The Prescription Has Meaning with Dr Kathleen McDermott

A prescription can land like a lifeline or like a verdict and we rarely ask what it means to the person holding it. We sit down with Dr Kathleen McDermott to unpack “psychodynamic psychopharmacology,” an approach to medication management that treats the prescription pad as part of the therapeutic relationship, not a replacement for it. If you’ve ever felt the tension between evidence-based psychopharmacology and the messy reality of trauma, family dynamics, stigma, and hope, this conversation brings language and structure to what you already sense in the room. 

We talk about why the therapeutic alliance and Peplau’s interpersonal theory still matter in modern psychiatric mental health nursing, especially when the system pushes quick med checks and constant changes. Kathleen shares how she frames expectations, why slowing down can be the intervention, and how authentic curiosity can transform “nothing works” from a dead end into clinical information. We also dig into medication hesitancy, intense reactions that may be shaped by trauma, and when genetic testing can help clarify options without dismissing lived experience. 

You’ll hear an integrative psychiatry mindset throughout: labs that often get missed, the basics of thyroid and vitamin D, sleep routines, sunlight, screen time, nutrition, hormones, and how to change one variable at a time so you can actually tell what’s working. We close with a candid look at where the field should go next: clearer public understanding of roles, more real choices for patients, psychotherapy staying on the menu, and healthy skepticism about profit-driven “breakthroughs.” If this supports your practice, subscribe, share the episode with a colleague, and leave a review so more clinicians can find it.

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 Community Updates

SPEAKER_05 0:31

Welcome back, everybody. Welcome to another episode of Peplao's Ghost. I am so thrilled that you're here. My name is Dr. Dan Wiesman. I am one of the hosts here. I'm joined by my two other esteemed ghost hosts. Ghost, oh, ghost host. Well, that was a little Freudy and Swift, wasn't it? But actually joined with Dr. Sean Convoy, Dr. Kate Molino, and Dr. Melissa Chapman-Hayes. We're all here and welcoming our next wonderful guest, Dr. Kathleen McDermott, who we're thrilled to get to know and have this conversation. As I like to say, just kind of a conversation among friends, sharing our passion, sharing what we love to do. Hopefully, other people will pick up on this fire and keep it burning. So a couple announcements. This is kind of unusual, but I'm gonna kind of steal the show a little bit. Got two announcements. One, as Sean and I were talking earlier this week, as I am a past president of the International Society of Psych Nurses, we do have our abstracts open. So anyone's listening who wants to put in an abstract and meet me and maybe Sean, hopefully Sean, in Asheville, North Carolina. That would be amazing for 2027, something to plan for. But yeah, the abstracts are open if you want to submit something. And you have questions about that, feel free to reach out to me as well. The other thing I'm really excited about is that we're gonna have another meeting in Barcelona, Spain, November 13th and 14th. This will be the second meeting and further development of the International Council on Mental Health Nurses. I was excited to be a part of kind of that introductory meeting last November, and we're meeting up again. So check out the social media. That's one of my jobs is to kind of push it out on social media. Definitely not my full-time gig, but I'm doing my best I can. And so, but again, hopefully can those any of you out there listening want to meet up in Barcelona, a wonderful city, went there last year. It's yeah, gorgeous. So all right, that's enough of my plugging. So let's get back to Kathleen. So thank you, Kathleen, again for

Psychodynamic Psychopharmacology Explained

SPEAKER_05 2:20

being here. You know, one of the things as we were talking before we started recording too, a little bit is this idea, you know, that that you're very much into kind of looking at this term, which I was I'll I'll ask you to kind of explain and maybe talk a lot about a little more, psychodynamic psychopharmacology, which in my mind is kind of this idea of how do we integrate, which again, here on Peplo's Ghost, we talk a lot about psychotherapy along with medication. So, so how do you do this? How do you bring psychodynamic lens to your prescription pad? How do you kind of utilize this? And again, thank you for being here.

SPEAKER_01 2:55

Yeah, well, thank you for having me. It's a pleasure and an honor to be here with you all and have these conversations that are so important. You know, I don't know if it's actually a coined phrase yet. Someone said it to me. I was describing to a colleague, a psychiatrist in a case consultation about how I work, and he sort of stood back and said, You practice psychodynamic psychopharmacology. And I thought, whoa, that's a lot of that's a lot of words. But I think it's I think it's how I was trained. And I think intuitively it's really important. So just maybe to step back a bit, I was trained in the late 1990s, early 2000s. And back then in the PMHNP programs, mine particularly back in New York at Columbia, really had a heavy psychotherapy focus. And so I I think that's a joy and a treat for me to be able to carry forward and then add on. Certainly, medications were part of the curriculum and the rigor, but that aspect of treatment has grown significantly, I think, as we've seen. And so I'm sort of fascinated with by the idea of psychodynamic psychopharmacology. I think it reminds us that the prescription has psychological meaning for people. And for some people, they can see medicines as failure or hope, rescue, sometimes punishment, sometimes proof that something is wrong. Excuse me. Sometimes there's a parent who's forcing them to do it, take medicine. And sometimes they can desperately want medicine that they've not had access to. So people come to us with all different reasons for medicine. And I think this is where Peplau's interpersonal theory is really incredibly relevant, in that our relationship with the patient, this is what shapes sort of how treatment is understood, how it's accepted, and how it's experienced by the patient. One of the things that's important to me in early practice in early sessions with new clients and patients is to as much as I can sort of dispel the hierarchy in that I am here because you came to me. I know a lot about medicine and the research and the art and the science of combining this and all other things about wellness and helping you feel better. And yet you, patient, are the expert on you and your life and your experience. And so we together are a team. I'm a consultant and someone to walk with you. And sometimes, surprisingly, that is surprising to patients who've not heard that before, who have not experienced that, who've maybe seen somebody for 15, 20, 40 minutes and walked out with a prescription and no explanation about why. And that sort of blows my mind that that happens out in the world, but it does, as we are aware.

SPEAKER_05 5:42

Very eloquently put. Thank you, Kathleen. I mean, it's yeah, I think a lot of the the terms and the words you use are just kind of hitting home for me. And uh yeah, I don't know, it just reminds me so much. I know sometimes I see people getting so concerned that we're gonna, you know, as as psych providers get turned into like a kiosk, you know, just kind of type in your symptoms and then they spit out a prescription. But there's so much more of what we do, and uh, and thank you for highlighting that. Turn it over to Sean. Thanks.

SPEAKER_04 6:06

Hey, friend. So yeah, I I appreciate your introduction here. And it got me thinking, and I'm sorry, Dan, I'm gonna go off a little bit and ask a different question. There are some amumas who believe that like the fundamental parts of psychotherapeutic practice, you know, they're kind of defined by things like unconditional positive regards, socratic questioning, benevolent inquiry, guided discovery. They're likely more influential than the particular brand of ferropsychotherapy that we deliver, whether we're talking psychodynamic, cognitive, rogiering, what have you. Can you think about that for a minute a moment and kind of speak to that? That from your perspective, what do you think is more actionable? Is it the foundation on top that subsumes the model or the model itself?

SPEAKER_01 6:49

Holy smoke, Sean. That's a big question. I don't know if I know the answer to that. What are my thoughts? I think that ultimately it's the important part is that relationship, right? Because that's where the healing happens. And so if you're angling to think about, should I be using CBT principles and should I mix in a little MI and how do I approach this? I think really I don't know. I guess that happens in the back of my mind to some degree. Let's hope it does, as I'm with someone, sort of feeling them, reading them, working with them, using ideally in person, right? I do a lot of in-person work every time I can. So many patients want to do telehealth these days. I appreciate the convenience. And yet, I think

Relationship Matters More Than Modality

SPEAKER_01 7:40

being in person and having that energetic exchange and the experience of another being and holding space together, literally geographic space, and then emotional space. So I feel like that's the guiding principle. I'm not sure that answers your question at all.

SPEAKER_04 7:58

I I think it's okay because I I, you know, Kathleen, one thing we know in this podcast is that we have a lot of experienced clinicians and we have a lot of students, right? So one of the things that I'm hoping to write, you know, to get out to the community is the idea that there's likely more than one path to get to psychotherapeutic value. So, you know, what we want, quite frankly, in advanced practice psychiatric mental health nursing is diversity in all of our skill sets. And not everybody have the same skill set. And I like the idea that a lot of us can get to the same place through different means. So thank you.

SPEAKER_01 8:30

If I can respond to that, I I completely agree. I think in the teaching that I do with the University of California and their statewide program, students come in often wanting, I want to know everything. I don't want to leave without knowing everything. And just teach me the algorithm, right? And what we know is that there are national guidelines and clinical guidelines and there are guidelines. But the idea that you need to develop reflection and curiosity, and that that leads you to therapeutic connection rapport and pathway to treatment.

SPEAKER_04 9:06

Yeah, I appreciate that. I think what we've learned is that you know the what's how I say this. I think uh the the pearls that we've learned psychotherapeutically are written in invisible link on the margins of our textbooks, you know.

SPEAKER_01 9:19

Beautiful way to say that. Yeah, absolutely.

SPEAKER_00 9:21

Thank you, Kathleen. I I really love what you said about you know, really exploring the meaning behind how people interpret the fact that they are being prescribed something. I mean, that's not something I think that is that's such an important skill, and I think it's a very underrepresented skill. So, you know, I'm I'm curious maybe if you could elaborate that on that a little bit more. You know, if you have a person that you're seeing who maybe really doesn't want to take medication and you think they would benefit from it, or I know often I run into this too, where I have people who, you know, really react very intensely to every medication trial to the point where I'm not really sure that it's just a biological reaction. How do you approach those type of scenarios with patients?

SPEAKER_01 10:08

I so appreciate that question. And I I have a small private practice, and it's been interesting to me to see the people that get referred to me. And sometimes, often, it's people who are totally med naive, never had a medicine in their life. I had one this week, a young 20-year-old female who clearly is struggling with symptoms of ADHD and also generalized anxiety, but also seems to maybe have a learning comprehension, there's something else going on as well. And so we talked about not just like, is there a medicine we should start? And in fact, we didn't start a medicine. We talked about sort of a a treatment plan and where to start and how to get more information. We talked about potential genetic testing, if that's something they're interested in. I also get people referred to me who have tried doing air quotes of every medicine out there, right? And I've been on everything, nothing works, or I've only been on these and these only work. And I think there's I have a lot of curiosity around that. Sometimes sometimes the genetic testing is very helpful for reasons I didn't expect. And I've learned this just within the past year. I consult for a trauma program that has residential PHP and IOP levels. And so I see their patients only by Zoom, which is unfortunate. It's quite a distance from where I practice. And often you hear with these patients who have experienced significant trauma that every medicine is having a big strong reaction. And so sometimes after really good establishment of strong therapeutic rapport, I introduce the idea of possible genetic testing, not so much to sort of validate, but and I hate to say it, I'm not really invalidating, but I want to shed light on maybe what they're experiencing that is different from the pure biology. It doesn't take away from the fact that they're experiencing what they are with medicine. And that can be a helpful tool,

When Medication Feels Loaded

SPEAKER_01 12:10

but one to be very careful with in this case. I think the other piece about this is it's not just what medicine's prescribed, it's how you talk about it. The expectation you set for it. I I find still a lot of people come in thinking they can have a medicine and they'll feel better in a week and they don't need to do anything different in their life. That, in my opinion, is never the case, right? And so we're talking about sleep and exercise and nutrition and inflammation and hormones, and often women who refer to me perimenopause or going through infertility treatments, trauma, certainly purpose and meaning making in their lives. And then there's this other piece that I don't want to leave out because I think it's so important is it's not just about what medicine you prescribe, but as you're using medicine, how they take their medicine, when they take their medicine, how much how often do they forget medicine, if they want to refuse medicine, particularly you see this in a parent-child dynamic. That tells us something really psychologically important. And so the medication discussion becomes a therapeutic discussion about the meaning for the patient.

SPEAKER_00 13:21

Again, I may have veered left from your question. Pardon me. I love that. You know, I just I love how, you know, the medication question, the medication part, you're how you're describing that it can really lead into an exploration of so much more about what's going on in this person's life. And I think that's such a beautiful illustration of how we can weave our psychotherapeutic skills into this other sort of very medical model piece that we are responsible for too. Yeah, thank you. I'll pass the mic to Melissa.

SPEAKER_03 13:53

All right. Um thank you very much for that. Um you have a wonderful way of blending rigorous, evidence-based psychopharmacology with holistic alternative approaches to wellness. How do you strike that balancing of practice? Like when you're sitting with a patient, how do you decide when to lead with traditional pharmacological intervention versus when to introduce holistic or lifestyle-based strategies?

SPEAKER_01 14:19

Thanks, Melissa. I appreciate the question. I hate to be trite and say it depends, right? But really, when you're in the room with someone and you're getting to know them, you're not just getting to know their symptoms or their trajectory or their history or when did this first begin? You're getting to learn who they are, contextualize in their life, right? What are their roles? What are their values? What's important to them? And often it can be for some people, it's a very direct question. How do you feel about medicine? How would you feel about making some changes or augmenting other parts of your life? One of the first things I do in my integrative private practice is ask to see recent lab work. And if they've had it done, hopefully they have. But if they haven't, depending on symptoms, of course, I'm gonna run sort of a basic panel on people. I really want to know what your vitamin D is. I had a young gentleman come in, referred from his therapist, had been seeing her for a couple years, and the the referral was he's depressed, needs medicine. Okay, fine. I met with him, lovely man, using quite a bit of cannabis, also seemingly depressed, and he had a vitamin D we found out of four. And so we need to do some things, right? This is our basis in psychiatry. Let's rule out any medical causation or strong influence. And so looking at labs, the basics, thyroid, vitamin D, things that could be contributing factors. I ask a lot about sleep. I think we probably all do, and not just how much are you sleeping, but how long does it take you to fall asleep? What's your sleep regimen like before bed? How often do you get sunlight in the morning? When do you grab for your phone when you wake up in the morning? All these lifestyle aspects. I I can't, I should, I would be remiss if I didn't mention screen time and the buzzword of that. All these lifestyle pieces, like that's the nursing model, right? It's not just I didn't go to medical school, obviously. I assume I what I understand from that model is you find the problem and you treat it with a pillar surgery. That is not the nursing model, right? We are looking at all the realms that are important to people and that contribute not only to overall wellness, but to having meaning in their life. So I mean, you know all the things, right? Their physical wellness, their mental health symptoms, their financial wellness, their spiritual connection, the roles they have in their lives, who they eat with, when they spend time with people, how much do they exercise? Again, I think I've diverted from the question, but I hope you I hope that's on point.

SPEAKER_03 17:05

And I guess as a follow-up, is anyone ever surprised? Say, for example, you know, the vitamin D made such a difference if it was that low versus some pharmacological intervention.

SPEAKER_01 17:16

Thank you. Sorry. There we go. No, thank you.

SPEAKER_05 17:21

It was very important, I'm sure. Yeah. I wanted to hear it.

SPEAKER_01 17:24

Yes, I I I have so many stories about that. There's two that come to mind. One is this gentleman I was just speaking about. We supplemented vitamin D, and he he then, resultantly with more energy, had some shifts in his life. He had some shifts with his cannabis use. And I'll just digress for a minute because I think one of one of the tenets for me, if I'm introducing a change, whether it's medicine or sleep or really anything, I I'm always saying to people, sort of like a good science experiment, we want the other variables to stay the same. We don't want those cofounding variables. And so that cannabis use you have, that alcohol use that you have, assuming that it's

Integrative Care With Labs And Lifestyle

SPEAKER_01 18:05

not dangerously high, I'm saying, please don't change that right now. And my hope is with you feeling well over time, whether it's sleep changes or medicine or exercise or supplementation, that over time the use of things external to help you feel better will lessen and drift away. And I I find so many patients are relieved of that. Because I'm I'm not here claiming abstinence, I'm not here to preach what they should or shouldn't do, right? It's it's not my job. My job is to walk alongside them as a partner and give information. One of the things that I tell people when I'm doing a consult is that my intakes are usually about an hour and a half to two hours. And the reason for that is there's a lot to learn, a lot to say, there's a plan to be made. But honestly, I do a lot of listening, I also do a lot of talking. I do a lot of educating. And so people, I say, you know, if you want to bring a notepad and take notes, you don't have to, but some people want to remember things. The other story I thought of I think that's relevant to your question is I I happen to treat a lot of therapists in my community. You know, many with therapy of of their own, some with medicine, but there's so much vicarious trauma. There's so many people who are in a field to help people because they initially came in to learn how to help themselves. And so I was treating a therapist, a very accomplished therapist, a therapist who I I her work is amazing. And we were I was looking very specifically, excuse me, at her med regimen. She was wanted to continue a specific stimulant with me that seemed appropriate. And as we're talking, she's telling me that she gets up in the morning and she takes her medicine for her thyroid as well as her stimulant, as well as her coffee, all at the same time. And I was like, oh, okay, okay. So we just talked about mechanism of action and some gentle guidance about spacing things out, not combining certain things, and the rationale for that made a huge difference for her. And so it's not about the prescription pad, right? Some medication can be important. It's rarely the entire answer. I think the curiosity about what's going on there, and sometimes it feels innocuous, like it's not really that important, but there's there's good fodder, there's good information to take in.

SPEAKER_05 20:25

Thank you. That's awesome. I I'm gonna continue on here and just kind of, you know, in thinking about kind of Sean's question a little bit, you know, a lot of our listeners here are gonna be people going through a PMHMP program or early, you know, career people. And I think this is something that I see a lot on social media and other places as well, where where they feel like they get a little bit shoestring, you know, it's like or shoehorned, I guess is a term, where it's like, you know, they have to do 15-minute med checks, you know, you have to see so many patients, and there's this pressure, you know, to fit into what's you know sarcastically you know called a pill mill where you're just kind of seeing people. And we talked a lot about that, you know, that that idea that is just not healthy, and you mentioned, you know, kind of you know, vicarious uh trauma, you know, that that mental health people can experience. Like I think that can come from very much just you know writing prescriptions all day and not seeing much success with that. Obviously, you're advocating for much more of an integrated model, which I think we're all probably in agreement here on this podcast. But how do you talk to people or how do you talk to an administration or or what do you tell people who are really kind of stuck in this pressure of kind of you know, see them, you know, turn and burn kind of thing where that's just not a very good model to feel good about with the work that you're doing.

SPEAKER_01 21:38

Yeah, I so appreciate that. I'm a big fan of vote with your feet, right? If it's not working, maybe maybe look for another option. And my hope is is that things will start to shift over time. We're not seeing that now, right? The pendulum is definitely swinging towards what you're describing. When I when I'm teaching, what I'm talking about with students is that sometimes the most important thing is the slowing down of the visit. And that's really hard to do in 15 minutes, right? But the question that students often go into a visit with with a patient that they're seeing for a follow-up is what medication do we change? What change needs to be made? I've had patients come to me and say, sort of with the expectation, like, okay, I'm here. What do we change this month? And like sometimes the important thing is to not change a thing and just give it time. We know that a lot of the antidepressants, anti-anxieties take time, maximum effect, eight to 12 weeks, right? That is not a month. That's not even six weeks. So slowing things down in terms of the temperament and we want to mirror to some degree, but we also want to guide discussions. And often people are coming to us with trauma, whether they know it or not. And so, you know, Keplow emphasized sort of understanding patients' lived experience and meaning making. And trauma-informed care these days really builds on those foundations. But rather than sort of looking at like what's wrong with you, the shift to what's happened to you, and then really now what's happened inside of you because of what's happened to you, this sort of resonant with Gabor Mate and his small T, big T trauma. And I think many patients dismiss their experiences because they weren't dramatic enough to count as trauma. And so one of my roles is I work at the VA and there's really clear drama, uh, drama, trauma, drama and trauma, actually, in those settings. And people, I I have yet to meet someone who I think doesn't have an element or a wisp of trauma, often because of growing up feeling either not emotionally safe, and how that, whether it's repeated criticism or emotional neglect, bullying, chronic unpredictability, and that influences our nervous system. So how do we make time? Just look at me, circling back to your question, Dan. How do we make time in those visits to to explore that? How do we change administration? I am really not sure, other than voting with our feet and setting up practices that do that.

SPEAKER_05 24:26

Yeah, that's I totally agree. I I think that's what I'm seeing a lot, at least maybe in my part of the world, is that people are voting with their feet and finding out finding themselves in private practice and allows them a lot more autonomy in what they do. So yeah, I'll turn it over to

Breaking The Fifteen Minute Med Cycle

SPEAKER_05 24:40

Sean.

SPEAKER_04 24:41

So, Kathleen, I'm gonna speak to our audience for a second and make you both make you uncomfortable and brag about something you said, and then I'm gonna follow it up with a question. I um you said something earlier to Kate that kind of screamed at me in the best possible way. As it relates to a treatment response, you said, I have a lot of curiosity about that. And I pray our listeners can reflect on that response. I mean, please note, audience, that she didn't say I'm frustrated by that. She said, I have a lot of curiosity about that. Uh that is such a healthy cognitive frame as a clinician. So this kind of brings me to my question to Kathleen. Can you speak to how curiosity informs and influences your psychotherapeutic practice?

SPEAKER_01 25:22

Yes, I'd love to talk about this. So thank you. I'm just making a note because it also reminds me of something I feel like it connects to Dan's question too, right? I had a mentor psychiatrist. I worked in community mental health for probably a decade and a half. Different varieties, but often street medicine in homeless encampments, making connections, building rapport, sometimes over months, months, and months, to get to a place where maybe we could talk about medicine. They trusted me enough. Maybe we could talk about a long-acting injectable and how that might be more beneficial. And and the relationship comes from curiosity. And I I would add also being open to them being curious about me. Right. And so I'm certainly not divulging my entire life or my political stance, but therapeutic rapport is sort of a two-way street. And so allowing someone in the mentor I was referring to, he he's the one who taught me. His words are, I'm paraphrasing, you can ask any question you want of someone if it comes from a place of authentic curiosity. And I would add kindness as well, right? I find myself sometimes in in sessions, I forget and I'm asking questions because I just want to know. Like, I want to know just to know. I'm curious, but not in that, like, I'm curious for your treatment, I'm curious for our relationship. Maybe I want to know about the timeline, but is that really important? Maybe, maybe not. People I think can detect when you're asking just to ask, you're going through a checklist, or when you genuinely want to know about them and their life. And this is the piece I was wanted to circle back with with Dan. In terms of teaching students and mentoring, one of the tenants, and I I'm always surprised because I feel like it's kind of new to these students. And I should clarify, the students I'm teaching, they're already nurse practitioners who are coming back to get a certification in psychiatry and psych mental health nursing. And they maybe they're shifting into the field. Maybe they are just going to incorporate it into their family practice or their primary care practice. But I think what I say is the most important thing with a patient, the the the only way you can help people is if they come back to see you. And they're only going to come back to see you if they felt safe in your presence, if they didn't feel judged, and that there was some level of either curiosity and or hope, depending on the person. So I think people feeling cared about, feeling heard, feeling understood, like that's where the healing happens.

SPEAKER_04 28:20

So I'll I'll add to your your your labels of psychodynamic psychopharmacology to also benevolent curiosity. Thanks. I'll pass it to Kate.

SPEAKER_01 28:28

Love that.

SPEAKER_00 28:30

Gosh, Kathleen, I have so many questions for you, but perhaps I will ask those to you another time. You know, we we know that you've been a leader in psych mental health nursing for you know two decades. You've been past state president of APNA, you are working with the UC Multi-Campus Program to, you know, train psych nurse practitioners, which is a huge, incredible program. So we're curious, you know, looking at the landscape of psychiatric mental health nursing today, where do you hope to see the field go? What are your hopes for the future?

SPEAKER_01 29:04

Hopes, dreams, and all things good, right? I hope that there is choice for patients. And I hope that there is more clarity about what those choices are. You know, just this week with this new patient who was hesitant about medicine, wasn't sure. Mom very much did not want her to take a medicine every day. Somehow a PRN medicine was better for her ADHD. We spent a lot of time talking about that. But she, the both of them, mom and daughter, didn't understand the difference between a psychologist, a psychiatrist, a psych NP, what was neuropsychevaluation, who could write a letter for accommodations if she needed it. I think there's so much confusion about the roles and beyond that, about treatment options, right? And so for PTSD, should we be talking about psychotherapy as the absolute first line of treatment? Yes. Should we also be talking about a medicine component potentially? Yes. Should we also be considering stelic ganglion block injections? Maybe yes. And so I think that there, I'm excited and a little concerned about the advances that are purely

Curiosity Hope And The Future

SPEAKER_01 30:20

biological. Frankly, I don't know enough about the research. And I would like, I want to believe that these are going to be evidence-based and that there's really good, strong research. I have some hesitation and skepticism about things that are just FDA cleared and not approved, and the difference and the lack of understanding perhaps of the public. People want hope, people want things that will help them, and sometimes there's a desperation about that. And so I worry that people will be misguided by something that is more for profit or has a benefit in a different way. And so I hope that there is a return to psychotherapy as a forefront treatment. I'm seeing this with some with psych NPs, more so with psychiatrists. I I've had a several referrals because my psychiatrist isn't prescribing anymore, they're only doing therapy. I don't know what that's about. I want to believe it's sort of a great thing. I don't know if it's a liability. I just don't know. But I think there will be people maybe who specialize and just do one thing. My goal and hope for my own practice and to mentor towards students is to offer as many options as you can withhold within yourself and within your practice and be knowledgeable about the others. Again, my role as consultant to patients is to talk about what all the options are, right? In that first visit. And sometimes they're very heavily biological, sometimes they're purely biological medication. Often there's also a psychotherapy component, like, and then lifestyle. So all of those things should be on the menu, not for patients to pick on their own without guidance, but to think about sort of what are the tiers of treatment and where do we start? What would that look like? And what I say to patients is we're gonna pick like steps one and two together. But my job is in my brain to do steps B C D E and all, you know, two, three, four, five, six, seven, eight, nine, ten, the the what if clinical guideline flow chart. That's my job to do that and help someone walk this road towards wellness and recovery with the installation of hope.

SPEAKER_05 32:33

That's amazing. Thank you so much. I think we're kind of up on time. So so this has been a great episode. Thank you very much to Dr. Kathleen McDermott. Again, just so many pearls here. So, again, hopefully everybody listening has gotten a few of those and take them along with their journey as well. So, look forward to another episode coming soon. Peplow's Ghost has guests lined up through the rest of 2026 and even going into 2027. If you're interested or know somebody who should be on the podcast, reach out, send us an email, like, subscribe, comment, all that good stuff that we hear. We are the only advertisement-free technical health infectious podcast in America. So feel free to jump in anytime. We'd love to have you. We're creating a community that we want you here with us. So thank you so much. And look again, looking for another couple coming up.