Clinical Psychology

psychological tests which, combined with

interviews/discussions with patients, help

provide a picture of a patient’s physical and

mental state. Their education and years of

clinical training and experience equip them

to understand the complex relationship

between emotional and other medical ill-

nesses, to evaluate medical and psychologi-

cal data, to make a diagnosis, and to work

with a patient to develop a treatment plan.

In contrast to psychiatrists, clinical psychologists
typically receive little training in medicine. How-
ever, clinical psychologists do receive more exten-
sive training in the psychological principles
governing human behavior, in formal assessment
of psychological functioning, and in scientific
research methods. As compared to psychiatrists,

clinical psychologists also receive more extensive

training in psychotherapy (i.e., “talk” therapy as

opposed to medications) and are more likely to

view psychopathology as a consequence of interac-

tions between individuals’biological/psychological/

social predispositions and their experiences within

the environment.

Psychiatry no longer enjoys the prestige and

popularity it once did. The proportion of medical

school graduates who choose psychiatric residencies

has generally declined since 1970, but over the last

5 years has stabilized at about 4.1 to 4.6% (Moran,

2011). In 2011, 640 U.S. medical school graduates

matched with a psychiatry residency program.

Unlike psychiatry, the medical specialties of family

medicine, pediatrics, and internal medicine are

enjoying significant growth (Moran, 2011). Further,

a large percentage of those entering psychiatry

BOX1-1 Professional Issues: But Is It the Right Prescription for Clinical Psychology?

For decades, a number of clinical psychologists

expressed the hope that they may eventually be

accorded the same privilege of writing prescriptions

that psychiatrists have long enjoyed (McGrath, 2009).

In particular, they want to prescribe psychotropic

medications that affect mental activity, mood, or

behavior. But others have urged caution here. They

suggest that the reason clinical psychology has flour-

ished is that it is different from psychiatry. Clinical

psychologists have developed unique skills in psycho-

logical assessment. They have built a profession on a

solid scientific basis. To imitate psychiatry by an ill-

advised attempt to write prescriptions might destroy

clinical psychology’s very uniqueness, they say.

Clinical psychologists frequently stress to troubled

clients their autonomy and the necessity that they, as

clients, collaborate with the therapist in the change

process. In contrast, psychiatrists often come from a

more authoritarian tradition. The doctor is an expert

who tells patients what is wrong with them and then

may prescribe medication to ease their suffering and to

make life better. Traditionally, clinical psychologists

have been committed to psychological, not biological,

treatments. Clinicians have not subscribed to the credo

of“better living through chemistry”when applied to

psychological problems. Although few clinical psychol-

ogists would argue that medication is never necessary,

many would argue that, ultimately, most clients must

learn to come to grips psychologically with their emo-

tional and behavioral problems. The bottom line seems

to be that, at present, the field is conflicted about the

value of prescription privileges.

Despite the field’s ambivalence, the American Psy-

chological Association did officially endorse this pursuit

in 1995 (Martin, 1995). Currently, two states (New Mex-

ico and Louisiana) allow“appropriately”trained psy-

chologists to prescribe medications for treatment of

certain mental health conditions (McGrath, 2010). This

development has important implications for research,

training, and practice. For example, major changes in

graduate training would be required to prepare clinical

psychologists for this new role.

It is clear that programs will have to be length-

ened by at least 1 year to provide even rudimentary

training to prepare graduate in this new arena of

practice. In some cases, programs would have to be

completely revamped. Currently, it appears that the

specialization required to earn the right to prescribe

will occur at the postdoctoral level (after the Ph.D. or

Psy.D. is granted). Most agree that this decision by the

APA to pursue prescription privileges will have a last-

ing impact on the direction of the field. Whether it is a

positive or negative effect remains to be seen. We’ll

have a lot more to say about this issue in Chapter 3.

6 CHAPTER 1