Adult Rotations

Adult Track

Heather Schatten, PhD, Track Coordinator

The focus of the Adult Track is on the application of empirical behavioral science to the understanding and treatment of adult behavior disorders. The general goals are to promote the achievement of adequate levels of proficiency in the assessment and treatment of adult psychiatric disorders, and to prepare residents for careers that integrate clinical research with clinical practice. Clinical psychology residents are exposed to a broad spectrum of problems, ranging from mild to severe psychopathology. They develop skills in both assessment and intervention with a particular focus on the broad family of cognitive-behavioral interventions. In addition, clinical psychology residents become familiar with biological components of adult psychopathology and acquire an awareness of the utility of psychotropic medications commonly used in the treatment of severe psychopathology. Clinical psychology residents also receive specialized training in one or two treatment interventions (i.e., cognitive therapy, exposure-oriented behavior therapy, dialectical behavior group therapy, acceptance, and commitment therapy) suitable for outpatient cases. Issues relevant to the ethical and professional practice of psychology are stressed.

The Adult Track is composed of the following rotations:

Adult Track - Acceptance and Mindfulness-Based Partial Hospital Program

Acceptance and Mindfulness-Based Partial Hospital Program – Rhode Island Hospital
Faculty Supervisor(s): Catherine D’Avanzato, PhD, Mark Zimmerman, MD, Olga Obraztsova, PhD, Doug Long, PhD, Adriana Hyams, PhD, Rachel Ojserkis, PhD, Kristin Davidoff, PhD, Molly Meth, PhD, Ruth Firmin, PhD, Vanessa Wu, PhD, Kristy Dalrymple, PhD

The Acceptance and Mindfulness-Based Partial Hospitalization Program at Rhode Island Hospital (RIH PHP) serves adults aged 18 years and older who present with a range of psychological problems, including mood, anxiety, substance use, and personality disorders.  The primary treatment model is based in Acceptance and Commitment Therapy (ACT), although other empirically supported behavior therapies may also be used as indicated. The partial hospital runs from 8:00AM to 2:00PM Monday through Friday, and the average length of stay for patients is 5-7 program days.  Patients attend 4 groups per day, providing them with skills in: values and goals clarification; greater acceptance towards difficult feelings and thoughts while engaging in meaningful behaviors; improving interpersonal relationships; and increasing mindfulness and other coping behaviors.  Patients also receive individual therapy and medication management on a daily basis. Three specialty treatment tracks are currently available tailoring ACT for (1) trauma/PTSD  (2) young adult issues and (3) BPD and difficulties with emotion regulation.

Adult Track - Alcohol and Drug Treatment Services

Alcohol and Drug Treatment Services Program - Butler Hospital
Faculty Supervisor(s): Deb Herman, PhD

ADTS Day Program (ADP) is a cognitive-behavioral treatment program for people who have already completed detoxification.  It is located in the Day Hospital and involves the treatment of a maximum of 20 patients.  Patients attend Monday through Friday from 9:00 a.m. to as late as 5:00 p.m., depending on individual needs and group participation.  The program involves daily group behavior therapy that focuses on a functional analysis of drinking and drug use and associated problem behaviors, implementation of self-control procedures, relapse prevention strategies, cognitive-behavioral group meetings, and family group meetings once a week.  Patients receive individual counseling with a therapist and a meet with a psychiatrist each day.  The program also includes goal setting meetings, structured activities periods, introduction to Alcoholics and Narcotics Anonymous, movies about alcohol, alcoholism, and other drug abuse, and individualized discharge planning.

Adult Track - Collaborative Addiction Recovery Services

Collaborative Addiction Recovery Services - Providence VA Medical Center
Faculty Supervisor(s): Jayne Kurkjian, PhD, Jane Metrik, PhD, and Robert Tilton, PsyD

The Collaborative Addiction Recovery Services (CARS) rotation at the Providence VA Medical Center is designed to allow the clinical psychology resident to develop skills in the psychological assessment and treatment of substance use disorders, taking into account the special needs for holistic, integrated care in this population. Each year, more than 250,000 outpatient visits occur at the Providence VA Medical Center.  Organized within the Mental Health and Behavioral Sciences Service of the Medical Center, CARS is a multifaceted program that provides, via its interdisciplinary treatment team, services that encompass the entire continuum of care in the treatment of addictive behaviors. CARS either directly provides or has access (via in-house referral, referral to other VAMCs in the region, or via an external treatment funding program administered by CARS) to the following services: comprehensive intake assessment, treatment planning and case disposition; CARS Consultation-Liaison Clinic (servicing the medical/surgical areas of the Medical Center); outpatient motivational drop-in group; inpatient detoxification; inpatient substance abuse rehabilitation; CARS Intensive Outpatient Treatment Program; evidence-based individual and group outpatient psychotherapy including CBT groups for Relapse Prevention and other groups focused on coping skills training; outpatient psychiatric and medication management services; Aftercare Group Program; and Opiate Treatment Program. Some services are offered via the VA's telehealth platform. Patients serviced by CARS present with a wide range of DSM-5 Substance-Related Disorders (usually severe and long-term in nature), often carry multiple DSM diagnoses, and typically have concomitant physical conditions that directly relate to their Substance-Related Disorder (e.g., chronic pain). CARS strives to provide addiction treatment that is well-integrated with patients' concurrent primary medical care (typically also provided in the Medical Center).

Adult Track - Intensive Outpatient Program for OCD and Anxiety Disorder

Intensive Outpatient Program for OCD and Anxiety Disorders - Butler Hospital
Faculty Supervisor(s): Maria Mancebo, PhD & Jose Rengifo, MD

The OCD and Anxiety Disorders Intensive Outpatient Program is a specialized program designed to help adults experiencing persistent obsessive compulsive disorder (OCD), intense fears (phobias), panic disorder, health anxiety, and social anxiety. Grounded in an exposure-based CBT model of treatment, the program is geared towards patients who have not responded to traditional outpatient treatment. Treatment takes place Monday through Thursday (2pm – 5pm), over an average 6 week period. Patients in this program receive individual therapy, daily group therapy, as well as home-based ERP, family consultations, and expert psychiatric medication consultation. Clinical psychology residents will participate and receive supervision in all aspects of program procedures.  This placement also includes program-relevant hospital consultations and one-half day each week on call in the Patient Assessment Services (PAS) at Butler Hospital, where the clinical psychology resident works with a psychiatrist to triage patients for hospital services. Treatment services are delivered in-person as well as via videoconferencing.

Adult Track - Mood Disorders Program

Mood Disorders Rotation – Rhode Island Hospital
Faculty Supervisor(s): Abigail Mansfield-Marcaccio, PhD, Tanya Tran, PhD, & Gabor Keitner, MD

The Mood Disorders Program and the Inpatient Psychiatric Unit at Rhode Island Hospital provide intensive psychiatric treatment for outpatients and inpatients with a special emphasis on mood disorders and a biopsychosocial approach. Each patient is treated by a multidisciplinary team, which formulates a treatment plan that is tailored to the specific needs and problems of the patient. Treatment is multidimensional and may involve combinations of individual psychotherapy, group therapy, family therapy, and psychopharmacological treatments. Clinical psychology residents sit in on daily rounds with the treatment team, in addition to having their own caseload of individual patients and groups. One afternoon a week, clinical psychology residents also participate in the outpatient family therapy clinic in the Mood Disorders and Family Therapy Program.  Supervised by Abigail Mansfield, PhD, the clinic uses the McMaster approach to assess and treat families and couples using a co-therapy model.  Residents sit in on sessions and become more active in co-therapy as the rotation progresses.  As part of clinical psychology residents’ experience on the inpatient unit, weekend coverage is included, which provides an opportunity to see a much broader range of patient problems. The frequency of the weekend coverage varies depending on how many medical students and clinical psychology residents there are (e.g. one in three weeks to one in six weeks).

Adult Track - Postpartum Depression Day Hospital

Postpartum Depression Day Hospital – Women & Infants Hospital
Faculty Supervisor(s): Margaret Howard, PhD & Shannon Erisman, PhD

The Postpartum Depression Day Hospital rotation is designed to introduce the clinical psychology resident to the recognition and treatment of perinatal psychiatric disorders.  To this end, the clinical psychology resident/fellow will function as a member of a multi-disciplinary treatment team in a partial hospital setting.  The mission of this specialized partial hospital program is to provide timely, comprehensive and cost-effective treatment to women suffering from psychiatric disorders during both pregnancy and the postpartum period.  The program is also designed to keep mothers and their infants together during treatment so that 1) the critical bonding period between mother and baby is not disrupted, 2) breastfeeding in nursing mothers in not interrupted and 3) we can directly observe how a mother’s illness affects interaction with her infant, while simultaneously fostering more positive attachment. The resident will be involved in all aspects of the treatment, initially as co-therapist, later independently—running groups, carrying individual psychotherapy caseload, conducting intake evaluations, family meetings, and treatment planning.  

Adult Track - Trauma Recovery Services

Trauma Recovery Services (Post Traumatic Stress Disorder) Rotation - Providence VA Medical Center
Faculty Supervisor(s): Lauren Reeves, PhD, William Unger, PhD, & Samantha Collum, PhD

In the Trauma Recovery Services (TRS) rotation, the clinical psychology resident learns, through direct participation, how to manage individuals suffering from trauma-related disorders, including PTSD, as well as other acute psychiatric and substance abuse problems. The TRS clinic at the Providence VA Medical Center is an outpatient treatment program for Veterans suffering from PTSD symptoms related to their military service as well as non-military traumas. The program primarily serves Veterans from the war in Vietnam, the Persian Gulf Conflict, and Veterans recently returned from Iraq and Afghanistan. Veterans receive a comprehensive diagnostic assessment and then engage in a treatment program with an emphasis on evidence-based interventions. Clinical psychology residents will participate and receive supervision in all aspects of program procedures. We offer individual psychotherapy, couples therapy (when cases are available), and group psychotherapy. Veterans in the program also present with many difficulties related to PTSD such as substance abuse and depression. Staff participate in several research projects and clinical psychology residents may have an opportunity to learn about ongoing research protocols. Additional involvement in research is completely optional and is discussed on an individual basis.

Adult Track - Women's Partial Hospital Program

Women's Partial Hospital Program Rotation - Butler Hospital
Faculty Supervisor(s): Theresa Morgan, PhD, Margaret Howard, PhD

The Women’s Partial Program (WPP) at Butler Hospital utilizes evidence-based, third-wave behavior therapies to treat women presenting with symptoms of personality pathology, and predominantly Borderline Personality Disorder.  Therapy modalities used include but are not limited to Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and other, similar therapies with a strong evidence base and components of acceptance, mindfulness, and behavior change.  The focus of treatment is patterns of unworkable emotional and behavioral avoidance strategies that interfere with optimal functioning.  Patients receive a combination of medication management, individual and group therapy, with an emphasis on groups.  The majority of women treated in the WPP have histories of trauma.  Most meet criteria for Borderline Personality Disorder or present with symptoms of this diagnosis.  Common additional presenting problems include mood, anxiety, addiction, and impulse control disorders.  The program runs from 8AM to 2:30PM Monday through Friday. It is run as part of the larger day treatment programming in the Goddard Building at Butler Hospital. 

Adult Track - MIDAS Clinical-Research (12 month experience)

MIDAS Project Clinical-Research Outpatient Psychiatry - Rhode Island Hospital
Faculty Supervisor(s): Mark Zimmerman, MD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Catherine D’Avanzato, PhD

Clinical-research focused experiences, unlike the 4 month rotations described above, are 12 month long experiences providing concentrated clinical-research training in a specialty area. Therefore, the MIDAS Project Clinical-Research track is a separate track from the Adult Clinical Track.  Although applicants may apply to both tracks, residents are matched to only one of these tracks. In the 1st 8 months of training on the MIDAS Project track, time is spent as follows: 60% MIDAS Project clinical research, 10% Rhode Island Hospital Outpatient psychiatry clinical practice, 20% Rhode Island Hospital Partial Hospital Program, and 10% didactics. In the last 4 months of training, time is spent as follows: 60% MIDAS Project clinical research, 40% clinical work in the Behavioral Medicine clinical rotation. Thus, the clinical psychology resident spends the entire year in the MIDAS project. 

The purpose of a clinical research-focused internship, as set forth by the Brown University Clinical Psychology Training Consortium, is to meet the goals and objectives of the Consortium while providing more concentrated clinical research training in a specialty area.  The Methods to Improve Diagnostic Assessment and Services (MIDAS) Project is an ongoing study of diagnosis, assessment and outcome in routine clinical practice conducted at RI Hospital in the context of an outpatient psychiatry and a partial hospitalization program. In addition, as part of the MIDAS project we evaluate candidates for bariatric surgery with the same methods used to evaluate psychiatric outpatients. The Outpatient Psychiatry Practice at RIH treats patients with a variety of problems, including mood and anxiety disorders, using evidence-based pharmacotherapy and psychotherapy. After the clinical psychology resident is trained in doing diagnostic evaluations, they conduct 2-3 evaluations per week through the year. 

The RIH Partial Hospital Program in Acceptance and Mindfulness-Based Therapies provides intensive, short-term treatment for individuals with acute psychiatric concerns.  Patients at the partial hospital program receive group psychotherapy, individual psychotherapy, and individual pharmacotherapy on a daily basis; psychotherapy is delivered from an acceptance-based theoretical model, using Acceptance and Commitment Therapy (ACT) and other consistent therapeutic approaches (e.g., DBT, CBT).  In addition to receiving research training, residents will be provided with clinical training at both the outpatient and partial hospital programs.   

Clinical psychology residents in the MIDAS Track will receive additional clinical training as part of the third rotation in Behavioral Medicine at Rhode Island Hospital and/or Miriam Hospital.  This third rotation may include experiences such as working in the Sleep Program, the Obesity and Bariatric Surgery Psychology Program, the Miriam Hospital Consultation and Liaison Service, or other behavioral medicine programs. The Sleep Program is connected with The Sleep Disorders Center of Lifespan Hospitals. This program is an interdisciplinary service designed to diagnose and treat a wide range of primary and secondary sleep disorders. The Obesity and Bariatric Surgery Psychology Program provides assessment, diagnosis, and treatment for patients seeking weight management and bariatric surgery services, as well as patients with a variety of disordered eating patterns and psychiatric conditions related to disordered eating. The Bariatric Surgery Program is multi-disciplinary, and includes psychiatry, psychology, surgery, nutrition, and nursing providers.  Treatments include tailored group behavioral interventions, pre and post surgical group adherence interventions, individual therapy, and psychotropic medications. The Consultation and Liaison Service at Miriam Hospital is a multi-disciplinary service that includes psychiatrists, neuropsychologists, psychiatric nurse clinicians, psychiatric social workers, and psychiatry residents. Services on this rotation include brief assessment and treatment of common psychiatric and behavioral problems associated with medical problems such as traumatic brain injury, seizure and stroke, and other medical illnesses.