Overview of Cognitive Behavior Therapy Tracks

The overarching aim of these tracks (as with the IOL internship as a whole) is the practical integration of psychological science and practice. Within this general framework, the CBT tracks will emphasize the use of critical thinking skills, the application of basic and applied research to complex cases, and the thoughtful and systematic evaluation of clinical work using evidence-based practices.

Two full-time positions will be offered by the Clinical Psychology Department; one focusing on Adult patients and one focusing on the treatment of children and adolescents. The training year is composed of three primary four-month rotations and several minor rotations. The primary training objective is to assist the intern in acquiring the necessary skill base to achieve a high level of competence in the evaluation, assessment, and treatment of acute and chronic psychiatric illness, including acute exacerbations of chronic mental illness. The Psychology Department believes that intensive training experience within an acute inpatient and outpatient hospital service provides exposure to the broadest range of psychiatric disorders and aids in the development of confidence in the interns’ diagnostic and treatment skills. Interns will be expected to integrate the use of cognitive-behavioral interventions, skills-training methodologies (e.g. Dialectical Behavior Therapy), and become familiar with psychodynamically-informed treatment planning when appropriate. The training faculty wants to assist the intern in deepening their ability to conceptualize on multiple levels and recognizing the interactions between intrapersonal, interpersonal, and systemic forces influencing the patients with whom they work.

This track will include the following training experiences and objectives:

  • To prepare psychologists who can consume new research findings and integrate them into practice. Using individual and group mentorship programs, interns will read, discuss, and evaluate practice-relevant research articles; develop treatment plans that consider the best available empirical evidence; and discuss the therapeutic, ethical, and legal aspects of evidence-based practice.

  • Interns will participate in research projects using evidence-based strategies of measurement and analysis in order to evaluate the efficacy of their treatments, to develop and refine programs, and to inform best practices for the institution.

  • To prepare psychologists who can produce new scientific findings that will contribute to the literature. All interns will have the opportunity to participate in the broad range of basic and applied research conducted at the Institute of Living, including psychotherapy research, pharmacotherapy clinical trials, neuroimaging research, and more.

The CBT track intern will spend at least 10 hours per week providing outpatient services at the Anxiety Disorders Center/Center for CBT for the entire internship year. This will allow them to treat patients over a longer period of time, become involved in longer-term projects at the ADC/CCBT, and provide a "home base" that will include meeting with a primary internship preceptor.

Core Training Rotations

The Adult CBT track intern will complete 3 rotations, each lasting 4 months. They are:

(A) Anxiety Disorders Center/Center for Cognitive Behavioral Therapy
The CBT intern will spend the majority of their time at the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy during one of their 4 month rotations. The Anxiety Disorders Center/Center for CBT is an outpatient clinic specializing in the cognitive-behavioral treatment of anxiety, mood, and obsessive compulsive spectrum disorders. Interns will provide outpatient CBT to the clinic’s patients, including accelerated (daily) exposure therapy sessions to patients with moderate to severe anxiety disorders and OCD. Interns will also complete assessments of new patients utilizing structured diagnostic interviews and well-validated self-report measures. The ADC/CCBT employs state of the art technology and assessment tools, including virtual reality technology, evidence based computerized assessment of treatment progress, which the interns will use in their patient care. In addition, interns will have the opportunity to contribute to research, gain experience in program development, and provide specialized consultation services to other departments of the Institute of Living. The ADC/CCBT provides services across the lifespan, although each of the two CBT interns will be assigned predominantly to either adult of children/adolescent cases.

(B) Adult Inpatient Service
Each intern will be assigned to the general inpatient service. The Adult service admits patients aged 18 and older for treatment of acute symptoms. This training site will prepare interns to succeed within a managed care environment and strengthen their brief therapy skills. Each will serve as primary therapist for up to two patients and provide conjunctive family/marital therapy when indicated. Many of these patients will be referred for admission from one of our partial hospitalization and intensive outpatient programs. The unit is milieu-based and provides short-term therapies for severely disturbed patients in need of hospitalization, many of whom have gone through unsuccessful outpatient and short-term inpatient treatments.

A broad spectrum of acute and high-functioning psychotic, personality-disordered, addicted, conduct-disordered, and affectively-disordered patients is represented. Interns gain experience not only as primary therapists and case managers, but also in functioning as psychologists in a multidisciplinary team while learning methods of milieu therapy. The intern will also be responsible for conducting a twice-weekly CBT group. Along with the unit psychologist and postdoctoral resident, the intern will also provide consultation to the other treatment teams. A minimum of two hours of supervision per week will be provided to each intern.
Competencies in rapid assessment of mental status, case formulation, diagnosis, and focal individual and group psychotherapy will be developed. In-depth exposure to psychopharmacological and other biological interventions (e.g., ECT) and close collaboration with psychiatrists, social workers, nurses, and physicians will prepare interns to assume careers in a hospital-based setting and settings servicing the broadest range of patient populations.

(C) Intensive Outpatient Programs
Each adult intern spends four months providing group psychotherapies and case management to adult patients admitted to the DBT Program and can seek elective experiences in one of several additional Partial Hospital Programs. They include our Professionals’ Program, our Young Adult/LGBTQ program and the Eating Disorders Track within the Adult Day Program. These are intensive outpatient programs for patients recently discharged from the inpatient service or referred from community providers who are in need of intensive services to prevent hospitalization and restore occupational/school and psychosocial functioning. The intern will function as a staff treatment manager, providing case management services to at least two ongoing patients, and provide up to eight hours of group psychotherapy.

The four-month rotation in the DBT program involves the provision of group therapy services to patients diagnosed with Borderline Personality Disorder receiving treatment in our DBT program. Interns will advance their skills with this population and co-lead groups along with the program’s clinical staff. The Intensive Outpatient DBT program is a three to four day per week program designed primarily for individuals in Stage One treatment. The program involves a minimum of three hours per day and focuses on safety, building connections in the community, and behavioral control.

The program encompasses a six week cycle that includes:

• Skills training
• Behavioral analysis
• Behavioral rehearsal
• Target-oriented case management
• Telephone consultation
• Medication management

Other Core Experiences

In addition, the CBT track intern may complete 3 electives, running concurrently with the Major Rotations, each lasting 4 months (although an elective could be extended to two periods by mutual agreement). The intern’s interests will be identified at the beginning of the training year so that a sequence of training can be established that takes into account any elective interests identified by the intern.

Electives offered will include:

• Young Adult Services
• Adolescent Inpatient Services
• Neuropsychology
• Health Psychology
• Schizophrenia Rehabilitation Program
• Anxiety Disorders Center/Center for Cognitive Behavioral Therapy
• Research (collaboration with faculty)

Seminar Program

Trainees attend a variety of seminars, offered by both the Psychology Department and the psychiatry residency training program. We anticipate that the following seminars will be available this year:

• Diagnosis and Assessment (Required)
• Modern Readings in Personality and Psychotherapy (Required)
• Family and Group Therapies (Required)
• Weekly Grand Rounds (Required)
• Child Psychotherapy Seminar and Case Conference (Required for Child Track)
• Connecticut Children's Grand Rounds
• Psychosis Seminar
• Focal Therapy and Case Conference (Required)
• Diversity Seminar (Required)
• Psychiatry Journal club (monthly)