The Howard University Counseling Service Doctoral Internship in Health Service Psychology espouses the belief that all individuals should have access to quality mental health care, regardless of race, religion, gender, sexual orientation, physical disabilities or socioeconomic status. It is further believed that to fully prepared to render quality mental health care in a diverse society with rapidly-changing demographics, psychologists and other mental health practitioners must have in-depth knowledge of issues of diversity. This conceptual orientation is part of the guiding philosophy for our program curriculum.
Interns, therefore, are selected from diverse educational environments in counseling and clinical psychology with varying training philosophies. Because of this diversity, the interns' core program is supplemented by training experiences that are tailored to fit specialized training needs. They have completed all their formal coursework and bring with them the most recent knowledge, theory, and research in psychology. Program emphasis is focused on training interns in the application of knowledge to a culturally, racially, and individually diverse population of clients. Training supervisors ensure that the training experience is consistent with the intern's personal and professional goals.
Interns are encouraged to evaluate their experiences throughout their training and to consider the relevance of these experiences to understanding of dynamics among people of diverse cultural, racial, and individual backgrounds. The total internship experience is informed by the psychodynamic framework. In addition, the psychodynamic framework provides a foundation for the integration of content and process dimensions of supervision. It is also the lens through which the didactic and experiential elements of the training are understood by both the supervisor and trainee.
The trainees are taught in seminars to follow a clearly defined theoretical rationale for their clinical and consultative work. In case conferences and supervisory sessions, careful attention is paid to ensure that trainees know how to identify and diagnose a problem by formulating hypotheses and gathering data to confirm or reject the hypotheses. Concepts of human development and intervention strategies are taught from a variety of theories such as Freudian psychoanalysis, ego-psychology, object relations, self-psychology, interpersonal and relational schools of thought. While the practice of psychology is the primary focus in this practitioner-scholar model, interns are provided the necessary resources to conduct research and engage in such scholarly pursuits as attending and presenting at professional conferences.
Training is provided in incremental levels of complexity. The first training requirement is participation in orientation. Interns participate in three-four weeks of orientation activities which include new employee orientation, sexual harassment training, and ethics presentation, and introduction to the DC Superior Court and assessment review. This orientation also includes a discussion of the history of Howard University Counseling Service, and the training program’s philosophy, objectives, and training plan; as well as a discussion of the evaluation process, due process, and grievance procedures. Interns are then exposed to training in conducting intakes and formulating their clinical intervention framework within an integrated theoretical model. This training takes place under the tutelage of the Training Director, Erica Shirley, Ph.D. The interns start their hands-on experience by first conducting intake interviews and writing intake reports for presentation at the weekly intake conference. Once they master that skill, the interns are assigned therapy cases for ongoing work. In the beginning months of the internship, the training staff works with interns in the selection of cases to help them achieve a balance between selecting cases with relatively straightforward clinical presentations and selecting cases with more challenging clinical presentations. In the ensuing months, interns are encouraged to select increasingly challenging cases.
Our overall model of the supervisory relationship is structured to move interns along a continuum of development as follows:
Stage 1 - Exploration of anxieties, expectations, and experiences focusing on interpersonal and intrapersonal dynamics are combined with skill development activities. During this stage of supervision, considerable discussion is devoted to the intern’s adjustment to the intern role, and attention is also given to the intern’s perceived strengths and areas of growth and how these perceptions are influencing the selection of cases.
Stage 2 - A more in-depth exploration of dynamic patterns and therapeutic feedback from the supervisor. Parallel process issues, transference and countertransference issues often warrant a more in-depth examination during this stage.
Stage 3 - The supervisor functions more as a consultant as trainee skills are enhanced and they gain more confidence. Professional identity development and the transition from trainee to professional are also focused upon in greater depth during Stage 3.
The above supervisory model characterizes individual clinical supervision during the training year, but it also informs, to some degree, many of the other training activities and supervisory relationships. While this model is the foundation for many of the training activities, most of them also have specific structure and/or components which ensure that the learning experience within the activity is sequential, cumulative, and graded in complexity.
Commitment to Diversity
The Howard University Doctoral Internship in Health Service Psychology espouses the belief that all individuals should have access to quality mental health care, regardless of race, religion, gender, sexual orientation, physical disabilities or socioeconomic status. It is further believed that in order to be fully prepared to render quality mental health care in a diverse society with rapidly changing demographics, psychologists and other mental health practitioners must have in-depth knowledge of issues of diversity. This conceptual orientation is part of the guiding philosophy behind our program curriculum.
Given that Howard University’s mission is to educate African Americans and other underserved groups, Howard University’s student population is rich in diversity. More than 88 countries are represented with large numbers of international students coming from Africa and the Caribbean. This unique setting gives the interns the experience that is needed in realizing the training goal of developing special competency in working with a diverse population. Interns are encouraged to evaluate their experiences throughout their training and to consider the relevance of these experiences to understanding the dynamics among people of diverse cultural, racial, and individual backgrounds. Additionally, the total internship experience is informed by an understanding of group process and the psychodynamic framework. Within this approach, interns are encouraged to explore their own individual differences, identities, and cultural backgrounds. This approach to addressing diversity also allows the interns to learn in experiential and didactic formats.
Our goal has always been to infuse diversity throughout the interns’ training experience. Discussions about diversity become increasingly more frequent and complex over the course of the internship. During orientation, interns are given the opportunity to role-play intake interviews with the Training Director. Discussion follows each role play. The Training Director gives feedback about issues of diversity and their impact on therapeutic rapport, diagnostic considerations, and potential implications in the therapeutic relationship. As the year progresses and interns begin to work with clients, one aspect of clinical supervision is the discussion of diversity issues. These discussions become increasingly complex during the course of the training year and a typical progression is as follows:
- identifying gaps in one’s cultural knowledge and working with the supervisor to supplement the gaps via readings and discussion of history–gathering as a therapeutic technique
- discussion of how the intern’s cultural identity along several dimensions (e.g., race, ethnicity, sexual orientation, gender) influences his or her worldview, identity as a therapist, and lens through which he or she views the client
- identification of projections (related to race, gender, sexual orientation, religion) and their contribution to transference and countertransference in the therapeutic relationship, and their contribution to parallel process issues within the supervisory relationship
- identification and discussion of processes and strategies which the intern can integrate into his or her continued self-growth with respect to diversity issues, as well as integrate into his or her continued growth as a culturally-competent therapist.