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SJHH ... / Mental Health & Addiction Services/ Mental Health Services/ Psychology Training/ Psychology Residency Program/ Description of Rotations

Description of Rotations

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

Core Faculty:

  • Randi E. McCabe, Ph.D. (Clinic Director)
  • Karen Rowa, Ph.D., C.Psych.
  • Brenda Key, Ph.D., C.Psych.
  • Irena Milosevic, Ph.D., C.Psych.

Adjunct Faculty:

  • Susan Chudzik, M.A., C.Psych.
  • Phil Shnaider, Ph.D., C.Psych. (Supervised Practice)
  • Richard P. Swinson, M.D., FRCPC

Primary Location:

Anxiety Treatment & Research Clinic (ATRC), West 5th Campus

The ATRC is an outpatient specialty unit staffed by professionals with a background in psychology, psychiatry, nursing or social work.  The Clinic receives more than 2000 new referrals per year, predominantly for individuals suffering from panic disorder, agoraphobia, social anxiety, 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, health anxiety, posttraumatic stress disorder).  Residents gain experience in clinical assessment using structured interviewing techniques for anxiety and other disorders, report writing, liaison 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, mindfulness, and biological factors in the etiology and treatment of anxiety disorders.  Resident involvement in ongoing research is strongly encouraged. For more information about the ATRC, refer to the website:  www.stjoes.ca/anxiety

Dialectical Behaviour Therapy

Core Faculty:

  • Lisa Burckell, Ph.D., C.Psych.

Primary Location:

  • West 5th Campus

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.

Major Rotation preferred. Minor Rotaion may be considered.

Early Intervention in Young Adult Mental Health 

Core Faculty:

  • Juliana Tobon, Ph.D., C.Psych.

Adjunct Faculty:

  • Peter Bieling, Ph.D., C.Psych.

Primary Location:

  • Youth Wellness Centre, 38 James Street South

The Youth Wellness Centre (YWC) is a new service that focuses on youth ages 17-25 years experiencing either emerging or complex and ongoing mental health difficulties, with the goal of rapid assessment, treatment, and recovery. This service has been identified as a key strategic direction for the hospital. The YWC is an independent, youth-based clinic located in downtown Hamilton, that is linked both to primary care and community referral sources, and to specialized mental health services within St. Joseph’s Healthcare. Two primary streams of the YWC are Early Intervention for early stage mental health difficulties, and Transition Support for ongoing and complex cases. Both streams are intended to ease and expedite access to services and resources, offer comprehensive psychiatric diagnosis, improve continuity and coordination of care, and advocate and support youth and their families.

Residents gain experience in clinical assessment using structured interviewing techniques, report writing, liaison with other treating professionals, and individual and group treatments for young adults with an array of mental health concerns using evidence-based treatments, such as CBT (individual), Motivational Enhancement (group) and DBT skills (group).  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, using a clinical staging approach. Residents are also expected to become familiar with the relevant research literature in the area of early intervention for youth mental health.

In addition to offering clinical services, the YWC includes an integrated program of research and evaluation led by faculty members from the Department of Psychiatry and Behavioral Neurosciences at McMaster University. Research interests of clinic staff members include understanding service use patterns for emerging adults within the adult mental health system, the development of short-term, cost effective assessments and treatments for youth, and the effectiveness of a sequential approach to intervention using a clinical staging model.  Resident involvement in ongoing research is strongly encouraged.

Eating Disorders

Core Faculty:

  • Michele Laliberté, Ph.D., C.Psych.
  • Stacey Tweed, Ph.D., C.Psych.

Adjunct Faculty:

  • Amrita Ghai, Ph.D., C.Psych.

Primary Location:

  • Eating Disorders Clinic, West 5th Campus

The Eating Disorders Clinic at St. Joseph’s Healthcare is a specialty outpatient clinic providing multi-disciplinary assessment and treatment to approximately 100 new clients with eating disorders each year.  The program offers transdiagnostic CBT group treatment for individuals with Anorexia, Bulimia and Other Specified Eating Disorders.  We provide specialized CBT group treatment for individuals with Binge Eating Disorder.  Additionally, the Eating Disorders Clinic also provides assessment and individualized CBT-E to youth ages 16-22 as part of a new transition youth treatment stream. Residents work within a multidisciplinary team including a psychologist, psychiatrist, nurse practitioner, and 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, and a body image group).

The Eating Disorders program is pursuing 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

Core Faculty:

  • Mini Mamak, Ed.D., C.Psych.
  • Heather Moulden, Ph.D., C.Psych.
  • Bruno Losier, Ph.D., C.Psych., ABPP-CN 
  • Kaitlyn McLachlan, Ph.D., C.Psych.
  • Peter Sheridan, Ph.D., C.Psych.

Adjunct Faculty:

  • Gary Chaimowitz, M.D., FRCPC

Primary Location:

  • Forensic Service, West 5th Campus

The Forensic Psychiatry Program at the West 5th Campus has undergone a significant expansion and now includes five inpatient units and 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 conditions. The focus of this rotation is forensic assessment, on occasion opportunities also exist to provide individual or group 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

Core Faculty:

  • Sheryl Green, Ph.D., C.Psych.
  • Joseph Pellizzari, Ph.D., C.Psych.
  • Sabreena Chohan , Ph.D., C.Psych.
  • Michael Coons, Ph.D., C.Psych.

Adjunct Faculty:

  • Matilda Nowakowski, Ph.D., C.Psych.

Primary Location:

  • Charlton and West 5th Campuses

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 and brief interventions. One can accomplish this within inpatient medical/surgical settings and outpatient clinics. Training experiences within both general behavioural medicine and sub-specialty clinics are negotiated in advance based on the completion of a major or minor rotation, resident preferences and supervisory availability.

Major/Minor Rotation

Below is a list of training opportunities available for a resident to consider. If a major rotation in health psychology is considered, resident preferences would be considered along with the following core components:

1) Training experiences in a minimum of three clinics/services throughout the year

2) Training with an inpatient population

3) Training in an outpatient clinic

4) Development of consultation skills

5) Individual short-term treatment, and

6) Group treatment

A minor rotation in health psychology would be based on resident preferences and supervisor availability and involve:

1) Development of consultation skills

2) Training with inpatient or outpatient populations

3) Individual and/or group treatment

The following opportunities are available:

Behavioural Medicine Consultation Service

This is a general consultation service for those medical/surgical inpatients or outpatients requiring psychological assessment and/or intervention. Our main partners are the Consultation-Liaison Psychiatry Service, Palliative Care, Complex Care, General Internal Medicine, and the Intensive Care Unit.  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 CBT group intervention for perinatal anxiety.

Respiratory Rehabilitation

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

1) Outpatient psychological consultation with patients attending the Firestone Institute of Respiratory Health (FIRH). The FIRH 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.

2) 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.

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. Research and program evaluation opportunities are also available in this training experience.

Mood Disorders

Core Faculty:

  • Peter J. Bieling, Ph.D., C.Psych.         
  • David Grant, Ph.D., C.Psych. 
  • David Grant, Ph.D., C.Psych. 
  • Margaret McKinnon, Ph.D., C.Psych. 
  • Colleen Merrifield, Ph.D., C.Psych.  

Adjunct Faculty:

  • Gary Hasey, M.D., FRCPC

Primary Location:

  • Mood Disorders Service, West 5th Campus

The Mood Disorders Service employs a multidisciplinary team of psychologists, psychiatrists, nurses, social workers, vocational rehabilitation therapists, recreational 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 co-morbid mood-anxiety conditions. Residents may also have the opportunity to be involved in delivering other forms of group therapy (e.g. mindfulness based cognitive therapy, behavioural activation, running therapy, brief emotion regulations skills). 

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. The current projects are always changing and residents have the opportunity to collaborate with on-going research. .

Neuropsychology

Core Faculty:

  •  Jelena King, Ph.D., C.Psych.
  •  Christina Gojmerac, Ph.D., C.Psych.
  •  Heather McNeely, Ph.D., C.Psych.
  •  Emily MacKillop, Ph.D., C.Psych. ABPP-CN
  •  Elena Ballantyne, Psy.D., C.Psych.
  •  Elmar Gardizi, Ph.D, C.Psych.
  •  Bruno Losier, Ph.D., C.Psych. ABPP-CN
  •  Margaret McKinnon, Ph.D., C.Psych. 

Adjunct Faculty:

  • Catherine Dool, M.A.
  • Michael Mosher, B.Sc.

Primary Location:    

  • Clinical Neuropsychology Service (CNS), West 5th Campus

Options for residency training in clinical neuropsychology include a Neuropsychology Stream for those candidates who intend to pursue professional licensure as a clinical neuropsychologists. Residents with a strong interest in neuropsychology but who do not intend to declare competence in neuropsychology have the option of completing a secondary major rotation or a minor rotation in neuropsychology.  Applicants interested in being considered within the Neuropsychology Stream should state this intention in their cover letter.  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.

Training provided within the context of the Neuropsychology Stream meets Division 40 Guidelines for Neuropsychology Training.  All residents in neuropsychology 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 in the Neuropsychology Stream will spend a minimum of 50% of the training year, up to a maximum of 80% of the training year, in neuropsychology services.  Stream residents will 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.  Stream residents will co-facilitate at least on cognitive remediation group.  Stream residents will also be required to attend weekly neuropsychology didactics and team triage meetings and will present at least 1 case during the neuropsychology seminar series.  Stream residents will be expected to participate in longitudinal assessment of patients undergoing electroconvulsive therapy (ECT) treatment.  In addition, Stream residents will be required to attend a minimum of 5 relevant Neurology/Neurosurgery rounds at the Hamilton General Hospital, and will have access to human brain anatomy samples for educational purposes.  Stream residents are encouraged to become involved in ongoing team based clinical research endeavours.

Special Qualifications
For those residents who wish to apply to the Neuropsychology Stream, previous relevant coursework in Neuropsychological Assessment and Theory is required, as is experience with a broad array of standard neuropsychological tests.

Psychodiagnostic Assessment Opportunities
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. In this work, the resident assumes the role of the consultant, answering specific questions about patients relating to the diagnosis of Axis I and II factors. Residents will gain experience using a variety of assessment techniques including structured and semi-structured clinical interviews (e.g., SCID-I and SCID-II, MINI) and various self-report personality inventories (e.g., PAI, NEO-PI-R, etc). 

Schizophrenia and Severe Mental Illness

Core Faculty:

  • Sandra McNally, Ph.D., C.Psych.
  • Elmar Gardizi, Ph.D., C.Psych.
  • Jelena King, Ph.D., C.Psych.
  • Heather McNeely, Ph.D., C.Psych.

Adjunct Faculty:

  • Suzanne Archie, M.D., FRCPC 

Primary Locations:

  • West 5th Campus

The Schizophrenia and Severe Mental Illness rotation involves opportunities to work in a number of settings.  Schizophrenia and Community Integration Services, located at the West 5th Campus, is a large program that includes inpatient and outpatient services (Cleghorn Early Psychosis Intervention Clinic; Schizophrenia Outpatient Clinic) for individuals with schizophrenia, psychosis spectrum and related problems. Residents have the opportunity to train in both inpatient and outpatient services at this location, and may focus on developing their skills in intervention and treatment and/or in psychodiagnostic/personality assessment, neuropsychological assessment, and cognitive remediation.  Residents are encouraged to attend monthly schizophrenia rounds, as well as applicable conferences and workshops.

The inpatient service, located at the West 5th Campus, offers services in assessment and intervention to 250adult inpatients per year who have an established or suspected diagnosis of schizophrenia or other psychotic disorder.  The inpatient service is located on four units, Orchard 2, Waterfall 2, Harbour East 2 and Harbour North 2: While working with an interdisciplinary clinical team, residents are offered supervision in a variety of interventions for patients with psychotic disorders. Supervision in individual psychotherapeutic treatment includes cognitive-behavioural, and interpersonal/insight-oriented approaches. Residents are also offered the opportunity to co-lead patient education and support groups, a Hearing Voices Psychotherapy Group, as well as developing other groups for patients. Residents may also assume the role of consultant, providing assessment of 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, and the PAI. Residents integrate information from various sources to arrive at a diagnosis, write assessment reports, and provide feedback to the interdisciplinary teams.  

The Cleghorn Early Psychosis Intervention Clinic at the West 5th Campus is an outpatient service which serves people experiencing early stages of psychosis. The interdisciplinary team aims to help clients and their family/friends to identify their concerns and goals, and to develop plans that work on recovering from psychosis. They provide rapid and specialized assessment, treatment and rehabilitation for people experiencing a first episode of psychosis, based on the principles of recovery, and in partnership with clients and their family, while maintaining a leadership position in the field of early intervention. Services include: diagnosis, assessment, neuropsychological testing, occupational and recreation therapy, psycho-education, family support, and peer support. The staff available to support client's recovery plans include: family educators, nurses, occupational therapists, psychiatrists, psychologists, recovery support workers, and recreation therapists. The model of service is recovery oriented. In addition, residents completing a major rotation in schizophrenia will have the opportunity to participate in cognitive remediation aimed at executive functioning impairments (Goal Management Training, GMT) through the Cleghorn program.  Research is available in the prediction of functional outcome in early psychosis and schizophrenia using cognitive tools.

The Schizophrenia Outpatient Clinic at the West 5th Campus serves approximately 600 outpatients with schizophrenia and other psychotic disorders. Residents are offered opportunities for training and supervision primarily in individual and group psychotherapy (cognitive-behavioural, interpersonal/insight oriented), and to a lesser extent, conducting psychodiagnostic assessments. Research opportunities in the psychotherapeutic treatment of psychotic disorders can be made available.