Psychology Training Program Internship Rotations
The following information provides a more detailed overview of the involvement of Psychology in patient care services at the Michael E. DeBakey VAMC.
Spinal Cord Injury Care Line Psychological Services
This rotation occurs within the Spinal Cord Injury Care Line and centers on assessment, treatment planning, intervention, and consultative services in the treatment of a very heterogeneous mix of inpatient and outpatient veterans with spinal cord injuries or dysfunction (SCI/D) of varied anatomical levels and completeness. The rotation is in a rehabilitation context but also has elements of behavioral medicine, health psychology and generalist psychological practice. Assessment experiences include interview based, objective personality assessment, and neuropsychological screening. Neuropsychological and projective testing experiences are not routine but may be available based on trainee interests and veteran need. Intervention experiences may include individual, family and group contexts. Occasional crisis related assessments and interventions are components of the typical rotation. System competency (i.e. knowledge related to accessing needed general and specialty services) development is an important training objective. SCI Care Line service delivery focuses on reducing obstacles to recovery, mobilizing assets, and fostering optimal adaptation on the part of the veteran with SCI/D. Identifying and mitigating the negative effects of co-morbid cognitive/psychological limitations are major psychological roles. An overview of medical and pharmacological aspects of rehabilitative medicine will be gained through supervision and interactions with a range of other professionals on the SCI team. The supervisors have many years experience offering direct service delivery to a broad range of veterans as well as a long-term commitment to the evolving MEDVAMC Psychology Training program. Both have pragmatic and integrative orientations, an appreciation of empirical and conceptual bases of practice, and focus on individualized training. Dr. Ames has an emphasis in CBT approaches and is also privileged to provide neuropsychological assessments. Dr. Anderson has more Interpersonal and Psychodynamic emphases. Active research projects are underway (e.g., enhancing vocational functioning in the SCI population) with other opportunities also possible.
Sex Offender Group
The intern on this rotation will co-lead a group for sex offenders who have been referred from the probation and parole departments. In conjunction with this population, the intern will be involved in the initial assessment of patients entering into the long-term outpatient sex offender group.
Posttraumatic Stress Disorder (PTSD) Clinical Team
This rotation affords the opportunity to work in a specialized assessment, consultation, and treatment program designed to address psychological trauma (e.g., combat trauma, military sexual trauma) in veterans of all eras in an outpatient setting. The rotation offers a focus on evidence-based psychotherapy, including prolonged exposure therapy and cognitive processing therapy (applied in both group and individual psychotherapy formats) within the context of a multidisciplinary treatment team. Other opportunities may include cognitive-behavioral treatment of PTSD-related insomnia and nightmares, coping skills, assessment/treatment planning, program development, and related research projects.
Community Integration Program (CIP) - Neuropsychology Clinic
The Neuropsychology Clinic receives inpatient and outpatient referrals from all the Care Lines within MEDVAMC and satellite clinics, excluding Rehabilitation and Neurology, to include Mental Health, Primary Care, Spinal Cord Injury, General Medicine, and Long Term Care. Populations served include dementias (e.g., Alzheimer’s, Vascular, Lewy Body, Frontotemporal Lobar Dementia), psychopathology, cerebrovascular disease, parkinsonism, substance abuse, ADHD, HIV, demyelinating diseases, toxic-metabolic, and brain tumor. In addition, capacity evaluations are routinely requested from various providers. Evaluations are tailored to individual patient needs and referral questions, using a flexible battery approach. The intern will have the opportunity to learn techniques of neuropsychological investigation and principles of interpretation and specific recommendations with regard to the functional and diagnostic significance of findings. It is understood that trainees have varying degrees of assessment experience/exposure to neurological populations and every effort will be made to address each trainee’s individual needs or interests. Additional didactic opportunities are available including the MEDVAMC Neuropsychological Seminar Series, Houston Neuropsychological Society meetings and other relevant educational meetings. There may be opportunities to participate in ongoing research projects with the goal of generating a poster and/or publication.
This rotation includes an opportunity to work with the Harris County psychologists inside the Harris County Jail doing competency and sanity evaluations. At times there are cases that allow the intern to attend court hearings to learn about the dynamics of psychological testimony in court. This rotation assists in sharpening interview and testing skills as well as providing the setting for learning about the functioning of a psychologist in the criminal justice system.
General Mental Health Clinic – Posttraumatic Stress Disorder and Readjustment Issues
This rotation focuses on treating Veterans with PTSD and related comorbidities, including readjustment issues. Interns will have opportunities to conduct mental health screenings and follow several Veterans for short term individual therapy. A main focus of the rotation will be on diagnostic assessment and treatment planning skills as well as short-term therapeutic interventions. Interns will also be able to participate in multidisciplinary treatment team activities.
Neuropsychology, Neurology Care Line
The Clinical Neuropsychology Service within the Neurology Care Line primarily receives consultation through various neurology outpatient clinics (e.g., cognitive disorders clinic, stroke clinic, seizure clinic, etc.). Less frequently there are requests for inpatient evaluations, usually for the purpose of addressing competency/limitations to independence. The patient population is typically older and the primary questions being asked are diagnostic in nature (e.g., differentiation of various dementias, cognitive disorders in the context of psychiatric illness, recovery of cognitive functioning following head injury or stroke, malingering, etc.). This service has direct involvement in the MEDVAMC epilepsy surgery program and there may be opportunities for interns to assist in the pre- and post-surgical evaluation of these patients as well as assisting with intracarotid amobarbital (e.g., WADA) studies. There may be opportunities to collaborate on research projects and to provide psychotherapy to patients with CNS disease and psychiatric illness. This is a rotation where the emphasis is on teaching the basics of neuropsychological assessment (including interviewing, test selection, interpretation of data, etc.) and exposure to different neurological/psychiatric populations. The assessment approach utilized on this rotation is one that is hypothesis driven to guide test selection with a flexible battery. Test findings are compared to normative data and interpreted within an information processing framework. It is understood that trainees have varying degrees of assessment experience/exposure to neurological populations and every effort will be made to individually tailor each training experience. Interns at all experience levels will be expected to complete readings in neuropsychology and to attend neuropsychology seminars. Interns will have an opportunity to work with the Clinical Neuropsychology Postdoctoral Fellows.
Primary Care-Mental Health (PC-MH)
The goal of this rotation is to provide interns an opportunity to increase proficiency in assessing and providing brief clinical services to a variety of Veterans in primary care (primarily Clinic 3). Trainees will be presented with a variety of cases with some emphasis on mild- to- moderate depression, anxiety, and/or alcohol/substance misuse, which are potentially co-morbid with health problems such as diabetes, chronic pain, and obesity. Opportunities exist for interns to (1) conduct diagnostic assessments for walk-in and/or scheduled patients referred by their primary care providers, (2) conduct short-term, brief individual therapy (typically cognitive-behavioral or solution focused) with the aim of transferring patients’ care to their primary care providers as appropriate, (3) develop and/or co-facilitate various behavioral medicine psychotherapy groups (including interactive psychoeducational or cognitive-behavioral groups with a focus on anxiety, depression, and healthy lifestyles), and (4) collaborate with other professionals within primary care including mental health and general practice providers. Opportunities also exist for the intern to participate in program evaluation as well as ongoing education efforts for primary care providers regarding mental health services.
Psychosocial Rehabilitation and Recovery Center (PRRC)
Interns on this rotation will have the opportunity to learn how to deliver recovery-oriented services to a population with serious mental illness. Interns will learn the basics of psychiatric rehabilitation that focuses on helping Veterans achieve self-identified goals for recovery, better psychosocial functioning, and greater integration in their communities. Interns will conduct screening assessments that focus on helping Veterans identify recovery goals, individual recovery coaching sessions to help them problem solve around goal achievement, and psychoeducational and skills-based groups, such as Social Skills Training for Schizophrenia, Illness Management & Recovery, and Wellness Recovery Action Plan development.
Primary Care Mental Health Integration / Health Services Research
This rotation is designed to provide interested interns and fellows with applied research and clinical training opportunities in the area of primary care mental health and medical psychology (the application of psychological principles to medically ill patient populations).
Interns electing this rotation will largely serve in the capacity of a research clinician with experiences ranging from the provision of direct clinical service (e.g. individual psychotherapy within the context of externally funded clinical research protocols), project oversight/design, patient recruitment, data management, and preparation of scientific manuscripts. Because interns will vary in their exposure and comfort with research, rotation goals and expectations will be based upon each student's individual interests and ongoing professional development. Although interns will be provided with authorship on submitted manuscripts, publications are not required for successful completion of the rotation.
The primary research emphasis for this rotation is on improving mental health care for depressed and/or anxious chronically ill patients. Current research projects range from observational studies (the prevalence and impact of mental health factors in chronic medical conditions) to manual-based psychotherapy intervention trials for Veterans with chronic medical conditions. Past projects have also included studies of mental health care in the VA specifically related to acute care for depression and adequacy of psychotherapy exposure in integrated health care settings.
General Mental Health Clinic – Posttraumatic Stress Disorder/Substance Use Disorder treatment
This rotation focuses on integrated dual diagnosis treatment of substance use problems and PTSD. Interns will have the opportunity to participate in group and individual therapy on inpatient and outpatient settings, working with clients in a variety of age groups, combat eras, and stages of change regarding substance use. Patients seen will be part of the general mental health clinic, PTSD clinical team, substance dependence treatment program, and inpatient treatment program for OEF/OIF veterans. Clinical experiences include Seeking Safety treatment, Acceptance and Commitment therapy, Motivational Interviewing, and other cognitive-behavioral interventions including more trauma-focused treatments. Interns can also be involved in case consultations and assessments.
Counseling Psychology/Vocational Rehabilitation Service
Counseling Psychology/ Vocational Rehabilitation includes 20 staff who are vocational rehabilitation counselors and a counseling psychologist. The program’s focus is on work restoration and the integration of veterans with psychiatric and physical disabilities to community employment. This is one of 169 sites nationwide that includes Compensated Work Therapy Supported Employment (CWT-SE). Supported Employment, an evidence based practice for people with SMI was implemented in 2005. Since then this has been expanded to veterans with traumatic brain injury (TBI), spinal cord injury (SCI) and homeless veterans.
Last year the ‘vocational unit’ worked with over 1100 Veterans with a daily census of about 250. 80% of Veterans have a substance use problem, 15% have other psychiatric disabilities including SMI and 5% have physical disabilities including TBI and SCI. Over 90% of the veterans in the work restoration programs are middle aged men. This is a diverse group of veterans and includes approx 60% African American, 35% White, and 5% Hispanic. The population is almost 100% urban with a large percent homeless (80%) and unemployed (98%). Trainees will participate in recovery and work restoration planning, group therapy, conducting didactic groups, individual counseling, and outreach activities in the community.
Substance Dependence Treatment Program
The Substance Dependence Treatment Program (SDTP) is an outpatient program which helps Veterans recovery from addictions to alcohol and drugs (primarily cocaine, but also opioid and marijuana). In addition to addictions, many Veterans receiving treatment in SDTP also struggle with homelessness, unemployment, other mental illnesses, and medical and legal problems. Veterans are assessed using the Brief Addictions Monitor at the outset of treatment and the SDTP is moving towards measurement-based care for addictions. The major treatment modality of SDTP is group-based education on early recovery and relapse prevention skills using the MATRIX model of the Substance Abuse and Mental Health Services administration (SAMSHA). Support groups and a variety of specialty groups (Sober Seniors, Grief Group, Smoking Cessation, Coping Skills, Sexual Addiction, and others) are also available. Depending on their particular schedule, Interns have the opportunity to serve as co-leaders, and possibly leaders, of various groups as well as gain experience in individual therapy, psychological assessment, breathalyzer testing, treatment planning, discharge planning, and interdisciplinary treatment team meetings within SDTP and with community partners. The main training goal is to increase interns' knowledge base and comfort level in assessing and treating substance use disorders.
General Mental Health Clinic
The General Mental Health Clinic is an outpatient clinic that provides care for patients experiencing affective, schizophrenic, psychotic, anxiety, adjustment, post-traumatic stress, personality, substance abuse and/or organic mental disorders. The treatment philosophy aims toward increasing interpersonal effectiveness and productiveness in the community. Psychological evaluations are done whenever appropriate, usually to assist staff with treatment goals and diagnostic clarification for difficult cases, and may include training in and use of the Rorschach, Exner system. Other duties include: conducting psychotherapy groups (for patients with thought disorders, affective disorders, and/or a women’s group) and psycho-educational groups (stress management, affective disorders education, and/or coping skills for affective disorders with a major cognitive therapy component); providing individual / couples / family psychotherapy, as time, interest and need dictate; participating in multidisciplinary team staffings; completing psychosocial assessments; and referring to and consulting with other staff and service providers.
Women's Inpatient Specialty Evaluation & Recovery Program (WISER)
The Women’s Inpatient Specialty Environment of Recovery (WISER) rotation will provide psychology interns with a unique opportunity to work with women Veterans in a trauma-informed, intensive 4-week long inpatient program.. WISER provides comprehensive evaluation and intensive specialized treatment using evidence-based treatments, such as, Dialectical Behavior Therapy Skills, Cognitive Processing Therapy, and Seeking Safety. The intern will participate in the co-creation of the rotation goals. Interns have the opportunity to: attend treatment team rounds (multidisciplinary meeting with each individual patient on the unit lasting approximately 1.5 hours); co-facilitate and potentially lead a 1.5 hour process group each day; conduct individual psychotherapy specific to the individualized treatment plan of the Veteran; conduct and interpret psychological evaluations(mini-reports); participate in other evidence-based groups such as Cognitive Processing Therapy, Seeking Safety, and DBT; and participate in research with IRB approved protocols for evaluation of clinical outcomes.
General Mental Health Clinic - Family Therapy
Family involvement is an important focus of mental health care within the VA. Trainees will have several opportunities to develop their skills with Veterans and their families as part of this rotation. This rotation provides supervision in Family Therapy and Family Consultation for patients with chronic and serious mental illness and their families. Behavioral Family Therapy is a structured approach to working with these families and consists of 5 components: engagement of the family; assessment; education; communication skills training and special problems. Family Consultation provides education about mental illness, support, advocacy, advice, skills training and referral to mental health resources, depending on the needs of the family. Trainees will also have the opportunity to engage in time limited, problem focused individual therapy and work within a multidisciplinary environment.
General Mental Health Clinic
The General Mental Health Clinic (GMHC) is a continuous care program that provides services to Veterans with affective, psychotic, anxiety, and cognitive disorders. GMHC has several components, including general outpatient services, Mental Health Intensive Case Management (MHICM), Family Psychoeducation (FPE), and Dialectical Behavior Therapy (DBT). A major goal of the programs in GMHC is to help Veterans achieve the highest possible level of functioning, productivity, independence, interpersonal effectiveness, and overall satisfaction with life. Respect for individuals is greatly emphasized. Interns will have the opportunity to be a part of a cohesive interdisciplinary treatment team, which includes psychiatry, psychology, social work, and nursing. 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 are also available.
Polytrauma Network Site
The neuropsychology service in the Polytrauma Network Site primarily provides outpatient assessment and treatment to Veterans with polytrauma from Operation Enduring Freedom/Operation Iraqi Freedom. These active duty soldiers and Veterans are typically in the post-acute stage of recovery from brain injury and often have suffered other injuries. Assessment and treatment of the polytrauma survivors entails monitoring cognitive functioning through neuropsychological assessment, improving cognitive functioning and maximizing independence through individual and group therapies, and facilitating psychological adjustment of the patients and caregivers through psycho-educational sessions. Consults are also routinely received from general inpatient rehabilitation clinics. Neuropsychological evaluation in this context is typically requested to assess competency and to make recommendations regarding assistance and supervision for older adult Veterans recovering from stroke or other acquired brain injuries. This is a rotation where the emphasis is on teaching the basics of neuropsychological assessment (including interviewing, test selection, test administration, interpretation of data, etc) and exposure to different neurological/psychiatric populations. Test selection is hypothesis driven and findings are compared to normative data and interpreted within an information processing framework. It is understood that trainees have varying degrees of assessment experience and exposure to neurological populations and every effort will be made to individually tailor each training experience. The experiences of trainees on this rotation may vary considerably depending on their familiarity with neuropsychological testing, availability, and goals. In general, it is expected that trainees will become reasonably proficient in administering, scoring, and interpreting test results within a neuropsychological framework by the end of the rotation. Trainees will also learn about the cognitive sequelae following brain damage, especially traumatic brain injury and stroke, and will become adept at using this knowledge to make functional recommendations and to educate the patients and their families. Trainees will also be expected to attend and to actively participate in neuropsychology seminars. Trainees may have the opportunity to work with extern students and to work under the guidance of the neuropsychology post-doctoral fellows.
TBI Center Of Excellence Research
The Traumatic Brain Injury Center of Excellence (TBI COE) is a grant-funded research center that was awarded to the Michael E. DeBakey VA Medical Center in 2009 by the VA Office of Research and Development. The TBI COE is comprised of multiple administrative cores and research pilots. The mission of the TBI COE is to clearly characterize outcome following blast-related mild TBI in returning Veterans and to identify the biopsychosocial variables that influence outcome, with the ultimate goal of developing empirically based interventions to facilitate community re-entry. Researchers supported by the TBI COE are currently using cognitive and behavioral assessment, structural and functional neuroimaging techniques, genetics, and virtual reality environments to assess and treat returning Veterans with a history of mild TBI. The TBI COE also has a mechanism to review applications for pilot funding for proposed projects consistent with the mission of the COE. Outreach efforts to be implemented by the TBI COE will serve to educate Veterans and the community about the effects of traumatic brain injury and to encourage Veterans to participate in traumatic brain injury services and research through the MEDVAMC. Dr. Pastorek serves as the co-director of the Behavioral Assessment Core. The purpose of this core is to collect cognitive and behavioral data on all participants. This data will be used by the Behavioral Assessment Core to fully characterize the participants through descriptive and correlational statistics, and to provide supplemental information to all other research pilots associated with the TBI COE. The experiences of trainees on this rotation may vary considerably depending on their familiarity with neuropsychological testing and other data acquisition techniques being used by the TBI COE, their availability, and their goals. In general, it is expected that trainees will become proficient in administering and scoring the behavioral and cognitive measures included in the Behavioral Assessment Core research protocol. Trainees will also learn about the cognitive sequelae following combat-related mild TBI. The ultimate goal of this research rotation is for the trainee to develop a research project (most likely within the confines of data currently be collected) and to develop a product by the end of their rotation. Depending on the trainee, the research product may include authorship on one or more abstracts or peer reviewed manuscripts.
Integrated Primary Care-Mental Health Rotation
This rotation allows interns the chance to assess and provide brief clinical services to a variety of Veterans based out of the primary care clinics (specifically Clinic 1). Trainees would be presented with a variety of cases with some emphasis on mild- to- moderate depression and/or anxiety that are potentially co-morbid with health problems such as diabetes, chronic pain, and obesity. Opportunities exist for interns to co-facilitate different behavioral medicine groups (including support and psychoeducational groups with a focus on coping with a variety of medical problems), conduct individual therapy, and collaborate with other professionals within primary care including mental health and general practice providers. One of the more unique aspects of this rotation is the focus on learning and implementing brief therapy, for instance, solution-focused therapy. The day/time for this 16 hour rotation can be flexible, but the primary supervisor spends half-time in compensation and pension. This rotation does not include experiences in compensation and pension. Flexibility depends upon the level of knowledge and independence for the trainee, although supervision is generally provided in a mentoring atmosphere with more independence coming later in the rotation.
Primary Care - Mental Health Integration, with special emphasis on Infectious Diseases
Primary Care-Mental Health Integration (PCMHI) program is an outpatient clinic designed to support primary care providers in identifying and treating patients with sub-clinical to moderate mental health diagnoses. Mental health services are delivered and embedded in the context of primary care clinics to allow for increased access to services, reduce stigma for services, and facilitate smooth linkages with specialty services as needed. The Fellow will be embedded in the Infectious Disease clinics, with a focus on co-morbid emotional and addictive disorders for persons diagnosed with HIV and Hepatitis C. The Fellow will have an opportunity to participate in all levels of treatment, including individual therapy, group therapy (support and psychoeducational), behavioral medicine classes, assessment, treatment planning, program development, and interdisciplinary treatment team meetings.
Acute Recovery Treatment Environment (ARTE) Inpatient Rotation
The Acute Recovery Treatment Environment (ARTE) Inpatient Rotation provides psychology interns exciting opportunities to develop professional skills on the MEDVAMC's primary, 32-bed acute psychiatric specialty unit. During Veteran hospitalization, the primary aims of the unit are to foster and support recovery journeys and to assist Veterans with successful, safe transition to outpatient services. The ARTE inpatient rotation offers trainees opportunities to engage in a variety of ongoing treatment and administrative activities related to delivery of evidence- and recovery-based services to Veterans on the ARTE unit. Clinical responsibilities include involvement in a multi-disciplinary team, treatment planning, development of recovery-based case conceptualization, best practice staff-Veteran interactions, and evidence-based group psychotherapy [e.g., SAMHSA toolkit implementation, CBT for psychosis (CBTp), DBT Skills, and Family Education, Social Skills Training, and Cognitive Rehabilitation]. Clinical opportunities include behavioral assessment, aggression prevention, team feedback, as well as individual psychotherapy consistent with the Veterans' individualized treatment plans and recovery objectives. Additional opportunities include assessment to support decision-making/track Veteran progress, Care Monitoring Meetings, and examination of relevant peer-reviewed literature to improve practices.
Clinical Research in Late-life Anxiety
A rotation is offered through the Houston Health Services Research and Development Center of Excellence that focuses on clinical research in late-life anxiety. Opportunities are available to participate in ongoing studies addressing the cognitive behavioral treatment (CBT) of generalized anxiety disorder (GAD) in older, primary care patients, the treatment of anxiety in patients with dementia, and the treatment of worry and anxiety in underserved, low income communities. The latter project offers participants the opportunity to integrate religion and/or spirituality into CBT. Training experiences can include participation in study recruitment, structured diagnostic and cognitive assessments, protocol-based treatment, data analysis, manuscript preparation, and grant writing. In addition to supervision provided by a licensed psychologist, supervision will also be available within a multi-disciplinary team including psychiatrists (Dr. Kunik), social workers (Ms. Wilson), biostatisticians (Drs. Rhoades, Khan), and internists (Drs. Masozera, Williams, Horsfield). Participants are from the MEDVAMC, Baylor clinics, and the community.
Compensation and Pension
Compensation and pension (C&P) examinations are conducted at the request of the Veteran’s Benefits Administration (VBA) to provide information that assists the local VA Regional Office in making rating decisions regarding veterans’ disability compensation and pension claims. Mental health C&P examination requests typically involve (1) determining if veterans currently meet DSM-IV criteria for a mental disorder and (2) ascertaining if their current mental disorder is a result of or is aggravated by their active military service and/or medical problems related to their active military service. Occasionally, examiners are requested to conduct competency exams to determine whether veterans are able to manage VA funds in their own best interest.
Dialectical Behavior Therapy
Trainees involved in this rotation will have an opportunity to participate in a DBT program for Veterans in the Mental Health Care Line. Patients in this program either meet full criteria for Borderline Personality Disorder or have significant problems in emotional and behavioral regulation, including self-harm behavior, frequent hospitalizations, or high utilization of crisis services. The DBT program consists of individual therapy, skills group, phone coaching, and team consultation meetings. Depending on the length of the rotation and level of experience, trainees can be involved in some or all of those treatment modalities. Trainees can also become involved in assessments and program evaluation.
Clinical Research in Posttraumatic Stress Disorder and Comorbid Anxiety Disorders
This rotation provides a number of opportunities for interns to learn more about assessment, time-limited individual and group psychotherapy, and clinical research. Diagnostic clinical interviewing using standardized structured interviews such as the Structured Clinical Interview for DSM-IV (SCID), Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV), and Clinician Administered PTSD Scale (CAPS) is emphasized. Interns interested in applied clinical research will also have the opportunity to become involved in treatment outcome research that involves innovative methods of delivering cognitive behavioral therapy. Additional experiences in providing trauma-focused therapy using evidence-based approaches (e.g., Prolonged Exposure Therapy, Multiple Channel Exposure Therapy) are also available. Administrative experiences are also available in conducting program evaluation and participating in the management and organization of the Psychology Training Program.
Posttraumatic Stress Disorder (PTSD) Clinical Team
This rotation affords the opportunity to work in a specialized assessment, consultation, and treatment program designed to address psychological trauma (e.g., combat trauma, military sexual trauma) in Veterans of all eras in an outpatient setting. The rotation offers a focus on evidence-based psychotherapy, including prolonged exposure therapy and cognitive processing therapy (applied in both group and individual psychotherapy formats) within the context of a multidisciplinary treatment team. In addition, trainees may choose to participate in a clinical demonstration project using a manualized meditation intervention compared to PTSD education in the treatment of PTSD. Other opportunities may include cognitive-behavioral treatment of PTSD-related insomnia, coping skills, assessment/treatment planning, program development, and related research projects.
General Mental Health Clinic – Geriatric and Health Emphasis
This rotation allows interns to gain a wide variety of clinical experiences with a diverse group of Veterans, primarily in an outpatient setting. Opportunities exist to work with high-functioning Veterans having a wide variety of presenting problems, including complicated bereavement, relationship/marital conflict, adjustment to major medical problems and life-threatening illnesses, recurrent major depression, PTSD, and other anxiety / mood disorders. Clinical experiences include learning/utilizing the Acceptance and Commitment Therapy (ACT) model; providing individual psychotherapy and couple's counseling; facilitating or co-facilitating specialized therapy groups; coordinating treatment plans and care with other mental health providers; occasionally conducting psychosocial assessments, psychological evaluations, and brief neuropsychological screenings for dementia; and teaching a skills course or psychoeducational class (if desired).
Returning OEF/OIF Veterans Environment of Recovery Program (ROVER)
This 4-month rotation will provide psychology interns with a unique opportunity to work with male combat Veterans from the OEF/OIF era in a trauma-informed, intensive 4-week long inpatient program. This program will provide comprehensive evaluation and intensive specialized treatment using evidence-based treatments, such as, Dialectical Behavior Therapy Skills, Cognitive Processing Therapy, and Seeking Safety. ROVER Veterans typically have a diagnosis of PTSD, substance abuse (SUD), interpersonal difficulties and/or personality disorder. The intern can co-create the rotation goals. Interns will have the opportunity to: Attend Treatment Team Rounds (multidisciplinary meeting with each individual patient on the unit lasting approximately 2 hours); Participate in Treatment Team staffing where patient applications are reviewed for acceptance into the program; Co-facilitate and potentially lead a 1.5 hour process group each day; Conduct individual psychotherapy specific to the individualized treatment plan of the Veteran; Conduct and interpret psychological evaluations (mini-reports); Attend Patient Care Monitoring (Wednesday only); Participate in other evidence-based groups such as Cognitive Processing Therapy, Seeking Safety, and DBT; and participate in research opportunities with protocols for post-treatment evaluation.
General Mental Health Clinic – Motivational Interviewing; Treatment of Substance Use Disorders, Depression, and Anxiety
This rotation provides opportunities for trainees to learn Motivational Interviewing and cognitive behavioral treatment approaches for depression, anxiety, and insomnia. Trainees may participate in diagnostic interviews and treatment planning. Interns will also have the opportunity to co-facilitate psychotherapy groups, with the goal being for interns to eventually lead portions of the group sessions. Individual psychotherapy cases may also be available. Training in Motivational Interviewing will also be available for interns interested in expanding their MI skills.
This rotation involves training experiences in assessment and treatment for Veterans experiencing chronic pain. Direct involvements with a broad range of Veteran characteristics and pain etiologies will be assured. The trainee will gain experience in both individual and group assessment and intervention, including participation as co-leader in regular groups such as Initial Assessment for Pain Clinic, Fibromyalgia, Complex Pain Conditions, “Alumni Pain/Coping Lab” (i.e., for Veterans who have already participated in introductory level education and groups). An important facet of this training rotation involves regular interaction and treatment planning with a variety of disciplines and care line staff outside as well as inside Mental Health, including Anesthesia Pain Clinic and Physical Medicine & Rehabilitation. The rotation will offer education and exposure to ongoing developments in chronic pain assessment and treatment following the Stepped Care Model at regional and national VHA levels. In addition, the MH PC Complex Chronic Pain Program is committed to continual evidence-based development, expansion and improvement efforts. This affords options within rotations for significant training involvements in administrative and program development and evaluation activities related to chronic pain services and service delivery.
Posttraumatic Stress Disorder (PTSD) Clinical Team
This rotation emphasizes the challenge of leading group therapy with patients suffering from PTSD, depression, and various personality disorders. Interns conduct individual therapy sessions with video-taped supervision, lead an outpatient psychotherapy/support group for older Veterans, co-lead psychodynamic process groups, conduct personality assessments learning to use the MMPI as a map of personality, and participate in the activities of the TRP treatment team. The experience focuses on helping interns learn how to successfully treat patients with PTSD and characterological disorders using short-term, intensive and process/object relations group and individual therapy. The rotation also focuses on the inevitable professional developmental stages that accompany the internship period and moves the intern toward a confident professional identity.
Health Psychology Rotation
This rotation allows interns the chance to participate in the assessment and treatment of behavioral medicine cases (pre-surgical evaluation for bariatric surgery, and liver, bone marrow and other transplants; development of behavioral contracts; and treatment to prepare patients to receive other medical interventions) as required. Opportunities exist for interns to conduct individual therapy, and collaborate with other professionals within medical and /or psychiatric teams. One of the more unique aspects of this rotation is the focus on learning and implementing brief, problem focused therapies in an integrated care context. Opportunities also exist for the trainee to participate in on-going research. Specific projects will be determined on an individual basis related to trainee skills and interests as well as the needs of the PC MH program. The day/time for this 8-16 hour rotation can be flexible but must include Friday if the trainee is interested in working with transplant patients. The rotation supervisor is the Associate Director for the General Mental Health clinic but also sits on the Health Promotion Disease Prevention and Cancer Committees as well as the Liver Transplant -Medical Review Board. However, flexibility depends upon the level of knowledge and independence of the trainee. Supervision is generally provided in a mentoring atmosphere with more independence coming later in the rotation.
Parkinson’s Disease Research Education and Clinical Center (PADRECC)-Neuropsychology
The Parkinson’s Disease Research Education and Clinical Center (PADRECC) is one of 6 centers of excellence across the United States for the treatment of Parkinson's disease and other movement disorders. The Neuropsychology service in the PADRECC receives consultation through the three Movement disorder neurologists. The referrals are for differential diagnosis of dementia and to determine surgical candidacy for deep brain stimulation surgery for the treatment of essential tremor or Parkinson’s disease. There may be opportunities to collaborate on research projects In this rotation some experience with Neuropsychological assessment is a requirement due to the specific nature of the patient population being assessed. There is an opportunity for trainees to observe neurological evaluations for movement disorder patients, observe a deep brain stimulation surgery, and participate in interdisciplinary team meetings. Trainees will also be expected to attend and to actively participate in neuropsychology seminars.