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
Nursing with Soul: When 15 Minutes Just Isn't Enough with Marcelli Rodriguez
Macelli Pascal Rodriguez--Owner and provider at Transformations
https://ruma.transformationhealthservices.com/team/
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. My answer number two welcome back everyone.
Speaker 2:Um, here we are another episode of peplau's ghosts. Thank you so much for joining and listening. Um, I think we're actually up to number 16 episode. So we've been rocking and rolling. This is good. Hopefully it's just a beginning as well.
Speaker 2:But I am joined with my esteemed colleagues Dr Sean Convoy from Duke, soon to be Dr Kate Molino from University of California, san Francisco, and Dr Melissa Chapman up in Minnesota. I'm really thrilled to have our guest here. I can't say enough thank you to him for giving us the foundation for this podcast, the intro music and outro music that you've all listened to, as you've listened to Pep Lau's Ghost yeah, it's here and this is the person who created that. This is the brilliant mind that it came from, and so really excited to welcome Marcelli Pascal Rodriguez to our podcast here and really excited to have him talk about his own business, transformations, which is an aesthetic and wellness spa, and so let's kind of get right into it and just kind of get talking to Marcelli. So, marcelli, my first question out of the gate what got you interested in doing psychotherapy and maybe kind of expand it, just kind of non-pharmacological type of stuff for people with mental health problems.
Speaker 3:Yeah, hey, everyone, I'm so happy to be here. Thanks for having me. But as far as like getting into like psychotherapy, I kind of chose the mental health field, I would probably say medical field. At four years old, I had a you know, a sick grandmother. I said I would, you know, take care of her. As time went on, she passed prior to, of course, me finishing school, but in high school, I would say that's where it really stuck out. You know, I saw a lot of substance abuse. You know I saw a lot of like just issues with self-worth, self-esteem. You know, it was just a lot going on in high school that I can remember and I was like, you know, maybe I could help people out just by finding what the root of the problem is, you know, kind of from there, and then I went to school, I kept going to school and then I met Dr Convoy, who really lit a fire under me to keep going when it came to psychiatry.
Speaker 2:So what kind of propellant did he use to light that fire? I mean, I just I'm sorry, going with that metaphor a little bit, maybe All right. So what was it that tried to? He did that, you know, because obviously the fire was probably there, right, he just kind of stoked it a little bit.
Speaker 3:He just kind of stoked a little bit. Yeah, so I think you know one of the things that I find in psychiatry is a lot of what we go through is stemmed in trauma, whether it's like perceived or something that you actually experienced. So you know, coming from a background that you know, I've had some trauma, like we all have, and Dr Convoy kind of what's the word he kind of validated things without even knowing that's what he was doing, Right. So it was one of the things like for me, I grew up kind of like a perfectionist because I was raised to be such, and Dr Convoy made it where it was okay to not be a perfectionist and to understand that whatever you have to offer is what the world needs, you know. So, yeah, I would say him Definitely.
Speaker 4:Well, it's really hard to mobilize a question after that comment. Thank you, sir, I'm going to. I want to take you kind of after school and you're now in clinical practice and you're doing it right and you're doing it well. I want you to think was there an experience you had with a patient or a family that kind of made you realize that, wow, spending more time than just 15 minutes with a patient adjusting meds does something special? And if so, can you de-identify and tell us that story?
Speaker 3:So my practice, we don't even do 15 minute med checks. They're not even allowed, um, to be honest with you, and part of that is because it's just not enough time. You know, and a lot of times it takes time for someone to even truly verbalize what they're going through and how they're feeling, and if they feel like they're in a time crunch, they'll never get the truth. So we have all our, all of our med checks are based on a 30 minute increment and we even go further, like longer, if we have to. So we get everyone to fill out, like the PHQ-9s, the GAD-7s, we do the mood disorder questionnaires and we kind of like really tap into the person.
Speaker 3:So when I say that, you know, we pay attention to how they walked in, what was their interaction, you know when they sit down, like you know their clothing, you know how's their hair, you know their makeup, that type of thing, eye contact, are they looking at us?
Speaker 3:When you know we're talking to them, we catch up on hey, you know how was your weekend or how was your week, how's work your children? You know, before we even get into meds, we're having a whole conversation about just them as a person. You know, and also, like I tell my staff that we can't look at people like they're a number. You know I want them to get to know, even when they come in to be checked into the practice. You know I want you to greet them by their name, their preferred name, if you know that in that case and you know, check in with them like how are things going? It starts there, you know. So I know I went on a little bit of a tangent with that, but I'm very passionate about, you know, taking the time that's needed with people, because a med check is just not enough.
Speaker 2:Have you ever had an experience with the 15? I'm guessing probably through clinicals and other experiences, you've had the 15 and like when did you feel like that wasn't going to work for you?
Speaker 3:I hated it. To be honest with you Insurance companies they tell us oh, you have this amount of time get them in and out. But I don't look at people as like financial gain. You know, it's really about helping people. So if I have to take more time, then that's just what I do. But the 15 minute med check a lot of people I could tell when they were leaving. It was like they would send messages like oh, I forgot to say, or hey, I didn't get a chance, can we still change the medication? You know, a lot of times when you do 15 minute med checks they're like oh, everything's good. Yeah, same med, just same pharmacy, thanks. And they leave.
Speaker 5:You know, yeah yeah, you know, um marshall, before we started taping, when we were just chatting, you had mentioned that you know you obviously do medication management in your practice, but you use psychotherapy techniques as well and you kind of modulate it to the particular client based on what you assess that they need. I'm wondering if you could give some examples of how you decide to do that and what types of techniques you use.
Speaker 3:Yeah, so I was just saying before we started. Actually I don't really stick to a modality. I know there's like CBT and all those different things you can use. I really just let you know whatever the conversation is, kind of guide the path and where we're going. So a lot of times if it's, you know, negative thoughts or like intrusive thoughts someone is having, I try to find what the root cause of that is, you know. So what I'm finding in my practice is, like I was saying earlier, a lot of things are just rooted in trauma, you know so, feelings of not being good enough or not belonging, or perfectionism or, you know, just inadequacy. All that stuff really stems from when we were growing up, you know.
Speaker 3:So I just had a client the other day who has like a a sexual addiction, right, so we were talking about that. He was like, you know day who has like a sexual addiction Right, so we were talking about that. He was like you know, my wife says is an addiction. So I was, I was trying to figure out. I was like, ok, so define to me what exactly is happening that you? You know that you're linking it with an actual addiction. So he was talking about some of the things. And so I said to him at what point, like how is your relationship with your mom? You some of the things? And so I said to him at what point, like how is your relationship with your mom, you know? And he told me we didn't have a really good relationship, you know. I'm like, okay, well, what about? What about your father? He was like there was a lot of abuse in the home, you know. And so then it went from okay.
Speaker 3:So growing up, were you like one of the popular kids? Did you play sports or were you kind of a loner? And he said I was really a loner, I wasn't one of the popular kids. And he said, you know, I can think back when I was a kid and I would, you know, do these acts growing up because I wanted to be cool.
Speaker 3:And now he's 35 years old, he's still doing the same thing that he's been doing since he was 15 or 16. And so he said to me he said I never thought about, like any of this stuff or how it could be linked to you know, what's happening in my relationship, you know, especially the relationship with my mom, the history of what I was doing prior. And he was like I really need to go to therapy and I was like you do, you know. So it's one of those things where I referred him to someone that can really like better assist in that arena. But I spent a lot of time like just talking to people trying to figure out what's going on with them before I, you know, send them to someone who's more specialized to help.
Speaker 5:I love that example, you know. It's just such a good example of how you know, using these sort of engagement strategies is really just holding up a mirror to patients, right Like you stay curious and you present the opportunity for them to reflect and figure things out. That's great.
Speaker 3:Yeah, definitely, because I mean, it really is just about guiding, you know, the individual through whatever they're going through and there's no judgment, you know. So I always tell people like, regardless to whatever you experienced, I want to know because that's the only way I can really help.
Speaker 6:Yeah, yeah, so I'd love to hear your thoughts on nursing, being a leader and performing psychotherapy. What are the yeah, what are the aspects to consider there?
Speaker 3:so I think nursing I think there's nothing better than a nurse to be honest with you, no shot to any physicians or anything. But I think when it comes to like just being bedside and more hands on, that's something that you know, we've just been trained to do. So I think it makes us more relatable and I feel like people trust us more, you know. So I think like nurses at the forefront of psychotherapy is something that the world definitely needs and we need to probably spend more time doing that training, even in these courses that we're taking. You know, I wish VCU had more of a psychotherapy perspective when I was going I mean, dr Convoy definitely played a part in that but maybe even like a course where that's all we learn, you know. Thank you, marcel.
Speaker 2:I mean where that's all we learn, you know. Thank you, marcel. I mean it's a great question and I appreciate Melissa bringing it up because I mean I can see you know all the potential that you have, just kind of listening to you for your first time, and you could have been a psychologist, you could have been a physician, but something chose you to say nursing fits me best, you know, fits my worldview, and even going all the way back to you know, helping your grandma when you know four years old and things. So do you have any concern about psych, mental health nurses doing psychotherapy or is there any anything that kind of you know you mentioned, kind of you know you need more of this, but does any concern come up when you think about that as far as nurses doing therapy?
Speaker 3:I don't think so. I think it would be a great thing, you know, to be honest with you. I mean, I don't take away from any other specialty. So you know, like LCSWs, lpcs, I mean, everyone plays an active role in helping the clients, you know. So I think it's really good if we look at it from a community perspective, where we all kind of come in and the common goal is what? To help people. You know. So if it's something where, like, I could extend that service and actually bill for it, you know, I wouldn't mind doing that because I'm doing it anyway and I'm not billing for it. Essentially, you know it anyway and I'm not billing for it, essentially, you know. But then there's people that can, if they specialize in something, then it's like, okay, well, you may specialize in eating disorders. So I'm going to send this person to you. But just the over, like overview or overall look of it, I think it would be good if we could offer it.
Speaker 2:Yeah, that's great, I think I share always. What a mentor of mine, dr Howard Butcher, kind of showed to me is like the nurse, you think of everybody that and again, this is very Midwest, so forgive the kind of thing. But a potluck, when people bring things to potluck they bring their, their trays, and nursing brings a tray, and you mentioned LCPCs bring a tray, physicians bring a tray, we all kind of bring a tray. We're all kind of in that same meal but we all kind of bring something special.
Speaker 3:So thanks, I appreciate your perspective on that, yeah, definitely, definitely, marcel.
Speaker 4:I'm going to go off script a little bit. I'm going to ask you a slightly different question. You are building a pretty significant footprint in the Hampton Roads area of Virginia. I'm interested, as you're kind of looking on the horizon are there particular subpopulations you're super interested in serving, and why so?
Speaker 3:I always root for the underdog. So whatever you know whoever that is. But right now we're in Virginia Beach and we're also in Richmond, so we have about 15 providers and the end of this month will probably be up to 18. And then we're going to expand hopefully to Newport News in Chesapeake within the next like six months. But my practice I just look for diversity, like everyone's inclusive, as far as like invited to come, you know. So we see a lot of the LGBT, qia plus population. We see a lot of military you know, active duty and vets. We see I mean children, I love to see children. So ages four and up, we don't typically start medication that early, but we do still see those clients. So you know, I really don't have like a subset of people, I just want everyone to come, you know.
Speaker 5:Thank you.
Speaker 3:Yeah.
Speaker 5:I love that and you know, to piggyback on that a little bit, you're talking to a room full of educators here. You know, from your perspective, as you know as someone who has been a student and alum and now running your own practice, what types of skills or modalities do you think we need to be teaching our students in order to meet the needs of all these diverse groups of folks?
Speaker 3:So a lot of it is what I find especially with, like, the LGBT population is there's no safe space for those individuals. So I actually have a contract with the LGBT Life Center and so we see a majority of those individuals in Hampton Roads, but what I always hear is that we don't feel welcome. You know, people will call and like cancel appointments or and cancel appointments or they'll misgender, and that really sets someone back if you don't use the right gender terms or pronouns or even names. So that's very important. I think that would be good to incorporate in training. Also, just meeting people with compassion.
Speaker 3:I always tell people like it's not about the diagnosis for me it never is. We have to document it, yes, but what we're treating is what you're experiencing. So people get caught up in labels and I find a lot of clinicians will say, oh, you're bipolar too, and a client will come to me like what does bipolar two mean? I'm only one person. You know they don't, they don't understand. So it's like we sit down and we go through these things and it's like, oh well, that's what it means and I'm like don't, don't worry about the label, worry about how you're feeling in the moment, you know. So I think that's the biggest thing Knowing things like oh, you know CBT, dbt, you know act therapy, play therapy all that stuff is great, but really just meeting individuals where they are and just having some compassion.
Speaker 6:Well, what do you see as barriers to more PNHMPs using psychotherapy in practice?
Speaker 3:barriers to more PNHMPs using psychotherapy in practice. Well, one of the barriers I can see is some kickback from you know therapists saying you're not therapists, so stop doing it. But as far as like time, the time constraints would probably be the biggest thing, because I know for therapy, you know individuals are seen for like 60 minutes, but how do you incorporate therapy and med management in the same visit? And still a lot for the amount of time that the individual needs.
Speaker 2:So that would be the only thing that would probably be more difficult to manage. Yeah, can I ask kind of further, because I don't know if I've asked, and maybe Sean, kate, melissa, please feel free to jump in. But this is one of the things that I sometimes talk to my colleagues who are just, you know, doing therapy. This idea between you know a 30 minute appointment, which I think, marcelli, if I heard you right, that's kind of primarily what you've got scheduled. You see them as much time as you need, but that's kind of what's on your kind of calendar. I mean, do you see any difference between, I mean, doing a 30 versus a 60 minutes, you know, appointment? Obviously there are different billing codes here, but I mean, I guess I've always thought that there is utility definitely in a 30 minute therapy appointment, but sometimes I get some pushback on that. I'd love your thoughts on that, maybe, and anyone else.
Speaker 3:Yeah. So for some clients, you know, 30 minutes I think is beneficial because they're used to like 15 minute check-ins, right. But there are some clients that are slower to feel comfortable or like kind of warm up that that 60 minutes gives them enough time to deal with the anxiety of coming, having to discuss what they have going on, kind of get comfortable. What I see is like at the 20 minute mark. That's where people kind of like sit back and relax some, you know. So if you only go for the 30 minutes, then like you have 10 minutes of like real engagement where I'm comfortable, Whereas the full 60, I think would be more beneficial.
Speaker 4:Yeah, it's kind of cool. I want to build off of that. I think you know your question is really cool because it made me think about OK, what is my, what is my thinking about how I coordinate this. And for me it's, I think early on in the therapeutic relationship more time is needed to kind of galvanize the therapeutic relationship. But when you get into this point in time as a team between a patient and provider, you start to fire really effectively together. A patient and provider, you start to fire really effectively together. You can probably shrink it down and unless we're dealing with somebody with serious mental illness, the goal is for our patients to fire us for the best of reasons because they don't need us anymore, right? So maybe that decrease in frequency but also duration of encounters is kind of the building process to disengagement.
Speaker 3:Yeah, I agree with that too.
Speaker 5:Yeah, I'll just share too again, since you asked. You know that made me reflect as well. I'm currently practicing on a house calls team. I'm seeing mostly geriatric patients who are nearing the end of life, and although I do have 60 minute appointments, but mostly I do 30 because folks get very tired and so I think there can also be a huge burden of engagement, right. So tailoring that to the patient population can be really important too.
Speaker 3:Yeah, that's a great point.
Speaker 4:Well this has been great.
Speaker 2:Sorry, go Sean.
Speaker 4:So, marcellia, I'm thinking about, like some possible registered nurses who are in your geographic area who are like I want to do what he's doing, so can you give them they're hopefully listening right now some anticipatory guidance about what they need to do to be able to be successful and would be transitioned from being a registered nurse to an advanced practice nurse in psychiatry?
Speaker 3:Yeah, first thing I would say is learn everything you can Right. So always be a student. A lot of times, when you're already like in you have your like degree in registered nursing, it's just like, oh, I know how to do that. But, yeah, you have to really listen and learn right. The second thing I would say is make sure you write everything down so, like I know, when I was in school I had a preceptor, yes, but I still made a spreadsheet of all the medication that you know, the mechanism of action, the ages that you can use it, and I use that as a guide so I could learn everything, not just from what I was being told, but also how it was in, like stalls, or how it was written, so that also you know it's under.
Speaker 3:It's understandable that you have to work to make money, but you also have to make sure that you take the time to study. So you know, kind of having some of that time out to make sure that you can do that and also kind of working in an environment that, wherever, like, you're trying to enter into. So if it's psych, find somewhere that you can learn more about psych. So if you can work on a psych unit that can be beneficial Outside of that, just being open to, like you know, critique and criticism.
Speaker 3:I have a lot of students that come in and they're just like you know they sit there. I have a lot of students that come in and they're just like you know, they sit there and I'm like are you sure you want to learn? Like this is really what you want to do? Because you're not as engaged as you know I would think that you would be. I was very engaged when I was a student. So that's another thing. You know, just if you love it, then it's going to work for you. Don't just go to something because you know you hear psych. Oh, I can make all this money in psych, but it's not about the money, it's about the people. So go where you love, like working and what you love doing. You know whatever your purpose is. So that's, that's the biggest thing for me.
Speaker 2:That's awesome. Yeah, Again, I, you know, just love doing these podcasts. I hope people listening kind of find a reason. But it seems like every episode I get a little bit of a little tingly and it's. It's a good feeling. And here we're recording on a Friday afternoon, that's, that's the best time to have these feelings to launch us into the weekend. So I got one more question, Marcelli if you wouldn't mind kind of sharing your story a little bit about the, about the song that you developed and made and and and thankfully didn't license, so we didn't have to pay you any money. That might've been a mistake on your end, Sorry.
Speaker 3:It's all good. It's one of those things that I hated, like writing a discussion board sorry, dr Convoy. So I was like you know what? I'm just going to wrap them all. Music, kind of, was like my first love. So you know, that was how I expressed myself and that's how I kind of dealt with what life was handing me. And I think music is universal, so like everyone can relate to it, no matter what walk of life you come from. So that was the biggest thing.
Speaker 3:But when I sat down and wrote the song, it was kind of like what have you experienced, what have you seen, you know? So I put it in there, like we have these beliefs that are embedded in us, whether it's from, like, how we were raised or what society tells us who we should be or how we should act, you know. So these intrusive thoughts, a lot of times that we have a lot of it, you know, has to do with what I can't even say. It's like it's not even who we are. A lot of times it's just like random thoughts that come in because of how we felt, like growing up, or like relationships that went wrong, and there's just so much to it, and I could talk about that all day. But that's where the song came from. It kind of came from like the feelings I was having in the moment and then having to do a discussion board about it. I was just like I'll just put it into words that way yeah, reminds me of like a painter.
Speaker 2:You know they can't use words, they have to put it into you, have to draw it on a canvas or something it sounds like for you. It's just, it has to come out in song, it has to come out in a, in a lyrical beat. So yeah, and it's still that way.
Speaker 3:It's still that way now. Yeah, even with my clients. You know we do like poetry. They, you know, like my younger clients, still write music. I mean music is still a big part of like what I do now Love it.
Speaker 4:And I'll add that, you know, while Marcelli is under undervalued his cognitive formal therapy skills, if you listen to the song, he talks about guided discovery, cognitive distortions. So there's a, there's a cognitive therapist wheeling out of his body. He realizes that or not.
Speaker 2:Oh man Love it. Well, thank you again for Marcelli Pascal Rodriguez. Thank you so much. Owner and provider at Transformations in Virginia Beach, virginia. I will be linking your website, so hopefully you'll get a bunch of people. I might be one of them. As I say, in all the services you provide, I think a little tweaking might not be a bad idea too. But uh and I hear virginia beach is a nice place for vacation. So thank you, marcelli, for this and thank you all for listening. Uh, please again like subscribe comment. Uh look forward to another episode coming up, coming out soon, and uh take care all right, thank you, I appreciate you all.
Speaker 2:After dark with Pep Louse.
Speaker 3:Ghost, I think it went well. I don't know How'd it go. Crystal Sounds good to me. Thank you again. Yeah, thank you. I appreciate you all, and I think Dr Convoy, where'd he go? I can't see him. He's still there, okay, cool. So I was going to say please get with us about the hypnotherapy breath work. I actually just went to a retreat and did that. I've done some sessions with some clients already and I'm going to be honest with you, I didn't think that breathing was going to be so effective.
Speaker 4:Cool, cool, cool. I've already. I'm in contact with her, so I will. I will circle the loop on that with you, I promise. Okay, cool, thank you.
Speaker 1:Too much seasoning.
Speaker 2:They feel it. Thanks everybody.
Speaker 1:Work hard until those thoughts are finally leaving, so you can be you. They feel it If all is true. Work hard until those thoughts are finally leaving, so you can be you.