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
Psychotherapy in Advanced Nursing: Beyond the Nod with Dr Tess Judge-Ellis
Dr. Tess Judge-Ellis shares her journey from family nurse practitioner to psychiatric mental health specialist, highlighting the power of nurse-led psychotherapy in rural communities and beyond.
• Starting as a family NP in a town of 1,000 people before adding psychiatric specialization
• Creating accessible mental health services through a designated "counseling room" that reduced stigma
• Using interpersonal psychotherapy (IPT) and motivational interviewing to help patients with grief and substance use disorders
• Emphasizing that every nursing encounter has psychotherapeutic potential from the first moment
• Comparing psychotherapy to "physical therapy for the brain" - small exercises that create lasting change
• Advocating for nursing education that strengthens psychotherapy skills beyond medication management
• Addressing barriers including time constraints and reimbursement systems that limit therapeutic interaction
Join our next episode in a few weeks as we continue exploring psychotherapy in nursing practice, including upcoming interviews with nurses who trained directly under Hildegard Peplau!
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 I think we're recording. Welcome back everyone. Decrease until they cease. You're stuck at a discovery, Identifying a challenge in your beliefs. I think we're recording.
Speaker 2:Welcome back everyone to Peplow's Ghost. All right, another episode. Hopefully everybody was dying for this episode, as we had the two-week break. I'll call it that it was our spring break, although we didn't really rest or anything. But we're great to see you back or hear you back. Hopefully we're talking out into the ether, so hopefully somebody's listening to this as well. I am joined with my esteemed colleague, dr Sean Convoy from Duke. Dr Kate Molino that is, dr Kate Molino from University of California, san Francisco, just completed her PhD. Dr Melissa Chapman-Hayes, from Minnesota, and then we love to have our guest here. Dr Tessman Hayes, from Minnesota, and then we are love to have our guest here, dr Tess Judge-Ellis, one of my colleagues from the University of Iowa. So looking really forward to getting to know her. So let's get into it. I always like kind of asking these questions, especially from a guest that knows me. Tess, do you remember the first time that we met?
Speaker 3:Probably when you took health assessment course, Dan, was that it?
Speaker 2:I you know. I don't know if that's the first time, but that is what I remember.
Speaker 3:I do too, you were my faculty. You were destined for greatness even then.
Speaker 2:You are too kind, yeah, but I remember that I got done with my assessment of kind of my final project and you pulled me aside and you're like you should be an FNP. I'm just like I'm okay, but I, you should be an FMP. I'm just like I'm okay. But but I always appreciate that and it's a you know, privilege to be working with you now. So so thank you so much for joining us here. I'll get us started with our first question of the podcast when did you first started getting interested in psychotherapy.
Speaker 3:Well, I think that you know, I think as a nurse you're always, or at least kind of having a psych bent, as a nurse is interested in the therapeutic process that goes on between people. But I think probably when I first got interested in psychotherapy was when I was in my psych NP program and met a therapist then who supervised me then doing interpersonal psychotherapy as a modality, and so I was able to do this with two clients, and so then I started to be interested. It was in my psych program. You know I started as a family nurse practitioner and so always kind of had this bent towards psychiatry, but it was really in the PMHMP program.
Speaker 2:So what made you go back and get your certificate? I've never kind of talked to you about that.
Speaker 3:It's all psych Dan.
Speaker 2:I know.
Speaker 3:It's all psych.
Speaker 2:We're all psych right.
Speaker 3:Nurses are all psych right it is, and I think you know I probably always had a lens towards mental health in addition to family practice. I really enjoy family practice as well. I do both addition to family practice. I really enjoy family practice as well. I do both, and so it was just natural when I went back to get my DNP the University of Tennessee Health Science Center in Memphis they were because it was really early. I got my DNP in 2008,. Before there were only like two or three programs in the country and so they had one where, if you were already a nurse practitioner, you'd go back and pick up your psych post-grad. And so I was like, wow, that sounds perfect for me.
Speaker 2:Yeah, that might date you, because now there are all these programs popping up everywhere, it's the number one growing post-grad cert population. So yeah, thanks, tess.
Speaker 4:So, tess, before I ask you a question, I'm just going to throw out a challenge to future guests on this podcast. Particularly, kate and Melissa and I are looking for an opportunity for somebody to share a really unsavory story about the first time they met Dan, because I think we need to kind of change the dynamic a little bit. So we'll see who dials into that, ok, so, tess, let me? Dan asked you a question specifically about the idea, about you know, psychotherapy. I'm going to ask you a more specific question about can you reflect on your experience through the lens of psychotherapy, and is there a particular case or encounter that crystallized the power of psychotherapy for you, and can you perhaps de-identify and share that story with us?
Speaker 3:Sure, when I was, I practiced for a long time in a small town of a thousand.
Speaker 3:I was first a family nurse practitioner and then I picked up the psych post-grad, so the program, so the clinic, became a real nurse-led, kind of nurse run what are you here for today?
Speaker 3:And I ended up doing quite a lot of psychotherapy and counseling and that's where I did some of my interpersonal psychotherapy work, but probably working with a couple of individuals who had traumatic grief and was able to pull in and see them for, you know, brief sessions Interpersonal psychotherapy is designed to be like a 12 to 15 week session and to see them for a brief time to walk through the process of grief with them. Those were amazing experiences, especially in a town of a thousand where people can just come in and do that. But then I also remember one doing more supportive psychotherapy with a woman who had just been newly sober and from alcoholism and I worked with her for about a year on a weekly or every other weekly basis, didn't do any medication adjustments but just walked with her as she was in this recovery process once a week in this town of a thousand. So those are, you know, just dramatic encounters, lots of. Yeah, those are probably two of my more favorite encounters, yeah.
Speaker 4:Thank you.
Speaker 2:Yeah, thanks, tess, and again owners yeah, thank you. Yeah, thanks, tess, and again probably need to cut me off guys, but I mean I just so I know about this clinic and I guess you know I imagine when you're kind of having somebody you know, a small town of a thousand people, you know, the idea of going to a mental health clinic is really kind of threatening. So was it, was it easier for the clients that you saw, just because you were a family nurse? You know it was just kind of a medical clinic, or or was it?
Speaker 3:Yeah, we had it set up so it had a. There was an office that didn't have a sink in it that we called the counseling room and so it was just had a table with some comfortable chairs in it and you know it was a. Yeah, I just had a. It was interesting because if somebody came in for a med management check or a follow up and they said, you know, tess, I'm doing just fine with this, but you know, I think I've got an ear to move and shift into something else. So it was really quite interesting to have that kind of flexibility and I do think small towns to have that available there without having to drive and without the like everybody knows my car as it's pulling up to the mental health clinic, kind of thing.
Speaker 5:So reducing that and just kind of normalizing it too just, I appreciate that I grew up in rural areas and have a lot of family in very small towns, like 500 people, so to hear that there is that access, um, with some of those barriers reduced, it's really cool. Um, and I know you've mentioned a couple of kinds of psychotherapy that you've used in those encounters. But are there forms or types of psychotherapy that you're drawn to kind of more recently, or do you, you know, draw from a kind of like a range of different approaches?
Speaker 3:I probably draw from more of a range of approaches. At this point I just I, my practice has shifted from that small town to where I work with people who have been formerly homeless, chronically homeless, and so there's a lot of substance use disorder and engagement needing, just people needing to be engaged. So I do quite a lot of motivational interviewing and I think MI is great. And then supportive psychotherapy, just being present with people and working on their strengths and being present with them. And then I don't really use too much IPT anymore because the population isn't really lending itself to it. But it really informs my aspect on attachments because IPT has such a strong attachment base to it with Boldy. So I think about folks and when they have trouble with making attachments or coming in. So it kind of contributes to a lens that I see people through.
Speaker 5:Thank you.
Speaker 6:And Tess, it's so great to hear about your experience, and something that really strikes me is just how the areas that you focus on and work on are so incredibly relevant, like these areas of folks with substance use and using supportive therapy and MI to help them, folks who have traumatic grief and thinking through the COVID pandemic and people coping with all these things going on in the world. So my question for you is really how do you see nursing, being a leader in performing psychotherapy?
Speaker 3:Well, I mean, I think it gets back to the basic.
Speaker 3:Well, first of all, I think that we have to continue to see that every encounter has a potential to be psychotherapeutic, and so that is part of our engagement.
Speaker 3:I mean, when we and if we believe in the nurse patient relationship that starts from the very minute, the minute you meet somebody in a therapeutic encounter, then I think that that the opportunity for a positive psychotherapeutic encounter happens all the time, and the more that we can pull into that as nurses, I think, the more that we can lead.
Speaker 3:I remember doing the IPT training and it was mostly with psychotherapists, and I remember the supervisor that I had, or the psychologist that supervised me, said well, you nurses never have any problem establishing rapport, and I think that that's just a big aspect of nursing too is that people can relate and we understand how to relate to one another. It's just the relationship is so fundamental into providing any sort of nursing care that I don't know if I'm getting at the answer to your question, but I think that nurses, I mean even just the action of you know distributing medications if you're a bedside nurse or you know, we bring something to the table, a high level skill in the nurse patient relationship and seeing that encounter that I think that we discount as part of our skill set. So I think the more we have to own that.
Speaker 2:Yeah, I've always learned from you, tess, is you know that you always find a place where nursing can be inserted into the healthcare system because we're the largest, you know, healthcare professionals in the healthcare system, and so it's always fascinating how nursing gets left out of certain things. You know boards, interventions and things like that. So I always kind of taken from you, you know, find a place where nursing can be, and I think psychotherapy is one of those places sometimes, as we get kind of not thought of as being able to do those kind of things. And so I guess my next question is maybe to kind of think of you know the flip of what Kate just asked. You know or do you have any concerns about psych, mental health nursing? You know nurses using psychotherapy? I mean, you know, is there anything that comes up that you think about, any concerns or apprehension you have about psych, mental health, nurses using psychotherapy?
Speaker 3:No, I don't think so. I think you know, from an advanced practice lens, we're going to fall into that trap of being a medical manager or medication manager and the developing relationship and that therapeutic relationship takes time. And when we're reduced to seeing people in a 15-minute or even 20-minute encounter, it still is therapeutic and psychotherapeutic but it really inhibits the ability to really practice good nursing care, I think. And so to that end, I think this reliance on medications as solving everybody's problem and discounting what goes on in the encounter with the nurse practitioner, the psych MP that is, I think we have a risk there and that's probably through employers and you know reimbursement systems. But I think the more that we do you know programs like this and the work that you guys have done on psychotherapy in practice and in curriculums and stuff like that then I think that it's going to stay alive.
Speaker 3:But I do think there's a risk. I don't know so much. You know I used to kind of get concerned about the amount of post-grad people coming in that are nurse practitioners with primary care background or anesthesia background coming in. That they are. I think that there's this idea that, and some may be attracted to the counseling component, but oftentimes it's more of a medical model. I think I always have to coach that. You have to put on your therapy hat. I mean, your therapeutic use of self is an advanced practice skill, just like writing a prescription for a psychotropic agent is a skill set. So I don't know if there's a risk, but I think that programs need to are going to have different strengths as they're pulling people into the programs that are post-grad certs and because this kind of therapeutic use of self and the kind of lens of psychotherapy is not a part of all the programs you know and certainly not a part of what people are coming into psychiatry for sometimes. Thanks, Tess.
Speaker 3:Does that get at? Your answer yeah, okay.
Speaker 4:Tess, I'm thinking of a Robert Frost poem of two roads diverged in a path right, and one path is where you want the future of psychotherapy for advanced practice nursing to go and the other path is where you think it's going to go. Can you speak to both paths?
Speaker 3:Where do I think it's going to go? I think that we need to have more programs in our post-grad education that gets advanced practice nurses more prepared and confident in delivering psychotherapy. It was really great. I just went to a CBTI or cognitive behavioral therapy for insomnia for our workshop, which was perfect to go to and to be able to incorporate that. So I think that the more we have those things available and see that, so I think that that's like an opportunity for that and I can't remember the other road that you asked the first road you identified.
Speaker 4:Really well, it's the one you want us to go down yeah what's the road you suspect we're going to have to go to?
Speaker 3:wow, um, I don't know. I guess I'm optimistic that that you know, you know, don't know. I think that the I don't know, that we are becoming well. I think I'm a little optimistic too, because I do think that there's more nurse practitioners building their own practices and I think that there can be opportunity for counseling and supportive, you know, incorporating counseling and psychotherapies into their practices that way. So I don't think I'm going to go down the negative route, except that you know who knows where medications are going to go to.
Speaker 3:But I mean they can't be the only use to that. I mean there's no. I mean I think we just have to keep reinforcing that, that as nurses we have this relationship based practice. These interactions are psychotherapeutic. I mean too many patients. I mean you leave the office. They come back to you the first visit and they said I left my, I left the office feeling so much better and they never took another pill. They didn't take a pill but they felt better because of that therapeutic interaction. A good, sound plan for moving forward. So I think that we just need to keep reinforcing that we are psychotherapeutic and that picking up different psychotherapeutic modalities or counseling skills is just a part of, you know adding tools to the toolbox, so I'm not sure I'm going to go down that road. Sean, too far.
Speaker 4:Thank you, and your answer was perfectly Rogerian in its answer.
Speaker 3:Okay, all right.
Speaker 2:I think she got cooking there. She was, yeah, she was getting. She wasn't going to go down that road for you, sean, that's great, that's awesome.
Speaker 3:Well, I think eventually in the poem both roads get back together again, don't they?
Speaker 4:Yes, just a little bit further down the road.
Speaker 2:That's right. So optimistic, that's great. Yeah, no-transcript. And psych isn't all about just learning how to prescribe Seroquel.
Speaker 3:And that's. That's something that I remember you've always said is, you know that's not the only thing you're coming to school for, so that's great. I remember a psychiatrist I used to work with and we were talking about the different perspectives of delivering care and he said well, you know, tess, I know how to nod, you know, and I was like what you know how to nod? Well, this is, you know, what we do is more than just nodding at the thing. There's a lot that goes on in there and you know people come in with distress and it's more than you know. You approach it in a much, I guess it's just much broader. I mean, we all need to be good at what we do from a prescribing standpoint, if that's what we're going to do, but we need to acknowledge that encounter and what the other people, what they bring to the table, what patients bring to the encounter.
Speaker 5:And so we've talked about medication and just the perception of the over-reliance on medication, sometimes as a barrier as well as maybe understanding. I've heard you say understanding it's more than an odd in terms of this work, but maybe in addition to that, or maybe you want to expand on those points about what you see as barriers for more PNHMPs using psychotherapy in their practice.
Speaker 3:Well, I think it probably starts with the schooling. I think we probably could do a better job of listening to recordings of students and giving them feedback and helping them see that they are developing these basic skills and the such. And I think, as they're going out and getting mentored, finding a mentor who wants to work with them and provide them with some structured support for pursuing extra certification, I think that it's you know, there's no way to really say, unless you're going to put somebody through their PMHMP program and say you're going to become a specialist, like I did and sought out extra support for interpersonal psychotherapy, you're really preparing them to become good therapists. But I think that we need more offerings in addition to what goes on in their graduate programs.
Speaker 2:Couldn't agree more yeah. I think that's what we talk about a lot here too. It starts at the education level, and there's a vicious cycle that can occur. If there's not good faculty out there ready to teach these skills or keep this important skill set in the program, then that's going to be the problem too. So thanks, tess, appreciate it. I just really want to thank you for joining us. Anybody any other questions? And we got some time here. Yeah, tess a question for you.
Speaker 4:One of the things we hope to do. You know, one community we hope to reach with this podcast are future psych NPs, right? So if I threw a question to you about what's a message or two you want to send to students who are thinking about applying to a psych nurse practitioner program in the lane of psychotherapy, what are some messages you would want to relay to them? It sounds like.
Speaker 2:Sean made this an assignment for his students, say.
Speaker 3:What are some messages that I'd want to relay to somebody about psychotherapy and being a psych nurse practitioner who's thinking about it? I guess that they enjoy, do they enjoy the lived experience of somebody you know and they're curious about the way people interact when you. I also think that the one thing about being in nursing which is really great is how we define. Health is so much broader than just the absence of disease. You know it's a, you know just this forward movement of creative energy and towards becoming more fully human. I mean, we can define it in multiple different ways from all of our great theorists. But I think you have to be excited about the brain and I think the other thing I think about psychotherapy and I'll explain it to patients sometimes too is it's like physical therapy for the brain, and so you know you enter into.
Speaker 3:I mean, physical therapy is all about doing what I call these stupid little band exercises that make you exercise these really small muscles and it's like hard to do.
Speaker 3:And I think the same is true when you go into psychotherapy. The therapist, nurse therapist is asking you to make really small but painful little steps of moving forward in insight. Or you know, homework assignments, examining encounters and that sort of thing and it's really small work. But over time and I mean a lot of times you're in physical therapy for two to three months you make small changes and sometimes there's big aha moments right at the beginning. But if you can make a small trajectory of change and build on that over time and give people skills we all know that therapy skills you know last longer than medication and we know that psychotherapeutic interventions are longer lasting. I mean you can give somebody ibuprofen for two weeks for a shoulder injury or you can send them to physical therapy for two or three months and that physical therapy exercise is going to last longer. So I think it's exciting to have those you know therapy skills in your toolbox.
Speaker 4:Thank you very much.
Speaker 2:Awesome Super job. And again, just looking ahead, looking at our schedule, we will be back in a few weeks. We've got some again. I don't want to call it spring break number two, but we're going to be off a couple of weeks, so we'll be back here too, and we've got a bunch of great guests coming up. If you're really excited about this podcast, we're actually lining up people to be speaking with them, who actually they had Hildegard Peplau as an instructor. They are students directly under them, so real excited about having those people on the podcast as well. So before we sign off, I want to kind of go back to this idea of spring break After dark with Peplow's ghost. What'd you guys do over your spring break? Do anything fun. I'm looking at somebody in particular here on the podcast. Anything exciting to report? Kate.
Speaker 6:Well, I traveled to beautiful Edmonton, alberta in Canada, to defend my dissertation at the University of Alberta. So, as Dan graciously mentioned at the beginning of the episode, I am now Dr Kate Molino, so very, very pleased to join this esteemed group of folks in having my terminal degree. That is so awesome, kate, thank you.
Speaker 4:And I can't beat that with anything that I've done during spring break Nothing, really, not a thing. No, can't even touch that.
Speaker 2:Yeah, right, can't even touch that right, melissa, anything.
Speaker 5:I'm out with my kids. Did some work paid in a bathroom, so nope, kate wins well, I was going to mention, you know, test.
Speaker 2:you mentioned going to um, this conference where you learned about cbti, um. So I was at that conference. Uh, it's the international society of psych nurses. We held it down in new orleans and somebody that you might know got induced as the president of ISPN. So that was fun. I do say it's a heck of a lot of weight, but I'm really excited about this next year and, for those of you listening out there on the podcast, we'd love to hear from you about how your experience with ISPN and maybe how ISPN can help you help your practice.
Speaker 2:These are challenging times, to say the least, a lot of chaos going on at the federal level with ISPN and maybe how ISPN can help you help your practice. You know these are these are challenging times, to say the least a lot of chaos going on at the federal level. You know organizations are the places to come, and so we're really looking forward to we're actually going to start to implement some listening sections, listening sessions through ISPN. So, again, you know a lot of things going on, a lot of things that are unfortunately affecting how we care for our patients, how we do research, education, policy, development. All those things are being affected by what's going on in the world today. So I want to hear from you. I want to hear how you're dealing with that and would welcome you to ISPN to find a warm home for that. So, all right, that's my little spiel. Sorry, guys took it over that.
Speaker 6:So all right, that's my little spiel. Sorry, guys took it over, not at all. Congrats, dan, and you know I would say you know, in times of turmoil like these, we're so glad to have people like you. You know leading our profession, so we're so proud of you.
Speaker 4:Absolutely. Yeah, you know, margaret Mead said it perfectly. She said never underestimate the power of a small dedicated group of people to change the world, because it's the only thing that ever has, that a small dedicated group of people to change the world, because it's the only thing that ever has.
Speaker 2:That's right. Love it, and I think we'll wrap it up there. Very well said, sean. Nice Thanks again to Dr Tess Jajelis here. Look forward to another episode in a couple of weeks and, yes, like, subscribe, comment to the podcast. We'll see you then.
Speaker 1:Bye reasoning. Too much salt like this, too much seasoning. They feel it. Therefore, it's true work hard until those thoughts are finally leaving so you can be you. Uh, they feel it. Therefore, it's true, work hard until those thoughts are finally leaving so you can be you. Guided discovery identifying, challenging your beliefs, reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until they cease. Yeah, discovery identifying, challenging your beliefs, core beliefs, reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until they cease.
