Adult Psychopathology Track (155217)

This track offers an array of clinical opportunities for trainees who are interested in evidence-based assessments and treatments for adults with a range of psychopathology, including but not limited to depressive/anxiety disorders, medical co-morbidities, and couples and families with relationship dysfunction. Settings include outpatient mental health for civilians (SATRP, HWI) , outpatient mental health for veterans (CBT Clinic; Couples and Family Clinic), and primary care for veterans (PCMHI) and civilians (BHCC). Each setting/rotation is supervised by faculty member(s) guided by the scientist practitioner model and well versed in a wide range of evidence-based approaches.

Biopolar Treatment and Research Clinic (BTRC)

The Bipolar Treatment and Research Clinic (BTRC) is an integrative outpatient clinic specializing in the treatment of bipolar spectrum disorders and related co-occurring psychopathology across the lifespan. With the support of our interdisciplinary staff, interns on the BTRC rotation gain foundational skills in assessment/diagnosis and case formulation for patients with bipolar disorders, build a strong understanding of currently available first- and second-line evidence-based treatments, and develop and deliver brief personalized treatment plans for patients tailored to their unique presenting problems. Upon patient intake, interns conduct extensive structured clinical interviews (directly aligned with DSM-5 diagnostic criteria) including the administration of “gold-standard” bipolar symptom-level measures for case formulation, work closely with staff psychiatrists to ensure optimized pharmacotherapy is delivered and, relatedly, routinely collaborate with the rest of our treatment team to propose and refine personalized treatment plans and track patient progress accordingly. Weekly case conferences are held to navigate and troubleshoot potential barriers to treatment success for a historically low resource and difficult-to-treat patient population.

By the end of the rotation, interns will be able to:

• Critically evaluate patients’ treatment history and confidently diagnose bipolar disorder subtypes with respect to various differential diagnoses (e.g., schizoaffective disorder, bipolar type; borderline personality disorder; substance-induced mania or depression, etc.).
• Conduct evidence-based assessments of bipolar disorder symptomology, critically evaluate results, and develop actionable treatment plans with respect to each patient’s unique circumstances.
• Prepare and deliver key elements of evidence-based psychotherapeutic interventions, such as psychoeducation (e.g., for bipolar disorder/medication management), cognitive behavior therapy (e.g., unified treatment for emotional disorders), and interpersonal and social rhythm therapy for patients with bipolar spectrum disorders, along with motivational enhancement (e.g., guided self-change) for patients with co-occurring substance use disorders.
• Closely monitor patients’ progress, utilizing a variety of data (e.g., self-report, collateral report, medical records), for prodromal symptoms of (hypo)manic and depressive episodes that may further guide treatment strategies.
• Effectively collaborate with interdisciplinary treatment teams as well as referring clinicians to help coordinate patient care.
• Identify and respond to unique psychosocial challenges associated with bipolar disorders in the context of a varied patient population in terms of age, race, ethnicity, sexual orientation, religiosity, substance use, psychiatric comorbidity, medical morbidity, and socioeconomic, educational and employment status.

Location of Rotation

Institute of Psychiatry, 5th Floor, South Tower

Clinic Hours

Hours for the Bipolar Disorder Treatment and Research Clinic are Monday through Friday 8 a.m. to 5 p.m.

The CBT Clinic for Emotional Disorders is a specialized psychotherapy clinic with the Mental Health Service Line (MHSL) with the Ralph H. Johnson VA Medical Center. Patients within our MHSL are assigned within a multidisciplinary treatment team to provide a wide-range of services, largely centered around their pharmacological interventions. MHSL patients that are identified for potentially benefiting from evidence-based psychotherapies are referred to the CBT Clinic.

The CBT Clinic for Emotional Disorders provides psychotherapeutic services to veterans with diagnoses of emotional disorders (e.g., major depressive disorder, panic disorder, social anxiety disorder, PTSD, OCD, specific phobia, GAD, etc.) and related co-occurring symptomatology (e.g., anger management, impaired sleep, nightmares, stress management). The clinic is staffed by an integrated team of psychologists with varied theoretical and evidence-based orientations. Within that context, CBT providers offer evidence-based psychotherapies (e.g., CBT for various disorders, PE, CPT, ERP, TBT) in individual, group, in-person, and telehealth formats.

The rotation strives to customize the intern training experience based upon mutually identified training goals. Examples of this include attempt to: 1) match supervisors with various expertise and theoretical orientations to interns’ training needs, 2) match patient referrals to intern training needs based on diagnosis, individual characteristics, or demographics, and 3) match patient referrals eligible for specific treatments to interns.

The rotation also strives to emphasize the multidisciplinary training features of the clinic. Interns will be encouraged to work closely alongside other providers on the patient’s interdisciplinary team. Whether they be providers of psychiatric medications (MD, NP, PharmD), psychosocial support and community integration (MSW, peer support specialist), or physical health providers (MD, DO, PT, OT, NP) within the medical center, it is expected that interns will embrace the VA Whole Health treatment approach of collaborative patient education to ensure improved outcomes.

After completing the CBT Clinic rotation, interns will be able to:

• Accurately diagnose and assess veterans with emotional disorders and related comorbidities.
• Develop evidence-based treatment plans for addressing disorder-specific and transdiagnostic symptoms related to the emotional disorders.
• Deliver evidence-based psychotherapy for the emotional disorders, including several different disorder-specific and transdiagnostic CBT protocols.
• Assess treatment progress via evidence-based assessment practices.
• Communicate and coordinate assessment/treatment findings through direct interactions with providers and via documentation in patient medical records.

Location of Rotation

Ralph H. Johnson Veterans Affairs Medical Center

Clinic Hours

Official VA hours are Monday through Friday, 8 a.m. to 4:30 p.m.

Couples & Family Clinic — VAMC

On this rotation, interns attain proficiency in thoroughly working up couple and family relationships through the multi-systemic assessment of behaviors, attitudes, and feelings via semi-structured interviews, self-report measures, and observational assessments.

Interns serve as co-therapists, primarily with the rotation supervisors, but also occasionally with other interested and proficient intern or post-doctoral fellow colleagues. The primary intervention focus in the Couples Clinic is dyadic therapy via Jacobson’s and Christensen’s Integrated Behavior Couples Therapy (IBCT), which is a sophisticated unification of “classical” Behavioral Marital Therapy (i.e., communication skills, problem solving skills, and increasing positive event density) and Emotion Focused Therapy, leading to additional key intervention techniques around emotion (“Empathic Joining”) and cognition (“Unified Detachment”). Additional couples interventions include Behavioral Couples Therapy for SUD and Cognitive Behavioral Conjoint Therapy for PTSD.

Consistent with national trends in primary care and managed care, brevity of intervention (typically an 8 to 10 session span) is stressed. Couples are also typically invited to participate in a VA multi-center clinical research outcome study. Additionally, interns with research interests in prevention and/or in relationship strategic planning, life balance development, and/or in empirically examining interaction data will find ample opportunity to participate in clinical research in the Couples and Family Clinic.

After completing the Couples Clinic rotation, interns will be able to:

• Administer, score, and interpret comprehensive interview, assessment, and observational data.
• Conduct functional behavioral assessments of couple dysfunction and use this information to tailor treatment plans.
• Functionally analyze, verbally and in writing, the etiology and maintenance of maladaptive inter-spouse behavior/cognitive chains.
• Communicate intake findings, conclusions, recommendations to couples and develop treatment plans to address these.
• Demonstrate appropriate and effective use of specific couple’s therapy techniques, including nurturing support, challenging, confronting, coaching, demonstrating, and modeling.
• Demonstrate modeling and effective teaching of behavioral intervention skills, including specific praise, effective commands, limit setting, time-out, planned ignoring, and cost-response systems.
• Demonstrate effective use of emotion-regulating tools.

Location of Rotation

Ralph H. Johnson VA Medical Center

Clinic Hours

Official VA hours are Monday through Friday, 8 a.m. to 4:30 p.m.

Department of Family Medicine - Behavioral Health Consultation Clinic (BHCC)

Family Medicine is unique among medical specialties in that it integrates care for people of all ages, genders, and states of health. Family Medicine encompasses prevention activities as well as the treatment of a broad range of acute and chronic illnesses. The approach of family physicians is evidence-based and incorporates biological, psychological, and social/cultural, and spiritual aspects. Family physicians serve as guides and advocates for their patients within the broader health care system. Family doctors are also specifically trained and skilled with regard to interdisciplinary practice and particularly place a high degree of value on the contributions of clinical and counseling psychologists towards their patient's well-being and overall health.

The Behavioral Health Consultation Clinic (BHCC) provides participating psychology interns with opportunities to work primarily within two outpatient Family Medicine clinics (Ellis Oaks faculty practice and Trident Family Health residency practice). Patients are referred by their treating physician for assistance with diagnostic assessment as well as time-limited evidence-based psychological interventions (generally 6 sessions or less). Typical presenting problems include: ADHD, depressive disorders, anxiety disorders, insomnia, pain management, tobacco abuse, alcohol abuse, and adjustment issues. Psychology interns will have ample opportunity to collaborate with referring physicians (both faculty and resident physicians) with regard to patient care.

Psychology interns will learn to effectively utilize both clinical interview as well as brief self-report measures to succinctly and accurately assess the mental health/behavioral needs of their patients (at baseline and across time). Interns will also learn to effectively and succinctly communicate their clinical findings and treatment plans to patients as well as referring physicians (both verbally and in writing). Given the central nature of the doctor-patient relationship in primary care practice, emphasis will be placed on developing knowledge and skill for managing the doctor-patient relationship to support optimal patient health and well-being. The psychology intern will become familiar with a variety of evidence-based psychological treatments (generally behavioral and cognitive behavioral) for the effective management of specific presenting conditions. Of note, many patients being referred to the BHCC will be taking psychotropic medication. Some patients may have mediation changes (including starting a new psychotropic medication) occur while participating in BHCC services. Other patients will prefer to address their presenting issues without the use of psychotropic medication. So, in addition to developing knowledge and skill regarding brief evidence-based psychological assessment and treatment approaches, the psychology intern will also become familiar with evidence-based biological approaches for addressing patient complaints. In all cases, consideration of patient preferences, evidence-based practice, and collaboration amongst treatment professionals will be combined to determine the optimal clinical approach for each patient.

After completing the BHCC rotation, interns will be able to:

• Accurately diagnose and assess mental health/behavioral symptoms within a civilian Family Medicine (primary care) setting.
• Effectively communicate clinical findings both verbally and in writing to the referring physician, other professionals, as well as to the patient.
• Develop evidence-based treatment plans.
• Deliver brief versions of evidence-based psychotherapy and other behavioral interventions appropriate to specific presenting problems.
• Assess treatment progress via evidence-based assessment practices.
• Effectively manager the doctor-patient relationship to promote the health and well-being of patients.
• Understand the evidence-base for both biological and psychosocial approaches to mental health/behavioral health issues as presented within the unique context of a civilian Family Medicine (primary care) settings.
• Document their findings appropriately within the Electronic Health Record.

Location of Rotation

The BHCC at Ellis Oaks (Faculty) Clinic (James Island)
The BHCC at 30 Bee St Clinic (Downtown)

Personal transportation required to complete this rotation.

Clinic Hours

Hours are currently Monday and Friday from 8:20 a.m. to 5 p.m.

Health & Wellness Institute (HWI)

The new, state-of-the-art MUSC Health and Wellness Institute houses the MUSC Mindfulness Center, which offers adults and teens a full array of evidenced-based strategies to bolster resilience and foster mindfulness practice. Program goals are to improve quality of daily life, enhance competence in managing life stressors, regulate emotion, improve sleep, reduce anxiety and depressed mood, and prevent mental and health complications associated with these problems. Resilience areas include: understanding stress and resilience, developing healthy personal connections, getting restful sleep, positive activity scheduling, and living a meaningful life (via values clarification). Mindfulness programming includes: basics of mindfulness in everyday living, guided mindfulness practice, and mindfulness-based stress reduction (MBSR). Programs are offered individual, group, and retreat-based formats. Programming is provided both in a community-based Center located in Mount Pleasant as well as within businesses and with healthcare providers. Interns completing a rotation at HWI will develop expertise in early intervention resiliency strategies, acceptance and commitment approaches, and mindfulness. Services will be provided within a multidisciplinary environment alongside dieticians, wellness coaches, sports medicine physicians, and other mental health clinicians. Interns will use semi-structured assessments to assist with determining needs and developing individualized treatment plans for clients. Intervention approaches typically include cognitive-behavioral strategies and acceptance and mindfulness-based interventions. Training in both individual and group interventions is provided. Further, interns are invited to engage in ongoing collaborative program evaluation of this innovative center.

After completion of the Health and Wellness Institute rotation, interns will be able to:

• Accurately assess areas to foster resilience and growth in adults and teens using semi-structured assessment batteries.
• Effectively deliver stress reduction coping skills and mindfulness-based strategies to promote meditative practice.
• Effectively deliver mindfulness-based stress reduction (MBSR) for short and long-term stress reduction, decrease of physical and physiological symptoms, and increased ability to deal with chronic pain.
• Collaborative effectively with a multidisciplinary team of clinicians, dieticians, and health and wellness specialists.

Location

Mount Pleasant MUSC satellite office (car is recommended)

Clinic Hours

Hours of rotation will require early morning and evening hours to accommodate client work schedules as group sessions will often be scheduled after work hours. Accommodations to daytime schedule will be adjusted.

Primary Care — Mental Health Integration Program (PCMHI) — VAMC

PCMHI is a primary care-based rotation that serves a wide range of presenting complaints within the scope of depressive, anxiety, adjustment, and mild substance use disorders. PCMHI patient referrals are based upon patient request, primary care provider recommendation, and/or cutoff scores on the VA primary care measures of depression and PTSD. Referred patients meet with a co-located mental health provider and complete a brief clinical interview, and self-report measures. Based on their level of impairment and interest in treatment, patients are offered a medication consultation with a PCMHI psychiatrist and brief evidence-based psychotherapy with a PCMHI psychologist, intern, or social worker. Patients with more severe psychopathology and/or impairment are referred directly to more intensive interventions in the mental health clinic. The PCMHI rotation at the VAMC is a primary care-based rotation that offers a wide range of presenting complaints within the scope of depressive, anxiety, adjustment, and mild substance use disorders. PCMHI patient referrals are based upon patient request, primary care provider recommendation, and/or cutoff scores on the VA primary care measures of depression and PTSD. Upon initial referral, patients met with a co-located mental health provider and complete a brief clinical interview, self-report measures, and a semi-structured clinical interview. Based on their level of impairment and interests in treatment, patients are offered a medication consultation with a PCMHI psychiatrist and brief evidence-based psychotherapy with a PCMHI psychologist, intern, or social worker. Patients with more severe psychopathology and/or impairment are referred directly to more intensive interventions in the mental health clinic based on a case-by-case clinical judgment (e.g., bipolar disorder, personality disorders, and psychotic symptoms). In addition, PCMHI staff (psychiatrist, psychologists, social workers, and nurse practitioner) work closely with their patients primary care providers (physicians and nurses) in order to coordinate PCMHI patient's physical and mental health needs.

Within this program, interns will be trained in a wide range of clinical activities, including brief evidence based psychotherapy, integration of behavioral health practices into psychotherapy, and coordination of treatment within a multidisciplinary team of primary care and mental health providers. Regarding psychotherapy training, interns will be trained in a wide range of evidence-based practices (e.g., Behavioral Activation Treatment for depression, Prolonged Exposure for PTSD, Panic Control Treatment for panic disorder, Cognitive Behavioral Therapy for GAD). Additional training will be provided on treatment protocols specifically designed for the PCMHI setting with high risk and poorly served veteran populations (brief behavioral therapy for depression and anxiety). Given the primary care setting, behavioral health practices (e.g., smoking cessation, weight management, reduction of alcohol consumption) also will be included in the training and treatment practices of interns. And finally, interns will be trained how to successfully function within a multidisciplinary team.

After completing the PCMHI rotation, interns will be able to:

• Accurately identify and assess psychiatric symptoms in veterans within primary care settings.
• Develop evidence-based treatment plans.
• Deliver brief versions of evidence-based psychotherapy for depressive and anxiety disorders.
• Provide brief interventions for related disorders and conditions (stress management, anger management, sleep disturbance, mild substance abuse).
• Assess treatment progress via evidence-based assessment practices.
• Communicate and coordinate assessment/treatment findings through direct interactions with providers and via documentation in patient medical records within the VA Primary Care and PCMHI programs.

Location of Rotation

North Charleston VA outpatient clinic, 6450 Rivers Ave, North Charleston 29406

This rotation is off campus. Transportation is required.

Clinic Hours

Official VA hours are Monday through Friday, 8 a.m. to 4:30 p.m.

SMART is an adult outpatient clinic providing state-of-the-art evidence-based treatments for various sleep and anxiety disorders. The clinic serves patients with primary diagnoses of social anxiety, obsessive-compulsive disorder, panic disorder, specific phobias, and generalized anxiety disorder. In addition, the clinic provides state-of-the-art sleep studies and behavioral and psychopharmacological interventions for sleep disorders, including insomnia, narcolepsy, and restless leg syndrome). Interns rotating at SMART develop expertise in cognitive behavioral approaches to the treatment of anxiety and sleep within a multidisciplinary environment alongside social workers, psychiatrists, and psychiatry residents. Interns use semi-structured assessment batteries to assist with diagnoses. Treatment approaches typically include exposure-based behavioral, cognitive-behavioral, and acceptance and mindfulness-based interventions. Interns participate in weekly individual and group supervision with psychiatry residents and the supervising psychologist.

Further, interns are invited to engage in ongoing collaborative anxiety research projects with psychiatry and psychology faculty. Current projects include the relationship between sleep disorders and anxiety and dissemination of evidence-based treatments for sleep and anxiety disorders.

After completion of the SMART rotation, interns will be able to:

• Accurately assess and diagnose anxiety disorders using semi-structured assessment batteries.
• Accurately assess and diagnose sleep related problems using semi-structured assessment batteries.
• Effectively deliver evidence-based cognitive behavioral protocols for anxiety disorders (including but not limited to exposure treatments (EX), exposure and response prevention (EX/RP), and acceptance and mindfulness ACT).
• Effectively deliver evidence-based cognitive behavioral protocols for sleep problems such as insomnia, parasomnia, narcolepsy, and hypersomnia.
• Document the delivery of services and patient response to services appropriately in each patient's electronic medical record.
• Integrate appropriate modifications to assessment and intervention of sleep and anxiety difficulties based upon unique needs of patients with varying backgrounds.
• Collaborative effectively with a multidisciplinary team of clinicians, psychologist, and psychiatrists.

Location of Rotation

SMART is in the MUSC Department of Psychiatry and Behavioral Sciences. Offices for in-person appointments are located in the MUSC Institute of Psychiatry. 

Clinic Hours

SMART runs on Monday through Friday from 8 a.m. to 5 p.m.

Suicide Prevention Team

The Suicide Prevention Team is comprised of Suicide Prevention Coordinators who act as champions for the VHA’s public health approach to suicide prevention and who assist with the care and management of Veterans at high acute risk for suicide. The team members work with Veteran patients, VA facility staff, and community partners in support of numerous suicide prevention initiatives.

As part of this rotation, the intern will:

• Consult with health care providers regarding suicide risk assessment and suicide risk mitigation strategies, including consultation with providers to assist in decision making about placement of High Risk for Suicide Patient Record Flags
• Respond to referrals from the Veterans Crisis Line to meet the needs of Veterans who have reached out to the crisis hotline for support at a local level
• Routinely conduct comprehensive suicide risk evaluations and engage in safety planning and discussions about lethal means safety with Veterans
• Provide postvention services to staff and family after a death by suicide
• Provide education to staff on topics related to suicide prevention
• Attend community outreach events and coalition meetings
• Lead and/or assist with process improvement projects
• Attend interdisciplinary meetings related to the care of Veterans at high risk for suicide

By the end of the rotation, the intern will:

• Understand, describe, and discuss a) empirically-supported theories of suicide and b) the VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide
• Conduct suicide risk assessments and interventions using evidence-based tools/instruments (e.g., Columbia Suicide Severity Rating Scale, Comprehensive Suicide Risk Evaluation, Stanley Brown Suicide Prevention Safety Plan, Lethal Means Safety counseling) aimed at assessing and addressing suicide risk. Interns will gain competency with the nationally mandated VA Suicide Risk Identification (“Risk ID”) process.
• Serve as a consultant to referring inpatient and outpatient providers to discuss appropriateness of high-risk flag placement, treatment-planning, and suicide risk mitigation strategies.

Location of Rotation

Ralph H. Johnson VAMC

Clinic Hours

Official VA hours are Monday through Friday, 8 a.m. to 4:30 p.m.