An approach to treatment that integrates the psychological, social, and physical needs of clients is emphasized. Counseling staff meets bi-weekly with campus physicians, physician’s assistants, and nurse practitioners to consult on therapeutic management of those cases seen in both clinics. Occasionally, effective treatment requires consultation and coordination with local physicians, hospital, community mental health, substance abuse treatment center staff, and other community resources.Interns are asked to videotape their individual and couple’s counseling sessions in order to enrich the training experience. Videotaped sessions are reviewed during supervision, after which it is the intern’s responsibility to ensure they are erased. In the beginning of the training year, interns are required to videotape every client at every session.
Supervisors assume the liability and professional responsibility for the clients with whom the intern works. Thus, acceptance of a particular client onto an intern’s caseload is up to the discretion of the intern’s primary supervisor. Agency demands and availability of particular client characteristics also influence disposition of clients to an intern’s caseload.Over the course of internship, interns might also engage in couples therapy. The number of couples seeking services from our clinic is small overall and varies from year to year. When couples do present for therapy, we attempt to funnel these clients to interns so that interns can obtain experience in this area. Supervision of couples work is integrated into ongoing individual supervision. However, given the low frequency of couples, couple’s work is not considered a core activity of the training and program and not separately evaluated as a distinct skill set.
The Counseling Clinic’s staff has a strong interest in groups and routinely offer group counseling to clients. At the start of each quarter the staff (including interns) discuss possible group offerings based on a combination of requests from client populations, service providers' interests, the expertise of staff, and traditional counseling clinic needs. Both interpersonal process groups and psychoeducational groups are typically available to clients throughout the academic year. Topics for problem-focused structured psychoeducational groups include anxiety management, stress management, depression management, and body image concerns. Structured workshops in time or anger management, grief issues or other topics are offered when the need arises or an adequate number of interested students for a specific topic are available.
In addition to these groups, the initial service provided for the majority of students requesting services is a series of 3 “seminars”/psychoeducational workshops introducing the basics of ACT theory and skills, problem definition, goal setting and implementation. All staff members including interns are involved in presenting and facilitating these seminars on a regular basis.
Interns are offered both clinical and administrative experience through their participation in the provision of group therapy. It is hoped that an intern will have experiences with both process and psychoeducational groups during the internship year. Development of group counseling skills is designed to be sequential. During fall quarter, an intern is expected to work with a senior staff member in the preparation and implementation of a group as well as a Pathways series. Initially, the intern may observe or co-facilitate the group with a senior staff member. Once approved, the intern has the option of conducting that group on her/his own, may supervise a master’s student as a group co-leader (in a psychoeducational group), may facilitate a group with another intern, or may choose to become involved in the facilitation of a different group with a senior staff member.
To ensure that all interns have at least some opportunity to provide supervision during the course of internship, the Graduate Assistant is assigned two intern supervisors for the duration of the academic year. One doctoral intern will serve as the primary supervisor and provide supervision for the entire academic year. The other two doctoral interns will serve as secondary supervisors, with one doctoral intern providing supervision for the first half of the academic year and the other doctoral intern providing supervision during the second half of the academic year. If a doctoral intern co-leads a group with the Graduate Assistant during winter or spring quarters, then the doctoral intern would have supervisory responsibilities in that co-leadership relationship as well. This could be one of the Graduate Assistant’s current supervisors or a doctoral intern not currently providing individual supervision.
When providing supervision of a Graduate Assistant’s individual therapy work, supervising interns are expected to provide one hour a week of regularly scheduled supervision, review tape (outside of the supervision hour) of their supervisee’s therapy sessions on a regular basis (at least one a week). Interns are also expected to be available to their supervisee for consultation and support as needed and to complete necessary evaluations.For interns supervising a “Group Intern” during winter quarter, the intern is expected to provide didactic training on Pathways material, mentor the master’s student in the competent facilitation of Pathways, work collaboratively with the master’s student to complete organizational tasks related to the psychoeducational or support group they will co-lead, meet for formal clinical supervision for a minimum of 1 hour a week (may be done in 30 minute segments depending on the need), and to complete necessary evaluation forms.
Interns must complete and pass two formal case presentations. Formal case presentations are scheduled at the end of January/beginning of February and at the end of Spring quarter. The structure of the case presentation is designed to model the general format for disseminating information within most mental health centers, however it will also include sharing of videotaped segments of therapy sessions with the client.
Interns are required to research, create, and deliver a grand rounds presentation to the clinic’s multi-disciplinary staff on a topic of their choice related to health service psychology. The presentation takes place in the second half of internship, after the interns have had the opportunity to observe and participate in grand rounds presentations made by others. Each intern will be assigned a senior staff person to provide mentoring and general supervision of the presentation’s development.
Interns are supported in working on their dissertations while on internship through their ability to use university/agency resources such as computers, printers, internet access, and the library to complete tasks related to their dissertations. They are also able to use work time for consultations with their chairs or committee members, encouragement to use slow times in the clinic to work on their dissertations, and the availability to professional leave for dissertation data collection and/or defense. As interns have time and interest, the clinic also supports interns being involved in ongoing formal and informal research endeavors at the clinic. These include client satisfaction surveys, looking at treatment outcome/relationship to academic persistence, and, currently, evaluation of our Pathways program. We caution interns against engaging in outside research unless their dissertations are already complete. Interns are also given up to $400 for conference attendance and could use this support to present research at a conference.
Interns regularly engage in two primary types of consultation. The first is consultation with medical staff (providers and nurses) at the Student Medical and Counseling Clinic. The medical and counseling staff work closely together and cross-refer many students. Consultations take place both formally during the biweekly Multidisciplinary Team Meeting and informally during conversations with medical staff throughout the week. Interns are encouraged to have regular contact with medical providers if clients are receiving psychotropic medications or have health conditions that may be directly affecting their mental health – or their mental health is directly affecting their physical presentation. Interns are also encouraged to consult with medical providers when questions arise regarding the interaction between physical and mental health. The second is consultation with university case managers. One or more of the university case managers attend the counseling clinic’s weekly Case Consultation Meeting. During this time work with common clients may be discussed and high risk students are reviewed. Through these consultations, interns gain experience navigating the complex legal and ethical issues related to client confidentiality, risk, and serving two clients – the student and the university.
Less frequent consultation opportunities arise throughout the year. Some of the typical experiences include:
(a) Consultation with Designated Mental Health Professional (DMHP). In Washington State, only DMHPs are given the authority to authorize involuntary hospitalizations. When a client is at significant risk and is either unwilling to safety plan or an adequate safety plan cannot be developed, interns consult with a DMHP to determine appropriate next steps, which often includes formal evaluation for hospitalization. During these evaluations, the intern serves as consultant to the DMHP, providing information regarding the client’s risks and other historical data that is important in determining appropriate level of intervention for the client. Interns can also consult informally with DMHPs if a student’s risk does not rise to the level of hospitalization but they are needing an additional perspective on risk issues and how to address them. Consultations with DMHPs are also initiated after consultation with a supervisor or senior staff member. Keeping with our developmental framework, a supervisor/senior staff person is often closely involved with a first consultation, modeling contact or walking interns through step by step. Later, interns are coached, as needed, from a distance, and encouraged to take on the primary role in working with DMHP.
(b) Consultation with faculty, staff, parents, or other students concerned about a student or client also occurs on an occasional basis. The Counseling Clinic Director often fields these contacts, but interns may be asked to serve this role, particularly later in the year. Such consultation involves active listening to concerns, provision of basic advice regarding how to refer the student of concern to the clinic or other resources or access emergency intervention if needed, and coaching on how to approach difficult conversations such as concern for a student.
(c) Consultation with off-site providers. Interns are encouraged to consult with past providers, either medical or counseling, when students transfer care to our clinic. This is particularly encouraged when a student will continue a relationship with this provider when they return home for breaks.
Successful completion of the internship requires a minimum of 500 hours of direct service in the form of individual, couple, crisis, and group counseling; screenings; testing; test interpretation and report writing (25% of time up to 20 hours total); psychoeducational outreach presentations; and provision of supervision to a junior trainee.
It is highly recommended that interns have complete a minimum of 140 hours of direct contact during Fall quarter, 160 hours during Winter quarter, and 150 hours during Spring quarter for a total of 450 hours by the end of Spring quarter. This leaves 50 hours of direct service for the Summer quarter. Although it can feel like a lot to achieve these hours on this timeline, client load in the summer can be unpredictable, and interns who do not meet these markers tend to feel quite stressed in the summer. During university breaks the clinic is closed to clients. Therefore, interns have approximately 39 weeks to accrue face-to-face, direct services hours.
***Very Important Direct Service Caveat. Although the inclusion of outreach, testing interpretation, report writing, and supervision as things that “count” toward the direct service requirement is consistent is allowable by state law and accreditation guidelines, many licensing boards will only count direct, face-to-face clinical contact in their definition of direct service when a person applies for licensure. For example, although Washington State law exempts internships that are accredited by APA from a series of specific content requirements for internship experiences that are not accredited, when applying for licensure, the application still requires minimum numbers of face-to-face clinical contact, for which supervision, report writing, and outreach would not count.
Therefore, it is strongly advised that interns work to complete 500 hours of direct, face-to-face client contact over the course of their internship to ensure that they have the most flexibility and options for future professional licensure and functioning.