The internship provides extensive training in each of the areas of competency required of the interns.
Requirements of the training program and the associated training experiences are designed to support the interns’ learning by providing the experience necessary to achieve learning, with clear messages about expectations for trainee performance.
Assessment and Psychotherapy
Philosophical understanding of assessment. The assessment component of our training program is influenced by Stephen Finn’s model of Therapeutic Assessment, which emphasizes the use of testing to create a positive and therapeutic experience for the client. Assessment is seen as the broad method by which psychologists determine the nature of the problems afflicting clients and arrive at a sound treatment plan. Interns receive experience in assessment through three basic components: clinical interviews (walk-in and intake), integration of testing with the intern’s own clients, and the administration of multitest batteries.
At the USDCC, quick, accurate and thorough assessment and referral/disposition of all new clients in need is a priority, reflecting our value of service to the university community. Consequently, all clinical staff members participate on a regular basis in some form of assessment.
Initial assessment and clinical interviewing skills are obtained through two activities: participating in the USDCC’s initial triage assessment system, which is being updated effective summer 2015, and providing intake interviews. Interns are expected to allocate three to four hours per week for initial assessments during the semester, and often more during Intercession and summer term. They are provided didactic training for this activity during orientation. Consistent with the developmental nature of our training, interns begin assuming initial triage duties with a designated back-up supervisor available at all times. Typically, interns will begin by observing one or more same day/next day appointments, then perform one under observation, then conduct one with the designated supervisor available for consultation. Once the intern has more comfort in this activity, the intern, triage appointment supervisor and primary supervisor may decide the intern no longer requires the designated back-up supervisor. However, as with other emergency situations, interns are encouraged to seek immediate consultation when needed.
Intake skills are also an important aspect of interns’ training, and are supervised by primary supervisors. The number of intakes per week varies depending how many clinical openings the intern has. Interns are expected to write their intake reports promptly; when interns have multiple intakes in one week they may negotiate this with their primary supervisor.
In addition to clinical interviewing, depending on the needs of any given client, different methods may be used in collecting the data needed for a sound evaluation. While for the majority of our clients, intake interviewing supplemented by client information forms, the AUDIT and the OQ-45 is adequate, some clients benefit from additional testing efforts. Consistent with the practitioner-scholar model, psychological testing supported by research may be incorporated into clinical work. Some clients benefit from occasional integration of testing data into ongoing clinical work. The occasional use of such data is role modeled by many staff psychologists.
Finally, when appropriate, clients may be referred for more comprehensive testing including multitest batteries. With the university population, these batteries generally take the form of either personality testing, learning disability screening, or some combination of both. In addition, interns may have the opportunity to collaborate on mandated assessments for students who are believed to possibly constitute risk to themselves or others.
Psychological testing and testing requirements Our program aims to expose interns to the use of psychological testing as one method of assessing clients. To ensure that a basic level of exposure is achieved, a minimum amount of testing is required. This standard is designed to be flexible, allowing for interns with different training goals to meet the standard in different ways while still covering the broad range of client concerns typically seen at a Counseling Center.
a. Single test administration. Throughout the course of the year, interns are required to incorporate psychological testing into their work with their own clinical cases on at least a monthly basis, and to present these assessments in Assessment Consultation. At least one of these should include the administration of the Barkley Adult ADHD Rating Scale-IV. Most cases generated from the intern’s caseload would involve one or two tests for the purpose of answering questions the intern and his or her client have identified. Interns are strongly encouraged to develop a broad assessment experience that may include a variety of different instruments over the course of the year.
b. Testing batteries. Interns have the option of completing multitest batteries utilizing the therapeutic assessment model, and writing a client letter summarizing these results. These batteries would typically be referred by other staff of the Counseling Center. Interns may also be assigned learning disability and/or ADHD screens by Disability and Learning Differences Resource Center (DLDRC). In addition, interns may have the opportunity to collaborate on mandated assessments for students who are believed to possibly constitute risk to themselves or others. When needed for the intern’s training, the Coordinator of Assessments may recommend additional testing experiences.
Individual, couple and family counseling and psychotherapy. Interns spend the bulk of their time in direct contact with clients. Depending on what training experiences they have selected on their service contract, they have between 12-18 client contact hours per week. Most client work will be short-term in nature. Interns may elect to take on one or two long-term clients and are encouraged to keep in mind their training goals as well as the USDCC’s policies regarding length of treatment. Doctoral interns use webcams to record sessions, with permission of clients, for the purposes of clinical supervision.
Crisis coverage. When a crisis situation emerges with an ongoing, walk-in or intake client, interns should exercise clinical judgment as to whether they should involve a supervisor while the client is still in session, or they should wait until completing the session and debrief immediately afterwards. However, interns must do one or the other: seek immediate consultation or debrief after session. For such supervision, interns should first seek their primary supervisor. If that person is unavailable, interns should look for the Director. If neither of those individuals is available, interns should go to the Coordinator of Training or any available staff member. If no staff members are available, staff may be interrupted in the following order: first staff involved in administrative work, then staff involved in meetings, then staff involved in supervision, then staff involved in clinical work.
Formal crisis training is achieved with didactic training each year coupled with mentoring in after-hours crisis coverage.
Halfway through first semester, interns are paired with a psychologist, typically their primary supervisor, in the after-hours coverage rotation. The intern’s supervisor will carry the after-hours emergency telephone, with the intern available by telephone. The staff member will receive the initial report from Public Safety, and will determine whether they (staff) will assess further first, or ask the intern to do so. This assessment will vary depending on the intern’s skills and abilities, as well as the developmental stage of the internship year. Interns will be expected to provide after-hours coverage at least four weeks during the year, and frequently more.
While the University of San Diego Counseling Center does not provide mandated psychotherapy, we do provide mandated assessments. These assessments are required by the university in situations involving the potential of threat to harm of self or others and other mental health emergencies. As a component of the interns’ crisis training, they are trained to provide these assessments, and participate in them. Intern involvement in mandatory assessments generally takes place during the second semester of internship.
Group counseling and psychotherapy. Interns are required to co-facilitate a therapy group each semester. Groups will often be co-facilitated and supervised by a senior staff member. In some cases, groups are co-led by interns under supervision. At least one hour of supervision will be provided per week for this activity, often provided in half hour increments (half hour pre-group preparation, and half hour debriefing).
Academic probation clients. All staff members at the USDCC see some clients referred to the Counseling Center because of having been placed on academic probation.
Outreach and Prevention
Outreach and prevention are viewed as an integral part of a psychologist’s efforts in the university counseling center setting. Philosophically, we see outreach as meeting several needs for our population: providing prevention efforts and identifying students who would benefit from services in critical topical areas (e.g., eating disorders, substance abuse), recruiting and providing nontraditional services to underrepresented client populations, reaching beyond the Center’s walls to introduce students to the Counseling Center staff and destigmatize counseling services, and providing creative services in an efficient way to a larger body of students.
Interns’ training in outreach, similar to other areas, is sequential. An Outreach Seminar is offered during orientation to prepare interns for their outreach training experience. As part of this, interns will assess their current level of outreach skill, as well as any individualized training needs they might have in this area. During orientation, interns observe senior staff members conducting training programs for resident assistants. This gives interns exposure to varying presentation styles. Interns’ training in outreach will be individualized depending on amount of skill and experience they have in this area; some interns may be encouraged to present several times with more experienced staff, while others may be encouraged to present on their own earlier. In either case, interns’ outreach work will be attended at least twice, ideally once by the outreach supervisor and once by another staff member, to provide interns with support and feedback as they continue to develop their outreach skills. Ongoing consultation with the supervisor is also given on both a formal and informal basis to allow interns to develop outreach skills and to solidify confidence in their ability to provide psychological services within this modality.
Interns may also experience the opportunity to gain consultation experience by participating in university committees and/or consulting with campus agencies. These opportunities vary each year depending on interns’ interests and campus needs. Supervision of such activities is provided by the outreach supervisor or primary supervisor.
Interns are required to present a minimum of eight outreach programs each year in addition to participating in university committees; most interns present more frequently than this. Interns are encouraged to develop a well-rounded experience which may include participating in a variety of different forms of outreach including psychoeducational workshops, committee work, introductions to counseling center services, screening days, or other activities. Although many (though certainly not all) interns experience some anxiety about the outreach training component, we have also found that skill and confidence quickly improve when interns volunteer early and actively in the year. To reach an optimal audience, many of our outreach workshops occur after-hours.
Because internship is the last formal aspect of an intern’s predoctoral training, we view the development of sound ethical knowledge and practice, professionalism, and the development of professional identity as a psychologist as integral to the training experience. In our view, this encompasses several components: ethics, deportment, self-awareness, professional judgment, responsible and timely record keeping, maintaining appropriate professional relationships, and emotional stability. These components are addressed through mentoring, supervision, modeling, and didactic training. When possible, we take interns to a Board of Psychology meeting to expose them to the decision making process and rules of the licensing board. Activity in professional organizations is encouraged by the agency, and is modeled by staff. Staff members strive to model self-care and to encourage interns to be aware of their limitations.
During the summer, when intern caseloads are low, interns are asked to take on at least one “summer project”, which typically involves assisting one or more USD Wellness Area staff member with an administrative project. Past projects have included assistance with creating several blogs for the Center for Health and Wellness website, assisting with aspects of the USDCC self study, assisting in compiling end of the year Counseling Center statistics and statistics on usage of the after hours crisis system, compiling a list of assessment resources, researching and making recommendations for the acquisition of various psychometric instruments including eating disorders and strengths-based assessments, creating a practicum policies and procedures manual for the Counseling Center’s practicum program, updating the center referral database, providing programming for the College Bound program, researching mindfulness and strength-based resources, providing assistance in building the group program, creating a curriculum for the DLDRC “Social Smarts” group for ASD-spectrum students, providing assistance to the Coordinator of Training in improving the Training Manual and designing the orientation schedule, and assisting with the development of large-scale outreach projects. These projects may involve administrative, outreach, or clinical planning tasks, and vary each year. Interns are also welcome to suggest summer projects they believe would be a contribution.
Provision of Supervision
Experiences in the provision of supervision can be provided in two formats. The first is individual supervision with a practicum student from an APA-accredited program in clinical psychology. The second opportunity occurs in an optional rotation during the spring semester, in which one or two interns may conduct group supervision of undergraduate peer advisors. This optional rotation may or may not be available. To prepare interns for the supervision experience, they are provided with a four hour supervision seminar, and during the practicum experience with weekly supervision of supervision that includes review of supervision session recordings. When only one practicum student is available, one intern will supervise the prac student’s individual therapy and the other will supervise her or his work in a psychoeducational or support group.
In addition to the training requirements described previously, interns have the option of completing one or more rotations in designated areas of interest. Interns may complete one rotation per semester. Please note that available rotation options are subject to change and may not necessarily be available each semester or each year. Rotations are typically two to four hours per week and include both experiential activities and supervision; they may also include didactic training. Examples of potential rotations that interns have engaged in include:
Alcohol and Other Drug Assessment and Education. Interns selecting this rotation will co-facilitate psycho-educational groups for students who are mandated to seek services due to an alcohol violation. Additional opportunities may include individual AOD assessments, working with peer educators, and providing outreach to the USD community. This rotation is four hours per week. This rotation will be supervised by a psychologist from the Center for Health and Wellness Promotion.
Integrated Care Rotation. The USD Wellness Integrated Care program developed from a 2011 mental health screening initiative implemented at the USD Student Health Center (SHC). Significantly more students present at the Student Health Center versus the Counseling Center. Hence, the SHC began conducting mental health screenings in the areas of anxiety, depression, alcohol and marijuana in an effort to identify and address mental health problems among the USD student population. First year data from this program showed that many students referred to the Counseling Center following a positive screening never followed through with the referral. While all the units of Wellness work collaboratively, we explored how we would strengthen our interdisciplinary approach to care and the USD Wellness Integrated Care program came to fruition. Clinical staff members from both the CC and CHWP spend several hours a week providing direct clinical services to students and consultation to SHC staff as mental health (MH) consultants. In this role, interns are trained and mentored as MH consultants and learn to provide collaborative services in a primary care environment.
Crisis. This rotation offers interns the opportunity to pick up increased number of weeks of After hours crisis coverage in conjunction with their supervisor or a designated supervisor.
Disability and Learning Difference Resource Center. During this rotation interns will be exposed to the workings of a disability services department, gain experience-coordinating services for, working with, and advocating for students with disabilities and their families. There will also be opportunities for administering and interpreting learning disability screening measures. Dr. Chris Burden and Dr. Jessica Hornbrook will supervise this rotation.
Group. This is a less formal rotation, but offers interns the opportunity to facilitate an additional group in a given semester.
San Diego Center for Children (summer only). This is an external summer rotation. Interns involved in this off site rotation have the opportunity to work with a group of highly diverse adolescents (and occasionally children) in a residential setting, typically providing group therapy. This rotation lasts about six weeks over the summer, and offers the opportunity to work with an interdisciplinary team in a residential setting.
Supervision of Student Success Coaches (spring only). The Student Success Coaches are a group of undergraduate peer advisors who have completed a course in peer to peer counseling. This rotation will only occur in the spring semester, and may not be available each year. The rotation will be three hours per week during the spring semester, including an hour of group supervision with the other supervisors, an hour to supervise the peer group, and an hour for additional documentation, file review, tape review, etc. In addition, interns who elect this rotation participate in selecting and training the Student Success Coaches during the end of the fall semester and intercession.
In addition to these formal rotations, interns with special interests are encouraged to make this known so Counseling Center staff can provide mentoring, assist in client referrals, etc. Additional rotations may be negotiated if adequate resources (e.g., client referrals, supervision) are present.
Individual Supervision is provided to enhance interns' clinical skills. Given that individual psychotherapy is interns' primary clinical duty at the USDCC, supervision is viewed as an integral part of the training experience. In order to provide exposure to varying theoretical styles and approaches of supervisor, supervision rotates midyear.
Consultation Group is designed to allow interns to receive and provide case consultation in a setting that includes about three staff members, one to two interns and a practicum student. In this setting, new intakes are presented and staffed, and ongoing cases are discussed. Interns receive exposure to the clinical work of different staff and have the opportunity to receive feedback from staff not currently supervising them. Interns are also encouraged to give feedback to staff presenting cases; this is a primary setting in which interns begin to view themselves as colleagues as well as trainees.
Supervision of Group Therapy is provided for each group the intern facilitates. This experience facilitates the intern's development of effective group therapy skills. One hour of supervision per group is typically provided, often in the form of one half hour of group preparation and one half hour of post-group discussion.
Consultation with Coordinator of Training occurs weekly. This group supervision session is held with the Coordinator of Training and the three interns. Within this group, emerging issues in the internship are processed, professional development issues discussed, and clinical consultation provided.
Diversity Consultation facilitated by a staff member. These meetings provide interns with an opportunity to develop a greater sense of self and cultural awareness, and how this impacts their capacity to integrate issues of diversity into their work and their professional identities as psychologists. This consultation group meets biweekly.
Assessment Consultation is scheduled biweekly. The focus of this experience is clinical consultation regarding the interns’ use of testing with their clients. Additional consultation is available as needed, and interns are also encouraged to discuss their testing experiences in primary supervision and consultation group.
Supervision of Supervision occurs weekly for interns supervising practicum students, and allows interns to process their supervision experiences. This is also an opportunity to review session recordings of supervision with the practicum students.
Outreach Supervision provides ongoing consultation and mentoring in outreach for intern activities. This begins weekly; frequency is adjusted as interns develop more skill and competence.
Rotation Supervision is provided for interns completing a rotation.
Additional supervision and consultation is available from all staff as needed.