🚀 go-pugleaf

In regards to this debate being relegated to a "training issue," I have to
disagree with those who feel that we can simply be trained with the
appropriate knowledge base to prescribe.  I work in a clinic site that has,
in my opinion, done extremely well in adopting a multidisciplinary approach
to medical problems in general, particularly in adding
Psychology/Psychiatry to traditionally "medical" specialty clinics, such as
endocrinology and pain management.  We as psychologists and psychiatrists
work as equal members of a team which includes other MD's and specialists,
such as Nurse Educators, Dieticians, etc.  Psychotherapy in many different
contexts is done as standard part of the treatment protocols, in
conjunction with med management and education.

Having said that, I work side by side with Psychiatrists who not only do
therapy, but also handle psych meds if needed in addition to other
medications, as is often necessary.  Even in the realm of medicine,
subspecialists know the medications used in their area and will, if they
are responsible, consult others with more experiene, such as psychiatrists
for psych meds.  As any psych extern/intern/post-doc can, at least here,
attest to, any of us who have been involved in, for example, affective
disorders clinics, can get pretty good and saying that such and such
patient would do best with Prozac vs. Paxil vs. a TCA, etc. in general
agreement with the psychiatrists.  However, there are many cases where
other medications are being used or other "medical" factors need be
considered and incorporated into the treatment plan.  So that knowledge of
pharmacology is not sufficient.  One would also need to know anatomy,
biochemistry, physiology, neurology, etc.  In other words, a basic MD
curriculum.  Even then, no first year resident would be trusted to make
medication decisions alone.

So yes, I agree that further training would allow us to have the requisite
knowledge to prescribe, but that training would be an MD training plus a
few years of residency added onto our PhD, not the 1 or 2 years post PhD
that have been talked about.  While some MD's might prescribe according to
what's new or popular, this is certainly not my experience, and most
reputable doctors of any kind, including PhD's, would use only those
therapies, medication or otherwise, that have shown some efficacy and after
ruling out possible iatrogenic effects, etc.  We as a field certainly have
no right to be calling for such data on medications and their efficacy when
MOST of us are trained in and practicing therapies that have little to no
empirical support.  Only a handful of therapies, for example, meet the APA
advisory committees recommendations as to what constitutes an empirically
validated treatment.

Secondly, I sit on our admissions committee and review incoming
applications for our graduate program.  One pattern I've noticed is that in
a great number of applications, one reads the personal statement which
describes in great detail how someone came to clinical psychology over
medicine because of his or her belief in therapy or dedication to research,
etc. and look in the transcript to see that coincidentally, their freshman
and sophmore forrays into chemistry and biology (i.e. premed classes)
weren't exactly noteworthy.  Not that this is indicative of everyone in our
field, but it certainly gives cause for pause when considering such issues
as prescription privileges.  I certainly would not want someone who did not
have a relatively comprehensive understanding of biochemistry to be giving
me medications.

Finally, I have to concur with whomever responded regarding CBT oriented
vs. dynamically oriented theory in regards to the role of medication.  As I
mentioned earlier, I work in a clinic where both therapy and medication are
equally valued as parts of an overall approach.  There are plenty of
patients for whom therapy alone does not work and plenty for whom
medication
alone does not work  There is no philosophical inconsistency in viewing
both as tools to use in order to help someone.  Insulin alone does little
good if said person is engaging in other harmful behaviors; Prozac alone
does little good if said person is similarly still engaging in harmful
behaviors.I would not deny someone suffering from severe Depression a
psychotropic medication any more than I would a Diabetic Insulin.  But both
also benefit from therapy and social support.

(Sorry that was so long...)

Norman Kim
UCLA Department of Psychology