Predoctoral Internship Training Program in
Clinical & Community Psychology

Training Sites

Yale-New Haven Hospital

YNHH and YNHPH Program Description
Psychology Internship Training Tracks

• Adult Dialectical Behavior Therapy Track
• Adolescent Track
• Behavioral Medicine Track

Psychological Assessment Training
Individual Psychotherapy Training
Research Elective
Supervision and Seminars

YNHH and YNHH Program Description

Yale-New Haven Hospital is the major teaching and clinical research facility of the Yale University School of Medicine. It is a 900 bed general hospital that encompasses the Yale-New Haven Psychiatric Hospital (YNHH) a 74 bed, acute care, psychiatric facility that consists of four main inpatient programs and a range of intensive outpatient/day hospital programs.

Psychiatric services at YNHH include:

1. 1. An Adolescent Inpatient and Intensive Outpatient Service: This service provides short term inpatient treatment for adolescent and young adult patients with a wide range of diagnoses including affective disorders, psychoses, developmental disorders, conduct disorders, and psychiatric disorders combined with substance abuse. Comprehensive biopsychosocial assessment and treatment, intensive family consultation and crisis intervention are the core treatment modalities. After discharge, some adolescents continue to be followed in a brief (6 to 8 week) after-school intensive outpatient program, which is designed to help patients make the transition from inpatient treatment to their home, school, and community environments.
2. Adult Inpatient Services: This service consists of three separate inpatient programs, a General Adult unit, an Adult Dual Diagnosis unit for patients with co-occurring psychiatric and substance abuse disorders, and a specialized Geriatric unit that focuses on treatment of the elderly. Patients within these programs generally present with complex combinations of disorders reflecting psychotic, affective, cognitive, neurological and medical components. Treatment in the short-term setting focuses on rapid comprehensive diagnosis, symptom reduction, and pharmacological treatments. Psychosocial treatments emphasize individual and family crisis intervention.
3. Adult Ambulatory Services (intensive outpatient programs): These services are geared to adult patients who do not require the level of supervision and support provided by an inpatient program, but who need more intensive intervention than is readily provided in most outpatient settings. Most patients are admitted for treatment of mood disorders, anxiety disorders, chronic suicidal ideation, co-occurring disorders (psychiatric and substance abuse disorders), personality disorders and family/interpersonal conflicts. Patients are admitted to one of four main treatment tracks: 1) General Psychiatric track for patients with mood, anxiety and/or psychotic disorders; 2) Dual Diagnosis track for patients with psychiatric and substance use disorders; 3) Dialectical Behavioral Therapy (DBT) track for patients with borderline personality disorder features who struggle with chronic patterns of suicidal or other self-destructive behaviors; and 4) DBT for substance use disorders (DBT-SUD) is provided for patients who struggle with borderline personality disorder features and substance abuse or dependence.
4. Behavioral Medicine Service: The Behavioral Medicine service is a psychological consultation and intervention service designed to improve access to mental health care for severely ill, medically compromised patients within select adult medical services of YNHH. The aim of this program is to improve accessibility of care through the integration of behavioral health services within the context of a patient’s overall medical care. Currently, behavioral medicine services are provided to patients within the Yale-New Haven Transplantation Center, the Yale Cancer Center, and to the Department of Neurology and Neurosurgery’s epilepsy program.
5. Psychiatric Consultation Service: This service provides psychiatric consultation for all adult medical, surgical, and obstetrical/gynecological services at YNHH. Each psychiatric consultation consists of a thorough assessment and the formulation of a treatment regimen based on a careful differential diagnosis, an understanding of relevant psychosocial factors, and a knowledge of psychopharmacology.
6. Psychiatric Emergency Service is known as the Crisis Intervention Unit. Located in the Emergency Department staff provide emergency evaluation and crisis management for approximately 4,000 patient visits per year. The CIU does rapid diagnostic assessments and formulates disposition plans for patients with a wide variety of diagnoses.

Psychology Internship:

The Psychology Internship at the Yale-New Haven Psychiatric Hospital provides interns with an opportunity to train in clinical settings that are using emerging models of mental health care. The internship provides experience reflecting the increasing emphasis on short-term inpatient and intensive outpatient care with triage to outpatient treatment. It provides the opportunity to work with acutely ill adults and adolescents who suffer from a range of psychiatric disorders including mood disorders, psychotic disorders, personality disorders, and substance abuse disorders, as well as with patients diagnosed with severe life-threatening medical illnesses. The settings in which the interns' participate allow for the development of skills in assessment of psychiatric disorders, rapid treatment strategies, multidisciplinary collaboration, and integration of therapeutic interventions including pharmacotherapy.

Applicants for predoctoral training must chose between one of the three training tracks. The training programs in each track emphasize the acquisition of core competencies in assessment intervention, consultation, research and cultural diversity. As such, interns within each track receive training in direct patient care, group leadership, effective participation in multidisciplinary team rounds and staff conferences, and therapeutic, administrative, and theoretical issues. Predoctoral interns are trained in multiple therapeutic modalities, including crisis intervention, individual case management, group therapy, family therapy, and in collaborative methods for pharmacologic and psychotherapeutic interventions including Dialectical Behavior Therapy. All predoctoral interns also receive clinical training in psychological assessment, and have the opportunity to conduct long-term psychodynamic individual psychotherapy within Yale's Long Term Care Clinic (LTCC). For all interns, one half day is reserved for Departmental seminars and related activities.

The Yale-New Haven Hospital offers training in a variety of practice settings based in three main settings. These include the Adult Dialectical Behavior Therapy Program, Adolescent Services, and Behavioral Medicine.

Option 1: The Adult/Dialectical Behavior Therapy Track (APPIC #118311):

Two predoctoral interns are selected into the Adult/ Dialectical Behavior Therapy Track. The training track consists of a twelve month rotation within the adult ambulatory services with special emphasis in Dialectical Behavior Therapy training.

Moderately to severely ill patients, who once would have been treated with extended stays in inpatient services, are now cared for in less restrictive community-based ambulatory service settings such as a partial hospital or intensive outpatient programs. Accordingly, the focus of the Adult Dialectical Behavior Therapy Track is on continuity of care from inpatient treatment to intensive outpatient treatment, and the acquisition of advanced clinical skills in evidence based therapies with particular emphasis on Dialectical Behavior Therapy for patients suffering from Borderline Personality Disorder and persistent self-destructive behavior.

Core clinical responsibilities:

In the Adult Ambulatory Services, predoctoral interns function as primary clinicians within a multidisciplinary team and serve as a primary clinician for 8–9 patients within the program's DBT and DBT-SUD tracks. The DBT and DBT-SUD tracks provide comprehensive DBT treatment modified for a group-based day hospital setting. DBT/DBT-SUD therapy groups include skills training, diary card review, behavioral analysis, and skills coaching. In addition, the interns and other DBT clinicians provide telephone skills coaching and meet weekly for a DBT consultation group. Interns may also have the opportunity to conduct brief individual therapy using the DBT model based on their interest and clinical availability.

Interns also receive additional training leading cognitive-behavioral psychotherapy and topic-focused groups (e.g., Family Issues, Motivational Enhancement), conducting admission assessments, consulting with the attending psychiatrists, participating in daily treatment planning/review meetings and Motivational Enhancement case conferences. As the primary clinician, the intern meets with the patient, receives information about the patient from other clinicians and program staff, coordinates program treatments with those provided by the patient's outpatient therapist, and plans for the patient's discharge from the program. The intern learns to coordinate knowledge of psychopathology, psychotherapy, and pharmacotherapy with management of environmental stressors.

During the entire training year, interns in this track will also receive clinical training in psychological assessment, and will have the opportunity to conduct long-term psychodynamically-informed individual psychotherapy within Yale’s Long Term Care Clinic (LTCC).

For more information about this placement site, please email seth.axelrod@yale.edu.

Option 2: The Adolescent Track (APPIC #118312):

One predoctoral intern will be selected into the Adolescent training Track. This track consists of a twelve month primary rotation within YNHH’s Adolescent Inpatient and Intensive Outpatient Services, and provides interns with the opportunity to receive a unique and rich inpatient and intensive outpatient clinical training experience with a broad range of demographically and diagnostically diverse adolescents and families.

Core clinical responsibilities:

The Adolescent placement is a twelve-month rotation within YNHH's short-term adolescent inpatient unit and step-down intensive outpatient program. This rotation provides interns with the opportunity to learn about a wide range of psychopathology in adolescents characterized by fairly diverse socioeconomic and ethnic backgrounds. The most frequently encountered problems involve mood disorders, psychosis, PTSD, disruptive behavior disorders (such as oppositional defiant disorder, conduct disorder, and ADHD), and substance use disorders.

Predoctoral interns function as primary clinicians within a multidisciplinary team to an assigned caseload of adolescent inpatient and intensive outpatient program patients. Thus, predoctoral interns have the opportunity to provide services for both acutely disturbed patients in need of inpatient crisis stabilization as well as for those requiring a step-down intensive outpatient level of care. Interns within this track work closely with families and local school systems and also have the opportunity to learn about the community context of adolescent psychopathology and how to perform multiple roles with this population. Clinical activities include primary clinician for approximately four adolescent patients, family therapy, group therapy (intensive group psychotherapy as well as a modified Dialectical Behavior Therapy skills groups), crisis intervention, and collaboration with community clinicians, schools and agencies.

During the entire training year, each fellow within the Adolescent Training Track will also receive clinical training in psychological assessment, and will have the opportunity to conduct long-term psychodynamically-informed individual psychotherapy within Yale’s outpatient Long Term Care Clinic.

For more information about this placement site, please e-mail dwain.fehon@yale.edu.

Option 3: Behavioral Medicine Track (APPIC #118323)

Two predoctoral interns will be selected into the Behavioral Medicine training track. This track consists of an eight month primary rotation within YNHH’s Behavioral Medicine service, and a four month secondary rotation in Neuropsychological Assessment within the Department of Neurosurgery's adult epilepsy program.

The role of the Behavioral Health psychologist is to provide support and assistance to medical care providers and their patients so that the patient’s emotional and mental health needs can be addressed within the context of their overall medical care. Behavioral Medicine services have the potential to benefit both patient and physician by improving access to behavioral health care for medically compromised individuals, improving adherence to medical treatments, targeting lifestyle and psychosocial issues effecting wellness, addressing issues of pain management, stress tolerance, coping, and by helping to prevent the development of more serious mental health disorders through early recognition and intervention.

Core Clinical Responsibilities:

During the eight month Behavioral Medicine rotation, interns will receive training within YNHH’s Behavioral Medicine Service—a psychological consultation and intervention program integrated within specialized medical services of Yale-New Haven Hospital. Interns work within multidisciplinary teams of medical providers (consisting of physicians, surgeons, nurses, and social workers) and gain valuable experience in the provision of behavioral health consultation, psychological assessment, and behavioral health intervention services to a broad range of medically ill patients.

Interns within the Behavioral Medicine service of Yale-New Haven Hospital receive clinical training within the Yale-New Haven Transplantation Center, Yale Cancer Center, and the Department of Neurology and Neurosurgery’s epilepsy service. In these settings, interns participate in weekly multidisciplinary case conferences, conduct clinical assessments, provide behavioral health treatment to medically ill individuals, and provide support to their caregivers. Interns also conduct evaluations of potential donors within the liver transplant service, provide pre- and post-surgical counseling to epilepsy neurosurgery patients, and participate in an interdisciplinary palliative care team.

During the four month Neuropsychology rotation, interns will receive basic training in neuropsychological assessment within the Department of Neurosurgery. This service conducts comprehensive assessments to a range of adult patients, with primary emphasis on patients with intractable epilepsy who are considering resective neurosurgery. Consequently, predoctoral interns have the opportunity to conduct pre-surgical cognitive evaluations, including WADA assessments.

Interns within the Behavioral Medicine track also have the opportunity to participate in several ongoing clinical research projects, including a study that examines the relationship between pre and post transplant psychological adjustment and quality of life, a randomized clinical trial of a mindfulness-based stress management and relaxation program for liver transplant candidates, and a study exploring psychological characteristic of patients with non-epileptic seizure disorder. Interns are supported in their efforts to generate and develop their own independent research projects during their rotation in Behavioral Medicine.

Interns within this track are invited to attend a Health Psychology training seminar sponsored by the Connecticut VA Health System, and a seminar on Neuropsychology sponsored by the Department of Neurosurgery.

For more information about this placement site, please e-mail dwain.fehon@yale.edu.

Psychological Assessment Training:

Predoctoral interns have the opportunity to conduct psychological diagnostic testing protocols during the year within each of the program’s three training tracks. Diagnostic assessments include evaluations of newly admitted patients on the inpatient units and patients who have been participating in treatment for longer periods in the ambulatory services programs. Each assessment involves administering and interpreting a variety of instruments, participating in individual testing supervision, consulting with the treatment team about the implications of test results for the patient's treatment, providing feedback to the patient in consultation with the treatment team, and writing a final report. Supervised full battery neuropsychological assessment training is also available through YNHH’s Department of Neurosurgery epilepsy service. Predoctoral interns within the psychiatric hospital conduct both traditional full battery assessments as well as brief forms of personality assessment and neuropsychological screening.

Individual Psychotherapy Training/Long Term Care Clinic:

In the outpatient Long Term Care Clinic, a psychotherapy training clinic operated by Yale University’s Department of Psychiatry and YNHH, interns have the opportunity to treat individual outpatients throughout the entire training year. Individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic modality most appropriate to the assigned cases. Typically, predoctoral interns see one individual therapy patient in either once a week or twice-a-week psychotherapy for the full duration of their training year.

Research Elective

An optional year-long research elective is available to predoctoral interns within the YNHH psychology training program. One-half day per week of protected research time is provided to allow interns the opportunity pursue and conduct clinical research within the Yale School of Medicine. Research training objectives are individually designed and achieved through an apprenticeship model where the fellow works closely with a faculty mentor involved in a program of active research. Interns are matched with faculty mentors based on their shared interests and faculty availability. The faculty member serves as supervisor and role model, with the goal of integrating clinical and research skills as well as professional role identity.

Supervision and Seminars:

Predoctoral interns at YNHH receive individual supervision with full and part-time faculty representing a broad range of interests and expertise. Each fellow is assigned a primary supervisor for weekly supervision of assigned cases including individual, group, and family therapy. Primary supervisors are permanent faculty assigned to the same clinical program that the fellow is assigned. In addition to formal weekly supervision, a major form of supervision is provided "on-line" via modeling, treatment team meetings, and consultation. Interns are also assigned an individual secondary supervisor who provides additional weekly clinical supervision for the entire training year. Through intensive supervision, interns also address issues of professional development and learn about the complexities of different roles within different treatment settings.

Interns at YNHH are also assigned the role of “peer supervisor” to junior trainees within their primary clinical service. Typically, junior trainees are second or third year graduate students from regional doctoral psychology programs who are participating in clinical practicum placements at YNHPH. As a “peer supervisor”, interns meet weekly with their supervisee and have the opportunity to develop basic skills as a clinical supervisor by processing this experience within the context of their own primary supervisory relationship.

Predoctoral interns at YNHH also attend, interact, and present material at the hospital’s weekly Psychology Fellow Seminar. Topics within this seminar include psychological assessment; theory and practice; crisis intervention; family assessment and treatment; and advanced group psychotherapy techniques. Additional topics are added each year depending on the interests of interns and faculty. In this seminar group, interns also have the opportunity to present clinical case material as well as findings from independent research projects. Interns may also attend a variety of optional departmental clinical and research forums, and a range of seminars within the Department of Psychiatry, including weekly Departmental Grand Rounds that cover both clinical and research topics.

Annual Borderline Personality Disorder Conference:

A one-day conference on Borderline Personality Disorder (BPD) is held each year co-sponsored by the School of Medicine Department of Psychiatry, the National Education Alliance for Borderline Personality Disorder, and NAMI-Connecticut. These conferences have addressed pressing clinical issues related to BPD such as suicidality in adolescents, trauma and resiliency, and problems of substance use, with internationally recognized experts in their respective fields. In addition to providing valuable continuing education to mental health professionals, these conferences are open to individuals who struggle with BPD and their families and strongly emphasis support and recovery models.

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