Download McLean Hospital / Harvard Medical School Behavioral Health Partial

McLean Hospital
Harvard Medical School
Teaching Hospital
HARVARD MEDICAL
McLean Hospital / Harvard Medical School
Behavioral Health Partial Hospital Program
(BHP)
Practicum Training Program
2017-2018
Thröstur Björgvinnson, Ph.D., ABPP
Behavioral Health Partial Program, McLean Hospital
Program Director
115 Mill Street
Belmont, MA 02478
Phone: 617-855-4180
I. Practicum Training Overview
A. Behavioral Health Partial Hospital Program
The BHP practicum training program is a nine month clinical training opportunity for 3rd
or 4th year psychology doctoral students. The program starts at the beginning of
September and runs through the end of May. The program is a three day per week
position requiring approximately 20 hrs of commitment. Given the intensive nature of
the program, we have found that students in their third or fourth year of doctoral training
are best prepared for this training opportunity. It is necessary for students to be able to
commit three non-consecutive days to the program (e.g. M W Th or Tu Th F). One of
the available days is required to be a Monday or Thursday as the student must attend one
hour of supervision rounds with senior psychologists held on one of these days.
The BHP is a multi-disciplinary, psychosocial milieu treatment program meeting the
needs of patients from every major diagnostic category in DSM-V. The BHP provides
sophisticated psychosocial treatments which are empirically informed and adapted to the
needs of our patient population. All clinical activities take place in the Recreation
Building where trainees and clinical staff also have their offices.
The BHP is a comprehensive service integral to McLean’s system of care. There are
approximately 800+ admissions (~70 admissions per month), with a comparable number
of discharges, on an annual basis. The program offers approximately 100 groups per
week. Approximately 50% of patients are referred from the McLean inpatient units, with
the remainder from local hospitals, community mental health centers, private
practitioners, and self-referrals. A small, albeit significant percentage come from out-ofstate to McLean for specialized treatment not available elsewhere.
The BHP has a comprehensive treatment philosophy that guides treatment and decisionmaking at all levels. It is essential for trainees to learn the philosophy and mission of the
program. In each specialty track, treatment plans are designed to stabilize and improve
functioning, and to enhance a patient’s quality of life. Treatment tends to be short-term,
which magnifies the importance of realistic goals and practical treatment interventions.
The patients in the BHP are varied and complex. Diagnostic categories include:
depressive disorders, anxiety disorders, bipolar disorders, personality disorders,
schizoaffective disorder, schizophrenia, atypical psychotic disorders, and other disorders.
The typical patient carries at least two diagnoses and pharmacotherapy is an essential
component of treatment.
The BHP is first and foremost a group-based CBT program. Practicum students will learn
effective and flexible clinical decision-making from a CBT perspective. Our approach to
training in CBT is to teach students clinical decision-making to match treatment to
patients. This is not about matching patients to protocols; rather, it’s about figuring out
the best approach for your patient in the context of his or her life with the goal of
improving functioning and quality of life.
The practicum training program at the BHP has four main areas of focus: group therapy,
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individual therapy, supervision, and mini seminar series.
B. Individual Program Therapy
Practicum students will act as program therapists carrying a case load of 2-3 patients.
Patients come to the BHP for very brief amounts of time (7-10 days average stay) which
require rapid, focused assessments of core issues with follow-up interventions. To
address these needs, case managers at the BHP assign each patient a program therapist.
The program therapist provides focused assessment and individual short-term therapy to
most patients that enter the program. The program therapist in the BHP has two main
roles:
1. The therapist functions as a therapy consultant responding to a request for a
specialized assessment from the case manager. The request is typically designated as
a “referral question.” The therapist reports back the findings and
recommendations for treatment to the referring clinician.
2. The program therapist also functions as an individual therapist implementing their
recommendations in short-term therapy sessions. Initial sessions with patients are 50
minutes. During the initial session the program therapist administers the MINI
structured diagnostic interview, takes a brief history, often completes a safety plan,
and collaborates with the patient to identify short-term treatment goals. Follow up
sessions are 30 minutes and typically focus on CBT, DBT, and ACT based skills to
help patients stabilize and better cope with negative emotions and problem behaviors.
Students meet with patients 3 times a week for a total of 2-6 sessions on average.
C. Group Therapy
Practicum students will gain extensive experience with group therapy during the training
year. Group therapy is central to the psychosocial treatment in the BHP. The program
offers approximately 100 groups per week, and practicum students typically lead or colead 4 to 5 of the groups. Practicum students will run many different kinds of groups
(e.g., psychoeducation, CBT/DBT/ACT skills, process groups) to address a range of
diagnostic categories. Group protocols are used for most groups. These protocols outline
general guidelines that provide structure while allowing flexibility in how leaders
facilitate groups.
Practicum students are trained to be group therapists who are aware of the purpose and
value of a group, can dictate the format and structure, are sensitive to group process and
group dynamics, and can be sufficiently flexible to manage groups with diverse and
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difficult patients. Practicum students will keep some of their groups for the entire year,
and change others based on interests, training needs, and program needs.
D. Supervision
Supervision and training for BHP clinical activities is provided in a number of ways:
individual meetings with supervisors, group supervision and seminars, and rounds.
1.
Individual Program Therapy
Supervision for program therapy is provided by psychologists on staff, clinical team
managers, BHP psychiatrists, and clinical associate faculty. Each practicum student will
meet for individual or group supervision with the clinical postdoctoral fellow who
organizes and oversees the practicum training program throughout the training year.
Students will also be assigned a clinical supervisor who is a licensed psychologist and
with whom they will meet for 1 hour per week to discuss clinical cases. Students will
also be assigned a clinical psychology intern at the BHP to provide 30 minutes of peer
mentorship around clinical work. Supervision assignments are made by the Program
Director, Thröstur Björgvinnson, and the clinical postdoctoral fellow.
Program therapy rounds are an essential meeting for practicum students to get support
and guidance for their individual treatment interventions. Students also receive
supervision in team rounds through the discussion and review of patient treatment plans
with relevant clinical team members.
2.
Group Therapy
Group therapy training seminar will be provided by Dr. Mark Santello early on in the
training year. Supervision also occurs with seasoned group co-leaders, and in individual
supervision.
E. Mini Seminar Series
Students will participate in a mini seminar series organized by the clinical postdoctoral
fellow. Common seminar topics include: risk assessment, personality disorders, CBT in a
partial hospital setting, DBT in a partial hospital setting, motivational interviewing,
psychiatric medications, group therapy, research, and administrative seminar. Seminars
typically occur once a week for 50 minutes for the duration of the training year.
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F. Training Goals
1.
Individual Program Therapy

Students will become proficient in mental status exams, functional assessments,
and risk assessments that are utilized in many situations at the BHP.

The BHP focuses on integrating treatment with clinical research initiatives.
Students will learn to use progress monitoring data to inform treatment decisions
and improve treatment collaboration with patients.

Students will learn how to interact, communicate, and synthesize information with
multiple treatment team members coming from several treatment
backgrounds/orientations (e.g. psychiatrists, psychologists, social workers, nurses,
occupational therapists, vocational counselors, and program counselors).

Students will learn to address the referral questions, write succinct reports, and
communicate findings to the treatment team.

Students will learn to formulate cases and then develop short-term, focused
treatment recommendations and present findings and recommendations to
treatment teams in rounds.
2.
Group Therapy

Students will learn how to prepare for and run small to large sized groups.

Students will develop an identity as a group leader/co-leader.

Students will build skills to manage difficult patient interactions in the context of
the group, and work to balance individual patient needs with the needs and goals
of the group.

Students will learn to use group protocols to address priority content areas
consistent with program treatment philosophy while remaining flexible to address
specific group and patient needs.
G. BHP Meetings
1.
Program Therapy Rounds – REQUIRED
Program Therapy rounds are held Mondays from 9-9:30am and Thursdays from 88:30am. Students are required to attend PT rounds once a week with Dr. Gary Taylor
and Dr. Matt Schrock. PT assignments are reviewed in rounds and students are taught
how to approach the case, coordinate with supervisors, report to the team who requested
the consultation, and present a case.
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2.
BHP Team Rounds – REQUIRED
Team rounds are held three times a week (Tuesdays from 8:30-10, Wednesday from
8:30-10, and Thursdays from 8:30-10). Practicum students are assigned to rounds based
on the student’s training schedule and assigned treatment team. All practicum students
attend one team rounds per week. In general, rounds serves the following purposes: to
share clinical information on patients, to observe different approaches to cases, to work in
an inter-disciplinary fashion, to reconcile disagreements between team members, to
receive information about consultations, and make recommendations to outside treatment
teams.
3.
BHP Monthly Research Meeting – OPTIONAL
The BHP research meeting is held the last Wednesday of each month from 12-1pm. BHP
staff interested in research meet to discuss the program research initiative. Phase I was
launched in May, 2010. Each patient entering the BHP now receives a semi-structured
diagnostic interview (Mini International Neuropsychiatric Interview; MINI) and several
self-report measures of symptoms and functioning, administered via computer. This
initiative serves as an infrastructure for conducting treatment outcome and other research
in a naturalistic partial hospital setting.
Opportunities for scholarly writing are available. The Phase I project and previous
research initiatives have yielded large databases with the potential for many scientific
contributions related to basic psychopathology research, treatment outcome research, and
mechanisms of change in CBT. Practicum students are welcome to develop research
questions, conduct analyses, and explore the existing databases.
In Phase II, we will implement several specific research/clinical interventions. Practicum
students are welcome to collaborate on proposed studies and/or initiate novel projects, in
conjunction with BHP staff and other departments within the McLean Hospital research
network.
Using data from the current protocol (as of May 2010), the laboratory has generated over
50 published manuscripts covering a wide breath of topics including examining the role
of self-compassion and positive beliefs in treatment, the relationship between social
anhedonia and clinical outcomes, the efficacy of cognitive bias modification programs,
and the psychometrics of instruments assessing a number of transdiagnostic processes
relevant to psychopathology and recovery in an acute clinical sample.
Over 3,700 patients have consented to research at the BHPP from July 7th, 2010 to today.
Practicum students are strongly encouraged to participate in research at the BHP.
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4.
Hospital Grand Rounds
McLean Hospital grand rounds are an excellent opportunity for further clinical and
professional development. They are held on Thursdays at 12pm.
II. Application and Contact Information
Interested students and graduate program faculty or supervisors can contact the program
with questions using the contact information listed below. Applications for the 2017-2018
practicum training year are due by January 3rd, 2017. Applications should be emailed to
Steve Marshall (info listed below) and must include a cover letter discussing the
applicant’s interest in the training program, a current CV, and at least one letter of
recommendation from a program faculty member or clinical supervisor. Applications will
be reviewed by the Program Director, Thröstur Björgvinnson, and the Psychology Fellow.
Selected applicants will be invited for an interview in mid-January, and 3-4 students will
be selected for the practicum and notified by February 6th.
Steve Marshall, M.S.
Psychology Fellow
Behavioral Health Partial Program, McLean Hospital
115 Mill Street
Belmont, MA, 02478
Phone: 617-855-3519
[email protected]
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