SEMINARS AND DIDACTIC TRAININGSeminar Training

All Interns attend three year-long seminars: The Psychotherapy Process Seminar, the Diagnostic-Treatment Seminar, and the Professional Issues Seminar.  All interns are also required to successfully complete a Diagnostic Intake Assessment and successfully conduct a Cognitive-Behavioral Therapy (CBT) Session. Finally, the AU/MCG Department of Psychiatry and Health Behavior's Grand Rounds series, which features speakers of regional and national prominence, as well as workshops pertaining to recovery-oriented mental health care, evidence-based assessment and treatment strategies, and cultural/diversity competence, are available for interns when their schedules allow for attendance. 

Diagnostic/Treatment Seminar. The Diagnostic/Treatment Seminar is a 1.5-hour seminar that meets weekly for eleven months of the year and includes application of a “Problem-Based Learning” (PBL) model.  The PBL approach to learning employs a clinical case/problem as the vehicle of learning and demands scientific thinking.  A case is presented in a progressive and stepwise manner, and the Interns are guided to engage in self-directed learning around salient issues of clinical practice.  It focuses explicitly on the development of the central components of the Empirical Clinical Model of training: attitudes of empiricism and reflection.  Learning results from both the content of the issue at hand and the process of working towards the understanding of the clinical problem.  The goal is active participation in learning by gathering, accessing, organizing and sharing information as well as participating in the evaluation process.  Distinct teaching modules (e.g., depression, anxiety disorder) with their associated clinical cases are identified, and the exploration of the case and pertinent clinical issues is facilitated by the course directors and by the module “expert.” Module experts are generally postdoctoral fellows and faculty members. Each module is approximately six-hours long and involves the presentation of a video recording or written report of an intake conducted by either a postdoctoral fellow or faculty member. Each module is self-contained while maintaining the fundamental learning principles of PBL (i.e., understanding is developed through the scrutiny of the data available, development of hypotheses and the additional data desired, and identification of learning needs).  Each intern participates in PBL by way of group interaction, development of learning issues, and seeking information related to outstanding learning issues. The module “expert” supplements the understandings developed through the processes of empiricism and reflection with didactic material pertinent to the assessment and treatment issues at hand.  Seminar instructors guide the progress of skill development in the seminar across the course of a year using the following strategies: (1) Early in the training year this seminar provides didactics in objective personality assessment and prepares the Interns for the Diagnostic Intake Assessment to be subsequently presented. The AADPRT Diagnostic Intake Assessment Form CSV.3 is used to rate the assessment performance along with the Diagnostic Intake Assessment Supplement – evaluates in greater detail evidence of conceptualization skills. These forms may be found in the Internship Manual). Faculty Raters will complete these forms separately during the viewing of the video recording and discuss their ratings, away from the Intern, following the viewing of the video. Although individual ratings are expected to vary somewhat, if ratings on a particular item vary by more than 2 points, the Raters should discuss this discrepancy and negotiate a more consistent rating.  Immediately following review of the ratings, the Intern is invited back into the room to discuss feedback with the Raters. This feedback should include a review of the Intern’s strengths and areas for growth, as well as developmental recommendations. This feedback should also be shared with the Overall Supervisors and Co-Training Directors by the end of that week.  If an Intern receives an Overall Score of 4 or less (“unacceptable”) in the areas of “Physician Patient Relationship,” “Conduct of the Interview,” or “Case Presentation” on the AADPRT Diagnostic Intake Assessment Form or receives an overall performance score less than 2 (“meets expectations”) on the Diagnostic Intake Assessment Supplement, the Intern will be required to provide the Raters with another video recording of a diagnostic interview exam by the end of November.  If the Intern receives acceptable ratings (5 or above) on the Overall Score in the three domains of the AADPRT Diagnostic Intake Assessment Form, but receives a rating of 4 or less on one or more items, then the Intern will have to be observed by their Overall Supervisor or a Rotation Supervisor as they complete a diagnostic interview examination. Similarly, if the Intern scores less than 2 on any items of the Diagnostic Intake Assessment Supplement, it is the responsibility of the Overall Supervisor or Rotation Supervisor to work with the Intern to improve in such identified areas. In all other cases, recommendations for improvement that do not require direct observation of another full intake interview will be provided. These recommendations may be integrated into the Intern’s training plan to inform ongoing training experiences and goals.

After introduction of the Problem Based Learning training model, the initial phases of the PBL conceptualization trainings places emphasis on learning how to effectively organize data and learning the basic principles of clinical conceptualization. As the Interns become more skilled in organizing data and avoiding common conceptualization errors (e.g., mistaking a hypothesis for a factual finding; engaging in confirmation bias, etc.), the seminar instructors then place more emphasis on understanding and using “illness scripts” and schemas to better identify key clinical issues at hand and to appropriately devise promising treatment strategies. 

Psychotherapy Process Seminar. The Psychotherapy Process Seminar meets for the entire year and provides a laboratory to develop skills of empiricism and reflection in the nonparticipant mode of peer supervision and in the participant mode of a live therapy session presentation.  The Interns are given the opportunity to observe each other and the faculty facilitators conducting therapy sessions, followed by peer and faculty supervision.  In the beginning of the year, interns observe the Seminar Facilitators (2 faculty members) engaging in therapy in the same manner that will be expected of the interns. This initial process is designed to reduce performance anxiety among the interns to some extent and provide modeling of the reflective process.  Then interns are assigned the duty of presenting and discussing their own cases.  The year-long seminar focuses upon the progression of therapy skills, identity as a therapist and eventual supervisor, and supervision skills.  The common factors of relationship in therapy are emphasized by a didactic session as well as throughout the seminar. Typically, at the end of the year interns are presenting their most complex and difficult cases, seeking supervision and receiving supervision on their countertransference, and self-reflections on their areas for continued growth, and accepting constructive criticism as well as positive feedback.  Didactics for the seminar focus upon:  1) Common factors in psychotherapy; 2) Supervision, and; 3) Termination.   Feedback from the interns each year consistently suggests that they find this seminar to be a very valuable experience with respect to their growth as clinicians, their often newly found respect for the process of therapy and the importance of the therapeutic relationship, and their development as supervisors. Each Intern presents a psychotherapy case live at three different times over the course of the year.  The Interns bring a brief (one-two page) summary of the patient’s history, case formulation, diagnostic impression, treatment plan, patient’s progress to date, and issues where feedback is requested from their peers and the faculty facilitators.  The Intern then conducts a 50-minute therapy session breaking for feedback from the “reflecting team” near the conclusion of the therapy session. This feedback is given to the patient by a reflecting team, usually comprised of two interns, or possibly an intern and a faculty member.   The remaining time in the seminar is used to discuss the interpersonal and conceptual issues of the case.  The Psychotherapy Process Seminar maintains an awareness of all the pertinent data in this reflection on the case; however, there is a specific emphasis on the integration of the idiographic patient and clinician data.  Particular attention is devoted to the capacity to reflect while in action. Time is provided near the end of the second hour to comment on what took place during the supervision time.  This “step back” allows participants to discuss the process of supervision as well as to voice personal reactions. The seminar demonstrates graduated levels of responsibility and autonomy both in provision of therapy and in supervision. 

The Seminar also facilitates a 9-10-week course (one and a half hours per week) that reviews Cognitive Behavior Therapy and introduces ACT, and includes joint psychology internship and psychiatry residency training activities. The CBT and ACT training consists of didactic materials, lectures, treatment skill exercises, and live supervision of therapy cases. As part of the Diagnostic/Treatment Seminar all interns must successfully conduct a Cognitive-Behavioral Therapy (CBT) Session judged by two faculty/supervisors as “good” on the question, “How would you rate the clinician overall in this session, as a CBT therapist?” as part of the Contextual CBT Therapy Rating Scale. Results of the session evaluation are immediately reviewed by the faculty/supervisors with the intern and the evaluation form is completed by the CBT instructor in the One45 evaluation system, reviewed by the Co-Training Directors and then released to the interns. Interns who are initially unable to satisfy this requirement by demonstrating necessary skills in the provision of CBT will be given an additional opportunities to be observed and evaluated as indicated above.

Professional Issues Seminar.  The Professional Issues Seminar is a 2-hour seminar that meets bimonthly for the year and is intended as a complementary endeavor to be devoted to the task of the professional development of the Intern.  The seminar primarily focuses on the non-therapy aspects of being a psychologist.  This seminar meets every other week to ensure that the following issues are adequately addressed during the year:

  1. Professional roles in medical settings including principles of consultation/liaison work, effective communication strategies, and proper documentation;
  2. The integration of legal, ethical, and organizational issues pertaining to successful clinical practice;
  3. Rural/Underserved populations;
  4. Appropriate responses to acute/crisis symptoms;
  5. Preparation for postdoctoral/first job search;
  6. Licensure/Career planning;
  7. Cultural Competence issues - race/ethnicity, sexual orientation, spiritual/religious world views;
  8. Special topics pertaining to treatment of military veterans;
  9. Program Evaluation – theories and methods;
  10. Psychopharmacology;
  11. Self-care to manage the stresses inherent in clinical work over the long term;
  12. Advocacy.

The typical progression of seminar topics begins at the basic level of understanding the cultures/contexts within the training environment and establishing basic professionalism habits and then moves toward more of a focus on preparation for the next steps in interns’ careers.