Psychology Doctoral Internship 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.

Each intern rotates through four of eight settings/programs. The training program on each rotation was designed by one or more psychologists who either manage the specific program or provide service within that program. At Sharp, we have two child/adolescent rotations, two general adult rotations, two adult SUD 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 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 intern's special interests and developmental needs. 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 is the norm.

Interns meet weekly with the training director for one hour of individual supervision and one hour of group supervision. Psychodiagnostic and assessment supervision occurs both within the rotations and in weekly seminar/group supervision with assessment supervisors. This evaluation (and the intern self-assessment) is tied to training goals in eight domains:

• 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)

These goals are consistent with the curriculum recommended by the APA Commission on Accreditation.

Rotations and supervisors.

• Children and adolescents (inpatient): Child and Adolescent Program (locked inpatient unit), supervised by Kelsey Bradshaw, PhD, and Alisha Carpenter, PhD
• Children and adolescents (outpatient): Child and Adolescent Program (Intensive Outpatient Program/IOP and Partial Hospitalization Program/PHP), supervised by Stephanie Lord, PhD, and Jennifer Wojciechowski, PhD
• Adults (inpatient): ICU and general psych (locked adult inpatient unit), supervised by Vanessa Zimmerman, PsyD
• Adults (outpatient): Cog-IOP (Intensive Outpatient Program), supervised by Laura Thackray, PsyD
• Adults/SUD (residential, partial hospital and IOP: Sharp McDonald Center (residential and PHP), supervised by Eric van der Voort, PsyD
• Adults/SUD (outpatient): Sharp McDonald Center Intensive Outpatient Program, supervised by Kristin Steele, PsyD
• Senior Behavioral Unit (locked inpatient): supervised by Lynn Northrop, PhD
• Senior Intensive Outpatient Program: supervised by Amber Salvador, PsyD
• Psychological assessment: all interns perform assessment throughout the year across rotations; adult and geriatric assessments are supervised by Jan Estrellado, PhD, Mary Beth Bryan, PsyD, and Ashley Malooly, PhD; child and adolescent assessment is supervised by Kelsey Bradshaw, PhD, Stephanie Lord, PhD, and Jennifer Wojciechowski, PhD

Working alongside staff psychologists and other professionals creates a rich and rewarding experience for interns. 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 McDonald Center and Adult Cognitive IOP rotations, interns also have regular contact with postdoctoral fellows who are receiving advanced training in clinical psychology (cog/DBT or SUD focus).

Rotations span the developmental age range and involve four main populations: child/adolescent, adult serious mental illness, adult substance abuse disorder and geropsychology. Each population has both inpatient rotation and outpatient rotations.

Child and adolescent rotations.

Child and Adolescent Program (inpatient)

On the third floor of the Sharp Mesa Vista Hospital CAP Building, you will find the 23-bed Child and Adolescent inpatient unit (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. CAP3 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 CAP3 rotation will familiarize interns with the developmental tasks and issues facing youngsters, and with 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. Interns help facilitate a weekly family support group for parents and family members to learn about safety planning, communication and methods to support their child or adolescent in recovery. Work is fast paced, exciting and high demand. Interns on this rotation are expected to multitask and have balance.

Interns will gain didactic and clinical experiences in these clinical issues:

• 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 housed in the CAP Building at Sharp Mesa Vista. The CAP Outpatient intern will primarily participate in our Adolescent Partial Hospitalization Program (APHP) and Changes Dual Diagnosis Intensive Outpatient Program (Changes IOP). The intern will also have the opportunity to gain some limited experience in our Child Partial Hospitalization Program and Adolescent Cognitive Intensive Outpatient Program.

APHP 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 and 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 intensive case management as well as evidence-based CBT, ACT and behavioral group therapy, individualized psychoeducational instruction (e.g., anger management, impulse control, self-esteem work), family therapy and multi-family group therapy.

The Changes IOP is designed to help teens who are struggling with substance abuse disorders as well as a mental health concern. Teens develop positive behaviors through evidence-based recovery-oriented groups and educational and therapeutic activities. Family involvement is crucial for treatment and includes parent education and mandatory group family therapy.

Outpatient CAP psychology interns participate in a wide variety of activities to learn about developmental issues, the nature of adolescent psychopathology and how the two interact.

Interns will gain didactic and clinical experiences with these clinical issues:

• Chemical dependency treatment with dually diagnosed adolescents
• CBT and ACT
• Developmental tasks of adolescents
• Family systems theory
• Family therapy
• Group psychotherapy with adolescents
• Psychopathology of adolescents

Adult serious mental illness rotations.

ICU and South Rotunda (inpatient adult)

The ICU and South Rotunda (SR) are two adult locked psychiatric units designed for individuals experiencing an acute phase of a psychiatric disorder. The ICU/SR  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. Working alongside the unit psychologist, interns provide evidence-based psychoeducation, group therapy, individual therapy and brief assessments.

This rotation will develop the intern's ability to effectively and quickly conceptualize and treat a challenging caseload of individuals who have multiple presenting problems. Interns will have the opportunity to conduct brief psychodiagnostic assessments to answer questions from the treatment team. These brief assessments are approached with a therapeutic assessment lens whenever possible, actively including the patient and the treatment team in better understanding and treating the individual. Additionally, interns will be actively engaged in program development, as ICU/SR psychology programming expands to meet the needs of this dynamic population.

Given short hospital length-of-stay, interns are faced with rapid patient assessments and formulate 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. Interns will learn to effectively communicate about these assessments with other interdisciplinary team members. Interdisciplinary collaboration is heavily emphasized in this rotation, and side-by-side work with social work, nursing, recreation therapy, psychiatry and peer support is encouraged and expected.

During the rotation, interns will be offered educational and clinical experiences in the following areas:

• Adult psychopathology assessment/diagnosis and treatment
• Brief, targeted assessment
• Behavior modification
• Brief crisis treatment of individuals, couples and/or families
• Electroconvulsive treatment (ECT)
• Group therapy process
• Program development
• Interdisciplinary 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 utilizes the principles of cognitive therapy in the treatment of depression, anxiety, panic and post-traumatic states and 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 mood, anxiety, thought and (co-morbid) personality disorders. This is achieved through participation in group therapy, education groups, clinical team meetings and supervision. Interns may also be able 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.

Interns will gain didactic and clinical experiences in these clinical issues:

• 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 - substance use disorder rotations

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 operate out of two buildings and include three distinct settings 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 substance use disorder diagnoses. The therapeutic services serve those who are not so at risk that they require an acute medical or psychiatric hospital stay. The programs treat patients who are able to function in a subacute inpatient, partial-hospital or intensive outpatient setting.

Residential, partial hospital and intensive outpatient programs are abstinence-based and facilitate sober living skills, requiring these adults to take responsibility for self-maintenance and maintenance of their environment. Sharp McDonald Center provides daily therapeutic programming to provide continuity of care and to maximize clinical gains.

Sharp McDonald Center interns will receive training and experience with the following:

• Evidence-based behavioral
• CBT and ACT group and individual 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
• Program evaluation and development

Sharp McDonald Center rotations.

One Sharp McDonald Center intern will work on the residential/partial hospital side, engaging in all the experiences described above.

One Sharp McDonald Center intern will work on the intensive outpatient side, engaging in all the experiences described above.

In both Sharp McDonald Center rotations, interns work side by side with experienced professionals from several disciplines (e.g., psychologists, postdoctoral fellows in clinical psychology, licensed clinical social workers, marriage and family therapists, CADAC counselors, psychiatrists, chaplains). Interns provide group therapy and carry a caseload of three to five patients for individual therapy, comprehensive case management, utilization review, family therapy and couples sessions.

Sharp McDonald Center interns have the unique experience of being supervised by and/or working closely with a psychologist who is the primary administrator of the hospital. Interns receive invaluable exposure and experience in the regulatory, program development/evaluation, staff development and other administrative/leadership domains.

Geropsychology rotations.

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.

Senior Behavioral Unit (SBU, inpatient)

At Sharp, we are committed to meeting the needs of the rapidly expanding senior population in San Diego County. The SBU is part of that commitment. In the last several years, we have nearly doubled the number of beds on the unit and we have more than doubled the number of psychology hours assigned to serve these patients.

Psychology, social work, recreation therapy, nutrition, pharmacy, nursing and psychiatry are members of the core team, with physical therapy, music therapy, chaplaincy and internal medicine also involved. The SBU interdisciplinary team is skilled in working together to compassionately and effectively meet the bio-psycho-social needs of older adults with severe mental health problems.

The doctoral psychology intern is an integral member of the SBU interdisciplinary team, serving under the supervision of Dr. Lynn Northrop as the primary face of psychology on the unit. The intern plays a leadership role on the SBU psychology team, helping to oversee and support the work of advanced doctoral students. The intern leads or co-leads a process or coping skills groups on the unit every day and carries an individual caseload of patients. Interns are routinely involved in leading interdisciplinary behavioral interventions, family education/support and psychological/neurocognitive screenings. Staff training and program development activities are an important part of the intern role. There is also time to spend in the milieu, and plenty of important clinical work occurs in these more informal interactions with patients and staff.

Many SBU patients are admitted from home and others come from board and care, assisted living or skilled nursing facilities. Patients typically are discharged to the same or higher level of care. Usual length of stay is one week to one month, though some patients stay much 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 receive follow-up care in our Senior Intensive Outpatient Program and there is some opportunity for interns to follow their individual therapy patients into the outpatient setting.

SBU interns can expect to develop knowledge and skill in:

• The Recovery Model and person-centered care
• Evidence-based, developmentally appropriate individual and group interventions (ACT, CBT, Behavioral Activation)
• Mood, anxiety, thought, neurocognitive, somatic, personality and substance use disorders in older adults
• 72-hour and 14-day holds, hearings and conservatorships
• Brief neuropsychological and psychological screening
• Caregiver support
• Community reintegration and other strategies to reduce relapse and readmission rates
• Electroconvulsive treatment (ECT)

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, collaborating with other programs and agencies throughout Sharp and in the San Diego community to ensure that patients continue to thrive, even after completing our programs.

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, 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

Psychological assessment (all interns, all year; not a separate rotation)

All interns participate in psychological assessment throughout the year, on top of the duties in their other rotation settings. Depending on the mix of training goals in an intern class, individual interns could spend all year doing adult-gero assessment, all year doing child-adolescent assessment or have a combination of both.

Assessment supervisors provides a weekly psychodiagnostic seminar that meets throughout the year. This seminar focuses on the development of assessment techniques through didactics and group supervision for all doctoral interns as well as some advanced practicum students. Interns have the opportunity to mentor and supervise graduate students in assessment as well.

Psychodiagnostic and assessment skills are developed by responding to referrals for psychological assessment from all of the hospital's inpatient, outpatient and partial hospital programs. 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 range of assessments also includes detailed neuropsychological screening examinations (e.g., three-to-four hour batteries, not full-day batteries). This 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, Rorschach 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 neuropsych rotation and interns seeking specialty training in neuropsychology should understand that our training program does not adhere to the Houston Guidelines.

Training in supervision.

In the 2014-15 training year we added an additional layer to our psychology training program - training of advanced graduate students. In each year since 2014, we have invited third-, fourth- and fifth-year graduate students in psychology (from local APA-accredited programs) to spend an entire year receiving training and gaining experience. This has allowed each of our interns the opportunity to clinically supervise and mentor one or more junior colleagues throughout the year.

Training and supervision-in-supervision is now a formal and integral part of doctoral intern training at Sharp. 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.

Your stipend and benefits.

Interns receive 12 monthly educational stipends of $1,924. Interns are not employees. Interns must arrange to pay their own taxes and receive no employer-supported health insurance. Previous intern classes 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 sick/self-care leave in the case of illness or injury. Interns are welcome to eat one meal per day in the hospital cafeteria, free of charge.

As psychologists, we understand the importance of social support and recreation in well-being. Interns are encouraged to form a cohesive unit during the training year. Some groups have formed book clubs and happy hours. In addition to spending time in clinical settings together, interns share office space. Department potlucks (also known as PIGS, or "psychologists in international gustatory studies") happen several times per year, and help to build cohesion among trainees and faculty. The department pays for an intern-only outing every year, such as a champagne brunch cruise on the bay, a day at Universal Studios or a day or picnicking and kayaking. A formal luncheon acknowledges the year's accomplishments and a "Hail and Farewell" picnic marks the transition from the old class to the new.

Interns work 40-plus hours per week at the hospital and are not to have additional outside employment. The faculty places 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 45 hours, including reading and other duties.