Prescription Privileges for Psychologists?

Should psychologists be given prescription privileges? What this means is simple: If a licensed psychologist is treating a client who has been formally diagnosed with a severe disorder, such as Major Depression, should the psychologist be legally able to write a prescription for an anti-depressant? Other drugs of interest would probably include antipsychotics, tranquilizers, hypnotics, lithium carbonate, and mood stabilizers. A handful of states already allow prescription privileges for psychologists, and other state legislatures are considering it. Is this a good trend?

Many psychiatrists – they obtain their MD and then specialize in psychiatry – argue that only those who have graduated from medical school should be allowed to write prescriptions as part of treatment of mental illness. Dr. Ryan Hall, MD, president of the Florida Psychiatric Society, says psychologists “should not be allowed to write prescriptions for things like opioids, benzodiazepines, mood stabilizers, antidepressants, or anti-psychotic medications.” Why not? Because psychologists do not have the extensive training in pharmaceuticals and the human body that medical doctors do. It’s a defensible argument.

I think there are additional arguments that can be made against privileges for psychologists. These arguments do not refer to limited medical training, but focus on the idea that drug intervention is not always the answer when treating psychological disorders.

For instance, doctoral-level clinical psychologists – who receive four + years of rigorous training beyond college – are exceptionally good at diagnosing mental illness and treating it. Some professionals argue that granting them prescription privileges runs the risk of diluting their focus on diagnosis and therapy, areas that are their true strength.

Granting prescription privileges might also tempt psychologists to think more like psychiatrists and rely too much on medications. Unfortunately, there are no medications that will help a client achieve the kinds of personal change psychologists stress: personal empowerment; learning that you control only your emotions and your thoughts; developing an action plan to navigate more effectively the challenges of life. Also, disruptions in emotions like anxiety and anger brought about by life circumstances can be confused with mental illness, and lead to unnecessary drug treatment. Do we want psychologists going down that road?

As another example, consider that psychiatric medications work well with severe levels of some illnesses – such as, Major Depression and Bipolar Disorder – but are generally no better than a placebo for low and moderate levels – such as, Persistent Depressive Disorder. It is the moderate illnesses that psychologists deal with most often, and medications might be inappropriate.

It’s also important to note that prescribing psychiatric medications, even by a trained psychiatrist, remains largely a trial-and-error process. Matching a particular compound with a particular body physiology is not as easy as some people think. Medications for psychological issues work only about a third of the time. When they do it can take weeks to “kick-in,” a delay that can produce considerable frustration and despair when a client discovers nothing is changing.

Given all these potential problems, why add psychologists – who are trained in assessment and diagnosis – to the prescription mix?

There is a coping lesson that emerges from this discussion. If you feel you have a persistent, chronic, severe problem that significantly interrupts your daily activities, consult both a psychiatrist and a psychologist. Research shows that for many conditions the combination of psychological “talking therapy,” and psychiatric prescription medication, is more powerful than either treatment alone. Many of these professionals work together and allow their respective areas of expertise to complement each other. This partnership will provide you with a thorough psychological evaluation and diagnosis, decrease the risk of diagnostic errors, and help you work actively as a participant in developing a treatment plan that may include medications.

On the other hand, if your “problem” is more along the lines of dealing with moderate everyday stressors of life – such as, you’re worried about a project at work; anxious about making a presentation; distraught because your son was caught shoplifting; wondering how best to tighten the family budget – you might be better off seeing a psychologist and receiving assistance that does not involve the use of medications.