Training for medical counselors requires that medicine and psychiatry give up the position that counseling is only a negligible offshoot that almost any professional can readily do. Instead, counseling can be considered a generic concept that covers a wide variety of interventions designed to help patients cope with the complications and consequences of their chronic illness. This report outlines the principles and scope of training for consideration in the area of counseling the medically ill and reviews the current status of training programs in the fields of psychiatry, psychology, social work, and nursing. Recommendations are made for future directions, including role clarification for disciplines, building a credible research base, provision of guidelines and possible accreditation, and incorporating medical counseling into training fellowships.