Olympic National Park

University of Washington
Psychology Internship Program

General Adult Psychology

  1. General Adult Psychology. (APPIC/NMS program code = 161913)
    Track Coordinator: Jessica Cronce, Ph.D. - jcronce@uw.edu
    1. University of Washington Medical Center
      1. Inpatient Psychiatry
      2. Outpatient Psychiatry Center
    2. Harborview Medical Center
      1. Consultation-Liaison Service

    This track is designed to allow residents to experience broad-based psychological work with adults including assessment and intervention with medical and psychiatric patients on both an inpatient and outpatient basis. The three four-month long clinical rotations and sites are listed above.

    1. GENERAL ADULT PSYCHOLOGY TRACK)
      (APPIC/NMS program code = 161913)

      Current General Adult Track Psychology Residents

      1. University of Washington Medical Center
        1. Inpatient Psychiatry (7N)
          (Jessica Cronce, PhD, & Tiara Dillworth, PhD)
          Rotation Description & Patient Demographics

          The University of Washington Medical Center inpatient psychiatry unit (referred to as 7-North [7N], which is its physical location within the hospital) houses up to 14 patients at any given time. The patients on this unit are generally voluntarily admitted for short-term psychiatric treatment, generally 5-7 days, although shorter and longer stays are possible. Patients reflect a wide range of ages, ethnic backgrounds, and problems. Most patients are admitted with diagnoses of mood and/or anxiety disorders, often with co-morbid substance use disorders and/or Axis II pathology. Psychosis is also frequently a reason for admission. A smaller percentage comprises geriatric patients with co-morbid medical and psychiatric problems.

          Training Experiences & Treatment Modalities

          Each psychology resident works as a member of a primary treatment team (Blue or Purple) on this unit. It is possible to spend 1 month on one team, then (with the permission of the current team’s attending) switch to the other in order to receive supervision from a different psychiatry attending; after spending 1 complete month participating in rounds with a given team, some residents choose to adopt a “consult” model, wherein they work with both teams simultaneously. Regardless of whether the resident chooses to stay with one team the whole rotation, alternate between teams, or adopt a consult model, the resident has primary responsibility for overseeing the care of several patients, serves as a team consultant on cognitive-behavioral interventions and behavior management plans, and leads a daily CBT group therapy session. On rounds, residents learn about descriptive psychopathology, interviewing, differential diagnosis, psycho-pharmacology, and biological psychiatry. In addition to the daily CBT group, residents meet with individual patients to conduct brief interventions aimed at stabilization in preparation for discharge. The resident also oversees the training of one or more psychology practicum students, which serves to develop supervision skills.

          Resident Expectations

          The 7N inpatient rotation is conducted on a full time basis for a period of four months.

          Rapid patient turnover makes it imperative that residents on this rotation be highly adaptable and mature. Many disciplines interact, including nursing, occupational therapy, social work, psychiatry and psychology, and boundaries among disciplines are not sharply defined. Much needs to be accomplished quickly, efficiently, and effectively. Initiative, appropriate assertiveness, and good interpersonal sensitivities are very important qualities on this service.

          Residents are expected to conduct the CBT group from 1-2pm Monday-Wednesday and Friday. On Tuesdays, residents serve as a mentor to one or more psychology practicum students, who, after working with a resident for 6 months, independently conduct the CBT groups on Thursdays. In terms of individual interventions, the number of patients seen each day will vary based on the needs of the treatment teams and the availability of patients. Generally, 11-12 and 3-4 are primary times in which to meet with patients individually. Outside these times, patients are generally engaged in other treatment activities (i.e., rounds, occupational therapy, lunch, educational groups). Except in extreme (and rare) cases, it is NOT appropriate to ask a patient to be pulled from another activity in order to meet with the resident; the resident must work in concert with the primary psychiatry team, nursing, OT, social work, and medicine. Residents are asked to administer the PHQ-9 during each individual intervention session (as clinically appropriate), and to include this information in the associated medical record documentation.

          Residents are expected to attend the monthly UWMC case conference, which occurs the first Wednesday of each month from 4:00-5:00pm in BB1640. This is an opportunity for residents to learn from the experience of other clinicians who are often dealing with challenges related to patient care, including morbidity and mortality. Residents may be invited, or, with the full knowledge and support of their rotation supervisor, request to present a case at the monthly conference, which serves to build case presentation skills in a multidisciplinary setting.

          In addition, residents are expected to give an evidence-based medicine (EBM) presentation to the psychiatry residents and faculty at the time/place specified. Residents should speak with the Chief Psychiatry Resident during the first 1-2 weeks of their inpatient rotation to arrange the date for their EBM presentation.

          Supervision

          The faculty psychologists provide at least two hours per week of individual supervision, two hours of group supervision (including co-leading 1 CBT group per week with the psychology resident), and are available on an as-needed basis (ongoing informal supervision is provided by the attending psychiatrists who lead the treatment teams).


        2. Outpatient Psychiatry Center
          (Michele Bedard-Gilligan, PhD, Debra Kaysen, PhD & Joan Romano, PhD)

          Rotation Description & Patient Demographics

          The University of Washington Psychiatry Outpatient Center (referred to as both UPOC and the OPC) is an outpatient psychiatry clinic staffed by faculty and residents in psychology and psychiatry. The OPC is located approximately five blocks west of the main campus of the University of Washington and approximately 10 blocks from the main School of Medicine complex. The clinic has a large waiting room, faculty offices, several examination and blood draw rooms, and therapy rooms assigned to psychology residents. Three rooms are equipped with videotape capability; portable audiotape equipment, and mobile VCRs/monitors are available for faculty and resident use. Computers are available in each clinic room, providing access to the scheduling and computerized medical chart systems, e-mail and the Internet. The OPC serves a predominantly middle and lower-middle class population. Patients come from diverse ethnic and cultural backgrounds and sexual orientations. Patients present with a broad range of clinical problems, including mood, anxiety, adjustment and personality disorders.

          Training Experiences & Treatment Modalities

          The educational model of the OPC emphasizes an empirically supported scientist-practitioner approach to psychological assessment and treatment. The psychology faculty have specialized training in evidence based cognitive-behavioral therapy, cognitive processing therapy and prolonged exposure for PTSD, and dialectical behavior therapy for borderline personality disorder. (DBT webpage )

          Resident Expectations

          The OPC rotation is conducted on a full time basis for a period of four months.
          The training objectives of the OPC are designed to foster the acquisition of a broad generalist experience from among the following activities:
          1. Treatment: Individual psychotherapy comprises the majority of the clinical caseload; although, periodically, couple and group therapy experiences are available. In coordination with the OPC Triage Team, attempts are made to match residents' preferences for particular training experiences. For example, residents may elect to have the majority of their caseload devoted to anxiety related disorders. Individuals with primary substance use disorders or those who report active suicidality at intake are often, but not always, referred to an alternate service or higher level of care. Should a resident desire to work with these populations specifically, it may be possible, but must be discussed with the rotation supervisors. Considerations of differential diagnosis, case conceptualization, and treatment planning continuously evolve over the course of care. OPC supervisors are generally, but not exclusively, cognitive-behaviorally oriented. Training books, manuals, video and audio tapes, and validated measures of therapist adherence and competence in specific treatments may be used to facilitate feedback and learning by the psychology resident. A typical caseload for each day will involve approximately four to five hours of direct clinical contact. Even though a resident is providing individual therapy, many patients receive medication management services from psychiatry residents and faculty in tandem with psychotherapy services provided by the psychology resident. Thus, like the 7N inpatient rotation and the HMC C/L rotation, the resident is part of a treatment team and must coordinate care with other providers across multiple disciplines.
          2. Assessment: Psychology residents can administer a range of self-report indices in the outpatient clinic or refer/consult with the UWMC for more comprehensive assessment batteries (e.g., neuro-psychological assessment). The decision to obtain testing and, if so, which tests, is made in consultation with the supervisor on a case-by-case basis. In this way, residents learn the indications for testing and the clinical utility of testing results in treatment planning. Psychology residents with specific assessment or treatment interests can obtain specialized supervision by qualified members of our clinical faculty.
          3. Case Conference: Residents are expected to attend the monthly UWMC case conference, which occurs the first Wednesday of each month from 4:00-5:00pm in BB1640. This is an opportunity for residents to learn from the experience of other clinicians who are dealing with challenging, and sometimes intractable, problems related to patient care. Residents may be invited, or, with the full knowledge and support of their supervisor, request to present a case at the monthly conference, which serves to build case presentation skills in a multidisciplinary setting.
      2. Supervision: Psychology residents will receive individual supervision with one of the attending psychologists. They will also participate in a 1 hour per week combined psychology and psychiatry resident clinical case conference, moderated by the OPC training faculty. The case conference is a combination of didactic presentations, readings and faculty/peer consultations.

      3. Harborview Medical Center
        1. Consultation-Liaison (C/L) Service
          (Barbara McCann, PhD & Chris Dunn, PhD)
          Rotation Description & Patient Demographics
          The C/L Psychiatry Rotation at Harborview Medical Center is one of the sites where psychology residents have the opportunity to learn and improve their consultation skills for medically hospitalized patients. Harborview Medical Center is a large medical center and a regional, level 1 trauma center; often times providing medical care for minority and underserved populations. The majority of patients present with complex medical and psychiatric conditions.

          Training Experiences & Treatment Modalities

          This service is a very active service with many new consults per day. Individuals on the team will have the opportunity to assess and develop brief treatment plans for patients who are medically ill, need suicide assessment, are delirious or need evaluation for decisional capacity. Treatment plans are often also directed toward how the service requesting the consultation may be better able to manage the patient. Unique cases are often seen, including varying types of somatization disorders (e.g., factitious disorder). In addition, there is a high rate of traumatic injury and substance abuse seen in patients at HMC and residents receive training in brief, motivational interventions.

          Resident Expectations

          The C/L rotation is conducted on a full time basis for a period of four months.
          The team on this rotation includes psychiatry and psychology faculty, two or three psychiatry residents, one psychology resident, and often medical students. The psychology resident is expected to act as a fully-functioning member of the team, seeing patients for whom medical intervention may be most appropriate as well as patients for whom behavioral interventions may be beneficial. The resident is expected to carry an equal caseload of patients as the psychiatry residents, to conduct clinical interviews, determine preliminary diagnoses, document the interview encounter (including relevant medical information, such as vital statistics, current medications, and medical history), and, in consultation with the psychiatry attendings, make recommendations to the primary medical team. Residents are also expected, when required, to write affidavits regarding patients who the C/L team determines is in need of inpatient care, but who refuse voluntary admission. These affidavits are read by the Designated Mental Health Professionals (DMHP) who independently interview patients and determine if an involuntary psychiatric hold is warranted. Residents may be called upon to go to court to testify to the content of their affidavit, although this is generally a very rare occurrence. Finally, residents are expected to provide brief bedside interventions, both as part of rounding with Dr. Chris Dunn and Dr. Barbara McCann (conducting motivational interviews) and at the request of the C/L team, if deemed part of the treatment recommendations to the primary medical team. For example, a resident may be asked to implement a behavioral management plan with a patient to facilitate their participation in their medical care.

          Supervision

          Residents receive two hours per week of individual supervision on the C/L rotation, both of which are spent conducting bedside brief interventions for alcohol and drug use among patients who were admitted with one or more substance in their system. Residents also receive on-going group supervision with the C/L team.