Now that APPIC internship applications have been submitted, you are hoping that you will be invited to some interviews. Yet, when those invitations come, there is often a mix of excitement and trepidation.
Naturally, going on an interview creates a lot of pressure. You are glad you made the “paper cut” and they liked you enough to want to interview you, but you worry how about how you will perform in person. We all want to come across as articulate, intelligent, likable, well-trained candidates who are a good match for the site we’re interviewing at.
It’s tough enough preparing to answer questions, but in most APPIC internship interview scenarios, you know you will also have to either present a case or respond to a vignette.
In my experience, this often causes the most anxiety about interviews. However, do not distress! You have solid clinical skills already, and you have likely done this kind of thing before many times over, so try to channel that. It helps to also know what to expect and how to actually best prepare. My tips below should help ease some of the angst and worry. And for more tips, check out the upcoming webinar on “How To Ace Interviews” on December 12, 2015 (details at the end of this article).
Selecting Your Case
When selecting a case for interviews, you should generally NOT present the one that you submitted to the site already (if they requested a written case summary as supplemental material).
Be sure to select a case that:
- Fits well with the population of the site you are interviewing for, but still highlights some of your best work.
- You know well, from EVERY angle, because you may be asked about any aspect of it.
- Is rich, including some successes, challenges, and possible unique, ethical, supervisory, or transference issues that make for good discussion (they may ask about those).
- You can be confident about. Remember, even if it was not perfect, it’s ok; they know you are still learning, so just be able to represent what you did well.
- Has a clear diagnosis and rationale.
- Has a clear approach / orientation / modality you applied WELL, and reason for using it.
Preparing Your Case Presentation
Interviewers are generally looking for you to articulate your cases in a clear, concise and coherent manner that allows them to form an impression of your clinical skills.
As most interviews, in total, last about 30 minutes, if you are asked for a case, they will typically not want to spend more than 10 minutes discussing it. That means you need to keep your initial presentation brief but substantive. A trick to doing this is to prepare one or two sentences that capture each of the following aspects of the case:
- Demographics (age, gender, ethnicity); treatment type & frequency (individual, weekly, etc.); setting (outpatient, inpatient, etc.)
- Presenting problem
- Psychosocial history (if relevant)
- Diagnoses and rationale
- Approach to treatment and patient’s general response
- Major highlights (successes or difficulties)
- Prognosis / outcome / final disposition
The following is sample case presentation language that includes all the relevant aspects of the case which you could likely recite in under 2 minutes:
“Last year, I treated a 22 y.o. Hispanic female in individual weekly therapy as an outpatient at my NY Hospital externship.
It was her first time in treatment and she came in requesting grief counseling after her mother’s death a few months prior. They had a close but conflictual relationship and she was experiencing a lot of guilt and anger. We soon discovered that she had a history of depression dating back to adolescence and a tumultuous and unstable family life.
I began by utilizing an integrative approach that focused on CBT to address her depression, along with some interpersonal and relational interventions that allowed us to work on the quality of her current and past relationships. As therapy progressed, she began expressing some symptoms of anxiety that had features of PTSD, and eventually disclosed some sexual trauma perpetrated by her mother’s boyfriend, which she had never mentioned to her mother.
I integrated some Relaxation and Mindfulness strategies, along with elements of Trauma-Focused CBT. We also tried to process how this experience of undisclosed trauma impacted her grief about her mother.
In time, her depression and anxiety improved significantly, and she was able to more adequately address her feelings of grief. She had difficulty working on the trauma directly so we made slow progress, but by the end of my training year, she had also reported fewer PTSD symptoms. And she actually agreed to continue therapy with the next extern in order to keep working on it.”
Questions interviewers might ask about the sample case presentation:
- Why an integrative approach? Why those particular interventions to address those issues?
- What gave you the impression her anxiety seemed to be more PTSD?
- What were the guilt and anger about?
- Why didn’t she disclose the sexual trauma to her mother?
- What was the most difficult aspect of this case?
- How did you feel working with her?
- What would you have done differently?
- How did it feel not to have made much progress on the trauma with her?
Preparing for Vignettes
Instead of asking you to present a case, the interviewer may present you with a vignette and ask for your impressions. This is gaining popularity more and more every year, so don’t be surprised if a good number of sites present you with vignettes, while the rest ask you to present a case.
Vignettes are great ways to assess your organic critical thinking and clinical reasoning skills because, by nature, you will not be familiar with the case material.
Typically, vignettes are short and sometimes vague because that requires hypothesizing, theorizing and informed speculation about the case. Remember, they are most interested in how you think clinically about cases more than creating “gotcha” situations. When the vignette is vague, it is because there is no discrete right or wrong answer, just better or worse reasoned responses.
You can expect that the case material in vignettes will be relevant to the population and kind of work you would be doing at that specific site. Bear in mind, however, that vignettes can be about:
- A new patient that is presenting for treatment, in which case the focus is on assessment, diagnosis, case disposition, treatment selection skills; or
- A case that you are purportedly already treating, in which case they are likely to assess your intervention, case formulation, conceptualization skills.
Vignettes are presented in a variety of ways. They can be:
- Given to you in written form for you to reference as you wish.
- Handed to you to read and then collected.
- Read to you by the interviewer and then given to you to reference.
- Read to you and then not given to you to reference.
Pay especially close attention if it is read to you, and ask if you can “take a look at it” if you feel comfortable; if they prefer not to, they just won’t but you typically wouldn’t lose any points for asking.
Responding to Vignettes
When responding to the vignette, just try to remember the 4 following steps:
- Offer your general impressions of what was presented. This is like a brief summary of the case material which is important so the interviewer knows what you are basing your impressions on. This is especially critical if you are not given any reference material and do not precisely recall all the details. It provides for clarification by the interviewer, if he or she chooses to. It also buys you some additional time to collect and organize your thoughts before the real clinical “heavy lifting” begins. You should also feel free to say that you need a minute to collect your thoughts before you begin at all, if you feel you need it. It’s better to take it and feel more confident (no one will mind) than not take the time and stumble through it.
- Discuss differential diagnostic and clinical impressions and rationale for each. Unless the diagnosis/clinical presentation is absolutely clear and unequivocal in the vignette, you should always do this. Remember, they are assessing your clinical reasoning, so it’s more about how you think, and why you think that way.
- Discuss what additional information you would like to have or would require to refine your diagnostic and clinical impressions (e.g. risk factors, any kind of relevant history, substance use, collateral information, medical data, etc.). They also want to see that you can recognize what you don’t know, and decide what data you need in order to inform further clinical reasoning. Remember, therapy is often an investigative process. That’s a big part of what we do.
- Discuss how you would proceed with the case strictly given the data you were provided, and taking into consideration any differential diagnoses and/or additional information. So, you may be offering a few alternative approaches. That’s ok, and in fact, often desired. It shows you know how to reason clinically and think on your feet.
Things to Remember
Some general considerations about case presentations and vignettes:
- They can take up to half of a 30 minute interview.
- You may get cut off while speaking; let them take the lead. There is usually a reason.
- You may get derailed on one particular question which ends up taking most of the time.
- You may get challenged. If so, always politely indicate that what they are saying is “an interesting point,” “I (or we, meaning you and your supervisor) didn’t consider that” and offer a rationale for why you chose or thought what you did. DO NOT get defensive.
- You may not get to finish your presentation/response before they start asking questions.
- You can end up in a conversation instead of a Q&A…that’s fine and in fact, preferred!
Avoiding common pitfalls:
- Do not use too much jargon. Clinical language is different than jargon.
- Do not disagree with them if they offer a different point of view.
- Do not pull out any notes on the case.
- Do not start talking about another case to make a comparison or for any other reason.
- Do not say anything that appears as though you are blatantly blaming your supervisor, your training program, the setting, or the patient.
- Do not get defensive (this can NOT be restated enough!).
Live Webinar & Special Offer [EXPIRED]
Interviews will be coming up very soon, so if you find this information and some of my other blog posts helpful, you won’t want to miss out on our in-depth 90-minute Interview Coaching Webinar on Saturday, December 12 at 12:00pm (recorded for those who can’t make it). This webinar covers ALL aspects of the interview process, especially case presentations!
We have a special discounted rate for Time2Track members; simply enter the code: nottoolate. To view details and take advantage of this offer, click here. And remember, if you can’t make it, you can still get the recording if you sign up.
If you have any specific questions, please feel free to comment below or email me directly. We hope you find our resources helpful!
Best of Luck,
Subscribe to the Blog
Get free resources each week from real professionals and students in the field of behavioral health.
Latest posts by Josephine Minardo, PsyD (see all)
- Ace Your Case Presentations & Vignettes in APPIC Internship Interviews - December 9, 2015
- APPIC Internship Applications: Is it Really All About the “Match”? - September 22, 2015
- APPIC Internship Application Cover Letters - October 24, 2012