From the Editor

This issue features two themes that are top-of-the-mind issues for practicing clinicians: psychoactive medications and licensing board enforcement. Both themes concern the “ecology” of the environment in which we practice. As Dr. Wiggins article explains, our practice environment has evolved over the past thirty years. Many of us can recall, at the beginning of our careers, little difference in the practices of many psychiatrists and many of us. Many members of both groups did psychodynamic psychotherapy. As things evolved, more psychiatrists turned towards strictly pharmacological practice, and recently graduated psychiatrists may have never been trained in, or practiced, psychotherapy.

For readers who have not kept up with this trend, I can assure you that many young psychiatrists are practicing today without even a rudimentary knowledge of psychotherapy. Their profession has attempted to gain marketplace domination from psychologists and other psychotherapy practitioners by defining most forms of mental and emotional illness as biochemically caused. In reaction to recasting psychological problems as biological, the definition of appropriate treatment has also been recast. Rather than talking about something, the solution what is now perceived as a “chemical imbalance” becomes a medication-based intervention. Ironically, this pharmacological emphasis and specialization failed to give psychiatrists the marketplace domination they probably hoped for. Instead, what Dr. Wiggins calls the “split treatment” model has evolved. Largely because of insurance reimbursement contingencies, the predominance of psychopharmacological prescribing in carried out by non-psychiatric physicians—family practitioners, internists, ob/gyn’s and pediatricians. The split treatment model does a disservice to patients. The left hand, the prescribing physician, may not know what the right hand, the psychotherapist, is doing. Dr. Wiggins cogently argues that psychologist prescribing will lead to an improvement in patient care and an the overall quality of treatment for emotional disorders in the United States, as a single, highly trained specialist takes control of patient care.

The article by Bernard Lewis, Ph.D., talks about the various stresses that befall psychologists who are on the receiving end of licensing enforcement. Dr. Lewis suggests some coping strategies in his very useful article. Licensing board enforcement is an issue of great concern of our Division. Independent Practitioners are the psychologists who are most likely to be recipients of adverse attention from their licensing boards. Division 42 has authorized, together with Division 31, an Interdivisional Task Force on licensing board matters. Members of this task force include myself, Lenore Walker, David Shapiro, Martin Manosevitz and Mark Peterson, with President-Elect Jeff Barnett as ex-officio member. We have established as our first goal to create a Primer for the Practitioner Facing a Complaint. We hope to collect a wealth of knowledge that will help level the playing field between the state boards’ enforcement apparatus and the practitioners, who feel overwhelmed, outgunned and outnumbered from the moment they learn of the complaint.

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