Peplau's Ghost
Psychiatric-Mental Health Nurse Practitioners (PMHNP) discussing using psychotherapy within their practice. Four PMHNP program directors and a biostatistician from across the Unites States sharing their passion on how psychotherapy can help people with nearly all their emotional problems.
Peplau's Ghost
Mental Health Care's New Frontier with Dr. Allyson Neal
This episode focuses on the necessity of integrating psychotherapy into mental health treatment, as highlighted by Dr. Allyson Neal. Through real-life experiences, she advocates for the vital role therapy plays in effective patient care and encourages nurses to lead the way in this essential domain.
• Dr. Neal's journey from pediatric nursing to psychotherapy
• The misconception that psychotherapy is secondary to medications
• Importance of addressing root causes of mental distress
• Case study highlighting successful therapeutic intervention
• Challenges faced by mental health providers in therapy delivery
• Encouragement for nurses to advocate for therapy training
• Vision for future collaboration among mental health professionals
• Empowering patients to demand needed therapy services
Dr. Allyson Neal
aneal7@utk.edu
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
All right, so I think we're recording. Welcome, welcome, welcome everyone, good to see you back in 2025 to Pep Lau's Ghost, the podcast that really highlights the use of psychotherapy, and again, really appreciate those of you who continue to tune in. I was just looking at the stats. We have people from all across the world, mostly United States, but it's great to kind of get that reach out there for other countries as well. But I am joined with my esteemed colleagues and definitely have a wonderful guest, dr Allison Neal, who I'll get into real quick. But just to kind of introduce who's here Dr Sean Convoy from Duke, dr Kendra Delaney from Vanderbilt and then Melissa Chapman, who is our non-expert, who keeps us kind of on track basically. So she is a program evaluator from Minnesota and always great to have her.
Speaker 1:So let me get into a quick introduction with Dr Allison Neal. She is a clinical associate professor and assistant dean to the graduate program at the University of Tennessee, so very impressive to have a dean here. I don't know about you guys, but whenever I say the word dean a little, you know, cold goes up my back a little bit, like you have to go to the principal's office type of thing. So it's great to have a dean on our side, right, that's always good to kind of be on that side of things, but that's very impressive. And she's also the PMHNP coordinator. I should have definitely said that too. So you have a lot of hats at University of Tennessee. So very, very accomplished, so very impressed. I also see that she has a probably a part-time practice still at Helen Ross McNabb Community Mental Health Clinic in Tennessee as well, and so still seeing patients, which is kind of what we all do, kind of practice, what we preach in a lot of ways.
Speaker 1:So but, dr Neal, you have your DNP from the University of Tennessee, msn from Emory University, bsn from University of Tennessee, chattanooga, and then an ADN from East Tennessee State University, and you are both certified as a psych mental health nurse practitioner as well as a psych mental health certified nurse specialist. So again, thank you very much for being here. You have a lot of different roles and leadership opportunities as well. You're the American Psychiatric Nurse Association representative to the National Task Force, as well as on the LACE Committee. So again, very impressed with that. And then, big news out of the gate. We just talked about this before we started recording, but you are officially the president-elect of the American Psychiatric Nurse Association. So welcome, welcome, welcome to the pod, and I get the privilege of asking kind of the first question when did you first get interested in psychotherapy, kind of what drew you to psychotherapy and doing it professionally.
Speaker 2:Well, dan, thank you for that. Even before I became a psychiatric nurse practitioner, I found a huge interest in psychotherapy. I started out as an advanced practice nurse, as a pediatric nurse practitioner. My master's is from Emory University, was well-educated and trained. I worked in pediatric primary care for about six years and what I saw was I would see like an ear infection, a strep throat, and then my child's getting thrown out of school or ADHD is not under control. And so I started my journey with just mental health in being a pediatric nurse practitioner. Then I moved into pediatric neurology where I would see children that had seizures but also had ADHD, or who had a traumatic brain injury or migraines, that suffered from anxiety and depression, and I knew as a PMP I could start some low-level medicines, but I needed to refer children on for psychotherapy. I have always known that. You know, medicines have their part to play, but therapy, psychotherapy is healing.
Speaker 2:And so from that journey I decided I needed to go back to school to become a psychiatric mental health MP. I decided I needed to go back to school to become a psychiatric mental health MP. So my education for my DNP led me to UT Health Science Center, which is in Memphis and that program was just extremely strong on yes, here's how you assess, yes, here's how you diagnose. These are medicines and therapy. Psychotherapy is just as important. We had rotations in psychotherapy, we had to do simulation with psychotherapy and that's when it really became ingrained with me, all of my professors in that program. It was never you could do medications or therapy, it was always therapy. And then if you needed to do medications, that's okay also, but you needed psychotherapy. You know, we know from neuroscience that therapy is healing. So that was my. My first was as a pediatric nurse practitioner, but it was really ingrained in me in my doctoral program.
Speaker 1:I loved how you said that that psychotherapy is healing and it's such a thing that doesn't get enough emphasis and yeah, I mean we talk about this a lot too. Unfortunately, it gets relegated to a complimentary or alternative. I constantly say with my students it's not complimentary, it's like you just said yeah, it should be primary. So thank you.
Speaker 2:Yes.
Speaker 1:Sean, you're on mute, sorry.
Speaker 3:Thank you very much. I had a dog barking behind me, dr Neal I. You know, dan, I asked you a question kind of more generally I'm going to ask you a little bit more refined focus question that really thinks about a foundational experience with psychotherapy that you know. When you did it you said, oh my God, this works, and it just got you more excited. So was there a certain experience or set of experiences that kind of served as both an anchor and a lighthouse for your current practice as a psychotherapist?
Speaker 2:Sure Thanks, sean. Probably the time in real practice after I'd gotten out of school, passed my certification exam and was working with real patients. I remember having a family that this child had significant ADHD, was on pretty good dose of medicine and had tried many different medicines, but there were just things that were still missing and the family was very frustrated, the school was frustrated, the kid was frustrated, and so my first really aha moment was working with this family and this child about how he felt about school. He felt like it was such a burden, so we started just unpacking what that felt like it was such a burden. So we started just unpacking what that felt like. When we really got to the bottom of that he, he absolutely had adhd, but he had a comorbid diagnosis of anxiety as well that no one had recognized me as well.
Speaker 2:Um, of course you know medicines can help that, but what we really worked on was some somatic-based therapies to help him overcome his feelings of anxiety before he went to school, when something didn't go right during school and when he was at home working on homework. So I started just talking to the family about some things we could do and I probably even myself thought, oh gosh, I'm not sure this is going to work. This family is really at a tipping point and they need something. But they hung in there. I gave the kids some cognitive behavioral therapy worksheets to take home to work on, told them this was not homework, this was fun stuff.
Speaker 2:We worked on a pause button and we worked on some real somatic based therapy of when your stomach feels like that or when you feel heavy in your chest what can we do about that? Because he had been just running, he felt like he needed to escape. So you know that landed him in the principal's office and the guidance counselor's office everywhere but the classroom, which is where he needed to be. So we worked on some cognitive based therapy. So we worked on some cognitive-based therapy. We also worked on some somatic-based therapy. Together had them come back in a month. Of course, things were not perfect, but things had improved to the point where the family said we need more of this. And that was my. It worked. It worked this time we can build on this. And that was when I said I'm starting there from here on out.
Speaker 3:So, dr Neal, that's absolutely awesome and I want to kind of bring some attention to what you said to the novice and advanced beginners in our profession that are listening to this podcast right now, which is that psychotherapy sometimes can provide psychodiagnostic clarification.
Speaker 2:Absolutely A hundred percent. I've seen it over and over and over.
Speaker 3:Cool Kendra.
Speaker 4:Yeah, you know, one of the things that I think really stood out about what you were just saying to me as well is that, you know, I think when we get to the point sometimes with our patients, when we're working with them, that it's just like we're feeling desperate, the patient's feeling desperate, their support systems are feeling desperate and I think that, unfortunately, what's what can happen sometimes is that's when people just start throwing medications and adding and polypharmacy becomes worse and worse and we're and we're not really getting anywhere.
Speaker 4:We're just increasing the risk of our prescribing and therapy sometimes I think gets lost is because it's quote unquote slower, when really it's. Sometimes what we do need is that pause button. So I'd be curious, you know, if you could talk a little bit more about in your experience when you're noticing, hey, I'm feeling the energy of the patient and their support systems is getting more escalated and more elevated and they're wanting the quick fix. But what I know is really going to help is that pause and is really circling back to the you know, the foundations of therapy. How do you communicate that with your patients and their families to help them get on board?
Speaker 2:And Kendra. I think that's a very good point. I attempt to be really honest and transparent with any client patient I'm working with, for diagnosing, for if we're going to do further testing, medications, therapy, whatever we're doing. So I always try to start out with. You know, this is not a problem that happened yesterday. You've been dealing with this for a while.
Speaker 2:Quick fixes never work. We need to talk about the brain and what's going on in the brain and the role that psychotherapy can play. And, yes, we're in this for the long haul. I'm willing to hang in there with you if you'll hang in there with me and we will work to have a positive outcome. But it's not going to be quick.
Speaker 2:So I usually ask them so how long have you you've been dealing with this?
Speaker 2:I've never had somebody say oh, it's been a week or it's been two weeks, it's been six months, three years, my entire life. So a problem of that magnitude is going to take a little bit of time to fix. So we all know, as providers, really working with psychotherapy for three months makes all the difference in the world and I rarely see someone who's not been dealing with their what they would consider their major problems for less than three months. So I really try to talk about it's a journey. We're going to make small steps, we're going to make positive steps and I guarantee that we will get some positive outcome. And I really talk a lot about the brain and what happens in the brain and how we can have new connections that are made and that for people who've been dealing with things for a long time, I try to instill hope that just because this has been your past doesn't mean that it's your future. We can change your path, but it's going to take some work.
Speaker 4:I love that. I think you know I find that when I'm working with patients, I take a similar approach of just saying hey, I know it's really hard and it makes a lot of sense that you want to feel better quickly, because who wouldn't? And you're human and suffering is, you know, our human, as humans were designed to, to try to move out of suffering and it didn't take us forever to get here, so it's not, it's your. It took us a long time to get here, so it's going to take some time to get out. So thank you so much. I think that's such an important thing, especially for novices, to be reminded of, because as providers again as humans we we so desperately want to support our patients, but I think I'm always reminding my students that we don't want to get wrapped up in our patient's energy. It's our job to be the ones who are remaining calm and looking at the bigger picture in the long-term trajectory.
Speaker 2:Oh, kendra, I agree 100%. I think another thing that helps is setting goals. Always try to set a couple of short-term goals and a couple of long-term goals, and I start every session with checking in on how we're doing on our short-term goals, how we're doing toward our short term goals, how we're doing toward our long term goals, and it's just, you can almost feel the energy lift in the room when you agree that you've met a short term goal, and I think that positive builds on positive, and so I think setting of goals is very important as well. And if you set a goal that needs to be changed, I mean I tell my patients all the time that's life, life changes on a dime. If that's this goal that we said, if that's not what you needed this time and it's something is changing something different, let's change the goal.
Speaker 4:Yeah, I love that there's.
Speaker 4:I think one of my favorite things in practice is being able to say to my patients hey, let's pause and look at all of the things that you've accomplished since we've been working together and the amount of times that you just see the light bulb going off in the patient's mind because they're already looking to the next thing, the next place they want to be, the next accomplishment, what they want to have, and then for them to say, wow, I really really have done a lot.
Speaker 4:I just had a patient I was working with where we just started doing trauma work together in January of 2024. And as we were wrapping up the year, you know a very complex childhood attachment trauma and has really done unbelievable work to unburden a lot of this and, you know, was kind of just okay, well, I still need to do that, I still need to that. I said let's pause and look at that and you know, to see her have this moment, she just had this huge beaming smile and it's so rewarding to say, like you're the one who did that, like we get to be the, you know, a, a container to help navigate that, but to really be able to say, hey, like, let's reflect on what you did is so cool.
Speaker 2:That is great. I love to hear that you're doing that. That's such an important thing to do.
Speaker 5:I'm going to jump in here next. Everyone on this call, except for myself, as Dan had noted, is a nurse, and so I'm particularly curious how you see nursing being a leader in performing psychotherapy, since there are certainly other professionals that engage in psychotherapy. Like how does nursing lead?
Speaker 2:That's a very important question because we're seeing more and more providers of mental health who are trying to slip into that shorter visits, medication management only, and are not having good outcomes. We all know that you cannot have good outcomes if you do mental health that way, and there's a lot of pressure for psychiatric mental health nurse practitioners who work in large organizations that do not get much say-so over how their patients are scheduled. I think this is a wonderful platform that we all need to be talking about more, sticking together more on bringing it to our legislators, bringing it to those who educate insurance companies to pay for the services that are important. So nurses have a very, very important part to play in that, and nurses are often more political savvy than some other professional groups with using their voices. I've been told by legislators over and over is it's the personal stories that matter to us. So I think any time that a nurse can sit in front of your legislator, you know that you are their constituent and they represent you, know that you are their constituent and they represent you. I recommend you bring forth personal stories of your clients, your patients, and why this is important.
Speaker 2:And then the other thing I think nurses need to do as leaders is for our accrediting bodies that accredit schools and colleges of nurses. They need to hold programs accountable for psychotherapy. There is a small little box on the form that we all have to check that says, yes, this student has been exposed to two types of therapy. It's important that they're held accountable to that, and if there are any students out there or future students listening, I would suggest before you decide to go to a school to get your degree and become a psych, mental health nurse practitioner, you look to see if they cover all the points they should cover, and psychotherapy is one of them. If you are going to go to a school that does not put your teeth into psychotherapy, that's not the school you need to go to. You're doing yourself a disservice and the profession and every client that you will ever serve from here on out.
Speaker 1:Thank you, allison, that was great. Since this is an audio podcast, I'll just share that. Sean was doing Raise the Roof so, yes, he was keeping it very young. Hopefully we're attracting some of those 20 millennials, you know, kind of into the podcast with that, but but that was so awesome. Yeah, thank you.
Speaker 1:Well said, alice, and I think it's yeah, it's, it's, yeah. It needs to be said, it needs to be said over and over again. It reminds me that. You know, I think through this podcast and through our conversations we've had, you know, I've kind of I've got a psychotherapy course I'm having this spring and one of my assignments is to go out and find a podcast that PMHNPs talk about psychotherapy. Obviously I give them this podcast, but I'm really curious to have the students go out and see if there are any others. I mean, it's anybody else talking about psychotherapy and how nursing is involved with that? Because we do have such a rich history with that, you know, going back to at least the 1950s. So I mean, yeah, we need to keep that fire burning, like we talked about. So so my next question takes a little bit of a negative turn, but that's, that's okay. We need to kind of look on the other side of the coin right so do you, do you have any concerns about psych, mental health nurses using psychotherapy?
Speaker 1:do you does anything kind of come to mind when you know, thinking about that, any concerns come up to mind?
Speaker 2:I guess concerns would be that the schools or colleges of nursing that are not really holding their students accountable for psychotherapy. That is a concern. I don't have any concerns with nurses out there providing psychotherapy. I think all the quality programs say to students as we do, this is your baseline, it's up to you to go get more training and certifications. So I don't have any concerns there. And I think the other big concern are organizations that have really leaned into these medication management visits only. I think that's perfectly fine if you've got enough therapists in your organization that patients can have a therapist as well. But most organizations do not. And when we have patients waiting three, six, nine months for a therapy appointment, that's not okay. So my concern is don't be complacent, don't say, yeah, I'm just going to be a med management provider. Don't do that. You have so much more to offer and the clients and patients of the world need us.
Speaker 3:Hey, dr Neal, I'm going to ask another question and I'm going to follow it with a shameless plug. Okay, absolutely.
Speaker 5:I'm ready.
Speaker 3:So, as the president-elect for AP&A, what do you see are some of the possible barriers to fortifying that psychotherapy skill set within the advanced practice psychiatric mental health nursing role?
Speaker 2:psychiatric mental health nursing role. Well, the APNA is getting ready to come out with a statement on the importance of psychotherapy and the importance of the education and training for psychotherapy. So our organization is very bought into. This is important. I think sometimes some of our newer providers that get out and see that it sometimes is difficult to get credentialed for an insurance company to provide psychotherapy. I think that hurts. But I think if there's enough of us like us here that believe in this, we'll come alongside newer providers and mentor them. That this is worth your time. It is worth the outcomes that you will have for your patients, that you need to do this. I only see ups from that. I don't see any downsides, I only see upsides.
Speaker 3:Great. So here comes the shameless plug. Are you ready for?
Speaker 2:it, I'm ready. I can't wait to hear this Sean. So here comes the shameless plug.
Speaker 3:Are you ready for it? I'm ready. I can't wait to hear this. Sean, wouldn't it be amazing if we had, like the opportunity, to bring together the president of APNA and the president of ISPN to perhaps have a conversation about how we would combine our resources to have a stronger message between the two national leaders as it relates to psychiatric nursing and advanced practice psychiatric mental health nursing?
Speaker 2:I think that's a wonderful idea. I do not know why that cannot happen. I think that can happen.
Speaker 3:You heard it here first, everybody. We're holding all four presidents accountable to that, absolutely.
Speaker 2:We both, both organizations have. Organizations have the same wants and needs for the people we serve, and psychotherapy is at the top of that, and we're both just could not be more pleased to be associated with either organization, and I think we'll make this happen.
Speaker 1:Right Pressure's on you too, dan Well, I was going to say this is maybe a catch-up for those of you who don't know, and maybe just kind of jumping in this episode. I've mentioned that obviously Dr Allison Neal is the president elect of APNA, but I will. I am the president elect of International Society of Psych Nurses. So, yeah, I agree with you, allison. I think you know we we do serve the same people, you know, and our constituents in both organizations, I think, want this. So I think you know there is power in numbers. So, yeah, it's going to be great and I know Sean will definitely hold my feet to the fire, and you know, and so I'm looking forward to kind of doing something that could benefit both of organizations and, again, the professional community at large.
Speaker 4:So yeah.
Speaker 1:Kendra, I think you're next.
Speaker 4:All right. Well, you know, one question that I had. You know, obviously we're both in Tennessee and so this is something I think we see as a you know throughout Tennessee, but I really we're seeing it nationally, as you know, in rural communities. One of the big you know feedback that are I often hear is that the access to psych mental health nurse practitioners is so limited, or any psychiatric specialist is so limited, that to have a psych NP use their time doing therapy is harmful to the community because it limits the number of patients who can access the care of a psych NP. What would your response be to that? Who can access the care of a psych NP?
Speaker 2:What would your response be to that? It would be that if there are therapists available and can come alongside and practice together holistically, I think that is a wonderful marriage and would work. But we both know that that's not how it works in the real world. One of the biggest barrier for our state, kendra, like so many other states, is full practice authority. We practice under the collaboration for us and other states' supervision of a physician, which really limits our practice.
Speaker 2:I am hopeful that one day we'll become one of those states practice. I am hopeful that one day we'll become one of those states I think we're up to maybe what 26 now that have full practice authority, but that we will join those ranks and being able to provide the care there that our clients and patients in Tennessee truly need. So do we only need med management? No. Do we need psychotherapy? Yes. Do we need them together? Absolutely. The research is very clear that together they provide the best benefits for our patients and I would not agree with, if you can only have one provider, that they're only going to provide medications. I don't think that's treating our patients holistically like we need to treat them.
Speaker 4:I totally agree, so thank you.
Speaker 5:All right. So kind of a summing it up question here what do you see as the future of psychotherapy for PMHNP Dr Neal?
Speaker 2:Well, melissa, I think that our patients, clients, are becoming more vocal over the last few years. I am hopeful that they will be able to demand from their insurance providers or Medicare Medicaid that this is important service for them. I think that that will help elevate and the stories obviously help elevate that. This is how I received help and this is how I got better. The more and more that that happens, the more that nurses use their voices, the more nurses that we can get into Congress, the more that ISPAN and APNA work together, I think that the future of psychotherapy is very bright.
Speaker 2:I think we all have to push this. I think it's difficult to sometimes to keep up the fight, but I think there's enough of us like-minded providers that we're never going to let this die, and it is our basis. This is how you know, psych CNSs were the first to do this kind of thing and as we morphed into that and an MP role doesn't mean we should lose any of the things that we can provide, especially when they're so helpful for our clients. So I think the future is very bright. I think we all have work to do to get there, but I think that we can get it done.
Speaker 1:Very well said. Yeah, that's inspiring, I mean, it is one of those things. It reminds me. You do hear that every once in a while, right, you hear someone coming in with a sore throat. Sometimes people do ask for nurse practitioners no-transcript their time a little bit more and provide them, you know, a little bit better bedside manner or whatever you want to call it. But I think you know, to really highlight what you said earlier too is, I mean, I think this is an evidence-based approach but it also feeds into our assessment. And that's kind of where you started talking about your example of that person.
Speaker 1:And we probably have all had that experience where we're treating a kid as ADHD and you can see it out in the waiting room. You don't need to make a full diagnostic assessment. You can see the ADHD all over them. But there is something underneath that sometimes and that anxiety which can drive that, and then treatments for ADHD sometimes conflict with that anxiety treatment. So therapy is going to be that choice and those somatic therapies you mentioned to you know, helping address some of their physical sensation which can be, you know, really problematic with those anxiety symptoms.
Speaker 1:So so thank you again, dr Allison Neal, for joining us. It's been a pleasure to kind of get to know you a little bit and share your inspiration and your passion for psychotherapy. Thank you all for listening to us. Please make sure to like, subscribe and comment to the podcast. We are jam-packed in 2025. We have a bunch of people currently scheduled to be here on the podcast, so come back weekly catch up if you need to, but and also reach out to us Let us know how we're doing. We'd love to hear from you and get some feedback on what you want to hear and what sort of things you want us to talk about next. So thank you so much and we'll see you next time, in the next episode.