Treating psychosexual issues

Have you considered Psych Mental Health Nurse Practitioner? It would enable you to diagnose and prescribe in addition to the good work you currently do.

I would very much like those responsibilities! I am just wondering if, as a PMHNP, I would get to do very much of this type of work. It may be a geographical thing, but in my experience, most of them work in community MHMR where I am thinking this would be a very slim portion of my job description... but that's why I'm here.

Thank you for your thoughts!

It sounds like these women need psychotherapy. I am surprised your psychology mentors are not more encouraging since they have the most education in psychotherapy. As a psych np you can do psychotherapy meds diagnoses. Often psych NP s don't do as much psychotherapy because others can do it cheaper.

What kind of further education do your psychology mentors suggest?

It's been mostly suggested that I stay where I am unless I want to teach. I wouldn't mind that, but it's not what I get up for in the morning, you know? The issue most often cited is the extensive education and cost for little guaranteed return on investment.

Jules, may I ask you: bipolar disorder, depression, anxiety, addiction, you treat these types of things but perform minimal (or no?) therapy? You could say I'm not necessarily income oriented, although I should think adding med management would potentially increase my earnings somewhat. I think. But as you point out, it may be unrealistic to land a day job doing what I want, in which case private practice may be the only avenue and take time to build, presumably.

If you have experience with this, is private practice uncommon for pmhnps? More trouble than it is worth? I appreciate any insight any of you may offer.

I'm beginning to see more and more transgender and gender dysphoria which really bothers me. I initially said I would never treat them and don't want to. I find it particularly vexing so I focus instead on their reported depressive and/or anxious symptomology. I find it disturbing actually.

I've ticked med checks back to 15 mins to better fit a 99213 and evals at 30 minutes. This allows me to see more patients. Had 22 in clinic today. I see everything including a genuine psychopath today.

Regarding therapy, I shoot for a therapeutic dialogue but stick to biomedical stuff. I only do therapy-lite when I have kids in with waste of space parents. I would like to learn hypnosis.

But of course since we're psychiatry we know what you're thinking, why you do what you do, when you're lying and what you do when you're by yourself. Or that's what people think anyway. Totally untrue.

Or is it?

How do you guys handle the med seeking and manipulation? That is one of the reasons I love the population I work with and am somewhat hesitant to do pmhnp. There is fairly little of that going on with the women I see, but then, as you mention Jules, psychologists in general make only a bit more than my therapist peers so I am also reluctant to do that. In my first job, and my masters rotations, I was inundated with people desperate for xanax or welbutrin, whether they actually needed it or not, and therapy was quite moot for a large number of them. Billing was hell. How does that issue look from your side of things?

I have been fortunate to work in practices where prescribing controlled substances is not pushed. I try other meds first and expect people to be working in therapy. Sometimes people self medicate mental illnesses and I try to evaluate for that. Often substance users are willing to try different meds when I discuss it with them. I try to avoid stimulants. I tell people most of their treatment is therapy and lifestyle change; meds are a small part.