Pre-doctoral Internship Program Minneapolis VA Medical Center

1. Pre-doctoral Internship Program Minneapolis VA Medical Center Wayne G. Siegel, Ph.D., ABPP Director of Training/Psychology Supervisor Thad Strom, Ph.D. Assistant Director of Training

2. What to Expect Today? Information Overload! • Actually, a good understanding of our Internship and our dedication to excellent clinical training

3. Schedule • 8:15 - 9:45 Description of the Training Program • 9:45 - 10:00 Break • 10:00 - 10:50 Interview 1 • 11:00 - 11:50 Interview 2 • 12:00 - 1:00 Break/Lunch in the cafeteria • 1:00 - 1:50 Interview 3 • 1:50 - 2:00 Break • 2:00 - 2:40 Meet with current interns • 2:40 - 3:15 Tour and wrap up with TD

4. Minneapolis VAMC Approximately 400,000 veterans residing in our primary service area, Tertiary referral center for the upper VA Midwest Healthcare Network Last fiscal year: More than430,000 outpatient visits 8,200 inpatient stays 1,000 extended care stays at this facility

5. Demographics • Predominately Caucasian, male population • Ethnic minorities - 7% of those treated • 65+ is the largest single clientele category • Women Veterans Comprehensive Health Center • 1 of 8 VAs • Over 2,500 women are seen in this medical center annually • VA lead polytrauma center

6. Competitively Funded Research Programs • Psychologists - more than $11,000,000 in merit-reviewed, multi-year research grants • One of the largest education and training programs in the VA system • Affiliations with 50 colleges, universities, and technical schools in allied health professions

7. The Presence of Psychology • 58 doctoral psychologists many of which hold clinical faculty positions at the University of MN • Psychologist are assigned to one or more of the specialized treatment units an have a strong presence in almost every area of the medical center • Many psychologists are in key leadership roles in the medical center and nationally. • Staff hold a diversity of interests, expertise, theories, and techniques

8. Training Model & Philosophy    • Accredited by the Commission on Accreditation of the APA • Member of APPIC and abides by its guidelines • Scientist Practitioner Model • Scientific data and scholarly work are incorporated into all training experiences • Significant opportunity to be involved in research through the internship year

9. Training is Developmental • Close supervision, mentorship, and intensive instruction to relatively autonomous functioning over the course of the year • Interns take an active role in developing their training plan • Graduating interns develop the competencies and a sense of professional identity needed for entry-level positions or post docs

10. Goal 1: Psychological Evaluation and Assessment  • Diagnostic interviewing • Administration and scoring of psychometrically-validated instruments assessing personality (e.g., MMPI-2) and cognitive functioning (e.g., WAIS-III)

11. Goal 2: Psychological Interventions  • Exposed to a range of therapeutic orientations, techniques, and approaches including empirically supported interventions

12. Goal 3: Providing Consultation & Supervision  • Provide colleagues and trainees with feedback and guidance • Translate psychological principles and findings to professionals from different disciplines

13. Goal 4:Professional Ethics • Interns will have a mature understanding of professional ethics as well as issues of ethnic, cultural, gender, and sexual diversity

14. Goal 5: Maturing professional identities • Have a sense of themselves as “Psychologists ”   • Awareness of their continuing developmental professional goals and areas needing further development

15. Goal 6: Interface Between Science and Practice • Being educated consumers of empirical research • Competence in one or more empirically-supported methods   • Critical thinking • Evaluate the findings of research • Opportunities to be involved in research

16. Mental Health Services in the VAMC

17. Training Tracks • 2 tracks with 2 separate Match numbers • Think of them as separate internships • 6 General Clinical/Counseling positions • 2 Neuropsychology positions • Emphasis on neuropsych training meeting APA Division 40 and Houston Guidelines (at least 50%) • Training is still broad and general in clinical psychology

18. The Neuropsychology Track • Neuropsychology and neuropsychological assessment • Meets the Houston Conference and APA Division 40 specialty training guidelines • Approximately 50% of his or her time to neuropsychology • 2 rotations 17 week-long rotation in neuropsychology and rehabilitation psychology as well as providing assessment and intervention services in our GRECC. • 3rd rotation areas outside of neuropsychology, usually dealing with severe mental illness • Weekly neuropsychology case conference, neurology rounds, and PM&R team rounds • Supervisors: Drs. Nelson, Clason, Lundgren, Cohen, Sim, and Bares.

19. Add/Delete Tracks • You can still change the tracks you are applying to • Just notify the Training Directors before you leave today

20. Rotations  • Assigned by interest and training needs • Orientation week • Learn about different rotations • Work with TD to choose and sequence rotations so that intern training goals and program competency standards are met   • Track activities are guaranteed, rotations are not • Schedules can be adjusted as needed later in the year

21. Addictive Disorders • Supervisors: Drs. Silversmith, Siegel, and Deloyski • Flexible and individual treatment by matching patient needs with interventions    • Assessment and intervention services to patients with primary SUDs and those dually diagnosed • Individual and group therapies (process-oriented and structured skill-building), behavior and case management, and patient education    • Diagnostic interviewing, objective and projective testing, and neuropsychological screening    • Provide consultation in the context of a multi-disciplinary team

22. Admissions/Crisis/Consultation Team (ACC) Supervisor:  Drs. Arbisi and Kodl • Main intake and evaluation center • Work closely with the Medical Center ER • Diagnostic interviewing, psychological and neuropsychological screenings and assessments, brief therapy, crisis management

23. The Mood Disorders and General Psychiatry Team • Supervisors: Drs. Perry, Walden and Koets     • Specializes in mood disorders and general psych patients   • Diverse theoretical perspectives    • Emphasizes diagnostic interviewing, psychological assessment, and psychological intervention    • Intake evaluations, outpatient personality assessment, and neuropsychological screening evaluations, individual and group psychotherapy   

24. Neuropsychology (rotation) • Supervisor: Drs. Nelson, Clason, Lundgren, Cohen, Sim, and Bares. • Ok for specialization as well as those wanting just experience • Eclectic test battery • Competence in consultation skills - TBI Team, Neuropsychology Case Conferences, and MS Team    • Variety of patients – dementia, strokes, TBI, tumors, seizures, and MS, etc.

25. Psychiatric Partial Hospitalization (PPH)  • Supervisor: Dr. Barrs, Peterson, Isenhart, Schumacher, and Broden • Not a tx team - cost-effective and clinically viable alternative to full hospitalization    • Intensive treatment while avoiding some of the malignant regressive temptations often associated with inpatient care    • Organized within a therapeutic community or milieu setting, the broad range of treatments include: • Case management, educational therapy, group therapy, occupational therapy, recreational therapy, and medication management • Competence in diagnostic testing, including the MMPI-2, Rorschach and other projective techniques, process-oriented group therapy and consultation    

26. Post-Traumatic Stress Recovery (PTSR) Program • Supervisors: Drs. Erbes, Polusny, Kattar, Strom, Kodl, Bemis, and Wagner-Mickle • Training in the assessment and treatment of patients with acute and chronic trauma-related disorders    • Assessment – diagnostic interviewing, objective, projective, and neuropsychological instruments • Individual, family, and group psychotherapy • EST – CPT, PE, MI and Seeking Safety • Consultation to the multidisciplinary team • Psychoeducational activities • Ongoing research • Female veterans, OIF/OEF service members • Variety of traumas.

27. Geropsychology • Supervisors: Drs. Bares and Rodman • Settings: the Extended Care Center (a transitional nursing home care unit), the Geropsychiatry Outpatient Clinic, and the GRECC Memory Loss Clinic. • Skills emphasized on this rotation are: • a) developing an understanding of normal functioning in aging, age-related changes in cognitive and physical functioning and common developmental issues/tasks associated with aging; • Personality, intellectual, neuropsychological, and behavioral assessment techniques with older adults • Interventions with adults: (e.g., time-limited dynamic and cognitive-behavioral therapy) as well as approaches tailored more specifically to the needs of older adults (e.g., life review, reminiscence therapy, chronic pain management, treatment of sleep disorders); d) time-limited, psychoeducationally-oriented group therapy (e.g., CBT for affective disorders, grief, caregiving); • Functioning as members of inter-disciplinary teams and consultants to a variety of services within the hospital.

28. Women’s Clinic • Supervisor: Dr. Van Egeren - cognitive-behavioral • Multidisciplinary team approach - primary care • Knowledge/ sensitivity to gender-specific issues • Male or female intern Health Psychology Focus (Health Psych Rotation) • Assessment and intervention skills relevant to health issues (e.g., chronic pain, sleep disorders, premenstrual dysphoria, weight loss, infertility). Mental Health Focus • Psychological evaluation and psychotherapy for common psychiatric disorders, such as major depression, and for psychological issues that occur more frequently in women than men, such as sexual trauma and domestic violence    • Consultative skills are emphasized

29. Primary Care Psychology/ Health Psychology • Supervisors: Drs. Billig, Meyers, Olson, and Skroch • Integration of mental health with primary care • Co-located working collaboratively with PC staff • Rapid access and tx for acute psychiatric disorders • Innovative models of co-managing care for patients with chronic medical and mental health conditions.   • Interns will have the opportunity to learn innovative models and skills for managing mental health conditions within an integrated primary care clinic setting. • Training in the assessment, treatment and consultation of medical patients.   • Orientation - Integrative, emphasizing contemporary behavioral approaches.  

30. Rehabilitation Psychology   • Supervisors: Drs. Engdahl, Clason, Helbock, Lundgren, Grace, Bares • Training in rehabilitation assessment and interventions to help patients reach their maximum potential    • Depending on training goals, • Conduct psychological, neuropsychological, chronic pain, and/or vocational assessments   • Provide adjustment counseling, family counseling, and behavioral interventions in a rehabilitation setting   • Serve as member of multidisciplinary teams • Inpatient - interventions tend to be brief

31. Rehab Psych – TBI Program • Training in rehabilitation and Neuropsychology • Recognized as a center of excellence • 1 of 4 such programs in the country • Provides a full range of intensive inpatient treatment to brain injured veterans and active duty patients, many in their late teens and early 20's    • Psychotherapeutic and behavioral interventions • Neuropsychological evaluations • Bed rounds • Neurological and psychiatric examinations

32. SPMI (Serious and Persistent Mental Illness) Team • Supervisors: Dr. Hegeman, Hoffman-Konn, Barrs, and Nienow • Assessment and treatment of patients with psychotic disorders including bipolar disorders • Patients vary in their level of functioning and persistence of psychopathology • Competence in the conceptualization and assessment of psychosis and other psychiatric symptoms as well as in the assessment of cognitive and social functioning in outpatients and inpatients • Individual therapy, group therapy, and couples or family interventions • New Programs – CBSST, Family Program, recovery Oriented

33. Adjunctive Training Experiences • Interns select 3-4 Adjunctive Training Experiences: • Family Therapy Training Clinic (FTTC) • Dialect Behavior Therapy (DBT) • Anxiety Intervention Clinic (AIC) • Time-Limited Dynamic Psychotherapy (TLDP) • Motivational Interviewing (MI) • CBSST • Cognitive Processing Therapy (CPT) • Prolonged Exposure (PE) • Psychodynamic Psychotherapy • Contemporary Behavior Therapy • Assessment Clinic • Administration • Research

34. Family Therapy Training Clinic • Supervisor:  Drs. Leskela and Erbes • Training in the assessment and treatment of couples and family-related concerns • Staff, postdoctoral fellows, and interns participate • Didactic presentations • Clinical experience using structural, strategic, solution-focused, and narrative techniques • Group supervision   

35. Anxiety Intervention Clinic • Supervisor: Dr. Olson • Utilizes empirically-supported approaches to treat Anxiety disorders • Critical thinking and professional development are emphasized    • Interdisciplinary training setting • Peer consultation/supervision model

36. Cognitive Processing Therapy Clinic • Supervisor: Drs. Kattar and Bemis • Utilizes empirically-supported time-limited approach to treat trauma-related disorders such as PTSD • Readings and discussions of didactic material, review of video and audio tapes of interactions with patients, and role-playing • Interdisciplinary training setting • Peer consultation/supervision model • Opportunity to serve as individual therapist and co-leader for group • Ongoing clinical outcome assessment

37. Time-Limited Dynamic Psychotherapy (TLDP)  • Supervisor:  Dr. Wagner-Mickle • Empirically-based treatment model: • Strupp and Binder (Psychotherapy in a New Key: A Guide to Time Limited Dynamic Psychotherapy • Training in a group/peer supervision/consultation format

38. Motivational Interviewing (MI) • Supervision: Dr. Isenhart • Empirically supported directive, client-centered therapeutic style for eliciting behavioral change • Help clients explore and resolve ambivalence about making changes • Applicable to SUDs and other psychological disorders   • Will learn basic MI goals and principles   • Readings and discussions of didactic material, review of video and audio tapes of interactions with patients, and role-playing

39. Acceptance & Commitment Therapy:ACT • A functional contextual therapy that views psychological problems dominantly as problems of psychological inflexibility.  • Uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility.  • Six months for the later part of the year

40. Dialectical Behavioral Therapy (DBT) • Supervisors:  Dr. Meyers, and Deadra Dahl, CNS • Empirically-supported, manualized treatment approach developed by Linehan, 1993) • Used to treat male and female patients who share key features with those diagnosed with Borderline Personality Disorder, particularly emotion dysregulation • Didactic, group supervision, consultation group • Individual and/or group interventions

41. Psychoanalytic Therapy • Supervisors: Dr. Peterson • Built on the contributions of Sigmund Freud and will focus on the technique of psychoanalytic psychotherapy • Opportunity to observe a course of psychoanalytic psychotherapy conducted by Dr. Peterson

42. Assessment Training Clinic • Supervisors: Drs. Arbisi and Peterson  • Ensures that all interns get good training in psychodiagnosis • Diagnostic interviewing • Intellectual assessment • Objective instruments • Projective instruments • Meets weekly for entire year • Cases are assigned on a rotating basis • Interns provide consultation and peer supervision • Interns can expect to become familiar with the relevant assessment related literature

43. Research/Scholarly Experiences Research: Consistent with our Scientist Practitioner Model, interns may participate in a research or other scholarly project for six or 12 months of the training year Averaging four hours of release time per week. Working on one’s dissertation, working on papers in progress for publication, or collaborating with staff who have ongoing research.

44. Administrative Experiences • Interns may elect to obtain administrative experience with psychologists who are actively involved in clinical administration. • This experience will involve some didactic, readings, shadowing staff and completion of a project or two.

45. Seminars • Seminars: weekly Psychology Training Seminar • Didactic focus (interns help choose) • Assessment and therapy case presentations • Include an integration of relevant literature • Adjunctive experiences often have didactic components • We are trying to foster development of competency, critical thinking abilities, knowledge, and professional identity • One of the presentations occurs in Mental Health Grand Rounds (formal and multidisciplinary in nature) 

46. Optional Didactics • Neuropsychology Case Conference • Year-long conference involves didactics and case presentations • Opportunity to improve their competence in interpretation of neuropsychological tests, consultation and peer supervision • Other educational seminars and case conferences throughout the hospital and community

49. Time Commitment • A one-year, full-time training commitment - averaging 45 to 50 hours a week on site • Expected that some work will occur off site as well • Balance of work and learning

50. Supervision • 2 to 4 hours of individual supervision per week • 2 to 4 hours of group supervision per week • Style and modes of supervision vary    • Videotapes, audiotapes, observation, role-plays, process notes, and co-therapy are among the tools used to aid in supervision    • Expect to be assigned readings and literature searches as part of supervision • Typically very consultative in nature