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
Nurses are doing psychotherapy whether they know it or not with Dr Celeste Foster
Dr. Celeste Foster shares her journey into psychodynamic practice and how her work with children experiencing medically unexplained symptoms led her to pursue specialized training in adolescent psychotherapy at the Tavistock Clinic.
• Originally trained in mental health nursing heavily influenced by Hildegard Peplau's relational approach
• Found that practice had shifted toward medicalization and symptom-focused models
• Developed interest in psychoanalytic approaches when working with children who couldn't articulate psychological experiences
• Research revealed nurses perform complex psychodynamic interventions without recognizing their value
• When asked directly about their contribution to care, nurses struggled to define their role beyond "keeping patients safe"
• Detailed research using work discussion groups showed nurses practicing sophisticated psychoanalytic techniques
• Identified container-contained relationships, decoding counter-transference, and interpreting symbolic communications as core nursing interventions
• Barriers include internalized professional insecurities and historical stigma around psychoanalysis
• Political context of care work being systemically devalued and considered less important than technical skills
• Growing optimism as more nurses reclaim psychoanalytic theory in their practice and writing
• Success of programs teaching psychoanalytic concepts to primary care nurses working in challenging environments
The team at Peplau's Ghost continues to explore the psychodynamic foundations of psychiatric nursing. Listen to more episodes by subscribing and sharing your thoughts with us.
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
Hello everybody. This is Dan Wiesman, your host for Peplau's Ghost. You're going to hear this in just a second, but I want to put a little foreword here. This is an episode in which I'm really excited to present Dr Celeste Foster, but I also want to warn people a little bit that there has been some technical issues. I try to do my best job editing, but editing is not my forte, I would say but I don't want to take away anything that Dr Celeste Foster is going to talk about. She's got a lot of great information to share. I hope you all enjoy it, but just be prepared. It's a little bumpy there, probably around the 20-minute mark and so forth. But again, enjoy, take care, and thanks for listening and we'll have you back on another podcast.
Speaker 2:Take care on the phone so if they need you they can reach you. They don't feel alone, but still devising a plan like there were no you, because you're just there to guide what's on the inside, Discovery, identifying, challenging your beliefs.
Speaker 1:I think we're recording. Welcome everybody. Another wonderful episode of Pep Lau's Ghosts here. I'm super excited. I like to say you know, pep Lau's Ghosts is going international again, so we're bringing somebody from across the pond to talk about their love and passion for being a psych, mental health nurse and really, really interested in getting to know and hearing Dr Celeste Foster really share her experience. I am Dan Wiesman as your host and then also shared here with Dr Sean Convoy from Duke University, dr Kate Molino from University of California, san Francisco, and Dr Melissa Chapman-Hayes, who is our lovingly non-nurse person on the podcast. Keeps us from getting too acronym-y as well. So, thank you, awesome.
Speaker 1:Well, I've got a really quick bio. Like I said, I'm trying to kind of break these down so they're not too long, but Dr Celeste Foster is from the University of Salford Am I saying that right? Salford? Yeah, her interest, according to her bio, is that she loves working with children and young people and has done a ton of research and been involved with many organizations and is just well-known, well-established and was the 2025 Skellerin Lecturer, so a very prestigious lecture that she participated in too. So again, thank you so much, celeste, for being here. So I have the privilege of asking the first question. When did you first get interested in doing psychotherapy?
Speaker 3:When did it kind of spark an interest in your life? So I think I have to answer it in two parts. So I think the system is slightly different. In first thing, before I start to speak, I should just say thank you for having me on and it's lovely to be here. So I think the system is a little bit different.
Speaker 3:In the UK we specialize in mental health nursing in our primary training, in our undergraduate training and mental health nursing, contemporary mental health nursing and its curriculum. When I trained back in the kind of late 90s, early 2000s, still was really heavily influenced by the work of Hildegard Peplau and I would say Hildegard Peplau more than anybody, but also some other important kind of psychoanalytically informed mental health nurses and the actual Eileen Skellen. And so I can say at one level from the outset. And so I can say at one level from the outset because it was the sort of philosophical basis of what I understood I was learning to do, which was to use sort of detailed tracking and engagement and reflective practice within relationships to build alliances and understanding of what was going on between myself and another person for the purpose of recovery. That was really how we were taught it. I guess what I found when I moved into my practice I've always worked with children and young people is that the sort of um, the impact of lots of different things austerity, um, the kind of medicalization and um, increased use of pharmacology in, uh, in mental health care for children and young people and I didn't really see a lot of that in practice. I held on to it very deeply as a kind of something to anchor me in my practice and in my supervision of students, and but practice moved much more towards a sort of diagnostic model, acute acute stabilisation, kind of symptom-focused CVT kind of model.
Speaker 3:And then in my work I moved from inpatient care to community care and then I set up a service in paediatric medical services for children who had medically unexplained symptoms, and that sort of brought back to life my interest in the unconscious and the extra rational and the how do you engage people, who's who, where direct talking isn't isn't the thing on its own and isn't sufficient. Lots of the young people that I was working with if you ask them about their experience of their sort of their mind, their psyche, their psychological experience, they really had nothing to say. Their difficulty was that they were in physical pain or parts of their body didn't work or, and so that prompted me to go and do my training as my adolescent psychotherapy training at the Tavistock, because really I felt like all the tools I had I'd sort of run to the end of them, the young people that I was working with. They needed something better, more complex, they needed a better nurse. So, yeah, so that's kind of what prompted it.
Speaker 3:And then I suppose, more laterally, I've been particularly interested in this. I've sort of gone back to this interest in the fact that particularly inpatient, hospital-based nursing of children, where children are away from home and need a sort of developmentally focused approach to care that isn't just about psychiatric symptoms, the, the role that psychoanalytic and psychodynamic theory has to help nurses understand their job and to describe it and to help understand the things that go wrong as well and how. Really that seems to have been kind of um, in the uk at least, sort of excised out of our mental health nursing curriculums and and history, um, uh, so that when you sometimes, when you do talk about mental health nursing as a psychodynamic process in certain in certain domains in the uk or certain settings, people say, well, you're not qualified for that where and actually the you know, not really understanding that the practice of psychoanalysis is not the same as being able to make use of a body of work that has always influenced who we are and what we do. So it's a long answer, sorry, but no, that's great.
Speaker 1:I I you know, I will agree with you. I think that's you know and I think that's you know. As you said at the end, this kind of unfortunately weeding out is what brings us together here today. I mean, this is what we continue to fight for, clawing at this idea that we keep this part of the role within. You know, psych, mental health, nursing and especially advanced practice here in the United States. But I agree too. You know in the United States, the advanced practice here in the United States. But I agree too. You know in the United States, the undergraduate level. We don't specialize. Unfortunately, there's too much of this. You know you're an RN, so you can go kind of anywhere and you're just a plug and play kind of provider, which is just unfortunate.
Speaker 3:So that's again. We got to learn from the UK on that for sure. So, thank you, yeah, well, and we're under under pressure. Our own regulatory body is under a lot of pressure sequentially to move towards a more generic model, and even as they don't, they make the curriculum more generic. So so, yeah, we're not. We're not so far apart, I don't think the last.
Speaker 4:Uh, dan's first question kind of challenge you to use kind of a wide angle lens and looking at this, my next question is going to be a little bit more of a narrow angle lens question, but ask you to take a second and think back upon one of those early foundational experiences you had delivering psychotherapy where in the midst of it you told yourself, wow, this is lightning in a bottle, this is really special, and could you perhaps de-identify the case and just explain where that was coming from?
Speaker 3:um, I would say, if I, if I think back to my experience as a, as a trainee, when I was working in um pediatric liaison, I think, working with um, I suppose the experience of tracking not just the young person's sort of moment-to-moment changes and states of mind, but also really tracking my own and thinking about the meaning of that. So you know, transference counts. Transference with a, with a young person, a young woman who really couldn't articulate anything about what was going on in their, in their minds, who was experiencing really profound physical symptoms of sort of expressed as numbness and pins and needles in their legs, and we had been stuck for a very long time and, I think, just really worrying less about was I doing a good job, what was the end treatment goal, but just being in the moment of the thing, really taking in and noticing the young woman in front of me, but also noticing my experience and then kind of reflecting on it and speaking to it just somehow, um, finding just a moment, a little bit of a kind of door that was ajar, and finding something where we connected, where I saw something of a shift in her, something of a shift in my mental state, if I'm honest actually first and then was able to think about what that and to hypothesize a bit about what that might mean and to see her kind of grab hold of it or come alive a little bit. To grab hold of it or come alive a little bit. I think it's only small, but those kinds of the beginning of those moments kind of stay with you, um, forever really, because it's the beginning of something being possible.
Speaker 3:I think is the the thing um and I, and linked to that, the sort of idea of symbolism, the idea of when you're working with somebody who's got a very particular pain that's not expressed as a psychological pain at that point. So not then being frustrated in the kind of detailed descriptions of that thing, but seeing it all as information, seeing it all as something that you can make use of and similarly working with, I suppose, as I sort of advanced in my career, I mean I re-experienced that again in terms of what happens when you provide supervision and reflective practice for nurses where they're struggling with what they experience is very problematic or provocative or arousal behavior that they're trying to extinguish, and you are able to get them to think about it as containing really valuable information that, if they just can be curious enough and kind of listen to enough and wonder about enough, then they'll be able to find a sort of pathway through it rather than just trying to make it stop or shut it down.
Speaker 4:I love those would be. I. I kind of connect with that in a very fundamental way. It almost sounds sounds like, if I understand you correctly, psychotherapeutically speaking, what you're saying is that, as a therapist, as soon as you let go of the expectations of outcomes and embrace the process, everything becomes easier.
Speaker 3:Yeah, and even the dark stuff becomes and even the difficult moments become. I don't know. I don't want to be too cliché, the word that came to my mind is joyful, but there is pleasure. There's pleasure in being together in something that you don't, neither of you, know the answer to, but you're sort of feeling your way through it and putting your minds together and your kind of somatic and emotional experiences to the kind of leaning in, leaning into trying to work something out together, with no knowing about where it's going to go.
Speaker 5:Um, yeah, all kinds of things become possible then, really wow, uh, you know, celeste, I'm so interested in in the types of work that you do and and your, uh, the types of work that you do and the types of concerns that your patients come to, these sort of like somaticized, maybe even conversion, symptoms. And certainly you've already spoken to some psychoanalytic concepts. But I'm curious you know, generally speaking, what schools, forms or types of psychotherapy are you drawn to and use in your practice?
Speaker 3:Yeah, so I trained at the Tavistock, which is a British object relations school, and I trained in the adolescent department. I was drawn there because I was working with children and young people and so obviously Klein's work is rooted in and the work that has come, work that has built on her work since, and the work that has come, you know, work that has built on her work since, is rooted in understanding children as a developmental process. I suppose the business of childhood is a developmental process and particularly the kind of relationship. I think, if I think about Bion's work in particular as a sort of advancement of that, that Bion took something, a sort of advancement of that, that beyond took something, a sort of way of understanding something which was about the sort of ordinary processes that produce mental health, well-being, identity, sort of uniqueness of who we come to be through childhood, for good or for bad and was able to use that to think about then how do we work with people who've got very severe and complex mental health difficulties and both sort of thinking about the past and what might have shaped that up, but thinking about who we are and how we can use that knowledge in the room, and so I think that sort of yeah I suppose kind of Kleinian, pat Kleinian British Object Relations School speaks to everything that I instinctively know about being close up and personal with young people and families and people with complex mental health needs.
Speaker 3:I can say in my own professional experience, which is that I was working in settings, and still do now, as a researcher and as a consultant to practitioners, I was working in settings where children were being looked after who had terrible stories of early complex trauma, disruption within their earliest relationships and were away from home and had been kind of separated at their most frightened time from all the things that kind of held them solid or grounded them.
Speaker 3:And the model of care in acute psychiatric inpatient care for children and young people in this country still is built on an adult psychiatric model. It has no mention of child development, parenting, let alone the container-container relationship or how nurses might provide some of the characteristics of good enough care that we absolutely accept are essential for children to grow up mentally healthy. But somehow when they struggle there's sort of no, there was no thinking about it at all. So I think it. I was also drawn to it because it spoke to something that I knew was missing and I knew was important, but I didn't have a language for before my training, as uh, really a really great segue into the next question and, as the non-nurse, I get to ask how, how do you see nursing being a leader and performing psychotherapy?
Speaker 3:yeah. So that's a really good and complicated question. I think I can only speak from a uk context, but actually we're sort of recovering from a period of being excluded, I think, from a psychoanalytic and psychodynamic um story. So so you, I think, if I understand right correct me if I'm wrong but I think that the kind of um pattern of training in the in the us is that people go on to do kind of postgraduate training where they might include psychotherapy as a, as a component. We don't really have that in the uk, so people do a mental health nursing undergraduate training and then often, if they do, come back and do postgraduate training, it often tends to be for mental health nurses that they'll do a cognitive behavioral therapy program or they will do something what we call advanced clinical practice, which has a very strong biomedical focus and non-medical prescribing. So I think actually nurses have always been placed to be leaders in terms of our original.
Speaker 3:Our professional identity is based on the work of a prominent psychoanalytic thinker more than one and mental health nursing is always about the therapeutic relationship as the agent for change and thinking about what goes on within that relationship. And yet we have not taken our place in progressing psychoanalytic and psychotherapy access. We've sort of gone along with a move towards short-term access to structured, short-term symptom-focused treatments and I suppose I count myself amongst them a little bit is that there are increasing numbers of nurse scholars in the UK and practitioners who are starting to write and reclaim and re-find their sort of psychoanalytic heart or their psychodynamic heart, who can see what a contribution it makes to understanding the things that are complex, that don't respond well to short-term treatments. So I feel like we're sort of at the beginning of a kind of re-remembering our um, our psychoanalytic heart, after a sort of period of being a bit in the desert um yeah, well, said I, you know, I, I.
Speaker 1:I think you kind of led to my next question, which is kind of thinking about you know what are you concerned about with the? You know psych, mental health nurses using psychotherapy? You know, when you were talking it reminds me of we had it was an old professor I shouldn't call him old, that'd be disrespectful but a previous professor of mine, dr Howard Butcher, who was on the podcast a while ago and he would always talk about that. You know, nurses need to define what they're bringing to the table, kind of like a potluck. Everybody you know psychiatry brings the meds. You know, things like this where nurses like you were I think you were saying is you know we can do psychotherapy, but we're not, we're not taking a lead on that, we're not kind of advancing how to use that. So no-transcript.
Speaker 3:Sorry, kind of an odd question. I don't know if this quite answers it, but I know. Um, one of the reasons why I'm so nervous about coming on this podcast is, uh, a few podcasts ago you had the the great Kathleen Delaney on, who is a kind of a bit of a hero of mine, but in in she's written a lot around children's mental health, nursing and inpatient nursing in particular about that. Actually, nurses mental health nurses working with children kind of struggle to define their work even to themselves, let alone to be able to say to other people what do they bring to the table. And if I give you an example which I think sort of might answer your question, so some of my research was around, oh no, oh, and we lost celeste.
Speaker 1:Maybe I'll kind of um keep going and maybe we can edit this too later. But uh yeah, right stretch stretch, so this is going good. I mean, again, I apologize for the internet breakdown, but um any thoughts about what she said so far, or not?
Speaker 4:so much about what she said. But I I had a thought, and I'm not even sure if I'm going to share it publicly with her, you know, for the podcast, but there's a theme that keeps coming back every time we speak with new people, about this dynamic of nurses doing psych, of doing psychotherapy. That's kind of reminiscent of that old madonna whore complex psychedelic learning, where the idea is that we want nurses to do one thing but not other things, but behind the scenes we're happy to let them do it, you know. So, from a dynamic perspective, this madonna whore complex seems to be like a nice way to kind of explore what our role is and how. In certain circumstances it's okay, but another place is absolutely not.
Speaker 1:Yeah, yeah, hey, do you have something more on that?
Speaker 5:Yeah, Well, and it's okay for you to do it if we don't have anybody else to do it, because we know, at the end of the day, you can do everything, and actually we need you to do everything.
Speaker 4:And in heels right.
Speaker 1:Yeah, yeah a lot of sexism in that, of course. Yeah, just to kind of layer that on that too, for sure. So any thoughts on that too, melissa.
Speaker 6:Well, I was on a call yesterday morning in Vermont with a whole bunch of healthy aging partners we meet every month and the lack, the shortage of psych, mental health nurses was brought up by someone. There are a lot of folks at different hospitals talking about the many, many challenges and breakdowns of systems or lack of communication, but that was one that I thought of this group and I went yeah, so other people are also noticing that, especially in the healthy aging spaces.
Speaker 5:Yeah, Well, and because, as far as I understand, I think Medicare actually pays for a therapy benefit for you right, they do, but there's not enough providers and so they're not getting it. Yeah.
Speaker 6:Not enough neurosurgeons, not enough psych mental health nurses, I mean not enough PCPs.
Speaker 1:Yeah, yeah, that's one of those things. Talking about PCPs, yeah, just all the primary care coming into psych, there's that kind of concern too of what's going to happen to their primary care world.
Speaker 4:But yeah, it reminds me of like remember the Frontier Nursing Service where you know we were willing to let you go out and do the midwifery work at the places in Kentucky that we didn't want to go to Right Right. This is the second generation of the frontier nursing service in terms of our access into being supporting the mental health population.
Speaker 1:Yeah.
Speaker 5:Yep.
Speaker 1:Unfortunate, very unfortunate yeah.
Speaker 4:Some dark conversations.
Speaker 5:Right, Dan, you can kind of cut and paste these for the future I hope so, yeah right yeah, this is good um, I also I don't know if you all saw and I I don't want to miss speak but I think I saw yesterday, just thinking about, you know, research and needs and stuff like that that the n-i-n-r budget has been slashed by almost 70% for next year. Yep.
Speaker 1:Ouch Absolutely.
Speaker 4:Yeah.
Speaker 1:Yeah, I saw that came out. There was a letter that ISPN tried to sign on or did sign on to, to kind of resist that. But obviously that's was for naught. So hey.
Speaker 4:Celeste, it's okay, it's all right, it's actually all good yeah.
Speaker 1:I'm glad you're back. I'm so glad you're back and we can edit this down, don't worry.
Speaker 3:I see Honestly.
Speaker 1:It's great when it works right. So do you remember where you left off?
Speaker 3:I think you were asking me about Hang on, let me have a look at the question. I was going to tell you a story about some research that I'd done, but let me remember how it frames the question so that I can.
Speaker 1:Yeah, I kind of I deviated a little bit from it, like the concerns you have about psych nurses using psychotherapy, and I talked a little bit about, you know, howard Butcher, kind of bringing this. You know, what do we bring to the table as far as psych nurses, it's, you know, feels like everything.
Speaker 3:Yeah okay, yeah, no, I remember where I was going, so awesome. Start from the top.
Speaker 1:That'd be great.
Speaker 3:Yeah, thank you okay, so you're recording now yeah, yeah, we are recording yeah okay, yeah, so you were asking me about um.
Speaker 3:I suppose this idea of what nurse, mental health nurses and psych nurses brings to the table is a really interesting thing and it it reminds me of the work of kathleen delaney, who is a kind of really big hero of mine in terms of um talking about or writing about how children's mental health nurses who work in inpatient settings really struggle to define what they do to their work for themselves, let alone thinking about how they sort of sit shoulder to shoulder with other disciplines who might be able to do that more easily. And a really big chunk of my most recent research has been working with in inpatient children's, inpatient units for children with severe mental illness, with nursing teams and using psychoanalytic work, discussion groups, reflective practice groups to support them with their work. And the research started because I asked the team that I was working with what their contribution to care was as a nursing team, given that they're with young people 168 hours a week and other people might do an hour or and they just couldn't answer the question. And then, when they really really thought about it, they said well, they thought that they probably kept young people safe so that other clinicians could come in and do things that would make the difference. And I asked them sort of what their contribution to young people's recovery was and they couldn't say that either. And so it started a sort of passion project really of undertaking really detailed using work discussion to groups.
Speaker 3:Because what I noticed is, if I asked them to talk about particular young people, they described these really complex interventions, really thinking carefully about the young person's kind of internal world, how that was influencing how they were, how it was influencing how the nurses would approach them, really kind of thinking hard about the meaning of behavior. That might seem like one thing but really was another, um, and so the research. It sort of evolved into a research study of using work-based discussions, um, to get people to talk about their work in detail and then to code it and transcribe it to be able to distill what nursing intervention was. And it aligned almost exactly and I'll lay it out in the papers that I published that what they were describing sort of aligned almost exactly with very core psychoanalytic interventions in terms of what you would call kind of decoding, kind of counter-transference responses, thinking about kind of symbolic meaning of particular communications, but in particular those things that fall within the container-contained relationship, part of a parent, that kind of really taking in all that the young person was presenting, both verbally, non-verbally, consciously, unconsciously making sense of it, managing their own feelings, even though what they were taking in might be really disturbing and really difficult to manage and there might be high levels of provocation from the young people, I suppose. And then finding a way to communicate it back that would produce both the sort of immediate or relatively short-term amelioration of their distress but also contribute some learning to the young person about what was going on.
Speaker 3:And I tracked that for six months through these and then wrote up a kind of model of their intervention based on that and gave it back to the nursing team and the impact for, and particularly for, some unqualified healthcare workers that really had very little. They loved their work but it was really hard for them and they didn't have a lot of pride in it, they were sort of slightly embarrassed by it to be able to see people kind of stand up, stand tall and be able to say this is, this is what I do, and it's a skill and there's a name for it and this, this thing that I thought was, you know, just about feeling my way through. Something is called reverie, and this thing is called, you know, maternal holding, and this thing is called, you know, I can't think what else.
Speaker 1:No, that's great. Yeah, the question I have is it may be kind of a feat on. That is one of two things. One it seemed like when you ask kind of more of them to to share what their their role as nurses did, they really struggled. But if you, you know, ask them more kind of how they related to patients, that was when they really kind of started to open up and then, and so that from the data you found, you know these are, I'm assuming are kind of you know rn, kind of you know undergraduate type nurses. Is it that people are just kind of drawn this way? I mean, it's, it's an almost like sounds like an innate thing that they do, that they and I'm assuming they're not getting much training in their undergraduate in this, but they're, but they're absolutely doing these, these very high level things.
Speaker 3:Yeah, I think that's exactly right, and actually some of these people weren't qualified at all. Um, because and in some ways it's because what I think in my field. It's what children who would restress demand so so if you are, so less you are.
Speaker 1:Yeah, yeah, I'm getting some feedback like, uh, we've been so fortunate. I was just um, I think. Uh, my wife said that she saw on her facebook like a memories type of thing. So we've been doing this for over a year now, so we got an anniversary. Yeah, so can't believe it.
Speaker 5:Well, we, I know we have. My mom listens to the podcast. She's not a nurse or at all in psych, and she always tells me let me know when it's going to be on. And I'm like no mom, the podcast is always there, like you could just press play.
Speaker 4:That's so great. So let's say something for us.
Speaker 3:Hey, any better? Perfect, in that case I blame our government.
Speaker 1:I blame the government no, it's somewhere in between, I'm sure. But no, why don't we then pick up where Sean? Maybe Sean and then Kate? You can ask your two questions and we'll wrap up thanks. Celeste.
Speaker 4:Celeste, thinking about, you know, when we think about translating the skill of psychotherapy to future generations of advanced practice nurses and nurses, what do you think are some of the barriers that would get in the way?
Speaker 3:Yeah, so I think there's barriers from a number of different domains. So I think there are some internalised barriers within the mental health nursing profession themselves. One of the things that I found very interesting in the UK we've recently had a member of the House of Lords, baroness Tavistock, undertake a big review of mental health nursing because it's difficult to recruit to, it's becoming more difficult to recruit to, and what was very interesting in that is that actually one of her recommendations is there needs to be a re-centering and a re-description of mental health nursing as a highly technical, relational, um, uh profession, a psych sort of, with a range of psychosocial interventions, because somehow it's been sort of slightly degraded to more, um, I suppose, less um, anything that's sort of care related and emotional management related, rather than you know, drips, uh, you know advanced assessments of medical symptoms, somehow has been degraded. So I think and I think we carry a bit of that as a profession internally um, so I think that's that's one thing. I think there's a bad reputation in the uk, I can say, around some elements. You know the history of psychoanalysis is complex. You know it includes misogyny and homophobia and wild interpretations of things that aren't very well substantiated and myths and legends about couches and men with beards, and so I think there's a sort of historical um stigma that that is always available to other um, other professions, other disciplines, other trains of thoughts to sort of trash um psychoanalysis, I think, and and I don't think we're always great at stepping up and taking that on um, so um, I think sort of is the opposite of your question.
Speaker 3:I think in recent times outcomes-focused research, with very sort of particular drive towards measurable, symptom-focused outcomes quickly, has really kind of got in the way and sort of led to the ascendancy of other kind of quicker, shorter-term psychotherapies. And I think the idea that we're sort of all in competition with each other, rather than thinking that all therapeutic modalities are trying to solve the phenomenon of distress and empower people to be able to manage without therapy at some point, and some people need short-term therapies and some people need long-term therapies, and some people need relational therapies and some people need skills focusedfocused therapies. I think that's been a bit of a problem, although what's great to see is increasing kind of research that shows longer-term maintenance of outcomes from psychoanalytic and psychodynamic therapy. So that's kind of being challenged a bit and I also think maybe it's okay to say this because I am one, but qualified psychotherapists can be a bit sniffy about nurses using um psychodynamic and psychoanalytic theory, that it's a sort of highly specialist thing and of course in-depth, intensive psychoanalysis is and requires long training and high levels of personal analysis and reflection and all of those kinds of things.
Speaker 3:But psychoanalytic theory has always been more than one thing. It has always been a particular form of therapeutic practice, a way of understanding human, interpersonal, human dynamics within helping organizations and helping professionals, and the theory of life, a theory of how we become who we are, and I think that always isn't, that isn't always very well distinguished, and so there's a sort of sense of you can't go near that stuff because you, you know you're not trained and somebody might die. And I should say really clearly I believe in high quality, rigorous psychological therapy, training and supervision and analysis. But there are other ways of using this body of knowledge that can really support and enable and improve the lives of people who are psychologically distressed. And I don't know that we've always been very good at kind of distinguishing those things.
Speaker 4:That's actually really great. In the beginning, when you were talking about some of the alterations in the role function, I thought about what's happening here on this side of the pond that we've recognized over the past 20, 30 years, kind of in correlation to the advent of managed care, that the role function of the psychiatric nurse has kind of degraded a little bit, with more of a focus on safety as opposed to therapy. So I kind of connected with what you're talking about from an American perspective in a way. So that really helps me understand. Thank you, kate.
Speaker 1:Yeah, I'll piggyback on that real quick before. Sorry, kate, but yeah, I remember all the time when I'd work on a psychiatric unit and hearing nurses saying you got to keep up your skills and what they were specifically talking about is starting IVs, doing Foley's and all that kind of you know stuff and that's what they considered skills. But they wouldn't consider, you know, your psychotherapeutic communication being present and all those kind of skills they just, again, just not valued. So thank you for putting that into much better said than I just did right now. So thank you, celeste.
Speaker 3:Well, I think that's right and there is a political context to that. You know there's a political context and a social and historical political context of the notion of care being invisible and therefore less valuable work and relational work being less valuable, and people have written about that much better than me. But I think it's no accident that we do it to ourselves. But it also suits other vested interests to degrade and downgrade what we do or not. Empower nurses with a language to say this is our domain and we know about it and we're good at it. Language to say this is this is our domain and we know about it and we're good at it.
Speaker 5:Well, thank you, celeste. And and our final, you know big, open-ended question, uh, for you today is what do you see as the future of psychotherapy for nurses, nurse psychotherapist, advanced practice, mental health nurses?
Speaker 3:yeah. So my hope, my hopeful, my hopeful sense is I. I see in um, uh, you know, in in my uh uk context I see more nurses reclaiming psychoanalytic theory and the kind of psychoanalytic process of nursing and writing about it, and and I also have been involved in some great pieces of work. So I've done some work recently with the queen's nursing institute in scotland who train primary care nurses so not psychiatric or mental health nurses and they devised and developed a 10-month program for primary care nurses working with people in highly deprived socioeconomic situations with um, comorbid physical and mental health problems, uh, teaching them really core psychoanalytic theories to help them think about how they could engage people that are very difficult to engage and improve their outcomes. And the impact of that program has been huge in terms of the reported indirect patient outcomes, the staff well-being outcomes and what it showed is actually even people who have no psychological training really beyond an adult because remember, we have an adult general training here, we don't have a generic training but those people were really able to take on, take in and work with concepts like counter-transference, projective identification, reverie, you know, holding splitting psychological defences and use them with some support. So I feel really hopeful about those things and about the sort of developing body of research and even in. You know I'm involved in a project at the moment, um working with uh amongst others, nhs england, around their specifications for um children's mental health units and that and for the first time the sort of uh, the, the head of that children's mental health transformation project and the reference group that go with it, are talking about the fact that they recognize that children's uh mental health needs cannot be met through a psychiatric symptom management focus only that it requires a developmental and a relational approach and it requires them to skill up nurses to understand that and to. So I'm cautiously hopeful about those things and people always find their way back to.
Speaker 3:It is the other thing. It stands the test of time. Because it stands the test of time it helps answer questions and solve problems and, you know, helps you formulate things that other things don't kind of reach. So I'm cautious in that way and in another way I'm also mindful that the state of our mental health care in the UK is services are under huge financial pressure, bed shortages, pressure to discharge people very quickly to provide minimal levels of care focused on acute stabilization in order to try and make sure everybody gets a little bit of something, and I think that that acts against those kind of cautious green shoots. But, um, but I think there's a growing interest in and re-interest in, what psychoanalytic theory has to offer, from and including making sense of this workforce experience what it's like to work in a system that's under duress. It has a lot to offer that as well, so it's a sort of a mixed bag, but I'm mostly optimistic.
Speaker 1:Well, I'm optimistic about Dr Celeste Foster. I think she's going to be one of those people that's going to see us into the next century. And again, thank you so much for being on this podcast. You know, I think you've shed a lot of light and have me thinking. I mean, I think we need to wrap up, but I've got so many more things to ask. We sometimes do this and maybe we'll have you in a you know, part two kind of thing for Celeste. That would be amazing. But thank you all for listening to Peplow's Ghost, please. But thank you all for listening to Pep Lau's Ghost. Please hit that like subscribe and comment button. We'd love to hear from you the only psych, mental health nursing, advanced practice podcast without advertisement. So I think that's important too. If you want to Venmo all of us some money, that sounds great too. But anyways, we'll wrap up here.
Speaker 2:Thank you so much and look forward to another episode of Pep Louse Goes Soon. Take care, work hard until those thoughts are finally leaving so you can be. You Got a discovery Identifying challenging 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 challenging your beliefs, core beliefs, reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until they cease.
