Is doing therapy as a psych NP realistic?

What Members Are Saying (AI-Generated Summary)

Members are discussing the time required for medication management appointments, with some stating that the standard 20 minutes may not be necessary for all cases. They also talk about the financial aspects of different appointment lengths and codes, as well as the potential for nurse practitioners to provide therapy along with medication management. Additionally, users are sharing their experiences and perspectives on balancing therapy and medication management in their practice.

Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal? 

RockyMtnHi-ya said:

Good for you for wanting to make a positive difference.  I'm a board-certified FNP in holistic/integrative practice, and virtually 100% of my patients with chronic disease, which I aim to manage conservatively through healthy changes, have traumatic histories that create barriers to adherence.  I'm considering PMHNP certification to enhance my current practice, with plans to remain independent and free-standing as I am now.  You won't likely find a hospital or mental-health clinic job with a primary focus on therapy, but who's to say that you couldn't complete additional continuing ED to become an expert for the therapeutic modalities that would allow you to practice as you wish to?  I hope you find the clarity that you need in order to make the right decision!

I would love to take the holistic route. Originally I wanted to become a clinical psychologist, but have always had a passion for medical sciences and most recently naturopathic/functional medicine. I was thinking of intergrading the two. I would love to become a pmhnp, and be able to utilize medication therapy (if needed, not because I have to push it on someone) while incorporating and placing emphasis on nutritional/supplementary approaches. Psychotherapy is something I would love to incorporate and place more emphasis on while working with patients. I would not be able to do the whole "15 min" sessions. What type of additional eduction would you recommend to provide more therapeutic modalities? 

Specializes in Psychiatric and Mental Health NP (PMHNP).
emgem9 said:

I would love to take the holistic route. Originally I wanted to become a clinical psychologist, but have always had a passion for medical sciences and most recently naturopathic/functional medicine. I was thinking of intergrading the two. I would love to become a pmhnp, and be able to utilize medication therapy (if needed, not because I have to push it on someone) while incorporating and placing emphasis on nutritional/supplementary approaches. Psychotherapy is something I would love to incorporate and place more emphasis on while working with patients. I would not be able to do the whole "15 min" sessions. What type of additional eduction would you recommend to provide more therapeutic modalities? 

I do not understand the attitude that PMHNPs and psychiatrists are just "pushing pills" and that it is somehow boring.  I certainly don't push pills.  I am honest with my patients and I have no issue telling some of them that they do not need, or are not suited to, taking medication.  If a patient expresses an interest in nonpharmaceutical interventions, I am happy to work with them on that level, as I am pretty knowledgeable in alternatives to pharmaceuticals.  Even a good primary care practitioner must be knowledgeable about lifestyle changes for improved health.  

Being really good at med mgt is not easy, nor it is boring.  I suggest those who feel this way enroll in programs like the NEI Master Class in Psychopharmacology. It is impossible to know everything about psychopharmacology and there are new developments every day.  

In order for a PMHNP to be good at their job, they must develop a therapeutic alliance with their patient.  That relationship alone can be very healing for the patient.  In fact, the therapeutic alliance is the most important component of successful treatment.  Good med mgt requires the ability to listen to the patient, elicit additional information, and be someone the patient trusts.  

 

TheMoonisMyLantern said:

No offense, but your experience in psychiatry is still quite limited. You may be able to legally provide and bill for psychotherapy but that doesn't mean you are competent at it. Compare the curriculum between PMHNP and LPC's, LCSW, LMFT, etc. not to mention in most states they have to have between 2,000 to 3,000 hours of supervised practice in order to be eligible for licensure. Most NP programs are what 600 hours? 700 hours at the most? And those clinical hours would be spent doing medication management and there's only so much psychotherapy you can provide in a 15-20min appointment where your primary focus are on medications. Do you really think that with the education you received, your clinical hours, and your limited experience as a psychiatric provider gives you the same grasp of understanding that a therapist has on providing therapy?

I'm not trying to be nasty and I'm not saying you're a lousy provider because it really does sound like you try to go above and beyond to provide excellent care to your patients. I simply want to point out that just because something is in your scope of practice and you bill for it, does not mean that you should do it. I think it's a case where the regulations haven't caught up with the state of PMHNP curriculum. Decades ago curriculum for psychiatric NP's and CNS's were psychotherapy heavy, in fact at most colleges and universities the only difference in curriculum was that NP's had the psychopharmacology piece added. Now that psychiatric CNS's have gone the way of the dinosaur the curriculum has gradually changed for NP's with a much heavier focus on medication management versus psychotherapy. I think this is the role that PMHNP's excel at and where the job security for the profession will lie. I really wish we could go back to the old days as far as the education, though.

Honestly,  before I started this journey I spent hours researching a variety of things r/t therapy treatments.    I LOVE this stuff and I throw at my friends all the time.  I fully plan to add extra certificates so I have something to back the talk.   You have NO idea the capabilities of the person you are talking to.    

Specializes in PMHNP.

Yes. Check out Happier Living where all appts are 40 min and therapy is a focus. 

Specializes in Psychiatric and Mental Health NP (PMHNP).
Kyky said:

Honestly,  before I started this journey I spent hours researching a variety of things r/t therapy treatments.    I LOVE this stuff and I throw at my friends all the time.  I fully plan to add extra certificates so I have something to back the talk.   You have NO idea the capabilities of the person you are talking to.    

So you believe your hours of "researching" are the equivalent of an LMFT or psychologist with a master's or doctoral degree + 5,000 hours of supervised practice?  

Specializes in PsychMH/consult liaison.

As a PMHNP who completed training years ago (1983), my masters program at UCSF (psych CNS) included 2 years of psychotherapy tng w/supervision. Post-masters I strengthened my psychopharmacology skills and have worked across settings and severity of illness. I love my work,  which currently involves locums work on secure inpatient psychiatric units and a part-time private practice where I prescribe meds AND provide therapy.  When I started out, our profession was still fighting for full prescriptive authority. Now it seems we are fighting to preserve our role as psychotherapists. The irony is tragic. I've served as a clinical preceptor for many grad psych NP students, both the psychpharm courses and the psychotherapy courses. My skill as a psychotherapist is on par with many Psy D. Providers. Yet this past year I had a PsychNP student who was NOT allowed to use me as a preceptor for therapy, only the psychopharmacology modules. They told the student it must be an LCSW, Psychologist,  or LCPC. Oh.. and a psychiatrist would also be an acceptable clinical preceptor!  This is so disappointing.  40+ years as an advanced practice nurse and this experience is disregarded, by a School of Nursing. This may be my final year of practice before I retire. For nurses coming on board now, I urge all of you to consider protecting the psychotherapy component of your practice. All therapists, to some extent,  get less-than-expected education and supervision during their initial training, whatever their discipline.  The best therapists are life long learners who are humble enough to keep abreast of advances in the field and seek out post-graduate training opportunities.  They also learn from their patients lived experience.  

Specializes in trauma therapy, mind body medicine, somatic therap.

YES! I'm a PMHNP and I only do therapy! And I train nurse practitioners in the types of therapy I use which are trauma therapy, inner child healing, hypnotherapy, breathwork, mind-body therapy, somatic therapy, emotional release work, attachment wound healing, etc.

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