Internship Interview Questions – UCSD – Flashcards

(a) expand upon my general psychotherapy and assessment skills, (b) gain more exposure to new training opportunities working on an inpatient unit, (c) broaden my experience working in multidisciplinary teams.

A: 1. Setting in AMC; 2. Training in assessment and general outpatient ; 3. Continue to specialize in CBT for mood and anxiety, 4. Substance abuse and pain clinic, more interaction with medical co-morbidities.

I had a testing case who was a 22 year old AA female, she had started in her first year of college and then had a psychotic break on her winter break and starting acting in an aggressive manner, gave her a set of test for cognitive and memory functioning and achievement, can she go back to school? No she cannot she had about average functioning in some domains but her working memory was very very low, she would probably not be able to go back to school without significant accommodations. I want to see more work with psychotic individuals and how quickly their life can change during early adolescence.

Best supervision experience - current with Dr. V or Fabi, because they are directive when need be in terms of areas for my growth, but also allow me to process my hypotheses about what is going on with patients, decision-making, discuss how to present information to clients, guide me gently where to go. Most difficult Dr. T: just because very new psychodynamic, unconscious processes, non-directive, difficult for me to know where to go with clients since had never seen the outcome of psychodynamic and the processes is expected to take so much longer. Learned to be very self-reflective about my own challenges and assertive in asking for help and more direction when needed for difficult cases.

Ask questions to get me thinking, Mix of directive (for newer treatments and orientations) and exploratory non-directive for clients who I have more familiarity with treatment approaches or diagnoses, look into function of emotions or behavior or thoughts for the client, this allows me to see more clearly; dislike - completely non-directive, or too rigid, not allowing space for self-reflection, not tying techniques and methods to the case conceptualization, help me to see why going a certain way in therapy.

I have not yet provided direct supervision however I would be interested in engaging in it in the future. I believe I would want to adjust my supervisory technique based on the developmental trajectory of my supervisee. Newer clinicians I think would do better with development of case conceptualization and directive help with decision-making about where to go in therapy. Maybe some role-playing of techniques to implement with clients.

EA, 33 y/o Caucasian Female, married with 1 young child, she was referred by a psychologist from primary care setting who diagnosed her with MDD, when she came to me I also gave her a diagnosis of SAD. She had pretty low mood, difficulty sleeping, difficulty concentrating and feelings of worthlessness as well as avoidant behaviors and lack of motivation at work. She did not have friends outside her immediate family and reported anxiety about others judgements in most social interactions such as automatic thoughts of They will find out I am weird and a feeling of her mind going blank. She revealed a core belief of "I am damaged." Also she did not spend a lot of time out of the house and reported fatigue and low motivation to engage in other activities she previously enjoyed such as playing music. I conceptualized her through a CBT lens due to the interplay between her negative views about herself and fear of judgement from others that contributed to her avoidant behavior and lack of motivation and energy, and ultimately reduction in activities that was reinforced in a negative cycle. I hypothesized that her MDD symptoms may have been as a result of her social anxiety and avoidance of social interactions thus I began by addressing her social anxiety by providing psychoeducation and and having her start to track her social anxiety cbt model. However after a few weeks of this she came in very hopeless and with even more depressed mood. Thus I believe the awareness from the traicking of her anxiety and understanding of the limiting nature of the disorder on her life was affecting her mood. This is also her first time in therapy so she was feeling hopeless about her chances for recovery. So I then switched to using ba tehcniques to increase her pleasure and mastery and affect her negative mood. This did seem to help although she still brings in situations of social anxiety and depressed mood and thus I have learned to become proficient in switching between BA and CBT for social anxiety conceptualization within my sessions. Then went to BA and monitoring along with some more psychoeducation about anxiety, mix of both in session, and some psychoeducation about believability of thoughts, and experiment curiosity about what is going on scientists, see if it works!

AS 38 AAF married 3x/kids - MDD, referred from primary care SSRI lots of side effects, stopped working, difficulties sleep an appetite, reduction in her activities spending most of her time at home. Conceptualized her through a CBT framework that her negative self--schema and beliefs of being worthless were affecting her mood and leading to extreme isolation and fatigue and lack of appetite along with guilt and worthlessness, in a negative cycle. Thus I implemented CBT techniques in therapy. Also over the course of therapy she revealed a past experience of sexual trauma that she had not disclosed to her husband so used supportive therapy and communication skills to address this component of her case. Initially started with referral to psychiatrist, psychoed about MDD and addressing some stigma she had around the disorder and asking for help (superwoman schema), BA (get back to work and doing small things), trauma supportive therapy and communication with her husband, CR for negative self-beliefs (also associated with trauma), mindfulness and values work to help improve her meaning and engage in longer term life enhancing project. By the end dramatic reduction in mood, sleep, appetite, and anhedonia. She had gone back to work and started to engage in more activities with her husband and kids, started cooking and sewing again and spoke about longer term goals of classes and projects to so used Started referral change in medication, BA, activity scheduling, interpersonal communication / stigma around her diagnosis, cognitive restructuring, trauma process and how to communicate with her husband disclosed, values work and short and long term values, mindfulness and relaxation.

AB: 34 y/o Caucasian, Female, who I am currently seeing at our outpatient clinic, she is married with 1 child, presenting with PTSD and GAD. She has a history of sexual abuse by a family member that continued for many years and is in a current domestic violence situation with sexual, verbal, and emotional abuse by her husband. He uses a lot of manipulative techniques and has in the past gotten very angry and thrown things in the house while yelling and arguing with my client and sometime yelling at their child. My client is planning for a separation from him. This case presented with two major ethical dilemmas. The first was the duty to warn and break confidentiality due to any potential child abuse. If the child were to report the child witnessing any DV and also was put in any "substantial harm." I wanted to monitor the situation closely. So to deal with this dilemma I regularly consulted with my supervisor and we decided it was best to communicate with my client directly the limits of confidentiality and how it may relate to her child witnessing the abuse and to make sure she understood the rationale behind this and my duty as a psychologist. My patient was very understanding when I had this conversation with her and noted she was taking precautions to try to protect her child from witnessing any arguments or fights. The second ethical dilemma was about limits of confidentiality with a child psychologist who started to see my patient's daughter and was in our clinic. My patient was hesitant about going to parent training with her husband due to the DV at home but the child psychologist really wanted my client to participate. To address this dilemma I consulted with my supervisor first and then spoke with my client about her thoughts on me speaking to the child psychologist. She stated she had already revealed the DV to the child psychologist and said it was ok for me to speak with her about what we talked about. So I met with the child psych and was reiterate the occurrence of DV while letting her know I was monitoring the safety of the child. I did not get into specifics but advocated for my client to let the other clinician know why she was hesitant. The child psychologist and I spoke about the purpose and course of therapy and I reported this back to my client. She and her husband decided to engage in the parent training and are learning skills now to co-parent for their child.

At my second practicum I had a primary supervisor that was psychodynamic in orientation. I did not have a wealth of knowledge about the process of psychodynamic psychotherapy and my supervisor was fairly non-directive. Thus, I believe at there was a mismatch in my needs at this introductory developmental level as psychodynamic clinician and the supervisory style. Thus I asked my supervisor for more specific feedback, background on psychodynamic techniques and process, and readings to supplement my learning. Also I enrolled in our programs psychodynamic psychotherapy course. I also used implemented a lot of self-reflection after my sessions with clients writing up my observations and impressions and then pulling out specific questions for my supervisor. It was a steep learning curve but I believe after asking for more directive feedback and gathering more knowledge about the process of psychodynamic psychotherapy I became more comfortable assessing change in my clients and understanding how their patterns of thinking and behavior were shaped and maintained, even in the room. I believe I gained a lot of valuable knowledge from my year working with this supervisor. I also was able to work on assertiveness and clinical decision making skills so that if I thought a different approach was warranted that I was able to justify this approach with my supervisor.

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I have worked with diverse clients with a wide-range of disorders but I hope to continue to improve my skills working to implement CBT and mindfulness-based therapy for anxiety and trauma disorders as well as with LBGTQ populations which is an area of interest for me.

I enjoy working with clients who are able to be self-reflective and open in therapy. I think I have gotten more comfortable with clients who are ambivalent about change (enhanced my MI techniques) but still would like to continue my skills in that area.

I enjoying helping my clients to be more accepting and self-compassionate and to provide them with information about disorders and the science behind treatment approaches to validate their experience and give hope about the outcomes of therapy.

- revealing previous trauma; - seeing resiliency of my clients

I hope to have someone who is flexible in their approach. I hope that at first they can guide me a bit more directly in techniques to use and next steps for treatment. See where I am going. But then I hope that they are able to be more of a supportive coach to ask me open-ended questions to get me to think deeply about case conceptualization, decision-making for next steps in therapy, and reflection on the technique implemented.

In the near long term (5 years) I would like to continue to working in collaborative team-based environments to provide therapeutic services so I hope to work in a AMC setting. I hope to be engaging and providing CBT and mindfulness-based care to individuals with mood, anxiety, or trauma related disorders in a hospital setting. I hope to be clarifying my specialty within these populations and treatment modalities. Additionally, I would like to conduct research to understand the mechanisms of treatment efficacy cognitive/behavioral level or I am open to implementing research on a larger scale such as utilization and efficacy of treatment throughout the hospital setting. Thus I believe that the setting here at U Rochester would be a wonderful next step to set me on my planned career path as this is a AMC with abilities to improve my stills with anxiety and DBT skills, work accross the continuum of care.

In the longer term future (10 years) I would be interested in continuing in a specialized clinical and research field as well as engaging in teaching, supervision, and training within the hospital setting. I also hope to work in diversity training for professionals interacting with LBGTQ psychiatric populations.

IMMC Stone U Chicago

Volunteer - GWUH volunteered on an inpatient unit and shadowed group therapy, great proportion of SI and homeless individuals, it was lead by a therapist who was blind and one of the most compassionate individuals I have ever met. The clients loved her and responded to her compassion. Also there was a art therapy group that I helped out with. I also led some mindfulness exercises with clients. NIMH - visual attention, stroke patients, imaging, development of effective study paradigms. Jackie - Anhedonia telemedicine study comparing BA with medication management and healthy behaviors intervention on reward sensitivity and learning using behavioral tasks; M-Body - worked at Komed Holman FQHC on the S side of Chicago, 70% below poverty line, 70% AA, 20% hispanic, 5% caucasian, 5% other. recruiting and starting an adapted MBSR program for women with depressive symptoms (stigma: self and other stigma, superwoman schema, triple disadvantage, changes in well being and depressive symptoms, some differences in stigma); Rush - resiliency study childhood interpersonal trauma, module-based CBT, client chooses, to assess change in symptoms (SCIDs has helped with diagnostic clarity and differential diagnosis) starting to work with veterans for a study looking at intergenerational trauma; Master's and Dissertation - neuroimaging functional and structural in depressed women; Mindfulness studies with Dr. Victorson - cancer pain and mindfulness interventions;

Yes!

Ethnic diversity - black, hispanic, mixed race, immigrant populations, Sex - gay, bisexual, lesbian, queer; More experience with gender minority individuals; Broad age range; Broad ability range; Broad range of psychiatric conditions.

Nope but want to gain more experience! Diversity is very broad and I have worked with some LBGTQ clients but want more of that as area of interest.

Diversity class - experiential exercises; Minority stress model, stigma research internalized and external stigma shame that keeps people from asking for help or participating fully in treatment;

meditation, exercise or moving body, music, animals, being in nature, spending time learning with others

I want to implement both CBT and ACT conceptualizations to allow individuals to increase their awareness of internal experiences, gain space from their difficult thoughts and beliefs, challenge these to reduce the believability, and then accept difficult thoughts and switch attention, allowing them to move towards what really matters.

I think I will continually be learning throughout my life, I have grown up in a family where knowledge was highly emphasized, knowledge is power, and communicating and reflecting on that knowledge is important. More that just book learning experiential learning, experiential exercises with my clients. I know that my travels and my own personal experiences with mindfulness have both shaped my perspective on diversity and acceptance and the flexibility needed to make clients feel validated and motivated for change.

My training provides a thorough background from which to understand and effectively treat mental health disorders. My research pursuits have allowed me to more comprehensively understand and communicate the origin of symptoms of psychopathology to my clients. I have also gained an appreciation of how to foster attentional flexibility and promote an awareness of distressing symptoms in my clients. These insights allow me to more effectively implement interventions aimed at cognitive restructuring and tolerance of distressing emotions. In my career, I hope to continue in my pursuit of both clinical and research endeavors.

I am using a dataset from our lab that was a part of a large study of women across the lifespan with and without depression. I am continuing my training in neuroimaging data analysis (functional) to examine white matter structural connectivity in our sample of depressed women. White matter allows for efficient and quick conduction of brain signals and thus is integral in allowing far-reaching brain regions to communicate effectively. Previously white matter abnormalities were only thought to play a part in neurodegenerative disorders such as dementia and Alzheimer's they are now being found in psychiatric populations such as in schizophrenia and mood disorders. I hope to look at how white matter abnormalities may be related to depression severity and different forms of rumination. Why does this matter? How does the brain of an individual with depression communicate differently? Are regions not talking as efficiently when high rumination (negative persistent thinking about self, stuck in this loop)?

1. Data is collected, 2. Data processing should be done by March, 3. Then writing and defense by June. if all goes as planned. Working with my committee and a data analyst to complete the project.

I am a learner and have a great curiosity about many topics and new fields. I like to gather knowledge so that I can see issues from many different perspectives. However this curiosity and focus on learning has had to be modified as in graduate school I have needed to learn to manage my time very efficiently. So in order for me to continue to absorb new knowledge I have learned to write about and organize my new knowledge so that I can use this to help my clients and translate to others and be able to interact with and help a broad range of clients while still understanding individuals unique experiences. Time management: I have a great interest in working on different projects and rotations but this involves a great deal of time management skills. I believe that this is something that I have needed to work on in order to mange my interests and diverse experiences. I believe at my last setting working at University of Chicago I have been able to enhance my time management skills by working to keep my schedule organized, improve my writing skills and note writing skills, and collaborating with other individuals to aid in managing aspects of projects.

In my first setting I worked with more acute patients, higher degree of SI, multiple diagnoses, and I learned a lot about SI management and individuals with co-morbidity but I want to gain more experience across the continuum of care so that I can be the most effective care provider possible and be a well rounded clinician. I think that training in inpatient will allow me to see the severe side of mental illness and be able to help people when they are at their most vulnerable. Scary place, help assess needs of individuals and assign to next steps, short-term interventions for clients.

Sup: Rebecca Lusk, Psy.D., ABPP,

Sup: Minden Sexton, Ph.D. (met her at ABCT)

VA generally: I have worked in three outpatient mental health clinics in the private sector and have gained experience with a wide range of diverse clients but I am excited about working at a VA because of the population that presents with complex psychiatric and medical comorbidities, as well as with differing levels of motivation for treatment. I would love to gain more experience working with these complex populations on internship. Additionally, over the course of my training I have increasingly become more interesting in trauma and PTSD and how it effects the clinical picture and so I hope to further my skills working with individuals with military and non-military trauma. I also would hope to build on my skills using evidence based treatments such as those for CBT, DBT and ACT within multidisciplinary teams and have heard from many individuals that the VA provides wonderful training in EBPs and I think the training here would help me to be a better clinician and effectively and flexibly implement these interventions with my patients. I also hope to be able to give back to a population that has selflessly served our country and would feel fortunate and very grateful to be able to serve this population. My previous work implementing mindfulness skills with a disadvantaged AA population of women, many of whom had not participated in traditional mental health treatment illuminated for me the need to address barriers to receiving psychological services such as access to effective care, trust in health care providers, as well as stigma against mental health care all of which I believe may be important to address in a veteran population and can help to increase motivation and retention in psychological treatments. Ann Arbor specifically - I am very excited about the generalist focus of Ann Arbor that would allow me to continue to work in a general outpatient setting as well as gain new and more specialized training on rotations implementing trauma treatment and working in women's mental health. Also, I really value the emphasis placed on research at the Ann Arbor VA as I believe research is an important part of mental health care that I would like to continue to engage in during my career. Rich supervision, flexible implementation of EBPs, ability to participate in many rotations and continue to develop my specialty areas in trauma and mindfulness interventions. multidisciplinary team.

I have worked in a lab that specializes in women's mental health, specifically related to affective disorders. There are different prevalence rates of mental disorders and different needs that women have related to their identities as caretakers, mothers, and different societal considerations that shape these need such as gender differences, violence and power dynamics, and expectations related to family and career decisions. Thus I hope to continue to provide mental health care to this population and help to specialize and provide effective and specialized care for these individuals. I also would love to gain experience working with a women veteran population due to the specific challenges that may come with the military culture and specifically gender dynamics in the male-dominated and heirarchical power structure of the military. Also I have an interest in sexual trauma and would be interested in gaining more experience working with individuals who have experience MST.

33 y/o AA woman, presents with PTSD and has a history of prolonged verbal and emotional abuse by her ex-husband as well as one instance of physical assault. She currently has intrusive memories of the event, avoidance of places and people where she may encounter him, she is easily startled and has a lot of depressive symptoms as well with significant avoidant behavior and anhedonia. She was previously treated at our clinic for MDD after the index trauma occurred but had difficulty engaging in treatment and eventually dropped out. I conceptualized her through a CBT lens that she had not fully recovered or digested the trauma experience with her ex-husband which lead to avoidance cognitively and behaviorally and perpetuated the negative cycle and symptoms of PTSD. She is a difficult case because she has a lot of avoidance behavior in-session and although we engaged in MI at the start of treatment she now has difficulty with engagement since starting imaginal exposure. Also there is the surfacing of some significant anger that makes it difficult for her to feel motivated. Thus if I could go back I would provide more sessions of MI at the start of treatment to help her explore her values and goals for re-engagement in activities and relationships that help to motivate her for this difficult treatment. But she has been a very rewarding case to work with and I feel fortunate to have a strong alliance with her and that she trusts me enough to discuss her ambivalence about treatment in-session.