The Adult Psychology track provides interns with supervised assessment, treatment and consultative experience with the broad range of adult patients treated at Duke University Medical Center. Interns work in an apprenticeship-collaborator relationship with senior staff psychologists, becoming functional members of the treatment team and contributing as professionals to the successful operation of the adult psychology service.
The adult program provides training in the following concentrations within the Adult Psychology track:
- Adult Cognitive Behavioral Therapy (CBT) concentration (APPIC Program code: 141314)
- Adult Health concentration (APPIC Program code: 141316)
Applicants may select only one of the above concentrations.
Dialectical Behavior Therapy (DBT) Emphasis
All CBT interns receive training in DBT, however the caseload is a mix of multi-diagnostic patients (e.g., BPD) and those with less complicated presentations. The most common diagnoses treated include mood, anxiety, trauma and personality disorders. All interns will receive training in providing CBT and DBT in Duke’s outpatient setting.
Interns may co-lead a weekly DBT group for patients with borderline personality disorder or other appropriate diagnostic categories struggling with emotion dysregulation. Co-leading a DBT group provides additional training in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills. Interns attend a weekly two-hour DBT consultation team meeting in addition to one hour of weekly individual DBT supervision.
Overall, the program’s primary goals for interns include increased understanding of the cognitive, behavioral, biological and emotional aspects of mood, anxiety and personality disorders; development of skills in cognitive-behavioral assessment and treatment of these disorders; and successful oral and written communication with other health professionals.
DBT supervising faculty:
Duke Collaborative Access Clinic (DCAC) & Population Health
The DCAC rotation provides unique and highly varied assessment and brief psychotherapy training opportunities. The DCAC provides specialized training focusing on learning about value-based care and integrated care models. The DCAC features rapid access, evaluation and brief therapy to help increase care to the many who are seeking mental health services throughout Duke Health. The intern will achieve competence in tailoring assessments (e.g., PHQ-9; GAD-7; PROMIS measures, etc.), clinical interviews, and brief therapy (e.g. CBT, ACT, etc. when and as needed) to address the specific needs of the client.
Unique to this rotation is that each client will be highly variable across age (e.g., ages 18-98), race, ethnicity, SES, gender identity, medical complexity and mental health presentations/needs. As such, this rotation will stretch the intern to think quickly, creatively, and reflectively about their work, and how they can best advocate for each client seen. The intern can expect to see three intakes and carry a range of two-three short-term treatment cases during their clinic day. They may also choose to follow up with some clients for longer term therapy in their CBT/DBT time slots. Supervision follows a developmental framework to meet interns where they are, and supervision time is curated with an interpersonal process and social justice focus.
DCAC supervising faculty:
Interns receive specialized training in the application of contemporary principle-driven CBTs in the inpatient setting, where one intern will serve as the psychology consultant to a multi-disciplinary team on the new Duke Psychiatry Inpatient Unit at Duke Regional Hospital.
The intern will learn how to provide collaborative care through working with the unit’s psychiatry teams to formulate goals for one-session psychotherapeutic intervention and/or assessment and direct delivery of brief, targeted interventions with inpatients. Consultation requests and patient clinical presentations vary widely, allowing for extensive development of case conceptualization skills and responsive, flexible use of contemporary CBT interventions, with heavy emphasis on DBT skills and strategies.
For interns interested in gaining exposure to clinician education, there will be opportunities to provide informal training in contemporary CBT strategies to medical students, residents and nursing staff at DRH inpatient unit.
Supervisor: Jeremy Grove, PhD
Outpatient CBT/Behavioral Activation/Mindfulness Interventions
Interns will learn contemporary cognitive behavioral therapies focused on emotion regulation and reward processes in major depressive and other mood disorders. Interns will participate in team meetings and supervision to learn how to translate knowledge from cognitive neuroscience research including functional neuro-imaging to better understand and improve psychosocial interventions, including cognitive behavioral and mindfulness interventions.
Supervisor: Moria Smoski, PhD
Duke Center for Eating Disorders
The Duke Center for Eating Disorders (DCED) treats conditions in which a trusting and responsive relationship to oneself and particularly to one’s body is disrupted. In addition to eating disorders such as anorexia nervosa, bulimia nervosa, Avoidant/Restrictive Food Intake Disorder (ARFID), and binge eating disorder, our focus includes other psychosomatic disorders such as pediatric pain. This focus also includes helping individuals to feel seen and understood as their authentic selves. Thus, a focus of our work is working with families of individuals who identity with diverse identities to help promote acceptance and understanding.
We have a weekly didactic seminar and weekly team meeting with psychiatrists, specialists in family medicine, social work, adolescent medicine, and psychology to discuss challenging cases and coordinate care. We treat individuals from the ages of three and up so interns can self-select the developmental stages they are comfortable working with or use this as an opportunity to try their skills with a new age group. New research and developments in the center include an NIMH clinical trial for five- to nine-year-olds with ARFID; a parent group for parents of transgender or gender diverse teens, an online middle school group for ARFID; and integrating DukeLine into the internship experience for supervision opportunities (DukeLine is an anonymous peer support text line of trained undergrads supporting other undergrads).
Neurosurgery Collaborative Peer Coaching Project
The program pairs psychology interns/psychiatry residents with neurosurgery residents in the spirit of providing 1:1 support in the form of processing the experiences of intensive professional training and potentially acquiring new skills for managing new roles and responsibilities. Interns have the opportunity to shadow neurosurgery residents including into surgeries, rounds, and other venues to truly understand the life of a neurosurgery resident. Development of short didactic presentations on specific themes identified by residents as areas where they would like to grow along with facilitation of small group discussions related to those presentations also will be part of the rotation.
This rotation may include other opportunities and efforts from our COVID Response Team, developed in March 2020.
Interns will have the opportunity to conduct evaluations and brief CBT intervention for adults with ADHD and co-morbid psychopathology. Many adults seeking evaluations have never previously been evaluated for ADHD as children, and concerns about inattention are emerging after treatment for other issues (e.g., sleep, substance use, mood, anxiety) has failed to fully address their symptoms. Evaluations include use of standardized rating scales and structured and unstructured interviews, psycho-education and treatment planning during feedback, and write-up of a brief diagnostic summary. CBT for ADHD addresses behavioral strategies to cope with symptoms of inattention, including organizational skills and strategies for reducing distractibility, as well as more traditional thought modification techniques. Interns may also have the opportunity to co-lead groups that provide a mindfulness-based intervention for ADHD.
Supervisor: John Mitchell, PhD
CBT Concentration Didactics
The CBT rotation provides didactics and educational opportunities to interns through several different activities.
The DBT consultation team meeting serves as an educational opportunity through interactions with faculty and post-doctoral level DBT therapists. One hour of each weekly two-hour meeting is devoted to didactic training. During the first quarter of training, interns will participate in intensive seminars on issues related to starting the clinical internship, including DBT: Model, Principles and Strategies.
Other seminars have included: cognitive behavioral therapy for insomnia, Unified Protocol, psychopharmacology basics for therapists and multicultural competence in psychotherapy for diverse populations. All CBT interns will have individual supervision that may include reviewing therapy tapes, live supervision (e.g., “bug-in-the-eye”), co-leading groups with supervisors and assigned readings.
Interns have multiple supervisors who will work with them continuously throughout the year, allowing for more in-depth supervisory relationships and the development of longer-term goals for clinical development.
Early in the internship year, all interns choose a faculty mentor for ongoing mentoring throughout the year about issues relevant to their professional growth (e.g., getting a post-doc or faculty position, balancing one's life with career aspirations, etc.). In addition, all interns attend weekly meetings that focus on professional development including a biweekly meeting with the training director, Dr. Chris Mauro, as well as a monthly supervision series and seminars on anti-racism, ethics and professionalism.
Adult CBT interns who have completed their dissertation may choose to have elective research time dedicated to collaborative projects with Duke faculty. Although research is not a requirement of the rotation, interested interns are encouraged early in the year to explore research options with faculty members. There are many ways to be involved with CBT faculty research projects while on internship. CBT faculty strongly encourage and are ready to support pursuing research activities during internship. Examples include:
Dr. Zach Rosenthal directs the Center for Misophonia & Emotion Regulation, the Cognitive Behavioral Research & Treatment Program and the Clinical Psychology Post-Doctoral Training Program. His currently funded research examines the role of emotional processes in misophonia, borderline personality disorder and psychopathology more generally.
Dr. Moria Smoski conducts NIH-funded studies of emotion regulation and reward processing in depression, including studies of depression in late life. Dr. Smoski is also involved in ongoing studies of mindfulness-based interventions.
Interns interested in research on eating disorders may participate in a weekly research meeting to explore ways to collaborate on Dr. Nancy Zucker’s research projects.
To enhance capabilities as a supervisor, in the first half of the year CBT interns receive didactic training in supervision. During the second half of the year CBT interns supervise Duke graduate students, social work students, or psychiatry residents early in their CBT training, and progress as a new supervisor is supervised during this time by CBT faculty.
Supervisors for CBT rotations:
- Ilana Brodzki Pilato, PhD
- Colleen Cowperthwait, PhD
- Nathan Dankner, PhD
- Chantal Gil, PsyD
- Jeremy Grove, PhD
- Stephanie Hargrove, PhD
- John Mitchell, PhD
- McLean Pollock, PhD
- Katherine Ramos, PhD
- M. Zachary Rosenthal, PhD
- Jeffrey Sapyta, PhD
- Moria Smoski, PhD
- Laura Weisberg, PhD
- Nancy Zucker, PhD
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