460 Health Psychology
advances in medical technology in assessment and treatment
(e.g., ambulatory monitoring, home testing, imaging tech-
niques, medical devices), organ and tissue transplantation,
pharmacology, telehealth, health informatics, primary care,
and issues of diversity in health care. Participants remained
excited about future opportunities for growth in the field and
for its potential to make significant contributions to the public
welfare.
Training in Europe
In Europe, education and training in health psychology is
characterized by wide variation in models and requirements
for practice across countries. Marks and colleagues (1998)
note that “many European countries still do not yet train
health psychologists in any specific and specialized manner”
(p. 156). However, the development of high-quality, formal-
ized training in health psychology has been a key concern for
the EFPA and the EHPS. Both organizations, separately and
in collaboration, have addressed these issues through the or-
ganization of task forces, committees, symposia, and publi-
cations (e.g. Johnston, 1994; Maes & Kittel, 1990; Marks,
1994a, 1994b; McIntyre et al., 2000; Methorst, Jansen, &
Kerkhof, 1991).
An important outcome that resulted from these efforts was
the creation in 1992 of a task force that had among its objec-
tives, as noted previously, the development of training guide-
lines for professional health psychologists. Requirements fall
into eight categories (Marks et al., 1998) and are very similar
to the U.S. core curriculum: academic knowledge base
(psychology), academic knowledge base (other), application
of psychological skills to health care delivery, research skills,
teaching and training skills, management skills, professional
issues, and ethical issues.
Currently, there is an effort to develop a common framework
regarding time and contents of qualification for professional
practice in psychology under the Europsych Project (Lunt,
2000). This is particularly important given the European Eco-
nomic Community (EEC) directive on free movement of pro-
fessionals between member states. The first matrix proposed
is for a 6-year minimal requirement equivalent to a master’s
degree, including generic training with later specialization,
which is the typical duration of health psychology professional
training in Europe. However, there is strong sentiment that
diversity in education and training patterns be preserved.
The EHPS has conducted two surveys regarding education
and training programs in health psychology in Europe that
demonstrate the development of the field. A survey conducted
in 1988 (Methorst et al., 1991) in 19 European countries,
North America, and Australia concluded that true specialized
training programs in health psychology existed only in the
United States and Canada. In Europe, postgraduate training
was part of clinical psychology, and doctoral training was
typically based on writing a dissertation. In 1999, the EHPS
created an Education and Training Committee that had as its
first task the development of a reference guide to postgradu-
ate programs in health psychology in Europe (McIntyre et al.,
2000). In the 23 countries surveyed, 133 programs in health
psychology or with a health psychology component
were identified. Of these programs, 86 lead to a master’s
degree and 47 to a doctoral degree. Although indicating
an impressive expansion of training in the field, doctoral
training typically consists of an independent course of study;
American-style formalized doctoral training programs in
health psychology in Europe are still scarce. In terms of mod-
els of training, the scientist-practioner model continues to be
considered central for professional training. However, the ap-
plicability of the American standard of PhD training to Euro-
pean settings has been discussed through the years (e.g.,
Maes, 1999; Maes & Kittel, 1990).CONCLUSIONAlthough certainly not exhaustive, this chapter has at-
tempted to review some highlights in the history of health
psychology, respecting that its roots are as old as human his-
tory. Within health psychology, there have been a number of
trends over the past century. The influence of psychody-
namic theories and specificity theories as explanatory mod-
els has decreased. Focus on psychophysiological processes
and the identification of pathways among systems (particu-
larly neuroendocrine and immunologic) has increased. Sta-
tistical models have been developed that permit examination
of multiple variables through multivariate analyses and path
analyses, thus facilitating more sophisticated theoretical
model building. Social and ecological dimensions to under-
standing health and illness have been added. Empirically
supported psychological interventions for the prevention
and amelioration of disease and disorders have been devel-
oped. Attention to the need to apply behavioral science to the
improvement of the health care system and health policy has
increased. More attention has been focused on issues of gen-
der and ethnic cultural diversity in health behavior research
and the delivery of health care services, and culturally sensi-
tive interventions have been identified.
Historically, the reasons for the rapid growth of health
psychology in the United States and Europe (and we might