A dangerous trend?

Yes,Jimmy, that's exactly what I was wondering about. Sounds clear. I am sure that the means of making expertise and limits obvious will vary from professional to professional, but it's got to be done, not only for honesty's but for liability's sake.

"Category creep" also seems to violate the Jesuit principle of subsidiarity (let the lower level handle it as far as is possible), in that it blurs the distinctions between different levels of competence or different fields of (properly credentialed) expertise. As my old mentor Fr. Michalyszyn used to say, "if you're going to throw rocks, make sure they fit the holes in the windows."

 

Interesting. I would guess that all of the Christian church folk I know are pre-mil of some sort. Are there many amill people in the movement today?

 

Hi Menger

I don't think the issue is quite that simple. I would hazard a guess that the same law that allows those folks to prescribe drugs also has a list of specific drugs they may prescribe and documents specific training in drug prescription they must have to write them. In my area a M.D. spend approx 5-10 minutes with you prior to writing a prescription. I am pretty sure a properly trained M.A. or Ph.D. could do an equal or better job.

 

Here's a few thoughts from a practicing psychologist. First, I want to make it clear that since I haven't a dog in the fight – I'm getting pretty long in the tooth and I don't care to take on what looks like an onerous learning task – I'm neutral. Additionally, for those who are interested, Morgan Sammons has published a text on the history of prescriptive authority for psychologists.

There is, indeed, disagreement within psychology about prescriptive authority and some of the concern has been that it may water down tradition. Models change though and just within my professional lifetime I've witnessed remarkable transformation in approach to treatment and measurement. Psychology has, most assuredly, incorporated biological bases of behavior which is a required component in doctoral training programs. The prevailing approach is the bio-psycho-social model. My understanding is prescriptive authority is not awarded retrospectively to anyone who is licensed to practice. I believe it takes two full years to qualify to prescribe a limited formulary; which when you think about it is the same duration an NP or PA-C takes to learn to prescribe for the entire range of medical disorders. The training includes chemistry, anatomy and physiology, physical assessment, etc. and lots of supervision. Nor is psychology the only profession to incorporate prescriptive authority: optometry, dentistry, and osteopathy come to mind. Prescriptive authority hasn't come about in a vacuum. Most psychoactive medications are prescribed by general practitioners who, if memory serves me, were a factor in the State of New Mexico's legislation. Having limited training in psychopathology, family physicians may feel exposed when they have no resources other than to provide treatment themselves. My point is this: I believe it is a misnomer to suggest that psychology stands alone in the history of disciplines earning the privilege to prescribe or that medical doctors across the board are in opposition. Moreover, the initiative is based upon a DOD demonstration project after a group of psychologists that was trained to prescribe and has been successfully doing so within military auspices for a number of years. One of this group, Morgan Sammons, reports that between his training in counseling psychology and his prescriptive authority he finds he has a much more inclusive set of arrows in his clinical quiver.

One of the comments made is that psychology boasts about the ability to help without drugs and I'm not sure that's accurate. I can't recall the last time I came across an article in a referred psychology journal suggesting that psychoactive medication has no place in the treatment of mental disorder. I suspect that these sorts of claims are the purview of sensationalist media looking for market share. APA ethics mandate psychologists remain current with the literature and evidenced-based practice shows that, in the case of depression, the most effective treatment is a combination of antidepressant medications and psychotherapy. The training students receive at every APA-approved program I'm familiar with is to refer to and work in conjunction with prescribers be they nurse practitioners, physician's assistants, psychiatrists, family physicians, or whatever.

I hope my musings are informative. I'm not an expert – which a professor once defined as a guy from out of town with a set of slides – just an average practitioner who reads the journals. Nowadays, I suppose it would be a guy from out of town with a powerpoint presentation.

David

 

True. One of the most quintessential principles in the life of a therapist in knowing his/her limitations and when to refer.

 

I cannot answer that categorically for all in the movement. I do have some ministerial colleagues in the independent Christian chruches/chruches of Christ who are amill.

Dr. Jack Cottrell, professor oftheology at one of our schools (Cincinnatti Bible College and Seminary) is amill. and presents a sound case for it in his book THE FAITH ONCE FOR ALL, a systematic theology book.

I, however, believe the Bible more fully supports the premill/posttrib view.

The independent Christian church/churches of Christ (instrumental) have no uniform doctrine. One will find a wide range of beliefs among them which is typical of its history.

 

Obviously should be "...is knowing..." Sorry. I see I made several errors in a few posts in this thread. Hopefully, the meaning and intent are obvious.

 

Prescribing Privileges

This has been talked about for years within the American Psychological Association - New Mexico and Lousiana just happen to the first states. The bottom line is that we're watching a battle between two powerful lobbying groups - American Medical Association and the American Psychological Association.

It's a old fashion turf battle and the AMA has fought them before -recently as someone mentioned, Nurse Practitioners and Physician's Assistants. It still continues as a few states now allows NPs and PAs to do solo practice not under the thumb of an MD or DO. Remember the battle between the AMA and Chiropractors - now they've accepted each other and some MDs work with DCs. And much earlier there was the battle between MDs (allopathic physicians) and DOs (osteopathic physicians). DOs are licensed to do anything an MD can do and you probably wouldn't know they're an osteopath unless you saw DO after their name.

Psychologists have always been better trained in the psychological aspects of mental health than psychiatrists, but mental illness was seen as within the domain of medicine so the psychiatrist took the lead. I agree with Gina that more training is needed and maybe eventually there will be a hybrid occupation that will be given equal training in the biological and psychological sciences.

 

Re: Prescribing Privileges

This is not exactly accurate. Read the works of Karen Horney and Harry Stack Sullivan and you will clearly see this. There was actually a time in the annals of psychotherapy when psychiatrists were wise, caring people who helped people tackle their problems. But the modern psychiatrist has no interest in "talking therapy."

Many psychiatrists today propose eliminating psychotherapy from the basic training of psychiatrists. In 1987, at a symposium entitled "Training Psychiatrists for the 90's: Issues and Recommendations," one of the presentations by psychiatrist Gary Tucker was "Psychotherapy Will Not Be Central in Psychiatric Education."

His stated "...our residency training program curricula should reflect this newfound theoretical freedom from domination by the psychotherapeutic model." The pharmaceutical industry took note, and the wining and dining of psychiatrists by sales reps began and hasn't stopped since.

 

Re: Prescribing Privileges

Tucker's is but one viewpoint, I don't see psychiatry abandoning "talking therapy" completely. I would like to have been in the audience to hear the response to his Symposium paper.

Passing out drugs is just an easier and faster way to deal with problems considering the huge ratio of psychiatrists to patients. And there are allied professions that deal with the cognitive treatments - psychologists, social workers, counselors etc.

When Horney and Sullivan practiced, psychotherapy wasn't as widely available as now and they didn't have the array of psychotropic drugs now available. And the allied professions were in their infancy. By the way the Chicago College of Medicine that Stack graduated from was considered a degree mill [not related to the current University of Illinois, Chicago - College of Medicine].

 

Re: Re: Prescribing Privileges

Ah, my friend, but Tucker's view is the prevailing viewpoint. One only needs to read the American Psychiatric Association's Psychiatric Times or the American Psychological Association's Monitor to see this.

Those in the field who dare challenge the status quo and move beyond linear thinking in any field are veiwed with derision. Remember when the Austrailian doctor said he had discovered that pepic ulcers were caused by a virus (Helicobacter pylori)? He was practically laughed out of the medical profession. Now, H Pylori's connection to ulcers is acknowledged.

Witness the incessant attacks on such notables as Drs. Peter Breggin, Ty Colbert, Seth Farber, August Piper, Elizabeth Loftus, Richard Gosden, et. al. Even Jay Haley, although not a psychiatrist, is criticised for his views regarding the legitimacy of the schizophrenic diagnosis.

Yes, I know Sullivan's alma mater was not accredited and considered by many a degree mill. I've mentioned that on here many times. Yet, his work with schizophrenics is unsurpassed and still highly tauted.

As far as your not seeing psychiatry abandoning "talking therapy," let me respond with this. When I worked in mental health, each place had two staff psychiatrists who came in ONE day per week each. They saw clients all day long for no more than 15 minutes each and in most cases not even that long.

The only reason for their presence was for medication checks, that's all! In the old days, when psychiatrists actually practiced psychiatry, hour long sessions or more were not uncommon. You will find very few psychiatrists who actually do more than write prescriptions. The days of the Glassers, Szasz', Ellis', Becks, are gone, gone forever, I'm afraid.

Nice "talking" to you.

 

Re: Re: Re: Prescribing Privileges

Funny, but the American Psychiatric Association still lists, "To conduct a range of individual, group, and family therapies using standard, accepted models..." as a core competency for psychiatrists. In reality are they just pushing pills and not doing much talk therapy, yes, but the profession is not going to officially give it up.

I also work in social services so I'm familar with the different professions. And pointing out Harry Stack Sullivans degree mill MD, does not detract from his great contributions to the field of interpersonal relations.

 

Re: Re: Re: Re: Prescribing Privileges

True. And they are to follow the dictum to "First do no harm." Yet, many psychiatrists prescribe Ritalin to children under six. Yet, the PDR states it should not be given to children under six and the last time I checked, the FDA has not approved it for children under six.

I am sorry if I came across implying that. It's just that, as you well know, graduates from unaccredited schools are not held in high esteem by some on the DL forum circuit

I am sure you and I agree on more than we disagree. I hope you enjoy your work in social services.

 

Re: Re: Re: Re: Re: Prescribing Privileges

Jimmy, I didn't mean any offence by pointing out Sullivans degree mill MD. During that time period there was very little regulation of academic institutions so it's necessary to put it in context. After all he did practice medicine in Illinois so CCM couldn't have been a total degree mill as we think of them now.

Sullivan, Horney and Adler gave much needed new perspectives that helped re-energize psychiatry and psychology.

Yes we do agree on more than we disagree.