Outpatient Clinical Practicum
RAMS Outpatient Clinical Practicum is opened to students in professional mental health training programs: psychology, social work, and marriage & family therapy.
General Information
RAMS Outpatient Clinical Practicum is opened to students in professional mental health training programs: psychology, social work, and marriage & family therapy.
The Training Center is located at the site of the RAMS Outpatient Clinic, a free standing mental health facility contracted by the City and County of San Francisco to provide community-oriented mental health services to families and individuals throughout their life span. While receiving didactic and supervisory training, practicum trainees function as integral members of the Outpatient Clinic’s diverse multidisciplinary and multicultural treatment team.
Our clinical practicum is designed to provide trainees with the generalized foundational professional practice skills, and the expectation is that proficiency will be established for the clinical evaluation and assessment, conduct of psychotherapy (individual, family, dyadic & couples) across the lifespan, as well as intervention with the more disturbed and chronically troubled patient. Trainees will learn to search for clients’ strengths and liabilities and make the evaluation data relevant to functional life skills. Because of the nature of the client population, in addition to developing their general clinical acumen, trainees will also learn to work with trauma, grief, and adaptation to major life changes. Thanks to the rich cultural diversity of both clients and staff, trainees have the opportunity to hone their skills while developing keen clinical sensitivity to issues of diversity: cultural, religious, ethnic, disability, sexual orientation, gender and class.
We seek students who have an expressed interest in cultural competency training and the vision of working with minority populations.
Training Program
RAMS Clinical Practicum Program offers 12-14 positions for doctoral-level psychology practicum students and masters-level counseling and social work interns.
This clinical training requires a 20-hour per week time commitment for twelve months: from the beginning of September until the end of August. There is no stipend; each trainee is entitled to 80 hours of time off (combined vacation and sick leave).
Work schedule is flexible. However, all trainees need to attend weekly seminars and team meetings on Tuesday and Wednesday mornings and mandatory group supervision on either Thursday morning or Tuesday afternoon. There are also two elective training experiences: Group Consultation on Working with Children and Families (Monday afternoon) and Clinical Understanding and Sociocultural Considerations in Working with Community Mental Health Clients (Wednesday afternoon).
Trainees work with a caseload of approximately 8-10 clients, including children, families, couples, and adults (the exact percentage of each is based on the actual cases referred to RAMS and varies from year to year) . There is an expectation of 10 hours of direct client contact per week, including a clinical intake hour.
Every week, trainees receive one hour of individual supervision with a licensed mental health professional (for brief Supervisor Bios, click here). Additionally, all trainees attend at least one 1.5 hour group supervision session per week (up to three and a half hours of group supervision including electives).
Training is predominantly psychodynamic in approach and emphasizes object relations and contemporary relational perspectives on working with severely disturbed clients. It also features a strong emphasis on cultural competency, especially in regard to Asian, Pacific Islander, and Russian-speaking ethnicities. Students can expect to receive considerable didactic and experiential training in these areas and cultural competency in general.
The training year starts with an intensive three-week-long Orientation Program. During these three weeks trainees are expected to attend orientation trainings 9am through 5pm on Tuesdays and Wednesdays. After that, there are two weekly Didactic Training Seminars. One, which is held on Tuesdays, is for practicum students and doctoral psychology interns only. During the second half of the training year, a case conference format is utilized for this seminar. The other seminar is our Wednesday In-service Training for the entire Outpatient Services staff. Additionally, trainees are welcome to attend agency-wide “feature trainings” such as the RAMS Psychoanalytic Scholar Series held throughout the year (for RAMS Training Sessions, click here).
Practicum Core Training Activities
Weekly Practicum Schedule
RAMS Clinical Practicum Program offers 12-14 positions for doctoral-level psychology practicum students and masters-level counseling and social work interns.
This clinical training requires a 20-hour per week time commitment for twelve months: from the beginning of September until the end of August. There is no stipend; each trainee is entitled to 80 hours of time off (combined vacation and sick leave).
Work schedule is flexible. However, all trainees need to attend weekly seminars and team meetings on Tuesday and Wednesday mornings and mandatory group supervision on either Thursday morning or Tuesday afternoon. There are also two elective training experiences: Group Consultation on Working with Children and Families (Monday afternoon) and Psychodynamic Conceptualization in Working with the Severely Mentally Ill Adults (Wednesday afternoon).
Orientation Program (required)
Orientation to the NAAPTC Internship Program, RAMS Outpatient and Rotation Clinical Work, and the San Francisco Community Mental Health System. Three Weeks at the beginning of the year.
Clinical Work at the RAMS Outpatient Clinic (required)
Half-time practicum trainees can expect to have about 10 hours of various direct clinical services per week, including: initial clinical intakes for new clients (1 hr on average); individual, family and dyadic psychotherapy with adult and child clients (8 hrs on average); collateral work, consultation to other providers, and clinical case management (2 hrs on average). Non-direct casework (initial/ongoing clinical assessment & treatment plan development, multidisciplinary teamwork, etc.) and clinical documentation (charting, billing, utilization reviews, etc.) are conducted as required (2 hrs per week on average).
Adult cases are assigned through the RAMS Adult Outpatient and Prevention (AOP) Services and child cases are assigned through the RAMS Children, Youth and Family (CYF) Services. The low-fee counseling center of the Asian Family Institute also refers some clients to the trainees. Combined, these three outpatient programs (with over 1200 open cases) cover the full range of diagnostic groups throughout the lifespan; a substantial percentage of these patients suffer from severe and persistent mental illnesses. Culturally, the client population is extremely diverse, which affords trainees a rich exposure to clinical work with minorities, particularly with Asian Americans and Russian-speaking immigrants.
In this setting, trainees have the opportunity to hone their clinical skills (psychotherapy, clinical evaluation, and clinical case management) while exercising flexibility in the use of clinical theory and methodology to account for matters of diversity and to accommodate the needs of the more disturbed and chronically troubled patients.
Through close collaboration with other RAMS programs and a broad variety of San Francisco community mental health agencies, medical clinics, social services and educational organizations, trainees gain knowledge of the place and function of the outpatient clinic-based treatment in the community mental health system and the overall system of care.
Clinical Supervision (Required and Optional)
Half-time practicum trainees receive one hour of individual clinical supervision and 1.5 hours of group supervision weekly. All psychology trainees are supervised by licensed psychologists; students from other mental health disciplines receive supervision from psychologists or other licensed clinicians.
Additionally, trainees have a choice of joining one or both elective one-hour-long weekly consultation groups/seminars: Group Consultation on Working with Children and Families and and Clinical Understanding and Sociocultural Considerations in Working with Community Mental Health Clients.
All supervision is predominantly psychodynamic/systems in approach and includes a strong emphasis on cultural competency, particularly with Asian American and Russian-speaking clients. Supervision especially targets trainees’ understanding of the ways in which their own culture manifests in the consulting room. Students receive considerable didactic and experiential training in these areas and clinical sensitivity to diversity in general.
Staff and Team Meetings (required)
Monthly one-hour-long Training Group Meeting with the Director of Training (includes practicum trainees and doctoral interns) and Monthly Clinical Grand Rounds (includes practicum trainees, doctoral interns, postdoctoral fellows, clinical staff from the Adult Outpatient Services, and clinical staff from Outpatient Child, Youth, & Family Services). Clinical Grand Rounds meeting is described in more detail under Clinical Case Conferences.
Didactic Seminars (required)
The training year starts with an intensive three-week-long Orientation Program. After that, there are two weekly mandatory ninety-minute training sessions where trainees and interns are exposed to clinical and diversity issues within the context of a multidisciplinary treatment team and training cohort. One, which is held on Tuesdays, is a Trainee and Intern Seminar; the other is held on Wednesday as an In-service Psychotherapy Training and is open to the entire RAMS clinical staff.
The Intern and Trainee Seminar (Tuesday, 10:25 am-11:55 am) involves practicum trainees and doctoral psychology interns. In the course of the training year, this seminar goes through several distinct stages.
The first module is designed to lay the foundation for culturally informed psychodynamic therapy with the poor, minorities, and severely mentally ill in the context of a community mental health center. It starts with a series of lectures on the history of treatments for the “insane” and gradually transitions to a group discussion of clinical papers on ways to maximize learning from patients in order to better meet each client’s unique needs.
The next training series is designed to help trainees and interns foster greater cultural self-awareness in the clinical context. At this stage, training is mainly experiential and consists of individual presentations and group discussions of cultural biases and predilections that influence how interns and trainees conceive of their work and how they experience their clients. (For a list of suggested questions to address in one’s cultural presentation, please click here.)
Later in the training year, the Intern and Trainee Seminar becomes a four month-long weekly Clinical Case Conference (for details, see Intern and Trainee Case Conference).
Toward the end of the training year, the focus of this forum shifts again, this time toward emphasis on terminations with clients and the training program and on related professional development issues.
At the In-service Psychotherapy Training (Wednesday, 9:10 am-10:30 am) interns and trainees participate with RAMS staff in classes on specific clinical, cultural, and professional development topics that are pertinent to work with RAMS client populations. To see the current Wednesday In-Service Schedule, please click here.
This series also includes monthly Clinical Grand Rounds and two year-long monthly clinical case conferences: Adult Case Conference and Child Case Conference.
Being a psychodynamic program, most presentations emphasize contemporary psychoanalytic theories and psychodynamic treatment principles as they apply to severe mental illness and working with minorities.
Additionally, trainees can choose one or both elective one-hour-long weekly consultation groups/seminars: Croup Consultation on Working with Children & Families and Psychodynamic Conceptualization in Working with Severely Mentally Ill Adults (both open to doctoral psychology interns, psychology practicum students, and postdoctoral psychology fellows).
Cultural Competency Training (required)
Development of cultural competency and clinical sensitivity to diversity is a hallmark feature of the RAMS Training Program, and this is an aspect of professional development that permeates all facets of the learning environment and clinical work at RAMS.
Our understanding of diversity encompasses all differences related to culture, ethnicity, language, race, class, religion, gender, sexual orientation, and physical condition. RAMS is committed to providing clinical services by a clinician who is fluent in the client’s language of preference and has appropriate bicultural life experiences. RAMS extraordinarily diverse staff speak over 30 languages and come from a wide variety of backgrounds: White, Asian, Pacific Islander, African American, Latino, and Biracial; men and women; gay and straight; religious and atheists; American-born and immigrant… The Practicum Supervision Team is also very diverse: 90 % of our supervisors identify as cultural and/or sexual minorities and are native speakers of languages other than English.
The exposure to a diverse client population, training cohort, and clinical staff provides rich experiential learning about cultural differences. It also faces trainees with their own assumptions held about various cultures and creates an opportunity and demand to address one’s own biases and limitations in tolerating diversity. In this environment, the trainees’ sensitivity to diversity is demonstrated in the overall context of their handling of their professional responsibilities. Clinical aspects of diversity are addressed in supervision, case conferences, presentations of trainees’ own clinical work, and didactic seminars throughout the year.
In addition, trainees have the opportunity to utilize the experience and expertise of diverse training cohorts and staff who are not core training faculty. In this way, peers and staff act as cultural consultants to cases with particular diversity issues, and supervisors often encourage trainees to seek cultural consultation.
A structured part of the diversity training is the Cultural Awareness Training module of the weekly Intern and Trainee Seminar (four months in the first half of the year). The objective of this training is to help interns and trainees increase awareness of their own cultural biases, predilections, and countertransferential tendencies with diverse populations in order to develop a level of self-awareness that permits optimal use of one’s own emotional reactions and behavioral responses in a therapeutic relationship with clients of diverse backgrounds. In the course of this training, group members take turns to present their reflections on how their own cultural background(s) and experiences affect them as clinicians. Each presentation is followed by a group discussion facilitated by the instructor and informed by assigned readings. In an exceedingly diverse training cohort, this leads to more than learning about other people’s cultures: Such intensive exposure to difference also faces trainees with their own pre-existing assumptions about various cultural groups and helps them to become more cognizant of their limitations in acknowledging, tolerating, and addressing diversity.
Clinically, grappling with one’s own biases creates an opportunity for fine-tuning of the use of self in a therapeutic encounter; while trying to understand the reaction to differences in oneself and others helps to foster development of ability to explore differences with clients. In addition, learning from the cultural expertise of their peers teaches trainees to competently utilize others as cultural consultants to cases with particular diversity issues.
Clinical Case Conferences (required)
At the RAMS Outpatient Clinic, we have several ongoing Case Conferences, each with a different focus and a different audience:
The monthly Adult Clinical Case Conference is conducted as a Staff In-Service Training (10:30-12:00 on the first Wednesday of the month) and involves interns, trainees, and the staff of the Adult Outpatient Clinic. The Director of the Adult Outpatient Clinic and the Director of Training oversee this conference.
The monthly Child Youth and Family Clinical Case Conference is also conducted during the Wednesday Staff In-Service Trainings (9:10-10:30 on the last Wednesday of each month) and includes interns, trainees, outpatient child therapists and school-based clinical staff. The Director of Children, Youth & Family Services and the Director of Training oversee this conference.
Both In-Service Case Conferences usually involve an external discussant who provides an in-depth analysis of the clinical case presented and moderates the discussion. Typically, the discussants represent psychodynamic approach to therapy, however, depending on the nature of the case and requests of the presenter, other arrangements can be made. RAMS staff clinicians, postdoctoral fellows, and doctoral psychology internstake turn presenting their cases in this format; practicum trainees who stay with RAMS for a second training year are afforded this opportunity as well.
Another monthly in-service conference is the Clinical Grand Rounds (9:00-10:25 on the first Wednesday of the month). This is a cross-program teamwork-oriented clinical forum: Staff, interns and trainees from multiple RAMS programs gather to take part in a free-flowing conversation on a pre-selected clinical topic relevant to their work or for a clinical discussion focusing on a particular client/family who receives services from multiple RAMS programs. The conversation is moderated by one of the program directors and is lead by a group of clinicians (both staff and trainees) who work with the clinical case presented or have a particular expertise with the topic under consideration.
The Intern and Trainee Clinical Case Conference is held at 10:25-11:55 every Tuesday in the second half of the training year (during the first semester, the Intern and Trainee Seminar is run as a didactic clinical training and a seminar on cultural self-awareness in clinical settings).
This conference is overseen by the Director of Training and involves practicum trainees and doctoral interns only. Each participant is expected to deliver one formal case presentation. This includes a comprehensive clinical case write-up (grounded in theory, empirical data, and informed sensitivity to diversity), an hour of process notes from a recent therapy session, and an oral presentation of a case to the group of peers. In addition to offering an opportunity for developing competency at professional presentation, the Intern and Trainee Clinical Case Conference also gives trainees a venue for trying their hand at peer-supervision and for practicing their proto-supervisory skills.
Application
Our clinical training program offers 10 to 12 positions for doctoral-level psychology practicum students and masters-level clinicians-in-training (counseling, social work, and marriage and family therapy trainees and interns).
Each application should include the following:
- Letter of interest and intent (What applicant hopes to learn at our training program and what qualifies him or her as a good fit)
- Curriculum vitae (Please provide detailed information about all supervised professional experiences, including types of settings,
clinical services provided, clinical and cultural populations served, and theoretical orientation of supervision. Additionally, we are
asking all applicants who speak languages other than English to provide information on their fluency in these languages –
“receptive skills only”; “minor to intermediate conversation skills”; “intermediate to fluent”; “fluent to very fluent”; “native speaker”) - Three recent letters of recommendation (Strong preference is given to recommendations from professionals who are familiar with
applicants’ clinical work, as opposed to letters that highlight applicants’ academic achievements.) - A brief clinical case write-up, with all identifying data removed. Select any clinical case that showcases your clinical skills at their best; we have no preference regarding clinical settings and/or types of client (age, cultural identity, diagnosis, etc.). Please do not send extended clinical intakes, assessment reports, and other write-ups that showcase mainly your diagnostic and
treatment-planning skills: We also want to see your acumen for understanding of and dealing with clinical dynamics in therapy. If you would like to see an example of a clinical write-up structure, you may refer to our Case Presentation Format.)
All documents must be emailed to florachan@ramsinc.org. Please make sure to put your full name both in the email subject line (e.g., “John Doe – RAMS Practicum Application”) and in the title of each document (e.g., “John Doe – Letter of Intent”, “John Doe – CV”, etc.) and send all application materials at the same time, attached to the same email.
For doctoral-level psychology practicum trainees who are applying through the Bay Area Practicum Information Collaborative (BAPIC), please refer to their website (https://bapic.info/) for application due date.
Applications from masters-level interns and doctoral-level psychology practicum trainees who are not applying through the BAPIC (supplemental practicums and non-BAPIC-affiliated programs) are accepted until all placement positions are filled (typically, end of April – early May).
Interview Process
Due to the COVID-19 pandemic, all selection interviews for 2022-23 training year will likely be conducted via teleconferencing.
A typical interview takes about an hour and is conducted as a rather informal conversation between an applicant and two supervisors from the RAMS Outpatient Clinical Practicum Program.
Applicants are asked about their past training and clinical experience, as well as training goals for the next year and overall career goals. Other topics of the interview may include applicants’ experience in working in the community mental health, with severely disturbed patients, and clients of diversity. All applicants are expected to be ready to present clinical cases and to discuss their understanding of their own cultural identity.
Selection of Applications
RAMS, Inc. is an Equal Opportunity Employer and does not discriminate on the basis of race, culture, religion, ethnicity, national origin, physical ability, gender, or sexual orientation. While some preference is given to bilingual/bicultural applicants, we are always happy to accept monolingual/monocultural English-speaking students who are genuinely interested in working with diversity. We also consider extra-training qualities that point to an applicant’s “good fit” for our program: relevant professional presentations and publications, teaching, awards, prior degrees in related fields or pertinent life experiences.
The criteria listed below are those we typically use for rating applicants during the interview. This information is provided to you in hope that it will help reduce the interview stress. It is not necessary that all areas apply to each applicant.
Selection Criteria for Practicum
Cultural/Diversity Sensitivity
- Sense of own ethnocultural identity
- Sensitivity to diversity issues (Emotional/Countertransference Skills)
- Knowledge regarding cultural diversity (Cognitive Skills)
- Commitment to culturally competent professional work
- Commitment to professional working with Asians, Asian-Americans and Immigrants
- Bilingual skills
Case Formulation:
- Presentation of relevant history and background
- Presentation of MSE and relevant assessment information
- Ability to diagnose according to DSM-V criteria
- Case formulation is relevant to history, MSE, clinical data, and diagnosis
- Case formulation is coherent and consistent with theoretical approach
- Cultural factors are considered in case formulation and understanding of clinical dynamics
- Treatment plan matches case formulation
- Working knowledge of psychodynamic approach
- Awareness of transference and its impact on his/her functioning as therapist
- Awareness of countertransference and its impact on the client
- Knowledge of medications and relevant biological factors
Personal Characteristics
- Ability to express self, understand questions and communicate effectively
- Emotional sensitivity as evidence of use of self in clinical work
- Capacity to be direct, self-assertive, candid
- Capacity to tolerate stress and work demands
- Commitment to own personal growth as an aspect of professional development
- Awareness of countertransference as impacting clinical work and ability to talk about it
- Unique skills that would benefit a placement here
- Unique interests that could be met at a placement here
Previous Experience
- Previous practicum experience
- Previous clinical experience with similar clinical populations (severely and chronically mentally ill, trauma, minorities, immigrants, urban poverty)
Recommendations:
- Settings (populations served, services provided, and approach to training – similarity to RAMS)
- Recommendations
