Training for prescriptions vs. prescriptions for training: where are we now? Where should we be? How do we get there?

Unique Roles for Students in Practitioner-Focused Doctoral Programs: Mentoring Practices for an Evolving Landscape

Studies suggest that training that culminates in the doctor of psychology (PsyD) degree is characterized by heterogeneity. However, elements of most of these practitioner-focused doctoral programs (e.g., larger class sizes, shorter periods of training, less funding for students), as well as the widely varying professional outcomes that they lead to, offer unique challenges and opportunities regarding mentoring. This article aims to (a) trace the development and current status of controversies surrounding the PsyD model; (b) determine the unique roles in which graduates of well-designed and scientifically grounded PsyD programs may be equipped to serve; and (c) drawing on the (limited) extant literature, offer recommendations for mentoring and other elements of training for these practitioner-focused programs. Finally, we offer suggestions for future empirical studies to shed light on the relative value of various training practices.

Evidence-Based Mentoring Across the Educational Spectrum: Introduction to the Special Issue

Mentoring across educational and training programs that prepare behavioral health care providers and related professionals is a critical topic and one that has been relatively neglected empirically. Articles in this special issue summarize extant literature on mentoring across several levels and contexts: undergraduate education, master’s level training, doctoral training (both PhD and PsyD), and internship and postdoctoral training. This introductory paper provides an overview of each contribution to the special issue, discusses the intended audience, and presents the issue as part of what should be an ongoing dialogue about best practices in mentoring. Overall, the special issue aims to raise and begin to address a number of significant questions related to where we are going as a field, who is equipped to move us in that direction, and how to mentor the next generations of those who will serve a variety of “clients.”

Predoctoral prescriptive authority curricula: a training option

The purpose of the current article is to encourage discussion among stakeholders about the viability and benefits of predoctoral prescriptive authority (RxP) training. The existing APA model curriculum for RxP training requires that such training is postdoctoral. However, predoctoral models are potentially viable and offer several distinct advantages: reducing the time and financial costs of training, attracting more applicants with a biopsychosocial orientation, and, as more individuals complete this training, enlarging the constituency for state prescriptive authority initiatives. Several possible predoctoral model curricula including the incorporation of a postdoctoral master's degree in clinical psychopharmacology are described within existing APA PhD program requirements, with suggested accommodations for PsyD programs. These are offered as alternatives to, rather than as replacements for, postdoctoral training for RxP.

Concerns about substandard training for prescription privileges for psychologists

This Commentary on the Muse and McGrath study (this issue, pp. 96-103) refutes its conclusion that the amount of training for prescription privileges for psychologists (RxP) is equal to or greater than that for psychiatric nurse practitioners and physicians. First, the sample failed to include only training programs for nurses and psychologists that lead to independent prescribing. Second, training was defined by an arbitrary, nonvalidated list of "key content areas" that excluded much of the standard medical curricula for nurses and physicians to prescribe. Third, the levels of training for which the "key content areas" were assessed omitted undergraduate prerequisites, apprenticeships, supervised practice, and residencies that are a standard part of the nursing and physician programs studied. RxP training remains substandard.

Prescription privileges for psychologists: a comprehensive review and critical analysis of current issues and controversies

The debate over whether clinical psychologists should be granted the right to prescribe psychoactive medications has received considerable attention over the past 2 decades in North America and, more recently, in the UK. Proponents of granting prescription privileges to clinical psychologists argue that mental healthcare services are in crisis and that the mental health needs of society are not being met. They attribute this crisis primarily to the inappropriate prescribing practices of general practitioners and a persistent shortage of psychiatrists. It is believed that, as they would increase the scope of the practice of psychology, prescription privileges for psychologists would enhance mental health services by increasing public access to qualified professionals who are able to prescribe. The profession of psychology remains divided on the issue, and opponents have been equally outspoken in their arguments. The purpose of the present article is to place the pursuit of prescription privileges for psychologists in context by discussing the historical antecedents and major forces driving the debate. The major arguments put forth for and against prescription privileges for psychologists are presented, followed by a critical analysis of the validity and coherence of those arguments. Through this analysis, the following question is addressed. Is there currently sufficient empirical support for the desirability, feasibility, safety and cost effectiveness of granting prescription privileges to psychologists? Although proponents of granting prescription privileges to psychologists present several compelling arguments in favour of this practice, there remains a consistent lack of empirical evidence for the desirability, feasibility, safety and cost effectiveness of this proposal. More research is needed before we can conclude that prescription privileges for psychologists are a safe and logical solution to the problems facing the mental healthcare system.

The scientifically-minded psychologist: science as a core competency

At the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, the Scientific Foundations and Research Competencies Work Group focused on identifying how psychologists practice scientifically. This article presents the subcomponents associated with the core competency of scientific practice. The subcomponents include: 1). access and apply current scientific knowledge habitually and appropriately; 2). contribute to knowledge; 3). critically evaluate interventions and their outcomes; 4). practice vigilance about how sociocultural variables influence scientific practice; and 5). routinely subject work to the scrutiny of colleagues, stakeholders, and the public. In addition, the article briefly discusses how the depth of training for and assessment of each subcomponent will vary by training model. Implications and future directions for individual psychologists, training programs, and the profession are discussed. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Concluding remarks on the debate about prescription privileges for psychologists

This article summarizes the six primary arguments for and against prescription privileges for psychologists (PPP or RxP) that were presented in this special issue. Four articles addressed points made in the testimony in favor of PPP by the American Psychological Association. Six articles addressed points in the testimony against PPP by the American Association of Applied and Preventive Psychology. It is concluded that the PPP debate reflects a deep schism in clinical psychology that represents a serious disunity in the field. The disunity is seen as a divide between those trained to be psychotherapists and those trained to be scientist-practitioners. It is argued that the former support PPP and are interested in the survival of professional schools, while the latter oppose PPP and are interested in the survival of university departments of psychology. For the discipline to survive there must be a rapprochement between these factions and alternatives to PPP for the retraining of psychotherapy practitioners.