The Downside of RxP for Psychology
October 16, 2016
Prescriptive authority won’t be harmful to every practice of psychology, as the scope of services provided by psychologists is very broad, but it will be harmful for the practice of psychotherapy, and a main service of many psychology practices is treatment, or psychotherapy.
For those practices, prescription authority will be a game changer, turning them into being primarily drug prescribers and moving practicing psychologists farther away from being psychotherapists.
With prescriptive authority, psychologist psychotherapists will be expected to prescribe drugs and over time the psychological psychotherapy practice will become limited more and more to psychotropic prescription. Psychiatry went down that road. Psychiatric practice once was the practice of psychotherapy.
Great pioneers in psychotherapy were psychiatrists: Freud, Jung, Adler, Reich, Jackson, Bowen, Whitaker, Wynne, Minuchin, Laing and Perls. But psychiatry has come to be defined by psychotropic drug prescription.
Insurance companies have cornered psychiatrists and pretty much forced them to limit the practice to drug prescription. And, of course, drug prescription is lucrative, which has all the more lured psychiatrists into being drug prescribers almost exclusively. The end result is that psychiatry has essentially given up psychotherapy.
My concern is that the psychology practice of psychotherapy will be seduced, dominated and defined by drug prescription just as has happened to psychiatry.
Psychological intervention and drug intervention are two different orientations, two different modalities, two different postures toward healing. They each have their value but they don’t mix any better than oil and water.
In psychotherapy, the patient learns to take responsibility for his or her symptoms. With drug prescription, it is the prescriber, as Carl Whitaker pointed out in supervision, who takes responsibility for being in charge of symptoms. This not only takes the responsibility away from the patient but also makes experiencing of the symptoms more frightening.
In psychotherapy the primary agent of change is the relationship between psychotherapist and patient. With drug prescription, the agent of change is the drug. In psychotherapy, people learn to trust their own experience. Drug prescription teaches people to trust the drug. Psychotherapy is re-empowering. Psychotropic drug prescription is disempowering.
I believe a professional can provide either psychotherapy or drug prescription but, as Whitaker would say, not effectively provide both to the same patient. It’s nearly impossible to control and engage at the same time. Being a player-manager doesn’t work, and both functions suffer.
If psychotropics are going to be prescribed, I believe it works best for one professional to provide the psychotherapy and another to be the drug prescriber. As American poet Edwin Markham said so well, “When you are the anvil, bear – when you are the hammer, strike.” You can’t be both.
While managing drugs, a psychotherapeutically oriented interaction can be provided, but I don’t believe psychotherapy in its deepest sense can be provided. When a clinical situation becomes stressful, when the therapist finds himself in deep water, drugs are something to turn to as a way out and psychotherapist and patient are likely to turn away from psychotherapy.
I believe it’s good for both psychotropic drugs and psychotherapy to be available. The problem is that when the practice of psychology gets drug prescription authority, the choice of psychotherapy will become less available. When psychologists have that tool in their tool box, that is the tool they will be evaluating for, the tool patients and insurance companies will expect them to use and psychotherapy will be put aside. Prescription authority won’t be just one more tool in the tool box – it will take over the tool box.
Medicine, by definition, is that which heals. When psychotropic drugs heal, they are medicine. Psychotherapy is psychological medicine, a viable medicine that is different than physical medicine. Psychotherapy is the way of relating. To the medical doctor, the way of relating is seen as essentially irrelevant to healing. It’s seen as bedside manner, and it’s preferable for the doctor to be nice and friendly, but it’s just the packaging.
Unfortunately, pharmacy and physical medicine have hijacked the word medicine, owned it as their own and equated medicine with drugs – and the public, happy to not take responsibility and wanting for some external power to produce health, accepts that medicine is a drug. The practice of physical medicine is seen as medicine. The practice of psychotherapy is also the practice of medicine.
With prescription authority, psychotherapy will be interrupted, undercut, overridden and left behind. Society doesn’t need more drug prescription. Drugs are already abundantly available and pushed as being the answer to all problems. Society needs the medicine that psychotherapy is and offers.
Research and development of drugs is constantly going on. It’s important that research and development of psychotherapy also be ongoing. The medicinal power of psychotherapy is hardly being realized. When psychotherapy isn’t working, it’s not that psychotherapy can’t work, it’s that better and stronger psychotherapy is needed.
My concern is that with prescriptive authority, psychologist psychotherapists will put their time and effort into drug prescription instead of plumbing the depths of psychotherapy and of themselves as psychotherapists.
Psychology doesn’t need to mimic the ways of physical medicine. Psychology is now the leader in psychotherapy, and psychotherapy is the foremost medicine for psychological problems. Chemicals don’t heal psychological problems, they cover them, and they’re often used to do that for the rest of a person’s life. Psychotherapy heals.
When psychiatry gave up on psychotherapy, psychology took it over and gave it a home. As psychology moves away from psychotherapy, psychotherapy won’t die – it’s too important to die – but another profession will adopt it and psychotherapy will once again find a new home.
That will be a major change and sad loss for psychology.
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David S. Doane, Ph.D., has been a psychologist psychotherapist in private practice for 40 years, currently in Perrysburg, Ohio. His special interests are systems, experiential and Gestalt psychotherapy. He is a monthly contributor to Life’s Journey online magazine. He may be reached by email at: firstname.lastname@example.org or his website is: drdaviddoane.com.
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