Chasing RxP: From Davenport to Clarinda

We have all been through at least one of those experiences where you get to the end and look back and say, “I am glad I did that but I would never want to do it again.” Completing the requirements to become a prescribing psychologist (RxP) to licensure has certainly not been one of those experiences. If I had the time, I would do all the training over again as there is so much useful information to learn. From the first day of psychopharmacology class in January of 2017 to the first day I was legally able to write a prescription, which was June 21st, 2021, each milestone along the way has been very enjoyable. There was not a single time I thought, “What the heck have I gotten myself into?”

I attended undergraduate at the University of Nebraska-Lincoln in the 1990s. While trying to build a resume for application to graduate school I worked at the clinic of Dr. Matthew Nessetti, who was one of the early presidents of Division 55 (Society for Prescribing Psychology). It was from his energy and enthusiasm about psychopharmacology and his vision for the future of psychologists being able to practice medicine, that I too became excited for RxP before I ever set foot into graduate school. That is when the chase began. 

Around 1996, I traveled to Davenport, Iowa, to the Iowa Psychological Association annual convention that was organized by Dr. Bethe Lonning. Along with Dr. Nessetti, I assisted in a presentation on the history of the pursuit of prescription privileges. Fast forward to over 20 years later, in December of 2019 I left my position as a neuropsychologist for Madonna Rehabilitation Hospital in Lincoln, Nebraska, where I had a rewarding career in neurorehabilitation. I left that job to take a position at Clarinda Regional Health Center in Clarinda, Iowa. Honestly, it was not a tough decision to leave and that has nothing to do with Madonna. For me, it was the last piece I needed to fulfill the chase of becoming a prescribing psychologist. Over the next year I completed supervised hours in physical assessment working alongside family practice and internal medicine physicians mainly as well as co-prescribing for my patients or those of the hospital physicians. It was at that time I realized just how different the rest of my career was going to be. 

As a neuropsychologist with RxP training, I find the scope of my practice to be much broader than before. Honestly, at times in the past, I found the practice of neuropsychology to be limited. I would provide a clinical interview, testing, and a written evaluation that usually would describe the severity of one’s deficits, the impact of limitations inherent to those deficits, and recommendations for symptom relief and functional improvement. We offered some interventions such as computer based cognitive rehabilitation programs, neurofeedback, virtual reality neurorehab, and we did explore some new interventions such as transcranial direct current stimulation and near-infrared spectroscopy. The research behind such interventions is quite fascinating and is some cases, very promising, but typically those interventions are difficult to incorporate into clinical practice due to barriers of insurance reimbursement, mainly. I also saw patients with possible dementia and found working with that population to be rewarding though limited as far as assuming a typically consultative role. The culmination of my work would either indicate the patient had dementia, did not have dementia, or had some other illness masquerading as such. From the training received through the psychopharmacology program, the expansion of my role as a neuropsychologist has been tremendous. At this time, I am much more comfortable evaluating the medications patients are prescribed to discern whether there may be a culprit that could be responsible for cognitive inefficiency presenting as memory impairment. I am much more comfortable evaluating patient’s medical history to identify alternative explanations to account for the presenting problem of memory impairment. I am able to conduct a full neurological examination from the training I received, and order laboratory work which has been a totally new experience and one I find of great value through the process of performing an evaluation for the differential diagnosis of dementia. I am able to order imaging to evaluate the structural integrity of the brain without having to rely upon someone else to do so based upon their schedule or preferences. And, in the unfortunate circumstances where a diagnosis of dementia is confirmed, I am able to follow along with the patient for medication management and for the first time, find myself to be taking a lead role in patient treatment, rather than a consultative role. So, at this point some of you may be thinking, “Congratulations, you are a quasi-neurologist.” However, that is not the case; RxP training expanded my role as a psychologist and did not change my role. 

I find such liberty in being able to use the many tools available whether it is behavioral modification, cognitive therapy and even an early love of mine, existential psychotherapy, integrated into the medical evaluations and interventions available through RxP training. Also, during the years practicing as a neuropsychologist I somewhat fell out of the practice of psychotherapy and experienced subsequent anxiety about my rusty psychotherapy skills. As we know, exposure is the best intervention for anxiety and exposure is certainly what I have experienced, now working at a rural hospital setting where the needs of the community are broad and diverse. Reassuming the role as a general clinical psychologist, it has been very rewarding to evaluate, diagnose, and treat people of all different ages for varying conditions. Whether that be psychological and cognitive testing for the diagnosis of ADHD, the treatment of anxiety associated with one's life tragedies, or the unfortunate and firm hold bipolar I disorder has on a person's life, utilizing the combination of psychometric testing, psychotherapy and now medication intervention, has been by far the most enjoyable experience of my career so far. Whether engaged in medication reduction for an intellectually disabled person with autism or changing the diagnosis of someone with chronic PTSD who has been mistakenly treated for bipolar disorder for many years, the role of a prescribing psychologist is exactly what I hoped it would be. Our training as psychologists with a sound foundation in assessment, as patient listeners, as ultra-pragmatic thinkers, as humble practitioners, as believers of the potential for human change, with respect for the mind and not just the brain, and now with a sound foundation in psychopharmacology, prescribing psychologists in my opinion should not considered just another prescriber of psychiatric medication, but as a profession with a unique set of skills and training that prepares us to have the patience for the simplest of cases and the expertise of treating the most difficult of cases. 

If there is a word I can use to describe my experience of becoming a conditional prescribing psychologist, it is grateful. I am grateful for the opportunity to earn the trust of patients to assist them with their psychological and physical health. I am grateful for those who put in the decades of work it took to make the pursuit of prescription privileges a reality for practicing psychologists. I am grateful for those in our field who are willing to share their enthusiasm, time and knowledge with others in the field, especially young psychologists or those aspiring to enter the field. I am grateful for Iowa. These are wonderful times in the history of the practice of psychology and spreading our passion is a key to attracting others into the profession. I believe RxP can be a big component to this as it drastically expands the role of practicing psychologists and subsequently, can be more attractive to a greater number of aspiring college students. If you have been considering enrolling in a RxP program, quit wasting the time and energy of considering and start planning on how to make it a reality. When you get to the other side, I very much doubt there will be any regrets. 


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