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
What Makes a Nurse Therapist Unique? Finding Your Voice in Mental Healthcare with Dr Howard Butcher
When Dr. Howard Butcher discovered a brochure about psychiatric nursing while studying biology, it changed the trajectory of his life. "I didn't know nurses could be therapists," he recalls, setting him on a path that would lead to becoming both a practicing nurse therapist and an influential nursing theory scholar.
The pull between theory and practice forms the heart of this compelling conversation. Dr. Butcher articulates why nursing theory isn't just academic posturing—it's the foundation that gives psychiatric mental health nurses their unique voice in healthcare. Using the vivid metaphor of a "potluck dinner" where different disciplines each bring their dish to the mental health treatment table, he asks the crucial question: "What's in the nurse's dish that gives us a seat at the table?"
The answer lies in nursing's holistic perspective. While psychiatrists may focus primarily on biology and psychologists on behavior or cognition, nurses integrate biological, psychological, social, cultural, and spiritual dimensions. This comprehensive lens isn't just nice to have—it's essential for truly understanding patients' experiences and helping them find meaning in their struggles.
Dr. Butcher warns against the "seductive" biological model that reduces mental health care to medication management. He advocates instead for approaches like narrative therapy and existential-phenomenological methods that align with nursing's holistic foundation. These approaches help patients reconstruct their stories and find meaning, something Dr. Butcher incorporated into his own research on therapeutic journaling.
Looking toward the future, he offers an optimistic vision. While online therapy platforms and AI may supplement mental health care, they cannot replace the human connection at the heart of nursing practice. "The human compassion and empathy, the human touch and the human heart—those things are simply not replaceable," he asserts.
Want to understand what makes nurse therapists unique? Listen now to discover how nursing theory creates a distinctive lens that transforms psychotherapy practice and offers patients something no other discipline can provide.
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 decrease until they cease. It's not a discovery Identifying challenge in your beliefs.
Speaker 2:I think we're recording. Welcome back everybody to Pep Lau's Ghost. Thank you for coming back. So much appreciated, really excited about our next guest here. Dr Howard Butcher is with us and, as I was just saying before we started recording, dr Butcher has a very special place in my heart as he was actually my professor I was getting my PMHNP when I was at the University of Iowa so it's been a pleasure to keep knowing him and to know him past graduation and was a colleague of his at the University of Iowa for a while before he decided to go on for greener grasses in Florida and such. So. But again very happy to have him on the podcast, as always, I should say.
Speaker 2:I'm joined by my esteemed colleagues Dr Sean Convoy, dr Kate Molino and Dr Melissa Chapman, and so we're here to kind of talk on peplau's ghost and so let's get to it. I got a quick introduction here. Don't like to drag out these introductions too much, but did want to say that, dr Howard Butcher, you're in Florida teaching. Still, one of your areas is really bringing nursing theory into practice, education and developing further research, and Sean is raising the roof. So that's love that that he's going to kind of get into that too.
Speaker 2:I was reading your bio a little bit. You are and I knew this, you are a Rogerian scholar, which I always have to kind of make sure that we. That's not Carl Rogers, that's the Rogers science of unitary human beings. So I believe you got your master's and your PhD in that focus. Yes, yeah so, and I believe you've had some mid-level theories, at least your bio mentioned. You had some mid-level theories that you developed based on that as well, and you are still the editor for the Nursing Intervention Classification, or NIC, which I think is in its eighth edition, if your bio is correct.
Speaker 2:We just had a meeting this morning, just working on ninth yeah, that's how it goes right. So, so, lots of international collaborations you know working on, you know expanding Nick as a framework of what you know understanding what nurses do, which sometimes, well, a lot of times, gets overlooked. So so again, thank you, dr Butcher, for being here with me and us on the podcast here, and so I'll get the ball rolling and kind of our focused, you know, really kind of looking at maybe, cause I know, again, you're a researcher and you're very much focused on nursing theory. But I know, based on you know your time with you know both working together, as well as you being my professor, you have done therapy and I hope you still are, but you've done it definitely and you've got a vast experience in that. So when did you first start getting interested in doing psychotherapy?
Speaker 3:Well, it's interesting because it goes all the way back to why I chose to become a nurse to begin with. Because I was actually a biology major and I was going to teach. I was going to be a high school biology teacher and I was my girlfriend at the time was in nursing school, but I always had a real strong interest in psychology, even in high school. I was reading all kinds of psychology books about psychotherapy, and I was reading that stuff in high school and I wanted to be a teacher. In high school I wanted to be a teacher. I didn't think about becoming a therapist until I went to the infirmary on campus. I was at Lebanon Valley College and I saw a brochure sitting on the table that described the role of a clinical nurse, specialist in psychiatric, mental health nursing and the brochure was from the University of Pennsylvania. It was their program and when I saw that I thought to myself gosh, I didn't know that nurses can you know, can be therapists. And I was thinking I was, you know, changed my major. Well, I didn't change my major. I was a biology major but I would settle on becoming a biology teacher because they don't teach psychology at most high schools. So that was kind of like a second choice. And then when I saw this brochure, I thought well, wait a second, I can be a therapist by being a nurse.
Speaker 3:I became more and more interested in nursing as I was learning more and more what my girlfriend at the time was doing, because we would study in the library together and I would say, gosh, you know, you're working with patients and you're making a difference in people's lives. And what am I doing? I'm like in the chemistry lab for four hours in the bio lab dissecting, you know, sharks and cats and things that weren't even alive. And I thought, you know, I'd much rather work with people. So once I saw there was a path for me, my goal from the very beginning was to be a nurse therapist, and that's why I changed my major to nursing.
Speaker 3:And when I finished that degree in biology I could have it was in the beginning of my senior year I could have, you know, changed my major then. But then in six years I would have come out with one degree. But I found out there were programs, bsn programs you can get into with only two years because you, you know, you transfer in at the junior year level. So that's what I did so. I went to Jefferson and in six years came out with two degrees, instead of six years only one degree if I had changed my major.
Speaker 3:And then in my BSN program, all the way through I focused on psychosocial issues. I just I knew that that's what I wanted to do and so, whatever kind of clinical, whatever population we were working with, I always made sure that my assignment and papers were kind of like looking at the psychosocial aspect and I knew I wanted to get a master's degree, because that's degree, because that's the aim was, to get a BSN, so I can go to a master's program and become a clinical nurse specialist and become a nurse therapist. So that whole thing is all intertwined together.
Speaker 2:Yeah, thanks. I guess you know it all goes back to studying in the library with a girlfriend, I mean that's a classic start to a lot of stories, right? Follow your heart, and that'll take you a long way. So thank you, howard.
Speaker 4:Howard, I'm going to play to your strength and I'm going to shift the question over to kind of focus a little bit on the theory here. You know, all of us teach to some great capacity with students on a regular basis and we typically have kind of this split with our students. Some half of the cohort are very theory-minded, the other half feel like a resistance to it. That is undefinable. Thinking about advanced practice psychiatric mental health nursing, is there one or two theories that you just keep in your left pocket that you think are translatable in almost every situation and circumstance?
Speaker 3:as an advanced practice psychiatric mental health nurse, yes, there definitely is, but let me step back a little bit and talk a little bit about theory. First of all, you can't separate theory from practice. People may not think that they're using theory or they have a divergent theory, but they're coming from some sort of interpretive framework, right, and it may not be explicit, it may not be scientific, because it's something that they mix up in their own mind, but everybody has a lens through which they look at the world and that is some form of a theory. That is some form of a theory. I've always believed that nurses and all practitioners need to be basing their practice on a scientific theory, which means then using the theory as it's designed. I think when you start becoming eclectic and start combining things together, that's not really a scientific process, you know. So you can use different theories for different situations, but you need to understand that some theories don't really jive together because they have, they're based on assumptions that are in conflict with one another, for example.
Speaker 3:So my whole career has been based around, you know really, about nursing science and nursing theory, because all professions are identified by their unique body of knowledge. If nursing didn't have a unique body of knowledge, then we really don't have a profession, because one of the criteria for a profession is to have a unique body of knowledge. Now, that doesn't mean that we don't use theories and knowledge, and certainly in psych, mental health we use theories. We learn about theories from psychology and different, you know mostly from psychology. But if you have a really strong grounding in a nursing perspective, a nursing lens, when you learn about psychoanalytic, you know gestalt, existential, phenomenological theory. You, for me, it's the idea is to understand those theories through a nursing lens. And when you see things, just like you're seeing things through a prison, it transforms the theory when you're looking at a theory through a nursing lens. And so for me, the choices of theories that I gravitate to are ones that are, first of all, are philosophically compatible with my nursing perspective, meaning that you know theories that are holistic, theories that I'm more of an existential. I believe that, for example, nursing, part of my nursing lens is that being holistic is what makes us unique as a discipline, and so those theories that are, you know, holistically oriented are ones that I gravitate towards. I also believe that nursing occurs more on the interpersonal relationship level and not on the cellular genetic level. So those theories it's not that I reject biological explanations for mental health conditions, but it has to be complemented with an interpersonal sort of level of understanding of what the person's condition is. So theories that are existential phenomenological, for example, I gravitate to because as a profession we're interested in human experiences. If we can't understand our patients' experiences, then how is it that we can really help them right? So those theories they get at, the human experience is what's relevant to me. And so existential phenomenology is the research, is a philosophy and a research method that fits with what nursing, I believe, is primarily about at the relationship level, to understand the experience so we can help them. And so there's therapies that come from that philosophy of existential phenomenology.
Speaker 3:So meaning-making and theories that are oriented towards meaning-making approaches to psychotherapy are things that I gravitate to. I find meaning-making essential actually to all realms of nursing practices, helping patients understand the meaning and the experience that they're going through. So narrative therapy, for example, is one of those realms of therapies that really, for me, fit really well. I actually my program of research came out of my interest in narrative therapy, because journaling is one of the main modalities that is used in narrative therapy. It's like it's often the, you know, you reconsider. The person is talking to you about their story Everybody lives a story and then narrative therapy is looking at that story and reframing reframing the story and finding new meaning in your life by by creating a new story. And so my, my research ended up being on journaling and the therapeutic benefits of journaling. So I was able to tie my interest in a particular therapy um to my program of research, and so narrative therapy is one of those areas that really mean a lot to me.
Speaker 3:Existential phenomenological approaches so I'm well-versed with Heidegger, but also Rollo May, there's a bunch of folks, humanistic approaches, carl Rogers, so those I think are consistent with that relationship level and fit with my view of who we are as nurses, more holistically oriented. So those end up being the therapies that I gravitate towards. And then I have a whole philosophical base that's all grounded in it and that's constructivism. So I would start with that is that you know I believe that people construct their own realities and I believe in the principles of constructivism. And narrative therapy and existential phenomenology are therapies that fit within that constructivist philosophy of science perspective. So I try to be consistent and congruent with my therapeutic approaches and my chosen theories, with my philosophy, my values and my grounding in nursing science.
Speaker 4:That helps. Thanks a lot.
Speaker 2:Wow, I just I had some flashbacks just remembering time. That was Dr Butcher's lecture. You want more of that follow? Him up where he's teaching now. But that was great, thank you.
Speaker 3:I did a presentation in class about narrative therapy. I remember doing that and I printed out the slides for that, in case I needed to refer to those that, how we are storytellers and that nurses are story gatherers and in our therapy is where you're gathering the patient's story of what they're. You know what they're coming to seek help about.
Speaker 5:Yeah, yeah, and I just wanted to note that while you're speaking, dr Boucher, everyone's face on this podcast turned into the emoji with the heart eyes. This is amazing and I think, to piggyback on the last thing that you just said, maybe if you could expand on that a little bit more, how do you see nursing becoming a leader in performing theory-informed psychotherapy?
Speaker 3:this metaphor. I guess it's a metaphor, an analogy, of a potluck dinner where everybody brings a dish to the party, and to me that's a metaphor of the multidisciplinary team. So, because as therapists, as nurse therapists, we work with folks from multiple disciplines. Right, we have psychiatrists that some of them have some therapeutic background, but most of them are fairly biologically oriented. But we have social workers to do therapy, we have psychologists to do therapies. So the thing is, you know, so we're in an area where we're working with multiple disciplines and everybody brings something to the table. Right? And my question has always been well, what gives us a place at the table? And you can't be a nursing leader unless you have a place at the table right, and my question has always been well, what gives us a place at the table? And you can't be a nursing leader unless you have a place at the table. So what gives us a seat at the table is what's in our dish, that's what we bring to the table. And my question throughout my career has been well, what's in the nurse's dish? Like, I know what's in the social worker's dish, I know what's in the psychologist's dish and I know what's in the physician's dish. You know they all bring their area of expertise to the table.
Speaker 3:The question to me has been well, what is the nurse bringing to the table that gives them a seat and a voice, that makes a contribution to the understanding of the patient that other disciplines are not addressing? You know, because if we're all bringing the same dish, we're all bringing a salad, then there's no diversity, there's nothing new. So while I believe in the multidisciplinary team and transdisciplinary perspectives, you still have to have a disciplinary perspective to have a seat at the table. So being at the table is not simply buying into and accepting and practicing from the perspective of other disciplines. It's like bringing something to the table that is unique. And what is unique is our nursing science perspective. When our perspective is informed by nursing science and I'm talking about nursing theories, I'm talking about our nursing classification systems then we have something to offer and bring to the table. That puts us in a leadership position, because we are offering a perspective that is not often seen by other disciplines. None of them are holistically oriented for one. So everybody's dealing with a piece of the patient's situation and only the nurse to me has that integrated perspective and can fill in the gaps where other people have these blind spots of what's really going on with the patient's situation.
Speaker 3:So I think being grounded in nursing science is what makes you a nursing leader. It brings you something to offer to the patient's perspective and they don't need another physician, another psychologist or another social worker. What patients need is a nurse. Every patient needs a nurse.
Speaker 3:So that's why I think that teaching from the ground up nursing education, teaching nurses what nursing is and how we're unique and distinct, that it becomes just a part of their way of seeing, it's their identity of who they are, you know. So for me it's learning those different nursing theories and seeing how they inform, how they can be formed to patients with psychological, mental health issues. And there are particular nursing theories that fit well with particular approaches that are from psychology. For example, I think Roy's adaptation model is a nice model that fits with cognitive behavioral therapies and so you can reframe cognitive behavioral therapy within Roy's framework, because she talks about the regulator and the cognator and it's all about behavior and stimuli, which is very much this kind of behavioral approach. So you just reframe that within a nursing perspective. So you just reframe them within our nursing models and nursing perspective and then I have a place at the table that nobody else is looking at it from that perspective.
Speaker 6:Thank you for that and I'm really curious, based on what you've shared so far, if you are concerned or have any concerns about PMH nurses using psychotherapy or in what cases you might have concerns, if you do it's at the advanced practice level.
Speaker 3:One To be a therapist is, you know, at the advanced practice level. So I think that if we have, if we're educating in our graduate programs that are preparing DNPs to be nurse therapists, and they have an education, you know, that prepares them to be cyclotherapists and to be therapists, then that's my only concern is whether or not they have the educational base. And I know that, like at Iowa's program, we had a course in cyclotherapy. Now it's not as rigorous as perhaps people that do, you know, if they're doing some sort of in psychology, they can take extensive courses in psychotherapy when I was at the, just to give you an example. So I do want to move away from your question, because I just the answer to your question is is that when nurses are educated and prepared to be therapists, then they're qualified and I don't have any concerns about them being therapists.
Speaker 3:When I did my master's degree at the University of Toronto, I specialized in consultation, liaison, therapy. Consultation, liaison is a subspecialty in psychiatry. Well, we had a. We had a psychiatric institute at the University of Toronto and I took electives in psychotherapy, both in psychoanalytic therapy and in psychosynthesis. Psychosynthesis was a big institute there at the University of Toronto. So I took it upon myself to prepare myself to be a therapist by getting educated, taking formal courses in my program that prepared me to do therapy and then as therapists.
Speaker 3:I think and I was part of a group we were in Iowa I think it was in Iowa, I don't think it was in Toronto but there was a nurse practitioner group of nurse therapists I'm pretty sure this was Iowa and they had once a month meetings where they would just talk about patients. It was kind of like, you know, kind of like nurses, like a support group for psychiatric, mental health nurses, and all of them were taking courses and doing extra certification programs to improve their practice, to improve not about prescribing medicine or medications, but on how to improve being a therapist. So I think that being an advanced practice nurse therapist, you need to continually build your knowledge base and your skill base by continuing your education in being a therapist and actually having somebody else that you have as a. You know, I can't think of the word right now, but when you know every therapist should have somebody who you talk to. What is it? What do they call that person? I forget now. Like you have your own therapist as a nurse therapist.
Speaker 6:That's all I'm thinking of. Every therapist needs their own therapist.
Speaker 3:Yeah, yeah.
Speaker 2:Like a consultant or supervisor.
Speaker 3:Yeah, yeah, I think it's supervision. It's like that. You have supervision, you have somebody that you go to and that's another way of improving your practice right when you have someone that you can talk to about the patients that you're working with and whether or not you're having transference, or you know if you're going to the psychotropic model, any transference and countertransference issues or things that are personally interfering with your therapeutic process to have that supervision. So if you're doing those kinds of things, I think that then you're, you're, you're. You are maintaining the skill level to be effective as a nurse therapist.
Speaker 2:Very cool. Yeah, and it's one of those things too. I forgot to mention a little bit that uh from the university of Toronto I I saw Kate light up a little bit. Yes, we also have a another Canada connection here with uh, dr Molino, and as well she's uh. Were you born and raised in Canada? I forgot Kate.
Speaker 5:I was and I did my. I did two undergraduate degrees at U of T, so yes, I know, I know the Institute you're speaking of Well and that.
Speaker 3:So that is where my life was transformed by, honestly so when? So, because I had that degree in biology. The truth is is that when I went into my undergraduate program in nursing, I had a very biological view and I did think that nursing was like a subset of medicine. I didn't see it as distinct. I didn't have that nursing lens perspective. I think they really worked hard at trying to transform that in my BSN program because at Jefferson in Philadelphia it was, we learned a lot about wholism, but I didn't understand. I didn't really understand the implications of this wholistic perspective they kept on talking about and the first year was all focused on health, so there was this real health focus and then the year two or a final year, our senior year, was more illness, like what are the deviations from health?
Speaker 3:And but it wasn't until I got to the University of Toronto, when I took the nursing theory course there, that my life was transformed, because then I became, I came to realize that nursing had its own theoretical base, that it wasn't just grounded in medicine. And I remember arguing with folks, as you know, when I was in my nursing program, saying, oh, everything is going to be explained at the genetic cellular level, and I really had that perspective. And then when I was at University of Toronto, I realized wait a second, that might be the view of other disciplines. Maybe, and you know, that might be the view of other disciplines, maybe, in you know, geneticists feel that way and and biochemists and those folks, medicine which builds heavily on that. But from nursing perspective, that's only one piece. So, like when you have a biopsychosocial, cultural, integrated person, right, then the biological component is viewed within these other dimensions, that they're all unified, they're all connected.
Speaker 3:So any physiological or biological event or explanation is only part of the puzzle from our perspective that we need to work with the patient, not only understanding their condition in all these five areas, but also our treatments need to be holistic too. So what are we doing spiritually? What are we doing with the person, you know, psychologically and socially, and their ability to function in roles, all of that sort of stuff? Knowing that the person is not separated from their environment is very much a part of what nursing is. So, rather than you know, we look at people in their context and their context matters. So that's what the environment is, their context, the cultural and that social part, and so we need to consider all those things when we're dealing with our patients, from understanding what their mental health issue is. It's not just mental, you know, it's all of these things all together.
Speaker 2:I love it Beating the drums. I just kind of, yeah, let's, let's get more nurses to nursing and yeah, know what we're bringing to the table. My next question is going to kind of piggyback on what Melissa talked a little bit more about, and I think this is kind of one of the reasons why we have the podcast is, you know, what are your thoughts on, what are the barriers why more PMHMPs aren't using psychotherapy in their practice?
Speaker 3:Well, think that the biological medical model is very seductive and to me it limits our practice. So if you're going to reduce your practice down to prescribing medicine and understanding things from just a biological perspective, then you're not really contributing something that's unique and different and what the patient really needs. So I do think that it's always an uphill battle for us to have our perspective appreciated and accepted because, like I said, the biological model is very seductive and so I think a lot of advanced practice nurses often are not grounded in that holistic perspective and then their practice becomes reduced down to a biological explanation that depression is just a chemical imbalance in the brain. So what we need to do is give more medication, but we know that the best treatment is a combination of psychotherapy and medication. So I'm not saying that we need to dismiss anything. We need to know what physicians are doing, we need to understand the biological perspective, we need to understand genetic perspective, all that. But that's just part of our practice, and so we need to have this broader view and it's not the dominant view.
Speaker 3:You know it's more complex, right? Not, it's it's. It's more complex, right, it's the simple thing is the prescribed medication. The more complex thing is to look at. Well, what are the underlying psychosocial causes, environmental cause, and that's that's kind of like the area that we're at. So, and it's also harder to research those kinds because there's so many there's how do you? You know, how do you do these research studies in the real world? It's really easy to do a clinical trial on medication, see which medication does best, and then the cost also associated with really addressing the psych, our social issues, the social problems within our environment.
Speaker 3:But this is really what we we don't want to be influenced by that. We need to continue to believe and, and, and and to show how our holistic perspective is making a difference in patients lives, and patients prefer to work with nurses anyway, and I think that's the reason why we're really good at communicating and listening to what people have to say. Our ethical values are, you know, not telling patients what to do, but I believe that they know on some level what is best for them. So really it's about empowering empowering them to make the best decisions that they can make for themselves. So it's a whole different perspective to me and we just need to keep on. Keep on what we're doing.
Speaker 4:Great Howard. I'm going to ask one last question. It's broken into two subsets so I'm sorry if it feels like a test question. We ask people a lot in this podcast about being a prognosticator and looking into the future, about psychotherapy. I'm going to ask you what is your vision for what do you think is going to happen to the practice of psychotherapy and advanced practice nursing in the future, and what's your hope? So your pragmatic vision and what's your hope.
Speaker 3:Well, it seems to me that the online therapy is, is, is something that is out there now and there's a lot of people that are gravitating to as having a therapist who is online. And now I'm hearing that there are AI, artificial intelligence, that there's therapy that's being done, you know, through AI, and I don't see these as replacements for what you can do at the interpersonal level from a human to human. I think they're adjuncts and they're supplements and they're options for patients that don't have access or can't, or maybe those become more affordable, but I don't see them as replacing the human to human contact and the kind of therapy that occurs on an interpersonal level. I just don't think that AI is ever going to be able to replace that. But I do think that we, as therapists, looking towards the future, need to grapple with this idea. And how can we use these online modalities and AI to complement our own practices, so that we are advancing our practice but not replacing it through something that I would say could never replace what a human is able to do? So, and I'm optimistic in that way, that I'm optimistic that therapy is not and nursing, by the way and, by the way, I'm not the only one that's saying this.
Speaker 3:So Gates, and Gates is only repeating what this person by the name of Pinker there's this book out there called A Whole New Mind, and it's about it's now about, I guess, about 12 years old, and he talked about the kinds of mind that we need in the future in order to you know that we're moving out of the information age and we're moving into the conceptual age is what he talks about. We're moving the conceptual age, and so he talked about the skills that are needed to be successful and the kinds of careers that are going to be successful in the conceptual age, and nursing was one of those that were mentioned. That is not going to be replaced in the future, because empathy and because, you know, empathy is one of having empathy and compassion is one of those skills that is needed for the future. And Gates said the same thing that those professions that are the interpersonal, at the interpersonal level, at the empathy and the compassionate level, are things that human nature craves for, and this is what we provide as nurse therapists. So, and that's not, that's not going to be able to be replaced by a machine that kind of human compassion and human empathy and understanding and the human touch and the human heart, those things I mean.
Speaker 3:So I have an optimistic view of our profession for the future. That we're actually going to become more in demand because of what we have to offer is not replaceable. It's just simply not replaceable. It's just simply not replaceable. Some aspects of what we do is replaceable, but not that human-to-human contact, the communication, the listening and the bond that really is created in the nurse-patient relationship, which is what Pepo talked about. That nurse-patient relationship is not going to be replaced by a machine. I'm positive about that and I don't think anybody really thinks that that's going to be the case.
Speaker 4:That's helpful.
Speaker 2:Thank you, that's amazing. Yeah, that's the whole tingly-feely type of thing. We'll definitely end there, because that's a great place to end. So thank you again, dr Howard Butcher, for joining us and look forward to another episode of Pep Lowe's Ghost coming out soon. Please make sure that you subscribe, like and comment. We look forward to coming back to you soon, so take care.
Speaker 1:Bye Before it's true. Work hard until those thoughts are finally leaving, so you can be. You Got a discovery Identifying challenge in your beliefs Core beliefs Reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until they cease. Yeah, got a discovery Identifying challenge in your beliefs, core beliefs Reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until.
