Is doing therapy as a psych NP realistic?

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? 

[FullGlass, BSN, MSN, NP]

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.  

 

[Kyky]

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.    

[Cascadia57, APRN]

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