Prescriptive Authority For Psychologists Movement - Opposition

Opposition

Prescriptive authority for other medical professionals who are not physicians (e.g., nurse-practitioners and pharmacists) has been controversial, even within the community of physicians. In the same way, there are psychologists who have raised objections to prescriptive authority for psychologists. Specifically, critics within the psychological profession have expressed concern that, if RxP became the norm, the biomedical approach could begin to encroach on the traditional psychology curriculum and that clinicians in training might eventually receive less grounding in psychotherapeutic interventions and research. At the present time, only psychiatrists who practice psychotherapy and psychologists with prescriptive authority are uniquely qualified to fit the treatment modality (pharmacology and/or psychotherapy) to patients' mental health needs. Some psychologists opposing prescriptive authority fear caseload pressures that might press increasing numbers of psychologists to respond to patients' needs via only one treatment modality (pharmacology), as do many psychiatrists.

Apprehensiveness towards the RxP movement may also be traced back to a series of events that occurred in the 1980s and 1990s. First, the introduction of the class of antidepressants known as serotonin selective reuptake inhibitors (SSRIs), also known as fluoxetine marketed under the name Prozac, between 1985 and 1999 let to a momentous increase in psychotropic drug prescription. In the 1990s, the New York Times declared the millions of Americans taking Prozac created a "legal drug culture", as antidepressants accounted for a 13.5% increase in the number of drugs prescribed during medical visits. There was also a significant rise in the amount of unwanted and serious side effects that accompanied the increased prescription of such drugs, especially in children and adolescents. As a result, concern then grew regarding the over-prescription of antidepressants and their safety.

Second, around the same time, the efficacy of both medication-based and psychotherapy-based treatments for depression were subjected to close scientific study. In 1989, the National Institute of Mental Health (NIMH) conducted a study called the Treatment of Depression Collaborative Research Program (TDCRP), which found various forms of depression treatments—interpersonal psychotherapy, cognitive behavioral therapy, antidepressant medication plus clinical management, or placebo plus clinical management—to be almost equally effective. Since then, proponents of pharmacological and nonpharmacological therapy have tirelessly attempted to prove one to be more effective than the other, with no definitive result.

Finally, the third event is the discovery of a substantial placebo response rate associated with antidepressant treatment, which has been shown to average 30-35%. Despite general rejection amongst clinicians that such a placebo effect denotes antidepressants as less effective, the placebo effect continues to serve as a strong basis for opposition over the use of antidepressants in therapy.

As Fox et al. (2009) found, most current opposition stems from the above stated events in the 1980s and '90s, and revolves around concerns about the overuse of psychotropic medications, the replacement of psychotropics for verbal or behavioral therapies, and the effectiveness of psychotropic medications in general. According to the APA, some also express concern that the RxP movement may exert pressure on psychologists that could lend itself to disparities in adherence to ethical and legal standards. Today, the dichotomy between those that support and those that oppose the RxP movement serves to hinder its progress in gaining legislative and authoritative support.