Prescribing psychologists share stories of their journey

Prescribing psychologists are growing in number and influence, providing increased access to care for the most underserved citizens. There are eight licensed prescribing psychologists in Illinois today with six more expected this year. There are an additional 50 prescribing psychology trainees and 75 undergraduate students at The University of Illinois, Champaign-Urbana in a pre-prescribing psychologist curriculum. Upwards of 2,000 prescribing psychologists are expected in Illinois in the next 20 years.

Jessica Ransom, Psy.D., Claudia Mosier, Ph.D., and Kyle Bonesteel, Ph.D., are pioneers among prescribing psychologists in Illinois. They are paving the way for psychologists throughout our nation. These are their stories:

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Jessica Ransom, Psy.D., MSCP

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Being a sole practitioner in Chicago, I had spent an inordinate amount of time searching for psychiatrists to see my patients. I often felt that I was not providing my patients with the continuity of care they deserved. If I couldn’t easily find appropriate referrals, despite my access to the larger mental-health provider community, then how could my patients find psychiatric care?

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Since Illinois had passed legislation that would give psychologists with specialized training prescriptive authority, I decided to follow suit. After completing my master’s in clinical psychopharmacology and the required undergraduate science classes, I began searching for the training grounds for clinical rotations. Although hospital administrators and physicians were initially reticent, once we began, we were able to easily demonstrate our contributions to overall patient care.

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In the first weeks of my emergency department rotation at a hospital, a homeless man, visibly psychotic, came in with multiple medical emergencies. He was uncooperative as the staff tried to address his medical needs. Recognizing that a psychologist could develop rapport,

the attending doctor asked me to “handle it.” Within a short time, the patient calmed down

and I was able to assist the medical team in giving him the appropriate care, including administering antipsychotic medication.

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I was also lucky enough to have a very generous and highly skilled preceptor at a private, free-standing psychiatric hospital. I facilitated the diversity and bias training, as well as rapport-building training, with our medical team to better care for a variety of difficult patient groups. The physician taught me how to treat diabetes, test each nerve and understand its importance, the difference among heart conditions, how to dose medications for physical illness, how to identify sexually transmitted diseases and how all of these physical illnesses can present psychiatrically.

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As a fully licensed prescribing psychologist, I have been able to prescribe, as well as unprescribe, for my patients. I have been able to do this thoughtfully, making the transition to providing integrative, comprehensive mental healthcare.

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Claudia Mosier, Ph.D., MSCP

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I’d heard a bit about psychologists’ being able to prescribe but hadn’t explored it. Then Beth Rom-Rymer, Ph.D., came to one of our department of children and family services consulting psychologist meetings and lit a fire. Several of us were interested and I started classes shortly thereafter.

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Once I had completed my requirements for the master’s in clinical psychopharmacology and the psychopharmacological exam for psychologists, 14 months of medical rotations were next. My little cohort of prescribing trainees was among the first doing these rotations. We scoured the various medical facilities to find them. Beth was right there, making it happen.

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One day, we secured some rotations at a psychiatric hospital and she

suggested we visit a general hospital down the street. Before I could get

intimidated, we were through security and in the office of the director of

medical training. When we left, we had been assured that I could have a

path to completing my general medical rotations at that hospital.

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The rotations forever changed my relationship with medicine and medical providers.

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Some startling brief moments come to mind:

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• My training psychiatrist saying, “Claudia, think what pill will fix this symptom.”
• My first day in surgery, thinking “Don’t faint. Don’t throw up. Don’t touch anything.”
• The day that I did psychological first aid for a resident who was sexually attacked by a patient.
• Having persuaded the gender affirmation surgical team to take me on as a trainee, I was then invited to join the team, as a licensed prescribing psychologist, to provide both psychological and psychopharmacological support to people seeking affirmative care for LGBTQ individuals, one of my passions as a psychologist.

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Being able to prescribe significantly adds to my ability to help my patients gain a better quality of life. I’ve unprescribed medications that had the effect of turning patients into confused, depressed almost comatose individuals. I’ve seen patients’ families become less afraid of a family member I’m treating as the patient calms and returns to their baseline.

 

Also, as a prescribing psychologist, I have the option to see patients weekly for longer periods of time. This gives me the opportunity to finely adjust treatments for the individual.

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Kyle Bonesteel, Ph.D., ABPP-CN, MSCP, BCN

 

My journey to become a prescribing psychologist originated out of a set of coexisting but not fully integrated interests and passions: the commitment to deeply learning the workings of both the mind and the brain; and the desire to be maximally equipped to transform my patients at multiple levels of need. So, when asked Why would you pursue this training? my answer is inherently quite simple: How could I not?

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Our psychiatric, general medical and nurse practitioner colleagues are undoubtedly beacons of wisdom and pharmacological expertise. Prescribing psychologists have now entered this elite arena. In addition, we have another entire world of advanced psychotherapeutic and psychodiagnostic methods, techniques and skills, unique to our profession of psychology, that beautifully integrate into psychopharmacological practice.

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One could make the case that the training of a prescribing psychologist is how you would ideally design a “mental health doctor.” I find myself valuing my neuropsychologist skills more than ever now that the full biological toolbox is available.  High quality neuropsychodiagnostic testing in my practice will remain the foundation for me to conceptualize the patient’s case and engender their trust.

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As prescribing psychologists, we can attain an efficient conceptualization of the patient’s case through concise neuropsychodiagnostics rather than trying to attain efficiency through crunching our prescribing practice into 10- minute office visits. I look forward to utilizing the principles of personalized medicine via pharmacogenomics, exploring the utility of biomarkers for algorithmically informed prescriptive decision making and employing holistic psychiatry principles for therapeutic augmentation. I believe I am bringing the best from all worlds to my clients.