Outpatient Psychiatry Clinic

Depending on interns’ areas of interest and training goals, they can choose one of two different tracks within the OPC rotation:

• trauma-focused psychotherapies 
• psychological evaluation services

It may be possible to design a “combined” track for interns who are interested in a rotation that includes both psychological assessment and trauma therapy. We will focus on creating an individualized learning plan for each intern in the OPC designed to meet their training needs and goals. For interns who participate in a combined track, they will receive at least 1 hour of supervision weekly, but likely more given the diversity of their activities.

The primary objective of this track is to teach interns how to evaluate, diagnose, and treat trauma-and-other-stressor related disorders, form case conceptualizations, and implement trauma-focused psychotherapies with adults. In the interest of a breadth of training and intern self-care, about half of their caseload will be comprised of trauma cases. At the completion of this rotation, trainees will be able to:

 

• Use a variety of validated assessment tools to gain nuanced understanding of trauma presentation, co-morbid mental health disorders, and functional impact.
• Engage in collaborative treatment planning that integrates patient preferences and patient readiness when making decisions about nature and course of trauma treatment.
• Develop case conceptualizations and treatment plans that incorporate the active ingredients of evidence-based trauma psychotherapies in ways that align with patient preferences, readiness, and treatment goals.
• Implement multiple evidence-based and evidence-informed psychotherapies for both single-incident traumas and complex trauma presentations.
• Document clinical visits.

 

Through this rotation track, trainees will have the opportunity to:

• Attend the clinic’s Multidisciplinary Team Meeting.
• Attend small group clinical case consultation meetings.
• Consult with multidisciplinary members of care teams.

Specific Training Activities -

Outpatient Therapy:

Interns will carry a caseload of individual outpatient psychotherapy cases consistent with the number of hours per week they are in the clinic. At least half of those cases will involve trauma treatment. Client visits are typically 50-60 minutes. Differential diagnoses, treatment formulation and treatment plan will be developed and refined over time in collaboration with the supervisor. Length of treatment will vary based on individual patients’ needs. Interns will gain experience in delivering both in-person and telehealth therapy.

Theoretical Approaches:

Evidence-based and evidence-informed psychotherapies are emphasized in the OPC. Depending on a client’s presenting concern and preferences, trauma-specific approaches may include elements of Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Internal Family Systems (IFS), Accelerated Experiential Dynamic Psychotherapy (AEDP), Emotion-Focused Therapy for Individuals (EFT), and Unified Psychotherapy for Trauma (UP-T). Supplemental interventions may Dialectical Behavior Therapy (DBT) and other “present-focused” approaches. The OPC recognizes the clinical value of “flexibility with fidelity.” That is, following the basic guidelines or “map” of EBPs without rigid adherence for the purposes of choosing interventions based on the patient’s unique history and presentation.

Population of Clients:

 

Because the OPC is a general outpatient clinic, a number of our adults patients present with difficulties influenced by trauma sustained in childhood and/or adulthood. Trauma types include but are not limited to childhood abuse, intimate partner violence, sexual assault, work or military service-related trauma, complex trauma, trauma related to physical health problems. Although the OPC sees the range of ages from early childhood to older adults, in this minor rotation, Interns will focus on adults aged 18 and up.

Types of Clinical Approaches:

Clinical activities include semi-structured and structured diagnostic interviews, administration and interpretation of assessment tools to inform clinical practice and make treatment recommendations (e.g., CAPS, PCL-5, TSI, DES-2), and the provision of integrative, individualized trauma treatment based on patient’s presenting concerns, needs, and goals.

 

Supervision:

 

Interns will receive supervision with a Licensed Psychologist for at least one hour every week. Supervision will typically focus on assessing and diagnosing trauma-related disorders, case conceptualizations and treatment plans, discussing next steps for follow-up and ongoing patients, and discussing issues of professional development and other relevant issues as needed. Interns have the opportunity to focus on a specific therapy of interest and can receive specialized training during supervision in that approach (e.g., CPT, PE, UP-T, AEDP). Interns who have been formally trained in EMDR may also receive supervision specific to EMDR.

The primary objective of this track is to teach interns how to conduct psychological assessments and produce comprehensive assessment reports to address a variety of referral questions. At the completion of this rotation, trainees will be able to:

• Compose thoughtful and individualized testing batteries to address specific referral questions.
• Collect relevant data using multiple sources and methods appropriate to the identified goals and questions of the assessment as well as relevant diversity characteristics of the patient. Assessments may include intellectual, achievement, personality, ADHD, neuropsychological screening, and other competency-based measures.
• Interpret assessment reports to inform case conceptualization, differential diagnosis and other diagnostic considerations; and provide individualized and thoughtful treatment recommendations.
• Provide accurate, high-quality assessment reports and personalized client feedback that communicates findings and recommendations in a clear, coherent, and useful manner sensitive to a range of audiences.
• The number and type of referrals the clinic receives varies, but interns will complete a minimum of five comprehensive psychological assessments during the intern year.

Through this rotation track, trainees will have the opportunity to:

• Attend psychological assessment consultation meetings.
• Consult with multidisciplinary members of care teams.

Specific Training Activities

Psychological Assessments and Types of Clinical Approaches:

Psychological assessments involve a process that may begin with consultation with the referring provider and conclude with providing client feedback and communicating findings to the treatment team. The use of a variety of assessment tools is encouraged including but not limited to behavioral and mental status observations, semi-structured and structured diagnostic interviews, assessments of context and culture, symptom checklists and other brief screens, patient self-report, collateral data, use of historical data (school reported cards, previous psychological testing report) cognitive testing, performance testing, and objective personality testing.

Theoretical Approaches:

PES uses best practice standards for assessment which are informed by up-to-date peer- reviewed research. PES also values the application of collaborative and therapeutic assessment approaches which, in addition to traditional psychological assessment methods, aim to serve as a helpful and collaborative process that facilitates positive changes in clients. Our assessment practices also emphasize the integration of multicultural considerations, patient strengths, and available resources and supports. The OPC PES does not use a standardized assessment battery. Our approach to test selection is based on the unique referral questions and seeks to prioritize the collection of the maximum amount of relevant data while also reducing the burden of testing on the client.

Population of Clients:

Most patients referred for psychological assessment are referred from internal providers (e.g., patient’s physician providing medication management) in the outpatient clinic, with a smaller proportion of referrals coming from other CU or UCH treatment clinics. Although the OPC sees the range of ages from early childhood to older adults, in this minor rotation, interns will focus on adults aged 18 and up.

Supervision:

Interns will receive supervision with a Licensed Psychologist for at least one hour every week. Supervision will typically focus on discussion of new testing referrals, assessment planning and decision-making (e.g., selecting appropriate battery), debriefing assessments, formulating diagnoses, and interpreting and integrating data. A portion of supervision will also be devoted to discussing issues of professional development and other relevant issues.