# Predoctoral Psychology

Internship Program

2008-2009

Veterans Health Administration

Medical Center

Dayton, Ohio

Inquiries and application materials should be addressed to:

> Director of Training
>
> Psychology Internship Program (116)
>
> VHA Medical Center
>
> 4100 West Third Street
>
> Dayton, Ohio 45428
>
> Phone: 937.268.6511 Ext 2657
>
> FAX: 937.267.3924
>
> Email: <552internship@med.va.gov>

National Matching Service Program Code

151211 General Psychology Internship

151212 Pre Post Doc Neuropsychology

Accredited by the American Psychological Association

Committee on Accreditation

750 First Street, NE

Washington, DC 20002-4242

202.336.5500

Member of the Association of Psychology and Postdoctoral Internship
Centers

10 "G" Street, NE Suite 440

Washington, DC 20002

202.589.0600

**TABLE OF CONTENTS**

[Predoctoral Psychology 1](#predoctoral-psychology)

[OVERVIEW 5](#overview)

[INTERNSHIP TRAINING PROGRAM 5](#internship-training-program)

[Philosophy 5](#philosophy)

[Title 6](#title)

[Model 6](#model)

[Mission 6](#mission)

[Approach to Training 6](#approach-to-training)

[Goals 7](#goals)

[Objectives/Competencies 8](#objectivescompetencies)

[Ethical/Professional Issues 8](#ethicalprofessional-issues)

[Assessment 8](#assessment)

[Intervention 9](#intervention)

[Diversity/Multicultural 11](#diversitymulticultural)

[Science and Practice 11](#science-and-practice)

[Completion 11](#completion)

[Evaluation 11](#evaluation)

[ROTATION FORMAT AND ASSIGNMENT 11](#rotation-format-and-assignment)

[ROTATIONS AND CONCEPTUALIZATION STATEMENTS OF TRAINING SUPERVISORS
12](#rotations-and-conceptualization-statements-of-training-supervisors)

[Health Psychology 12](#health-psychology)

[Description 12](#description)

[Conceptualization Statement 13](#conceptualization-statements)

[Mental Health 16](#mental-health)

[Description 16](#description-1)

[Conceptualization Statements 16](#conceptualization-statements-1)

[Neuropsychology 18](#neuropsychology)

[Description 18](#description-2)

[Conceptualization Statement 19](#conceptualization-statements-2)

[Geropsychology 2](#__RefHeading___Toc104885966)1

[Description 2](#__RefHeading___Toc104885967)1

[Conceptualization Statement 2](#__RefHeading___Toc104885968)2

[Post Traumatic Stress Disorder Day Hospital Program PTSD Clinical Team
2](#post-traumatic-stress-disorder-clinical-team)3

[Description 23](#description-4)

[Conceptualization Statements 23](#conceptualization-statements-3)

Special Emphasis Program 24

Description 24

Conceptualization Statement 25

[ADDITIONAL TRAINING EXPERIENCES AND SUPPORT
2](#additional-training-experiences-and-support)6

[Training Seminars 2](#training-seminars)6

[Group Supervision 2](#group-supervision)6

[Testing Laboratory 27](#testing-laboratory)

[Library 27](#library)

[Medical Media 27](#medical-media)

[Professional Development 27](#professional-development)

[PHYSICAL SETTING AND SUPPORT 2](#physical-setting-and-support)7

[APPLICATION
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**2](#application)8

[Eligibility 28](#eligibility)

[Appointment and Benefits 2](#appointment-and-benefits)8

Application
Procedures................................................................................29

[DIRECTIONS TO THE VHA MEDICAL CENTER, DAYTON,
OHIO](#directions-to-the-vha-medical-center-dayton-ohio) 30

[MATCH DAY](#match-day) 31

[PSYCHOLOGY TRAINING COMMITTEE 3](#psychology-training-committee)3

[**INTERVIEW DATES AND ROTATION PREFERENCES
35**](#interview-dates-and-rotation-preferences)

# 

# 

# 

# OVERVIEW

The Veterans Health Administration (VHA) is part of the Department of
Veterans Affairs which is a cabinet level organization. The VHA Medical
Center, Dayton, Ohio offers a full time, one year, funded predoctoral
internship to doctoral students enrolled in clinical or counseling
psychology programs that are accredited by the American Psychological
Association (APA). Our psychology internship program is accredited by
the APA. The next regularly scheduled site visit will be during 2009.

The origin of the Dayton VHA Medical Center dates back to March 3, 1865,
when President Abraham Lincoln signed into law an act of congress
establishing the National Home for Disabled Volunteer Soldiers to care
for disabled veterans of the Union Army. Dayton, Ohio was one of three
original sites selected. Originally, the grounds consisted of 355 acres
west of the city of Dayton. Lakes, surrounded by scenic trails, provided
a relaxing atmosphere for relaxation and rehabilitation. A large farm
provided much of the produce used by the interns. By the turn of the
19th to the 20th century, Dayton was the largest facility in the
National Soldier's Home System. During 1930, when the Veterans
Administration was formed, the National Solder's Home System was
discontinued and incorporated into the new organization. During 1989,
the Veterans Administration was made a cabinet level organization and
the title was changed to the Department of Veterans Affairs.

The medical center is located at the west edge of Dayton, Ohio. Much of
the pastoral setting was preserved while establishing a modern, state of
the art comprehensive medical facility. The current complex consists of
approximately 60 buildings on about 240 acres. The medical center
provides a broad spectrum of programs in primary, secondary, and most
levels of tertiary care. The medical center serves 29 counties in
central and western Ohio along with one county in Indiana with a total
patient population of about 380,000. There are approximately 6500
inpatient stays and 200,000 outpatient visits each year. The medical
center is a teaching facility that has numerous affiliation agreements
with colleges, medical centers, medical schools, universities, and
training programs throughout the area along with sharing agreements with
other medical centers in the area and the Department of Defense. The
medical center has excellent research facilities along with
administrative and clinical support of such activities. The Dayton
Department of Veterans Affairs Medical Center is a well established
multicultural setting that employs about 1600 full-time employees who
reflect considerable diversity.

# INTERNSHIP TRAINING PROGRAM

## Philosophy

We believe the internship year is crucial in the transition of the
individual from student to professional. We encourage the development of
professional knowledge, skills, and beliefs/attitudes that form the
basis for a solid professional identity along with the competent
practice of psychology. We encourage individual professional
responsibility while recognizing the importance of communicating and
sharing responsibility with other professionals. Interns are encouraged
to be innovative and creative with their professional development while
using well established principles, techniques, and procedures as a basis
for professional activities. In the perennial balance of medical center
and training needs, we recognize that a high quality training program
must be designed for the needs of the interns.

## Title

We use the title of Psychology Intern.

## Model

The Psychology Internship Program is based on the Vail
(Practitioner-Scholar) Model. Within the context of the practice of
psychology, the mutually interdependent roles of science and practice
are recognized and applied within a public service setting. The
Practitioner-Scholar Model is consistent with the tripartite mission of
the VHA: patient care, education/training, and research.

## Mission

We take pride in our profession and in the training of interns to become
psychologists. We recognize the special responsibilities associated with
the training of interns. The mission of the Psychology Internship
Program is to establish and maintain an environment that maximizes the
potential for professional development for each psychology intern.

## Approach to Training

There are various forms of supervision. Within the internship program,
we define supervision by using the term "Supervision for the Purpose of
Training."

-   Inherent in supervision for the purpose of training is a complex
    social relationship that is operated on a number of levels
    simultaneously. We recognize, and are sensitive to, the multiple
    levels.

-   Supervision for the purpose of training has four components.

-   Formal knowledge

-   Skills/experience

-   Attitudes/beliefs

-   Insure safety of patients

-   Supervision for the purpose of training has a developmental quality.

We utilize a programmatic approach to training. Within a programmatic
approach, each intern enters an ongoing patient care system and performs
the duties of a psychologist. Within the context of programmatic
approach, the apprenticeship approach is utilized to varying degrees.
Variation is due to the specific needs of each intern and the tasks
being learned.

We have adopted situational leadership theory as our conceptual basis.
The role of a training supervisor evolves as an intern develops
competence in a given task: direct, coach, consult, independence. The
theory is elegant in its simplicity and incorporates well the
developmental nature of a psychology Internship.

Within the various guidelines, rules, regulations, laws, standards of
care, and models that govern our professional behavior, training is
individualized in order to meet the professional needs of each intern
There is a proactive dialogue among all relevant parties that begins
before, and continues throughout, the internship year.

Our general approach is to behave in a manner consistent with American
Psychological Association guidelines and Department of Veterans Affairs
Policies regarding the disclosure of personal information and to
routinely maintain good boundaries in that regard. Legitimate training
supervision activities include, but are not limited to, the exploration
of professional and personal values, the exploration of personal
experiences along with their impact on the practice of psychology, the
development of understandings regarding emotional reactions to events
that occur during the course of professional activities, and the
exploration of consistencies/inconsistencies between one's personal
behavior patterns and behavior patterns that are consistent/inconsistent
with good health and quality of life.

The Psychology Internship Program was developed to assure high quality
training. We developed a specific, competence based approach. The
competencies notion is applied to all aspects of the training program.
Within the context of this competence based structure, both positive and
negative feedback have equal value. Each serves to inform how well an
element or process is functioning.

The Lead Psychologist and the Co Directors of Training are
administratively responsible for the Psychology Internship Program while
the Psychology Training Committee is the general body. Regular meetings
are held and the minutes are distributed to all staff and interns.
Interns are members of the training committee. A training supervisor who
is actively supervising is required to attend all meetings. A training
supervisor who is not actively supervising an intern is not necessarily
required to be at all meetings, but attendance is recommended. Although
the members of the training committee work toward consensus when making
decisions, a simple majority vote is all that is required.

## Goals

We designed the internship program to provide a broad predoctoral
training experience that forms a sound basis for a professional career.
The focus is on the acquisition and/or development of formal knowledge,
professional skills, and attitudes/beliefs that make for a solid
professional identity. The expectation is that, by the end of the
training year, an intern will be able to function competently (i.e.,
entry level or better) in five core areas: Ethical/Professional Issues,
Assessment, Intervention, Diversity/Multicultural, and Science and
Practice. We emphasize general skills. Within the context of sound
professional growth, however, we support actively the development of
specialist skills.

## Objectives/Competencies

Our overall goal is for each intern to be fully prepared for entry level
practice. Entry level practice is defined as being fully prepared to
begin the required period of supervision prior to licensure. It is the
equivalent to a GS-11 psychologist in the Department of Veterans
Affairs.

The core areas of Ethical/Professional Issues and
Diversity/Multicultural are essentially the same for all rotations. Each
rotation has some unique competencies in the core areas of Assessment,
Intervention, and Science and Practice. The competencies are documented
in the form of competency grids. What follows are generic statements
that provide a reasonable guideline for the purpose of communication
through a brochure.

### Ethical/Professional Issues

Ethical/Professional Issues is a collective term that includes the many
behaviors inherent in the many roles of a professional psychologist.
Many do not fit easily into well defined categories.

-   Observance of the American Psychological Association (APA) [Ethical
    Principles of Psychologists and Code of Conduct]{.underline}, and
    Department of Veterans Affairs rules, regulations, and laws as well
    as other documents that govern our professional behavior.

-   Ability to engage effectively in the various processes involved in a
    internship.

-   Dependable professional demeanor consistent with the practice of
    psychology.

-   The ability to monitor one\'s professional behavior along with the
    provision of unimpaired psychological services.

-   Ability to understand the nature of his or her behavior within the
    context of each rotation.

-   Knowledge of one\'s personal and professional strengths and
    limitations along with the recognition of the need to seek
    assistance or refer.

-   Ability to recognize and deal with personal and professional issues
    in a constructive manner: e.g., use of supervision.

-   Awareness of the nature of the impact of one\'s professional
    behavior.

-   Appreciation for the power inherent in one\'s position relative to
    others.

-   Management of time.

### Assessment

Assessments are a unique role for psychologists. We perform a variety of
assessments and each intern is required to demonstrate competence with
the types of assessments involved in a given rotation. The expectation
is that by the end of the internship year, each intern will have
completed a wide variety and large number of assessments. At the
beginning of the internship year, it is important to plan experiences so
that there is variety in the nature and content of the assessments.

-   All assessments involve a referral question (i.e., purpose). Each
    intern is required to demonstrate proficiency in understanding and
    explaining the nature of each referral question. If the nature of
    the referral question is not clear, the intern must clarify it with
    the referral source.

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-   Procedures

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-   Selection of Procedures: For any given referral question, a variety
    of assessment procedures are possible. It is important to select the
    types and numbers of procedures that provide meaningful information.
    Each intern is required to become familiar with the concept of
    incremental validity and be able to apply it to actual situations.

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-   Record Review: In most cases, medical records will be available.
    Each intern is required to be familiar with medical records along
    with usual and customary medical terminology.

-   Interview: Each intern is required to demonstrate competence in
    interviewing techniques: Mental status, open ended questions,
    content related to the referral question, etc.

-   Test Administration and Scoring: Actual test procedures utilized
    will depend upon the nature of the referral question and the
    rotation. Each intern is required to demonstrate proficiency in
    administration and scoring of tests.

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-   Interpretation of the Data

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-   Each intern is required to demonstrate competence in interpreting
    data in a reasonable manner relative to the referral question.

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-   Written Report

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-   All assessments require written documentation designed to meet the
    needs of the person - sometimes multiple persons. Each intern is
    required to demonstrate proficiency in writing clear, cogent reports
    that involve the integration of data in a coherent manner.

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-   Feedback

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-   The provision of feedback in a manner that a patient can understand
    is a necessary professional skill. Also, in many cases, feedback to
    the referral sources is indicated as well. Each intern is required
    to demonstrate proficiency.

### Intervention

Intervention occurs within the context of a special socially sanctioned
relationship designed to maximize change in one party. Interventions are
literature based and utilize well established psychological knowledge
and principles. Psychologists perform a variety of interventions. Each
intern is required to demonstrate competence with the types of
interventions required for a given rotation. At the beginning of the
internship year, it is important to plan well to insure some variety in
the types of therapy and patients treated.

-   Conceptualization/Theoretical Orientation: A wide variety of
    conceptualizations and/or theoretical orientations are considered
    acceptable in the practice of psychology. Each intern is required to
    articulate a theory and/or conceptualization for each intervention.

-   Modality: A fairly wide variety of treatment modalities are
    recognized in the practice of psychology. Each intern is required to
    demonstrate competence in the selection of a treatment modality that
    is appropriate to a given case. Emphasis is placed on intervention
    strategies that have a degree of verified effectiveness.

-   Treatment Planning: The development of specific, attainable goals is
    important in interventions. Each intern is expected to be able to
    identify functional, measurable goals for each intervention.

-   Process: Interventions are complex interpersonal processes. Each
    intern is expected to demonstrate competence with those processes
    relative to each rotation. Some examples are:

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-   Personal and professional knowledge of self along with an awareness
    of one\'s impact on the therapeutic process.

-   The establishment and maintenance of feedback mechanisms utilized
    during the therapeutic process.

-   Identifying and processing one\'s own emotions as part of the
    therapeutic process.

-   Awareness of cause and effect relationships between one\'s behavior
    and change in a patient.

-   Ability to predict the consequences of one\'s specific intervention,
    comment, or behavior.

-   Timing of a specific intervention, comment, or behavior.

-   Awareness of boundaries with a given patient.

-   The presentation of clear and consistent messages to a given patient
    along with the avoidance of mixed or inconsistent messages.

-   Recognition when therapy has been completed or has become
    counterproductive.

-   Awareness of and ability to articulate when and how a relationship
    is therapeutic or not therapeutic in nature.

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-   Termination. There are various, acceptable reasons for termination
    of a case. Each intern is required to demonstrate the ability to
    terminate cases appropriately.

### Diversity/Multicultural

Each intern is required to demonstrate competence in providing
psychological services to individuals from diverse backgrounds:
different ethnic histories, gender issues, sexual orientation issues,
disabilities, unique experiences of veterans, etc.

### Science and Practice

We are a rather fast paced patient care oriented setting. Consequently,
our internship program has a practice focus. However, research
influences practice and practice influences science. The use of relevant
literature is an integral part of each rotation. As part of a given
rotation, each intern is required to demonstrate and ability to use a
quality literature base and apply it to professional practice through
one or more of the following.

-   Completion of a literature search on a specific subject and applying
    the knowledge during the rotation.

-   Reading current literature on a subject related to the rotation and
    applying the knowledge.

-   Participation in ongoing research.

## Completion

Completion of the internship program is conditional upon an intern
meeting the stated objectives along with professional behavior that
meets or exceeds competencies. No partial credit is granted regarding
the internship. Successful completion of the internship is an
all-or-none decision.

## Evaluation

Evaluations are an integral component of the internship training process
and occur throughout the internship year. At the beginning of each
rotation there is a general assessment of an intern's professional
skills. There is an informal assessment of competencies about half way
through a rotation and a formal assessment at end of each rotation. At
the end of each rotation, the intern completes a competency form on the
supervisor. Also, at the end of the internship year each intern
completes formal evaluations of the program.

# ROTATION FORMAT AND ASSIGNMENT

The basic rotation structure is three four month rotations with each
intern spending one day per week in the Mental Health Clinic for the
entire internship year. Any group of three rotations plus the one day
per week in the Mental Health Clinic is consistent with our
objectives/competencies. The one day per week in the Mental Health
Clinic does not preclude a four month rotation in Mental Health. In
other words, one may do both. However, based upon feedback from prior
interns, we have learned that the one day per week in the Mental Health
Clinic is sufficient for training purposes. Interns who desire a full
rotation in Mental Health are assigned to the Inpatient Mental
Health/Emergency Room.

Consistent with the updated guidelines and principles of accreditation,
there will be contact between the training committee and an intern's
graduate program prior to the onset of the internship year. Also, there
will be interactions between the internship program and the interns. The
goal is to have rotation structure in place prior to the beginning of
the internship year.

We recognize that after arrival and familiarization with the setting, an
intern may wish to change a rotation and/or the sequence of rotations.
Also, professional development plans can, and do, change. Our preference
is for such changes to take place early during the internship year (the
first month) in order to maximize predictability for all parties
concerned.

Based upon feedback from prior interns, the Psychology Training
Committee decided to adopt a 6-2-4 structure for individuals who have a
well organized professional development plan that includes emphasis or
specialization. The decision is made on a case by case basis and we
anticipate meeting such requests.

# ROTATIONS AND CONCEPTUALIZATION STATEMENTS OF TRAINING SUPERVISORS

Training supervisors are psychologist whose responsibilities include the
provision of supervision for the purpose of training. The statements are
similar to the conceptualization statements written by applicants with
an orientation toward the setting in which the supervisor engages in the
practice and training of professional psychology.

## Health Psychology

### Description

The rotation in health psychology emphasizes the provision of
psychological services in the medical primary care clinics at the
medical center. Such services include: assessment of patients referred
for a variety of issues -- most commonly depression, anxiety, substance
abuse, nonadherence to indicated treatment regimens, adjustment to
medical conditions/disabilities, psychological factors impacting
presentation of medical symptoms, and stress management. Interventions
offered to primary care patients typically include brief, time limited
treatments as well as psychoeducational activities such as health
education groups. Each intern will become involved with the primary care
team that consists of physicians, nurses, a psychologist, physician
assistants, dieticians, a social worker, a pharmacist, and
administrative associates.

Psychologists assigned to health psychology provide a range of other
services. Such services include programs for chronic pain management,
weight management, smoking cessation, and problems in sexual health.
Consultation services are provided to specialty clinics and inpatient
wards: cardiology, infectious disease, neurology, oncology, surgery, and
rehabilitation. Also, health psychology is responsible for conducting
evaluations of patients who are candidates for an organ transplant and
bariatric surgery.

While many of the training activities and professional responsibilities
are established as part of the routine program, the rotation is designed
with an orientation toward flexibility to meet an intern's specific
professional interests and needs. One of the explicit competencies in
all rotations is the provision of consistent messages to patients. An
intern can anticipate an exploration of his/her personal behavior
patterns (e.g., use of nicotine products) relative to behavior patterns
that maximize good health and quality of life.

### Conceptualization Statements

Frederick Peterson, Psy.D.

My conceptualization statement addresses two overlapping areas of my
clinical activity within the field of health psychology, sex therapy and
tobacco use treatment. When assisting people in need, I find it
impossible to exclude the numerous influences on the formation of my
professional perspective on human nature and the practice of psychology.
Certainly the teachings of James, Maslow, Rogers, Adler, Albee, Ellis,
and Perls come to mind.

The three most influential people in my professional life happen to be
my former supervisors. I've been fortunate to have studied with three
people I consider leaders of their field, if not pioneers. They are Dr.
Ron Fox, past president of APA; Dr. William Masters, pioneer sex
researcher and co-founder of the Masters and Johnson Institute, and Dr.
Judy Seifer, past president of the American Association of Sex
Educators, Counselors and Therapists (ASSECT).

As founding dean of the School of Professional Psychology at Wright
State University, Dr. Fox taught me the importance of getting psychology
"out of the box" of just having people coming to me in my office and
doing traditional talk therapies. I see my calling in psychology,
especially health psychology, as integrating psychologically sound
principles and practices into all slices of normative life, such as
child birthing, the transition into parenthood and becoming a family.
Psychology should not be restricted and conceptually segregated from
everyday life, just "on call" for those experiencing crisis in their
life. When I am doing talk therapies, I find myself being as much of a
health educator as I am a psychologist. Also, I tend to use what works
in therapy with a particular client (eclectic pragmatism), whether that
involves movement, trying to solve a riddle or singing.

My theoretical emphasis on the teachings of George Albee and Ron Fox
lead me to be active in teaching and prevention work. Much of that is
done outside the Department of Veteran Affairs, particularly at Wright
State University, University of Dayton and other hospitals. At the VA,
my interest in prevention led me to start the smoking cessation
education classes seventeen years ago. Today, smoking is widely accepted
as the number one preventable cause of death in the country and smoking
cessation is considered the "gold standard" of cost/benefit ratios
within all of medicine and healthcare. Ironically, applied psychology as
a whole has little involvement with smoking cessation relative to other
healthcare professions.

For two years, I chaired a group a statewide group of smoking cessation
specialists which developed a "best practice model" within the
Department of Veteran Affairs. The interventions within the best
practice model are based upon a strong theoretical foundation of three
interlocking models. The first is the Nicotine Addiction Model,
developed by many but championed by Alan Lesher (the former Director of
National Institutes of Health), which basically perceives nicotine
dependence as a brain disease within a social context. Secondly,
Prochaska and DiClemente's Transtheorectical Model of Change is
emphasized and applied to smoking cessation, as it has been applied to
about every other form of human behavior. Finally, a Three-Factor Model
developed by Gary DeNelsky at the Cleveland Clinic was incorporated into
the best practice model. This Three-Factor Model addresses nicotine
addiction, behavioral associations or "linkages" to smoking and a
special set of "psychological meanings" tobacco use has for the smoker.

My work with Drs. Seifer and Masters occurred during my increasing
observations about how sexual concerns so often occurred in therapy yet
there where so few means of competently addressing these concerns within
the teachings of traditional psychology. In my opinion, this state of
affairs continues today as reflected by the divisional organization of
APA, which has nearly sixty professional divisions but not one committed
to sexual health.

The term "Sexual Health" is defined as the integration of the physical,
emotional, intellectual and social aspects of sexual being, in ways that
are positively enriching and enhance personality, communication and love
(World Health Organization, 1992). The concept of sexual health
developed from the writings of the sexosophers of the 19^th^ century
(such as Freud, Ellis, Van de Velde) and the sexologists of the 20^th^
century (especially Kinsey, Masters and Johnson, Kaplan, Bancroft and
Money). This collective body of writing provided the theoretical
foundation to the development of an entirely new health profession -
sexual health.

Sexual health is a multidisciplinary field that includes sex education
and sex therapy. It conceptualizes sexual functioning as a natural state
and disruptions to sexual functioning as typically multicausal and
needing intervention on multiple levels for optimal treatment outcome.
The field of sexual health and sex therapy is regulated through a code
of ethics developed by a professional body called the American
Association of Sex Educators, Counselors and Therapists (AASECT).

Contingent upon this theoretical foundation, the Sexual Health Clinic at
the VA Medical Center addresses the concerns of male and female veterans
and their partners, which include, but are not limited to, sexual
dysfunction, sexual trauma, sexual compulsiveness, gender dysphoria
disorders and issues of sexual orientation.

Ramon Verdaguer, Ph.D., ABPP (Clinical Health Psychology)

It is now well understood that many chronic medical illnesses such as
coronary artery disease, diabetes, and hypertension, whose causes
include strong behavioral components, are readily preventable. As a
result we are gradually experiencing a shift in focus from treatment of
disease to illness prevention. This is especially so in the VA
Healthcare system where much attention is given to primary care programs
and primary care based interventions. Counseling about the health risks
of smoking, and alcohol use as well as the benefits of exercise, seat
belt use, and a healthy diet, is now commonly integrated into routine
primary care visits.

One of the roles of a psychologist in the primary care setting is to
facilitate change in people who have identified the implementation of
healthy behaviors as an effective mean to prevent and/or manage chronic
illness and are prepared to embark in such a change. The
Transtheoretical Model (Prochaska & DiClemente), a process theory of
change, is a useful construct in determining who may be ready to embark
in that change and to which interventions they may be more receptive.

Although skill acquisition and enlargement is an objective, the
underlying goal is to assist in the development of a self-regulatory
mechanism that can maintain and drive those positive behaviors on a
long-term basis in the face of occasional lapses, frustrations, and lack
of concrete positive feedback and reinforcement. The concept of
*integration*, as defined by Deci et al. (1994) in the
Self-Determination Theory perspective, in which a behavior is
"volitional" and "emanates from oneself" and results in self-determined
behavior seems to capture the essence of this aim. A combination of
psycho-educational strategies, client-centered and cognitive-behavioral
therapeutic interventions are useful in enabling individuals to attain
this level of integration.

Yet, we also know that availability of information and education about
the consequences of high-risk behaviors and the availability of
alternative health behaviors does not always translate into positive
behavior change. In that light, another role of the psychologist is to
promote behavior change with those people who may not be necessarily
ready or prepared to undertake such a change. In this case, it is
important to acknowledge that people may not be ready to change for a
variety of reasons. Some of these reasons may be the result of
intrapersonal issues such as perceived susceptibility, low
self-efficacy, ability, and outcome expectations. Environmental issues
can also impact the decision to change and may include situational
barriers or lack or resources and demographic or sociological variables.
Clearly, the nature and severity of the illness can also impact on
decision to change. The biopsychosocial model is, therefore, a useful
umbrella framework through which we can conceptualize the individual and
the factors influencing readiness to change. It lays out an outline for
inquiry that can lead to an actionable roadmap for intervention.

In general, the orienting principle of my work is to assist people to
act in ways that are consistent with their life values and goals. As
such, I conceptualize my work as involving 2 phases. The first phase
moves forward the process of value elucidation, goal determination, and
choice clarification. Cognitive, emotive, and experiential strategies
tend to be most effective in this phase. This process leads to the
second phase, which involves facilitating decision making and actions
that are consistent with attainment of the goals. Behavioral strategies
tend to have a good response during this phase.

This process implicitly accepts that some people's values and goals are
not necessarily congruent with the majority's values and that not
everyone can, will, or should change. This may at times be incongruent
with the institutional goals but its acceptance is crucial if one is to
respect the individual and if one is to remain vitally committed to good
patient care without losing oneself in the process.

## Mental Health

### Description

The program is structured such that, regardless of rotation setting,
each intern spends one day per week in the Mental Health Clinic setting
for the entire internship year. The arrangement is intended to provide
interns with the opportunity to follow patients for the purpose of
therapy on a more long term basis. Our experience has been that one day
per week in this setting is sufficient for the purpose of learning.

When an intern selects a four month rotation in Mental Health the
emphasis will be on provision of outpatient mental health interventions
from an Integrative Cognitive Behavioral model, incorporating aspects of
Dialectical Behavior Therapy, ACT (Acceptance and Commitment Therapy)
and Motivational Enhancement Therapy.  A major emphasis on this rotation
is placed upon delivering treatment in a group format.   There is also
opportunity, however, for application of these models in an individual
psychotherapy format.

### Conceptualization Statements

Arthur Aaronson, Psy.D.

I learned in graduate school that the goal of psychotherapy is to make
the unconscious, conscious. I don¹t know too may therapists that do that
these days, certainly not I. I have come to the realization that the
goal of psychotherapy is to reduce the level of discomfort that a
client/patient is experiencing. Make a patient more comfortable often
means that the therapist reduce symptoms, improve relationships, change
lifestyles and/or help the patient accept their unique circumstances.

If pressed to define the way I perform psychotherapy, I tell people that
I am eclectic with a dynamic bias. In reality, therapy for me is like
reading a Sherlock Holmes novel (or more topically, Johithan Kellerman
or Steven White). Often we will just talk about what has been
problematic for them during the time between the sessions. Sometimes,
when we do a history, the patient might notice parallels in the behavior
of other member of their family and their behavior.

I spend a lot of time with assessment and using tests like the Minnesota
Multiphasic Personality Inventory\--2 to help the patient/client see
themselves like they are seen by others. This view is often the
beginning of the trail to find out how the patient/client developed.

Rebecca Graham, Ph.D. 

My clinical practice within the Mental Health Care takes place in two
settings: the Acute Inpatient Mental Health Unit and the Outpatient
Mental Health Clinic. I view human behavior as being multi-determined,
with assessment and interventions needing to be multi-dimensional and
functional, in nature.     

The goal of acute inpatient mental health treatment is to return the
patient to baseline behavior and functioning as rapidly as possible. 
Because of that, on our unit there is a heavy reliance upon biological
treatments but psychological and environmental interventions are not
neglected.  As I psychologist, I use primarily interpersonal and
cognitive-behavioral perspectives to guide me in designing and
implementing circumscribed psychological interventions.  Essentially, I
ask myself, "What needs to change psychologically or environmentally to
help this patient return to her or his pre-hospitalization level of
functioning?" Sometimes this involves helping the patient negotiate a
difficult life transition.  Sometimes it involves teaching skills to
cope better with one's own emotions or situations.  Sometimes, it
involves a marital or family intervention. 

In outpatient settings, I use an Integrative Cognitive Behavioral model
with particular emphasis on Dialectical Behavior Therapy, ACT
(Acceptance and Commitment Therapy), Motivational Enhancement Therapy
approaches. Currently, I'm working on developing a standardized Life
Values intervention to assist patients in clarification of their own
Life Values hierarchy and examination of the congruence (or lack of
congruence) between their actual behavior and what they say they value.
The goal of such an intervention is to increase awareness of any
discrepancy between attitudinal values and behavioral valuing and, then
to utilize awareness of this discrepancy to motivate self-determined
change in the patient's behavior. The hypothesis, is that such an
intervention will enhance patient readiness and willingness to change.
In addition to individual therapy, I utilize group skills training in
Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal
Effectiveness to enhance the Action phase of change.

## Emmanuel Papadakis, Psy. D.

I utilize brief therapy, cognitive- behavioral, interpersonal and
systems approaches in assessing and treating veterans at the Dayton VA
Medical Center.

Understanding how aging, medical illness effect the individual's ability
to function at home, work and community is of utmost importance. 
Cost-effective assessment of problems and working with in the medical
center and community systems - in order to help the veteran and his
family to cope with stress is essential.

## 

## Neuropsychology

### Description

The purpose of clinical neuropsychology is the assessment of
brain-behavior relationships. The relationships are examined through a
variety of measures utilizing a flexible procedure approach. Each
examination assists in identifying the etiology, brain region, and
extent of impaired functions along with well preserved abilities.
Assessments are requested from disciplines across the full spectrum of
patient care providers for an equally full range of purposes. The nature
of a given assessment can range from a brief interview to a very
involved series of tests and procedures. Throughout the rotation there
is a series of readings on various topics (mental status, neurology,
attention, executive functions, etc.) along with regular supervision
meetings to discuss them. Additional learning experiences are obtained
through contact with Radiology, brain cuttings, Neurology Clinics,
quarterly peer review meetings, and state neuropsychology meetings.

Within the overall programmatic structure of the internship program,
there is a strong apprenticeship approach with the neuropsychology
rotation. The general structure is for the supervisor to begin with a
directive style and move toward a consultant, or even independent, role
relative to a given professional skill as a intern demonstrates
competence consistently in that particular skill. Initially, direct
observation of the supervisor is the modal style. Almost simultaneously,
there is training in the various tests and procedures used customarily
in a neuropsychological assessment. The nature of the relationship
evolves to the supervisor observing the intern administer tests along
with a careful review of all protocols. Usually, report writing begins
with the administration of one's first series of tests. There is
considerable structure so the process is more of a "filling in the
blanks." Eventually, the intern brings in a completed protocol and
report for review. Rather quickly the number of assessments by an intern
becomes a minimum of two per week. The usual schedule is face to face
testing during the morning and writeup during the afternoon. Such a
structure serves to maximize the experiential learning component. During
the initial learning phases, the supervisor will adopt a directive role
in report writing in order to insure timely completion of documentation.
Although there is a large amount of structure on which to base the
learning process, the development of individual style is encouraged and
supported once an intern has demonstrated competence in the basic
processes of an assessment.

Progress through the rotation is measured both quantitatively and
qualitatively: more assessments, more complex assessments, less direct
supervision, more independence with the process, faster completion of
full reports, more sophisticated tests/procedures, etc.

Although the basic training structure remains the same, training is
oriented to two different tracks. One is for an intern who wishes a
workable knowledge of neuropsychology within the context of a well
rounded internship experience. Any intern is considered qualified for
the track. The other is for an intern who has aspirations of becoming a
clinical neuropsychologist through a two year post doctoral training
experience. Customarily, the latter opts for a 6-2-4 structure -- though
it is not required. Competency levels have higher thresholds since a
superlative letter of recommendation from the supervisor is required and
the supervisor prefers to adhere to Division 40 Guidelines. Acceptance
into the track is not automatic and is at the discretion of the
supervisor. If you have aspirations for a post doctoral position in
clinical neuropsychology, be sure to make such intentions clear as part
of your application.

### Conceptualization Statements

Anthony Byrd, Psy. D.

The practice of clinical neuropsychology involves the quantitative and
qualitative evaluation of brain functions by measuring and assessing
their cognitive and behavioral correlates. These are assessed with
regard to an individual's relative cognitive strengths and weaknesses,
and within the historical context of the myriad means by which brain
damage and its consequent cognitive-behavioral dysfunction may occur.
While there are various approaches or schools of thought by which
neuropsychological assessment may be competently accomplished, I believe
the most efficacious means of doing so is first and foremost through
possession of a broad and deep foundational knowledge base, and in the
use of a flexible approach to neurocognitive evaluation.

A sound foundational knowledge base, to include an understanding of
so-called "normal" cognition and behavior, cognitive dysfunction and
psychopathology as defined by validated diagnostic nomenclatures,
knowledge of neuroanatomy and function, common neurological disorders
and their manifestations, as well as the risk factors for susceptibility
to brain dysfunction and the devices and normative data used to assess
these, are absolute necessities.

Given that our national population is rapidly aging with many living
longer, the likelihood of greater numbers of individuals who will, at
some point, need an evaluation of their competence to live independently
and to competently adapt to their environments, make decisions, or who
will require confirmation of the need for prescriptive intervention or
evidence of its efficacy, will only increase. I have certainly found
this to be true with this VA population, for whom I have provided
neuropsychological services over the last years.

With these facts in mind, knowledge of the diseases and conditions often
or exclusively associated with aging that adversely affect adaptive
functioning, such as Mild Cognitive Impairment due to cardiac arrest ,
for example, or Alzheimer's Dementia, Stroke or Vascular Dementia is
imperative for any neuropsychological practitioner. Furthermore, as
brain disease and injury are not the exclusive domain of the aged, one
must be versed and experienced in the following common central nervous
system problems, including but not limited to: Transient Ischemic
Attacks, Parkinson\'s' Disease, Multiple Sclerosis, Transient Global
Amnesia, Alcoholic Dementia, Korsakoff's Disease, neurosurgical
intervention sequelae, seizure disorder effects, chronic, severe mental
illness, iatrogenic difficulties associated with long-term psychoactive
medications, and of course Traumatic Brain Injury. Such a breadth of
knowledge is imperative, in that it is within the context of the history
and known course of these disease processes, conditions, injuries and
illnesses (along with familiarity with neuroanatomical structure and
function), in confluence with attendant risk factors for brain
dysfunction, that an evaluation must be interpreted in order to be
effective. It is my firm belief that a neuropsychological evaluation
must demonstrate the neuropsychologist's THINKING and her/his
conceptualization of the patient's performance and conditions affecting
performance, rather than a written narrative of often minimally useful
and potentially confusing array of age-scaled scores, standard scores,
percentages and ranges of performance.

In accomplishing such a task, I have found the most effective means
within this VA medical setting and patient population to be the use of a
"core" group of neuropsychological measures, along with the use of
additional measures as indicated by the explicitly determined purpose of
the evaluation, the clinical/collateral interview findings, and the
individual's ongoing performance and reaction to the testing process.
While this approach requires a comprehensive knowledge base and relies
on qualitative aspects as well as the quantitative patient performance,
it allows (and demands) that the practitioner generate active clinical
hypotheses, make in vivo evaluation judgments and instrument selections,
and it affords more specific clarification of cognitive findings and
diagnoses. I have also found this flexible approach to evaluation to
support more parsimonious use of clinical time and, more importantly, it
prevents subjecting the patient to unnecessarily lengthy testing
sessions and procedures. The latter is especially true and pragmatic
with the most aged and debilitated of patients, often having multiple
co-morbidities. This non-fixed battery process as described, I feel,
allows for a richer neuropsychological profile that, at the same time,
is better fashioned to respond to the specifics of the reason(s) for
referral over a more "fixed" battery approach to assessment or a
"screening only" approach to neurocognitive evaluation.

While the practice of clinical neuropsychology will continue to evolve
over time due to: the necessity for increasingly ecologically valid,
meaningful and efficient appraisals of the brain-behavior interface, the
changing scope and footprint of managed care practices, the advent of
new and more incisive (functional) imagining devices, a solid foundation
in brain-behavior functions and structure, normality and dysfunction,
illness and injury, psychopathological conditions and proper test
selection required to validly and reliably assess these, will always be
a necessary aspect of a comprehensive assessment of individual human
cognitive capacities.

## 

## Geropsychology Supplementary Experience

### Description

The Geropsychology rotation incorporates a variety of clinical work with
an inpatient elderly population. Geropsychological services are provided
to multiple units on the medical center campus: Hospice/Palliative Care,
Rehabilitation, and five Nursing Home Care units (including skilled care
and a secured dementia unit). The rotation offers the intern a wide
variety of assessment, intervention, and consultative experiences
involving the care and treatment of geriatric patients within the
context of an interdisciplinary team approach. Specific intern
activities will be determined by intern-supervisor goals, the intern's
interests, and prior level of experience, as well as rotation competency
requirements. Previous geropsychology and neuropsychology experience are
not prerequisites for the rotation. Examples of professional psychology
activities include: individual, group, and family therapy;
psychological/emotional, grief, decisional capacity, and cognitive
assessments; and attendance at family and treatment team meetings. The
intern will work with the rotation supervisor in responding to
consultation requests and providing pertinent oral and written feedback
to staff, as well as to patients and families, as indicated. The
rotation provides a unique opportunity for the intern to acquire an
appreciation of issues impacting an aging population, such as: dementia,
delirium, cognitive assessments, death and dying, psychology and
spirituality, adjustment to physical and mental decline, and elder
psychiatric conditions. The acquisition of this knowledge can come from
multiple sources including didactics with the rotation supervisor, VHA
medical center sponsored seminars, readings, interactions with
experienced interdisciplinary team members, and clinical work. In
addition to clinical duties, the intern is required to complete assigned
readings and attend regularly scheduled supervision meetings.
Supervisor: Dr. Nicole Best

\*\*Although a full Geropsychology rotation is not being offered at this
time, certain learning aspects of the rotation will be made available to
interns as a supplement to another major rotation.

### Conceptualization Statement

Nicole A. Best, PsyD

Although true with clients of any age, culture, gender, or health
status, it is especially important when working with geriatric and
medically ill individuals that a bio-psycho-social-spiritual model be
the foundation of any theoretical conceptualization. We are all
spiritual, physical, mental, and social beings who are constantly and
simultaneously functioning at each of these levels.

Over and above this basic foundation, an appreciation for the role of
grief becomes essential when working with a geriatric population.
Whether terminally ill, residing in a nursing home, or continuing to
function in the community, aging brings multiple losses and raises core
existential questions. It is a time when many individuals have a need to
review the story of their life, and to find meaning in past trials and
triumphs, as well as in current illnesses and suffering. It is for some,
the first and last time they will contemplate their place in the
universe, a relationship with a Higher Power, their life's mission, and
whether they believe they have reached a satisfactory conclusion.

Issues of faith and spirituality are often at the forefront of my
patients\' minds and consequently, often take center stage in therapy
sessions. In addition to an ever-present vigilance regarding boundaries
of professional competence (i.e. knowing when to involve a chaplain), a
psychologist must be equally aware of the fact that some patients do not
feel comfortable talking to a clergy person, that most ministers are not
trained counselors, and that the role a properly educated psychologist
can play in this area can be pivotal in the lives of the patient and
their family.

Working with individuals at this stage of their life's journey
necessitates a solid common factors approach, grief work, and an ability
to be flexible (eclectic) in interventions based on the client's
presenting issues, personality, belief system, cultural background,
cognitive abilities, and readiness for change.

Although continually evolving, much of my inspiration at this point in
my own professional development, comes from the works of countless
psychologists, physicians, philosophers, and theologians who are
dedicated to the research, exploration, and integration of psychology
and spirituality (e.g. Harold Koenig, Robert Roberts, Paul Vitz), the
grief and end-of-life literature (e.g. J. William Worden), the Common
Factors data (e.g. Hubble, Duncan, Miller); as well as my own faith, and
lessons learned from the best teachers of all -- dying patients whom I
have had the privilege to know.

## 

## 

## 

## Post Traumatic Stress Disorder Clinical Team

### Description

The PTSD Clinical Team offers outpatient treatment to patients with
PTSD. Patients are offered a menu of different treatment formats that
include individual and group therapies.

### Conceptualization Statements

Peggy Cisneros Arnott, Ph.D.

Working with veterans with Post-Traumatic Stress Disorder affords me the
opportunity to work with a complex population and use a variety of
approaches largely driven by "where the veteran is at." The majority of
the veterans I see in therapy are combat veterans. Although the majority
are Vietnam War era veterans, I also provide services to WWII, Korea,
and Persian Gulf veterans. My responsibilities include conducting
diagnostic assessments, treatment planning and conducting individual and
group psychotherapy.

A person can be seen as not only a sum of his/her experiences, but also
how those experiences are interpreted and internalized. I attempt to see
my patients in a holistic fashion. Trained with a developmental
background, I find it extremely important to know about any past trauma
history and what s/he was like before they were exposed to trauma.
Understanding post-trauma lifestyle is also essential as I try to
"paint" the picture of this veteran, including his/her strengths. I
consider myself as having an integrative theoretical orientation, mostly
humanistic, interpersonal, and cognitive-behavioral. For assessment
purposes I rely mostly on clinical interviewing, although on occasion I
will use objective personality measures to help with my
conceptualization of the veteran. I also believe in forming a
collaborative alliance with the veterans, giving them responsibility for
the pace and topics to be discussed in treatment.

My understanding of trauma is that it is an event(s) that impacts our
biology, social functioning, emotional integrity and calls into question
the very core of our existence. Issues of guilt and spirituality are
commonplace as veterans explore how they survived their traumas. My
multifaceted view of how trauma impacts the self is manifested in my
practice as I espouse eclectic pragmatism. With an overall interpersonal
approach, I use a variety of therapeutic techniques and schools of
thought to understand and assist the veterans I work with. This includes
cognitive-behavioral techniques to teach relaxation training, stress
management and mastery over triggers, or more existential therapies as
veteran's struggle with the "why's" that trauma seems to generate. The
roles of unresolved grief, limited emotional expressiveness and
spirituality become essential when working with many trauma survivors.
All the while, reflective and empathic listening are used in order to
provide a safe environment where the veteran can chose to experience
some very intense emotions. With certain veterans, trauma processing can
be very beneficial as we "go back" to the trauma in order to understand
this experience's bearing on their life today.

I see myself as an educator, helping veterans understand the effects of
trauma. I find it valuable to spend time helping them understand PTSD
and it effects on their lives. At the outset of therapy, many veterans
state that they feel like they are "going crazy." Spending time helping
them understand PTSD helps them feel more "normal" providing much needed
validation as well. I teach them about mind-body interactions by helping
them identify and master their triggers as they attempt gain some
control back of their bodies and thoughts. The purpose is to empower the
veteran, since one of the main diagnostic criterias of PTSD is having
feelings of helplessness and powerlessness during the trauma.

What we hope to achieve is that a veteran that we work with feels good
enough about his understanding of and mastery of PTSD symptoms that s/he
can function independently without our help. We are not always likely to
see remission of all symptoms, but we hope to help them gain some
mastery over symptoms by taking a proactive approach to dealing with
symptoms. We encourage healthy behaviors and refer to many hospital
clinics to help the veteran take care of his overall health which, as we
know, impacts his/her outlook on life and mood.

## 

## Special Emphasis Programs

**[Description]{.underline}**

This rotation involves the provision of psychological services to
veterans in the following programs: Polysubstance Rehabilitation, Dual
Diagnosis, Health Care for Homeless Veterans, Domiciliary Care for
Homeless Veterans, Psychosocial Rehabilitation, and PTSD Day Treatment.
Services typically include assessment, individual psychotherapy, group
psychotherapy, psychoeducational groups, and psychosocial skills
training. The majority of these services are provided in the internal
programs with the option to continue treatment on an outpatient basis
once veterans are discharged from their respective programs.

The Special Emphasis Programs rotation allows for a considerable amount
of flexibility to meet an intern's specific professional interests and
needs. Interns have the opportunity to work with complex patients whose
diagnoses include, but are not limited to, the following:
substance-related disorders, psychotic disorders, mood disorders,
anxiety disorders, sleep disorders, impulse control disorders,
adjustment disorders, and personality disorders. The majority of
veterans receiving treatment in these programs have substance-related
disorders. Consequently, considerable emphasis is placed on the
assessment and treatment of substance abuse/dependence.

Interns in this rotation also have the opportunity to participate in a
treatment program co-developed by Drs. Graham and Gustin entitled, Life
Skills Training and Coaching. This program incorporates a week-long
Values Group (two hours per day for five days) followed by a week-long
Goals Group (two hours per day for five days). The Values and the Goals
Groups utilize a positive psychology approach that affirms individuals
where they are. The groups were developed to help veterans have
increased hope, a sense of purpose and valued direction in life, and a
realistic and achievable plan for recovery.

The Values Group includes a standardized assessment based on a validated
theory of universal values (Schwartz, 1991) that assists individuals in
clarifying their Values hierarchy (i.e. what is important to them).
Through a combination of assessment, psychoeducation, and experiential
exercises, the individuals learn about their values and examine how they
have put their values into action. Participants learn that congruence
between their values and behaviors contributes to an increased sense of
well-being while incongruence between values and behaviors leads to
cognitive dissonance and decreased well-being. Finally, they learn how
to examine the effectiveness of their behaviors and consider some
healthy ways to put their values into action.

The Goals Group helps the individuals to put their values into action
effectively. Participants determine what they want to have in their
lives, choose a goal, and learn effective goal-setting strategies
through a combination of psychoeducation, worksheets, and group
discussions. They are taught how to put the power of their minds to work
for them in achieving their goals through the use of guided imagery and
visualization. Finally, participants create an action plan, detailing
exactly what they need to do in order to achieve their goals.

**[Conceptualization Statement]{.underline}**

Nancy Gustin, Psy.D.

My work in the Special Emphasis Programs affords me the opportunity to
serve the following patient populations: substance dependent; dually
diagnosed; homeless; severely mentally ill; and combat veterans with
co-morbid substance abuse/dependence and Posttraumatic Stress Disorder.

Although the presenting problems may appear very different, one common
theme that I have found with these populations is a tendency to avoid
unpleasant subjective experiences, whether due to the negative affect
associated with painful life experiences, physical pain, or the natural
consequences of their behaviors. This tendency, coupled with a lack of
healthy coping strategies, often leads these populations to turn to
substances as a way to self-medicate. Consequently, one of my goals is
to facilitate change by providing psychosocial skills training
(intrapersonal and interpersonal) including mindfulness, emotion
regulation, distress tolerance, stress management, anger management, and
interpersonal effectiveness.

Although my training has encompassed Cognitive Behavioral Therapy,
Humanistic/Existential, Psychodynamic Self-Psychology, Strategic, and
Family Therapies, I consider my theoretical orientation to be
integrated, with primary emphasis on the Cognitive Behavioral Therapies.
In working with the substance dependent (which includes the majority of
the above mentioned populations), I have been trained in the use of
Motivational Interviewing/ Motivational Enhancement Therapy (Miller &
Rollnick, 2002), 12-Step Oriented Treatment, Harm Reduction (Marlatt,
1998), Relapse Prevention (Marlatt & Donovan, 2005), and the
Transtheoretical Model (Prochaska & DiClemente).

I conceptualize individuals using the biopsychosocial model while taking
into consideration their stages of change with regard to recovery. I
tend to use a Positive Psychology approach and incorporate Motivational
Enhancement Therapy to facilitate movement from the pre-contemplation,
contemplation, or preparation stages of change to the action stage of
change. In regards to psychosocial skills training, I draw predominately
from CBT, Dialectical Behavior Therapy (Linehan, 1993), Relapse
Prevention (Marlatt & Donovan, 2005), and Seeking Safety (Najavits,
2002) for co-morbid PTSD and substance abuse/dependence.

In addition to the evidence-based practices mentioned above, I have
co-authored a Life Skills Training and Coaching Program with Rebecca
Graham, Ph.D. This program incorporates a week-long Values Group (two
hours per day for five days) followed by a week-long Goals Group (two
hours per day for five days). The Values and the Goals Groups utilize a
positive psychology approach that affirms individuals where they are.
The groups were developed to help veterans have increased hope, a sense
of purpose and valued direction in life, and a realistic and achievable
plan for recovery.

# ADDITIONAL TRAINING EXPERIENCES AND SUPPORT

## Training Seminars

There is an ongoing didactic series throughout the internship year. The
meeting time is each Wednesday, 1000 -- 1200. The subjects and
presenters are quite varied. Attendance is mandatory. We have been a
process of sharing didactics and resources with two other psychology
internship programs in the immediate area. The arrangement provides
breadth and depth to the training experiences.

## Group Supervision 

Each Wednesday, 0900 -- 1000, is group supervision. The general approach
is to augment supervision taking place in other settings and to provide
a venue in which interns can support their mutual professional
development. Specific subjects are quite varied: case presentations,
mandatory medical center training, practice oral defense of
dissertation, administration of internship program, concepts/theories,
etc. Attendance is mandatory.

## Testing Laboratory

Medical records are totally computerized -- to include a wide variety of
personality inventories, self rating forms, etc. We maintain and update
regularly an extensive selection of noncomputerized psychological tests
and neuropsychological instruments.

## Library

The Health Sciences Library houses many volumes of professional books
and subscribes to over 300 professional journals. Staff are experts in
completing literature searches and obtaining copies of articles and
borrowing books from other institutions. Also, the library has an
extensive collection of audio, video, and microfilm holdings.

## Medical Media

Medical Media is available to assist the hospital staff with a variety
of services including photographs, graphic art, and video production.
The staff are quite helpful with teaching and the development of
presentations.

## Professional Development

An intern will be given a reasonable amount of authorized absence to
attend professional presentations, conferences, workshops, and
organizational meetings that are consistent with professional
development plans. We support strongly the completion of the
dissertation and allow a maximum of six days of authorized absence for
trips to the university, oral defense, etc. Also, if appropriate, an
intern may select a four hour block of time each week for the purpose of
dissertation work. Finally, each intern is encouraged to make use of the
many educational presentations within the medical center and the
surrounding academic community.

# PHYSICAL SETTING AND SUPPORT

Primary intern offices are located in 9D-132 of Building 330 (the
Patient Tower). Each intern has an individual office along with a
workstation (computer connected to the mainframe) along with a telephone
that has voice mail. Two psychologists are located in the suite. Two
conference/multipurpose rooms are part of the suite as well. Mental
Health Clinic offices and Inpatient Mental Health are located on the 7th
floor of the Patient Tower. There is an office, along with a
workstation, in Mental Health Clinic for the interns. The Post Traumatic
Stress Disorder Program and Substance Abuse Treatment Program each has
an office, along with workstation, for an intern.

Medical records are electronic and almost all of the professional
activities are accomplished through use of various computer programs.
The first week of the academic year is devoted almost entirely to
training in the various computer programs so that within a few days each
intern has access to all the computer programs and is, therefore, able
to engage in the full range of psychological services. The standard
programs are the Computerized Patient Record System (CPRS) which exists
in a dual form (Graphic User Interface and List Serve -- the latter is a
more DOS based system which is being phased out), psychological tests,
Microsoft Outlook, Microsoft Word, Microsoft Windows 2000, Excel, Power
Point, and Internet.

# APPLICATION

## Eligibility

An applicant must be a U.S. citizen who is enrolled in a clinical or
counseling psychology graduate program that is accredited by the
American Psychological Association. We require that all academic
requirements, other than dissertation, be completed prior to the
beginning of the internship year. We strongly desire that a prospective
applicant be sufficiently advanced with the dissertation so that
completion can be anticipated by the end of the internship year.

The VHA Medical Center, Dayton, Ohio maintains a policy of equal
employment opportunity in intern recruitment and retention. All
recruitment processes are consistent with existing federal laws,
guidelines, and policies.

## 

## Appointment and Benefits

Technically, each intern receives a one to three year temporary
appointment per Department of Veterans Affairs regulations. The type of
appointment translates to an actual one year plus one day appointment.
There is a specific reason for such technicalities. The arrangement
allows us to provide the benefits provided to any regular employee such
as health insurance.

The internship year will begin on Monday, August 18, 2008. The total
number of hours is 2,088 to include established holiday leave, annual
leave, and sick leave. Annual leave and sick leave are accrued at a rate
of four hours per pay period. We are not authorized funds to purchase
unused annual leave. Sick leave can be accrued and maintained "on the
books" indefinitely and used if one should become a federal employee at
some time in the future. For the purpose of state licensure, our
procedure is to verify the usual and customary 2,000 hour
internship/internship. The pay is \$23,164 for the year to be paid in
equal installments over 26 biweekly pay periods.

As a federal employee, drug screens and background checks are routine.
Prior to the actual appointment, a matched applicant must complete the
appropriate paperwork and complete a physical examination that certifies
s/he is capable of the duties required. The Department of Veterans
Affairs, and consequently this medical center, adheres to the Americans
With Disabilities Act and will provide reasonable accommodations for an
individual who informs us that s/he has a disability.

The official appointment as a Psychology Intern is contingent upon
successful completion of practica and academic requirements (other than
dissertation) along with continued professional conduct consistent with
quality practice of psychology.

Dissemination of information about the Psychology Internship Program is
designed to be consistent with the concept of informed consent. We take
care to ensure that each applicant, and especially each who is invited
for an interview, receives considerable information so that s/he can
make high quality informed decisions about our site relative to his/her
professional development plans. Decisions on our part regarding an
applicant are based upon the assumption of informed consent. We require
accurate and complete factual information, as well as complete
empirically based qualitative judgments, in order to make informed
professional decisions that are of high quality regarding each
applicant, intern, or graduate. The requirement supercedes any and all
prior decisions, nondisclosure agreements or judgments, and/or similar
arrangements whether formal, informal, tacit, and/or passive in nature.
The requirement does not include the usual and customary professional
development struggles or issues. Our overwhelming experience has been
that provision of accurate and complete factual information, along with
empirically based qualitative judgments, consistent with the concept of
informed consent is routine -- though exceptions occur. Acquisition of
knowledge that there were one or more apparent and noteworthy acts of
omission and/or commission that misled us significantly in professional
decision making processes is likely to be considered by the training
committee as justification to reevaluate the status of an applicant,
intern, or graduate**.** Feel free to contact us if you have any
questions.

## Application Procedures

We use the uniform application and add a sheet unique to our internship
program. The additional sheet is included with this brochure. We adhere
to the Association of Psychology Postdoctoral and Internship Centers
(APPIC) guidelines for the recruitment and selection of psychology
interns including the policy that no person at this training facility
will solicit, accept, or use any ranking related information form any
applicant prior to Uniform Notification Day.

We need the following documents

> APPIC Uniform Application: available on the Internet at
> [www.appic.org](http://www.appic.org/)
>
> A resume or curriculum vita.
>
> Official transcripts of graduate work. The transcripts should cover
> all post baccalaureate course work.
>
> Three letters of recommendation from professionals who are familiar
> with your academic and professional competencies.
>
> Completed Interview Dates / Rotation Preference Form (unique to our
> site).

The deadline for receipt of application materials is December 1, 2007.
Our preference is that all the materials be included in a single, large
envelope. We do not require it, however. Please insure that letters of
recommendation, the verification form, and transcripts are enclosed in
appropriately sealed envelopes.

Our procedure is to review each application in detail and invite 25-28
applicants for interviews. The customary agenda is for the applicants to
meet with the Professional Chief and Directors of Training as a group.
Each applicant meets with three different supervisors who are chosen
based upon rotation preferences. Applicants meet with current interns as
a group in a totally nonevaluative information sharing meeting. Finally,
there is a general meeting among all applicants, supervisors, and
current interns. We encourage applicants to become familiar with our
staff and setting to assist in the decision making process. We try to
schedule seven applicants per interview day. We do not schedule more
than eight on a given day as a greater number overtaxes our resources.
Our practice is to make the applicants, who are invited for interviews,
our pool for the purpose of match day. That is, further reductions in
the pool of applicants are unlikely.

If you are unable to be present for a scheduled interview date, we can
arrange a conference call telephone interview. On site interviews on
other than the specified dates will be less formal and be accommodated
to the extent that they do not interfere with patient care duties.

Scheduled interview dates are:

Friday, January 4, 2008, 0800 -- 1215

Monday, January 7, 2008, 0800 -- 1215

Thursday, January 10, 2008, 1200 -- 0415

Tuesday, January 15, 2008, 1200 -- 0415

# DIRECTIONS TO THE VHA MEDICAL CENTER, DAYTON, OHIO

Interstate Road 70 runs east-west a few miles north of Dayton.
Interstate road 75 bisects Dayton in a north-south direction and US 35
bisects Dayton in an east-west direction. The VHA Medical Center is on
the west side of Dayton. Visitors are advised to use US 35 west from the
Interstate Road 75 / US 35 interchange. Take US 35 west to Liscum Drive
(second traffic light). The medical center is on the right. The Patient
Tower is the only nine story building in the area. If you need further
directions, lodging information, or have other questions, please feel
free to contact use using telephone or email. Also, a map is part of the
Dayton VHA Medical Center Web Site at
[www.dayton.med.va.gov](http://www.dayton.med.va.gov/)

Our main offices are located on the 9th Floor, Room 9D-132 of the
Patient Tower (Building 330). Parking is free throughout the medical
center and ample parking is available on the south and west sides of the
Patient Tower -- though please be prepared to walk a distance.

# MATCH DAY

The official dates for the 2008 -- 2009 academic year are as follows:

-   Wednesday, February 6, 2008: Deadline for submission of Rank Order
    Lists.

-   Friday, February 22, 2008: Applicants informed as to whether or not
    they were matched.

-   Monday, February 25, 2008: APPIC Match Day.

Immediately after learning the names of applicants with whom we have
been matched, a CoDirector of Training will contact each through email
and/or telephone. Also, s/he will be mailed two signed copies of a
letter confirming the match. Each applicant is to return one copy of the
letter after signing it.

# PSYCHOLOGY TRAINING COMMITTEE

**Aaronson, Arthur L.**

Psy.D., Clinical, 1988, Wright State University School of Professional
Psychology.

Staff Psychologist, Mental HealthCare Line.

At VHAMC-Dayton since 1988.

Licensed Psychologist, State of Ohio.

Professional Organizations: American Psychological Association (APA),
Divisions 12-Clinical Psychology, 18-Psychologists in Public Service,
41-American Psychology-Law Society.

Research Interests: MMPI/MMPI-2 and using assessment instruments to
predict outcome success.

Clinical Interests: assessment, psychopharmacology.

**Arnott, Margaret I.C.**

Ph.D., Counseling, 2000, The Ohio State University

Co-Director of Training, Staff Psychologist, PTSD Clinical Team

At VHAMC-Dayton since 2000

Licensed Psychologist

Research Interests: Quality of life issues in PTSD

Clinical Interests: group psychotherapy, assessment, psychoeducation

Theoretical Orientation: Integrated

#### 

#### Best, Nicole

Psy.D., Clinical, 1997, Wright State University School of Professional
Psychology

Staff Psychologist, Geriatric Extended Care Line

At VHAMC-Dayton since 1999

Licensed Psychologist, State of Ohio

Professional Organizations: American Psychological Association (APA),
Ohio Psychological Association.

Research Interests: psychoneuroimmunology, cancer, psychology and
spirituality, sports psychology and performance enhancement

Clinical Interests: geropsychology, psychological interventions with
terminally ill patients, grief work, end of life issues,
neuropsychology, health psychology, psycho-education, narrative therapy.

Theoretical Orientation: eclectic (common factors, cognitive-behavioral,
existential, and psychodynamic conceptualizations)

**Byrd, Anthony**

####### Psy.D., Clinical, 1989, Wright State University School of Professional Psychology

Clinical Neuropsychologist, Mental Health Care Line.

At VHAMC-Dayton since 1992.

Licensed Psychologist, State of Ohio & Arizona

Professional Organizations: American Psychological Association (APA),
Division 40, National Academy of Neuropsychology.

Clinical Interests: neuropsychology, dementia, psychopharmacology.

Theoretical Orientation: Eclectic

**Drown, Eric**

Psy.D., Clinical, Wright State University

Staff Psychologist, PTSD Clinical Team

At VAMC-Dayton since 2006

Professional Organizations: APA, INS, DAPA

Clinical Interests: Dual diagnosis population, special needs of elderly,
PTSD, mental health services in primary care

Theoretical orientation: Cognitive-behavioral with appreciation for
insight oriented interventions.

**Graham, Rebecca L.**

Ph.D., Clinical, 1991, University of Louisville.

Staff Psychologist, Inpatient Mental Health/Emergency.

At VHAMC-Dayton since 1991.

Licensed Psychologist, State of Ohio.

Professional Organizations: Society for Personality Assessment.

Clinical Interests: personality assessment; brief psychodynamic
psychotherapy; group therapy.

Theoretical Orientation: interpersonal/psychodynamic.

**Gustin, Nancy**

Psy.D., Clinical, 2005, Wright State University School of Professional
Psychology

Staff Psychologist, Mental Health Care Line

At VAMC Dayton since 2005.

Professional Organizations: APA

Research Interests: Evaluating the effectiveness of treatment
interventions such as values clarification and goal-setting for veterans
with complex problems (e.g., substance dependence, dually diagnosed,
PTSD, and homelessness)

Theoretical orientation: Integrative (primarily Cognitive Behavioral but
also incorporating other evidence-based practices such as Dialectical
Behavior Therapy, Stages of Change, and Motivational Enhancement
Therapy)

**Herr**, **Peter**

Ph.D., Clinical, 2001, University of Cincinnati

Staff Psychologist, Mental Health Care Line

At VAMC Dayton since 2007.

Licensed Psychologist, State of Ohio

Professional Organizations:

Research Interests: Substance dependence, chronic mental illness, group
processes, attribution process

Theoretical Orientation: Cognitive-Behavioral, Psychodynamic

**O\'Brien, William F.**

Ph.D., Counseling, 1975, Ohio State University.

Manager, Mental Health Care Line. Lead Psychologist.

At VHAMC-Dayton since 1984.

Licensed Psychologist, State of Michigan.

Professional Organizations: American Psychological Association (APA),
Division 18-Psychologists in Public Service (officer); Association of VA
Chiefs of Psychology (officer).

Research Interests: substance abuse; PTSD.

Clinical Interests: substance abuse; PTSD.

Theoretical Orientation: eclectic - client centered.

**Papadakis, Emanuel A.**

Psy.D., Clinical, 1987, Wright State University School of Professional
Psychology.

Staff Psychologist, Mental Health Care Line.

At VHAMC-Dayton since 1992.

Licensed Psychologist, States of Ohio and Indiana.

Professional Organizations: American Psychological Association (APA).

Research Interests: chronic illness; primary prevention.

Theoretical Orientation: biopsychosocial model; systems theory;
solutions orientation.

**Peterson, Frederick L. Jr.**

Psy.D., Clinical, 1985, Wright State University School of Professional
Psychology.

Staff Psychologist, Primary Care / Health Psychology.

At VHAMC-Dayton since 1985

Licensed Psychologist, State of Ohio.

Professional Organizations: AIDS Foundation of Miami Valley, American
Association of Sex Educators, Counselors, and Therapists, American Board
of Sexology, American Psychological Association (Div 51), American Lung
Association.

Research Interests: Smoking cessation, organizational assessment and
consultation, gender and management, HIV and volunteerism, sex education
and therapy, sexual trauma, men\'s studies.

Clinical Interests: clinical sexuality, smoking cessation, health
psychology, primary prevention in psychology, getting psychology out of
the box.

Theoretical Orientation: psychological pragmatism.

**Verdaguer, Ramon**

Ph.D. Clinical, 1990, Loyola University of Chicago.

ABPP 2004, Clinical Health Psychology

Co-Director of Training, Staff Psychologist, Primary Care/Health
Psychology

At VHAMC-Dayton since 1996.

Licensed Psychologist, State of Ohio and Illinois (inactive).

Professional Organizations: Div. 38, APA.

Research Interests: Positive psychology.

Clinical Interests: Wellness and health promotion, pre-surgical
psychological evaluations

Theoretical Orientation: Cognitive-Behavioral.

#  

# INTERVIEW DATES AND ROTATION PREFERENCES[^1]

Interview Dates

Please rank your preferred interview dates. We will contact you to
arrange an interview.

Morning Afternoon

Friday, January 4, 2008 \_\_\_\_\_\_\_\_

Monday, January 7, 2008 \_\_\_\_\_\_\_\_

Thursday, January 10, 2008 \_\_\_\_\_\_\_\_

Tuesday, January 15, 2008 \_\_\_\_\_\_\_\_

Rotation Preferences

Please rank order your three rotation preferences. Remember that,
regardless of rotation, each intern spends one day per week in the
Mental Health Clinic setting.

Health Psychology \_\_\_\_\_

Mental Health \_\_\_\_\_

Neuropsychology \_\_\_\_\_

PTSD Outpatient Program \_\_\_\_\_

#####  

Special Programs \_\_\_\_\_

Geropsychology (supplementary experience) \_\_\_\_\_

If you wish a six month rotation, please note it below.

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

(name)

[^1]: Pleased be advised that, for a number of reasons, we are in the
    process of redeveloping some of the rotations. We will try to update
    the brochure regularly.