Internship Training

IRVING B.WEINER, Editor

Innovations in Clinical Psychology Internship Training

A. Jack Hafner, University of Minnesota

In 1970 the Association of Psychology THE QUESTIONNAIRE

Internship Centers (APIC) formed a In an effort to determine what the
Committee on Innovations in Train-
current practices in clinical psychology
ing. The primary purpose of the com-
internship training are, particularly
mittee was to assess current practices
those of an innovative nature, an open-
in clinical psychology internship train-
ended questionnaire was sent to 541
ing, particularly those practices that
centers. The questionnaire asked for a
might be considered to be innovative. summarization of each center's current
The committee was an outgrowth of
internship program in terms of its
general interest expressed by APIC in
format and goals. In addition, the
reconsidering the model of the clinical
centers were asked to identify those
psychology internship as currently con- features of their programs that they
ceived. In particular, the question
considered to be innovative. The 541
arose as to whether or not there may
centers surveyed represented an ex-
be a prevailing model in internship haustive listing compiled in 1970 by
training that was developed 25 years Robert M. Martin of the University of
ago on the basis of what was thought Manitoba for APIC of all centers in
would be needed for adequate clinical the United States (522) and Canada
training. (19) that were thought to offer intern-
ship training in clinical psychology.
The questionnaire was sent out in May
A. Jack Hafner is a professor in the Divi-
sion of Clinical Psychology at the University 1971 and returns came it? over a six-
of Minnesota. He is chairman of the Training month period.
Committee of the division with responsibility One hundred and thirty-nine centers
for the internship training program in clinical responded to the survey. Seventeen
psychology at the University of Minnesota
Health Sciences Center. respondents indicated that they did not

PROFESSIONAL PSYCHOLOGY FEBRUARY 1973 111

offer internship training. A total of 122 intern. The majority of the centers
centers (116 in the United States; 6 in provide some kind of individualization
Canada) comprised the final number of training placements to take into
actually taking part in the survey. (In consideration both the interests and
a separate survey conducted in 1971 by training needs of a particular intern.
Robert M. Martin for APIC, he found Some form of a rotation system is also
187 agencies to be offering internships.) utilized in the majority of the programs
The 122 centers of the present survey so that the intern is getting training
included 61 of the 105 APA-approved experiences in a variety of clinical
clinical psychology internship training placements during his internship year.
programs. Twenty-seven of the 122 The broad variety of placements now
centers indicated that they provided
postdoctoral training in addition to
predoctoral internship training. The Table 1: Descriptive Characteristics of One
survey material presented in this report, Hundred and Twenty-Two Internship
Training Programs
however, pertains only to predoctoral
internship training in clinical psychol- Characteristic
ogy.
Twelve-month stipend (N = 63)
AREAS OF INNOVATION Mean = $5,252
Mode = $3,600
Table 1 summarizes the basic descrip- Patient populations
tive characteristics of the 122 centers Adult only 20
in the survey. The specific figures after Child only 16
Child and adult 78
each notation were derived from the Intern placements
information that was sent in by the Rotation system 22
centers. The figures as such must be Individualized placement 35
considered as representing trends since Rotation and individualized
information sent in by some centers options 41
Types of training provided
was limited and did not permit specific Diagnostic evaluations 114
categorization. Psychotherapy 116
The current trend in internships Consultation 75
would seem to be one of providing Community experience 58
training with both child and adult Research participation en-
couraged 56
populations rather than with a single Research participation re-
age group. Even centers with clinical quired 25
programs developed around one age Teaching and/or supervision 21
group of patients are now tending to Team approach 12
offer options to the intern of experi- Administration 2
Types of supervision provided
ences in different settings with other Intensive individual super-
patient groups. In many programs the vision 97
intern may now select emphasizing Seminars and lectures 84
work with children or adults in ac- Supervisor-adviser assignment 9
cordance with his particular training Use made of closed-circuit TV 15
interests. Related to this are the service Personal therapy provided for in-
tern
placements or settings available to the

112 PROFESSIONAL PSYCHOLOGY FEBRUARY 1973

available to the intern seems to reflect Medical Center, the interns experience
a shift in training away from the tradi- acting and living the part of disabled
tional inpatient and outpatient psychi- patients through role playing. At the
atric setting. Examples of this breadth Veterans Administration Hospital in
in training placements are day hospi- Roseburg, Oregon, the interns experi-
tals, day care and nursery schools, de- ence living five days in the actual role
velopmental clinics, drug abuse cen- of a patient on a ward.
ters, alcoholic treatment units, crisis Few centers emphasize a particular
and walk-in centers, court services, theoretical approach in their internship
medical consultation services, schools, program. Michael Reese Hospital and
and community mental health centers. Medical Center in Illinois stresses an
Some programs in particular em- analytic orientation. The unique Pri-
phasize a breadth of training oppor- vate Practice Internship in Chicago
tunities through a consortium arrange- under the direction of Harold H.
ment, for example, the Memphis In- Mosak stresses an Adlerian orienta-
ternship Training Consortium, the tion. The Center for Behavior Therapy
Wichita Guidance Center, and John in California, as the name implies,
Umstead Hospital in Butner, North stresses behavior modification. Most of
Carolina. Each of these programs the other internship centers have an
utilizes a variety of settings to form a eclectic orientation or could be more
training consortium. A unique adminis- accurately described as being pluralistic
trative arrangement which also en- regarding theoretical approaches.
hances providing a variety of place- Most of the training centers provide
ments is that at the University of a one-year full-time internship. One of
Washington School of Medicine. There the few exceptions to this is the On-
the internship is administered out of tario Department of Health, which
the hospital director's office rather than offers three months of internship train-
through a single department of the ing during the summer. Another excep-
medical school. tion is the Northwestern University
Some centers have developed inno- Medical School, which in addition to
vative orientation approaches for their offering a one-year internship also
interns' placements on particular serv- provides a one-third time internship
ices. At the Wisconsin Children's spread over three years. They feel this
Treatment Center the intern begins his latter pattern allows for more con-
internship as a child care worker to tinuity of training.
familiarize himself with treatment in The actual structure of the internship
an intensive unit. The interns at the relating to the types of training pro-
Dammasch State Hospital in Oregon vided varies considerably among the
spend their first week working as psy- programs. It varies from the essentially
chiatric aides. The interns at the nonstructured program of the Veterans
Southbury Training School in Connect- Administration Hospital in Fort Lyon,
icut begin their training by living with Colorado, to programs requiring a
the patients in one of the patient cot- percentage of time spent in various
tages. At the Institute of Rehabilitation activities to programs having basic core
Medicine of the New York University requirements regarding the number of

PROFESSIONAL PSYCHOLOGY FEBRUARY 1973 113

 diagnostic and therapy patients seen as versity of California School of Medi-
well as the kinds of patients seen and cine at San Francisco, the Community
the types of therapy used. Child Guidance Clinic of Portland,
It is evident from Table 1 that diag- and the Camarillo Mental Health
nostic evaluations continue to be an Center in California. The latter center
important part of the training provided also encourages its interns to try new
during the internship. However, it is and creative therapy approaches.
evident that a broad variety of other Some of the innovative aspects of
training experiences are now also being some programs have to do with par-
provided, which suggests somewhat of ticular kinds of therapy experience.
a shift away from or de-emphasis on The University of Wisconsin Medical
diagnostic evaluations. Six of the cen- School has a Behavior Therapy Clinic
ters in the survey indicated that such a providing specialized training experi-
de-emphasis had been intentional in ence in that area. The Range Mental
their programs. Health Center in Virginia, Minnesota,
One of the innovative features in the stresses a program of short-term in-
training programs of the Ohio State dividual and group therapy. Another
University Health Center and the Uni- unique aspect of this latter program is
versity of Minnesota Health Sciences that the intern may work with the
Center is in the area of diagnostic patient in the patient's natural setting.
evaluations. These centers have devel- The Wisconsin Children's Treatment
oped psychometric laboratories to Center also has a home and community
handle routine psychological testing. treatment program whereby the thera-
The interns are freed thereby from a pists are sent into homes and schools
heavy service demand for testing and to provide treatment "in vivo."
instead are able to emphasize their Another area of training that was
supervisory functions in overseeing the stressed by the respondents in the
consultation of the Psychometric Lab- survey was that of consultation, which
oratory personnel. seems to have enhanced the innovative
Psychotherapy is another area re- process as it pertains to new training
ceiving considerable attention in intern- experiences. Consultation frequently
ship training (see Table 1). Patient involves working outside of a psychi-
treatment responsibility for both inpa- atric setting and applying professional
tients and outpatients is now a common skills to a broader consumer popula-
experience for interns according to the tion of both patients and nonpatients.
respondents. What is also evident in Different demands are made on the
therapy training is a shift away from psychologist that cause him to alter
long-term one-to-one therapy to a his approach and adapt to the needs of
broad spectrum of approaches includ- the situation, which frequently leads to
ing short term, group, family, marital, innovation.
behavior modification, hypnosis, re- Training at comprehensive medical
laxation, desensitization, and psy- centers has shown an expansion of the
chodrama. Centers that particularly consultant role through consultation
emphasize a broad experience of psy- to various medical or nonpsychiatric
chotherapeutic techniques are the Uni- services such as pediatrics, neurology,

114 PROFESSIONAL PSYCHOLOGY FEBRUARY 1973

physical medicine, internal medicine, ternship (see Table 1). While many
and family practice. An example of centers encourage or provide oppor-
such a program, which is also very tunities for such training, a rather
comprehensive in the broad spectrum small number of respondents actually
of techniques and experiences offered, require the intern to engage in research
is the University of Rochester School activities. A new area of research
of Medicine. training, which was reported by nine
Consultation training offered during of the respondents, was in program
the internship has been even further development and evaluation. This is
expanded with the development of an important part of internship train-
community mental health centers. ing at the Northville State Hospital in
Table 1 shows this emphasis under the Michigan and the Range Mental
Community Experience entry. These Health Center in Minnesota. The
centers emphasize training in consulta- training role of the intern at the Hawaii
tion through consultation to other State Hospital is less that of the practi-
professionals and paraprofessionals in tioner with emphasis on the role of
the community and to other groups and the consultant and the program devel-
agencies such as schools, courts, and oper and evaluator over that of the
welfare departments. They emphasize practitioner. A related kind of re-
outreach programs in the community search training is that provided at the
and work with high-risk groups or Washington University Guidance and
persons, including crisis intervention, Evaluation Clinic in St. Louis, where
and provide preventative educational the intern is required to participate in
programs. These centers as such pro- a follow-up research program involving
vide the interns with training in differ- former patients.
ent delivery systems for mental health Teaching and supervisory experience
services. Examples of these very com- for interns is provided by a relatively
prehensive community approaches are small number of the responding cen-
the Genesee County Community Men- ters. This teaching tends to be done
tal Health Services in Michigan and primarily for medical students, allied
the Range Mental Health Center in health professionals, paraprofessionals,
Minnesota. The latter stresses the role and lay groups. The supervisory train-
of the intern to be that of an agent of ing of the intern is most frequently in
change following a public health rather relation to psychology practicum stu-
than a medical model. This agent of dents and paraprofessionals. From the
change role, however, may also be comments of the respondents it would
applied in a medical setting. The Uni- seem that teaching and supervision are
versity of Colorado Medical Center a relatively new part of internship
stresses the agent of change role for training but one that is on the increase.
their interns whereby the intern learns Administrative training is a very
to be an effective instrument personally new kind of internship training, offered
and professionally in promoting con- by only a few centers; for example,
structive functioning and change. only the Wichita Guidance Center and
Research activities tend to play a the Range Mental Health Center in
somewhat limited part during the in- Minnesota mention this as an offering.

PROFESSIONAL PSYCHOLOGY • FEBRUARY 1973 115

 The final area that is listed in Table the groups is that the interns learn
1 under types of training is that of the from the other interns' cases as well as
team approach. Only 12 centers indi- their own. The University of Minnesota
cated that the intern is trained as a Health Sciences Center offers this kind
part of a team in providing clinical of group supervision for individual
services. The team approach usually therapy, family therapy, group therapy,
implies a circumscribed professional and personality assessment.
role for the psychologist. The fact that Several centers indicated that super-
so few centers emphasize this approach visors act as cotherapists with interns
seems to suggest a considerable amount in group therapy. At the Indiana Uni-
of role diffusion for the intern. The versity Medical Center a supervisor
program of the New York Medical acts as a cotherapist with the intern on
College—Metropolitan Hospital is in- an individual therapy case as well. A
novative in dealing with this issue. It related kind of training experience is
provides specific training in various that of the intern observing a super-
role experiences including as a team visor doing evaluations or therapy.
member, as a consultant, and as an This is done at the State University of
individual practitioner. New York Upstate Medical Center
In addition to the kind of place- and at the Center for Behavior Therapy
ments and type of training, the type of in California. An extension of this is
supervision provided the intern is an- the intern critiquing a supervisor's
other area of training where innova- therapy as is done at the UCLA Center
tions are evident. Intensive individual for the Health Sciences.
supervision is provided by most of the Another variation of the intern ob-
internship centers taking part in the serving his supervisor is that of the
survey. The actual amount of super- emphasis on modeling behavior where
vision provided, however, varies notice- the intern accompanies his supervisor
ably in some programs. At the Veterans and observes him functioning in the
Administration Hospital in Fort Lyon, role of a consultant. This is done in the
Colorado, the amount of supervision Private Practice Internship of Harold
varies depending on the interns' needs, H. Mosak in Chicago and as a part of
with some interns performing as staff. the program at the University of
Since the intern is to learn by doing Minnesota Health Sciences Center.
little therapy supervision is given. The As a way of promoting two-way
program at Central State Hospital in feedback, the Veterans Administration
Georgia begins with intensive super- Hospital in Portland, Oregon, holds
vision which is phased out as the intern weekly sensitivity groups with interns
progresses and assumes more responsi- and supervisors. The UCLA Center
bility, with the intern eventually using for the Health Sciences also holds
the supervisor as a consultant. staff and intern sensitivity and mara-
While one-to-one supervision is re- thon groups. In addition, this center
ported by most of the respondents, promotes feedback by having the in-
seven internship centers indicated that terns evaluate the program and their
in addition they provide supervision to supervisors each quarter as well as
groups of interns. The advantage of participating on the intern training

116 PROFESSIONAL PSYCHOLOGY FEBRUARY 1973

committee. This procedure of quarterly TV has considerable potential for in-
intern evaluations and intern member- novations in internship supervision.
ship on the training committee is also The last entry in Table 1 of six
followed by the University of Minne- centers providing personal therapy for
sota Health Sciences Center. their interns suggests that this is an
A new development in supervisory area that receives little emphasis as
arrangements would seem to be that of part of internship training practices.
assigning a specific supervisor to act
as an adviser for the intern through- SUMMARY OF FINDINGS
out his internship. This supervisor/ad-
viser assignment was reported by nine The present survey would seem to
centers. suggest that internship training as
While some centers like the Hawaii represented by the 122 respondent
State Hospital emphasize learning centers has undergone a number of
through experience and minimize di- changes or innovations with certain
dactic presentations, Table 1 indicates trends being evident. From the com-
that seminars and lectures are utilized ments of the respondents, the attitude
by a majority of the training centers. toward innovation is quite variable, as
The format for this kind of training might be expected. Some centers in-
varies considerably. The McMaster tentionally want to continue to em-
Psychiatric Unit of St. Joseph's Hospi- phasize traditional approaches, while
tal in Ontario provides a basic orienta- centers like the Pittsburgh Child Guid-
tion course the first month of training. ance Center stress freedom for the
This is followed by areas of training intern to innovate with any given task
such as psychotherapy, which is not as part of their program. In reviewing
presented for a specific discipline but the material of this survey, it would
rather for any professionals who will seem that traditional training empha-
be conducting therapy. The training sized approaching the patient through
courses as such are done by areas and diagnostic testing and individual psy-
are for all appropriate disciplines. The chotherapy. Gradually, psychotherapy
New York Medical College—Metro- began to receive more training empha-
politan Hospital provides a 10-week sis with the proliferation of various
techniques workshop where the interns individual and group therapy ap-
observe the staff working with a variety proaches. The move into consultation
of patients and techniques. The Uni- outside of psychiatry has also led to a
versity of Oregon Medical School offers broadening of training experiences.
a set of well-defined seminar areas for The expansion of consultation to pro-
their interns. The University of Texas fessionals and paraprofessionals has,
Medical School at San Antonio also in addition, led to less reliance on
offers a large number of seminars in psychological testing and stressed func-
specific areas for its interns. tioning in the role of the expert. Con-
The use of closed-circuit TV was sultation training was further accentu-
reported by a relatively small number ated by community mental health
of centers, as shown in Table 1. How- programs, which emphasized consulta-
ever, it would appear that the use of tion to community agencies as well as

PROFESSIONAL PSYCHOLOGY FEBRUARY 1973 117

to various lay groups. New treatment munity programs tend to make a prac-
approaches in training have also been tice of being innovative, not enough
an outgrowth of new delivery systems emphasis is placed on evaluating the
of health services by the community innovative programs or techniques. The
centers as well as a new emphasis on need for adequate evaluation would
preventative programs. seem obvious, yet only nine centers re-
The move away from traditional di- ported providing training in this area.
agnostic and treatment functions seems Program evaluation would seem at this
to enhance innovations in training. At time to be an innovation in research
the same time, however, this may tend training for the intern, but it may need
to result in a loss of identity or pro- to become a basic training area as a way
fessional role function for the intern of systematically dealing with innova-
and enhance role diffusion. As one tion. As one respondent commented in
respondent pointed out in his reply to his reply to the survey, the continued
the survey, this loss of professional role use of innovative practices without
function results in the psychologist be- adequate evaluation may result in the
ing valued as a person rather than as a intern being poorly trained, lacking in
representative of a profession. As such, experience, and psychologically naive.
innovations of this kind may tend to Obviously, innovations in training per
make clinical psychology obsolete. se do not necessarily make for a mean-
Another concern voiced by some of ingful enhancement of internship train-
the respondents was that while com- ing.

118 PROFESSIONAL PSYCHOLOGY FEBRUARY 1973