Adult Psychology Track

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.

Overview

The CBT Concentration provides an emphasis in full model Dialectical Behavior Therapy  (DBT) approximately 40% time or 2 days as well as one full-day of an assessment rotation in the Duke Collaborative Access Clinic (DCAC) emphasizing population health. After interns match to Duke, interns will rank their preferences for one or two other minor rotations to diversify their clinical experiences based on their interests. Interns on the CBT concentration will be trained over the course of the internship year to conduct individualized assessments and provide evidence-based CBT and DBT for individuals with mood, anxiety, trauma, substance use and personality disorders. Interns will train in several clinics to obtain a diversity of experiences.  Rotations are year-long, allowing more challenging patients to be seen throughout the year for longer-term care.

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:

Inpatient Consultation

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).

Supervisors:

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.

Supervisors:

ADHD Program

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.

Professional 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.

Research Opportunities

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.

Supervision Training

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:

Click on a faculty member’s name to view their profile, including their grants and publications.

Overview

The Adult Health Concentration involves didactic training, patient care and research experiences. Interns are exposed to empirical and theoretical perspectives from a number of disciplines and are expected to use that information while working in both inpatient and outpatient settings. 

In the Adult Health Concentration, all three interns spend 40-60% working in the Cancer Behavioral Management and Support Clinic. After the match, interns may then rank their preferences for the following minor rotations: Duke Fertility Center, Health Risk Behavior Management Clinic, Palliative Care Clinic, Pain Psychology and Neurosurgery Collaborative Peer Coaching Project.

Cancer Behavioral Management and Support Clinic Rotation

The rotation in the Cancer Behavioral Symptom Management and Support Clinic is based on a scientist-practitioner model of training and is comprised of clinical and research activities that address the psychological, social, behavioral and symptom management needs of cancer patients. This rotation’s clinical activities are conducted as part of the Duke Cancer Patient Support Program and the Duke Adult Blood and Marrow Transplant Program.
 
The Duke Cancer Patient Support Program provides psychological services to cancer patients and their families in the outpatient and inpatient clinics of the Duke Cancer Institute, a National Cancer Institute-designated comprehensive cancer center.
 
The Duke Adult Blood and Marrow Transplant Program, which is closely associated with the Duke Cancer Institute, is internationally recognized for its novel approaches to treating leukemia, lymphoma and myeloma through bone marrow and stem cell transplantation. The Duke Cancer Institute and the Duke Blood and Marrow Transplant Program treat patients from a range of ages, ethnic and racial backgrounds and socioeconomic statuses, and from rural and urban settings in North Carolina and the larger region.
 
Experiences on this rotation aim to increase interns’ knowledge and skills for treating psychological, social, behavioral and symptom management issues that occur during the cancer experience. Interns in this rotation work closely with the multidisciplinary Cancer Patient Support and Bone Marrow Transplant teams, including:
  • Psychologists
  • Psychiatrists
  • Marriage and family therapists
  • Social workers
  • Physicians
  • Nurse practitioners
  • Pharmacists
  • Nutritionists
  • Physical therapists
  • Patient financial advisors
Interns gain experience in the role of a psychologist on a medical team and learn how to collaborate within and contribute to a multidisciplinary team.
 
Interns are trained to conduct and interpret psychological assessments and health behavior evaluations for patients, their families and caregivers. Assessment techniques include behavioral observation, standardized psychological measures, semi-structured interviews and diagnostic interviews. Interns also perform regular follow-up assessments of post-treatment quality of life for patients undergoing bone marrow transplant.
 
Through training and clinical experiences, interns become skilled at assessing the psychological, relationship and behavioral health issues that impact individuals and families affected by cancer.
 
Interns provide psychological services for patients, their families and caregivers. Clinical experiences include inpatient and outpatient CBT based psychotherapy, manualized behavioral interventions for symptom management and health behavior interventions. Psychological services are provided in individual, couples and group settings through face-to-face meetings, phone and web-based technologies.
 
Interns gain competence in developing treatment plans and choosing appropriate, evidence-based interventions for the range of issues and problems that arise for patients and their families when faced with a serious, life-threatening illness.
 
Interns participate in weekly individual supervision sessions for psychological assessment and psychotherapy cases. Interns also participate in weekly multidisciplinary team meetings that include all members of the Cancer Patient Support Team. Through this weekly multidisciplinary meeting, interns gain a sophisticated conceptualization of patients.  
 
During the rotation, interns attend educational seminars on psychopharmacology and psycho-oncology. A developmental approach is used. Initially interns are given educational materials about cancer and the bone marrow transplant process, and they work closely with a psychologist or other team member to promote understanding of the treatment process and the clinic environment. Later, the intern is assigned their own patients and groups.
 
Finally, interns have the opportunity to participate in ongoing research activities. Interns are exposed to issues of research design, quality control and data analysis inherent in the testing of standardized treatment protocols and program evaluation.
 
Supervisors for Cancer Behavioral Symptom Management and Support Clinic:

​Click on a faculty member’s name to view their profile, including their grants and publications.

Minor Health Rotations

Duke Fertility Center 

This clinic in the Department of Obstetrics and Gynecology provides a Psychological Services Program through the Department of Psychiatry & Behavioral Sciences. The Psychological Services Program serves individuals and couples with diverse ethnic and racial backgrounds, gender identities and sexual orientations who are working to achieve parenthood.
 
Interns in this rotation learn about the psychological aspects of reproductive medicine and provide psychological services on-site alongside healthcare providers. Interns gain assessment experience conducting structured diagnostic interviews and psychological testing with egg donor and gestational carrier candidates. They also provide consultation and counseling to future parents who need an egg donor, sperm donor or gestational carrier to build their family. 
 
Interns receive training in:
  • Conducting individual, couples and group therapy with patients facing fertility treatment, recurrent pregnancy loss, perinatal mood disorders, fertility preservation or embryo disposition concerns after conclusion of fertility treatment
  • Crisis management interventions (e.g., ultrasound reveals no fetal heartbeat; panic attack prior to egg retrieval procedure, etc.)
  • CBT and ACT theory and interventions
  • Use and interpretation of the Personality Assessment Inventory (PAI)
  • Providing psychosocial consultation in complex medical decision-making  
Interns attend and/or present in a weekly Third Party Reproductive team meeting (comprised of Reproductive Endocrinology physicians, fellows and nurses) and thus gain experience in contributing as a health psychologist within a multidisciplinary medical team.
 
Interns receive weekly, individualized supervision delivered in a combination of individual and small group formats. Interns also have the opportunity to gain experience in providing supervision to the Duke clinical psychology graduate students completing a year-long clinical rotation in our program. Interns are supported in their learning about the psychological aspects of reproductive medicine through a combination of weekly educational seminars and weekly supervision of recorded therapy sessions.
 
Diagnoses commonly seen include:
  • Mood disorders
  • Anxiety disorders (particularly panic disorder, specific phobia & GAD)
  • Adjustment disorders
  • Personality disorders
  • Eating disorders (among both obese and underweight patients)
  • Patients with a trauma history
Issues commonly addressed include:
  • Grief and loss
  • Marital conflict
  • Existential concerns ("Why do bad things happen to good people?"; "Am I being punished?")
  • Stress and coping
  • Parenting concerns
  • Alternate family-building strategies (e.g., donor egg/sperm, adoption)
Supervisor for the Duke Fertility Center: Julia T. Woodward, PhD

Health Risk Behavior Management Program  

A rotation in the Health Risk Behavior Management Program is an opportunity to develop important skills for assessing and treating individuals with a substance use disorder (SUD) or who have difficulty living in accordance with recommendations for overall healthy living. Services are provided in an outpatient clinic serving adults across the lifespan, and some young adult referrals are co-managed with the Duke Center for Adolescent and Young Adult Substance Use Treatment (CAST) program. Common problems addressed on this rotation include:

  • Alcohol, cannabis and tobacco use disorders
  • Patients stable on opiate replacement therapy (e.g., Suboxone)
  • Chronic pain with long-term prescription opiate use
  • Difficulty with effective management of chronic conditions
Many individuals treated in the program have comorbid mental health conditions including depression, PTSD and anxiety. 
 
Experiences on this rotation aim to increase interns’ knowledge and skills for understanding and treating individuals from a transdiagnostic, functional behavioral perspective. Interns are trained to use a range of assessment tools (e.g., standardized psychological assessments, semi-structured interviews and urine tox screens) to assist in diagnosis and establishing a coherent treatment plan that accounts for an understanding of health concerns, substance use disorder (SUD) and mental health issues. 
 
Evidence-based approaches to care employed in the clinic include cognitive-behavioral, Relapse Prevention, and mindfulness- and acceptance-based approaches such as Acceptance and Commitment Therapy (ACT). Interns also develop and implement skills for collaborative management of suicidality when it arises in the context of SUD or other health risk behaviors. An abstinence-based approach to SUD care is provided for patients seeking this goal (most commonly in response to alcohol, cannabis or tobacco use), but interns also become familiar with and practice implementing the principles of harm reduction as a means to reduce overall health risk and improve overall wellbeing. 
 
Interns provide individual counseling services, co-facilitate groups (e.g., relapse prevention for alcohol use disorder), conduct co-therapy as appropriate, and have opportunities to work with partners, parents and other family members to bolster an individuals’ progress toward healthier living.
 
Interns participate in weekly individual supervision, and early on in the rotation supervision meetings incorporate didactic material to assist interns in learning the foundational skills for seeing patients independently. Interns on this rotation also have the opportunity to participate in ongoing activities to improve the quality of care offered through formal and informal quality improvement projects and to participate in ongoing efforts to expand services. 
 
Supervisor for the Health Risk Behavior Management Program: Jennifer Plumb Vilardaga, PhD

Palliative Care Clinic  

In this rotation, interns receive training in empirically-based cognitive-behavioral, mindfulness and couple-based strategies for psychological distress and symptom management among patients with serious medical illness and their family caregivers. They also receive training in the role of mental health providers in palliative medicine.
 
The rotation includes one half-day per week in the outpatient palliative care clinic under the supervision of Dr. Jason Webb, where interns are members of a multi-disciplinary team. They have the opportunity to conduct brief psychological assessments of patients and caregivers and provide brief, focused interventions for distress and symptom management.
 
Another half-day per week is in the outpatient psychiatry clinic under the supervision of Dr. Laura Porter, where interns provide longer-term psychotherapy to patients and caregivers focused on helping them manage the symptoms and psychological challenges associated with serious illness.
 
Supervisors for the Palliative Care Clinic:

Pain Psychology

The rotation in Pain Psychology would be located either within the Duke Pain Clinic which is a satellite medical clinic incorporating the interdisciplinary care of chronic pain patients or at the Duke Spine Center which is an interdisciplinary surgical and nonsurgical setting focusing on the treatment of back and spine disorders.

This training opportunity is heavily focused on the assessment of medical and surgical patients who are being considered for chronic opioid management, neuromodulation surgery and/or being prepared to undergo cognitive behavioral psychotherapy with an emphasis on behavioral pain management.

Interns would be trained on the unique challenges of conducting a psychological assessment of a medical/surgical patient, the behavioral and psychological eligibility criteria for chronic opioid management to reduce risk of the abuse of opioid medication and the behavioral and psychological eligibility criteria to undergo neuromodulation surgery.

Supervisor: Katherine Applegate, PhD


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. 

Supervisors: