Psychosis Emphasis Track

Consistent with the overall purpose of the clinical psychology internship, the primary goal of the Adult Psychiatry-Psychosis Emphasis track is on the acquisition of clinical skills.  Specific training objectives of the Adult Psychiatry- Psychosis Emphasis program include:

• Provide interns with a core knowledge base of the clinical features, treatment, neurobiology, and psychosocial factors involved in psychotic disorders;
• Provide comprehensive training and experience in the assessment and/or psychotherapeutic treatment of psychotic disorders;
• Provide comprehensive training in neuropsychological assessment of older individuals with suspected cognitive impairment and/or epilepsy;
• Further develop the intern’s research skills and expertise;

At the end of the internship, the intern should be able to function competently, autonomously, and with confidence in a variety of clinical settings.  

Consistent with the overall structure of the Consortium, the Adult Psychiatry-Psychosis Emphasis intern will spend 3.5 days per week at their primary placement in Adult Psychiatry, one day per week (currently Thursdays) at a secondary placement within the Consortium, and one-half day of didactic training (currently Friday Mornings).  Within the primary placement, one and a half days will focus on clinical assessment and research of psychotic disorders.  For the remaining 2 days per week, interns will choose two elective training experiences (each 1 day per week, all year): Geriatric Neuropsychology, Epilepsy Neuropsychology, and Psychotherapy.  At least one of the elective training experiences must be in neuropsychological assessment (i.e. geriatric or epilepsy).  For example, an intern may spend 1.5 days per week in psychosis assessment/research, 1 day per week in geriatric neuropsychology, and 1 day per week engaged in psychotherapy.  Details regarding the psychosis emphasis training and elective neuropsychology and psychotherapy training experiences are described in detail below.

Core Training Experience: Psychosis Assessment, Treatment, and Research

Supervisor(s): Neil D. Woodward, Ph.D.

Location: Vanderbilt Psychiatric Hospital

Working within a multidisciplinary treatment and research team, the intern will receive training in the following areas:

• Diagnostic Interviewing and Clinical Assessment of Psychotic Disorders.  The intern will have the opportunity to receive training and become competent in the administration of semi-structured diagnostic interviews and clinical symptom rating scales commonly used in evaluating and tracking outcomes in individuals with psychotic disorders. The Intern will also receive training and become competent in the administration and interpretation of clinical neuropsychological tests commonly used to assess individuals with a psychotic disorder. In collaboration with other psychologists, psychiatrists, and allied health professionals, the intern will determine working diagnoses and eligibility for participation in clinical research.  Interns will be asked to summarize results of their assessments at multidisciplinary team meetings and, where relevant, prepare neuropsychological reports.
• Research.  Research is an important component of the training experience.  The intern will be expected to become involved in on-going programs of research and complete an individual research project.  Current studies include neuroimaging investigations of brain function (i.e. working memory), functional connectivity, brain structure, and white matter integrity.  A significant focus of on-going research projects is on the early stage of psychotic disorders.  Interns will also have access to a large repository of existing clinical, cognitive, and neuroimaging data collected on several hundred individuals with a psychotic disorder and healthy subjects.  

At the end of training, the intern should be able to:

• Describe the biological, psychological, and social factors involved in the etiology, clinical features, and treatment of psychotic disorders;
• Conduct structured/unstructured clinical interviews for assessing and diagnosing psychotic disorders;
• Administer and interpret clinical neuropsychological measures commonly used to evaluate individuals with a psychotic illness;
• Communicate results of psychological/neuropsychological assessments and subsequent recommendations to patients and their families, and/or other healthcare professionals in the context of a multidisciplinary team setting;

Setting: The Vanderbilt Psychotic Disorders Program (VPDP) consists of a 22-bed unit within the VPH, a partial hospitalization program, and an outpatient clinic.  The VPDP incudes clinicians and researchers who assess, treat, and study patients with a psychotic disorder.  The clinical focus of the program is on the acute stabilization of psychotic inpatients at VPH and the implementation of long-term treatment plans through outpatient services affiliated with the Department of Psychiatry.  Each year the VPDP provides treatment to approximately 600 patients with a primary psychotic disorder, including over 90 first episode patients.

Elective Training Experience: Geriatric Neuropsychology

Supervisor(s): Neil D. Woodward, Ph.D.; Monica Jacobs, Psy.D., ABPP-CN

Location: Vanderbilt Psychiatric Hospital

Interns selecting this elective training experience will obtain experience conducting neuropsychological evaluations of older individuals with suspected cognitive impairment.  Referrals come mainly from the Vanderbilt Psychiatry Memory and Aging Clinic (VMAC), an outpatient clinic focused on assessment and treatment of older individuals with a wide array of psychological and neurological disorders.  These include depression, mild cognitive impairment, Alzheimer’s disease, fronto-temporal dementia, stroke, vascular dementia, and dementia with Lewy bodies. Training emphasizes the role of the neuropsychologist in the context of a multi-disciplinary team which includes a geriatric psychiatrist and registered nurse.  Under direct supervision, interns will conduct clinical interviews; administer, score, and interpret neuropsychological tests; prepare neuropsychological reports; and provide feedback to patients and families.

Interns selecting this training experience will develop the following competencies:

• Proficient in the administration and interpretation of clinical neuropsychological measures commonly used to evaluate older individuals with suspected cognitive impairment;
• Demonstrable understanding of the neuropathology, differential diagnosis, and treatment of dementias and other cognitive disorders associated with aging;
• Communicating results of psychological/neuropsychological assessments and subsequent recommendations to patients and their families, and other healthcare professionals in the context of a multidisciplinary team setting;

Elective Training Experience: Epilepsy Neuropsychology

Supervisor(s): Monica Jacobs, Psy.D., ABPP-CN

Location: Vanderbilt Psychiatric Hospital

This is an outpatient adult neuropsychological rotation at the Vanderbilt Psychiatric Hospital. Interns will see patients referred from the Vanderbilt Epilepsy Program, including patients with intractable epilepsy referred as part of their pre- and post-surgical workups, patients with cognitive impairment related to epilepsy, and patients with non-epileptic spells.  Interns may also have the opportunity to observe Wada testing and participate in multidisciplinary case conferences. Interns will see one patient per week and will be responsible for interviewing, testing scoring, and report writing. Turnaround time for reports is one week.  Interns will also be expected to set up times to provide feedback to patients regarding test results. It is expected that interns will have some experience with the administration of neuropsychological batteries and report writing. By the end of internship, it is expected that interns will be able to discuss lateralization and localization of deficits in patients with epilepsy, be able to make pertinent recommendations for patients with epilepsy related cognitive impairment, and differentiate between psychogenic and neurologically based cognitive impairment. It is also expected that interns will be proficient at writing reports that integrate information obtained from the clinical interview and medical records with the test findings, and will be able to convey this information to patients and their families in feedback sessions.

Interns selecting this training experience will develop the following competencies:

• Proficient in the administration and interpretation of clinical neuropsychological measures commonly used in the evaluation of individuals with a seizure disorder;
• Demonstrable understanding of the neuropathology, differential diagnosis, and treatment of seizure disorders;
• Communicating results of psychological/neuropsychological assessments and subsequent recommendations to patients and their families, and other healthcare professionals in the context of a multidisciplinary team setting;

Elective Training Experience: Psychotherapy

Supervisor(s): Kirsten Haman, Ph.D.; Heather Kreth, Psy.D.

Location: Vanderbilt Psychiatric Hospital

The primary focus of this elective experience is on the provision of individual and group therapy to a variety of patient populations in: 1) Partial Hospitalization Program (PHP); and 2) outpatient settings. 

1. Rotation through the PHP allows the intern experience with designing and leading group therapy with adult patients struggling from an array of symptomatology including depression, anxiety, mood regulation problems and psychosis. It will also provide opportunities for collaboration with the patient and multi-disciplinary team in formulation of treatment plans and delivery of patient care. 
2. An additional training experience focused on outpatient psychotherapy for individuals with a psychotic disorder, primarily first episode patients, is also offered.  Individuals experiencing their first psychotic episode are usually transitioned from the inpatient setting to the outpatient clinic with both psychiatrist and psychotherapist follow-up appointments. Patients meet with the psychotherapist prior to discharge to ensure smooth transition between the levels of services (inpatients to PHP to outpatient).  Individual psychotherapy places a strong emphasis on engagement skills, with a focus on cognitive-behavioral therapy (CBT) for symptom reduction.  Additional features of the outpatient experience include collaborative treatment planning and joint conceptualization with other providers.  

Psychotherapy in either setting is recovery focused and plans for transition back to college/work as soon as symptoms are stabilized. Across settings, Family Therapy is also offered to address issues including communication/roles/boundaries, and development and utilization of crisis planning.  The diversity of psychotherapy training experiences offered allows the intern to tailor their training experiences to meet their specific goals.

Depending on the specific experience (i.e. individual, group therapy through PHP) interns selecting this training experience will develop the following competencies:

• Initial interviewing, diagnostic assessment, treatment planning and case formulation;
• Proficiency in designing and implementing skills-based, group psychotherapy education for patients admitted to the Partial Hospitalization Program;
• Proficiency in implementing psychological interventions  including empirically supported approaches (e.g. CBT) in individual therapy;
• Building therapeutic rapport and appropriate setting of professional boundaries;
• Effectively communicating psychological concepts to non-psychologists  through ongoing consultation and collaboration with multidisciplinary staff

Consistent with other interns in the Consortium (e.g. those at the VA), interns will be expected to a complete an individual project (IP) during the course of the year. At the beginning of the internship year, the intern, working in collaboration with the intern’s primary supervisor and other psychosis researchers within the department, will select an IP that is aligned with the intern’s research interests and graduate training, and is feasible within the constraints of the internship year and resources of the program. 

Consistent with the overall structure of the Consortium, interns will be required to select a secondary placement outside their primary placement in Adult Psychiatry.  Given the emphasis on psychosis, neuropsychology, and research, interns will select a secondary placement that adds to the breadth of their training, rather than duplicating training experiences included in their primary placement.

Given the goals of the Psychosis Emphasis track, applications from interns whose achievements reflect a strong commitment to pursue careers emphasizing research and training in academic/research settings will be viewed favorably.  Prior graduate training/experience and research in psychotic disorders is essential.  Consistent with the overall requirements of the Consortium, applicants should have a minimum of 550 Total Intervention and Assessment Hours as defined by the AAPI.  While not required, it is recommended that applicants have at least 150 hours of assessment experience.

Jennifer Urbano Blackford, Ph.D.
Associate Professor of Psychiatry
Interests: Neural and genetic substrates of anxiety; temperament risk for psychiatric disease; neuroimaging; amygdala; BNST; schizophrenia

Emma Finan, LMFT
Associate in Psychiatry
Interests: First break/early stage psychosis; CBT; family therapy

Kirsten Haman, Ph.D.
Assistant Professor of Clinical Psychiatry
Interests: Training and supervision of CBT; efficacy of CBT for anxiety and depressive disorders; relation of medical conditions (cancer, POTS) to anxiety and depression

Stephan Heckers, MD.
Chair of the Department of Psychiatry, Professor of Psychiatry
Interests: Psychotic disorders; neuroimaging; neuroanatomy

Ellen Margaret House, MD.
Assistant Professor of Psychiatry
Interests: Child and adolescent psychiatry; college mental health; first episode psychosis

Monica Jacobs, Psy.D.
Assistant Professor of Clinical Psychiatry
Interests: Neuropsychological assessment

Heather Kreth, Psy.D.
Assistant Professor of Clinical Psychiatry
Interests: Children/adolescents; trauma; family therapy

Jeffrey G. Stovall, MD.
Associate Professor of Psychiatry
Interests: Schizophrenia; community psychiatry

Neil D. Woodward, Ph.D.
Assistant Professor of Psychiatry and Psychology
Interests: Neuropsychological assessment; psychotic disorders; neuroimaging