Chapter 12. Clinical Internship and the Post-doctoral, Pre-licensure Period



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CUA Clinical Psychology Student Handbook 2013

12- Internship



Chapter 12. Clinical Internship and the Post-doctoral, Pre-licensure Period

The clinical psychology program requires a calendar-year clinical internship (or half-time over 2 years) as the culmination of clinical training.


Competitiveness of Internships
Clinical internships have become highly competitive, especially in popular areas such as Washington and Boston. Although CUA students have long held a strong reputation at internship settings, careful preparation of your internship application and consideration of a wide range of alternative placements is strongly encouraged. We also strongly urge you to add to your application list, internship sites outside of the immediate area and other very desirable places to live. Sites in the midwest and in small towns are not inundated with applications as are sites in attractive urban environments. Do apply in the DC area if you would like to stay here, because our students have done extremely well in the area, but you will increase the chances of getting an internship that you are pleased with if you also plan to apply more widely. But also keep in mind our great success rate in the last many years in placing students on internship in their first year of applying! As a final and important consideration, your application for clinical internships has implications for the larger program, our reputation, and the maintenance of our accreditation. Applying for internship requires that you are ready and that you make the maximum effort to ensure success. For example, some students consider applying when they are perhaps less than fully prepared or consider applying to only 1-2 sites thinking that if they don’t get in, they can try again next year. This kind of approach has implications beyond the student applicant—such an approach can adversely affect the larger program if you fail to obtain an internship on a first try. If there are any questions about your readiness or strategy, please talk to your faculty advisor, the Associate DCT, or the DCT.
Preparation and Applications
Gather information about internships early. The summer before applying is a good time to collect information about sites, although the sites will typically not have their actual materials available until around September. The source for information on sites and many other aspects of internship application is the website of the Association for Psychology Postdoctoral and Internship Centers (APPIC), the professional organization of internship sites, http://www.appic.org/. APPIC has a searchable database of internships with links to internship websites.
APPIC has several listservs that can be joined by going to the APPIC website. Students applying for internship must subscribe to the Match listserv because the information is essential (and yields few messages). There is also a discussion list for applicants, which some students find useful and others find anxiety-provoking and not helpful
The Associate DCT and DCT hold a meeting each September for those who are planning to apply for internship. All facets of the application process are discussed. Students who are currently on internship are invited to this meeting, because their advice is invaluable. Beyond this meeting, a listserv of applicants and current/recent interns is created each year to facilitate questions and answers.
APPIC has an application form, the AAPI, which is accessed via their web site (see link above) that all sites use. Note that, the AAPI is completed entirely online. The application includes a detailed break-down of hours spent in various clinical activities, as well as tests administered. There is also a set of essays on the AAPI. In addition to the standard AAPI, many sites add their own set of questions.
Application deadlines range from late October to December. Most are November 1 currently, although they keep getting earlier. Give yourself time to work and re-work your internship applications. It is essential to tailor your application to each site in the final essay, and the new online AAPI allows for doing so. General statements (e.g., "I want to intern at your setting because it offers the best training") are less effective than those that can detail what is unique about each internship and how it fits into your overall plan for professional development. In our experience, in preparing your essays it can be helpful to look at other essays of peers or in books, but then be sure to put them away before writing your own. Your essays must reflect your original work and you never want to literally or inadvertently use the work of others! But be sure to ask your advisor to read all your essays and give you feedback.

High-quality internships are geared toward training, not providing service cheaply through student labor. It stands to reason, then, that the best internships consider more than just the quantity of prior clinical experience. The quality of experience and the student's demonstrated scholarship in all areas of psychology are equally or more important. Give consideration, therefore, to soliciting recommendations from advisors who may know you primarily through research collaboration or seminar work, as well as from clinical supervisors.


Readiness to Apply for Internship

Students must receive program approval (from their advisor or the DCT) prior to applying for internship. All criteria are included in the Clinical Practica and Externship Policies and Procedures Guide (Appendix A of this handbook). Faculty meet early in the Fall semester to review the list of students intending to apply for internship that year. Briefly, the criteria are: students must be in good academic standing; students must have submitted their brief (2-page) dissertation proposal to the department faculty by October 1 of the year in which they are applying for internship; students will have completed at least two 9 month clinical externships by the time they begin internship (this rule effective with classes entering in Fall 2011 and later), students will have received satisfactory evaluations from all on-campus and off-campus practicum and externship supervisors, or have satisfied the requirements of any remediation plans that were developed for unsatisfactory evaluations; students will have received satisfactory faculty ratings on the clinical case conference (beginning with classes entering in Fall 2009 or later). In addition to these specific criteria, faculty make a global determination of whether the sum total of each student’s training experiences will have provided sufficient breadth of training to satisfy program expectations and requirements. Operationally, the Director of Clinical Training will not complete the portion of the internship applications that attests to the student’s readiness for internship unless the student has met these criteria.


APA-Accredited Internships

All APA-accredited internships are acceptable to the program, and non-accredited sites are acceptable if they meet the criteria below as determined by the Director of Clinical Training. The program strongly encourages students to go to accredited sites. APPIC’s database of sites indicates which are APA-accredited. A list can also be found at http://www.apa.org/ed/accreditation/. An APA-accredited internship is not required for licensing in most jurisdictions, although it is in some. Those jurisdictions that do not require an accredited site may require the applicant for licensing to provide much more documentation than an applicant with an accredited internship. Further, some employers give preference to job candidates who have had an accredited internship.

Here are some useful websites for investigating the rules about internship in different jurisdictions:
http://www.asppb.net/ (general information on licensing requirements and specific licensing requirements of every jurisdiction in the US and Canada)
http://www.uky.edu/Education/EDP/psyinfo2.html (links to psychology boards and licensure laws in all U.S. jurisdictions)
The clinical faculty has devised a set of guidelines for non-APA-accredited internships (see below). A student must demonstrate that such an internship meets these minimum standards for the internship to be an acceptable placement. Any student who wishes to undertake such an internship should submit all information necessary for the clinical faculty to evaluate the internship's acceptability, such as the description of the training and the list of faculty. This should be done at least 4 weeks prior to the date for submitting your rank-order list. (Don’t wait until the day before you must submit your list to ask the Director of Clinical Training if it is acceptable to take a non-accredited site.)
Specialty Internships

Some internships offer specialized training in a particular treatment modality (e.g., psychodynamic) or with a particular population (e.g., inpatients; children and adolescents; college students). Decisions about whether to do such an internship should be made in light of the student's overall training experience (pre- and post-internship) and career goals.


Guidelines for Non-APA Accredited Internships

Students in the CUA Clinical Psychology Training Program are encouraged to seek an APA-accredited clinical internship. However, occasionally a student elects a non-accredited internship. In order to assure the quality of training, the following guidelines serve as minimum standards for non-APA-accredited internship programs. Any internship that fails to meet these guidelines will not qualify as an acceptable training experience for CUA clinical psychology students. The guidelines are not meant to suggest what constitutes a good internship program, merely a minimally acceptable one. An attempt is made to specify certain features which we feel are essential, as well as other features which may be desirable but not absolutely necessary.

1. The student must be clearly designated as a trainee in a formally identified training program, in contrast to being hired as a junior staff member of the facility itself.

2. The program must have a licensed/certified psychologist (Ph.D. or Psy.D.) who functions as training director and who is responsible for the following:

a) establishing a contract with the trainee regarding the content of the training program. This contract should take into account the trainee's specific skill deficits. It should specify a set of required training experiences (number of hours of direct client contact, seminars, conferences, etc.), and a set of elective training experiences.
b) insuring that the trainee's program is evaluated periodically, so that the training program can be modified, if necessary.

c) insuring that mid-year and end-of-year evaluations are made of the trainee's skills and deficits as a clinical psychologist and that these are sent to the CUA Director of Clinical Training.

3. The trainee must receive broad exposure to a reasonable variety of significant clinical problems. It is difficult to specify in advance just what constitutes "broad exposure" or "significant problems." For example, exclusive contact with just one of the following problem groups would constitute too restricted a training experience: an incarcerated prison population, or a chemically dependent sample (even if both in-patient and out-patient). The internship facility itself could provide direct service only to a limited clientele, as in the case of a prison. However, the training director will be responsible for providing supplementary training experiences at outside training agencies, in order to insure broad exposure to diverse problems as well.

4. It is desirable that the trainee gain experience in a wide variety of treatment modalities, such as individual, group, marital/family, long-term, short-term inpatient and outpatient treatment. Moreover, it is desirable that the trainee receive exposure to a variety of theoretical approaches to treatment (e.g., cognitive-behavioral, psychodynamic). However, exposure to a variety of treatment modes and models does not substitute for experience with a broad client population.


5. The trainee's internship experiences should represent a reasonable balance of activities undertaken by a clinical psychologist, including direct treatment, consultation, assessment, and research. Formal seminars and case conferences are also desirable components of the training year.

6. Adequate supervision time must be allocated for all training activities in which the intern is engaged. This supervision must be provided by two or more licensed/certified psychologists (Ph.D. or Psy.D.) on the training program staff. Total supervision time should amount to at least 5 or 6 hours per week, at least 2 hours of which should constitute individual supervision by a licensed/certified staff psychologist. In addition, it is desirable that the trainee receive some consultation with, and/or supervision by, other mental health professionals, in order to foster a multidisciplinary perspective.


Very important: If you do an unaccredited internship, you may be asked by the jurisdiction in which you seek licensing to provide voluminous documentation on the hours you spent on internship. Track your hours just as you did earlier in the program in preparation for internship application, e.g., by how many face-to-face hours with what type of client, and so on. It is important to know that some future employers (like the VA system) may require an APA accredited internship experience, which may influence your decision-making therein.
The Match Process
APPIC administers a matching process of applicants and sites. In other words, after a process of applications and rank ordering, a complex computer program comes up with the best match of an applicant to the highest rank-ordered site possible. Applicants are told where they are going, and sites are told who their interns will be. Information on the match can be found on the APPIC website, http://www.appic.org.
Students must sign up for the match with APPIC and pay a fee. Most applications are due about November 1, and interviews take place in December and January. In Phase I of the match, both applicants and sites submit rank-ordered lists early in February. In other words, students rank-order all the sites they are willing to attend, and sites rank-order all the applicants they are willing to train. APPIC convincingly demonstrates that it is in applicants’ (and sites’) best interest to submit an honest rank-order list, regardless of what chance the applicant thinks he or she has of getting the top-ranked site. The Phase I match outcome is announced on a Friday in late February.
Sites are never told what rank an applicant with whom they are matched gave the site, and vice versa. In submitting a rank-order list, applicants are guaranteeing that they will attend the site to which they are matched; it is ethically unacceptable to change one’s mind after the match has been announced. That is why it is so important to rank-order only those sites to which an applicant is willing to go.
Beginning in 2011, students who do not obtain a position in this first phase of the match are eligible to participate in a Phase II match. Those applicants use the AAPI Online service to submit applications to programs with unfilled positions from Phase I approximately one week after the Phase I match. Applicants and programs submit new rank order lists for Phase II of the Match by a deadline that is roughly 3 weeks after the Phase I match. A second matching process is carried out, and the results of Phase II of the match are distributed 1 week later.

Preparation Tips for Applications and Interviews (From the Experience of Past CUA Students)
A. Applications
In addition to the standard AAPI form and questions specific to each site, you will need:
1. An up-to-date vita.
2. Copies of graduate school (and occasionally undergraduate) transcripts.
3. One or two places ask for a recording or transcript of a therapy session. (Some students have gotten by with a treatment summary, though.)
4. One or two places ask for descriptions of every graduate psychology course you have taken.
5. Several places ask for copies of assessment reports (usually two) that you have written from complete batteries. Be sure to omit the client’s name!
6. At least 3 letters of reference, as well as the APPIC form attesting to readiness for internship that must be submitted by the Director of Clinical Training.

B. The Interviews (Note: This section is very helpful for externships too, although externship interviews will take into account that the student has less experience.)
Most places give individual interviews. A few places interview applicants in groups. A few internships have two interviewers talk to you together.
Since interviews take place in the winter, you might ask what to do if there’s bad weather.
Some typical questions are below.

1. What are your strengths and weaknesses as a person? As a professional?

2. What makes you interested in this internship program? How is this setting relevant to your professional goals?

3. Tell me about your supervision experiences. Ever had a conflict with a supervisor? How did you handle it? What were your best and worst supervision experiences?

4. What would you do if your supervisor wanted you to do something you thought was unethical?
5. Why do you think you entered this field?

6. What have you learned about yourself in supervision?

7. How well do you know Exner scoring, MMPI interpretation?

8. What have you read in psychodynamic theory? (Often by psychodynamic sites or supervisors)

9. Describe a client you have treated...Why did you pick that case? (By the way, it’s a good idea to have a case prepared that’s similar to the clientele at that site, if possible.) Keep your case presentation short and clear. You might practice it aloud beforehand; many sites ask this.

10. What is special about you, why should we take you instead of other applicants?

11. Why didn't you get an A in this one course? (Don't get defensive and don't panic. Think about explanations for any low grades you may have gotten in graduate school in advance of your interviews.)

12. How far along are you on your dissertation? Why did you choose your topic?

13. What do you see yourself doing in 10 years? What would you like people to say about you at your retirement party?

14. What is your theoretical orientation? Why? (If eclectic or integrative, a survey of internship training directors says that’s fine but you must be able to articulate a system for deciding what to do when.)

15. Interviewer describes case and asks how you would intervene.

16. What was your most/least successful therapy case? What types of clients are easiest/hardest for you to deal with?

17. Interviewer points out an area of inexperience, in your background, asks you to comment. Previous students' advice (which may not be the only way to go, but which worked for them): Avoid becoming defensive. Acknowledge the weakness and say this is why you are interested in this internship, because you feel it can help fill in the gap in that part of your experience, that you are committed to working on "X" and believe your record demonstrates that you can be successful at it. An alternative strategy: beat them to the punch if you have a glaring weakness in your experience or knowledge. Tell them right off the bat that one reason you are interested in their program is to become proficient at "X," an area you are very excited about but one in which you would like to gain more competency.

18. What do you think the role of diagnosis is in psychotherapy? What do you think of the DSM? What are its strengths and weaknesses? How would you change it?

19. Imagine you are asked to assess a client. What one (they asked for two at one site) test(s) would you use and why?

20. The interviewer presents you with an ethical dilemma, asks what you would do etc., followed by the question, "would you turn in your colleague to hospital administration?"

21. How would you feel about/deal with working with murderers, rapists, and/or child abusers? We have some patients like that here. How would you handle it?

22. How do you make sense of doing clinical work with individuals based on research, when research uses means?

23. How would your best friend describe you?

24. Sites with a high percentage of ethnic minority clients, if you’re not a minority yourself, may ask how it would feel being white working with a predominantly African American clientele.

25. You may be asked about any personal therapy you’ve had. A good way of responding is to talk about its relevance to your clinical work.

26. What do you like best about your program, and what would you change about your program if you could?

27. Is there anything else you'd like me to know about you?
Have questions ready for them, but not things you can readily find out from their website, or it will annoy them. Good questions include:
1. What your interviewer’s interests are.

2. What do your interns do after internship here? Do you help interns get jobs?

3. If there are new faculty and/or some have left, what kinds of changes will that have on the program? Also you can ask about upcoming changes or who might not be supervising in the coming year.

4. One good question to ask is what sort of trainees do you think are happiest here?


Here’s a list of questions that was posted one year on the APPIC website:
PRACTICE INTERVIEW QUESTIONS
Personal/Professional

1. How did you become interested in psychology?

2. How did you become interested in (specific interest area)?

3. What would you be doing if you were not in psychology?

4. Personal strengths and weaknesses? How do they influence your work? What have you done to deal with your shortcomings?

5. What are your goals after internship? In 5 years?

6. Tell me about yourself?

7. Personal strengths and weaknesses? Who are you, personally?

8. What do you do in your spare time? To relax?

9. Tell me about your interest in this area (geography)?

10. Why did you choose your training program?

11. Why should we accept you over other equally qualified candidates?

12. What do you have to contribute to us?
Research

1. Dissertation topic? How is your research progressing? Where do you see it going?

2. How did you get interested in this topic?

3. Clinical relevance of research?

4. Master's thesis?
Assessment

1. Tell me about an instrument with which you feel competent.

2. Opinion of projective testing.

3. What Rorschach scoring system? Why?

4. Opinion of MMPI-2.

5. What further assessment training or experiences do you need?


Treatment

1. Greatest strength as a therapist?

2. Type of client most difficult to work with? What types of feelings do you have toward such cases? How do these feelings interfere with treatment?

3. Orientation in therapy? What do you think of __ approach?

4. How do you see yourself as a therapist?

5. Challenges you expect to face as a therapist?

6. Experience with family/group/inpatient/etc. treatment?

7. Talk about a therapy case you had. How did you conceptualize the case? What was most effective? (mini-case presentation, 5 minutes)

8. Most challenging case?

9. What type of client do you work best with?

10. What sort of supervisors have you had? What type of supervision is best for you?

11. What further therapy training or experience do you need?


Recruiting

1. What can we do to make you want to come here?

2. How do you see us fitting with your goals?

3. Which of your interest areas are (not) addressed by our program?

4. Where else have you applied and what attracted you to these places?

5. What attracts you most to our internship?


Other

1. What else would like me know about you that isn't apparent from your CV?

2. What is the one question you would like me to ask you?

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