Response to questions posed by the Bulletin

APA has taken a position of promoting prescription privileges for psychologists. I support that decision and have supported the effort with advice and consultation. The issues have been debated and assessed in great detail in our journals, over the internet, and at conventions.  I am convinced that prescribing is feasible with a reasonable amount of education and practical training. The regulatory, ethical, and other practical issues can easily be dealt with. I am also convinced that prescribing indeed can be done in a psychological context. Prescribing psychologists will be different providers than psychiatrists.

As I see it, the major issue is that we must go into this new area with a goal of education and service of high quality and integrity.  We do not want to set up programs and credentialing that are shoddy, easy for anyone to attain, and not safe for the protection of the public.  I think we are moving in the right directions to assure that we will have high quality prescribing psychologists.  APA has developed carefully considered fundamental documents regarding education and training.  The levels one, two and three model curricula are well thought out and thorough. The model legislation should help states pass laws that have some uniformity and consistency in levels of practice. In addition, a model licensure law was developed.  I served on the Board of Educational Affairs when these curricula and the model law were being developed.  I was a member of a cross directorate group that looked at these products from the perspectives of science, education, public interest, and practice and made modifications that, I believe, strengthened the end products.

Currently, APA is in the process of creating a psychopharmacology exam that can be used for licensing prescribing psychologists or for certification of psychologists for psychopharmacological consultation.  I have been attending the meetings of the committee that is constructing the exam as a liaison from the Association of State and Provincial Psychology Boards, for whom I serve a chair of the licensing Examination Committee.  My impressions are that the process that has been set up, the experts who have been assembled, and the content outline that has so far been drafted, are indications of serious purpose. The committee’s clear intent is to put together a thorough and tough examination.

Prescription privileges have been a divisive issue in psychology.  The debate has been heated. Surveys consistently show that the majority of psychologists support the prescription privilege effort. The majority is smaller among academics, but still the majority.  The primary issue that I hear is a fear that prescriptive training will fundamentally alter the practice of psychology and psychology education and remove us from our psychological research tradition.  I am not fearful.  If psychology’s legislative experience with licensing laws, freedom of choice laws, et cetera teaches us anything, it is that this process is likely to evolve over they next couple of decades.  I see it as a series of experiments.  We will have trial runs in one or two states.  We will see how it works and we will change our laws or try a new experiment in the next state.  I find it hard to imagine that all of professional psychology will be involved in prescription training at any point.  We will have two types of psychologists for the foreseeable future.  Psychology as a science and profession has been going in an increasingly biological direction for years and prescription education will be a specialized extension of this direction.

 Fifty years ago psychologists fought among themselves over the issue of whether we should expand our practice into psychotherapy. Many argued that psychotherapy was properly the domain of psychiatry and we should properly restrict ourselves to limited forms of counseling and retain our strength and integrity as mental testers.  There was a great concern that we would be fundamentally changed as a profession and loose our assessment tradition.  We expanded our practice in spite of the opposition, we were changed, and we all survived it.  Psychologists fought with each other over accreditation and over licensing.  It was argued that accreditation and licensing would restrict our academic freedom and impose professional standardization. Some psychologists testified in legislatures again licensing. We achieved accreditation and licensing, we were changed again, largely for the better, and we survived it all.  We’ll probably achieve prescription privileges for those who want it, we will be changed as a profession, and we will survive it.

Department of Psychology at University of Houston
Comments to: lprehm@uh.edu