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Psychiatry question - Must I provide Therapy too?

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PMHNP Man has 7 years experience as a MSN, APRN, NP and specializes in Psychiatry.

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Obligatory anecdote:

I currently work in an environment in which all the psych staff tend to spend more time with patients engaged in "supportive counseling" or other therapeutic dialogue. Despite being at the cusp of burn out, I really don't wish to do this. I only want to assess symptoms and medication efficacy and frankly feel that's all I'm good at and have a fairly low emotional intelligence of my own. 

Question:

How many of you are brazen enough to say something akin to "How about we just talk about your medication today?"

Passive resistance to responses:

At my last job I was ok with this, but it was a different time/place/population and until the mortgage is paid I'm hooked. 

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Do you have behavioral therapists where you're at?

Me personally, other than light motivational interviewing, I'm not all that into providing therapy. I don't believe our education really focuses heavy on it (don't quote me as psych isn't my specialty as of yet). 

I tell them my focus is on med mgmt, and that I can refer them for therapy. We have therapists on site. 

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PMHNP Man has 7 years experience as a MSN, APRN, NP and specializes in Psychiatry.

80 Posts; 464 Profile Views

52 minutes ago, ToFNPandBeyond said:

Do you have behavioral therapists where you're at?

Me personally, other than light motivational interviewing, I'm not all that into providing therapy. I don't believe our education really focuses heavy on it (don't quote me as psych isn't my specialty as of yet). 

I tell them my focus is on med mgmt, and that I can refer them for therapy. We have therapists on site. 

Yeah, I'm with the VA. They're very med heavy and very therapy light. Fortunately, the therapy is mostly evidence based and not supportive nonsense that leaves people in counseling for years, yet it is a very rigid, formalized referral process.  Previously, I was the only med person (no doc) for around 25 therapists.  

I think there's a quasi expectation of using the 90833 add on and actually providing therapy or psychoed. All of us know the NPs are not well trained in therapy and a big dump of psychoed in one visit is low yield for the learner. Even if I could do therapy well, I wouldn't want to. I'm not interested in being a therapist and don't really want to "fake it" either. Being a highly politicized organization with therapy-oriented bosses makes it difficult to have people in and out quickly and focus on pharmacotherapy. 

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Very anecdotal. but I studied, and attempted to practice various forms of CBT over the years.

I became a believer in Solution Oriented therapy, and ACT. I practice them in my personal life, and have found them to be somewhat helpful.

They don't apply much with my current population, however.

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PMHNP Man has 7 years experience as a MSN, APRN, NP and specializes in Psychiatry.

80 Posts; 464 Profile Views

30 minutes ago, FiremedicMike said:

Is it possible to be a PMHNP who focuses on therapy?

In theory, yes. However, you'd probably have to work independently and accept, exclusively, only cash or insurances that reimburse PMHNPs for psychotherapy. Additionally, you'd want to engage in your own training and certifications, e.g. EMDR, ACT, CP, CBT-I, etc.

Frankly, the money is to be made in meds. 

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8 hours ago, PMHNP Man said:

In theory, yes. However, you'd probably have to work independently and accept, exclusively, only cash or insurances that reimburse PMHNPs for psychotherapy. Additionally, you'd want to engage in your own training and certifications, e.g. EMDR, ACT, CP, CBT-I, etc.

Frankly, the money is to be made in meds. 

That’s disappointing, but glad to know it now..

While I’ve been pretty steadfast about working towards an inpatient medical role, there’s a small part of me that’s considered PMHNP so that I can focus on CISD/PTSD in public safety.  I feel with my resume I’d be a great asset to that side of things...

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PMHNP Man has 7 years experience as a MSN, APRN, NP and specializes in Psychiatry.

80 Posts; 464 Profile Views

1 hour ago, FiremedicMike said:

That’s disappointing, but glad to know it now..

While I’ve been pretty steadfast about working towards an inpatient medical role, there’s a small part of me that’s considered PMHNP so that I can focus on CISD/PTSD in public safety.  I feel with my resume I’d be a great asset to that side of things...

Yeah, I was in public safety myself and have had those same thoughts, but it's not really practical. On a side note, I read something about CISD making trauma worse later down the road. The theory was in sitting around thinking and talking about it you're adding more time remembering and applying words to the trauma which serves to anchor the memory.  Interesting nonetheless.

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12 hours ago, PMHNP Man said:

Yeah, I was in public safety myself and have had those same thoughts, but it's not really practical. On a side note, I read something about CISD making trauma worse later down the road. The theory was in sitting around thinking and talking about it you're adding more time remembering and applying words to the trauma which serves to anchor the memory.  Interesting nonetheless.

Yeah I’m torn on this.  On one hand - I think decompression after a bad run is important.  Should that be guided or not I guess becomes the core issue here.. 

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umbdude has 2 years experience as a BSN, RN and specializes in Psych/Mental Health.

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16 hours ago, PMHNP Man said:

On a side note, I read something about CISD making trauma worse later down the road.

I did an EBP project on immediate post-trauma interventions and most of the research during the lit review do not recommend CISD (psychological debriefing). 

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adventure_rn is a BSN and specializes in NICU, PICU.

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Lol, off topic, but this is reminding me so much of my own experience seeing a psychiatrist several years ago. This guy clearly fancied himself a therapist even though he was surprisingly terrible at it (he'd spend the whole time musing about his own life experiences, which is precisely what you learn *not* to do in psych 101). He kept wanting to bill me for hour-long appointments, and practically had to tell him, "I'm looking for a 15 minute appointment so you can review my medication and refill my rx; I don't need to spend an hour hearing about your journey through med school. I've already got a LCSW therapist who is far more skilled and costs about 25% as much." My experience sounds like exactly the opposite of what you guys are describing.

Edited by adventure_rn

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Hey All,

  I am currently a PMHNP student....more than halfway through as I am in a post masters program. I can believe I found this topic! I have been so annoyed with my programming in that they’re focusing on all therapy. Disclaimer: I am an advocate for therapy. It is just that I do not want to be a therapist. What I’d like to do is therapeutically communicate with patients and manage them medically with drugs and prescribing them therapy. 

My clinical experience has been nothing but this! Yet, school is focusing on Freud and Skinner, CBT,DBT, and motivational interviewing (which I like and think is effective to use in short office visits). Maybe you should look into a consultation liaison role. This is my plan to see patients inpatient and move on to the next one . Where I previously worked we had no outpatient clinic in psychiatry so we referred out to the community mental health clinic or if the patient had a provider, back to them. It’s crazy how the ANCC is attempting to make this role like a lcsw rather a psychiatrist when the need is exactly as a provider! I understand your frustration. I hope it works out for you.

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