How Psychiatric NPs Turn Basics Into Healing by Dr Janine Panker

Lots of PMHNPs quietly carry the same worry: “I’m not a real therapist.” That belief doesn’t just shrink our scope, it also hides some of the most effective parts of psychiatric nursing. We sit down with Dr. Janine Panker, a Duke University alum and private practice PMHNP, to name what’s been in front of us all along: psychoeducation, supportive interventions, and relationship-building aren’t “extra” skills, they’re psychotherapy in action.

We explore what “back to basics” looks like when you’re treating anxiety, depression, insomnia, and trauma in the real world. Janine breaks down how she uses medications as scaffolding so the nervous system can settle enough for meaningful change, then leans into fundamentals like sleep, nutrition, connection, and labs. We also talk personalized psychiatry and functional mental health care, including why factors like vitamin D, thyroid function, and genetic variants can change the whole clinical picture when patients feel stuck after standard approaches.

Then we look ahead: AI therapy platforms, TikTok diagnoses, and the growing need for mental health professionals who can evaluate quality and safety without shaming patients for where they get information. You’ll also hear a powerful example of “low fidelity” therapy that rebuilds trust and becomes a bridge to higher fidelity psychotherapy, plus concrete advice for students and new grads on mentorship and finding community.

If you’re working in medication management, psychotherapy, or both, subscribe for more conversations like this, share the episode with a colleague, and leave a review if it helps. What’s one “basic” intervention you think we underestimate most?

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

Welcome And Guest Background

SPEAKER_02 0:31

Welcome back, everybody, to another episode of Peplau's Ghost. This is real exciting. I'm super excited to meet a new person to me, Dr. Janine Panker. And she is an alumni of Duke University. So what really makes me excited about this is we get to kind of show a lot of love and affection towards Sean, Sean Convoy, as the program director for the PMHMP program here at Duke. So really looking forward to learning about the program at Duke and kind of learning how that kind of really influenced her. But Janine is a recent graduate of Duke University, and really, again, just looking forward to seeing, you know, how Duke nurtured and really kind of grew your intention of using psychotherapy within your practice. So maybe that's where we'll start. Do you during your time as a PMHNP at Duke University, did you develop or you know, please feel free to talk about your interest in doing psychotherapy? And then maybe what was that spark or moment that you realized psychotherapy was really not just a you know part of doing your practice, but actually maybe possibly even a primary intervention of your practice?

Naming Psychotherapy In Nursing

SPEAKER_05 1:37

Yeah, so what's interesting is when I look at my path of what brought me to the psych NP program, I had been in a director of nursing position, and it was not for me. I just missed the client facing time, being face to face, hearing people's stories, and that exchange with them. And so that's what made me seek out going back for to become a psych NP. And so what's interesting is I still never thought of that in the sense of psychotherapy. You know, I thought I was gonna go back and I wasn't looking at it just through the lens of prescribing, but I had a very concrete picture of what a psychotherapist was. And I think about, you know, our therapist colleagues who do 3,000 hours of clinical training and supervision. And I thought, well, if we're gonna contribute to imposter syndrome, that's kind of the fastest way if we're thinking that we're gonna hold the same level. And it wasn't until actually a couple of years after practicing where I was actually having a conversation with Sean. And he said, you know, we're gonna start talking about how we are all psychotherapists and really, you know, this is after having the training. And I felt kind of activated by that, you know, still this concrete, concrete sense of we're not psychotherapists. And and then I started, you know, examining that feeling, like, wait, think about everything we do. And it was this epiphany moment. Like if you asked someone what they did today, they would, you know, list the things, but they wouldn't say that they took, you know, 87 breaths, you know, in an hour or that they did all of these things that are just automatic. And I realized that so much of what we did was really automatic to nursing. So the interpersonal, the supportive therapies, the psychoeducation. And that's where I really focus is the psychoeducation and really empowering patients with the knowledge and information that, you know, I've seen such a difference in how that contributes to self-agency, self-efficacy. And so when I would hear psychotherapy, I didn't align with that. And it was until having that, you know, full circle moment of wait, that's everything we've done since day one of being an RN has been that. And so it was like this new revelation of, well, you're already doing this. And so now being more deliberate about naming it, because you know, if you don't name it, you don't measure it. If you don't measure it, you can't improve it. And so having that epiphany moment, probably later than I should have, because I was so set on you know, the science of it, really added to that meaningful change of you know, perspective. And then really wanting all NPs to know you're doing this, you know. So when they'll talk about billing for visits and like, oh, I don't do psychotherapy, I'm like, well, that's innate. You should automatically, it's part of the conversation because if you don't have a core, you don't have anything. And so you you are doing it, but you're not recognizing that. And so I think a lot of people who are in practice don't realize how much they're doing it and and that they can cultivate that more. You know, maybe you're not doing EMDR, but someone who specializes in EMDR is not gonna say, Oh, I'll wing it today and do DBT or IFS. Like you're you're gonna stick with what you know, but you have more of that than you realize.

SPEAKER_02 4:49

That's great. Yeah, it's you know, it and maybe kind of just add it when you went to Duke. I mean, was this something so you kind of mentioned that that was something that that you discovered as you kind of went along, but was it surprising how much it got you were kind of drawn to it as you were going through the program? Or yeah.

SPEAKER_05 5:05

What I think is interesting is when I decided to go back, you know, I wanted to, I think a lot of us do like we want to find the best program, the best that's gonna support us, and we have this idea of who we want to be. And I think when I was applying to Duke, when I interviewed, and I I had this idea in my head, it was kind of of, you know, maybe you're gonna learn this high level, and it was very high level, but almost like this next level thing. And and what was so interesting about the education at Duke was teaching us how much we need to understand the basics. You know, you can have all of these complex thoughts and theories, but if you're not saying to the person, wait, hey, did anything else happen? Hey, did you know this you just lost your dog, you just lost this person. So if you're going on to these complexities of thinking of the biochemistry and all this, and you're not saying, hey, what's going on in your life? What's that, you know, on the shelf behind you? Tell me about, you know, this and that. Then so that was interesting was how valuable the education was in getting back to the basics of people and not getting so caught up in I am a degraduate, but who that turned you into by having that, you know, education.

SPEAKER_03 6:19

Janine, thank you. You uh you just used the word I'm gonna build upon a word you just said using a therapeutic skill, right? You talked about the basics that got me interested. Can you kind of describe what are the component parts of your basics that are psychotherapeutic?

SPEAKER_05 6:36

Well, what's interesting in the approach I take is, or I think where I sort of focus is I'll say a lot of back to the basics with my patients and their labs and their basic nutrition and their basic connections with other people. Very much with the medications I presented as scaffolding. Like this is the scaffolding, because if you're at 10 out of 10 anxiety, 10 out of 10 depression, you can't meaningfully engage in you know therapy because your nervous system needs to come into that space where, you know, just some of the basics, as much as we want to push our protocol or this, if their basic needs aren't met, they can't take a deep breath, they can't, you know, cognitively engage, and we're not able to move forward with any of the other things. And and once we get that into a more neutral space, it's looking at basics as far as some of their vitamin levels. I mean, up here in New England, I know some people say vitamin D levels can't be life-changing. Well, giving people education about their vitamin D levels, giving them education about, you know, if you don't have enough vitamin D, it doesn't activate this enzyme that helps turn 5 HTP into melatonin, into serotonin. So, you know, giving them these basic tools and the basic education really empowers them. And then we see an increase in adherence to that and the amount of people that I had who were diagnosed with seasonal affective disorder, when again, sort of back to the basics of let's look at what's going on at the cellular level, shouldn't be as life-changing as it was because this is not, you know, some advanced concept. It's back to the basics. You know, if you, you know, looking at running a marathon, but you're dehydrated and like start with the basics when get to that space, right?

SPEAKER_03 8:22

Thank you.

SPEAKER_04 8:24

Yeah, I I I want to pick up on this idea of the basics because I really love what you're saying. You know, we've had something you said earlier about, you know, folks doing EMDR and other sort of really you know intensive, time-intensive therapies. And some people definitely are doing that. And lots of us are not doing that. What we're doing is integrating psychotherapy into our med follow-ups and you know our 15 or 30-minute appointments. So I was wondering if you could share a little bit about how do you how do you weave in psychotherapy into these shorter appointments while you're also doing medication management and talking to folks about their nutrition and other things.

Basics First Meds As Scaffolding

SPEAKER_05 9:02

Right. And so that was actually part of the reason that I felt so strongly about starting my own practice after graduation all those years ago, was I didn't want to be part of the Broken system. There were so many jobs that were hiring where it was like a 15-minute follow-up and 40-minute intake. And there is nothing in my life that I can do in 15 minutes or 40 minutes that, you know, match up with those levels of involved, you know, it takes my opening hello is probably a good seven minutes. So, you know, I knew that that wasn't the standard that I wouldn't be able to provide that quality care, like that level of care that I wanted to. And so really it's, I feel like I get to be way more patient-centered in this space. And so a lot of times it's interesting because when you look at the billing perspective, you know, I know a lot of times we're focused on clinical, but you're supposed to separate out what amount of time was therapy and then what was medication management. And to me, that's it's very clearly not a concept that came from a clinician because it's so intertwined, right? This is something I also have to stress when I'm precepting students, and I love precepting them because it makes me more aware. But I'm very big on the use, therapeutic use of self and making sure that it's only when it is adding value to the patients. But really, once you have that rapport, the conversation just flows and all this information comes so quickly, so readily. But something I'll point out when I'm precepting is that may look like we were hanging out and sharing, and it's not. You have to recognize that behind it, it was very much still focused. If you notice it was something with shared therapeutic use of self, but it was only because it added value to being able to get more information here, being able to show that you legitimately can relate to what you're talking about, and people can sense phony right away. And so I do find that sometimes my visits run over, so I'm not going to pretend I'm perfect with time management. But you know, if there's something that it feels like there's a concern, I can schedule them sooner. But I think the rapport actually that really is set from the intake, and I'll do an hour and a half to a two-hour intake. I never really do less than 90 minutes, really makes those other visits sort of easier because you can jump right in. If you haven't built that rapport, and then, you know, there's not really the comfortable time to ask the heavy questions, whereas some of the visits, I'm like, all right, you look different. So what's going on here? You know, and you can jump right into that because there is that trust and rapport that you don't have to tiptoe around or you know, wait for them to feel comfortable and open up. That answers the question.

SPEAKER_00 11:44

And I think this next question will probably add upon what you were talking about. So we've talked with a lot of guests on this podcast about the role of prescriber versus the role of therapist identities. And I'd love to hear you talk about how you define your professional identity to your patients and your colleagues. So do you see yourself as a therapist who happens to prescribe, a prescriber who happens to use therapy, or maybe some other identity? If you could kind of speak to how you balance that in your work, that would be lovely. Thank you.

Therapy Inside Medication Visits

SPEAKER_05 12:19

Yeah, well, it's so interesting is when I'll, you know, meet my patients and they say, Oh, what should I call you? I said Oscar Hangers, I'm like, oh, I'm just Janine. And and I'd say that that's just kind of how I describe myself, right? So I don't necessarily want to say coach or therapist. I don't think of myself as just a prescriber. I would say more of an educator or facilitator. I very much try to make sure when I say that there's not a power dynamic, like when we're doing the intake and we're going to ask sensitive questions, I make sure they know that they never have to answer anything they don't want to, and really stress that this is an even playing ground. There's no, you know, you have to answer this or that. So even when it comes to that part of it, you know, I very much subscribe to the idea that I'm the expert on this content and you're the expert on yourself. And we're sort of going to bring all of our tools together. And sometimes that means talking about the medications, sometimes it means talking about the genetic variants or their nutritional deficiencies and looking at that approach and really just arming them with the information for it. And so, you know, when they come back and say, like, oh, like thank you. I'm like, I gave you the information, you know, I helped to facilitate and provide this, but you are the one who did it. You're the one who took that information. And so it's, I don't think I would describe myself as a prescriber, but I don't necessarily consider myself a therapist. I just consider myself a support and to help provide those resources to show, you know, is this giving feedback that maybe the therapy is not, you know, hitting the nail on the head. If uh, you know, I've had where patients came to me and they said, Oh, like, oh, I love my therapist. They're like my best friend. I could just call and give. And I'm like, oh, but what are the tools? And I'm like, oh, we just really talked. I'm like, well, you have a friend for that, right? Like, so, you know, sort of calling out those things and and sort of helping to give insight and maybe be that mirror back, but maybe with a few extra resources that they didn't have before. So I don't think I had never really thought about it in what I would describe myself because it's sort of whoever they need me to be. Do they need me to tell them about their genetic variants? Do they need me to, you know, point out that, you know, this blind spot is getting in the way of things, that there is a more formal therapy that would really help target what's showing up here. So I think it's, you know, not an identity I've ever thought about. It's just sort of different for whoever's in front of me.

SPEAKER_02 14:58

Yeah, Janine, thank that's great. I mean, actually it it hits home for me too. Because I mean, I've for the longest time I've thought, you know, why why do we have these? It's almost like silos, right? Of, you know, I'm a nurse, I'm a psychiatrist, I'm a, you know, LMHC, I'm a social worker. And so why can't we just break down those things and just all be kind of mental health professionals and things like that? So I really kind of resonated when you when you started talking about that, kind of, you know, breaking down some of those things. But uh I appreciate your perspective. That's that's something that I think we don't think about enough, probably is you know, what is our identity when we do so many things within a practice and such. So I do need to step back because I'm hearing my wife in my back uh on my shoulders. She's not literally there. I'm not hallucinating her either, I don't think. But I did a terrible job of introducing people. I'll introduce you again, Janine. You are the private, you're in private practice at Stratera, I believe, Stratera, Statera, Stratera. Behavioral Stratera, Behavioral Help in New New Hampshire. So I know you already mentioned that you're interested, you know, you're taking patients and you precept students and things like that. You're also a consulting associate at Duke School of Nursing, and I am joined here by my uh lovely colleagues, Dr. Sean Convoy, Dr. Kate Molino, and Dr. Melissa Chapman-Hayes. So thank you again. This is not the end of the podcast, so don't turn off. But I I I think the next question really is more about future. Maybe, you know, getting the crystal ball out again. Where do you see yourself, your practice? You know, and and maybe you can think of within your practice, or or do you have some other ambitions as far as how you're going to utilize yourself and that kind of more, you know, multimodal type of approaches that you have with with your clientele or or or different, you know, teaching? I mean, thinking again, what where do you see yourself in the future, maybe using using these skills that you've uh developed at these last several?

Identity As Educator And Ally

SPEAKER_05 16:44

Yeah, well, and I think that it's sort of everything is coming at us at record speed right now, right? So even if we had a way that we were practicing, I think we're going to be pushed into a different way. And it's sort of keeping an openness to what is best going to meet that need. I think one of the best things I learned too at Duke was even if we're not doing the formal psychotherapy, knowing what the standard should be, so that, you know, when our patients are going to another therapist, we can give feedback for, you know, maybe this isn't the quality that it should be. And, you know, typically it is, but being able to check and balance it. And I point that out because I think that that was really a great foundation for what we're seeing now is people using AI and more computer-based, like learning language model platforms as therapy. You know, some of these are going to tell you what you want to hear. And so I think we really need to make sure that we're up to date on our understanding of what is the patient experience from that, you know, because they're going to engage in that. And for some people it can be helpful, but making sure that we're helping to identify the quality there and some safety concerns there. I think I also have a different approach to or a different view than some providers. I know some people, when when patients come to them and they say, like, oh, I saw this on TikTok, and I think that I have this. I love that. I think here we go. Like this is opening the conversation, and we can look through what part of that identified, you know, did you identify with? And, you know, let's dig deeper into that and see what's at the root there. And so I think patients are more informed. And it doesn't mean that it's always the right information or the best information, but being open to them, having more access and making sure that we're hearing them and that we're addressing that need and sort of responding to that. And so for me, though, where I really focus is very much on the personalized medicine. So that's actually why I had gone back for my DNP. I had already been in practice for a few years when I decided to go back for it. And, you know, for practice, it didn't necessarily make a difference. But I saw this huge difference in my patients just from addressing some of the genetic variants they had, where they'd have higher demands for vitamin D or from certain things that are basically the building blocks for our neurotransmitters. And so focusing on that, and it was not a steep learning curve, just identifying some of those vulnerabilities and then seeing this shift into patients improving significantly. And all of a sudden I could feel that I wasn't at the edge of burnout. I didn't feel like, you know, I'm doing all of this and getting frustrated and running into the wall. And just as therapy offers another avenue, if we know that if we're putting all of our eggs into the basket of prescribing, it's the fastest way for clinician burnout because it is a band-aid, a little scaffolding, it has its role. But if that's the only tool that we have, it's not good for them. And it's probably even worse for our own longevity in the field. And so seeing this change from addressing these variants and these nutrient deficiencies and very sort of basic things really like reinvigorated my passion for going back for teaching, pushing for change in the field, that we're not just sort of throwing meds at things, but digging a little deeper. You know, someone could be depressed, it could be their thyroid, it could be, you know, personal circumstances, it could be vitamin D deficiency, it could be all of these, a number of things. And if we're just throwing an antidepressant at it without digging a little deeper. And so part of the reason I went back for that was to be able to take on more of a role of educating the next, you know, generation of psych MPs and pushing more for that personalized approach to medicine. We always hear that, you know, look for the horses, not the zebras. And I would argue when you're a specialty, it should be the opposite. You know, that there are when patients are seeing us, they've already been amongst the horses and and those approaches have not worked. And so we need to be treating them as the individual they are and not sort of adding to some of the medical gaslighting of, well, this works for the majority.

SPEAKER_02 21:07

That sort of goes. That that might be our episode title. So nice thanks, Janine. Appreciate it.

SPEAKER_03 21:14

So I'll I'm gonna make a statement, I'm gonna ask you a question, Janine. And uh I'll I'll share as an educator the best days ever are when you encounter alumni that you've worked with who now know more about areas of the profession than you have or ever will. And as it relates to this niche area, you your knowledge about this dwarfs me, and I could not be more proud. That's the statement. Here's the question. Do you know? Take us back to psychotherapy because this is Peplau's ghost, right? Uh so here's here's the question. Can you think about a clinical situation? And I know you've been formally trained in cognitive therapy and cognitive therapy for insomnia, and we we've talked a lot in the academic side about sometimes there's opportunities for high fidelity therapy, and then there's opportunities for low fidelity. Fidelity therapy, right? And then they both have a place within our practice, particularly as psychiatric nurse practitioners. Can you come up and de-identify a situation where you leveraged a low fidelity therapy intervention that worked for a patient? And the reason why I'm asking this is that we've got future nurse practitioners listening right now, and we have novice and advanced beginner nurse practitioners listening right now who could benefit from your example. So can you give us a de-identified example about how you leverage this?

SPEAKER_05 22:30

Well, so I can't, I can give an example of how low fidelity therapy helped to get someone prepared for high fidelity to engage with high fidelity therapy. Um a patient who is extremely suicidal. You know, you you can tell when you have a feeling about certain patients that, you know, a lot may have passive and there's a lot of risk. And of course, we always say that the meds can only do so much, you know, when there is significant trauma and there is. And of course, you want to push but not push about engaging in therapy because everything else will be limited when that trauma is, you know, subsumes everything else, right? And so I would mention it, but then sort of just worked on what we could do in our time with our session. And sometimes it was just acknowledging that there are a lot of things that suck right now. And we also have these tools. And, you know, and we it was a low fidelity therapy. We weren't building tools, we were sort of coping with some of the things, you know, maybe building a little resilience there. But above all, what it was doing, and it it took months and months, but build trust in the system again because there had been a negative experience with therapy in the past. And so coming into this, the the patient was very much like, I'm not doing that. So if the meds can't do it, like that's our last option. I'm like, fair enough. I'm not gonna try to force you into anything. And nothing was a game. I really didn't know which way it would go. I just know I have control over what we do here. And I would mention, you know, we mentioned that this was helpful, it was therapeutic. I'm like, yeah, it's not formal therapy, you know, like so. Yes, you're this isn't necessarily building anything to, you know, make the meds more supportive or get them out of the picture. But it was, you know, an hour visit that was a break from all of the other stuff. And so just from sort of showing that that could exist, it built trust in the system again and made it possible for him to then actually. And I thought it was um, you know, he was messing with me because we'd have sort of like the the give, give and take with some of that. I'm very sarcastic and I use a lot of humor where it is appropriate. I was like, oh yeah, sure. And he's like, no, I think I'm ready to to start considering it. And so it was even using that low fidelity piece, that wasn't the thing that will change the foundation of his therapeutic experience, but it made that possible for now the the very formalized good stuff to happen.

SPEAKER_03 25:00

So if I understand correctly, you use low fidelity strategies as a bridge to higher fidelity.

SPEAKER_05 25:06

Yep. And it wasn't intentional, it wasn't, you know, I'm gonna keep doing this until he sees. It was just was us doing what we do, you know, just being that person as the provider and showing up with our authentic self. And and I think it ended up with that outcome, which was very nice and unexpected.

SPEAKER_02 25:27

Thanks. Go ahead, Kate.

Low Fidelity Bridge And Mentorship

SPEAKER_04 25:30

Janine, so I think I I have perhaps our last question for today. So, you know, as Sean reminded us, our podcast is called Peplow's Ghost. So if Hildegard Pepplau were, you know, here with us today, she would probably remind us that the nurse is the medicine. So for students who are currently sitting where you were not too long ago, you know, what advice would you have for them in terms of really protecting or growing their interest in providing therapy to patients, both as a student and then later as an NP?

SPEAKER_05 26:06

Well, I think it's getting an idea. We always we learned about Jahari's window, right? You know what you know, you know what you don't know, and then you don't know what you don't know. I think it's also being aware that you know much more than you do and integrating that. And then also really, and I stress this whenever I give guest lectures about entrepreneurship or functional medicine or any of that, you have to have mentorship. And so even if it's not formalized supervision the way therapists would, especially that first year in practice, don't be shy. You know, even if it's the collaboration with the peers from your cohort, there are so many psych and groups out there that you can get engaged in. And so sometimes we need that feedback because again, until there was a conversation, I felt like, well, we're not psychotherapists. Then, you know, that's why you are what you're doing is psychotherapy. And so sometimes we need those very obvious things pointed out to us. And I think, you know, really when you graduate and you go into first year of practice, there's this thought that you're all alone, but it's so important to make sure you're not. And sometimes you're in a practice that doesn't have that supervision or doesn't have that support, but there are so many opportunities to seek it out. And, you know, you seek it out different mentors for different areas. And so I went right into practice. So it's coming up on five years. So I went right into uh my own private practice and I had my psych and peak group mentorship, and I also had business mentorship groups, and so and then when I went the more functional route, have those mentorship groups and those peer support groups. And so I can't stress that enough that you have this community here. I mean, nurses, psych and peas by nature are helpers. They want to give, you know, and they want to support each other in that space. And so, you know, don't be shy. You're not leaving school, you know, out from under the protection of that. You still have all of these people and not being shy about making those connections or trying to do it alone or feeling like you should know it. And and especially if there's a specific type of psychotherapy that you want to specialize in, seek out those who are there already. You don't have to reinvent the wheel. You seek it out and you get that feedback there.

SPEAKER_02 28:20

That's awesome. Yeah. So this is kind of coming up on our time. So thank you, Janine. This has been a wonderful conversation. You know, I have more to kind of ask you, but I I know we want to get out on a certain time. But uh, but this has been very enlightenful. And again, I hope people have been learned a few things. It's always one of those things where, you know, take a few things away from these podcasts and and then learn to give a little bit as well. So so thank you, Dr. Janine Panker, for for sharing your expertise and and sharing your experiences. Look forward to more episodes coming out here soon. We've got uh a bunch of people scheduled at this time. So looking forward to having more opportunities to learn and kind of share this passion and and and really kind of keep this as part of our practice that we all love and care about. So thank you again. Look forward to another episode soon and take care.