Internship in Professional Psychology

INTERNSHIP IN PROFESSIONAL PSYCHOLOGY

(APA-ACCREDITED)

BHN The CARSON CENTER

77 MILL STREET, WESTFIELD, MASSACHUSETTS 01085

2018 – 2020

Overview of the Internship in Professional Psychology

The Carson Center for Adults and Families, a program of Behavioral Health Network (BHN)in Westfield, Massachusetts, offers a half-time two year (2,000 hours) Internship in Professional Psychology fully accredited by the American Psychological Association (APA). The internship is located in Adult Outpatient Services of a not-for-profit community mental health clinic that provides general and specialized mental health services for adults. In August, 1998, our Internship in Professional Psychology was first accredited by APA. We were most recently reaccredited by the APA in May, 2015 for an additional seven years. Our next APA site visit is anticipated to be in 2021.

Philosophy of Training

The overarching goal of the Internship in Professional Psychology is to prepare interns to develop the knowledge base, skills, and attitudes that will further their development as competent and ethical psychologists, with a special understanding of the mission and concerns of community mental health. The training model that we subscribe to has three dimensions:

• practitioner-scholar, withan emphasis on evidence-based treatments and psychotherapy integration.

• multiple roles, including: intervention (individual and group therapy), assessment (psychological testing, substance use evaluations, risk assessment), providing supervision, providing consultation, and conducting program evaluations.

• competency-based, focusing on developing foundational and functional competencies.

1) The practitioner-scholar model. Our training program is based on a practitioner-scholar model.We place “practitioner” first to reflect our priority in training interns to be competent, first and foremost, in clinical practice. However, we also expect our interns to develop to be scholars; that is, to be intellectually curious, to think critically, to be able to access appropriate data bases, to utilize evidence-based treatments and “best practices”, to demonstrate cognitive flexibility and openness, and to be integrative and dialectical thinkers.

In regard to a scholarly approach to multiple roles, we subscribe to the belief that clinical practice needs to be informed by both current developments in psychological research and theory. In other words, our emphasis is on applying evidence-based and conceptual knowledge to the practice realm. This is exemplified by our emphasis on training interns in evidence-based practice and in psychotherapy integration.

We educate and train our psychology interns in a number of evidence-based treatments, such as Dialectical Behavior Therapy,cognitive-behavioral treatment of PTSD, and Panic Control Treatment. We also have an emphasis on training Psychology Interns in a number of evidenced-based approaches designed to treat those clients with co-occurring mental health and substance use disorders. Interns are exposed to integrated treatment of co-occurring disorders,Motivational Interviewing, and Relapse Prevention. In addition, interns receive training inComprehensive Addiction Treatment (CAT), Dialectical Behavior Therapy of Substance Abuse (DBT-S), and Seeking Safety / Creating Change. For interns who have had basic training in Eye-Movement Desensitization and Reprocessing (EMDR), there are possibly opportunities for consultation with an EMDR-certified consultant. In keeping with our emphasis on multiple roles, Psychology Interns will receive training in consultation to individuals, programs, and / or organizations.

Our emphasis is on evidence-based practice, not just empirically supported treatments. Therefore, being scientifically-minded applies to each of the multiple-roles for which we train interns in addition to psychotherapy, including: assessment, consultation, supervision, and program evaluation. In that regard, our objective is to stay current with the research and the latest developments in the field and to model this for our interns. Furthermore, evidence-based practice needs to include a contextualized approach that is sensitive to cultural factors and individual differences.

A second emphasis in developing practitioner-scholars is on psychotherapy integration. We strongly encourage interns to value and draw on a multiplicity of theoretical perspectives to guide their clinical work (including cognitive, behavioral, narrative, systemic, interpersonal, humanistic, and psychodynamic approaches) and to find their own “blend” or “integration”. It is our contention that each of these rich traditions within the field of psychotherapy has something of value to offer, and we strongly encourage students to eschew being ideologically wed to a single model. Rather, through theNarrativeSeminar and the Seminar inpsychotherapy Integration, we encourage psychology interns to be able to shift frames and to view clinical data from multiple perspectives.This may take the form of prescriptive eclecticism or systematic eclectic psychotherapy or a more assimilative integration. Of course, in order to shift between approaches or actually integratetwo or more perspectives, interns must know two or more specific traditions or frameworks (e.g. cognitive, interpersonal, narrative, systemic, psychodynamic, behavioral) in depth. Therefore, in clinical supervision and on the diagnostic / treatment team, we place a strong emphasis on case conceptualization. More specifically, interns are trained to think carefully about clinical phenomena with special attention to factors that have caused or maintain a client’s difficulties. In many psychiatric illnesses, it is important for clinicians to also be aware of risk and protective factors so as to minimize or prevent relapses. We also encourage interns to be appreciative of client strengths (both internal and external resources) and cultural factors; there is a specific section designated for this in our comprehensive assessments and treatment plans.

2) The competency-based developmental model.

The goal of our Internship in Professional Psychology is to provide the supervised experience and training that develops specific foundational and functional competencies that adequately prepare our Psychology Interns to assume the various roles and responsibilities required for one’s first postdoctoral professional employment or fellowship as well as to provide the necessary training and experience required for eventual licensure as a psychologist. A fundamental objective of our internship is to facilitate the development of doctoral level students in clinical or counseling psychology into competent professional psychologists who are ready to assume the responsibilities of entry-level professional clinicians at the completion of the internship. This includes awareness and adherence to ethical principles as well as working effectively with individual and cultural differences .

In keeping with a competency-based model, we see our internship program as facilitating the development of foundational competencies andfunctional competencies.

Foundational competencies are generic and broad-based and are comprised of basic attitudes toward others, toward learning, and toward professional growth and development essential to becoming a competent and ethical professional psychologist. They consist of: a) reflective practice / self-assessment, b) scientific knowledge/ methods, c) relationships, d) ethical-legal standards, e) individual and cultural diversity, and f) interdisciplinary systems. They are foundational in the sense that a significant deficiency in any of these competency areas, such as the ability to be empathic, open-minded, or being able to accept feedback non-defensively – represents a significant obstacle to becoming a competent psychologist. These competencies are also foundational in the sense that they are the building blocks of the functional competencies delineated below.

The functional competencies that we emphasize are consistent with our training psychology interns for multiple roles involving the following activities: a) psychotherapist (i.e. intervention), b) assessment (including psychological testing), c) supervision, d) consultant, and e) program evaluation. These functional competencies are isomorphic with the multiple roles for which we prepare psychology interns that were described previously. They build on the foundational competencies and often include more specialized skills and knowledge

3)Multiple roles and Functional Competencies. Psychologists today, and even more so in the future, need to be prepared to assume a number of different roles, each of which require their own subset of specific competencies. The third precept upon which our training is based is the strong conviction that current and future psychologists need to be trained in multiple roles. This approach is consistent with the functional competencies in professional psychology that have been identified as important . Our primary emphasis is on training in interventionand assessment. In the intervention area, examples would be learning and applying the DBT model or using Motivational Interviewing with a client who is ambivalent about leaving an abusive relationship. In the assessment area, this would include competencies related to conducting psychological testing using the Rorschach or the Q-Interactive system or assessing a client's stage of change.Our program also provides, to a lesser extent, training in clinical supervision, consultation andprogram evaluationthrough didactic seminars and supervised experience.PsychInterns typically have an opportunity during their second year as an intern to provide ancillary supervision to a doctoral-level practicum student (and peer supervision during their first year). In addition to being exposed to a consultation model, Psych Interns gain experience providing consultation to both an individual and a group / program. Regarding gaining skills in program evaluation, Psychology Interns as a group take on a project during one of their two years whereby they evaluate one of the clinic's programs (e.g. DBT Program, walk-in intakes, co-occurring disorders) and make recommendations to the agency.

In terms of the professional development of psychologists, we believe that the internship serves a vitally important function in facilitating the transition from doctoral student to psychologist. In that the internship experience is uniquely positioned in the education and training of future psychologists, it is incumbent upon the training program to serve both a training and quality control function. To that end, we provide Psychology Interns with verbal feedback concerning their performance on an ongoing basis and a written evaluation which includes both ratings and narrative commentary evaluation once a year.

The CarsonCenter for Adults and Families

The Psychology Internship is part of Adult Outpatient Services in theCarsonCenter for Adults and Families (CCAF), a program of Behavioral Health Network (BHN). The Carson Center merged withBHN, a growing non-profit community behavioral health agency that has numerous outpatient therapy and addiction services, in-home therapy, crisis, residential, and outreach services, in July, 2017.

CarsonCenter for Adults and Families(CCAF)is in Westfield, Massachusetts. a small city one half-hour west of Springfield whose largest employers are Westfield State University andBaystateNobleHospital. We also serve West Springfield to our east and the hill towns to our west as far as the boundary with BerkshireCounty. These include some very rural and poor communities.

To respond to the needs of our catchment area, several interrelated programs are housed at our site: Adult Outpatient Services, Psychiatry, Emergency Services, Crisis Stabilization and Respite Services, Community-Based Flexible Supports, Center for Development, and Intensive Case Management. Working together, these programs provide comprehensive adult outpatient and crisis services to individuals 18 and older. The Center for Children and Youth and Intensive Family Therapy program is located in the same site, serving children, adolescents, and their families.

The Psychology Internship is embedded in Adult Outpatient Services at CCAF, which provides assessment and psychosocial treatments to adults. Interns work with clients from age 18 and older. Many of the clients served at our clinic are persons with psychiatric disabilities, including serious mental illness and receiving multiple services. Weserve a range of ages: from students atWestfieldStateUniversity who need more than brief treatment to elders who are dealing with issues related to retirement, health, family, and loss.

In terms of ethnicity, although most of our clients are Euro-Americans, there is a significant Latino community, mostly of Puerto Rican descent, in our service area. In addition, there is a significant community of Russian émigrés as well. In terms of socioeconomic status, the majority of our clients are lower SES; many are on disability, unemployed, underemployed, working poor or eligible for Medicaid. There is also a homeless shelter in Westfield that frequently refers their clients to us for evaluation and treatment for psychiatric and substance use problems.

Clients present with a variety of problems and mental disorders, including depression, anxiety, substance use disorders, personality disorders, trauma-related disorders, and serious and persistent mental illness. As a vendor for the Massachusetts Department of Mental Health (DMH), we have contracts to provide services to those clients who meet criteria for such serious disorders as Schizophrenia, Schizoaffective, Bipolar Disorder, and Major Depression, as well as some of the severe Personality Disorders, including Borderline and Paranoid Personality Disorders. Given the severity and chronicity of these mental illnesses, a majority of clients who are DMH-eligible have a history of multiple psychiatric hospitalizations and consume a disproportionate amount of mental health services. Many of these clients also meet criteria for Substance Use Disorders, which complicates their treatment. These clients also often require additional collateral services, such as transportation and outreach, and case management. which are provided by a program in our agency, Community Based Flexible Supports (CBFS). The Community Support Program (CSP) is available for clients who were recently discharged from the hospital and provides services to help stabilize these clients so as to reduce hospital re-admissions. We work closely with other community agencies which provide residential and day treatment programs. The CarsonCenter is also affiliated with NobleHospital in Westfield, which provides inpatient psychiatric care and partial hospitalization programs.

We have a contract with the Massachusetts Department of Public Health (DPH) to provide substance abuse services to clients who meet criteria for abuse or dependence, especially those who are without health insurance. DPH mandates that a substantial portion of our treatment be offered through groups and we offer a variety of groups for these clients (e.g. exploration group, relapse prevention group) that are matched with the client’s stage of change (e.g. contemplation, maintenance). We aspire to integrated treatment for dual disorders whereby the Substance Use Disorder (SUD) and mental disorder (MD) are both considered “primary” and need to be treated concurrently rather than in a parallel or sequential fashion.

In order to serve this diverse community, the Carson Center for Adults and Families offers a broad range of treatment modalities tailored to suit the needs of individual clients and their families and include: crisis intervention, stabilization and respite, psychological assessment, psychiatric evaluation, substance use evaluations, psychopharmacological treatments, brief and long-term individual psychotherapy, group psychotherapy, EMDR, and Dialectical Behavior Therapy.

Supervised Experience and Training Activities

The following are the required training activities that comprise the core our internship training program:

1. Individual Supervised Experience

We have identified supervised experience as the primary learning method for professional growth and development. Our internship program is structured so that interns, although half-time, receive two hours of individual supervision with a licensed psychologist who is a member of the training staff. Interns have two such supervisors, primary and secondary, who divide up responsibility for the interns’ clinical cases, but who are accessible for emergency supervision on any aspect of the intern’s experience. Psychology interns also receive supervision of their DBT cases in the DBT Consultation Team that meets weekly and in their weekly Diagnostic / Treatment Team on an as needed basis.

Supervision is designed to provide a safe environment for interns to develop clinically and professionally. It is our philosophy that the intern’s sense of safety increases when the internship is perceived to be an evaluation-rich rather than an evaluation-free environment. Supervisors provide psychology interns with ongoing feedback on all aspects of their performance as an intern. This includes feedback not only about their clinical work, but regarding their functioning in the clinic, documentation, following policies and procedures, and overall professionalism. Psychology interns receive formal written evaluative feedback on the various foundational and functional competencies, using a Likert-scale and narrative commentary.

1. Direct Service

Psychology Interns are on site 20 hours per week and average 9billable direct service “hours”per week, with the remainder of their time devoted primarily to training and supervision. Psychology Interns can expect that 20-30% of their caseload will consist of clients who experience serious and persistent mental illness (SPMI). Another 20-30% of their caseload typically includes clients with co-occurring disorders - who meet criteria for a mental health diagnosis such as anxiety or depression as well as substance abuse or dependence. Interns are also expected to work with one or two DBT clients who, by definition, meet criteria for Borderline Personality Disorder and / or co-lead a DBT or Life Skills Group. Psych Interns have led or co-led a number of other different therapy groups, including Anxiety management group, Mindfulness and Behavioral Activation for Depression, Relapse Prevention, Dual Diagnosis, and Seeking Safety.

In the interest of providing a broader learning experience, we are careful to balance the interns' caseloads so as to expose them to clinical work with clients who are also higher functioning and presenting with less severe problems that are amenable to shorter term work, such as Adjustment Disorders and specific anxiety disorders (e.g. Panic Disorder, Social Phobia), or relationship / marital problems.

Psychology Interns also learn to do intakes or diagnostic evaluations and write up Comprehensive Assessments on new clients. Intakes and psychological testing or other assessments are included as direct service activities and count toward productivity expectations.

All clinical work with clients is documented through Comprehensive Assessments, Individual Action Plans, and Progress Notes via our Electronic Clinical Record (CareLogic).

1. Diagnostic / Treatment Team

During this weekly hour-long staffing, all clinical staff, including interns, present new and ongoing clients to a multidisciplinary team which discusses diagnostic and treatment issues and makes recommendations. This is an opportunity for the intern to develop a number of different competencies, whether presenting or not. They learn to present a case in an organized, coherent, concise, and professional manner and to have adequate data to support diagnoses and recommendations. Interns may be questioned or challenged by other team members in terms of diagnostic or treatment considerations, giving them an opportunity to demonstrate how to listen to and respond to feedback non-defensively, yet how to support their own clinical impressions and hypotheses, or modify them if warranted. In addition to the explicit feedback interns receive from other members of the team, they have an opportunity to learn to workcollaboratively with psychologists, social workers, nurses, and mental health counselors, and to benefit from a multiplicity of perspectives.