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Article Excerpt
The process of specialty recognition in professional psychology has become increasingly formalized in recent years. The American Psychological Association (APA) now formally defines and recognizes specialties in psychology and organizations such as the American Board of Professional Psychology have repositioned themselves as specialist credentialing bodies. A process model of specialization is presented with increasing levels of specialization arranged from more generalized to more specialized as follows: nonspecialized general practice, niche practice, proficiency, and formal specialty practice. The distinction between de facto and de jure recognition of specialty practice is discussed. It is argued that clinical work with religious/spiritual issues (RSI) already constitutes a practice niche and that numerous de facto proficiencies have been developed for this niche. The prospects and challenges for more formal specialty recognition of the domain of practice are discussed. The article concludes by briefly considering the relationship of "Christian counseling" to a possible formal specialty in clinical work with religious/spiritual issues.
The APA (2002) Ethics Code calls all practitioners to show respect for client religiousness and spirituality as a diversity domain. But how equipped are they to do this? Only a small subset of psychologists report receiving any training in working with religious/spiritual issues (hereafter referred to as RSI) in practice. Researchers have found only between 10 to 30% of psychologists report that they have ever received training in working with RSI (Hathaway, Scott & Garver, 2003). There are also indications that professional psychologists as atypically irreligious compared to the general American population (Shafranske & Maloney, 1990, Sorenson & Hales, 2002). This finding has led some to wonder whether RSI are being neglected in routine practice (Hathaway, Scott, & Garver, 2003).
Still there is evidence that at least some clinicians have developed more deliberate and informed approaches to working with RSI. There has been a promulgation of scholarly texts and journals dedicated to the practice area (Richards & Bergin, 2000, 2005; Shafranske, 1996; Miller, 1999; Griffith & Griffith, 2002; Nielsen, Johnson, & Ellis, 2001). Additionally, an increasing number of articles have been published in mainstream clinical journals focusing on practice with RSI (Ellis, 2000; Miller & Thoresen, 2003; Pargament, Koenig & Perez, 2000; Zinnbauer & Pargament, 2000). There are now several APA accredited doctoral programs that focus on the provision of professional training in a context that emphasizes the integration of RSI. Graduates from these programs are typically required to take formal coursework in the domain. Other doctoral programs and internships exist that offer specialty rotations or practice concentrations in contexts where clients frequently present with RSI (Yarhouse & Fisher, 2002).
Client demand for therapists who personally share a particular faith perspective with the client is not uncommon (Worthington, Kurusu, McCullough, & Sanders, 1996). In some cases, mental health professionals have self-identified as providing services that incorporate faith traditions such as "Christian counseling" (AACC, 2008). This client demand, coupled with the professional self-identification, has produced enough public awareness for some managed care panels to inquire whether professionals do "Christian counseling" as part of their range of services.
Given these trends, how are we to understand clinical practice in this domain? Is practice with RSI an underdeveloped area of general practice or is it a type of emerging specialty practice whose maturation would improve the services delivered? In order to more clearly address this topic, a brief overview of recent trends in clinical specialization will be given.
SPECIALIZATION IN CLINICAL PRACTICE
The Specialization Trend
The trend towards specialization in professional psychology, and some of the factors driving it, has been described by Drum and Blom (2001). They acknowledge that the process of specialization emerged very early in the history of contemporary psychology as "applied psychology" attempted to differentiate it self from academic psychology:
Distinguishing or special patterns of practice competencies arose in response to such variables as service delivery, populations being served, settings for service delivery, and the like-hence, the emergence of specialization. Practitioners with the characteristic configurations of competencies required to deliver such special patterns of service therefore became known as specialists and their practice areas as specialties. Of necessity, becoming a specialist requires specialty-specific practice education and training. (p. 514)
Drum and Blom (2001) point out that " ... the evolution of specialization proceeded spontaneously and without the benefit of much systematic guidance" (pg. 514). They suggest that a two tiered process of specialty training process has emerged over the last half century. The first tier consists of the 'general practice specialties': clinical, counseling and school psychology, and industrial-organizational psychology. The general practice specialties are specialties in the sense that they are professional service extensions of academic psychology to their respective populations. They do not reflect neatly demarcated approaches to professional psychology as their techniques, and models of practice, and client populations are increasingly overlapping (Poston, 1991, Drum & Blom, 2001).
While the training for practice in the general practice specialties is 'broad and general', the scope of practice for professional psychology has now exceeded pre-doctoral training capacity. A number of "delimited specialties" have grown as domains of practice building on the general practice skills common to professional psychology training. Drum and Blom (2001) describe these domains of practice as the "second tier" of specialization in professional psychology. They include specialties such as clinical neuropsychology, forensic psychology, health psychology and clinical child psychology. The second tier specialties matured as formal mechanisms for the recognition of specialization were emerging. The American Board of Examiners in Professional Psychology was founded in 1947 to provide a mechanism of peer recognition of clinical competence in practicing psychologists (Dattilio, 2002). In 1980, APA's Board of Professional Affairs formed the Sub-committee on Specialization (SOS) whose job it was to...
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