General Adult Psychology Track

General Information

(APPIC/NMS program code = 161913)

Track Coordinator:
Adam Carmel, PhD: adultpip@uw.edu

Current General Adult Track Psychology Residents

UWMC Outpatient Psychiatry/Psychology Clinics

• Psychiatry Clinic (Outpatient) at UW Medical Center – Roosevelt

Michele Bedard-Gilligan, PhD | Kristin Lindgren, PhD | Ty Lostutter, PhD | Joan Romano, PhD | Kate Comtois, PhD

HMC Outpatient Psychiatry/Psychology Clinic (5 East Clinic)

• Mental Health and Addiction Services at Harborview

Barbara McCann, PhD | Adam Carmel, PhD | Sarah Kopelovich, PhD

Fred Hutchinson Cancer Center

• Fred Hutchinson Cancer Center’s Psychiatry and Psychology Services

Ty Lostutter, PhD | Julia Brechbiel, PhD | Jesse Fann, MD, MPH | Nicole Bates, MD  | Julia Ruark, MD, MPH

Rotation Description & Patient Demographics

The University of Washington Outpatient Psychiatry Center (OPC) is a standard outpatient specialty care clinic staffed by faculty and residents in psychology and psychiatry. The OPC is located approximately 5 blocks west of the main campus of the University of Washington and approximately 10 blocks from the University of Washington Medical Center. The OPC serves a predominantly middle and lower-middle class population. Patients come from diverse ethnic and cultural backgrounds and sexual orientations. Patients present with a broad range of clinical problems, including mood, anxiety, substance use, adjustment and personality disorders. Portable digital recording equipment is available for faculty and resident use, as well as a room for live observation of sessions. Computers are available in each clinic room, providing access to the scheduling and computerized medical chart systems, e-mail and the Internet.

The Harborview Outpatient Psychiatry/Psychology Clinic (5 East Clinic) is a standard outpatient specialty care clinic staffed by faculty and residents in psychology and psychiatry. The 5 East Clinic is located at 325 Ninth Avenue, between Jefferson and Alder streets in Seattle’s First Hill neighborhood. Harborview Medical Center is a comprehensive healthcare facility dedicated to providing specialized care for a broad spectrum of patients, including the most vulnerable residents of King County. Harborview serves as the regional trauma and burn referral center for Alaska, Montana and Idaho and the disaster preparedness and disaster control hospital for Seattle and King County. Patients given priority for care include the non-English speaking poor; the uninsured or underinsured, victims of domestic violence or sexual assault; people incarcerated in King County’s jails; people with mental illness or substance abuse problems, particularly those treated involuntarily; people with sexually transmitted diseases; and those who require specialized emergency, trauma or burn care. 5 East Clinic is able to receive referral patients from other specialty mental health clinics located at HMC including patients from the Harborview Medical Center, Mental Health and Addictions Services (HMHAS), Early Psychosis Clinic, and the Sleep Center at Harborview to enrich the outpatient training available.

The Fred Hutchinson Cancer Center (FHCC) outpatient clinic is located in Southeast Lake Union and is accessible by a 15-minute shuttle from UWMC, which runs regularly throughout the day. Residents will work at the interface of psychology and oncology and become an integral member of a large multidisciplinary collaborative care team that includes psychiatrists, psychologists, advanced practice practitioners, clinical social workers and patient navigators. The FHCC, the comprehensive outpatient cancer clinic of the University of Washington and Fred Hutchinson Cancer Research Center, provides care for patients with a wide variety of malignancies in various stages of treatment. Residents will provide direct consultation to the FHCC clinics under supervision and will evaluate and treat a range of psychosocial issues that arise in the context of medical illness. They will also participate in a collaborative care model reviewing and managing patient cases using a multidisciplinary team. Examples of presenting problems with which residents will gain experience are: depression, anxiety, demoralization, confusion and cognitive problems, behavioral and compliance issues, issues surrounding grief and end of life, family issues in medical illness, and systems issues unique to working within a multidisciplinary medical setting. With all patient visits lasting a full hour, residents will have the unique opportunity to integrate a variety of psychotherapeutic modalities in the short- and long-term care of medical outpatients. Pertinent directed readings, webinars, and other educational materials are provided on our dedicated Psycho-Oncology training website.

Training Experiences & Treatment Modalities

The educational model of the OPC, 5 East Clinic, and FHCC emphasizes an empirically supported scientist-practitioner approach to psychological assessment and treatment. The psychology faculty at OPC have specialized training in evidence based cognitive-behavioral therapy, including expertise with cognitive processing therapy and exposure therapies for PTSD and other anxiety disorders. The primary modality is individual treatment although group treatments are also provided. There is also a multidisciplinary DBT training clinic that is run out of this clinic. DBT Workshops and seminars are offered as part of this comprehensive DBT training for residents. The faculty at 5 East Clinic has expertise in sleep disorders including insomnia (CBT-I), hypnosis in psychotherapy, Dialectical Behavior Therapy (DBT), Common Elements Treatment Approach (CETA), and Cognitive Behavioral Therapy for Psychosis (CBT-P). The faculty at FHCC have expertise in psycho-oncology, mindfulness-based cognitive behavioral therapy interventions, adjustment disorder, grief, end-of-life issues, and motivational interviewing strategies to increase medication adherence. Computers are available in each clinic room, providing access to the scheduling and computerized medical chart systems, e-mail and the Internet.

The Adult Track offers generalist training model where residents are integrated into collaborative, multidisciplinary teams at the three sites noted above. All residents are present at all three sites throughout the year, and each resident is assigned to a primary site for two days a week. All residents will have a small caseload of DBT patients and attend weekly OPC DBT consultation team meetings throughout the year.

Resident Expectations

The training objectives of the OPC/5 East Clinic/FHCC are designed to foster the acquisition of a broad generalist experience from among the following activities

1. Treatment: Individual psychotherapy comprises the majority of the clinical caseload. In coordination with the OPC/5East Clinic/FHCC Triage Team, we balance residents’ preferences for particular training experiences with the needs of the clinic. For example, residents may elect to have the majority of their caseload devoted to specific related disorders, such as anxiety, substance use. However, they are also expected to carry a diverse caseload and be willing to take on cases that need care or that expand their existing skill set.Considerations of differential diagnosis, case conceptualization, and treatment planning continuously evolve over the course of care. Clinic supervisors are predominantly, but not exclusively, cognitive-behaviorally oriented. Training books, manuals, video and audio tapes, and validated measures of therapist adherence and competence in specific treatments may be used to facilitate feedback and learning by the psychology resident. A typical caseload for each day will involve approximately 4-5 hours of direct clinical contact.Even though a resident is providing individual therapy, many patients receive medication management services from psychiatry residents and faculty in tandem with psychotherapy services provided by the psychology resident. Thus, the resident is part of a treatment team and must coordinate care with other providers across multiple disciplines.
2. Assessment: Psychology residents can administer a range of self-report indices in the outpatient clinic or refer/consult with the UWMC/HMC for more comprehensive assessment batteries (e.g., neuro-psychological assessment). The decision to obtain testing and, if so, which tests, is made in consultation with the supervisor on a case-by-case basis. In this way, residents learn the indications for testing and the clinical utility of testing results in treatment planning. There is also an option for the psychology resident to conduct full intake assessments for the clinic, often alongside a psychology or psychiatry attending.

Supervision

OPC/5 East CLinic

Psychology residents will receive individual supervision with two of the attending psychologists. They will also participate in a 1 hour per week combined psychology and psychiatry resident group supervision, moderated by the OPC/5 East Clinic training faculty (one attending psychologist and one attending psychiatrist). Group supervision is a combination of didactic presentations, readings and faculty/peer consultations. Supervisors are also available on an as needed basis. DBT supervision is provided in the form of one-on-one individual supervision with a clinical psychologist and participation in a multi-disciplinary consult team (psychiatry, psychology, social work).

FHCC

Psychology residents will receive individual supervision from one of two attending psychologists at this time 1 hours per week. They could  also participate in 1 hour per week attending our FHCC collaborative care group meetings, which consist of psychiatrist and social workers case review. The clinical social workers have been trained in behavioral activation as the primary intervention to help their clients and the psychology resident can assist with psychological interventions supervision during these team meeting.