Baylor University



Internship Training Model and PhilosophyThe underlying philosophy for the training program is a Practitioner-Scholar model that emphasizes the value of both science and practice with the practical application of scholarly knowledge to practice.? For the Practitioner-Scholar, “Psychological science is viewed as a human practice and psychological practice is construed as a human science, and the two inform each other (Rodolfa, E. et al.).”? This model integrates theory, research, and clinical practice to help interns develop as strong generalist practitioners.? Furthermore, we believe that sensitivity to individual differences and cultures in a diverse society and openness to self-reflection and life-long learning are necessary to bring these all together. As part of this model, we believe the development of reflective skills and a reflective practice are essential, for trainers and trainees alike.? Together we will focus on building supervisory and training relationships that self-examine and continually reflect on, discuss, and explore ways to grow and meet the needs of the trainee more effectively.? Similarly, we will assist interns to self-examine, reflect on, discuss, and explore the therapeutic alliance and ways to meet the needs of their clients more effectively.? We are training psychologists who gain clinical experience to inform his or her practice, rather than conducting laboratory science.? We are training psychologists who will think critically and engage in disciplined inquiry that focuses on the idiographic needs of an individual client, but in the context of society and cultural considerations.? We will emphasis internship learning as a relational and reciprocal process, with an emphasis on the process versus the content of learning and valuing the use of self and creativity.? While this may be viewed as incorporating elements of a Practitioner, Apprenticeship, or Mentor model of training, and we do highly value the training characteristics of these models, the mutually informative emphasis on both clinical practice and on science is what we strive toward for our primary training model.? Interns will be trained in an empirically-based and self-reflective clinical practice to gather information from clients, reflect upon and evaluate the process and outcome of their interventions, and plan future interventions based upon an integration of this experience. To accomplish this goal, psychological theory and research will be incorporated with supervised clinical experiences and self-reflective learning. Supplementary learning methods will include didactic presentations, skill-building seminars, small group discussions, behavioral rehearsal and modeling, and consultative guidance.This training approach to clinical work is trans-theoretical, multi-cultural, and process-oriented.? Growth comes by attention to the process of interns’ work, as well as attention to their personhood.? We are helping interns to find their own path as a clinician and as a professional.? So, our overall training focus for Interns will be exploring and discovering answers to the two questions, “Who am I as a therapist?” and, “How am I therapeutic?”? In this manner they shall explore both the self-awareness/self-reflection part of a therapeutic alliance and the ways they express these parts of themselves in skills and techniques.? Interns will explore these questions as they apply to the overall goals of the internship.??? Answering these questions, on a continual basis is vital to the process of becoming a therapist and a psychologist.? These questions will be explored in trainings, workshops, and the supervisory process.? Rodolfa, E. R.; Kaslow, N. J.; Stewart, A. E.; Keilin, W. G.; and Baker, J. (2005). Internship Training: Do Models Really Matter?? Professional Psychology: Research and Practice, Vol 36(1), Feb, 2005.? Models of Internship Training. pp. 25-31.? A “Use of Self” ApproachBalancing the tension between our two training questions, 1) “Who am I as a therapist?” and 2) “How am I therapeutic?” is a primary thread running through all of our training activities. By focusing our training on the concept of “Use of Self” we are able to integrate interventions with the personhood of the therapist. By this we mean that in assisting the trainee in exploring and understanding the qualities and dynamics that he or she brings to each interpersonal encounter and how these facilitate or hinder effective interactions the intern will grow as a therapist. The intern will be encouraged to become more attuned to his or her thoughts and feelings in working with clients, and recognize how this increased self-awareness can be used to better understand client dynamics and develop effective treatment strategies. We believe in the working alliance as an indispensable ingredient in any helping relationship, and therefore we encourage trainees to recognize, improve and employ those personal qualities that will assist in forming effective working relationships with clients, peer, center staff, and other members of the university community. Because our training program emphasizes self-reflection and the “use of self” we believe that optimal professional development occurs within the context of personal exploration. Our training activities ask interns to appropriately disclose personal information such as reactions to experiences they are having with a client, within supervision, or in another training activity. Our training staff take very seriously their responsibility to foster and maintain a safe, trusting, and supportive environment that will allow such disclosures to occur in accordance with the goals and objectives of our training model. Interns have full discretion over the personal information that they disclose within the training process. We believe that training is the most useful when it occurs within a supportive environment in which questions and differences can be explored openly, and where diverse viewpoints are respected and valued. Our staff strive to create an environment in which both supportive and challenging feedback can be provided with the goal of furthering professional growth. In addition, we ask trainees to provide us feedback about their experiences while involved in the training process. A Relational-Cultural ApproachTraining and supervision do not occur unilaterally or in a vacuum, but in the context of layered relationships (with power differentials) that are also full of cultural diversity and complexity. This can enrich the experience and create a growth producing dyad.? In this dyad, all parties are balancing the same human needs for both connection and safety, but with an intentional focus on the process and repairing ruptures they can move in and out of connection with each other in a relational dance that produces personal and professional change for the trainee – as well as for the trainer.? We credit a prior Training Coordinator at the Baylor University Counseling Center, Dr. Roderick Hetzel, for initially focusing our training program on “how the rich and complex inner worlds of supervisee and supervisor, which lie just beneath the veneer of skills-based training and clinical formulations, invariably shape the ebb and flow of the supervisory relationship.” According to Hetzel & Kroll, in their article titled, Relational Psychotherapy Supervision: A Shared Supervision Story (2006), “Relational-Cultural Theory (RCT) offers a useful conceptual model for understand the relational dimension of psychotherapy and supervision (p.22).”? They conclude their article with, “Whether acknowledged or not, supervisor and supervisee engage in a relational dance as they attend to the professional work of supervision as well as the more personal (yet rarely mentioned) business of working out their own needs for connection and disconnection.? When established as a central focus of supervision, however the supervisory relationship can form the very crucible in which supervisees learn how to become therapeutic.? This relational learning can empower both supervisee and supervisor (p.27).”This conceptualization remains highly valued by the current Training Director and by our training program, and we will focus intentionally on the relational aspects of the training process throughout the internship year.The Supervisory RelationshipThe supervisory relationship is fundamental for the growth and change process of a developing therapist.? A personal connection is developed that creates a safe place for exploration and trying new ways of being therapeutic for clients.? As humans, clients, developing therapists, and supervisors are all very similar in our basic needs for connection, safety, belonging, and challenge.? It is incumbent upon the supervisor to create this type of a safe mentorship atmosphere.? Evaluation is always present, but is not so much focused on the personhood of the trainee as it is focused on the development of awareness and values, increasing knowledge, and application of these through behavioral interventions and skills.? The most effective supervisory relationship is one in which an approach that acknowledges the power differentials in the relationship is taken. From this perspective supervisors work to share that power. This approach views the supervisor-trainee as a dyad, which is exploring, learning, growing together as part of this process.? Rather than critiquing a trainee out of a position of authority and power, a supervisor will invite the trainee to examine the supervisory dyad together, and explore ways to enhance the safety of the relationship, and find ways to leave each person’s comfort zone and try new things that will help the trainee grow and flourish.? This will help the supervisor grow and flourish too.? Supervision should never be a stale, intellectual, handing down of information from an expert to a novice, but rather an energized, engaged relationship, where all members learn and grow, bringing all aspects of their diversity and individual uniqueness together, to create a supervisory relationship and culture that is empowering for everyone. A Transtheoretical & Common Factors ApproachWe offer a generalist internship informed by a Common Factors approach to therapy. Described by editors Duncan, Miller, Wampold, and Hubble in The Heart and Soul of Change the Common Factors framework takes into account decades of empirical psychotherapy research as well as the most recent research on what works in therapeutic practice. The conclusion is that therapy outcomes are influenced in degrees by four variables40%: client and extra therapeutic factors (such as ego strength, social support, etc.)30%: therapeutic relationship (such as empathy, warmth, encouragement of risk-taking)15%: expectancy and placebo effects15%: techniques unique to specific therapiesThis framework shows that the bulk of client improvement is attributable to factors common to all different types of counseling and psychotherapy. The common factors approach will be reviewed and discussed in several didactic trainings. Interns will gain an understanding of the empirical bases of therapy through this framework, and how their previous course and training experience apply to the therapeutic process considering the four factors outlined in the approach.As outlined by the Common Factors approach, the largest factor of therapeutic outcome that is directly influenced by the clinician is the therapeutic relationship (30%). With this understanding we seek to intensively train interns on the interpersonal process in therapy, so that they can develop their own answers to the two questions. Interns will be provided with concentrated didactic and experiential training targeting skills related to interpersonal processes evident in therapeutic relationships. This will involve 1) understanding the process dimension, 2) the role of anxiety, 3) the corrective emotional experience, 4) client response specificity, 5)? a collaborative relationship, 6) empathic understanding, 7) immediacy interventions, 8) honoring client resistance, 9) an internal focus for change, 10) placing the locus of control with the client, 11) working with affect, 12) providing a holding environment, 13) addressing and repairing ruptures, and last, but not least, 14) an intensive focus and understanding of accurate and thorough conceptualizations that include the process dimension.? Interns will also be trained in interventions from various theoretical orientations and schools of thought. They will be provided with micro-skills training on intermediate-advanced interventions that will compliment a generalist therapy skill set. Specific populations, presenting diagnoses, professional issues, procedural competencies, and organizational functions will be addressed through the training program. Short term and time-limited models of therapy will be highlighted in training. Interns will also receive supervision regarding long term therapy modalities and will have the opportunity to work with a limited number of long term patients. The content of these trainings create the remaining 30% of therapy outcomes influenced by the clinician composed of expectancy and placebo effects (15%) and techniques unique to specific therapies (15%).The early training schedule is designed to provide interns with a strong foundation in understanding the therapy process from a generalist perspective while giving them a range of skills to utilize as they work interpersonally with clients.Over the course of the training year, both the training content and the expectations from interns will be increasing, in a developmentally targeted manner that builds on prior experiences and trainings, and is focused on more complex competencies for mastery. ................
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