Strengthening Health Psychology in
a Counseling Psychology Program
Nicole J. Borges, Ph.D., Wright State University
Larra Petersen-Lukenda, Ph.D., NWI VA Healthcare System
Trisha L. Raque-Bogdan, M.S., University of Maryland
Donald R. Nicholas, Ph.D., Ball State University
Brian L. Lewis, Ph.D., University of Miami
Mary Ann Hoffman, Ph.D., University of Maryland
Marilyn Stern, Ph.D., Virginia Commonwealth University
Symposium Overview
• Panelists discuss health psychology
training in counseling psychology
programs
• Panelists present ideas for increasing
health psychology training in areas of
• Curriculum
• Practice
• Research
• Discussant will provide overview and
next steps in improving training
Assessing Health Psychology
Training Within Counseling
Psychology Doctoral Programs
Trisha L. Raque-Bogdan, M.S., University of Maryland
Carrie L. Torrey, M.S., University of Florida
Brian L. Lewis, Ph.D., University of Miami &
Nicole J. Borges, Ph.D., Wright State University
Counseling Health Psychology:
The Time is Ripe
• Counseling psychology’s commitment
to wellness and prevention,
multiculturalism, social justice, career
development
• Number of counseling psychologists in
medical settings quadrupled in past 30
years
• Council of Clinical Health Psychology
Training Programs (CCHPTP)’s
aspirational competencies and training
practices
Counseling Health Psychologists
• Clinical practice:
– 14% employed in VA
medical centers &
9% in general
hospitals
– Assessment,
diagnostic and
treatment roles in:
•
•
•
•
•
•
•
•
Coronary heart disease
Pain management
Neuropsychology
Eating disorders
Infertility
Chronic disease
Cancer
HIV/AIDS
• Research:
– 68% of websites of APA
counseling psychology
programs report faculty
involvement in health
psychology
What is the Scope of Counseling
Health Psychology Training?
• Student and faculty involvement in
health-related research, practice, and
teaching
• Programs’ expectations and ability to
increase health training opportunities
• Perceptions of counseling health
psychology
Methods for Assessing Health
Psychology Training
• Surveyed training directors of
counseling psychology training
programs with membership in CCPTP
– 22 out of 78 programs responded (28%)
• 15 item survey regarding general
program information, clinical and
practice requirements, and current
faculty and student research
Results: Programs’ General
Information
• Which area of CP their program is
particularly “known” for?
•
•
•
•
•
Multicultural counseling (41%)
Social justice (27%)
Vocational/career (18%)
GLBT/GLBTQ (14%)
Health (14%)
• 59% had no minor, concentration, or
track in counseling health psychology
– 45% offer option of seeking individual or
informal health psychology training
Results: Student & Faculty
Interest in CHP
• 16% of graduates pursue a health
psychology position
• Majority of students perceived to be
interested in CHP
– 73% somewhat interested
– 18% very interested
– 5% extremely interested
– None reported that students were not at all
interested
• 21% of faculty members had expertise
in CHP
Results: Experiential Training
in CHP
• 91% VA hospitals
• 64% community hospitals
• 59% medical school or university
hospitals
• Majority had no specific CHP practica
requirements
• 57% had developed specific practicum
training opportunities to address the
needs of CHP students
Results: Counseling or Clinical
Health Psychology?
• 86% did not distinguish between
counseling & clinical health psychology
• Of those that did, noted differences in:
– “emphasis and focus”
– “in lens through which the therapist, client,
relationship, setting, and goals are viewed”
– “counseling: more wellness focused, more
diversity focused, less medical model”
– “counseling: more emphasis on prevention,
well-being, helping people live more
productive lives”
Key Findings
• Is CHP is emerging identity?
• Widespread general interest in CHP
– 95% of TD reported students at least
somewhat interested in CHP
– 1 out of 6 graduates pursuing CHP-related
employment
• Faculty with expertise in CHP not
matching students with interest in CHP
• Still wide range of CHP related research
conducted by faculty and students
Future Research
• What activities do students engage in
at VA hospitals, community hospitals,
and other medical practicum sites?
– How might these activities relate to health
psychology competencies?
• What is the need to develop
benchmarks for counseling-healthpsychology-specific competencies?
– To what extent do the core values of
counseling psychology extend to work as
health psychologists?
Limitations
• Survey completed by training directors
• 28% response rate
– Results similar to those obtained in a 2006
survey of training directors (D’ArchiardiRessler et al., 2006) and to a 2010 study
examining websites of 53 APA-accredited
counseling psychology programs
(Nicholas, 2010)
Summary
• Interest in HP within CP programs, yet
minority offer structured HP curricula.
– Revise counseling health psychology curriculum
• Need for practicum sites offering HP related
experience
– Secure and implement practice opportunities for
students specific to health
• Need to identify research areas where
counseling psychologists can make unique
contributions
– Provide opportunities for conducting
research with a health focus.
For a copy of the our manuscript, please email
Trish Raque-Bogdan at [email protected]
Counseling Health Psychology:
Competencies, Curriculum and
Taxonomy of Terms
Donald R. Nicolas, Ph.D., Ball State University
Public Description of Counseling
Psychology: CRSPPP
• Counseling psychology is a general practice
and health service provider specialty in
professional psychology. It focuses on
personal and interpersonal functioning
across the life span and on emotional, social,
vocational, educational, health-related,
developmental and organizational concerns.
• Counseling psychologists help people with
physical, emotional and mental disorders
improve well-being, alleviate distress and
maladjustment, and resolve crises.
Public Description of Clinical Health
Psychology (CHP): CRSPPP
• CHP 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.
• The distinct focus of CHP (also known as
behavioral medicine, medical psychology and
psychosomatic medicine) is at the juncture of
physical and emotional illness, understanding
and treating the overlapping challenges.
Join CCHPTP
Competencies
• Competency Cube Model (Rodolfa, et al, 2005)
– All of professional psychology
• Application to Clinical Health Psychology
(France et al, 2008)
– CCHPTP application
• Training in Clinical Health Psychology (Larkin,
2009)
– Discussion of where training occurs
• Best Practices in training (Masters et al, 2009)
– Refined competencies and discussed “best practices”
for incorporating into doctoral training
• Counseling Health Psychology: A specialty
perspective (Nicholas & Stern, 2011)
– Discusses the contributions of counseling psychology
Competency Cube Model
• Focused on competency development in
professional psychology
• 4 major components
– Foundational Competency Domains
• “building blocks of what psychologists do” (p. 350)
– Functional Competency Domains
• “knowledge, skills, and values necessary to perform
the work of a psychologist” (p. 351).
– Stages of Professional Development
• framework for gaining, maintaining and enhancing
competence throughout one’s career.
– Domains of Professional Practice
• Populations served, problems addressed, procedures
used, settings/systems/contexts
• Serve as the distinguishing characteristics of
specialties
Competencies in Clinical Health
Psychology (France et al., 2008)
• One of the first groups to use the cube
model to define competencies
• Focused on functional competencies of
the entry-level clinical health
psychologist
– Knowledge Base
– Applied Competencies (i.e. skills)
•
•
•
•
•
Assessment
Intervention
Consultation
Research
Supervision-Training
Competencies Summary
• Foundational & functional competencies
in professional Psychology (Cube Model)
are shared by all specialties
–
–
–
–
Counseling psychology
Clinical health psychology
School psychology
Clinical psychology
• Parameters of practice such as the
populations served, the problems
addressed, the procedures/theoretical
orientations used and the
settings/systems/context in which
practice occurs serve to distinguish
specialties.
Join CCHPTP
Curriculum and Training in
Clinical Health Psychology
Settings
Sources of Curriculum Information
Challenges
Training Settings in Clinical Health
Psychology (Larkin, 2009)
• Predoctoral training in clinical health psychology
occurs in different types of training programs.
– Exclusive training programs (e.g., Univ of Fla, UC Denver)
– Embedded training programs (e.g., BSU, VCU, U. Miami)
• Various settings
–
–
–
–
Psychology departments
Health science centers in academic medical centers
Schools of education
Professional schools
• Various accreditation statuses
–
–
–
–
Clinical psychology (n = 72)
Counseling psychology (n=3 - 5)
Combined (n= 2)
None
Common Program Characteristics
(Larkin, 2009)
• Common training competencies (Cube
model, France et al, 2008)
• Fully integrated in the biopsychosocial
model
• Training that is sequential, cumulative,
and graded in complexity (e.g,.
Stairway model, Collins et al., 2008)
• Broad and general training
• Integration of science and practice
Fully Integrated in the
Biopsychosocial Model
• Biopsychosocial Model (Engel, 1977)
– The essential conceptual paradigm for training in
health psychology
– Organ systems beyond the CNS, as well as public
health models
An Example: Psycho-Oncology
– BIO – an understanding of cell growth/apoptosis,
oncogenes, impact of radiation/chemotherapy,
immune system)
– PSYCHO – emotional reactions to diagnosis
– SOCIAL – importance of social support,
relationships to coping
Sequential, Cumulative, Graded
Complexity (Collins, et al, 2007)
Broad and General Training
• Ongoing “essential tension” (Roberts, 2006) between
broad and general (counseling psychology), and
unique and specialized (health psychology).
– Not unique to counseling health psychology
• Always been in professional psychology, given the
broad/general accreditation (clinical, counseling,
school) and need for specialized knowledge (e.g.,
child, assessment, career, supervision, prevention)
• Thus, similar tension between the broad/general
knowledge of counseling psychology (e.g.,
strengths-based, prevention, developmental) with
the specialized knowledge of health psychology
(e.g., psycho-oncology, chronic pain, cardiology) will
exist.
Integration of Science and Practice
• Practitioner training
– Assessment related to health diagnosis;
– Social and family systems related to health
– Personality–psychopathology as related to
health problems;
– Interventions relevant to health problems;
– Medical knowledge
– Consultation
– Interdisciplinary collaboration
– Health care delivery systems
– Professional, ethical, and legal issues
related to health care
Curriculum Development
• Broad/General & Specialized Training
• Sources of Information
– Broad/General
• APA, Commission on Accreditation
– Specialized
• Arden House National Working Conference on
Education and Training in Health Psychology, -- Harriman, NY, May 23-27, 1983.
Curriculum Development
• Training Models (3)
– Scientist-practitioner/Boulder model
– Practitioner-scholar/Vail model
– Clinical science (McFall, 1991)
Curriculum Development:
Coursework
• As Recommended by Arden House
Conference
– Social bases of health and disease,
– Biological bases of health and disease,
– Health policy and organization,
– Health assessment and intervention,
– Health research methods, and evaluation
research.
• Courses such as child health, behavioral
genetics, epidemiology, public health, anatomy,
and pathophysiology.
Curriculum Development :
Challenges
• How to do both?
– Broad/general training
– Specialized training
• See Taxonomy by CRSPPP (2012)
• Defines terminology.
• Defines and allows for varying levels of
intensity of specialized training
CRSPPP Taxonomy for Education
and Training
• Purpose
– To provide a consistent set of terms and
definitions related to education and
training in APA recognized specialties in
health service psychology. The guidelines
also provide a structure for the use of
these terms within the education and
training sequences for each of these
approved specialties. The overarching
goals of these guidelines are to facilitate
clear and consistent communication in the
use of terminology for training programs,
students, professional organizations and
members of the public.
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Ball State University
Cognate in Health Psychology
An Emphasis in Health Psychology (“cognate”)
24 (if doing 1 cognate) or 15 credit hours (if 2 cognates)
Required Courses (# credit hours)
PSYSC 668 Physiological Psychology (3)
CPSY 634 Introduction to Behavioral Medicine (3)
Directed Electives
1. Physiology and Anatomy - two (2) of the following for a 24 hour
cognate or one (1) of the following for a 15 hour cognate
PHYSL 520 Neuroscience (3)
PHYSL 535 Pathophysiology (3)
CPSY 635
Medical Aspects of Disability in Rehab. Counseling (3)
PHYSL 515 Physiology of Aging (3)
PHYSL 514 Cardiovascular Physiology (3)
2. Program Planning and Evaluation, Epidemiology one below
HSC 686
Health Promotion Planning and Evaluation (4)
HSC 683
Epidemiology (3)
Ball State University
Cognate in Health Psychology
3.
Specialized Techniques and Practicum
(e.g. techniques of psycho-oncology, behavioral cardiology,
pediatric health psychology, chronic pain)
Specialized Practicum in Counseling Psychology (2-6)
• (E.G, chronic pain, integrated primary care, psycho-oncology, - VA, Local FQHC, IUBMH, private practice)
Ball State University
Cognate in Health Psychology
3. Other Specialty Courses to Select From . . .
PSYSC 670 Health Psychology (3)
HSC 56 Patient Education: A Team Approach (3)
HSC 569
Health and Aging (3)
HSC 571
Death and Dying (3)
HSC 572
Women and Health (3)
HSC 581
Stress Management (3)
WELNS 650 Foundations of Wellness
WELNS 625 Changing Health/Wellness Behaviors (3)
WELNS 630 Health, Wellness, and Aging (3)
WELNS 675 Alternative and Complementary Therapies (3)
ANTH 527 Culture and Medicine (3)
CPSY 603 Introduction to Rehabilitation (3)
CPSY 608
Psychosocial Aspects of Rehabilitation (3)
FCFSN 540 Human Nutrition (3)
Other Program Examples
• Virginia Commonwealth University
– Marilyn Stern, PhD
• Area of Concentration
• Student-Proposed
• Typically 2 courses + clinical + research
experience
• University of Miami
– Brian Lewis, PhD, ABPP
• Concentration sequence
• Course – behavioral medicine
• Practicum experiences + research experience
Summary
• Use Competencies Cube as guide
• Be aware of CRSPPP specialty
definitions & taxonomy
– Emphasis, Experience, Exposure
• Consult with existing programs for help
(BSU, VCU, Miami, Denver)
• Adapt to your local setting
For references, please email Don Nicholas at
[email protected]
Strategies for Practicum Site
Development in
Counseling Health Psychology
Brian L. Lewis, Ph.D., ABPP, University of Miami
Challenges in Finding Appropriate
Health Psychology Practicum Sites
• Developmental competencies and
finding appropriate placements
• Financial constraints of the institutions
• Lack of qualified supervisors
Three Strategies for Practicum
Site Development
• Utilizing the academic training clinic for
beginning-level skill development
• Partnering with community health-care
organizations where health psychology
services are lacking
• Collaborating with medical school
colleagues within the university
Example #1:
Antioch Stress & Wellness Clinic
• Specialty clinic within the
Psychological Services Center
• Entry-level practicum: training in
mindfulness & principles for mind-body
interventions
• Client services:
– Stress management groups
– Support groups for patients with chronic
illness
– Psychoeducational pain management
groups
Example #2:
Hospital Behavioral Medicine Services
• Rural hospital with no behavioral
medicine services
• Educational/consultation services to
medical departments: Surgery, cardiac
rehab, industrial rehab
• Grant-funded collaboration between the
hospital and the university for services
in cardiac rehabilitation
Example #3:
University Family Medicine Collaboration
• Shared faculty assignment between the
Counseling Psychology & Family
Medicine Dept.
• Advanced student placement in
Community Health Clinic primary care
• Faculty training/supervision of both
Counseling Psychology doctoral
students & Family Medicine Residents
Future Directions:
“Tele stuff” and Practicum Placement
• Tele-health
• Primary care tele-consultation
• Primary care tele-supervision
For further information, please email Brian
Lewis at [email protected]@edu
Promoting a Health Psychology
Research Focus in Counseling
Psychology Programs
Mary Ann Hoffman, Ph.D. University of Maryland
Promoting Health Psychology
Research in Counseling Psychology
Counseling psychologists currently contribute research in
clinical health psychology (interdisciplinary field including
clinical, counseling, social, and developmental psychology)
To develop and strengthen this emphasis, three goals are
important:
(1) Increasing visibility of clinical health research in key
counseling psychology journals
(2) Facilitating scholarship by identifying topics that
fit counseling psychology core values; and
(3) Mentoring students in health psychology research
Visibility of Clinical Health Research
in Counseling Psychology Journals
• A significant minority of clinical health
researchers trained and identify as counseling
psychologists (Nicholas & Stern (2011)
• Yet, my perusal of 2 key journals (past 10 years)
shows:
• TCP: about 12 articles related to health
• JCP: about 4 articles related to health
• To develop and strengthen this area of research:
 Mind-body interface needs to be framed as an
important and timely research topic; and,
 More research needs to be published in key CP
journals
Facilitating Research by Identifying Topics
that Fit Values of Counseling Psychology
• Hygiological (vs. pathological) perspective: (healthrelated quality of life and well-being)
• Strengths-based approach to adaptation and coping
(self-compassion, forgiveness, positive coping, meaning
making, gratitude)
• Importance of work/career and other key life roles
(Interface of health and work/other life roles,
occupational health, ADA, stigma)
• Respect/Valuing Diversity (LGBT health, elder health,
culturally-based health practices or beliefs; global
issues)
• Importance of Social Justice (health disparities, access
to health services, barriers to compliance with health
regimens/treatments)
Need Other Ideas?
Healthy People 2020
• Healthy People 2020 Overarching Goals:
– Attain high-quality, longer healthy lives
– Achieve health equity; eliminate disparities
– Create social and physical environments that
promote good health
– Promote quality of life, healthy development, and
healthy behaviors
• Examples of Key Objectives relevant to
Counseling Psych:
– Health disparities; cancer survivorship; STDs;
substance abuse; violence prevention; physical
activity, aging, living with chronic disease; health
communication
Mentoring Our Students in Health
Psychology Research
• Increasing number of doctoral applicants express
interest in the mind-body interface
• Faculty w/ interest and expertise in health
psychology are essential in attracting/mentoring
these students
• Mentoring is related to research productivity,
workforce diversity, and retention in a variety of
research settings
• How to build a “bridge” that connects
advisee/advisor interests- when one doesn’t have
health expertise
• Importance of conducting health psychology
research to promote a career in clinical health
psychology
Summary
 Counseling Psychology core values align with
important and timely topics related to the mindbody interface
 These health-related topics are increasingly
important in the context of current societal and
global issues
 Research mentoring is critical in preparing
students for careers in health psychology
 Career opportunities involving research and
intervention on health-related issues appear to
be increasing (e.g., cancer survivorship;
adjustment to chronic disease)
Mary Ann Hoffman, Ph.D. University of Maryland
[email protected]
http:www.positivecopinghealthandwellbeinglab.com/
Summary and Discussion
Marilyn Stern, Ph.D., Virginia Commonwealth
University
A Recent Recommendation
"We recommend that CCPTP in conjunction with the SCP Health
Psychology section develop a blueprint to integrate health
psychology into counseling psychology programs that includes
curricula materials, strategies for developing behavioral health
practicum training options, and increased attention to preparing
students for internships with health psychology major and
minor rotations. We believe the ramifications of the growing job
market for psychologists within an integrated health care
delivery system requires focused attention by counseling
psychology educators“ (p. 146)
After so many years of us trying to get our CPY colleagues on
board, its nice to see this recommendation in the most recent
Handbook....
From the APA CPY Handbook(2012) by Forrest and Campbell on
Emerging Trends in CPY education and training
CCHTP Program Mission
•The purpose of the CCHPTP is to promote the
advancement of graduate and postgraduate education and
training within the field of clinical health psychology.
•Consistent with this purpose, CCHPTP member programs
shall strive to educate and train future clinical health
psychologists to promote human welfare and to advance
the growth of health psychology science and practice.
•CCHPTP espouses graduate and postdoctoral education
and training that produces a clinical health psychologist
capable of functioning as a scientific investigator and as a
practitioner, consistent with the highest standards of
clinical health psychology.
MEMBERSHIP:
http://community.wvu.edu/~ktl000/CCHPTP/membership.htm
Marilyn Stern, Ph.D., Virginia Commonwealth
University
[email protected]
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Strengthening Health Psychology