By Jessica Haberman, Ph.D.
Growing up, I spent a great deal of time with my grandmother. I often accompanied her to church services and then visits with her friends and neighbors. As a result, I have always been comfortable around and have enjoyed the company of older adults. However, my professional interest in Geropsychology did not really begin to take form until my junior year of college when I was enrolled in a Cognitive Psychology course and found myself fascinated with studying normal aging vs. dementia processes. Then, during my final year of undergraduate studies, I sought an internship at a local County Council on Aging. My role there was primarily to learn about and participate in the various services provided through the local Senior Center. I escorted drivers transporting clients to miscellaneous appointments and delivering meals to home-bound seniors, I helped package meals for delivery and served clients who came to the Center for congregate lunches, and I helped with a variety of administrative tasks; but I spent the bulk of my time visiting with seniors who came to the Center for socialization and activity engagement. While not “clinical,” per se, this was my first experience interacting with older adults in a professional capacity.
Later, during my graduate studies, I sought out other opportunities that would further enrich my Geropsychology pursuits. Unfortunately, there were no opportunities for clinical work with older adults during either my Master’s or doctoral training. However, there were plenty of research opportunities both with program faculty and in the community. I participated in a number of federally funded research projects aimed at understanding and improving the quality of life of older adults, both those residing in the community and in long-term care facilities. Many of these studies focused on topics such as resiliency and proactivity in late life, dementia programming, creation of dementia-level-appropriate reading materials, and addressing barriers to medication adherence for adults with chronic medical conditions and infectious diseases.
When it was time to apply for pre-doctoral internship, I sought out training sites that would provide the opportunity for me to hone my Geropsych skills, with the focus of course being on clinical work with older adults. To be honest, I was rather nervous about my chances of matching somewhere due to my limited clinical experience. However, in my applications, I stressed how the research and other training opportunities I had had helped shape my clinical perspectives and illuminated key areas of growth. I also emphasized that the training offered at the site was not only in line with my personal and professional interests but that it would meet my specific training needs as well.
Since my clinical and research interests are generally related to providing services to older adults, particularly those individuals who are medically and psychiatrically complex, I was thrilled when I matched at the VA Medical Center in Cleveland. This site offered a variety of didactic and other training experiences that would meet my specific clinical needs, as well as provide the opportunity to work as part of a multidisciplinary team, which is not only a valuable professional experience but also quite a marketable skill. What’s more, this placement allowed me to further establish a career and professional network in the area where I preferred to live and work. As a pre-doctoral Health/Geropsychology intern, I worked on an inpatient Geriatric Evaluation and Management (GEM) Unit, conducting diagnostic assessments and individual and group therapies and participating in rehabilitation and discharge planning for patients with a variety of conditions including altered mental status, dementia, debility, failure to thrive, and a variety of specific medical problems. I provided similar services to more medically stable patients in a Geriatric Primary Care Outpatient Clinic, and conducted family therapy with patients and caregivers. In addition to the above gero-specific experiences, I completed a training rotation in Neuropsychology, performing neuropsychological and capacity evaluations for inpatient and outpatient clients. I also engaged in an enrichment experience in Hospice, providing care to patients who were end-stage in their illnesses, addressing issues such as end-of-life pain management and mood disturbances, and helping patients and their families cope with anticipatory grief and bereavement. Since internship is meant to be a person’s last real opportunity for generalist training, I also completed a rotation in an area where there had been a clear gap in my training to date – I conducted group and individual therapies for individuals with severe mental illness in an intensive outpatient/partial hospitalization program.
When it was time to apply for post-doctoral fellowships/residencies, I referred to the fact that I now had developed competence both as a general practitioner and as a geriatric-specific provider. I highlighted specific experiences I had had on internship that contributed to these new competencies including running Montessori-based, Cognitive-Behavioral, and stress management/relaxation groups and conducting psychological assessments to clarify patients’ cognitive status (sometimes for the purpose of assessing capacity for independent living and decision making) as well as to help guide treatment based on clients’ personal and diagnostic issues.
Given my preference to remain in the Cleveland area, I was again quite pleased when I was offered the Geropsychology Resident position at the Cleveland VA Medical Center where I had the opportunity to obtain greater depth in the training experiences to which I had been introduced on internship. Since I had completed my internship at this site, I was able to jump right into my post-doctoral residency without delay (i.e., no time lost learning “the ropes” or inserting myself into the treatment teams with which I had already worked). In addition to a more in-depth training experience in the various settings I had worked on internship, I also gained additional breadth of learning with activities such as relationship building with community agencies such as Adult Protective Services, placement in a Community Living Center working with individuals needing long-term rehabilitation and providing multidisciplinary patient care and staff psychoeducation, conducting driving safety evaluations for persons with cognitive impairment, providing umbrella supervision to pre-doctoral interns and doctoral practicum students, and completing a quality improvement project to increase the type and frequency of dementia programming available to veterans at the facility.
Upon completion of my residency, I was fully prepared to take on independent practice and accepted a position as a Geropsychologist. My training had been comprehensive and of high quality. Even as an early career psychologist, though, my development is ongoing. While the transition from trainee to staff brings with it a sense of independence and excitement, it’s still nice to know that other, more experienced providers are available for ongoing mentoring. As an independent practitioner, the task is no longer meeting training goals, per se. Rather, the task is finding your voice as a competent, well-trained psychologist so that you (and not necessarily your supervisor) can ensure optimal treatment is provided to your clients/patients. I am glad to say that I am making progress toward accomplishing this task!
About the Author: Jessica Haberman received her Ph.D. in Urban Education: Counseling Psychology from Cleveland State University in 2013 after completing a pre-doctoral internship in Health/Geropsychology at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center. She went on to complete a Geropsychology post-doctoral fellowship at the same training site. She currently works as a Licensed Psychologist at the Cleveland VAMC with duties primarily in Primary Care-Mental Health Integration in the Geriatrics Outpatient Clinic as well as work on the Consultation/Liaison team conducting capacity evaluations for hospitalized veterans.