Just as these innovative concepts of medical science and practice call for greater multidisciplinary knowledge and interdisciplinary collaboration by physicians, so do they require a reconsideration of what is to constitute the scientific domain of clinical health psychology. The trend toward greater interdisciplinary collaboration in research argues for the increased integration of knowledge from the neurosciences and other relevant biological sciences into clinical health psychology (Calhoun & Craighead, 2006). Doctoral training in clinical psychology purports to require knowledge of the “biological aspects” of behavior, yet the depth and breadth of that training is embarrassingly inadequate for a science that purports to be a health care profession. To insist that psychologists should only achieve mastery over a narrowly prescribed domain of scientific knowledge, and that the science of psychology should be limited only to the study of psychological phenomena and not to the biological processes that make that phenomena possible smacks of dualism and a provincial professionalism that has no place in science. Such attitudes are clearly inconsistent with the current explosion of research by psychologists into bio-behavioral mechanisms, research that demonstrates a broadening interest of psychologists in other sciences that contribute to our understanding of psychological processes. Examples include research such as efforts by psychologists to seek out the complex bio-behavioral interactions and mechanisms contributing to our understanding of psychopathology (e.g., Cacioppo et al., 2007; Kreuger & Markon, 2006), psychotherapy efficacy (e.g., Felmingham et al., 2007) fear reduction (e.g. Sotres-Bayon, Bush, & LeDoux, 2004), relationships between chronic stress and psychiatric and medical disorders (e.g. Miller, Chen & Zhou, 2007), cognitive processes such as language, memory and decision-making (e.g., Fogassi & Ferrari, 2007; Rubin, 2006; Sanfey, 2007), genetic-environmental interaction effects on behavior and psychopathology (e.g., Moffitt, Avshalom, & Rutter, 2006), and the interaction of biological, behavioral, experiential, and socio-cultural effects upon developmental processes (e.g., Hayman, 2007; Park & Gutchess, 2006). Clearly, psychologists’ participation in multidisciplinary research and health care projects such as these requires much broader, multidisciplinary training than is currently afforded by our clinical training programs.
Clinical health psychology, of all the health care professions, has the potential to utilize its science to discover, describe, interpret, teach and clinically apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural and environmental processes. With appropriate training, clinical health psychologists can be the bio-behavioral scientists that: define and explain how stress, both internal and external, impacts the neuroendocrine system and subsequently all organ systems; the mechanisms by which stress adaptation can lead to health, but also disorder, disease and illness; and how the stress response promotes learning, fosters cognition and problem solving and influences communication, behavior, socio-cultural processes, and the patient’s response to disease and treatment efforts. Clinical health psychologists are also in the unique position to draw upon this knowledge to develop empirically based bio-behavioral intervention strategies and programs, and to teach about bio-behavioral interaction.
In striving to become a health care profession, some psychologists, not unlike their physician colleagues, have forgotten that psychology is a science, that it is more than just a collection of insights into the doctor–patient relationship; more than just a set of interviewing techniques, assessment instruments, or treatment interventions. The object of any science is to expand its range of knowledge and establish its links to other sciences. The universe does not operate in discipline specific spheres. Significant advances in science often involve the discovery of common principles, processes and mechanisms universal to multiple sciences. If adopting a bio-psycho-social model undermines our unique understanding of the psychological component of behavior, then three decades of efforts by psychologists at trying to persuade physicians of the importance of that model would seem hypocritical. Obviously, no reasonable medical educator would so conclude. Nor should any reasonable psychologist conclude that increasing one’s knowledge of biological and other sciences basic to understanding behavior, in some way dilutes the specialized expertise of psychologists. I know of no evidence that suggests that psychologists are uniquely limited or impaired in their capacity to process such new information, or that such new information will in some way deprive them of their ability to apply already familiar psychological knowledge.
The push for interdisciplinary research, prompted by translational medicine initiatives and behavioral science career development and demonstration projects, is fueling increased attention to the bio-behavioral research and teaching that the IOM Committee found so wanting in medical education. Interdisciplinary research and multidisciplinary collaboration is also fueling the development in health care of new and innovative clinical applications of these new discoveries. Such collaboration inevitably involves the sharing of knowledge, concepts, principles and methodologies. As Sonnanburg (2007) acknowledges, multidisciplinary education “equips us to benefit clients” yet the discipline of psychology seems hesitant to take the steps required to broaden the knowledge base of trainees. Clinical psychology training programs profess to include familiarity with the biological aspects of behavior in their requirements for the doctoral degree, yet preparation in this domain is woefully deficient when compared to training in the other health care professions and, despite some nominal improvements, has changed little in the past 50 years!
As has happened in the past, other health care professions, and now other behavioral sciences, will take advantage of the opportunities and initiatives emerging in health care and academic medicine. As psychologists we can continue to set ourselves apart, or we can seek to expand our range of knowledge, not only in pharmacology, but also in the behavioral neurosciences, social neurosciences, psychoneuroendocrinology, behavioral genetics, behavioral medicine, etc. We can broaden our interdisciplinary collaborative relationships, our multidisciplinary knowledge, and our applied clinical skills, or we can watch psychology as a discipline become increasingly irrelevant to evolving medical research, medical education and health care practice.