Get Off The Stage And Stop Speed-Running Med Checks with Dr Julie Roebuck

If you’ve ever felt the squeeze to move faster, prescribe quicker, and save the “real conversation” for someone else, this one is for you. We talk with Dr. Julie Roebuck from the University of Virginia about what it actually takes to keep psychotherapy central in psychiatric mental health nurse practitioner practice, especially with children and adolescents where trust, safety, and development matter as much as diagnosis.

Julie shares how her early fascination with how people experience the world shaped a career built around curiosity and connection. We dig into inpatient child and adolescent psychiatry, what can change when you have enough time to meet with a teen consistently, and why progress still counts even when the home environment is messy. One of the most memorable takeaways is her “get off the stage” metaphor: pause, ground, and choose a response instead of reacting, a practical psychotherapy skill that helps kids handle conflict, stress, and big emotions.

We also wrestle with the real-world pressures psych NPs face: “med check” culture, billing expectations, and the ongoing identity shift from psych CNS to psych NP. Julie explains how she protects holistic care through comprehensive psychiatric evaluations, collaboration with social work, and clear boundaries around appointment length. We close by looking forward: AI may help generate plans, but it cannot replace the therapeutic relationship, and that makes psychotherapy training and certifications like CBT even more important than ever.

Subscribe, share this with a colleague, and leave a review so more psych nurses and psych NPs can find the show and keep this part of our role alive.

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 Melissa Chapman

Email: mchapman@pdastats.com

Transcript

SPEAKER_02 0:09

We are coming to beat the boat, every beat, every breath, we'll nice the comfort. We are nurses what the girls are.

Welcome And Guest Introduction

What Drew Julie To Psychotherapy

SPEAKER_04 0:31

Welcome back, everybody. Another ep episode of Peplouse Ghost. My name is Dan Weesman. I am, again, very excited to have this next guest, Dr. Julie Robuk here. You know, funny quick story. I was we were just at the ISPN, International Society of Psychic Nurses conference in Seattle. And I was sitting across from her at the foundation dinner. And I don't know why, but it came into my head that, like, I need to have Julie on the podcast. You know, and so I don't think I said anything to you, but because then later on I was like, oh yeah, we've already booked her. And that's just, I think, a credit to the show that we've got people booked out far enough where I forget that we've actually booked them. So I'm really excited to have you on the podcast. I know this is going to be great. And again, just kind of share some of our experiences and our love and passion for keeping psychotherapy within the role of the psych mental health nurse practitioner. Of course, joined with my friend and colleague, Dr. Kate Molino from University of California, San Francisco, and same Dr. Melissa Chapman-Hayes. So again, let's get going. Dr. Julie Robuck is from the University of Virginia. She's an assistant professor, and I believe the PMHMP program director there as well, still. That's a big role. I know that Kate and I kind of have done that role. And so I was looking at some of your publications. You do have an interest in pediatrics, so would love to kind of get into that and talk a little more about how to use psychotherapy with kids. That's uh that's really great. And again, just really thankful. And Julie and I have done some work together looking at, we just presented at ISPN on the role transition from the CNS to the nurse practitioner and did kind of a qualitative analysis on some people and their thoughts and opinions on what we lost, what we gained possibly, and just the hurt feelings that are still out there biting because we retired that uh that role of the clinical nurse specialist. But uh but this uh podcast very much focuses on Peplau, Hildegard Pepplau, and her uh foundational work in establishing the therapy role within the advanced practice role. So let's get into it. So, Julie, you know, I I know you you went through a program very similar than mine. Correct me if I'm wrong, but I think you went through a similar program than I uh with as a student in which was a CNS and nurse practitioner focused. And and I believe you did get certified as a CNS. So you I think you'd have both certifications. And so what kind of got you there? I mean, where take us back, you know, what's what personally, personally and professionally got you interested in psychotherapy, either with yourself or said professional too. So thanks.

SPEAKER_01 2:53

Right. Thank you, and thank you for having me. I love the podcast, so I I want to put that out there. Thank you for having me. I I have always been interested in psychology, psychotherapy, since since I was a little girl, actually back in the 70s. My my mother would have this gathering every week, and there would be this person sort of on the periphery, someone who clearly was psychotic, experiencing visual hallucinations, auditory hallucinations, and it fascinated me. And I I tried to get as close as I could for to observe for observation while maintaining a distance. And so I was probably nine or 10 years old at the time. And and and also since I've always been interested in how think people think and their perceptions of what they're experiencing and what others around them are experiencing in the world.

SPEAKER_04 3:50

That's great. You know, I this this kind of reinforces what I think too is I think people either either get psychiatry or psychology or they don't. And so I love this story that even at nine, how a person who is having florid psychotic symptoms, which I think a lot of people would be really put off by, like, oh my god, what's going on? You know, and really kind of put off. You were very intrigued. You you were actually drawn into that.

SPEAKER_01 4:10

So that's amazing. I I was, I was. And and my mother, of course, was saying, stay away, stay, you know, this we're no keep your just stay over here, you know, uh redirecting me. But I I found it very interesting how someone, what are they hearing, what are they experiencing, what is happening? It's so different, right? Than than as we usually think and interact with others. And so I was off and running and knew from then forward that I wanted to do something in psychiatry, mental health. And and so that's what I did. And I pretty much stayed on that trajectory.

A Child Inpatient Therapy Success Story

SPEAKER_00 4:50

Yeah. And Julie, I appreciate how you're really speaking to this quality of curiosity about how other people see the world and how other people's minds work. I mean, I think that's something that's such a fundamental quality that you know you bring to the work as a psych advanced practice psych nurse. So I'm curious if you could perhaps share a story with us. Maybe the first time that you perform psychotherapy with a patient or any kind of session with a patient that really stands out to you, maybe because you learned something or you felt that there was success.

SPEAKER_01 5:24

Well, so primarily my clinical work has been within an acute care setting, working with children and adolescents. There's been a few things in between. And so, as you know, in an acute care setting, there's limited time. However, I was very fortunate in that the state psychiatric hospital that I worked for, we had the luxury of more time than you would typically. And back then there was a lot more time than there is today, right? Now it's in and out in in less than a week. But and so I would have longer periods of time. And so working with children and adolescents was something I accidentally fell into. But once I found it, I thought this, this, this is where this is where I want to be. I this is I can't imagine a better calling than helping to facilitate sort of this trajectory in life and and being a child and adolescent, especially is tough when everything is going okay, right? And so I had the opportunity to work primarily with middle schoolers. That was my my age range, just the toughest time, again, for children. And so working with these children, in particular, a patient that comes to mind was a a young adolescent girl who was really struggling with some what what we know as parent-child relational things. And so working with her over a period of time after repeated hospitalizations and helping helping guide her and facilitate sort of this progression to this inner wellness and really focusing on her role and and her contribution, despite the limitations that clearly were obvious with regard to her parents, especially her mother, and and and and saying and working with her about you know, these are the things I think that would be really helpful. And have have we thought about this? And and really working with her, and I and I and I was able to see her every single day and work with her for therapy two to three times for you know half an hour to an hour, usually closer to an hour at a time, and to see her progression over a period of really about three weeks was amazing because we think that, or we know that with children, getting helping to get things on track. But if you're going back into that home environment that's not on track or isn't the most supportive or isn't the healthiest, it can be really difficult, a really difficult transition. So helping her get to a place that she felt stronger and felt more prepared and had more coping mechanisms that were that were healthy and not maladaptive, and to sort of get off the stage, right? Observe and think about her piece was remarkable. Was remarkable. And so she comes to mind when I think about impactfulness and being able to make a difference because I think sometimes we wonder what we're doing and how helpful really especially especially the the patient population that I've I worked with. It's it's very hard to gauge that sometimes, but to see the progression over time was very it was very rewarding.

SPEAKER_04 9:06

Well, sorry, sorry. Can I interrupt me? I just I just want to clarify just something you said there. You said about you know allowing her or getting her off the stage. Can you tell me more about I mean I think I know what you're meaning there? Can you kind of describe what that means, though, maybe for the listeners?

SPEAKER_01 9:21

Well what that means is sort of pause, taking time to be mindful, grounding yourself, and the ability to empowering her to respond in a way that is healthy despite what's coming from you know from the other side, right? We can't control how others are responding to us, but we can't we have control, but that takes time. And if you're on if you're on the stage and thinking and impulsive and and and you know, engaging in a way that there's not going to be resolution, if you can just step off the stage, pause, think through what your response is going to be rather than listening and having an immediate response, grounding and being mindful.

SPEAKER_04 10:05

Thank you. That's great. I I honestly have never I've not heard that. So I thought I thought I knew what you meant, and that's yeah, so thank you for clarifying. Sorry, Melissa, I'm stepping on your toes.

Stepping Off The Stage

SPEAKER_03 10:13

I had a still a lot of questions, so thank you. And Julie, I'd love to hear more either with this case or more broadly in your experience and practice, if there's particular types of psychotherapy that you're more drawn to, or maybe you have a wide toolbox of approaches that you draw from. So I'd just love to hear how you approach that.

SPEAKER_01 10:33

Right. You know, I I really admire, excuse me, I really admire folks who are really sort of married to a specific type of therapy, a type of therapeutic approach. I think for me in working with children, it's never the same day after day, and it's never the same type of child or temperament or age. And so what we wind up doing, and I think this is not unique to me, is we wind up pulling from a lot of different therapeutic approaches and theory. But in general, of course, and if it's you know more time-limited, DBT, CBT, of course, but and I working with children and adolescents really and tied to Piaget as that initial developmental piece, working with children and adolescents, but really feel strongly about CBT and you know our thoughts and our feelings are related. And working with children and adolescents, if they're younger, right, a younger child, it's harder to do CBT, right? Because there's not that contemplative thought or that lack of insight, because developmentally they're they're not there, right? That that limited insight can make it a little more difficult. But I think children and adolescents are remarkable beings. And I think they are so capable of so much more than we give them credit for. And I I really have only met a few adolescents, especially, that uh didn't have a voice who didn't want to share if someone would really listen, right? And felt approachable and felt safe and felt comfortable.

SPEAKER_03 12:14

So thank you. Even just taking the approach that you value and know that children have a voice and give them that space is powerful. Thank you.

unknown 12:26

Thank you.

Picking Therapy Tools For Kids

SPEAKER_04 12:27

Yeah, I agree, Melissa. I mean, yeah, when you said that last part to Julia, I just got a little tingly. It was, yeah. I mean, just sometimes, I mean, and I think that's what you're saying. You know, there's there's probably not any specific form of therapy that you can do with kids. You you just gotta connect with them and allow them to get that space. So that's amazing. Thank you for for sharing that a little bit with us. So I would like to talk a little bit more, and and I think we've had these kind of discussions too. And again, this is one of the things that we keep talking about on this podcast a lot, but you know, thinking about nurses and psych mental health nurses and and and how what we add to the field of psychotherapy and you know, that that tension that we can, that most of us, you know, and probably listening or even here in the room, we we feel that tension between, you know, prescribing, you know, there's that tension to write a prescription, and then that's that tension for for you know actually connecting, like you were just saying, giving giving a child some space and things. So how do you how do you kind of merge those things together? And and how do you see you know, nursing kind of being maybe a leader in how we kind of do that sort of work?

SPEAKER_01 13:31

Well, first of all, I think the the advanced practice nurse being able to, again, I think I probably mentioned it at the conference that I was really confused in graduate school about what the difference between a psych CNS and a psych N P was. And Catherine Kane, I've mentioned to you, was the leader of the program. And she made sure she said to us, the message is clear. If you want to be a psych NP, you must be a psych CNS first. We can't lose that piece. And at the time, as students, we didn't know that that we what was happening at the time, which was CNS was on its way out. Discussions had had already begun at that point. And so for me, I was always confused, and I still am a little confused because, and I think that's because for me, in order to be a psych and pee, I must have what a psych CNS has. I must possess that in order to work, especially with children and adolescents, and with adults to some degree, but especially with children and adolescents, you must have that therapeutic approach. You must have that understanding developmentally what's happening and that ability to connect with them. And so for me, it's as a psych and pee, I am a psychic CNS as well. There are pressures there, certainly, to write the prescriptions. And I don't know how many times I've heard over the years there's lots of people who can do therapy. There's not lots of people who can write prescriptions, and especially for child and adolescent psychiatry. And so I can hire 10 therapists, but I can't hire 10 prescribers. And so the pressure is there, certainly. But I think it's really important for the psych NP to slow down and take the time and really put those stops in place, those barriers, those protectance, so that as a psych NP, we have the time to really incorporate the psych CNS approach. It's much more holistic and systematic rather than more goal-directed in prescribing and not to minimize the psych NP. That's amazing. I wanted to do both. I wanted to do therapy and I wanted to do prescriptions as well. And so, but I think the the psych NP with some additional training, because we're losing those psychotherapy aspects and components and training within the programs is really important. And and I tell I tell my students now, even still, whether you whether you're doing psychotherapy, because I know that most will not, that there needs to be a clear understanding, a clear foundation of what we're doing, so that at the very least we can provide some supportive therapy, but also know who we might refer a patient to and what type of therapy might be the best approach, or if they're working with a therapist, that we have an understanding of what that therapist is working on with them. And so I don't know if that answers your question, but no, perfect.

SPEAKER_04 16:42

Yeah, I think it's yeah, it's it's one of those things. And I appreciate you saying this too. I mean, that vulnerability of just kind of and and I think I learned a lot through our project too of you know, what's what's what is a CNS role? What does it actually imply? And since, you know, I've never practiced as a psych mental health nurse practitioner. Um sorry, psych mental health CNS. But yeah, so I mean, I think, yeah, I think it was very well spoken. So thank you.

SPEAKER_01 17:05

Right. I mean, I eventually learned that the psych CNS does teaching and liaison work and psychotherapy. And my interest was psychotherapy, but I loved teaching as well. And then I thought, oh, it how wonderful it would be to be able to do psychotherapy and also manage the medications as well. And so that was my way of thinking at the time. But my initial was to be a psych CNS and do just psychotherapy.

Protecting Time From Prescribing Pressure

SPEAKER_00 17:38

Thank you, Julie. This is so interesting. Um you have brought up a few of the barriers that people often cite to providing psychotherapy as part of our role. I'm curious, how do you negotiate some of the barriers that you mentioned?

SPEAKER_01 17:53

Well, when I when I finished the programs, I went into, I knew that for me it made much more sense to be in an inpatient setting. And it was an inpatient setting that had, I wouldn't say prolonged, but longer lengths of stay. So that I'd have the opportunity, I'd have the luxury of time on my side, not just as a new provider, as a new psych NP, psych CNS, but the opportunity to really engage and establish these therapeutic relationships with patients versus an acute private inpatient hospitalization, where the turnaround time we don't have as much time to really think clinically about what what let's let's let's pull this together. And also the collaboration from all the folks working in that hospital. And so I did I did some time in private, and so there weren't a lot of barriers for me in that regard, I have to admit. And so, and and I'm so grateful for that. But when I did private practice, they really wanted to put several, several patients there. And so I immediately said, no, there's no way that I'm gonna do 15-minute or 20-minute even medication checks and and psychavalves, I'm not gonna do them in in one hour. So I said, I need two hours for my initial appointments to do a comprehensive psychiatric evaluation, not a quick, a comprehensive psychic psychiatric evaluation. And then uh I will only see two patients an hour, so 30 minutes for medication follow-up appointments. And so there was pushback, of course, financially. It was in my best interest to see more than two patients an hour or to see patients in less than two hours for a psychiatric initial appointment. And so I understand, uh I acknowledge that there are the pressures there from the provider as well, right? Folks are going, they're they're doing something so they can buy groceries too, right? Everyone's trying to buy groceries. And so, and so, but I I encourage the students to really think about what it is that they want. And some and some students and some folks feel really comfortable at that pace, at that speed. So it's really thinking about what you want your contribution to be, how you want to feel about what you're doing. And to me, that's really important. Was I as happy with my paycheck and private practice as others? No. But I felt good about what I was doing, and I felt like I really connected with and I really knew who my patients were, and therefore could could be a better provider.

SPEAKER_00 20:34

That's beautiful. Thank you. And I also just that seems also like a really good approach for staying in this work for a long time. This feeling that you were contributing something meaningful and you feel good about it.

Biopsychosocial Evaluations And Family Work

SPEAKER_03 20:49

Well, so throughout this podcast, you've talked a bit about the whole person and a holistic approach. And I wondered if we could talk a little, speak a little bit about the biocycle social slash spiritual model and practice. So maybe sometimes moving beyond standard medical, the standard medical model to how you might integrate broader aspects of a patient's life, their history, community, beliefs, into a cohesive treatment plan that honors the whole person.

SPEAKER_01 21:17

Right. So uh again, I think for me, really connecting with that comprehensive psychiatric evaluation. And so when I do comprehensive psych psychiatric evaluations, they are really truly comprehensive. I'm going through all systems. And I'd add, you know, recommend comprehensive social work assessment. Social work folks are, I tell all students, cozy up to the social worker. They're gonna be the folks that you really, really will value and and can really help you get a better sense of what's going on. Cause it's not, it's not just home, it's not just what's happening. Here and it's at school, it's it's everywhere. And so I always take into consideration, right? Any underlying medical conditions. I always take into consideration what's going on from a psychosocial standpoint, developmentally, where children and adolescents are, what's happening at home, past traumas that are occurring, what they're currently engaged in, what the planning is, what what what does it look like every day when when they go home and turn that front door knob and they walk in? Are they do they expect there's going to be the same thing every day? Hi, how was your day? Or is it is do they are they unclear? Right? Are they unsure how impactful that is to think you're going home every day and you don't know what you're walking into? Right. So really thinking about what's happening in those areas, as well as academically, and whether they're struggling only at home or they're struggling at home or only at school or both, with regard to, you know, is this truly ADHD? Is this anxiety? Is it both? And so just getting a better overall comprehensive clinical picture to know which direction to go when when I'm navigating and synthesizing everything to determine what ultimately the treatment plan will be.

SPEAKER_03 23:18

Thank you. Yeah, that takes some time. Yes.

SPEAKER_04 23:22

Takes quite a bit of time. Yeah. And that's the luxury of, you know, like you said, you know, finding a your place that could do that, like acute settings. And then I'm assuming you found kind of that getting restrictive, and that kind of pushed you into more private practice, probably.

SPEAKER_01 23:35

Right, right. And so, you know, when you think about children staying in a hospital or hospitalization for a month, people think uh that's that that's that's a tragedy. That's that's you don't want children in a hospital for a month. Well, we don't want them coming back 10 more times, right? We really want to get it right the first time, and we really want to slow things down and get a good understanding, do some family therapy while they're still there in the hospital. And so one of our requirements before discharge was to do three sessions, family therapy sessions with the with the psychologist that was there and weekly meetings with the parents who would come in with the and meet with the adolescent and the rest of the treatment team as well. And so again, it was luxurious. Today is different. Today is different for sure. But again, I feel really fortunate and grateful to have had that experience for so long.

AI, Training Gaps, And The Future

SPEAKER_04 24:36

Awesome. Well, thank you again. And so we're gonna kind of finish up here on with our last question. We just hand you the crystal ball and say, you know, tell us what you see. What is the future of psychotherapy within this role? What's you know, and and the first thing that jumps to my mind, I mean, you can go anywhere with this, of course, but you know, reflecting back on our time at the ISPN conference and all the presenters on AI and things like that too. And so does that incorporate, is that part of your calculus, or or what where else do you see kind of the future of psychotherapy within this role?

SPEAKER_01 25:08

Well, I think AI certainly is something that is obviously in the forefront and something on all of our minds, but I don't think that AI is going to replace the human connection. I think it's it's impossible. And I think that therapists, psychologists, psych NPs are safe in that regard. I think AI can generate a medication regimen, but I don't think AI can really forge a therapeutic relationship in a way that we as humans can. And so I think that there is a place for psych NPs to do psychotherapy, and I hope that they do. I think given where we are in academia and and the changes that are happening, programs really being able to slow down and pause, get off the stage, and really think about what they're offering their students and and how they're sending their students out the door when they, you know, in their cap and gown, what what that's going to look like. And and because folks are paying attention. Folks are really paying attention to what's what's happening with psych and peas, what we're doing, what we have to offer. And we have so much to offer. And I don't, I don't want us to lose that connection. I think that this effort to align psych and peas and all the NP specialties uh is a wonderful thing. And I I understand it, but I think I think, and all specialties think thinks they're unique, right? We all are unique, but I think psych and peas really are unique. We are not black or white. There's it's all gray, right? If you're not comfortable with gray, being a psych and pea is something maybe we should rethink a little bit. But I think that because we're not getting as much of that, students aren't, we're not able to capture that because we're capturing so many other things now that really instilling the importance in these additional certifications. And I and I've and I have students who are doing clinical rotations, and one of our requirements also is in addition to uh the clinical the mandated hours required hours, I also have my practicums also have a component of indirect hours that I require. And so with that, for students who uh are have a particular interest in something or or haven't been exposed to something particular, they're encouraged to get indirect hours that way. But I also always encouraged getting some type of certification. And I have students that start CBT training while they're students, so getting some additional certifications and training because graduating as a psych NP, depending on which program you're graduating from, I say that you can bill for psychotherapy. Are you prepared to do psychotherapy? Those are two things you really need to consider and really think about is because you can this soon following graduation and this early into your career, should you, given how much you're getting while you're in school. Right.

Closing Thanks And Listener Requests

SPEAKER_04 28:31

Yeah, thank you. Thank you. Excellent recap too. That was a good job. I was like, we didn't even rehearse that. That's amazing. Thank you, Julie. This has been a wonderful conversation, and thank you so much for being on here. Like I said, I was looking forward to this and just having just a just a lovely conversation. So hopefully everybody out there listening enjoyed this. And feel free to hit that subscribe button, like, comment, please send us comments. Would love to hear from you. And we will be having more episodes coming out. Like I said, we've got people booked all through the summer here of 2026. So I'm so excited to have more guests on here. So thank you so much and look forward to us uh being on another episode. Take care.

SPEAKER_01 29:07

Thanks so much for coming.

SPEAKER_02 29:13

We have no breath, but I'll do the case. We have no idea.