Clinical Psychology: Current Controversies & Directions PDF

PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE Should a Clinical Psychologist prescribe medicine for WHY CLINICAL PSYCHOLOGISTS SHOULD PRESCRIBE psychologic...

PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE Should a Clinical Psychologist prescribe medicine for WHY CLINICAL PSYCHOLOGISTS SHOULD PRESCRIBE psychological disorders? Shortage of Psychiatrists PRESCRIPTION PRIVILEGES In some states or countries, there simply aren’t enough psychiatrists to serve the Historically, the ability to prescribe medication population adequately has been one of the primary distinctions between psychiatrists and psychologists Especially in some rural areas, there is a strikingly low ratio of professionals with the However, in recent years, some clinical training and ability to prescribe psychoactive psychologists have actively pursued medications to the number of people who prescription privileges need them To contribute in the discussion about granting Underserved segments of society would prescription privileges to psychologists, the benefit from a higher ratio of prescribers to American Psychological Association published patients numerous articles endorsing prescription privileges and offering suggestions for the Clinical Psychologists are more expert than primary training of psychologist to be proficient in care physicians practicing the said privileges Asides from psychiatrists, primary care physicians (general doctors) also writes MOVEMENT TOWARD PRESCRIBING prescriptions for psychoactive medications Patrick H. De Leon, the former president of American When it comes to expertise in mental health Psychological Association, promoted the movement problems, clinical psychologist’s training is toward prescribing more extensive an specialized than physicians’ Morgan T. Sammons, a widely recognized expert on therefore, clinical psychologists could be psychopharmacology and 1 and 10 psychologists who better able to diagnose problems correctly took part in the first experimental pilot program of and select effective medications psychologists prescribing medication Other nonphysician professionals already have Along with Sammons was Robert McGrath, the prescription privileges training director of the Psychopharmacology Dentists, Podiatrists, Optometrists, and Postdoctoral Training Program in the School of Advanced Practice Nurses are among the Psychology at Fairleigh Dickinson University and professionals who are not physicians but have former president of the American Society for the some rights to prescribe medication to their Advancement of Pharmacotherapy patients The efforts on the movement toward granting Their success in this activity sets a precedent prescribing prescription privileges to psychologists for specially training clinical psychologists to resulted to the granting of the said privileges to two do the same states – New Mexico and Louisiana Especially when we consider that general Other states/areas such as Illinois, Iowa, and Idaho practitioner physicians who have limited were granted with prescription privileges as well training in psychological issues, it would be more reasonable to allow clinical psychologists to used specialized expertise for the purpose of prescribing Magnayi, Beatrice 1 PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE Convenience for Clients It has incorporated many treatment techniques that were initially unfamiliar, and in the process, the profession has thrived Without prescription privileges, clinical psychologist can provide the therapy, but they Embracing prescription privileges is seen by cannot provide the medication to their many as the next logical step in the patients progression. To stand in its way, some argue, is to impede the evolution of the field Patients needing drugs would be referred to a physician or a psychiatrist to be evaluated for Revenue for the profession medication The profession and its members stand to benefit financially from prescription privileges This process is time consuming a is costly. as well They would have to pay double for consultations In fact, strong opposition to the prescription privilege movement has emerged from In addition, it would also require the two psychiatrist organizations, whose members already busy mental health professionals to stand to lose business if psychologists gain the communicate consistently with each other ability to prescribe about their clients WHY CLINICAL PSYCHOLOGISTS SHOULD NOT Professional Autonomy PRESCRIBE With prescription privileges, clinical psychologists can feel capable of Training Issues independently providing a wider range of Experts are arguing that for a comprehensive services to their clients understanding of everything involved in a prescription decision, prescribers need These prescription privileges give the clinical something close to full-fledged medical school psychologists the ability to treat the physical training so that they could appreciate the and psychological aspects of their clients’ potential impact of a drug on the multiple difficulties autonomously, without relying on systems of the body, the possibility of drug psychiatrists or other physicians interactions, and all other medical factors Professional Identification Others have argued that with far less training, In the eyes of the general public, psychologists clinical psychologists could gain a basic may be difficult to distinguish from other non- competence in psychopharmacology prescribing therapists or counselors such as licensed professional counselors, social This shows that the pharmacology training for workers, and the like clinical psychologists is not entirely resolved as is currently undergoing discussions and The ability to prescribe immediately sets debates psychologists apart from other professions Threats to Psychotherapy Evolution of Profession Some have wondered if we will see a drift Clinical psychology has undergone many within the profession from “talk therapy” to significant changes in its brief history pharmacological intervention Clients may come to expect mediation from clinical psychologists, and clinical Magnayi, Beatrice 2 PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE psychologists may discover that prescribing is This lack of uniformity between therapies is a problem more profitable than psychotherapy in terms of replicating the therapy to same issues or cases The way psychologists understand and intervene with their clients may Evidence-Based Practice is an approach to fundamentally shift from an appreciation of clinical practice that integrates the best behavioral, cognitive, or emotional processes available evidence with clinical expertise and to symptom reduction via pharmacology patient values and preferences Identity Confusion Manualized therapy refers to a structured and Granting psychologists prescription privileges standardized form of psychotherapy where could lead to the emergence of identity crisis specific treatment protocols or manuals guide in the clinical psychology profession the therapist through the therapeutic process Some clinical psychologists will prescribe, EVIDENCE-BASED PRACTICE PROCESS whereas others won’t Formulating a clinical question Some may have been trained during graduate Searching for and appraising relevant school; others may have returned for evidence specialized training long after they gained their doctoral degrees Applying the evidence to clinical practice The Potential Influence of the Pharmaceutical Assessing the outcomes and making Industry adjustments as needed Reports of drug companies’ attempts to increase profit – by offering gifts to MANUALIZED THERAPY CHARACTERISTICS prescribers, funding research, and controlling Structured Format: Therapy sessions follow a the publication of research results have predetermined structure outlined in a manual. become widespread Specific Techniques: The manual includes If psychologists prescribe, they will inevitably specific therapeutic techniques and find themselves targeted by the interventions. pharmaceutical industry and will be pressured to consider factors other than client welfare Treatment Fidelity: Therapists are expected to when making prescription decisions adhere closely to the manual to ensure consistency and standardization. EVIDENCE-BASED PRACTICE/MANUALIZED THERAPY Pros and Cons of Manualized Therapy During the 1970s, in doing psychotherapy, you and the Research Standardization: Manualized other therapists are each assigned a certain number of therapy facilitates consistency in research clients and are instructed simply to provide therapy to studies, allowing for better evaluation of them treatment outcomes. The instructions are no more specific or detailed than Training and Replication: It provides a clear that framework for training therapists and allows As a result, the therapy done at that time varies for the replication of interventions in different widely from one client to the next and from one settings. therapist to the next Magnayi, Beatrice 3 PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE Flexibility Concerns: Some argue that that a potentially incompetent or detrimental manualized therapy may limit the therapist's therapist will be educated in treatments with ability to tailor treatment to individual client demonstrated effectiveness needs. Decreased reliance of Clinical Judgement Overemphasis on Structure: Critics suggest Clinical judgment can be susceptible to bias that excessive structure may hinder the and, as a result, quite flawed therapeutic relationship and spontaneity. When subjective, personal judgment of this ADVANTAGE OF EVIDENCE-BASED type is applied to therapy decisions, the PRACTICE/MANUALIZED THERAPY outcome of therapy can be compromised Scientific Legitimacy Manualized therapies can lessen the reliance In the past, each psychologist provided his or on clinical judgment and replace these her own unique, “homespun” form of components of therapy with evidence-based psychotherapy for a particular disorder techniques, outcome may be enhanced Such inconsistency hardly seems appropriate DISADVANTAGE OF EVIDENCE-BASED for a discipline that calls itself a science PRACTIVE/MANUALIZED THERAPY We expect such standards of treatment from Threats to the Psychotherapy Relationship medical doctors treating physical diseases, Although some of “what works” in therapy is and if clinical psychology subscribes to the attributable to specific techniques that medical model of diagnosis and treatment, therapists employ, a greater proportion of the same expectation should apply to our field therapy’s success is due to the quality of the as well therapeutic relationship (or “alliance”) between the therapist and the client Establishing Minimal Levels of Competence Inevitably, if all clinical psychologists are Therapy manuals typically don’t emphasize allowed to practice their own unique brands this relationship; instead, they tend to of therapy, a few of them will be ineffective or emphasize technique. In other words, they even harmful to clients generally overlook “how” therapists relate to their clients in favor of “what” therapists do However, as manualized, evidence-based with (or to) their clients treatments are disseminated and used by clinical psychologists, their presence ensures Diagnostic Complications that a potentially incompetent or detrimental Each evidence-based treatment manual therapist will be educated in treatments with targets a particular disorder or issue demonstrated effectiveness Such specificity is at the heart of testing Training Improvements specific treatments for specific disorders Inevitably, if all clinical psychologists are In fact, when manualized treatments are allowed to practice their own unique brands tested in clinical trials, the clients who are of therapy, a few of them will be ineffective or allowed into the study are those with the even harmful to clients target problem—for example, panic However, as manualized, evidence-based disorder—and without other complicating treatments are disseminated and used by factors clinical psychologists, their presence ensures Magnayi, Beatrice 4 PSYCH15X CLINICAL PSYCHOLOGY: CURRENT CONTROVERSIES BSP 221A & DIRECTIONS NATIONAL UNIVERSITY - LAGUNA | ADRIAN CHRISTIAN D. PUGATE This means that the manualized therapy may In considering the disorders, they review research and not work well with those clients with solicit feedback from practicing professionals comorbidities Despite the rigorous process that they are doing in Restrictions on Practice considering the disorders, their decisions still cause To some, the evidence-based significant controversy among those who believe that practice/manualized therapy movement has many of today’s disorders actually describe normal life suggested that the only therapies worth experiences – unfortunate or unpleasant experiences, practicing are those with empirical support certainly, but nothing that warrants a label of mental disorder In other words, if a therapy is not on the list of evidence-based treatments, it is unfounded and should be avoided In the “advantages” section above, a decreased reliance on personal, clinical judgment was praised, but if empirical support trumps personal decision making completely, the therapist’s role may include little more than the routine application of prescribed techniques Debatable Criteria for Empirical Evidence Others have argued that the criteria are biased in favor of more empirically oriented therapies (e.g., behavioral and cognitive), while therapies that produce less easily quantifiable results (e.g., psychodynamic or humanistic) are shut out OVEREXPANSION OF MENTAL DISORDERS In a long period, the Diagnostic and Statistical Manual has vastly increased since its inception in the 1950s Correspondingly, the number of people with mental disorders has climbed OVERDIAGNOSIS This climb in mental disorder rates goes by many names: overdiagnosis, diagnostic expansion, diagnostic inflation, diagnostic creep, medicalization of everyday problems, false positives, and in severe cases, false epidemics EXPANDING THE DSM The authors of the DSM spend significant time and energy considering every proposed disorder Magnayi, Beatrice 5