All Psychology Interns participate in the following training activities during their year with Counseling, Health and Wellness Services
Orientation to Counseling, Health and Wellness Services
Interns begin their time at CHWS by going through an intensive month-long orientation program. During this time Interns engage in team building, needs assessments, and learn about CHWS service delivery processes, crisis intervention procedures, campus resources, and overall organizational structure. There are also several didactic sessions on clinical issues such as suicide risk and ethical decision making. The orientation period also involves the collaborative design and implementation of many outreach programs with CHWS psychologists. During orientation, interns prepare for intake assessments, select supervisors and therapy groups, and choose their discretionary activities and their developing specialty. We provide an incredibly thorough orientation, in large part because our interns function so fully as psychology staff once the academic year begins.
Training in intake skills is an important part of the internship at CHWS. Interns are taught a semi-structured intake format. Learning objectives include an ability to follow diagnostic clues, familiarity with symptomatology and college student development, quickly establishing strong rapport, informed case disposition, and comfort with discussion of confidentiality. We typically take on as individual clients those students we see at intake, so the intake assessment is more the first session of a working relationship than it is a fact-finding mission.
Provision of Individual Counseling to University Students
Interns provide individual psychotherapy to college students presenting roughly 50% V- codes and 50% clinical diagnoses such as mood disorders, eating disorders and trauma recovery. A full weekly individual caseload should be roughly 15 clients, including intake sessions. We work from a brief therapy model, but have no session limit at CHWS. Interns treat clients from the theoretical frameworks deemed most effective (in consultation with the primary supervisor, of course); an integrative treatment approach is generally valued here. Interns usually carry several long-term cases, but the majority will be for fewer than 20 sessions. Though we are a private liberal arts college, interns report that their caseloads are surprisingly diverse with regard to client background and treatment concerns.
Coverage of Walk-in Hours
We all handle clients presenting for counseling without a prior appointment one afternoon each week for two hours. Walk-in sessions vary greatly in the skills required of the counselor, as client needs vary from acute, problem-solving needs, to building rapport towards a working alliance, to crisis intervention. Interns sharpen triage skills, intervention approaches and comfort with the psychologist role, as they at times manage multiple walk-ins within a two-hour period.
Clinical and Objective Assessments
In addition to the clinical assessment that occurs at each intake, limited diagnostic testing is performed at CHWS. We utilize objective instruments such as the Beck Anxiety and Depression Inventories as they are deemed clinically helpful, and interpret these results for our clients. In terms of training, our interns learn semi-structured assessment protocols in three areas: (1) substance abuse; (2) anger management/impulse control and (3) suicide/self harm risk.
Individual Supervision with a Licensed Psychologist
Psychology Interns receive two hours per week of individual supervision, which is devoted to development of their psychotherapy skills. The supervisory relationship includes case conceptualization, treatment planning, ethical decision-making, counselor self-awareness and career development discussions. Review of audio and video recordings of sessions is part of this process, too. The psychology staff at Puget Sound all have very high regard for trainees and for the supervision process. Naturally, we are looking for interns who share this value and openness.
Group Screening Interviews
Interns receive training in the theory and practice of group selection and composition. They conduct group screening interviews with their co-leader. Screenings present group norms to prospective members, explain benefits of group therapy, the focus of this particular group, and describe confidentiality. Co-leaders thus support clients while assessing their "fit" for group psychotherapy.
Co-leadership of a psychotherapy group
We attempt to provide the opportunity for each intern to co-lead at least one therapy group with a psychologist during their tenure here. Examples of these groups are Eating Disorders, Survivors of Sexual Trauma, General Therapy (mood, interpersonal skills, identity) Grief Support, AD/HD Support, and Gay/Lesbian/Bisexual/Trans/Questioning Support (called As Is.) Unfortunately, we have struggled in recent years to get therapy groups to fill. Fortunately, interns find that they obtain group experience in other ways because there are numerous training activities call for group facilitation. For example, advising the student organization for sexual minorities ("B-GLAD") or co-leading the bi-weekly substance risk-reduction workshop ("DYRT") would require group facilitation skills, too.
Supervision of Group Therapy with a Licensed Psychologist
Group co-leaders meet for 30 minutes following each session for processing the work and supervision. Discussion may include attending to group process, modeling communication between members, and providing behavioral observations. Interns are equal co-leaders of the groups, and contribute fully to the conceptualization of dynamics and treatment planning in supervision. Of course, they also receive feedback on their group therapy skills.
Interns engage in a minimum of 2 hours per week in didactic activities, usually in the form of our Intern Seminar, although we sometimes attend colloquia and special trainings, too. During our month long orientation, interns receive approximately 30 hours of didactic training.
Treatment, Diversity and Professional Issues Seminar
2 hours/week (Fall, Spring)
In this seminar we address clinical service provision issues. Topics include particular diagnoses (e.g., eating disorders), intervention strategies (e.g., DBT), treatment modalities (e.g., couples therapy), assessment skills (e.g., suicidal ideation) and the counseling relationship (e.g., termination issues). To begin, seminar topics are selected by the training staff. As the year progresses, interns participate in selecting topics, are responsible for presenting seminars themselves, and our format shifts from didactic to discussion and analysis.
We address diversity in this seminar in terms of race, culture, religion, gender, class, age, sexual orientation, physical and learning differences. Seminars thus include discussion of specific populations (e.g., Asian Americans), counseling across cultures (e.g., working class college students), identity theories (e.g., biracial identity development, the coming out process.) In Spring, we pay increasing attention to professional issues, such as helping our interns update their vitae and prepare for job interviews.
This seminar addresses professional practice and identity issues in more depth than is possible during the academic year. We typically learn about the private practice setting as a career option. We take advantage of the slower clinical pace of the summer and engage in discussions about current topics related to the fields of psychology (e.g. DSM-5, Transgender treatment from a historical perspective, etc). Interns also present a special colloquium based on the "developing specialty" they identified at the start of their training year.
Multidisciplinary case conferences are woven into the Fall and Spring seminar schedules. Training staff and interns each present a formal, hour-long case conference every semester. Medical practitioners and Practicum Counselors are invited to join Psychology Staff for case conferences. Psychology Interns learn a format for these presentations and assist other staff with their treatment planning during case conferences.
Clinical Supervision of a Counseling Trainee
Graduate students in local clinical and counseling programs apply to be "Practicum Counselors" at CHWS. Usually these are students late in their master's work or early in their doctoral work. Prac Counselors have a Doctoral Psychology Intern as their primary clinical supervisor. They see 2-5 clients at CHWS and receive one hour of individual supervision per week. Doctoral Interns review trainee recordings of sessions, provide feedback on interventions and conceptualization, support counselor development, and foster professional growth such as documentation skills and managing ethical dilemmas. Interns consistently report that this opportunity to supervise (and be supervised – more below) is one of the most profound learning experiences of their internship year here.
Supervision of supervisory skills ("Sup of sup")
Psychology Interns meet together with a CHWS psychologist one hour each week. The psychologist provides training on supervisory skills, such as counselor developmental level, support vs. challenge, parallel process and teaching micro-skills. Interns provide this psychologist recordings of themselves supervising Practicum Counselors. The supervising psychologist carries ultimate legal responsibility for these cases, but the Psychology Intern is in every respect the primary, clinical supervisor.
Outreach and Program Development
Interns collaborate on the design and implementation of these programs, and often design their own workshops, as well. Outreach may take the following forms:
For interns interested in health psychology, pharmacology, etc., developing a program is a good way to collaborate with our medical providers. For example, "Bananas Over Sex" is an outreach frequently requested by Residence Life. Interns pair with a medical provider to talk about healthy and safe sexual behavior (ending with a demonstration of how to put a condom on a banana - and then everyone enjoys banana splits!).
Consultation with parents, faculty, staff and students
Interns may be called upon for consultation, particularly during their walk-in hours. Faculty may request help assessing a student's in-class behavior; administrators may request documentation of a student's disability for accommodations; university staff may seek personal referrals to community providers; housing colleagues may wish to provide us information regarding problem behaviors, etc. Interns learn to manage client confidentiality, informed consent, professional boundaries and public relations. Occasionally, CHWS staff provide an organizational consult for some university department (e.g., teach feedback skills, communication skills, recognizing mental illness, setting boundaries in the workplace, etc.).
During the academic year, CHWS Psychology staff respond to campus crises that occur both during business hours and after hours or on the weekend. Each week we develop a "First Responder" list to determine who will be available to handle any crises that may occur that weekend. Interns start off lower on the list during the Fall semester and are higher on the list during the Spring semester. Crisis response may include telephone or in-person counseling with a student in distress, follow-up consults with appropriate others, or group debriefings following an incident. After hour responses also include providing consultation to Residence Life and Dean of Students staff. Interns always consult with one of the Psychologists when providing after-hours crisis response. In the event of a campus-wide emergency we participate in a local school consortium of counselors, who are prepared to intervene for one another if a major disaster should overwhelm one particular school.
Participation in staff meetings
Development of a specialty or growth area
Though university counseling center work usually demands generalist skills by its nature, and our internship is generalist by design, CHWS Psychology Interns do identify one specialty area during their year with us. The "developing specialty," as we call it is some area of professional practice the intern would like to emerge from their internship year having made special progress on. Ideally, they carve enough of a niche that they may then move into job interviews able to describe their unique understanding of this one area of practice. The developing specialty may be an area of longstanding interest or expertise an intern wishes to deepen, or it may be an area (s)he believes has been under-developed in his/her clinical education, which (s)he would like to develop a stronger grounding in.
Some examples of past interns' developing specialties: Attention-Deficit/Hyperactivity Disorder; Sexual Assault and Healthy Relationships; Holistic Treatment of Moderate Psychopathology; and Needs Among Students of Color. Psychologists help interns apply the developing specialty to the job search process.
Documentation of Direct Service Provided
Documentation of clinical service is an important aspect of our professional identity as psychologists. Attention to training in documentation skills is covered from legal, ethical, and writing skill perspectives. Interns are allocated five hours each week for documentation. Intake assessments, management of complex cases, consultations with prior providers, etc. often mean that professional case notes cannot be written in the ten minutes following each session!
Data gathering and entry
As with any organization, gathering data is an important part of our ability to keep track of what we're providing and to demonstrate that these are important services. Part of any week here is entering clinical data on the computer, keeping a tally of the consultations you've provided people outside CHWS, tracking the outreach programs you've provided, and so on. Later in the year, Interns assist the CHWS Director by writing some sections of our annual report, which is based on this data we've all collected.
Intern Selection Committee
Doctoral interns are an important part of our selection team for the following year's class. They participate in the review of files, Skype/telephone interviews, selection and ranking of finalists. Interns also speak privately with applicants who call or visit in person, if they care to. Serving on the selection committee is a highly illuminating process.
In addition to the above required training activities, CHWS interns engage in the following optional activities for about 6 hours each week. We encourage trainees to take advantage of as many of these experiences as their interests and time allow, while setting reasonable limits.