The Program
The training program consists of three components: clinical rotations, seminars/teaching, and long-term psychotherapy supervision.
ROTATIONAL ASSIGNMENTS
The interns receive their training in a variety of settings, each one stressing a variety of treatment modalities.
The year is divided into three major four-month rotations. We require that the intern complete two major rotations. Traditionally one provides an inpatient psychiatry experience and the other an outpatient experience. The remaining four months may be used as an elective and may be selected by the intern from a variety of placements available. The intern spends a minimum of 25 hours on the rotation site. The remaining time is spent in case conferences, grand rounds, seminars, or other educational activities. We also require all interns to rotate through a part-time experience on our Psychiatric Crisis Unit. Rotation options are outlined below.
MAJOR ROTATIONS
Albany Medical Center Department of Psychiatry (Inpatient Psychiatry Service and Albany Medical Center Outpatient Psychiatry Clinic). Interns serve on both inpatient and outpatient psychiatry services on this “split” rotation. On the AMC inpatient psychiatry unit, interns work closely with senior faculty in a multidisciplinary setting providing assessment and consultation services, and brief psychotherapeutic interventions. Patients may present with a broad spectrum of psychiatric diagnoses including PTSD, mood disorders, personality disorders, polysubstance dependence, and/or schizophrenia (average length of stay is 10 days). In the AMC outpatient clinic, the training clinic of the Department of Psychiatry, interns work alongside psychiatry residents, faculty and staff. A primary focus of this portion of the rotation is psychological assessment, with an emphasis on “therapeutic assessment” (Finn & Tonsager, 1997). Interns also conduct intake evaluations and carry a select number of psychotherapy
clients (2-3).
Inpatient Intensive Care Program (CDPC). Interns work on an inpatient psychiatric unit that houses individuals with a variety of psychiatric difficulties including psychotic disorders, mood disorders, characterological disorders, and cognitive disorders who are exhibiting behavioral dyscontrol. Interns provide individual therapy and co-lead various therapy groups. They also provide psychological assessment and screenings that include cognitive and mental status evaluations. Interns are part of a multidisciplinary treatment team that is responsible for treatment planning.
ELECTIVE ROTATIONS
Child and Adolescent Psychiatry (CDPC). Interns are primary therapists for children, adolescents and their families. They receive experience in play therapy, family therapy, and child assessment, as well as consultation to schools and family court. Interns also have the opportunity to consult at secure detention facilities for behaviorally disordered adolescents. As consultants, they may provide diagnostic assessments, supportive therapy, and didactics for facility staff.
Post-Traumatic Stress Disorder Program (VAMC). The PTSD program is a short-term intensive program designed to provide treatment for the problems of Vietnam and Iraq Veterans with readjustment problems (including PTSD). As substance abuse is a problem afflicting the majority of this population, a close relationship exists between the PTSD program and chemical dependency programs. Services provided by the PTSD program take three basic forms: 1) consultation services regarding the diagnosis and treatment planning, 2) a 16-week outpatient treatment program designed to address skill deficits which frequently interfere with adaptive function, and 3) individual treatment focusing on desensitization and the emotional processing of traumatic memories via intensive exposure-based psychotherapy. Interns work closely with faculty and staff in providing these psychological services.
Clinical Neuropsychology (VAMC). This is a full-time elective rotation that provides the intern an opportunity to expand his/her understanding of Clinical Neuropsychology in a medical setting. Interns work closely woth a Neuropsychologist in responding to request for consultation from various areas of the hospital, but most commonly from Neurology, Polytrauma and Behavioral Health. A diverse patient population presents a variety of important issues, including neurodegenerative disorders, neurodevelopmental conditions and traumatic brain injury. Interns on this roation function as members of multidisciplinary team and assume responsibility for the delivery of psychological services. In addition to direct patient care and report writing, interns also interact with referral sources and provide education and/or brief counseling to patients and their families. Opportunities may be available for the interested trainee to assist with program development, special projects and research.
Crossroads Adolescent Day Treatment Program (CDPC). The Crossroads Adolescent Day Treatment Program is an intensive day program for adolescents between the ages of 12 and 18. Referred from school districts' Committees on Special Education, these adolescents have been diagnosed with a severe emotional disturbance and/or mental illness. Crossroads has a capacity for 18 adolescents who are serviced with educational and clinical programming including a 6:1:1 classroom, individual therapy, group therapies, family therapy, pharmacotherapy, and milieu treatment. Psychology interns are part of the multidisciplinary team and serve as a primary therapist to one of the students. In addition, psychological testing and facilitation of group therapy are also included. Interns participate in weekly staff meetings and patient treatment review meetings. Active involvement in the milieu is also encouraged.
Primary Care Collaborative Health Care Team (VAMC). The Collaborative Health Care Team provides behavioral health consultation within the Medical Primary Care Clinics at the VA Medical Center. The major emphasis for interns in these clinics is the application of behavioral and cognitive therapies for medical disorders, particularly those in which stress is seen as a causal or exacerbating factor (e.g., hypertension, cardiac or pulmonary disease, diabetes, obesity, chronic pain, fatigue, insomnia). Interns are also responsible for short-term treatment of adjustment reactions, depressive and anxiety disorders, and for screening for more severe psychopathologies requiring treatment elsewhere. In addition, psychologists assist patients in adjusting to chronic illness/disability, making life role transitions, coping with acute grief/loss, and enhancing personal well-being and relationships through improved stress management. The intern will participate in the health care of adults of varied ages, but with the opportunity to emphasize clinical work with older adults. The intern will develop skills in rapid assessment and case formulation; triage; consultation/collaboration with physicians, nurse practitioners, and physicians' assistants; short-term, solution-focused individual psychotherapy; and development and implementation of psychoeducational programs.
Chemical Dependency Rehabilitation Program (VAMC). Interns serve as a member of a multidisciplinary treatment team consisting of professional and paraprofessional staff devoted to the treatment of veterans with alcohol and drug dependence. A multimodal treatment approach is used, which includes individual and group therapy, lectures, 12-step meetings, and experiential tasks. Interns work as co-therapists in group therapy, conduct screenings and assessments, and carry 1-2 individual patients.
MINOR ROTATION
Psychiatric Emergency Room and Crisis Intervention Unit (CDPC). Interns serve as crisis team members, evaluating acutely ill psychiatric patients who present in the emergency room for treatment. In conjunction with psychiatric staff, interns coordinate patient disposition and referral. This is a part-time (approximately 15 clock hours) rotation that is required of all interns.
EDUCATIONAL OPPORTUNITIES
Seminars/Case Conferences. The core seminar experience is provided by psychology and psychiatry faculty from consortium institutions and the community. Each week, interns are given up to four hours of didactic training in such areas as personality assessment, psychotherapy technique, psychopharmacology, neuropsychological assessment, family therapy, and group therapy. Along with seminars, case conferences are opportunities to discuss cases of educational interest. Case conference presentations are made by senior faculty, psychiatry residents, and psychology interns.
Grand Rounds. Grand Rounds presentations are sponsored by the Department of Psychiatry,
Teaching Days. There are workshops and teaching days throughout the year. In the past, these teaching days have covered such topics as advanced psychopharmacology, anorexia nervosa, treatment of phobias, short-term dynamic treatments, cognitive therapy of depression, neuropsychology, and treatment of borderline and narcissistic disorders. In addition to the educational experiences listed above, interns may attend classes offered in the residency training program such as advanced psychoanalytic techniques, Freudian theory, brief therapy, psychopharmacology, family therapy, and hypnosis.
Teaching/Supervision Experience. Interns are provided elective opportunities to serve in teaching and supervisory roles within the Department of Psychiatry,
Long-Term Therapy. While time-limited forms of psychotherapy play a major role in contemporary clinical practice, we feel that the best way to prepare for shortening treatment is by obtaining an in-depth understanding of patients, acquired via intensive (“long-term”) psychotherapy. Once interns internalize the process of intensive psychotherapy, they can then become more efficient in therapy and subsequently work towards shortening treatment length. In the long-term psychotherapy program, interns, upon arrival, are assigned two or three carefully selected psychotherapy patients to see during the entire year. For each case, interns have a different supervisor who provides hour-for-hour supervision. These cases are seen in addition to brief psychotherapy cases associated with their outpatient rotation(s).
Supervision. On each rotational assignment, the intern is assigned a principal supervisor, usually the most senior psychologist. This principal supervisor provides the bulk of the supervision and oversees the rotational experience. The supervision is close, intensive, and follows an apprenticeship model. On each rotation, interns may receive additional supervision from other psychologists as well as from other mental health professionals.
EVALUATION
Interns are formally evaluated six times during the course of the year. Detailed feedback is solicited from all supervisors, and the Director collates the data for a supervisory feedback meeting with the intern. When problem areas arise, plans of correction and remediation are implemented in a timely manner. Twice a year, the interns' home training programs are given written evaluations of the student's progress.
The interns are also encouraged during the evaluation periods to give the program feedback about their training experiences. When problems arise, plans of remediation are quickly implemented to insure a responsive and supportive training experience for the intern.
THE WORK WEEK
We are a full time internship, which runs from September thorough August. As a full-time intern, a forty-plus hour workweek is expected. It is not expected that interns will ever have to work more than 45 hours (at most), and there are no weekend commitments. We are a training institute, which believes the interns earn a stipend for being trained. They are not here to see large numbers of patients, or to produce volumes of reports. The only time we are concerned about numbers is when attempting to determine an optimal workload is for training. Training needs come first. Service needs come second. This has always been a core value of the internship.
FRINGE BENEFITS
CDPC/AMC stipendees receive 10 days of vacation with 11 sick/personal leave days during the course of the year as well as paid national holidays. The VA stipendees receive 13 vacation days and 13 sick/personal leave days per year with paid national holidays. Pay periods are once every two weeks, with a total of 26 pay periods per year. All interns have health insurance benefits. Stipend for 2008-2009 is approximately $26,000.
Both the
On all but two rotations, the interns have their own individual offices. On two of the busiest services, the interns have shared office space with one or two other professionals in training. There is ample secretarial support, and computer access on all rotations for word processing, web resources, and email. Interns are provided pagers. Interns have free parking at the VA and pay $5.00 a month for garage parking at AMC/CDPC.
POST-DOCTORAL TRAINING OPPORTUNITIES
Recently interns at the Consortium have been fortunate as the
