Psychologists’ Latest Proposal Appears to Continue Push for Expanded Scope of Practice

Has the proverbial camel’s nose just inched slightly farther under the tent?

That may be the concern of those who maintain that the care of medically ill people should remain the province of physicians and professionals with medical training when they ponder a recent decision by the American Psychological Association.

That organization announced in early December that it is establishing a formal specialty area for psychologists who treat the mental health problems of medically ill people. Called "clinical health psychology," the designation is being implemented to recognize psychologists who have doctoral or postdoctoral training that has "prepared them to treat the psychological aspects of physical illness and disability," according to a press release from the 150,000-member association.

The psychological association’s archival description of clinical health psychology provides a more complete picture, pointing out that the specialty "applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social, and biological components in health and disease to the promotion and maintenance of health [and] the prevention, treatment, and rehabilitation of illness and disability. . . . Fundamental to clinical health psychology is the biopsychosocial model and the ability to work in a broad range of health care settings with other health care providers."

The description of the new category also states that these clinical health psychologists will likely be involved in both "health promotion and improvement of health care systems."

The American Psychological Associ-ation’s background paper articulates the following problems on which these specialists will focus:

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1. [P]sychological conditions secondary to diseases/injury/disability, (e.g., post myocardial infarction depression, family issues in chronic illness or death, body image concerns secondary to burns, amputation, surgery)


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2. somatic presentations of psychological dysfunction (e.g., chest pain in panic attack, somatization disorders)


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3. psychophysiological disorders (e.g., tension and migraine headache, irritable bowel syndrome)


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4. physical symptoms/conditions responsive to behavioral interventions (e.g., vasospasms, urinary and fecal incontinence, anticipatory nausea)


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5. somatic complications associated with behavioral factors (e.g., mismanagement of diabetes, noncompliance with medical regimens


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6. psychological presentation of organic disease (e.g., hypothyroidism presenting as depression, steroid-induced psychosis."

The American Psychological Association points out that its recognition of a new specialty field does not come with a requirement that practitioners seeking the designation complete a licensing, certification, or credentialing process in that area, just that the new specialty "demonstrate distinctiveness with respect to populations served, problems addressed, and techniques or methodologies employed." The association has recognized 50 "subfields" of psychology that meet this criterion.

APA’s Director of Government Relations, Jay Cutler, J.D., told Psychiatric News that he "would speculate that this new ‘specialty’ is more about scope of practice and the continuing effort of some branches of psychology to imply that they are ‘medical health professionals’ than it is about any objective change in the structure of psychology that would warrant such a self-designated name change."

Cutler pointed out that information appearing in American Psychological Association publications suggests that the new specialty field is motivated as much by politics and economics as "by any plausible link to ‘medical care’ since articles have emphasized insurance coding and reimbursement issues and scope-of-practice advocacy, particularly in situations where psychologists are required to be supervised by psychiatrists."

He reiterated APA’s long-standing concern that the psychological association is taking steps that may place economic issues over patient care.

"As APA has consistently argued regarding prescribing privileges, the overriding issues are the safety of patients and the quality of care they receive. This focus must not be lost in their search for expanded privileges or licensure changes without appropriate didactic and clinical education and training," Cutler said.