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 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 • 8:00 - 9:00 Intros. Brief Program Description • 9:00 – 9:30 Overview of Research Opportunities • 9:30 - 10:20 Interview block • 10:30 - 11:20 Interview block • 11:30 - 1:30 Lunch/ Rotation/Adjunctive Supervisors (2nd Floor Atrium – see map) • 1:30 - 2:30 Interview block • 2:30 - 3:15 Meet with current interns • 3:15 - 3:45 Tour by Postdoctoral Residents • 345 – 4:14 Wrap up with TDs • Each applicant will have 2 interviews of approximately 45 minutes. Two interviews in three blocks. • The second interview will include a clinical vignette.

4. Minneapolis VAMC Approximately 500,000 veterans residing in our primary service area, Tertiary referral center for VSIN 23 Ethnic minorities - 7% of those treated 65+ is the largest single clientele category but a growing mid 20’s cohort Women Veterans Comprehensive Health Center VA Lead Polytrauma Center State of the art Spinal Cord Injury center (SCI ) Telemedicine / CBOC Opportunities Will host VISN Tertiary Chronic Pain Tx Center

5. 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

6. The Presence of Psychology • 70 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 • The discipline of Psychology is highly valued in the Medical Center

7. Training Model & Philosophy    • Accredited by the Commission on Accreditation of the APA • Member of APPIC and abides by its guidelines • Member of APCS • 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

8. 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

9. Broad Training Goals  • Goal 1: Psychological Evaluation and Assessment Diagnostic interviewing • Goal 2: Psychological Interventions • Goal 3: Providing Consultation & Supervision • Goal 4:Ethics & Diversity • Goal 5: Maturing Professional Identity • Goal 6: Interface Between Science and Practice

10. 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

11. 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. Carter, Clason, Eidson, Lamberty, Lundgren, and Sim.

12. Rotations  • Assigned by interest and training needs • Orientation week • Learn about different rotations • Work with TDs 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

13. Addictive Disorders • Supervisors: Drs. Deloyski, Silversmith, and Siegel • 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

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

15. The Mood Disorders and General Psychiatry Team • Supervisors: Drs. Hess, Perry, and Walden     • 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   

16. Neuropsychology (rotation) • Supervisor: Drs., Carter, Clason, Eidson, Lamberty, Lundgren, and Sim. • 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.

17. Psychiatric Partial Hospitalization (PPH) • Supervisor: Dr. Isenhart, Peterson, Schumacher, and Broden • Not a treatment 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 • Opportunity for psychoeducational and process group experience   

18. Post-Traumatic Stress Recovery (PTSR) Program – Team L • Supervisors: Drs. Curry, Ferrier-Auerbach, Kaler Meyers, Polusny, Voller, and Wagner • 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.

19. Primary Care Psychology/ Health Psychology • Supervisors: Drs. Billig, Helbok, Mallen Olson, Chiros, 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. • Chronic pain assessment and intervention, • Training in the assessment, treatment and consultation of medical patients.   • Orientation - Integrative, emphasizing contemporary behavioral approaches.   • Telemedicine opportunities

20. Polytrauma/Rehab • Supervisors – Drs. Petska, Collins, Blahnik, Lamberty, McGuire, Sim, Howard, Kennedy, and Merladet • 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 • Family interventions • Bed rounds • Neurological and psychiatric examinations

21. VISN Pain Center • New VSIN Tertiary Pain Center • New rotation or part of rehab rotation? • Staff being hired. • We will know more at start of training year • Assessment and intervention with chronic pain

22. SPMI (Serious and Persistent Mental Illness) Team • Supervisors: Dr. Hegeman, Nienow, Rogers, and Sponheim • 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

25. Adjunctive Training Experiences • Interns select 3 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 • Acceptance and Commitment Therapy (ACT) • Assessment Clinic • Administration • Research

26. 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   

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

28. Prolonged Exposure • Supervisors – Drs. Polusny and Strom (VA National Trainers); Drs. Voller and Ferrier-Auerbach • Didactics starting with 1.5 day PE training and weekly readings • Weekly 90 min. appointments with 1-2 veterans • Bi-monthly consultation group • Weekly group and individual supervision • Video tape and review by supervisor • Will be PE certified with the VA (same as staff)

29. Cognitive Processing Therapy Clinic • Supervisors: Drs. Curry & Petska (VA Regional Trainers) • 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

30. Time-Limited Dynamic Psychotherapy (TLDP)  • Supervisor:  Dr. Wagner • 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

31. Motivational Interviewing (MI) • Supervisor: 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

32. Acceptance & Commitment Therapy:ACT • Supervisors: Drs. Billig & Hess (VA Consultants) • 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

33. Dialectical Behavioral Therapy (DBT) • Supervisors:  Drs. Meyers and VanEgeren • 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 deregulation • Didactic, group supervision, consultation group • Individual and/or group interventions

34. DBT/PE • New pilot program • Co-lead skills group (6 week intensive module) • Co-lead mindfulness exercises • Lead community outings – skill practices • Individual patient if experience with DBT

35. Psychoanalytic Therapy • Supervisor: Dr. Walden • This year-long clinic is intended to give trainees experience with psychoanalytic-informed approaches to psychotherapy with individuals. • One to two cases, meeting once or twice weekly, for a total of two clinical hours per week. • Process notes for use in a weekly group supervision meeting. • Readings covering various psychoanalytic ways of thinking about and working with people are assigned and discussed in supervision.

36. Assessment Training Clinic • Supervisors: Drs. Arbisi and Siegel  • Ensures that all interns get good training in psychodiagnosis • Diagnostic interviewing • Intellectual assessment • Objective instruments • Exposure to projective instruments • Meets weekly for entire year • Wide range of 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

37. 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. Can devote more on own time.

38. 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 based on intern’s interests.

39. Seminars • Seminars: weekly Psychology Training Seminar • Didactic focus (interns help choose) • Adjunctive experiences have a didactic component • One of the presentations occurs in Mental Health Grand Rounds (formal and multidisciplinary in nature)  ***** Want to foster development of competency, critical thinking abilities, knowledge, and professional identity

40. 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

43. 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

44. Supervision • 2 + hours of individual supervision per week • 2 + 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    • May be assigned readings and literature searches • Mostly consultative in nature

45. Mentors • Each intern will choose a mentor • A non-evaluative but not absolutely confidential relationship Role: • Help the intern negotiate the internship program • Integrate feedback from various supervisors • Plan for post-internship goals

46. Postdoc Opportunities • 2 postdocs in the specialty of Clinical Neuro (2 years) • 4 Postdocs in Clinical Psychology – emphasis (1 year) • PCMH/Health • Rehab Psychology/Polytrauma • SMI (interprofessional center) • Trauma • Accredited – Clinical focus with 25-49% time in research • Current interns very competitive but no overt preference (about 50% selection)

47. The Application Process We seek applicants who have: • A sound clinical and scientific knowledge base • Strong basic skills in standard assessment, intervention, and research techniques • Personal characteristics necessary to function well in our internship setting • Open to supervision, thirst for learning, strong initiative   • Selection criteria are based on a "goodness–of–fit" with our scientist-practitioner model

48. Training Term • Full-time for one year beginning on about the 3rd week of August • One year at full-time equals 2080 hours Leave: • 10 federal holidays • Sick leave and annual leave (4 hours of each per two-week pay period (a total of 13 days of each) • Authorized leave for conferences, presentations, PD interviews, and to complete activities required by your university - # day is flexible  

49. Stipend and Benefits • $25,402 per year • Health and life insurance is available. • The United States Government covers interns for malpractice under the Federal Tort Claims Act

50. Our Strength is Our Weakness • Opportunity and Choice! • Many training options • Can be overwhelming! • Cannot pick them all • Need to try and prioritize • Many ways to get training goals met • Several rotations/options can meet goals