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? 

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 Psychiatric and Mental Health NP (PMHNP).
LlamaMama said:

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. 

Unfortunately, most PMHNP programs now emphasize psychopharmacology.  While they cover talk therapy, there is very little in the way of supervised talk therapy training in these programs.  

At least in Calif, an LCSW or psychologist must complete their education and an additional 5,000 hours of supervised therapy.   There is just no way a 2 year PMHNP program can compare to that.  These programs provide 500 to 750 hours of clinical time and most of that is for med mgt.  Does anyone reasonably think that 100 to 200 hours of supervised talk therapy (maybe) is adequate to be delving into others' psyches and stirring up who knows what?

Bad talk therapy can cause a lot of harm.  As a PMHNP, I've seen this happen to my patients.  In addition, the way mental health care is structured now, PMHNPs and MDs usually only have 40 minute intakes and 15 to 20 minute follow ups.  That is not enough time for talk therapy; they are supposed to just do med mgt.  In fact, it is barely enough time for decent med mgt.  That is due to how insurance reimburses for mental health care.

Health insurance companies pay crap for talk therapy, unfortunately.  This is one reason why so many areas have a dire shortage of talk therapists that will accept insurance.

Therefore, it is best for PMHNPs to stay in their lane and that means med mgt.   Talk therapists can be sued and so can PMHNPs.  A PMHNP that represents they are qualified to perform talk therapy that ends up harming a pt can be sued.  

A PMHNP that wants to provide talk therapy should consider additional education and training as an LCSW or psychologist.  This is no different from what a lot of psychiatrists do - they get a PhD or PsyD in psychology.

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.

Specializes in PMHNP-BC.

I signed up in here just to be able to comment on this thread. I think it's important. I prescribe medications; I do not pretend to be an MD or a DO or have that training. I perform psychotherapy; I do not pretend to be a PsyD or LMFT/LCW/LCSW or have that training. I know that I don't, but the training I have is absolutely valuable and relevant. What I do know is that a really good PMHNP will know when psychotherapy is appropriate and needed, if they are able to provide it in the time they are allotted, but they will also know when someone needs more psychotherapy that is beyond their capacity and may do more harm than good. Good PMHNPs are not reckless! Lives and souls are precious! I am NOT saying that PMHNPs who do not believe in offering or are not able to offer psychotherapy are not good PMHNPs. I'm talking about those who do offer that treatment. I am an independent contractor, thank heavens, and would NEVER be able to function with fifteen minute follow-ups. Kudos to you if you can - great! I know my limitations, and I know I can't do that. But also, many patients that I see are absolute messes, far beyond: "Mood? Great, Sleep? Great, Anxiety, Great. Nutrition? Great. Get out of here." Many are extremely complex. Many have concomitant substance use issues and/or eating disorders. Many do not adhere to recommended treatments or get labs that are recommended (like my severely anorexic patient who refuses to get lithium labs). I cannot pretend that they do, and it is difficult to assess all of this in 15 minutes and explain to them the vital importance of WHY adhering to recommendations is necessary. I can't look the other way either. How am I helping the patient in that capacity? So many providers already look the other way, and the patient does not get help. Our patients need to know why adherence is important; this is therapy. An educated and empowered patient is more-likely to adhere to and get the most out of treatment! This is psychotherapy! And there are other ways to manage symptoms aside from psychopharmacology. We are not just bodies! We are bodies, minds, and spirits! I have been through years and years of therapy and have learned many valuable tools along the way. I have also taken it upon myself to learn more about CBT, DBT, and Solution-Focused therapy. You bet I pass these tools along to my clients. I even want to become trained and offer EMDR therapy. I myself had 20 years of unhelpful psychotherapy from PsyDs and therapists with Doctorates of Behavioural Therapy. I could have talked to my cat for free. It was a PMHNP that offered therapy and changed my life. I want to give this to my patients. If you don't agree - good for you. If you agree, keep rocking on with your bad@ss self! I don't treat bodies, I don't treat labels, I treat people. People are comprised of body, mind, spirit, and so much more that I don't know about! But I'm here for all of it. Psychotherapy and Psychopharmachology each need each other. Many of my patients have therapists who empathize, nod, say "I'm sorry," but give the patients ZERO tools to change. This was me in my first 20 years of therapy with the providers that had doctorates and more training than the PMHNP who gave me therapy and quite literally saved my life. I don't pretend to have that training of an MD, DO, PsyD, or DBH, but I am a nurse, and nurses are amazing, whether you have an LPN, RN, BSN, MSN, DNP, Ph.D,. Think about all of our nursing founders and how hard they worked for our specialty. Dang it - I know what tools I do have, which are many and are powerful, and I have the presence of mind to know when it is appropriate to use or not use them. I have the scope of practice and ability to empower my patients, and thank goodness no one can tell me that I can't. A PMHNP who dared to give me psychotherapy saved my life. I think a PMHNP has every bit of business providing psychotherapy to our patients. We are NURSES, and we treat humans, not diagnoses. If you are a nurse and you don't believe that, again, good for you, though I believe our nursing founders would all turn in their graves. But please don't trash those who do. I am so proud to be a nurse. I know that I was put on this planet to serve others. I have known it since I was very little. I am so grateful that I can give back to others in this capacity. ♥

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