Overlap Among Clinical, Counseling, and School

Psychology: Implications for the Profession and

Combined-Integrated Training
䊲

Harriet C. Cobb
James Madison University
䊲

Ronald E. Reeve
University of Virginia
䊲

Craig N. Shealy
James Madison University
䊲

John C. Norcross
University of Scranton
䊲

Mitchell L. Schare
Hofstra University
䊲

Emil R. Rodolfa
University of California–Davis
䊲

David S. Hargrove
University of Mississippi
䊲

Judy E. Hall
National Register of Health Service Providers in Psychology
䊲

Mardi Allen
Mississippi State Department of Mental Health

Correspondence concerning this article should be addressed to: Harriet C. Cobb, Department of Graduate
Psychology, James Madison University, MSC 7401, Harrisonburg, VA 22807; e-mail: cobbhc@jmu.edu.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 60(9), 939–955 (2004) © 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20028
940 Journal of Clinical Psychology, September 2004

Health care providers within psychology currently fall into three dominant
practice areas: clinical, counseling, and school psychology. This article
reviews data from four different sources—archival descriptions, training
curricula, internship and employment outcomes, and professional
activities—to examine the overlap among the three practice areas. Archi-
val descriptions revealed substantial similarities, with smaller but interest-
ing differences. A comparison of actual curricula from 10 programs
accredited in each of the three practice areas yielded similar findings:
Programs across the three practice areas were much more similar than
different. Within-practice area variations among programs were nearly as
large as across-practice area differences. We briefly review the profes-
sional activities of clinical, counseling, and school psychologists, again
demonstrating considerable similarity. We conclude by explaining impli-
cations for doctoral training programs, internships settings, and profes-
sional credentialing. © 2004 Wiley Periodicals, Inc. J Clin Psychol 60:
939–955, 2004.

Keywords: training; doctoral; combined; Combined-Integrated; curricula

Prior to World War II, applied psychology was a generic field. Practice area training in
professional psychology has evolved over the past half-century.1,2 Clinical psychology
largely emerged from the mental health movement, psychoanalytic psychology, the psy-
chometric traditions of assessing intellectual and personality functioning, and an early
emphasis on diagnosing and remediating major psychopathology. Counseling psychol-
ogy developed from the vocational guidance movement and emphasized assessment of
vocational aptitudes and career interests. Interventions focused on utilizing conscious
processes to develop adaptive responses, typically in relatively well-functioning individ-
uals. School psychology developed from a combination of clinical psychology, educa-
tional psychology, and special education, with a primary setting in the schools. The three
practice areas evolved from their common roots in response to the needs of different
problems, populations, and settings. Organized psychology and universities responded
by developing professional training programs, which differentiated among these three
practice areas (Beutler & Fisher, 1994; Beutler, Givner, Mowder, Fisher, & Reeve, 2004).
The predominant practice areas are clinical, counseling, and school psychology.Accord-
ing to the American Psychological Association (APA) Commission for the Recognition of
Practice Areas and Proficiencies in Professional Psychology (CRSPPP), all three areas are
considered to be “general practice” and “health service provider” areas. Each practice area

1
The views in this article do not necessarily represent “official” policy of any of the organizations or groups to
which these authors may be affiliated.
2
Three terms—“practice areas,” “specialty areas,” and “substantive areas”—are commonly used in reference to
the categories of clinical, counseling, and school psychology. The Commission for the Recognition of Practice
areas and Proficiencies in Professional Psychology (CRSPPP) uses the term “specialties.” The Committee on
Accreditation (CoA), in its Guidelines and Principles of Accreditation, affirms clinical, counseling, and school
psychology as the “substantive areas” for accreditation. Language including “specialties” is used by the CoA
only in relation to postdoctoral training. While CRSPPP uses the language of “specialty” with regard to clinical,
counseling, and school psychology, the CoA does not recognize these as “specialty groups” because each of
these areas is responsible for providing “broad and general” training—a major point of this article. Paul Nelson
(personal communication, November 8, 2002) prefers the term “practice area,” as it avoids the semantic dis-
agreement that is evident within these larger regulatory and professional groups. Therefore, the term “practice
area” is used throughout this article.
 Practice Areas and the C-I Model 941

has a division within the APA (Clinical: 12, Counseling: 17, School: 16), and one or more
scholarly journals. The doctoral programs for these practice areas may apply for accredi-
tation through the APA. The majority of accredited training programs (over 200) are in
clinical psychology, with substantially fewer programs in counseling psychology (75) and
school psychology (54). Ten “combined” programs also are listed as accredited by APA
(Accredited Doctoral Programs in Professional Psychology, 2003).

CRSPPP Archival Descriptions

Language regarding the scope and nature of each area was developed in the context of
the CRSPPP, which was established in 1996 by APA to formally differentiate among
“specialty areas” (see Footnote 2) to aid accreditation and credentialing bodies (see
www.apa.org/crsppp). CRSPPP maintains a listing of archival descriptions of the rec-
ognized “specialties and proficiencies” of professional psychology. They are intended
to articulate to the public and to peers the nature and uniqueness of each area. The
descriptions are derived as part of the formal petitioning process by which a “specialty”
or “proficiency” becomes recognized.
The highly structured nature of the CRSPPP archival descriptions allows for direct
comparison of their content section by section. In the following sections, we compare the
archival descriptions for clinical, counseling, and school psychology.
All three practice areas expressly consider themselves to be “general practice” and
“health service provider” practice areas—two important commonalities. As Table 1 shows,
there is a 100% overlap in basic or foundational knowledge across the practice areas
when comparing the three CRSPPP definitions within the scientific and theoretical knowl-
edge area. Such overlap should be expected, as all APA-approved doctoral programs

Table 1
Comparison of Training Program Curricula Across Practice Areas (APA
Accreditation Guidelines)

Clinical Counseling School

Breadth of Psychology
Biological Aspects of Behavior X X X
Cognitive/Affective Aspects of Behavior X X X
Social Aspects of Behavior X X X
History & Systems of Psychology X X X
Psychological Measurement X X X
Research Methodology X X X
Techniques of Data Analysis X X X
Foundations of Practice
Individual Differences in Behavior X X X
Human Development X X X
Dysfunctional Behavior/Psychopathology X X X
Professional Standards/Ethics X X X
Assessment and Intervention
Assessment Diagnosis X X X
Effective Interventions X X X
Consultation/Supervision X X X
Evaluating Effectiveness X X X
Cultural/Individual Diversity X X X
942 Journal of Clinical Psychology, September 2004

Table 2
Comparison of Client Populations Served Among Practice Areas
(Archival Descriptions)

Clinical Counseling School

Age Range
Infancy/Early Childhood all ages all ages X
Childhood all ages X X
Adolescence all ages X X
Young Adulthood all ages X X
Adulthood all ages X
Serving
Individuals X X X
Couples X X
Families X X
Groups X X
Organizations X X

must meet common core knowledge requirements as articulated by APA’s Committee on

Accreditation (CoA). In fact, the APA accreditation guidelines for evaluating doctoral
programs do not differentiate among practice areas. Clinical, counseling, school, and
“combined” programs must respond to an identical set of criteria to meet APA accredi-
tation standards (see www.apa.org/accreditation).
At the same time, several differences do emerge among practice areas when popu-
lations served are considered. As can be seen in Table 2, clinical and counseling psychol-
ogy indicate that they serve all age ranges. The school psychology practice area does not
include adulthood as an emphasis area; however, this is a questionable omission as inter-
ventions with children frequently involve working with parents, teachers, and other sig-
nificant adults in a child’s environment. In terms of therapy formats, counseling
psychology’s archival description indicates that they serve clientele in all formats (i.e.,
individuals, couples, families, groups, and organizations). Clinical psychology is described
as conducting all formats except organizations, and school psychology is described as
serving just individuals and organizations—curiously leaving out group and family work.
Few differences emerge between the areas when populations served are considered.
In the CRSPPP definitions, the “problems” section reflects the general areas of dys-
function and/or psychopathology addressed by the discipline. As shown in Table 3, the
descriptions of counseling and school psychology embrace coverage of a broad range of
problems addressed. The description of clinical psychology does not specify school/
educational or career/vocational issues.
The archival descriptions for each practice area also describe the types of procedures
used. The definitions were assessed for practices of each of the practice areas. These
results are summarized in Table 4. Interestingly, an identical range of procedures was
noted, with two exceptions. Working in crisis/trauma was not specified in the clinical
psychology description—an obvious omission. School psychology’s description does
not include the terms “counseling/psychotherapy,” instead referring to “psychological
interventions.”
Based on these archival descriptions, the practice areas have markedly more simi-
larities than differences. As defined by the practice areas themselves, the required foun-
dational knowledge, populations served, problems addressed, and training procedures
demonstrate that the practice areas exhibit a tremendous degree of overlap.
 Practice Areas and the C-I Model 943

Table 3
Comparison of Problems Addressed Among Practice Areas
(Archival Descriptions)

Clinical Counseling School

Physical Disabilities X X X
Cognitive/Intellectual Deficits X X X
Adjustment/Coping Issues X X X
Emotive/Behavior/Mental Disorders X X X
School/Educational Issues X X
Career/Vocational Issues X X

Table 4
Comparison of Training Procedures Among Practice Areas (Archival
Descriptions)

Clinical Counseling School

Individual Psychodiagnostic Assessment X X X

Interventions
Counseling/Psychotherapy X X
Prevention X X X
Crisis/Trauma X X
Consultation X X X
Supervision X X X
Program Development/Evaluation X X X
Training/Education X X X

Curricula Review
To further evaluate how practice areas compare with each other, we reviewed curricula
across a random selection of APA-accredited programs in each practice area (10 pro-
grams in each for a total of 30 programs). For inclusion, a program had to have a Web site
describing its required (core) curriculum. A content analysis of curricula indicated that
some coursework was more typically included within a particular practice area. For exam-
ple, clinical psychology programs more often included psychopharmacology, health psy-
chology, and neuropsychology than did other practice areas. Counseling psychology
programs were more apt to require career development/vocational assessment, develop-
mental disabilities/mental retardation, and human sexuality. School psychology pro-
grams included required coursework in educational policy and law, educational psychology,
special education/reading disabilities, and educational assessment. Interestingly, how-
ever, from this qualitative review at least, there may be more variability within than
among practice areas. That is, some programs accredited under each practice area desig-
nation required courses listed earlier as relatively unique to the other practice areas. (The
exception, from this review at least, was that no clinical or counseling programs offered
educational policy and law courses.)
An additional difference among practice areas was in settings typically used for
practicum training. Obviously, school psychology programs always utilized schools as a
practicum site; however, such settings as medical centers/hospitals, mental health clin-
944 Journal of Clinical Psychology, September 2004

ics, and university counseling centers also were used across practice areas. Individual
program philosophy and goals likely are contributing factors to an individual program’s
choice of practicum settings.
Figure 1 provides a visual schematic of the overlap and uniqueness of the practice
areas. The common core represents between 80 and 90% overlap among the practice
areas with regard to curriculum. Practice areas have more commonalities than differences
in coursework. Figure 1 also lists the relatively unique coursework across practice areas.
Such factors as theoretical orientation of a program’s faculty (behavioral, psycho-
dynamic, cognitive, systems, etc.) appear to influence curriculum as much as does the
program’s practice area. An additional factor appears to be the institutional settings in
which programs are based (i.e., the department, school, and college within the institu-
tion). Clinical programs typically are in departments of psychology within colleges of
arts/sciences (77%); counseling (75%) and school (73%) programs more often are located
in schools/colleges of education (Castle & Norcross, 2002). Furthermore, the program’s
respective location on the scientist–practitioner continuum certainly influences the train-
ing experiences regardless of whether it is a clinical, counseling, or school program
(Mayne, Norcross, & Sayette, 1994).
Other research also supports the underlying similarity in coursework among clinical,
counseling, and school psychology. For example, there is substantial overlap in course-
work and requirements of child clinical programs and school psychology programs (Minke
& Brown, 1996). School psychology training at the doctoral level also is broadening to
include experience outside of the school setting and with adolescents and families as well
(Tryon, 2000). Some differences remain, however, such as more courses in consultation
and education in school programs and more courses in psychopathology in child clinical
programs. Nonetheless, the core curricula are quite similar.
At the same time, the training and research interests of clinical psychology and
counseling psychology faculty also are increasingly converging (Norcross, Sayette, Mayne,
Karg, & Turkson, 1998). For both practice areas, the most frequently listed areas of

Figure 1. Common and distinctive curriculum across practice areas.

 Practice Areas and the C-I Model 945

faculty research were behavioral medicine/health psychology, minority/cross-cultural

psychology, psychotherapy process and outcome, family therapy and research, child/
pediatric psychology, neuropsychology, mood disorders, anxiety disorders, eating dis-
orders, and assessment. By far, the largest differences occurred in minority/cross-cultural
psychology and vocational assessment; 69 and 62%, respectively, of counseling psychol-
ogy programs listed these compared to only 32 and 1%, respectively, of the clinical
programs. Counseling psychology programs also more frequently provided research and
mentorship in human diversity (e.g., gender, sexuality minority/cross-culture) while clin-
ical psychology programs offered more research opportunities in psychopathological pop-
ulations (e.g., affective disorders, chronic mental illness, personality disorder, PTSD) and
in activities traditionally associated with medical and hospital settings (e.g., neuropsy-
chology, pain management, psychophysiology).

Internship and Employment Outcomes

The significant overlap among the practice areas of clinical, counseling, and school psy-
chology also is evinced in internship and employment data. The data in Table 5, from the
Association of Psychology and Postdoctoral Internship Centers (APPIC, n.d.), indicate
whether clinical, counseling, or school psychology applicants are preferred or accepted
during intern selection. Two points should be emphasized. First, at least from these data,
it appears that there is relatively little difference overall between preference or accep-
tance rates for applicants from clinical or counseling psychology practice areas. Second,
every program type (except “Armed Forces”) prefers or accepts at least some proportion
of students from all three practice areas. Although school psychology students are not
preferred or accepted at the rates of clinical or counseling applicants, they still are pre-
ferred or accepted at substantial levels within programs that might not seem hospitable to
such students but apparently are nonetheless.
More specifically, and along these same lines, consider the preferences of training
directors in counseling centers. Counseling center training directors prefer or accept appli-
cations from clinical or counseling practice area programs at about an equal rate; inter-
estingly, school psychologists are preferred or accepted by a sizable majority. The same
situation is revealed by training directors of school programs. Here, applicants from all
three practice areas are preferred or accepted in relatively equal measure by training
directors for such programs. Finally, even within training sites that are perhaps perceived
as the bastions of clinical psychology, the data say otherwise. Counseling and school
psychologists are now preferred or accepted at substantial rates by the training directors
of, for example, VA medical centers, medical schools, psychiatric hospitals, and state/
county hospitals.
In short, based upon these data at least, a student’s practice area does not appear to be
a good predictor of preference or acceptance rates by internship directors. Does practice
area predict actual employment? Consider Table 6, which presents the 2001 data col-
lected by the APA’s Office of Program Consultation and Accreditation. Consistent with
the internship preference and acceptance rates (Table 5), a graduate’s practice area is
neither a particularly robust predictor of initial employment setting nor does it preclude
employment in areas that may be considered nontraditional to a particular practice area.
Percentages do differ across several categories, to be sure; for example, 60% of school
psychology graduates initially are employed in the schools. More broadly, however,
graduates of clinical, counseling, and school psychology programs are employed across a
wide range of settings; in some cases (particularly between graduates of clinical and
946 Journal of Clinical Psychology, September 2004

Table 5
APPIC Member Programs that “Prefer” or “Accept” Clinical, Counseling,
and School Psychology Applicants

Variables Total Clinical Counseling School

All Programs 608 596 550 200

98% 90% 33%
University Counseling Centers 129 128 127 91
99% 97% 71%
VA Medical Centers 85 84 82 4
99% 96% 5%
Child/Adolescent 95 95 85 66
100% 89% 69%
Community Mental Health 127 124 114 54
98% 90% 43%
Medical Schools 97 95 75 41
98% 77% 42%
Correctional 36 36 36 7
100% 100% 19%
Private Psychiatric Hospital 21 21 19 8
100% 90% 38%
School District 21 19 17 17
90% 89% 81%
State/County Hospital 83 82 75 26
99% 90% 31%
Armed Forces 11 11 10 0
100% 91% 0%
Consortium 57 55 51 22
96% 89% 39%
Private General Hospital 39 38 33 18
97% 85% 46%
Private Outpatient Clinic 23 22 19 7
96% 83% 30%
Psychology Department 16 16 14 6
100% 88% 38%
Other 54 51 47 23
94% 87% 43%

Note. Some sites fall under more than one category.

counseling psychology programs), percentages of employment are relatively similar across

a number of different settings.
Consistent with such findings, Bechtoldt, Norcross, Wyckoff, Pokrywa, and Camp-
bell (2001) compared the employment settings of 1,389 clinical and counseling psychol-
ogists (members of APA Divisions 12 & 17). Private practice and university settings
accounted for about 60% in each division. Within this broad category, however, some
differences do emerge. For example, clinical psychologists were more frequently employed
in two settings—private practice and hospitals—whereas counseling psychologists were
more often located in universities and other settings. Similarly, according to data over a
10-year period from the APA Research Office (identifying employment characteristics of
APA members), Division 12 (Clinical) members are more frequently employed in private
practice (37 vs. 22%) and hospital settings (13 vs. 5%) while Division 17 (Counseling)
members are more often employed in university settings (33 vs. 21%).
 Practice Areas and the C-I Model 947

Table 6
Employment Setting by Doctoral Program Area

Settings Clinical Counseling School Combined Total

CMHC 253 39 8 10 310

19% 12% 3% 13% 16%
HMO 33 4 0 3 40
3% 1% 0% 4% 2%
Medical Center 123 15 4 7 149
9% 5% 2% 9% 8%
Military Medical Center 23 11 0 0 34
2% 3% 0% 0% 2%
Private General Hospital 28 3 4 8 43
2% 1% 2% 10% 2%
General Hospital 30 13 1 0 44
2% 4% 0% 0% 2%
VA Medical Center 35 9 2 0 46
3% 3% 1% 0% 2%
Private Psychiatric Hospital 25 6 5 4 40
2% 2% 2% 5% 2%
State/County Hospital 53 6 2 4 65
4% 2% 1% 5% 3%
Correctional Facility 44 10 6 2 62
3% 3% 3% 3% 3%
School District/System 46 11 143 19 219
4% 3% 60% 24% 11%
University Counseling Center 42 46 1 4 93
3% 14% 0% 5% 5%
Academic Teaching Position 92 43 19 7 161
7% 13% 8% 9% 8%
Academic Nonteaching 19 6 9 2 36
1% 2% 4% 3% 2%
Independent Practice 146 29 6 1 182
11% 9% 3% 1% 9%
Medical School 54 4 1 0 59
4% 1% 0% 0% 3%
Other 122 23 10 4 159
9% 7% 4% 5% 8%
Not Employed 42 7 2 2 53
3% 2% 1% 3% 3%
Multiple Employment Settings 101 34 16 3 154
8% 11% 7% 4% 8%
Total 1,311 319 239 80 1,949
100% 100% 100% 100% 100%

Note. Based on 335 doctoral programs that provided data on initial employment positions of their graduates from 2000–2001.
Due to rounding, column percentages may not add up to 100%. Interpret data cautiously when n is small. From the 2001 Annual
Report, Office of Program Consultation and Accreditation, 2002.

Professional Activities
Along these lines, note that a dozen or so studies also have examined the professional
activities of clinical, counseling, and school psychologists. The researchers have asked,
in different ways, “How special are the specialties?” They have uniformly answered,
“Not very” (Fitzgerald & Osipow, 1986). Some studies on the roles and functions of
clinical and counseling psychologists do substantiate traditional differences, but the sim-
948 Journal of Clinical Psychology, September 2004

ilarities are far more numerous (Brems & Johnson, 1997; Fitzgerald & Osipow, 1986;
Norcross, Karg, & Prochaska, 1997a, 1997b; Watkins, Lopez, Campbell, & Himmell,
1986). In particular, clinical psychology graduates tend to work with more seriously
disturbed populations and are more likely trained in projective assessment whereas coun-
seling graduates work with healthier, less pathological populations and conduct more
career and vocational assessment. But the aggregate results suggest only modest differ-
entiation and considerable commonality, at least in regard to daily activities. In short, in
terms of internship preferences, employment settings, and professional activities, it would
appear that no single practice area can claim sole authority or significant ownership of
“turf” vis-à-vis the other practice areas.

The Rationale for Combined-Integrated Training

The demonstrable overlap among the practice areas is central to the rationale for Combined-
Integrated (C-I) programs, which have deliberately “combined” and/or “integrated” the
practice areas for the past three decades (Beutler et al., 2004). Specifically, and consistent
with the previous discussion, the C-I model assumes that
there exists a common corpus of knowledge that cuts across all three specialty areas, that this
body of knowledge can be taught in a graduate training program, and that this corpus of
knowledge and skill can serve as a foundation both for predoctoral specialization and for
postdoctoral training in a more narrowly defined area of subspecialization. (Beutler & Fisher,
1994, p. 67)

The notion of C-I doctoral training thereby cuts across the archival descriptions and
monolithic practice areas in professional psychology. Recognizing that few substantial
differences exist among the practice areas frees these programs from the constraints of
feeling the need to be territorial in the training of new psychologists. The following
mission statement for C-I programs makes this point explicit:
Combined-Integrated Doctoral Training Programs in Psychology produce general practice,
primary care, and health service psychologists who are competent to function in a variety
of professional and academic settings and roles; these programs achieve this goal by inten-
tionally combining and/or integrating education and training across two or more of the rec-
ognized practice areas. (Consortium of Combined and Integrated Doctoral Programs in
Psychology, n.d.; Shealy, Cobb, Crowley, Nelson, & Peterson, 2004)

The C-I model builds on the major overlap among areas and is therefore consistent
with the view that graduate training has the goal of providing basic, broad training for
students to become health service providers, who then may specialize in more depth at a
later point in their careers (see also Schulte et al., 2004). A summary rationale for this
approach was articulated by Consensus Conference participants via the following four
points (see Shealy et al., 2004):

1. There is tremendous overlap in the basic competencies (i.e., knowledge, skills,

and values) needed to function effectively in each of the single practice areas of
psychology;
2. psychologists with training across the practice areas are employed in increasingly
similar settings and thus are required to possess comparable competencies;
3. psychologists are perceived as alike by many outside the field, including relevant
funding systems and regulatory boards; and
 Practice Areas and the C-I Model 949

4. competence within and across the practice areas of psychology can and should be
taught in a manner that is complementary and synergistic.

Implications for Professional Psychology

The C-I model explicitly addresses the fact that there is substantial overlap among the
practice areas of clinical, counseling, and school psychology. Therefore, and in the con-
text of the previous discussion, we see at least seven summary implications for training
and credentialing in professional psychology.

1. The nature of students’ internship placements and eventual employment do not

appear to be differentially or accurately predicted by the practice area in which
one is trained.
As noted earlier, perhaps the most striking data from Table 6 are those of gradu-
ates from combined programs. Castle and Norcross (2002) observed that of 80
psychologists who had recently graduated from combined programs, employment
was secured in a variety of settings, e.g., 13% in CMHCs, 9% in medical centers,
10% in hospitals, 24% in school districts, and 9% in teaching. They interpreted
this as concurrent validity for combined training, i.e., broader training resulted in
broader employment opportunities.
This basic conclusion—that graduates of C-I programs may enjoy a wider
range of employment possibilities—receives further support from an analysis of
C-I program outcome data (see Braxton et al., 2004).
2. Conversion to the C-I Model is relatively straightforward.
Clinical, counseling, and school psychology have long traditions within the pro-
fession (50⫹ years). A person trained in a typical clinical or counseling psychology
program will have limited coursework and practica addressing children, school set-
tings, and special education (essentials of school psychology practice). The tradi-
tionally trained clinical or school psychologist also is unlikely to understand, for
example, the critical role of career interests and vocational aptitudes. School psy-
chologists, likewise, often possess limited knowledge of severe psychopathology.
One logical solution is for programs to train more broadly (i.e., to include the
important knowledge and experience that their graduates may well need to func-
tion in today’s marketplace). Should a clinical, counseling, or school psychology
program decide to broaden its scope to train students more comprehensively for
multiple roles and settings, some modifications certainly are necessary (see Brown
et al., in press; Shealy et al., 2004). Foremost among these is to determine how to
incorporate the important “spirit” and traditions as well as the skills and special-
ized populations associated with the practice areas to be added. Either hiring new
faculty (i.e., from the practice area that the program wishes to include or from an
extant C-I program) or co-opting existing faculty who were themselves trained in
the “new” practice areas are among the possible solutions. However, it also is
possible for existing clinical/counseling/school faculty to “cross train,” formally
or informally, in the new practice area so that they can provide the critical skills of
additional practice areas. Faculty themselves model lifelong learning, and increas-
ingly must engage in continuing professional education to maintain licensure.
Sufficient immersion in the culture and skills associated with an additional prac-
tice area could be accomplished credibly within an intensive CE framework.
950 Journal of Clinical Psychology, September 2004

Introducing additional coursework into the program, or at least broadening

the scope of current courses, also will be necessary; however, as demonstrated
earlier, applied doctoral programs across practice areas overlap 80 to 90% in
coursework, so only a few added or revised courses are typically necessary.
Perhaps more critical, practica must include exposure to settings and popula-
tions that are sufficiently diverse to incorporate the “new” practice areas. A clin-
ical program that did not expose students to children, schools, and educational
issues would have to do so to be considered “combined” with school psychology.
Both school and clinical programs would include courses in vocational assess-
ment and developmental disability, for example. Such inclusion is not unusual. In
addition to C-I programs, which engage in such inclusion as a matter of course,
review of curricula in counseling programs indicated that most now offer course-
work on major psychopathologies as part of the natural evolution of that practice
area over time.
Incorporating the full spectrum of applied psychology into a former single
practice area program—becoming a C-I program—requires faculty to be open to
“new” ideas, skills, traditions, settings, and populations. The collegial inter-
actions necessary to accomplish this can be exciting, and may bring out the best in
collaboration with our professional psychology siblings (see Johnson, Stewart,
Brabeck, Huber, & Rubin, in press). Perhaps that is why Consensus Conference
participants explicitly affirmed that
C-I program administrators and faculty demonstrate that they are supportive of the
combined-integrated model of education and training, and recognize that aspects of
the single practice model (e.g., training processes and cultures) must be modified
somewhat in order to create the unique learning environment provided by C-I pro-
grams (Principle 9) (see Shealy et al., 2004).

3. Psychology licensure is already “generic” across much of the United States and
Canada.
According to the Association of State and Provincial Psychology Boards (ASPPB;
n.d.) it appears that over 90% of jurisdictions in the United States and Canada
license psychologists generically (e.g., as psychologists or licensed psycholo-
gists, although nine states license generically as health service psychologists).
As such, as long as an individual meets criteria for licensure as a doctoral-level
psychologist in a given state, that individual may be subsequently licensed as a
psychologist and may therefore practice according to the statutory regulations
that are promulgated by each state’s psychology licensure board. The state or
province typically places no additional restrictions on what appears to be com-
monly recognized as the scope or nature of a psychologist’s practice. Therefore,
from a licensure perspective, and at the doctoral level, calling oneself a clinical,
counseling, or school psychologist does not appear to be a crucial determinant of
eligibility for licensure, although such designations may have particular meaning
within specific professional settings or practice contexts such as the schools.
4. Clinical, counseling, and school psychologists are credentialed as health service
providers.
The National Register of Health Service Providers in Psychology seeks to:
disseminate standards for evaluating the education and training of licensed psychol-
ogists; evaluate programs that enhance the education, training, and delivery of ser-
vices by psychologists; review the practices and ethics of psychologists to ensure
 Practice Areas and the C-I Model 951

integrity in the profession and quality of patient care; and provide information on
psychologists to the health care community and to the general public. (see National
Register of Health Service Providers in Psychology, n.d.)

The National Register credentials appropriately trained and qualified psycholo-

gists as health service providers in psychology, regardless of the practice area in
which those psychologists were originally trained. A significant rationale for such
generic credentialing is to promote greater professional mobility by all profes-
sional psychologists. As Schulte and colleagues (in press) discuss, psychologists
are already recognized as health service psychologists at the federal level in numer-
ous settings (e.g., the Graduate Psychology Education grant system). As both the
National Register and GPE illustrate, the putative distinctions among clinical,
counseling, and school psychology are rarely recognized in the context of these
national credentialing, policy-making, and funding rubrics.
5. Although APA does not differentiate among practice areas in accreditation crite-
ria (a reality that is aligned with the C-I model), a number of accreditation issues
still must be addressed.
The CoA does not differentiate among the practice areas in its criteria for accred-
itation; all programs seeking accreditation are required to meet identical criteria.
APA’s Office of Program Consultation and Accreditation reviews a program’s
self-study and may require clarification or additional information. The Office
approves a program for a site visit when the self-study is judged to be adequate.
Site visitors then are chosen with some input from program faculty. The roles of
site visitors are to serve as APA’s “eyes and ears” and to verify and clarify infor-
mation provided in the self-study. Typically, three visitors are sent to review pro-
grams seeking initial or continuing accreditation, two with applied/practice training
and experience and one representing the science of psychology.
A practical problem experienced by “combined” programs is that few site
visitors were themselves trained in this model. Thus, the site visitors to these
programs often are practice area oriented, with little familiarity with the philos-
ophy underlying C-I programs.3 The visitors may then spend much of the visit
trying to understand this unfamiliar model. (It is much easier for practice area
programs to find visitors trained in their practice area.) Not surprisingly, then,
perhaps the single greatest complaint by C-I programs vis-à-vis accreditation is
that they have to expend an inordinate amount of time simply trying to explain
what it means to train from a C-I perspective since historically at least, site teams
to such programs have not always included site visitors who are familiar with and
open to the C-I model. Compounding matters, despite the fact that such programs
are philosophically and structurally aligned with the “general” accreditation stan-
dards promulgated in the Committee on Accreditation’s Guidelines and Proce-
dures (Guidelines and Principles for Accreditation of Programs in Professional
Psychology, n.d.), as of this writing, they currently have no formal representation
on the Committee on Accreditation (unlike the three other doctoral program types).
In short, the facts that (a) APA does not differentiate among practice areas in
accreditation criteria but (b) CoA members and site-team visitors typically “come
from” practice areas where differences are often assumed introduce a problematic
confound into the review process for C-I programs. Specifically, there is no guar-

3
Representatives of “Combined” doctoral programs endorsed changing the name of their type of program to
Combined-Integrated doctoral programs (see Bailey, 2003; Shealy et al., 2004).
952 Journal of Clinical Psychology, September 2004

antee that either the CoA or its site team will have any direct familiarity with the
nature and scope of C-I training at any point in the accreditation review process.
Ironically, then, despite the fact that the Committee on Accreditation does not
formally differentiate between the practice areas in terms of accreditation criteria,
in the actual process accreditation review such distinctions may become quite
relevant. Thus, from a C-I perspective at least, an important implication is that
these issues must be recognized and addressed throughout all aspects and phases
of accreditation review. (A request to this effect has been forwarded to the Com-
mittee on Accreditation and other relevant parties; see www.jmu.edu/ccidpip for
the current status of this issue.)

6. It is questionable whether distinctions among clinical, counseling, and school

psychology are meaningful or helpful to the profession or public.
At the Competencies 2002 conference, the Practice Areas and Proficiencies Work-
group concluded that

neither the term ‘substantive areas’ (used by the CoA) nor the term ‘specialty areas’
(recommended for use by CRSPPP) is meaningful to the profession or the public in
reference to Clinical Psychology, Counseling Psychology, and School Psychology;
rather it is recommended that these areas be identified as areas of general health
service practice in psychology, in that they prepare students in the core competencies
for health service practice, beyond which additional preparation is required for prac-
tice area practice. (see www.appic.org/downloads/CompetenciesCombined Work-
group Summaries.doc, p. 59)

Such a conclusion is entirely consistent with the previously mentioned implica-

tions and thrust of this article. Also note that APA’s Committee on Accreditation
is grappling with similar issues in a debate about whether additional or “emerging
substantive areas” should be accredited (e.g., such as family psychology and
industrial-organizational psychology). The fact that the CoA is addressing this
matter speaks to a number of interrelated dynamics, including the fact that other
“practice areas” within professional psychology may or may not wish to pursue
accreditation in their own right (see http://apaoutside.apa.org/accreditation).
Part of the challenge here is that the profession of psychology has only recently
attempted to achieve consensus on what “specialization” actually means, much
less develop a sanctioned process through which specialization may occur and be
officially recognized. Along these lines, the Council of Credentialing Organiza-
tions in Professional Psychology (CCOPP) circulated for review in 2003 its Com-
prehensive Principles for Health Services Specialization in Professional Psychology
(see www.apa.org/crsppp). The CCOPP document attempts to “bring order” to
the process of establishing “a comprehensive, conceptual framework or taxon-
omy for specialization in professional psychology.” The CCOPP document rec-
ognizes that concepts and processes of specialization have not been well specified
by the profession of psychology. Significantly, and again congruent with the pre-
viously discussed implications, the CCOPP document also describes professional
psychologists generically as “health service psychologists” (see also Schulte et al.,
in press).
7. When advising current or prospective students about training and careers in pro-
fessional psychology, the previous implications and issues should be fully and
openly discussed.
 Practice Areas and the C-I Model 953

When a prospective student seeks a graduate training program in professional psy-

chology, one of the first decision points is whether to pursue clinical, counseling, or
school psychology as a career. That decision may be based on limited or biased informa-
tion. For example, if the student attends a college or university with no applied psychol-
ogy graduate programs, he or she may rely primarily on advisors who themselves have
little understanding of similarities and differences among applied doctoral areas. Like-
wise, if the student’s undergraduate institution has a graduate program in only one prac-
tice area, the student may opt to train in that practice area because of the faculty member’s
influence rather than on the basis of a full and open exploration of various education and
training options.
Once a student enters a graduate program, their acculturation as a psychologist typ-
ically is shaped by the program’s practice area. Faculty in training programs almost
invariably come from training programs with the same practice area designation. Thus,
knowledge is passed down within a practice area with little perceived need to look else-
where. Because of these historical and practical issues, the notion that “clinical” psychol-
ogists have much in common with “counseling” or “school” practitioners gets lost, with
the history and politics of psychology tending to emphasize differences rather than sim-
ilarities among applied, doctoral-level psychologists. As a result, prospective and current
students often do not appreciate that the practice area in which they are trained (a) may
inadvertently or deliberately limit their exposure to key aspects of the other practice areas
(e.g., settings, populations) that may be quite relevant to their eventual professional func-
tioning and (b) may not be a significant predictor of the internship they secure, license
they obtain, or career they assume. Given the legitimate needs and real-world concerns of
today’s students (Braxton et al., 2004), when advising prospective or current doctoral
students, full and open discussion of these important implications and issues seems
imperative.

Summary
In summary, the considerable overlap among the practice areas of clinical, counseling,
and school psychology—in description, coursework, internships, and employment—
suggests that we should reconsider the meaningfulness of such distinctions for our pro-
fession, training, students, and the public at large. From the perspective of C-I programs,
an excerpt from the APA’s Committee on Accreditation’s discussion of “Emerging Sub-
stantive Areas” seems tailor made for our summary and conclusion:
For many reasons then (e.g., practically, economically, professionally) . . . a single accred-
ited “Health Service Psychologist” role (or related title/identity) would fit better what we
already do, with the clear possibility of acquiring additional accredited “specialization”
toward the end of doctoral training or on internship, and especially at the postdoctoral
level. If the field elects to move in this direction, such an approach could 1) provide
optimal flexibility and opportunity for students and the profession (especially in this time
of managed care, reduced state/federal funding, and increased competition from other
providers); 2) create an opportunity to function in a more interprofessional manner . . . ;
3) facilitate greater congruence with legislative and funding opportunities at a national
level (e.g., through the Graduate Psychology Education program); 4) provide an oppor-
tunity for us to stop battling each other over issues of clinical, counseling, and school
“turf;” 5) direct our energies instead toward ways in which we can—upon acquisition of
agreed upon competencies—work effectively across the spectrum of appropriate practice
areas/settings (which we largely do anyway after graduation, regardless of the specific
practice area in which we are originally trained); and 6) help us join together to achieve
954 Journal of Clinical Psychology, September 2004

our rightful place within the larger health care field, broadly defined [see CCIDPIP response
to “Emerging Substantive Areas” (CCIDPIP, n.d.)].

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