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    Psychology Internship Training Track

    The CPMC psychology internship has a number of different training tracks that offer a variety of clinical experiences. The current offerings are combined into the following positions for a total of ten full-time pre-doctoral internship slots.

    Adult Outpatient

    Three interns are selected to see adult patients in the Outpatient Mental Health Clinic. Interns see individual psychotherapy patients, conduct intakes,couples therapy, and see Employee Assistance Program clients.

    Mental Health Clinic (MHC)
    The Outpatient Mental Health Clinic is operated by California Pacific Medical Center, Department of Psychiatry. It serves adults, children, adolescents, families and couples on an outpatient basis. Faculty include psychologists and psychiatrists who oversee the psychology training programs and the psychiatry residency program. Interns work closely with psychiatric residents who are also involved in the stimulating training culture at CPMC.

    Intern Duties and Responsibilities
    Interns divide their time approximately equally between clinical service and training activities (supervision, seminars, and case conferences). Individual psychotherapy forms the largest segment of clinical work, but interns also provide intake evaluations and Employee Assistance Program counseling (EAP). Some crisis intervention and intake work is required. In the Outpatient Department, we have recently expanded our programs in Couples Therapy and Women’s Mental Health. Interns with interest in these areas are encouraged to apply. Approximately 14 weekly clinical contacts are considered to be a full caseload.

    Patient Characteristics and Supervision The patient population of the Outpatient Mental Health Clinic is diverse with regard to ethnicity, age, and economic status. Patients with personality disorders (mild to more severe) represent the largest patient group; approximately half the patients served by the Clinic fall into this group. Approximately 10-20% of the intern's caseload is made up of patients with a chronic psychiatric illness (i.e., Schizophrenia or Bipolar Disorder). The remainders are higher functioning neurotic patients. Patients whose primary presenting problem is substance abuse are referred out.

    Supervision is provided by highly experienced and dedicated psychodynamically oriented psychologists and psychiatrists. Every intern receives at least three hours per week of individual psychotherapy supervision. The format of "off-site" supervision is up to the intern and supervisor. Generally, however, one patient at a time is followed with each supervisor, using detailed process notes. Interns have two off-site supervisors for individual psychotherapy.

    Seminars and Conferences
    Seminars currently include Topics in Psychoanalytic Psychotherapy, Crisis Intervention, Couples Therapy, Professional Issues in Psychology, Evaluation Conference, Psychodyanimic Theory, Psychiatry Grand Rounds, and Group Psychotherapy. In addition, the intensive Time-Limited Dynamic Psychotherapy program of Hanna Levenson, Ph.D. is a part of the internship.

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    Adult Outpatient/Child Outpatient

    Four interns will do a combined internship in Adult and Child Outpatient Services. For this rotation, interns are based in the Outpatient Department and see children, adolescents, and adult patients. Interns working with children also provide four hours of service in a local school setting. These interns combine the Adult and Child training programs during their full-time internship experience. Occasionally, a half-time child internship will be offered instead of the Child/Adult combination program.

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    Child and Adolescent Service

    Mental Health Clinic (MHC)The Outpatient Mental Health Clinic is operated by California Pacific Medical Center, Department of Psychiatry. It serves adults, children, adolescents, families and couples on an outpatient basis. Faculty include psychologists and psychiatrists who oversee the psychology training programs and the psychiatry residency program.

    Internship Training Program
    The Child and Adolescent internship training program is a half-time (24 hours per week) CAPIC predoctoral internship. It may be taken alone or in conjunction with the Adult Outpatient track to form a full-time internship. The Child and Adolescent track has evolved and changed over the years and reflects the consolidation of internships formerly offered at Children's Hospital, San Francisco, Outpatient Psychiatry and Pacific Presbyterian Medical Center, Family Therapy Clinic. The program emphasizes a primarily psychodynamic theoretical orientation with some integration of family systems and cognitive behavioral models. The internship year begins on July 1 and concludes on June 30. Generally, four interns are selected each year.

    Training Philosophy
    The Child and Adolescent program is committed to training and has as its central goal a desire to deepen students' understanding and skill in the area of child and adolescent psychotherapy. The training program offers a variety of intensive child seminars, case conferences, access to weekly Grand Rounds, and experiences in individual and group therapy, as well as opportunities to do psychodiagnostic assessments with children and adolescents. Interns will also have the opportunity to do evaluations and therapy in school settings. The Clinic uniquely features an interdisciplinary approach to treatment, with ongoing collaboration with psychiatry residents and faculty.

    Intern Duties and Responsibilities
    This is an ambitious internship, offering several seminars and conferences as well as intensive supervision. An intern's time is divided between the activities listed below. The approximate amount of time (weekly) an intern generally devotes to these activities appears in parenthesis after each item below:

    1. Direct clinical services (8-10 hours)
      • Child and adolescent individual (play) psychotherapy

      • Collateral work with parents, caretakers and teachers

      • Family psychotherapy

      • Psychological testing

      • Evaluations and therapy in schools

      • Intake evaluations

    2. Seminars and conferences (6-8 hours)

    3. Intensive supervision (2-3 hours)

    4. Staff meeting (1 hour)

    5. Charting and paperwork (1-2 hours)


    Caseloads and Supervision
    Interns will have caseloads that reflect the community served by the Clinic, with a mix of individuals in terms of ethnicity, socioeconomic status and psychopathology. A sample of the behavioral and emotional concerns seen in the intern's child/adolescent caseload includes: school failure, depression, anxiety disorders, suicidal behavior, physical/sexual abuse or neglect, substance abuse, oppositional behavior, attachment difficulties, runaways, placement in foster care, impending divorce, multi-generational family problems and juvenile delinquency.

    Supervision is provided by highly experienced psychodynamically and family systems oriented psychologists and psychiatrists. Caseload supervision is provided by the Training Director. The format of off-site supervision is up to the intern and supervisor. Generally, however, one or two patients are followed at a time with each supervisor using process notes. Interns have one or two off-site supervisors for individual and/or family therapy. Additional testing supervision is provided.

    Seminars and Conferences
    The following curriculum (some required, some optional courses) is planned for the 2010-2011 training year:
    • Child Psychotherapy: Theory and Technique

    • Child Continuous Case Conference

    • Sand tray Technique

    • Child Development and Psychopathology

    • Family and Couples Therapy

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    Inpatient Psychiatry

    The Inpatient Psychiatry Service is a modern, 16-bed inpatient psychiatry unit, serving acutely disturbed adults who are admitted on a voluntary or involuntary basis. The focus of the unit is on rapid evaluation, stabilization, and discharge planning in a "managed care" context. Average length of stay is approximately one week. The unit is staffed by psychiatrists, psychiatric residents, nurses, and social workers; the staff is characterized by a high level of expertise, collegiality, and commitment.

    Internship Training
    The goal of the Inpatient training is to provide an intensive, practical education in current approaches to evaluation and treatment of severe psychopathology in adults. The psychology internship training program in inpatient psychiatry is an approximately 25 hours/week training track lasting for six months to be taken in conjunction with the Health Psychology and Adult Outpatient training tracks and forming a varied and demanding full-time program. We expect to accept two interns into this program.

    Training Philosophy
    Regardless of the setting in which she or he functions, whether in the private practice of psychotherapy or in one of the many group and institutional settings in which psychologists make their careers, the ability to diagnose, manage, and treat patients with severe psychopathology is an invaluable asset for the practicing psychologist. Such patients are ubiquitous in any mental health setting including private practice. The psychologist who is able to work with them in a comprehensive way, providing thorough diagnosis, estimating prognosis, providing psychotherapy, and making informed recommendations regarding medications and other treatments, is able to assume significantly greater responsibilities in practice, teaching, and supervision than psychologists lacking this background. A sophisticated inpatient psychiatry unit with an active teaching program is the ideal place to acquire the necessary knowledge to exercise these skills. Moreover, psychologists function as primary clinicians on some inpatient units, and also provide treatment and psychological testing in these settings. These professional opportunities require intensive inpatient training.

    Intern Duties and Responsibilities
    The intern functions as primary clinician for two patients at a time. Under supervision, and with the collaboration of other members of the treatment team, she or he obtains the relevant history, makes a diagnosis, and develops a treatment plan. Medications are prescribed by a resident or attending psychiatrist. During the inpatient stay, which generally lasts from 3 days to two weeks, the intern provides supportive psychotherapy, monitors the patient's progress, and coordinates the staff in providing treatment and planning for discharge (again, with daily consultation with supervisors).

    Psychological testing, adapted to the special needs of an inpatient setting, is another part of the training experience. Interns also provide group therapy.

    Caseloads and Supervision
    The primary supervisor for the overall, full-time program is Bram Fridhandler, Ph.D. A minimum of 3.5 hours/week of group supervision by a board-certified psychiatrist is provided.
    Interns carry two patients at a time. Because of the short length of stay, a large number of patients are seen during the year. The population is highly diverse with regard to ethnicity, age, and economic status.

    Approximately 60% of the intern's inpatient time is devoted to providing clinical service. This time includes diagnostic interviewing, individual psychotherapy, group psychotherapy, psychological testing, paperwork, and meetings with unit staff. The remaining time is devoted to seminars and supervision.

    Seminars and Conferences
    Close supervision in psychopathology, interviewing, inpatient group therapy, and psychopharmacology is included. In addition, interns attend the weekly Grand Rounds of the Department of Psychiatry. Also, most Health Psychology seminars and Adult Outpatient seminars are included in the overall program.

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    Core Faculity

    • Sharon Tyson, Ph.D., Chief Psychologist and Director of Psychology Training, CPMC Mental Health Clinic
    • Janos Zahajszky, M.D., Chairman, Department of Psychiatry, CPMC; Medical Director, CPMC Mental Health Clinic
    • Kathleen Fahrner, Ph.D., Director of Training, Child & Adolescent Psychology Program, Mental Health Clinic
    • Robert Root, M.D., Director, Child and Adolescent Psychiatry
    • Dongmei Yue, M.D., Staff Psychiatrist
    • Hanna Levenson, Ph.D., Director, Brief Therapy Program, CPMC; Clinical Professor, UCSF
    • Richard Zuniga, M.D. Inpatient Psychiatry Service, Medical Director

    Supervision and seminars provided by over 150 psychologists and psychiatrists affiliated with CPMC.

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    Prerequisites

    Previous clinical exposure to severe psychopathology is required; this may have been in a day treatment program, community mental health outpatient clinic, or other setting where this population is seen. Course work in psychological testing is also a prerequisite.

    Previous clinical exposure to severe psychopathology is required; this may have been in a day treatment program, community mental health outpatient clinic, or other setting where this population is seen. Course work in psychological testing is also a prerequisite.

    Applicants must be enrolled in a clinical psychology training program (Psy.D. or Ph.D.) and must have met their school's requirements to undertake internship level training.


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