Prescription Privileges for Psychologists

by Edward Dreyfus, Ph.D.

When the issue of prescription privileges was first being debated, I found myself arguing against having the privilege on the grounds that it would medicative psychology. However, as the months have passed I find that I have done a 180 degree shift in my thinking. It is not that I necessarily want the privilege for myself. Rather, I have widened my perspective from that of a simple, perhaps naive, practitioner wanting to provide psychological services to those in need. I have begun to look at the issue from the perspective of a realistic clinical psychologist/business man with an eye on the future of the profession.

When psychiatrists abandoned the practice of psychotherapy in favor of a bio-medical approach to emotional disorders, clinical psychologists should have moved in to fill the void. We should have presented ourselves to the consumer (individuals and businesses) as the "doctors" of choice for the diagnosis and treatment of psychological, emotional and behavior al difficulties. We should have promoted our psychological knowledge and research, multiple clinical skills, in the areas of psychodiagnosis, psychopathology, psychological theory, neuropsychology, consultation, as well as individual, marital, and group psychotherapy. Instead, we merely promoted ourselves as psychotherapists along with many other master's level professionals who also provide psychotherapy -- and do so at a much lower price. In so doing, we reduced ourselves to a single skill profession that could not prove that its doctoral level psychotherapists were any more proficient than the master's level practitioners.

Then came another opportunity when managed care came along. Rather than taking charge of the direction it would take by forming psychologist-owned managed care organizations and preferred provider panels as we had the opportunity to do under the leadership of then-president of APA, Nicholas Cummings, we resisted. We thought that managed care would simply go away. It hasn't.

Now we have yet another opportunity. This time it is prescription privileges. With prescription privileges, clinical psychologists will have another opportunity to take a leadership role in the practice of health care delivery. We will have greater political and economic clout with managed care organizations. We will have to be recognized as the pre-eminent providers of psychological services with the ability to utilize all of our psychological expertise in such areas as diagnosis, treatment, supervision, and research. We will be able to treat our patients utilizing the full gamut of treatment options within the scientist-practitioner model.

The issue of whether or not clinical psychologists should have prescription privileges should not be based on a particular theoretical orientation or philosophical belief about the role and scope of practice of psychologists. It is not whether meds are more effective than psychotherapy in treating certain forms of psychopathology, or whether both should be used. Nor does it have to do with outcome studies or whether or not you or I would choose to have prescription privileges. Rather, the issue is whether or not clinical psychologists should have the choice to either prescribe or not prescribe. While one may not be pro-prescription, one should be pro-choice.

4/17/98

Dr. Edward A. Dreyfus is a Clinical Psychologist, Marriage, Family, Child Therapist, and Sex Therapist. Dr. Dreyfus has been providing psychological services in the Los Angeles-Santa Monica area for over 30 years. He offers individual psychotherapy to adolescents and adults, divorce mediation, couples counseling, group therapy, and career and vocational counseling and assessment.His book, Someone Right For You, is available in the Amazing Bookstore Catalog.

Dr. Dreyfus can be reached at: (310) 208-5700.

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