Stanley J. Berman, PhD
The Master of Science in Clinical Psychopharmacology at the Massachusetts School of Professional Psychology (MSPP) can serve as one example of the issues that arise as psychologists opt to pursue training in this area. The program is now 5 years old. MSPP graduated their first class in 2003 and additional classes in 2004 and 2005 and now has an alumni group of 30 psychologists from Massachusetts, Maine, New Hampshire, Connecticut and Rhode Island.
Year I Curriculum
Our four semester program begins with a course in Biological Foundations, including Human Anatomy, Physiology and Pathophysiology and Selected Topics in Biochemistry. This course is taught by a health psychologist who is also a professor of physiology and a Ph.D. level neuropharmacologist. The next course taught is Introduction to Physical Assessment and Pathophysiology II. This course is taught by a family physician and a psychiatrist. Our students then proceed to a Neuroscience course taught by two neuroscience professors from M.I.T. and University of Massachusetts and a psychiatrist from a leading medical school faculty.
Year II Curriculum
Year II begins with Pharmacology and Clinical Psychopharmacology I, which is followed by Pharmacology and Psychopharmacology II. These courses are directed by a psychologist and neuropharmacologist with assistance from additional teachers from the fields of psychology, behavioral neurology, adult and child psychiatry, psychiatry with a specialty in substance abuse and a professor of pharmacology. In the later sections of this course, we teach the scientific bases for the psychopharmacological treatment of, for instance, schizophrenia and psychotic disorders with one or more days with an active practitioner in this area who addresses clinical management considerations. For example, our psychoses section finishes with instruction from a psychiatrist and a psychologist who direct an urban community health center caring for the chronically mentally ill. In the latter half of the fourth and final semester, we conclude with a course on Pharmacotherapeutics which covers areas including practicing in a diverse world, legal, ethical and professional issues as well as medical co-morbidity, drug-drug interaction and pharmaco-epidemiology. This course is team taught by two psychologists and a professor of pharmacology.
Depending on past training in the sciences, students report studying 6 to 15 hours a week outside of class in the first year. In the second year, when students have a solid foundation in the sciences, the study time per week decreases. Students use e-mail to discuss course content in between classes. Examinations and papers are most often given as take home tests.
We have also been able to demonstrate that distance learning can be effective. Distance trainees are required to attend a number of residential weekends over four academic semesters. When a psychologist is at home or in her office in Caribou, Maine or in Southern Connecticut, she hears the lecture in real time, or at a non-class time convenient to her, sees the PowerPoint and board work, and can raise her hand electronically and through her microphone at home can actively and routinely participate in Q/A sessions and discussions. All our trainees use the archived lectures for study and review.
The majority of the MSPP alumni have chosen to enroll in a clinical fellowship program that the school offers. Trainees arrange for clinical rotations in their communities. Two trainees moved from their solo private practices to part-time employment with a group practice specializing in geropsychology. The clinical rotations were readily available and embedded in their work in this practice. Another trainee was able to use his job site at an inpatient hospital setting. A final example can be identified in the work of a health psychologist who has furthered his collaborations with primary care settings. MSPP screens and approves the proposed supervisors, provides a monthly supervision morning one Saturday a month, an annual two-day update in clinical psychopharmacology, and evaluates the students' clinical performance through a multi-modal assessment approach. Trainees are all offered an intensive five-day Psychopharmacology Examination for Psychologists (PEP) review course and can elect to sit for the PEP at any time during their fellowship experience. Some trainees want to take the exam soon after their coursework ends and others want to integrate their classroom experience with applied clinical work prior to the exam.
Collaborating with Other Professions
One myth that we have quickly dispelled is that only psychologists who want to have independent prescription privileges enroll in a training program. We have a number of psychologists who study to fill in those gaps in their previous training so they can more fully understand the role and actions of medication in the treatment of their patients. A child psychologist in rural Maine who does a substantial amount of work in the local public schools is one example. Two private practitioners, one with adults and one with children, in Connecticut are further examples. We have also had three psychologists who work as substance abuse researchers who found the training invaluable for their research pursuits. This constituency represents 30 to 35 percent of enrolled psychologists. The remainder plan to pursue prescription authority and are in leadership roles in advocating for these legislative changes. Regardless of goal, training has had unexpected benefits for all students in enhancing trainees' understanding of medicine and pharmacology with clear implications in behavioral medicine, neuropsychology, child psychology, geropsychology and in their ongoing collaborations with physicians and nurse practitioners.
Another myth we have been able to dispel is that no physicians and certainly no psychiatrists would serve on our faculty. On our faculty, we have physicians in behavioral neurology, family medicine, endocrinology and child and adult psychiatry joining our psychologists, physiologists, neuroscientists and Ph.D. and D.Pharm pharmacologists.
I want to report on additional learning in the five years we have offered this degree program. Advanced practice nurses and nurse practitioners in primary care began requesting admission to our program. They were routinely writing prescriptions for psychopharmacological agents, but felt that they required both a broader and deeper training in psychology in order to meet their own professional goals of greater competence in this area. In 2004, we began offering a training track within our program for these A.P.R.N.s. We hired a number of nursing professors with Ph.D.s in Nursing, as well as a Ph.D. who is also an A.P.R.N. The coursework includes a semester in Psychopathology and DSM-IV-TR, which is offered while psychologists are studying Anatomy, Physiology and Pathophysiology. When psychologists and nurses come together in some lectures, there is a healthy exchange in which nurses share additional primary care medicine expertise while psychologists contribute their expertise in the treatment of mental disorders. The joint lectures have a very positive synergy. Faculty are available for one-on-one office hours, e-mail exchanges or small group discussions to make sure that all trainees have a firm grasp of the coursework.
The 1995 APA task force had encouraged three levels of training which includes: Level I: Enhancing education in psychology for all psychologists at the pre and post doctoral levels, Level II: Advanced training for psychologists working in collaborative healthcare settings and Level III: Advanced training for psychologists seeking to be independent practitioners of psychopharmacology. The training directors of the eight psychopharmacology programs are now discussing how they can contribute to enhancing training at all levels. The Education Committee of Division 55 plans to continue working closely with different governing bodies in organized psychology to establish the best national guidelines for training and practice. With the majority of psychotherapy patients utilizing psychopharmacology as one component of their care, it is incumbent on all practitioners to have the best understanding possible of the appropriate role, and the potential misuse of this arm of treatment.
Stanley J. Berman, Ph.D., is the Dean, Programs of Advanced Graduate Study and Director, Master of Science in Clinical Psychopharmacology program at the Massachusetts School of Professional Psychology.