A common misconception about sport psychology is that its practitioners at the NCAA level are paid simply to improve the competitive performance of student-athletes.

While performance enhancement is a major part of sport psychology and often provides a psychologist entrée to discuss more serious clinical issues, some NCAA member institutions are hiring licensed, clinical psychologists to work with student-athletes on issues ranging from mental preparation for competition and relaxation to clinical depression and eating disorders.

The term "sport psychologist" can be a tricky one. Commonly, it can mean one of two things -- someone who is licensed to practice psychology and can diagnose and treat mental-health problems with a special emphasis on athletes, or someone trained to apply mental-preparation techniques to athletes with an understanding of how physiological processes relate to performance.

Martha Ewing, president of the Association for the Advancement of Applied Sport Psychology and an associate professor at Michigan State University, said the media appropriated the term "sport psychologist" and now applies it liberally to either field, though only the clinically trained, licensed person actually is a psychologist.

"Instead of saying psychology in sport, which took up more inches in their columns, we became sport psychologists. I've tried to use all kinds of terms with the media, and they keep coming back to sport psychology," Ewing said. "That's what I teach, but I don't call myself that because I'm not licensed. We have some issues in trying to make sure that everybody, the public in particular, understands what they're getting when they are looking for a sport psychologist."

Two fields related

While not hired by Michigan State as a performance-enhancement specialist, Ewing is a member of the institution's sports medicine team, which is a group on campus and in the community, including physicians, athletic trainers, dentists, optometrists, clinical psychologists, chiropractors, nutritionists and others, who agree to make student-athletes in need their priority. Ewing works with high-school athletes to improve their performance. Sometimes, if she suspects that an athlete's issue is not performance-related, she will refer him or her to a clinically trained colleague.

Jennifer Carter, sport psychologist at Ohio State University, said she tries to educate coaches and student-athletes at her institution that she and her colleagues do both performance enhancement and counseling.

"We use that title 'sports psychologist' and it is a bit confusing to some people when they think we only do the performance-enhancement side or we only do the clinical side," she said. "A study my colleague Sam Marniar did showed that athletes were more willing to see a sports psychologist before seeing a clinical or counseling psychologist."

Roberta Sherman, an eating-disorders specialist who consults with the athletics department at Indiana University, Bloomington, said she chooses not to do any performance-enhancement work, but ultimately, the two sides are related. Psychological health can have an impact on a student-athlete's performance in practice or in competition.

"The issues often overlap because people who are having emotional problems or eating disorders usually are having performance problems," she said. "Oftentimes when their psychological health improves, their sport performance improves also. It's not that they're unrelated."

Leonard Zaichkowsky, director of the sport and exercise psychology specialization at the Boston University division of graduate medical sciences, agreed. He said sometimes clinical psychological issues can paralyze a student-athlete in all aspects of life, including athletics. Having a psychologist who also understands the culture of athletics can be invaluable. Coaches often are territorial about motivation and team-building, Zaichkowsky said, but they frequently are in over their heads when confronted by a student-athlete with a serious clinical problem such as depression or adjustment disorder. Such a problem can have a major effect on a student-athlete, both in competition and in life.

"They become dysfunctional; they're nowhere near their potential," he said. "I think somebody who cares, somebody who will listen to them and care about them as individuals, makes a big difference. It's the same thing dealing with injuries -- they sometimes are psychological as well as physical," he said.

A holistic approach

Chris Carr, a clinical sports psychologist for the Methodist Sports Medicine Center in Indianapolis, also serves a part-time sports psychologist for Purdue University. He said performance-enhancement training can sometimes provide a clinical or counseling psychologist with opportunities to be approached by athletes who may have less resistance to identifying a performance issue than identifying a mental-health concern, but performance-enhancement specialists are limited in their psychological capabilities.

"It's opened the door to people whose backgrounds aren't in psychology, so they deal with one aspect of that student-athlete's life," Carr said.

As a former student-athlete herself, Carter said her background provided her familiarity with the culture of athletics, allowing her to be comfortable in her role as a psychologist for the Buckeyes' athletics department.

Even though that resume was valuable, Carter said she still had a lot to learn about different sports.

"I've had to learn about fencing and field hockey and lacrosse, and I still don't know a lot of those sports in depth," she said. "I think you need to know the language of each sport and really understand each sport. You want to be comfortable knowing how to be available and approachable without being intrusive while you're there on the sidelines."

Ewing's background as a coach and training in kinesiology helps her to better relate to student-athletes, she said.

"You need to know sports in order to work with athletes. They will see through you immediately if you're using language that's not sport-related. It's like, 'you know when you're on the balance beam, and you're doing one of those twirly things,' " she said. "It just doesn't fly."

Nicki Moore, a sport psychologist at the University of Oklahoma and a former student-athlete, said that though her experience has been vastly beneficial, she doesn't believe a sports psychologist needs to be a former student-athlete to do the job effectively.

"I certainly think it takes a concerted effort to become familiar with what this culture is about before just assuming that you've got it," she said.

Many sports psychologists said that their role with certain teams as performance enhancers seems to make it a little easier for student-athletes to seek them out if they have a deeper, clinical issue or value their feedback on tougher issues.

"I think when you get the opportunity to do some performance enhancement, even in the midst of counseling interventions, it gives (student-athletes) more of a sense that you see them as a capable and competent and potentially successful athlete and individual, as well as having an understanding of their other difficulties. It's nice to be able to sort of go back and forth with that," Moore said. "So often, someone's psychological difficulties are a product of those performance difficulties and psycho-social difficulties. By being able to address all of those, I think it enables us to take a more holistic approach to working with student-athletes."

Psychologist tool kit

Licensed psychologists can enhance the medical care for student-athletes by:

• Providing mental-health screening and prevention education.

• Pre-participation evaluation screenings.

• Providing continuing care for concussion management.

• Managing eating disorders.

• Providing counseling on challenges and stresses related to being a student-athlete.

• Resolving conflict between athlete and coach, athlete and athlete, coach and administrator, etc.

• Serving as a key member of the athletics department catastrophic-incident team (see NCAA Sports Medicine Handbook Guideline 1e).

• Assisting with part of the exit-interview process for athletes who are released from a team for any reason.

Finding a licensed psychologist

Student-athletes who believe they may need psychological assistance should consult the following:

• Athletics department academic services.

• Athletics department sports medicine services.

• University student health and counseling services.

• University medical school.

• University graduate programs (health sciences, education, medical, allied health).

• Local community.

Psychologist check list

When choosing a licensed psychologist, an athletics department might ask these questions:

• What are their degrees?

• Are they licensed within the state?

• Do they have a current vitae with references?

• How they handle confidentiality?

• What is their availability?

• What is their fee for service structure?