See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/247506116

Introduction of a clinical psychology intern program to a rural mental health

Service

Article in Australian Psychologist · July 2002

DOI: 10.1080/00050060210001706776

CITATIONS READS
7 495

5 authors, including:

Greg Murray Gene Hodgins

Swinburne University of Technology Charles Sturt University
294 PUBLICATIONS 7,537 CITATIONS 46 PUBLICATIONS 976 CITATIONS

SEE PROFILE SEE PROFILE

Fiona Judd Henry Jackson

University of Melbourne University of Melbourne
268 PUBLICATIONS 8,277 CITATIONS 330 PUBLICATIONS 17,705 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Anxiety and depression View project

Book Reviews View project

All content following this page was uploaded by Henry Jackson on 17 May 2014.

The user has requested enhancement of the downloaded file.

 Introduction of a Clinical Psychology Intern Program
to a Rural Mental Health Service
GREG MURRAY
Swinburne University of Technology and Bendigo Health Care Group

GENE HODGINS
University of Melbourne and Bendigo Health Care Group

FIONA JUDD
Monash University and Bendigo Health Care Group

HENRY JACKSON
University of Melbourne

JULIAN DAVIS
Bendigo Health Care Group

competencies. This deficiency is likely to be more

pecialist clinical psychology skills have become
increasingly rare in public mental health services.
This lack is particularly problematic in rural and
regional Australia, where psychology services of any kind are
difficult to access. One model for the reintroduction of these
skills is to employ later-year clinical psychology postgraduate
trainees under supervision. This model has the advantage
of encouraging evidence-based interventions integrated with
an emphasis on professional development, evaluation, and
applied research. The aim of this paper is to describe the
development, implementation and evaluation of a clinical
psychology intern program within a regional area mental
health service. It is expected the information presented will
be useful for other services considering the introduction
of these skills using this model.
Before describing the program itself, it is important
to describe current issues in the provision of clinical psychol-
ogy services and the context in which the program developed.
Clinical PsychologyServices in Mental Health
There is growing recognition that the enthusiastic uptake
in public mental health of a case-management model
(see, e.g., Giesler & Hodge, 1999) has had some negative
consequences for service delivery (Belcher, 1993).
Primarily, it can be argued that an unintended consequence
of the case-management model is the progressive deteriora-
tion of discipline-based expertise, through growing recruit-
ment to generic mental health positions. Cognitive
behavioural therapy (CBT; Beck, Rush, Shaw, & Emery,
1979) and personality assessment, for example, are two
skills that have traditionally been identified with the disci-
pline of clinical psychology'. As the number of specific
clinical psychology positions has decreased, mental health
services have therefore become relatively deficient in these
marked in rural areas, where (even before the arrival of the
case-management model) clinical psychology has not had
a strong presence (Griffiths & Andrews, 1995).
At the same time as specific clinical psychology
positions in mental health have decreased, the demand
for postgraduate clinical psychology training positions has
increased, producing a shortage of appropriate placement
experiences for trainees. The dearth of regional and rural
placements, in particular, has been identified as a barrier
to recruiting clinical psychologists into country positions
(Dollard, Shafik, Court, & Heffernan, 2000a).
PsychologyInterns
Postgraduate training towards the profession of clinical
psychology has traditionally involved a 2-year masters
degree, but more recently a 3-year doctoral degree has
become the norm. Completion of an honours degree
in psychology is a minimum entrance requirement,
but successful candidates tend to have both superior acade-
mic records and some relevant life/employment experience.
All accredited programs in Australia are driven by the
"scientist-professional model", which emphasises the inter-
relationship between research, teaching, professional train-
ing and practice (Australian Psychological Society
Accreditation Guidelines, 2000).
Under Victorian legislation, trainees are registered
probationary psychologists, and will become fully registered
psychologists on completion of their degree. By the second
and third years of the program, students have had training
and practicum experience in the assessment and treatment
of a range of major mental disorders. With appropriate
supervision, then, these students can undertake clinical
psychology work. We use the term "intern" to describe
trainees when they are on a paid placement.

Address for Correspondence: Dr Greg Murray, School of Social and Behavioural Science, Swinburne University of Technology, Hawthorn 3122 VIC,
Australia. Email: gwmrnswin.edu.au

JULY 2002 V AUSTRALIAN PSYCHOLOGIST

VOLUME 37 NUMBER 2 pp. 129-134

129
GREG MURRAY, GENE HODGINS, FIONA JUDD, HENRY JACKSON AND JULIAN DAVIS
Arguably, an intern program has some specific benefits
as a means of providing clinical psychology services.
Interns bring with them the attention of a university depart-
ment and the attendant commitment to research and evalua-
tion (see, for example, Bridgewater, 1998; Dollard, Shafik,
Farrin, & Heffernan, 2000b). A major advantage of interns,
therefore, is that they tend to enhance a culture of evidence-
based practice. Similarly, teaching staff of the interns' home
university are actively involved in clinical research
(Australian Psychological Society Accreditation Guidelines,
2000). A second consequence of interns' connection to
a university department, therefore, is that their clinical
approaches should be informed by state-of-the-art findings.
Finally, interns tend to bring an optimism or idealism to
a service (Farrin & Dollard, 2000) which may provide
a useful counterpoint to the attitude of staff with many
years' experience working with serious mental illness.
Progressive rotations of interns provide a constant source
of new perspectives on the way that clinical psychology
operates in a service.
Alternative Models
Dollard and colleagues have reported extensively on a previ-
ous trial of rural placements for clinical psychology students
in South Australia (Dollard, Farrin, & Heffernan, 2001;
Dollard, et al., 2000a, 2000b). While the present program
can be seen as a development from this seminal work,
it differs from the South Australian project in a number
of ways. First, the present program is ongoing, while
Dollard et al. (2000b) investigated a one-off trial. Secondly,
the South Australian project employed a senior clinical
psychologist solely as a supervisor for trainees on rural
placement, while in the present program a senior clinical
psychologist was employed not only to supervise and
oversee the program on site, but also to initially develop the
program in consultation with the area mental health service
where interns are placed. Finally, the present program is
integrated into a broader service enhancement strategy in
the area (as described in Judd et al., 2001). One aim of this
strategy is to develop a shared language about psychological
interventions. Continuous with the intern program, structured
professional development seminars are being conducted for
all case managers. Hence, interns might introduce a specific
behavioural intervention to a client, which can then be
reinforced over time by the relevant case manager.
Novel ways of improving access to clinical psychology
services are being investigated by two other groups. Vines
and colleagues have designed a project in which postgradu-
ate clinical psychology students are placed in general
practices in rural NSW (Commonwealth Department
of Health and Aged Care, 2001; Vines, Thomson & Hurley,
in press). Winefield and colleagues (Winefield, Marley,
Williams, Turnbull & Taplin, 2001) are currently evaluating
a General Practice Psychology program in which an experi-
enced clinical psychologist is placed in a suburban general
practice (with the inclusion of psychology interns as a future
development). Given the growing commonwealth govern-
ment emphasis on management of anxiety and mood disor-
ders through primary care settings, both projects are
important and timely. Our program can be seen as comple-
mentary to these efforts, in exploring the role of clinical
psychology interns in the treatment of more severe presenta-
tions within a mental health service.
The Bendigo Health Care Group
The present program grew out of strong links between
the Bendigo Health Care Group and the University of
Melbourne Department of Psychology (Cockram et al., 2000;
JULY 2002 AUSTRALIAN PSYCHOLOGIST
130
Judds et al., 2001). In mid-2000, it was agreed that
University of Melbourne trainees would be offered rural
internships within the Bendigo Health Care Group (BHCG)
Psychiatric Services.
The catchment area of BHCG Psychiatric Services
extends across the Loddon Campaspe and Southern
Mallee regions, which constitute 20% of Victoria's landmass.
The region stretches from Gisborne in the south to Swan Hill
in the north, and is centred around the city of Bendigo
(approximately 2-road-hours from Melbourne). An adult pop-
ulation of approximately 190,000 resides in the catchment area.
The service has a structure typical of many Adult Area
Mental Health Services (AMHSs) in Victoria. Specifically,
the majority of clinical appointments over recent years have
been to generic case manager positions. Psychiatric nurses
hold most of these positions, and prior to the introduction
of the present program, there were no clinical psychologists
working as case managers in the service. The service has
a 20-bed acute inpatient facility located on the grounds
of the Bendigo Base Hospital. A primary aim of the ward
is to ensure continuity of care between the community and
the inpatient unit.
Program Development
Logistics and Costing
In recognition of the challenges of an intensive rural place-
ment (two days and one night per week in Bendigo), it was
decided that interns would be placed in pairs. The senior
clinician would be on site for one of the two days, but
always contactable by email, providing a rapid procedure
for review of reports. Two pairs of interns would cover the
48-week year, with some trainees taking up a 40-day (third
year) and some a 55-day (second year) placement.
The program is funded through a recurrent grant held
by the BHCG. Salaries are the major expense. A senior
academic clinician is employed one day per week, initially
to develop the program and subsequently to provide super-
vision and ongoing direction. Interns are paid pro rata of the
P1, Year salary (approximately $25,470 per annum), and
are not offered reimbursement for food or incidental
expenses for the two days that they spend in Bendigo.
Testing materials (approximately $1000 for each of the
test kits - see below) were purchased to permit structured
assessments to be conducted, and clinical psychology
textbooks (to the value of approximately $1000) were
purchased to support clinical training and service delivery.
Satisfactory and economical accommodation was available
in the nurse's quarters of the Bendigo base hospital, and the
university department agreed to provide a departmental car
and petrol for transportation. As noted by others (Dollard
et al., 2000b), adequate computing and networking facilities
are critical in a rural placement. Networked computers were
made available through the BHCG, providing access
to email accounts and the web-based facilities of both the
university and the health care group.
Consultation and Goal Setting
Prior to commencement of the intern program proper,
a 12-day block of consultation and planning was undertaken
with the aim of maximising the interns' clinical impact and
their training experience. A needs analysis for the service
was based on interviews with major stakeholders - outpa-
tient team leaders, inpatient unit manager, consultant
psychiatrists and psychiatric registrars, as well as the
Executive Director of Psychiatric Services. The consultation
process identified a number of weaknesses that the intern
program could address. On the inpatient unit, there was no
 CLINICAL PSYCHOLOGY INTERN PROGRAM IN RURAL MENTAL HEALTH
structured ward program, no psychological assessment
service and little psychological input to case formulations.
Neither behavioural nor psychotherapeutic interventions
were routinely available on the ward. While continuity
of care was an important goal of the service, no interven-
tions were available to "bridge" inpatient and outpatient
phases of treatment. The general consequence of these
deficits was believed to be a drift towards biomedical
conceptualisation of clients who passed through the ward.
In the community, a deficit was identified in the use
of evidence-based interventions for anxiety and mood disor-
ders and problems. Anxiety and mood disorders are the
most prevalent in Australia generally (Australian Bureau
of Statistics, 1998), and probably also in rural and regional
settings (Elliott-Schmidt & Strong, 1997).
On the basis of the consultation process, therefore, four
objectives were defined for the program:
* Provide timely and constructive assessment and diagnos-
tic services to the inpatient unit.
* Provide brief (1-3 sessions) intervention services
for inpatients, with the goal of improving patients'
management of anxiety, mood and adjustment problems.
* Develop and implement an inpatient group program
providing patients with distraction, activity, psychoeduca-
tion and limited skills training.
* Provide effective outpatient treatment for patients
with anxiety and mood symptoms and disorders, with an
emphasis on offering bridging interventions for patients
moving from the inpatient to the community setting.
An Evidence-based Approach to Clinical Objectives
Relevant literature was reviewed to inform the choice
of strategies for achieving the defined program goals.
Specific tests for assessment and diagnostic purposes
were chosen against the criteria of wide clinical acceptance
and extant reliability and validity data. The WAIS-III and
WMS-III (Tulsky & Ledbetter, 2000) were therefore
selected for cognitive testing, and the MMPI-II (Butcher
& Williams, 2000), NEO-PI-R (Costa & McCrae, 1992)
and SCID-II (First, Spitzer, Gibbon, & Williams, 1995)
were chosen for structured personality testing.
It was decided that brief interventions for anxiety, mood
and adjustment problems amongst inpatients would
be informed by CBT for anxiety disorders and depression
(Beck, 1995) and Interpersonal Psychotherapy for adjust-
ment processes (Weissman & Markowitz, 1998). While data
supporting the efficacy of these approaches is substantial
(see e.g., Chambless & Gillis, 1996; Hollon, DeRubeis,
& Evans, 1996; Markowitz, 1998), there is as yet little
evidence that specific strategies or elements from these
approaches are effective in the current context (Clarke,
1996; Nathan, Stuart, & Dolan, 2000). An aim of the intern
program, therefore, is to undertake real-world effectiveness
research on these therapeutic methods.
The inpatient group program was designed to follow
an open group format. The content and process of the group
was based on previous research and practice (e.g., Freeman,
Schrodt Jr, Gilson, & Ludgate, 1993; Maves & Shulz, 1985).
A core principle identified from this literature was the
problem-solving stance commonly associated with cognitive
and behavioural therapies (Medalia, Dorn, & Watras-Gans,
2000; Pollack, 1991; Sautter, Heaney, & O'Neill, 1991).
The specific content of the program was designed to cover
skills that had been observed to be deficient in this popula-
tion, and were amenable to presentation in a simple and
time-limited form. The topics therefore included anxiety and
sleep management, self-esteem behaviours, assertion and
structured problem-solving. Attendance at the weekly
inpatient group program was to be voluntary, but encour-
aged. The program was initially scheduled to run on an 8-
week cycle across the year, with 45-minute sessions taking
place each Tuesday afternoon.
CBT was the therapeutic approach selected for the time-
limited outpatient treatment of anxiety and mood symptoms
and disorders (Beck, 1995). It was reasoned that patients
need not have a primary diagnosis of an anxiety or mood
disorder (it was predicted that many clients would in fact
have Axis II diagnoses as primary). The model of treatment
was of 12-14 weekly sessions. While there is ample efficacy
evidence for cognitive-behavioural therapy of anxiety and
mood problems in pure form (see, for a summary, Nathan
& Gorman, 1998), less attention has been paid to the impact
of personality comorbidity on therapeutic outcome (Jarrett,
Kraft, & Silver, 1997). The program aims to progressively
generate research into the effectiveness of CBT for anxiety
and mood symptoms within more complex presentations.
Operation and Initial Evaluation
of the Program
Supervision
Weekly supervision sessions last for approximately 1 hour
per intern per 2-day week and tend to cover new referrals
to the intern program, progress of the inpatient group
program, assessments (and associated reports), and ongoing
treatment cases. Supervision of the pair of interns
is conducted both singly and jointly. The advantage of the
former approach is it enables supervision to be targeted
to the specific training needs of each intern, the advantage
of the latter is that training is enhanced by interns offering
input on each others' activities. Supervision sessions are
also used as an opportunity to monitor structural features
of the program.
Clinical Throughput
Over the first 6 months of operation, 65 referrals were made
to the intern program 2. Thirty referrals were for assessment
only, with the primary aim of identifying Axis II or cogni-
tive features that might be confounding either diagnosis
or clinical progress. Structured personality testing was
involved in the majority of these, but four referrals were for
cognitive assessment and five were based on a clinical inter-
view alone. An unintended outcome of some assessments
was that patients benefited from the opportunity to situate
their current distress in the context of stable features of their
personality and history.
Twenty-two inpatients were referred for short-term
therapy, either whilst on the ward or upon discharge.
The majority of these clients.had marked anxiety-phobic
symptoms, and interventions primarily involved relaxation
training and cognitive restructuring (Beck, 1995).
The presenting problem in one case was first episode
psychosis. This is a problem where targeted short-term
therapy has shown promise (Drury, Birchwood, Cochrane,
& MacMillan, 1996; Drury, Birchwood, Cochrane,
& MacMillan, 1997; Gould, Mueser, Bolton, Mays, & Goff,
2001), and we expect to be involved in the treatment
of a growing number of such cases.
Attendance at the inpatient group program has averaged
6-7 patients per session. The program is also attended
by consumer advocates and the service's occupational thera-
pist. As is typical of acute inpatient group programs,
a fundamental challenge for the facilitators is to manage the
symptom-driven input of some participants while presenting
a coherent session that will be useful for less symptomatic
JULY 2002 V AUSTRALIAN PSYCHOLOGIST
131
GREG MURRAY, GENE HODGINS, FIONA JUDD, HENRY JACKSON AND JULIAN DAVIS

individuals. A strength of the program is that it increases
interaction between psychology staff and patients, and
between psychology staff and other ward staff.
Fifteen patients were referred from community-based
case managers for short-term treatment. Some of these cases
had relatively circumscribed anxiety or mood features that,
while not necessarily the primary diagnosis, were found
to respond reasonably well to short term cognitive-behav-
ioural treatment. Others were complex cases where Axis I
features could not be usefully isolated from personality
issues, such as severe mood variability or impulsive self-
harm. Treatment of this group of cases was informed
by Linehan's structured approach to the treatment of person-
ality disorder (Heard & Linehan, 1994; Linehan, 1995).
To effectively manage the large number of community
referrals for anxiety and mood problems, a four-session
"Health and Well Being" group was developed and
conducted in one of the outlying regions (Castlemaine) and
in Bendigo itself. The group's therapeutic approach empha-
sises a continuum of wellbeing, the importance of positive
affect (Headey, Kelley, & Wearing, 1993; Nemanick Jr.
& Munz, 1994) and personal meaning (see, Fava, Rafanelli,
Cazzaro, Conti, & Grandi, 1998, for a discussion of
a related approach). The group is run as a closed program,
and has a largely psycho-educational content, covering
anxiety management, the role of cognitions in mood, self-
esteem enhancement, sleep hygiene and activity scheduling.
Patients can further explore these skills with their case
managers after completion of the group, because the group
content overlaps with professional development seminars
that have been offered to case managers within the service
(Judd et al., 2001).
Initial Evaluation
The first 6 months of operation was evaluated qualitatively,
with the impact of the program assessed by the consultant
psychiatrist, nurse unit manager, the consumer consultant,
the senior clinical psychologist and the interns themselves.
Respondents were asked to comment on strengths,
weaknesses and areas for future development of the intern
program. As summarised in Table 1, there were a number
of themes in the feedback. The major strengths of the
program as perceived by stakeholders include the provision
of evidence-based psychological input to case formulation
and management, and the introduction of a well-regarded
inpatient group program. The major perceived weakness
of the program is its limited breadth (in both days of the
week, and availability for therapy and counselling work).
Future developments identified include improved integra-
tion between the intern program and the ward (both nursing
staff and patients), and the systematic quantitative measure-
ment of clinical outcomes.
Conclusions
The clinical psychology intern program described here
is in an early stage of development, but indications to date
suggest that two fundamental goals are being achieved.
First, it can be argued that interns under supervision provide
a high quality clinical alternative for a rural AMHS. Fully
qualified psychologists are simply difficult to attract to rural
settings (Dollard et al., 2000a). Conversely, later-year

TABLE
Strengths, Weaknesses, and Potential Future Developments of the Intern Program, as Perceived by Major Stakeholders
Source Strengths
Consultant psychiatrist Timely, well integrated aspect of service
Increased emphasis
on psychological issues.
Objective assessment of personality
an improvement over "gut feelings"
and pejorative personality labels.
Weaknesses
Only provides two days cover.
Limited capacity to offer therapy.
Limited neuropsychological testing.
Future developments
Provide training and support
for nursing staff to take over
the running of the inpatient
group program, and expand
inpatient group program out
to daily sessions on a
2-week cycle.

Consumer consultant Assertion and self-esteem training
(ininpatient group program) very useful.
Good attendance at inpatient group
program, and inpatient group program
highly regarded by consumers.
Consumer engagement with The inpatient group program
psychologists would be improved could be followed up inthe
by an initial rapport-building stage community
(more presence on the ward).
For acute patients, extensive
information given in handouts
can be overwhelming.
Psychologists could inform inpatients
that they are available for counselling.

Nurse unit manager Presence of psychological services.
Professional development for ward staff
(provided by senior psychologist).
Interns provide a different perspective
on cases, and positively challenges
staff attitudes.
Available only 2 days per week.
Limited experience of the interns.
Would like a documented
summary of psychology
contacts.
Nurses could have input to
the training of the interns.

Senior clinical Rapid introduction of an effective, No quantitative data on the outcome Institute systematic measure-
psychologist targeted psychology service. of interventions, nor the impact ment of intervention outcomes
of assessments on case formulations. (pre- and posttreatment
symptom scales and client
satisfaction measure).

Interns Interns act with relative independence, Inconvenience of travel Improve coordination of the
and deal with a wide range of clients. (to Bendigo and within Bendigo). two interns' activities.
Rewarding to follow patients from inpatient Two days placement is insufficient.
to community setting.

JULY 2002 V AUSTRALIAN PSYCHOLOGIST

132
 CLINICAL PSYCHOLOGY INTERN PROGRAM IN RURAL MENTAL HEALTH
postgraduate trainees are at a stage of their professional
development when they are armed with up-to-date skills and
enthusiastic to apply them independently and critically.
With optimism balanced by appropriate planning and evalu-
ation, the service as a whole has the opportunity to create
new ways of doing psychology business. Second, for clini-
cal psychology trainees, a rural placement provides
exposure to a range of problems and contextual features that
they are unlikely to experience in other services (Merwin,
Goldsmith, & Manderscheid, 1995).
In the longer term, programs such as this can be expected
to have flow-on effects for psychological services in rural
Australia (Hargrove & Breazale, 1993). First, the program
demonstrates to the AMHS the effectiveness of specialist
psychology activity and should thus encourage funding
of more discipline-specific ongoing positions. Second,
a rural exposure during training may decrease psychological
barriers to qualified practitioners relocating to the country.
Finally, the presence of a clinical/academic infrastructure
will make specialist psychology positions more attractive
and sustainable, through opportunities for supervision and
the creation of a collegial environment.
Specialist clinical psychology services have had
a diminishing presence in public mental health over recent
years, with negative consequences most apparent in rural
areas. The program described here aims to counteract this
trend by taking advantage of the symbiosis between profes-
sional training and service provision. Further evaluation and
refinement will test the limits of the program in effecting
positive change.
Endnotes
I Clinical psychology is not, of course, the only mental health
discipline to boast identifying skills. For example, liaison
between services may be considered a forte of the social work
discipline.
2 An electronic data base of all referrals to the psychology office
was created, facilitating tracking of cases and generation
of summary data
References
Australian Bureau of Statistics (1998). Mental health and well-
being profile of adults - Australia 1997. Canberra: Author.
Australian Psychological Society (2000). Australian Psychological
Society Course Accreditation Guidelines. Melbourne: Author
Beck, A.T., Rush, A. J., Shaw, B.F., & Emery, G. (1979).
Cognitive therapy of depression. New York: Guilford Press.
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond.
New York: The Guilford Press.
Belcher, J.R. (1993). The trade-offs of developing a case manage-
ment model for chronically mentally ill people. Health and
Social Work, 18(1), 20-31.
Bridgewater, K. (1998). Survey of South Australian undergraduate
ruraland remote education and experience: Health disciplines
(Project report No. South Australian Centre for Rural and
Remote Health, Adelaide.
Butcher, J.N., & Williams, C.L. (2000). Essentials of MMPI-2
and MMPI-A interpretation. Minneapolis, MN: University
of Minnesota Press.
Chambless, D.L., & Gillis, M.M. (1996). Cognitive therapy
of anxiety disorders. In K. S. Dobson & K.D. Craig (Eds.),
Advances in cognitive-behavioraltherapy (pp. 116-144).
Thousand Oaks, CA: Sage Publications.
Clarke, G.N. (1996). Improving the transition from basic efficacy
research to effectiveness studies: Methodological issues and
procedures. Journal of Clinical and Consulting Psychology,
63(5), 718-725.
Cockram, A.M., Judd, F.K., Jackson, H., Kyrios, M., Yeatman, R.,
Murray, G., Hordern, C., Wainwright, K., Komiti, A., Allen,
N., & Singh, B. (2000). The development of a clinic for the
management of depression and anxiety: The Depression and
Anxiety Research and Treatment (DART) Clinical Program.
AustralasianPsychiatry, 8(2), 132-136.
Commonwealth Department of Health and Aged Care, Partnerships
in Service Reform Section, Mental Health and Special Projects
Branch, Health Services Division (2001). Clinical psychology
in rural general practice Project: Progress report. Canberra:
Author.
Costa, P.T., & McCrae, R.R. (1992). Revised NEO Personality
Inventory and NEO Five-Factor Inventory professional
manual. Odessa: Psychological Assessment Resources.
Dollard, M., Farrin, J., & Heffernan, P. (2001). A model for
improved health of rural and indigenous Australians through
education, support and trainingfor psychologists. Paper
presented at the 6th National Rural Health Conference,
Canberra, Australia.
Dollard, M.F., Shafik, S., Court, J., & Heffernan, P. (2000a).
Issues in the practice of rural and remote psychology.
Paper presented at the 4th Regional Australia Conference,
Volume II Rural Psychology, Whyalla, South Australia.
Dollard, M. F., Shafik, S., Farrin, J., & Heffernan, P. (2000b).
Rural psychology and education: Rural internshipsfor clinical
psychology students. Whyalla: University of South Australia.
Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1996).
Cognitive therapy and recovery from acute psychosis: A
controlled trial: I. Impact on psychotic symptoms. British
Journal of Psychiatry, 169(5), 593-601.
Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1997).
Cognitive therapy and recovery from acute psychosis:
A controlled trial: II. Impact on recovery time. British Journal
of Psychiatry, 169(5), 602-607.
Elliott-Schmidt, R., & Strong, J. (1997). The concept of well-being
in a rural setting: Understanding health and illness. Australian
Journal of Rural Health, 5, 59-63.
Farrin, J., & Dollard, M. F. (2000). Rural clinical psychology
handbook: Rural internships for clinical psychology students.
Whyalla: University of South Australia.
Fava, G. A., Rafanelli, C., Cazzaro, M., Conti, S., & Grandi, S.
(1998). Well-being therapy: A novel psychotherapeutic
approach for residual symptoms of affective disorders.
PsychologicalMedicine, 28(2), 475-480.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W.
(1995). The Structured Clinical Interview for DSM-III-R
Personality Disorders (SCID-II): I. Description. Journal
of PersonalityDisorders,9(2), 83-91.
Freeman, A., Schrodt Jr, G. R., Gilson, M., & Ludgate, J. W.
(1993). Group cognitive therapy with inpatients. In J. H.
Wright, M. E. Thase, A. T. Beck, & J. W. Ludgate (Eds.),
Cognitive therapy with inpatients: Developing a cognitive
milieau (pp. 123-153). New York: The Guilford Press.
Giesler, L. J., & Hodge, M. (1999). Case management in behav-
ioral health care. InternationalJournal of Mental Health,
27(4), 26-40.
Gould, R. A., Mueser, K. T., Bolton, E., Mays, V., & Goff, D.
(2001). Cognitive therapy for psychosis in schizophrenia:
An effect size analysis. Schizophrenia Research, 48(2-3),
335-342.
Griffiths, S., & Andrews, H. (1995). Issues in rural and remote
psychological practice. Australian Journal of Psychology
Supplement: Combined Abstracts of 1995 Australian
Psychology Conferences, 47, 80.
Hargrove, D.S., & Breazale, R.L. (1993). Psychologists and rural
services: Addressing a new agenda. Professional Psychology
Research and Practice,24(3), 319-324.
Headey, B., Kelley, J., & Wearing, A. (1993). Dimensions
of mental health: Life satisfaction, positive affect, anxiety and
depression. Social IndicatorsResearch, 29, 63-82.
JULY 2002 AUSTRALIAN PSYCHOLOGIST
133
 GREG MURRAY, GENE HODGINS, FIONA JUDD, HENRY JACKSON AND JULIAN DAVIS
Heard, H.L., & Linehan, M.M. (1994). Dialectical behavior
therapy: An integrative approach to the treatment of borderline
personality disorder. Journal of Psychotherapy Integration,
4(1), 55-82.
Hollon, S.D., DeRubeis, R.J., & Evans, M.D. (1996). Cognitive
therapy in the treatment and prevention of depression. In P.M.
Solkovskis (Ed.), Frontiersof cognitive therapy (pp. 293-317).
New York: The Guilford Press.
Jarrett, R.B., Kraft, D., & Silver, P. (1997). Cognitive therapy
of mood disorders with comorbidity. In S. Wetzler & W.
Sanderson (Eds.), Treatment strategies for patients with
psychiatric comorbidity (pp. 135-162). New York: John Wiley
and Sons.
Judd, F. K., Jackson, H., Davis, J., Cockram, A., Komiti, A., Allen,
N., Murray, G., & Kyrios, M. (2001). Improving access
for rural Australians to treatment for anxiety and depression:
The University of Melbourne, DART - Bendigo Health Care
Group initiative. AustralianJournalof Rural Health, 9, 91-96.
Linehan, M.M. (1995). Skills training manual for treating border-
line personality disorder. New York: The Guilford Press.
Markowitz, J.C. (Ed.). (1998). Interpersonalpsychotherapy.
Washington, DC: American Psychiatric Press.
Maves, P.A., & Shulz, J.W. (1985). Inpatient group treatment
on short-term acute care units. Hospital and Community
Psychiatry, 36(1), 69-73.
Medalia, A., Dorn, H., & Watras-Gans, S. (2000). Treating
problem-solving deficits on an acute care psychiatric inpatient
unit. PsychiatryResearch, 97(1), 79-88.
.
JULY 2002 AUSTRALIAN PSYCHOLOGIST
134
View publication stats
Merwin, E.I., Goldsmith, H.F., & Manderscheid, R.W. (1995).
Human resource issues in rural mental health services.
Community Mental Health Journal,31(6), 535-537.
Nathan, P.E., & Gorman, J.M. (1998). A guide to treatments that
work. New York: Oxford University Press.
Nathan, P.E., Stuart, S.P., & Dolan, S.L. (2000). Research
on psychotherapy efficacy and effectiveness: Between Scylla
and Charybdis? PsychologicalBulletin, 126(6), 964-981.
Nemanick Jr., R.C., & Munz, D.C. (1994). Measuring the poles
of negative and positive mood using the positive affect
negative affect schedule and activation deactivation adjective
check list. Psychological Reports, 74, 195-199.
Sautter, F.J., Heaney, C., & O'Neill, P. (1991). A problem-solving
approach to group psychotherapy in the inpatient milieu.
Hospital and Community Psychiatry,42(8), 814-817.
Tulsky, D.S., & Ledbetter, M.F. (2000). Updating the WAIS-III
and WMS-III: Considerations for research and clinical
practice. PsychologicalAssessment, 12(3), 253-262.
Vines, R., Thomson, D., & Hurley, B. (in press). Clinical psychol-
ogy in rural general practice. ClinicalPsychologist.
Weissman, M. M., & Markowitz, J. C. (1998). An overview
of interpersonal psychotherapy. In J. C. Markowitz (Ed.),
Interpersonal psychotherapy (pp. 1-33). Washington,
DC: American Psychiatric Press.
Winefield, H., Marley, J., Williams, B., Turnbull, D., & Taplin, J.
(2001). Adding a psychologist to a general practice: Results
from the GPs' perspective. Paper presented at the General
Practice and Primary Health Care Research Conference:
Embedding Research in Practice, Adelaide.