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Psychology Internship Training Program
Program PhilosophyPreparation of the professional psychologist requires broad exposure to the knowledge base of the science of psychology and the related fields that form the foundation of the discipline. Developing psychologists must acquire the knowledge, skills, and attitudes that encourage the scientific approach to practice, whether through the conduct of scientific research, application of the products of scientific research, or through the enhancement of existing knowledge by way of professional practices that include reflective reasoning. It is our philosophy that at this level of professional development, psychology interns should be exposed to experienced psychologist/supervisors who will build upon interns' previously-acquired scientific knowledge though guidance and supervision in the application of that knowledge and through the encouragement of practice-based inquiry and obtainment of clinical expertise. At this stage of professional education, interns are expected to access and apply the scientific and experiential database of psychology, as, for example, would be reflected through awareness of empirically supported interventions. Interns will also be nurtured in the development of the reflective judgment characteristic of expert practice. Consistent with recommendations of Hoshmand and Polkinghorne (1992), this program places extensive emphasis upon the development of reflective skills to enhance the capacity of deliberative control over the biases that hamper full understanding, suppress appropriate skepticism, and lessen practitioners’ effectiveness. This program incorporates the concept of the "reflective practitioner" whose professional wisdom includes the ability to evaluate and critique one's own understanding and actions (Schon,1987). Therefore, this program emphasizes the practical value of reflecting through intensive case study, mastering the skills of locating/incorporating existing scientific knowledge, and seeking experiential wisdom. Hoshmand, L.T. & Polkinghorne, D.E. (1992). Redefining the science-practice relationship and professional training. American Psychologist, 47, 55-66. Schon, D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey-Bass. Philosophy of Intern Professional DevelopmentIntensive exposure to experienced psychologist supervisors during the internship year will enable interns to demonstrate marked growth in professional competencies. The year is conceptualized to consist of an organized sequence of training experiences that will build upon the interns' scientific knowledge base and previous clinical training. Interns' abilities will be assessed at several critical points during the year and overall progress will be monitored continually through the collaborative efforts of the intern, the immediate supervisors, intern preceptors, and internship training committee. Although there will be variations in each student's training plan, several consistent principles are incorporated. Autonomy and Increase in Independent Functioning (Frequency and intensity of supervision) - Although interns never participate in less than the minimum four hours per week of formal supervision, they will receive considerable informal supervision throughout the year. However, as the year progresses and they move toward more professional autonomy they will have less need for informal supervisory input. Complexity of clinical cases – Over the course of the internship year, interns should demonstrate sufficient competence with the more straightforward and familiar clinical cases to warrant assignment of more complex and challenging clinical cases as the year progresses. Complexity of Interdisciplinary Role--As the year progresses, interns will be expected to increase the complexity of their contributions to interdisciplinary teams through a variety of activities including, but not limited to, staff education, assisting the team with process improvement activities, assisting the team with the development, expansion and/or evaluation of i nterventions to meet the needs of patients served by the team etc. Core CompetenciesCompetency #1: Interns will become proficient in an assessment process that is theoretically consistent and thorough enough to identify the etiology and sustaining factors in client problems, as well as recognize clients' psychological resources that guide clinical intervention. In addition to the skills of any assessment process that may be unique to an intern's personal theoretical orientation, interns will also become proficient in assessment processes that are commonly expected of clinicians in the medical community. Competency # 2: Interns will become appropriately proficient in a model of psychotherapy that is a logical outgrowth of their theoretical orientation. They will be able to formulate treatment plans, develop effective working relationships with clients, maintain therapeutic boundaries, manage therapeutic crises, prepare clients for therapeutic termination, and identify personal sources of reactivity to clients. In addition to the therapy skills inherent in their personal theoretical orientation, interns will also develop adequate skills in short-term, problem-focused psychotherapy and group therapy. Competency # 3: Interns will become skillful in provision of consultation services to medical staff and multidisciplinary treatment teams. They will manifest theoretical and practical appreciation of many subtleties of the consultant role. They will utilize both their psychological expertise and their interpersonal skills to influence treatment systems and demonstrate the utility of psychological consultation. Competency # 4: Interns will recognize the importance of the APA ethical code and the ethical implications of their clinical behavior. They will be alert to situations that require ethical decision-making and will have the capacity to determine the most ethical course of action. Competency # 5: Interns will be able to tailor their clinical interventions with sensitivity to clients' race, ethnicity, socioeconomic status, age, physical status, and sexual orientation. Interns will be able to identify the dominant cultural influences in their own lives and recognize areas of potential value clashes with client populations. Competency # 6: When confronted with clinical challenges and novel situations, interns will be able to access the knowledge base of psychology to improve their clinical interventions. Competency # 7: Interns will be able to utilize their scientific background and conceptual skills to formulate methods for improving delivery and effectiveness of clinical services. Competency # 8: Interns will be able to identify areas of needed development and professional interest, to formulate a plan for professional growth and career development. Internship Training CommitteeDesign and administration of the program has been delegated to the Director of Psychology Training. However, most matters such as development of training policies and procedures, selection of interns, assessment of interns' competencies, evaluation of training experiences, and development and implementation of quality assurance activities, are managed through collaborative interactions between the Director of Training and Psychology Internship Training Committee. The Psychology Internship Training Committee is composed of members of the Psychology Service who have a strong commitment to professional training. Interns also serve on the committee on a rotating basis. The Internship YearPrior to the beginning of internship, all incoming interns are invited to a social gathering where they can meet with training staff and outgoing interns in a relaxed and supportive environment. During the first week of the internship year, interns are provided with a comprehensive orientation to the Central Texas Veterans Health Care System and the internship program. Interns are given a thorough orientation to all elements of the training program including seminars, specialty rotations and journal clubs. By the end of the orientation period, interns have developed an initial training plan, selected rotation preferences and are matched with a preceptor. The process of rotation selection is based on a collaborative effort between each intern, the Training Director and the Internship Training Committee. While there are no mandatory rotations and interns usually do not compete with each other for rotations, the rotations chosen are a function of the Internship Committee's evaluation of the interns' training needs and the interns perception of their professional development needs for the internship year. All rotation choices are approved by the Internship Training Committee. Process of rotation selection is as follows: During the orientation week, the interns complete a professional development plan which includes a summary of previous clinical training, a self-assessment of professional development in the core professional competencies, career goals, and training goals relative to the core competencies. The Training Director reviews each intern's application file with attention paid to strengths and weaknesses of previous training and provides feedback to the intern. Based on a collaborative effort between the interns and the Training Director, an initial rotation plan is developed for submission at the Internship Training Committee meeting which is held at the end of orientation week. The Training Director ensures that each rotation plan provides opportunities to remediate any area of weakness in previous training and provides sufficient new learning opportunities in the areas of diagnosis, assessment, intervention and consultation. At the end of orientation, the intern rotation plans are submitted to the Internship Training Committee for approval or modification on the basis of the degree to which the rotation plans meet the learning needs of each intern. At the beginning of each rotation, a formal training contract is developed. This contract specifies the experiences to be offered and the skills to be taught on the rotation. This contract is signed by the intern, the preceptor, and the rotation supervisor. Over the succeeding months of the year, interns meet regularly with preceptors to review progress toward training goals, concerns about training settings or relationships, and broader issues of interns' development as professional psychologists. In the early portion of the training year, interns and preceptors meet frequently. M eetings becoming less frequent as the year unfolds. Approximately one month into the training year, interns present a clinical case conference that will provide a reasonable baseline estimate of interns' clinical strengths and weaknesses. The case conference will be attended by the preceptor, first rotation supervisor and Training Director. Special efforts are made to create a collegial and non-threatening environment, with emphasis on constructive identification of developmental needs. Following the case conference, the preceptor, site supervisor, and the Training Director meet to make their best estimate of each intern's standing in respect to the core competencies of the internship program. Results of this assessment provide a principal basis for any need for modification of each intern's training plan. Based on interactions among the intern, the preceptor, and the Training Committee, the previously identified training plan is affirmed or modified and a tentative plan is shaped for the second half of the training year. The collaborative assessment of intern competencies provides the heart of the training objectives for each rotation and the specifics of each rotation training contract. The general requirements of the training program are the following:
Supervision and EvaluationDoctoral level psychologists supervise all intern work. All notes and reports are countersigned by supervising psychologists and a supervising psychologist is always available when the intern is on duty. We take pride in feedback from former interns, which identifies accessibility of supervisors and quality of supervision as strengths of our program. Interns and staff members work closely together, often working as co-therapists or jointly participating in treatment planning meetings, clinical rounds, patient education activities, supervision/education of medical students, or consultation activities. As a result, interns have abundant opportunities for observational learning and informal supervision. The program has a sincere commitment to the creation of a training environment of support and trust, where interns feel comfortable to reveal weaknesses, ask questions, and discuss concerns or problems. Supervisors, preceptors, and the Training Director attend to the interns' needs for professional development and ethical awareness. Interns are primary sources of information for the program's self-assessment and quality enhancement activities, both through formal feedback and continual encouragement of suggestions to improve the program. During the training year, interns receive a weekly minimum of four hours of supervision. The primary site supervisor provides a minimum of two hours of individual supervision, but additional supervision is provided by supervisor(s) of special training electives, by preceptors, and by the Training Director in monthly group supervision. In actuality, there is a great deal more informal supervision and collaboration between intern and supervisor in most training settings. Although supervision is always made available when needed, the program philosophy is that intern growth and movement toward professional autonomy will be reflected throughout the year. As a result, it is anticipated that informal and unscheduled supervision will be most plentiful earlier in the internship year. Informal feedback and constructive suggestions are, of course, given to interns throughout the training year. More formalized feedback is provided in several ways. As noted above, at the one-month point of the internship year, interns participate in case presentation to acquire an initial assessment of relative standing on the program's 8 core competencies. The results of this baseline assessment are discussed with the intern by the preceptor and the rotation supervisor. Additionally, at the mid-point of each rotation, the intern, Preceptor, and rotation supervisor convene to review interns' general performance and progress toward fulfillment of the rotation training contract. At the conclusion of each training rotation, the rotation supervisor completes a formal written evaluation of the intern's performance (including appropriate input from any "off-rotation" supervisors). Once again the intern, Preceptor, and rotation supervisor convene to review, discuss, and, if appropriate, modify the evaluation. A copy of the resulting evaluation is then provided to the intern, Director, and Internship Coordinator at the intern's university. Evaluation is a reciprocal process, as interns formally and informally evaluate the quality of the training. As a regular component of meetings with interns, preceptors will solicit specific feedback about the intern's perception of rotation quality. To accommodate this important quality assurance process, Preceptors will meet more intensely with interns during the first few weeks of each rotation (or during any times of difficulty). Also, at the conclusion of each rotation, interns complete a formal rotation evaluation form that will be sent to the Internship Training Committee. To assure candid assessments, intern evaluations are kept sealed until the conclusion of the internship year. At that time, the Internship Director and Training Committee review the evaluations, subsequently providing appropriate feedback and suggestions to rotation supervisors. In addition to their evaluations of the training rotations, interns also complete separate evaluations of the quality and utility of the annual seminar series. These seminar evaluations are summarized by the Director of Internship Training and used to plan future seminar series as well as to provide constructive feedback to seminar presenters (with close attention to the intern's wishes for disclosure). Seminars and MeetingsPsychology seminars, case conferences, and journal club meetings are scheduled each Wednesday. The seminar series is a set of didactic learning experiences designed to build upon the intern's academic training and supplement the experiential learning of the internship rotations. Early seminars will address topics thought to be of most immediate need (clinical interviewing, risk assessment, DSM-IV, crisis intervention, psychopharmacology, and cultural awareness of the VA treatment population). Later seminars will address topics relevant to the interns' long range professional development and broadened clinical competence. Because most of the seminar topics are considered core elements of interns' professional education, there is a large degree of constancy in the annual schedule. Nevertheless, many seminars are designed to meet the unique interests of the specific intern group or to redress shortcomings identified in the initial baseline assessment of intern competencies. For example, neuropsychological screening, diagnosis and treatment issues in substance abuse and PTSD, ethical issues, and cultural diversity perspectives are a fixed component of each annual seminar series. Other topics, such as biofeedback, motivational interviewing, and couples counseling are more variable in terms of length and intensity. In addition to the formal didactic seminar series, training staff and interns participate in monthly case conferences to examine critical issues of assessment and treatment. Twice monthly journal club meetings provide and opportunity for training staff and interns to interact and exchange views about multicultural issues in the practice of professional psychology and to discuss recent developments in the scientific and professional literature including the empirically supported treatment literature.
For questions or comments about the internship, contact: Bruce.Allen@va.gov For questions or comments about this website, contact: Karen.Pope@va.gov | |||||||||||||||||||||||||||
