This track offers an array of clinical opportunities for trainees who are interested in evidence-based assessments and treatments for adults with a range of psychopathology, including but not limited to depressive/anxiety disorders, conditions requiring psychiatric hospitalization, and/or couples and families with relationship dysfunction. Settings include outpatient mental health for civilians (SATRP) and students (CBT-CAPS), outpatient mental health for veterans (CBT Clinic; Couples & Family Clinic), primary care for veterans (PCMHI), and psychiatric inpatient for civilians (CIPS). Each setting/rotation is supervised by faculty member(s) guided by the scientist practitioner model and well versed in a wide range of evidence-based approaches.
The CBT Clinic for Emotional Disorders is a specialized psychotherapy clinic with an integrated staff of psychologists and social workers. The clinic serves veterans with diagnoses of emotional disorders (major depressive disorder, dysthymia, panic disorder, social phobia, PTSD, OCD, specific phobia, and GAD) from referring providers throughout the VAMC mental health service. The CBT Clinic focuses evidence-based psychotherapies, including various versions of behavioral and cognitive therapies (e.g., PCT, PE, CPT, ERP) and newer adaptations (e.g., DBT, mindfulness, ACT). Because comorbidity is extremely common in this population, transdiagnostic approaches to psychotherapy are emphasized. Telehealth-based treatments also are used to provide evidence-based psychotherapy to veterans in underserved areas and/or with other obstacles to in-person treatments (e.g., transportation, severe avoidance).
The scientist-practitioner/clinical scientist model is highly valued by the staff within the CBT Clinic and plays an important role in clinical practice, supervision, and related research projects. Although the CBT Clinic primarily serves as a treatment service within VAMC, there are several recent and ongoing research projects within the clinic. To date, these projects have focused primarily on better understanding prevalence, severity, and diagnostic comorbidity of the emotional disorders and adapting evidence-based psychotherapies to real-life clinical practices (e.g., effectiveness, dissemination, and implementation research). Past interns also have been successful in publishing case studies resulting from the complex cases treated during the clinic.
Interns rotating within the CBT Clinic will receive both individual and group psychotherapy experiences in addition to supervision and training in evidence-based psychotherapies. Given the large number of referrals and opportunities, the CBT Clinic supervisors attempt to match/address an intern’s individual training needs with specific patient characteristics, diagnoses, and/or treatment practices or modalities.
After completing the CBT Clinic rotation, interns will be able to:
Ralph H. Johnson Veterans Affairs Medical Center
CBT-CAPS provides psychological assessment and individual and couples therapy to MUSC students, whose problems are representative of the wide spectrum of adjustment and mental health disorders.
Assessment: Comprehensive behavioral and intake assessments; assessments of mood and anxiety disorders; and assessments of issues affecting learning and academic performance.
Outpatient Individual Therapy: Psychotherapy ranging in duration and scope from brief cognitive behavioral work to longer-term therapy; couples therapy training is available, depending on demand.
Psychoeducational Groups: Groups are developed when appropriate patient populations are identified and may include social skills, conflict resolution, stress management, or relationship enhancement groups, for example.
Interns may elect to conduct research with the clinical population at CBT-CAPS. There is an extensive database available for use by the interns.
After completing the CAPS-CBT rotation, interns will be able to:
Medical University of South Carolina
Alice Q. Libet, Ph.D., clinical associate professor
On this rotation, interns attain proficiency in thoroughly working up couple and family relationships through the multi-systemic assessment of behaviors, attitudes, and feelings via semi-structured interviews, self-report measures, and observational assessments.
Interns serve as co-therapists, primarily with the rotation supervisors, but also occasionally with other interested and proficient intern or post-doctoral fellow colleagues. The primary intervention focus in the Couples Clinic is dyadic therapy via Jacobson’s and Christensen’s Integrated Behavior Couples Therapy (IBCT), which is a sophisticated unification of “classical” Behavioral Marital Therapy (i.e., communication skills, problem solving skills, and increasing positive event density) and Emotion Focused Therapy, leading to additional key intervention techniques around emotion (“Empathic Joining”) and cognition (“Unified Detachment”). Additional couples interventions include Behavioral Couples Therapy for SUD and Cognitive Behavioral Conjoint Therapy for PTSD.
Consistent with national trends in primary care and managed care, brevity of intervention (typically an 8 to 10 session span) is stressed. Couples are also typically invited to participate in a VA multi-center clinical research outcome study. Additionally, interns with research interests in prevention and/or in relationship strategic planning, life balance development, and/or in empirically examining interaction data will find ample opportunity to participate in clinical research in the Couples & Family Clinic.
After completing the Couples Clinic rotation, interns will be able to:
Ralph H. Johnson VA Medical Center
PCMHI is a primary care-based rotation that serves a wide range of presenting complaints within the scope of depressive, anxiety, adjustment, and mild substance use disorders. PCMHI patient referrals are based upon patient request, primary care provider recommendation, and/or cutoff scores on the VA primary care measures of depression and PTSD. Referred patients meet with a co-located mental health provider and complete a brief clinical interview, self-report measures, and a semi-structured clinical interview. Based on their level of impairment and interest in treatment, patients are offered a medication consultation with a PCMHI psychiatrist and brief evidence-based psychotherapy with a PCMHI psychologist, intern, or social worker. Patients with more severe psychopathology and/or impairment are referred directly to more intensive interventions in the mental health clinic. All patients within the PCMHI program also are followed by a social worker serving as a care manager. In addition, PCMHI staff (psychiatrist, psychologists, social workers, and nurse practitioner) work closely with their patients’ primary care providers to coordinate the patient's physical and mental health needs.
PCMHI interns are trained in a range of clinical activities including brief evidence-based psychotherapy, integration of behavioral health practices into psychotherapy, and coordination of treatment within a multidisciplinary team of primary care and mental health providers. Regarding psychotherapy, interns may be trained in a wide range of evidence-based practices (e.g., Behavioral Activation Treatment, Prolonged Exposure, Panic Control Treatment, Cognitive Behavioral Therapy for GAD). Additional training will be provided on treatment protocols specifically designed for the PCMHI setting with high risk and underserved veteran populations (brief behavioral therapy for depression and anxiety). Given the primary care setting, behavioral health practices (e.g., smoking cessation, weight management, reduction of alcohol consumption) also will be included in the training and treatment practices of interns. And finally, interns are trained to function successfully within a multidisciplinary team.
After completing the PCMHI rotation, interns will be able to:
Ralph H. Johnson VA Medical Center
The SATRP is an adult outpatient clinic providing state-of-the-art evidence-based treatments for various sleep and anxiety disorders. The clinic serves patients with primary diagnoses of social anxiety, obsessive-compulsive disorder, panic disorder, specific phobias, and generalized anxiety disorder. In addition, the clinic provides state-of-the-art sleep studies and behavioral and psychopharmacological interventions for sleep disorders (insomnia, narcolepsy, and restless leg syndrome). Interns rotating at SATRP develop expertise in cognitive behavioral approaches to the treatment of anxiety and sleep within a multidisciplinary environment alongside social workers, psychiatrists, and psychiatry residents. Interns use semi-structured assessment batteries to assist with diagnoses. Treatment approaches typically include exposure-based behavioral, cognitive-behavioral, and acceptance and mindfulness-based interventions. Individual and group therapy training are provided. Interns participate in weekly individual and group supervision with psychiatry residents and the supervising psychologist.
Further, interns are invited to engage in ongoing collaborative anxiety research projects with psychiatry and psychology faculty. Current projects include the relationship between sleep disorders and anxiety and optimizing existing anxiety interventions.
After completion of the SATRP rotation, interns will be able to:
MUSC Department of Psychiatry and Behavioral Sciences