Psychology Internship
Structure of the Internship
Each intern engages in training activities in three areas throughout the year:
- Inpatient assessment and treatment,
- Outpatient assessment and treatment, and
- Supervision, seminars, consultation, and research.
In general, about one-third of the intern's schedule each week is devoted to each area.
Our program is particularly attentive to individual differences in training needs. Under the guidance of the Director, a diversity of opportunities and resources is available for the interns to utilize in developing a program in keeping with their unique interests and professional goals. While some experiences are required of all interns, our philosophy of flexibility dictates the individual needs, interests, and professional goals of each intern must be considered in determining supervised activities throughout the year. In the development of an individualized learning contract at the beginning of the training year, each intern will select rotations that reflect the core competencies of internship training at U Mass Medical School and Worcester State Hospital. These competencies are Assessment, Treatment Interventions, Multicultural Diversity, Collaboration with Multidisciplinary Treatment Teams, and Supervision.
Inpatient Rotations
For the inpatient component of their training, interns select from several sites based on their training needs. Over the course of the internship, interns choose two hospital rotations to learn about the care and treatment of individuals with severe and persistent mental illness.
Psychiatric Treatment Center: This admission unit is an acute-care unit that specializes in the evaluation and treatment of individuals with psychiatric disorders. The average length of hospitalization on this unit is one week. Approximately eighty percent of those admitted to the Psychiatric Treatment Center are discharged back to the community and twenty percent are transferred for further inpatient treatment to other units. Patients on this service display severe psychopathology and are primarily diagnosed as having a schizophrenic disorder, a major affective disorder, or a severe personality disorder. Approximately one-half of admissions have abused alcohol and/or illicit drugs and are in need of substance abuse treatment. The Psychiatric Treatment Center utilizes a multidisciplinary clinical model with active participation by psychiatry, psychology, social work, rehabilitation therapists, and nursing staff. Psychology interns, as well as students in other disciplines, are an integral part of the clinical program on the unit.
back to top
UMass Adolescent Treatment Program: The UMass Adolescent Treatment Program is a 30-bed, continuing care inpatient facility sited on the grounds of Westborough State Hospital. Clients range in age from 13 to 18. This population is culturally, ethnically, racially, and socioeconomically diverse. Assessment and treatment of clients is provided with a multidisciplinary approach. Each treatment team is comprised of psychiatrists, social workers, nurses, occupational therapists, recreational therapists, mental health counselors, and psychologists. Most clients have been hospitalized in psychiatric facilities or have been placed in residential or multiple foster homes prior to assignment to this unit. Because of the demonstrated level of need, patients typically stay from 6 to 18 months allowing for extensive clinical services. This includes psychopharmacological intervention, individual, group and family therapies as well as occupational, recreational, and milieu treatments. Four beds are allocated to forensic services. Clients are referred from the courts for assessment of competency to stand trial, criminal responsibility, or aid in sentencing. Average length of stay ranges from 7 days up to around two months, depending on demonstrated level of need. Treatment includes pharmacological intervention, behavioral treatment, individual and treatment of patients is provided using a multidisciplinary approach. The core treatment team consists of the program director (licensed clinical psychologist), medical director (psychiatrist), internist, nurse practitioner, occupational therapist, social worker, and behavioral coordinator. The unit works collaboratively with neurology due to the large number of individuals who have neurological comorbidities. We receive all referrals from and work closely with The Department of Mental Retardation (DMR). The unit serves the entire state of MA, along with CT and ME. The psychology intern will participate as a member of our treatment team, while attending daily AM rounds and participating in all phases of a patient’s hospital course, focusing on assessment, treatment plan development, and implementation of that plan. Learning objectives for this rotation will include, but are not limited to: (1). Understand symptoms associated with mental illness in the MR/MH population, (2). Describe and assess commonly identified medical problems that affect people with developmental disabilities, (3). Describe ways in which a physical health problem may cause a clinical picture that appears like but is not a psychiatric disorder, (4). Describe psychotropic medication side effects that may exacerbate challenging behaviors, and (5). Increase knowledge in differential diagnosis, both medically and psychiatrically. As the rotation is completed, the intern will be well-versed in working with medically and psychiatrically complex cases on an acute psychiatric inpatient unit.
This is a six-month elective to be agreed upon by the intern, the UMass Adolescent Treatment Program and the UMass/Worcester State Hospital Clinical Psychology Internship Program. Interns are expected to be on site two days per week with a minimum commitment of 12 hours per week. While a challenging population, there are few sites in the Commonwealth that provide this type of dynamic learning environment. At least one hour of individual/dyadic supervision per week will be offered by an on-site licensed psychologist. This rotation will expose the intern to the complexities of inpatient care within the context of a multidisciplinary team. The intern will learn about assessment, treatment, and discharge planning along with specialized services to forensic clients. By the end of this rotation, the intern will have grounding in differential diagnosis, risk management and the child service delivery system. We expect that the intern’s confidence in dealing with complex cases will increase significantly.
back to top
Worcester State Hospital: The hospital currently has six treatment wards. These units are closely connected to the hospital-wide Skills Training and Rehabilitation program. This psychosocial rehabilitation program includes therapeutic, vocational, educational, and recreational elements. Opportunities exist in several specialized areas.
Worcester State Hospital Treatment Wards: The treatment wards at Worcester State Hospital focus on preparing adults in the transition process from an inpatient stay to community living. The treatment approach is multidisciplinary in nature and is aimed at assisting the individual in engaging in treatment, maintaining adequate behavioral and emotional control, and taking the steps necessary to succeed while living in the community. The treatment model incorporates a thorough diagnostic work-up, psychosocial rehabilitation, and Dialectical Behavior Therapy (DBT). Inpatients are empowered to understand symptoms associated with mental illness and follow through with strength-based interventions and plans that will maximize adjustment and transition to less restrictive alternatives to hospitalization.
At Worcester State Hospital, DBT/CBT programs have been implemented on a number of treatment wards, with several members of the staff trained intensively in DBT. The psychology interns participate in all phases of the individual’s hospital course from assessment/ psychological testing to providing treatment interventions, to helping the individual work through an integrative discharge plan. The staff at Worcester State Hospital has recently implemented an Illness Management and Recovery (IMR) treatment program, and evidence-based group and individual treatment protocol to assist individuals in learning more about and coping with their psychiatric disorders.
back to top
MI/PSB Program: The Mentally Ill/Problematic Sexual Behavior (MI/PSB) Program is a statewide initiative, which is designed to address the assessment and treatment needs of chronically mentally ill individuals, who present with co-occurring sex offending and/or problematic sexual behaviors. Psychology internship training experiences include didactic training and individual supervision in the assessment and treatment of WSH inpatients, who have been identified as MI/PSB clients. This includes the administration of psychometric instruments, report writing geared to the formulation. The MI/PSB Director, Laurie Guidry, Psy.D.,is an experienced sex offender clinician, who has expertise in working with patients with patients with co-morbid mental illness and problematic sexual behavior.
back to top
The Adult Neuropsychiatric Disabilities Unit (NDU): The NDU is located on the University Campus as UMass Memorial Medical Center (8 South) is a ten-bed program that serves adults with developmental disabilities and acute psychiatric disorders. Average length of stay ranges from seven days to two months, depending on demonstrated level of need. Treatment includes pharmacological intervention, behavioral treatment, individual and group therapy, along with occupational and recreational treatments. Assessment and treatment of patients is providing using a multidisciplinary approach. The core treatment team consists of the program director (licensed clinical psychologist), medical director (psychiatrist), internist, nurse practitioner, occupational therapist, social worker, and behavioral coordinator. Other critical team members include the neurology and neuropsychiatric consultants. The unit works collaboratively with neurology due to the large number of individuals who have neurological comorbidities. We receive all referrals from and work closely with The Department of Mental Retardation (DMR). The unit serves the entire stat of Massachusetts, along with Connecticut and Maine. The psychology intern will participate as a member of our treatment team, while attending daily morning rounds and participating in all phases of a patient’s hospital course, focusing on assessment, treatment plan, development, and implementation of that plan. Learning objectives for this rotation will include, but are not limited to:
Understanding symptoms associated with mental illness in the MR/MH population.
Describe and assess commonly identified medical problems that affect people with developmental disabilities.
Describe ways in which a physical health problem may cause a clinical picture that appears like a psychiatric disorder, but is not.
Describe psychotropic medication side effects that may exacerbate challenging behaviors.
Increase knowledge in differential diagnosis, both medically and psychiatrically. As the rotation is completed, the intern will be well-versed in working with medically and psychiatrically complex cases on an acute psychiatric inpatient unit.
back to top
Forensic Program
Inpatient Rotation Forensic Track: The inpatient rotation for the Forensic Track is six months in duration and is located at the Worcester State Hospital on the Court Evaluation Unit. The court evaluation unit is a 15-bed unit where male and female defendants are evaluated. The types of charges that defendants have on the CEU range from minor offenses to felonies. Interns will conduct psychological testing and assist in court-ordered evaluations (i.e., Competency to Stand Trial, Criminal Responsibility, Aid to Sentencing). Interns will also participate in Risk Assessment Evaluation. During the rotation, interns will be trained in the use of forensic and risk assessment instruments, including the ECST-R, MacCAT, PCL-R and PCL-SV. Interns will participate (and eventually conduct) evaluation sessions and co-author forensic reports with the goal of being able to produce a high-quality forensic report by the completion of the evaluation. Because WSH has a court on-site, interns will have the opportunity to observe court proceedings.
back to top
Outpatient Rotations
Neuropsychology: The outpatient rotation in Neuropsychology provides supervision and training in the neuropsychological assessment of patients from neurological, neuropsychiatric, and general medical populations. Training takes place within the outpatient service of the Department of Neurology on the UMMS campus. A commitment of 16-hours per week for 12 months is required. In addition, at a minimum, a commitment of 3-5 hours of off-site time is required for activities such as report writing. The rotation is especially designed for individuals wishing to establish themselves as clinical neuropsychologists as their professional goal. While this represents the standard rotation, alternative arrangements involving fewer hours may be negotiated, and will be considered on a case-by-case basis. The rotation provides training in the administration, scoring, and interpretation of neuropsychological assessment instruments, and focuses on the consolidation of this information into succinct written reports. Patient populations include the broad range of neuropsychological disorders, and referrals come from multiple services both within and outside of the hospital. Opportunities are available to see both adult and child patients. In addition, various didactic offerings are available within the Medical School, including the Departments of Neurology and Psychiatry Grand Rounds, Epilepsy Conference, case conferences, and lecture series that offer some of the most clinically relevant research findings available.
Supervision is under the direction of Brian Dessureau, Ph.D. at the UMMS Department of Neurology. In addition to neuropsychological assessment of outpatients with a wide variety of neurological and neuropsychiatric disorders, an opportunity to provide psychotherapy to individuals with medical conditions within the hospital setting is also available.
back to top
Community HealthLink: Community HealthLink (CHL) is the major provider of outpatient services to patients with major mental illness in the Central Massachusetts area. Due to deinstitutionalization and decreasing length of hospital stays, the opportunity to treat and follow the progress of a person with severe and persistent mental illness occurs more frequently in the community setting. Interns will have the opportunity to provide services to a number of such clients. Some may be clients they have assessed and/or treated in their inpatient rotations. Interns will be introduced to the array of services these clients receive, including individual therapy, assertive outreach, substance abuse services.
back to top
Electives for Psychology Interns
Introduction
The outpatient electives at the University of Massachusetts Medical School (UMMS) are comprised of four specialty areas: adult outpatient, child outpatient, behavioral medicine, and neuropsychology. During the orientation period interns become acquainted with the opportunities in each elective area. Upon selecting an area the intern then works with the training faculty to arrange for specific clinical activities and related seminars.
The outpatient electives comprise one-third of the intern's training week, at least 16 hours/week. The intern may select one major outpatient rotation or combine two rotations (e.g., 8 hours each) to fulfill this training requirement.
back to top
Health Psychology Outpatient Rotation
The Health Psychology Outpatient Rotation is coordinated through the Adult Outpatient Psychiatry Service in the Dept of Psychiatry. The outpatient health psychology service consists of psychologists working with medical and surgical outpatients for a host of issues including: Depression or anxiety associated with medical illnesses, individual and family adjustment to illness, coping with disease management demands, adoption of healthy lifestyles, non-pharmacological symptom management, preparation for surgery and coping with medical interventions. Referrals come from any of the primary or tertiary care clinics within the hospital system, with particular emphasis on Cardiac Rehabilitation, Multiple Sclerosis, Women’s Health/Reproductive Endocrinology and Compulsive Eating.
Interns on this rotation will have the opportunity to provide consultation to patients, family and staff, participate in psychoeducational groups (Pain Management, Living Well with Chronic Illness, Post-Partum Depression, Compulsive Eating, Stress Management in Cardiac Rehabilitation), perform individual assessments and treatment planning, participate in individual psychotherapy and occasionally meet with family members. As is typical of the health psychologist role, work would also include contact with multi-disciplinary treatment teams.
This rotation may also include experience in the Cardiac Rehabilitation Program and the Multiple Sclerosis Clinic as scheduling permits.
Half-year or full year rotations are available, and clinic time can be distributed over multiple days. Additionally, if choosing a full year rotation, research opportunities or a greater emphasis with specific populations are also available for those interns that are interested. Clinical supervision is coordinated by Dr. Elizabeth Austin, Director, Clinical Health Psychology.
back to top
Weight Center: The UMass Memorial Weight Center, located on the University Campus, is a multidisciplinary, patient-focused service designed to help adults struggling with obesity and weight-related disease. Physicians and specialists in nutrition, behavioral medicine and exercise work together with the patient and referring physician to develop individualized treatment plans.
Behavioral Track: A long-term, high-intensity, nonsurgical weight management program integrating medical, nutritional, behavioral and physical activity elements.
Surgical Track: A comprehensive program that prepares potential patients for success with weight loss (bariatric) surgery. Surgical options include either the Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding.
Custom Track: A tailored program for patients with special weight loss goals.
The Weight Center provides the most advanced strategies for lasting weight loss. Referrals from primary care physicians are generally required for participation. Patients also benefit from convenient access to the comprehensive services available at UMass Memorial Medical Center, providing a complete health care continuum. The Weight Center is fully accredited by the American College of Surgeons as a bariatric surgery center. Weight Center psychologists work from a healthy psychology / biopsychosocial conceptualization of obesity. There is a strong emphasis on working within a multidisciplinary setting. Clinical and professional opportunities include:
Conduct pre-bariatric surgery psychological assessment of the psychosocial, emotional, behavioral, and lifestyle challenges of each patient to assist in proper treatment planning and intervention. Coordinate care with external mental health providers as well as health care professionals as needed. Attend weekly team meetings with the multidisciplinary Weight Center team of professionals to coordinate and plan patient care. Conduct post-surgery groups to provide ongoing support and monitor the psychosocial, emotional, behavioral, and lifestyle challenges of patients as they move through the stages of weight loss and into weight maintenance phase. Conducting cognitive-behavioral, time limited, lifestyle based weight management groups for overweight and clinically obese adults. Conduct Pre-Surgical Skills groups for bariatric surgery patients to assist them in their preparation for this intervention. The primary objective of the Skills Group is to provide psychoeducation regarding the pre and post-surgery process which emphasizes the importance of behavioral change.
back to top
Adult Consultation-Liaison: The Consultation-Liaison rotation is housed in the Psychosomatic Medicine Division of the Dept of Psychiatry. The consultation-liaison rotation generally consists of health psychologists working with medical/surgical inpatients for a diverse range of issues including: depression/anxiety due to medical illness or injury, exacerbation of psychological issue due to medical condition, coping with pain, sleep disruptions, adjustment to hospital, addiction issues, cognitive decline/dementia, PTSD, cultural issues that interact with medical treatment plans, and suicidal/self-harm behaviors.
Consultations may come from any of the specialty medical units in the hospital (cardiac, trauma, OB/GYN, oncology, neurology, GI, surgery, general medicine, etc). Interns on this rotation will have the opportunity to provide bedside therapy, perform neuro-cognitive assessments, and will occasionally work with the families of patients. This rotation would also include interacting with multi-disciplinary treatment teams to establish strategies for working with difficult patients and education about psychological and socio-cultural issues that may affect medical treatment.
This rotation may also include experience in the Emergency Mental Health department (adjacent to the University campus ER) which provides emergency mental health care through brief therapy/crisis intervention and facilitates mental health admission or connection with outpatient mental health providers.
Half-year or full year rotations are available. The best format for this rotation is a minimum of 8 hours divided across two days, but other arrangements can be made. Additionally, if choosing a full year rotation, research opportunities or a greater emphasis with specific populations are also available for those interns that are interested. Clinical supervision is provided by Amy Wachholtz, PhD.
back to top
Outpatient Adult Psychiatry Clinic: Under the supervision of Robert Carey, Ph.D. or his designee, interns can receive training in evaluation and therapy with a variety of adult psychiatric conditions, including psychosis, affective disorders, eating disorders, personality disorders, marital discord, anxiety disorders, and sexual dysfunction. Individual, couples, family, and group therapy procedures using a variety of theoretical approaches, including behavioral, cognitive-behavioral, and psychodynamic strategies, are utilized in this clinic and provide interns with a broad range of experiences in outpatient adult disorders. Monthly case conferences in this clinic provide a further opportunity for interns to more thoroughly examine the processes involved in the assessment, differential diagnosis, and treatment selection.
back to top
Domestic Violence/Anger Management Rotation: The Men's and Women's Workshop/Anger Management Program at UMass is a university-based research and treatment program for domestic violence. Under the supervision of Lynn Dowd, Psy.D. and Mary Bennett, LICSW, interns receive training in the assessment and treatment of anger problems, aggression, and intimate partner violence in men, women, and adolescents. Interns will participate in all aspects of the program, perform intake assessments, and conduct groups with an experienced co-leader.
For interns who desire more intensive training in family therapy, clinical rotations with William Vogel, Ph.D. and Stuart Fisher, Ph.D. can be arranged. Dr. Vogel directs the family therapy training program in the Department of Psychiatry and holds a diplomate in family psychology, ABPP.
back to top
Child and Family Forensic Center: A variety of opportunities are available in the Child and Family Forensic Center, which serves the Worcester Probate and Family Court. Brief evaluations in the Worcester Family Court Clinic address issues in areas such as visitation. Comprehensive evaluations may address issues such as custody, termination of parental rights, and domestic violence. Interns attend sessions of Parents Apart, a court-mandated parent education program for divorcing parents, and may observe or provide testimony. Linda Cavallero, Ph.D. and Geri Fuhrmann, Psy.D. provide supervision.
back to top
Pediatric Psychiatry: Under the supervision of Jessica Edwards George, Ph.D., Psychology interns can participate in a yearlong experience focusing on consultation and short-term treatment with children and families referred by physicians within the UMMS/UMMHC community. This experience will be a minimum of five or more hours per week. Interns will work in a program that provides support to all the pediatric subspecialty clinics, including, hematology/oncology, neurology, gastroenterology, immunology/rheumatology, etc. Interns also participate in a weekly seminar jointly sponsored by Behavioral Medicine and Pediatric Psychology. Faculty, post-doctoral fellows, and other trainees from both services attend the seminar.
back to top
Primary Care and Family Medicine: The Department of Primary Care and Family Medicine offers a longitudinal experience in Primary Care Psychology. Interns will provide behaviorally oriented brief therapy and family therapy to patients in a primary care medical setting. They will also conduct groups focused on changing health risk behaviors and participate in conferences on patient diagnosis and treatment with resident and attending physicians. The experience takes place at the newly remodeled Hahnemann Family Health Center on the UMMHC Hahnemann campus. Supervision is done by Alexander Blount, Ed.D., Director of Behavioral Science. Interns should expect to spend 5 hours per week for 12 months.
back to top
YOU, Inc.: YOU, Inc. is a large not-for-profit organization that provides a wide range of services for troubled children and adolescents, and their families. The counseling center offers several exciting opportunities for pre-doctoral interns, including psychological testing and other special evaluation services (e.g., ADHD, sexual abuse, fire setters), psychotherapy cases (children, teens, adults, and families), co-facilitating parent education groups or child therapy groups, and consultation to schools. In addition, interns may sit in on the seminar in family therapy (from September through May) which features a lecture-discussion section, selected readings, and live demonstration cases with families utilizing a reflecting team format. Licensed clinical psychologists provide supervision.
This rotation requires a yearlong commitment of a minimum of 8 hours per week. An additional 4 hours on Wednesday mornings will be required if the intern chooses participate in the Family Therapy State Hospital. These conferences are interspersed with lectures on clinical topics of particular importance in public sector mental health systems. There is a weekly Psychiatry Grand Rounds covering a wide variety of clinical topics related to the assessment and treatment modalities of children and adults with psychiatric disorders. Also, the Psychiatry and the Law program at UMass Medical School conducts a bi-monthly lecture series on topics relevant to Forensic Psychology.
back to top
Supervision, Seminars, Consultation, and Research
Approximately one-third of the intern's time is spent in these areas. All interns receive both individual and group supervision for their inpatient work throughout the year. In addition supervisors are assigned for psychological testing and forensic assessments on a case-by-case basis. The number of outpatient supervisors varies somewhat but all work is closely supervised. In general, interns may have 2-4 supervisors for their outpatient rotations. Licensed doctoral psychologists provide clinical supervision.
Interns have an extensive series of seminars. Major topics include: assessment with particular emphasis on interviewing, neuropsychology, and forensic assessment; psychopathology, psychopharmacology; physiological and hormonal factors; and psychological treatment modalities with particular emphasis on family and group approaches. This seminar series also includes topics such as empirically-based treatment interventions, psychosocial rehabilitation, and the importance of the assessment and integration of multicultural and ethnic diversity. Two regularly scheduled seminar times throughout the year provide an opportunity to cover these assessment and intervention topics in some detail. Although research is not a required activity, interns are encouraged to continue their own research or to participate in ongoing research in the Worcester area. Four hours per week are dedicated to the interns’ research.
Finally, there are numerous teaching conferences, grand rounds presentations, and professional activities in the Worcester/Boston area. There are weekly teaching conferences that utilize the case presentation format both at the Psychiatric Treatment Center and Worcester.
back to top