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, conditions requiring psychiatric hospitalization, and/or couples and families with relationship dysfunction. Settings include outpatient mental health for civilians (SATRP) and students (CBT-CAPS), outpatient mental health for veterans (CBT Clinic; Couples and Family Clinic), primary care for veterans (PCMHI), and psychiatric inpatient for civilians (CIPS). 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.

Cognitive Behavioral Therapy Clinic for Emotional Disorders — VAMC (CBT-VA)

The CBT Clinic for Emotional Disorders is a specialized psychotherapy clinic with an integrated staff of psychologists and social workers. The clinic serves veterans with diagnoses of emotional disorders (major depressive disorder, dysthymia, panic disorder, social phobia, PTSD, OCD, specific phobia, and GAD) from referring providers throughout the VAMC mental health service. The CBT Clinic focuses evidence-based psychotherapies, including various versions of behavioral and cognitive therapies (e.g., PCT, PE, CPT, ERP) and newer adaptations (e.g., DBT, mindfulness, ACT). Because comorbidity is extremely common in this population, transdiagnostic approaches to psychotherapy are emphasized.

The scientist-practitioner/clinical scientist model is highly valued by the staff within the CBT Clinic and plays an important role in clinical practice, supervision, and related research projects. Although the CBT Clinic primarily serves as a treatment service within VAMC, there are several recent and ongoing research projects within the clinic. To date, these projects have focused primarily on better understanding prevalence, severity, and diagnostic comorbidity of the emotional disorders and adapting evidence-based psychotherapies to real-life clinical practices (e.g., effectiveness, dissemination, and implementation research). Past interns also have been successful in publishing case studies resulting from the complex cases treated during the clinic.

Interns rotating within the CBT Clinic will receive both individual and group psychotherapy experiences in addition to supervision and training in evidence-based psychotherapies. Given the large number of referrals and opportunities, the CBT Clinic supervisors attempt to match/address an intern’s individual training needs with specific patient characteristics, diagnoses, and/or treatment practices or modalities.

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.

Faculty

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 plan.
  • 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.

Faculty

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 Trident Family Health (Residency) Clinic (North Charleston)

Personal transportation required to complete this rotation.

Clinic Hours

Hours at the Ellis Oak location are currently Monday and Friday from 8:20 a.m. to 5 p.m.

Hours at the Trident location are Tuesday and Thursday from 9 a.m. to 5 p.m.

Faculty

 

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. All patients within the PCMHI program also are followed by a social worker serving as a care manager. In addition, PCMHI staff (psychiatrist, psychologists, social workers, and nurse practitioner) work closely with their patients’ primary care providers to coordinate the patient's physical and mental health needs.

PCMHI interns are trained in a 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, interns may be trained in a wide range of brief evidence-based practices, tailored to the 30 minute sessions and 3-6 session PCMHI format (e.g., Problem-solving therapy, brief behavioral activation, and CBT for insomnia). 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 are trained to function successfully 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

Ralph H. Johnson VA Medical Center

Clinic Hours

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

Faculty

Sleep & Anxiety Treatment & Research Program (SATRP)

The SATRP 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 (insomnia, narcolepsy, and restless leg syndrome). Interns rotating at SATRP 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. Individual and group therapy training are provided. Interns participate in weekly individual and group supervision with psychiatry residents and the supervising psychologist. Because this rotation serves a cross-section of the community, interns are expected to be available to work in an evening clinic one day per week until approximately 8 p.m.

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 optimizing existing anxiety interventions.

After completion of the SATRP 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 culturally diverse backgrounds (e.g., race/ethnicity, gender, SES, sexual orientation, etc.).
  • Collaborative effectively with a multidisciplinary team of clinicians, psychologist, and psychiatrists.

Location of Rotation

MUSC Department of Psychiatry and Behavioral Sciences

Clinic Hours

SATRP runs on Monday through Friday from 8 a.m. to 6 p.m.

Faculty