The Program
The training program consists of three parts: clinical rotations, seminar presentations, and long-term psychotherapy supervision.
ROTATIONAL ASSIGNMENTS
The interns receive their training as diagnosticians and treating clinicians 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 on an inpatient service and one on an outpatient service. 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:
OUTPATIENT PSYCHIATRY
(Albany Medical Center Outpatient, Stratton VA Medical Center Mental Health Clinic) Interns serve as staff psychologists working on a multidisciplinary team with responsibility for screening, diagnosing, assessing, and treating a broad spectrum of patients. An average caseload is between 8-10 patients. Depending on the site, specific opportunities exist for working with veterans with combat related PTSD, doing group, marital and family therapies, and consulting on psychopharmacological issues.
ALBANY MEDICAL CENTER INPATIENT PSYCHIATRY
Interns serve as primary therapists and treatment team members on an inpatient unit for the severely mentally ill. The average length of stay for patients is 10 days. Interns are members of a multidisciplinary treatment team working with a broad spectrum of psychodiagnostic groups, including PTSD, mood disorders, personality disorders, and schizophrenia. Interns carry an average caseload of 3-4 patients and gain experience in conducting diagnostic interviews, administering diagnostic batteries, and writing psychological reports. Additionally, interns are given the opportunity to facilitate group therapy sessions and to gain experience in case management and community liaison work.
CHILD AND ADOLESCENT PSYCHIATRY
(Capital District Psychiatric Center) Interns are primary therapists for children and adolescents in need of treatment. They receive experience in play therapy, family therapy, and diagnostics (interviewing and testing), 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 provide diagnostic assessments, supportive therapy, and didactics for facility staff.
CHEMICAL DEPENDENCY REHABILITATION PROGRAM (CDRP)
(Stratton VA Medical Center) Interns serve as an integral member of a multidisciplinary treatment team consisting of professional and paraprofessional staff devoted to the treatment of veterans with alcohol and drug abuse/dependence problems. A multimodel treatment approach is used, which includes individual, group, and milieu psychotherapy/counseling, lectures, discussions, 12-step meetings, experiential tasks, and other therapeutic activities. An important subset of the CDRP population is the patient who is dually diagnosed with both mental illness and addictions. Interns work as co-therapists in group therapy, conduct screenings and assessments, and carry 1-2 individual patients.
POST TRAUMATIC STRESS DISORDER PROGRAM (PTSD)
(Stratton VA Medical Center) The PTSD program is a short-term intensive program designed to provide treatment for the problems of Vietnam and Iraq Veterans with readjustment problems (including Post Traumatic Stress Disorder). 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 diagnostic and treatment issues of this population; 2) a 16-week outpatient treatment program designed to address skill deficits which frequently interfere with adaptive function; and 3) individual inpatient treatment focusing on desensitization and the emotional processing of traumatic memories via intensive exposure-based psychotherapy. Interns work closely with staff in providing these psychological services.
PSYCHIATRIC EMERGENCY ROOM AND CRISIS UNIT
(Capital District Psychiatric Center) 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 rotation that is required of all interns.
CROSSROADS ADOLESCENT DAY TREATMENT PROGRAM
The Crossroads Adolescent Day Treatment Program is an intensive day program for adolescents between the ages of 12 and 18. Referred from school districts' Committees on Special Education, these adolescents have been diagnosed with a severe emotional disturbance and/or mental illness. Crossroads has a capacity for 18 adolescents who are serviced with educational and clinical programming including a 6:1:1 classroom, individual therapy, group therapies, family therapy, pharmacotherapy, and milieu treatment. Psychology interns are part of the multidisciplinary team and serve as a primary therapist to one of the students. In addition, psychological testing and facilitation of group therapy are also included. Interns participate in weekly staff meetings and patient treatment review meetings. Active involvement in the milieu is also encouraged.
PRIMARY CARE WITH COLLABORATIVE HEALTH CARE TEAM
The Collaborative Health Care Team provides behavioral health consultation within the Medical Primary Care Clinics at the VA Medical Center. The major emphasis for interns in these clinics is the application of behavioral and cognitive therapies to medical disorders, particularly those in which stress is seen as a causal or exacerbating factor (e.g., hypertension, cardiac or pulmonary disease, diabetes, obesity, chronic pain, fatigue, insomnia). Interns also are responsible for short-term treatment of adjustment reactions, depressive disorders, and anxiety disorders, and for screening for more severe psychopathologies requiring treatment elsewhere. In addition, psychologists assist patients in adjusting to chronic illness/disability, making life role transitions, coping with acute grief/loss, and enhancing personal well-being and relationships through improved stress management. The intern will participate in the health care of adults of varied ages, but with the opportunity to emphasize clinical work with older adults. The intern will develop skills in rapid assessment and case formulation; triage; consultation/collaboration with physicians, nurse practitioners, and physicians' assistants; short-term, solution-focused individual psychotherapy; and development and implementation of psychoeducational programs.
INTENSIVE CARE PROGRAM (CDPC)
Interns work on an inpatient psychiatric unit that houses individuals with a variety of diagnostic categories including psychotic disorders, mood disorders, characterological disorders, and cognitive disorders who are exhibiting behavioral dyscontrol. Interns provide individual therapy and co-lead various therapy groups. They also provide psychological testing and psychological screenings that include mental status evaluations. Interns are part of a multidisciplinary treatment team that is responsible for treatment planning.
CLINICAL NEUROPSYCHOLOGY
(Stratton VA Medical Center) This is a full-time elective rotation that provides the intern an opportunity to expand his/her understanding of Clinical Neuropsychology and to experience its application in a medical setting. The intern who chooses this rotation will work closely with a Neuropsychologist in responding to requests for consultation from various areas if the hospital, but most commonly from Neurology and Behavioral Health. A diverse patient population presents a variety of important issues including neurodegenerative disorders, neurodevelopmental conditions, traumatic brian injury, and so on. Interns on this rotation function as members of a multidisciplinary team and assume responsibilty for the delivery of psychological services. In addition to direct patient care and report writing, students also interact with referral sources and provide education and/or brief counseling to patients and their families as appropriate. Opportunities may be available for the interested student to assist with program development, special projects, and research.
EDUCATIONAL OPPORTUNITIES
Seminars/Case Conferences: The core seminar experience is provided by psychology and psychiatry faculty. Each week, interns are given four hours of didactic training in such areas as personality assessment, psychotherapy technique, psychopharmacology, diagnostic interviewing, neuropsychological assessment, family therapy, and group therapy. Other timely topics in psychology are added as the year progresses. Along with seminars, there are case conferences where cases of educational interest are presented to the intern group. These presentations are made by senior faculty, as well as by the interns themselves.
Grand Rounds: Grand Rounds presentations are sponsored by the Department of Psychiatry at Albany Medical College. Interns are asked to attend weekly Grand Rounds as part of their educational experience. Lectures of topical importance, as well as specific case material, are presented by the Consortium faculty, and respected 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.
Long-Term Therapy Program: Although some believe that training in long-term psychotherapy is inappropriate in the era of managed care, we disagree. We contend that the best way to prepare for shortening treatment is by obtaining an in-depth understanding of patients, acquired by spending time with them, listening to them, exploring the roots of their problems, and learning methods of responding to their dilemmas. Once interns understand this long-term process, 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 to 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 the required outpatient rotation.
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.
The 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. Here too, when problems arise, plans of remediation are quickly implemented to insure a quality 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 will not be a fifty, or sixty or seventy-hour workweek, and there are no weekend commitments. We are a training institute, which believes the interns earn a salary for being trained. They are not here to see large numbers of patients, to produce volumes of reports, or to help earn someone else's salary. The only time we are concerned about numbers is to determine whether or not the workload is optimal for intern learning. Training needs come first. Service needs come second. This has always been part of our philosophy. Rest assured, however, that the interns work hard, and they do indeed feel they have put in a solid week at the end of each Friday. But it will always have been a forty plus hour week at most, and a week that had been designed to optimize learning.
FRINGE BENEFITS
Both the VA and the Albany Medical College have full medical libraries with ample resources for the interns' research and scholarship needs.
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 (at most) other professionals in training. There is ample secretarial support (some limitations on only one rotation) and there is computer access on all rotations for word processing, utilizing web resources, and email. Our interns also have pagers. Interns have free parking at the VA and pay $5.00 a month for garage parking at AMC/CDPC.
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.
