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­­­­Argosy University : San Francisco Bay 

Practicum Information Form

I. AGENCY INFORMATION

Ananda Institute

Date completed:

8/10/05

Address:

401 South A Street

City, State, Zip:

Santa Rosa , CA 95404

Phone:

707-544-4441

Fax :

707-544-4492

Agency Website address:

www.Ananda-institute.com

List multiple agency programs/sites:

 

Director of Training:

Juaquin Sanchez, Ph.D.

Director Degree and CA License #:

PSY11020

Director Phone:

707-544-4441

Director email:

MICHAELSAN@MSN.COM

Other contact person information:

 

 

II. PRACTICUM TRAINING PROGRAM BASICS

A. Year Level Openings

Estimated

2 nd Year ( Grad School ) Practicum Openings

2

3 rd Year ( Grad School ) Practicum Openings

2

-Total Practicum Openings

4

-Total Pre-Doc Internship Level Openings

 

B. Students at Agency

 

Number of Practicum Applicants last year

3

Number of Current Argosy Practicum Students

2

Number of All Current Practicum Students

3

Number of Current Argosy Pre-Doc Interns

2

Number of All Current Pre-Doc Intern Students

 

C. Practicum Dates and Times

 

Beginning Date

8/15/05

Ending Date

7/31/06

Number of weeks for practicum

52

Hours per week for practicum

16-20

Required days and times at agency

Thurs. 12-3:30. Other days open

D. Stipend : Is there Stipend? If yes, amount per year?

No

 

 

*Note: 2 nd year practicum is 16 hours and 3 rd year is 16 up to 20 hours per week.

Minimum of 38 weeks required with maximum of 52 weeks.


III. AGENCY DESCRIPTION: Please describe below.

 

 

 

A. Population: Indicate estimated % of clients in each category.

%

Gender

%

Life Cycle

50

Male

0

Infants (0-4)

50

Female

20

Children (ages 5-12)

 

Transgender:

20

Adolescents (ages 13-17)

100%

Total

50

Adults (18-64)

 

 

10

Seniors (ages 65+)

 

Ethnic/Cultural Identity

100%

Total

10

African American

 

 

2

Asian American

 

Other Identified Groups

50

Euro-American

10

Gay/Lesbian:

30

Hispanic/Latin American

10

Disabled Population:

3

Native American

2

International:

5

Other : Pacific Islander

 

Other:

100%

Total

 

(Note, above will not total 100%)

 

Populations Treated

 

 

25

Individual

 

Functioning Level of Clients

5

Couples

10

Severe Dysfunction (i.e., psychotic, severe personality or substance abuse dx)

5

Families

80

Moderate Dysfunction (i.e., moderate personality dx, anxiety, depression)

65

Groups

10

Mild Dysfunction (i.e., adjustment dx, transitions, growth)

100%

Total

100%

Total

? Others notes about populations :

 

 


B. Specialty Areas: Mark an X next to all specialties that apply at agency.

 

Behavioral Medicine

 

Hospital

 

Psychology of Women

 

Health Psychology

X

Community Mental Health Clinic

 

Disabilities

 

Psychopharmacology

X

Forensics

 

Gay/Lesbian

 

Pediatrics

 

Management/Administration

X

Multicultural Therapy

 

Infant/Parent

 

Program Evaluation

X

Spirituality/Psychology Integration

X

Family

 

Vocational/Career Development

 

Death/Dying/Bereavement

X

Geropsychology

X

Psychological Assessment

X

Domestic Violence

 

School Based

X

Neuropsychological Assessment

 

PTSD/Trauma

 

College Based

 

Psychology of Men

X

Serious Mental Illness

X

Bilingual in treatment

 

Others (specify):

 

IV. PRACTICUM TRAINEE RESPONSIBLITIES AND FUNCTIONS

A. Treatment Modalities performed by student: (Mark X in all that apply.)

X

Individual Therapy

 

Crisis Intervention

X

Couples Therapy

X

Brief Therapy

X

Family Therapy

X

Long Term Therapy

X

Group Therapy

X

Psychological Assessment

 

Community Intervention

X

Neuropsychological Assessment

 

Consultation/Liaison

 

Case Management

 

Others (specify):

? Describe practicum trainee duties and responsibilities : Individual, group, couples, family counseling, psychotherapy.

 

V. ASSESSMENT and PSYCHOLOGICAL TESTING

A. Assessment Overview

 

Will trainee have opportunity for assessment/testing experiences?

Yes

Is there additional supervision/training for assessment/testing?

Yes

Percentage of practicum time allotted for providing assessment services:

5

Estimate of average # of Test Batteries completed per year:

10

 

B. Assessment Modalities performed by student: (Mark X next to all that apply.)

X

Projective

X

Intelligence

X

Personality

X

Neuropsychological

 

Academic

 

Vocational

 

Other:

? Describe the Assessment Program : One hour training every week.

 

 




VI. TRAINING/SUPERVISION PHILOSOPHY and OBJECTIVES : A. Please describe below.

Provide close supervision so that the trainee/intern has a clear understanding and guidance towards becoming a competent therapist.

 

B. Supervisor Licenses: Please note the number of supervisors with the following licenses.

2

*Licensed Psychologists (PsyD/PhD/EdD)

2

MFT

 

*Psychiatrists

 

LCSW

 

Other:

*Note: Primary Supervisor must be a licensed provider at the doctoral level of training. Primary Supervisor may be individual or group supervisor & must sign or co-sign evaluation forms for students.

 

C. Supervision and Training

Hours per week

Individual Supervision

1

Group Case Consultation

1

Didactic Training

1.5

Other:

1 hr neuropsych training

Total hours Training/Supervision

4.5

 

D. Methods of Supervision : (Mark X next to all that apply.)

 

Live Observation

X

Process Notes

X

Two Way Mirror

 

Case Reviews and Discussion

X

Videotapes Review

X

Audiotape Review

 

Other:

 

E. Theoretical Orientations of the Supervising Staff (check all that apply)

 

Biopsychosocial

 

Jungian

X

Cognitive Behavioral

X

Narrative

X

Family Systems

 

Psychosocial Rehabilitation

 

Feminist

X

Psychodynamic/analytic

X

Humanistic/Existential

 

Transpersonal

X

Integrative

 

Recovery Based Model

 

Others (specify):

? Comments on theoretical orientation : Ananda Institute provides a divers theoretical framework.

 

 

F. Training Emphasis Areas: Please fill out the following classifications below to assist us in differentiating practicum placements. Indicate with X areas where substantial training program and experience exists such that it would qualify for graduate program practicum in these training emphasis areas.

X

Community/Multicultural

X

Cognitive Behavioral

 

Health Psychology

X

Assessment

X

Forensic Psychology

 

 

Geriatric

X

Family/Child

 

Gender

 

Psychodynamic

 

Not Applicable

 

Others (specify):

? Please add specific information regarding all Emphasis Area(s) you checked:

 

 

VII. PRACTICUM APPLICATION PROCESS FOR STUDENTS

Application Deadline:

First Monday in March

Selection Date Estimate:

First Monday in April

Standard required materials

Vita, Letter of Intent, 3 Letters of Recommendation

Agency specific materials:

Graduate transcripts

Preferred Experience:

1 year personal counseling experience

Preferred Coursework:

Family systems, neuropsych assessment

Interview Process: (keep those that apply, erase rest)

Individual Interview

Other application/interview information:

 

 

VIII. Verifying Information: I verify that the above information is current and accurate.

Date:

8/10/05

Directors Name:

Joaquin Sanchez, Ph.D.

*Directors Signature:

JS

*If emailing, you may add signature through copy and paste or just put in your initials.

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