The Reproductive Psychology Track is designed to offer interns comprehensive experience in the assessment and treatment of psychiatric symptoms the occur in the context of reproductive transitions, including pregnancy, postpartum, and the transition to menopause (“perimenopause”). This track offers exposure to a diverse range of settings and modalities with the intent of facilitating intern growth in both knowledge of reproductive psychology and delivery of evidence-based interventions.
The clinics and inpatient settings within this track serve a diverse patient population. Interns will receive training and supervision with a focus on cultural sensitivity and cultural humility. Didactics are aimed at increasing trainee knowledge of oppression and marginalization issues as they relate to our patients and our clinical practice. We use the ADDRESSING Model to understand cultural influences as a multidimensional combination of age, developmental and acquired disabilities, religion, ethnicity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. Interns will apply the ADDRESSING Model to conduct clinical assessments through the use of the DSM-5 Cultural Formulation Interview, and the resulting cultural formulation will be used to inform case conceptualization and clinical interventions.
The Center for Mood Disorder’s Perinatal Psychiatry Inpatient Unit is one of the only facilities in the nation providing multidisciplinary care to patients with severe mental illness during pregnancy and postpartum in a separate, stand-alone psychiatric unit that minimizes patient/baby/family separation. The inpatient unit is dedicated to treatment of severe mental illness, including treatment for mood disorders, anxiety disorders, substance use disorders, psychosis, trauma, and chronic suicidality, during pregnancy and the immediate postpartum period. Interns will round with the psychiatric team, participate in multidisciplinary team meetings, and provide consultation regarding assessment questions. Interns will provide psychological assessment to facilitate differential diagnosis, participate in case conceptualization, and provide brief evidence-based interventions to promote distress tolerance, affective regulation, acceptance, mindfulness, and well-being.
Interns will also have an opportunity to teach assessment and therapy techniques to medical students and residents and may supervise graduate-level clinical psychology practicum students.
Additionally, interns will have opportunities to provide partner sessions to promote psychoeducation, communication, and coping skills to the partners of patients hospitalized on the unit. Interns may also participate in family meetings, coordinate with patients’ outpatient therapists, and facilitate arrangements for outpatient psychotherapy as part of discharge planning.
Supervisor: Emily Pisetsky, PhD
The Perinatal DBT program, directed by Dr. Tiffany Hopkins, is one of the only full-model DBT programs in the US adapted specifically for perinatal patients. The DBT program includes weekly skills group, individual therapy, phone coaching, and consultation group. Additionally, interns will have the opportunity to complete Dr. Melanie Harned’s DBT+Prolonged Exposure protocol, for patients with primary PTSD diagnoses. Interns will co-facilitate the skills group with a licensed clinician, and over the course of the year-long experience, gain autonomy in planning and leading group sessions. Interns will co-lead individual therapy for at least one patient over the course of the internship year, and depending on skill level, experience, and interest, may see patients individually under Dr. Hopkins’ supervision. Interns may provide phone coaching and participate in consultation group, depending on their level of experience and training goals.
Interns will receive one hour of individual supervision and one hour of peer consultation each week. Interns may also participate in a one-day workshop on DBT at the outset of internship, and have access to a wealth of training materials for deeper self-study. Interns may also have an opportunity to teach DBT skills and techniques to graduate-level clinical psychology practicum students.
Supervisor: Tiffany Hopkins, PhD
Interns will gain experience in screening, diagnosis, and treatment of mental illness in the context of the perinatal period (pregnancy, infertility and assisted reproduction, pregnancy loss, postpartum, and weaning); patients present with a full array of complexity, acuity, and diagnostic presentations. As part of the assessment process, interns will administer a full assessment battery, complete diagnostic evaluations, and write integrated reports. Moreover, interns will gain experience in case formulation, treatment planning, and provision of feedback from multiple evidence-based theoretical perspectives.
In the outpatient clinic, the intern will participate in the provision of evidence-based treatments for perinatal patients experiencing mood and anxiety disorders such as perinatal depression and anxiety, bipolar disorder, trauma-related distress disorders, panic disorder, obsessive-compulsive disorder, and affective instability. Outpatient cases will be assigned based on intern interest and training goals. Treatment modalities commonly offered in this clinic include Prolonged Exposure, Cognitive Processing Therapy, Exposure and Response Prevention, Acceptance and Commitment Therapy, Cognitive-Behavior Therapy (including specific iterations for panic, insomnia, and eating disorders). Training in specific modalities is therefore contingent on the patients’ presenting concern and supervisor availability.
Supervisor: Tiffany Hopkins, PhD
The perimenopause is the transitional time when a women’s period becomes irregular and will eventually stop, signaling the end of menopause. For many women this reproductive transition happens naturally, whereas for others it can occur related to medical treatment or surgery. The menopausal transition can be accompanied by physical and emotional symptoms related to hormone changes occurring during this time. For some women these symptoms can impact their function and quality of life.
The Perimenopause Clinic, directed by Dr. Margo Nathan, supports women and their providers who are seeking further understanding of whether the hormonal changes of menopause may be playing a role in their psychiatric symptoms. The clinic provides specialized consultations which includes a reproductive and psychiatric evaluation as well as discussion of recommendations for the management of hormonally associated mood and anxiety symptoms. These consultations can last between 1-4 visits and include collaboration with the referring provider.
Interns provide evaluation, consultation, and brief behavioral interventions for perimenopausal women experiencing mood and anxiety symptoms. Dr. Schiller will be the primary supervisor, but the intern will work closely with Dr. Nathan to coordinate care.
Supervisor: Crystal Schiller, PhD
Additional Track Opportunities
A one-day DBT training workshop is offered within the first month of the internship to prepare interns with the foundational skills necessary to co-facilitate the DBT program. Interns also have access to numerous online trainings in the provision of PE, CPT, and other EBPs. Additional DBT didactics are offered on a weekly basis throughout the year, depending on the interns’ training needs.
General didactics are offered once weekly for one hour and are tailored to the training needs of interns on the service.
Didactics will aim to enhance trainee knowledge of oppression and marginalization issues as they relate to our patients and our clinical practice. Interns will be instructed in the use of the ADDRESSING Model to understand cultural influences as a multidimensional combination of age, developmental and acquired disabilities, religion, ethnicity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. Interns will receive training to apply the ADDRESSING Model to clinical assessment using the DSM-5 Cultural Formulation Interview. Interns will be trained to use the DSM-5 Cultural Formulation Interview to support case conceptualization and clinical interventions.
Didactics may also include instruction on reproductive psychology and/or the evidence-based modalities employed in the service, including Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, Behavioral Activation Therapy, Exposure Therapies, Motivational Interviewing, and mindfulness-based approaches, depending on fit and interest.
Supervisors in the Reproductive Psychology track are actively engaged in supporting interns’ professional development. Training and professional development goals are set at the beginning of each rotation. Professional development goals may include writing a case report or research manuscript, presenting at an academic conference, attending a training workshop, supervising practicum students or medical residents, or giving a talk in the Department of Psychiatry. Support is also provided regarding career transitions and preparation for postdoctoral fellowship applications and interviews.
We have several research projects underway, both large-scale projects with extramural funding and smaller-scale clinic-based projects. Research opportunities include 1) assisting with studies of the effects of estrogen on brain function (using brain imaging) and mood in women with reproductive-related mood disorders, 2) conducting clinical interviews (SCID) with women with/without mood disorders, and 3) helping to prepare manuscripts using existing data. Additionally, interns may contribute to projects to determine clinical services utilization, effectiveness, and patient needs. Finally, existing infrastructure and funding exist to support interns’ healthcare utilization projects, with a focus on diversity, equity, and inclusion.
Interns may have opportunities to supervise graduate-level clinical psychology practicum students and will have opportunities to provide education and training to medical students and psychiatry residents. Interns will be trained and supervised by core faculty to identify the training goals of the supervisees and design a training experience tailored to supervisees’ needs and goals. Potential training contexts include the PPIU and DBT program.