Anxiety Disorders
Dialectical Behaviour Therapy
Eating Disorders
Forensic Psychology
Health Psychology/Behavioural Medicine
Long Term Psychotherapy

Mood Disorders
Neuropsychology
Schizophrenia and Severe Mental Illness
Other Training Opportunities

For all rotations, the specific responsibilities of each resident will be determined collaboratively with his or her supervisor, in order to meet the requirements of the core competencies and the resident’s personal training goals.

Major rotations typically require a time commitment of 400 or more hours.  Minor rotations typically involve a commitment of between 100 and 400 hours.

Anxiety Disorders

The ATRC is an outpatient specialty unit staffed by professionals with a background in psychology, psychiatry, or social work. The Centre receives more than 800 new referrals per year, predominantly for individuals suffering from panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder, and generalized anxiety disorder. Opportunities are also available for working with patients who suffer with other anxiety related difficulties (e.g., specific phobias, posttraumatic stress disorder, hypochondriasis, body dysmorphic disorder, and trichotillomania). Residents gain experience in clinical assessment using structured interviewing techniques for anxiety and other disorders, report writing, liaising with other treating professionals, and individual and group treatments for anxiety disorders using evidence-based, cognitive behavioural treatments. Residents are an active part of the multidisciplinary team that meets on a weekly basis for case conferences. During the case conferences, residents are expected to discuss diagnostic issues and treatment recommendations pertaining to their assessment cases from the previous week. Residents are also expected to become familiar with the relevant research literature.

In addition to offering clinical services, the ATRC is among the most active anxiety research centres in Canada. Research interests of clinic staff members include the development of short-term, cost effective assessments and treatments for anxiety, and the investigation of cognitive, behavioural, and biological factors in the etiology and treatment of anxiety disorders. Opportunities are available for residents to become involved in ongoing research projects.

For more information about the ATRC, refer to the website:  www.stjoes.ca/anxiety

Dialectical Behaviour Therapy

St. Joseph’s Healthcare, Hamilton has implemented a strategic plan to provide people with borderline personality disorder (BPD) with an empirically validated treatment. This treatment is based on a Dialectical Behaviour Therapy (DBT) framework, which was originally developed by Marsha Linehan. DBT is recognized to be an effective best practice approach that supports both people with BPD and clinical care teams in providing a consistent approach to care.

Residents will have the opportunity to provide time-limited skills training, individual therapy and skills coaching in an Outpatient DBT program. Residents will learn how to conduct assessments to diagnose BPD and to assess for the presence of suicidal and non-suicidal self-injurious behaviors. As part of this rotation, residents will have the opportunity to attend interdisciplinary consultation teams and provide additional training/consultation as needed. In addition, there are opportunities for participation in ongoing outcome research or other special interest research projects.

This rotation is designed to teach residents how to conceptualize and to treat the complex, multi-diagnostic problems that individuals with BPD experience. Residents will learn and participate in all four components that comprise outpatient DBT: 1) individual therapy; 2) skills training; 3) consultation team; 4) skills coaching. Supervision will focus on 1) case conceptualization from a DBT perspective, including application of the biosocial model and behavioral principles, and 2) application of DBT strategies. After completion of the rotation, residents will possess knowledge of strategies to work effectively with challenging, complex, and difficult-to-engage clients in an outpatient setting.

DBT is currently available only as a Major Rotation.

Eating Disorders

The Eating Disorders Clinic at St. Joseph's Healthcare is the regional centre for the treatment of adults with eating disorders in the Central South region of Ontario, providing consultation and treatment to approximately 100 patients annually. The program offers services to patients with a range of eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and the spectrum of disordered eating understood as Eating Disorders Not Otherwise Specified. Residents work within a multidisciplinary team including psychologists, a psychiatrist, a nurse, an occupational therapist, and a dietician. Residents gain experience in the assessment of eating disorders, clinical report writing, individual treatment, and group therapy for eating disorders (including a CBT based symptom-interruption group, a family education session, a body image group, and a DBT based emotion-regulation group).

The Eating Disorders program is developing a number of research initiatives looking at factors influencing response to treatment, relapse prevention, and family factors that contribute to or protect against the development of eating disorders. Residents are expected to familiarize themselves with the research literature relevant to the treatment of eating disorders, and are encouraged to participate in ongoing research projects.

Forensic Psychology

The Forensic Service at the West 5th Campus houses a busy 20-bed minimum-security inpatient unit, as well as a 20-bed medium security inpatient unit. There is also a very active outpatient department. On this rotation, residents focus on the intersection of psychological disorders and the criminal justice system, conducting forensic psychological assessments that are used by the multidisciplinary team to inform their recommendations to the court about issues concerning fitness to stand trial and criminal responsibility. Residents also participate in risk assessments, conducted in the context of pre-sentence assessments for the court or for the provincial review board. Residents can expect to assess a broad range of psychopathology on this rotation including Schizophrenia, Bipolar Disorder, Antisocial Personality Disorder, and various other personality disorders and Axis-I conditions. The focus of this rotation is forensic assessment, on occasion opportunities also exist to provide individual treatment or become involved in the Forensic DBT program. The focus of treatment is typically criminogenic risk factors such as, substance abuse or anger management, in order to ameliorate risk. Interested residents have the opportunity to participate in clinical research within the forensic program.

Health Psychology/Behavioural Medicine

Opportunities for training in health psychology / behavioural medicine occur within several contexts and settings. Patient presentations are typically complex from both medical and psychiatric perspectives.  The aim is to develop competency in psychological consultation; within both inpatient and outpatient medical/surgical settings.  Training experiences are negotiated in advance with the expectation that there will be a combination of general behavioural medicine consultation along with opportunities to explore sub-speciality interests according to resident preferences and supervisory availability.  The following opportunities are available:

Health Psychology Consultation Service

This is a general consultation service for those medical inpatients or outpatients requiring psychological assessment and/or intervention.  Our main partner is the Consultation-Liaison Psychiatry Service.  However, referral sources also include other mental health and medical subspecialty services.  Brief psychological interventions target mood, anxiety, somatization, adherence, and adjustment-related concerns for the medically ill.

Women's Health Concerns Clinic (WHCC)

The Women's Health Concerns Clinic (WHCC) is a unique outpatient clinic that provides assessment, consultation and treatment for women who are experiencing mood and anxiety problems associated with reproductive life cycle events, including menstrual cycle changes, pregnancy and postpartum periods and menopause. The WHCC also conducts clinical and biological research in these areas. Within the clinic, the team consists of psychiatrists, psychologists, gynecologists, nurses, social workers, mental health counselors, research and laboratory staff, and trainees.

Residents within this rotation will have exposure to various clinical scenarios in women's health and will be able to provide psychological assessments/consultations and brief cognitive behavioural treatments for difficulties that are gender-related. Residents will participate in clinical/research team meetings. Lastly, residents will participate in an ongoing group intervention for menopausal symptoms in women based on cognitive-behavioural strategies.

Pain Management Centre

Primary Location: Hamilton Health Sciences Centre (Hamilton General Hospital)

Psychological consultation is offered to patients of this large, tertiary care, interventional pain management clinic.  Delivery of service is on-site, within the clinic, in a collaborative care model that includes anesthesiologists, neurologist, and nurses. Residents on this rotation will perform psychological consultations and conduct brief psychological interventions both individually and in the form of group-based CBT.

Respiratory Rehabilitation

This patient population consists primarily of those suffering from Chronic Obstructive Pulmonary Disease (COPD).  Training opportunities include:

i)                    outpatient psychological consultation with patients attending the Firestone Institute of Respiratory Health (FIRH). The “Firestone” is the regional respiratory service for the City of Hamilton and the Hamilton Niagara Haldimand Brant Local Health Integrated Network (LHIN).  Psychological services are delivered within the clinic, on-site, in a collaborative care model;

ii)                   psychological consultation with patients attending inpatient and day treatment pulmonary rehabilitation programs.  This involves both individual and group-based modalities and working in an interprofessional model of care that includes respirologists, nurses, occupational therapists, physiotherapists, social worker, pharmacist, and respiratory therapist.

Reasons for psychological consultation include anxiety and mood-related concerns, adherence issues, adjustment difficulties, and smoking cessation.

Palliative Care

Training opportunities are available in collaboration with the palliative care consultation service.  This interprofessional collaboration involves team-based and individual consultation for patients (and their family members) dealing with end-of-life issues.  Both inpatient and outpatient opportunities are available in this emerging area of psychological practice.

Bariatric Surgery

The Bariatric Surgery Program is one of four centres of bariatric excellence in Ontario, providing services such as pre- and post-surgical care, counseling and weight loss treatment.  Training opportunities exist in all these areas, both individual and group-based, within the context of an interprofessional model of care that includes surgeons, general internal medicine physicians, endocrinologist, psychiatrist, nurses, social worker, and dietitian.

 Long Term Psychotherapy

The Long Term Psychotherapy rotation provides residents with the opportunity to obtain intensive supervision on an individual psychotherapy case carried for up to one year. Clients referred to this service are individuals whose circumstances and symptomatology (e.g., diagnostically complex presentations, personality psychopathology) are such that long term intervention is indicated. Therapeutic modalities offered within this rotation include psychodynamic, interpersonal, experiential, and schema-focused therapies. Residents in this rotation typically see 1-2 clients once per week (seeing clients twice/week is an option if indicated) and receive one hour of supervision per week. The goal of this rotation is to develop residents’ competence in their knowledge of the theory and practice of long term modalities, and, for those who have had prior experience in this area, to aid in extending and refining existing skills. 

Long Term Psychotherapy is available as a Minor Rotation only.

Mood Disorders

The Mood Disorders Service employs a multidisciplinary team of psychologists, psychiatrists, nurses, social workers, vocational rehabilitation therapists, and occupational therapists who assess and treat individuals with either unipolar depression or bipolar disorder. Residents gain experience with diagnostic interviewing for mood disorders (both inpatient and outpatient), psychodiagnostic testing (e.g., personality and intellectual assessment), and individual and group therapy. The primary treatment orientation on this rotation is cognitive behavioural, based on empirically validated protocols for the full spectrum of depression, bipolar disorder, and comorbid mood-anxiety conditions. Residents also have the opportunity to develop brief relational and schema-focused treatment skills for patients with co-morbid personality disorders.

In addition to the clinical service, the mood disorders program incorporates a large, well-funded and internationally renowned research facility that investigates the causes and treatment of mood disorders. Current projects involve studying cognitive changes in response to cognitive behaviour therapy vs. pharmacotherapy, the efficacy of mindfulness-based cognitive therapy for relapse prevention in depression, and psychological predictors of chronicity in patients with a first episode of mood disorder.

Neuropsychology

A new Neuropsychology Stream has just been added to the residency program for the 2012-2013 training year.  Applicants interested in being considered within the Neuropsychology Stream should state this intention in their cover letter, and rank Neuropsychology #1 on their St. Joseph's Supplemental Application Form (see application procedures).  The APPIC Program Code for the Neuropsychology Stream for the purposes of the Match is 184612.

The Clinical Neuropsychology Service (CNS) is a centralized consultation service that provides comprehensive assessment of psychological and neurocognitive functioning in a wide range of adult inpatients and outpatients including those with neurological (e.g., brain injury, stroke, neurodegenerative), medical (respiratory, cardiac) developmental (e.g., autistic spectrum, learning), psychiatric (e.g., psychotic, mood/anxiety), and substance abuse disorders.   Supervisors in the CNS are actively engaged in both individual and team-based research and the service emphasizes evidence-based practices. 

Neuropsychological services are provided to virtually all SJHH medical and psychiatric programs. These include but are not limited to: (1) the Schizophrenia Service, where neuropsychological assessments are provided as a consultation service for 3 inpatient units and 1 outpatient clinic; (2) the Mood Disorders Program, where neuropsychological consultation is provided to both the inpatient unit and outpatient programs; (3) the Community Psychiatry Services, where neuropsychological evaluations are often requested in the context of complex diagnostic considerations, as well as the basis for access to community based support services; (4) the Acute Mental Health programs, where neuropsychological consultations are incorporated in the treatment plan and discharge disposition of patients; (5) The Cleghorn Early Intervention in Psychosis Program, where comprehensive cognitive and psychological evaluations are provided for those in the early stages of psychotic illness; and (6) medical programs such as Respirology, Nephrology, Neurology and Rhumatology. 

Residents will build proficiency in assessing intellectual and academic skills, problem-solving and executive functioning abilities, attention and memory, visual and perceptual construction skills, language abilities, motor functions, mood, personality and behaviour.  Residents will integrate information about the patient’s neuropsychological and psychiatric status to arrive at a diagnosis and recommendations for rehabilitation strategies, will sharpen skills in report writing and the communication of assessment results and recommendations to referring agents, patients, and their families. 

Residents have the opportunity to collaborate with other medical professionals in the implementation of individualized rehabilitation programs including cognitive remediation and adaptive skills training for both inpatients and outpatients.  New in 2012 – 2013 will be the implementation of cognitive remediation intervention groups for outpatients of the Mental Health and Addictions Program. 

Residents are expected to become familiar with relevant literature and attend pertinent case conferences.  Additionally, residents are required to attend and present at the bi-weekly Neuropsychology Seminar Series.  Moreover, residents in this rotation are encouraged to attend weekly Neurology Rounds at the Hamilton General Hospital as well as subject-related conferences or workshops. 

Special Qualifications

For those residents who wish to complete a major rotation in Neuropsychology, previous relevant coursework and familiarity with basic neuropsychological tests is required.  Major rotations may extend up to 4 days per week devoted to neuropsychological activities for a period approximating 8 months.

Psychodiagnostic Assessment

Faculty in the CNS also provide psychodiagnostic assessment services in consultation to psychiatrists in the Acute Mental Health Programs.  Residents completing a neuropsychology rotation will also be involved in psychodiagnostic assessment.  Residents without a background in neuropsychology may elect to complete a minor rotation focused on psychodiagnostic assessment.  On this rotation, the resident assumes the role of the consultant, answering specific questions about patients relating to the diagnosis of serious mental illness, cognitive functioning, personality, and other psychosocial factors. Residents will gain experience using a wide variety of assessment techniques including cognitive testing, neuropsychological screening, semi-structured clinical interviews, self-report personality inventories, and projective testing.  As a full member of an interdisciplinary team consisting of psychiatry, social work, occupational therapy, vocational rehabilitation, recreation therapy, nursing, pharmacy, and chaplaincy, residents provide assessment feedback to other team members, the patient, the patient’s family, and community care providers.  Interdisciplinary team membership also provides the opportunity to develop skills in collaborative consultation and interdisciplinary care planning. 

Schizophrenia and Severe Mental Illness

The inpatient service, located at the West 5^th Campus, offers services in assessment and intervention to 250 adult inpatients per year who have an established or suspected diagnosis of schizophrenia or other psychotic disorder.  The service is located on three units: C2, the Assessment and Treatment Unit; A2, the Psychosocial Rehabilitation Unit; and D2, the Intensive Treatment Unit.  Residents assume the role of consultant, providing assessment of cognitive and intellectual functioning, personality functioning, personality dynamics, and provision of diagnosis.  Residents are supervised in the administration, scoring and interpretation of psychological assessment tools including, most commonly, the MMPI-2, the MCMI-III, the PAI, the WAIS-III, and the WMS-III. Under supervision, residents integrate information from various sources to arrive at a diagnosis, write clinical assessment reports, and provide assessment feedback to the interdisciplinary teams.  Residents are also offered supervision in a variety of interventions for patients with psychotic disorders. Supervision in individual psychotherapeutic treatment includes supportive, cognitive-behavioural, and interpersonal/insight-oriented approaches. Residents are also offered the opportunity to co-lead patient education and support groups, a voice group, as well as developing other groups for patients. 

Training in outpatient treatment takes place primarily at Community Schizophrenia Services (CSS) and to a lesser extent at the Hamilton Program for Schizophrenia (HPS) and the Cleghorn Program for Early Intervention in Psychosis.  CSS is an outpatient programme affiliated with Schizophrenia Services that serves approximately 600 outpatients with schizophrenia and other psychotic disorders. Residents are offered opportunities for training and supervision in conducting psychodiagnostic assessments and individual and group psychotherapy. HPS is a comprehensive community-based treatment and rehabilitation program for adults with schizophrenia. Located near the hospital in the First Place building at 350 King St East, the program serves approximately 150 outpatients in long-term case management.  Residents completing a major in schizophrenia may have the opportunity to participate in group CBT for psychosis. Current research within this program explores the psychotherapeutic treatment of psychotic disorders, with a particular focus on the phenomenon of voice-hearing and the role of coping self-talk.

Residents also have the opportunity to take formal courses such as psychotherapy or supervision courses through McMaster University's Clinical Behavioural Sciences (CBS) Program, if they are so inclined. Information about the CBS program may be found at: www.fhs.mcmaster.ca/cbs

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