The postdoctoral training program is designed to be flexible in order to meet each resident’s individual goals for training within the selected emphasis areas. The following is a more detailed description of some of the didactic and training areas:

Seminars: Residents select among the weekly seminars that emphasize the development of competency, knowledge, and professional identity. A number of nationally recognized figures are available for case consultation or presentations on research, assessment, interventions and professional issues. Residents take an active role in selecting training topics and consultants in concert with their supervisors/mentors. During the seminars, both residents and interns deliver at least one scholarly presentations. Residents' presentations are expected to reflect their advanced training status. While some seminar time is shared with the interns, other seminar time is specific to the needs and wants of the postdoctoral resident.

Opportunities are available for residents to attend and participate in other educational seminars and case conferences throughout the hospital and community.

Neuropsychology Case Conference: (Optional or required depending upon track chosen) This year-long, weekly conference involves didactics and case presentations and provides residents with the opportunity to improve their competence in interpretation of neuropsychological tests, consultation, and peer supervision. Staff, students, interns, and residents of more than one discipline often attend. Preceptors: Drs. Bares, Lamberty , Lundgren (ABPP), Nelson (ABPP), Simm, and Wickie-Cohen.

Research: Research and scholarly activity are viewed as integral parts of the postdoctoral training experience. Residents who have ongoing projects will be allotted time to continue their research endeavors. Residents may also choose to contribute to ongoing projects conducted at the Medical Center. Reesearch can take on several forms depending upon the training goals of the resident. For residents that are more clinically focused, between 15-25% research time is provided to complete a scholarly project that is commensurate with the release time allotted. For residents who are more research or academically oriented, up to 49% research time is provided to complete research project(s) that are commensurate with the release time allotted. Since completing original data collection projects can be challenging within the confines of a 12 month training program, residents typically take advantage of collaborating with several of our very productive clinical researchers on staff. Regardless of focus, all residents are expected to develop a strong working knowledge of the scientific literature pertaining to assessment and intervention and all clinical activities should be guided by this knowledge base. The Training Staff and Funded Research pages highlight some of the current research interests and activities of our doctoral staff. Other opportunities can be discussed with specific staff members as desired.

Administrative Experience: Residents are required to obtain administrative experience with psychologists who are actively involved in clinical administration. This experience involves didactics, shadowing and completion of an administrative project. Supervisors: Drs. Billig Leskela, Lundgren, Mylan, Perry, Schumacher, and Siegel.

The Psychological Assessment Training Clinic: (Optional or required depending upon past experience). Through this year-long group training experience, residents may conduct a range of assessments for the purpose of psychodiagnosis. Competencies emphasized include diagnostic interviewing, intellectual assessment, personality assessment using the MMPI-2, the Rorschach, and other instruments, and the provision of consultation and peer supervision. Residents can expect to become familiar with the relevant research. Supervisors: Drs. Arbisi and Peterson

Addictive Disorders Section (ADS): Psychologists at this medical center play a major role in providing clinical, administrative, and research/program evaluation services to patients with substance use disorders. The major focus is to provide flexible and individual treatment by matching patient needs with the most appropriate interventions. Patients are exposed to a wide range of assessment and treatment activities over varying lengths of time. These services are provided to patients with a primary substance use disorder; however, many patients are dually diagnosed with medical and/or psychiatric comorbidities. Treatment activities include individual and group therapies (process-oriented and structured skill-building), behavior and case management, and patient education. Assessment techniques include face-to-face diagnostic interviews, objective and projective personality testing, substance use questionnaires, and neuropsychological screening. Also, psychology staff provide consultation, participate in multi-disciplinary treatment planning and review, and are actively engaged in research programs. Residents are expected to participate in these activities and thereby develop competencies in a wide array of assessment and intervention strategies used for substance abuse as well as in consultation. Supervisors: Drs. Kotes, Siegel, and Silversmith.

Admissions/Crisis/Consultation (ACC): ACC is the main intake and evaluation center for patients with mental health problems. It is composed of Psychiatry Urgent Care, an Inpatient/Outpatient Consultation Group, and an Inpatient Team. The ACC Team works closely with the Medical Center Emergency Room, Inpatient Psychiatry, and Primary Care/Mental Health to assess and stabilize patients in emotional crises. Training objectives for interns include the development of competencies in diagnostic interviewing, psychological and neuropsychological screenings and assessments, brief therapy, crisis management, and consultation, as well as development of a professional identity as a psychologist. Supervisors: Drs. Arbisi and Kodl.

Geropsychology: The Geropsychology rotation provides training in the evaluation, assessment, and treatment of geriatric medical and psychiatric patients. The primary training settings include the Extended Care Center (a transitional nursing home care unit), the Geropsychiatry Outpatient Clinic, and the GRECC Memory Loss Clinic. Additional training experiences with older adults can be obtained through hospital-wide geriatric referrals that involve a wide variety of diagnostic and therapeutic issues. Skills emphasized on this rotation are: a) developing an understanding of normal functioning in aging, such as age-related changes in cognitive and physical functioning and common developmental issues/tasks associated with aging; b) using of a variety of assessment techniques (personality, intellectual, neuropsychological, behavioral) with older adults; c) individual psychotherapy with older adults, including interventions that are typically employed with psychiatric patients (e.g., time-limited dynamic and cognitive-behavioral therapy) as well as approaches tailored more specifically to the needs of older adults (e.g., life review, reminiscence therapy, chronic pain management, treatment of sleep disorders); d) time-limited, psychoeducationally-oriented group therapy (e.g., CBT for affective disorders, grief, caregiving); and e) engaging in consultation and professional development through functioning as members of inter-disciplinary teams and consultants to a variety of services within the hospital. Additionally, some work with couples/families is possible, contingent upon previous training or participation in the Family Therapy Training Clinic at this facility. The primary theoretical orientation of the rotation is cognitive-behavioral, although other approaches (e.g., behavioral, narrative/solution-focused, and psychodynamic) also are integrated when appropriate. Supervisors: Drs. Bares and Rodman.

Primary Care/Health Psychology: Trainees, as do staff psychologists in this setting, function as interdisciplinary team members on one or more of the Primary Care Teams to assist the primary care providers in managing the overall health of their enrolled population. Goals of this integrated, biopsychosocial model of care include increased accessibility to mental health services and consultation for all patients and primary care staff, early identification and intervention regarding a broad range of mental health problems, and elimination of common barriers to mental health care. The psychologist’s and intern’s role within this model is to provide immediate, onsite consultation, targeted assessment and evaluation, clinical triage, and brief, solution focused treatment utilizing evidence-based modalities such as cognitive behavioral therapy targeted toward symptom reduction and improved health and quality of life. Stages of change theory and motivational interviewing techniques are also commonly utilized in this setting. Continued communication with the primary care provider regarding the patient’s progress and treatment plan is a hallmark of this model. Psychologists and interns will encounter a wide range of presenting problems to include depression, anxiety, PTSD, substance use problems, insomnia, chronic/terminal medical illness, interpersonal problems, chronic pain, adjustment problems, and somatic concerns. Supervisor: Drs. Billig, Meyers, Olson, Skroch, and VanEgeren.

Home Based Primary Care: This interdisciplinary team (MD, nurses, social workers, OTs, Dietitian, psychologist) delivers primary care and related services to veterans in their homes.  Most of the patients are elderly and have difficulties coming to the hospital due to medical reasons, but we also serve some younger veterans with long-term medical illness.  The rotation offers trainees the unique experience of meeting patients in their regular living environment, which provides a more complete picture of all the variables and systems impacting a patient’s psychological functioning.  The following learning experiences are part of this rotation and will be tailored to the intern’s needs and abilities:

• Initial evaluation and screening for cognitive functioning and psychiatric symptoms
• Diagnosis and treatment planning
• Focused psychotherapy, including family therapy and couples counseling
• Behavioral health interventions (e.g., smoking, pain management)
• Psychoeducation for patients and family members
• Care coordination with other providers
• Taking part in interdisciplinary team meetings and the neuropsychology seminar

Supervision is provided from an integrative stance that includes cognitive-behavioral, psychodynamic, Acceptance and Commitment Therapy, and family therapy approaches, with the aim of building on the trainee’s existing skills, while at the same time teaching new perspectives.  Supervisor: Dr. Hess

Mood Disorders and General Psychiatry: This team specializes in mood disorders and also has a very large general mental health focus. It is staffed by two psychologists, three social workers, two registered nurses, two clinical nurse specialists, and eight psychiatrists. Diverse theoretical perspectives are represented on the team. There are several models of individual and group psychotherapy utilized by practitioners on the team, including cognitive-behavioral and interpersonally-oriented therapies. This rotation emphasizes diagnostic interviewing, psychological assessment, and psychological intervention. Residents working with the team will have the opportunity to participate in team intake evaluations, outpatient personality assessment, and neuropsychological screening evaluations. They will also have the chance to conduct individual and group psychotherapy. Supervisors: Drs. Perry and Walden.

Neuropsychology: The neuropsychology rotation is appropriate both for interns desiring to specialize in neuropsychology and for those with limited experience. The test battery is an eclectic one and is based upon the Boston philosophy of a flexible battery approach. Competence in consultation skills is developed through participation in the Polytrauma Center’s Traumatic Brain Injury (TBI) Team Clinic, weekly neuropsychology seminar, GRECC Memory Clinic Team and Multiple Sclerosis Team meetings. Residents may expect to see a variety of patients, young and old, including those with strokes, dementia, head traumas, tumors, seizures, multiple sclerosis, and various other neurological disorders. Exposure to the evaluation and treatment of acquired aphasias also is available. Drs. Bares, Blahnik, Clason, Collins, Lundgren, Lamberty, McGuire, Nelson, Sim, and Cohen.

Partial Psychiatic Hospitalization (PPH): PPH is a cost-effective and clinically-viable alternative to full hospitalization. All patients receive intensive treatment while avoiding some of the malignant regressive temptations often associated with inpatient care. Patients preserve some of the adaptive skills and the dignity associated with living in their own residence while attending daily programming focused on the maintenance or restoration of social competence. Organized within a therapeutic community or milieu setting, the broad range of treatments include, but are not limited to, case management, educational therapy, group therapy, occupational therapy, recreational therapy, and medication management. The psychologist working within these partial hospitalization programs performs routine and special diagnostic assessments, conducts group therapy, consults to the multidisciplinary team, and participates in the patient education. Residents can expect to be involved in all aspects of the partial hospitalization programming and thereby develop competence in diagnostic testing, including Structured interviewing, the MMPI-2, the Rorschach and other projective techniques, psychoeducational groups, motivational interviewing, process-oriented group and consultation. Supervisor: Drs. Barrs, Broden, Isenhart, Peterson, and Schumacher.

Post-Traumatic Stress Recovery (PTSR): PTSR provides training in the assessment and treatment of patients with acute and chronic trauma-related disorders. Through clinical experience, supervision, and didactic training, interns can expect to develop a comprehensive understanding of the sequelae of trauma and treatment approaches for trauma-related disorders. Skills developed on this rotation include: diagnostic interviewing, psychological testing using objective, projective, and neuropsychological techniques, psychotherapy with individuals, families, and groups, and consultation to the multidisciplinary team. Residents also have the opportunity to participate in psychoeducational activities. Treatment orientations include cognitive-behavioral, family systems, narrative, and psychodynamic but an emphasis on empirically supported treatments including Acceptance and Commitment Therapy, Cognitive Processing Therapy, Dialectic Behavior Therapy, Prolonged Exposure, and Seeking Safety which addresses PTSD symptoms and comorbid substance use problems. Residents have the opportunity to fully participate in these activities and function as an active member of a multidisciplinary team. Supervisors: Drs. Erbes, Glaser Kattar, Leskela, Polusny, Strom, and Wagner-Mickle.

Rehabilitation Psychology: provides training in assessment and intervention to help patients reach their maximum rehabilitation potential. Depending on background and an interns training goals, you will:

• Assess psychopathology among inpatients on rehabilitation, medical, and surgical wards
• Use abbreviated and full neuropsychological evaluation batteries for differential diagnosis, document the level of cognitive dysfunction and determine rehabilitation potential
• Use neuropsychological / personality / vocational testing to increase the patient's awareness of strengths and deficits and determine appropriate rehabilitation planning
• Assess rehabilitation needs of psychiatric patients (primarily the seriously mentally ill) and integrate supported employment with psychiatric and rehabilitative treatments through our Medical Center's supported employment program, Veterans Industries
• Serve as a member of multidisciplinary teams (e.g., Stroke, Spinal Cord Injury, Multiple Sclerosis, Polytrauma Rehabilitation (see below), Cardiac Rehabilitation, Psychiatry Partial Hospitalization, and Veterans Industries)
• Treat chronic pain and / or provide general consultation / liaison services to medical and surgical patients
• Develop expertise in medical and psycho-social aspects of disability; brain-behavior relationships; neuroanatomy and physiology; psycho/medical pharmacology; the effects of aging on disability and independent living; ergonomics and barrier removal; policy and advocacy issues; the relationship of psychopathology to vocational and behavioral functioning; and the rehabilitation process in general, including cross-disciplinary contributions and assistive technology.

Supervisors: Drs. Blahnik, Broden, Clason, Collins, Grace, Harris, Engdahl, Howard, Kennedy, Lamberty, Lundgren, McGuire, Merladet, Petska, Sim, Spoont, and Cohen.

Serious and Persistent Mental Illness (SPMI): Previously known as the Schizophrenia and other Psychotic Disorders Program (SPDP) Team. This team specializes in the treatment and assessment of patients with psychotic disorders. The team is staffed by various mental health professionals, including psychologists, social workers, addiction therapists, psychiatric nurses, clinical nurse specialists, and psychiatrists. Patients treated range widely in their level of functioning, insight, and persistence of psychopathology. Residents develop competence in the conceptualization and assessment of psychosis and other psychiatric symptoms, as well as in the assessment of cognitive and social functioning in both outpatients and inpatients. Residents working with the team will have the opportunity to participate in team intake evaluations, objective psychological assessment, and neuropsychological evaluations. Training opportunities also exist for individual therapy, patient psycho-education, group therapy, and couples or family interventions. Although some clinicians may assume that biological abnormalities in psychotic disorders justify only somatic treatment, there is a vast need for psychological and social interventions with these patients. Supervisor: Drs. Barrs, Hegeman, Hoffman-Konn, Nienow, and Sponheim.

Women’s Clinic: The Women’s Clinic utilizes a multidisciplinary team approach and provides primary care for women who are veterans or on active duty. An important emphasis of training is to develop knowledge of and sensitivity to gender-specific issues, such as the impact of violence on women’s health, single parenting, and women’s health problems (e.g., gynecological cancer). The Women’s Clinic rotation can have either a health/primary care or mental health focus. Residents with a health/primary care psychology focus develop assessment and intervention skills relevant to health issues (e.g., chronic pain, sleep disorders, premenstrual dysphoria, weight loss, infertility), including biofeedback, relaxation, and group interventions. Residents with a mental health focus develop competence in psychological evaluation and psychotherapy for common psychiatric disorders, such as major depression, and for psychological issues that occur more frequently in women than men, such as sexual trauma and domestic violence. Regardless of focus, consultative skills are emphasized. Supervision is from a cognitive-behavioral theoretical orientation. Supervisor: Dr. VanEgeren.

Acceptance and Commitment Therapy (ACT): ACT is a functional contextual therapy that views psychological problems dominantly as problems of psychological inflexibility. ACT uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility. Training includes didactic presentations, experiential exercises, and review of clinical material including audio- or videotapes in weekly small group supervision. Residents can serve as individual ACT therapists or group therapists. Supervisor: Drs. Billig and Wagner-Mickle.

Family Therapy Training Clinic (FTTC): Social Constructionist therapy including Solution Focused and Narrative approaches are presented in the FTTC. This clinic provides training for staff, postdoctoral residents, and interns in the assessment and treatment of couples and family-related concerns. The clinic format includes didactic presentations (augmented through videotapes), and experience using solution-focused, and narrative techniques. All sessions are videotaped, and supervision occurs in a group setting. Skills acquired include case conceptualization, basic techniques, and provision of peer supervision. Training is augmented by consultation with a community family therapy expert. Supervisors: Drs. Erbes and Leskela.

The Anxiety Interventions Clinic (AIC): AIC is a national VA award-winning training program which employs distinctive, empirically-supported approaches to treat social and simple phobias, panic disorder with and without agoraphobia, generalized anxiety disorder, and obsessive-compulsive disorder. Techniques include but are not limited to diagnostic assessment, psychoeducation, relaxation training, cognitive restructuring, exposure and response prevention. Residents can expect to develop competence in assessment and differential diagnosis of anxiety disorders using standardized forms and structured interviews, and in the application a CBT approach to specific anxiety disorders. Trainees become familiar with the empirical literature regarding the application of CBT strategies with anxiety disorders, and are encouraged to utilize process and outcome measures to track therapy progress as a part of standard care. Critical thinking and professional development are emphasized. The training setting is interdisciplinary and a peer consultation/ supervision model is used. Supervisor: Dr. Olson.

Cognitive Behavioral Social Skills Training (CBSST): This training is targeted towards individuals with serious mental illness (SMI), including schizophrenia and other psychotic disorders. The program utilizes techniques from cognitive behavioral therapy and social skills training that are implemented within a group format, which is augmented with individual sessions and consultation with other involved providers. Specific targets include modifying maladaptive thoughts, coping with persistent symptoms, identifying and monitoring warning signs of relapse, increasing problem-solving skills, promoting effective conflict management and improving communication skills. This differs from traditional supportive group therapy in that veterans' current concerns are addressed through learning and applying new skills to their everyday experiences. The intention is to improve quality of life and social functioning in our veterans with SMI, thus we work primarily within a "recovery" model. In addition, there is an emphasis on family education and involvement with the National Alliance for the Mentally Ill (NAMI). Skills acquired include case conceptualization from a CBT approach, techniques of the CBSST intervention, assessment of psychotic symptoms and other areas of patients' functioning, familiarity with relevant empirical literature, peer supervision, and multidisciplinary consultation. Supervisor: Drs. Hegeman and Hoffman-Konn.

Cognitive Processing Therapy (CPT): CPT is an evidenced-based, manualized, time-limited (12-17 weeks) treatment approach for trauma-related symptoms. Symptoms are conceptualized as developing from an inability to resolve conflicts between the traumatic event and prior beliefs about the self or others, as well as the consequent avoidance of a range of strong affects such as anger, shame, guilt, and fear. CPT treats trauma-related symptoms within the framework of a “recovery” model. The primary focus is on cognitive interventions, and treatment is structured such that skills are systematically built upon throughout the course of therapy. Treatment elements include psychoeducation, emotional processing, and cognitive interventions. Process and treatment outcome measures are used to track therapy progress as part of standard care. The CPT clinic provides training consisting of didactics, a video instruction series, bi-weekly case consultation, and participation as a CPT therapist. Opportunities are available for trainees to also serve as a group co-facilitator for both the men’s and women’s groups. Supervisors: Drs. Kattar, Petska, Rodman, Strom, and VanEgeren.

Time-Limited Dynamic Psychotherapy (TLDP): Trainees participate in a group supervision model of training to learn and apply TLDP with a minimum of one patient during the course of the 6-month training clinic.  Competencies acquired include case conceptualization and application of TLDP as well as peer supervision/consultation. Supervisor: Dr. Wagner.

Motivational Interviewing (MI): MI is a directive, client-centered therapeutic style for eliciting behavioral change by helping clients explore and resolve ambivalence about making changes. The therapist assesses the client's level of readiness for change and uses MI to help the client define treatment goals, time frames, and the strategies to achieve those goals. The MI training will consist of learning the basic MI goals and principles, traps to avoid, and opening strategies, eliciting self-motivational statements, handling resistance, and assessing readiness for change. The process will include readings and discussions of didactic material, review of video and audiotapes of interactions with patients, and role-playing. Supervisor: Dr. Isenhart.

Dialectical Behavioral Therapy (DBT): DBT is the empirically-supported, manualized cognitive behavioral approach to treat male and female patients who share key features with those diagnosed with Borderline Personality Disorder, specifically emotion dysregulation, distress tolerance, and interpersonal difficulties. Training includes didactic presentations and review of clinical material, including videotapes, in weekly small group supervision. Residents can serve as individual DBT therapists, skills group co-leaders, and/or applications group co-leaders (i.e., a primarily interpersonal process group for DBT patients who have completed skills group). They also participate in a weekly Consultation Group. Supervisor: Drs. Meyers and Schumacher.

Psychoanalytic Therapy Clinic: This clinic is built on the contributions of Sigmund Freud and will focus on the technique of psychoanalytic psychotherapy, not the arcanum of general psychoanalytic theory. In harmony with contemporary psychoanalytic practice, the contributions of the interpersonal school, object relations and self psychology will not be neglected. Believing that students will benefit from exposure to a "coping model", those participating in this experience will observe a course of psychoanalytic psychotherapy conducted by Dr. Peterson.

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