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Pathways to Success:
Professional Development Throughout the Career-Span

My name is Mary Bradshaw. I’m happy to say that I’m going to be talking to you about my past experiences of being an intern, I finally completed my doctorate requirements and I am working at Central State Hospital as a treatment team psychologist in forensics. When Dr. Entin asked if I would be interested in joining him along with the other speakers today at APA, my first reaction was “I’m just an intern, what do I have to offer”. However, Dr. Entin was my supervisor and I didn’t want him to think I lacked motivation, so instead I said, “what a great opportunity, sure”. I think it is important for all interns to understand they have value and how supervision during internship plays a significant role in cultivating an awareness of their values. Primarily, I will focus today on my experiences with supervision and specifically the supervisory relationship.

Before I continue sharing my experiences about internship, I’d like to digress for a moment and explain another reason why I feel strongly about the need for quality supervision. When I was accepted into my graduate program I received a warm welcome and congratulations. I was also informed that graduate school would consume my daily life, as I knew it. In order to succeed I must give up any other job I had and greatly restrict my social life. Well, that advice didn’t set well with me or with my three children. I was under the impression that a balanced life was a healthier lifestyle. However, I thought it was best to keep my personal life, strictly personal. I felt like others would view having a family as a check against me and I needed to prove to faculty that a student can succeed and be more than just a student. In my opinion, this promoted a culture of fear, anxiety and projected failure. That type of environment did not encourage a trusting relationship between supervisors and supervisee’s. Of course, we all should have appropriate boundaries, but in many cases if a supervisee is anxious he/she is likely to build walls, which may negatively impact their training. I believe I succeeded because of my family’s support and the balance they helped create. I decided I wanted more out of supervision on internship.

My internship was based on an apprenticeship model. The program’s philosophy believed that interns entered the program with a basic understanding of psychological theories and techniques. The internship was designed to augment the already acquired core clinical skills of assessment, psychotherapy, and consultation across diverse populations. Through these experiences the intern is expected to become more sensitive to her/his professional identity and responsibility with heightened awareness of ethical concerns related to the delivery of psychological services. This model encouraged us to work collegially with supervisors to further enhance and develop concentrated skills in a variety of settings with a diverse patient population. This type of model also provided us with graduated levels of autonomy throughout the internship depending upon comfort and skill level. The goal is to help the intern transition smoothly from a graduate student to a competent, ethical, autonomous psychologist.

I had the opportunity to work with physicians, psychiatrists, medical students and psychologists with various orientations. I had 3 major rotations including, inpatient, consultation/liaison and forensic/outpatient. I also chose a biofeedback elective. I noticed pretty quickly within the hospital that supervision had various levels of priority among the departments. For example, on one of my rotations it was my duty to present an article on anything related to the field of health psychology and psychiatry and choose a discussant. Dr. Entin readily agreed to help out and we thought supervision would be a great topic. After I turned in my information, I was notified that my subject choice was not relevant. I later found out that mine was the first article that was ever rejected. At that point, I wondered why I wasn’t supposed to speak out about supervision. I talked to others about they’re experiences and recognized the need for effective supervision and how valuable supervision can be. One of the common themes I heard was the concern about appearing inadequate. In Dr. Sternberg’s column “letter from the president” (2003), he shared his reaction about a negative critique. What caught my attention was Dr. Sternberg’s* sensitivity to how a newly credentialed psychologist may have reacted to such harsh criticism. I think many times supervisors forget the power differential in the supervisory relationship. They may forget how vulnerable the intern may feel. With some of my supervisors I would feel a little anxious, then begin to wonder about my anxiety, which only exacerbated my condition. During the first few weeks of internship I experienced the “Imposter Phenomenon”. I had achieved success on the outside, but part of me was thinking my supervisors doubted my competency. I also compared myself to my other interns and both appeared to be exceptional interns.

Our program provided us with a support group and our facilitator was an independent psychologist in the community who had little to do with the rest of the supervisors at our site. I strongly recommend that if your site doesn’t offer such a support group that you initiate one. Sharing our experiences with each other helped normalize my anxiety. During our first meeting both admitted to similar feelings of inadequacy. Group also provided a safe place to express our concerns. This reminded me that one of the basic goals in therapy is to develop a trusting environment. If the patient does not trust the therapist, he / she will not openly share their symptoms. So it is likewise with the supervisee. They are less likely to discuss areas of concern that may be problematic. This could develop into problems for the supervisor who does not have contact with the patient, but is still liable for the well being of the patient.

In preparing for today’s speech I talked with other interns and it seemed like most of us felt like we digressed during our first rotation. In our second rotation our confidence returned and we felt comfortable with our roles. However, in the early stages of that final rotation our comfort zone was once again shaken. The reality of finding a job or a post-doc hits us. Somehow, things usually work out and by the time internship is over most interns have secured a position and are more than ready to cross that threshold and enter the professional ranks.

As I mentioned earlier, my internship program was a medical facility. Unfortunately there are only 61 medical teaching hospitals that provide internships for psychology interns. I find that surprisingly low and disappointing. I think it is important to continue to encourage the fields of psychiatry and psychology to communicate closely with each other. This is especially important with the newer generations of medical doctors, who may be more open to change. I had several medical students inquire about specific questions related to therapy and assessment. We also had numerous conversations about prescription privileges for psychologists. Such discourse is necessary since society’s needs for mental health care are becoming more prevalent with primary care. According to the recent commissioner’s study, and I think we all can agree, that our current health system is seriously fragmented. One way to integrate services would be to have more psychologists join with primary care docs in private practices. I believe more and more physicians and psychiatrists acknowledge and encourage therapy in hopes of eliminating unnecessary medications. Additionally, preventive care is significantly more cost-effective than the current crisis treatment approach. Unfortunately, my site lost funding for the internship program. I wonder what message that sends to the medical community and clients receiving psychological services regarding the value of psychology. I think it is the responsibility of experienced psychologists to support internship sites along with interns documenting and speaking up about the extent of valuable services they provide. Hopefully, senior psychologists will continue to provide a positive supervisory environment that encourages interns to express their views.

In closing, my internship provided the experiences I need to gain confidence in my clinical skills and abilities and helped develop an awareness of my value as a psychologist. Most importantly my internship connected me with a supervisor (Dr. Alan Entin) whom genuinely wanted to share his enthusiasm for psychology and showed an interest in helping a new psychologist develop her career. I remembered in my last month of supervision that it hit me, I wouldn’t be meeting with Alan every week and our time was running out. If an intern is lucky they may find a supervisor who goes beyond the standard definition of supervision and is willing to mentor their supervisee after internship to help them transition from an intern to a doctor.

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