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
Psychodynamic Nursing: A Lifelong Journey with Cheryl Puntil
Have we lost the art of truly seeing our patients? In this profound conversation with Cheryl Puntil, a psychodynamic psychotherapist who recently retired as Chief Nursing Officer at Austin Riggs Center, we explore the unique power nurses bring to therapeutic relationships after her remarkable 43-year career in psychiatric mental health nursing.
Cheryl shares why she chose nursing over other professions, calling it "the best profession ever" for its unique integration of psychology, medicine, and social work perspectives. With passionate conviction, she explains how nurses observe patients in contexts no other providers witness, creating unparalleled opportunities for meaningful connection and healing.
The conversation ventures into fascinating territory as Cheryl describes how psychodynamic principles operate not just in individual therapy but throughout entire organizations. She reveals the concept of "parallel process" – how themes emerging in staff meetings mysteriously appear in patient community meetings, creating unconscious connections throughout therapeutic communities.
Perhaps most compelling is Cheryl's concern about the future of psychodynamic nursing. Despite overwhelming evidence that combined therapy and medication approaches work better than either alone, healthcare systems increasingly devalue nurse psychotherapists who don't prescribe. Meanwhile, educational foundations weaken as non-psychiatric specialists teach mental health content in nursing programs, and many students never experience psychiatric clinical rotations.
The episode concludes with an inspiring tour of Austin Riggs Center's unique approach – an open-setting residential treatment facility where patients lead community meetings, engage in creative programming, and receive intensive psychodynamic psychotherapy four times weekly. This 100-year-old model stands as living proof that relationship-based care produces transformative results.
For anyone concerned about the direction of mental healthcare or seeking to deepen their therapeutic approach, this conversation offers both validation and a roadmap forward. What might our healthcare system look like if we truly valued knowing our patients?
CLARIFICATION FROM THE EPISODE
Mrs Cheryl Puntil does have a certificate in psychodynamic approach but is NOT a psychodynamic therapist as she does not provide direct care to patients in her role as CNO.
Also the the Austin Riggs Center opened in 2019 not 2017.
Please reach out with any other questions or comments to Mrs. Cheryl Puntil at cherylpuntil@gmail.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
Yeah, just my take on things. My answer number two I think we're recording.
Speaker 2:Welcome back everybody to peplau's ghost. Another episode so excited. Uh, I'm thrilled for our next guest here, um cheryl putinil. I hope I'm pronouncing that right uh, puntil, thank you thank you.
Speaker 2:Cheryl puntil will be joining us and sharing her experiences and really excited about the summer we've got lined up here on Pep Lau's Ghost. You know kind of to give a little background with Cheryl. She actually approached us about being on the podcast. So I'm super excited about this idea that the podcast is actually reaching people that are interested and want to be on here. So really encourage you, if you're listening to this right now and you like this podcast, like this content, reach out to myself, dr Kate Molino, dr Sean Convoy, any of the people that are here on the podcast and really just kind of reach out and say, hey, I want to be on here and hey, we'll probably allow you to be on here. We're not very picky. We want to kind of have people, we want to generate that interest and really kind of move that needle and keep keeping psychotherapy within the role here.
Speaker 2:So my quick introduction with Cheryl Puntil here is that she is, or was recently retired, the CNO, the chief nursing officer at Austin Riggs Center, which is a psychodynamic facility in Massachusetts, and has practiced as a PMH CNS. Melissa, I know you're going to ask me what that means. That's a psych, mental health certified clinical nurse specialist. She's practiced for 43 years, so congratulations, cheryl. You must've got your certification when you were 12. Does that sound right?
Speaker 3:Yeah, in 1998, that was a long time ago.
Speaker 2:It's a minute, so that's great. She's also certified as a psychodynamic psychotherapist and again really excited to kind of get to know her experience in using these forms of psychotherapy. So my privilege of asking the first question is when did you first get interested in doing psychotherapy? What was your first foray into it and really maybe what got you hooked?
Speaker 3:So I have a certificate in psychodynamic psychotherapy, which was a two-year program that I did after my master's in clinical nurse specialist at UCLA and at that time California UCLA know, the UCLA split, the NP. You could go into either the NP or the CNS, so I chose to go to the CNS. I didn't particularly want to prescribe and so, but I did learn because I think UCLA was so biologically motivated you know the approach was very biologic that I learned a lot about medications and you know that, and I felt like I needed a little more understanding of what drives people, what motivates people, what are their. You know a lot, I believe that patients or people have, you know, the unconscious, are things that you know. How do we get their unconscious into awareness, to be more self-aware so they can make better decisions, et cetera? So I did the two-year program at the Southern California Psychoanalytic Institute and I did actually do psychotherapy at that time with four patients that were older.
Speaker 3:I worked in geriatric psychiatry and I did that for most of my profession. But I also take the psychodynamic piece into supervision, into leadership, into working with patients in the inpatient setting, working with students, working in organizations, et cetera, because I think that that's, it's just, you know consumes me in a way that I it's just the way that I think dynamically and you know. So, in terms of psychotherapy, I use the patient relationship and the nursing therapeutic relationship as a way to communicate with the patients and to develop a rapport and to help the patient find their way to self-determination. So, yeah, that's just Great.
Speaker 2:Well, I appreciate that. I mean, I think what really kind of stood out a little bit to me too is is the idea that you use this within organizations as well. I think that's a if I can say this I mean that's a very CNS kind of thing to do. I mean, I think you think not just of the person, but you think of populations, you think of organizations and how you can apply that. Do you mind sharing maybe an example of that, how you applied psychodynamic approaches to an organization, or can you think of something just off the top of your head?
Speaker 3:Well, it was interesting that because, you know also, the community is very important, right?
Speaker 3:What's going on in the community and in a residential center, treatment center, where people live, where patients live and staff are involved in the therapeutic community, what I find happening unconsciously is that the patients or the staff will reflect it'll be like parallel process. We'll be in a meeting and you know, and go through the same kind of issues or discussions about, let's say, threat to the organization or whatever, and then we'll go into the community meeting and the patients will be speaking about the same thing as well and it just seems like, wow, we just talked about that. And so it's this dynamic, sort of unconscious way of thinking in an organization that one group affects another group. Whether we, you know, it's not so obvious, but until you know, we have to look for that. There's threads that affect the community as well as the professional, et cetera. So there's a lot of links there and I just felt that that was fascinating. You know, that was fascinating. Thank you for sharing that. That was, you know, very insightful, so that that was fascinating.
Speaker 2:you know that was fascinating. Thank you for sharing that. That was, you know, very insightful, so appreciate that, kate. I think you got the next question.
Speaker 4:Yeah, it also makes me think, Cheryl, about how, you know, I do groups provision with my psych and peace students and often we talk about how you'll have a day in clinic where everyone is bringing up the same stuff. Right, there are these sort of invisible threads that are woven, that weave us together. So thank you for that.
Speaker 3:Well, I remember one of the analysts that I was supervised by while I was in Los Angeles. He told me think of the common thread, like you know, in a weaved, you know in a rug that's weaved. Where is that common thread that's being weaved through the whole rug? Or the patient, or the staff nurse, or the CEO, or me myself? Right, what are the common things? That's the thread that you have to follow and that will lead us, I think. Look at that and evaluate it and really try to understand it.
Speaker 4:Yeah, and, and so my question for you is you know, if you can, we love to ask here on the podcast people to share stories of maybe maybe the first time you performed psychotherapyotherapy or maybe a session you had with someone where it was kind of like a aha moment happened and it really taught you something. Is there any situation like that that comes to mind that you could share with our listeners?
Speaker 3:well, you know, it's not. It's not while I was doing psychotherapy, it was while I was, I think, as a nurse and a in a in a geriatric psychiatric nurse. You, you have to really try to be a detective. And and um, we had a patient once that was very young, who had um, she had come onto the unit and she was neurologically felt. We felt that the nursing staff felt that it was, she was neurologically impaired, meaning that something had happened to her physically or medically, and there was other people who thought that this was all psychiatric and that she was having a break, a schizophrenic break, and it was being a detective, it was interviewing. You know, like I think hilliard peplow was the one that talked about knowing your patient you, you have to know your patient and it's how you ask questions and who you ask the questions to, because you're not going to get the, the answers that you want. Well, the answers that you want, well, the answers that you want, I mean, or the answers, depend on the questions you ask, right? And so I thought that and I talked, it was a puzzle as to what was happening with this person, and one of the nurses told me she said Cheryl, I think she's worse with the medication.
Speaker 3:And then I kind of put two and two together and I talked to the family and the history and we found out that she had a sore throat in, you know, a sore throat that was never really treated and I, we, we got her a strep titer and she had the biggest, the highest level that they had seen. And we found out that she had the pediatric on pandas, you know, the pediatric autoimmune neurological disorder, and and and it was so interesting because the team that saw her as an adult, like the neuro team that saw her as the adults, said one thing completely different than the infectious disease team in in peds infectious disease because she was, she was young, she was right on the edge of adult, you know, adolescent, and completely same, same person, same manifestation of the symptoms, but completely different assessment. And so you need to look at the patient as well as the family and the context of when things were, how things happen in the context, and so that's that was an aha moment for me about how important it is to be thorough, to really know your patient, to listen to everybody, listen to staff, to look at your patient. I don't think the staff now are not staff, but sometimes you're not looking at.
Speaker 3:When I go to my primary care provider and get my physical, they don't necessarily even look at my. Listen to my heart. They don't have me on dress anymore, and so are you really looking at your patient? That's, that's what I would think. In terms of psychotherapy, you know there's always therapeutic moments. Every interaction should be therapeutic one, or with intention. That's how I kind of see it, and you know so. I don't know if that answers your question, but I think so.
Speaker 5:I'm seeing some nods. Thank you for sharing. I would love to pivot just a little, although I hear aspects of what might come out in your response to this next question how do you see nursing?
Speaker 3:being a leader in performing psychotherapy. Psychotherapy. Well, you know, nursing is really for me. People ask me how come you didn't become a doctor, how come you didn't become whatever? I think nursing is, for me, the best profession ever, because it's a conglomeration of a lot of different things, of social work, of psychology, of a lot of different things of social work, of psychology, of medicine, of physical therapy, of you know, and it really what I feel is that the nurse's role is trying to assist the person become less ill, I guess, or move towards wellness, either because as a response to their illness or as a response to a perceived or thought of their illness or to the treatment of that illness. And so we have a and we see the patients more in terms of spending time with the patients, more than any other profession, I think. And so, as a nurse, we have a lot of impact, we can have a lot of impact and we're in charge of the milieu, we are their eyes and ears, the physician's eyes and ears or the provider's eyes and ears, and can see patients in the context of their behavior, you know, because there are many.
Speaker 3:In many ways the patient will act very differently with the therapist An hour. You know it rigs, they, they take, um, they get very intensive psychodynamic or psychoanalytic psychotherapy four times a week and then the rest of the time the patient is in programs or in community meetings or socializing, or they're in their activity programs and just doing activities but so, and or else they're just kind of hanging out with the nursing staff or with the therapeutic community staff, and that is when we can gain a lot of information about about the patient and what they're thinking and what they're experiencing and what they're struggling with, and we can make an impact then as well. And I also think that you know we meet nursing staff. They meet with patients. You know, even when I was on an inpatient unit, on our unit, when I first started, we had community meetings, you know, and excuse me, and everybody attended, everybody. It wasn't just this one person. You go to one appointment and then you go to another appointment and then you go to another appointment and no one, you know, and and the patient is seeing, all the staff are there too. So I remember that and that was really, really important.
Speaker 3:That seems to have gotten lost in the inpatient settings, the community meetings, and then we also have teams. You know where there's continuity. I know for the nurse in the inpatient setting. We did primary nursing when I was at UCLA and also when I was at Mayo. We did primary nursing and also at Rush when I was at Rush and the continuity was so important because you really got to know your patient, know your patient and if the patient also kind of knew what the limitations were or what the boundaries were, the frame you know was in the relationship, um too, and we have to keep keep repeating the boundaries of the relationship or the frame of the relationship, so you know um well, the relationship keeps coming out in these examples and the humanness and multidimensionalness of a person, of the patient, the patient, but as on, like a human level, with our limitations as well and we try to clarify that with patients.
Speaker 3:I think the patient has a sense of what a nurse should be and that needs to be clarified right in the beginning of the relationship, when you're in the orientation phase, when you're trying to develop what the patients, collaborate with the patient and build on the alliance. And what are we doing together Not what am I doing to you and build on the alliance and what are we doing together, not what am I doing to you? I think as a psychotherapist, you know one of the biggest roles is trying to understand the person and in many ways I don't think patients have difficulty. I'm using the word patients and I know it's interchanged with clients, but I use the word patients and they may have a hard time communicating or identifying what they're feeling or what they're thinking or why they're thinking there, or managing or tolerating their, their feelings. And I think the therapist or the nurse can help them, help them with that, so they can kind of calm down their system, to really try to, I guess, accept or understand or make more choices or be more responsive versus reactive.
Speaker 3:I think that that's really, really important. It's a big part of nursing staff being with patients, you know, being with them, not doing for them unless they can't do it for themselves. And then you know and also thinking about is it developmentally, what are we doing in terms of our interventions that are helping the person developmentally or to mature is, as peplow would say, you know, um, it's a maturing force. You know we're not, we shouldn't, um, I guess we can impact that in positive ways. So the person grows, you know, like maybe their personality or their thoughts could be less rigid, or we can open up, be more curious about what is happening so they, the patient, can talk about it versus right and be open in it and let allow the patient to be who they are and free to you know, free to explore with a person, with a therapist.
Speaker 2:I love it, Cheryl.
Speaker 2:I mean this is, yeah, I'm always wondering too, because I mean I'm assuming all the nurses listening are just getting goosebumps, like I am, but I'm wondering how other professions kind of hear this message, Because I, I agree, I think you know nurses within healthcare systems maybe this is, you know it's, it's one of those things where we're a profession that gets undervalued and and ignored a lot but we're the kind of the glue of an organization, right, we, we make it, we make it all happen, and it's one of those things that you know we don't get represented well, like on a billing form. People don't kind of, you know, when they're in trouble, ask for a nurse specifically, but then a nurse is always there. Right, it's, a nurse is always going to be there because they're they're just everywhere throughout a hospital system. So so maybe that's my question, maybe to kind of lean that towards my next item, to maybe think about or hear your perspective on. You know, or do you have any concerns about psych, mental health nurses using psychotherapy, either now or in the future?
Speaker 3:I have concerns. Well, I, I don't. I hope that they're getting trained. That's that's one thing that I'm getting a little bit concerned about right, that I get concerned that people are not trained in the way or get supervision, because that's so important, that have to have that space to think and to be self-reflective, space to think and to be self-reflective, and that I'm. I hope that that still is valued or or that we can bring that back into. I mean nursing staff. They're running from what? They're short staff, they're running from one space to the next and they don't really get a good. They may not get supervision. I hope that they are getting supervision with the nurse practitioners. I'm not sure, but they're expected to be prescribing.
Speaker 3:I know that I, I I'm actually it's interesting that I'm looking for psychotherapy to be to me, to be more psychotherapy jobs, and I'm not finding. If I'm not a nurse practitioner, forget it. They don't want me, which I've, which is really, and I've said to them I just think you're making a big mistake because I think that I can provide a lot more, especially in, like, maybe, primary care settings. You know where, where the you need an adjunct person who understands medical and medical and psych, and I do understand the medications and sort of the actions and side effects and contraindications, et cetera, and indications I just can't prescribe and so I'm discounted. So just much like I think maybe the psychotherapist a nurse psychotherapist might be therapist might be undervalued.
Speaker 3:I also think that if you're prescribing there's a huge you know Dr Mintz at Riggs. He wrote a book on psychodynamic prescribing, psychopharmacology, and there's so much about the patient's relationship to the medications and what it means and what they think it might do for them or not do for them or how they're attached to the medication. That really needs to be discussed and I hope that the nurse practitioners are using that also as a way to develop a relationship and enhance the effects of the medication. Because I think we know what is it? 33% effective rate for medications yeah, yeah, right.
Speaker 2:Guiltiest charge. I think we say yeah, right, I mean, it's right yeah.
Speaker 3:So we can't just be prescribing, we have to be doing both and I hope that that gets emphasized in nursing programs and advanced practice psychotherapy programs. And I do hope that there is a piece. I'm not sure because I haven't. I remember when I was in grad school that I did have an analyst, a nurse analyst, teaching my psychotherapy class, and I think that's when I first got interested in the psychodynamic piece. Her name was Rose Vasta.
Speaker 3:I remember her specifically and she said you have to like your patient, find one thing that you like about them and connect to them. And connection is so important, right For for healing and for, um, even suicide prevention. How important connection is. Uh. So this she, she sort of got me very, very interested in the psychodynamic piece. And there are nurses that are interested in being analysts to the programs and I hope that the programs are more willing to accept nurses as analysts, because we have a very big, nice big perspective. We have the psych perspective, we have the medical perspective, we have family, we see patients with families perspective. We have family, we see patients with families, we know family dynamics, systems. I mean I just think you know it's the response to the person's illness or the person's the treatment of that illness, that we that nursing, that's the nursing role and we can impact the person so much.
Speaker 3:So yeah, I don't know if I'm answering your questions or just going off on a tangent?
Speaker 2:That's, that's what I hope really. I mean, tangents are good, we're accepting of tangents here. We're not going to, we're not going to look to prescribe anything for that. But yeah, I know, I think I think what you said too is important because you know the undervalued.
Speaker 2:I think I've shared a story before where I interviewed for a job once and asked about my ability or capacity within this role to do psychotherapy and the person interviewing me just kind of really strangely and almost kind of chuckled a little bit, like that's why we got social workers, I mean.
Speaker 2:So I just knew right at that point the interview was over and I wasn't going to be coming there. But it is something that you're right, it's not advertised and it's. And it's interesting too because and maybe share your perspective on this too because we did a study, you know, as part of this team, where we looked at you know what forms of psychotherapy PMHMP programs are utilizing and I'm sorry to say that psychoanalysis was kind of far down on the list. You know it was CBT, it was motivational interviewing, those kinds of things, those kind of, you know, bread and butter kind of forms of psychotherapy. And so again, thinking about that undervalued approach here, undervalued as a therapist and undervalued as a analyst and our dynamic approach. Do you kind of, do you have a perspective on that and why that undervalued?
Speaker 3:is there or yeah, do you have a perspective on that and why that undervalued? Is there? I think, coming from a psychodynamic perspective, you have to. It's harder. I shouldn't say that, but there's no manual. I mean, really, is there a manual? Is there? You're the tool. You are the tool that has to be refined and self-reflective and responsive to the patient and hold oneself in. You know, ethically, morally, and come from a perspective of really understanding the patient.
Speaker 3:I think that's where patient-centered is. It's not doing whatever the patient wants you to do. That's not patient-centered. It's really addressing the core problems, the core issues with the patient, and that takes a lot of work and it's not trying to get rid of a problem. It's not. It's not it's. It's it's helping the patient understand where that, where the, where that issue is coming from and the repetitiveness of it and the compulsive, the compulsive nature of it and the rigidity of it. And it's working through something over and over and over and over again again and coming to it with a perspective that, okay, we're doing this again, we're doing this again and it's okay, it's okay. Okay, because the patient needs time and they need the relationship and they need the space, and that I don't think that's what I'm afraid of is that the there's not enough time. There's not enough. The expectation is I have this problem, I want to get rid of it, and if you can do it for me quickly, that's great. And that's just not the way that psychodynamic therapy works.
Speaker 4:I don't think at all so and Cheryl, I think what you're saying is so interesting and important because it makes me think about how many of us are working within health care systems that see working over the same thing over and over again as a failure. They want to see concrete, measurable, billable outcomes for everything that we do. And that's very hard to quantify what you're describing, and I think so much of this sort of emphasis on CBT and MI and stuff is because it's brief intervention, that is, you know, measurable in some way. And so you know there's a bit of a mismatch right between our very quantitative system and this very qualitative work. And so, you know, on that note, I kind of want to ask you our final question, which is you know, given that and given everything you say, what do you see as the future of psychotherapy for PMHMPs or advanced practice psychiatric nurses?
Speaker 3:Well, first of all, before I answer that question, I think there's a place for the for when someone is really really in distress and and suicidal and, you know, for like, even for patients that need to be have electroconvulsive therapy, which was very effective, so they can kind of get into a place where they can do the psychodynamic piece. So that's just one thing that I want to say. There is a place for that. So what's the future? I think we hopefully can do more educating of those that hold up our purse strings. I guess that people that were out there doing it, who are doing psychotherapy, can educate and inform patients and insurance companies and even get on insurance companies to try to make like, even even get on some of the regulatory bodies like Joint Commission and Department of Mental Health and try to enter in, involve themselves and integrate these principles to, uh, to allow us to practice up to our you know, our highest authority. I think that that's that's, it's, you know that that's what we need to do. It's just an open door. There's a lot of opportunities. So that's one thing and, um, I think for also for faculty, you know, for I'm is, you know, just from the undergraduate level, because I've taught. I taught at Hawaii Community College, but also I taught at UCLA and I taught et cetera.
Speaker 3:But but what I'm seeing is that, like, med surge nurses are teaching psych and that that shouldn't, were someone else is teaching or they're expecting me to teach. I mean I can teach fundamentals and and go to the nursing home, because I was in geriatric psychiatry, things like that. But if you want me in labor delivery or ICU, I don't, you know, I don't think that's going to work. Or a med surgeon is teaching psych and that's accepted because of the limitations of not, maybe not not a lot of us around. The pay isn't that great.
Speaker 3:I mean, I feel like I'm a dying breed really, you know, and when you, when you're an educator and really value and passionate about psych, mental health, nursing, I'm how many? I don't know how many people are willing to do the clinicals as well, you know they're not a lot of people that are willing to do that. So I, in that way, I'm afraid, I'm afraid for, for for the psych mental health nurse, for for the psych mental health nurse, and I also think we need to advocate for psychotherapy as being effective or necessary in also combined with, maybe, medicaid. You know with medication that the two together work much better than either one, maybe either one separately.
Speaker 2:Yeah.
Speaker 2:And that's what the data says. Right, and I appreciate you talking about this upstream issue of you know undergraduates and I know so many college nursing programs I know of this too. You know where they make you do those four core classes. You know med, psych, geropedes, and you know, and you have to do two of them. So so many students don't even get psych in their undergrad and then, unfortunately, they go into grad school, you know, after discovering their passion for it, and so then they don't have that foundational skills too. So I appreciate you bringing that up. That's something you're right administratively and getting on those boards. You know we need to kind of speak up for this sort of thing, cause if it don't it'll just die on the on the vine, like you're saying. So, um, one thing I and again this isn't kind of some of our standard questions, but I think this is kind of I'm going to call this kind of our after dark part of our podcast today, after dark with Peplow's ghost Um, because I wanted you to kind of be able to highlight your organization, austin Riggs Center.
Speaker 2:You know this is an organization that sounds like you devoted most, you know, several years of your life at least to and again thinking about it. As far as you know, not available to everybody. You know I will say I'm from the University of Iowa. You know, finding a psychodynamic facility to send some of my patients is very challenging. I pretty much have to send them to Chicago to find some sort of Adlerian type of approach which is, you know, psychodynamic in nature. But you know, one of the questions I do have about your facility, if you wouldn't mind kind of just talking about a little bit, you know, kind of brag on it a bit, but also kind of share. Why is it called Austin Riggs? Because I will share kind of.
Speaker 2:A facility that I worked at was called the Robert Young Center. I'm not old enough, but I understand that they also. I'm sorry, robert Young was an actor on a very wildly popular show for a while and he's a physician and so it was interesting that he actually came it was like from California. He came to the middle of the country to get psychiatric care and got better and so donated a lot of money and that's how this our, you know, one of our local community mental health centers was developed, and named after Robert Young Center is the name. So so it just, if you wouldn't mind, cheryl, just kind of sharing a little bit about the Austin Riggs center and, uh um, how it got named and what you're maybe most proud of it for.
Speaker 3:Well, I, I can do a little bit of that. Uh, and he, austin Fox Riggs, was a psychiatrist, american psychiatrist, and apparently he came to the Berkshires, which is the western part of Massachusetts, and landed in Stockbridge and formed the Austin Riggs Center, and it's 100, it was formed, I believe, in 1917, I think it was, and so in 20, was it 1907? I think, or no, it was 1917. I'm sorry. So I think in 2017, we had our 100-year anniversary. In 2017, we had our 100 year anniversary, you know, and it's, and what I want to tell more, too, though, is, and there are there is the emphasis on, uh, the residential piece, or residential treatment centers, which I don't think are, are, um, are valued or even known. A lot of the residential, if you think of substance use, the 28-day substance use program but there are residential treatment centers that are popping up all over. Menninger has one now, mclean has many, and I think that that might be a really good place for a nurse practitioner or a psych, mental health or, you know, dnp, to get involved in that and to use a psychodynamic approach there, because you have people there for a long period of time that are really trying to. You can develop a relationship with them.
Speaker 3:The other thing about austin riggs, which I think is um, which I think is another issue that is problematic, not when I think boston riggs, I think of the open setting. There are no locked doors. They are their patients, are there voluntarily, on their own will doesn't mean that they have don't have crises and things like that they do. But we work through that with people and we build on the alliance you know the therapeutic alliance with, and then they're in a very intense relationship with their therapist. So that's sort of like the centrality of it. And then we social work, psychologists, et cetera, nursing staff, therapeutic community staff, et cetera, nursing staff, therapeutic community staff also work very diligently and intimately with the patient right, and they're on team. So there's continuity.
Speaker 3:But the other thing about this center is that you know it's an open setting. There is a very robust patient government. So they have community meetings that are led by patients Monday through Friday. They have representatives from facilities, from the, you know, from gym, from the activities department, and then there's also an activities department. That is really quite, I think, beautiful in terms of it's a non-therapeutic space. So they hire artists. We have a person who's the director of Shakespeare and Company, who does? They do two plays a year. One is a Shakespeare play, I can imagine, and the patients get involved and you know there's also a greenhouse, there's ceramics, there's um music as well and we try to get people um to. You know, there's so much competence, so much competence, and you know people have left Riggs and gone and done you artwork and been artists and been been actors and and that has been a huge part of the of the treatment as well. You know the creative side that someone needs to explore and value and embrace, and so that's that's really important. And so there's also a very robust therapeutic community staff so they're hired to be in the community, they work with the patients.
Speaker 3:In terms of the different programs that the patients are in, there's a, there's a nursing program that the patients reside at the inn, which is, which has like 40 beds, and they are a group program, which there's groups that the therapists, that the analysts, the therapists run as well as nursing staff run, as well as the therapy community staff run. And then there's different groups that focus on living in a smaller home, you know, but still on campus, that focus on how do you live in a family, how do you be a civilian, you know, a community member, what kind of community do you want? So there's a lot of freedom in that. And then there's also, then, you know, trying to get more into the community, into the Stockbridge community or to the Berkshire community, maybe going back to school or working or you know, and then kind of transitioning out, all still getting the four days a week intensive psychodynamic psychotherapy which is the core, you know, central piece of the treatment.
Speaker 3:So and they also get, they have a psychopharmacologist or a psychiatrist or a provider, a physician who provides medications, who could be their therapist or they could be separate, you know, they get maybe an MD and a therapist. So they have a huge team, a very consistent team and a dedicated team to the, to the person as well. So it just is the it works, but the, you know, and the minimum, the length of the minimum length of stay is six weeks where there's an evaluation period and at the end of that there's a case conference. Everybody weighs in, including nurses, about what, how their work, they showcase their work with patients. So you know it's probably one of the last open setting residential. Well, yeah, you know, you used to have Shepard Pratt Chestnut Lodge. You know, I don't know if people knew about them, but Austin Riggs has been around a long time.
Speaker 2:But Austin Riggs has been around a long time and I think it's because the approach that we use is very, very helpful for patients. They transform themselves. They get to let their lives back, log off before that to find out about those experiences. But thank you for just sharing that and giving us a peek inside the doors, a little bit of Austin Riggs. But thank you for the listeners. This is the end of our podcast. We're going to come back with another podcast next week and so super excited to have another guest and continue to get people excited about this topic. So please like subscribe, put a comment in there and we'll be back next week, take care.
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