January 31, 2025 • 26 mins
Chris McCormick-Pries discusses her journey in psychotherapy and the importance of building therapeutic relationships. Throughout the episode, she shares her insights on various psychotherapeutic modalities, the challenges faced by psychiatric nurses, and the need for mentorship in the field.
• Building relationships as a cornerstone of successful therapy
• Personal anecdotes highlight the transformative power of psychotherapy
• Importance of diverse psychotherapeutic modalities in practice
• Addressing barriers for advanced practice psychiatric nurses
• Emphasizing the need for mentorship and supervision in clinics
• Advocating for the inclusion of psychotherapy training in nursing education
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Yeah, just my take on things.
Speaker 2 (00:08):
My answer number two Welcome everybody to another
wonderful episode of Pepow'sghost.
So appreciative of everyonelistening here and I'm so
excited to be introducing ournext guest is Chris McCormick
(00:31):
pre.
It's a it really is kind of acoming back to home type of
episode for me, so I might get alittle sappy on this podcast
and and I know Kate and Sean arehere to kind of keep me in line
with that but really appreciateChris and spending time and
again for all of you listeningto make sure that you're all
kind of keeping this podcastafloat.
(00:51):
So the only podcast I knowthat's about PMHNPs with no
commercials, although I'd loveto have some commercials someday
.
So not opposed to getting paid.
So let me do a quickintroduction for Chris
McCormick-Pree.
She is a PMHNP I believe she isalso one of the which we've got
others on this podcast rightnow too a PMHCNS which is a
(01:15):
certified nurse specialist Beenin practice for a while.
I don't want to make Chris feelold and I don't want to make
myself feel old in saying thistoo, but I was reading kind of a
little bit.
She's been in practice for over40 years, so I'm really
appreciate she's going to sharesome of her wealth of experience
.
We just honored her at theUniversity of Iowa with our 2024
College of Nursing NotablePreceptor Award.
(01:37):
That's the one preceptor weidentify out of all the programs
that's doing amazing work, andso I was able, fortunate enough,
to hand her that award andshare a couple of humorous
stories with her, so that was agreat day as well.
But the other thing that's,like I said, it's kind of a
coming back to home is that thisChris was my preceptor back in
the day, and so I always like tokind of I found a quote online
(02:01):
before we get to that that Chriswas described, and I love this
wording just Chris has abeautiful energy that lights a
fire in nearly every person sheencounters.
That was just really great,which I agree.
I think she's just got thatkind of personality that people
are attracted to and just kindof want to know more about.
Speaker 3 (02:32):
So the first question I always like to ask Chris is
do you remember the first timewe met?
You know, I don't, and I'veheard you ask other people that,
and I have been pounding mybrain.
Speaker 2 (02:37):
I think it was before you were a student, yeah.
So you know, kind of taking alittle bit back just to kind of
share.
Chris is kind of one of thefirst psych you know nurses
advanced practice in ourcommunity here and her and Judy
Collins were kind of very closeand kind of working with
children, adolescents, and soJudy kind of took me under her
wing a little bit and introducedme to you as well.
(02:57):
That's kind of the first timeso, but yeah, that's, that's
awesome so so yeah, thank you,chris, appreciate that.
And so my first question kindof about the podcast is when did
you first get interested indoing psychotherapy?
Speaker 3 (03:11):
You know, I think from the very beginning.
I was really struck when DrCynthia Hanthrope was on your
podcast.
Her journey and my journey arevery similar.
All my training waspsychotherapy, so you are very
gracious not to mention my ageand how long I've been working.
But I graduated from nursingschool in 1971, university of
Maryland Immediately went backto New York, which was where my
(03:34):
family had been from, and workedon a psych unit, and I worked
at Jacoby Hospital and even as astaff nurse, talking to those
patients who were part of ourpatient load was very important
and that's really the beginningof psychotherapy as far as I'm
concerned Learning how to becomecomfortable and communicate and
(03:59):
learning how to be present andto be attentive and to be detail
oriented.
Now, I didn't have a backgroundof six theoretical frameworks
with which I could interpret allof what I was hearing and
talking with folks about, butthat was our foundation.
I mean, that's what nurses did,that's what psychiatric nurses
(04:21):
did.
We were there to really engagein relationship and I think, dan
, you know, as I have seenstudents year after year after
year, I say to them the mostimportant thing you need to do
with a patient is build arelationship.
No relationship, no movementforward.
And you know we are given thegift of many different means of
(04:44):
psychotherapy to build thatrelationship.
But that's where psychotherapyreally started for me.
Then, obviously, after workinga year there, I was engaged and
the individual I was engaged towas a physician who was in the
US Public Health Service and hewas stationed in Rock Island in
(05:05):
the U?
S public health service and hewas stationed in Rock Island,
illinois.
So you know he moved out hereand then I moved out here and I
then started teaching at acommunity college and started
learning more aboutpsychotherapeutic interaction
and process and frameworks andyou know different modes of
psychotherapy and becameinterested in graduate school
and I was so blessed to go tograduate school.
(05:27):
In the early 1970s I got atraineeship, I got paid to go to
graduate school.
You know, as I hear my studentstell the story of of student
loan and student debt, I Icontinue to be so grateful for
what my opportunities were,which was to be able to go to
school and get paid to do that.
So I didn't have to work, Icould concentrate and focus
(05:50):
Sorry, that's my dog I couldconcentrate and focus everything
, all my energy on really beinga student and learning
everything I could.
So University of Iowa that'swhere I went to school was the
University of Iowa and of coursewe were very
psychotherapy-oriented, taking aclass and a course, individual
psychotherapy, familypsychotherapy, group
(06:12):
psychotherapy and, you know,first began engaging with our
patients in psychotherapy.
But I think you know, now thatyou asked me that question, I
think really the first formofotherapy I ever ever did was
that ipr that we used to do innursing school where you had to
write down your interaction withindividuals.
Speaker 2 (06:33):
So you know it started at the very beginning
it's a long answer to a verysuccinct question no, no, no,
it's good, I like the backgroundand things.
Um, just so people arelistening.
Ipr stands for Interpersonalrecording.
Thank you, yeah, good Awesome.
Speaker 4 (06:52):
All right.
So, chris, I share some of yourlineage.
I'm also a dual trained CNS NP,so I appreciate your passion
for psychotherapy.
I didn't ask you a questionkind of more globally about your
relationship with psychotherapy.
I like to follow up, usuallywith a question.
That kind of laser focuses onan experience with psychotherapy
(07:13):
.
I don't know about you, butsometimes in my interactions
with patients not because ofwhat I do but more because of
what happens in the relationshipit sometimes feels like
lightning in a bottle.
So I'm asking you to think fora moment was there a particular
experience or encounter inpsychotherapy that made you
realize that, oh, my goodness,this is something really special
.
Speaker 3 (07:34):
You know, I worked with an adolescent probably in
the early 80s and I was pairedup with a physician, dr Lois
Hokanson and I don't know if youremember her, dan, but I was
(08:01):
doing psychotherapy with thisparticularly difficult
adolescent who was hostile andangry and hurt and traumatized
and wanted no part of arelationship with me at all.
And I can remember Dr Hokansoncontinuing to remind me how
important it was to be presentand to just acknowledge her pain
.
And after about three or fourmonths in psychotherapy there
became obvious a dramatic I saya dramatic change.
(08:24):
It wasn't that dramatic, butshe really engaged with me and
opened up and I think for thefirst time felt that there was
someone who was listening to herand helping her sort through
what her thoughts and feelingswere about circumstances that
had happened to her.
And interestingly, here we are.
(08:47):
You know, decades later, Istill hear from her periodically
.
That's awesome and hear from herhow important psychotherapy was
to her.
Speaker 4 (08:59):
That's fantastic.
Speaker 3 (09:00):
Thank you, and it really cemented for me again the
importance of the relationshipand the focus on the individual
in the relationship.
Speaker 5 (09:11):
Yeah, what a beautiful example.
Thank you for sharing that.
And, chris, you mentioned atthe beginning you know how lucky
we are to have so manymodalities of psychotherapy at
our disposal to build theserelationships with patients.
We'd love to hear a little bitabout any specific forms or
types of psychotherapy thatyou're drawn to.
Speaker 3 (09:32):
Well, early on I was very involved in interpersonal
psychotherapy, now working inNew York in the 70s.
Hildegard Peplau was rightacross the river in New Jersey,
so the interpersonal theory ofnursing and all of the things
that she had to say.
And then I was very, very luckyto be able to go to the
(09:53):
Sullivanian Institute forIndividual Psychotherapy, the
William Allenson White Institutein New York, for a year.
So that focus was veryinterpersonal.
Coming out to Iowa was quite ashock because at the time Iowa
was very biological I don't knowif you remember that, dan, but
a long time ago very biological.
(10:13):
So I really struggled with themodality of their psychotherapy
at that point because everybodyI was working with was was
focused, different things.
But I began to learn more about,you know, rational emotive
therapy, cbt.
And then I was trained by NancyBloom at the University of Iowa
(10:35):
in the STEPS program, which isa DBT program.
That has now become my love andeven in in medication checks.
You know I am saying to people,you know, tell me about my,
your thoughts, how do youchallenge them, how do you
redirect them, how do youreplace them?
We talk about emotionalregulation, mindfulness, all
(10:56):
those kinds of things, but thethe content of the DBT program
from the steps manual has reallybecome almost a Bible for me.
I love it and it's easy toincorporate pieces of it in a
med check.
Speaker 2 (11:13):
That's great.
Yeah, I think it's one of thosethings.
Even going back to that exampleof interacting with that kid
and still seeing him as an adult, you never know when you create
a memory, right, I mean it'salways one of those things.
And that's the gift I thinkyou've been saying too.
It's kind of the gift that wehave as our role we get to
interact with these people andsee them grow.
(11:33):
I mean I'll never forget, kindof, when I interviewed actually
for my DMP program, it wasactually a non-psych person
interviewing me and asked thequestion I'll never forget
saying you know, do people getbetter in psych?
And I was kind of set back likeoh yeah, they do.
I'm surprised by that question.
But yeah, I think you know and Iappreciate you kind of giving a
(11:55):
plug for Hildegard Peplau,obviously, that you kind of
giving a plug for HildegardPeplau, obviously that's kind of
the mother of psych, mentalhealth, nursing and the name of
our podcast here.
So, kind of going back to that,how do you see nursing?
Because I think you've kind ofbeen for me at least you know
again, hopefully I don't get alittle verklempt, but you've
been for me kind of the idealnurse and how to be a psych,
(12:16):
mental health advanced practicenurse.
And so how do you see nursingbeing a leader in performing
psychotherapy, because obviouslyother professions can do that
skill as well.
But how do you see nursing asbeing kind of central or part of
you know what we do basically.
Speaker 3 (12:31):
Well, first of all, I think, as nurses first, and
advanced practice nurses second,we have a wealth of knowledge
about health and about illnessand about environment and the
social determinants of healththat I believe unfortunately
(12:53):
many of our colleagues do nothave.
So I think we come into ourrelationships with a much
broader base of knowledge and amuch more advantageous
perspective on really assessingand intervening with the
(13:15):
individuals that we're workingwith.
I mean I, you know, for yearsand you know this, dan I mean my
certification was in child andadolescent psychiatric, mental
health nursing.
So all my early years, my first25, 30 years of working, were
with children and adolescents.
You know they all grow up.
So now I see them as adults orI see their kids.
But understanding development,understanding child health,
(13:40):
understanding nutrition,understanding all of those
things is so important tohelping children.
Kids that wiggle and move inschool are not all children who
have ADHD, you know.
Some of them drink too muchcaffeine, some of them have
worms, some of them don't getenough sleep, some of them are
uncomfortable because ofsomething else.
(14:01):
You have to have a broaderperspective.
So that is what I believe thegift of nursing gives to us.
As psychotherapists, we go intoit with a much broader base by
which we can, as I said, assessand intervene what's happening,
and I think, therefore, weshould be leaders in the field
(14:23):
of psychotherapy.
Unfortunately, because of ourknowledge about biology and
medicine and the reduction ofpsychiatrists, we're slotted
into becoming chemists and weare so much more than that.
And, by the way, all thechemical knowledge we have in
the world, all the medicineknowledge we have in the world,
(14:46):
doesn't work if people don'tlike us and don't trust us.
So without the relationship youknow, we're nowhere.
We're nowhere.
Speaker 4 (14:52):
Chris, I'm going to shift the focus a little bit in
a slightly different directionand I'm going to ask the focus a
little bit in a slightlydifferent direction and I'm
going to ask you a question.
I mean, you know very well thatour scope and standards of
practice published by theAmerican Nurses Association, the
International Society forPsychiatric Nurses and the
American Psychiatric NursesAssociation they established
that we are credentialed to beable to deliver psychotherapy
(15:16):
Correct.
That we are credentialed to beable to deliver psychotherapy
Correct.
Looking at the other side ofthe coin, do you see any risks
associated with that standard ofpractice in terms of how we are
turning students out into themarket right now?
Speaker 3 (15:31):
Boy.
That's an interesting andcomplicated question.
A complicated question.
I think if the programs do notinclude psychotherapy, there is
a risk because we are partiallypreparing them and I think that
that is a disservice to thestudent and I think it's a
disservice to the patients thatwe see, and I think that and I
(15:57):
think it's the NLN more than theANA and some of these other
organizations that oversee theeducational credentialing of
programs but I think we nursingleaders have to be strong and
vocal in supporting theinclusion of psychotherapy in
the programs that we takestudents from.
(16:18):
So I feel pretty strongly aboutit, sean.
I think we you know it's likepreparing people and tying one
hand behind their back, and Ithink there is a risk associated
with that in terms of placingthem then in situations where
they get stymied and stuck andthey don't know what to do with
somebody.
Speaker 4 (16:38):
Thanks for establishing the genesis of this
podcast, Chris.
Speaker 3 (16:41):
You're very welcome, Sean.
It's my pleasure.
Speaker 5 (16:46):
And I'd like to piggyback a little bit on Sean's
question.
You know I'm so struck by yourincredible wealth of experience
and expertise in this field andI'm curious, Chris, you know,
what have you seen or what doyou see as the barriers for more
psych NPs or advanced practicepsych nurses using psychotherapy
(17:06):
in practice, and any ideasabout how we could address some
of those barriers?
Speaker 3 (17:13):
And let me say that I say this out of a framework of
working in a mental healthcenter and Dan was gracious in
saying 40 years.
I've been there 50 years.
In May I will have been at VeraFrench 50 years.
So what I see in terms of thebarriers are it's cheaper to
hire a social worker than it isto hire an advanced practice
(17:33):
nurse.
To hire an advanced practicenurse.
So when you have organizationsthat are administratively
managed by non-nursingindividuals, you have folks in
administration that do notunderstand that although a psych
(17:53):
nurse may engender a highersalary, he or she is much better
prepared to intervene in thedistress and the illnesses that
patients have and very oftenhelp them reach a higher level
of wellness and quality of lifemore quickly.
When you have one person doingpsychotherapy and somebody else
(18:17):
doing medicine, very often theydon't talk to each other and
you've got people working downdifferent tracks and missing
things.
If that individual is the sameperson, you're able to really do
a combination of things and, Ithink, promote better health and
better treatment.
(18:40):
I always try, when I havepatients in a med check and
they're seeing a social workeror one of our mental health
therapists, I very often say tothem tell me about your
psychotherapy, what are thegoals of your psychotherapy?
And you know, sometimes they'resaying, hmm, I'm not sure.
What do you and yourpsychotherapist talk about?
(19:00):
Well, we talk about school, wetalk about life, we talk about
things and it.
It distresses me sometimes whenI hear that they're not
focusing on learning skills.
I say to patients in a medcheck I can prescribe a medicine
that helps you feel better inthe short run and perhaps you
have a lifelong condition andyou will need some maintenance
(19:22):
care with medication in thatcondition.
But psychotherapy teaches youtools and skills that will last
your whole life, skills that youcan use at any point in your
life and you can pull them outof your toolbox whenever you
need them.
So those are the arguments, soto speak, or the rationales when
(19:44):
I am talking to ouradministrators, what I say.
And you know, for many years Iwas on the leadership team.
I'm not anymore.
I only work part-time and Iadvocate strongly to get an
advanced practice nurse on thatleadership team.
I think physicians are wonderfuland I love working with them,
(20:04):
but we don't have we don't havevery many here anymore.
Many of them are in privatepractice in the larger cities,
think the other barrier is formany, for many newer
professionals in this business.
There's an excitement aboutbeing able to prescribe a
medicine, and psychotherapy ishard work and, as, as we all
(20:30):
know, the excitement issomething that is it.
It takes some time tounderstand it and to build it.
So I think sometimes we don'tgive our students the right
perspective of what theimportance of our positions are
and what the importance of ourwork is.
(20:50):
So those are a couple of things.
You know.
I think there is a financialinitially, on first glance,
there's a financial incentive tohire someone who costs less,
but I'm always saying what aboutrisk, what about the length of
treatment and what about thefact that often they miss things
(21:10):
, that they need to be seen?
So you know, those areconversations we need to have
and hopefully we're allowed tohave them in different
situations.
Speaker 2 (21:20):
Yeah, thanks, chris.
I mean it's you know.
What I try to tell people toois you know, when you go to
therapy, you know you learnthings that you don't need
refills on right.
You don't need to get a refillfor how you do your CBT or how
you do you know various types ofthings.
You can just kind of do thatand take away those skills, like
you mentioned in that example,from adolescence all the way
through their life.
(21:40):
They can kind of carry thosecoping skills and you know,
fortunately, that pharmacy youdon't need to, you know, stand
in line for.
So it's a, it's a great thing.
So my next question you know,and you know we can spend some
time to talk about some otherthings if you want to talk, but
(22:01):
the next question we'd like toask is just to pull out your
crystal ball and kind of lookinto the future.
What do you see as a future forusing psychotherapy within the
psych mental health?
Speaker 3 (22:06):
nurse practitioner role.
Well, I think if we don't teachit, we're not going to use it.
So the future depends on whetheror not programs include a basis
of psychotherapy in theirprogram.
So that becomes critical.
So we have to continue to beadvocates of recognizing how
(22:30):
important psychotherapy is andcontinue to put it in programs
and teach it.
I think the other piece of thatis we need to continue to find
preceptors who have experiencewith psychotherapy, who are
willing to mentor their studentsin psychotherapy.
And then the other thing that Ihave found very important is we,
(22:55):
as experienced psychiatricnurse practitioners, need to be
willing to provide supervisionand mentorship to new graduates
who come into our programs andwe have to continue to encourage
them to be engaged inpsychotherapy with their
patients.
So I think those things willhave an implication for the
(23:17):
future of psychotherapy in thepractice of psychiatric nursing.
I think the other thing is thatwe need to continue and I
applaud you, dan, and I applaudall of you who are involved in
professional organizations weneed to continue to remind
policymakers how important therole of advanced practice nurses
(23:39):
is in all of our fields ofnursing, in all of our fields of
health care, but for usespecially in psychotherapy or
in psychiatric nursing, and weneed to continue to be at the
table, having conversations withpolicymakers about the
importance of making thesepractitioners available and
(24:04):
being able to include them inpolicymaking and in planning
policymaking and in planning.
Yeah, I think those things Sorry, no, no.
Speaker 2 (24:16):
I was going to say, yeah, it's, you know it's
important to kind of just havethat seat at the table.
I think it's.
You know it's something thatgets overlooked a lot.
I don't know why.
I mean, I struggle with thatkind of understanding of why
some sometimes boards and otheryou know organizations that are
making policy don't kind ofconsider nurses as a profession
(24:36):
and why they're not getting kindof that seat at the table.
So that's great.
Thank you, chris again.
Chris, yes, like I said, Itried to kind of minimize your
years of practice and hopefullydidn't short sell you but and I
also will share, I know Chris ison her third retirement.
You but and I also will share,I know Chris is on her third
retirement.
I mean, you keep trying tophase out of retirement.
I think that's just something Ialways see for people who are
(24:58):
just driven and this is not,this is not a job, this is, this
is your life passion.
Speaker 3 (25:02):
So it's been my vocation.
I truly see this as my vocation.
I love what I do, and I hopethat being able to transmit how
much I love what I do tostudents will help spark that
passion in them so they too willhave a wonderful vocation or
(25:23):
career in a field that they love.
Speaker 2 (25:25):
Yeah, thank you, chris.
That's a good way to end thepodcast.
Thank you so much for thoselistening.
Make sure that you like,subscribe and comment, and look
forward to having anotherepisode soon.
Speaker 5 (25:36):
Thank you so much, chris McCormick-Pree, from Vera.
Speaker 2 (25:38):
French.
Speaker 1 (25:39):
Community Mental Health Center.
Thank you as well for Dr SeanConvoy from Duke and Dr
soon-to-be Dr Kate Molino fromUniversity of California, san
Francisco.
Speaker 2 (25:50):
Thank you, and take care, we'll see you soon in the
next episode.
Speaker 1 (25:54):
Bye.
Yeah, just my take on things.
Speaker 2 (00:08):
My answer number two Welcome everybody to another
wonderful episode of Pepow'sghost.
So appreciative of everyonelistening here and I'm so
excited to be introducing ournext guest is Chris McCormick
(00:31):
pre.
It's a it really is kind of acoming back to home type of
episode for me, so I might get alittle sappy on this podcast
and and I know Kate and Sean arehere to kind of keep me in line
with that but really appreciateChris and spending time and
again for all of you listeningto make sure that you're all
kind of keeping this podcastafloat.
(00:51):
So the only podcast I knowthat's about PMHNPs with no
commercials, although I'd loveto have some commercials someday
.
So not opposed to getting paid.
So let me do a quickintroduction for Chris
McCormick-Pree.
She is a PMHNP I believe she isalso one of the which we've got
others on this podcast rightnow too a PMHCNS which is a
(01:15):
certified nurse specialist Beenin practice for a while.
I don't want to make Chris feelold and I don't want to make
myself feel old in saying thistoo, but I was reading kind of a
little bit.
She's been in practice for over40 years, so I'm really
appreciate she's going to sharesome of her wealth of experience
.
We just honored her at theUniversity of Iowa with our 2024
College of Nursing NotablePreceptor Award.
(01:37):
That's the one preceptor weidentify out of all the programs
that's doing amazing work, andso I was able, fortunate enough,
to hand her that award andshare a couple of humorous
stories with her, so that was agreat day as well.
But the other thing that's,like I said, it's kind of a
coming back to home is that thisChris was my preceptor back in
the day, and so I always like tokind of I found a quote online
(02:01):
before we get to that that Chriswas described, and I love this
wording just Chris has abeautiful energy that lights a
fire in nearly every person sheencounters.
That was just really great,which I agree.
I think she's just got thatkind of personality that people
are attracted to and just kindof want to know more about.
Speaker 3 (02:32):
So the first question I always like to ask Chris is
do you remember the first timewe met?
You know, I don't, and I'veheard you ask other people that,
and I have been pounding mybrain.
Speaker 2 (02:37):
I think it was before you were a student, yeah.
So you know, kind of taking alittle bit back just to kind of
share.
Chris is kind of one of thefirst psych you know nurses
advanced practice in ourcommunity here and her and Judy
Collins were kind of very closeand kind of working with
children, adolescents, and soJudy kind of took me under her
wing a little bit and introducedme to you as well.
(02:57):
That's kind of the first timeso, but yeah, that's, that's
awesome so so yeah, thank you,chris, appreciate that.
And so my first question kindof about the podcast is when did
you first get interested indoing psychotherapy?
Speaker 3 (03:11):
You know, I think from the very beginning.
I was really struck when DrCynthia Hanthrope was on your
podcast.
Her journey and my journey arevery similar.
All my training waspsychotherapy, so you are very
gracious not to mention my ageand how long I've been working.
But I graduated from nursingschool in 1971, university of
Maryland Immediately went backto New York, which was where my
(03:34):
family had been from, and workedon a psych unit, and I worked
at Jacoby Hospital and even as astaff nurse, talking to those
patients who were part of ourpatient load was very important
and that's really the beginningof psychotherapy as far as I'm
concerned Learning how to becomecomfortable and communicate and
(03:59):
learning how to be present andto be attentive and to be detail
oriented.
Now, I didn't have a backgroundof six theoretical frameworks
with which I could interpret allof what I was hearing and
talking with folks about, butthat was our foundation.
I mean, that's what nurses did,that's what psychiatric nurses
(04:21):
did.
We were there to really engagein relationship and I think, dan
, you know, as I have seenstudents year after year after
year, I say to them the mostimportant thing you need to do
with a patient is build arelationship.
No relationship, no movementforward.
And you know we are given thegift of many different means of
(04:44):
psychotherapy to build thatrelationship.
But that's where psychotherapyreally started for me.
Then, obviously, after workinga year there, I was engaged and
the individual I was engaged towas a physician who was in the
US Public Health Service and hewas stationed in Rock Island in
(05:05):
the U?
S public health service and hewas stationed in Rock Island,
illinois.
So you know he moved out hereand then I moved out here and I
then started teaching at acommunity college and started
learning more aboutpsychotherapeutic interaction
and process and frameworks andyou know different modes of
psychotherapy and becameinterested in graduate school
and I was so blessed to go tograduate school.
(05:27):
In the early 1970s I got atraineeship, I got paid to go to
graduate school.
You know, as I hear my studentstell the story of of student
loan and student debt, I Icontinue to be so grateful for
what my opportunities were,which was to be able to go to
school and get paid to do that.
So I didn't have to work, Icould concentrate and focus
(05:50):
Sorry, that's my dog I couldconcentrate and focus everything
, all my energy on really beinga student and learning
everything I could.
So University of Iowa that'swhere I went to school was the
University of Iowa and of coursewe were very
psychotherapy-oriented, taking aclass and a course, individual
psychotherapy, familypsychotherapy, group
(06:12):
psychotherapy and, you know,first began engaging with our
patients in psychotherapy.
But I think you know, now thatyou asked me that question, I
think really the first formofotherapy I ever ever did was
that ipr that we used to do innursing school where you had to
write down your interaction withindividuals.
Speaker 2 (06:33):
So you know it started at the very beginning
it's a long answer to a verysuccinct question no, no, no,
it's good, I like the backgroundand things.
Um, just so people arelistening.
Ipr stands for Interpersonalrecording.
Thank you, yeah, good Awesome.
Speaker 4 (06:52):
All right.
So, chris, I share some of yourlineage.
I'm also a dual trained CNS NP,so I appreciate your passion
for psychotherapy.
I didn't ask you a questionkind of more globally about your
relationship with psychotherapy.
I like to follow up, usuallywith a question.
That kind of laser focuses onan experience with psychotherapy
(07:13):
.
I don't know about you, butsometimes in my interactions
with patients not because ofwhat I do but more because of
what happens in the relationshipit sometimes feels like
lightning in a bottle.
So I'm asking you to think fora moment was there a particular
experience or encounter inpsychotherapy that made you
realize that, oh, my goodness,this is something really special
.
Speaker 3 (07:34):
You know, I worked with an adolescent probably in
the early 80s and I was pairedup with a physician, dr Lois
Hokanson and I don't know if youremember her, dan, but I was
(08:01):
doing psychotherapy with thisparticularly difficult
adolescent who was hostile andangry and hurt and traumatized
and wanted no part of arelationship with me at all.
And I can remember Dr Hokansoncontinuing to remind me how
important it was to be presentand to just acknowledge her pain
.
And after about three or fourmonths in psychotherapy there
became obvious a dramatic I saya dramatic change.
(08:24):
It wasn't that dramatic, butshe really engaged with me and
opened up and I think for thefirst time felt that there was
someone who was listening to herand helping her sort through
what her thoughts and feelingswere about circumstances that
had happened to her.
And interestingly, here we are.
(08:47):
You know, decades later, Istill hear from her periodically
.
That's awesome and hear from herhow important psychotherapy was
to her.
Speaker 4 (08:59):
That's fantastic.
Speaker 3 (09:00):
Thank you, and it really cemented for me again the
importance of the relationshipand the focus on the individual
in the relationship.
Speaker 5 (09:11):
Yeah, what a beautiful example.
Thank you for sharing that.
And, chris, you mentioned atthe beginning you know how lucky
we are to have so manymodalities of psychotherapy at
our disposal to build theserelationships with patients.
We'd love to hear a little bitabout any specific forms or
types of psychotherapy thatyou're drawn to.
Speaker 3 (09:32):
Well, early on I was very involved in interpersonal
psychotherapy, now working inNew York in the 70s.
Hildegard Peplau was rightacross the river in New Jersey,
so the interpersonal theory ofnursing and all of the things
that she had to say.
And then I was very, very luckyto be able to go to the
(09:53):
Sullivanian Institute forIndividual Psychotherapy, the
William Allenson White Institutein New York, for a year.
So that focus was veryinterpersonal.
Coming out to Iowa was quite ashock because at the time Iowa
was very biological I don't knowif you remember that, dan, but
a long time ago very biological.
(10:13):
So I really struggled with themodality of their psychotherapy
at that point because everybodyI was working with was was
focused, different things.
But I began to learn more about,you know, rational emotive
therapy, cbt.
And then I was trained by NancyBloom at the University of Iowa
(10:35):
in the STEPS program, which isa DBT program.
That has now become my love andeven in in medication checks.
You know I am saying to people,you know, tell me about my,
your thoughts, how do youchallenge them, how do you
redirect them, how do youreplace them?
We talk about emotionalregulation, mindfulness, all
(10:56):
those kinds of things, but thethe content of the DBT program
from the steps manual has reallybecome almost a Bible for me.
I love it and it's easy toincorporate pieces of it in a
med check.
Speaker 2 (11:13):
That's great.
Yeah, I think it's one of thosethings.
Even going back to that exampleof interacting with that kid
and still seeing him as an adult, you never know when you create
a memory, right, I mean it'salways one of those things.
And that's the gift I thinkyou've been saying too.
It's kind of the gift that wehave as our role we get to
interact with these people andsee them grow.
(11:33):
I mean I'll never forget, kindof, when I interviewed actually
for my DMP program, it wasactually a non-psych person
interviewing me and asked thequestion I'll never forget
saying you know, do people getbetter in psych?
And I was kind of set back likeoh yeah, they do.
I'm surprised by that question.
But yeah, I think you know and Iappreciate you kind of giving a
(11:55):
plug for Hildegard Peplau,obviously, that you kind of
giving a plug for HildegardPeplau, obviously that's kind of
the mother of psych, mentalhealth, nursing and the name of
our podcast here.
So, kind of going back to that,how do you see nursing?
Because I think you've kind ofbeen for me at least you know
again, hopefully I don't get alittle verklempt, but you've
been for me kind of the idealnurse and how to be a psych,
(12:16):
mental health advanced practicenurse.
And so how do you see nursingbeing a leader in performing
psychotherapy, because obviouslyother professions can do that
skill as well.
But how do you see nursing asbeing kind of central or part of
you know what we do basically.
Speaker 3 (12:31):
Well, first of all, I think, as nurses first, and
advanced practice nurses second,we have a wealth of knowledge
about health and about illnessand about environment and the
social determinants of healththat I believe unfortunately
(12:53):
many of our colleagues do nothave.
So I think we come into ourrelationships with a much
broader base of knowledge and amuch more advantageous
perspective on really assessingand intervening with the
(13:15):
individuals that we're workingwith.
I mean I, you know, for yearsand you know this, dan I mean my
certification was in child andadolescent psychiatric, mental
health nursing.
So all my early years, my first25, 30 years of working, were
with children and adolescents.
You know they all grow up.
So now I see them as adults orI see their kids.
But understanding development,understanding child health,
(13:40):
understanding nutrition,understanding all of those
things is so important tohelping children.
Kids that wiggle and move inschool are not all children who
have ADHD, you know.
Some of them drink too muchcaffeine, some of them have
worms, some of them don't getenough sleep, some of them are
uncomfortable because ofsomething else.
(14:01):
You have to have a broaderperspective.
So that is what I believe thegift of nursing gives to us.
As psychotherapists, we go intoit with a much broader base by
which we can, as I said, assessand intervene what's happening,
and I think, therefore, weshould be leaders in the field
(14:23):
of psychotherapy.
Unfortunately, because of ourknowledge about biology and
medicine and the reduction ofpsychiatrists, we're slotted
into becoming chemists and weare so much more than that.
And, by the way, all thechemical knowledge we have in
the world, all the medicineknowledge we have in the world,
(14:46):
doesn't work if people don'tlike us and don't trust us.
So without the relationship youknow, we're nowhere.
We're nowhere.
Speaker 4 (14:52):
Chris, I'm going to shift the focus a little bit in
a slightly different directionand I'm going to ask the focus a
little bit in a slightlydifferent direction and I'm
going to ask you a question.
I mean, you know very well thatour scope and standards of
practice published by theAmerican Nurses Association, the
International Society forPsychiatric Nurses and the
American Psychiatric NursesAssociation they established
that we are credentialed to beable to deliver psychotherapy
(15:16):
Correct.
That we are credentialed to beable to deliver psychotherapy
Correct.
Looking at the other side ofthe coin, do you see any risks
associated with that standard ofpractice in terms of how we are
turning students out into themarket right now?
Speaker 3 (15:31):
Boy.
That's an interesting andcomplicated question.
A complicated question.
I think if the programs do notinclude psychotherapy, there is
a risk because we are partiallypreparing them and I think that
that is a disservice to thestudent and I think it's a
disservice to the patients thatwe see, and I think that and I
(15:57):
think it's the NLN more than theANA and some of these other
organizations that oversee theeducational credentialing of
programs but I think we nursingleaders have to be strong and
vocal in supporting theinclusion of psychotherapy in
the programs that we takestudents from.
(16:18):
So I feel pretty strongly aboutit, sean.
I think we you know it's likepreparing people and tying one
hand behind their back, and Ithink there is a risk associated
with that in terms of placingthem then in situations where
they get stymied and stuck andthey don't know what to do with
somebody.
Speaker 4 (16:38):
Thanks for establishing the genesis of this
podcast, Chris.
Speaker 3 (16:41):
You're very welcome, Sean.
It's my pleasure.
Speaker 5 (16:46):
And I'd like to piggyback a little bit on Sean's
question.
You know I'm so struck by yourincredible wealth of experience
and expertise in this field andI'm curious, Chris, you know,
what have you seen or what doyou see as the barriers for more
psych NPs or advanced practicepsych nurses using psychotherapy
(17:06):
in practice, and any ideasabout how we could address some
of those barriers?
Speaker 3 (17:13):
And let me say that I say this out of a framework of
working in a mental healthcenter and Dan was gracious in
saying 40 years.
I've been there 50 years.
In May I will have been at VeraFrench 50 years.
So what I see in terms of thebarriers are it's cheaper to
hire a social worker than it isto hire an advanced practice
(17:33):
nurse.
To hire an advanced practicenurse.
So when you have organizationsthat are administratively
managed by non-nursingindividuals, you have folks in
administration that do notunderstand that although a psych
(17:53):
nurse may engender a highersalary, he or she is much better
prepared to intervene in thedistress and the illnesses that
patients have and very oftenhelp them reach a higher level
of wellness and quality of lifemore quickly.
When you have one person doingpsychotherapy and somebody else
(18:17):
doing medicine, very often theydon't talk to each other and
you've got people working downdifferent tracks and missing
things.
If that individual is the sameperson, you're able to really do
a combination of things and, Ithink, promote better health and
better treatment.
(18:40):
I always try, when I havepatients in a med check and
they're seeing a social workeror one of our mental health
therapists, I very often say tothem tell me about your
psychotherapy, what are thegoals of your psychotherapy?
And you know, sometimes they'resaying, hmm, I'm not sure.
What do you and yourpsychotherapist talk about?
(19:00):
Well, we talk about school, wetalk about life, we talk about
things and it.
It distresses me sometimes whenI hear that they're not
focusing on learning skills.
I say to patients in a medcheck I can prescribe a medicine
that helps you feel better inthe short run and perhaps you
have a lifelong condition andyou will need some maintenance
(19:22):
care with medication in thatcondition.
But psychotherapy teaches youtools and skills that will last
your whole life, skills that youcan use at any point in your
life and you can pull them outof your toolbox whenever you
need them.
So those are the arguments, soto speak, or the rationales when
(19:44):
I am talking to ouradministrators, what I say.
And you know, for many years Iwas on the leadership team.
I'm not anymore.
I only work part-time and Iadvocate strongly to get an
advanced practice nurse on thatleadership team.
I think physicians are wonderfuland I love working with them,
(20:04):
but we don't have we don't havevery many here anymore.
Many of them are in privatepractice in the larger cities,
think the other barrier is formany, for many newer
professionals in this business.
There's an excitement aboutbeing able to prescribe a
medicine, and psychotherapy ishard work and, as, as we all
(20:30):
know, the excitement issomething that is it.
It takes some time tounderstand it and to build it.
So I think sometimes we don'tgive our students the right
perspective of what theimportance of our positions are
and what the importance of ourwork is.
(20:50):
So those are a couple of things.
You know.
I think there is a financialinitially, on first glance,
there's a financial incentive tohire someone who costs less,
but I'm always saying what aboutrisk, what about the length of
treatment and what about thefact that often they miss things
(21:10):
, that they need to be seen?
So you know, those areconversations we need to have
and hopefully we're allowed tohave them in different
situations.
Speaker 2 (21:20):
Yeah, thanks, chris.
I mean it's you know.
What I try to tell people toois you know, when you go to
therapy, you know you learnthings that you don't need
refills on right.
You don't need to get a refillfor how you do your CBT or how
you do you know various types ofthings.
You can just kind of do thatand take away those skills, like
you mentioned in that example,from adolescence all the way
through their life.
(21:40):
They can kind of carry thosecoping skills and you know,
fortunately, that pharmacy youdon't need to, you know, stand
in line for.
So it's a, it's a great thing.
So my next question you know,and you know we can spend some
time to talk about some otherthings if you want to talk, but
(22:01):
the next question we'd like toask is just to pull out your
crystal ball and kind of lookinto the future.
What do you see as a future forusing psychotherapy within the
psych mental health?
Speaker 3 (22:06):
nurse practitioner role.
Well, I think if we don't teachit, we're not going to use it.
So the future depends on whetheror not programs include a basis
of psychotherapy in theirprogram.
So that becomes critical.
So we have to continue to beadvocates of recognizing how
(22:30):
important psychotherapy is andcontinue to put it in programs
and teach it.
I think the other piece of thatis we need to continue to find
preceptors who have experiencewith psychotherapy, who are
willing to mentor their studentsin psychotherapy.
And then the other thing that Ihave found very important is we,
(22:55):
as experienced psychiatricnurse practitioners, need to be
willing to provide supervisionand mentorship to new graduates
who come into our programs andwe have to continue to encourage
them to be engaged inpsychotherapy with their
patients.
So I think those things willhave an implication for the
(23:17):
future of psychotherapy in thepractice of psychiatric nursing.
I think the other thing is thatwe need to continue and I
applaud you, dan, and I applaudall of you who are involved in
professional organizations weneed to continue to remind
policymakers how important therole of advanced practice nurses
(23:39):
is in all of our fields ofnursing, in all of our fields of
health care, but for usespecially in psychotherapy or
in psychiatric nursing, and weneed to continue to be at the
table, having conversations withpolicymakers about the
importance of making thesepractitioners available and
(24:04):
being able to include them inpolicymaking and in planning
policymaking and in planning.
Yeah, I think those things Sorry, no, no.
Speaker 2 (24:16):
I was going to say, yeah, it's, you know it's
important to kind of just havethat seat at the table.
I think it's.
You know it's something thatgets overlooked a lot.
I don't know why.
I mean, I struggle with thatkind of understanding of why
some sometimes boards and otheryou know organizations that are
making policy don't kind ofconsider nurses as a profession
(24:36):
and why they're not getting kindof that seat at the table.
So that's great.
Thank you, chris again.
Chris, yes, like I said, Itried to kind of minimize your
years of practice and hopefullydidn't short sell you but and I
also will share, I know Chris ison her third retirement.
You but and I also will share,I know Chris is on her third
retirement.
I mean, you keep trying tophase out of retirement.
I think that's just something Ialways see for people who are
(24:58):
just driven and this is not,this is not a job, this is, this
is your life passion.
Speaker 3 (25:02):
So it's been my vocation.
I truly see this as my vocation.
I love what I do, and I hopethat being able to transmit how
much I love what I do tostudents will help spark that
passion in them so they too willhave a wonderful vocation or
(25:23):
career in a field that they love.
Speaker 2 (25:25):
Yeah, thank you, chris.
That's a good way to end thepodcast.
Thank you so much for thoselistening.
Make sure that you like,subscribe and comment, and look
forward to having anotherepisode soon.
Speaker 5 (25:36):
Thank you so much, chris McCormick-Pree, from Vera.
Speaker 2 (25:38):
French.
Speaker 1 (25:39):
Community Mental Health Center.
Thank you as well for Dr SeanConvoy from Duke and Dr
soon-to-be Dr Kate Molino fromUniversity of California, san
Francisco.
Speaker 2 (25:50):
Thank you, and take care, we'll see you soon in the
next episode.
Speaker 1 (25:54):
Bye.
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