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 screening and intake assessments, select supervisors and therapy groups in collaboration with senior staff, 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 a 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 13 clients, plus covering a Recommendation and Referral shift. 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 a few longer-term cases which may involve seeing a client for 16 or more sessions depending upon the time of the year the client began treatment and the frequency of sessions. Interns have reported that their caseloads are surprisingly diverse concerning client background and treatment concerns.
Coverage of Recommendation and Referral Hours
We all handle clients presenting for support to initiate counseling, to address a crisis or for referrals one day each week. Recommendation and Referral 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 will be conducting brief screening assessments and making referrals to intake, group support, medical evaluation, other campus supports or off-campus.
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 -7, Patient Health Questionnaire, -9, Alcohol Use Disorders Identification Test, and Cannabis Use Disorder Identification Test 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 to develop 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 will co-lead group with a staff psychologist and they may co-facilitate screening interviews if such interviews are appropriate for the group. Co-facilitators will assist interns in assessing potential group members for fit.
Co-Leadership of a Psychotherapy Group
Our interns will have the opportunity for to co-lead at least one therapy or support group with a psychologist during their tenure here. Examples of these groups are Survivors of Sexual Trauma, Life Hack / Coping Skills, Between the Lines (LGBTQIA Support group), and Adult Children of Alcoholics.
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 training's, too. During our month-long orientation, interns receive approximately 30 hours of didactic training.
Intern Seminar: 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 co-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 clinical co-supervisor. They typically see 3-8 clients at CHWS and receive one hour of individual supervision per week.
The 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 during the semester will still be involved, as they will facilitate the practicum seminar series and case conferences.
The co-supervision model allows the practicum counselor to receive supervisory input from two skilled clinicians! The psychologist co-supervisor participates in the supervision session, providing an opportunity for direct observation of the intern’s supervisory skills. The intern takes the lead on reviewing recordings of clinical sessions, drafts of clinical documentation, etc.
Supervision of Supervisory Skills ("Sup of sup")
The Psychology Interns in the supervision rotation meet once a week with the the psychologist co-supervising with them as a small group. The psychologist provides training on supervisory skills, such as counselor developmental level, support vs. challenge, parallel process and teaching micro-skills.
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 dietitian. There is a monthly diversity dialogues group sup and monthly supervision with the training director. During the summer the group sup is two hours per week and rotates between diversity dialogues and challenging 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:
- Skills training for student leaders (e.g., listening skills, crisis response)
- Psycho-educational workshops for athletes, Greeks, residence halls, etc.
- Guest lectures in academic courses (e.g., trauma recovery, suicide assessment, body image)
- Support for at-risk groups, such as students returning from study abroad
- Referral skill primers for faculty and administrators
- Description of CHWS services for parents, new faculty, etc.
- Health education for campus groups (e.g., contraception, sleep disorders, etc.)
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 Recommendation and Referral 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. Interns will not be included in the weekend availability list that is submitted to the Dean of Students and thus is unlikely to be asked to respond to an after-hours or weekend crisis. However if their client is involved an intern may be called for consultation and/or to assist with the crisis response. 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. The psychology staff consults and assists the intern through the management of the crisis.
Participation in staff meetings
- Psychology staff meetings
We discuss at-risk students, client flow, ethical dilemmas, personnel issues, policy decisions, program requests; you name it. Learning administrative aspects of college health contributes to the breadth interns develop in this multi-disciplinary setting.
- CHWS staff meetings
We meet weekly as a full staff to discuss emerging issues, programs, policy and to learn about other campus departments. Twice a month time is reserved for case consults with medical and psychological staff. We also lead mini "cross-training" between psychology and medical staff.
- Division of Student Affairs (DSA) staff meetings
This monthly meeting of the entire Division enables a view of the context in which CHWS provides service to the University. It also gives those with administrative career goals exposure to the operations of student affairs work.
Changes to our training and service provision due to the COVID-19 Pandemic
In the spring of 2020 our clinic responded to the pandemic by offering remote services to help slow the spread of this virus. Our supervisors and interns participated in webinars on telehealth and then began to offer therapy, recommendation and referral, intakes, groups and outreach via telehealth. We continued working remotely for the 2020-21 academic year. We look forward to a hybrid model for the 2021-22 academic year.
Development of a Specialty or Growth Area
Although 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," is an 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: Working with Minoritized Students; Sexual Assault and Healthy Relationships; Substance Use and Trauma; Mindfulness Meditation; 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 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 based on the 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 reviewing 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 2-4 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. During peak clinical times our discretionary hours may be taken up with documentation or seeing a client in crisis. Our discretionary hours increase during summer and winter break.
- Dissertation and professional development time
Two hours per week may be devoted to dissertation research, professional reading, job search activity, etc. during the academic semester. Since interns arrive at different stages in their dissertation process, we expect that this time will be utilized in different ways. As a discretionary activity, more hours can be committed to this during the winter break and summer months.
- Engage with a student organization
Interns might explore the possibility of being engaged with student leaders in a mentoring role to help the students consider their roles as leaders, decision making within organization, etc. There are many student groups on campus to look into, such as Prims (gay-straight alliance) and BRAVe (Bystander Revolution Against Violence).
- Collaborate with medical providers
Interns with special interest in Behavioral Medicine or Health Psychology may wish for more exposure to the medical practice in CHWS. Interns might assist our medical providers with outreach, such as public health campaigns regarding vaccinations, presentations on wellness (ex: sleep, nutrition, and exercise) or on sexual health, etc.
- Additional outreach/program development experience
Interns need not wait for an outreach request that fits their particular interests and schedule. They are welcome to develop programs for specific groups or advertise workshops that are open to the campus community. Interns may revamp existing outlines or develop new programs from scratch.
- Additional assessment experience
Although all interns will receive training in the administration of the suicide/self harm and substance abuse protocols, trainees interested in gaining more depth of experience with one or more of these may request additional service hours. For example, the University mandates four MARSSH sessions with a clinician in response to suicidal behaviors reported. An intern may request to be in the MARSSH rotation more frequently to increase the likelihood of working with high risk clients. Please note that standardized testing and evaluation are not services we offer.
- Additional preparation for the supervision of practicum counselors
Interns may elect to spend some of their discretionary time with additional preparation for Practicum Counselors' supervision. They may wish to review multiple recordings of supervisee's sessions, to do some theoretical reading on counselor development or supervisor development, to prepare some materials for the supervisee to study, etc.
- Program evaluation within Division of Student Affairs
Assessing program effectiveness is a marketable skill and a welcome contribution to the Division of Student Affairs. Interns are welcome to devote discretionary hours to the observation, test construction and formal evaluation of programs and services.
- University committee service
Interns may increase their understanding of higher education administration by sitting on a university committee. Examples include the Health Professions Advising Committee, Race and Pedagogy Committee, the Judicial Honor Court and the Sexual Harassment Prevention Committee.
- CHWS administrative project creation
Especially good for interns aspiring to a career in a university counseling center or community mental health: Initiate a project you believe could be helpful to the operation of our Center. Interns may also collaborate with a psychologist on long-term projects. In the past interns have helped develop/revise the suicide/self harm assessment protocol, alcohol peer education program, and the University's sexual assault policies.
- Create opportunities to deepen developing specialty
In concert with training staff, we can craft a plan for using your discretionary time to gain exposure to your developing specialty. Can we be made aware of the types of clients you'd like referred to you? Might there be a faculty person doing research in the very area you want to develop expertise in? If you were to design a workshop on this issue, what campus population might we target? Might CHWS consider offering a short-term group in this area? We check in with interns about their sense of progress at several points in the year.