Thinking about pursuing PMHNP post-masters

[jaldyAPRN]

I am currently a AGACNP, but since I started clinical I began questioning if it was really for me. I've thought more about it, and am thinking of pursing the PMHNP degree. I've always had an interest in psych disorders and psychopharmactotherap. To what extent do PMHNPs have to practice psychotherapy? I would like to diagnose and treat mental illness, but do not have much interest in providing long psychotherapy sessions.

[PG2018]

Some people bill for it in their med management sessions, but more often than not there is no psychotherapy beyond a therapeutic dialogue. Frankly, I feel you can see more level 3 E&Ms if you just handle meds and move on. Depending on the insurer, the psych eval can be pretty lucrative.

We don't generally do talk therapy. We're horribly trained in it, and most are disinterested in it. I know I am. Don't sweat it. I was never in psych before this. It'll all work out in the end. You'll diagnose all day, dole out a lot of meds, fix a lot of crap that PCPs screw up, and change a lot of "adjustment disorders" to more valid diagnoses. That diagnosis, by the way, is the psychotherapist crutch. A lot of PCPs will shoot Xanax and Seroquel bullets with subtherapeutic doses of citalopram, fluoxetine, and sertraline before throwing their hands up and sending them your way. If you choose to work inpatient then summon JulesA. I have little insight in how hospitals work since I hate them. Outpatient is tons of fun. It's everything I ever hoped for in a job.

It seems more relevant for you to choose adut/geriatric primary care before psych, but if you've got to complete the acute care then bless you.

[jaldyAPRN]

Thanks, PsychGuy. Good to know many PMHNPs don't like talk therapy. I'm not sure if I would rather do inpatient or outpatient. I am starting to get the idea that the more time I spend in hospitals, the less I like being in them. As far as switching to primary care track...too late!

[banana, MD]

Aside from providing "supportive psychotherapy" (whatever that means) and being friendly to the patient and billing it as a psychotherapy session, there most likely won't be any actual psychotherapy going on. Clinical psychologists are trained for years upon years with tons of hours of supervision to provide actual evidence based psychotherapies for specific disorders (IPSRT, DBT, ExRP, PCIT, exposure tx, etc...) and most specialize only in a very specific area or kind of therapy and patient population. Most psychiatric residencies provide laughable "psychotherapy" training at best let alone NP school. You're probably better off referring these patients to psychologists if they're not already in treatment

[yhl1975]

Aside from providing "supportive psychotherapy" (whatever that means) and being friendly to the patient and billing it as a psychotherapy session, there most likely won't be any actual psychotherapy going on. Clinical psychologists are trained for years upon years with tons of hours of supervision to provide actual evidence based psychotherapies for specific disorders (IPSRT, DBT, ExRP, PCIT, exposure tx, etc...) and most specialize only in a very specific area or kind of therapy and patient population. Most psychiatric residencies provide laughable "psychotherapy" training at best let alone NP school. You're probably better off referring these patients to psychologists if they're not already in treatment

In regular Outpatient programs like OASIS, 99% "psychotherapists " are counselors CASAC with minimal training, they have some supervision, but the case load is 25-50 clients for full time. Unfortunately they trained "fast" have loose skills and the conditions of the work, prevent them to give any kind of "psychotherapy", so clients no show and other ...Referral need to be done to "real therapist", that knows what he does and such providers usually have private clinics or "out of network".

Referral could be done for biofeedback and neurofeedback, art therapy and other.