From the Chair: Counseling Health Psychology Training: Creating Opportunities for our Discipline by Kathleen Chwalisz

Professional psychology and the health care system are changing rapidly. It seems as if a new development (e.g., health and behavior CPT codes, patient’s bill of rights, prescription privileges in New Mexico) is revealed almost daily. I often find myself thinking about how our discipline, and particularly new counseling psychologists, will navigate this ever-changing professional landscape.

How we think about our discipline and how we shape the future of our discipline, in the form of new professionals, are critical factors in our ability to thrive professionally. I believe that strong and systematic counseling health psychology training can play a critical role in the future success of counseling psychology, given that many opportunities for psychologists have been predicted in the health care system. Furthermore, developments in the health care system and national public health initiatives are converging on more holistic approaches to health, cultural dimensions of health, and preventive and psychoeducational interventions to increase "healthy life years" (Healthy People, 2010)—counseling psychology’s long-standing areas of expertise.

A recent survey of APA-accredited Counseling Psychology programs, examining training opportunities in counseling health psychology (D’Achiardi, 2002), revealed that most if not all counseling psychology programs are in a position to offer systematic training in counseling health psychology. That is, when programs were asked whether students could access training in a variety of areas, previously identified in the counseling health psychology training literature, a great deal of training (e.g., courses, practicum placements, research opportunities) was available—even among programs that claimed not to offer any health psychology training.

Training programs should systematically examine/develop the training they provide, and counseling health psychologists in applied settings should influence the development of training models in counseling health psychology, keeping our discipline on the cutting edge. It’s time to take serious action regarding counseling health psychology training.

Please contact me (chwalisz@siu.edu), if you have ideas and/or are interested in getting involved in the development of counseling health psychology training.

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From the Chair-Elect: Third Biennial Counseling Health Psychology Conference August 21, 2002 at Rush-Presbyterian-St. Luke's Medical Center in Chicago by Dan Clay

The focus of this year's one-day conference is on positive psychology, health, and helping people change. The conference will be held on the day prior to the 2002 APA conference to make it more convenient and cost-effective for people to attend. For more information, link to https://email.uiowa.edu/redirect?http://www.uiowa.edu/~hlthpsy/conference/index.htm

The previous two conferences were very successful, and we expect this year's conference to be excellent. The format of the conference will include keynote speakers and breakout sessions. Keynote speakers will present on positive psychology and health, and breakout sessions will allow more in-depth discussion of research and practice issues. Keynote speakers and topics include: (a) Arthur Hoffman, M.D. and David Goldberg, M.D. - "Mindfulness and Medicine," (b) George Fitchett, D. Min. - "Varieties of Religious Coping and Contributions to Health," (c) Carol Farran, Ph.D. - "Finding Meaning: An Option for Family Caregivers of Persons with Dementia," and (c) Carol Ryff, Ph.D. - "Psychological Well-Being and Health."

This conference is especially great for students because of the low cost and opportunity to network with scholars and national leaders in counseling health psychology.

Continuing education credits will be available for psychologists, nurses and physicians.

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Feature Article: Counseling Health Psychology in the Hospital Setting: An Increasing Trend by Toni L. Gesler & Stacy Blankenbuehler, Ball State University

Counseling psychologists work in a variety of employment settings (Good, 1992). Poston (1991) found that students in APA-accredited counseling psychology programs ranked the following employment settings according to their preference: (1) private practice, (2) counseling centers, (3) academia, (4) community mental health centers, and (5) hospital/medical settings (as cited in Good, 1992). Consequently, there has not been a lot of research done on counseling psychologists in hospital and medical settings (Good, 1992; Kagan et al., 1988, May, 1977). Therefore, this paper will answer some frequently asked questions about counseling psychology in hospital settings including: how many counseling psychologists are in hospital and medical settings; the roles of counseling psychologists in hospital and medical settings; the advantages and disadvantages of counseling psychologists in hospital and medical settings; and why the number of counseling psychologists in hospital and medical settings have increased considerably over the past twenty years.

A very small percentage of counseling psychologists, currently work in hospital and medical settings (Banikiotes, 1977; Good, 1992). However, the percentage of counseling psychologists working in these settings appears to be growing. Banikiotes (1977) collected data regarding job placements for 112 graduates of 17 APA approved programs and 296 graduates of 23 non-APA approved programs. Of those students from APA approved programs 25% received jobs in academic, research, and professional settings; 63.8% were employed by organizations providing psychological services; 4% were in private practice; and 7.2% were in a miscellaneous category (Banikiotes, 1977). Of the 63.8% of counseling psychologists found in organizational settings, 4.5% were in a hospital setting. Data representing students of non-APA approved programs included 20% in academic, research, and professional settings; 66% in organizational settings; 4.7% in private practice; and 8.4% in a miscellaneous category (Banikiotes, 1977). Moreover, only 1% of students graduating from non-APA approved programs received employment from a hospital setting (Banikiotes, 1977).

In a retrospective study, Neimeyer, Bowman, and Stewart (2001) collected survey data from the past 26 years from the Council of Counseling Psychology Training Programs (CCPTP) which includes approximately 76 programs. It was reported that since 1982 a significantly larger percentage of 1^st-year graduates of counseling psychology graduate programs have become employed in hospitals than in prior years. This trend appears to have remained stable since its original increase in 1982. However, data from 1989 to 1998 indicates job placement for 1^st year counseling psychology graduates as follows: 14.6% in academia; 17.5 % in University Counseling Centers; 12.8% in Community Mental Health Centers; 16% in private practice; and 17.1% in hospital settings (including Veteran Administration Hospitals). Thus, it appears that there is an increase from about

1% -4% in the mid-1970s to about 17% in the decade from 1989-1998.

Why is there such an increase of counseling psychologists in hospital settings? May (1977) predicted an increased need for counseling psychologists in hospital settings due to new developments in the field. For example, new treatment approaches have been pioneered with cancer patients in the past twenty years. Holland (1998) found that psychotherapeutic, psychosocial, behavioral and psychoeducational interventions are effective for patients who are identified and treated due to the multidimensional approach the treatment teams are currently implementing. Furthermore, Holland (1998) suggests that patient-centered care is necessary because it incorporates concern for quality of life using psychological, biological, behavioral, and social approaches. Therefore, with the increased demands for patient-centered care, counseling psychologists are becoming more and more essential in the composition of treatment teams in hospital and medical settings.

Counseling psychologists provide a wide variety of services in hospital settings (Good, 1992; Kagan et al., 1988; May, 1977). Medical schools and hospitals hire counseling psychologists to provide skills and knowledge to other medical personnel in addition to designing and teaching courses in psychoeducation and counseling for the patients (Kagan et al., 1988). Specifically, counseling psychologists can assume the role of a diagnostician and consultant, psychoeducator or trainer and translator, counselor, researcher, and vocational and rehabilitation specialists (Carmin and Roth-Roemer, 1998; Bernard, 1992; May, 1977; Kagan et al., 1988). The roles of counseling psychologists in hospital or medical settings are important because "the counseling psychologist is trained as an expert in human behavior, in the means of facilitating interpersonal relationships, and in a philosophy emphasizing strengths, potentialities, and actualization" (May, 1977, p.83).

Frequently, counseling psychologists will be requested to evaluate patients. Carmin and Roth-Roemer, (1998) state that physicians may call upon counseling psychologists to determine if a medical patient is experiencing psychological difficulties. Psychologists must be aware of medical problems that have similar symptoms to psychological problems. Many times, counseling psychologists may be asked to assist in differentiating between medical and psychological problems. Furthermore, counseling neuropsychologists may be requested to perform a neuropsychological evaluation (Larson, 1992). Part of the role of being a diagnostician is serving as a consultant since counseling psychologists are part of a treatment team composed of physicians, nurses, and support staff. This role is extremely important since the counseling psychologist provides information to the rest of the team regarding the psychological well being of the patient (Kagan et al., 1988). Moreover, the counseling psychologist can make recommendations or referrals based on the patient’s mental status and psychological evaluations.

Counseling psychologists serve as psychoeducators or trainers in order to teach subject matter related to counseling psychology to medical personnel. For example, counseling psychologists train medical personnel concerning issues such as interpersonal sensitivity, familial patterns of illness, stress management, and wellness (Kagan et al., 1988). Counseling psychologists also serve as supervisors when informing medical personnel about individual or group therapy and gathering information for psychological evaluations (Kagan et al., 1988). Furthermore, they may be called upon to translate "medicalese" for patients in order to help these patients get adequate information about their situation (Larson, 1992).

Additionally, counseling psychologists provide individual and/or group therapy to patients, family members of patients, and support staff. Therapists can provide support groups for families or support staff that care for patients with debilitating or terminal illnesses. In addition, counseling psychologists can offer their counseling services to patients who are having emotional problems as a result of adjustment difficulties, side effects of an illness or disease, or physical alterations.

Counseling psychologists can serve as researchers in order to study issues like family dynamics, psycho-oncology, rape/sexual abuse trauma, and diabetes. Counseling psychologists can also apply for grants to study these issues in addition to program evaluation and development (Kagan et al., 1988).

Lastly, counseling psychologists can serve as vocational and rehabilitation assessment specialists in VA Hospital settings, which is a role consistent with traditional training (Bernard, 1992). These duties involve training and research in areas such as physical rehabilitation, neuropsychology, gerontology, substance abuse treatment, and pain management (Bernard, 1992). Counseling psychologists can also provide career assessment and rehabilitation to help veterans explore career interests and return to work.

There are many advantages and disadvantages of being a counseling psychologist in a hospital or medical setting. Advantages of working in a hospital setting include the diversity of roles for the counseling psychologist, as previously discussed; the status of being in a medical setting; and the opportunity of earning a reasonable, stable income with benefits (Good, 1992). Disadvantages include understanding the medical hierarchy; language and communication difficulties; and maintaining confidentiality.

The medical hierarchy exists because "the medical system generally operates on the principle that physicians are superior to other hospital professionals" (Good, 1992, p.68). In hospital settings, physicians are expected to attract patients in order to make money for themselves as well as the hospital. As a result, hospital staff members are expected to keep physicians happy, which results in political turmoil for other staff members such as psychologists and other types of consultants (Good, 1992). A way to avoid the ramifications of the medical hierarchy is for the counseling psychologist to obtain hospital privileges where they are authorized to treat the patients independently as well as have a voice in determining hospital policies and practices (Good, 1992). Developing working relationships with physicians can also be advantageous because physicians will make referrals to counseling psychologists who they know and trust. Good (1992) also states that the medical system is frequently patriarchal, sexist, and racist and advises counseling psychologists to learn not to take organizational problems too personally.

Psychologists also face problems with language and communication in hospital and medical settings because medical diagnostic codes can be difficult to understand. Moreover, it is critical that counseling psychologists follow the traditional medical model where "if a patient’s problem lacks a diagnostic code, then it does not exist and no one should be paid to treat it" (Good, 1992, p.71). Therefore, it is beneficial for counseling psychologists to be familiar with medical as well as psychological diagnostic codes. Counseling psychologists have also been encouraged to use qualifiers (i.e. appears, seems, etc.); however, for physicians, the use of these qualifiers suggests that the speaker is not confident or knowledgeable (Good, 1992). Thus, counseling psychologists are advised to be direct and to the point as much as possible.

The Ethical Principles of Psychologists and Code of Conduct established by the American Psychological Association (APA, 1992) states that psychologists have a primary obligation to maintain the confidentiality rights of those whom they work or consult with. Maintaining patient confidentiality while working in a hospital setting can be challenging for psychologists. Robinson-Kurpius and Vaughn-Fielder (1998) outline some of these challenges. First, counseling psychologists often work within interdisciplinary treatment teams where communication with other staff members can sometimes be critical. Oftentimes, psychological progress notes are kept in the patient’s medical file where other staff members may view them. In addition, psychologists often have to communicate with patients in hospital rooms that are occupied by other patients. Considering these difficulties, it may be prudent for psychologists to obtain release of information forms from patients in order to discuss problems with other members on the treatment team. Furthermore, counseling psychologists must take detailed precautions when working in the hospital setting in order to maintain patient confidentiality.

In conclusion, counseling psychologists have a choice to work in a hospital or medical setting. Trends show that the number of counseling psychologists who work in hospitals have increased over the years. Nonetheless, there is a relatively small percentage of counseling psychologists in hospital settings. There are however, diverse roles for counseling psychologists to assume. Counseling psychologists must be educated on some of the difficulties of working in hospitals in order to be prepared for the challenges that may occur. There are many advantages and disadvantages of working in a hospital setting; however, it is possible for counseling psychologists to overcome the disadvantages and have a worthwhile experience working in a hospital or medical setting.

American Psychological Association (1992). Ethical Principles of Psychologists andCode of Conduct. Washington D.C.: Author.

Banikiotes, P.G. (1977). The training of counseling psychologists. The Counseling Psychologist, 7, 23-26.

Bernard, C.B. (1992). Counseling psychologists in general hospital settings: The continued quest for balance and challenge. The Counseling Psychologist, 20, 74-81.

Carmin, C. and Roth-Roemer, S. (1998). Working in medical settings: Diagnostic, practice, and professional issues. In Roth-Roemer, S., Robinson-Kurpius, S., Carmin, C. The Emerging Role of Counseling Psychology in Health Care. New York: W.W. Norton & Company.

Good, G.E. (1992). New and early professionals in counseling psychology: Issues in various settings. The Counseling Psychologist, 20, 5-9.

Good, G.E. (1992). Counseling psychologists in hospital/medical settings: Dilemmas facing new professionals. The Counseling Psychologist, 20, 67-73.

Holland, J. (1998). Psycho-oncology. New York, New York: Oxford University Press.

Kagan, N., Altmaier, E.M., Dowd, E.T., Hansen, J.C., Mills, D.H., Schlossberg, N., Sprinthall, N.A., Tanney, M.F., Vasquez, M. J. (1988). Professional practice of counseling psychology in various settings. The Counseling Psychologist,16 347-365.

Larson, P.C. (1992). Neuropsychological counseling in hospital settings. The Counseling Psychologist, 20, 556-559.

May, E.P. (1977). Counseling psychologists in general medical and surgical hospitals. The Counseling Psychologist, 7, 82-85.

Neimeyer, G.J., Bowman, J., and Stewart, A. E. (2001). Internship and initial job placements in counseling psychology: A 26-year retrospective. The Counseling Psychology, 29, 763-780.

Robinson-Kurpius, S. and Vaughn-Fielder, K. (1998). Ethical issues and the health care setting. In Roth-Roemer, S., Robinson-Kurpius, S., Carmin, C. The Emerging Role of Counseling Psychology in Health Care. New York: W.W. Norton & Company.

EDITOR'S NOTE: A Means of Encouraging Student Interest in Counseling Health Psychology. The above feature article was written, as an assignment in a first year doctoral seminar, by two doctoral students in counseling psychology interested in the career of a Counseling Health Psychologist. As mentioned by Dr. Chwalisz earlier in this edition, as we encourage our students to develop an interest in health psychology, this is offered as an example of how students new to the field, might first begin to investigate the possibility of a career in Counseling Health Psychology.

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Interdivisional Health Care (IHC) Midwinter Report By Cyndy McRae & Marilyn Stern, Division 17 Representatives

The midwinter meeting of the APA Interdivisional Healthcare Committee (IHC) addressed several important topics of interest to Division 17 members. The IHC is composed of representatives from five divisions; 17 (Marilyn Stern and Cyndy McRae), 22, 38, 40, and 54. Two additional members of Division 17, Dan Clay and John Corrigan, are on the committee representing other divisions. The IHC is a collaborative working group of psychologists who share a common purpose of pursuing a health agenda both within and outside the structure of APA.

One of the major accomplishments of this group has been the development and recent implementation of six new reimbursement codes that allow psychologists to bill for services provided to patients with a physical health diagnosis. Psychologists can now use codes under the Current Procedural Terminology (CPT) coding system for services related to the prevention, treatment or management of physical health problems. A workshop to discuss the new CPT codes will be held at APA. The workshop will be co-sponsored by each of the divisions participating in the IHC. Additional information on the CPT codes can be found at https://email.uiowa.edu/redirect?http://www.apa.org/practice/cpt_2002.html. Additional information on "Frequently Asked Questions" will soon be posted there as well.

A brief report from the APA Work Group on Complementary and Alternative Medicine (CAM) was presented. CAM is the terminology currently recognized by NIH and a White House Commission on CAM Policy (WHCCAMP) was established in 2000. Although some CAM procedures are regarded as mainstream psychological interventions (including cognitive-behavioral interventions, relaxation/hypnosis techniques, guided imagery, lifestyle interventions, and psychosocial support groups), psychology generally does not regard itself as CAM. It is anticipated that a work group will be established to develop an action plan for working with CAM following the presentation of the report to the APA Board of Directors and the report by the WHCCAMP in early Spring.

John Corrigan reported that the Ticket-to-Work program, which was passed by Congress in November 1999 and had potential for psychologists interested in vocational rehabilitation, is essentially "on hold" under the present administration. The program, which was to be administered by the Social Security Administration, is starting very slowly in only a few states.

Members of the committee also created a list of potential candidates for the APA slate that we felt would represent healthcare interests if elected.

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Editor’s Note: by Don Nicholas New Newsletter Editor Appointed

I am pleased to announce that, beginning with the Fall 2002 Issue of the newsletter, Suzanne Mazzeo, Ph.D., an Assistant Professor at Virginia Commonwealth University, will assume responsibilities as newsletter editor. Look for more details of this change in upcoming newsletters

Once again we are interested in your feedback about the newsletter. Let me know your thoughts about its usefulness, and I am particularly interested in any ideas you have about other features we could include. Please consider writing a brief article about an issue, or a substantive content of interest. We have approximately 115 persons to whom the newsletter announcement is distributed, and with this wide network, I would expect we are unaware of a number of your interests and areas of expertise.

Anyone interested in sharing your "typical day" as a Counseling Health Psychologist, or a particularly unique training program, or other opportunity should contact me at dnichola@bsu.edu

Counseling for Health is published three times per year in the Fall, Spring and Summer.

to: Counseling for Health

Donald R. Nicholas

Department of Counseling Psychology Deadlines for submissions:

Ball State University Fall Issue-October 1

Teachers College, 619 Spring Issue-February 1

Muncie, IN 47306-0585 Summer Issue-June 1

Phone: (765) 285-8058

FAX: (765) 285-2067 dnichola@bsu.edu

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Our own Dan Clay, trustee webmaster for the entire time we have had a website and homepage, is now interested in passing that responsibility on to someone else. As Chair Elect, Dan has certainly been working hard on behalf of the Section and we want to thank him for his time and hard work on initially setting up the website and the ongoing work to keep it updated. If you are interested in assuming these responsibilities, please contact Dan at daniel-clay@uiowa.edu.

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