emphasis on cost-effective psychological interven-
tions, provide clinical training in managed care set-
tings, and incorporate didactic instruction in applied
health services research into their curricula. Ideally,
these suggestions will be heeded so that future clini-
cal psychologists receive the training necessary to
thrive in a managed care environment.
Prescription Privileges
Over the last two decades, a hotly debated issue
concerns the pursuit ofprescription privileges(some-
times called “prescriptive authority”) for clinical
psychologists (McGrath, 2010). Although the
American Psychological Association endorsed this
pursuit in 1995, many remain either neutral or ada-
mantly opposed to obtaining prescription privileges.
The decision to pursue these privileges will have
far-reaching implications for the role definition of
clinical psychologists, the training they require, and
their actual practice.
Background. Clinical psychologists have ex-
panded their area of interest from mental health
issues to health issues in general. This redefinition
of clinical psychology as a field concerned with
general health (including mental health) raises a
number of interesting issues regarding how best to
ensure that clinical psychologists can function
autonomously and not be controlled or regulated
by medical or other professions. Several advocates
have argued that obtaining prescription privileges
will ensure the autonomy of clinical psychologists
as health service providers and will enable a conti-
nuity of care that is missing when a psychiatrist
prescribes the patient’s medications and a psycholo-
gist provides the same patient’s psychotherapy
(McGrath, 2010). Further, DeLeon (1988) and
Norfleet (2002) have argued that it is our profes-
sional and ethical duty to improve and broaden the
services we offer so that society’s needs can be met.
Clinical psychologists with prescription privileges
would be available to meet the needs of under-
served populations (e.g., rural residents, geriatric
patients).
However, the pursuit of prescription privileges
has been questioned on philosophical grounds
(McGrath, 2010). For example, some have argued
that the need for professional boundaries between
clinical psychology and psychiatry dictates that we
should not incorporate medical interventions (med-
ications) into our treatment repertoire. Further,
they assert that it is clinical psychology’s non-
medication orientation that identifies it as a unique
health profession and that is responsible for the
field’s appeal. Following are some of the major
arguments for and against prescription privileges.Pros. A number of arguments have been made in
favor of seeking prescription privileges; we briefly
present several of the most commonly cited reasons.
These arguments were discussed in a 1995 inter-
view with the executive director of the Practice
Directorate of the American Psychological Asso-
ciation (Nickelson, 1995) and have been empha-
sized by others advocating prescription privileges
(e.g., DeLeon & Wiggins, 1996; McGrath, 2010;
Norfleet, 2002).
First, having prescription privileges would
enable clinical psychologists to provide a wider vari-
ety of treatments and to treat a wider range of clients
or patients. Treatment involving medications would
now be an option, and this would lead to more
involvement by clinical psychologists in the treat-
ment of conditions in which medications are the pri-
mary form of intervention (e.g., schizophrenia).
A second advantage of having prescription
privileges is the potential increase in efficiency and
cost-effectiveness of care for patients who need
both psychological treatment and medication.
These individuals often enlist more than one mental
health professional (a psychiatrist for medications, a
clinical psychologist for cognitive-behavioral treat-
ment). A single mental health professional who
could provide all forms of treatment might be desir-
able from both a practical and an economic
standpoint.
There is also the belief that prescription privi-
leges will give clinical psychologists a competitive
advantage in the health care marketplace. The
health care field is becoming increasinglyCURRENT ISSUES IN CLINICAL PSYCHOLOGY 75