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The Behavioral Medicine rotations in the Internship in Clinical Psychology are designed to provide a broad range of clinical experiences.
The Outpatient Psychiatry Department (OPD) rotation is a year-long rotation. Interns provide evidence-based cognitive-behavioral treatments to individual therapy outpatients. Behavioral Medicine (BMED) interns have the opportunity to treat a wide range of psychological disorders (e.g., mood disorders, anxiety disorders and adjustment disorders) in patients with and without medical comorbidities. Common medical populations served include cancer patients (and those with survivorship status), neurological problems (such as epilepsy or multiple sclerosis), HIV and endocrine disorders like type 2 diabetes. Interns carry a caseload of approximately 8-10 OPD patients, and they receive high-quality supervision weekly from multiple supervisors (two hours of individual clinical supervision and one hour of small group supervision). Interns also have the opportunity to work as part of multidisciplinary team, communicating with patients’ primary care providers, psychiatrists and/or medical specialists to provide comprehensive and high-quality patient care. Patients can self-refer to the OPD or be referred by their medical providers.
The neuroscience ICU rotation combines clinical training with research. Each of the 2 interns will rotate in the Neuro-ICU one day a week for several months. The interns will participate in multidisciplinary staff meetings, co-lead a 30 minute skills group for caregivers and provide assessments and brief interventions to patients and families within the ICU. All interns will receive hands-on training though shadowing an experienced clinical psychologist within the neuro-ICU, as well as supervision of clinical cases. Research opportunities include participation in an ongoing prospective study of patients and caregivers aimed at identifying predictors of depression and post traumatic stress at 3 and 6 months post ICU admission, manuscript preparation, assistance in the design of semi-structured interviews, conducting focus groups with patients and caregiver, intervention development and help with grant preparation and intervention delivery.
Each BMED intern spends one half-day per week at the Mass General Weight Center for six months of his or her internship year. The Weight Center is a multidisciplinary subspecialty obesity medicine clinic treating patients with obesity or other conditions related to weight. Each Weight Center patient is assessed by a team that includes a physician, dietitian and psychologist, who together formulate a comprehensive, individualized treatment plan. Weight Center treatments for obesity include behavioral weight management intervention, pharmacological treatments and weight loss surgery; for many Weight Center patients, the team psychologist plays an active role in treating eating disorder symptoms and/or providing behavioral problem-solving, motivational interviewing, and sleep hygiene interventions. Under the supervision of Weight Center psychologists, the intern conducts psychosocial evaluations of new Weight Center patients, formulates treatment recommendations and carries a caseload of 1-3 short-term therapy cases at any given time during the rotation, which typically involve treating emotional eating and binge eating disorders, supporting healthy lifestyle changes and reducing distress related to body image. Interns work closely with the other team members to provide coordinated care. Interns receive one hour of formal supervision weekly, with informal supervision contact as needed. There is also a strong didactic component to this rotation, with assigned readings of scientific articles related to a wide range of obesity and obesity treatment topics and weekly discussions of these articles during supervision.
As part of the generalist training component of the internship, interns complete a six-month rotation for one half day per week in the Acute Psychiatry Service (APS) in the Emergency Department. Interns learn to work in a fast-paced environment, perform a comprehensive, time-sensitive psychiatric evaluation, conduct a complete risk assessment, work with an interdisciplinary team of doctors, nurses, psychiatry residents and attending psychiatrists, and compose concise clinical documentation. Specifically, interns will conduct a full psychiatric evaluation focused on risk assessment, planning and disposition for children, adults and geriatric patients who present to the ER with emergent concerns around mental health (e.g., suicidality, homicidality, psychosis, substance abuse or intoxication). Interns will present each case to the attending psychiatrist, giving a clear outline of the psychiatric and medical history, impressions of the possible psychiatric diagnoses and differential diagnoses, and a preliminary assessment and plan. The attending psychiatrist will interview the patient him or herself, and the intern is encouraged to observe during this process if time permits. The intern will work with the attending psychiatrist to finalize the assessment and disposition plan, and will then work with support staff to implement the plan, which may include discharge, referral to partial hospitalization program, or inpatient psychiatric admission. As part of this rotation, interns will also attend a weekly APS seminar, which will provide an opportunity for clinical supervision, as well as education and training around working in the APS environment.
Each intern will participate in the Dialectical Behavior Therapy (DBT) rotation for six months of the internship. This rotation includes co-leading a weekly 90-minute DBT skills group through the outpatient psychiatry department at Mass General for patients with borderline personality disorder and other psychiatric comorbidities. During the rotation, the intern will co-lead the DBT group with an expert in DBT and have the opportunity to participate in a weekly DBT team meeting with other expert clinicians and trainees.
In order to better serve patients, behavioral medicine has psychologists embedded in several hospital clinics and centers, including the Digestive Healthcare Center at Mass General. The majority of behavioral medicine patients seen through the Digestive Healthcare Center are diagnosed with inflammatory bowel disorders (Crohn's Disease and Ulcerative Colitis) or functional gastrointestinal disorders such as Irritable Bowel Syndrome, Gastroparesis, and Cyclical Vomiting Syndrome. Typical referrals include (1) patients having difficulty adjusting to a recently diagnosed chronic GI condition, (2) patients facing challenges around adherence to medication, diet, or lifestyle changes, and (3) patients for whom stress and anxiety management strategies could improve their medical conditions either directly (by reducing episodes) or indirectly (by improving coping). Directly addressing these challenges often yields noticeable benefit after just a few sessions. Opportunities may be available for interns interested in working with this population.
Dr. O’Cleirigh directs the Behavioral Science Team at The Fenway Institute with a primary focus on intervention development to support HIV prevention and treatment and LGBT health disparities. The rotation at The Fenway Institute is available to interns who have an interest in HIV research and/or in LGBT health. The rotation is typically arranged for the intern to spend one full day a week at The Fenway Institute with the potential to increase their time during the second semester of the internship year. The opportunities for interns on the Behavioral Science Team at The Fenway Institute multiple and varied and are typically linked to current research projects in progress or in development. These projects are generally conducted by researchers who have their primary appointment at Harvard Medical School and in the Behavioral Medicine Program at Massachusetts General Hospital. The Directors of the Fenway Institute are Drs. Kenneth Mayer and Judy Bradford who work closely with the Behavioral Sciences Team.
Current behavioral research projects at The Fenway Institute include:
The opportunities for interns on these projects include participating in treatment and treatment development studies as protocol therapists. This involves learning and implementing novel manualized cognitive behavioral treatments and receiving weekly clinical supervision. The intern also participates in weekly research team meetings and other trainings. The intern will also be expected to participate in preparing manuscripts for publication and preparing conference submissions from study data sets. Opportunities to make co-author and first author contributions are available on most of these projects. The Behavioral Science Team is constantly developing new projects and the opportunity to contribute to new and ongoing grant submissions is expected and forms part of the supervised research mentorship that is provided through the rotation at The Fenway Institute.
Interns who elect this rotation enjoy the experience of working in the more relaxed atmosphere of an LGBT Health Center (the largest Health Center meeting the needs of the LGBT Community in the country). This rotation also provides opportunities to become involved in biomedical research projects, ongoing epidemiological studies, and policy and education initiatives all of which form part of The Fenway Institute’s portfolio.
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