Lesson 3 CP

• The movement for prescription privileges has its roots in the 1980s or before, but in the 1990s and 2000s, it rose to the level of a high-profile, high-stakes debate.
• New Mexico and Louisiana were granted prescription privileges to appropriately trained psychologists in 2002 and 2004, respectively.
• Clinical psychologists are more expert than primary care physicians in mental health problems, hence they could be better able to diagnose problems correctly and select effective medications.
• Other non-physician professionals already have prescription privileges, which sets a precedent for specially trained clinical psychologists to do the same.
• Treatment is streamlined, saving both time and money when clinical psychologists prescribe.
• The risk of problems due to miscommunication is eliminated when clinical psychologists prescribe.
• Clinical psychologists can feel capable of independently providing a wider range of services to their clients when they have prescription privileges.
• The size and scope of the DSM has vastly increased since its inception in the 1950s, leading to criticism about overdiagnosis of DSM-5.
• The expansion of the scope of mental disorders happens in at least two ways: introduction of new disorders to capture experiences once considered normal, and lowering the bar for existing disorders that more people meet the criteria.
• Criticisms about overdiagnosis of DSM-5 include the assertion that there has been no real epidemic of mental illness, that the diagnostic labels have become too elastic, and that problems that used to be an expected and tolerated part of life are now diagnosed and treated as mental disorders.
• Disadvantages of evidenced-based treatments and manualized therapy include threats to the psychotherapy relationship, diagnostic complications, restrictions on practice, and debatable criteria for empirical evidence.
• Manualized therapy is a form of psychotherapy that follows a therapy manual, which provides detailed instructions for all phases of the treatment of a specific disorder, typically used in outcome studies supporting evidenced-based treatments.
• Evidenced-based treatments and manualized therapy offer scientific legitimacy, establish minimal levels of competence, improve training, decrease reliance on clinical judgment, and offer an empirical approach.
• Ability to prescribe sets psychologists apart from non-prescribing therapists, counselors, social workers, etc.
• Embracing prescription privileges is seen as the next logical step in the progression of the profession.
• Increased income may offset some of the salary decreases reported by psychologists, including those occurring as a result of the impact of managed care.
• Comprehensive understanding of everything involved in a prescription decision, hence something close to full-pledge medical training is essential for prescribing.
• Cybertherapy appears to work as well as more traditional, in-person forms of psychotherapy for a variety of disorders.
• As clinical psychologists embrace new technologies and incorporate them into their practices, professional issues continue to arise.
• Psychologists can control the confidentiality of their own private files but not the clinical information that they have been required to share with the insurance company.
• The APA ethical code includes several updates designed to address the increasing use of technological tools.
• The pharmaceutical industry is trying to "colonize" psychiatry.
• Evidenced-based practice is the practice of clinical psychology based on empirical research evidence in combination with clinical expertise and client characteristics, culture and preferences.
• The movement in favor of evidence-based treatments/manualized therapy has intensified in the 1990s and 2000s, with researchers seeking to answer questions about the benefits of psychotherapy.
• Psychologists can control the confidentiality of their own private files but not the clinical information that they have been required to share with the insurance company.
• Pharmaceutical companies are pleased if those who write the DSM were on their payroll.
• Suggestions for those who use technology-based practice include obtaining informed consent from clients, knowing and following any applicable laws on telehealth and telemedicine, knowing and following the most recent version of APA/PAP ethical code, ensuring the client’s confidentiality by using encryption or similar methods, appreciating how issues of culture may be involved, not practicing outside the scope of your expertise, and being knowledgeable about emergency resources in any community from which your clients may seek services.
• Overdiagnosis can lead to people receiving treatment they don't need, affecting their self-image via stigma, self-efficacy, and overall wellness, influencing how health insurance companies consider the person as a potential enrollee, and affecting how a court of law views the person in terms of guilt or suitability for child custody.
• Most health insurance and managed care companies require a DSM diagnosis for treatment.
• The APA ethical code includes several updates designed to address the increasing use of technological tools.
• Practicing clinicians often make diagnoses without detailed consideration of the precise definition of mental disorders and offer treatments whether or not a diagnosis has been made at all.
• Mental health professionals rely more on professional experience, intuition and "gut feelings" than symptoms checklist to guide diagnostic decisions.
• As clinical psychologists embrace new technologies and incorporate them into their practices, professional issues continue to arise.
• Cybertherapy appears to work as well as more traditional, in-person forms of psychotherapy for a variety of disorders.
• The pharmaceutical industry is trying to "colonize" psychiatry.
• The more disorders there are, the more potential customers the pharmaceutical industry has to target their advertising toward.
• Technological tools are now used in the direct delivery of psychological services.