Counseling Health Psychology

Abstract

Training directors of American Psychological Association–approved counseling psychology doctoral programs completed a questionnaire assessing (a) student and faculty involvement in health-related research, practice, and teaching; (b) health-related research conducted by students and faculty; and (c) programs’ expectations and ability to increase health training opportunities. Statistical comparisons suggest that a high frequency of programs name health psychology as an area of emphasis, offer specialized health psychology training, and provide health-psychology-related practica. Many reported faculty and student interest and involvement in health psychology training and research. Yet few faculty in these programs identified themselves as counseling health psychologists. Results suggest that there is interest in health psychology within counseling psychology training programs but that only a minority of programs has developed structured curricula in the area. Given counseling psychology’s unique emphasis on prevention, well-being, multiculturalism, and social justice, counseling psychology programs are well suited to developing counseling health psychology curricula.

Keywords

counseling health psychology training students faculty counseling psychology doctoral programs

Over 20 years ago, in a major contribution to The Counseling Psychologist, Tucker (1991) asked, “Counseling psychology and health psychology: Is this a relationship whose time has come?” Many of the promises and challenges facing counseling health psychology that were outlined in the 1991 major contribution (e.g., Kaplan, 1991) continue to be relevant today, including the potential role for counseling health psychologists in shaping and delivering health care. Given recent health care reform efforts as well as psychologists’ increasing role in primary care services, the time is ripe for counseling psychologists to have a presence in clinical health psychology.¹ Counseling psychologists are poised to make unique contributions to clinical health psychology given counseling psychology’s long-standing focus on wellness and prevention; a holistic, developmental, and strengths-based approach to individual health (Chwalisz & Obasi, 2008); and multiculturalism (Epperson, Fouad, Stoltenberg, & Murdock, 2005). Furthermore, the estimated number of counseling psychologists working in hospital settings has quadrupled in the past 30 years (Neimeyer, Bowman, & Stewart, 2001). The Council of Clinical Health Psychology Training Programs (CCHPTP) recently created aspirational competencies and training practices for clinical health psychologists (Masters, France, & Thorn, 2009), and little is known about the extent to which the training of counseling health psychologists corresponds to these competencies. To better assess the relationship between counseling psychology and clinical health psychology more than 20 years after Tucker’s (1991) major contribution, more information is needed on the opportunities for counseling health psychology training to determine whether graduates of counseling psychology programs will be prepared for employment within health care settings.

The Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (2010) defines clinical health psychology as the specialty that “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; the prevention, treatment, and rehabilitation of illness and disability; and the improvement of the health care system” (American Psychological Association, 2011). It is an area of psychology that has grown over the past 30 years (Kerns, Berry, Frantsve, & Linton, 2009), with the American Psychological Association (APA) Division 38 (Health Psychology) ranked as 7th in membership out of the 54 APA divisions (Masters et al., 2009). Health psychology has received increased attention as health care reform has become a national health issue. In response, members and staff of the APA, including health psychologists, have advocated actively for health care reform provisions related to integrated health care (e.g., psychological services integrated in primary care medicine), parity for mental health and substance use benefits, prevention, and wellness, and health disparities.

Historically, health psychology emphasized pathology and remediation (Baum, Perry, & Tarbell, 2004), which could conflict with counseling psychologists’ focus on hygiology, or concern “with the normalities even of abnormal persons, with locating and developing personal and social resources and adaptive tendencies” (Super, 1955, p. 5). The biopsychosocial model of health and illness acknowledges the importance of contextual forces, disease prevention, and health promotion, and health psychologists have attempted to implement this model within biomedical establishments with uncertain success (Suls & Rothman, 2004). Yet in spite of these implementation challenges (Suls & Rothman, 2004), the application of the biopsychosocial model holds the potential to create opportunities for counseling psychologists to utilize their specialized expertise (Chwalisz & Obasi, 2008; Nicholas & Stern, 2011). For instance, counseling psychology’s commitment to multiculturalism, social justice, and vocational development provides counseling psychologists with a unique position from which they can help improve the quality of life of those with chronic health issues, such as HIV (Chwalisz, 2008).

Furthermore, clinical training, practice, and research conducted by counseling psychologists indicate an interest in counseling health psychology. According to Nicholas (2010), approximately 12% of APA-accredited doctoral programs in counseling psychology offer clinical health psychology coursework or practicum training (as cited in Nicholas & Stern, 2011). Most recent data from the Council of Counseling Psychology Training Programs (CCPTP) indicates that the percentage of counseling graduates employed in Veterans Administration medical centers has nearly tripled from 4.7% in 1995–1996 to 14.0% in 2004–2005, and the percentage of counseling psychology graduates employed in general hospitals rose from 5.6% in 1995–1996 to 9.0% in 2004–2005 (CCPTP, 2005). In these and other settings, counseling psychologists are working in assessment, diagnostic, and treatment roles in such health areas as coronary heart disease, pain management, neuropsychology, eating disorders, infertility, chronic disease, and life-threatening illnesses including cancer and AIDS (Roth-Roemer, Robinson-Kurpius, & Carmin, 1998). With regard to research, a survey of 53 of the 66 APA-accredited doctoral programs in counseling psychology revealed that 68% of the programs’ online websites described faculty research involvement in health psychology (Nicholas, 2010, as cited in Nicholas & Stern, 2011). In addition, theoretical and empirical health psychology research has appeared in major contributions in The Counseling Psychologist (e.g., January 2008), multiple editions of the Handbook of Counseling Psychology (e.g., 2000, 2008), and seminal texts and chapters such as The Emerging Role of Counseling Psychology in Health Care (Roth-Roemer et al., 1998).

In recognition of the increasing role of counseling psychologists in health psychology, the Section on Counseling Health Psychology of Division 17 (Society of Counseling Psychology) was established in 1995. As of 2011, it had more than 190 members. Included in the section’s bylaws is its dedication “to promote and support the education and training of counseling psychologists who are interested in health related fields” (Section on Counseling Health Psychology of Division 17, 2005).

A major step forward in the movement to identify core professional competencies occurred at the 2002 Competencies Conference, at which the “cube model” of core competency areas in psychology (Rodolfa et al., 2005) began to gain acceptance. Fouad et al. (2009) offered a significant contribution to this area in their competency benchmark document, in which they provide a useful articulation of the “essential components” and “behavioral anchors” for each of the 15 core competencies identified in the cube model. The field of health psychology has also been a part of this movement, with Division 38 sponsoring the Tempe Summit to identify foundational and functional competencies for clinical health psychology in 2007 and the CCHPTP meeting to specify the developmental dimension of the cube model in 2008. As a result, several articles on aspirational competencies and training practices for clinical health psychologists have been published (e.g., France et al., 2008; Kerns, Berry, Frantsve, & Linton, 2009; Larkin, 2009; Masters et al., 2009). Although France et al. (2008) openly acknowledge that the clinical health psychology competencies that they outline are unlikely to be acquired by all students in all programs, they express the desire that the competencies will facilitate dialogue around predoctoral training in health psychology. Masters et al. (2009) point to the competencies as an impetus to describe more fully “what it means to be an entry-level clinical health psychologist” (p. 200).

In light of the increased focus on competency-based education, more dialogue is needed on what it means to be an entry-level counseling health psychologist. In contrast to the attention given to competencies in clinical health psychology, little has been written on training counseling psychologists for health settings. In 1998, Alcorn suggested that in addition to the training requirements outlined by the APA accreditation guidelines and principles, counseling psychologists interested in working in health settings should also obtain predoctoral training in the following content areas: (a) biological basis of health systems and behavior, (b) social basis of health systems and behavior, (c) psychological basis of health systems and behavior, and (d) knowledge and skills regarding health policy and organization (p. 41). Furthermore, Alcorn recommended the following additional course content: (a) introduction to health psychology, (b) medical aspects of disability, (c) psychopharmacology, (d) medical terminology, (e) neuropsychology, and (f) community health (p. 42). Practica, externships, a predoctoral internship, and postdoctoral training and fellowships have also been deemed integral components of training counseling health psychologists (Alcorn, 1998). But it remains unknown as to what extent counseling psychologists are acquiring these training experiences.

On a more basic level, more information is needed on how counseling psychologists define what it means to be a counseling health psychologist and to what extent that definition relates to what it means to be a clinical health psychologist. In addition, in response to the push for competency-based education, more research is necessary on the training opportunities that currently exist in the area of health within counseling psychology programs. How are counseling psychology training programs responding to the inherent tension between broad training in psychology with the specialized knowledge outlined in the competencies for clinical health psychology? In other words, to what extent have formal as well as informal opportunities for health psychology training been integrated into counseling psychology training programs?

Purpose of the Current Study

The purpose of the current study is to determine the scope of health psychology training opportunities within APA-approved counseling psychology doctoral programs in the United States. This study assesses training directors’ perceptions of (a) current student and faculty involvement in health-related research, practice, and teaching activities; (b) health-related research topics currently being investigated by students and faculty; and (c) programs’ expectations and ability to increase the number of health training opportunities for students.

Method

Participants

Potential participants included all training directors of counseling psychology programs with institutional membership in the CCPTP because this is the organization recognized within APA to represent the interests of counseling psychology–identified programs. Membership in CCPTP is restricted to doctoral programs in counseling psychology that either are APA accredited or are determined to have curriculum “largely consistent with APA requirements” (CCPTP, 2011). There are currently 78 academic programs listed as institutional members. A total of 22 programs responded to the survey, reflecting a response rate of approximately 28%.

Measures

The survey contained 15 questions regarding counseling psychology programs’ current training and research activities in health psychology. The survey questions were based on a similar 14-item survey administered to training directors at the 2004 annual CCPTP midwinter meeting in San Antonio, Texas (D’Achiardi-Ressler, Zerth, Chwalisz, & Miller, 2006). Survey questions addressed the extent of counseling psychology training within three separate areas, including (a) general program information (e.g., distribution of faculty and student interest among counseling psychology areas), (b) clinical and practice requirements (e.g., practica, internship requirements), and (c) current faculty and student research areas of interest. Additional survey questions were created based on a review of the counseling and clinical health psychology literature and consultation with expert counseling health psychologists from the Section on Counseling Health Psychology of Division 17 (Society of Counseling Psychology). Of the 15 survey questions, 14 were forced-choice questions, most of which included an “other” option that allowed for participants to report their unique perspectives. Forced-choice questions were chosen to expedite survey completion, which also increased the potential for an optimal response rate. The open-ended questions were broader in nature (e.g., “For which area(s) of counseling psychology is your program particularly ‘known’?”), and some were included as an extension of forced-choice questions to provide counseling psychology training directors with the opportunity to provide their perspectives on what it means to be a counseling health psychologist (e.g., “Do you make a distinction between counseling and clinical health psychology? If yes, please describe how counseling health psychology is different from clinical health psychology.”).

Procedure

After obtaining institutional review board approval, announcements regarding the survey were made at the 2011 annual meeting of the CCPTP, where participants were provided a paper version of the survey to complete. An online version of the survey was created using Qualtrics Survey software to allow for the participation of training directors who were not able to attend the annual meeting. A general email announcement for the survey was sent to the training directors Listserv shortly after the annual meeting asking participants to complete the survey within the following 2 weeks. A follow-up reminder announcement was sent to the Listserv 1 week later, and the survey was closed 2 weeks after the initial email announcement. In all, 15 participants completed a paper-and-pencil version of the survey and 7 participants completed an online version of the survey.

Training directors indicated their consent by completing and returning the survey. The survey’s final two questions asked participants if we could contact them through email or mail to get a description of their program and whether they would like to receive a copy of the survey results. On the paper copy of the survey, this information was collected on a separate page. Electronic and paper survey responses were stored separately from all identifying information.

Results

Descriptive analyses and comparisons among the programs are presented and grouped into the areas of programs’ general information, experiential training, and research interests of faculty and students.

Programs’ General Information

Of the 22 participating training directors, 18 (81.8%) indicated that their program utilized a scientist–practitioner training model, 3 (13.6%) indicated that their program utilized a practitioner–scholar model, and 1 (4.5%) indicated that his or her program utilized a practitioner–scientist model. Of the program directors, 20 (90.9%) reported that their programs had approved APA accreditation status and 2 (9.1%) reported that their programs were in the process of receiving APA accreditation. Next, training directors were asked to identify for which areas of counseling psychology their program is particularly “known.” The responses for this question are displayed in Table 1. The most common response was multicultural counseling (40.9%), followed by social justice (27.3%), vocational or career (18.2%), gay, lesbian, bisexual, and transgender or gay, lesbian, bisexual, transgender, and queer issues (13.6%), and health (13.6%).

Table 1.

Frequency of Responses for the Different Subspecialty Areas Across Programs

Area	n	%
Multicultural/diversity	9	40.9
Social justice	6	27.3
Vocational/career	4	18.2
GLBT/GLBTQ	3	13.6
Health	3	13.6
Ethics	2	9.0
Mind-body integration/mindfulness	2	9.0
Family systems	1	4.5
Generalist	1	4.5
Psychotherapy process/outcome	1	4.5
Community	1	4.5
Gerontology	1	4.5
Brief systemic therapy	1	4.5
Constructivism	1	4.5
Substance abuse	1	4.5
College student development	1	4.5
Primary care	1	4.5
Prevention	1	4.5
Rural	1	4.5
Integrated care	1	4.5
Counseling psychology	1	4.5

The frequency numbers of subspecialty areas do not add up to 35 as many programs reported more than one area.

Coursework and Teaching Opportunities in Counseling Health Psychology

A series of questions was then posed to assess the presence of counseling health psychology training and interests in each program. First, training directors were asked if their program offers a minor, a concentration, or a track training in counseling health psychology. If they responded that such a level of specialization did not exist in their program, they then were asked to indicate if students could seek training in counseling health psychology on an individual or informal basis. Of the 22 programs that were represented in the survey, 1 (4.5%) reported having a minor, 2 (9.0%) reported having a concentration, 3 (13.6%) reported having a track, and 3 (13.6%) reported that they offered training in counseling health psychology that took the form of something other than a minor, a concentration, or a track. Of these 3, 1 has begun to incorporate training in integrated primary care through a required course and inclusion of primary care in the practica, and another reported having a graduate psychology education program grant administered by the Bureau of Health Professionals that all students are required to participate in during their training. One program described having no formal minors or tracks structured into their program. More than half of the responding programs (n = 13, 59.0%) reported that they do not have a minor, a concentration, or a track in counseling health psychology, and of these 10 (45.5%) indicated that students have the option of seeking training in counseling health psychology on an individual or informal basis.

The following question asked the 13 training directors who indicated that their program did not have a minor, a concentration, or a track in counseling health psychology how difficult it would be for their program to offer training in counseling health psychology if there were a demand for it. One (7.7%) training director responded that it would be “impossible (e.g., no faculty interest, environmental constraints)” to offer this training, 3 (23.0%) responded that it would be “difficult (e.g., requiring additional staff and/or training sites),” 7 (53.8%) responded that it would be “possible with some difficulty,” and 2 (15.4%) responded that it would be “fairly easy (e.g., courses already available in the department or university).” One of the program training directors who endorsed the “fairly easy” response noted that the program had faculty with this as a research interest but there was no specific class available for this type of training.

An additional question asked whether students have the opportunity to teach health-psychology-related courses. An overwhelming majority of respondents (n = 18, 81.8%) replied that no such teaching opportunities currently exist for students in their programs. Of the 4 (18.2%) respondents who replied such teaching opportunities did exist for their students, it was specified that these teaching opportunities included courses in health psychology, behavioral medicine, and courses in other departments across the university and medical center. This finding is limited in that no information was obtained about whether teaching opportunities were available in other areas (e.g., multicultural issues, career counseling).

Student and Faculty Interest in Counseling Health Psychology

Training directors then were asked to reflect on student interest in counseling health psychology training. The first question on this topic asked training directors to write in the percentage of graduating students in a typical class who pursued a research or clinical position related to health psychology over the past 5 years. On average, training directors reported that 15.8% of graduating students pursued a health psychology position, with answers ranging from 0% to 75% and 10% as the mode.

The second question asked training directors to rate their students’ interest in health psychology using the response options of not at all interested, somewhat interested, very interested, extremely interested, and do not know. None of the training directors indicated that their students were not at all interested in health psychology. The majority (n = 16, 72.7%) said that their students were somewhat interested, and 4 (18.2%) said their students were very interested in health psychology. One (4.5%) training director responded that his or her students were extremely interested, and one (4.5%) expressed not knowing whether students were interested in health psychology.

Given that students’ pursuit of a specific graduate program may be influenced by faculty expertise areas, we asked training directors to indicate how many of their program faculty have expertise in health psychology out of their total faculty members. Of the 16 training directors who responded that their students were somewhat interested in health psychology, 7 programs reported not having any faculty with health psychology expertise, 6 programs reported having only one faculty with counseling health psychology expertise, and 3 programs reported having two expert faculty in health psychology. Across these 16 programs, these responses summed to 12 faculty members with expertise in health psychology out of 91 total faculty members (or 13.2%). Of the four training directors who responded that their students were very interested in health psychology, one reported having no faculty members with expertise in this area, one reported having 2 counseling health psychology faculty, one reported having 2.5 counseling health psychology faculty, and one reported having 5 counseling health psychology faculty. Across these four programs, these responses totaled to 9.5 counseling health psychology faculty out of 27 total faculty members (35.2%). The one training director who said his or her students were extremely interested in health psychology also reported having 5 of 8 faculty members (62.5%) with expertise in health psychology. Finally, the one training director who selected the do not know response replied that none of his or her four faculty members had expertise in counseling health psychology.

Experiential Training in Counseling Health Psychology

To assess which applied training settings are available to students to help them gain clinical skills in counseling health psychology, we asked training directors to select from a list of common settings or to write in additional settings. The most common response for applied training setting was Veterans Administration hospitals (n = 20, 90.9%), followed by community hospitals (n = 14, 63.6%), medical school or university hospitals (n = 13, 59.1%), rehabilitation hospitals (n = 6, 27.3%), physicians’ offices (n = 4, 18.2%), and family practice residency programs (n = 3, 13.6%). Four training directors marked that “other” applied training settings were available and listed these as federally qualified health centers, neuropsychology practices, university wellness centers, inpatient psychiatric hospitals, and inpatient substance abuse hospitals. In addition, training directors were asked whether there were specific requirements for practica, externships, and/or internships for students concentrating in counseling health psychology, checking all requirements that applied. The majority of training directors (n = 15) stated that their programs had no such requirements. Five programs required practice or externship related to counseling health psychology, with the time requirement ranging from no set length to at least one year. Two programs required an internship related to counseling health psychology. Four training directors wrote in responses to the “other” response option with explanations such as they recommend but do not require such training, their program structure does not allow for it, they encourage hospital or clinical practica, students develop their own practica to form their concentration, and they have not had enough students interested in counseling health psychology to establish requirements.

A final question on this topic queried training directors as to whether their programs have developed practicum training opportunities to specifically address the training needs of counseling health psychology students. Of the 21 respondents to this question, 12 (57.1%) replied in the affirmative and 9 (42.9%) replied in the negative. Descriptions of such programs included the following: students working at a local health science center involved in clinical trials, at medical clinical practices, hospital settings (e.g., transplant unit, heart center, university hospital health center), medical school (e.g., oncology department), primary care rotations, community clinic, university science centers, family medicine residency clinic, integrated care centers, and federally qualified health centers.

Research Interests in Counseling Health Psychology

Training directors were asked to indicate the health areas in which their students and faculty were conducting research from a provided list, with the opportunity to specify other areas of research. Table 2 displays the results for these questions with the frequencies of responses for each of the health areas researched by students and faculty. Program training directors reported a wide range of health psychology research topics being investigated by counseling health psychology students and faculty.

Table 2.

Counseling Health Psychology Research Interests of Faculty and Students

	Faculty (N = 130)		Students^a
Area	n	%	n
Stress and coping	11	8.5	13
Wellness (e.g., prevention/health promotion, well-being)	10	7.7	12
Body image (e.g., eating disorders)	8	6.2	11
Health disparities	8	6.2	8
Men’s health	5	3.8	6
Pediatric health psychology (e.g., infant)	4	3.1	4
Diet and exercise	4	3.1	6
Chronic pain	4	3.1	5
Chronic illness (e.g., coping, adherence, behavioral modification, depression/suicide)	4	3.1	5
Families dealing with disabilities (e.g., caregiver stress and coping, family burnout, bereavement)	3	2.3	7
Sexual health (e.g., HIV, AIDS, STDs)	3	2.3	6
Gerontology (e.g., aging, dementia, care giving)	3	2.3	5
Rehabilitation (e.g., spinal cord injury, attitudes toward disability, life care planning)	3	2.3	5
Women’s health (e.g., motherhood, infertility, breast cancer)	3	2.3	3
Cancer	2	1.5	5
Neuropsychology	2	1.5	5
Addictions (e.g., smoking cessation, alcohol abuse)	2	1.5	5
Physician training (e.g., burnout, self-care)	1	0.08	3
Genetic testing/counseling	1	0.08	3
Physician training	1	0.08	3
Heart disease and hypertension (e.g., cardiac rehabilitation, psychosocial aspects)	1	0.08	1
Other: Mindfulness	1	0.08	1
Other: Forgiveness and health outcomes	1	0.08	0
Other: Homelessness	1	0.08	0
Other: Adverse health impact resulting from marginalization	1	0.08	0

The number of students in the training programs represented in the survey was not able to be obtained, and therefore only the raw data are presented.

Definitions of Clinical and Counseling Health Psychology

Given the recent efforts by clinical health psychologists to specify training requirements for their students, we were interested to examine to what extent counseling psychology training directors distinguish between counseling and clinical health psychology. Of the 21 training directors who responded to this question, 18 (85.7%) stated that no, they do not make a distinction between counseling and clinical health psychology. Also, 3 training directors (14.3%) stated that they do make such a distinction and explained that the two have a “difference in their emphasis and focus” and in “the lens through which the therapist, client, relationship, setting, and goals are viewed.” Another respondent explained that “counseling: more wellness focused, more diversity focused, less medical model.” A fourth training director stated that counseling health psychology differs from clinical health psychology in that it has an “emphasis on prevention, well-being, helping people live more productive lives.”

Discussion

The stated purpose of this study was to determine the scope of health psychology training opportunities that currently exist in doctoral programs in counseling psychology in the United States. Our strategy for obtaining this information was through a survey distributed to the training directors of all 78 counseling psychology programs currently holding institutional membership in CCPTP. Although caution must be exercised when attempting to generalize the results of this survey because it had a response rate of 28%, the findings do suggest that there is interest in the topic of health psychology within at least a segment of the counseling psychology training community.

One way we attempted to gauge a program’s commitment to the topic area of health psychology was by asking the open-ended question, “For which area(s) of counseling psychology is your program particularly ‘known’?” This question was designed to tap elements of the program’s self-described identity, and we were curious to see how many programs included health psychology in their list. It is not surprising that multicultural or diversity training and social justice were the two most frequently cited areas of recognition, with 40.0% and 27.3% of all programs, respectively, reporting they are known for these areas of emphasis. Three programs (13.6%) spontaneously identified health psychology as an area of recognition. Although this percentage might not appear large on the surface, it is interesting to note that of the 20 different areas of concentration identified by training directors, health was tied for the fourth most frequently identified along with GLBT/GLBTQ—one behind vocational/career. If one thinks in terms of a focus on vocational/career as being a foundational component of the identity of a counseling psychologist, at least by history, one might wonder if its current proximity to health as an area of program recognition might reflect an emerging identity on the part of counseling health psychology. Moreover, in addition to the four training directors who identified “health” as the area for which their program was known, others also listed “mind-body integration/mindfulness” (2 respondents), “primary care” (1 respondent), and “integrated care” (1 respondent). If these health-related areas were combined with the more general “health” response, health as an area of concentration would have been tied with social justice as the second most frequently identified area.

Perhaps a better indicator of a program’s commitment to health psychology is the degree to which the program has incorporated opportunities for health psychology education within the structure of its curricular offerings. A number of programs in both clinical and counseling psychology do this by offering students the opportunity to pursue a minor, a concentration, or a track in health psychology. Of the programs responding to this survey, 41% indicated that they did in fact offer students one of these three avenues for receiving specialized training in this area. The percentage of programs responding positively to offering these options was somewhat of a surprise, as a minor or track represents a significant commitment on the part of both students and faculty in a program in addition to a potentially sizable allocation of resources. This finding needs to be viewed with some caution, however, because definitions were not provided on the survey for what constitutes a minor, concentration, or track, and it is possible that these categories were interpreted overly liberally by those completing the survey. It is also possible that the high percentage represents sampling bias; those programs that do offer this level of structured curricular concentration may have been more likely to respond to the call to complete the survey in the first place. This finding warrants further investigation.

Even with the 13 programs (59%) that reported that they did not offer a minor, concentration, or track, 10 (45% of the total) indicated that students in their programs had an opportunity to obtain training in health psychology on an individual or informal basis within their program if desired. This finding is similar to that obtained in a 2004 survey of training directors at the 2004 annual CCPTP midwinter meeting in San Antonio, Texas, at which time 68.6% of training directors indicated that their students had the chance to pursue health psychology training on an informal or individual basis (D’Achiardi-Ressler et al., 2006). So clearly the vast majority of programs offer students at least some opportunity to begin to develop competencies in the specialty area of health psychology even while engaging in the “broad and general” training that most agree should remain the primary focus of predoctoral education (Commission on Accreditation, 2009).

Given that opportunities do exist for students to receive training in health psychology in the majority of programs—at least those responding to this survey—we were also hoping to gain a sense of the extent to which typical students within a program are currently interested in this topic area. We approached this question in two ways: First, we asked the training directors a general question: “To what extent are your students, in general, interested in health psychology?” Second, we asked directors to estimate the percentage of students in a “typical class” who go on to pursue “research and clinical positions related to health psychology.”

In response to the first question, the vast majority of training directors (approximately 95%) indicated that their students are at least somewhat interested and approximately 23% indicated that their students were either very or extremely interested. A previous survey of counseling psychology program training directors also reported that nearly 95% of respondents reported that students were at least somewhat interested, with more than 30% indicating that students were either very or extremely interested (D’Achiardi-Ressler et al., 2006). In response to the second question in the current survey, directors estimated that close to 1 out of 6 graduates go on to pursue employment positions in health-psychology-related areas. With the same caveat regarding caution in interpretation noted above, these results again appear to support the conclusion that there is widespread general interest in the topic area within most programs, with a strong interest and focus within a minority of the programs.

For counseling psychology students who are interested in health psychology, obviously an important issue in selecting a program would be the opportunity to work with faculty with expertise in this specialty. The survey results suggest that this could be an area of concern. The fact that 7 of the 16 programs that indicated their students are somewhat interested in the topic and 1 of the 4 programs that indicated their students are very interested in the topic have no faculty with expertise in this area suggests that students in these programs may have limited opportunities to develop these interests while they are students. Doing so would probably require individualized programs of study where the majority of education and training opportunities in the area are concentrated outside the program. Although this is certainly possible with sufficient oversight of faculty advisors, it probably is not optimal.

Given these limitations in faculty expertise in the specialty area of health psychology, it is noteworthy that there is still a wide range of research being conducted on topics related to health by both students and faculty in the majority of programs. For example, 50% of the programs indicated that they have both faculty and students currently conducting research on topics related to stress and coping. Close to 50% of the programs reported ongoing research in each of the areas of wellness (e.g., prevention/health promotion), body image (e.g., eating disorders), and health disparities. More specifically, of the 9 programs with no reported faculty expertise in health psychology, 2 programs have faculty conducting research on body image, 2 have faculty conducting research on health disparities, 1 has faculty conducting research on women’s health, 1 has faculty conducting research on men’s health, 2 have faculty conducting research on sexual health, 3 have faculty conducting research on stress and coping, 1 has faculty conducting research on chronic pain, 3 have faculty conducting research on wellness, and 1 has faculty conducting research on chronic illness. The fact that there are a number of programs with no faculty with specific expertise in health psychology but with faculty actively involved in research programs on topics related to health is not a surprise. Conducting research on a topic related to health does not make one a health psychologist; health psychology is an area of specialization recognized in the practice arena by diplomat status in clinical health psychology by the American Board of Professional Psychology (2011). What is promising about the results of this survey is that even in programs with faculty who do not profess to be experts in the specialty of health psychology, there is expertise available on topics related to health, which could provide part of the foundation for students who eventually plan to go on to develop specialization in this area. It is important to emphasize that the purpose of predoctoral training for counseling psychologists should remain “broad and general,” as stipulated within the guidelines of the Commission on Accreditation, and we are not advocating specialization at this stage in training for predoctoral students. What we are advocating for are avenues for students who have a future interest in specializing in counseling health psychology to begin to develop some of the competencies they will need in later stages of training, including during internship (for a detailed discussion of these competencies, see France et al., 2008; Larkin, 2009).

Another question we attempted to address through this survey was the availability of sites for applied-health-psychology-related clinical training in practicum. All of the responding programs indicated at least one practicum training site where their students can obtain health-psychology-related practicum experience, and it is not surprising that these center on hospitals and medical centers; more than 50% of programs indicated VA hospitals, community hospitals, and medical schools or university hospitals as training options for their students. In a 2004 survey of counseling psychology training directors, nearly 90% of respondents indicated that their students had the option of practica training at hospital or medical centers (D’Achiardi-Ressler et al., 2006). What we are unable to determine from these surveys, however, are the specific activities these students engaged in at these sites. It is possible, for example, that these sites may offer students some opportunity to engage in health-related activities (e.g., working with medical patients with chronic disease or a traumatic physical injury) but that their primary rotation may be in psychiatry or an outpatient mental health clinic. Additional information about these practicum experiences would be necessary before one could determine the degree to which the experience might be considered to facilitate the development of health psychology competencies.

One final question we were curious to explore through the survey was whether counseling psychology training directors recognized a difference between counseling health psychology and clinical health psychology. This is an interesting question because it speaks to the larger question of whether one believes that there are factors that truly distinguish the professional identity of a counseling psychologist from that of a clinical psychologist and, if so, if this extends into areas of mutual subspecialization such as health psychology. Nicholas and Stern (2011) make a convincing case for both of these contentions as they suggest that the core values defining the discipline of counseling psychology—with its emphasis on issues such as multiculturalism, social justice, prevention, and optimal human development—extend to their work as health psychologists. Clearly, many of the foundational and functional competencies of a health psychologist would be the same for each discipline, but it is also possible that the actual work of a typical counseling health psychologist might differ in subtle ways based on differences in relative emphasis on some of these core values. If such were the case, the work of Fouad et al. (2009) in identifying specific behavioral anchors for competency benchmarks might be extended to include additional benchmarks for counseling-health-psychology-specific competencies. The fact that more than 85% of the training directors responding to this survey did not recognize a difference between clinical and counseling health psychology might call this contention into question. It is also possible, however, that this result simply reflects the fact that we are still in the early stages of considering the competencies that define a health psychologist and many counseling psychologists in academic settings have not yet given much thought to the question of relative differences in training to develop these competencies.

Moreover, the authors compared these results to those from an unpublished study by D’Achiardi-Ressler et al. (2006) that asked similar questions concerning the level of interest and availability of health psychology training to program directors of counseling psychology programs. A total of 35 programs were surveyed in the D’Achiardi-Ressler et al. (2006) study, and in this informal comparison, interest in health psychology among counseling psychology students and faculty remained consistent between 2006 and 2011. Specifically, health psychology remains an area for which faculty are most known in various programs between 2006 and 2011, ranking as the third most frequently identified area in 2006. Furthermore, student interest and reported faculty expertise in health psychology appears consistent between 2006 and 2011, as 94.4% of programs reported student interest ranged from somewhat interested to extremely interested in 2006, as compared to 95.4% of reported student interest in this range in 2011. As for faculty expertise, directors reported 14.3% of faculty in their program were involved in health psychology research in 2006 as compared to 13.2% in 2011. These findings suggest consistent perceived student interest and faculty research in health psychology topics over this time span. Finally, the availability of practicum sites to students interested in health psychology settings also appears consistent between 2006 and 2011. In 2006, community hospitals, Veterans Administration hospitals, and rehabilitation hospitals were ranked as the top three most frequented sites offered, with these sites offered among 45.7% to 77.1% of programs; Veterans Administration hospitals, community hospitals, and medical school or university hospitals ranked as the top three sites among 59.1% to 90.9% of programs in 2011. These comparisons suggest that interest in health psychology among counseling psychology faculty and students has remained strong between 2006 and 2011.

Limitations

This survey was completed by training directors and included questions asking them to reflect on student interest in counseling health psychology training. Ideally, students would have been asked about their interests directly, but given the purpose and scope of this study, only training directors were surveyed. As a result, the findings are limited in that they represent only training directors’ perceptions of student interest in counseling health psychology. Future research could incorporate the perspectives of current students and program graduates to demonstrate the reliability of the information obtained using this type of survey.

In addition, the response rate of 28% raises questions about the extent to which the findings accurately represent members of the CCPTP. Cook, Heath, and Thompson (2000) argue that response representativeness is more critical than response rate when conducting survey research. But because of the anonymity of respondents, it is impossible to determine response representativeness for this survey. An informal website search conducted of 53 APA-accredited counseling psychology program websites in 2010 (Nicholas, 2010) with a response rate of 68% yielded very similar findings overall compared to those in the current study. The website search and the current study found similar figures for the number of programs reporting having a track, minor, or concentration in counseling health psychology, suggesting that although low, our response rate may have captured a representative sample. The context (or lack thereof) in which some of the survey questions were asked must also be kept in mind when explaining the results. For instance, the question asking about the opportunities for students to teach health-psychology-related courses found that the majority of respondents answered that no such teaching opportunities existed for their students. It is difficult to interpret this finding because no questions were asked about whether teaching opportunities in other subject matters (e.g., career counseling) existed or whether there was an undergraduate student population affiliated with the program that would serve as the audience for such a course. Without further information about the context of teaching opportunities, it is challenging to speculate on the meaning of these findings. Despite these limitations, we believe this study contributes to our understanding of the current status of counseling health psychology.

Conclusions and Implications

Based on the current findings, several conclusions and implications can be drawn. Perhaps most important is that there appears to be wide interest in health psychology within counseling psychology training programs, but at this point only a minority of programs has taken the step of developing structured curricula in the area. It remains unclear as to the cause for this discrepancy between the level of interest and the available structured training programs, yet hopefully this study will spark curiosity to explore this further. It is interesting to note that of the 22 APA-approved doctoral programs that are currently members of CCHPTP, only 4 are counseling psychology programs, and 2 of these 4 programs were just recently added. Membership in CCHPTP presumes a significant commitment on the part of the program to providing training in health psychology through coursework, research, and practicum training, and it is possible that representation within CCHPTP by counseling psychology programs will begin to grow as more programs recognize the value of developing curricula to enhance the health psychology training of their students.

The current study also points to the need for more discussion involving the question of whether counseling health differs from clinical health psychology and what the implications are regarding academic training in the area. Moreover, this question raises the issue of whether there is the need to define specific competencies in line with the current “culture of competence” within professional psychology (Roberts, Borden, Christiansen, & Lopez, 2005), For example, in counseling psychology there has been much written on defining multicultural and social justice competencies (e.g., Vera & Speight, 2003). Further reflection is warranted on how these multicultural and social justice competencies might be folded into the competencies expected of a counseling health psychologist.

Finally, given some of the unique contributions that counseling psychologists are poised to make to clinical health psychology, perhaps more should be done to develop unique opportunities for practicum training that are consistent with the values of counseling health psychology. For example, rather than complete counseling health psychology practica in hospitals where the emphasis is on treating individuals who are already sick and on the biomedical model, trainees could complete practica in settings where the emphasis is on prevention and on a holistic, community-based approach to health. Furthermore, for students interested in health psychology, especially those planning to pursue internships and postdoctoral training that includes this specialty focus, it is important that they gain some experience in practicum settings that include a focus on an integration of physical and mental well-being and that allow for the development of at least beginning-level competencies in health psychology practice. A major challenge for academic programs in counseling psychology that include an emphasis on health psychology is to identify practicum training sites in the local community that are appropriate training opportunities for their students who desire and need health-psychology-related experience. Counseling psychology programs need strategies for developing practicum training opportunities for students interested in health psychology in settings where these opportunities currently do not exist.

An underdeveloped area in training in health psychology for students is research with a clinical health focus. Although students interested in health psychology may have research interests, we need faculty expertise in counseling health psychology to help identify research areas where counseling psychology can make unique contributions. What are ways that counseling psychology programs can promote and engage students in research with a clinical health focus building on the strengths of counseling psychology? This is an important area of health psychology training where much attention is needed.

In summary, given some of the unique contributions that counseling psychologists are poised to make to clinical health psychology, perhaps more should be done to (a) develop or improve health psychology training by revising counseling health psychology curriculum, (b) secure and implement practice opportunities for students specific to health, and (c) provide opportunities for conducting research with a clinical health focus. Although counseling psychology has worked to position itself in the area of health psychology, challenges in these areas require further attention.

Footnotes

Acknowledgements

We would like to thank Kathleen Chwalisz, PhD, for her assistance with survey administration at the 2011 annual meeting of the Council of Counseling Psychology Training Programs. We also thank Donald Nicholas, PhD, for his helpful feedback on an earlier draft of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

Bios

Trisha L. Raque-Bogdan, MS, is a doctoral candidate in counseling psychology at the University of Maryland, College Park.

Carrie L. Torrey, MS, is a graduate student in counseling psychology at the University of Florida.

Brian L. Lewis, PhD, ABPP, is a clinical associate professor and the director of training in the Counseling Psychology Program at the University of Miami. He is also the director of the program’s training clinic, the Institute for Individual and Family Counseling. He earned his doctoral degree in counseling psychology from the University of Florida in 1981, and he completed his predoctoral internship at the Boston V.A. Medical Center in 1980. He is a licensed psychologist and board certified in clinical health psychology through the American Board of Professional Psychology. His scholarly interests include clinical training, social justice, and factors related to healthy lifestyle change in health psychology. He currently serves as chair-elect for the Health Psychology Section of Division 17 (Society of Counseling Psychology) of the American Psychological Association.

Nicole J. Borges, PhD, is assistant dean, medical education research and evaluation for the Office of Academic Affairs at Wright State University Boonshoft School of Medicine in Dayton, Ohio. She is a professor in the Department of Community Health. She earned her doctoral degree in counseling psychology from Indiana State University, interned at the Veterans Administration Hospital in Danville, Illinois, and completed a fellowship in health psychology at Virginia Commonwealth University School of Medicine. She is a licensed psychologist. Her scholarly work focuses on medical education, noncognitive factors contributing to student success, personality and medical specialty choice, physician career development, and HIV disease. She currently serves as chair for the Health Psychology Section of Division 17 (Society of Counseling Psychology) of the American Psychological Association.

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