Division 38 statement on the use of the term "Medical Psychology"

You may have caught some of the debate about the use of the term "medical psychology" among prescribing psychologists. In Louisiana, prescribing psychologists are officially referred to as "medical psychologists" and are licensed under the authority of the state's medical board rather than the state's psychology board (see Louisiana Act 251). Meanwhile, there is a bill pending in Illinois that also calls for the use of the term "medical psychologist" to refer to prescribing psychologists. Recent events in Louisiana and Illinois prompted Division 38 to assemble a Task Force to consider our position on use of the term "medical psychology."

Division 38 takes no position - for or against - psychologists obtaining prescription authority. However, it is the position of the Division that the term "medical psychologist" should not be equated with having prescription authority.

The memo, approved by the APA Interdivisional Healthcare Committee and endorsed by the Division 38 Executive Committee, explains the Division 38 perspective on this issue.

Jerry Suls, Ph.D.
President
APA Division 38 (Health Psychology)
apadiv38@verizon.net

The following statements have been reviewed and endorsed by the Executive Committee. This statement is an official statement of Division 38, the Division of Health Psychology, and does not represent the position of American Psychological Association, any of APA's other Divisions or other units of APA, unless so stated.

From: Rob Glueckauf, Ph.D., Chair, Interdivisional Healthcare Committee

Re: Definition of Medical Psychology and Relevance for Prescribing Authority

Date: January 23, 2010

As many of you know, two state legislations are considering extending prescription authority to medical psychologists. Although the Interdivisional Healthcare Committee (IHC) does not take a stand on whether prescription authority should or should not be extended to psychologists, the IHC does have concerns about the use of the term "medical psychology" as preferred terminology to describe a psychologist with prescribing authority. The IHC wishes to formally express its concern with the use of "medical psychologist" as synonymous with "prescribing psychologist."

It is the opinion of the IHC that the use of the term "medical psychologist" as synonymous with "prescribing psychologist" could cause considerable confusion within the psychology training community, the broader health care community, and with the public. The use of the term, medical psychology has a long history; a history that has not been associated with medication prescriptions by psychologists.

The following is the definition of "medical psychology" from the online medical dictionary: "The branch of psychology concerned with the application of psychological principles to the practice of medicine; the application of clinical psychology or clinical health psychology, usually in a hospital setting. "

Within the psychology community, medical psychology has been defined as: "the study of psychological factors related to any and all aspects of physical health, illness, and its treatment at the individual, groups, and systems level" (Asken, M. Medical psychology: Toward a definition. Professional Psychology, 1979, 10, 66-73).

Additionally, there are numerous doctoral training programs (including APA accredited programs), departments, and clinics using this term; in none of these cases does the term refer to prescribing psychologists.

For example (excerpts taken verbatim directly from their websites):

• The Department of Behavioral Neuroscience is one of six basic science departments in the School of Medicine at Oregon Health Sciences University. It was originally established in 1957 under the leadership of Joseph D. Matarazzo, Ph.D., as a freestanding medical school division (Division of Medical Psychology) affiliated with the Department of Psychiatry. Four years later (1961), the school's Executive faculty unanimously recommended conversion of the division into a basic science department, thus completing the process of establishing the first Department of Medical Psychology within a medical school in the United States. See the following link for a historical article by Joe Matarazzo entitled, "Psychology in a Medical School," http://www.ohsu.edu/behneuro/pdf/jMatarazzoArticle.pdf.
• University of Alabama at Birmingham's Medical/Clinical Psychology program is an APA-approved program. Each student receives intensive training in the psychological bases of behavior. Biomedical bases of behavior, health psychological theories, and clinical applications are emphasized with courses in psychophysiology, health psychology, and neuropsychology. Courses in medical sciences and public health are also available. A second level of training involves generic clinical professional skills, including assessment, intervention, consultation, and evaluation. These skills are applied in both mental health settings but with emphasis on medical applications and medical / surgical settings. http://www.psy.uab.edu/medpsych.htm
• Uniformed Services University of the Health Sciences Medical Psychology program is designed to provide systematic research training in biobehavioral and psychosocial factors involved in the etiology, pathogenesis, and treatment of physical disease and mental disorders, disease prevention and public health. The clinical track within the Medical Psychology Program is aimed at training psychologists who are both academically and clinically prepared to work as researchers in academic or medical settings. The program is designed based on the premise that psychologists conducting physical and mental health-related research and research in health settings need skills in clinical psychology to complement their strong foundation in areas related to physical and mental health, disease processes, and research. This track emphasizes combined year-round training in health psychology research and the development of skills in the clinical application of health psychology. The medical psychology clinical track requires completion of all Medical Psychology Program requirements plus completion of a one year internship to be eligible for clinical licensure. http://www.usuhs.mil/mps/clinindex.html
• Duke University Medical Center's APA-approved Clinical Psychology Internship Program, part of the Department of Psychiatry's Division of Medical Psychology, provides one year of doctoral-level internship training in the essential skill areas of Clinical Psychology: assessment and diagnosis, effective intervention, consultation and evaluation, and supervision. Training takes place in a health care setting and offers all interns training in general Clinical Psychology, as well as the opportunity to concentrate on specific areas of Health Psychology. Training takes place within the context of the scientist-practitioner model and has as its overarching goal, to produce a Psychologist who is able to integrate science with professional practice knowledge, attitudes, and skills. At the completion of the program interns are expected to have developed proficiency in observation, interviewing, assessment, report-writing, short-term psychotherapy, cognitive-behavioral treatment, family therapy, and group therapy, which will serve them well in subsequent clinical practice. Graduates of the program may function as clinicians, as researchers, or as both. http://psychiatry.mc.duke.edu/Education/Psychology/Psychology.htm.
• University of California at Los Angeles Medical Psychology - Neuropsychology Program is charged with oversight of the activities of psychologists throughout the UCLA Healthcare Enterprise. Its principle activities are conducted within the UCLA Neuropsychiatric Institute and Hospital, where faculty, staff, and trainees contribute to a broad spectrum of clinical, research, and educational activities. The program offers an APA accredited internship and postdoctoral training. http://psychology.npih.ucla.edu/.
• The two-year APA accredited Postdoctoral Medical Psychology Fellowship Program at Mayo Clinic in Rochester, is designed for recent graduates of an American Psychological Association (APA)-Accredited Clinical or Counseling Psychology Doctoral Program and an APA-Accredited Predoctoral Psychology Internship who wish to acquire specialty training in one of three Substantive Specialty Practice Programs offered in this fellowship: Clinical Child Psychology; Clinical Health Psychology; Clinical Neuropsychology. http://www.mayo.edu/msgme/psychology-rch.html
• Johns Hopkins Medical Psychology Clinic offers a full range of psychological services for adults. These include: psychological and neuropsychological assessment; consultation with physicians, other health professionals, educators, social service agencies and attorneys; counseling of medical patients; individual, couples, and group psychotherapy. It serves patients with a wide variety of conditions, including: memory disorders; cognitive impairment due to brain injury or neurological disease; emotional and behavioral disorders; relationship problems; stress-related disorders; learning disabilities and attention-deficit disorder; problems adhering to medical treatment regimens; problems adjusting to chronic illness; alcohol and other substance abuse. http://www.hopkinsmedicine.org/Psychiatry/med_psychology/
• Drake's Medical Psychology Services: Traumatic injury, chronic illness, or disability can cause emotional upheaval that can be difficult and challenging for both patient and family. The patient is often faced with the reality of reduced independence and an altered lifestyle. Research has shown that attitude, outlook, and coping skills are essential foundations of effective rehabilitation, and non-treatment of these emotional issues can lead to further disability. Drake Center's medical psychology professionals are trained and experienced in treating the overlapping area between medical illnesses and psychological problems. In fact, we are a unique resource in the region for this kind of service. http://www.drakecenter.com/patientcare/outpatient_psych.asp

A search of Amazon books using the term "medical psychology" located the following five top listings; none are focused on prescriptive authority for psychologists:

• Medical Psychology by Lydia Ross
• Clinical Health Psychology in Medical Settings: Practitioner's Guidebook by Cynthia D. Belar and William W. Deardorff
• Handbook of Clinical Health Psychology: Medical Disorders and Behavioral Applications (Handbook of Clinical Health Psychology) by Thomas J. Boll, Nathan W. Perry, Ronald H. Rozensky, and Suzanne Bennett Johnson
• Medical and Psychological Aspects of Sport and Exercise by David I. Mostofsky and Leonard D. Zaichkowsky
• Medical Psychology: Contributions to Behavioral Medicine by A. A. Bradley and Charles Prokop

Further, there are numerous medical psychology departments throughout the world, and medical psychology courses are taught to medical students in the U.S. and worldwide. The IHC is concerned that the proposed use of "medical psychologist" as synonymous with "prescribing psychologist" is inconsistent with the historic use of the term both within the United States and worldwide.

Through the Commission on the Recognition of Specialties and Proficiencies in Professional Psychology, APA recognizes proficiencies and specialties within professional practice http://www.apa.org/crsppp/rsp.html. Currently, 11 specialties and 6 proficiencies are recognized; "medical psychology" is not one of them.

Therefore, the IHC advocates that the words, "medical psychologist" or "medical psychology," not be conflated with "prescribing privileges authority." We are not opposed to psychologists seeking prescriptive privileges, only to the misuse of the term, "medical psychologist." We request that these concerns be considered by CAPP, and ask that the language of the Model Legislation for Prescriptive Authority be rectified to address this concern.

Thank you for considering this matter.

Sincerely,

Robert L. Glueckauf, Ph.D., Chair, Interdivisional Healthcare Committee

Daniel Bruns, Psy.D.
(Representing APA Division 38; Health Psychology)
Health Psychology Associates, Greely, CO

Rob Glueckauf, Ph.D.
(Representing APA Division 22; Rehabilitation Psychology)
Department of Medical Humanities and Social Sciences, College of Medicine
Florida State University, Tallahassee, FL

Nancy Hansen Merbitz, Ph.D.
(Representing APA Division 38; Health Psychology)
Independent Practice, Pontiac, IL

Barry Nierenberg, Ph.D., ABPP
(Representing APA Division 22; Rehabilitation Psychology)
Center for Psychological Services
Nova Southeastern University, Ft. Lauderdale, FL

Donald R. Nicholas, Ph.D.
(Representing APA Division 17; Society of Counseling Psychology)
Department of Counseling Psychology
Ball State University, Muncie, IN

Margaret Norris, Ph.D.
(Representing APA Division 12; Section 2, Society of Clinical Psychology, Clinical Geropsychology)
Independent Practice, College Station, TX

Nancy Ruddy, Ph.D. (Representing APA Division 43, Family Psychology)
Independent Practice, Verona, NJ

Cheryl L. Shigaki, Ph.D., ABPP
(Representing APA Division 12; Section 2, Society of Clinical Psychology, Clinical Geropsychology)
Department of Health Psychology, School of Health Professions
University of Missouri-Columbia, MO

Kevin C. Smith, Ph.D.
(Representing APA Division 54 (Society of Pediatric Psychology)
Nationwide Children's Hospital, Department of Psychology
Columbus

Daniel Bruns, Psy.D.
(Representing APA Division 38; Health Psychology)
Health Psychology Associates, Greely, CO

Rob Glueckauf, Ph.D.
(Representing APA Division 22; Rehabilitation Psychology)
Department of Medical Humanities and Social Sciences, College of Medicine
Florida State University, Tallahassee, FL

Nancy Hansen Merbitz, Ph.D.
(Representing APA Division 38; Health Psychology)
Independent Practice, Pontiac, IL

Barry Nierenberg, Ph.D., ABPP
(Representing APA Division 22; Rehabilitation Psychology)
Center for Psychological Services
Nova Southeastern University, Ft. Lauderdale, FL

Donald R. Nicholas, Ph.D.
(Representing APA Division 17; Society of Counseling Psychology)
Department of Counseling Psychology
Ball State University, Muncie, IN

Margaret Norris, Ph.D.
(Representing APA Division 12; Section 2, Society of Clinical Psychology, Clinical Geropsychology)
Independent Practice, College Station, TX

Nancy Ruddy, Ph.D.
(Representing APA Division 43, Family Psychology)
Independent Practice, Verona, NJ

Cheryl L. Shigaki, Ph.D., ABPP
(Representing APA Division 12; Section 2, Society of Clinical Psychology, Clinical Geropsychology) Department of Health Psychology, School of Health Professions
University of Missouri-Columbia, MO

Kevin C. Smith, Ph.D.
(Representing APA Division 54 (Society of Pediatric Psychology)
Nationwide Children's Hospital, Department of Psychology
Columbus,OH

© 2010, APA Division 38
All rights reserved.