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
a shift in training away from the tradi-
tional inpatient and outpatient psychi-
atric setting. Examples of this breadth
in training placements are day hospi-
tals, day care and nursery schools, de-
velopmental clinics, drug abuse cen-
ters, alcoholic treatment units, crisis
and walk-in centers, court services,
medical consultation services, schools,
and community mental health centers.
Some programs in particular em-
phasize a breadth of training oppor-
tunities through a consortium arrange-
ment, for example, the Memphis In-
ternship Training Consortium, the
Wichita Guidance Center, and John
Umstead Hospital in Butner, North
Carolina. Each of these programs
utilizes a variety of settings to form a
training consortium. A unique adminis-
trative arrangement which also en-
hances providing a variety of place-
ments is that at the University of
Washington School of Medicine. There
the internship is administered out of
the hospital director's office rather than
through a single department of the
medical school.
Some centers have developed inno-
vative orientation approaches for their
interns' placements on particular serv-
ices. At the Wisconsin Children's
Treatment Center the intern begins his
internship as a child care worker to
familiarize himself with treatment in
an intensive unit. The interns at the
Dammasch State Hospital in Oregon
spend their first week working as psy-
chiatric aides. The interns at the
Southbury Training School in Connect-
icut begin their training by living with
the patients in one of the patient cot-
tages. At the Institute of Rehabilitation
Medicine of the New York University
PROFESSIONAL
Medical Center, the interns experience
acting and living the part of disabled
patients through role playing. At the
Veterans Administration Hospital in
Roseburg, Oregon, the interns experi-
ence living five days in the actual role
of a patient on a ward.
Few centers emphasize a particular
theoretical approach in their internship
program. Michael Reese Hospital and
Medical Center in Illinois stresses an
analytic orientation. The unique Pri-
vate Practice Internship in Chicago
under the direction of Harold H.
Mosak stresses an Adlerian orienta-
tion. The Center for Behavior Therapy
in California, as the name implies,
stresses behavior modification. Most of
the other internship centers have an
eclectic orientation or could be more
accurately described as being pluralistic
regarding theoretical approaches.
Most of the training centers provide
a one-year full-time internship. One of
the few exceptions to this is the On-
tario Department of Health, which
offers three months of internship train-
ing during the summer. Another excep-
tion is the Northwestern University
Medical School, which in addition to
offering a one-year internship also
provides a one-third time internship
spread over three years. They feel this
latter pattern allows for more con-
tinuity of training.
The actual structure of the internship
relating to the types of training pro-
vided varies considerably among the
programs. It varies from the essentially
nonstructured program of the Veterans
Administration Hospital in Fort Lyon,
Colorado, to programs requiring a
percentage of time spent in various
activities to programs having basic core
requirements regarding the number of
PSYCHOLOGY FEBRUARY 1973 113
 diagnostic and therapy patients seen as
well as the kinds of patients seen and
the types of therapy used.
It is evident from Table 1 that diag-
nostic evaluations continue to be an
important part of the training provided
during the internship. However, it is
evident that a broad variety of other
training experiences are now also being
provided, which suggests somewhat of
a shift away from or de-emphasis on
diagnostic evaluations. Six of the cen-
ters in the survey indicated that such a
de-emphasis had been intentional in
their programs.
One of the innovative features in the
training programs of the Ohio State
University Health Center and the Uni-
versity of Minnesota Health Sciences
Center is in the area of diagnostic
evaluations. These centers have devel-
oped psychometric laboratories to
handle routine psychological testing.
The interns are freed thereby from a
heavy service demand for testing and
instead are able to emphasize their
supervisory functions in overseeing the
consultation of the Psychometric Lab-
oratory personnel.
Psychotherapy is another area re-
ceiving considerable attention in intern-
ship training (see Table 1). Patient
treatment responsibility for both inpa-
tients and outpatients is now a common
experience for interns according to the
respondents. What is also evident in
therapy training is a shift away from
long-term one-to-one therapy to a
broad spectrum of approaches includ-
ing short term, group, family, marital,
behavior modification, hypnosis, re-
laxation, desensitization, and psy-
chodrama. Centers that particularly
emphasize a broad experience of psy-
chotherapeutic techniques are the Uni-
114 PROFESSIONAL PSYCHOLOGY FEBRUARY
versity of California School of Medi-
cine at San Francisco, the Community
Child Guidance Clinic of Portland,
and the Camarillo Mental Health
Center in California. The latter center
also encourages its interns to try new
and creative therapy approaches.
Some of the innovative aspects of
some programs have to do with par-
ticular kinds of therapy experience.
The University of Wisconsin Medical
School has a Behavior Therapy Clinic
providing specialized training experi-
ence in that area. The Range Mental
Health Center in Virginia, Minnesota,
stresses a program of short-term in-
dividual and group therapy. Another
unique aspect of this latter program is
that the intern may work with the
patient in the patient's natural setting.
The Wisconsin Children's Treatment
Center also has a home and community
treatment program whereby the thera-
pists are sent into homes and schools
to provide treatment "in vivo."
Another area of training that was
stressed by the respondents in the
survey was that of consultation, which
seems to have enhanced the innovative
process as it pertains to new training
experiences. Consultation frequently
involves working outside of a psychi-
atric setting and applying professional
skills to a broader consumer popula-
tion of both patients and nonpatients.
Different demands are made on the
psychologist that cause him to alter
his approach and adapt to the needs of
the situation, which frequently leads to
innovation.
Training at comprehensive medical
centers has shown an expansion of the
consultant role through consultation
to various medical or nonpsychiatric
services such as pediatrics, neurology,
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
intern evaluations and intern member-
ship on the training committee is also
followed by the University of Minne-
sota Health Sciences Center.
A new development in supervisory
arrangements would seem to be that of
assigning a specific supervisor to act
as an adviser for the intern through-
out his internship. This supervisor/ad-
viser assignment was reported by nine
centers.
While some centers like the Hawaii
State Hospital emphasize learning
through experience and minimize di-
dactic presentations, Table 1 indicates
that seminars and lectures are utilized
by a majority of the training centers.
The format for this kind of training
varies considerably. The McMaster
Psychiatric Unit of St. Joseph's Hospi-
tal in Ontario provides a basic orienta-
tion course the first month of training.
This is followed by areas of training
such as psychotherapy, which is not
presented for a specific discipline but
rather for any professionals who will
be conducting therapy. The training
courses as such are done by areas and
are for all appropriate disciplines. The
New York Medical College—Metro-
politan Hospital provides a 10-week
techniques workshop where the interns
observe the staff working with a variety
of patients and techniques. The Uni-
versity of Oregon Medical School offers
a set of well-defined seminar areas for
their interns. The University of Texas
Medical School at San Antonio also
offers a large number of seminars in
specific areas for its interns.
The use of closed-circuit TV was
reported by a relatively small number
of centers, as shown in Table 1. How-
ever, it would appear that the use of
PROFESSIONAL PSYCHOLOGY
TV has considerable potential for in-
novations in internship supervision.
The last entry in Table 1 of six
centers providing personal therapy for
their interns suggests that this is an
area that receives little emphasis as
part of internship training practices.
SUMMARY OF FINDINGS
The present survey would seem to
suggest that internship training as
represented by the 122 respondent
centers has undergone a number of
changes or innovations with certain
trends being evident. From the com-
ments of the respondents, the attitude
toward innovation is quite variable, as
might be expected. Some centers in-
tentionally want to continue to em-
phasize traditional approaches, while
centers like the Pittsburgh Child Guid-
ance Center stress freedom for the
intern to innovate with any given task
as part of their program. In reviewing
the material of this survey, it would
seem that traditional training empha-
sized approaching the patient through
diagnostic testing and individual psy-
chotherapy. Gradually, psychotherapy
began to receive more training empha-
sis with the proliferation of various
individual and group therapy ap-
proaches. The move into consultation
outside of psychiatry has also led to a
broadening of training experiences.
The expansion of consultation to pro-
fessionals and paraprofessionals has,
in addition, led to less reliance on
psychological testing and stressed func-
tioning in the role of the expert. Con-
sultation training was further accentu-
ated by community mental health
programs, which emphasized consulta-
tion to community agencies as well as
FEBRUARY 1973 117
to various lay groups. New treatment
approaches in training have also been
an outgrowth of new delivery systems
of health services by the community
centers as well as a new emphasis on
preventative programs.
The move away from traditional di-
agnostic and treatment functions seems
to enhance innovations in training. At
the same time, however, this may tend
to result in a loss of identity or pro-
fessional role function for the intern
and enhance role diffusion. As one
respondent pointed out in his reply to
the survey, this loss of professional role
function results in the psychologist be-
ing valued as a person rather than as a
representative of a profession. As such,
innovations of this kind may tend to
make clinical psychology obsolete.
Another concern voiced by some of
the respondents was that while com-
118 PROFESSIONAL PSYCHOLOGY FEBRUARY
munity programs tend to make a prac-
tice of being innovative, not enough
emphasis is placed on evaluating the
innovative programs or techniques. The
need for adequate evaluation would
seem obvious, yet only nine centers re-
ported providing training in this area.
Program evaluation would seem at this
time to be an innovation in research
training for the intern, but it may need
to become a basic training area as a way
of systematically dealing with innova-
tion. As one respondent commented in
his reply to the survey, the continued
use of innovative practices without
adequate evaluation may result in the
intern being poorly trained, lacking in
experience, and psychologically naive.
Obviously, innovations in training per
se do not necessarily make for a mean-
ingful enhancement of internship train-
ing.
1973