Strengthening Health Psychology in a Counseling Psychology Program

1
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
2
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

3
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 FloridaBrian L.
Lewis, Ph.D., University of Miami Nicole J.
Borges, Ph.D., Wright State University
4
Counseling Health Psychology The Time is Ripe

• Counseling psychologys 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

5
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

6
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

7
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

8
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

9
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

10
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

11
(No Transcript)
12
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

13
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

14
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-health-psychology-specific
  competencies?
• To what extent do the core values of counseling
  psychology extend to work as health
  psychologists?

15
Limitations

• Survey completed by training directors
• 28 response rate
• Results similar to those obtained in a 2006
  survey of training directors (DArchiardi-Ressler
  et al., 2006) and to a 2010 study examining
  websites of 53 APA-accredited counseling
  psychology programs (Nicholas, 2010)

16
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.

17
For a copy of the our manuscript, please email
Trish Raque-Bogdan at tlraque_at_umd.edu
18
Counseling Health Psychology Competencies,
Curriculum and Taxonomy of Terms Donald R.
Nicolas, Ph.D., Ball State University
19
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.

20
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.

21
Join CCHPTP
22
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 to clinical health psychology

23
(No Transcript)
24
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 ones career.
• Domains of Professional Practice
• Populations served, problems addressed,
  procedures used, settings/systems/contexts
• Serve as the distinguishing characteristics of
  specialties

25
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

26
(No Transcript)
27
(No Transcript)
28
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.

29
Join CCHPTP
30
Curriculum and Training in Clinical Health
Psychology

• Settings
• Sources of Curriculum Information
• Challenges

31
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 (n3 - 5)
• Combined (n 2)
• None

32
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

33
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

34
Sequential, Cumulative, Graded Complexity
(Collins, et al, 2007)
35
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.

36
Integration of Science and Practice

• Practitioner training
• Assessment related to health diagnosis
• Social and family systems related to health
• Personalitypsychopathology 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

37
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.

38
Curriculum Development

• Training Models (3)
• Scientist-practitioner/Boulder model
• Practitioner-scholar/Vail model
• Clinical science (McFall, 1991)

39
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.

40
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

41
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.

42
(No Transcript)
43
Join CCHPTP
44
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)

45
Ball State UniversityCognate in Health Psychology

• 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)
•  

46
Ball State UniversityCognate 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)

47
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

48
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

49
For references, please email Don Nicholas at
dnichola_at_bsu.edu
50
Strategies for Practicum Site Development in
Counseling Health Psychology Brian L. Lewis,
Ph.D., ABPP, University of Miami
51
Challenges in Finding Appropriate Health
Psychology Practicum Sites

• Developmental competencies and finding
  appropriate placements
• Financial constraints of the institutions
• Lack of qualified supervisors

52
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

53
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

54
Example 2Hospital 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

55
Example 3University 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

56
Future DirectionsTele stuff and Practicum
Placement

• Tele-health
• Primary care tele-consultation
• Primary care tele-supervision

57
For further information, please email Brian Lewis
at blewis_at_miami_at_edu
58
Promoting a Health Psychology Research Focus in
Counseling Psychology Programs Mary Ann Hoffman,
Ph.D. University of Maryland
59
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  
60
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

61
Facilitating Research by Identifying Topics that
Fit Values of Counseling Psychology

• Hygiological (vs. pathological) perspective
  (health-related 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)

62
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

63
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 doesnt have
  health expertise
• Importance of conducting health psychology
  research to promote a career in clinical health
  psychology

64
Summary

• Counseling Psychology core values align with
  important and timely topics related to the
  mind-body 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)

65
Mary Ann Hoffman, Ph.D. University of
Marylandhoffmanm_at_umd.edu httpwww.positivecoping
healthandwell-beinglab.com/
66
Summary and Discussion Marilyn Stern, Ph.D.,
Virginia Commonwealth University
67
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

68
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/CCHPT
  P/membership.htm

69
Marilyn Stern, Ph.D., Virginia Commonwealth
Universitymstern_at_vcu.edu