Our intention is to prepare pre-doctoral interns for entry-level practice in professional psychology. The training program is geared toward this general aim, as well as the specific interests and needs of the intern class. We subscribe to a "general practitioner model," with emphasis on public service to the severely mentally ill.
We offer generalist training because we believe that the focus of pre-doctoral training should be on the acquisition and consolidation of general clinical skills. Training is provided in the treatment of patients with severe mental disorders. An intensive training experience with severely disturbed individuals can provide an invaluable foundation for understanding the entire spectrum of mental disorders.
Interns are trained to provide a broad range of clinical services, which is also consistent with a generalist approach. Interns will be able to apply skills obtained here to a variety of treatment settings and populations. By "practitioner," we mean that our focus is on the acquisition of professional skills, which are based on the science of psychology. We encourage and provide ample opportunities for interns to obtain specialty training (e.g., neuropsychological assessment) provided they are making satisfactory progress in the acquisition of generalist skills.
We evaluate learning outcomes on the nine core competencies described below. These core competencies are further elaborated on 33 essential components. Interns are rated on these 33 test items at the end of each 6-month rotation, using the Profession-Wide Competencies Rating Form.
Core Competencies and Essential Components
1. Seeks out and utilizes scientifically derived knowledge, critically evaluates existing theoretical and research literature, and applies scientific methods to inform practice and evaluate outcomes.
2. Critically evaluates theoretical and research literature presented in seminars or in assigned readings, Grand Rounds presentations, and hospital-wide trainings.
3. Demonstrates skills as a state hospital psychologist to effectively generate and disseminate knowledge (e.g., contributes psychological knowledge at team meetings, seminars).
Ethical and Legal Standards
4. Knows the APA Ethical Principles of Psychologists and Code of Conduct and, in particular, those principles most germane to work in a forensic hospital (e.g., dual roles, limits to confidentiality, informed consent, etc.).
5. Knows hospital rules/regulations and the relevant state and federal laws that pertain to work in a state forensic hospital. Independently and consistently integrates an understanding of forensic policies and procedures when performing all functional competencies (e.g., safety, mandated reporting requirements).
6. Recognizes ethical dilemmas as they arise in professional work and applies ethical decision-making processes to resolve the dilemmas.
7. Acts consistently in an ethical manner in all professional activities to support the welfare of patients and staff.
Individual and Cultural Diversity
8. Demonstrates an understanding of how their own personal/cultural history, attitudes, and biases may affect how they understand and interact with others who differ from themselves.
9. Knows the current theoretical and empirical literature as it relates to addressing and responding effectively to diversity in all professional activities.
10. Integrates and applies an awareness and knowledge of individual and cultural differences to work effectively and respectfully across all professional roles in response to individual, cultural, and role differences.
Professional Values, Attitudes and Behavior
11. Behaves in a mature, professional manner that reflects the values and attitudes of psychology, including integrity, deportment, professional identity, accountability, lifelong learning, and concern for the welfare of others.
12. Engages in self-reflection regarding personal and professional functioning and engages in activities to maintain and improve performance, well-being, and professional effectiveness.
13. Actively seeks supervision when needed, accurately recognizes limits of knowledge/skills across competencies, and demonstrates openness and responsiveness to feedback and supervision.
Communication and Interpersonal Skills
14. Develops and maintains effective relationships with a diverse range of individuals including colleagues, supervisors, managers/administrators, representatives of the legal system (e.g. public defenders, CONREP) and those receiving professional services.
15. Produces and comprehends verbal, nonverbal, and written communications that are informative, concise, and well-integrated; demonstrates a thorough grasp of professional language and concepts.
16. Demonstrates advanced interpersonal skills and the ability to manage affect and difficult communication well.
17. Selects and applies assessment methods that draw from the best available empirical literature and that reflect the science of measurement and psychometrics; collects 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 service recipient.
18. Interprets assessment results, following current research and professional standards and guidelines, to inform case conceptualization, classification, and recommendations, while guarding against decision-making biases, distinguishing the aspects of assessment that are subjective from those that are objective.
19. Communicates orally and in written documents the findings and implications of the assessment in an accurate and effective manner sensitive to a range of audiences.
20. Can establish and maintain effective relationships with the recipients of psychological services.
21. Independently applies theoretical concepts to organize and understand clinical material.
22. Develops evidence-based intervention plans specific to the service delivery goals.
23. Implements interventions informed by the current scientific literature, assessment findings, diversity characteristics, and contextual variables.
24. Demonstrates the ability to apply the relevant research literature to clinical decision-making.
25. Can modify interventions effectively so they are sensitive to the demands of an inpatient setting (e.g., implement interventions that go beyond the individual patient).
26. Can modify and adapt interventions effectively when a clear evidence-base is lacking.
27. Provides on-going evaluations of intervention effectiveness and adapts intervention goals and methods accordingly.
28. Demonstrates knowledge of supervision models, best practices, and stages of clinical skill and professional development, reflecting on the process of supervision and their own role as a supervisee.
29. Applies this knowledge in direct or simulated practice with psychology trainees, or other health professionals. Examples of direct or simulated practice examples of supervision include, but are not limited to, role-played supervision with others, and peer supervision with other trainees.
Consultation and Interdisciplinary Skills
30. Demonstrates knowledge and respect for the multiple and differing worldviews, roles professional standards, and contributions of other professions across contexts and systems. Works effectively with staff members of different disciplines and from different cultural and ethnic backgrounds.
31. Can collaborate with other professionals to address a problem, seek or share knowledge, or promote effectiveness in professional activities.
32. Understands the tasks and roles of a consultant, asks clarifying questions and shifts roles accordingly to meet referral needs, and selects appropriate and contextually sensitive means of data gathering to address consultation questions.
33. Applies knowledge of relevant research and clinical expertise in direct or simulated practice to inform effective consultative services and articulate appropriate feedback and recommendations.
Opportunities for Forensic Training
We do not offer a formal forensic training track. At the present time, the CPIP offers an orientation to select areas in forensic psychology only. As noted above, we believe that the pre-doctoral year should focus on the consolidation of generalist skills. Our orientation to forensic psychology has several components. We offer a forensic seminar sequence covering topics such as "NGRI: History and Case Law" and "Risk Assessment." In addition, interns can participate in the hospital-wide forensic trainings noted above. They can also attend the forensic case-consultations at DSH-Napa offered by the Department of Psychiatry and Behavioral Science, U.C. Davis.
Training is primarily provided in four ways:
- Clinical service delivery
- Individual supervision
- The Preceptor/Mentor Program
Clinical Service Delivery
A. Working on an Inpatient Unit
The 12-month internship is divided into two 6-month rotations. A rotation commitment entails 15-20 hours per week on an inpatient unit. The psychologist at the site provides supervision. The clinical responsibilities for the intern are the same as for the unit psychologist and are described above. The one exception is that interns cannot testify in court but are welcome to observe licensed staff testify as fact or expert witnesses.
B. Psychological Assessment
Interns are expected to complete a minimum of eight psychological assessments during the internship year. Interns typically test patients from throughout the hospital, as an effort is made to funnel the best training cases to interns. Each intern meets weekly with their psycho-diagnostic assessment supervisor and has a minimum of two different assessment supervisors during the training year. Interns with an interest in specialized assessments (e.g. neuropsychological or forensic risk assessment supervisor) may add an additional supervisor who has clinical privileges in these areas. All interns will acquire basic skills in risk assessment and opportunities are available to conduct comprehensive violence risk assessments (e.g., HCR-20, VRAG, PCL-R). Similarly, training in neuropsychological assessment can range from simply developing basic neuropsychological screening skills to completing several full neuropsychological assessment batteries. These opportunities are available to those who have satisfactorily meet generalist assessment skill thresholds.
C. Individual Psychotherapy
DSH-Napa's commitment to intensive training in case conceptualization and individual psychotherapy is unique among forensic hospitals. We provide training in psychoanalytic theory as applied to primitive mental states and we also cover empirically validated psychodynamic treatments. Empirically validated cognitive behavioral treatments are equally addressed in our training program. The training program is committed to both "bottom-up" and "top-down" treatment approaches (Caligor and Clarkin, 2010), so that interns can successfully understand, evaluate, and treat severe mental disorders.
Interns are expected to carry three to five long-term psychotherapy cases throughout the training year. Long-term patients are typically seen one or two times per week. These cases can be selected from anywhere in the hospital and thus may reflect a broad or narrow range of psychopathology. In addition to long-term psychotherapy, interns may provide short-term therapy to patients at their rotation site. The rotation supervisor generally provides supervision of short-term therapy cases and psychotherapy groups at the rotation site.
Interns receive a minimum of 4 hours per week of individual, face-to-face supervision, and 1 hour of group supervision. These include meetings with a rotation supervisor, psychological assessment supervisor, group supervisor, and two individual psychotherapy supervisors. The intern meets with each supervisor once a week and more if desired or needed. The Director of Training works with each intern in the selection of supervisors for each rotation, and in the selection of long-term psychotherapy cases.
There are three core weekly seminars, including:
A. Psychodiagnostic Assessment Seminar
This seminar is composed of a sequence of training modules, from simple to more complex. In each module, didactic training alternates with intern case presentations, so that principles learned during the didactic seminars can be applied to case material. The seminar begins with the cognitive assessment module, where didactic training is followed by intern case presentations in cognitive assessment. The second module covers cognitive/personality assessment. This module includes training on several personality measures (e.g. MMPI-2, MCMI, PAI, and Rorschach). Case presentations cover the ways in which cognitive and personality data inform each other, and how cognitive and personality data are integrated in a test report. Second rotation covers more complex assessment issues and "specialty assessments" (e.g. violence risk assessment, and neuropsychological testing).
B. Psychotherapy Seminar
Our aim in this seminar is to present the major psychodynamic and cognitive behavioral approaches to the treatment of the severely mentally ill, and the empirical basis for these approaches. We generally begin with several seminars introducing basic concepts in working with the severely mentally ill and providing individual therapy in a forensic setting. We proceed with an introduction of basic concepts in each treatment orientation, and then provide training on more complex issues. As in the Assessment Seminar, didactic training alternates with intern case presentations so that principles learned during the didactic seminars can be applied to case material. Interns will receive intensive training in psychodynamic case conceptualization in this seminar. The work of Melanie Klein, D.W. Winnicott, Michael Balint, Thomas Ogden, Heinz Kohut and Otto Kernberg, among others, is applied to an understanding of primitive mental states and defenses. Interventions derived from these conceptualizations are pitched at a level where the patient can understand and hopefully derive meaning from them. CBT conceptualizations and interventions are explored, with particular emphasis on Dialectical Behavior Therapy.
C. Professional Issues Seminar
Our aim in this seminar is to provide didactic and applied training in Consultation, Supervision, Cultural Diversity, and Legal and Ethical Issues. The seminar also covers select topics in Forensic Psychology. In this seminar, we also cover a range of topics which pertain to work in our setting (e.g. Working with the Interdisciplinary Treatment Team).
Preceptor / Mentor Program
Some interns have reported that our Preceptor Program was the most valuable aspect of their training experience here. The goal of this program is to provide an opportunity for interns to discuss the range of concerns they may have, related to their professional development, with a member of our training staff (preceptor). The preceptor has no evaluative function. The mentor/student relationship is essentially confidential, so that issues might be discussed in a more unencumbered fashion. Participation in this program is optional.
Hospital-Wide Training Opportunities / Resources
- The Department of Professional Education Grand Rounds
Weekly presentations on a wide range of topics in mental health are offered where DSH staff, U.C. Davis faculty or outside specialists are featured.
- Department of Psychology Training
Specialists from the Bay Area and around the country provide training that addresses the specific educational needs of psychologists.
- UC Davis Forensic Case Consultation and Mock Trial
U.C. Davis faculty and forensic fellows offer periodic consultations on forensic patients who have been referred by DSH-Napa treatment teams. In addition, U.C. Davis faculty provide opportunities for DSH staff to practice testifying in court. Staff are placed on the stand, testify, and are cross examined on their testimony using information from upcoming court cases.
- Professional Library
The DSH-Napa Professional Library subscribes to nearly 120 journals. The library also offers the computer search services of PsychINFO and Medline.
- Field Trips
Interns may participate in two to three field trips each year. In recent years, interns have visited several California State Prisons or county inpatient treatment facilities.
- Computer Software for Assessment
The Department of Psychology has test-scoring and interpretation software, including programs for interpreting the MMPI-2, Rorschach, and the Millon Clinical Multiaxial Inventory-3, among others. Each intern also has his or her own computer network account, allowing access to the Local Area Network (LAN). Network accounts include Microsoft Outlook e-mail for communication and correspondence, and access to the Internet.
Evaluation of Intern Performance
Each intern meets regularly with the Psychology Internship Director to discuss his or her training experience. Training supervisors meet monthly to review each intern's progress (and to provide peer supervision in their work as supervisors). Areas of strength and areas requiring more attention for continued professional development are identified for each intern. Formal rotation evaluation meetings occur in the middle and at the end of each 6-month rotation period. At these meetings, each intern meets with all 5 or 6 of his/her supervisors to review their progress in the program. At the end of each rotation, each supervisory team meets to complete a written evaluation of each intern's performance. Concurrently, each intern is asked to evaluate each supervisor.