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Introduction
The Veterans Affairs Medical Center, Washington, D.C., offers a psychology internship to qualified graduate students in APA-approved clinical and counseling psychology programs. Because psychologists participate widely in this large and active teaching center, psychology interns confront a broad range of potential training experiences, including those in traditional psychiatric settings, therapeutic communities, and contemporary health psychology. An enrichment program permits the intern to be exposed to nonveteran populations in facilities outside the medical center. The internship program has been fully accredited by the American Psychological Association since 1981.
Comprehensive in scope and eclectic in philosophy, the program emphasizes the broad base of psychology. The variety within our setting and the diversity among our in-house and consultant staff enable us to approach each intern's training through an individualized plan, with the goal of maximizing the intern's personal growth and technical competence. While focused on clinical and counseling practice, the internship is structured to permit some research.
The Medical Center
The Washington VA Medical Center comprises a general medical hospital and an outpatient department. Included are specialty clinics, primary care clinics, and a 120-bed nursing home. All medical and surgical specialties except pediatrics and obstetrics are represented. Advanced treatment and research programs are in progress in the areas of AIDS, Alzheimer's disease, drug abuse, hemodialysis, oncology, and orthopedic surgery.
The patients are veterans of the United States armed forces, most of whom reside in the District of Columbia and neighboring parts of Maryland and Virginia. The gamut of mental and physical disease is treated. Patients of all adult ages come from inner city, suburban, and rural environments and have a wide variety of socio-economic, ethnic, and racial backgrounds.
The medical center engages in residency and internship programs in medicine, surgery, neurology, and psychiatry in affiliation with the Georgetown, George Washington, and Howard University medical schools. Psychology is one of several allied health disciplines that conduct training programs here. The atmosphere is that of a modern, active teaching and research-oriented health facility. The medical center is heavily computerized, e.g., medical records are computerized and staff and students have ready access to the Internet and its research capabilities.
Psychology
Ten doctoral-level psychologists offer psychological services within the medical center. In 1999 psychology service became part of a product service line, the Mental Health Service Line. The VA has increasingly been reorganized around product service lines to more closely emulate HMOs. The Mental Health Service Line incorporates psychiatrists, psychologists, nurses, and social workers who answer to a Mental Health Facility Service Line Manager who is currently a psychiatrist. Our immediate supervisor is still a psychologist.
Psychology offers programs to all sectors of the medical center. Psychologists serve on a variety of medical center committees. All psychologists serve on multidisciplinary teams or as consultants throughout the medical center. Psychology is a prominent and valued participant in the life of the medical center.
To learn about current psychology staff members, click here. Our psychologists' backgrounds, current activities, and major interests are diverse, and they have a great variety of special skills and theoretical outlooks. Taken as a whole, the staff has some degree of expertise in many areas of current clinical and counseling psychology practice. We have, in addition, arranged consultation from senior professionals in the local area to supplement in-house skills and interests.
Philosophy of Training
The psychology service recognizes and respects the varied interests, backgrounds, and professional goals interns bring to our training program. Every effort is made to accommodate such diversity. Nevertheless, the staff observes certain general principles as a guide for our training program. The internship contains five areas which we regard as fundamental to psychological practice--psychotherapy, assessment, research, consultation, and administrative and professional issues.
The essence of professional practice in this setting is intervention, either singly or in groups, to sustain or improve the quality of life for individuals. The internship includes systematic exposure to psychotherapeutic approaches and support in choosing an effective and appropriate method of treatment. Our aim is to foster evidence based intervention. Training in these areas is intended to build on the interns' prior skills, with responsibilities increasing in complexity based upon their professional development over the course of the internship.
Interns are trained in psychological assessment because of its importance within all psychotherapeutic endeavors. The internship focuses on the use of both structured and unstructured diagnostic interviewing supplemented with formal psychological assessment measures in treating patients with both intrapsychic and interpersonal problems. The impact of family, social network, medical conditions, living arrangements, and cultural diversity are essential. Individualized assessment is emphasized, and training is given in the use of projective, objective, and computer-supported assessment instruments.
Use of research literature to guide psychological practice is also important. Interns are encouraged to make use of such literature in seeking solutions to practical patient problems. We teach interns to develop a realistic view of the limits as well as the applications of research literature as a guide in treating patients.
Consultation is a separate and essential area of expertise for professional psychologists. Individual supervision time is devoted to helping interns become consultants to other professional colleagues, and to developing the ability to handle referral questions sensitively and effectively, with attention to and respect for the needs of referring professionals as well, of course, as the needs of the patients referred.
Administrative and professional issues frequently arise in day-to-day practice and are more formally addressed in supervision and staff meetings. Ethical practice is stressed repeatedly in supervision and training, and is considered at all times in addressing appropriate and feasible solutions to patient care. Sensitivity to cultural issues is emphasized through seminars and cross-cultural experiences.
The overall goal of the internship program is to train effective, independent, ethical psychologists. Therefore, training takes precedence over revenue generation, and is co-equal with service delivery.
Finally, the training program follows the "Guidelines and Principles for Accreditation of Programs in Professional Psychology" and the Code of Ethics of the American Psychological Association. These guidelines give our program its direction and guide our professional practice.
The Internship Program
The training of clinical and counseling psychologists has been a major commitment since this Psychology Service took its present form in 1965. In the ensuing years, a few hundred graduate students have received supervised practicum and internship experience here at all levels of training and in amounts ranging from 500 to 2000 hours. We currently concentrate our training efforts on the internship.
As a general rule, all staff members participate in training activities. Possibilities exist for interns to train in all areas of the medical center. There are seven rotations to choose from at this time as well as other opportunities outside the rotations to work with psychologists on the staff. The following is a description of the major rotations.
Inpatient Rotation On the inpatient rotation, psychology interns participate in a multidisciplinary treatment team. Interns assist in direct patient care, lead therapy groups, and contribute to treatment planning. Psychology interns help to empower patients to better manage their psychiatric illnesses, increase their self-efficacy, improve their coping skills, reinforce their positive behaviors, and educate patients and families on the nature of mental illness. The psychologist also strives to help provide structure and consistency to the inpatient environment.
On this rotation, psychology interns will:
- Attend morning report and treatment team meetings.
- Conduct group psychotherapy on the unit, typically two psychoeducational groups per day.
- Provide short-term, intensive individual psychotherapy to patients who might benefit from such an intervention at the request of the treatment team. The psychologist might assist in an individual therapy intervention by providing the following:
- Relaxation Training
- Cognitive Behavioral Skills Training
- Distress Tolerance and Symptom Management (i.e. grounding strategies for flashbacks, distress tolerance skills)
- Education on Mental Illness
- Education and Support to Families
- Conduct psychological assessments at the request of the treatment team for diagnostic and treatment planning purposes. Psychology interns perform diagnostic and personality testing (including the MMPI-2, The Rorschach, the Millon Clinical Multiaxial Inventory, Beck Depression Inventory, Personality Assessment Inventory, etc.) for differential diagnosis, treatment planning, and treatment recommendations.
- Assist in screening patients who need further psychological treatment and in the coordination of treatment from the inpatient unit to the outpatient psychology service.
Neuropsychology This rotation is intended for interns at any level of training in neuropsychology, from beginner to highly-experienced. Training will be tailored to meet the needs of the intern. On this rotation, interns will be trained in all aspects of neuropsychological evaluation, including: clinical interviewing, test administration, test scoring, interpretation, and report write-up. A flexible battery approach is used with test selection based on referral issue and age of patient. Interns will also be trained in neuropsychological consultation with other medical professionals and will take part in multidisciplinary team meetings. Opportunities exist to attend brain cuttings and partake in inpatient procedures, which include neuropsychological evaluation. Opportunities for training in neurocognitive rehabilitation also exist. The goal of this rotation is to provide interns with well-rounded training in all aspects of neuropsycholoi cal evaluation and consultation.
Comprehensive Nursing & Rehabilitation Center (CNRC) Rotation This is a half-time rotation providing training opportunities with the geriatric population. The veterans served by the CNRC are either receiving rehabilitation or are residing in one of the nursing home units (Long-Term Care, Palliative Care, and Hospice Care). Interns participate as members of an interdisciplinary team consisting of social workers, physicians, nurse practitioners, physical therapists, recreation therapists, dieticians, a chaplain, a physiatrist, an occupational therapist, and a creative arts therapist. As a member of the team, the intern would assist the supervising psychologist in providing direct patient care, including initial, quarterly, and annual evaluations on all veterans admitted to CNRC, as well as individual and group therapy as appropriate. Assessments will generally include conducting clinical interviews and administration of screening measures to identify levels of cognitive and psychological functioning. Interns would have the opportunity to present the results of information gained from these evaluations to the veteran and his or her family during five weekly interdisciplinary team meetings. Interventions provided by the intern at the request of the consulting treatment team member may include various cognitive-behavioral interventions such as relaxation training, assertiveness training, cognitive restructuring, couples therapy and behavioral modification. Interventions may include goals of assisting in adjustment to a medical condition and/or loss of independence as well as estrangement from family and friends and end of life issues. Many opportunities exist for challenging differential diagnoses regarding medically versus psychologically-related mental and emotional states from delirium to dementia and depression.
Primary Care In primary care, psychologists provide immediate consultation to staff members and treatment to patients in primary care clinics. The primary care program in this medical center follows 25,000 patients. The psychologist provides diagnosis, referral to appropriate treatment resources, or direct support to those patients who have been identified as having a mood disorder, significant trauma, or some form of substance abuse. Psychologists also support those patients who are experiencing difficulty in their psychological adjustment to a medical condition. Thus, psychologists focus on the mind-body connection, which is consistent with the most recent understanding and appreciation of physical-psychological disorders. The goal of the rotation is to teach interns to make brief interventions with a wide range of patients and to provide immediate consultative service to a variety of referral sources.
Partial Hospitalization Program (PHP) PHP has a multidisciplinary team that treats patients who have severe, chronic, emotional disabilities on an outpatient basis. Interns provide individual and group psychotherapy, conduct psychological assessment, and participate in multidisciplinary team meetings. The main training goal is to prepare interns to work with a chronic, psychiatric population and serve as consultants to a multidisciplinary staff.
Chronic Pain Management Program and Behavioral Medicine This rotation includes a 14 week cognitive behavioral, psycho-educational program which helps veterans minimize the effect of chronic pain on their lives. Other groups within the program include a support group and a psychotherapy group. Interns conduct assessment, co-lead groups, and provide individual psychotherapy. A major goal of the rotation is for interns to appreciate how behavioral interventions can be used for patients with chronic pain and other medical problems. Existential and psychodynamic conceptualizations can also be used in both group and individual psychotherapy. Other roles may include staff training, program development, and consultation. Interns can also work with other medical patients including those in the cardiac rehabilitation program and infectious disease clinic.
Post-traumatic Stress Disorder Clinical Team (PCT) The PCT is an outpatient program that provides treatment for posttraumatic stress disorder (PTSD) to men and women who served in combat from WWII through the Global War on Terrorism. The clinic is staffed by a multidisciplinary team of professionals (psychiatrists, psychologists, nurses, social workers and psych techs) that provide group and individual therapy, psychoeducation (for the family and the veteran), extensive evaluations for post-traumatic stress disorder, spirituality and recreation groups, and psychopharmacology. Currently, the PCT provides treatment to over 600 patients with a primary diagnosis of PTSD. An intern would have the opportunity to obtain extensive experience in assessing PTSD, co-facilitate group therapy, provide individual therapy, participate as a member of the multidisciplinary team, perform psychological evaluations, and provide family educati on and therapy.
Substance Abuse Rehabilitation Program (SARP) SARP is an outpatient drug treatment program that uses a multidisciplinary team to treat veterans with alcohol and drug addictions. The major treatment modality of SARP is group therapy, which allows interns the opportunity to serve as co-leaders of various groups. Different groups address issues such as career choice, relationships, and making changes. Interns also provide individual therapy, conduct assessment, and participate in multidisciplinary team meetings. The main training goal is to prepare interns to treat alcoholism and drug addiction in a multidisciplinary setting.
Enrichment Training
Without special arrangements, the psychology intern in a VA setting will have a training experience heavily weighted in the direction of adult males. Accordingly, provisions have been made for interns to spend as much as 1/6 of their time in the training year away from the medical center to work with nonveteran populations under cooperative agreements with outside agencies or psychologists in private practice. The intern with the approval of the Training Committee either arranges these programs or they are developed by the Psychology Service in response to a specific intern's needs. Interns are not paid for this work beyond their stipends. Supervision is provided at the enrichment site. Evaluations from enrichment facilities are incorporated into the year-end report to the intern's academic program. Accommodations for enrichment activities will be made as flexible as possible if schedule conflicts arise between the VA and the enrichment site. However, in cases of unavoidable time conflict, the within-VA assignment takes precedence. The training committee will reevaluate the enrichment throughout the year in order to determine whether the enrichment remains consistent with our training goals.
Formulating an Individual Program
During an initial weeklong orientation period in September, interns are given first-hand experience with the previously described rotations, including any enrichment activities of interest. On the last day of the orientation period, each intern meets with the director of training to begin selecting a program. The program must include three, four-month within-facility assignments and may include one yearlong enrichment activity. The staff reviews the selection and may make recommendations. Two mandatory seminars are also held for the interns as a group, to be more fully described below. As a general rule, within-facility assignments are consecutive, and enrichment assignments are concurrent with them. The internship year and first rotation begin in early September; the second and third rotations begin in January and May.
The primary function of formulating a schedule is the selection of the intern's personally constructed training plan. An additional function is to coordinate assignment choices among interns and among the various program elements in the medical center. The need for even distribution of interns across assignments rarely interferes with interns' assignment choices, but an intern might be asked to take second choice if a particular rotation is oversubscribed. Intern preferences cannot always be accommodated and cannot be guaranteed.
Some rotations may be split into two concurrent rotations, each with their own supervisor. When split, the rotations may have equal weight or one may have more emphasis than the other, i.e. a major and minor rotation. The time spent in each of concurrent rotations is a decision made by the supervisors, director of training, and intern prior to the rotation.
To help ensure long-term psychotherapy experience, interns may see outpatients who have been referred to the Psychology Service. Interns are permitted to continue treating up to three patient cases from one rotation to another or a group and two individual cases.
Meetings, Seminars, and Conferences
Training meetings have been established for interns as a group, in addition to any conferences or meetings originating with the intern's specific assignment. The nature and pattern of these meetings vary somewhat, but they typically include two training seminars and one administrative meeting with staff.
In-house Seminar This group meeting is supervised by both our own staff and by psychologists who serve as consultants to the psychology service. All staff members regularly present lectures on their specialties. Outside consultants present interns with an even broader variety of psychotherapeutic approaches other than those of our own staff members. We are devoted to helping the intern evolve a personal style of psychotherapy that is both helpful to others and personally meaningful. It is assumed that wide latitude exists in how one may be an agent of beneficial change in others, and the emphasis is on acquaintance with the full spectrum of those possibilities.
Outside Seminar This seminar is conducted at Walter Reed Army Medical Center, Bethesda Naval Hospital, and Malcolm Grow Air Force Medical Center through an arrangement which permits our interns to attend their training seminars. The seminar meets weekly for various lengths of time and covers the gamut of professional issues. Suicide evaluation, Rorschach, family therapy, psychological autopsy, short term psychodynamic models, learning disabilities, women's issues, mental status exams, behavioral medicine, behavior therapy, and the MMPI are a sampling of the topics that are discussed. Ethical issues of professional practice, such as avoiding malpractice, keeping patients' records, and informed consent, are discussed, as well.
Staff Meetings The full psychology staff holds a monthly administrative meeting. Since one of the aims of the internship is to give training in administrative as well as clinical skills, all interns are required to attend. A variety of topical issues are discussed of both local and national concern to psychology, which include privileging, ethics, and quality improvement standards.
Case Conference Each intern is expected to conduct four case conferences throughout the year. These case conferences are presented to the staff and other interns. Interns may choose either therapy cases, assessment cases, or a mixture of both. The purpose of the case conference is to have interns learn to present information about patients to a "team" and to assist interns better understand a selected patient.
Psychotherapy Supervision and Seminar In addition to the clinical rotations that the interns select, each intern treats two psychotherapy patients independent of the rotation. These patients often require longer-term psychotherapy, and can be treated for up to the entire internship year. Additionally, each intern will lead both an 8-week problem-solving psychotherapy group and a 16-week depression group. The same supervisor will conduct the supervision of the two individual therapy patients for all the interns, as well as for the problem-solving group. This supervisor will also conduct weekly seminar/group supervision in psychotherapy.
Neuropsychology Video teleconference: This is a video teleconference in which neuropsychology fellows from a number of military sites present journal club readings and cases. Interns on the neuropsychology rotation are invited to attend this weekly two-hour seminar. During the journal club portion, important readings in neuropsychology are reviewed. During the case conference portion, different cases are presented each week, and there is a monthly ABPP-style case presentation led by the fellows.
Neurology Grand Rounds: All interns in neuropsychology attend weekly grand rounds in Neurology. Rounds typically consist of lectures covering a wide range of neurological diseases. Periodically, an attending neurologist will lead a case conference and demonstrate the neurological examination.
Neuropsychology Group Supervision: All neuropsychology interns attend the weekly neuropsychology group supervision. Here, an extern or intern presents a case, and the team (including attending neuropsychologists and fellows) offers insights and thoughts on interpretation of the data.
Internship Hours and Benefits
To meet the standards of the Veterans Administration as well as various state licensing boards, the internship is 2080 hours in duration over a 52-week period. Hours cannot be accrued for credit at a rate greater than 40 per week except under extraordinary circumstances. At the same time, no intern will be asked to put in more than 40 hours per week except under unusual circumstances which merit giving time credit. Interns are employees who accrue four hours of annual leave and four hours of sick leave every two weeks. In addition interns have the following ten holidays: New Year's Day, Martin Luther King's Birthday, Washington's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran's Day, Thanksgiving, and Christmas.
We expect that under normal conditions the internship will be completed within one calendar year. The Psychology Service does not conduct a two-year, half time internship.
The internship year starts in September. New personnel come to the hospital for physical examinations before reporting to work. After official processing in the Human Resources Management Service and orientation to the medical center, which usually requires 11/2 days, interns report to the Psychology Service for orientation to the internship. This orientation lasts for one week and offers each intern the chance to sample all facets of the Psychology Service programs. Time spent in orientation is credited toward the 2000-hour total.
The Internal Revenue Service has held that intern pay is taxable as income; interns will thus find state, federal, and social security taxes withheld from paychecks. Gross pay is $19,915.00 per year, paid out bi-weekly in 26 equal installments. Interns are not eligible for the Federal Employee Retirement System, although if an intern later becomes a federal employee, time spent in internship status can be credited toward retirement. The VA is interested in offering jobs to former interns, and they are encouraged to apply for federal employment, which would begin after completion of degree requirements.
Interns can elect to participate in health and life insurance programs. They are required to pay a portion of the premiums, as any employee would.
Interns should also obtain professional liability coverage if they intend to participate in an enrichment assignment. Federal law provides for the legal defense of federal employees if a patient brings suit for alleged wrongdoing while the employee is in the line of duty, but this umbrella does not cover interns in the enrichment aspects of the program. In some cases the enrichment site will make insurance protection available. Before working at an enrichment site, the Psychology Service must verify insurance coverage. APA has been a source of adequate and reasonably priced malpractice insurance for graduate students.
Each intern's work is formally evaluated three times during the internship year, at the end of each assignment. However, free interchange between intern and supervisor is encouraged at all times. Staff members prefer to relate openly and collegially with interns in carrying out the evaluation function as well as all other aspects of professional work.
Means to Achieve the Objectives of the Internship
Nondiscrimination Policy
The Department of Veterans Affairs and this medical center are equal opportunity employers and do not discriminate among internship candidates on the basis of sex, race, religion, age, handicap, or ethnic background. Psychology fully adheres to these principles. In the interest of diversity, psychology actively encourages inquiries and application from persons of both sexes and from members of minority groups. Psychology is a member of the Association of Psychology Postdoctoral and Internship Centers (APPIC) and abides by all APPIC guidelines regarding intern recruitment and notification procedures. Details are given in the application cover letter.
Application Policy and Procedures and Admission Requirements
Policy and procedures regarding the selection of interns in clinical and counseling psychology.
Policy
1. To choose applicants who want to participate in a training program in a multidisciplinary medical center.
2. To attract as many applicants as possible with whom we have mutual training-related interests.
3. To avoid bias in the evaluation of applicants based on race, nationality, ethnicity, religious preference, sexual preference, gender, or age.
4. To avoid bias based on preferred theoretical or practical approach, in accordance with the diversity within this medical center, limited only by the presence of appropriate role models on our staff or consultant rosters.
5. To promote applications from students who are members of minority and other underserved groups.
6. In all cases, however, applicants must satisfy the requirements of the Department of Veterans Affairs, the American Psychological Association, the parent academic program, the Association of Psychology Postdoctoral and Internship Centers, and this medical center.
The Washington VAMC internship is a traditional internship in that we require applicants to have adequate experience in both psychotherapy and psychological assessment. Experience in psychotherapy must show diverse settings and a fair number of individual cases. Experience in group therapy is a plus, but not mandatory. Experience in psychological assessment must show both course work and actual test experience using both cognitive measures (e.g. WAIS) and objective personality measures. We will only consider applicants with backgrounds in both psychotherapy and psychological assessment.
We recognize that there are many graduate programs that are geared to a very specific theoretical model and provide intensive education and training in that model. We prefer applicants who have familiarity with a range of evidence-based therapy models, however, even if their program is more focused.
Our selection of intern applicants is based on a review of the documents we request and the interview. We do not have weighted values for individual parts of an application such as GPA or the interview. We are seeking people who have demonstrated excellent social and communication skills. Interns must write well and have some computer literacy. We are highly selective because we receive about 80 applications for three positions, and our highly ranked applicants tend to accept our offers. In accordance with APA guidelines, we are especially attentive to applications from members of minority groups, but the selection standards are the same for all applicants.
Procedures
Each year the Psychology Service updates its website describing the internship program. By the end of August the updated website and application may be downloaded by any applicant, but only applicants from accredited programs can be selected. An institutional application is required and the APPIC application is not used.
The deadline is November 1
To ensure a basic quality for applications and also to ensure compliance with VA policy, the applicant must meet the following requirements:
1. Grade point average of 3.00 or higher.
2. 1000 hours of total practicum experience, supervised by licensed psychologists, with a minimum of 800 hours of intervention and assessment due by the start of internship. Applicants need to acquire 500 hours of intervention and assessment by November 1.
3. Applicant must submit a work sample in assessment.
4. APA-approved graduate program in clinical or counseling psychology.
To increase the probability of a good match with possible supervisors and possible training sites, we request the following:
1. A personal statement.
2. Three letters of recommendation and a formal statement from the program director of eligibility for internship.
(Please see application for instructions).
Letters to the successful applicants and their academic program directors will confirm all selections. Acceptance will not be final until a signed agreement to accept the internship offer is received from the successful applicant.The internship follows the match policies of APPIC. These policies can be downloaded by clicking on the following link: http://www.appic.org/d08match-policies.html
Download Institutional Application and Cover Letter
To view the internship application, click here. You can print or save the application using your browser.
Contact the Training Director
The psychology training director is Neil Bien, Ph.D.Method of communication in order of preference:To obtain an application application and information about the program, download from website.If you have any additional questions, e-mail: neil.bien@va.gov
Snail mail:
Neil Bien, Ph.D.
Director of Psychology Training
Psychology Service (116B)
Veterans Affairs Medical Center
50 Irving Street, N.W.
Washington, D.C. 20422
Phone: (202)745-8173
We would appreciate any feedback about this website and its contents. neil.bien@va.gov
Public Disclosure
The internship training program is committed to public disclosure. Our training brochure and application is available on our website. Our last site visitor report is available upon request. We are fully accredited by the American Psychological Association.
The contact information for the office of accreditation is:
Office of Program Consultation and Accreditation
American Psychological Association
750 First Street, N.E.
Washington, D.C. 20002-4242
(T)202-336-5979 (F)202-336-5978
http://www.apa.org/ed/accreditation
Email: apaaccred@apa.org
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