Psychology's heritage and prescription privileges: an unconsummatable marriage

Canadian Psychology, Nov 1995 by Dozois, David J, Dobson, Keith S

Abstract

In our article on the prescription debate, and its implications for Canadian psychologists (Dozois & Dobson, 1995), we sought to stimulate a balanced discussion by presenting arguments both for and against this highly politicized issue. On the basis of three main arguments (quality of care, marketability, and psychology's heritage), we concluded that Canadian psychologists should not endorse prescription privileges as a means of professional evolution. The response by Hayes, Walser, and Follette (1995) coincides with our arguments, and emphasizes that prescription privileges are incompatible with the fundamental approach of psychology. DeLeon, Sammons, and Fox (1995) and Pagliaro (1995) take exception to our thesis, but evade the issue of psychology's heritage. In this rejoinder, we recapitulate the heritage of psychology argument, and address some specific concerns regarding the invited "pro - prescription" commentaries. When the fundamental question of whether psychologists should seek prescription privileges is confronted, our conclusion remains... "No"!

On the basis of our review of the arguments both for and against prescription privileges, we concluded that psychologists should not pursue this agenda (Dozois & Dobson, 1995). In addition to the fundamental question of should psychologists prescribe, we also raised numerous practical impediments for psychology as a whole, and Canadian psychology in particular. We do not dispute that psychology should evolve to meet the growing demands of consumerism. Where contention exists, however, pertains to how this evolution should proceed.

We appreciated the editor's decision to round out this discussion by inviting commentaries from both Canadian and American perspectives. We are pleased to have this opportunity to clarify our position on this very important issue. The response by Hayes et al. (1995), which essentially mirrors our earlier arguments, emphasizes that the science and approach of psychology is discordant with the authority to prescribe. As we share similar positions, we will highlight only some of their points in the ensuing discussion. In general, we were disappointed with the other two responses with regard to the content (and in the case of Pagliaro's apparently cathartic response, the overall tone) of their arguments. Although Pagliaro's article challenged our arguments point by point, it minimized and evaded the core issue of psychology's heritage and approach. Deleon et al., who also adopted the "pro" side of the debate, avoided the issue of the essential nature of psychology altogether by emphasizing the pragmatics of how to go about seeking prescription privileges, and by suggesting that we set aside the salient issue of whether or not we should prescribe: "The prescription privilege agenda is, after all, fundamentally a clinical training agenda" (DeLeon et al., 1995, p. 321). This approach, we contend, does not address the fundamental question. The issue of psychology's heritage, definition and even evolution, dictates that we not lay the "should" arguments to rest.

The Issues

SHOULD PSYCHOLOGISTS PRESCRIBE?

As stated previously (cf. Dozois & Dobson, 1995), how psychology defines itself is crucial to the "should" or "should not" debate. Psychology has a long history of substantive changes in its evolution and, despite this important growth and change, psychology's primary focus has consistently been on the covert experiences of sensations, feelings, and thoughts, as well as on the overt experiences, as a science of behaviour (Hebb & Donderi, 1987; Hilgard, 1987). As such, psychologists are trained in the description, prediction, explanation, and treatment of both internalizing and externalizing experience and disturbance.

Further, it is also important to reiterate the fact that psychology has established itself as a profession that seeks to assist individuals through the use of psychological methods (Freedheim & Russ, 1992; May & Belsky, 1992). Specifically, psychological intervention aims to help and empower individuals to change their cognitive, affective and behavioural experience through corrective emotional experiences, emotional expression and insight, the development of internal control and stability, and the acquisition of problem - solving and coping strategies (Freedheim & Russ, 1992).

Pagliaro states that the current opposition to prescription licensure is merely analogous to the early dissent regarding the use of biofeedback. To this comparison, we reemphasize our earlier point - the rationale for biofeedback is that it serves as a technique which allows the patient to learn and generalize principles of self - control. Medication, on the other hand, treats the patient without purposely attempting to provide a scaffolding of self - efficacy; it represents a direct intervention at the level of biological processes. Thus, we do not believe that prescription privileges fall within the realm of psychology.

The parallel argument raised by Hayes and his colleagues (1995) is that psychology is defined by its approach, and that psychology's approach is distinct from the medical model. These authors define psychology as "the study of individual whole organisms interacting in and with an environmental and behavioral context" (p. 313; Emphasis added). Employing an example of relevance to biochemistry, Hayes et al. contend that the movement toward prescription privileges would require that psychologists begin to study organ systems (i.e., a micro - organismic level) rather than to investigate the impact that biochemistry has on cognition, affect, behaviour, and their reciprocal interactions (i.e., a whole organism level). Hayes et al. cogently argue that mixing these micro and macro levels of analysis, whether at the M.Sc., the Ph.D., or the post - doctoral status, will fundamentally alter the nature and strength of our discipline.