United States Department of Veterans Affairs

Michael E. DeBakey VA Medical Center - Houston, Texas

Psychology Training Program Postdoctoral Fellowship Program

 

Introduction | Training Staff | Predoctoral Internship Program | Internship Experience Internship Rotations | Internship Application Process | Postdoctoral Fellowship Program Postdoctoral Fellowship Application Process  |  Closing Comment and Contact Information | Clinical Neuropsychology Fellowship

INTRODUCTION

The Postdoctoral Fellowship Program in Clinical Psychology is administered by the Psychology Training Committee and resides primarily within the MEDVAMC Mental Health Care Line. The fellowship program offers seven postdoctoral positions. Five of these are one-year clinical positions that provide emphasis training in the areas of Serious Mental Illness (2 positions), Trauma/Anxiety Disorders (2 positions), and Primary Care Mental Health Integration (1 position). The Postdoctoral Fellowship Program in Clinical Psychology is currently APA accredited. We also have a two-year Neuropsychology Specialty Program (2 positions) that is directed by Robert Collins, Ph.D., ABPP-CN. This program is currently in the process of seeking APA accreditation. For specific information about the Clinical Neuropsychology Specialty Program follow this link: http://www.houston.va.gov/neuropsy_fellowship.asp 

Fellowship Organization Chart 

TRAINING MODEL AND PROGRAM PHILOSOPHY

The Psychology Postdoctoral Fellowship Program is based on a scientist-practitioner model of training. Fellows are expected to engage in clinical and didactic training 80% of their time and be actively involved in research 20% of the time. We view research and scholarly activities as informing and directing clinical practice and clinical practice, in turn, guiding research questions and activities. We view the vital inter-dependence of science and practice in clinical psychology as a core principle upon which the training system is structured.  While our internship program is designed to provide a broad range of clinical experiences, the fellowship program aims to prepare Fellows for an advanced level of competency through focused training experiences in the clinical applications of psychology. This model of training fully supports the mission of the Department of Veterans Affairs by providing training and research opportunities that further the quality of clinical care provided to Veterans.

GOALS AND OBJECTIVES

The primary goal of the MEDVAMC Psychology Postdoctoral Fellowship Program is to provide a foundation in advanced clinical service delivery (and other relevant professional skill areas) to prepare our Fellows to become licensed psychologists qualified to work in public sector medical settings. This is accomplished by providing a systematic and sequenced program for developing advanced skills that expand and build upon the existing knowledge bases developed during graduate and internship training. By the completion of their training term, Fellows will have the preparation necessary to function as autonomous professional psychologists in a variety of settings, including VA medical centers and other public sector environments.

Training objectives include attaining advanced knowledge and skills in 1) comprehensive psychological assessment, 2) a broad range of psychological interventions, 3) strategies of scholarly inquiry, 4) relevant administrative and organizational activities, 5) consultation, program evaluation, supervision, and teaching, 6) professional issues and conduct, and 7) cultural and individual diversity competencies.

All Fellows work within their emphasis area, but also complete other clinical rotations and are expected to be involved actively in research and program evaluation activities. Fellows, working with their preceptors, must develop and follow an individualized training program with specific objectives, competencies, and time lines across the training term. In addition, competency attainment at advanced levels in core and specific areas must be demonstrated through work sample presentations and successful performance in broad competency areas as indexed by supervisory ratings on Fellow evaluation instruments.

AREAS OF EMPHASIS

Serious Mental Illness

The Serious Mental Illness (SMI) emphasis area provides training opportunities to Fellows in developing advanced knowledge of theoretical models and empirical studies related to the etiology, epidemiology, and evidence-based interventions for Veterans with major affective disorders, severe schizophrenic spectrum disorders and other chronic psychotic disturbances. Fellows learn through direct clinical service delivery and educational seminars to assess, diagnose, and treat persons with SMI, develop knowledge of family systems, comorbidities, and support groups relevant to this patient population. There are also opportunities to engage in program evaluation, research, and administrative experiences.

The Fellow in the SMI area works with the preceptor throughout the year and typically has rotations of varying lengths with the other supervisors within the emphasis area.  The Fellow is expected to devote a minimum of 50% time throughout the training year to this emphasis area. Additional rotations outside of the emphasis area are encouraged and can be arranged as mutually acceptable with any psychology staff member approved to serve as a supervisor.  These additional rotations may not exceed 25% (i.e., 10 hours) of a regular work week.

Fellows in the SMI emphasis area will gain:

  •  Knowledge of theoretical models and empirical studies related to the etiology, epidemiology, usual course and efficacious treatment interventions with respect to SMI (i.e., major affective disorders, severe schizophrenic spectrum disorders and other chronic psychotic disturbances).
  • Abilities to correctly assess, diagnose, and treat persons with SMI.
  • Knowledge of family systems issues relevant to fuller understanding of persons with SMI and modes of intervening systemically in a way that is helpful to family members and the identified patient.
  • Knowledge of important co-morbidities (e.g. substance abuse, Axis II disorders) of SMI, and effective treatment planning and intervention skills with these multiply diagnosed persons.
  • Knowledge of program evaluation skills with this population translated into program evaluation activities.
  • General knowledge of pharmacotherapeutic aspects of treatment.
  • Knowledge of and abilities to collaborate with relevant support groups (e.g., National Alliance for the Mentally Ill, relevant 12-step groups) that provide patient/family support and advocacy.
  • Awareness of current trends in efficacy research and the latest research findings with respect to best intervention approaches with this population and its various subsets.
  • Knowledge of program management and administrative aspects of effective psychological practice.

Sites/Resources:

The primary training sites for the SMI emphasis area include the Comprehensive Mental Health Program (CMHP), the Psychosocial Rehabilitation and Recovery Center (PRRC), and the two inpatient units (6A and 6F). The Preceptors for the Postdoctoral Fellow in the SMI emphasis area are Amy Cuellar, Ph.D, and Justin Springer, Ph.D. Fellows in this emphasis area and those who elect it as a rotation may have the following supervisors: Quang (Charlie) Nguyen, Ph.D., (CMHP); Amy Cuellar, Ph.D. (PRRC), Cristina Gamez-Galka, Ph.D. (Local Recovery Coordinator, Mental Health Careline [MHCL]), Deborah Mullins, Ph.D. (CMHP Program Director), Karen Waldman, Ph.D., (CMHP, geropsychologist), and Justin Springer, PhD (Inpatient).

Comprehensive Mental Health Program (CMHP)
CMHP is an outpatient program that provides mental health care to over 6000 Veterans with diagnoses including psychoses (25%), mood disorders (55%), and cognitive disorders (20%). The Program Director of the CMHP is a psychologist who provides a training rotation focusing on working with Veterans and their families.  Four psychologists (including the Program Director) are assigned to this program full-time. CMHP offers a wide variety of services, including psychological assessment, pharmacotherapy, individual, group, and family counseling, case management, social work assistance, and others. The program has strong appreciation for evidence-based practice and encourages participation in scholarly activity. Several members of the CMHP staff, including the SMI preceptors, have ongoing research projects and are active in the dissemination of scholarly work. Training experiences in CMHP include opportunities to provide a range of services to Veterans experiencing affective, psychotic, and cognitive disorders. Based on each Fellow’s goals and interests, opportunities exist to be part of interdisciplinary treatment teams through the variety of services offered within this program, which include Mental Health Intensive Case Management (MHICM), PRRC, Family Psychoeducation (FPE), and Dialectical Behavior Therapy (DBT). Training opportunities include participation in group therapy, psychoeducational classes, individual therapy, and psychosocial and psychological assessments. Opportunities to accompany the MHICM team in the field and observing ECT treatment arealso  available.

Psychosocial Rehabilitation and Recovery Center (PRRC)
The PRRC is an outpatient consultation program housed within the Community Integration Program (CIP) in the Mental Health Care Line (MHCL).  The PRRC is located on the MEDVAMC campus in a new building dedicated to CIP.  As a consultation service, Veterans enrolled in the PRRC are referred from other continuous care "parent" programs within the MHCL (e.g. CMHP).  The PRRC has a membership of approximately 65 Veterans, with an average daily attendance of 25-30 Veterans. The primary goal of the PRRC is to help Veterans with SMI enhance skills and supports so that they can work towards achieving personally conceived recovery and life goals.   The program offers Veterans a wide variety of recovery-oriented services, including goals assessment and planning, skills groups, individual recovery coaching, and opportunities for skills practice in the community.  The core staff includes two social workers, a psychologist, an occupational therapist, a recreational therapist, and a social services assistant. However, staff from other MHCL programs also contribute to therapeutic programming (e.g. facilitation of groups). Training experiences in PRRC include opportunities to learn how to deliver recovery-oriented services to a population with SMI.   Fellows learn and become adept with the principles and application of psychiatric rehabilitation that focuses on helping Veterans achieve self-identified goals for recovery, better psychosocial functioning, and greater integration in their communities.  Fellows conduct (1) screening assessments that focus on helping Veterans identify recovery goals, (2) individual recovery coaching sessions to help them problem-solve around goal achievement, and (3) psychoeducational and skills-based groups, such as Social Skills Training for Schizophrenia, Illness Management & Recovery, and Wellness Recovery Action Plan development.  There are also opportunities to engage in research activities.

Inpatient Units 6A and 6F
The two inpatient units have a total of 53 beds with an average daily census of approximately 44 patients (about 84% capacity).  Services include assessment, crisis management and stabilization, therapeutic programming (individual and group counseling, recreation therapy, skills acquisition), discharge planning, social work assistance, and others, delivered in a supportive and recovery-oriented milieu.  The primary goal of the inpatient units is to provide state-of-the-art therapeutic services to help Veterans regain stabilization and strengthen coping skills to optimize functioning and quality of life in their respective communities.   The environment and therapeutic programming embrace the principles of recovery. Consistent with the goals of MHCL, there is heavy emphasis on providing evidence-based care. The inpatient units present an important opportunity for the SMI Fellow to gain competence in treating Veterans with SMI who are in more acute phases of their mental illness.  

Mental Health Care Line (MHCL):
Fellows have  the opportunity to engage in clinical and administrative activities focused on Veterans experiencing SMI. Clinical activities include conducting group, assessment, and recovery coaching with Veterans involved with the PRRC and group and individual therapy on the inpatient unit. There are also opportunities to engage in activities with recovery-oriented services such as the Domiciliary, Supported Employment, and Peer Support. Fellows may also participate in VISN and national level projects based on interest and availability.


Trauma/Anxiety Disorders

The Trauma/Anxiety Disorders emphasis area provides training opportunities to Fellows in developing advanced knowledge of theoretical models and empirical studies related to the etiology, epidemiology, and treatments for Veterans with PTSD and related anxiety problems such as panic disorder and generalized anxiety disorder. Fellows learn through direct clinical service delivery and educational seminars to assess, diagnose, and treat these patient populations. Fellows also will advance their understanding of how psychiatric and medical comorbidities impact treatment and learn to incorporate family systems and support groups in treatments with this patient population. There are also opportunities to engage in program evaluation, research, and administrative experiences. Within the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) track, Fellows work primarily with returning Veterans and develop additional advanced competencies in readjustment issues as they impact Veterans and their families.

Fellows in the Trauma/Anxiety Disorders emphasis area work with their preceptors throughout the year and typically have rotations of varying lengths with other supervisors within the emphasis area. Fellows are expected to devote a minimum of 50% time throughout the training year to this emphasis area. Additional rotations outside of the emphasis area are encouraged and can be arranged as mutually acceptable with any psychology staff member approved to serve as a supervisor.  These additional rotations may not exceed 25% (i.e., 10 hours) of a regular work week. There are two Fellows in this emphasis area. One works primarily with the general Veteran population (i.e., Gulf War, Vietnam, Korean) and the other works with the returning OEF/OIF Veterans.

Fellows in the Trauma/Anxiety Disorders emphasis area will gain:

  • Knowledge of theoretical models and empirical studies related to the etiology, epidemiology, usual course and efficacious treatment interventions with respect to PTSD and related anxiety disorders.
  • Abilities to correctly assess, diagnose, and treat persons with PTSD and related anxiety disorders.
  • Knowledge of family systems issues relevant to fuller understanding of persons with PTSD and related anxiety disorders and modes of intervening systemically in a way that is helpful to family members and the identified patient.
  • Knowledge of important co-morbidities (e.g. substance abuse, Axis II disorders) of PTSD and related anxiety disorders, and effective treatment planning and intervention skills with these multiply diagnosed patients.
  • Knowledge of program evaluation skills with this population translated into program evaluation activities.
  • General knowledge of pharmacotherapeutic aspects of treatment.
  • Knowledge of and abilities to collaborate with relevant support groups (e.g., national, regional, and local Veterans’ organizations, relevant 12-step groups) that provide patient/family support and advocacy.
  • Awareness of current trends in efficacy research and the latest research findings with respect to best intervention approaches with this population and its various subsets.
  • Knowledge of program management and administrative aspects of effective psychological practice.


Site/Resources:

The primary site for this emphasis area is the Trauma Recovery Program (TRP). The TRP was established in April 1994 to provide care for Veterans suffering from PTSD and related anxiety disorders. The TRP is a comprehensive program that provides specialized mental health services to over 5,000 Veterans and their family members. The vast majority of patients suffer from combat-related chronic PTSD. TRP treats patients from all wartime eras, including World War II, the Korean War, Vietnam War, Operation Desert Storm, and Operation Enduring Freedom/Operation Iraqi Freedom.  Psychiatric comorbidity is common in this patient population and includes substance abuse/dependence, mood disorders, personality disorders, and psychotic disorders. Outpatient services are designed to meet the needs of Veterans in need of psychiatric treatment but who do not require hospitalization. Following the initial assessment, we offer a variety of mental health services that range from psychoeducational groups, skills groups, process groups, individual therapy, case management, and medication management. Inpatient mental health care is provided on nursing units 6A, 6D, and 6F. These units provide respite for Veterans in need of brief, crisis-oriented interventions. Nursing Unit 6D specializes in the care of returning OEF/OIF Veterans and women Veterans. A team approach is used in the TRP because bringing together professionals from Psychiatry, Nursing, Social Work, Psychology, and other disciplines allows us to provide comprehensive assessment and treatment for Veterans. The preceptors for this emphasis area are Helen (Minette) Beckner, Ph.D., and Darlene Witcher, Ph.D.. Fellows in this emphasis area and those who elect it as a rotation may have the following supervisors:  Helen (Minette) Beckner, Ph.D., Ashley Clinton, Ph.D., Nancy Jo Dunn, Ph.D., Ellen J. Teng, Ph.D., Wright Williams, Ph.D., ABPP, and Darlene Witcher, Ph.D.

The TRP provides interdisciplinary care to Veterans with PTSD and related anxiety disorders. Treatment options include pharmacological management of symptoms and/or outpatient programming. The TRP offers empirically supported treatments such as Prolonged Exposure Therapy, Cognitive Processing Therapy, Anxiety Management, and Panic Control Treatment, to name a few. A number of additional groups are regularly offered, such as, PTSD Education, Seeking Safety, Expressive Therapy, and Anger Management. There are several specialty treatment tracks available within the TRP that provide excellent training opportunities to Fellows:

Intensive Outpatient Program (IOP)

The TRP offers a six-week Intensive Outpatient Program to a cohort of Veterans that meets three days a week and provides a structured series of therapeutic activities for Veterans with PTSD. IOP includes psychodrama, anger management, process group, Cognitive Processing Therapy, and a community meeting and breakfast held on Fridays.

General Anxiety Treatment

Veterans who experience unhealthy levels of anxiety on a regular basis are able to participate in the anxiety treatment track. This eight-week program provides brief interventions designed to help Veterans gain coping skills to manage their anxiety and prevent the development of more serious problems.

Sexual Trauma Treatment Track

The TRP provides a treatment track for both men and women Veterans who have experienced sexual trauma. This 12-week program meets twice a week. The goals in this track are to teach coping skills to increase quality of life, provide opportunities for Veterans to gain mutual support from one another, and to create a safe environment in which Veterans can work through unresolved issues related to past sexual trauma.

Specialty Track for OEF/OIF Veterans

The needs of Veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom often differ from issues of older Veterans from previous wars. The TRP provides a separate treatment track to meet their unique needs. This component of TRP offers a variety of services to address mental health issues resulting from service during OEF/OIF, including educating Veterans and their families about stress-related symptoms and offering groups to teach new coping skills and provide peer support. Additional services include identifying resources to help Veterans with housing, finances, education, employment, legal, and other concerns.

Primary Care Mental Health Integration

The Primary Care Mental Health Integration (PCMHI) emphasis area allows the Fellow the opportunity to develop advanced training skills primarily in health psychology/behavioral medicine in a primary care setting. The Fellow learns from a combination of direct client care, in the form of advanced and brief interventions, and psychological assessments for surgical procedures. Training will go beyond that of an intern level and is designed to prepare a future clinician for employment in a health setting, particularly in a major medical center. The Fellow will also participate in didactics, seminars, and research opportunities which promote the scientist-practitioner model shared by the overall fellowship program. The Fellow in the PCMHI area works with the preceptor, Paul Sloan, Ph.D., throughout the year and typically has rotations of varying lengths with the other emphasis supervisors.  The Fellow is expected to devote a minimum of 50% time throughout the training year to this emphasis area. Additional rotations outside of the emphasis area are encouraged and can be arranged as mutually acceptable with any psychology staff member approved to serve as a supervisor.  These additional rotations may not exceed 25% (i.e., 10 hours) of a regular work week.

Fellows in the PCMHI emphasis area will gain: 

  • Knowledge of theoretical models and empirical research on bio-behavioral etiology and epidemiology of co-morbid medical and psychiatric disorders (i.e., depression and anxiety in the context of cardiovascular disease, diabetes and chronic pain) and evidence-based interventions for these conditions.
  • Abilities to correctly assess, diagnose, and treat persons with comorbid medical and psychiatric illness in individual and group settings, as well as within the context of a family or community. 
  • Abilities to conduct evaluations and provide interventions to support surgical candidacy and other specialty medical procedures, including multiple transplant/implant procedures and bariatric surgery.
  • Advanced training in Motivational Interviewing skills, Mindfulness-based interventions and Cognitive Behavioral Therapy techniques, with an emphasis on brief intervention modalities.
  • General knowledge of pharmacotherapeutic aspects of treatment. 
  • Skills related to the delivery of recovery-oriented services with a focus on helping Veterans achieve self-identified goals for recovery, better psychosocial functioning, and greater integration in their communities.   
  • Interdisciplinary communication by participating on treatment teams within PCMHIP and throughout the hospital.
  • Knowledge of program evaluation skills and the ability to disseminate information learned in these evaluation activities. 
  • Analytical and research skills through the development and dissemination of performance improvement projects and grant-funded research on interventions to enhance treatment outcomes in medical patient populations and implementation of evidence-based practices. 
  • Participation in ongoing projects or design his/ her own project with the expectation of presenting results in an appropriate venue.

Sites/Resources:

The primary setting for the fellowship is in the Primary Care Mental Heath Integration Program at the MEDVAMC. In the first nine months of operation, the PCMHI program provided mental health care to approximately 2,800 Veterans and is expected to serve more than 3,500 Veterans in the 2011-2012 academic year. The PCMHI is a busy program and the Fellow will have opportunities to gain diverse training experiences, as Veterans present with a variety of mental health concerns including, depression and other mood disorders (56%), anxiety (27%), adjustment disorders (7%), substance use (5%), psychoses (1%), and other disorders (3%) including somatization, cognitive difficulties, sexual dysfunction or identity disorders, and personality disorders. These psychiatric conditions are typically co-morbid with medical problems such as pain, diabetes, cardiovascular disease, and obesity.

The PCMHI includes four psychiatrists, a registered nurse, two licensed clinical social workers, and supports three medical residency/fellowship positions. This diversity provides the Fellow with an interdisciplinary work environment. The Fellow has many opportunities to plan and coordinate activities with PCMHIproviders in nursing, psychiatry, social work, and psychology. There are also opportunities to engage in research, program evaluation, and administrative activities consistent with the Fellow's interest and past experience. Established supervisors for this emphasis area include 7 psychologists.  Each psychologist provides expertise in a specific area that offers specialized training experiences in addition to the provision of behavioral medicine services for mood, anxiety, and adjustment disorders. Kaki York-Ward, Ph.D. is in the specialty behavioral medicine section and conducts pre-surgical evaluations for organ transplants and also treats patients with hepatitis. Paul Sloan, Ph.D., specializes in pain management with medical patients.  Carrie Dodrill, Ph.D. treats substance abuse and anger management problems. Jeffrey Cully, Ph.D. operates a cognitive-behavioral clinic for patients with comorbid medical disorders. A number of PCMHI psychologists provide services within other specialty clinics, including Angelic Chaison, Ph.D., who provides services within the Women's Clinic and the Post-Deployment Center, and Michael Kauth, Ph.D., who provides services within the HIV Specialty Clinic. Karen Waldman, Ph.D. is a geropsychologist within the Comprehensive Mental Health Program who  conducts bariatric assessments and weight management classes for PCMHI patients.

Program Consultation and Accreditation
American Psychological Association
750 First Street NE
Washington DC 20002-4242
(202) 336-5979