Per San Francisco Mayor London Breed’s announcement of a “shelter in place" directive, our internship transitioned to a remote program on March 17, 2020. Our interns are providing clinical services remotely from their homes (teletherapy) in accordance with the laws and regulations of the California Board of Psychology and the boards of other states. The number of hours devoted to weekly training remains unchanged, and interns are receiving the required number of supervision hours through telesupervision and participating in seminars and trainings through videoconferencing.
Training Philosophy, Program Aims, and Competencies
The American Psychological Association–accredited program at the University of San Francisco Counseling & Psychological Services (CAPS) provides doctoral internship training in Health Service Psychology (HSP) within a university counseling center context. Best described as a practitioner model, an emphasis is placed on grounding clinical practice in theory and research and the development of mentoring relationships with supervising psychologists.
USF CAPS has a strong commitment to training that includes participation of all staff. The training program is cumulative and sequential, supporting and enhancing knowledge and skills that interns possess while also providing didactic and experiential opportunities that facilitate development as a generalist in Health Service Psychology. CAPS is consistent with USF’s core value of having a commitment to the “full, integral development of each person” by providing a training program that facilitates the development of ethical, competent psychologists who can function independently and make positive contributions to the profession.
CAPS is committed to a brief, time-limited therapy approach to clinical practice that is grounded in evidence-based treatment. We believe that the important aspects of training in brief therapy include: 1) an attitudinal shift on the part of the therapist to see brief therapy as efficacious and oftentimes the treatment of choice; 2) an exposure to a multiplicity of therapeutic frames and methods, with a focus on adapting them to brief work; 3) an insistence, to the extent possible, that therapeutic frame and method be fitted to the client rather than the reverse; 4) an integration of a multicultural perspective into both the case formulation and an interactive approach to the client; and 5) an emphasis on continual practice in defining a focus with the client and in orienting the therapy to that focus and its associated therapeutic goals.
Also in line with our sponsor institution’s “belief in and commitment to a diversity of perspectives,” our training in brief therapy is based on an integrationist approach. Our approach incorporates various theoretical models and interventions while keeping in mind individual, cultural, and societal considerations. These ideal characteristics of a multicultural, integrationist approach to brief therapy are not simply actualized in some absolute fashion, even by experienced staff members. Rather, they represent orienting considerations that inform our work and training in an ongoing fashion. We see training as a process in which we share our struggles and questions, our successes and failures, as a group. In the end, we are committed to assisting interns in developing their own perspectives toward brief therapy and moving closer to the integration of evidence-based frameworks and methods.
Clinical and training activities are structured in a sequential, graded, and cumulative format, consistent with the Revised Competency Benchmarks in Professional Psychology (APA, 2012). Through achievement of Profession-Wide Competencies, the overarching aims of the training program is for interns to: (1) develop and demonstrate skills and competencies for entry-level practice as a generalist in Health Service Psychology and (2) develop ethical integrity and a professional identity as a psychologist. By the end of the training year, interns will have developed advanced levels of competence consistent with the required Profession-Wide Competencies (PWC):
a. Ethical and Legal Standards
b. Individual and Cultural Diversity
c. Professional Values, Attitudes, and Behaviors
d. Communication and Interpersonal Skills
h. Consultation and Interprofessional/Interdisciplinary Skills
By the end of the training year, interns will also have developed specific competence in the following Program-Specific Areas: Crisis Response and Outreach.
Interns participate in several weekly structured training activities that support the training program aims. Interns receive specialized training in and provide: intake assessment, individual and group psychotherapy, crisis intervention, psychoeducational outreach, consultation, and utilization of University and community resources and referrals. The training program does not utilize distance education technologies for training and supervision, with the exception of the Careers in Psychology Panel, in order to include panelists who reside outside our geographic region. There are occasional opportunities for distance education offered by the Division of Student Life and/or the University at large. These offerings are supplemental training outside weekly scheduled seminars.
Educational Staff Meeting: Interns participate in a weekly 1-hour meeting with the entire clinical staff to address clinical issues and center procedures and policies and increase effective response to needs of clients and the University at large.
Peer Consultation: Clinical material and interventions are discussed in peer consultation meetings each month facilitated by the postdoctoral fellows.
Case Conference: Interns participate with senior staff in a 1-hour case conference, where clinical staff present cases for group feedback and discussion. During the first month, interns observe senior staff and postdoctoral fellows presenting cases and have the opportunity to witness the case conference format and provide feedback. For the remainder of the training year, interns present on a rotating basis with the clinical staff.
Intercultural Seminar: Interns participate in a weekly 1-hour seminar during which they are provided with a forum to explore a variety of intercultural issues relevant to the practice of psychology. This seminar utilizes a variety of training modalities including staff/guest speaker presentations, readings, films, and group discussion of case material. The purpose of this seminar is to integrate intercultural issues in an ongoing manner while continuously striving for competence in assessment, case formulation, and the delivery of psychotherapy services to a diverse college campus community. Interns examine how their own cultural beliefs and values may impact interactions with one another and their clients. At the end of spring semester, each intern develops and presents a Capstone Intercultural Case Presentation to the CAPS clinical staff.
Didactic Inservice Seminar: Interns participate in a weekly 2-hour seminar in which CAPS senior staff and guest speakers from the community present topics relevant to the acquisition of assessment and psychotherapy skills in Health Service Psychology within a university setting, grounded in evidence-based practice and legal and ethical guidelines.
Supervision, Program Evaluation, and Professional Development Seminar: Interns participate in an 8-session series with three components: (1) knowledge of best practice models of supervision and acquisition of basic supervision skills; (2) knowledge of models of program evaluation and execution of a summer program evaluation project; and (3) an exposure to career options in psychology (through interactions with psychologists in the greater professional community), an understanding of the licensing process, and an emphasis on networking within the professional community and involvement in professional organizations.
CAPS provides assistance to students seeking counseling/psychotherapy for a wide range of presenting concerns, from typical developmental and situational issues to significant clinical concerns. We work within a session-limited approach (12-session maximum) and make an assessment at intake regarding the appropriateness of a brief individual or group therapy approach or referral for longer-term or more specialized work outside the University.
Individual Counseling/Psychotherapy: Focus on brief, time-limited integrative therapy with a maximum of 12 sessions per academic year per client. Individual clients are not typically seen on a weekly basis.
Group Counseling/Psychotherapy: Both structured thematic and process-oriented groups are offered each term. Interns are encouraged to serve as co-therapists in ongoing CAPS groups or to initiate a new group relevant to the needs of the student population. There are no limits on the number of group sessions per client.
Intake Assessment and Disposition Planning: Intakes entail interview-based evaluation of presenting problems and differential diagnosis, assessment of the client's motivation for treatment, and disposition planning.
Crisis Intervention: Crisis intakes and consultations entail evaluation, intervention, and crisis management, including assessment of safety and risk factors, effective response to crisis situations, and facilitation of hospitalization when needed. During summer semester, interns participate in after-hours on-call duties, which include consultation with Public Safety, Student Housing and Residential Education (SHaRE), and other University representatives, as well as provision of referrals. Interns consult with a senior staff member in crisis situations involving potential harm to self or others.
Psychological Testing: This entails routine administration of the Counseling Center Assessment of Psychological Symptoms (CCAPS-62) to clients at intake and termination and of the CCAPS-34 at specific intervals during the course of therapy. The CCAPS is supplemented by other brief assessment instruments, including the Beck Depression and Anxiety Inventories, Alcohol Use Disorders Identification Test (AUDIT), and the Eating Attitudes Test (EAT-26), as relevant to the evaluation and treatment of the client.
Consultation and Collaboration Activities: This entails providing consultations to staff, faculty, and other University representatives; parents and family members; and students regarding mental health issues and CAPS services. This service also entails provision of appropriate on- and off-campus referrals, discussion of rationale, and follow-up, as well as establishment of professional relationships with other University colleagues.
Outreach Activities: Outreach entails providing training and represent CAPS to resident advisers, student athletes, and other student leaders; conducting educational programs, workshops, and lectures to students in residence halls, classrooms, and club meetings; and serving as a liaison to student organizations, such as a culturally focused student club or other academic and/or service-oriented organization. Interns are expected to participate in outreach activities, including cultivating new or maintaining an existing liaison with a student group or other campus partner, tabling/liaison outreach activities, and facilitation/presentation of outreach activities.
Individual Supervision: Interns receive 2 hours of individual supervision on a weekly basis. The primary supervisor, a licensed staff psychologist, provides 1 hour of weekly face-to-face supervision and monitors the intern’s overall clinical work, professional development, and individual caseload throughout the training year. The primary supervisor and intern develop specific goals to supplement the general aims of the internship and provide an individualized learning experience.
An additional hour of weekly supervision is provided by the individual delegated supervisor, another licensed staff psychologist. Interns submit recordings to their primary and delegated supervisors each semester to be discussed in supervision. In addition, supervision may include review of case notes or direct observation in the therapy room, depending on the needs and skill level of the intern. There are opportunities to change individual delegated supervisors during the summer semester to broaden the training experience.
Group Supervision—Cohort: Interns participate in 1.5 hours of weekly group supervision with the training director, during which cases are presented on a rotating basis for consultation and discussion by the training cohort. Discussion of issues related to the internship experience and professional development are also provided during this time.
Group Supervision—Evidence-Based Practice: Case Formulation and Intervention: An additional hour of group supervision is provided with a focus on case formulation and clinical intervention skills from an evidence-based practice perspective. Drawing from their caseload, interns present case formulations and video recordings of their work on a rotating weekly basis from a variety of evidence-based treatment models.
Supervision of Group Therapy: Additional supervision is provided for any group counseling experiences, usually by the senior staff psychologist functioning as the co-therapist.
Intern Weekly Hours—Sample Schedule
|I. Direct service|
|A. Individual psychotherapy||13–17|
|B. Group counseling/therapy (includes 1/2 hour supervision)||0–2*|
|C. Intake assessment||3|
|D. Crisis intake/crisis consultation||0–1|
|E. Single-session therapy (SST)||2|
|II. Training activities|
|A. Supervision: Individual: 2 hours (Primary, 1; Delegated, 1)
Group: 2.5 hours
|B. Inservice Didactic Training Seminar (fall and spring semesters)/
supervision, program evaluation, and Professional Development Seminar (summer semester)
|C. Intercultural Seminar (fall and spring semesters)||1|
|D. Case Conference||1|
|E. Educational staff meeting||1|
|III. Professional development|
|A. Weekly professional development||4|
|IV. Administrative planning|
|A. Records/case management/planning||9.5**|
|Average estimated weekly hours||44|
* Group therapy is optional. Interns who co-facilitate therapy groups have a reduced individual client caseload.
** Hours not spent in direct service are administrative hours.