Adult Clinical/ Behavioral Medicine Track
Interns on this track enhance their psychotherapy and behavioral medicine skills while experiencing psychologists’ various roles within a medical setting. They collaborate with psychiatric, medical primary care, and medical specialty teams in both outpatient and inpatient settings. Major experiences include: adult outpatient, primary healthcare, oncology, cardiology, weight management, chronic pain, diabetes, hospital consultation-liaison, and emergency services.
Adult Outpatient Psychiatry
Interns conduct assessment and time efficient therapy with adults referred for a broad range of psychological and behavioral medicine problems. Depression, anxiety, relationship problems are the most frequent psychological referrals. Bariatric surgery evaluations, pain, and adjustment to illness are the most frequent behavioral medicine referrals. Interns observe and practice therapy using cognitive behavioral, acceptance and commitment, biological, problem focused, and motivation interviewing models to assist patients in learning new skills to manage their lives. The psychologist’s task is to connect with the patient, understand the story, then collaborate to develop a therapy that offers clarity, hope, and self efficacy. Interns become adept at assessing disorders, core beliefs, and personality patterns; focusing treatment; and collaborating with medical teams.
Primary Health Care
Collaborating with primary health providers is an integral part of the adult practice in all settings. Psychologists also practice part time in a family practice medical primary care clinic, collaborate with the medical team, and experience the unique culture of primary care–its pace, priorities, language and communication style. Interns learn about various collaboration models to deliver care to patients with depression, anxiety, pain, somatoform problems, medical compliance, and health behavior change.
Psychologists are integrated with the oncology department across several specialty programs. Interns spend six months in the breast cancer clinic as an integral part of the multidisciplinary team. Interns will have the opportunity to assess patients at diagnosis and follow patients throughout the treatment process. Additionally, the psychologists facilitate a psychosocial conference for the oncology department to help the team discuss difficult cases. Through these experiences, the intern will become knowledgeable about the salient medical and psychosocial issues for patients with a cancer diagnosis and how to work effectively in integrated care settings.
Psychologists work with a wide variety of cardiac issues for patients within cardiology, including congestive heart failure, post heart attack, post intervention (angioplasty, bypass), and electrophysiology (pacemakers, implanted defibrillators). Interns will work with patients across the diagnostic continuum from those who are at risk for cardiac disease to those who have experienced a cardiac event. The focus in these settings is on facilitating behavioral change in an effort to reduce risk factors. Interventions are brief and targeted. Interns will learn to identify the stages of change and use motivational interviewing techniques to help patients modify cardiac risk behaviors.
Weight Management Team
Psychologists spend significant time as integral members of the gastroenterology-led Weight Management Team that includes physicians, dieticians, nurses and physician assistants. Interns assist in evaluating and preparing patients for bariatric surgery, attend support group meetings, lead groups for patients struggling post-surgery, and assist individual patients with health behavior changes. This work offers the opportunity to learn about weight management issues, medical comorbidities, health behavior change and motivational interviewing.
Psychologists serve as important members of Geisinger's Interventional Pain Clinic. Interns assist in evaluating and preparing patients for spinal cord stimulator implantation, a procedure used to relieve chronic low back and leg pain when other treatments have not been effective. Interns will have the opportunity to work individually with patients struggling with chronic pain and emotional distress and co-lead a psychoeducation group for patients newly referred to pain psychology.
Interns learn the biopsychosocial model of chronic pain and use evidence-based strategies to enhance quality of life, increase physical activity, and prevent further disability in this unique patient population.
Interns work with patients struggling to manage diabetes due to life stressors, depression, diabetes "burnout," and other psychosocial barriers to self-management. The focus will be on helping patients make health behavior changes through motivational interviewing and also addressing distress commonly associated with having this complex chronic illness.
Psychiatric Emergency Services
Geisinger Medical Center provides around-the-clock psychiatric emergency coverage, seven days a week. During the day the intern functions as part of the emergency services team comprised of a staff psychiatrist, clinic triage case worker, physician assistant, and a medical resident. Patients are assessed either on site in the emergency department or in the outpatient psychiatry clinic. The intern learns basic emergency psychiatric assessment skills to include an understanding of medical conditions that may simulate psychiatric conditions, an ability to assess and triage suicidal or aggressive patients, a working knowledge of psychopharmacologic agents and somatic therapies, and an appreciation of psychiatric treatment resources that are available. This rotation is for one day a week for six months.
Psychiatric Consultation / Liaison Service
Geisinger Medical Center provides full psychiatric services to patients hospitalized on the medical and surgical floors. The entire spectrum of psychiatric illnesses are diagnosed and treated, either as pre-existing conditions or conditions that arise as part of having a serious illness or being in the hospital. Short-term crisir-intervention and supportive therapies are also offered. Special attention is given to issues of dealing with difficult patients, chronic pain, terminally ill patients, and legal/ethical issues in consultation. THe experience involves one day a week for six months in conjunction with the psychiatric emergency rotation.