Implications of Faith-Praxis Integration for Training Sally Schwer Canning

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2000 Integration as Service: Implications of Faith-Praxis Integration for Training Sally Schwer Canning

Carlos F. Pozzi

J. Derek McNeil

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Recommended Citation Canning, Sally Schwer; Pozzi, Carlos F.; and McNeil, J. Derek, "Integration as Service: Implications of Faith-Praxis Integration for Training" (2000). Faculty Publications - Grad School of Clinical Psychology. Paper 218. http://digitalcommons.georgefox.edu/gscp_fac/218

This Article is brought to you for free and open access by the Graduate School of Clinical Psychology at Digital Commons @ George Fox University. It has been accepted for inclusion in Faculty Publications - Grad School of Clinical Psychology by an authorized administrator of Digital Commons @ George Fox University. For more information, please contact [email protected]. Journal of Psychology and Theology 2000, Vol. 28, No. 3,201-211

I n t e g r a t io n as S ervice:

Implications o f Fa it h -P raxis

I n t e g r a t io n f o r T r a in in g

S a l l y S c h w e r C a n n i n g , C a r l o s F. P o z z i , J. D erek M cNeil, &nA M ark R. M cM inn Wheaton College

Faith-praxis integration should be given further atten- tant to patiently work out the various ways in which tion as the integration of applied psychology and Christianity and psychology relate and interact. Christian theology proceeds. The authors outline a It has become clear that integration is not a unidi- rationale for faith-praxis integration based upon pat- mensional activity in which we are searching for the terns of mental health needs and resources in the U.S. single true method of combining psychology and and for a Kingdom mandate. Implications of a faith- Christianity. Rather, there are multiple integration praxis perspective for trainers of Christian psycholo- schemes and foci, each with distinctive features and gists are suggested in relation to a program’s missions emphases (Bouma-Prediger, 1990; Worthington, statement, faculty, course work, practical training, 1994). These disparate approaches to integration are research, and relationship to the community. Selected derived both by the varying perspectives of integrators activities of existing Christian psychology training pro- and by the fluid needs and demographics of changing grams are included to illustrate these implications. cultures and societies. Though the foundational truths Ongoing discussion is invited concerning this emerging about human nature and God’s character will not area of integration. change, approaches to interpreting and applying these truths in a culturally relevant manner will change. Í throughout the many centuries in which psy- In the 25th Anniversary issue of the Journal o f I chology and religion have been “inextrica- Psychology and Theology; Tisdale, Thelander, and TA bly intertwined” (Vande Kemp, 1996, p. Pike (1997) observe that “we have the opportunity to 72), various systems of integrating the two fields begin a new era in integration” (p. 3). In this new era, have been articulated and attempted. Even in the Christian psychologists will be wise to consider what contemporary integration movement of the 20th Bouma-Prediger (1990) has called “faith-praxis” inte- Century, characterized by distinctive graduate train- gration. Faith-praxis integration involves a practical ing programs and specialty journals, there have been and applied focus on matters of authenticity, human twists and turns in the development of integration service, and vocation. That is, professional work is models and themes (Bouma-Prediger, 1990; Eck, seen as Christian calling or ministry. Faith-praxis inte- 1996). Most of these integration models have per- gration involves a commitment to service and has tained directly or indirectly to the branches of psy- clear implications for the training of psychologists. chology related to human services (e.g., clinical, The purpose of this article is to provide a ratio- counseling, community). These varying approaches nale for faith-praxis integration in psychology and to to integrating applied psychology and Christian the- suggest implications of this notion for the process of ology may be viewed pessimistically as pre-paradig- clinical training. In it, we outline our perspective that matic fumblings or, more optimistically, as part of increasing our attention to integration as service is an evolving exploration of the nature of human not only needed in order to respond to demographic need and human service. In either case, it is impor- and epidemiological realities in our society, but it is supportable, even compelling, from a theological Correspondence and requests for reprints may be sent to Sally Schwer Canning, PhD, Wheaton College, 501 College Avenue, vantage point. We discuss implications for profes- Wheaton, IL 60187. Electronic mail may be sent via Internet to sional training and highlight a few examples from [email protected] existing Christian training programs. In so doing, we

201 202 INTEGRATION AS SERVICE hope this article serves to invite others to join in dis- across populations. These three points are devel- eussions about this emerging area of integration. oped in this section.

F a i t h -P r a x is I n t e g r a t io n a n d The Allocation of Mental Health Resources t h e F u t u r e o f O u r D is c ip l in e It has been well documented that the prevalence For those who train psychologists, a set of chal- of cognitive, emotional, behavioral, and social prob- lenging decisions must be tackled concerning the lems in our country far outweighs the people and knowledge to be transmitted, the values developed, services available to respond to those needs. the skills that students should be prepared to compe- Whether documenting broadly defined problems of tently perform, and the types of clients to whom stu- living or detailing a more circumscribed analysis of dents should be exposed. Along with conventional diagnosable mental disorders, a wide gap between concerns about providing solid preparation in the existing needs and existing resources can be core aspects of the discipline, programs training pro- observed (Levine & Perkins, 1996). Examining the fessional psychologists may look for a particular contours of this chasm more closely, however, niche to fill or emphasis to provide. In the wake of reveals irregular patterns of distribution across the managed care, discussions of the future of our disci- recipients who have been able to access existing pline in recent years have oft been punctuated with mental health resources. The list of groups who are the language of the marketplace in which the sue- documented as disproportionately underserved cur- cessful marketing of a commodity (typically psy- rently includes children and adolescents (Kazdin, chotherapy) is emphasized (Brickey, 1998; Fraser, 1990), rural residents (Murray and Keeler, 1991), 1996; Karon, 1995; Resnick & DeLeon, 1995). In older adults (Teri, 1993), some ethnic minority response to perceptions of threatening health care groups (Cheung, 1991), people with low socio-eco- conditions, the discourse has a survivalist ring to it, nomic status (Hammons, 1993), those with chronic as besieged professionals batten down the hatches or severe mental illnesses (Hargrove, 1992), and and huddle to plan a defense (see Cummings, 1995; those who are homeless (Rosenberg, Solarz, & Bai- Hersch, 1995). What is being posed or answered in ley, 1991). Ironically, when members of underserved these edgy discussions appears to be the question, groups do receive services, they tend to be over-rep- “how can psychology position itself to survive?” resented in the most restrictive and expensive service delivery settings, such as in-patient psychiatric facili- F a i t h -P r a x is I n t e g r a t io n a n d a n ties (Orford, 1992). E pidemiological P e r s p e c t iv e Many of the groups identified here are likely to Although not unsympathetic to the question of retain their underserved status in the future. Indeed, fiscal viability, we wish to raise a very different one. several are predicted to increase in proportion to Our question follows directly from a faith-praxis the total population. Recent percentages of eco- perspective on integration and asks the Christian nomically disadvantaged young children in this trainer of psychologists committed to the process of country, for example, are greater than any time in integration to consider “how can psychology posi- the last 30 years (Children’s Defense Fund, 1994). tion itself to serve?” While this question has impor- Likewise, over one-fifth of the U.S. population is tant theological origins discussed later in this article, projected to be age 65 or older by the year 2020 it also follows from an examination of existing pat- (APA, 1997), at which time so-called minority terns of mental health needs and resources in the groups will constitute a majority of the population United States. Data describing these patterns come (Takanashi & DeLeon, 1994). together to provide a sort of epidemiological ratio- Factors contributing to the underserved status of nale for “integration as service,” which has three these groups are as numerous and diverse as the basic components: (a) the allocation of resources groups themselves. The U.S. Surgeon General’s for existing mental health needs in the U.S. is dis- (1999) recent report on mental health acknowledged proportionate across populations, (b) practitioners cultural, financial, organizational, and diagnostic are disproportionately homogeneous, and (c) the influences on the underserved status of racial and tools available to practitioners (i.e., assessment and ethnic minority groups, for example. Five barriers to intervention methods) are differentially relevant outpatient treatment which were specifically high CANNING, POZZI, McNEIL, and McMINN 203 lighted include cost, differences in help-seeking (though, again, not all) will be restricted from behavior across ethnic groups, mistrust of the mental obtaining services by ill health or restricted mobility, health system based on a history of negative experi- limited finances or inadequate social supports. enees, biases in clinicians’ judgments in their work Having mentioned these factors, we want to with diverse groups, and the stigma associated with avoid an analysis of the problem of “under-service” mental illness and treatment. that seeks explanations solely through the examina- Some groups may present disproportionately tion of attributes of the groups themselves. The greater needs for services. People living in poor con- problem is a complex one, more appropriately dirions, for example, are exposed to disproportion- viewed from an ecological rather than a within-group ately high levels of health compromising risk factors. perspective. More germane to our purposes in this The robust relationship between socio-economic paper is a focus on those elements of the problem status and both mortality and morbidity has been which we can most direcdy influence as scholars and shown to be a gradient in which death and disease trainers of the next generation of psychologists. The rates rise as socio-economic status decreases, with last two components of the epidemiological ratio- the effect observable across the entire span of the nale outlined here highlight inherent limitations in socio-economic continuum (Adler et al., 1994). the tools and methods of our discipline which are One way of interpreting this sort of finding is to currently available to meet the needs of underserved conclude that disproportionately higher levels of groups. It is our contention that these limitations health problems pose greater challenges to our abili- help perpetuate the underserved status of groups. ty to meet those higher levels of need with services. While increased vulnerability to various forms of dis- Homogeneity of Practitioners ease and problems in living can be linked to socio- economic status, we want to stress that this sort of Despite clear evidence of disproportionate need, relationship has not been demonstrated for status the field of psychology has been less than successful variables associated with all the underserved groups in attracting and equipping practitioners and schol- we mention here. Even when such evidence exists, ars to work effectively with underserved groups. Peo- such as with socio-economic status, increased vulner- pie with chronic mental illnesses, for example, expe- ability alone cannot account for the underserved sta- rience a shortage of human resources from our field, tus of that particular group. despite the fact that treatment of serious mental ill- In other ways, however, significant barriers to ness accounts for large proportions of annual receiving adequate services are related to variables spending on mental health (Millet & Schwebel, which define the life circumstances of some of these 1994). In a recent survey of clinical psychology train- underserved groups. Communities which are sparse- ing directors, only 8% of programs were identified ly populated expose residents to a greater risk of that offered a special track focusing on serious men- needing services that may be not accessible to them tal illness (Johnson, 1993). Earlier studies indicate because people and services are so widely dispersed. that graduate students and mental health profession- Consequently, residents in small, rural communities als report a lower preference for work with the seri- may find that they have access to a relatively small ously mentally ill than any other population (see number of mental health services which may be lim- Hargrove, 1992, for examples). ited in scope or may require travel at a distance that Age-defined underserved populations have also is prohibitive. received disproportionately little attention by our Barriers to accessing services exist as well for field. Kazdin (1993) provides evidence that children other groups by virtue of their unique attributes. and adolescents in general, and minority youth in Children, dependent upon adults to identify and particular, have been underrepresented by profes- respond to their needs, are affected at the individual sionals in both clinical practice and research activi- level when educational or emotional needs are ties. Similar omissions have occurred at the other unrecognized or not brought to the attention of pro- end of the developmental spectrum as well. While fessionals. Children, who hold little power as a polit- interest in older adults appears to be on the rise in ical constituency, are also affected by public policy recent years, federal support for research and train- decisions which may negatively impact or ignore ing with older adults has waned since the 1970’s, and their concerns. In the case of older adults, some relatively less progress has been made in training psy 204 INTEGRATION AS SERVICE

chologists to work effectively with this population practice. Canning, Case, and Johnston’s (in press) (Teri, 1993). analysis of Christian psychological scholarship over a -year period suggests that “Christian psychol־Likewise, psychology as an applied discipline has recent 6 a continuing need to grapple with significant limita- ogy” may be at least as guilty of this lack of attention tions in our relevance to culturally diverse groups to more diverse populations. The field needs theo- (Hall, 1997). Although APA-accredited psychology retical models that are relevant in addressing the programs have made some advances in the areas of needs and competencies of groups that are under- minority training, 74% do not require the comple- served. Without such models, our methods are in tion of a course specifically addressing minority danger of becoming void and irrelevant. Indeed a issues (e.g., Psychology of the African-American) and variety of evidence showing limited success with 40% do not offer practicum training in locations diverse client groups would support just such a where minorities are served (Bernal & Castro, gloomy prediction. Child psychopathology and its 1994). Despite continuing calls to increase the num- treatment, for example, have suffered from a historic -color, the number of African- lack of attention and from the practice of “down־of־ber of psychologists American candidates who enter and complete psy- ward extension,” a process in which a priori adult chology graduate programs has remained flat at constructs and methods are used with children, with- around 3.5% since 1977 (Kohut & Pion, 1990). Alii- out adequate appreciation of important develop- son, Echemendia, Robinson, and Crawford (1996) mental distinctions (Ammerman, Last, & Hersen, 1993; Kazdin, 1993). The field of parent education is argue that psychology must continue to address these concerns with aggressive recruitment and train- another case in point. Strategies which have been effective with middle-class parents have not translat- ing of ethnic minority psychologists while simultane- ed well to other populations when it comes to ously increasing the cultural competence of all psy- attracting and maintaining participants, as well as chologists. achieving, maintaining, and generalizing treatment A recent study of the perceptions of psycholo- gains. Pronounced limitations in the acceptability gists toward professional engagement with under- and effectiveness of parent training strategies have served groups provides additional evidence of the been associated with poverty (Duman, 1984), single- problem we have attracting practitioners to work parent status (Webster-Stratton, 1985), and minority with underserved client populations (Johnston, group status (Holden, Lavigne, & Cameron, 1990). 1999). Reports of clinical activity by 268 members of Finally, the acceptability of counseling and therapy the American Psychological Association who indicat- modalities in general to clients-of-color may be ques- ed that they specialized in applied work confirmed tioned given evidence of their comparatively early their low levels of clinical engagement with under- termination from treatment (Sue & Sue, 1990). served populations. These practitioners reported sig- The professional response to our limitations in nificantly less satisfaction and interest in clinical these arenas has traditionally been rather narrow in work with underserved groups than with other client focus. Suggested solutions have often centered populations, perceiving far greater barriers and far around identifying the most effective inducements fewer rewards involved in working with underserved to engage difficult populations in evaluations and populations than with other groups. interventions which are presumed to be in no need of overhaul. It is only recently, and in limited mea- Assessment and Intervention Methods sure, that professional psychology has begun to Finally, the match between currently available examine how the very nature of our own tools and assessment and intervention methods and the cur- methods limits our acceptability and effectiveness rent needs and values of underserved groups is often with diverse groups. an ill fitting one. An analysis of the evolution of mod- Taken together, these four observations from the els and methods in psychology shows that the ori- epidemiology and service delivery literature brings gins of most of our technology and theory are found into focus the persistent distribution of psychology squarely in the community of adults reflecting the resources away from those who need it most. The dominant culture. Ivey (1995) argues that traditional picture is clear: A distressing portion of our citizenry counseling and psychotherapy theory are Caucasian, do not receive the mental health services they need. male, eurocentric, and middle-class in origin and This contemporary reality represents a real-world CANNING, POZZI, McNEIL, and McMINN 205

context for scholarship and practice to which psy- As Christians, we are challenged to transcend chologists with a Christian world view and commit- the “now” for the ‘not yet,” to pursue the work of ment must respond. Christ with an eye toward his full reign. It is our challenge, as it has been with other Christians F a i t h -P r a x is In t e g r a t io n a n d t h e throughout the ages, to work out this faith in a K in g d o m o f G o d socio-historic context. The biblical narrative serves Woven into the heart of any mission to train com- to point us backward to the victory of the cross and petent Christian psychologists should be a commit- forward to Christ’s full reign. The initiation of the ment to serve those populations traditionally consid- Church offers evidence of Christ’s eternal victory, ered underserved. For Christian psychologists, this while the promise of the Kingdom signals His immi- aspect of a training mission is one of significant chal- nent rule. Hence, the Kingdom of God offers to us lenge best perceived as an expression of hope, a spiritual and psychological point of reference that revealing an earnest commitment to the work of the is less reactive or subject to the opposing political Kingdom of God. Without this essential identifying wills and social resources of our generation. This marker of faith-praxis integration, coupled with a perspective, however, holds us accountable to work commitment to other forms of integration, we out these transcendent mandates in our socio-historical context. would offer little that is not available in any compe- One such mandate is found in Matthew 25:31-46, tent secular training program. In good conscience, in which inheritance of the Kingdom is linked to a we should question the necessity of establishing response to the disenfranchised and those who another training site in a marketplace already consid- dwell on the fringes of society. This text in Matthew ered saturated by many (Robiner, 1991). suggests that our inheritance in the Kingdom of The label “underserved” holds a great deal of Christ is contingent on our willingness to respond to political symbolism that might easily detract from a the socially wounded. When we ignore those who sit Kingdom perspective. For many, the term functions on the outside, the fringe dwellers, we deny Christ as a categorical role call of those who have tradition- and His Kingdom. Hence, if we accept the reality of ally advocated their victimized status. For others, Christ’s Kingdom, we are faced with social and per- the mere acknowledgment of the dispossession of sonal responsibility that has eternal consequence these populations is a political statement in and of (Lk. 19:11-27). Serving the underserved represents a itself. Thus, discussions about underserved popula- declaration of the presence of Christ’s Kingdom, not tions often take on an overly guarded and cynical a politically correct posture. character. This is not surprising; the present socio- To assume a perspective of the Kingdom is to historical environment evokes a suspicion of those assume a posture of faith, one that constrains us to perceived as social reformers and a frustration deal with the tension of expressing the eternal in our toward those who advocate politically correct own time-bound context. With Christ we declare the behavior. This highlights the necessity of viewing Kingdom as present, in the now, among us (Lk. faith-praxis integration within the framework of a 17:21). However, this declaration holds an inherent Kingdom perspective. tension of the “not yet,” or that which is still to come Faith-praxis integration must be consistent with a in human events. Hence, we are faced with a particu- Kingdom mandate. Without such linkage, the work larly human dilemma. How do we declare the King- loses its legitimacy as a Christian enterprise. When dom in a period where cynicism is warranted and we speak of a Kingdom mandate, we mean those mistrust is appropriate? How do we declare the endeavors that are biblically directed, ideologically Kingdom in a social context where almost all strug- focused, Holy Spirit inspired, and surrendered to the gle with some experience of alienation? How do we, Lordship of Christ. Although it would be impractical as Christians, declare the Kingdom in an environ- to engage each of these propositions within the lim- ment where it is easier to give up and let others ited scope of this article, we hold that the commit- respond? Furthermore, how do we as Christian psy- ment to the underserved hinges on a perspective of chologists pursue the Kingdom when it is in tension the Kingdom as a teleological anchor. This provides with our vocational socialization? us with a vantage point from which to assert the As social scientists it is appropriate to question legitimacy of our undertaking. the goals, design, and impact of previous social poli- 206 INTEGRATION AS SERVICE cy on populations that have been considered under- as the central players of the drama, is as misguided as served, simply because we have found very few inter- withdrawal. If faith-praxis integration is viewed sole- vendons that have had long term effectiveness. How- ly as moral crusade, then we become useless to ־ever, as Christ’s disciples, we must avoid the God’s work at best, or counterproductive and rebel particular form of fundamentalism that asks us to lious at worst. Johnson (1997) in his article, “Christ, ignore the social urgencies of our day to focus exclu- the Lord of Psychology,” asserts that God must be sively on tasks that fundamentalists consider to be the central figure: the King with final authority, more spiritual. Evangelism and discipleship are cen- ordering the events of the Kingdom. Hence, it is for tral to our service to God’s Kingdom, but they are Christ and his Kingdom that we respond in a not exclusive or devoid of context. Under the anoint- redemptive way to the lives of those who have ing of the Spirit, Christ reminds us that the good become “the least of these” (Matt. 25:3446) and our news must respond to the needs of the poor, the cap- neighbors in need (Lk. 10:25-37). We are challenged, tive, the blind, and the oppressed (Lk. 4:17-21). via our call to obedience, to assume a position of “co- Christian psychologists should be cautious and collaborators” with Christ, declaring and pursuing prudent; but, our circumspection should lead to the presence of the Kingdom of God and the healing questioning and examination for the purpose of of persons (Matt. 4:23-24). Essentially, serving the effective engagement, not systematic withdrawal. underserved must be a Kingdom enterprise, not a The Kingdom pulls us forward in human time good Christian deed. It must be a work in line with toward an anticipation of the eternal and with an the teleological goals of the Kingdom. The Kingdom assurance of God’s intention that does not allow us holds us accountable spiritually and socially, but it to relinquish hope for those broken in our present. also provides us a point of reference, an anchor by Consequently, there is little validation within the which to interpret the human condition and there- Christian narrative for a self-protective resignation in fore human history. Hence, our commitment to ser- which we rationalize away our responsibility for vice is done as an act of obedience and a statement being “salt” (Matt. 5:13). On the contrary, in the face of faith, for when we serve the underserved, we of God’s Kingdom, we are challenged, first, to love agree that Christ’s Kingdom is in our midst. God utterly, and in so doing to love and engage those who have need (Lk. 10:25-37). Christ was con- F a i t h -P r a x is I n t e g r a t io n a n d cerned essentially with the reign of God and the I mplications f o r C l in ic a l T r a in in g restoration of humanity. As his disciples, we are com- Responding to this Kingdom mandate and to the pelled to re-examine our practices and our vocation epidemiological realities in our country will require in light of this different purpose, this different teleo- us to articulate specific training philosophies and logical end. We must ask how we function as emis- develop relevant methods of practice which are con- saries of God’s active love, and how we might work out our commitment as Christ’s Church to establish sistent with the sort of mission we outline here. An emphasis on faith-praxis integration does not suggest the Kingdom. Having urged for a Kingdom pursuit, we must a practice void of theory. Rather, it calls for a theory caution against assuming this is simply a moral significantly informed by practice. As the word “prax- imperative. The summons to a Kingdom pursuit is is” implies, faith-praxis integration must transcend a not the spiritual, psychological, or social salvation of rational or scientific worldview and affect the practi- people as a result of extensive human efforts: the sal- cal work of psychologists. This calls for the provision vation of humans by humans. It is also not a form of of services to those especially in need, challenging the Christian Humanism in which we trust our goodness systems that lead to the specific need, and assisting to overcome evil. It is, however, recognition and clients in developing the necessary skills to challenge acknowledgment that God is invested in establishing those systems. A faith-praxis integration model the Kingdom in the earth, utilizing available surren- should encourage the clinician to have an impact on dered human vessels. For those who are disciples of the individua, as well as the systems, and should focus Christ, this mandate supersedes ethical or moral pur- on helping the client change both individual, and sys- poses even as its expression is moral and ethical. To tem characteristics. think of the Kingdom-building process as Thus, faith-praxis integration forces us to exam- quintessential^ a human endeavor, and of ourselves ine the ways we have traditionally trained profession- CANNING, POZZI, McNEIL, and McMINN 207

al psychologists. The major models which have guid- vice, especially to the Body of Christ, the Church, ed our training (Boulder and Vail) have largely been and also to those persons who have been marginal- an attempt to determine the degree to which compe- ized and wounded by our society on the basis of tencies in practice and research should be empha- racial or ethnic identification, age, socioeconomic sized. The roles and responsibilities of the psycholo- status, or gender . . (Wheaton College Graduate gist in society (advocate, consultant, one who School, 1996). While we are in no way claiming to intervenes in the context of systems) have received have arrived in this statement, or in our implementa- less attention in clinical programs, being left to our tion of the aspirations it reflects, we do believe the colleagues in other disciplines (community psycholo- commitment it articulates is a necessary foundation. gy, to name one). Within the context of Christian psychology, counseling and psychotherapy have Faculty been the dominant practice and training models. The paramount contribution that faculty make to Analyses of the myriad Christian approaches to students’ training is undisputed, and the nature of counseling or therapy have sometimes included the training faculty will influence how well students are notion of “service” (see Bufford, 1997 for some prepared for service with underserved groups. By examples). To date, however, these and other refer- virtue of their own identities and life experiences, enees to service, in our notions of integration or our faculty members provide students with diverse role methods as practitioners, have not appeared to lead models with respect to age, gender, ethnicity, socio- to widespread, explicitly stated commitment to economic status, and regions in which they have underserved groups. lived; the scholarly and practical expertise of faculty Teaching our students competencies which will are also critical. Without close exposure to faculty enhance services provided to underserved popula- who are actively engaged with underserved groups, tions continues to be a challenge—one that we have students can hardly be expected to value such work not yet mastered as a discipline, Christian or other- and may not receive the instruction necessary for wise. In the following section, we begin a discussion developing needed competencies (Allison et al., about training implications of our position and offer 1996). a few illustrations with examples from existing programs. In it we introduce six aspects of a training Course Work program which provide opportunities for the appli- Programs can examine whether or not course cation of a faith-praxis perspective: the missions work follows recommendations in the literature on statement, faculty, course work, practical training, cultural competence. Psychology training recom- research, and relationship with the community. mendations generally fall into two categories. The first advocates that programs provide a specific Mission Statement course to deal with general diversity concerns, or A mission statement is the anchor of any Chris- offer individual courses on a specific population tian psychology training program. The purpose of (e.g., Gerontological Psychology, Psychology of the such a statement is to identify the values and aspira- African-American, Psychotherapy with Children and tions which will guide policies, faculty selection, and Adolescents). A second approach stresses immer- curriculum decisions, and which are meant to be sion, or the incorporation of these concerns reflected in the character and activities of graduates. throughout the curriculum. Here, course material, A faith-praxis perspective on integration, then, may regardless of subject area, is chosen and examined in first be evident in the content of a training program’s such a way that information and perspectives that mission statement. Given the barriers existing in our are relevant to underserved populations are high- current health care system, Christian training pro- lighted. Examples of this include emphasizing seri- grams will not somehow become more effective at ous mental illness or developmental disabilities in an turning out competent psychologists to serve these assessment seminar, including special consideration groups without an explicit, intentional commitment to rural contexts in an ethics discussion on avoiding to this end. The mission of the authors’ own training multiple relationships, or assigning a paper on the program includes the following: “to emphasize and role of culture in intervention to students in a course model a commitment to professional practice as ser- on cognitive-behavioral therapies. Both the individu- 208 INTEGRATION AS SERVICE al course work and immersion approaches deserve kinds of projects in our department include an evalu- consideration. For example, one study showed that ation of an intervention for caregivers of older even a one credit course was associated with a more adults, a Rural Psychology special interest group, a positive, non-racist racial identity on the part of Cau- longitudinal study investigating factors affecting stu- casian students (Neville et al., 1996). Beyond the dents’ interest in working with underserved popula- question of course content is the concern about how tions, and a project that seeks to develop and imple- learning processes are designed. Some have noted ment a parenting training program for Latino that exposure to pedagogical models which incorpo- families. Many of these projects have received fund- rate diverse learning styles may better prepare stu- ing from within the institution. Beyond providing dents for their work with diverse populations (Pon- opportunities for students, departments can and terotto, Alexander, ôc Grieger, 1995). should invest in evaluating their training with respect to the concerns we raise here. Our own program’s Practical Training outcome research on practicum training with under- Programs must also prioritize exposure to clients served groups (described in the section “Practical within underserved groups for their students. Not Training” earlier) is one example of evaluation which surprisingly, practical experience has been linked to can contribute to the effective implementation of the development of cultural competency. Allison et our call to serve. al. (1996) found that the number of therapy cases handled during training was a significant predictor Relationship with the Community of competence in work with 10 of 13 client groups. A final, particularly noteworthy illustration of a Our own training program has invested economic faith-praxis commitment to training is in the use of and human resources in the recruitment of desirable community-based sites to provide services and train- sites, and all students are required to spend at least ing. A fitting example is The Center for Aging one year in a site where they will have significant Resources, which is part of the School of Psychology engagement with at least one underserved group. A at Fuller Theological Seminary. The center serves as departmentally-sponsored research project enabled a setting for professional training of graduate psy- staff to track these experiences over time. In a recent chology students while the community is provided reporting period, a mean of 34% of our students’ with a broad array of services. Clinical services client contacts were with individuals belonging to an include in-home and outpatient therapy, evaluation underserved group. One-third of our students for psychiatric medication, and support groups for reported 50% or more of their client contacts with isolated elders in residential families and for other individuals belonging to an underserved group (Can- older adults on topics such as parenting young rela- ning, Pozzi, & Crisafulli, 1997). Although we have tives or coping with a family member’s substance documented evidence of students’ practicum activi- abuse. In addition, the center offers adult day care ties, we do not know how those activities compare for clients with dementia, elder abuse prevention to students at other schools or the impact of our workshops, trauma debriefing, peer counseling and training program on student’s activities after gradua- consultation about home safety concerns (Center tion. These are both areas for future research and for Aging Resources, 1999). The center’s model consideration. exemplifies our vision in a number of ways. First, attention is given to a group which has traditionally Research received inadequate resources. Second, in choosing Research activities provide additional contexts which services to offer, the center augments tradi- for students to engage with marginalized groups, tional clinical methods with a host of other strategies increasing their vision and skills. Programs can foster in a manner responsive to the unique qualities and students’ research competencies with underserved needs of this population. Finally, the center provides populations by choosing relevant classroom material a context for psychology students’ exposure to older and assignments, and exposing them to alternative adults, potentially fostering future interest in such research models such as participatory action work (Johnston, 1999; Mirabi & Weinman, 1985) research. Faculty can provide research opportunities and providing the sort of experience essential to eth- pertaining to underserved groups. Examples of these ical, competent practice. In combination, the Center CANNING, POZZI, McNEIL, and McMINN 209

goes beyond providing services (important in and of appeal “for the integration of Christian commitment itself) by contributing to the future supply of quali- and theorizing, by way of the commitment becoming fied practitioners available to older adults. the governing interest of the theorizing ... that places itself in the service of the cause of struggling C o n c l u d in g C o m m e n t s for justice” (p. 164) is one Christian psychologists What forms of psychology or service would result today would be wise to consider. Whatever the direc- from our arguments? The implications we raise and tion this sort of theorizing might take, our mandate the illustrations we offer here are modest, mostly seems clear. Facing the irrelevance of our psychologi- staying well within the bounds of what is the current- cal and integrative theories for some groups, we ly accepted approach to contemporary Christian need to prepare individuals who can produce schol- professional psychology training. Admittedly, we arship, provide services, and change social systems in have only scratched the surface of these implica- the light of the pressing realities we have outlined in ־tions. We believe it is likely that a strong commit- this article. In short, we need to prepare psycholo ment to our Kingdom mandate would stretch the gists who will “act justly, love mercy, and walk field well beyond current emphases on individualis- humbly with (our) God” (Micah 6:8b). tic, pathology-focused theories of personality and modes of practice, encouraging approaches that are R e f e r e n c e s more ecological and competency-focused and meth- Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., ods which are more community-based, collaborative, Kahn, R. L., and Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, and preventive in nature. But many methodological 49(1), 15-24. and structural questions remain unanswered here. Allison, K. W., Echemendia, R. J., Crawford, I., & Robinson, W. What would more adequate services and mecha- L. V. (1996). Predicting cultural competence: Implications for nisms of delivery for underserved groups look like? practice and training. Professional Psychology: Research and What training methods are best suited to these Practice, 27(4), 386-393. goals? Our chief aim in this article has been to high- American Psychological Association. (1997). What practitioners light a perspective on integration that has allowed us should know about working with older adults [Brochure]. to explore the implications of that view for training Washington, DC: Author. future psychologists. We would like to encourage Ammerman, R. T., Last, C. G., & Hersen, M. (1993). A prescrip- dialogue about the issues raised in this article among tive approach to treatment of children and adolescents. In R. T. Christian clinical training directors, faculty, supervi- Ammerman, C. G., Last, & M . Hersen, (Eds.), Handbook of prescriptive treatments for children and adolescents (pp. 1-8). sors, and trainees within individual training institu- Boston, MA: Allyn and Bacon. tions, but also across institutions and within our pro- Bernal, M. E., & Castro, E G. (1994). Are clinical psychologists fessional organizations. prepared for service and research with ethnic minorities? In his cogent and inspiring work Until Justice Report of a decade of progress. American Psychologist, and Peace Embrace, Wolterstorff (1983) identifies 49(9), 797-805. an important tension with which we wish to end our Bouma-Prediger, S. (1990). The task of integration: A modest pro- discussion. Addressing the scholarly community, he posai. Journal of Psychology and Theology, 18,21-31 speaks of “the difficult and complex task of weighing Brickey, M. (1998). Integrating an internship into a market-driven the need for praxis-oriented theory against the need psychology practice. Professional Psychology: Research and for non-praxis-oriented theory ...” (p. 172). While Practice, 29(4), 390-393. acknowledging the valid place of each, he argues that Bufford, R. K. ( 1997). Reflections on the distinctives of Chris- decisions about where to invest our energies be tian counseling. Journal of Psychology and Theology, 25(1), 111- 122. made “... in the light of the deprivations and oppres- sions to be found in the social order as it stands” (p. Canning, S. S., Case, P. W., & Johnston, S. L. (in press). Contem- porary Christian scholarship and “the least of these”: An empirical 172). The well-documented pattern in which certain review. Journal o f Psychology and Christianity. groups are disproportionately underserved by the Canning, S. S., Pozzi, C. F., & Crisafulli, R. S. (1997). [Wheaton mental health resources in our society appears to us doctoral psychology students’ clinical training contact with under- to be one such deprivation in the social order which served populations]. Unpublished raw data. must factor into our decision-making as trainers of Center for Aging Resources. (1999). The Center for Aging future generations of psychologists. Wolterstorff’s Resources [Brochure]. Pasadena, CA: Author. 210 INTEGRATION AS SERVICE

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*color, parent train־of־Vande Kemp, H. (1996). Historical perspective: Religion and clin- with urban, low-income children and families ical psychology in America. In E. P. Shafranske (Ed.), Religion ing, professional psychology training, and underserved groups, and the clinical practice o f psychology (pp. 71-112). Washing- POZZI, CARLOS F. Address: Wheaton College Department of ton, DC: American Psychological Association. Psychology, Wheaton, IL 60187. Tide: Assistant Professor of Psy- Webster-Stratton, C. (1985). Predictors of treatment outcome in chology, Director of Clinical Training. Degree: Psy.D., Clnical parent training for conduct disordered children. Behavior Ther- psychology, Illinois School of Professional Psychology, Licensed apy, 16,223-243. Clinical Psycholotist. Specializations. Parent training with Latino Wheaton College Graduate School. (1996). Doctor o f Psy cholo- and African-American parents, behavioral therapy, theoretical and gy in Clinical Psychology [Brochure]. Wheaton, IL: Author. applied psychology in the Latin American context. Wolterstorff, N. (1983). Until justice and peace embrace. McNEIL, J. DEREK. Address: Wheaton College Department of Grand Rapids, MI: Eerdmans. Psychology, Wheaton, IL 60187. Title: Assistant Professor of Psychology, Coordinator of Diversity. Degree: Ph.D., Counsel- Worthington, E. L., Jr. (1994). A blueprint for intradisciplinary ing psychology, Northwestern University. Specializataions: integration. Journal of Psychology and Theology; 22,79-86. Marriage and family therapy, African-American male identity development. A u t h o r s McMINN, MARK R, Address: Wheaton College Department of CANNING, SALLY SCHWER. Address: Wheaton College Psychology, Wheaton, IL 60187. Title: Rech Professor of Psychol- Department of Psychology, Wheaton, IL 60187. Title: Assistant ogy. Degrees: Ph.D., Clinical Psychology, Vanderbilt University, Professor of Psychology. Degree: PhD, Professional-Scientific Psy- Licensed Clinical Psycholotist. Specializations: Cognitive thera- chology, University of Pennsylvania, Licensed Clinical Psychologist. py, professional ethics, church-psychology collaboration, integra- Specializations: Child psychology, community-based interventions tion of psychology and Christian spirituality.