This presentation was developed by Dr. Elaine Levine the first prescribing psychologist in New Mexico. In it, she described the Psychobiosocial Model of care which is a holistic model referenced in The Integration of Psychopharmacology and Psychotherapy in PTSD Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence, Disaster, Health and Illness. It also includes an overview of the requirements and responsibilities of prescribing psychologists in New Mexico.

1. Prescribing Psychologists
A Different Model of Care
Elaine LeVine, Ph.D., ABMP

2. A NEW MODEL/
THE PSYCHOBIOSOCIAL MODEL
Tenets:
The patient’s phenomenological view of psychotherapy and medication management is
central.
By assessing resilience and vulnerability within all dimensions of functioning, the patient’s
perceptions, personal values and needs as the basis for deciding all forms of biological,
psychological and social interventions
Least invasive, empirically-supported approaches are considered first line interventions
Combined intervention may be necessary dependent on needs preferences conditions
Medication management is integrated into therapy and serves varied goals through phases of
therapy
LeVine, E., Mantell, E., The Integration of Psychopharmacology and Psychotherapy in PTSD
Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence,
 Disaster, Health and Illness, Westport, Conn

3. Clarifying the Diagnosis
Using psychologists’skill to
differentiate:
1. Stress from psychological disorder.
2. Psychological disorder from
underlying medical condition.
3. Recognizing that the diagnosis and
focus of treatment may change
over time.
– Thereby assuring that medication
targets core of the disorder not
“chasing symptoms.”
– Possibly requiring modification of
psychotherapy and medication.
Deepening the Relationship
Considering patients’ desires of which
symptoms they consider most
problematic and side effects they
can tolerate.
Extensive informed consent about:
1. Various drug effects
2. Side effects
3. Drug interactions
4. Pros and cons of psychotherapy,
medication and both
Close work with physicians increases
patients’ sense of safety and thereby
fosters the therapeutic alliance.
ISSUES DURING THE INITIAL AND
ONGOING PHASE

5. PSYCHOBIOSOCIAL ISSUES IN THE
ACTIVE WORKING PHASE
 Work of the first phase continues
 Medication compliance interpreted as transference
increases compliance and facilitates change
 Patient choice of approaches and changes in
approaches increases patient’s sense of autonomy
 Confronting “drug by seeking behavior of addicts
and pain patients” the prescribing/medical
psychologist can help
 Patients learn new ways to handle problems and
relate to others.

6. PSYCHOBIOSOCIAL ISSUES IN THE
MAINTENANCE PHASE
 Discussion about actual reduction in number of sessions
and amount of medication.
 Analyzing possible “poop out” effect. (Are there new
stressors, has patient relapsed or medication has
“stopped working?”)
 Look at long term effects and side effects of changes in
psychological environment (i.e., divorce) as well as
medication (i.e., sexual, tardive dyskinesia).
 Consequently, patient learns to become expert observer
of self and the need for psychotherapy and/or medication
change.

7. PSYCHOBIOSOCIAL ISSUES IN THE
TERMINATION PHASE
- Assessing how rapidly the psychotherapy and the
medication should be terminated
- If changing to periodic medication checks, discussing
the nature of the change in the relationship with the
patient
- Dealing with fears about stopping therapy or stopping
the medication (which may include review of
attachment issues and over-reliance on
pharmacological interventions)

8. Prescriptive Authority for Psychologists
Can Be a Vital Link in the Medical
Home/Primary Care/Integrated Health
Care Movement

9. Vector 1 Findings: Pressures on Primary Care
Physicians
• Increasingly, primary care physicians are faced with helping patients with
emotional problems.
• They have neither the time nor extensive training to deal with these
issues in depth.
• They often respond to these pressures by prescribing psychotropic
medications.
• Over 80% of psychotropic medications are prescribed by primary care
doctors.
• Yet, meta-analyses reveal that often these emotional needs could be
addressed as effectively, or more effectively, by psychotherapy.
• Moreover, psychotherapy plus medication is often more effective than
medication alone.
 (In LeVine & Foster, 2010 Integration of Psychotherapy and Pharmacotherapy y
Prescribing Psychologists: A psychobiosocial model of care. In R. McGrath & B.
Moore, Therapy for Psychologists: Prescribing Collaborative Roles. Washington,
DC: American Psychological Association)

10. Vector 2 Results: Pressures on Psychologists
◦ It is increasingly difficult to maintain a private practice
◦ Limited insurance reimbursement
◦ Endless paperwork
◦ It can take young graduates years to be accepted on
insurance panels
◦ New graduates need jobs in which they can quickly pay back
huge college loans
◦ Many psychologists report more barriers to triage in our
fragmented care system

11. Vector 2 Results: Pressures on Psychologists
◦ New positions are available in primary care centers,
spurred by federal funding streams that require
behavioral specialists in the centers
◦ The behavior specialists are being asked to adopt a
biopsychosocial model of care (George Engel,
1981) as they triage with medical colleagues in
these settings
◦ Their expertise must include: health psychology,
knowledge of psychopharmacology, and knowledge
about the dynamics of primary health care settings

12. Vector 3: Enter Prescribing Psychologists
• Prescribing psychologists, by law, must maintain a
collaborative relationship with primary care physicians
• Many are working in medical settings
• Many report increasing referrals from physicians
• They also note increasing referrals for
– Dual diagnoses patients
– Severely mentally ill

13. Vector 3: Enter Prescribing Psychologists
• They are adopting a different model which includes the
following:
–Less use of multiple medications
–A trend to take some patients off medications in favor of
psychotherapy
–Extensive informed consent

15. Overview of Training
to become a
Prescribing
Psychologist
In
New Mexico

16. Requirements for Prescribing Psychology
License
• Must have a doctoral degree and license as a psychologist in good standing to be
accepted into the SIAP/NMSU program
• Must complete a post-doctoral program in Psychopharmacology which includes
– 36 academic hours
– 80 hour practicum with primary care physician
– 400 hour/ 100 patient practicum in diagnosis and treatment of mental disorder
• Must pass a nationally standardized test, Psychopharmacology for Psychologists
(the PEP).
• Then can obtain a conditional license to prescribe
• With conditional license, must see 50 patients over two years under supervision
• After review of records by New Mexico Board of Psychologist Examiners,
conditional psychologists can obtain an unrestricted license to prescribe
psychotropic medications

17. Rights and Responsibilities of Prescribing
Psychologists
• Remain in a consultative relationship with a Primary Care Physician
• Formulary is limited to psychotropic medications
• Must order appropriate lab tests to be a safe prescriber
• Must practice within area of specialization of the psychology license
and with appropriate post-doctoral supervision
• Those with hospital practices and privileges can prescribe at
hospitals for their patients
• Child psychologists with prescriptive authority and appropriate post-
doctoral supervision can prescribe for children
• Must also have appropriate background and specialized
supervision to work with geriatric populations

18. Rights and Responsibilities of Prescribing
Psychologists
• Prescribing psychologists can bill for Medicaid and most private
insurances at a rate
• approximately $10 higher per hour than other psychologists
• Medicare does not yet recognize prescribing psychologists
• Prescribing psychologists offer the state great cost savings as they
provide psychotherapy, psychological testing and assessment, and
psychopharmacological intervention in each session by one
provider

19. Summary
Prescribing Psychologists Are:
Providing quality care to those with mental health
issues
Increasing access to care for all
Becoming a formative part of Integrated Health Care
Models with particular emphasis on underserved
populations in rural settings

20. Training For The Future For Our Patients
Through RXP Psychology!
And – How about the Netherlands, now?