The PsychContinuingEd.com Blog

Robert Frost, baseball and… my take on RxP

At least one of the other APA presidential candidates has come out in favor of seeking prescription privileges and it is reasonable to wonder about my views on the matter. I have nothing against the suggested training regimens for prescribing psychologists and I believe psychologists are smart enough to learn how to prescribe medication.

However, I believe supporting efforts to gain prescription privileges for psychologists is a waste of our limited national resources.

The field itself is generally split with some who even criticize the amount of research support for certain medication approaches. My views are not as extreme as those at this point and I do not oppose all uses of medication for psychological concerns. However, I do question blind assumptions that medications are the only treatment of the future or that somehow psychologists would be better prescribers than psychiatrists. I also question the assumption that psychologists are the best professionals in underserved areas who could provide this service. In addition, those same underserved areas are also likely to need people providing assessment and psychotherapy services as well.

I do not oppose demonstration projects or existing programs within the federal government or locations that have approved prescriptive authority for psychologists. I also admire those professionals who gambled on training programs designed to teach psychologists how to prescribe. I also welcome APA divisions and other organizations to continue to pursue their passions on both sides of this issue.

There are many paths that psychology, as one traveller, could try to take. There are only so many pitches we can actually swing at. Let’s let the less important pitches go by so we can knock the ones that truly matter out of the park.

I believe seeking prescription privileges on a wider scale will consume national resources that are better spent on advocating for psychologists’ role as the premier provider of evidence-based, nonpharmaceutical interventions (as opposed to a mediocre version of a psychiatrist). Let’s stand on the very top of a peak that is well within our wheelhouse and well within the reasoning of why many got in to this field in the first place. Pursuing RxP would not be a focus of my presidency and I would in fact view it as a distraction from APA’s national mission.

Seeking prescription privileges is not a path to increased credibility for psychologists, advancing the status of evidence-based psychosocial interventions is. Our advocacy should be on supporting and promoting the incredible things Psychology is already accomplishing.

Todd Finnerty, PsyD is President of PsychContinuingEd.com, LLC and is running for President of the American Psychological Association.

“Evenly Distributing” Psychology’s Future

William Gibson said,“The future is already here — it’s just not very evenly distributed” The American Psychological Association has launched an effort to establish treatment guidelines starting with depression and obesity. This initiative is a welcome one, and we must continue to press even further to promote the use of evidence based approaches. All psychotherapeutic approaches are not equally effective for all problems.

I am pleased to announce that I, Todd Finnerty, Psy.D., am running for APA President. The nomination ballot should be available starting February 1st.

I am also pleased to announce “The Psychology Super Bowl Commercial Challenge”

While we could debate the merits of APA actually paying for a Super Bowl commercial for Psychology, a Super Bowl Commercial sized number of people (or more) are impacted by our field every year.

A Challenge to you: What Would Your Psychology Super Bowl Commercial Look Like? What message about the science and/or practice of Psychology would you focus on? I challenge each one of you to record “Psychology Super Bowl Commercials” and put them on YouTube. We’ll help you show them to the world.

In the meantime our Super Bowl Commercial is happening all around us. Millions of people each year benefit from Psychology. The best “Super Bowl Commercial” for Psychology is the collective actions of each one of us. We advertise the benefits of psychology every day with our actions and interactions with others- and that is how the news spreads.

How will millions of people learn more about Psychology? They already are learning through their contacts with us (and possibly will learn more from your upcoming hit YouTube video). It is important that in our actions we do not miss the opportunity to deliver the most evidence-based and supported Super Bowl Commercial that we can.

I’m challenging every Psychology Club and Psi Chi chapter and every other person or organization interested in Psychology to create a “Psychology Super Bowl Commercial” touting what you see as the benefits of the field of Psychology and upload it to YouTube. Who knows? The Psychology Super Bowl commercial with the most “likes” on YouTube might even get promoted on APA and other websites and possibly even aired on TV. I will also promote all of them on my blog and on Twitter and Facebook.

You are welcome to forward this message on to everyone you feel cares about our field and cares about educating the world about Psychology.

Thank you for your support of The Psychology Super Bowl Commercial Challenge. I also welcome your support for President of the American Psychological Association.

Thank you,

Todd Finnerty, Psy.D.
www.toddfinnerty.com

Meet other professionals in your area

I was thinking of a more amusing title for this blog post but I’m sure something racey would annoy spam filters. Happy new year by the way, I hope everyone has a spectacular 2012!

Last weekend I had the honor of speaking at the first ever Central Ohio Peer Consultation Network event. It was jointly sponsored by the Ohio Psychological Association and Central Ohio Psychological Association, it was free to attend and it was open to both members and non-members of these associations. The OPA plans to help stimulate these types of groups all over Ohio. I believe this is a model that other groups can emulate all around the country.

Mental health practice can be isolating, particularly for solo practitioners or others without an extensive network of colleagues. This can be stifling and isolated professionals could potentially not continue to develop to their full potential.

Professional development doesn’t necessarily come from simply taking a course now and then. Our interactions, consultations and discussions with colleagues serve to deepen our awareness and understanding of the issues in professional practice. In short, we can learn and grow by connecting with others. The exposure to the puzzles, thoughts and experiences of others leads us to new ideas and broader perspectives.

My life is now richer for having met and interacted with the approximately 18-20 other individuals who came to talk about the DSM-5 proposals. We will all continue to meet over coffee at a Panera or elsewhere around once a quarter to benefit from each others’ perspectives and experiences. If you are interested in learning more about this or how you could start something similar in your area feel free to contact me, Todd Finnerty, Psy.D.

Thanks again for your interest in PsychContinuingEd.com, LLC.

See the News Release at the Ohio Psychological Association’s website.

Some potential discussion questions we may use include:

Each paragraph is meant to stimulate discussion around a central theme; the specific questions are less important than the ensuing discussions:

(1) The DSM is sometimes referred to as the “bible” of psychiatry. If this is true, should it be “interpreted literally?”  Why and when should it be? Why and when shouldn’t it be?

(2) If you had a magic wand and could change anything about the DSM-IV what would it be and why?

(3) The DSM-5 will likely recommend the use of a number of specific rating scales. In addition, third party payors like Medicare will likely increasingly look for psychologists to report various outcomes related to their practice. With available time to see patients a constant issue, what strategies can psychologists use to best incorporate these scales in to their practice (if at all)? How do we decide which scales are best to use?

(4) At least 3 DSM-5 personality disorder work group members have published and sell personality tests. Should the authors of personality assessments be allowed to author how personality is assessed under DSM-5? How would you select DSM work group members given that their lines of research and professional identities may also be impacted by the outcome of the “expert consensus” that is arrived at by the chosen group.

(5) A dimensional conceptualization suggests that something falls on a continuum without discrete boundaries. A categorical conceptualization would imply that specific categories were 2 separate entities. Some examples of things we tend to dimensionally conceptualize, but have categorical cut offs for, are blood pressure and intelligence (IQ). DSM-5 is moving towards increasing the emphasis on dimensional conceptualizations, particularly with personality. 2 personality disorder work group members suggested that “there might be specific pharmacologic treatment implications” for personality traits such as having high neuroticism (ex: antidepressants, mood stabilizers) or low conscientiousness (ex: stimulants) Widiger, Clark & Livesley (Psychological Assessment Vol. 21, No. 3, 243–255). Should personality traits be medicated? How/”where” do we draw the line between traits and a disorder and whether they get treatment? Some concerns are that the DSM may lead to the “over-medication” of some people. Is it inherrently bad or good if more or less people become “eligible” for treatment? When would it be desirable or undesirable for someone to get treatment and/or have a diagnosis?

(6) Many of the criticisms levelled at DSM-5 also apply to DSM-IV. Can psychologists survive without the DSM? If so what would that look like? Can we throw away diagnostic labels altogether? What role could psychologists play in training others to diagnose and treat under the upcoming ICD-11?

(7) Despite vocalizing a desire to move toward a diagnostic system grounded in neuroscience and “identifiable pathophysiologic etiologies,” the DSM does not contain a listing of genetic syndromes (ex: Downs). The DSM-5 will remove Rett’s Disorder- the rationale is “Rett’s Disorder patients often have autistic symptoms for only a brief period during early childhood, so inclusion in the autism spectrum is not appropriate for most individuals. Like other disorders in the DSM, Autism Spectrum Disorder (ASD) is defined by specific sets of behaviors and not by etiology (at present) so inclusion of a specific etiologic entity, such as Rett’s Disorder is inappropriate. To ensure that etiology is indicated, where known, clinicians will be encouraged to utilize the specifier:  ”“Associated with Known Medical Disorder or Genetic Condition.””  In this way, it will be possible to indicate that a child with ASD has Fragile X syndrome, Tuberous Sclerosis, 22q deletion, etc.” The DSM-5 has proposed to include Sleep Apnea, Somatic Symptom Disorders, Language & Tic disorders, etc. Where do the boundaries of what should be included in the DSM end and begin? What should be considered in arriving at this?

(8) What is in a name? Would Aspergers by any other name smell as sweet to parents? What should impact the names of diagnoses and name changes such as Mental Retardation to Intellectual Developmental Disorder?

Thanks again for your interest in PsychContinuingEd.com

I  have found myself using “Catch” a lot to take non-confidential notes, jot down ideas, etc. The basic service is free and allows for more space than I really need. In away it is sort of a poor man’s cloud computing. You can take notes to yourself and then access them from the web (using any computer). You can also allow some notes to be shared so that you can work on something together. There is a Catch “app” for your smartphone which seems to be something I use frequently and have found myself jotting less on scraps of paper that I’ll just end up losing anyway. Another free “app” that integrates with Catch is called Ijournal. This is something that patients and their therapists may be interested in using since the price is right (free). While it isn’t specifically designed to track moods, etc. like some apps designed for individuals with bipolar, etc., it certainly can be used as a daily journal and to keep track of CBT homework or other things you might use a journalling for. You can learn more at Catch.com

A similar service to Catch is called Evernote. Evernote’s basic service is also free. You might like to compare the two to see which interface you prefer. Learn more at Evernote.com

Of course, if you’re simply looking to share documents, spreadsheets, presentations, etc.  out there and work on them collaboratively with one or more people there is always Google Docs

Thanks again for your interest in PsychContinuingEd.com

This week I wanted to share with you this brief clip on YouTube from Ross Greene, Ph.D.  Dr. Greene is the author of The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children among other books (and as you may know you can get CE credit for reading the Explosive Child at PsychContinuingEd.com

Dr. Greene has multiple videos that are worth watching for parenting and/or working with challenging children- check out his YouTube channel or his website at livesinthebalance.org