Feature

When health psychologist Yelena Chernyak, PhD, was an intern at the May Institute in Boston, she saw a number of patients with sleep problems — everything from stress-induced insomnia to sleep apnea to difficulty adjusting to their CPAP, or continuous airway, machines.

As they learned the techniques of behavioral sleep medicine, the patients made rapid progress. The work was so rewarding, in fact, "I knew I wanted to get more experience and training in the area," says Chernyak, now an assistant professor at the Indiana University School of Medicine.

She took a fellowship at the Cleveland Clinic, where she learned from board-certified sleep psychologists who worked with difficult-to-treat cases — geriatric patients with treatment-resistant insomnia, surgical and transplant patients unable to adhere to the treatment plan for the CPAP machine, and patients with nightmares linked to post-traumatic stress disorder. The experience inspired her to seek her own board certification in behavioral sleep medicine, which she received from the American Academy of Sleep Medicine in 2012.

It's paid off well: "Sleep referrals now make up about half my practice, and it's growing quickly because so many people are sending folks my way," says Chernyak, who notes she's the only board-certified behavioral sleep medicine specialist in Indiana.

Chernyak is among a growing number of psychologists and graduate students who are becoming or are considering becoming board-certified in one of the 14 APA-recognized specialties — including clinical, counseling, sleep, clinical health and neuropsychology.

Those specialties are recognized by APA based on recommendations from the Commission for the Recognition of Specialties and Proficiencies in Professional Psychology, or CRSPPP, which provides information to APA about which areas constitute specialties but is not a credentialing organization. (See sidebar for an overview of how this process works.)  

Related to but autonomous from APA is the country's oldest and largest psychology credentialing organization, the American Board of Professional Psychology, or ABPP, the entity from which most psychologists who receive board certification earn it. In 2008, 504 people applied for certification through one of ABPP's 14 specialty boards, and by 2013, that number had climbed nearly 30 percent to 724, signaling an increase in the interest and importance of this type of recognition, says ABPP President Randy Otto, PhD, of the University of South Florida. (ABPP and a few other boards such as the American Academy of Sleep Medicine require peer review and evaluation and should not be confused with "vanity boards," which require little but paying a fee to gain a credential attesting to your competence.)

Last year, APA formally approved the recognition of ABPP as a board certification organization, holding that those with an ABPP diplomate may note it after their name and doctoral degree in the APA membership directory. ABPP is the first organization to receive that recognition, says APA Deputy Executive Director for Education Catherine Grus, PhD.

ABPP's specialties overlap considerably with those of APA, and the two organizations jointly sponsor the Council of Specialties in Professional Psychology, a non-profit venture that represents and supports the development and functioning of recognized specialties in professional psychology.

The board certification credentialing process is not without challenges. It takes time, commitment and money — in the case of ABPP, about $850 total for a credentials review, practice samples reviewed by peers, an oral examination conducted by board-certified psychologists and, for a few specialties, a written examination. ABPP also charges an annual maintenance fee of $185 for board-certified psychologists. In addition, psychologists who become board certified by ABPP after January 2015 will be required to demonstrate a "maintenance of certification" every 10 years, says Otto.

Despite such expenditures, it's worth the effort, says early career psychologist Laura Meyers, PhD, of the Minneapolis Veterans Administration, who spent eight months amassing practice samples and preparing for an ABPP oral examination in clinical psychology. 

"ABPP wants the exam to be something that any solid clinician in the field could pass, and it felt that way to me," says Meyers. "And once you have the credential, it gives you a bit of an edge. People see it on your door, and it gives you a little higher level of professional respect."

Growth in specialty recognition

Despite the growing number of psychologists seeking specialty certification, the credential remains relatively untapped. About 5 percent of psychologists have ABPPs, for instance, with neuropsychology and clinical psychology being the most populated specialties, each with about 1,000 board-certified psychologists.

That said, it's easy to grasp why psychologists might want to avoid the extra hurdle of specialty certification: After all, they've already spent years on education and training to earn their doctorates and become licensed, and they're eager to practice. But it's more vital than ever to consider specializing, say specialty proponents. One big reason: Hospitals, other institutional settings and insurance companies increasingly want psychologists to be board certified, much as other health professionals are. The Patient Protection and Affordable Care Act, with its call for increased provider professionalism and accountability in the service of quality patient care, underscores the point.

"When you define yourself as a board-certified specialist, you're committing yourself to a focused, competency-based practice, which assures that you're more accountable for what you're doing clinically," says University of Florida professor Ronald H. Rozensky, PhD, a board-certified clinical and clinical health psychologist and former chair of CRSPPP who has written extensively on the importance of board certification. "And consumers demand that as a measure of competence."

Another reason is the growth of the psychology field. "Psychology has gotten to the point where you can't know it all, and you can't do all of it well," says Otto. "So you have to make some choices."

Perhaps the most important reason for psychologists to consider specializing is the need for practitioners in expanding key areas, such as sleep psychology and geropsychology, others say.

"Psychology lags behind other health-care professions in educating graduate students on how to address the mental health issues of older adults," says board-certified psychologist Victor Molinari, PhD, of the University of South Florida, who is spearheading a movement to make geropsychology an ABPP specialty board and credential. "We need as many competent practitioners to work with older adults as possible."

Starting the process

How do you determine the right specialty for you, and when do you begin?

While you can't get board certified until you are licensed, it's never too early to start thinking about potential specialties, says ABPP Past-president Gregory Lee, PhD, who directs adult neuropsychology services at the Medical College of Georgia. If you're a graduate student, look for topics that resonate with you and consider how you'd feel about diving in deeper.

When you've homed in on an area of interest, "throw yourself into it," Otto says. The ABPP website lists all of the experience, knowledge and skills you'll need to meet each specialty's education and training criteria and pass its exams.

Even if you're an established psychologist who has been practicing for years, certification can help you and your practice by fine-tuning your skills and allowing you to create or hone a niche, says Lee. You may even want to consider becoming board certified in more than one specialty: Some psychologists specialize in related areas — child clinical and family psychology, for example, or forensic and police and public safety psychology. This strategy gives you expertise in areas that are bound to overlap anyway, he says, as well as greater access to related clientele.

A leg up

Psychologists who have gained board certification cite many benefits. For one, board-certified psychologists can expect more and better career opportunities and greater job security than those without the assignation. The country's largest, most respected health-care organizations — the Mayo Clinic in Rochester, Minn., and the Cleveland Clinic, for example — require psychologists to be board certified. Many VA hospitals offer financial incentives for board certification, as well.   

Preparing for the ABPP also helps you feel more solid in your professional identity, says Lee. "It helps you consolidate your skills and become very thoughtful about what you do and how you do it, and to be able to communicate that easily."

And board certification is a boon to the public because it validates your background, training and experience, says ABPP Foundation Chair Christine Maguth Nezu, PhD, a professor of psychology and medicine at Drexel University who is board certified in clinical and cognitive behavioral specialties.

"The public needs to know about your experience for so many reasons — for their care, for their understanding of how mental and physical issues relate, for decisions about health care and coverage," she says.

Another important benefit is what board certification does for psychology's self-image, Nezu adds.

"It raises the integrity of the field," she says, "both in peers' perception, and in the public's perception."

Tori DeAngelis is a writer in Syracuse, N.Y.