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
Elevating Therapy through Nursing Expertise with Chris McCormick-Pries
Chris McCormick-Pries discusses her journey in psychotherapy and the importance of building therapeutic relationships. Throughout the episode, she shares her insights on various psychotherapeutic modalities, the challenges faced by psychiatric nurses, and the need for mentorship in the field.
• Building relationships as a cornerstone of successful therapy
• Personal anecdotes highlight the transformative power of psychotherapy
• Importance of diverse psychotherapeutic modalities in practice
• Addressing barriers for advanced practice psychiatric nurses
• Emphasizing the need for mentorship and supervision in clinics
• Advocating for the inclusion of psychotherapy training in nursing education
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
Yeah, just my take on things.
Speaker 2:My answer number two Welcome everybody to another wonderful episode of Pepow's ghost. So appreciative of everyone listening here and I'm so excited to be introducing our next guest is Chris McCormick pre. It's a it really is kind of a coming back to home type of episode for me, so I might get a little sappy on this podcast and and I know Kate and Sean are here to kind of keep me in line with that but really appreciate Chris and spending time and again for all of you listening to make sure that you're all kind of keeping this podcast afloat. So the only podcast I know that's about PMHNPs with no commercials, although I'd love to have some commercials someday. So not opposed to getting paid.
Speaker 2:So let me do a quick introduction for Chris McCormick-Pree. She is a PMHNP I believe she is also one of the which we've got others on this podcast right now too a PMHCNS which is a certified nurse specialist Been in practice for a while. I don't want to make Chris feel old and I don't want to make myself feel old in saying this too, but I was reading kind of a little bit. She's been in practice for over 40 years, so I'm really appreciate she's going to share some of her wealth of experience.
Speaker 2:We just honored her at the University of Iowa with our 2024 College of Nursing Notable Preceptor Award. That's the one preceptor we identify out of all the programs that's doing amazing work, and so I was able, fortunate enough, to hand her that award and share a couple of humorous stories with her, so that was a great day as well. But the other thing that's, like I said, it's kind of a coming back to home is that this Chris was my preceptor back in the day, and so I always like to kind of I found a quote online before we get to that that Chris was described, and I love this wording just Chris has a beautiful energy that lights a fire in nearly every person she encounters. That was just really great, which I agree. I think she's just got that kind of personality that people are attracted to and just kind of want to know more about.
Speaker 3:So the first question I always like to ask Chris is do you remember the first time we met? You know, I don't, and I've heard you ask other people that, and I have been pounding my brain.
Speaker 2:I think it was before you were a student, yeah. So you know, kind of taking a little bit back just to kind of share. Chris is kind of one of the first psych you know nurses advanced practice in our community here and her and Judy Collins were kind of very close and kind of working with children, adolescents, and so Judy kind of took me under her wing a little bit and introduced me to you as well. That's kind of the first time so, but yeah, that's, that's awesome so so yeah, thank you, chris, appreciate that. And so my first question kind of about the podcast is when did you first get interested in doing psychotherapy?
Speaker 3:You know, I think from the very beginning. I was really struck when Dr Cynthia Hanthrope was on your podcast. Her journey and my journey are very similar. All my training was psychotherapy, so you are very gracious not to mention my age and how long I've been working. But I graduated from nursing school in 1971, university of Maryland Immediately went back to New York, which was where my family had been from, and worked on a psych unit, and I worked at Jacoby Hospital and even as a staff nurse, talking to those patients who were part of our patient load was very important and that's really the beginning of psychotherapy as far as I'm concerned Learning how to become comfortable and communicate and learning how to be present and to be attentive and to be detail oriented.
Speaker 3:Now, I didn't have a background of six theoretical frameworks with which I could interpret all of what I was hearing and talking with folks about, but that was our foundation. I mean, that's what nurses did, that's what psychiatric nurses did. We were there to really engage in relationship and I think, dan, you know, as I have seen students year after year after year, I say to them the most important thing you need to do with a patient is build a relationship. No relationship, no movement forward. And you know we are given the gift of many different means of psychotherapy to build that relationship. But that's where psychotherapy really started for me. Then, obviously, after working a year there, I was engaged and the individual I was engaged to was a physician who was in the US Public Health Service and he was stationed in Rock Island in the U? S public health service and he was stationed in Rock Island, illinois. So you know he moved out here and then I moved out here and I then started teaching at a community college and started learning more about psychotherapeutic interaction and process and frameworks and you know different modes of psychotherapy and became interested in graduate school and I was so blessed to go to graduate school.
Speaker 3:In the early 1970s I got a traineeship, I got paid to go to graduate school. You know, as I hear my students tell the story of of student loan and student debt, I I continue to be so grateful for what my opportunities were, which was to be able to go to school and get paid to do that. So I didn't have to work, I could concentrate and focus Sorry, that's my dog I could concentrate and focus everything, all my energy on really being a student and learning everything I could. So University of Iowa that's where I went to school was the University of Iowa and of course we were very psychotherapy-oriented, taking a class and a course, individual psychotherapy, family psychotherapy, group psychotherapy and, you know, first began engaging with our patients in psychotherapy. But I think you know, now that you asked me that question, I think really the first form ofotherapy I ever ever did was that ipr that we used to do in nursing school where you had to write down your interaction with individuals.
Speaker 2:So you know it started at the very beginning it's a long answer to a very succinct question no, no, no, it's good, I like the background and things. Um, just so people are listening. Ipr stands for Interpersonal recording. Thank you, yeah, good Awesome.
Speaker 4:All right. So, chris, I share some of your lineage. I'm also a dual trained CNS NP, so I appreciate your passion for psychotherapy. I didn't ask you a question kind of more globally about your relationship with psychotherapy.
Speaker 4:I like to follow up, usually with a question. That kind of laser focuses on an experience with psychotherapy. I don't know about you, but sometimes in my interactions with patients not because of what I do but more because of what happens in the relationship it sometimes feels like lightning in a bottle. So I'm asking you to think for a moment was there a particular experience or encounter in psychotherapy that made you realize that, oh, my goodness, this is something really special.
Speaker 3:You know, I worked with an adolescent probably in the early 80s and I was paired up with a physician, dr Lois Hokanson and I don't know if you remember her, dan, but I was doing psychotherapy with this particularly difficult adolescent who was hostile and angry and hurt and traumatized and wanted no part of a relationship with me at all. And I can remember Dr Hokanson continuing to remind me how important it was to be present and to just acknowledge her pain. And after about three or four months in psychotherapy there became obvious a dramatic I say a dramatic change. It wasn't that dramatic, but she really engaged with me and opened up and I think for the first time felt that there was someone who was listening to her and helping her sort through what her thoughts and feelings were about circumstances that had happened to her. And interestingly, here we are. You know, decades later, I still hear from her periodically.
Speaker 3:That's awesome and hear from her how important psychotherapy was to her.
Speaker 4:That's fantastic.
Speaker 3:Thank you, and it really cemented for me again the importance of the relationship and the focus on the individual in the relationship.
Speaker 5:Yeah, what a beautiful example. Thank you for sharing that. And, chris, you mentioned at the beginning you know how lucky we are to have so many modalities of psychotherapy at our disposal to build these relationships with patients. We'd love to hear a little bit about any specific forms or types of psychotherapy that you're drawn to.
Speaker 3:Well, early on I was very involved in interpersonal psychotherapy, now working in New York in the 70s. Hildegard Peplau was right across the river in New Jersey, so the interpersonal theory of nursing and all of the things that she had to say. And then I was very, very lucky to be able to go to the Sullivanian Institute for Individual Psychotherapy, the William Allenson White Institute in New York, for a year. So that focus was very interpersonal. Coming out to Iowa was quite a shock because at the time Iowa was very biological I don't know if you remember that, dan, but a long time ago very biological. So I really struggled with the modality of their psychotherapy at that point because everybody I was working with was was focused, different things.
Speaker 3:But I began to learn more about, you know, rational emotive therapy, cbt. And then I was trained by Nancy Bloom at the University of Iowa in the STEPS program, which is a DBT program. That has now become my love and even in in medication checks. You know I am saying to people, you know, tell me about my, your thoughts, how do you challenge them, how do you redirect them, how do you replace them? We talk about emotional regulation, mindfulness, all those kinds of things, but the the content of the DBT program from the steps manual has really become almost a Bible for me. I love it and it's easy to incorporate pieces of it in a med check.
Speaker 2:That's great. Yeah, I think it's one of those things. Even going back to that example of interacting with that kid and still seeing him as an adult, you never know when you create a memory, right, I mean it's always one of those things.
Speaker 2:And that's the gift I think you've been saying too. It's kind of the gift that we have as our role we get to interact with these people and see them grow. I mean I'll never forget, kind of, when I interviewed actually for my DMP program, it was actually a non-psych person interviewing me and asked the question I'll never forget saying you know, do people get better in psych? And I was kind of set back like oh yeah, they do. I'm surprised by that question.
Speaker 2:But yeah, I think you know and I appreciate you kind of giving a plug for Hildegard Peplau, obviously, that you kind of giving a plug for Hildegard Peplau, obviously that's kind of the mother of psych, mental health, nursing and the name of our podcast here. So, kind of going back to that, how do you see nursing? Because I think you've kind of been for me at least you know again, hopefully I don't get a little verklempt, but you've been for me kind of the ideal nurse and how to be a psych, mental health advanced practice nurse. And so how do you see nursing being a leader in performing psychotherapy, because obviously other professions can do that skill as well. But how do you see nursing as being kind of central or part of you know what we do basically.
Speaker 3:Well, first of all, I think, as nurses first, and advanced practice nurses second, we have a wealth of knowledge about health and about illness and about environment and the social determinants of health that I believe unfortunately many of our colleagues do not have. So I think we come into our relationships with a much broader base of knowledge and a much more advantageous perspective on really assessing and intervening with the individuals that we're working with. I mean I, you know, for years and you know this, dan I mean my certification was in child and adolescent psychiatric, mental health nursing. So all my early years, my first 25, 30 years of working, were with children and adolescents. You know they all grow up. So now I see them as adults or I see their kids. But understanding development, understanding child health, understanding nutrition, understanding all of those things is so important to helping children. Kids that wiggle and move in school are not all children who have ADHD, you know. Some of them drink too much caffeine, some of them have worms, some of them don't get enough sleep, some of them are uncomfortable because of something else. You have to have a broader perspective. So that is what I believe the gift of nursing gives to us. As psychotherapists, we go into it with a much broader base by which we can, as I said, assess and intervene what's happening, and I think, therefore, we should be leaders in the field of psychotherapy.
Speaker 3:Unfortunately, because of our knowledge about biology and medicine and the reduction of psychiatrists, we're slotted into becoming chemists and we are so much more than that. And, by the way, all the chemical knowledge we have in the world, all the medicine knowledge we have in the world, doesn't work if people don't like us and don't trust us. So without the relationship you know, we're nowhere. We're nowhere.
Speaker 4:Chris, I'm going to shift the focus a little bit in a slightly different direction and I'm going to ask the focus a little bit in a slightly different direction and I'm going to ask you a question. I mean, you know very well that our scope and standards of practice published by the American Nurses Association, the International Society for Psychiatric Nurses and the American Psychiatric Nurses Association they established that we are credentialed to be able to deliver psychotherapy Correct. That we are credentialed to be able to deliver psychotherapy Correct. Looking at the other side of the coin, do you see any risks associated with that standard of practice in terms of how we are turning students out into the market right now?
Speaker 3:Boy. That's an interesting and complicated question. A complicated question. I think if the programs do not include psychotherapy, there is a risk because we are partially preparing them and I think that that is a disservice to the student and I think it's a disservice to the patients that we see, and I think that and I think it's the NLN more than the ANA and some of these other organizations that oversee the educational credentialing of programs but I think we nursing leaders have to be strong and vocal in supporting the inclusion of psychotherapy in the programs that we take students from. So I feel pretty strongly about it, sean. I think we you know it's like preparing people and tying one hand behind their back, and I think there is a risk associated with that in terms of placing them then in situations where they get stymied and stuck and they don't know what to do with somebody.
Speaker 4:Thanks for establishing the genesis of this podcast, Chris.
Speaker 3:You're very welcome, Sean. It's my pleasure.
Speaker 5:And I'd like to piggyback a little bit on Sean's question. You know I'm so struck by your incredible wealth of experience and expertise in this field and I'm curious, Chris, you know, what have you seen or what do you see as the barriers for more psych NPs or advanced practice psych nurses using psychotherapy in practice, and any ideas about how we could address some of those barriers?
Speaker 3:And let me say that I say this out of a framework of working in a mental health center and Dan was gracious in saying 40 years. I've been there 50 years. In May I will have been at Vera French 50 years. So what I see in terms of the barriers are it's cheaper to hire a social worker than it is to hire an advanced practice nurse. To hire an advanced practice nurse. So when you have organizations that are administratively managed by non-nursing individuals, you have folks in administration that do not understand that although a psych nurse may engender a higher salary, he or she is much better prepared to intervene in the distress and the illnesses that patients have and very often help them reach a higher level of wellness and quality of life more quickly. When you have one person doing psychotherapy and somebody else doing medicine, very often they don't talk to each other and you've got people working down different tracks and missing things. If that individual is the same person, you're able to really do a combination of things and, I think, promote better health and better treatment.
Speaker 3:I always try, when I have patients in a med check and they're seeing a social worker or one of our mental health therapists, I very often say to them tell me about your psychotherapy, what are the goals of your psychotherapy? And you know, sometimes they're saying, hmm, I'm not sure. What do you and your psychotherapist talk about? Well, we talk about school, we talk about life, we talk about things and it. It distresses me sometimes when I hear that they're not focusing on learning skills. I say to patients in a med check I can prescribe a medicine that helps you feel better in the short run and perhaps you have a lifelong condition and you will need some maintenance care with medication in that condition. But psychotherapy teaches you tools and skills that will last your whole life, skills that you can use at any point in your life and you can pull them out of your toolbox whenever you need them. So those are the arguments, so to speak, or the rationales when I am talking to our administrators, what I say. And you know, for many years I was on the leadership team. I'm not anymore. I only work part-time and I advocate strongly to get an advanced practice nurse on that leadership team.
Speaker 3:I think physicians are wonderful and I love working with them, but we don't have we don't have very many here anymore. Many of them are in private practice in the larger cities, think the other barrier is for many, for many newer professionals in this business. There's an excitement about being able to prescribe a medicine, and psychotherapy is hard work and, as, as we all know, the excitement is something that is it. It takes some time to understand it and to build it. So I think sometimes we don't give our students the right perspective of what the importance of our positions are and what the importance of our work is. So those are a couple of things. You know. I think there is a financial initially, on first glance, there's a financial incentive to hire someone who costs less, but I'm always saying what about risk, what about the length of treatment and what about the fact that often they miss things, that they need to be seen? So you know, those are conversations we need to have and hopefully we're allowed to have them in different situations.
Speaker 2:Yeah, thanks, chris. I mean it's you know. What I try to tell people too is you know, when you go to therapy, you know you learn things that you don't need refills on right. You don't need to get a refill for how you do your CBT or how you do you know various types of things. You can just kind of do that and take away those skills, like you mentioned in that example, from adolescence all the way through their life. They can kind of carry those coping skills and you know, fortunately, that pharmacy you don't need to, you know, stand in line for. So it's a, it's a great thing. So my next question you know, and you know we can spend some time to talk about some other things if you want to talk, but the next question we'd like to ask is just to pull out your crystal ball and kind of look into the future. What do you see as a future for using psychotherapy within the psych mental health?
Speaker 3:nurse practitioner role.
Speaker 3:Well, I think if we don't teach it, we're not going to use it.
Speaker 3:So the future depends on whether or not programs include a basis of psychotherapy in their program.
Speaker 3:So that becomes critical.
Speaker 3:So we have to continue to be advocates of recognizing how important psychotherapy is and continue to put it in programs and teach it.
Speaker 3:I think the other piece of that is we need to continue to find preceptors who have experience with psychotherapy, who are willing to mentor their students in psychotherapy.
Speaker 3:And then the other thing that I have found very important is we, as experienced psychiatric nurse practitioners, need to be willing to provide supervision and mentorship to new graduates who come into our programs and we have to continue to encourage them to be engaged in psychotherapy with their patients. So I think those things will have an implication for the future of psychotherapy in the practice of psychiatric nursing. I think the other thing is that we need to continue and I applaud you, dan, and I applaud all of you who are involved in professional organizations we need to continue to remind policymakers how important the role of advanced practice nurses is in all of our fields of nursing, in all of our fields of health care, but for us especially in psychotherapy or in psychiatric nursing, and we need to continue to be at the table, having conversations with policymakers about the importance of making these practitioners available and being able to include them in policymaking and in planning policymaking and in planning.
Speaker 3:Yeah, I think those things Sorry, no, no.
Speaker 2:I was going to say, yeah, it's, you know it's important to kind of just have that seat at the table. I think it's. You know it's something that gets overlooked a lot. I don't know why. I mean, I struggle with that kind of understanding of why some sometimes boards and other you know organizations that are making policy don't kind of consider nurses as a profession and why they're not getting kind of that seat at the table. So that's great. Thank you, chris again. Chris, yes, like I said, I tried to kind of minimize your years of practice and hopefully didn't short sell you but and I also will share, I know Chris is on her third retirement. You but and I also will share, I know Chris is on her third retirement. I mean, you keep trying to phase out of retirement. I think that's just something I always see for people who are just driven and this is not, this is not a job, this is, this is your life passion.
Speaker 3:So it's been my vocation. I truly see this as my vocation. I love what I do, and I hope that being able to transmit how much I love what I do to students will help spark that passion in them so they too will have a wonderful vocation or career in a field that they love.
Speaker 2:Yeah, thank you, chris. That's a good way to end the podcast. Thank you so much for those listening. Make sure that you like, subscribe and comment, and look forward to having another episode soon.
Speaker 5:Thank you so much, chris McCormick-Pree, from Vera.
Speaker 2:French.
Speaker 1:Community Mental Health Center. Thank you as well for Dr Sean Convoy from Duke and Dr soon-to-be Dr Kate Molino from University of California, san Francisco.
Speaker 2:Thank you, and take care, we'll see you soon in the next episode.
Speaker 1:Bye.