The internship year provides training and experiences within a developmental framework that are sequential and graded in complexity. From the initial orientation month through the end of the training year, our interns are exposed to a wide range of experiences to prepare them to enter the field of health service psychology as skilled generalists with strong ethical decision making skills and multicultural competencies.
The training components include: a comprehensive orientation, weekly didactic seminars, a supervision rotation and a substance abuse prevention rotation, individual and group supervision with licensed psychologists, and group supervision with a multidisciplinary treatment team. Interns’ direct clinical, outreach and consultation experiences include: provision of individual therapy, intake assessments, crisis and walk-in triage assessments, conducting risk assessments with mandated and non-mandated students, the possibility of group psychotherapy co-led with a psychology staff member, psycho-educational outreach presentations to the campus community, and consultations with campus administration, staff, faculty and parents.
All Psychology Interns participate in the following training activities during their year with Counseling, Health and Wellness Services
Orientation to Counseling, Health, & 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.
Provision of Individual Counseling to University Students
Interns provide individual psychotherapy to college students presenting roughly 50% developmental concerns and 50% clinical diagnoses such as mood disorders, eating disorders and trauma recovery. A full weekly individual caseload should be roughly 15 clients, including 3 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. Interns have reported 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 Generalized Anxiety Disorder Assessment and Patient Health Questionnaire, as screening tools. In terms of training, our interns learn semi-structured assessment protocols in two areas: (1) suicide/self harm risk and 2) substance abuse.
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 sessions include 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 may 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, Grief Support, and Between the Lines (LGBTQIA Support group). 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 that call for group facilitation. For example, co-advising Q & A (LGBTQIA and ally education/advocacy group) or co-leading the substance risk-reduction workshop ("DYRT") requires group facilitation skills.
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 and Summer)
In this seminar we address clinical service provision issues. Topics include particular diagnoses (e.g., eating disorders), intervention strategies (e.g., DBT), assessment skills (e.g., suicidal ideation), evidence based intervention (e.g., CAMS), 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.,Trans* students), addressing intersectionality (e.g., cultural exercises, discussion of multiple identities), and/or identity theories (e.g., biracial identity development).
In the summer each intern presents 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. Each intern presents a formal case conference every semester, including relevant research on the diagnoses or treatment approach. Medical practitioners attend the first hour of the case presentation. The psychology staff spend the second hour of seminar more thoroughly addressing clinical, diagnostic and/or ethical issues.
Each intern supervises a Practicum Counselor for at least one semester, during the Fall or Spring. We have two Practicum Counselors. These students are usually 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 typically 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. Because we only have two practicum counselors, the interns rotate participation in supervision. The intern who is not supervising a practicum counselor, for a semester, will facilitate the practicum seminar series and case conferences.
Supervision of Supervisory Skills ("Sup of sup")
The Psychology Interns in the supervision rotation 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 with recordings of themselves supervising the Practicum Counselors. The supervising psychologist carries ultimate legal responsibility for these cases, but the Psychology Intern is the primary supervisor.
Substance Abuse Prevention Rotation
Each intern will spend a semester learning strategies to address substance abuse from a prevention, education, and/or intervention approach based upon the NIAAA Tiers 1-3. The rotation involves training in the Brief Alcohol and Screening Intervention for College Students (BASICS) model, motivational enhancement, and harm reduction approaches. Interns participating in the SA rotation in the fall and spring will conduct substance abuse assessments and co-lead psychoeducational workshops for mandated students. During the summer the SA rotation involves program evaluation and development.
Interns receive group supervision with a variety of different foci depending upon the time of the year and the content of the supervision. During the academic year interns receive group supervision with our consulting psychiatrist and our consulting dietician. There is a monthly diversity dialogues group sup and a monthly supervision with the training director. During the summer the group sup is two hours per week and rotates between diversity cases and high risk cases.
Outreach and Program Development
Interns collaborate with staff on the design and implementation of outreach programs, and often design their own workshops. 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 "weekend availablity" 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 first half of Fall semester and then rotate to take the first position role several times during the remaining academic year. 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. Even when an intern is first on the list they are not expected to handle a crisis alone. The psychology staff consult and assist the intern through the management of the crisis.
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 that has been under-developed during graduate education, which the intern would like to develop a stronger grounding in.
Some examples of past interns' developing specialties: Attention-Deficit/Hyperactivity Disorder; Sexual Assault and Healthy Relationships; Substance Use and Trauma; and Trans* Resources. 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 involves tracking the outreach programs you've provided. It is also important that you keep a log of your hours in preparation for licensure. 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. 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 4-6 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.