The training program consists of three components: clinical rotations, seminars/teaching, and long-term psychotherapy supervision.
The interns receive their training in a variety of settings, each one stressing a variety of treatment modalities.
The year is divided into three major four-month rotations. We require that the intern complete two major rotations; one providing an inpatient psychiatry experience, and the other an outpatient experience. The remaining four months may be used as an elective and may be selected by the intern from a variety of placements available. The intern spends a minimum of 25 hours on the rotation site. The remaining time is spent in case conferences, grand rounds, seminars, or other educational activities. We also require all interns to rotate through a part-time experience on our Psychiatric Crisis Unit. Rotation options are outlined below.
Albany Medical Center Department of Psychiatry Inpatient Psychiatry Service – E2 (AMC). On the AMC inpatient psychiatry unit, interns work closely with senior faculty in a multidisciplinary setting providing assessment and consultation services, and brief psychotherapeutic interventions. Patients may present with a broad spectrum of psychiatric diagnoses including PTSD, mood disorders, personality disorders, polysubstance dependence, and/or schizophrenia. The average length of stay is approximately 10 days; however, some patients will receive treatment for a number of weeks.
Inpatient Transitional Program – Unit E (CDPC). Interns work on an inpatient psychiatric unit populated by individuals manifesting a broad range of psychiatric difficulties including psychotic disorders, mood disorders, characterological disorders, and cognitive disorders who are exhibiting behavioral dyscontrol. Presenting problems include adaptive functioning deficits, suicidal behaviors, and forensic patients who have been found not responsible for a crime by way of mental disease or defect. Patients on this unit are considered to be actively working towards discharge. Interns function as part of a multidisciplinary treatment team and more specifically provide individual therapy and co-lead therapy groups. They also conduct psychological assessments that include intellectual, personality, and neuropsychological evaluations.
Inpatient Admissions Unit – Unit M (CDPC). The admissions unit is an acute hospital setting responsible for assessing the individual needs of each patient as they enter the hospital. Initial screening assessments are completed with each admission to determine treatment needs and the need for psychological testing based on hospital specific criteria. Interns would work with an interdisciplinary treatment team to assist in making treatment decisions and recommendations for patients with a wide variety of mental health concerns, including psychotic disorders, mood disorders, characterological disorders, cognitive disorders and those who have legal/forensic issues. Opportunities exist to co-lead groups, to offer individual therapy (generally brief in nature, but there are options to work with patients on a longer-term basis) and to evaluate patients for cognitive functioning and diagnostic clarification.
Albany Medical Center Department of Psychiatry Outpatient Clinic (AMC). In the AMC outpatient clinic, the training clinic of the Department of Psychiatry, interns work closely with psychiatry residents, faculty and staff. A primary focus of this portion of the rotation is psychological assessment, with an emphasis on therapeutic models of assessment (Finn & Tonsager, 1997). Interns also conduct intake evaluations and carry a select number of psychotherapy clients (3-4). Opportunities may exist for group therapy, couples and/or family therapy. Patients present with a range of psychiatric issues including trauma, mood disorders, personality disorders, polysubstance dependence, and co-morbid health related issues (e.g., HIV).
Stratton VA Medical Center Mental Health Clinic (VAMC). Interns serve as staff clinicians working in an active VA outpatient Mental Health Clinic. With an average caseload of between 8-10 patients, interns provide psychotherapy and psychological assessment services. Interns conduct primarily individual therapy while on rotation; however, referrals for couples and family therapy are not uncommon. Opportunities exist for working with veterans with a range of psychiatric problems (e.g., combat related PTSD, mood and anxiety disorders, and personality disorders).
St. Joseph’s/Therapeutic Support North (CDPC). The St. Joseph’s/Therapeutic Support North is a New York State Office of Mental Health certified program conceived as an intensive clinic model in which mental health services are provided in a school setting. The program serves adolescents (ages 11-18) from Northern Saratoga, Warren and Washington counties. St. Joseph’s school houses BOCES classrooms for students in 6th through 8th grade, while the Therapeutic Support North program, housed in the Fort Edward High School, consists of BOCES classrooms for students in 9th through 12th grade. Students served require a blend of intensive mental health treatment services and special education instruction. To be considered for these programs, they must have a DSM-IV Axis I diagnosis and must be classified as Emotionally Disabled (ED) by the school district. Children referred to the program have a wide range of Axis I diagnoses. Most have had multiple psychiatric hospitalizations and have been treated in other outpatient settings. Although not all students have learning disabilities, all have had their mental health problems significantly interfere with their academic functioning. Services provided include evaluation and assessment, treatment planning, individual psychotherapy, group therapy, family therapy, crisis intervention, consultation to teaching staff and medication therapy. Interns will serve as primary therapists for adolescents and their families. They will receive experience in conducting intakes, providing individual and group psychotherapy, family therapy and assessment, and will have opportunities to provide consultation to teaching staff.
Child and Adolescent Psychiatry (CDPC). Interns are primary therapists for children, adolescents and their families. They receive experience in play therapy, family therapy, and child assessment, as well as consultation to schools and family court. Interns also have the opportunity to consult at secure detention facilities for behaviorally disordered adolescents. As consultants, they may provide diagnostic assessments, supportive therapy, and didactics for facility staff.
Post-Traumatic Stress Disorder Program (VAMC). The PTSD program is a short-term intensive program designed to provide treatment for the problems of region w:st="on">Vietnam and Iraq Veterans with readjustment problems (including PTSD). As substance abuse is a problem afflicting the majority of this population, a close relationship exists between the PTSD program and chemical dependency programs. Services provided by the PTSD program take three basic forms: 1) consultation services regarding the diagnosis and treatment planning, 2) a 16-week outpatient treatment program designed to address skill deficits which frequently interfere with adaptive function, and 3) individual treatment focusing on desensitization and the emotional processing of traumatic memories via intensive exposure-based psychotherapy. Interns work closely with faculty and staff in providing these psychological services.
Chemical Dependency Rehabilitation Program (VAMC). Interns serve as a member of a multidisciplinary treatment team consisting of professional and paraprofessional staff devoted to the treatment of veterans with alcohol and drug dependence. A multimodal treatment approach is used, which includes individual and group therapy, psycho-education, 12-step meetings, and experiential tasks. Interns work as co-therapists in group therapy, conduct screenings and assessments, and carry 1-2 individual patients.
Geriatric and Health Psychology (VAMC). This rotation may include individual and group psychotherapy, family interventions, psychological and cognitive assessment, behavioral interventions, education to staff on inpatient medical units (i.e., sub-acute rehabilitation, inpatient Hospice & extended care medical units). Interns work in concert with medical providers, physical and recreation therapists, nursing staff, administration, behavioral health providers and all members of the multidisciplinary team. A subcomponent of the rotation includes an opportunity for experience with the Home Based Primary Care (HBPC) program, providing exposure to interdisciplinary and innovative care practices, enabling a view into the homes of patients who may typically be seen only in office settings. HBPC serves a largely geriatric patient population for whom complex mental health and cognitive issues merge with myriad medical problems. The HBPC psychologist provides a full range of psychological assessment and diagnostic services and treatment of primarily Axis I conditions such as mood and cognitive disorders (e.g., dementia). Additional areas of intervention are likely to include grief and loss, life transitions, pain and health behavior management, and capacity/competency and memory assessment. Importantly, the HBPC psychologist provides mental health services for spouses, family members/caregivers in conjunction with the veteran’s care plan to support the veteran remaining in the home. As part of a training program, trainees earn progressive responsibility for the care of veterans and their caregivers under the supervision of the HBPC psychologist.
Clinical Neuropsychology (VAMC). This is a full-time elective rotation that provides the intern an opportunity to expand his/her understanding of Clinical Neuropsychology in a medical setting. Interns work closely with a Neuropsychologist in responding to request for consultation from various areas of the hospital, but most commonly from Neurology, Polytrauma and Behavioral Health. A diverse patient population presents a variety of important issues, including neurodegenerative disorders, neurodevelopmental conditions and traumatic brain injury. Interns on this rotation function as members of multidisciplinary team and assume responsibility for the delivery of psychological services. In addition to direct patient care and report writing, interns also interact with referral sources and provide education and/or brief counseling to patients and their families. Opportunities may be available for the interested trainee to assist with program development, special projects and research. Note: This rotation requires that an intern has some prerequisite experience (e.g., a neuropsychology practicum and/or coursework) prior to internship.
Psychiatric Emergency Room and Crisis Intervention Unit (CDPC). Interns serve as crisis team members, evaluating acutely ill psychiatric patients who present in the emergency room for treatment. In conjunction with psychiatric staff, interns coordinate patient disposition and referral. This is a part-time (approximately 15 clock hours) rotation that is required of all interns.
Seminars/Case Conferences. The core seminar experience is provided by psychology and psychiatry faculty from consortium institutions and the community. Each week, interns are given up to four hours of didactic training in such areas as personality assessment, psychotherapy technique, psychopharmacology, neuropsychological assessment, family therapy, and group therapy. Along with seminars, case conferences are opportunities to discuss cases of educational interest. Case conference presentations are made by senior faculty, psychiatry residents, and psychology interns.
Grand Rounds. Grand Rounds presentations are sponsored by the Department of Psychiatry, Albany Medical College. Interns are asked to attend weekly Grand Rounds as part of their educational experience. Lectures on a variety of topics in psychiatry and psychology are presented by Consortium faculty, as well as researchers and professionals from around the country. Interns have also been invited to present at Grand Rounds.
Teaching Days. There are workshops and teaching days throughout the year. In the past, these teaching days have covered such topics as advanced psychopharmacology, anorexia nervosa, treatment of phobias, short-term dynamic treatments, cognitive therapy of depression, neuropsychology, and treatment of borderline and narcissistic disorders. In addition to the educational experiences listed above, interns may attend classes offered in the residency training program such as advanced psychoanalytic techniques, Freudian theory, brief therapy, psychopharmacology, family therapy, and hypnosis.
Teaching/Supervision Experience. Interns are provided elective opportunities to serve in teaching and supervisory roles within the Department of Psychiatry, Albany Medical College. Interns, closely followed and mentored (supervised themselves) by senior faculty, are afforded the opportunity to teach medical students (3rd year) in evidence based psychosocial treatments and cognitive-behavioral therapy. Interns also serve as leaders of a cognitive-behavioral supervision group for second year psychiatry residents. These roles allow interns to develop an understanding of the unique knowledge base and value of psychology in a multidisciplinary academic medical center.
Long-Term Therapy. While time-limited forms of psychotherapy play a major role in contemporary clinical practice, we feel that the best way to prepare for shortening treatment is by obtaining an in-depth understanding of patients, acquired via intensive (“long-term”) psychotherapy. Once interns internalize the process of intensive psychotherapy, they can then become more efficient in therapy and subsequently work towards shortening treatment length. In the long-term psychotherapy program, interns, upon arrival, are assigned two or three carefully selected psychotherapy patients to see during the entire year. For each case, interns have a different supervisor who provides hour-for-hour supervision. These cases are seen in addition to brief psychotherapy cases associated with their outpatient rotation(s).
Supervision. On each rotational assignment, the intern is assigned a principal supervisor, usually the most senior psychologist. This principal supervisor provides the bulk of the supervision and oversees the rotational experience. The supervision is close, intensive, and follows an apprenticeship model. On each rotation, interns may receive additional supervision from other psychologists as well as from other mental health professionals.
Interns are formally evaluated six times during the course of the year. Detailed feedback is solicited from all supervisors, and the Director collates the data for a supervisory feedback meeting with the intern. When problem areas arise, plans of correction and remediation are implemented in a timely manner. Twice a year, the interns' home training programs are given written evaluations of the student's progress.
The interns are also encouraged during the evaluation periods to give the program feedback about their training experiences. When problems arise, plans of remediation are quickly implemented to insure a responsive and supportive training experience for the intern.
The Work Week
We are a full time internship, which runs from September thorough August. As a full-time intern, a forty-plus hour workweek is expected. It is not expected that interns will ever have to work more than 45 hours (at most), and there are no weekend commitments. We are a training institute, which believes the interns earn a stipend for being trained. They are not here to see large numbers of patients, or to produce volumes of reports. The only time we are concerned about numbers is when attempting to determine an optimal workload is for training. Training needs come first. Service needs come second. This has always been a core value of the internship.
CDPC/AMC stipendees receive 10 days of vacation with 11 sick/personal leave days during the course of the year as well as paid national holidays. The VA stipendees receive 13 vacation days and 13 sick/personal leave days per year with paid national holidays. Pay periods are once every two weeks, with a total of 26 pay periods per year. All interns have health insurance benefits. Stipend for 2010-2011 is approximately $28,000.
Both the Albany Medical College and the Stratton VAMC have full medical libraries with ample resources for the interns' research and scholarship needs. Interns have electronic database (PsycINFO, MEDLINE) and electronic journal access, inter-library loan services, and research/reference support.
On all but two rotations, the interns have their own individual offices. On two of the busiest services, the interns have shared office space with one or two other professionals in training. There is ample secretarial support, and computer access on all rotations for word processing, web resources, and email. Interns are provided pagers. Interns have free parking at the VA and pay $5.00 a month for garage parking at AMC/CDPC.
Post-Doctoral Training Opportunities
Recently interns at the Consortium have been fortunate as the Albany Medical Center, Department of Psychiatry and the Stratton VAMC have established post-doctoral fellowship positions. New in 2008, the Stratton VA has established a post-doctoral training program with a focus on the treatment of PTSD. The program will accept two intern/graduates each year. For further information see: www.psychologytraining.va.gov. Likewise, the AMC, Department of Psychiatry, has funded a single post-doctoral fellowship position for the past five years. AMC post-doctoral fellows have developed personalized training opportunities in inpatient psychiatry, psychological assessment, and consulting psychology.