> ![](media/image1.png){width="1.125in"
> height="1.6979166666666667in"}**Psychology Internship Program**

**Edith Nourse Rogers Memorial VA Medical Center - Bedford**\
Psychology Training Program (116B)

200 Springs Road

Bedford, Massachusetts, 01730

> *(781) 687-2378*
>
> ***\
> **[http://www.bedford.va.gov](http://www.bedford.va.gov/)*

**MATCH Number: 1322**

**Applications due: November 7, 2008**

## 

## Accreditation Status

The predoctoral internship at the **Edith Nourse Rogers Memorial VA
Medical Center - Bedford** is fully accredited by the Commission on
Accreditation of the American Psychological Association

The next site visit will be during the academic year **2013**.

## 

## Application & Selection Procedures 

The program seeks qualified applicants from both clinical and counseling
doctoral training programs in psychology. The program does not
necessarily favor any particular area of practicum clinical training or
prior experience; however, training, experience, and interest relevant
to the program\'s primary rotations and/or veteran issues may be
desirable.

Interns selected to the internship program have been carefully reviewed
and ranked by a two-stage selection process that includes all members of
the training committee. After initially reviewing and rating all written
applications (rated along six dimensions: amount of clinical experience,
quality of academic performance, research achievement, letters of
recommendation, personal attributes as well as breadth and depth of past
experience, and the ability to understand diversity), selected
applicants are invited for interviews. The interview process is
conducted in the form of four "open houses", with all members of the
training staff sequentially presenting about aspects of the internship
training pertaining to their respective clinical programs during the
morning portion of the day. Following the presentations and lunch, each
intern participates in three individual interviews. Interns typically
interview with prospective supervisors associated with one or more
specialty rotations for which they expressed interest in their
application. The program asks prospective applicants to rank order
specialty rotations regarding their interest, however, such rankings are
only for the purpose of establishing interviews with supervisors most
associated with initial applicant interest. Following the open house,
applicants are encouraged to express interest (not rankings) in any of
the four specialty rotations we offer, regardless of whether or not they
specifically interviewed with training staff associated with those
rotations. Ratings from the three interviews occur along four dimensions
(clinical sensitivity, critical thinking, interpersonal and personal
qualities, and match between applicant and program). Lastly, the
training committee convenes for another series of meetings to comprise a
rank ordering of all final candidates.

***Applications are due on November 7^th^ and all applicants are
notified via email of their status on or before December 15^th^.***

Please complete the Edith Nourse Rogers Memorial VAMC Application Form
(which can be found at the end of this document) as part of your
internship application. No application will be reviewed without this
one-page form. The form includes a checklist of other required materials
as well as instructions for submitting the application.

***For further application questions:***

> ***Judy Bradley***
>
> Administrative Assistant

*(781) 687-2378*

> *judy.bradley@va.gov*

***Psychology Setting***

![](media/image2.jpeg){width="2.5in" height="1.8909722222222223in"}The
Psychology Training Program at the Edith Nourse Rogers Memorial VAMC is
a component of the Psychology Service, which employs 24 psychologists
along with a large number of associated staff. The Training Program
offers three tracks of training in clinical psychology: a full-time
yearlong APA-accredited postdoctoral residency; a full-time yearlong
APA-accredited predoctoral internship; and a part-time 20 to 25 hour per
week practicum for ten months. The training program will have eight
postdoctoral residents, six predoctoral interns, and six practicum
students for the 2008-2009 training year. Students from nursing, social
work, psychiatry and other disciplines also train at the medical center
each year.

Psychologists are involved in a range of leadership positions around the
hospital, many of whom are program directors within their respective
areas. Staff areas of expertise are broad, with a particular emphasis on
psychosocial rehabilitation, integrative psychotherapy, PTSD, and
research. Regarding the practice of psychosocial rehabilitation, a
number of Psychology Service-run programs have received national awards
for innovation. In addition, there is a large Psychology Service-run
Mental Illness Research, Education, and Clinical Center (MIRECC), in
which a number of psychology staff are actively involved in research.
Staff psychologists are also active in a range of outside research,
including NIMH, Boston University, and the nationally recognized
Geriatric Research, Education, and Clinical Center (GRECC) located on
the Bedford campus.

Psychology Service and the training program are academically affiliated
with the Boston University School of Medicine, where the majority of
ENRM psychologists hold faculty appointments.

## Training Model and Program Philosophy

The educational philosophy of the Psychology Service training program is
scholar-practitioner. Psychological scientific data, empirically derived
clinical findings, and the theoretical underpinnings of human
functioning are each integrated within all aspects of internship
training. The program aims to incorporate these psychology domains
through supervision, didactic training, and the manner of clinical
conceptualization and intervention methodology practiced. Throughout the
training, interns are encouraged to apply empirical findings and
clinical theory to their work and to critically evaluate the various
clinical methodologies to which they are exposed. Similarly, interns are
encouraged to actively participate in research and to use such findings
to inform their clinical activities.

Additionally, the program values the development of critical thinking
and the ability to understand diverse theoretical perspectives,
flexibility and independence with regard to professional behaviors, and
clinical sensitivity and empathy in all aspects of interpersonal
interaction. The internship seeks to facilitate professional development
in accord with these values and it recognizes that a training philosophy
incorporating psychological science, applied research, and clinical
theory forms the foundation for such development.

## 

## Program Goals & Objectives

The overall goal of the internship program is the cultivation of a broad
range of professional skills, understanding, and knowledge, while
particularly emphasizing the development and refinement of clinical
competencies. Consequently, the internship aims to prepare psychologists
to function effectively within diverse professional settings and with a
particular appreciation of the special needs of the VA population and
the nature of service in the public sector.

In order to establish this solid foundation for professional practice,
the training objectives of the internship are focused upon developing
skills in the basic areas of psychology including assessment, treatment,
understanding of systemic, organizational and diversity issues,
consultation, scholarly inquiry, and professional issues. Additionally,
the program values the development of critical thinking and the ability
to understand diverse theoretical perspectives, flexibility and
independence with regard to professional behaviors, and clinical
sensitivity and empathy in all aspects of interpersonal interaction. The
internship seeks to facilitate professional development in accord with
these values and within the basic areas of psychology listed above.

A secondary focus, while still maintaining this generalist training, is
upon developing a particular knowledge/skill base in a specialty area,
thereby providing preparation for subsequent professional activities
and/or postdoctoral training in a particular area of interest. As will
be discussed below, the intern is assigned (on the basis of the intern's
ranking of programs via the national computer match) to one of the four
following primary rotations: neuropsychology, psychosocial
rehabilitation, outpatient psychotherapy, or addictions treatment.

Throughout the training year, the intern is taught to understand the
larger systems (e.g. hospital, VA, health care) in which service is
provided and to anticipate and function effectively over time within
changing environments. Additionally, the intern learns about the role of
the psychologist across a number of professional contexts and to
function effectively as a member of an interdisciplinary team.

Within each rotation, a set of learning objectives have been designed,
which designate a specific body of knowledge and clinical skills that
all interns are expected to achieve by the completion of the rotation.
These learning objectives are achieved through direct clinical
experience, active involvement within various organizational and
clinical contexts, supervision, and didactic-oriented training. These
competencies are presented under \"Training Experiences\" below.

Although the internship program is fairly rigorous with its focus upon
achieving specific learning objectives, the program values flexibility
in each intern's training, thereby taking advantage of the particular
interests of the intern as well as the wealth of opportunities available
for training at the ENRM VAMC. Accordingly, each intern's training
experience is somewhat unique for that particular student, reflecting
the varied options to address individualized interests, needs and
learning objectives.

Regardless of the particular nature of each intern's training
experience, all interns are expected to complete the internship with the
basic skills listed above. Therefore, at the outset of the training
year, all decisions regarding training take into account the intern's
skill level across the basic areas of psychological practice. Interns
are afforded ample time at the beginning of the year to meet with their
assigned preceptor as a training plan is discussed and refined. The
preceptor continues to meet regularly with the intern to ensure that his
or her training goals, needs, and interests are being met. In addition,
the Director of Training also remains involved with regard to assisting
the intern and the preceptor in achieving the intern's individual and
program goals.

The Internship Program views high quality patient care and high quality
clinical training as integrated non-competing goals. Learning objectives
are developed that allow case assignment consistent with both these
goals.

## 

## Program Structure

Clinical training is flexible with two required core rotations,
assessment and psychotherapy, as well as one primary rotation. The
primary rotation is chosen (via the national computer match) from one of
the following four areas \-- neuropsychology, psychosocial
rehabilitation and time-limited psychotherapy, outpatient treatment, and
addictions treatment.

Additional training is also offered in the following areas: clinical
research, smoking cessation, and program development. These optional
training experiences are flexible and usually involve between one and
four hours of weekly activity.

All three rotations (i.e., the primary rotation, the assessment
rotation, and the psychotherapy rotation) run concurrently throughout
the year. This training structure provides the intern an opportunity to
deepen their understanding, skills and practice in each of these areas
of professional activity and practice. On a weekly basis, the primary
rotation usually consists of 16-20 hours, the psychotherapy rotation
10-12 hours and the assessment rotation 6-8 hours.

Each rotation draws on the rich array of resources of the medical center
and staff to support professional training. Typically, multiple sites
are combined to support a particular primary rotation, providing a
diverse range of clinical situations, patients, and professional
contexts in which the intern can develop confidence and proficiencies.
Additionally, collegial interaction on a multidisciplinary team is a
highly valued component of training. All clinical services, inpatient
and outpatient, are built around the team treatment model allowing
psychology interns to work directly on a regular basis with staff and
trainees from psychiatry, social work, nursing, neurology, and
psychosocial rehabilitation. On a number of the rotations, interns
become identified primarily with one particular unit and become a part
of that milieu while serving as consultant to other unit(s). Thus, all
primary rotations involve activities with multiple sites, while milieu
treatment and team functioning occur to varying degrees in different
rotations.

An initial orientation period commences the training year and provides
interns with the time and information necessary to structure their
training compatible with both their personal/professional goals as well
as the philosophy and training objectives of the internship program.
Assignments to training experiences, supervisors and determinations
about appropriate training goals are based upon consideration of these
factors. Although final responsibility for assignment remains with the
program, the process is collaborative and offers interns significant
opportunities to sculpture their training experiences.

**SUPERVISION AND PRECEPTORSHIP**

A minimum of 3.5 hours of formally scheduled individual supervision is
provided for interns each week. Typically, additional supervisory
sessions and supervisor contact, as needed, supplement this total.
Interns participate in two group supervision sessions per week: one
group focuses on clinical assessment and is facilitated by Dr.
Ryabchenko, in which a range of objective instruments are reviewed (with
a particular focus on the assessment of PTSD) and individual cases are
discussed; the second group supervision, facilitated by Dr. Bitman,
focuses on the process psychotherapy groups co-lead by interns and
postdocs. The Psychology Staff provides the vast majority of clinical
supervision. Other clinical staff do provide additional supervision for
particular aspects of training, such as the Psychiatry Walk-in Clinic
rotation, where psychiatrists provide on the spot supervision regarding
the intern's intake evaluations.

Each intern is assigned a preceptor for their training year. Typically,
the preceptor is one of the intern's primary rotation supervisors, and
hence that supervisor functions in both the role of clinical supervisor
and preceptor. In addition to the clinically-based supervision, a
preceptor also attends to other areas of professional and personal
functioning, such as professional interests and development, career
preparation, overall goals and progress on the internship, and personal
issues influencing professional work as well as any personal challenges
that may arise. The intern regularly meets with their preceptor for at
least one hour per week. Within this context, both clinical and broader
professional issues are discussed, with the focus flexibly determined by
the nature of the intern's current learning need.

**SEMINARS**

The internship offers a number of didactic opportunities in which
interns can participate. All interns attend the weekly psychology
seminar series, which covers a range of topics: the mental status exam,
evaluation of dangerousness to self and others, neuropsychological
screening and assessment issues, clinical indicators of
neuropsychological functioning, assessment and treatment of PTSD,
cognitive-behavioral therapy, psychosocial rehabilitation, experiential
psychotherapy, ethical issues, motivational interviewing, addiction
treatment, psychopharmacology, spirituality and religiosity in
psychotherapy, grief and loss, geropsychology, and professional issues.
Seminars are presented by both staff and postdoctoral residents. The
residents particularly present seminars on a range of professional
issues relevant to psychologist-in-training issues.

All interns, along with postdoctoral residents, attend a biweekly
diversity seminar, presented by a staff psychologist with particular
expertise in the area of multicultural issues and individual differences
(either Dr. William Alexander or Dr. Chivi Kapungu) . All interns also
participate in a monthly supervision training seminar (facilitated by
Dr. Ed Federman) in which they learn about models of supervision,
ethical and multicultural issues in supervision, and key elements
regarding supervisee shame, resistance, and how best to address limits
to personal awareness within the supervision.

In addition to the general seminar series, there are two long-term
didactics available to the intern: a six-month or yearlong comprehensive
psychotherapy series addressing cognitive-behavioral and integrative
approaches to treatment; and a six-month or yearlong group supervision
for group psychotherapy, primarily from a psychodynamic perspective, by
Donald Wexler, M.D., a well-respected authority in the area of group
work. Interns select one of these training opportunities in which to
participate for the entire training year. However, interns are also
permitted to switch trainings at midyear, should they so choose, or to
participate in both trainings.

Hospital-wide psychiatry grand rounds, typically on a bi-weekly basis,
as well as weekly geriatrics and extended care grand rounds, occur over
the course of the year. Grand round presentations feature a range of
well-known professionals from the greater Boston area.

In the spring or summer, there is an optional experientially-oriented
seminar series that explores the experiential psychotherapy process,
particularly emphasizing awareness-based frameworks and interventions.

Lastly, Interns have the option of attending the yearlong seminar in
behavioral neuroscience through the Boston University School of Medicine
as well as a seminar in neuropsychological assessment (typically taught
by Drs. Roberta White and/or Edith Kaplan).

**INTERN EVALUATION**

Individual supervisors (in addition to the intern's preceptor)
continually evaluate the student's progress toward the learning
objectives. Routine monitoring of the intern's progress toward
completing the target clinical and professional experiences determined
to be necessary to achieve the objectives enhances the evaluation
process.

Formal evaluation of each intern's performance occurs three times over
the training year: at four months, eight months, and at the completion
of training. For these evaluation periods, each intern's supervisor
completes a trainee competency rating form. The same form is used for
each of the three evaluation periods, and the form is actually used by
training program supervisors for rating both intern and postdoctoral
resident performance. The form utilizes concrete descriptors of
competency performance across key domains of professional functioning
for which the student is rated. The evaluation items on the form
generally parallel and encompass the learning objectives associated with
each of the rotations as well as the general competency domains of
training listed above. Due to the somewhat unique learning objectives
associated with each of the primary rotations, an additional one-page
evaluation form encompassing each primary rotation's set of learning
objectives is included in the evaluation process for each intern's
respective primary rotation.

Summary ratings representing satisfactory and acceptable performance
prior to the completion of the internship (i.e., at the four- and
eight-month marks) and at the end of the year are included within the
trainee competency rating form. Similar criteria are used with regard to
the ancillary primary rotation evaluation forms.

## 

## 

## 

## 

## Training Experiences

**THE CORE ROTATIONS**

**Psychotherapy**

The full-year psychotherapy rotation takes place within the Center for
Integrative Psychotherapy (CIP), which is a Psychology Service-run
clinic housed with the larger Psychiatry Service-run Mental Health
Clinic. The CIP is administratively staffed and run by two psychology
postdoctoral residents, under the active supervision of the Director of
Training. All psychology students, which include practicum students,
interns, and postdoctoral residents, train within the CIP, and a range
of clinical supervisors support student work within the CIP. Within this
setting, interns are afforded an opportunity to engage a variety of
veterans in both short- and longer-term individual and group
psychotherapy. A range of psychological issues and severity are
represented, including PTSD (combat and non-combat related) and other
anxiety disorders, mood disorders, and disorders of addiction.

Interns typically engage an average of four hours per week of
psychotherapy, and carry a caseload of approximately four to six
veterans. Two supervisors are assigned to each intern for this rotation,
with one supervisor providing one hour per week of individual
supervision and the other supervisor providing one hour of supervision
every other week, for an average of 1.5 hours per week of supervision.
Video recording of therapy sessions is utilized within the supervision
process as a means of enhancing the learning process for the intern

The CIP operates from an integrative psychotherapeutic orientation. In
collaboration with one's supervisor, students are encouraged to
conceptualize clinical cases broadly and from more than one perspective,
and they are similarly encouraged to implement interventions
thoughtfully from relevant therapeutic schools to best meet the
presented clinical needs of a veteran. In addition to this overall
integrative stance, supervisors represent a range of theoretical and
clinical expertise, including cognitive-behavioral, cognitive
processing, psychodynamic, humanistic, experiential, and transpersonal
orientations.

In addition to individual psychotherapy, group psychotherapy is an
important part of the provision of psychological services within the
CIP. Therapy groups within the CIP include short-term skill-development
groups and longer term interpersonal process groups. Skill-building
groups involve either an intensive 4-week general CBT group or 8-week
specialty groups, tailored to a particular issue or disorder, such
depression, anger management, relational skills, anxiety disorders,
bipolar disorders, vocational rehabilitation, and stress management. In
addition, wellness groups, particularly incorporating aspects of DBT,
CBT and mindfulness, are offered, and such groups are planned to become
a larger offering within the CIP.

Longer-term process groups (six months or longer) are also offered
within the CIP. In the past, these groups have often involved a focus on
a particular theme, such as relationships or PTSD, however, more
recently, the process groups have been structured as Yalom-informed
heterogeneous psychotherapy groups. Each intern will typically have the
opportunity to co-lead (with another intern or postdoc) one process
group during the training year. Supervision for the process group is
provided in the form of weekly group supervision with one or more of the
training program's supervisors.

Lastly, PTSD program, directed by a staff psychologist with expertise in
PTSD treatment, will provide additional opportunities to learn about
trauma-related theory and practice. Specifically, the PTSD program
offers a series of skill development therapy groups that interns have an
opportunity to co-lead. In addition, training in cognitive processing
therapy for veterans with PTSD is also be available.

***Learning Objectives***

1.  formulate sound case conceptualizations that incorporate various
    theoretical perspectives and research knowledge

2.  identify and collaboratively develop treatment goals with the client

3.  accurately assess, and modify as necessary, the progress of the
    therapy

4.  effectively implement skills with regard to one or more
    psychotherapeutic approaches, such as cognitive-behavioral,
    psychodynamic, and experiential orientations

5.  be aware of and effectively incorporate one's experience and
    emotional reactions pertinent to the therapy

6.  facilitate effective skill-building time-limited psychotherapeutic
    groups

7.  facilitate effective process-oriented psychotherapy groups

***Target Clinical Experiences***

1.  four hours per week of individual psychotherapy throughout the
    training year

2.  co-lead one longer-term process group

3.  co-lead two or more short-term specialty groups, from CBT, DBT
    and/or PTSD psychoeducational perspectives

**Assessment**

The full-year assessment rotation consists of three four-month trainings
in assessment, affording the intern a range of assessment and evaluation
experiences.

During one four-month rotation, the intern will spend one full day/week
in the Walk-in Clinic within the Mental Health Clinic. Here interns have
the opportunity to work in conjunction with interdisciplinary staff,
including on-the-spot supervision and training by staff psychiatrists
and other licensed Mental Health Clinic staff. Interns will evaluate a
variety of patients, presenting with a range of acute psychopathology
and circumstances. The emphasis in this setting is on diagnostic
evaluation and the formulation of a decision plan, typically within a
relatively brief (less than one hour) time frame. Interns serve on
\"first call\" after an initial triage screening and registration.
Procedures include problem-oriented interviewing, identification of
relevant symptoms, history taking, and a mental status examination.

During another four-month rotation, the intern will be involved in the
evaluation of acute psychopathology through participation on the Acute
Inpatient Unit (78G). This is a 30-bed unit designed for evaluation,
crisis intervention, and disposition as well as the management of
acutely disturbed patients who are unable to be managed in a less
restrictive environment. The patient population on this unit is mixed,
including patients with major psychiatric disorders, substance abuse,
dual diagnosis, PTSD, severe personality disorders and dementia. The
intern typically evaluates approximately three patients/month, often
addressing issues of diagnosis and potential risk of harm.

Within another four-month rotation, interns engage veterans in more
formal assessments, incorporating a variety of objective instruments
(such as the MMPI) and a structured interview (SCID), along with
occasionally cognitive measures (such as the WAIS). Training also covers
the assessment of PTSD, including relevant instruments and structured
evaluations (e.g., CAPS). Referrals for assessment come from all over
the hospital and represent a range of referral questions, including
diagnostic issues and the presence of PTSD, personality dynamics
impacting functioning, and dangerousness/risk of harm. Throughout the
training year (whether or not the intern is presently on this particular
assessment rotation) interns participate in a weekly group supervision
of assessment with Dr. Ryabchenko and Dr. Rekart. This supervision
includes review of a number of cases as well as a more systematic
overview of various assessment instruments.

A valuable resource for students is the Assessment Center, which is
staffed by a full-time master\'s level psychology technician who
administers a variety of assessment instruments under the supervision of
the doctoral staff. The Assessment Center provides services throughout
the Medical Center and enables interns to see a diverse group of
patients. There are a number of computer terminals in the Assessment
Center with a full Mental Health Users Package on line, allowing direct
administration of over 80 \"interviews\", tests and questionnaires.
Additionally, a variety of assessment instruments are stored within the
Center and are available for student use.

***Learning Objectives***

1.  formulate clear clinical conceptualizations to address referral
    questions

2.  determine accurate DSM diagnoses

3.  conduct brief focal evaluations with regard to a variety of acute
    psychopathology

4.  conduct and interpret a mental status examination

5.  assess probable risk pertaining to violence and suicidality

6.  accurately select, administer, score, and interpret a set of
    psychodiagnostic assessment tools, particularly the MMPI, Rorschach,
    and CAPS

7.  integrate evaluation/assessment data into a concise, well-written
    report

8.  effectively communicate results to relevant interdisciplinary
    clinicians and to the patient

***Target Clinical Experiences***

1.  25-35 Walk-in Clinic evaluations

2.  10-12 Acute Inpatient Unit/78G assessments

3.  4-5 full battery assessments

**THE PRIMARY ROTATIONS**

**Neuropsychology**

The Neuropsychology Service receives consults from the entire VA medical
center, including primary care, neurology, and psychiatry. Veterans are
referred primarily for evaluations of cognitive dysfunction. Common
referral questions include differential diagnosis of neurodegenerative
disorders, questionable cerebrovascular compromise, determination of
cognitive sequelae secondary to head injury, identification of cognitive
disturbance secondary to psychiatric illness and/or substance abuse, and
detection of Attention Deficit Disorder/Learning disabilities. The
Neuropsychology Service also offers group, individual, family, and
couples counseling aimed at providing rehabilitative treatment and
psychoeducation to veterans with cognitive disability and their
families. The Neuropsychology Service works closely with the Geriatric
Research, Education and Clinical Center (GRECC). The GRECC at Bedford is
one of numerous GRECC programs in VA facilities nationwide. It provides
comprehensive services to individuals suffering from dementia, primarily
Alzheimer's disease.

The neuropsychology rotation provides interns with intensive experience
in neuropsychological evaluation with a wide variety of patients.
Training in neuropsychology focuses on brain-behavior relationships and
represents a combination of clinical psychology and behavioral
neurology. The Neuropsychology Service provides consultation to clinics
and units throughout the hospital. The majority of cases are seen on an
outpatient basis, but there are also opportunities to see psychiatric
and geriatric inpatients. The clinical presentations of patients are
quite varied and include dementia, focal cortical syndromes from
cerebrovascular accident, psychiatric disorders, issues related to
substance abuse, and learning disabilities. Emphasis is placed on the
integration of multiple data sources (e.g., testing, interview,
behavioral observations, report of family, medical records, neuroimaging
studies) in order to reach a diagnostic impression and provide practical
treatment recommendations.

When indicated, interns may provide short term cognitive rehabilitation,
supportive counseling, and/or psychoeducation to assist the patient and
family in reaching an optimal outcome. The intern would have the
opportunity to work with a range of the geriatric veteran population
within both individual and group psychotherapy contexts. Such clinical
opportunities are available throughout the main medical center as well
as within the CIP.

In addition to the general seminar series for all interns,
neuropsychology interns participate in both a weekly neuropsychology
seminar and weekly case conference. Interns may also have the
opportunity to attend brain cutting at the Bedford VA and elective
courses offered through the BU School of Medicine (e.g., neuroimaging,
neuroanatomy, neuroscience, child clinical neuropsychology), as
indicated by the intern's availability and interests. Leaders in the
field, notably Edith Kaplan, Ph.D., are regular participants in
educational programs of the Neuropsychology Service.

Although not a requirement of the rotation, the neuropsychology intern
has the opportunity to become involved in cutting edge research on
Alzheimer\'s disease (AD), through collaboration with the Boston
University Alzheimer\'s Disease Center. Current investigations at the
Center include studies examining basic mechanisms of AD, genetic and non
genetic risk factors, managing symptoms, helping families and caregivers
cope with the impact of the illness, and disease prevention. The
interested intern would have the opportunity to be involved in a
specific project which can be completed within the training year, as
defined by their availability and interests.

***Learning Objectives***

1.  administer and score a variety of neuropsychological instruments

2.  interpret results of neuropsychological instruments both
    quantitatively and qualitatively as the findings relate to cognitive
    functioning

3.  select appropriate instruments for evaluations of various diagnostic
    issues and referral questions, particularly those referral questions
    which pertain to treatment planning, return to home and work, and
    competency

4.  translate evaluation results into overall patterns of cognitive
    functioning

5.  accurately identify patterns of cognitive functioning associated
    with various diagnoses, such as Alzheimer's disease and other
    dementias, ADHD, and psychiatric disorders

6.  gather a history from the patient and family that is sufficient to
    aide in diagnosis and recommendations

7.  identify aspects of the history most important to differential
    diagnosis

8.  write concise, organized, understandable neuropsychological reports

9.  obtain an understanding of the clinical care common to various
    neurological disorders, such as Alzheimer's disease and other
    dementias, ADHD, and psychiatric disorders, including common
    pharmacological treatment, surgical treatment, health management,
    psychosocial intervention, and family care

10. understand the fundamentals of cognitive rehabilitation as they
    apply to neuropsychological recommendations and patient treatment

***Target Clinical Experiences***

1.  a minimum of 30 neuropsychological reports

2.  lead clinician for a minimum of 20 face-to-face feedback sessions

3.  lead interviewer for a minimum of 20 initial interviews

4.  a minimum of one time-limited cognitive rehabilitation treatment
    (group or individual)

5.  participation in Neuropsychological Assessment courses offered at
    Boston VAMC

6.  weekly participation in Neuropsychology Seminar

7.  minimum of 3 case presentations to the neuropsychology training
    group

8.  minimum attendance at 2 conferences/seminars on neuropsychology
    related issues to be pre-approved by the interns supervisor

**Psychosocial Rehabilitation and Time-limited Psychotherapy**

The Mental Health field is in the midst of a shift in the paradigm that
will govern our work. The increased advocacy of people receiving
services from the Mental Health System and current research requires us
to consider issues of power and choice and how these concepts interact
with our belief that we psychologists have an expertise that is valuable
to the veterans who come to us for help. Our hope is that, as we engage
with the veterans in a collaborative recovery-oriented process, the
veterans will discover an increased sense of independence and
empowerment, and that by building their skills they will find themselves
achieving the highest possible level of community-based functioning. We
understand that this orientation requires that we address our own,
society's and the veteran's own stigmatizing attitudes towards people
who have been diagnosed with mental illness, and that we are constantly
moving toward having the veterans integrally involved in the design of
their treatment and of the program itself. These issues form the
background for student involvement in the Psychosocial Rehabilitation
Rotation.

Many of the veterans at this facility experience personal and
environmental difficulties in achieving their goals (housing,
employment, financial stability, satisfying interactions with their
families and other people, a sense of personal accomplishment, symptom
reduction, etc.). In situations where these difficulties overwhelm their
many strengths, they may seek help. At those times they may be able to
benefit from the availability of an integrated continuum of services to
work with them to reach their best level of functioning. As a nationally
recognized center for Psychosocial Rehabilitation, the ENRM VAMC is
uniquely equipped to provide an opportunity for staff to cooperate with
the veteran\'s in promoting their welfare across many levels of
functioning.

Psychologists can provide a unique viewpoint to this developing clinical
area. This is a time to develop new methods of effective treatment that
are supported by appropriate research. In the midst of change,
psychologists, because of their orientation and training, are able to
bring a unique perspective to issues of systemic change and an ability
to accurately evaluate and develop innovative approaches to working with
people struggling with the challenges presented by serious mental
illness.

The Psychosocial Rehabilitation rotation offers a range of experiences
that allow the intern to engage in a variety of clinical activities
including time-limited psychotherapy. The intern will follow veterans
through various phases of the rehabilitation process, including the
initial processes of discovering and developing the veteran's personal
goals through the application of a number of therapeutic techniques that
allow for the achievement of those goals. Specifically, the rotation
combines clinical activity and training from two main areas: the Mental
Health Intensive Case Management (MHICM) program and the Veterans
Community Care Center (VCCC). Each of these areas is described below.

The MHICM program has been designated as a VA Center of Excellence for
its exemplary clinical practices and outcomes. The program is a
community-based outpatient program working with veterans who have been
diagnosed with a severe mental illness (including schizophrenia, bipolar
disorder, major affective disorder, or severe post-traumatic stress
disorder), many of whom carry a secondary diagnosis of substance
dependence or substance abuse. The program is based on the Assertive
Community Treatment (ACT) model. State of the art services, including
individual and group psychotherapy, family therapy, psychoeducation,
pharmacotherapy, advocacy, outreach, substance abuse treatment, etc.,
are provided by a multidisciplinary team that includes a psychologist
director, a psychiatrist, a nurse manager, a program support assistant,
an occupational therapist, and nine case managers who come from many
disciplines.

Working with MHICM will provide an opportunity for students to learn
community-based rehabilitation treatment. The learning will take place
both in the hospital and out in the community. Interns will have the
opportunity to work individually with three or four veterans in
conjunction with their case managers to provide therapy directed toward
achieving the veteran's personal goals. Interns learn how to choose
different psychotherapy interventions depending on the need addressed,
as well as how to integrate their interventions into a coherent
treatment agreement. Understanding of systems and their impact is
emphasized. In addition opportunities for group psychotherapy, case
management, interaction and coordination of treatment with the staff of
other programs, and active involvement in an interdisciplinary team and
an outpatient milieu setting are all afforded.

The Veterans Community Care Center (VCCC) is a community-based treatment
program located in Lowell Massachusetts. The Center provides a
supportive environment in which veterans having difficulty with
community adjustment, interpersonal relations, medication management,
addiction problems and vocational problems can receive assistance. The
mission of the Center is to support and encourage the integration of
veterans within the community. The majority of veterans at the Center
have histories of major mental and/or physical illness, substance abuse
and traumatic brain injury. The Center also provides transitional
services for recently hospitalized veterans, and serves as an
alternative to hospitalization for individuals in crisis. The program
offers an opportunity for veterans to receive intensive treatment while
remaining within their social and family environment.

***Learning Objectives***

1.  effectively conduct individual and group psychotherapy targeted at
    rehabilitation including modular approaches (e.g. Anthony
    psychiatric rehabilitation technologies)

2.  facilitate veteran integration into the community (e.g., employment,
    education, social activities, etc.)

3.  accurately assess readiness for change

4.  effectively assist veterans to develop rehabilitation readiness

5.  coolaboratively work with the veterans to set an overall
    rehabilitation goal

6.  general understanding and intervention skills with regard to the
    treatment of substance abuse

7.  evaluate history, conflicts, ego strength and skill deficits to
    identify veterans for time-limited therapy

8.  appropriately select among cognitive-behavioral, interpersonal and
    dynamic treatments to utilize within time-limited psychotherapy

9.  deal effectively with disruptions to the therapeutic alliance

10. understand institutional dependency and how to help veterans
    overcome psychological barriers to living in less restrictive
    environments

11. understand how intellectual, cognitive and personality factors
    interact with other areas of functioning

12. understand how hospital and community resources impact
    rehabilitation and how to help veterans access resources

***Target Clinical Experiences***

1.  four individual therapy cases per week with a diverse group of
    veterans within the MHICM and/or VCCC

2.  lead/co-lead one or more groups per week

3.  regular participation in team treatment planning meetings

4.  learn to design psychosocial rehabilitation interventions that
    assist in program development.

5.  Two to three cases on one's CIP caseload targeted for time-limited
    psychotherapy and/or psychosocial rehabilitation

**Addictions Treatment**

The rotation in addictions treatment consists of several training
opportunities, including working with veterans in the Veterans Center
for Addiction Treatment (VCAT), the residential treatment program
(Domiciliary), and the medical center\'s smoking cessation program. The
intern will also conduct the counseling sessions for veterans enrolled
in Dr. Kalman's NIH-funded research study and will have an opportunity
to learn about conducting clinical trials research.

The intern's focus in the VCAT is in the outpatient program (Aftercare).
Aftercare offers individual therapy, group therapy and psychoeducation
to provide tools to help veterans maintain abstinence and achieve
long-term lifestyle changes. Within the VCAT, the intern will also be
afforded the opportunity to function as a member of an interdisciplinary
team, providing assessment, individual and group psychotherapy, and
consultation to the larger treatment team staff. There are options for
the intern to be creative in designing his/her particular training plan,
including opportunities to engage in program development and staff
training and education.

Within the domiciliary, the intern meets with newly admitted veterans
and uses the principles and techniques of motivational interviewing to
help them make the adjustment to residential treatment and explore their
own motivation to make changes in their lives. There may also be
opportunities to administer a "Drinker's Check-up" (structured
assessment with normative feedback) to veterans with a probable
substance abuse or dependence problem. This approach to assessment,
which has received strong research support, is designed to enhance
motivation for self-change. The intern also works with veterans who want
to quit smoking and will provide a psycho-educational group at the
domiciliary designed to encourage smokers who are recovering from other
drug dependencies to consider quitting.

Overall, the addiction rotation provides an in-depth learning
opportunity with regard to understanding the key therapeutic approaches
within the field of addictions treatment, particularly those involving
motivational enhancement, cognitive-behavioral therapy, and 12-step
approaches. The intern will learn about current empirically supported
interventions with regard to various segments of the addiction
population, as well as a range of information regarding contemporary
substance dependence research.

***Learning Objectives***

1.  understand the range of treatment approaches for people with
    substance use disorders, particularly motivational enhancement
    therapy, CBT, and 12-step programs

2.  understand the concept of dual diagnosis in terms of the
    interrelationship between mential illness and substance abuse

3.  familiarity with the different stages of substance abuse recovery,
    particularly as applied to group psychotherapy processes

4.  accurately conduct a bio-psychosocial assessment of people with
    substance use disorders

5.  provide empirically-based interventions from the principles and
    techniques of motivational interviewing

6.  provide empirically-based interventions from the principles and
    techniques of cognitive behavioral treatment for substance use
    disorders

7.  understand how the basic principles of 12-step programs interface
    with the current VCAT program

8.  provide treatment for tobacco dependence based on an approach that
    blends motivational interviewing techniques with cognitive
    behavioral interventions

9.  generally to be able to provide high quality treatment to
    individuals with substance dependence disorders in one-to-one
    sessions and groups

10. familiarity with methods for evaluating the efficacy of various
    approaches to substance abuse treatment

***Target Clinical Experiences***

1.  co-lead two therapy groups for veterans at different stages of
    substance dependence recovery (early recovery, middle and/or late
    recovery groups)

2.  after initially observing, co-lead one relapse prevention group

3.  provide individual psychotherapy for two or more veterans with
    substance use disorders

4.  conduct one-hour psychoeducational groups on smoking and quitting
    smoking on an every other week basis

5.  provide a one-hour session of smoking cessation treatment on a once
    per week basis

6.  conduct a one hour substance abuse treatment assessment per week
    using motivational interviewing techniques

**Outpatient Treatment**

This rotation focuses upon the provision of clinical services through
both the CIP (described earlier under the "psychotherapy rotation") and
a community-based outpatient clinic. Typically, the intern spends one
day/week in one of the satellite outpatient clinics, providing
evaluation and psychotherapy to a previously under-served population of
veterans living in the community. Interns on the outpatient rotaton have
a unique opportunity to see how several outpatient clinics function
within a larger institution, and how such clinics interact with and are
integrated within a range of services throughout the medical center.

Interns on the outpatient rotation engage an expanded role within the
CIP, maintaining a larger caseload of group and individual therapy
cases. Intern's work typically involves both short- and longer-term
psychotherapy with individual patients. A variety of group opportunities
are also available. The Psychology Service-directed CIP is housed within
the Psychiatry Service-directed Mental Health Clinic. Over the years,
the respective departments of Psychiatry and Psychology have
demonstrated a very effective collaboration and integration of clinical
services, resulting in exceptional treatment for the veteran.

Outpatient interns spend one full day per week at the community-based
outpatient clinic (CBOC) in Haverhill, Massachusetts, approximately 30
minutes away from the medical center. Within the CBOC, the intern will
function as a member of an interdisciplinary primary healthcare team,
providing evaluation and treatment to a range of underserved veterans in
the community. There is an opportunity to become involved in program
development work with regard to designing and implementing clinical
services, particularly psychotherapy groups. There are a number of
pertinent treatment needs in this population, such as those pertaining
to PTSD, wellness, and substance dependence.

Interns on the outpatient rotation will be specifically exposed to three
psychotherapeutic orientations -- psychodynamic, cognitive-behavioral,
and experiential -- via weekly supervision from three supervisors, each
with a broad assimilative integration approach to treatment that
emphasizes one of the above three perspectives. Consequently, interns
will be encouraged to conceptualize their therapy cases from multiple
perspectives and to experiment with interventions from various
orientations, as appropriate, within their therapy work.

Overall, this rotation is a flexible combination of clinical services
and training. The intern will have the opportunity to shape a training
structure that reflects their particular interests and experience. For
example, the intern can concentrate on particular psychotherapeutic
models of work and/or emphasize a particular population or disorder in
their training.

***Learning Objectives***

1.  understand the overall functioning and integration with other
    services of two outpatient therapy clinics

2.  assess current program needs related to an outpatient clinic,
    particularly a community-based clinic with limited available
    resources

3.  familiarity with the characteristics and treatment needs of an
    underserved veteran population within community-based services

4.  knowledge and professional skills related to working within a
    primary healthcare multidisciplinary treatment team

5.  ability to perform assessment, intake evaluation, and crisis
    management within a community outreach center

6.  clinical skills with regard to understanding and facilitating
    PTSD-oriented psychotherapy groups

7.  ability to conceptualize clinical cases from three particular
    theoretical perspectives -- psychodynamic, cognitive-behavioral, and
    experiential

8.  implement interventions from psychodynamic, cognitive-behavioral,
    and experiential therapeutic approaches, as relevant, for each
    clinical therapy case

9.  ability to become aware of one's experience as a therapist,
    including biases, countertransference and subtle tendencies, through
    the understanding and application of the principles of mindfulness

***Target Clinical Experiences***

1.  provide approximately eight hours per week of individual
    psychotherapy within the Haverhill CBOC and the CIP (in addition to
    the four hours of individual therapy within the CIP psychotherapy
    rotation)

2.  receive supervision from three supervisors representing assimilative
    integration psychotherapy models from the psychodynamic,
    cognitive-behavioral and experiential perspectives

3.  based on the programmatic needs of the clinic, provide a particular
    psychotherapy group or groups to address clinical needs

4.  co-facilitate one or more PTSD psychotherapy groups

5.  participate in a primary healthcare multidisciplinary treatment team
    in the Haverhill CBOC

## Geropsychology Rotation 

The Geriatric Psychology  rotation draws on the outstanding resources
available at ENRM which is a Center of Excellence for Geriatric Care. 
The settings, clinics and services supporting this rotation are six
Nursing Home Care Units  (aka Community Living Center) , including a
psychiatric-medical unit;  inpatient and outpatient care provided by the
GRECC, Memory Disorders Clinic, Respite Program,;  Hospice  Program. and
Home Based Primary Care.   There is great depth of clinical expertise in
geriatrics at ENRM.  Psychology Service has three specialists in
geriatrics and two trained neuropsychologists (one in the general
clinical service and one primarily in long term care).  Psychiatry
Service has  staff boarded psychiatrists  in Geriatric Psychiatry.  
Also, GRECC's nationally prominent researchers welcome the participation
of psychology staff and students.  The intern will be associated
primarily with one or two  of the nursing home care units and serve as
consultant to other sites that support the rotation.

###             *Learning objectives*

> 1)   understand the cognitive, psychosocial and geromedical issues
> associated with normal aging
>
> 2)   understand psychopathology and psychiatric treatment of the
> geriatric patient and his/her family
>
> 3)   develop skills of psychological assessment of the geropsychiatric
> patient, with emphasis on differential diagnosis of neuropsychiatric
> disorders
>
> 4)   recognize the psychological aspects of death, dying and
> bereavement
>
> 5)   learn how to facilitate coping with the physical, mental and
> interpersonal losses associated with chronic illness and aging
>
> 6)   develop skills regarding individual and group psychotherapy,
> including interventions such as reminiscence,  skills maintenance, and
> life review
>
> 7)   develop proficiency regarding behavioral interventions with the
> elderly
>
> 8)   to consult with staff  in terms of inservice education on
> managing difficult behaviors
>
> 9)   familiarity  of the continuum of geriatric care from outpatient
> to homebased primary care to long term care.

### *Target clinical experiences  * 

> 1)   ten psychological/psychosocial  assessments which attend to
> functional capacity and/or differential diagnosis
>
> 2)   ten  hours per week of individual psychotherapy
>
> 3)   lead/co-lead one weekly therapy group
>
> 4)   participate in team treatment meetings, patient rounds, case
> conferences for two-three hours per week
>
> 5)   consult with staff to develop behavioral programs (eight over
> course of rotation)
>
> 6)   provide consultation/therapy/education for families of four
> patients
>
> 7)   to go out on at least one home based primary care visit with
> supervising psychologist

 

**GENERAL COMPETENCY DOMAINS OF TRAINING**

*(Not specific to particular rotations)*

**Diversity**

The program is committed to the full appreciation of the range of human
diversity and regards it as a training objective of the internship. A
monthly yearlong seminar, co-facilitated by two psychologists with
expertise in the area of multicultural issues and individual
differences, are presented to the psychology students (interns and
postdocs) each year. In addition, a multiple-session presentation, the
"Culture of the VA", involving didactics and group process addressing
issues of gender and role, is also offered each year. A number of
Psychology Service staff are involved in the facilitation of this
training. Finally, a focus on issues of diversity within individual
supervision complements the didactic offerings. Interns also encouraged
to attend additional training on diversity outside of ENRM, thereby
taking advantage of the rich offerings in the Boston Metropolitan area.

Of special relevance to the training program, the Psychology Service
considers the understanding and effective treatment of the disabled
American veteran as a diversity issue in its own right, requiring the
development of competency in this area. Particular emphasis is focused
upon the issues related to both the Vietnam-era veteran and the homeless
veteran with chronic mental illness or a dual diagnosis. Additionally,
the nature of the middle-aged to older male veteran in psychotherapy, a
context that is often quite foreign and counter to the veteran's
self-identification, is another area requiring attention. In these
regards, interns are encouraged to understand presenting problems and
issues of the veteran from different perspectives and to develop a
sensitivity and heightened empathy toward this population. Supervisors
at ENRM, given their extensive experience with veterans, are important
sources of learning for the intern. These issues, along with other areas
of diversity, are given primary attention within supervision.

Central to being able to understand diversity is the capacity of empathy
and the ability to understand and conceptualize from different
perspectives. The development of these abilities, combined with a
breadth of clinical experiences and knowledge regarding diversity issues
gained through didactics and supervision, are the ingredients the
training program incorporates to develop competency in the understanding
of diversity.

In order for interns to develop a general understanding of the issues
associated with multicultural populations as well as a sensitivity to
how such issues may impact clinical work, the following learning
objectives were designed:

***Learning Objectives***

1.  understand how issues of diversity, particularly those related to
    ethnicity, age, gender, and the disabled veteran, may influence the
    course of psychotherapy and assessment

2.  effectively and sensitively intervene with such populations

3.  understand how large organizational (such as health care system) and
    societal dynamics impact such populations and its effect on the
    nature of clinical intervention

***Target Professional Experiences***

1.  Clinical work with a range of veterans, varying in age, culture,
    ethnicity, background, and when available, gender

2.  Yearlong monthly seminar series on multicultural issues and
    individual differences

3.  Participation in the "Culture of the VA" series

**The Role of Psychologist**

The internship training program places a high value upon the development
of the range of professional roles and ethical understanding requisite
to be an effective psychologist. Consequently, the training program
values the capacity of psychologists to function flexibly across a range
of professional contexts. Learning to function as an effective
interdisciplinary team member as well as a consultant to diverse
professional audiences is therefore an important component of the
internship training.

***Learning Objectives***

1.  understand the various levels of professional development within the
    field of psychology and how to effectively work with each (i.e.,
    earlier level practicum students, intern peers, postdocs, clinical
    supervisors, and psychologist program directors)

2.  function effectively within interdisciplinary teams

3.  proficiency in providing consultation and feedback for various
    clinical contexts

4.  well-reasoned ethical understand as applied to a range of clinical
    situations

***Target Professional Experiences***

1.  interact with a range of Psychology Service students, supervisors,
    and administrators functioning within the roles of mentor, peer,
    colleague, and supervisee

2.  participate within one or more interdisciplinary teams and/or
    function within interdisciplinary clinical contexts

3.  provide consultation and feedback to various clinical programs and
    medical center staff

**Organizational and Systemic Dynamics**

The training program believes that in order to develop efficient
functioning across a range of professional skills and roles, the
psychologist must possess an understanding of organizational and
systemic dynamics. Such proficiency allows the psychologist to
understand both the implicit and explicit protocols present within the
environment, heightening the possibility that proposed suggestions and
interventions will be adopted. Understanding the impact of system
dynamics upon patients is also required to engage in effective treatment
on the individual level. Lastly, the training program encourages the
intern to see all individuals involved within a situation (i.e., both
staff and patients) as potential recipients of beneficial intervention,
and to conceptualize in terms of both larger (system level) and smaller
(individual patient) "presenting problems".

***Learning Objectives***

1.  understanding of the interacting systemic issues which affect an
    organization's formal policies and informal protocols of behavior

2.  knowledge of the various dynamics and situational forces which
    operate within particular contexts of clinical care

3.  understand how such specific program dynamics and larger
    organizational dynamics affect the nature of care provided to
    individuals

4.  ability to engage various clinical contexts to effect change

***Target Professional Experiences***

1.  function within various program settings and/or interdisciplinary
    treatment contexts

2.  modify and/or design intervention strategies which take into account
    particular system dynamics associated with clinical care contexts,
    as relevant and in collaboration with superivors

3.  integrate an understanding of systemic dynamics into assessments and
    other case conceptualizations, as relevant

**ADDITIONAL TRAINING OPPORTUNITIES**

**Program Development**

The development and evaluation of mental health services is becoming
increasingly important in clinical psychology. Interns have the
opportunity to work with senior staff psychologists, postdoctoral
residents and other students at all levels of training to learn the role
of healthcare administrators in planning, implementing, and evaluating
treatment programs. Program development activities have already been
integrated into several of the core rotations, and this option exists
within many of the available rotations as well as with regard to
potential activities hospital-wide. Some of the activities in which
interns may participate include program design, implementation and
evaluation, staff training and staff development, outreach, liaison with
other agencies, and manual construction.

This secondary placement in program development can either be integrated
within the scope of the intern's primary rotation, within the CIP as
part of the psychotherapy rotation, or within other
programs/administrative settings of the medical center. Presently, the
CIP is a particularly dynamic opportunity for involvement in program
development. The CIP program development team meets consistently
throughout the year to explore and address a range of issues, including
articulating and refining our mission and structure, developing group
psychotherapy offerings and associated manuals, modification and
refinement of clinic policy and procedures, consultation and outreach,
and treatment outcome research.

**Clinical Research**

There are a variety of active research programs at Bedford, both within
the Psychology service as well in other services and programs. Interns
have the opportunity to collaborate with staff on existing projects or
develop independent research interests. A number of the Psychology staff
are actively engaged in research, with a number of the staff currently
receiving grant funding. Psychology staff funding includes the Mental
Illness Research, Education and Clinical Center (MIRECC) as well as a
National Institute on Drug Abuse (NIDA) grant. The MIRECC's current
projects include a Pathways to Care study of vocational rehabilitation
services, a comparison of abstinence and harm reduction approaches to
treating problem gambling, and the use of incentives to reduce substance
use and improve work outcomes. Upcoming projects include the
effectiveness of peer support on improving work outcomes and the
effectiveness of Motivational Interviewing in resolving spiritual
ambivalence for veterans with PTSD. The NIDA study is examining smoking
cessation treatment interventions. Additionally, opportunities for
research also exist within the CIP and the CWT program.

Research opportunities also exist in other parts of the hospital,
notably in the Geriatric Research, Education and Clinical Center (GRECC)
and the Health Services Research & Development (HSR&D) Programs. The
HSR&D Program also has multiple large grants with potential for
participation by psychology interns.

**Smoking Cessation**

Dr. David Kalman conducts clinical research designed to improve smoking
cessation treatments for nicotine dependent smokers, particularly heavy
smokers and smokers with psychiatric comorbidity. He is currently
conducting a multi-year clinical trial with heavy smokers who are in
alcohol recovery. The overall goal of the project is to investigate the
incremental efficacy of counseling plus two smoking cessation
medications (nicotine patch and Zyban) vs. one medication (nicotine
patch). Dr. Kalman is also involved in writing papers for publication in
the area of addictions treatment and presenting at conferences.

Interns have the opportunity to receive clinical and research training
through their participation in Dr. Kalman\'s projects. Clinical training
focuses on treatment of substance use disorders, with an emphasis on the
treatment of nicotine dependence. Research training focuses on learning
about the day-to-day conduct of a clinical trial, the grant writing
process, and the preparation of manuscripts for publication

*(Note: Because of the range of learning objectives potentially
available, the specifics of which would necessarily depend upon the
particular training experience designed, learning objectives regarding
these secondary placements are not here specified.)*      

## Requirements for Completion

Students continue to be in good standing while on internship provided
they are able to maintain acceptable minimum levels of engagement in
training related activities as well as achieve minimally acceptable
levels of competence with regard to their work, while demonstrating
reasonably appropriate ethical and professional behvaviors. Acceptable
levels of performance with regard to each competency area within the
internship are detailed within the evaluation forms. As noted above,
evaluations of interns occur formally three times over the course of the
training year. Successful completion of the program involves the intern
completing the equivalent of a full year of full-time training as well
as achieving at least a minimal level of competency in each of the basic
areas of psychology listed above with regard to the program\'s training
objectives.

## Facility and Training Resources

All interns are given offices within a suite of offices, which also
includes a conference area and a full kitchen. The one exception to this
is for the neuropsychology intern, who is in a nearby in suite of
offices in the Neuropsychology Service area, along with postdocs and
practicum students engaged in neuropsychological training. Each intern
has a computer assigned to them and access to the suite\'s network
printer. Computer access allows the intern internet access as well as
access to the sophisticated Computerized Patient Record System (CPRS) of
the VA.

The Administrative Assistant to Psychology provides substantial program
and clerical support to the internship program, as does a part time
administrative assistant dedicated primarily to the training program.
Administrative and support staff throughout the medical center provide
support to interns working within particular areas.

The library service at Bedford has over 5600 professional titles and 275
journal titles, the majority of which are in the fields of psychiatry,
psychology, gerontology, nursing and social work. As a member of the VA
library network, and various biomedical library consortia, it has access
to the collections of major research, university, hospital and public
libraries.

## 

## Administrative Policies and Procedures

Internships are for 2080 hours to be completed over a 12-month period.
Interns accrue a total of 13 days of personal leave as well as sick
leave over the course of the year. In addition, interns are granted up
to five days for educational leave (up to two of which can be used for
professional development, such as dissertation-related activities or
postdoctoral interviews).

The training manual of the internship outlines specific policies
regarding grievance options and procedures, due process with regard to
intern performance or professional functioning issues, and other
relevant policies related to the medical center and the training program
specifically.

**Please note, our privacy policy is clear:** we will collect no
personal information about you when you visit our website.

## 

## Training Staff

***William H. Alexander, Ph.D.*** is a staff psychologist at the 4-month
inpatient Domiciliary program. His clinical and research interests
include psychosocial rehabilitation, substance abuse, men and
masculinity and the use of cognitive behavioral therapy as it relates to
addiction and recovery.

***Brandon A. Ally, Ph.D.*** is a clinical neuropsychologist who
primarily works on the inpatient geriatric units performing cognitive
assessments and rehabilitation intervention planning. He is an Assistant
Professor of Neurology at the Boston University School of Medicine and
the Director of Neuropsychology Research at the Bedford VAMC Center for
Translational Cognitive Neuroscience. His funded research examines how
memory breaks down in healthy and diseased aging. He has specific
clinical and research interests in the role of parietal cortex in memory
retrieval and its implications in the earliest stages of Alzheimer\'s
disease.

***Richard Amodio, Ph.D.*** is the Director of Psychology Training and
Director of the Center for Integrative Psychotherapy (CIP). He holds a
faculty appointment at the Boston University School of Medicine. His
specialties are in the areas of psychosocial rehabilitation, addiction
treatment, experiential and awareness-based psychotherapy, and
transpersonal theory.

***Lee Ashendorf, Ph.D.*** is a clinical neuropsychologist. In addition
to providing services in the general neuropsychology clinic, he serves
as the neuropsychologist for the Polytrauma Clinic.  His clinical and
research interests within neuropsychology include assessment of older
adults, use of qualitative and process measures, and symptom validity
testing.

***Douglas Bitman, Ph.D.*** is the Associate Director of Psychology
Training and the Director of the Mental Health Intensive Case Management
(MHICM) program. He has special interests in the process of discovering
people's goals and working with them to accomplish their goals, and in
the process of system change during times of multiple paradigms. He also
has interest and experience working with veterans who are living with
the effects of mental illness, trauma, addiction and homelessness.

***Lisa Bloom-Charette, Ph.D***. is a staff psychologist, collateral EEO
manager, and on the faculty at the Boston University School of Medicine.
She is a specialist in clinical gerontology with interests in substance
abuse in the elderly, life review and diversity. She is the co-editor of
the book, Enhancing the Quality of Life in Advanced Dementia.

***Sandra Diaz, Ph.D., C.P.R.P.*** is a staff psychologist for the
Veterans Construction Team, a component of the Compensated Work Therapy
Program. Her special interests include child development and family
therapy, inter-cultural clinical competency, cross-cultural psychology,
the efficacy of culturally sensitive integrated clinical treatment, the
relationship between spirituality and healing, and the efficacy of
complementary and alternative medicine.

***Charles Drebing, Ph.D.,*** a neuropsychologist, is the Chief of
Psychology and the Bedford Site Director of the New England MIRECC. He
is an Assistant Professor of Psychiatry at the Boston University School
of Medicine and an adjunct professor at UMASS Boston. His funded
research has included work in the areas of vocational rehabilitation,
healthcare decision-making, and health services research. His special
interests include health outcomes research, employment and vocational
services, and community reintegration.

***Edward J. Federman, Ph.D.,*** the former Director of Psychology
Training, holds a faculty appointment at Boston University School of
Medicine and has special interests in pathological gambling,
supervision, program development and outcome research.

***David Kalman, Ph.D.*** is on the staff of the Psychology Service and
is a faculty member in the Department of Psychiatry at the Boston
University School of Medicine. He is currently conducting a multi-year
study of smoking cessation treatment with smokers in alcohol recovery
that is funded by the National Institute on Drug Abuse. His primary
interest is in research and treatment pertaining to persons with
nicotine and alcohol dependence.

***Chivi Kapungu, Ph.D.*** is the Program Manager of the Veteran
Community Care Center (VCCC) and is on faculty at M.I.T., Department of
Women and Gender Studies. Her clinical and research interests include
psychosocial rehabilitation as well as transcultural, gender and
community issues related to traumatic exposure.

***Christopher Krebs, Ph.D*** is the Director of the Bedford Positive
Psychology Initiative and a research staff member of the Bedford Mental
Illness Research, Education, and Clinical Center (MIRECC). The Positive
Psychology Initiative is dedicated to improving VA healthcare services
and outcomes through promoting understanding and use of positive
psychology principles and practices among VA healthcare providers,
programs, and administrators.

***Charles Lewis, Ph.D.*** is a staff psychologist with special interest
in assessment, rehabilitation, long-term care, and the resolution of
psychological trauma through the use of art.

***Heidi Lilienthal, Psy.D.*** is a staff psychologist at the Bedford VA
& Haverhill CBOC. She has been involved with clinical work, academia and
research for over 15 years. A great deal of her work has involved
program design and implementation (both in clinical settings and in
academic settings). She has diverse interests and experience including
health psychology and biofeedback, the psychology of men, eating
disorders, severe and persistent mental illness, dual diagnosis issues,
working with older adults and dialectical behavioral therapy/trauma
issues.

***Tu Anh Ngo, PhD, MPH*** is the co-director of the Primary Care
Behavioral Health program in the primary care clinic. She is a health
psychologist with a specialty in integrated primary care. She has an
integrative background, particularly in mindfulness-based therapies with
CBT and biofeedback for the treatment of chronic disease and health
behaviors. She also has interests in complementary and alternative
approaches. 

***Maureen K. O'Connor, Psy.D., ABPP-CN*** is the Director of the
Neuropsychology Service and Director of Cognitive Rehabilitation in The
Center for Translational Cognitive Neuroscience.  She is an Instructor
in the Department of Neurology at Boston University School of Medicine. 
Dr. O'Connor's research interests are focused on the development of
treatment interventions designed to improve daily living and well being
in individuals with neurocognitive disorders and their family members.
Currently funded work includes examining the outcome of an intervention
for caregivers of individuals with dementia.

***Carolee Rada, Psy.D., MSc.*** is a staff psychologist with clinical
and research interests in the areas of PTSD, psychoanalytic
psychotherapy, group psychotherapy, and child development.

***Kathleen Rekart, Ph.D.*** is a staff psychologist working within the
Assessment Center and the Veteran\'s Center for Addictions Treatment
(VCAT). Her primary interests include psychosocial rehabilitation,
cognitive behavior therapy, group therapy, psychological assessment, and
program development.

***Karen Ryabchenko, Ph.D.*** is a staff psychologist and the
Coordinator for PTSD & Returning Veterans Programs. She specializes in
the assessment and treatment of PTSD, substance abuse, depressive and
personality disorders. Her major clinical and research interests
include: the influence of life stressors and comorbidity on the course
of PTSD and depressive disorders, pathways to mental health treatment,
and the implementation of evidence-based psychotherapy for treatment of
PTSD.

***Dolly Sadow, Ph.D., ABPP*** is Director of the Empowerment and Family
Services Center. She is on the faculty at the Boston University School
of Medicine and Suffolk University, and she is on the Advisory Board for
Mental Health for Middlesex Community College. Her areas of special
interest include milieu treatment, psychoeducation, and psychodynamic
psychotherapy.

***Patricia Sweeney, Psy.D.*** is a clinical psychologist and the
Education Director for the New England Mental Illness Research,
Education, and Clinical Center (MIRECC). Her clinical and research
interests include psychosocial rehabilitation, systems change, and
education activities related to the development of peer support
services.

***Alice Van Ormer, Ph.D.*** is a counseling psychologist who is the
Local Recovery Coordinator for Bedford. As part of its commitment to
shifting all mental health services to a Psychosocial Rehabilitation
framework, the VA has funded a LRC position at each site. Dr. Van Ormer
facilitates the Bedford VA's movement in this direction and is also
co-chair of the Psychosocial Rehabilitation Fellowship. She is also
associated with the Mental Illness Research, Education and Clinical
Center (MIRECC). Her clinical and research interests include
psychosocial rehabilitation, working with systems to create lasting
changes and religion/spirituality.

**Brian Zuzelo, Psy.D.** is a staff psychologist in home based primary
care services providing psychotherapy and assessment services with
veterans in the community. His special interests include research and
clinical work in Geropsychology, psychodynamic therapy, PTSD, mental
health issues facing nursing staff and other direct care providers..

## Trainees

**2007-2008**

Northeastern University Ph.D. Counseling Psychology

Suffolk University Ph.D. Clinical Psychology

Chicago School of Prof. Psychology Psy.D. Clinical Psychology

George Washington University Psy.D. Clinical Psychology

Illinois School of Prof. Psychology Ph.D. Clinical Psychology

Suffolk University Ph.D. Clinical Psychology

Mass School of Prof. Psychology Ph.D. Clinical Psychology

University of Hartford Psy.D. Clinical Psychology

**2006-2007**

East Michigan U Ph.D. Clinical Psychology

U of Missouri/St. Louis Ph.D. Clinical Psychology

U of New Mexico Ph.D. Clinical Psychology

Boston College Ph.D. Clinical Psychology

Boston College Ph.D. Counseling Psychology

Carlos Albizu U Psy.D. Clinical Psychology

Antioch New England Psy.D. Clinical Psychology

UMass/Boston Ph.D. Clinical Psychology

**2005-2006**

Suffolk University Ph.D. Clinical Psychology

Boston College Ph.D. Counseling Psychology

Wheaton College Psy.D. Clinical Psychology

Northwestern U Ph.D. Clinical Psychology

Northeastern U Ph.D. Counseling Psychology

Antioch New England Psy.D. Clinical Psychology

**2004-2005**

Boston College Ph.D. Counseling Psychology

Antioch New England Psy.D. Clinical Psychology

Antioch New England Psy.D. Clinical Psychology

Columbia U Ph.D. Clinical Psychology

Illinois Inst. Of Psychology Ph.D. Clinical Psychology

Suffolk U Ph.D. Clinical Psychology

**2003-2004**

Antioch New England Psy.D. Clinical Psychology

Fuller Theological Seminary Ph.D. Clinical Psychology

U of Hartford Psy.D. Clinical Psychology

U of New Mexico Ph.D. Clinical Psychology

Clark U Ph.D. Clinical Psychology

U of Rhode Island Ph.D. Clinical Psychology

U of Rhode Island Ph.D. Clinical Psychology

Georgia School of Prof. Psy. Psy.D. Clinical Psycholgoy

Fielding Graduate Institute Ph.D. Clincal Psychology

**2002-2003**

U of Northern CO Psy.D. Counseling Psychology

UMass Boston Ph.D. Clinical Psychology

Antioch New England Psy.D. Clinical Psychology

Kent State U Ph.D. Clinical Psychology

Fielding Graduate Inst. Ph.D. Clinical Psychology

Fileding Graduate Inst. Ph.D. Clinical Psychology

U of Miami Ph.D. Counseling Psychology

Fuller Theological Seminary Ph.D. Clinical Psychology

Catholic U of America Ph.D. Clinical Psychology

**2001-2002**

Virginia School of Prof. Psy. Psy.D. Clinical Psychology

U of Miami Ph.D. Clinical Psychology

Pepperdine U Psy.D. Clinical Psychology

Mass School of Prof Psychology Psy.D. Clinical Psychology

SUNY/Albany Ph.D. Counseling Psychology

Fordham U Ph.D. Clinical Psychology

Case Western Reserve U Ph.D. Clinical Psychology

Loyola U of Chicago Ph.D. Clinical Psychology

Adelphi U Ph.D. Clinical Psychology

## ![](media/image3.jpeg){width="2.2604166666666665in" height="1.648611111111111in"}Local Information

The Medical Center is located in Bedford, MA, a town of 14,000 that
retains the charm of a quiet New England town although its expansion
over the years marks it clearly as a suburb of Boston some 20 miles to
the southeast. Bordered by Concord to the west and Lexington to the
south, Bedford lies within earshot of the "shot heard 'round the world"
that initiated the American Revolution (www.lexingtonchamber.org) The
Minuteman National Historical Park offers historical tours and events,
as well as 11 miles of trail for biking, running, or walking.

Heading south from Bedford, metro-Boston and surrounding cities, such as
Cambridge and Somerville are a close and commutable 15-20 mile drive.
Boston is one of America's oldest cities (founded in 1630) and retains
its cozy European charm (www.bostonusa.com; www.boston-online.com). Like
any big city, Boston offers an array of cultural events and
opportunities, such as large theater productions, smaller independent
theater, annual film festivals, and music venues both large and small.
Cambridge and Somerville are smaller cities surrounding Boston and offer
a myriad of restaurants, theaters, and music venues. The famed Charles
River, which runs through Cambridge, offers opportunities for rowing and
miles of trails for running, and serves as the backdrop for many area
festivals. Harvard Square, one of the most well-known areas of Cambridge
and home to Harvard University, is well known for its bookshops,
coffeehouses, music, festivals, and street theater. Harvard University
and Cambridge Center for Adult Education offer an impressive array of
continuing education courses. MIT, Boston University, Boston College and
Tufts are other major schools that make the Boston/Cambridge area a
world center for higher education. The Boston area is also known for its
world class hospitals including Mass General, Mass Eye and Ear, Beth
Israel, Brigham and Women's, Dana Farber Institute, Children's, and
McLean. Various lectures and educational opportunities are available
through area academic centers and teaching hospitals.

![](media/image4.jpeg){width="3.0in"
height="2.0368055555555555in"}Heading 2 hours north from Bedford one
finds the White Mountains of New Hampshire, and the Green Mountains of
Vermont, with some of the finest hiking, climbing, and skiing in the
Northeast. Cape Cod's expansive beaches lie two hours to the south and
Martha's Vineyard and Nantucket Islands are accessible by ferry from the
Cape. Other beautiful ocean beaches are less than an hour from Bedford.
Walden Pond (actually a small lake), where Thoreau lived and swam, is
just 15 minutes from the hospital and is perhaps the prettiest of the
local fresh water swimming options. Stockbridge, the home of both
Alice's Restaurant and the Austen Riggs Center, is in the southern
Berkshire Mountains two hours to the west. The natural beauty and
artistic offerings (music at Tanglewood, dance at Jacob's Pillow and
several first rate summer theaters) of the Berkshires are among the
reasons many urbanites establish this as their second home.

**Edith Nourse Rogers Memorial VA Medical Center**

Psychology Internship Application

# Name \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Home phone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work phone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

e-mail address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Graduate program
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

APA accreditation status of program \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Citizenship \_\_\_\_\_\_

\*Primary Rotations for which

you would like to interview: First choice
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Do [not]{.underline} list "Assessment" or

"Psychotherapy" rotations) Second choice
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Third choice (optional)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

APPIC match \# \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\* NOTE: We are asking for your interview preferences in accordance with
APPIC Match Policy

3d. We will use this information for the scheduling of interviews only,
and will not use it for any other purpose in the selection process. We
request this information because we have limited interview slots, and
must make choices about where and with whom applicants can interview.

**Required Materials**:

-   Curriculum vitae

-   ENRM application form (i.e., this form)

-   APPIC application form

-   APPIC application program's verification of eligibility

-   Letter of reference from a professor at current program

-   Letter of reference from a clinical supervisor

-   Third letter of reference

-   Transcripts of all graduate work

-   Transcripts of all undergraduate work

-   Listing of all additional courses to be completed prior to
    internship

-   One assessment report (or one neuropsychology report)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## Please send all materials together in ONE envelope.

## Last day for receipt of your application package is November 7, 2008

Send all materials to:

Internship Training Program

Psychology Service (116)

Edith Nourse Rogers Memorial VAMC

200 Springs Road

Bedford, MA 01730