Concentrations | Duke Department of Psychiatry & Behavioral Sciences

Applicants are encouraged to apply to only one concentration. Reason(s) for applying to more than one concentration must be clearly outlined in the applicant’s cover letter.

Autism (1 intern)

APPIC Program Code: 141311

The Autism concentration intern has its primary rotation in the Duke Center for Autism & Brain Development and must have some background experiences or special interest in autism.

The Duke Center for Autism & Brain Development provides a wide range of clinical services for children, adolescents and young adults with Autism Spectrum Disorders (ASD). The center’s multidisciplinary team is comprised of licensed psychologists, board-certified child psychiatrists, licensed clinical social workers, behavior analysts and a pediatrician.

Center faculty and staff strive to provide patient-centered, coordinated team-based care and collaborate closely with experts from a wide range of medical subspecialties, including:

Pediatric neurologists
Pediatric primary care physicians
Speech-language pathologists
Medical geneticists
Gastroenterologists
Developmental pediatricians

These interdisciplinary collaborations foster a comprehensive model of care that is designed to address the complex medical and behavioral health needs of individuals and families who seek services through the center.

Clinical Experiences & Didactics

The autism rotation offers numerous clinical experiences, including evidence-based evaluation and treatment of ASD and other neurodevelopmental disorders. In the evaluation component of the rotation, interns gain first-hand experiences administering, scoring and interpreting diagnostic and assessment tools, preparing psychological reports and collaborating with the clinical team.

In the intervention component, interns may be involved in the provision of individual, family and group therapy services. Opportunities to participate in infant-toddler diagnostic evaluations are available. In addition, interns are introduced to early behavioral intervention, based on the Early Start Denver Model (ESDM). The ESDM is a comprehensive behavioral early intervention approach for children with autism aged 12 to 48 months that has been validated in a randomized clinical trial.

Finally, interns participate in case consultations and are encouraged to pursue opportunities to take part in school-based consultations, community presentations and other training experiences. Supervision is provided in individual and group formats. Interns also gain supervisory experience by providing peer supervision to graduate student trainees.

In addition to the clinical training experiences, the rotation involves active participation in a weekly didactic seminar. The didactic series provides exposure to ongoing clinical research that is focused on innovative evaluation and treatment approaches.

Supervisors

The Autism intern will spend one day in the Pediatric Neuropsychology Clinic and one day in the Pediatric Primary Care Clinic.

Behavioral Medicine (1 intern)

APPIC Program Code: 141312

This concentration provides an emphasis in Behavioral Medicine Health Psychology with two days in the Transplant Medical Psychology Program and one day in the Pain Psychology Program.

Transplant/Medical Psychology Program

This rotation offers psychological services to solid organ transplant recipients as well as to patients being considered for solid organ transplantation at Duke, including patients with chronic heart failure, end-stage pulmonary disease, chronic liver disease, and renal failure.

We offer a full range of psychological services for organ transplant patients, including pre- and post-transplant psychological evaluations, inpatient and outpatient psychotherapy, peri-operative neurobehavioral screening assessments for delirium and psychosocial functioning, and psychoeducational/support groups for lung transplant candidates. Evaluations with transplant candidates assess:

Patient adherence
Substance use
Cognitive functioning
Psychological functioning/coping
Transplant-related motivation/knowledge
Social support

The intern also can play a prominent role in the assessment of living kidney donors, and can participate in weekly interdisciplinary team meetings for the lung, heart, liver and renal transplant programs. Services are provided both in- and outpatient and at times, urgent evaluations are requested (e.g., Tylenol overdose). Donor evaluations assess:

Readiness/motivation to donate
Psychological functioning/coping
Social support
Cognitive functioning
Ability to adhere to post-surgical recommendations
Substance use

If interested, there are opportunities to participate in educational lectures provided to transplant coordinators and staff and to participate in morbidity and mortality (M&M) conferences and quality improvement projects.

Supervisors:

Pain Psychology

The rotation in pain psychology is located at the Duke Spine Center, which encompasses an interdisciplinary outpatient clinic focusing on the treatment of back and spine disorders. This training opportunity is heavily focused on the psychological assessment and treatment of medical and surgical patients who are being considered for chronic opioid management, implantation of medical devices for pain management (e.g., SCS, TDDS), and cognitive-behavioral psychotherapy with an emphasis on behavioral pain management. Patients at the Spine Center reflect a diverse racial and ethnic heritage, age ranges, socio-economic backgrounds, sexual orientations, and gender identities.

Interns on the pain psychology rotation will receive didactics and training in the psychology of chronic pain, performing semi-structured diagnostic clinical interviews in this setting, and communicating behavioral treatment plans to both patients and their referring interdisciplinary teams. Common diagnostic categories represented in this patient population include mood disorders, anxiety, PTSD, adjustment disorders, somatic symptom disorders, substance abuse, personality disorders, traumatic brain injury, mild cognitive impairment and psychosis.

Interns also receive training on:

Cognitive-behavioral psychotherapy for chronic pain
The application of mindfulness meditation for patients with chronic pain
Crisis management
Interdisciplinary case consultation
Psychometric assessments (If on-site services are active)

Interns receive individualized supervision adjusted to their developmental level based on familiarity with chronic pain populations and diagnostic evaluations. A comprehensive training manual aids in providing interns an evidence-based approach to the clinical assessment and interventions on the rotation.
Trainees are also invited to participate in the Pain Lecture Series to learn more about the multidisciplinary treatment of chronic pain with surgeons, anesthesiologists, physical therapists, pain psychologists, and rehabilitation specialists, as well as to participate as an intern co-facilitator with the monthly clinical health psychology symposium.

Supervisor: Katherine Applegate, PhD

The intern will then spend one day in the inpatient psychology clinic and one day in an outpatient clinic.

Interns will be trained over the course of the internship year to conduct individualized assessments and provide evidence-based Cognitive Behavioral Therapy (CBT) and DBT. This includes training in case formulation and intervention in DBT and many other contemporary CBTs (e.g., CPT, PE, UP, BA, CT) as well as in process-based approaches tailored to the individual using interventions such as reappraisal, defusion, mindfulness, exposure, skills training, etc.

Cancer (1 intern)

APPIC Program Code: 141313

This 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. The intern will spend 60% or three full days working in the Cancer Behavioral Management and Support Clinic and two days in the Duke Fertility Center.

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.

The intern will gain experience in the role of a psychologist on a medical team and learn how to collaborate within and contribute to a multidisciplinary team.

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 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 the intern’s knowledge and skills for treating psychological, social, behavioral and symptom management issues that occur during the cancer experience. The intern in this rotation work works 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
Patient and nurse navigators

Assessments

The intern is 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. The intern will also perform regular follow-up assessments of post-treatment quality of life for patients undergoing bone marrow transplant.

Through training and clinical experiences, the intern will become skilled at assessing the psychological, relationship and behavioral health issues that impact individuals and families affected by cancer.

Psychological Services

The intern will provide psychological services for patients, their families and caregivers. Clinical experiences include 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.

The intern will also 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.

Supervision

The intern will participate in weekly individual supervision sessions for psychological assessment and psychotherapy cases. The intern will participate in monthly group team meetings with other psychologists (e.g., faculty, post-doctoral fellows) working with the Cancer Patient Support Program. This meeting will provide group supervision on therapy cases and can be a forum for clinical research training.

Each week the intern will also participate in a multidisciplinary team meeting that includes members of our collaborating care teams (e.g., Cancer Patient Support Team, Blood and Marrow Transplant Team). Through regular participation in multidisciplinary team meetings, the intern gains a sophisticated conceptualization of patients.

Educational Seminars & Research

During the rotation, the intern will attend educational seminars on psychopharmacology and psycho-oncology. A developmental approach is used. Initially the intern is given educational materials about cancer and the stem cell and bone marrow transplant process, and they work closely with a psychologist or other team member to develop an understanding of the treatment process and the clinic environment. Later, the intern is assigned their own patients and groups.

Finally, the intern will have the opportunity to participate in ongoing research activities. They are exposed to issues of research design, quality control and data analysis inherent in the testing of standardized treatment protocols and program evaluation.

Supervisors

Clinical Child, Adolescent, and Emerging Adults (1 intern)

APPIC Program Code: 141314

This intern will spend one day in the Outpatient Pediatric Neuropsychology Clinic, two days in either the Psychosocial Treatment Clinic or ADHD program, and two days at Duke Counseling and Psychological Services (CAPS).

The goal of this concentration is to give the intern excellent clinical experiences within a developmental perspective from early childhood to emerging adults. The intern will have a variety of assessment and intervention experiences across three different clinical rotations.

Eating Disorders (1 intern)

APPIC Program Code: 141315

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 treating individuals with eating disorders such as anorexia nervosa, bulimia nervosa, Avoidant/Restrictive Food Intake Disorder (ARFID), and binge eating disorder, our focus includes the treatment of other psychosomatic disorders such as pediatric pain and medical conditions (e.g., children and adolescents with musculoskeletal disorders).

An overriding value in our work is helping individuals to feel seen and understood as their authentic selves. To that end, we work closely with families so that all identities and perspectives can be supported by the individuals closest to them. We have a weekly didactic seminar and weekly team meeting with psychiatrists and 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 the study of DukeLine, an anonymous mental health text support line for college students. Work with DukeLine also provides trainees with the opportunity to supervise undergraduate mental health coaches.

Supervisors

The Eating Disorder intern will spend two days in the DCED clinic, two days at Duke Counseling and Psychological Services (CAPS) and may choose time on the Pediatric Consult/Liaison service focusing on patients with eating/feeding concerns.

Pediatric Neuropsychology (1 intern)

APPIC Program Code: 141316

The pediatric neuropsychology intern must have some background or special interest in assessment, consultation and intervention with pediatric medical populations. This intern spends the majority their time engaged in pediatric neuropsychological and clinical work through three mechanisms:

Outpatient Pediatric Neuropsychology Clinic (2-3 days/week)
Consultation-Liaison Service (1 day/week)
Pediatric Chronic Pain & Somatic Symptoms Program (1 day/week)

Outpatient Pediatric Neuropsychology Clinic

The role of the intern is to assess neuropsychological and psychological changes secondary to disease processes and/or treatment regimen. The clinic is located at the Duke Child and Family Study Center. The focus for the pediatric psychology intern may include evaluation of patients from the following clinics:

Pediatric Blood and Marrow Transplant Program
Pediatric Hematology/Oncology
Pediatric Neuro-Oncology
Pediatric Neurology and Neurosurgery (Epilepsy Monitoring Unit; Autoimmune Brain Disease Clinic)
Pediatric Genetics
Undiagnosed Disease Network Program

Consultation-Liaison Service

The pediatric neuropsychology intern also works as part of the Child Psychiatry Consultation-Liaison (CL) service at Duke Children’s Hospital. The CL service is a multidisciplinary team that includes psychologists, child psychiatrists, social work case manager, residents, fellows and medical students. The CL team serves patients throughout the Children’s Hospital with a broad range of conditions.

Consultations are initiated by members of a child’s medical or surgical team. Common reasons that consultation may be requested from psychology include:

Adjustment to illness
Coping with acute or chronic pain
Assessment of emotional or behavioral concerns
Family coping and support
Treatment adherence

The intern may participate in initial consults or follow-up care for patients being followed on the service. All of the patients seen by a member of the CL team have been admitted as inpatients to the Children's Hospital.
If continuing mental health services would be helpful after a patient is discharged from a medical floor, they may be referred within Duke or provided with referrals for providers closer to home. Interns may have the option to provide outpatient therapy should the patient’s care remain within Duke.

Pediatric Chronic Pain and Somatic Symptoms Program

The pediatric neuropsychology intern may have the opportunity to work in this multidisciplinary program serving youth with a variety of chronic pain conditions. The treatment team is composed of psychologists, physicians, nurse practitioners, social workers, physical therapists and occupational therapists.

As part of this rotation, the intern provides initial evaluations as well as weekly CBT for chronic pain; participates in weekly case conferences; and serves as a consultant to other members of the treatment team as well as to patients’ schools. This outpatient clinic takes place at The Duke Child and Family Study Center.

Program Staff

Pediatric psychology is composed of medical psychology faculty, post-doctoral fellows, interns, clinical psychology graduate students, psycho-diagnostic technicians and support staff who work in a hierarchical supervision model.

Didactics

Pediatric Neuropsychology hosts a monthly didactic covering topics specific to the rotation, including assessment training, overview of populations served, report writing techniques, and case conceptualization. Depending on specific interests, interns can also attend other didactics including crossover rounds, epilepsy conference, palliative care, transplant academia, etc.

Current research by pediatric neuropsychology faculty focuses on coping with chronic childhood illness and on the cognitive and behavioral changes associated with disease processes and treatment. Interns have the opportunity to participate in these projects.

Supervisors

Process-Based Cognitive Behavioral Therapies – Adults (1 intern)

APPIC Program Code: 141317

This concentration provides focused training in psychological services rooted in a process-based model (Hayes and Hofmann, 2018) to flexibly offer evidence-based personalized treatment approaches and manualized interventions with a range of complex patient presentations in adults age 18 and above.

Both PBCBT interns receive training in full-model standard Dialectical Behavior Therapy (DBT). However, a typical case mix includes patients receiving other manualized treatments (see examples below) and process-based approaches tailored to individual needs, values, and treatment goals.

Primary Goals

Overall, the 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
Successful oral and written communication with other health professionals

Training Overview

Interns receive structured training in:

Functional, process-based assessment
Trauma-informed, culturally conscious, and relationally attuned care
Personalized, mechanism-focused treatment planning
Evidence-based transdiagnostic strategies across all three “waves” of CBTs
Training in manualized CBTs and process-based case formulation-driven approaches

Examples of manualized treatments commonly learned:

Dialectical Behavior Therapy (DBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure (PE)
Unified Protocol (UP)
Acceptance and Commitment Therapy (ACT)
Behavioral Activation (BA)
Cognitive Therapy (CT)

Examples of transdiagnostic interventions commonly learned:

Management of therapy-interfering processes
Reappraisal
Exposure-based procedures (inhibitory learning and habituation-based)
Cognitive defusion
Stimulus control
Contingency management
Mindfulness and acceptance
Skills training (e.g., arousal reduction, emotion regulation, distress tolerance, etc.)

About the DBT Training

The DBT caseload is a mix of multi-diagnostic patients (e.g., borderline personality disorder) and those with less complicated presentations. The most common diagnoses treated include mood, anxiety, trauma, and personality disorders.

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.

Concentration Didactics

The PBCBT concentration 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 participate in intensive seminars on issues related to starting the clinical internship, including “DBT: Model, Principles and Strategies.” These include:

Using diary cards in DBT
Conducting chain analyses in DBT
Implementation of DBT
Telephone consultation for skills generalization in DBT

All CBT/DBT interns 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 supervisors who will work with them continuously throughout the year, allowing for more in-depth supervisory relationships and the development of strong case formulation skills across transdiagnostic models of evidence-based care.

Research Opportunities

Interns who have completed their dissertation may participate in collaborative research projects with Duke faculty. Although research is not a requirement, interested interns are encouraged early in the year to explore research options with faculty members.

There are many ways interns can get involved with CBT faculty research projects. CBT faculty strongly encourage and are ready to support interns pursuing research activities. Examples include:

Jeremy Grove, PhD, is conducting research funded by NIH/NIAAA to develop a mobile health-supported behavioral intervention to reduce risk of suicide, hazardous drinking, and other maladaptive post-discharge outcomes for adults hospitalized for suicidality and co-occurring alcohol misuse/alcohol use disorder.
Zachary Rosenthal, PhD, directs the Center for Misophonia & Emotion Regulation and the Cognitive Behavioral Research & Treatment Program. His currently funded research examines the role of emotional processes in misophonia, borderline personality disorder, and psychopathology more generally.
Moria Smoski, PhD, 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.

Supervisors

PBCBT Adult Intern Experience Overview

The PBCBT Adult intern will spend four days in outpatient therapy in the Civitan Building (DBT, ACT, BA/Mindfulness) and one day at the Psychology Consultation Service at Duke Regional Behavioral Health Inpatient Psychiatry.

The Psychology Consultation Service at Duke Regional Hospital’s psychiatric inpatient unit provides brief evidence-based treatment for adults hospitalized for an acute mental health crisis. Interns on this rotation serve as the psychology consultant to various multidisciplinary treatment teams on the unit. As the psychology consultant, interns operate independently of the treatment teams, utilized by request to address specific needs of the patient/or the team itself.

The most common consultation request made by teams is for the psychology consultant to provide patients a brief, single-session intervention targeting a specific problem (typically the very problem that contributed to their hospitalization in the first place). Interventions are process-based, drawn from contemporary CBTs with heavy emphasis on DBT skills and strategies.

Because of the brief nature of the contact and intervention with patients, interns serving as psychology consultants will learn to rapidly assess for and prioritize treatment targets most relevant to the chief complaint put forth by the patient’s treatment team, and select and flexibly apply CBT (e.g., DBT) strategies accordingly. In addition to brief interventions, treatment teams often utilize the Psychology Consultation Service to receive assistance with differential diagnosis for patients with complex presentations. As a result, interns will hone skills in rapid informal assessment strategies (e.g., behavioral chain analyses) to generate a clinical impression of the patient that will inform the course of the patient’s inpatient treatment.

The intern will be exposed to a wide range of clinical presentations and presenting concerns on the unit, most commonly:

Suicidal thoughts and behaviors, and non-suicidal self-injury
Personality pathology
Traumatic stress
Psychosis
Mood and anxiety disorders
Substance use disorders
Treatment-interfering behaviors (e.g., medication non-compliance, disruptive behavior)

At the heart of this rotation is the consultation process prior to meeting with patients, whereby the intern meets with the treatment teams to shape consultation requests so that the requests are behaviorally-based, targeted, and linked to an actionable intervention or assessment plan. Treatment teams typically include psychiatrists, social workers, nurses, behavioral technicians, and pharmacists. As a result, interns will emerge from the training experience with a unique skill that is crucial to inpatient psychology: the ability to “translate” the ways other disciplines in the field describe patient behaviors/concerns into the language of clinical psychology.

There are additional training opportunities for interns, depending on the intern’s interest and needs of the inpatient unit. For instance, interns can lead DBT skills straining groups on the unit. Interns will also have the opportunity to provide clinician education, including informal supervision and didactic training of learners from other fields, such as psychiatry residents, medical and physician assistant students, nursing, and social work students.

At the outset of the rotation, interns will receive 1:1 didactic training on core CBT (especially DBT) skills and strategies, and observe Dr. Grove conduct consultation meetings and 1:1 sessions with patients on the unit. Once foundational knowledge is acquired, for a short time the intern will take the reins on cases while Dr. Grove observes. This onboarding process typically unfolds over the course of three to four weeks until competence is demonstrated, at which point the intern will begin practicing independently on the unit (though will meet with Dr. Grove for supervision weekly).

Given the heavy emphasis on DBT strategies, prior experience in the direct (i.e., face to face) application of the four modules of DBT skills through practicum or other experiential learning is helpful but certainly not a requirement. Regardless of previous training, Dr. Grove will meet the intern where they are developmentally to provide supervision in skills implementation to build upon foundational training and gain competence in the rapid application of person-centered DBT and other CBT-based skills in an inpatient context. Learn more

Supervisor: Jeremy Grove, PhD

Process-Based Cognitive Behavioral Therapies – Emerging Adults (1 intern)

APPIC Program Code: 141318

Primary Goals

Overall, the 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
Successful oral and written communication with other health professionals

Training Overview

Interns receive structured training in:

Functional, process-based assessment
Trauma-informed, culturally conscious, and relationally attuned care
Personalized, mechanism-focused treatment planning
Evidence-based transdiagnostic strategies across all three “waves” of CBTs
Training in manualized CBTs and process-based case formulation-driven approaches

Examples of manualized treatments commonly learned:

Dialectical Behavior Therapy (DBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure (PE)
Unified Protocol (UP)
Acceptance and Commitment Therapy (ACT)
Behavioral Activation (BA)
Cognitive Therapy (CT)

Examples of transdiagnostic interventions commonly learned:

Management of therapy-interfering processes
Reappraisal
Exposure-based procedures (inhibitory learning and habituation-based)
Cognitive defusion
Stimulus control
Contingency management
Mindfulness and acceptance
Skills training (e.g., arousal reduction, emotion regulation, distress tolerance, etc.)

About the DBT Training

Interns attend a weekly two-hour DBT consultation team meeting in addition to one hour of weekly individual DBT supervision.

Concentration Didactics

The PBCBT concentration provides didactics and educational opportunities to interns through several different activities.

Using diary cards in DBT
Conducting chain analyses in DBT
Implementation of DBT
Telephone consultation for skills generalization in DBT

All CBT/DBT interns 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.

Research Opportunities

There are many ways interns can get involved with CBT faculty research projects. CBT faculty strongly encourage and are ready to support interns pursuing research activities. Examples include:

Jeremy Grove, PhD, is conducting research funded by NIH/NIAAA to develop a mobile health-supported behavioral intervention to reduce risk of suicide, hazardous drinking, and other maladaptive post-discharge outcomes for adults hospitalized for suicidality and co-occurring alcohol misuse/alcohol use disorder.
Zachary Rosenthal, PhD, directs the Center for Misophonia & Emotion Regulation and the Cognitive Behavioral Research & Treatment Program. His currently funded research examines the role of emotional processes in misophonia, borderline personality disorder, and psychopathology more generally.
Moria Smoski, PhD, 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.

Supervisors

PBCBT Emerging Adult Intern Experience Overview

The PBCBT Emerging Adult intern will spend three days in outpatient therapy in the Civitan Building (CBP & DBT) and two days at Duke Counseling and Psychological Services (CAPS). They will NOT have an inpatient rotation.

The Duke Consultation & Brief Psychotherapy Clinic (C&BP) provides empirically-based services to individuals primarily affiliated with the Duke community (current employees/faculty/students) across the adult lifespan. The clinical focus of the C&BP clinic is to increase access to brief, efficacious psychotherapy by offering a combination of targeted functional assessment and brief integrative psychotherapy.

This rotation includes extensive training in integrative case formulation, which intends to identify behavioral, interpersonal, and cultural factors that contribute to the ongoing maintenance of problematic issues. This rotation will also emphasize intentional assessment of strengths and individual differences that impact the client’s personal growth and engagement in mental health services.

Learners will gain experience in how to quickly establish and maintain therapeutic alliance, clarify SMART goals, and provide brief empirically-based psychotherapy approaches (i.e., up to 10 sessions). Learners will achieve improved skills in client motivation enhancement, routine outcome monitoring, and use of modular care pathways that best target the patient’s specific proximal needs. Due to the brief format, learners will also have the frequent experience of taking ownership of the full treatment-arc that includes assessment, implementing targeted brief care, case management, and empowering patients to continue their individual work after leaving the C&BP clinic.

Supervisors:

Student Mental Health (1 intern)

APPIC Program Code: 141319

This concentration emphasizes training in university mental health. Interns in this concentration will spend 80% of their time, or four days a week, at Duke University Counseling and Psychological Services (CAPS) providing outpatient mental health services to a diverse group of undergraduate, graduate, and professional students. Three interns in other concentrations will complete a minor rotation at CAPS (40% of their time, two days a week). All four interns rotating at CAPS will share one day together to provide cohesion and continuity of care.

Duke CAPS provides a comprehensive range of psychological and psychiatric services to support students in managing psychological and social difficulties, with an immediate goal of strengthening their abilities to succeed in the University’s undergraduate, graduate, professional, and allied programs. Duke University is a privately supported institution with an enrollment of 17,499 students who come from 50 states and 124 foreign countries. The University provides a stimulating learning environment in its ten colleges and schools: Trinity College of Arts and Sciences, School of Law, Divinity School, Graduate School, School of Medicine, School of Nursing, Nicholas School of the Environment and Earth Sciences, Pratt School of Engineering, Sanford School of Public Policy, and Fuqua School of Business.

The Student Mental Health concentration prepares interns for health service psychology in university mental health settings and other settings serving emerging adults. Training occurs within an interdisciplinary agency of psychologists, clinical social workers, clinical mental health counselors, and psychiatry professionals. Training emphasizes experiential clinical learning and incorporates evidence-based intervention approaches, including solution-focused brief therapy, CBT, DBT, and ACT. Training experiences in this concentration include brief assessment, crisis intervention, individual and group psychotherapy, outreach, workshops, advocacy, and mental health consultation.

Service activities are balanced with individual and group supervision, seminars, clinical consultation teams, and professional development activities. Seminars will cover topics relevant to the clinical population, including identity and development, cultural considerations, mood and anxiety disorders, eating and body image concerns, executive functioning challenges, among others.

CAPS affirms and provides opportunities to increase awareness and knowledge of human diversity at the micro and macro levels of intervention. Training activities are designed to promote the acquisition of critical thinking skills related to individuals, environments, cultures, and systems and to develop culturally responsive psychological interventions.

Supervisors

Leigh Spivey-Rita, PhD (CAPS Site Training Director)
Chantal Gil, PsyD
John Mitchell, PhD

CAST Clinic

This intern will also spend one day at the Duke Center for Adolescent & Young Adult Substance Use Treatment (CAST) Clinic in the Department of Psychiatry & Behavioral Sciences at the Duke Child & Family Study Center.

The clinic works with families to create customized plans that help young people overcome alcohol and other drug problems. Our treatment options include outpatient and intensive outpatient treatment programs. Interns will participate in all intensive outpatient activities including team meetings, individual and group interventions.

Supervisors:

Trauma (1 intern)

APPIC Program Code: 141320

This intern will spend three days at the Trauma-Focused Training Clinic (THRIVE), one day at the Inpatient Consult Service, and one day in Family Studies Clinic.

The THRIVE clinic provides psychology interns with comprehensive experience in trauma-informed screening, assessment, and intervention across the lifespan. Interns will work with children, adolescents, and/or adults in both outpatient and inpatient settings, serving patients with a wide range of trauma experiences. Through the THRIVE program, interns will learn to collaborate with individuals from diverse backgrounds, honoring each person as the expert on their own experiences, while integrating evidence-based practices.

This rotation emphasizes a justice-oriented approach, with attention to cultural identity, systemic inequities, and contextual factors at each stage of care. Interns will provide trauma-focused treatment, conduct trauma-informed assessments, and participate in the screening and referral process for individuals entering the outpatient clinic.

Interns will receive weekly individual supervision and live session supervision as needed from a licensed psychologist specializing in trauma-focused interventions. They also will participate in a weekly interdisciplinary consultation team, collaborating with psychology faculty and postdoctoral fellows, as well as psychiatrists, social workers, nurse practitioners, and other providers to deliver holistic, team-based care.

Clinical Training Experience

Trauma-Informed Assessment

Training in Comprehensive Trauma-Informed Assessments (CTIA), which centers partnership with youth and families, collaboration with systems involved (e.g., schools, DSS, etc.), foundation in cultural humility, and utilization of trauma-focused standardized measures as one of many ways to conduct collaborative assessments for diagnostic clarity and strength-based, holistic treatment recommendations.

Direct Clinical Care

Provide trauma-focused interventions for individuals across the lifespan. Interns gain exposure to and experience in multiple approaches, including but not limited to:

Attachment, Regulation, and Competency (ARC) Framework
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure (PE)
Dialectical Behavior Therapy (DBT)-informed interventions

Supervisors

Inpatient Psychology Service

In addition to at least two days in outpatient clinic, the trauma intern will spend at least one day on the inpatient psychology service at Duke University Hospital. The intern will provide psychotherapeutic intervention and/or assessment to patients currently hospitalized for acute medical conditions often experiencing traumatic stress. Trainees in this rotation will:

Meet with patients in their hospital room to provide treatment either once or on an ongoing basis depending on the need
Consult with a wide range of providers and staff
Offer recommendations and support to the patient’s treatment team. Consultation requests and patient clinical presentations vary widely, allowing for extensive development of case conceptualization skills and responsive, flexible use of evidence-based interventions.

Common consultation requests include addressing:

Trauma, including medical trauma or traumatic injuries, such as loss of a limb or injuries caused by a gunshot wound, assault, motor vehicle accident, etc.
Suicide attempts, where patients are not medically stable for placement at a psychiatric hospital
Depression and/or anxiety in the context of medical condition, new diagnoses, and/or pre/post-surgery
Severe eating disorders
Substance use
Behavioral change
Difficulty managing long-term hospitalization
Difficulty engaging with care and/or treatment team

Trainees will receive training in delivering empirically supported interventions, including Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Acceptance and Commitment Therapy in acute care settings. Trainees will also have the opportunity to collaborate with a multidisciplinary team, including psychiatrists, psychiatry residents, nurses, social workers, and medical providers across a wide range of specialties (e.g., trauma, surgery, oncology, etc.).

In addition, there are opportunities to learn how to develop comprehensive behavior plans for managing challenging behaviors and enhancing the safety of both providers and nursing staff.

Depending on current clinical presentations of the patients available, trainees can request to focus on areas of interest (e.g., trauma, cancer). Of note, although in a medical context, a background in health psychology is not required. However, trainees will be expected to engage in research when necessary to be prepared to meet with patients with a wide range of medical diagnoses.

Trainees will receive direct/live supervision at the beginning of this rotations or long as developmentally needed, as well as weekly individual supervision.

Supervisor: Briana Brownlow, PhD

Women's Health (1 intern)

APPIC Program Code: 141321

The Women’s Health Intern will spend two days in perinatal mental health, two days at the Duke Fertility Center, and one day at the Duke Cancer Institute Women’s Sexual and Reproductive Health Rotation

Perinatal Mental Health Rotation

Department of Psychiatry & Behavioral Sciences

The Perinatal Mental Health Clinic is a specialized clinic that uniquely addresses the mental health needs of women in the perinatal period, provides consultation to primary care providers, seeks to address health inequities in perinatal care, and offers specialized training in perinatal mental health. Our multidisciplinary team includes psychiatrists, psychologists, a perinatal social worker, and trainees in psychiatry and psychology.

This training experience offers opportunities to provide assessment and treatment services to women with diverse presenting concerns, with a particular focus on perinatal mood disorders, in addition to OCD, bipolar disorder, trauma and ADHD. Other treatment foci may include adjustment to perinatal loss, infertility, and birth trauma. Trainees will receive instruction in the delivery of empirically supported interventions, including Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Interpersonal Psychotherapy. Trainees also may assist with care coordination and consultation to other members of the care team. Finally, as a part of a multidisciplinary team, students will gain experience working on a collaborative care team for perinatal patients.

Students will receive weekly individual supervision, group supervision as well as direct/live supervision. In addition, students will be expected to attend a weekly interdisciplinary didactic seminar covering topics related to perinatal medication management and mental health treatment.

Supervisors

Duke Fertility Center Rotation

Department of Psychiatry & Behavioral Sciences
Department of Obstetrics & Gynecology

This rotation at the Duke Fertility Center provides training in an integrated Psychological Services Program through the Department of Psychiatry & Behavioral Sciences. The Psychological Services Program serves individuals and couples, including those with diverse gender identities and sexual orientations, who are working to build their families through fertility treatment.

Interns in this rotation learn about the psychological aspects of reproductive medicine and provide psychological services on-site alongside an interdisciplinary healthcare team. Interns may provide individual, couples, and group therapy to patients experiencing infertility and pregnancy loss. They gain assessment experience with gamete donors and gestational carrier candidates by conducting structured diagnostic interviews and psychological testing. Interns also provide consultation and counseling to future parents who need an egg, sperm, or embryo donor or gestational carrier to build their family.

Interns receive training in:

Psychotherapy to patients facing fertility treatment, recurrent pregnancy loss, perinatal mood disorders, fertility preservation or embryo disposition concerns after conclusion of fertility treatment
Evidence-based theory and interventions emphasizing ACT, CBT and trauma treatments
Psychosocial consultation in complex medical decision-making
Crisis management intervention (e.g., ultrasound reveals no fetal heartbeat; panic attack prior to egg retrieval procedure, etc.)
Administering and interpreting the Personality Assessment Inventory (PAI)

Diagnoses commonly seen include:

Mood disorders
Anxiety disorders (especially panic disorder, specific phobia, and general anxiety disorder)
Adjustment disorders
PTSD/trauma exposure
Eating disorders (among both obese and underweight patients)
ADHD

Therapeutic issues commonly addressed include:

Grief and loss
Relationship conflict / Couples therapy
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)

Interns attend and/or present in a weekly Third-Party Reproductive team meeting (comprised of Reproductive Endocrinology physicians, APPs, REI Fellows, OBGYN residents, and nurses) and gain experience in contributing as a health psychologist within a multidisciplinary medical team.

Interns receive weekly, individualized supervision, partner with and observe supervisors in delivering care in complex case, and complete a year-long weekly didactic seminar on special topics in reproductive psychology.

Supervisors

Duke Cancer Institute Women’s Sexual and Reproductive Health Rotation

Duke Cancer Institute Supportive Care & Survivorship Center
Department of Psychiatry & Behavioral Sciences

The Duke Cancer Institute (DCI) Women’s Sexual and Reproductive Health Rotation offers clinical psychology interns the opportunity to gain specialized training in the unique challenges faced by women following a cancer diagnosis and treatment. This rotation is part of the DCI Supportive Care and Survivorship Center’s Women’s Sexual Health and Oncofertility programs and emphasizes the integration of psychological services into multidisciplinary cancer care.

Interns work closely with an interdisciplinary team that includes psychologists, marital and family therapists, pelvic health physical therapists, oncologists, gynecologists, nurse practitioners, patient navigators, and other specialists in sexual and reproductive health. Together, this team addresses a broad spectrum of concerns experienced by women after cancer, including changes in sexual function (e.g., desire, arousal, orgasm, resolution), impacts on sexual well-being, sexual pain, concerns related to iatrogenic menopause, fertility preservation and decision-making, and treatment-related impacts (e.g., vaginal changes after pelvic radiation, sexual changes related to endocrine therapy).

Interns develop competencies in both assessment and psychotherapy within this rotation. They provide individual therapy and couples therapy addressing sexual and reproductive health concerns, with integrated sex therapy training throughout the experience. In collaboration with the oncofertility team, interns also provide decision support and psychological care related to fertility preservation, fertility treatment after cancer, pregnancy during or after treatment, and fertility loss. Interns will receive weekly individual supervision along with group supervision, interdisciplinary case consultation meetings, and didactics.

The rotation emphasizes evidence-based and theory-driven interventions, including Acceptance and Commitment Therapy (ACT), Cognitive-Behavioral Therapy (CBT), trauma-focused approaches, and sensate focus interventions. Through these modalities, interns gain experience supporting women and couples navigating the complex intersections of sexuality, fertility, cancer survivorship, and overall personal and relational well-being.

This rotation is ideally suited for trainees with interests in women’s health, health psychology, psycho-oncology, sexual and reproductive health, sex therapy, and integrated care. Interns completing this experience will develop advanced skills in providing sensitive, evidence-based, and collaborative care to women and their partners during and after cancer treatment.

Supervisors