For Interns and Fellows
Psychology Doctoral Internship Program Supervision, Rotations and Stipend
Sharp HealthCare's APA-accredited psychology doctoral internship in clinical psychology provides psychologists-in-training with a yearlong, in-depth training experience.
Interns play important roles as team members, participating alongside nurses, recreation therapists, social workers and physicians in the coordination of treatment for patients. In addition to direct delivery of service, interns assume active roles as team leaders and to contribute to ongoing program development. Interns are seen as the face of psychology and are highly regarded team members who shoulder important responsibilities.
Interns are encouraged to mutually support one another. The form of this support, of course, depends on the needs and desires of the interns. In addition to spending time on the units, interns share office space, so daily contact with other interns is the norm. Interns work 40+ hours per week at the hospital and are not to have additional outside employment. The faculty place strong value on work-life balance and self-care, and every effort is made to keep average work hours in a comfortable range.
However, interns should anticipate that assigned and elective reading, preparation for case presentations, spikes in assessment referrals and special or elective projects sometimes require interns (and faculty) to work more than a 40-hour week. Typical range is between 40 and 49 hours.
During the course of the year, each intern rotates through three of seven specialty programs. The training program on each rotation was designed by the psychologist(s) who provide(s) service in or manage a given program. We have two child/adolescent rotations, three adult rotations and two gero rotations.
At the beginning of each of the three rotations (R1, R2, R3), interns complete a Self-Assessment of Competency in Clinical Psychology (SA) and review it with their primary rotation supervisors. The relevant Rotation-Specific Training Plan (RTSP) is discussed at the outset of R1, R2 and R3, and modifications are made to reflect the special interests and developmental needs of the intern. This personalized approach allows each intern the maximum benefit of training on any given rotation. While each intern receives a minimum of one hour per week of scheduled, face-to-face, individual supervision with their rotation supervisor, daily contact and feedback with the rotation supervisor is the norm.
Interns also meet weekly with the training director for one hour of individual supervision as well as one hour of group supervision. Psychodiagnostic and assessment supervision occurs both within the rotations as well as in weekly seminar/group supervision with the adult/gero psychodiagnostic assessment supervisor. Weekly individual and group supervision ranges from four to seven hours per week.
At the midpoint and end of each rotation, interns receive formal feedback and evaluation from their primary supervisors. This evaluation (and the intern self-assessment) is tied to training goals in eight domains, consistent with the curriculum recommended by the APA Commission on Accreditation. Those goals are:
- Professional conduct, ethics and legal matters
- Individual and cultural diversity
- Theories and methods of psychological diagnosis and assessment
- Theories and methods of effective psychotherapeutic intervention
- Scholarly inquiry and application of current scientific knowledge to practice
- Professional consultation and supervision
- Theories and methods of evaluation (program and patient)
Rotations for 2014-15 training year.
- Children and adolescents (inpatient): Child and Adolescent Program (locked inpatient unit), supervised by Kristin Steele, PsyD, and Alisha Carpenter, PhD
- Children and adolescents (outpatient): Child and Adolescent Program (Intensive Outpatient Program/IOP and Partial Hospitalization Program/PHP), supervised by Jennifer McWaters, PsyD, and Jennifer Wojciechowski, PhD
- Adults (inpatient): Adult Services (locked and open adult inpatient unit), supervised by Thomas Lee, PsyD
- Adults (outpatient): Cog-IOP (Intensive Outpatient Program), supervised by Kiandra Hebert, PhD
- Adults/CD (residential and outpatient): Sharp McDonald Center (chemical dependency, residential, IOP and PHP), supervised by Larkin Hoyt, PsyD
- Older adults (inpatient): Older Adult Program (locked inpatient unit), supervised by Lynn Northrop, PhD
- Older adults (outpatient): Senior Intensive Outpatient Program, supervised by Dara Schwartz, PsyD
- Psychological assessment: all interns perform assessment throughout the year across rotations, supervised by Mary Beth Bryan, PhD (adult/gero), Kristine Steele, PsyD (child/adolescent), Jennifer McWaters, PsyD, and Jennifer Wojciechowski (PhD)
Working alongside staff psychologists creates a rich and rewarding experience for interns, and is the norm on our rotations. Several of our treatment programs involve a group co-therapy (two therapist) model. On all units, interns are in regular contact with their rotation supervisors and are mentored by these psychologists and other clinicians on the team. On the Senior and Cognitive Intensive Outpatient Program rotations, interns also have regular contact with postdoctoral fellows who are receiving advanced training in clinical psychology (cog/DBT or Gero focus).
Rotations span the developmental age range. There are three main populations: Child/Adolescent, Adult and Geropsychology. Each of these populations has an inpatient rotation as well as an outpatient rotation.
Child and adolescent rotations.
Child and Adolescent Program (Inpatient)
On the third floor of the Sharp Mesa Vista Hospital Pavilion Building, you will find the 21-bed Child and Adolescent Program (CAP3). CAP3 is divided into two patient treatment programs: An adolescent intensive care unit, treating acutely disturbed adolescents and dual-diagnosis youth, and a program for children ages 5 through 12. CAP treats youth who are experiencing impairment in their family, school or health functioning as a result of psychiatric illness. Typical presenting problems include depression/suicidality, runaway/conduct disorders, substance abuse/dependence, mood disturbance/behavioral disturbance/bipolar and/or the acute phase of a psychotic disorder.
The primary goals of the CAP3 rotation are to familiarize interns with the developmental tasks and issues facing youngsters as well as how psychopathology becomes interwoven with such developmental issues. In the context of a shorter stay and the increasing severity of patients' disturbances, interns learn how to set appropriate acute-care treatment goals and disposition planning and learn how to use the program milieu to achieve these goals. Family work (single and multifamily sessions) is a critical component of treatment. Work is fast paced, exciting and high demand. Interns on this rotation are expected to multitask and have balance.
Clinical issues with which interns will gain didactic and clinical experiences are:
- Case management skills
- Chemical dependency treatment with dually diagnosed adolescents
- Cognitive-behavioral treatment with youth
- Crisis intervention with youth and families
- Developmental tasks of youth
- Group psychotherapy with adolescents and latency age children
- Inpatient management of acutely disturbed youth
- Multidisciplinary team approach
- Psychopathology of youth
CAP3 strongly emphasizes a team approach in which psychologists, psychiatrists, nursing staff, social workers, activity therapists, teachers, consulting staff, the patient and the patient's family work together on treatment goals. Interns become an integral part of the treatment team during the rotation. Interns serve as co-therapists in a variety of groups, serve as a liaison between staff and consulting psychologists and participate in treatment planning and treatment conferences, attend team meetings and in-service presentations and provide informal consultation to other staff.
Child and Adolescent Program (Outpatient)
Child and Adolescent Outpatient Programs are also housed in the Pavilion Building at Sharp Mesa Vista. The CAP Outpatient intern will primarily participate in our Adolescent Partial Hospitalization Program (A PHP) and Changes Dual Diagnosis Intensive Outpatient Program. The intern will also have the opportunity to gain some experience in our Child Partial Hospitalization Program and Adolescent Cognitive Intensive Outpatient Program.
A PHP provides an arena for adolescents to receive treatment for family mental health and chemical dependency issues. It is a five-day per week, eight-hour per day program where participants receive therapeutic intervention, as well as attend school at the hospital. The program is used as an alternative to hospitalization, as a step-down program from an inpatient level of care, as well as for triage and assessment. While in treatment, patients receive, among other things, cognitively and behaviorally oriented group psychotherapy, individualized psychoeducational instruction (e.g., anger management, impulse control, self-esteem work), substance abuse intervention, family therapy and multi-family group therapy.
The Changes Dual Diagnosis Intensive Outpatient Program (Changes IOP) is designed to help chemically dependent or substance abusing teens who may also be struggling with a mental health concern. Teens develop positive behaviors through recovery-oriented groups, educational and therapeutic activities and 12-step self-help groups. Family involvement is crucial for treatment and includes parent education and group family therapy.
Psychology interns participate in a wide variety of activities, with the aim of teaching them about developmental issues, the nature of adolescent psychopathology and how the two interact. Clinical issues with which interns gain didactic and clinical experiences include:
- Chemical dependency treatment with dually diagnosed adolescents
- Cognitive-behavioral therapy
- Developmental tasks of adolescents
- Family systems theory
- Family therapy
- Group psychotherapy with adolescents
- Psychopathology of adolescents
Adult Services (Inpatient)
Adult Services — with both open and locked inpatient units — is designed for patients 18 years and older who are experiencing an acute phase of a psychiatric disorder. All Sharp Mesa Vista programs are heavily influenced by the Recovery Model. Working closely with an experienced psychologist, interns provide evidence-based (primarily CBT) psychoeducation, group therapy, one-to-one interventions and skill development for patients experiencing severe and sometimes chronic mood, thought, personality and other disorders.
The Adult Services rotation provides clinical experience in the evidence-based treatment of patients across a broad spectrum of age and diagnoses, including psychiatric and substance abuse disorders. The primary goals of this rotation are to develop the intern's ability to assess adults and establish individualized, empirically informed treatment approaches for psychiatric inpatients. Interventions may be executed directly - as in the case with group therapy — or through indirect means — as in the case of treatment and discharge planning conferences. The intern is an active participant in team meetings and is involved in staff consultation and program development.
Given short hospital length-of-stay, interns are faced with rapid assessments of patients and formulation of effective interventions to stabilize disequilibrium. By the end of the rotation, interns should be able to efficiently assess a patient with regard to differential diagnosis and with regard to particular strengths and weaknesses. Additionally, interns should be capable of developing and leading a multidisciplinary team approach to treatment, working in conjunction with psychiatrists, social workers, nursing staff and activity therapy specialists.
During the rotation the interns will be offered educational and clinical experiences in the following areas:
- Adult psychopathology assessment/diagnosis and treatment
- Behavior modification
- Brief crisis treatment of individuals, couples and/or families in conjunction with their assigned case managers
- Electroconvulsive treatment (ECT)
- Group therapy process
- Multidisciplinary treatment team approach
- Seclusion and restraint issues
Cognitive-Intensive Outpatient Program (Outpatient)
Sharp Mesa Vista Hospital offers a Cognitive Intensive Outpatient Program (COG-IOP) for high functioning patients whose symptoms are not severe enough to require hospitalization, but who need more structured and intensive treatment than general outpatient therapy can provide. Patients may be admitted directly into Cog-IOP, or it can be used as a step-down program from inpatient care to facilitate the patient's transition back into the community. This program has been designed to use the principles of cognitive therapy in the treatment of depression, anxiety, panic and/or post-traumatic states as well as co-morbid personality disorders. All groups use a co-therapist model. Case conceptualization and intervention in this program is heavily influenced by the work of Aaron Beck and Jeffrey Young, among others. The team includes psychologists, psychiatrists, psychiatric nurses and social workers.
The goals of this rotation are to familiarize interns with the principles of cognitive therapy and to provide them with experience in applying these principles to a population with both mood, anxiety, thought and (co-morbid) personality disorders. This is achieved through participation in group therapy, education groups, clinical team meetings and supervision. There may also be opportunities for interns to participate in couples or family sessions. Some interns participate in Cog-IOP's sister program — the Dialectical Behavioral Therapy-Intensive Outpatient Program (DBT-IOP) where there is also a Postdoctoral Fellow on the rotation. Upon completion of the Cog-IOP rotation, interns are expected to be able to conceptualize patients from a cognitive perspective, co-facilitate cognitive group therapy and clearly present educational material on a variety of topics related to cognitive therapy for depression and anxiety.
Clinical issues with which interns will gain didactic and clinical experiences are:
- Assessment of suicide risk
- Cognitive group therapy
- Cognitive model of psychopathology
- Cognitive therapy for anxiety and panic
- Cognitive therapy for depression
- Cognitive therapy for personality disorders
- Interpersonal processes in cognitive therapy
- Multidisciplinary team approach
- Schema-focused therapy
Sharp McDonald Center — Chemical Dependency Recovery Hospital
Sharp McDonald Center provides comprehensive, evidence-based treatment to chemically dependent adults. It is San Diego's only freestanding fully Joint Commission-accredited chemical dependency recovery hospital. All programs are operated out of two buildings and include, at present, three distinct programs that have areas of integration, including medical detoxification/residential, partial hospitalization and intensive outpatient programming.
The treatments provided are evidence-based interventions for individuals with chemical dependency diagnoses. The therapeutic services are designed to serve those who are not so at risk that they require an acute medical or psychiatric hospital stay. The programs are geared to treat patients who are able to function in a subacute inpatient setting, partial-hospitalization program or intensive outpatient program.
All programs are abstinence-based and are designed to facilitate sober living skills requiring these adults to take more responsibility for self-maintenance and maintenance of their environment than could be expected from the more traditional acute population. Sharp McDonald Center provides therapeutic programming seven days a week to provide continuity of care and to maximize clinical gains.
Clinical issues with which interns will gain didactic and experiential understanding include:
- Behavior-based interventions/preventions
- Cognitive behavioral group therapy
- Comprehensive psychosocial assessment and treatment planning
- Discharge planning
- Exposure to patient placement guidelines for the American Society of Addiction Medicine (ASAM) and Utilization Review
- Family therapy
- Individual therapy
- Participation in research opportunities?
Although the Sharp McDonald Center is our newest rotation at Sharp HealthCare, interns have quickly become an integral aspect of the treatment team. They work side-by-side with experienced chemical dependency professionals from several disciplines (postdoctoral therapists, LCSW, MFT, CADAC, psychiatry, etc.) in supporting patients in their recovery. Interns provide group therapy serving all patients in the inpatient program and carry a caseload of three to five patients. Interns provide psychotherapy, comprehensive case management and utilization review, family therapy, couples sessions, etc. They have the opportunity to follow patients from inpatient detox through outpatient treatment. The average length of stay for a patient is approximately 23 days, which includes participation in the partial hospitalization program. In addition, Sharp McDonald Center interns have the unique experience of being supervised by a psychologist who is also the primary administrator. Thus, they receive invaluable exposure and experience in the regulatory, program development/evaluation, staff development and other administrative/leadership domains.
Sharp is proud to be one of only a few non-VA, APA-accredited doctoral psychology internships in the U.S. that offers multiple geropsychology rotations. Our clinical practice and training programs are in line with the philosophy and recommendations set forth in the APA Guidelines for Psychological Practice with Older Adults and the Pikes Peak Model. Our gero supervisors have advanced specialty training in geropsychology and are actively involved in the local and national geropsychology community.
Older Adult Program — Inpatient
This is an exciting time on the Older Adult Program (OAP). The unit is poised to move to a new home in the Pavilion Building at Sharp Mesa Vista in the fall of 2014 and will nearly double in size at that time - going from 13 to 24 beds. Sharp is committed to meeting the needs of the rapidly expanding senior population in San Diego County and this unit expansion is just part of that commitment.
The OAP interdisciplinary team is second to none in their ability to work together to compassionately and effectively meet the bio-psycho-social needs of older adults with severe mental health problems. Psychology, social work, recreation therapy, nutrition, pharmacy, nursing and psychiatry are members of the core team, and physical therapy, music therapy, chaplaincy and internal medicine are involved as well. Expanded strategic development, staff training and program development is already underway so that the new OAP will be even more impressive than the current program.
The OAP intern is an integral member of the interdisciplinary team, serving shoulder to shoulder with the staff psychologist, and indeed serving as the primary face of psychology at times. The intern leads/co-leads a process/coping skills group on the unit every day and carries an individual caseload of one to five patients, depending on patient need. Interns are also routinely involved in leading interdisciplinary behavioral interventions, family education and support and brief cognitive assessments. Staff training and program development activities are an important part of the intern role. There is also time to simply spend in the milieu, and plenty of important clinical work occurs in these more informal interactions with patients and staff. The OAP is also home to a psychology graduate student practicum experience. Thus, the OAP intern has the opportunity to learn with and mentor a junior colleague.
Many OAP patients are admitted from home and others come from board and care, assisted living or skilled nursing facilities and are typically discharged to the same or higher level of care. Length of stay is typically one week to one month, though some patients stay more than a month. Most patients are hospitalized voluntarily, but some are there on a legal hold and/or under conservatorship. Many of our patients are discharged to our Senior Intensive Outpatient Program and there is some opportunity for interns to follow their individual therapy patients into the outpatient setting.
OAP interns gain didactic and clinical experiences in areas including:
- 72-hour and 14-day holds, conservatorships
- Capacity assessment
- Caregiver support
- Community reintegration
- Electroconvulsive treatment (ECT)
- Evidence-based, developmentally appropriate individual and group interventions (CBT, ACT, Life Review, Behavioral Activation, Bmod, etc.)
- Interdisciplinary team development
- Mood, anxiety, thought, neurocognitive, somatic, personality and substance use disorders in older adults
- Staff consultation and training
- Strategies to reduce relapse and readmission rates
- The Recovery Model and person-centered care
Senior Intensive Outpatient Program
The Senior Intensive Outpatient Program (SIOP) is one of the fastest growing programs at Sharp Mesa Vista. It has quadrupled the number of actively enrolled patients in the last several years, and continues to expand. The SIOP staff are at the forefront of helping the hospital meet the needs of a rapidly growing senior population.
The SIOP provides behavioral and cognitive behavioral group interventions, as well as case management, individual, couples and family sessions to support group work. Patients primarily present with severe mood disorders and/or anxiety disorders. Somatoform and Axis II disorders are also represented, as are thought disorders and mild cognitive impairment. Patients are triaged into the SIOP track that is the best fit for their presenting problems and level of functioning. Length of stay ranges from six weeks to six months or more. We begin "transition" or discharge planning with patients from their first day in the program.
The intern is an active, integral member of the interdisciplinary team. Under the supervision of the staff psychologist and the geropsychology postdoctoral fellow, the intern is involved in all aspects of the program.
The SIOP intern can expect to develop skills in:
- Adult development and aging
- Application of/adaptation of evidenced-based treatments for older adults (individual, group and family)
- Community outreach (building bridges with programs that serve/support older adults in the community)
- Community reintegration and Recovery Model
- Program development and evaluation
Adult and older adult assessment training.
Psychological Assessment (all interns, all year — not a separate rotation)
Psychodiagnostic and assessment skills are developed by assessing the hospital's inpatient, outpatient and partial hospital patients. In addition to full psychodiagnostic assessments, brief assessments using self-report measures — Personality Assessment Inventory (PAI), Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF), Million Scales, etc. — round out psychodiagnostic activities. The adult/gero psychodiagnostic supervisor provides a weekly psychodiagnostic seminar/group supervision that meets throughout the year. This seminar focuses on the development of assessment techniques through didactics and group supervision to all doctoral interns as well as practicum students.
The range of assessments also includes providing Neuropsychological Screening Examinations (not full batteries). Referrals come from many units where physicians are looking to rule out dementia and identify learning, attentional or autistic spectrum disorders. This area of training is intended to provide interns with a broad skills neuropsychological/cognitive screening. Testing typically involves assessment of a premorbid IQ, intellectual assessment and broad evaluation of memory (e.g., CVLT-2, and selected Wechsler Memory Scales), language, frontal/executive (Trails, Stroop), motor and some form of personality assessment such as the PAI, Rorshach or MMPI-2-RF. Neuropsych screenings and brief neuropsych assessments are performed with patients of all ages throughout the hospital. This is not a specialty rotation and interns seeking specialty training in neuropsychology are discouraged from applying to Sharp HealthCare for internship training.
Training in supervision.
In the 2014-15 training year we added an additional layer to our psychology training program. We have seven third- and fourth-year graduate students in psychology (from local APA-accredited programs) who spend an entire year here in clinical practice. Thus each of our seven interns has the opportunity to clinically supervise and mentor a junior colleague throughout the year. Training and supervision-in-supervision is now a formal part of doctoral intern training at Sharp. As we expected, this has become a rich and meaningful aspect of the training year for both interns and practicum students. And faculty report that training interns to supervise is resulting in faculty members' growth as supervisors as well. We will continue this new aspect of our training in 2015-16.
Interns receive 12 monthly stipends of $1,776.66. Interns are classified as "paid volunteers," not employees, and receive no employer-supported health insurance. However, an additional one-time stipend of $1,776.66, to be used only for health insurance, is provided at the outset of the training year. Thus, the total annual stipend is just over $23,000. This is a 10 percent increase over the 2013-14 stipend. Previous classes of interns have become quite adept at living in San Diego on this frugal income, and are happy to share housing and lifestyle tips to new interns after the APPIC match.
Interns receive 16 days of paid time off (including 6 holidays) plus 5 admin days that can be used for conferences, dissertation meetings and the like. They also are eligible for 5 days of extended sick leave in the case of illness or injury. Interns are welcome to eat one meal per day in the hospital cafeteria, free of charge.