so might influence curricula design in graduate programs. However, it could conflict with the generalist nature of the exam and the aim of reflecting current rather than optimal practice.

A training focus on cancer appears to occur principally through supervised experience in cancer care settings. Any call for additional core or basic training should probably focus on the psychosocial aspects of chronic illnesses generally rather than cancer in particular. The knowledge and skill gained through basic training in medical illness and its psychosocial effects could then be applied during additional supervised clinical experience with unique populations of chronically ill individuals, such as persons with cancer. However, training activity in this profession, as in much of medicine, tends to be organized around hospital settings and funded through hospital-based activities. This situation serves as a barrier to the development and delivery of psychosocial services to medically ill patients in nonhospital community settings.

A striking finding is that there appear to be no detailed competency sets or model curricula related to cancer care in use within this profession; there is merely a brief list of “core curricular areas” from a seminal 1983 health psychology conference. The development, dissemination, and adoption of competency sets and model curricula are potential high-yield interventions for advancing training in the psychosocial aspects of illness. In addition to the absence of clear competencies and curricula, other apparent barriers to improved education and training in this area include the absence of funding for training and a lack of qualified faculty.

Requirements to become a licensed counselor include completing a master’s degree in counseling, passing a state-recognized exam, adhering to ethical codes and standards, and completing continuing education (BLS, 2006a). Professional educational programs in counseling voluntarily undergo review by an accrediting body, such as the Commission on Rehabilitation Education (CORE), which accredits graduate programs in Rehabilitation Counselor Education (RCE) (CORE, 2006), or the Commission on the Accreditation of Counseling and Related Educational Programs (CACREP), which accredits a variety of master’s degree programs, including family, community, gerontological, and mental health counseling (CACREP, 2006). Licensed counselors may become certified by the Commission of Rehabilitation Counselor Certification, which grants the credential Certified Rehabilitation Counselor (CRC) (CCRC, 2006), or by the National Board for Certified Counselors (NBCC), which grants the general practice credential National Certified Counselor (NBCC, 2006).