For the most part, health psychology is still a
kind of ad hoc appendage to doctoral programs in
psychology (Larkin, 2009). The student enters a
clinical, social, or experimental program and then,
in addition to the core experience, does some spe-
cialized research or takes a practicum or two in a
health-related topic. Perhaps this is augmented by
an internship at a health care site. But essentially,
the health experiences are grafted onto an already
existing program in clinical psychology or some
other related discipline. However, what is notewor-
thy is that the number of clinical doctoral programs
that offer a clinical health psychology track is
increasing, with recent estimates suggesting that
about one-third of programs offer some training
in this concentration (Larkin, 2009). At least six
offer a formalized track in pediatric psychology. In
addition, there at least seven doctoral training
programs in clinical health psychology exclusively
(Larkin, 2009).
Other ChallengesAny newly emerging field has problems in defining
the roles of its members; health and pediatric psy-
chology are no exception. Years ago, Taylor (1984)
identified several of these problems. One is simply
role ambiguity. No one is totally prepared to say
just what a health or pediatric psychologist should
do—especially in a practical work setting. Health
and pediatric psychologists may actually find them-
selves without psychology colleagues or role models
in the health setting, which only adds to their con-
fusion. Second, issues of status also arise. In health
settings, the physician is clearly at the top of the
heap. Sometimes the psychologist enjoys much
less status in a medical center setting than, for
example, in an academic setting. Furthermore, the
psychologist and the health care professional may
have competing goals. The latter may be interested
only in identifying immediate ways of helping the
patient. The psychologist may be more tentative
and contemplative while thinking about research,
theoretical models, and interventions.
As one way of establishing their identity and pres-
ence in settings traditionally dominated by physicians,
health psychologists need to document the cost-
effectiveness of their interventions (Brannon & Feist,
2010). In this era of health care reform, insurance com-
panies and government agencies are scrupulously
examining ways to drive down the cost of health
care. Given the many successful and cost-efficient
interventions performed by those specializing in health
psychology and behavioral medicine, Friedman et al.
(1995) ask: Why haven’t these interventions been inte-
grated to a greater extent into our health care system?
They suggest several possible reasons:- Many of the data supporting the role of health
psychology are unknown to physicians. - Biological origins of diseases and illnesses have
been emphasized, causing many to overlook
the possible benefits of psychosocial explana-
tions and behavioral interventions. - Patients may be resistant to psychological
interventions (and explanations). - Clinical health psychology and behavioral
medicine are still confused with traditional,
long-term psychotherapy.
Clearly, physicians, insurance companies, the
federal government, and the general public need
to be educated regarding the role of health psychol-
ogists as well as the potential financial and clinical
benefits of their interventions.
Another challenge for the field concerns eth-
nicity and health, as mentioned above. The health
profiles (e.g., life expectancy and health status) of
various ethnic minority populations in the United
States appear to differ greatly from one another, and
more research is needed on health-promoting and
health-damaging behaviors among members of
these groups. But as Brannon and Feist (2010)
note, in the United States one cannot consider eth-
nicity separately from social, economic, and educa-
tional factors that impact health and health care.
Economic disadvantage and lower educational
level are also associated with poorer health outcome
and with poorer access to appropriate health care.
Therefore, it is important to consider a number of
factors in addition to ethnicity when evaluating
health and health needs.
HEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 507