Southern Arizona VA Health Care System
Postdoctoral Clinical Activities
Mental Health Residential Rehabilitation and Treatment Program, PTSD Track (MH RRTP-PTSD)
The residential PTSD training experience involves intensive trauma and skills-based treatment and psychosocial rehabilitation for a diagnostically and psychosocially complex patient population, within a complex interdisciplinary system. Patients have typically experienced multiple (and repeated) types of trauma exposure, have significant medical and psychiatric comorbidities, and have needs for psychosocial stabilization (e.g., housing, employment). Case conceptualization, interdisciplinary consultation and coordination, and balancing multiple clinical (i.e., group therapist, individual therapist, case manager) and professional (e.g., educator, co-facilitator, consultant) roles are hallmarks of the experience. As the program emphasizes therapeutic exposure, individual treatment typically utilizes Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Written Exposure Therapy (WET), or adapted PE (e.g., COPE, STAIR/NST, Adaptive Disclosure) imaginal protocols. Group therapy offerings include DBT-based skills, mindfulness-based approaches, CPT, and in vivo exposures. As the program employs cohort-based treatment, interventions in interpersonal processes and group dynamics (within the patient cohort and the treatment team) are also necessary. Elective groups are developed based on assessment of client needs and are often cohort-specific. A distinctive role of the psychology service in this environment is ongoing assessment and creating data-based individualized treatment plans, case conceptualizations, and progress feedback for Veterans and staff. In addition, residents may have the opportunity to engage in research and program evaluation. Residents may also have opportunities to provide formal and informal education and training to staff, or to collaborate on outreach to current or potential referral sources. The resident’s individual training goals will shape the character of the residential PTSD rotation, although duration and timing of the rotation is typically dictated by cohort admission and discharge schedules. Staff involved: Dr. Aubrey Rodriguez
Military Sexual Trauma (MST)
The Military Sexual Trauma (MST) program provides treatment for any veteran regardless of gender who experienced sexual harassment or sexual assault while in the military. Treatment is evidence based and provided in group and individual formats. Specific modalities used include Cognitive Processing Therapy, Prolonged Exposure, and Dialectical Behavior Therapy informed skills training. Staff involved: Dr. Kathleen Young
PTSD Clinical Team (PCT)
The out-patient PTSD Clinic Team (PCT) training experience is intended to deepen clinical acumen in assessment and treatment of combat veterans with PTSD. The primary evidenced-based treatment modalities include both individual and group Cognitive Processing Therapy (CPT), as well as Prolonged Exposure (PE) Therapy. Opportunities exist to lead the PTSD Introduction and Readiness Class, a four-week psycho-education class for veterans new to the program, in addition to the PTSD Skills Group, which is designed to enhance treatment readiness. There may also be an opportunity to participate on the DBT Team providing group and individual therapy. A weekly one-hour PE Consultation Group offers the resident a chance to train and consult with other professionals administering this therapeutic modality. Finally, opportunities exist to provide therapeutic services to any of the seven Community Based Out-Patient Clinics (CBOC’s) via tele-mental health. As with the other programs, hours spent with the PCT will be determined by the resident’s individual training goals. Staff involved: Dr. Sandra Gallagher
Substance Use Disorder Clinic-PTSD Rotation
The purpose of the PTSD/SUD rotation is to provide the postdoctoral fellow with intensive experience in the assessment and treatment of trauma with co-occurring substance use disorders. On this rotation, trauma exposures may include both simple (e.g., combat) or complex trauma (e.g., a history of maltreatment in childhood plus combat) as well as a history of, or current, active, substance use disorders. The clinical settings for the rotation are with multidisciplinary programs in the Substance Use Disorders Treatment Program (SUDTP), which target Veterans struggling with PTSD and substance use disorders.
Postdoctoral fellow receives education and training in the clinical psychology of trauma-related disorders, including etiology, diagnosis, and treatment. They participate in intake interviewing, psychological assessment, team treatment planning, consultation, and individual and group psychotherapy. The rotation utilizes Evidence-Based Treatment (EBT) including: Cognitive Processing Therapy (CPT, individual therapy), Prolonged Exposure (PE, individual therapy), and Seeking Safety (group therapy).
Dialectical Behavior Therapy (DBT) Program
The psychology post-doctoral fellow will also participate in the DBT program. The fellow will provide individual therapy to at least one veteran enrolled in the DBT program. SAVAHCS has had a full DBT program since 2012 comprised of a group of multidisciplinary staff. The program includes individual therapy, group skills training, consultation team meetings and phone coaching consistent with evidence-based DBT. The afterhours skills coaching component is provided by trained inpatient unit staff and is not a requirement for the post-doctoral fellow. As one of only a handful of full DBT programs in the country, this is an outstanding learning opportunity for the post-doctoral fellow. The fellowship supervisors are members of the DBT team and consider this skill set vital given that emotion dysregulation, poor distress tolerance and interpersonal ineffectiveness commonly present in traumatized populations. Staff involved: Dr. Young, Dr. Gallagher
SAVAHCS DBT Program Description:
- Modes of Treatment provided on outpatient treatment basis:
- Individual Therapy (Weekly)
- Group Skills Training Therapy (Weekly)
- Phone Coaching (Weeknights, Weekends & Holidays provided by inpatient nursing staff)
- DBT Consult Team (Weekly staff meeting, Th. @ 1500)
Supervision Training Seminar
In order to develop further expertise in providing supervision, the Postdoctoral Fellow co-leads (in conjunction with staff psychologist Dr. Young) a weekly Supervision Training seminar attended by all psychology interns. The Supervision Training Seminar allows for exposure to principles and models of supervision both through didactic and experiential approaches. Readings on models of supervision and critical issues in the supervisory process and relationship are assigned and discussed with special attention to multicultural issues. Self-reflective practice is encouraged and modeled by the Fellow through facilitated peer supervision of intern’s psychotherapy cases and supervision of social work interns. Staff involved: Dr. Kathleen Young.
