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

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