed a strong emphasis on biological bases of behavior, and it contained not only a behavioral neuroscience but also a behavioral genetics program. Several of the clinical students focused their research on psychophysiological research (e.g., EEG, ERPs), the interplay between phenotype and genotype, the role of HPA Axis reactivity in psychopathology, and novel applications of neuroimaging (e.g., fMRI and treatment response). Not surprisingly, several of the faculty members were focused on the same. Yet surprisingly, not every student in the clincial program has gone on to pursue a research career. So basically, here are examples of practicing clinical psychologists who are well trained in a biopsychosocial approach.

Otherwise, I am also in agreement about the reasons why pursuit of RxP is a detriment to our field. Without restating all of it, I would only add that I believe strongly in expanding our scope of practice. But I don't believe that it should be in the area of RxP. Rather, I think we should be pushing much more to demonstrate to our colleagues that what we do best (in my opinion, assessment and behavioral treatment) should be more broadly applied.

For example, I believe that there is a place for psychology on an acute inpatient unit, and that the evidence supporting the use of adjunctive brief behavioral interventions for severe mental illness might go a long way in reducing rehospitalization rates (or at least prolonging periods in between hospitalizations). However, how many inpatient units can you identify that employ psychologists?

Edited to Add: I do accept the reality that RxP are here to stay. But with that said, I disagree with the amount of effort put forth by the APA, in particular, to fight for the cause. Those who want to pursue this privilege have the right to do so, and I think that they are the ones to advocate for themselves (e.g., through whatever section of the APA represents RxP). But APA is supposed to advocate for all psychologists (not just clinical, actually), and it is disheartening to see their entire agenda be hijacked by this one issue. I, for one, haven't paid my APA dues in quite some time.
 
I am not an APA member either. I am glad your training was so good, and that is how it should be. However, this is the exception to rule in alot of places now, and YES PsyD programs have made this even worse. The basic PhD/PsyD program in clinical psych is very lacking in basic sciences, neuroanatomy/phsyiology, and clinical medicine at the expense of PCish courses, and other antiquated subjects.
 
psisci said:
I have to admit I am getting a little bit annoyed with psychologists saying the are anti-RxP, or that psychologists should not deal with meds etc... What planet are you practicing in? If you don't want to prescribe then don't get the further training to do so; you have that choice. I have never heard a nurse say they do not think there should be NPs!!
My belief is that people are intimidated by the prospect of seemingly not knowing anything about the bio part of the bio-psycho-social model we are all supposedly adhering to. So if they don't want to learn it then nobody should because it will make them look bad. Why be against something that is at best optional?? It is like being against neuropsych because you don't know anything about it..........sigh.
Click to expand...

100% agreement.
 
[QUOTE=PublicHealth]Have you considered writing a letter describing your thoughts to your state psychological association? Perhaps they'll run it in the next newsletter? I agree that psychology as a profession has failed to keep up with the explosion of knowledge from the neurosciences in general and psychopharmacology in particular. Most of the psychologists who say they are "anti-RxP" are either dinosaurs deeply rooted in their Freudian or Skinnerian traditions or students/interns/post-docs/psychologists who fear the added responsibility that comes with RxP. Why these folks are trying to put a stick in the RxP legislative wheel is ignorant and just plain stupid.

Clinical psychology programs adhere to an antiquated training model and teach solely psychosocial treatments. Neurosciences, psychopharmacology, and courses on biological bases of behavior are heavily neglected in most training programs. Sadly, clinical psychology PhD programs, in all their ivory tower glory, have failed to recognize that what they are teaching their students is outdated and last resort in today's managed care environment. Oddly, PsyDs seem to be uniquely poised to lead the RxP movement for psychology, as they have played a major role in getting RxP legislation passed in NM and LA, and tend to be more concerned about the practitioner aspect of clinical psychology training.

People in favor of RxP need to be heard. Write letters to your state association, government officials, etc. Psychology needs RxP to remain viable in today's healthcare system. Otherwise, psychologists will be nothing more than overtrained social workers.[/QUOTE]

100 % agreement. Unfortunately, many psychologists are already functioning as over trained social workers. They do not understand why psychologists would want to do “medical training” or why it would be important. We are not a threat to them or psychiatrists. I agree with psisci, it shouldn’t be a fight. We have had turf battles with psychiatrists for 50 years, and psychologists almost never agree on anything. And as we know, the best indicator of future behavior is …….kinda sucks.

The whole malpractice concern is a non-issue. Contact the APA insurance program, Trust Risk Management Services. Prescribing psychologists have not received an increase in their mal practice premiums. If malpractice goes up for prescribing psychologists in the future, it will not be much. I have several friends who are psychiatrists, their malpractice is around $2,500 for the 1 million/3 million. My malpractice is $1,000 or so for the 1 million/3 million. Were not talking about 15-20 thousand a year in malpractice. Most don’t realize this.

It seems like every psychologist could benefit from RxP training, whether or not they ever prescribe.
 
psisci said:
Amen! Your last statement I agree with the most!!
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Anatomy, neuroanatomy, pharmacology, psychopharmacology, differential diagnosis, ethical issues, when to refer/when not to, medical conditions masking as psychological disturbance, psychological disturbance masking as a medical condition, physiological/behavioral changes as related to medications and or medical conditions, what meds are capable of, what they are not capable of, what conditions are best with therapy, meds, or both. What psychologist couldn’t benefit from this? We can’t practice psychology in a vacuum. We claim to be interested in integrated and collaborative care, well, its time to learn the language.
 
Jon Snow said:
I don't know about you, but those issues have all been primary training points for me and everyone associated with programs I've worked in. Check at Div. 40 internship sites, for example. Many require participation in neuropathology. Div 40 postdocs often require medical school neuroanatomy. Grad programs with behavioral neuroscience focus often require pharmacy courses. Neurotransmitter interactions are important in understanding the progression of many conditions (e.g., distribution of 5HT receptor sites, neurotransmitter interactions in the motor pathways of the basal ganglia, what neurotransmitters impact prefrontal cortex function, and so on).

I agree that every psychologist should have neuroscience training.
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True, but shouldn't the training begin at the predoctoral level? Why not have a "medical psychology/prescribing psychologist" track for clinical psychology graduate students?
 
What about physical assessment?
 
psisci said:
I have to admit I am getting a little bit annoyed with psychologists saying the are anti-RxP, or that psychologists should not deal with meds etc... What planet are you practicing in? If you don't want to prescribe then don't get the further training to do so; you have that choice. I have never heard a nurse say they do not think there should be NPs!!
My belief is that people are intimidated by the prospect of seemingly not knowing anything about the bio part of the bio-psycho-social model we are all supposedly adhering to. So if they don't want to learn it then nobody should because it will make them look bad. Why be against something that is at best optional?? It is like being against neuropsych because you don't know anything about it..........sigh.
Click to expand...

An excellent post! Thank you for posting with eloquence and logic. You did a great job summing up what I've been saying for a long time.
 
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PsychEval said:
We can’t practice psychology in a vacuum. We claim to be interested in integrated and collaborative care, well, its time to learn the language.
Click to expand...

And how would you recommend that psychologists and psychologists-in-training do that? Does a postdoctoral Master's degree in Clinical Psychopharmacology suffice?
 
New Mexico and Louisiana psychologists who complete requisite postdoctoral training in clinical psychopharmacology have prescriptive authority. However, the curriculum for the Clinical Psychology Ph.D. programs at the University of New Mexico and Louisiana State University seem to be lacking desperately in medical science education:

http://psych.unm.edu/grad_clinical.htm

http://www.lsu.edu/psychology/graduate/Clinical.html#c

Either they haven't updated their websites or their training models. Is the American Psychological Association holding these programs to adhere to the traditional "APA-accredited" training model in order to appease "anti-RxP" proponents in these states? I'm curious to know what a "medical/clinical practicum" entails.

Anyone a student at either of these programs?
 
Hey,

I am a 4th year Ph.D. clinical psychology graduate student at Louisiana State University, Baton Rouge. The director of the program tried to change the doctoral program structure to include pre-doctoral RxP training, but this idea was rebuffed by the APA. As a result, the training model here has not changed in 10 years. We have almost no exposure to the bio bases of behavior.

I will say this: One of the only reasons the RxP bill passed was the involvement of the graduate students. I think it is great that we debate RxP on these boards, but debate is not enough. It is very important to become a member of your state psych association, the APA and Division 55.

Here is an interesting article on RxP from NM:
http://www.nmpa.com/displaycommon.cfm?an=1&subarticlenbr=4



PublicHealth said:
New Mexico and Louisiana psychologists who complete requisite postdoctoral training in clinical psychopharmacology have prescriptive authority. However, the curriculum for the Clinical Psychology Ph.D. programs at the University of New Mexico and Louisiana State University seem to be lacking desperately in medical science education:

http://psych.unm.edu/grad_clinical.htm

http://www.lsu.edu/psychology/graduate/Clinical.html#c

Either they haven't updated their websites or their training models. Is the American Psychological Association holding these programs to adhere to the traditional "APA-accredited" training model in order to appease "anti-RxP" proponents in these states? I'm curious to know what a "medical/clinical practicum" entails.

Anyone a student at either of these programs?
Click to expand...
 
I think the MS program suffices for didactic, but there needs to be an applied component to the training. It is often said that the residency makes the doctor, not the MD, and it is the same for us. The training is good, but I learned 100X more in my medical psych post-doc than I did in school.
 
psisci said:
I think the MS program suffices for didactic, but there needs to be an applied component to the training. It is often said that the residency makes the doctor, not the MD, and it is the same for us. The training is good, but I learned 100X more in my medical psych post-doc than I did in school.
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Where did you complete your post-doc? Are you referring to a postdoctoral clinical psychopharmacology program?

Judging by this comparison of postdoctoral clinical psychopharmacology programs, practicum training is lacking:

http://www.division55.org/pdf/ProgramComparisons.pdf

It's great to have the coursework, but what about practical experience? Does this depend on State requirements?
 
PublicHealth said:
Where did you complete your post-doc? Are you referring to a postdoctoral clinical psychopharmacology program?

Judging by this comparison of postdoctoral clinical psychopharmacology programs, practicum training is lacking: http://www.division55.org/pdf/ProgramComparisons.pdf

It's great to have the coursework, but what about practical experience? Does this depend on State requirements?
Click to expand...

???


http://www.cps.nova.edu/programs/psypharm/Practicum.htm - NOVA
http://www.zianet.com/jamesthomp/practicumManual.doc - SIAP
http://www.rxpsychology.com/crsstudy.htm – Fairleigh Dickinson
 
PsychEval said:
???


http://www.cps.nova.edu/programs/psypharm/Practicum.htm - NOVA
http://www.zianet.com/jamesthomp/practicumManual.doc - SIAP
http://www.rxpsychology.com/crsstudy.htm – Fairleigh Dickinson
Click to expand...

Yeah, but 80 hours and 100 patients? That seems woefully inadequate given the complexity of pharmacotherapy and medical knowledge required to fully understand and treat psychiatric illness. Psychiatrists endure years of training before they are able to prescribe psychotropics and manage psychiatric disorders. Taking a bunch of on-line courses and then shadowing a psychiatrist for two weeks? Give me a break.
 
PublicHealth said:
Yeah, but 80 hours and 100 patients? That seems woefully inadequate given the complexity of pharmacotherapy and medical knowledge required to fully understand and treat psychiatric illness. Psychiatrists endure years of training before they are able to prescribe psychotropics and manage psychiatric disorders. Taking a bunch of on-line courses and then shadowing a psychiatrist for two weeks? Give me a break.
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Come on, everyone knows psychiatrists have one of the lighter residencies. Not to mention, how many years of training did the family doc get in treating the mentally ill before prescribing an anti-psychotic?
 
PsychEval said:
Come on, everyone knows psychiatrists have one of the lighter residencies. Not to mention, how many years of training did the family doc get in treating the mentally ill before prescribing an anti-psychotic?
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How commonly do family docs prescribe antipsychotics!?

Whether psychologists can be trained to prescribe safely and effectively is an empirical question. One can argue about training, access, safety, effectiveness, and so on, but without data, we cannot know whether psychologist RxP is a good idea. Much of the literature on psychologist RxP refers to the DoD Psychopharmacology Demonstration Project as evidence for safety and effectiveness of psychologist prescribing. However, the DoD psychopharmacology training model is different from the current training model proposed by the American Psychological Association. Whether the APA training model will produce safe and effecive prescribing psychologists is not clear. Hopefully, folks in NM and LA are collecting data. At the very least, such data may spur psychologist RxP legislation efforts in other States.

Latest on psychologist RxP from NM: http://www.rld.state.nm.us/b&c/psychology/RxP Rules/Rules.htm
 
I do not think the 100 pt model is very good. What if you see 90 depressed folks and no complicated cases? The best model to train psychologists to prescribe is to put them in primary care settings seeing patients referred by MD's. I do this for my job. I do not prescribe, but I make all the psychopharm decisions. In this setting I see something new every day...do this for a year, and you will be much better prepared to prescribe. I really wish the almighty APA could spend some of its time focusing on the "integrated behavioral health in primary care model", as it has been proven effective. Docs are happy to have someone who is a good psychopharmacologists direct them with patients who need meds, and are happy to order labs etc.. when asked. Midlevels are even more appreciative! RxP is one issue, but integrated care is really the model of the future.
 
In rural areas, pcp’s are forced to take care of nearly everything. In a small town, there is no developmental pediatrician, no rheumatologist, and certainly no psychiatrist.

It seems we are working under a model that assumes physicians are the safest of those who prescribe. Show me the data. At least once a month I hear of a pharmacist calling the hospital because he/she has caught a potential lethal interaction before the meds were distributed. A cattle call model of pt care lends itself to mistakes, potentially lethal mistakes. My impression is that psychologists, as a group, are thorough, spend considerable time with patients, and are extremely conscientious. Among the big 5 personality factors, conscientiousness is the most stable over time.
Therefore, it seems those who prescribe, will likely be very careful (even a little perfectionistic, neurotic, and obsessed), knowing that they will not get away with a mistake caught by the local friendly pharmacist. There are a lot of people watching this unfold.

I am not referring to anyone on this forum, but as related to what psychologist can be trained to do, I am amazed at the lack of self esteem and confidence within our professional community. It seems there is an abundance of psychologists with a FSIQ of 130, and a whole lot of insecurity. Sigh..
 
I totally agree, and have created a new diagnosis called "PhD syndrome" ;)
 
psisci said:
I totally agree, and have created a new diagnosis called "PhD syndrome" ;)
Click to expand...

Sell this idea to a drug company, "validate" the diagnosis, and reap financial rewards!
 
PublicHealth said:
Sell this idea to a drug company, "validate" the diagnosis, and reap financial rewards!
Click to expand...

I have noticed those of us with just a little healthy touch of 4-9 do not have the syndrome.
 
psisci said:
I totally agree, and have created a new diagnosis called "PhD syndrome" ;)
Click to expand...

I love it. I suspect those without the syndrome make more money (or will in the near future). What's this, a confident, knowledgeable, and decisive psychologist who works closely with my family physician. You are very different than my last therapist of 10 years! He was nice, but it didn't really help.


No wonder patients find this new type of psychologist amazing.
 
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