What if you could teach your patients to be their own therapists? Chelsea Landolin, psychiatric-mental health nurse practitioner from UCSF (University of California-San Fransisco: Chelsea.Landolin@ucsf.edu), reveals how cognitive behavioral therapy creates lasting change beyond medication alone.
Chelsea shares her fascinating journey from psychopharmacology researcher to CBT advocate, describing that pivotal moment watching Carl Rogers' therapeutic approach with 'Gloria' and recognizing how empowering the right therapy can be. Her candid explanation of how our brains process negative thoughts literally—"When you say 'I'm a failure,' your brain believes it completely"—offers a compelling case for cognitive restructuring as an essential skill for mental health providers.
The conversation explores a powerful success story of an elderly patient who transformed decades of self-criticism through CBT, developing a gentler relationship with herself as she learned to challenge core beliefs about her worth. Chelsea's innovative approach adapts traditional CBT to fit into brief clinical encounters, making therapy accessible even in busy settings. "If you only have five minutes to do cognitive restructuring, you can make meaningful progress," she explains, describing how separating treatment over multiple sessions often deepens the therapeutic impact.
Most provocatively, Chelsea highlights how nurse practitioners are uniquely positioned to address America's mental health access crisis. While psychiatrists increasingly focus on medication management alone, NPs can bridge the treatment gap, especially for Medicare patients typically excluded from many therapy options. Her vision? A future where every psychiatric nurse practitioner receives comprehensive CBT training, dramatically expanding access to this life-changing therapy nationwide.
Ready to expand your therapeutic toolkit and help patients develop skills that last a lifetime? Like, subscribe, and comment to join the conversation about the evolving role of nurse practitioners in transformative mental healthcare.
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.
My answer number two decreaseuntil they cease.
It's not a discoveryIdentifying a challenge in your
(00:26):
beliefs.
Speaker 2 (00:27):
All right, welcome back everyone.
Here we are another episode ofPep Lau's Ghost.
Thank you for joining us.
Really excited to have our nextguest here, chelsea Landlin,
from the University ofCalifornia, san Francisco.
So I'm really excited to get toknow her and her passion for
psychotherapy in this podcast.
(00:47):
I'm also joined by Dr KateMolino from the University of
California.
Maybe they know each other,maybe they don't Find out this
episode we'll kind of probablyget into that and then Dr
Melissa Chapman-Hayes, who'swith us always as kind of that
voice of reason maybe I don'tknow, but it keeps us from
getting too jargony and thingslike that.
So one of the exciting things Ido have to share I don't know if
(01:10):
anyone else here listening, oreven on the podcast right now
this is our 21st episode.
Can you believe it?
21.
So now we can start drinking.
Right, so let's order.
Around.
Here we go, no, just kidding.
So right so.
So let's, let's order.
Around.
Here we go, uh, no, justkidding.
So, yeah, 21, this is our 21stepisode, really excited.
So, um, and again, we continueto get lots of listeners.
(01:30):
So, uh, from all across theunited states and then even
internationally.
We, I'm just so surprised weget probably about one to five
percent um for international,especially up in our nordic
areas, in denmark and finlandand such so.
So thank you very much forlistening all around the world.
So so again, really excited.
Thank you, chelsea, for takingsome time today and getting to
(01:53):
to kind of share your thoughtshere on this.
But let us get this ballrolling and and get with the
first question when, when didyou get first get excited in
psychotherapy?
I mean, what's kind of was yourfirst draw, what was your first
kind of you know?
Gosh, I want to do more of thator just really kind of dive
into it.
Speaker 3 (02:11):
Wonderful and first of all, thanks for having me.
This is such an exciting thingto be doing and such a valuable
podcast, because I do think thatnurse practitioners are so
important and increasinglyimportant providers of
psychotherapy, especially tofolks who have, you know,
(02:34):
limited access because ofinsurance and other things.
A lot of times we can provideit when no one else can that's
been my experience at least.
So I'm just delighted that youall are leaning in to this
content.
So I got interested inpsychotherapy oh goodness, it
was probably during my program.
(02:59):
So I trained at UCSF in both theadult Psych NP program as well
as the adult nurse practitionerprogram.
So primary care and I was doingI'd come previously from the
world of psychopharmacologyresearch and health psychology
(03:21):
research before that back inMassachusetts and but came out,
came out here and got started inthe program.
And then what I was trying todo was figure out gosh, how do I
, if I'm going to provideintegrated primary care and
psychiatric care, which was theintention of the program that I
was in at the time, I was likewhat modality would be
(03:46):
appropriate, right?
What kind of therapy shouldsomeone provide if they are
providing both your mentalhealth care as well, as you know
, performing sensitive physicalexams on you, right?
So I thought, geez, what shouldI do?
So when I encountered open,rogers was able to help Gloria
(04:09):
be.
You know, I don't know ifyou've spoken about Gloria
(04:38):
previously on this podcast, Ican.
Speaker 2 (04:41):
No, yeah, get into it .
Speaker 3 (04:42):
Yeah, yeah, what's that A little bit Okay.
So this was done years ago, Idon't know, yeah, get into it.
Yeah, yeah, what's that?
A little bit Okay so.
So this, this was, this wasdone years ago, I don't know,
probably seventies or something,and they basically this one
woman.
She was a real patient and shewas interviewed by by three
different famouspsychotherapists who had their
own modalities, right, and heand so Carl Rogers had, you know
(05:05):
, 30 minutes or something, um,to conduct a, an interview and
find out what was going on withher.
And you know, she, she had, shehad a lot to share and it was
very vulnerable and I was ableto see gosh when he interviewed
her.
It just she, she opened up andthen I saw her interviewed by
some of the otherpsychotherapists and she just
(05:25):
clammed up and was very stressedout, and so I was like, wow, I
kind of like this, and so Ithought, okay, maybe, maybe a
Rogerian approach is is rightfor me, which, aligned with who
I am as a person.
I'm sort of a walking talkinghuman care bear.
So it really seemed to fit,because you know his, you know
(05:50):
that that approach, you knowwe've been to have a have a
technical term for loving yourpatient, which is having
unconditional positive regard,right.
So I that that that worked forme and so I.
So I started kind of bringingthat approach into what I was
doing.
And when I went out to startworking, I took a job with, with
(06:14):
an assertive communitytreatment team that was
providing this wraparound, youknow multidisciplinary services
to people with severe mentalillness who'd been chronically
homeless.
And so, and I, you know,instantly had a panel of I don't
know 95 patients or so you knowfresh out of school, and
(06:36):
they're all you know some of theyou know sicker outpatients in
that whole County.
And I was like, oh boy, okay.
And so I thought, what am Igoing to do?
So I start doing somesupportive psychotherapy and
then with certain patients I wasable to go a little bit deeper
and I was able to use a Rogerianapproach.
(06:57):
But I did struggle a little bitbecause I didn't encounter very
easily training resources.
So I read books and that kindof thing to try to try to
develop the skills.
But I only went so far withthat Um.
And then fast forward abouteight years later, um, I took a
(07:19):
job, um, with uh, with UCSF, inone of the primary care clinics.
I was asked to start a pilotprogram, provide integrated
mental health care in this kindof medium-sized primary care
clinic, which was an excitingopportunity because I had gotten
(07:40):
the whole growth curve fromcaring for people with severe
and persistent mental illness.
I knew my, my antipsychoticsbackwards and forwards, you know
, et cetera and so, but you know, hardly ever got to prescribe
medicines for ADHD, for example,because a lot of people you
know they were using meth orwhatever and you know it just
(08:01):
wasn't appropriate.
So this was a differentpopulation.
They were generallycommercially insured or they had
Medicare.
Those were the folks I was ableto see and I knew going in.
I wanted to develop a specificskill set for them and I had
(08:22):
gotten interested in CBT justover the years because when I
was back at the other program,occasionally I would have a
patient that you know justseemed to be so appropriate for
for CBT and I just I was likewow, you just can't get access
to this.
It's so difficult, right?
We, there was, was there wasone place that would take, that
(08:44):
would take patients, uh, forkind of sliding scale or low,
low-cost services.
Um, it's the right Institute inthe East Bay, but I had a.
But I had a bipolar patientthat got turned away, um, you
know, and it just was sad.
So I was like, wow, I, how do Iactually get this to my patient
(09:06):
?
So I was like I better gettrained myself.
Okay, so that's, that's what Idid.
So this, this was right aroundwhen place and everything.
I I looked into some classes andstarted and I got signed up for
(09:28):
for some of the fundamentalcourses with Beck Institute.
So you know, so how to provide,you know, cbt for depression
and anxiety, another course, soa few things.
So I got, I got going withthose and I just loved it.
I thought it was so fantastic.
And then I would nerd outsometimes on like old, like
(09:50):
Aaron Beck videos, um, and youknow him talking about like how
he discovered automatic thoughtsof this one, like I love that
story which I can tell if youwant it's.
It was just so exciting to meand so I developed that.
(10:10):
And then and then when I startedpracticing at, you know, at the
primary care clinic, you know Iwould just communicate to
patients that had that I coulddo this.
And you know, more and morepeople, people got interested
and I developed a little spieland an approach to doing it.
So much so that I eventuallydeveloped a sort of a training
(10:34):
module for how to performcognitive restructuring in sort
of a busy clinic setting and sothat I presented at a few
conferences setting, and so thatI presented at a few
conferences and I've also beentraining the UCSF students on
that pretty much every year forthe past several years, and then
now training students in theonline multi-campus program that
(11:00):
we're doing at the Universityof California too, in this, in
this approach, and what I reallylike is that it enables people
who've learned in theirschooling, right, some
principles of CBT but theyreally don't know where to start
and how to really implement it.
(11:22):
So I, you know, so I did zeroin more on.
You know, cbt is very big,right, so I narrowed it down to
like, let's focus on thecognitive restructuring part of
it and let me teach that, right,because that's like the core,
sort of beating heart of youknow, the cognitive side of CBT,
right?
So, in my opinion, correct meif you think differently,
(11:45):
Melissa, but that's how I see it.
So, yeah, so I started teachingthat and I've just loved the
excitement that students getwhen they grasp it.
It's just, you know, wonderful.
So I teach it as a usually athree hour workshop and then
(12:07):
space it out by two weeks or soand then do another two hours,
and so they learn like a step bystep process.
And then they do partnerpractice using like simulated
cases.
I have them do a thought recordin that interim, two weeks for
themselves, right, and then theypair up in the last one and
(12:31):
then they work with their ownmaterial, you know, trading off,
and so they really get theexperience of what's it like to
be the patient when you're doingcognitive restructuring, how
does it feel right when you'redoing cognitive restructuring,
how does it feel Right, and andthen what's it like to provide
it in this sort of friendlysetting.
Speaker 2 (12:51):
Thank you, chelsea, that's, that's amazing.
I love this story.
I, you know.
Two thoughts come to mind andmaybe just one to kind of follow
up with is you know, it'sinteresting how you start off in
pharmacology, I guess, and kindof that's a different type of
you know way to approachpatients and to care for them
and such.
Maybe, in asking, you know,thinking back on that time, was
(13:14):
there something maybe kind of inthe back of your head or
something kind of maybe just alittle dissatisfied with what
you were doing, that kind ofdrove you back to school and
maybe kind of pushed you in thisdirection that you're so
passionate in now?
Or was it just happen, chanceand things like that?
Speaker 3 (13:32):
I mean, my path into this has many different threads.
We can get into some of them.
I think one of the biggestdrivers was feeling like I just
wanted a more diverse toolbox,right?
Because when all you have is ahammer, all you see are nails,
(13:57):
and you know, I think it's justbetter to um for both, for me,
as a practitioner, to be able tofeel like I'm doing more than
pushing pills, cause that's notwhat I am trying to bring to my
practice, right, I I want tohave a, you know, an
(14:19):
encyclopedic understanding ofall of the medicines and be able
to use them as as as needed, asneeded and as fit right.
But psychotherapy is different.
It is more potentially curativethan our medicines are.
Right, and what I love aboutCBT, right, is that you're
(14:39):
actually training the person tobe their own therapist, and so
that has long-termsustainability.
You know, once you teachsomeone to fish, so to speak,
right, they can feed themselves.
So I liked that and I foundthat it also was a way you know
(15:00):
it's like, by using, likepsychotherapy, add-on codes, to
have longer visit times, alittle bit longer visit times
with my patients, and that was ahuge plus too, because you know
when you.
When you do that, you almostdouble your RVUs, your
productivity, and so I didn'thave to see, you know, 16
patients a day.
(15:21):
I, you know I could see 10, andthat was good for me and as
well as for the patients.
So it started kind of allfitting together like that.
But I remained very passionateabout psychopharmacology as well
, and on the faculty at UCSF,like Andrew Penn and I are
(15:45):
always kind of nerding out aboutit, and so I I wouldn't say
I've, you know, I just I triedit.
Speaker 2 (15:56):
They're sort of like equal, I think, to me yeah, no,
thank you, and I guess you knowjust kind of seeing, because it
is a life change Right, I mean,and I think it takes a lot of
courage to kind of, you know,listen to your own kind of inner
voice.
I think, in a sense, because Ithink you were saying that you
just felt like the pharmacology,while it did a lot, and again,
meds save lives, I definitely.
(16:16):
You know, I always want to talkabout these sort of things.
I don't want people to skewlike it's either psychotherapy
or it's meds, it's, it's bothRight, I mean, that's the best,
you know, that's the besttreatment for our patients.
But but again, just, yeah,maybe just want to highlight I
want to turn it over to Kate toobut I mean just that idea of
(16:37):
listening to your own innervoice to to make that change and
go back to school.
Speaker 3 (16:40):
I mean that's not easy to do, that's, that's quite
a leap of if I can.
And that's just that.
When I was doing working inresearch, I was, you know, this
was an entry level job I was, Iwas a research coordinator and
so I got trained on a lot ofpsychiatric, you know,
structured instruments so that Icould do those at a very high
(17:01):
level of reliability.
Very high level of reliability,you know I got, I was working
on like 10 different studies atone point.
So I was doing, doing a lot andit was really great center that
I was working.
But as a research coordinator,like you know, you're actually
performing diagnostic interviewsbut what you can say and do
(17:21):
right is very like predefinedright, uh, very, very structured
.
You're going to go through thesame same steps and so I was
able to use, like, um, you know,to be supportive of patients,
right, and have some, um, youknow the way that I would
outreach and greet them andeverything provide, like you
(17:44):
know, sort of support.
Uh, because I, you know, myempathy was activated right with
all the folks that I was I wasworking with, uh, but yeah, but
I couldn't, you know, I reallyit was like I can't do anything
that's like remotely likepsychotherapy here, right?
So, um, yeah, so thatdefinitely made me excited about
(18:04):
a career as a psych MP, becauseI'll get to choose what I'm
doing right.
I have a lot more options.
I get to direct the plan andimplement it.
Speaker 4 (18:16):
Absolutely.
And, Chelsea, it's so much funto hear about your trajectory
and all the different sort ofphases and how one very much led
to the next, and also what Ireally hear in what you're
sharing is how much yourrealization about what patients
need in this given setting kindof informed your next steps in
(18:40):
your own professionaldevelopment.
It's so cool and I love whatyou said about how CBT is really
about training the patient toeventually become their own
therapist.
So that's really where I wantto focus.
My next question for you is I'mwondering if you can maybe
describe for our audience, thinkabout a patient you've worked
with, or you know a specificthing you worked with a patient
(19:03):
on and how that kind of unfoldedas a success story.
Speaker 3 (19:09):
Okay.
So I'm going to think back tomy practice in that primary care
clinic because I just had a lotof opportunity to have kind of
like nice clean cases, I guessin that setting.
And so I would say that some ofthe most exciting work was with
(19:40):
people were very invested,right, they.
They once, once they got, theyheard the spiel, right, you know
, they got excited about doingdoing CBT.
Some of them, oh my goodness,it was so lovely working with
people who are kind of later intheir life, right, they're in
their seventies, sometimes evenin their eighties doing
psychotherapy with them.
(20:01):
Right, and the the way thatdoing cognitive restructuring
like changed their relationshipwith themselves, right With with
with the way that they think.
So I, so I had people who I'mthinking of a patient who'd
received, you know, reallynegative messages from their
(20:22):
parents and, you know, haddeveloped some very negative
opinions of themselves, right asas a parent, and had struggled
in some different ways.
I'm just trying to keep itgeneral right here, but but it
was, it was really great becausethis patient was very organized
(20:45):
.
I was able to really bring herinto the process.
So, you know, over time, as youwork with someone in CBT, you
develop what's called a, youknow, cognitive
conceptualization diagram, andshe became part of working on
the diagram, like with me, right, and she was having her own
realization diagram, like withwith me, right, and she was
(21:05):
having her own realization.
She was doing doing this, youknow, impromptu, as thoughts
came up right, related to whoshe was as a parent, and so it
was really cool to see thisprogress toward a more gentle
(21:26):
relationship with herself andhow she was able to reframe the
past as something, as a, as atime when she was really doing
her best.
It might not be as good as whatshe, she wanted, right, but
nonetheless she, she really wasdoing her best and she has the.
And seeing that now, in thepresent moment, right, she has
the opportunity to do evenbetter, right, as she, as she
(21:49):
learns, learns into the deeperstuff, into core beliefs, into,
(22:09):
you know, conditionalassumptions, right, because,
like I said, if you believe thatyou're not good enough, right,
then you're going to developrules of living, right, so that
you will kind of be okay, right?
So if I'm not good enough, thenif I do everything perfectly,
(22:29):
then I'll be okay.
If I do everything people askof me, I'll be okay, right, and
these are very rigid and youknow, ultimately, like, take a
huge toll on people over time.
And so being able to, you knowwork on, you know individual,
like automatic thoughts and thesituations that prompt them, and
(22:50):
you know the, the feelings thatcome from that and the
behaviors that follow that,right, and you do that for a few
different situations and thenyou're like, wow, there's some
common themes here.
You know, if this automaticthoughts through true, what does
it mean about you?
Right, and then you startgetting to the core beliefs and
(23:10):
then you can perform like asimilar process on the core
belief, right, but you can't dothat until you crack the surface
Right by, because, people, youcan't just tell people that
their thoughts are not always100 percent true, right, you
know the brain's very literaland that's that's something that
I people, you can't just tellpeople that their thoughts are
not always 100% true, right, youknow the brain's very literal,
and that's that's something thatI explain to patients.
(23:31):
Like the things that you say toyourself, right, you might know
that they're only partly true,but when you say that to
yourself, your brain isn'tgetting that right, it's
actually taking everythingliterally.
So if you say to yourself, youknow I'm at, I'm such a failure,
right.
Your brain's going to be like,oh, we're a failure, right, we
(23:54):
need to feel awful, right.
And then you feel awful.
And then you know you're,you're, you're despairing,
you're disappointed in yourself,right, you know.
And then it's going to affectyour behavior, right.
So so you have to start, youknow, observing that process to
(24:21):
see, ok, well, I mean, I failedat this thing, but not at that,
right.
And so just getting to thatplace of, like, realistic
thinking, which, when you have arealistic thought, like you
meet it with a shrug usually,rather than than putting your
face in your hands, right, sothat's just like the power of it
.
I love that.
It's just about being realisticand it's.
You know, life is less painfulwhen you're not making these
(24:43):
dramatic over generalizationsright in our, in our minds.
Speaker 2 (24:47):
Um, so anyway, um I'm gonna steal that chelsea.
I I've never heard it that waythat that solid you know brains.
I you know I'm gonna be alittle crass here and say your
brain is kind of autistic insome way.
It doesn't see sarcasm.
But that I'm gonna steal that.
I'm sorry, I'll quote you andexcite you on that, but that's
(25:08):
great.
I've never heard it kind of putthat way, so thanks.
Speaker 4 (25:10):
Yeah, and I want to say too, I really, really
appreciate how you're describinghow this all works, because I
think sometimes one of the ideasthat people have about CBT
maybe not knowing too much aboutit or haven't applied it yet is
that it really is all veryintellectual and, uh, it very
much stays up here I'm pointingto my head right now, um, but in
fact, these, this whole processis very, actually, heartfelt.
(25:33):
In the end, it very muchaffects our emotions and our
whole sense of well-being, um,and so I just appreciate how you
are making it so clear thatit's infused with that too.
Speaker 3 (25:44):
Yeah, yeah, you know, I, I, I just love how, how life
changing this this has been,and I also love just the way
that cognitive restructuring canbe used as this like pretty
general tool.
Right, you can use it forepisodic treatment of mental
health problems, right, and solike even you know.
(26:08):
So, whatever diagnosis you knowthat might be associated with
it, right, it's something thatyou can just have in your pocket
, you know, and be ready to helppatients with, and I've just
found it really makes peoplefeel like they're getting
something from psychotherapyright.
A lot of people really do likethe option of something
(26:31):
structured.
It's not that that's alwaysmaybe what's needed, but a lot
of times it is.
And it's a nice entry point, Ithink, to psychotherapy for
people who are, who are new toit, because, uh, you know,
they've, they've heard, oh, youknow, psychotherapists.
They just say, you know, theyask you about your mother and
(26:53):
whatever.
They or they just repeat backwhat you said to them.
And you know, they've heard ofpeople like I don't really get
much out of therapy, so, um, sothis is, this is sort of a
corrective experience, I think,for people to have like, okay,
oh, this is little thing and Ialso I don't use like worksheets
(27:13):
.
You know things like that thatare often associated with CBT.
You know, kate, kate knows mystyle, which is generally like
getting a white sheet of paperand just like folding in a
certain number of quadrants orsections and then each section
like means something and youfill it in.
(27:34):
I started doing that years agoand it's just stuck with me.
So I like giving people thefeeling like you could start,
you know, a cognitiverestructuring cycle anytime.
Right, you just grab a sheet ofpaper, we're going to get going
, right, and yeah, I just feelit's empowering.
(27:56):
And then for people who doactually need meds, like after
they make some effort inpsychotherapy, right, and they
see, oh wow, I was able to makeprogress in this, but I still
have trouble with this.
They feel like they've, likemeds, become more like of a
reasonable option because youknow it's like you, you, you,
you try.
I've had that experience alsodoing like, like sleep
(28:23):
restriction, right For insomnia.
I had a patient that wasstruggling and they didn't want
to take medicine.
So, okay, so we did astructured approach to sleep
restriction and that was very,very difficult, right, and you
know, some progress occurred.
But eventually the patient waslike okay, let's talk about meds
(28:43):
now.
Sure, let's do that right, butyou feel like you kind of came
to it the right way for them,you know.
Speaker 4 (28:55):
I love these examples .
Speaker 5 (28:57):
These examples are so great and you are, like Kate
said, making this so accessible.
I feel like I'm going throughthe process with you and I
appreciate that my question is alittle bit of a different level
.
I'd like to we'd like to hearyour opinions on how you see
nursing being a leader inperforming psychotherapy.
Speaker 3 (29:18):
Yeah, well, I think there's a great opportunity
because what we see elsewhere,right in the, in the psychiatric
provider, like landscape, um,is people, you know, the more
trained you are, the furtheraway you know that you're
(29:39):
getting from psychotherapy,right, so many psychiatrists
feel very hemmed into like ameds only practice, for example,
when that was not historicallythe case, right, they were
providing psychoanalysis and soon.
So it's really, you know, it'ssad to see that, but it's also,
(30:00):
you know, sort of a functionsometimes of the pay scale and
everything.
So, nurse practitioners, right,you know, you know, depending
on where you are, you know itcan be a, you know, reasonably
compensated profession, but it'sstill, like, not quite at the
scale of psychiatry.
So, you know, it's not ascostly for you to spend a little
(30:24):
extra time with the patient.
You know, by comparison, right,and you can treat people who
have Medicare which, like, forexample, here in California,
people who have Medicare have alot of trouble and particular or
Medicare and Medicaid will havea lot of trouble accessing
(30:48):
psychotherapists because there'swhole classes of
psychotherapists that are not,like, permitted or might not be
contracted, right, so you know.
So, if you're so, if you are aclinical psychologist, right, or
if you are, you know, apsychiatrist or a psychiatric
nurse practitioner or a licensedclinical social worker, like
(31:10):
you might be, those are like theoptions.
You can't be, you know, an LCSWor an LMFT, for example, right
or or associate level to toprovide those services.
So I'm just like, so we and wealso are able to train people in
larger numbers.
(31:31):
You know, like you know a lotof times right so the so the
program that you know that Kateand I are, you know, like you
know a lot of times right so theso the program that you know
that Kate and I are, you know,connected with right, we'll
train, you know, over over 20people you know, in a cohort,
right and they, you know they'redoing a two, three year program
, right, so you know we've beenover 30 before right In the past
(31:53):
.
You know you know we've beenover 30 before right In the past
.
You know, and you talk aboutthose numbers with with, you
know, department of Psychiatryand the number of people they're
training is so much smaller andtheir numbers are like,
restricted by, you know, by somesome of the federal like rules,
I, if I recall correctly, soit's it, it's's tough, um, so we
(32:17):
have.
So there's this gap, kind of,and so nurse practitioners can
step into this.
They just need the, thetraining and the um to and and
enough to build their confidence, um, and to get enough feedback
so they, you know, really canfeel oh yeah, I'm doing this,
right, um, they just have tohave that.
And then also, like I said this,this strategy with the
(32:39):
cognitive restructuring Idesigned really so that if you
only have five minutes to dosome cognitive restructuring in
a session, which might be itright, you can do that and then
you're gonna, and then you'regonna take pick it up the next
time.
You see the patient, right, andthey're going to do some, some
work in between.
So, and it actually becomeseven more powerful sometimes
(32:59):
when you separate it out,because people have a chance to
sort of think and ponder and dosome work in between, and so
sometimes it's even deeper.
So I think we we have thatopportunity, you know, for a
variety of reasons.
And I mean, and I'm like sortof a frontier that I'm very
curious about is actuallywhether primary care nurse
(33:24):
practitioners since they doprovide primary mental health
care to a lot of people, rightof people, right, they're the
ones who are prescribing, youknow, you know, antidepressants
and anti-anxiety medicines andand so on.
To, to to a lot of people.
Right, at what point do we takesomething like, you know,
(33:46):
cognitive restructuring and sortof step-by-step approach right
and enable them to do it right,because there's a, you know,
we're teaching patients how todo it themselves, right?
They're not licensedpsychotherapists, right, you
know?
And a lot of primary care nursepractitioners have a lot of
(34:06):
like, a lot of soft skills interms of how they're relating to
patients.
So that's been sort of aquestion in my mind, like can
you know at what point you knowscope of practice wise, like you
know, could we start puttingthis in the hands of those folks
to to further expand access?
You know they might not have,you know, the depth of training
(34:27):
right in in CBT but andpsychotherapy in general.
But, like I said, this, Ireally would view this as
primary right mental health care, and so it you know there's a
case to be made, I guess.
Speaker 2 (34:45):
Yeah, no, that's yeah , and you may be aware, you know
there's, there's literature outthere using interpersonal
psychotherapy and nurses overthe telephone they would call
patients and do you know,obviously not a full session or
full, kind of robust eight to 12sessions.
But you know, yeah, like yousaid, picking apart little
pieces of those theories andapplying it so and that's even
you know RN levels.
You know kind of doing thosekind of things.
So I think you know we're kindof we're coming up on time here
(35:08):
a little bit for our podcast,but I think you've led into kind
of.
The next question is just kindof thinking about the future of
psychotherapy.
Where do you kind of see it?
What's your crystal ball?
Tell you, you know what's where.
If you ran, if you had a timemachine, went back and were able
to talk to Chelsea from thepast and you know what, would
you tell her to?
Kind of, you know, start goingthis way or that way, what do
you think?
Speaker 3 (35:50):
Gosh, I would like.
My dream really is thatpsychiatric nurse practitioners,
like you know, and psychiatricCNSs, like all over the country,
you know, like get trained bythe Beck Institute so that we're
, you know, and it's not likeyou know it costs something, but
it's not like you're notspending thousands and thousands
of dollars, it's not like that,right, it's, they're reasonable
, they're very reasonable peopleat the Institute and you know
(36:11):
to, if, if everyone was gettingthat and if this kind of
material was being featured,like in a lot of the training
programs.
Right, I would just love if youknow if, when people think of,
like where can we get, see,where can this patient get cbt,
be like, oh, let's send them toa psychiatric nurse practitioner
.
They're all trained, you know.
Um, you know, because Iguarantee, right, if you're
(36:38):
getting treated at a federallyqualified health center or
something like that, if theyhave psych services, they're
probably provided by Psych NP.
If you're working for you know,you're being served by a small
community-based organization,right, it's probably a psych MP,
and so we actually have thishuge opportunity to like expand
(36:58):
access.
So I think, and this, I thinkthat would be unexpected and
wonderful.
So that's, that's the kind ofthing I would like to see in the
future.
Speaker 2 (37:08):
Very great.
Thank you, chelsea, so much forthis time.
I agree it just you know thistime has flown by.
I can't believe we're on up ontime and things like that.
But thank you for sharing yourexpertise.
Wonderful to hear from yourexperience.
I think you have so much moreto share.
I hope you can maybe come backfor a future podcast.
That would be amazing.
Speaker 3 (37:27):
Oh, I'd love to Thank you so much.
Speaker 2 (37:29):
Yeah, but thank you all for listening, appreciate it
.
Another episode will be comingout shortly and look forward to
having many more episodesthroughout this summer.
So have a great day and like,subscribe and please comment.
Speaker 1 (37:41):
All right, take care, bye too much salt like this,
too much seasoning.
They feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving, so you can beyou.
Uh, they feel it before.
It's true, work hard untilthose thoughts are finally
leaving, so you can be you.
Uh, they feel it before.
It's true, work hard untilthose thoughts are finally
leaving, so you can be.
You got a discovery identifyingchallenging your beliefs or
(38:03):
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discoveryidentifying challenging.
yeah, just my take on things.
My answer number two decreaseuntil they cease.
It's not a discoveryIdentifying a challenge in your
(00:26):
beliefs.
Speaker 2 (00:27):
All right, welcome back everyone.
Here we are another episode ofPep Lau's Ghost.
Thank you for joining us.
Really excited to have our nextguest here, chelsea Landlin,
from the University ofCalifornia, san Francisco.
So I'm really excited to get toknow her and her passion for
psychotherapy in this podcast.
(00:47):
I'm also joined by Dr KateMolino from the University of
California.
Maybe they know each other,maybe they don't Find out this
episode we'll kind of probablyget into that and then Dr
Melissa Chapman-Hayes, who'swith us always as kind of that
voice of reason maybe I don'tknow, but it keeps us from
getting too jargony and thingslike that.
So one of the exciting things Ido have to share I don't know if
(01:10):
anyone else here listening, oreven on the podcast right now
this is our 21st episode.
Can you believe it?
21.
So now we can start drinking.
Right, so let's order.
Around.
Here we go, no, just kidding.
So right so.
So let's, let's order.
Around.
Here we go, uh, no, justkidding.
So, yeah, 21, this is our 21stepisode, really excited.
So, um, and again, we continueto get lots of listeners.
(01:30):
So, uh, from all across theunited states and then even
internationally.
We, I'm just so surprised weget probably about one to five
percent um for international,especially up in our nordic
areas, in denmark and finlandand such so.
So thank you very much forlistening all around the world.
So so again, really excited.
Thank you, chelsea, for takingsome time today and getting to
(01:53):
to kind of share your thoughtshere on this.
But let us get this ballrolling and and get with the
first question when, when didyou get first get excited in
psychotherapy?
I mean, what's kind of was yourfirst draw, what was your first
kind of you know?
Gosh, I want to do more of thator just really kind of dive
into it.
Speaker 3 (02:11):
Wonderful and first of all, thanks for having me.
This is such an exciting thingto be doing and such a valuable
podcast, because I do think thatnurse practitioners are so
important and increasinglyimportant providers of
psychotherapy, especially tofolks who have, you know,
(02:34):
limited access because ofinsurance and other things.
A lot of times we can provideit when no one else can that's
been my experience at least.
So I'm just delighted that youall are leaning in to this
content.
So I got interested inpsychotherapy oh goodness, it
was probably during my program.
(02:59):
So I trained at UCSF in both theadult Psych NP program as well
as the adult nurse practitionerprogram.
So primary care and I was doingI'd come previously from the
world of psychopharmacologyresearch and health psychology
(03:21):
research before that back inMassachusetts and but came out,
came out here and got started inthe program.
And then what I was trying todo was figure out gosh, how do I
, if I'm going to provideintegrated primary care and
psychiatric care, which was theintention of the program that I
was in at the time, I was likewhat modality would be
(03:46):
appropriate, right?
What kind of therapy shouldsomeone provide if they are
providing both your mentalhealth care as well, as you know
, performing sensitive physicalexams on you, right?
So I thought, geez, what shouldI do?
So when I encountered open,rogers was able to help Gloria
(04:09):
be.
You know, I don't know ifyou've spoken about Gloria
(04:38):
previously on this podcast, Ican.
Speaker 2 (04:41):
No, yeah, get into it .
Speaker 3 (04:42):
Yeah, yeah, what's that A little bit Okay.
So this was done years ago, Idon't know, yeah, get into it.
Yeah, yeah, what's that?
A little bit Okay so.
So this, this was, this wasdone years ago, I don't know,
probably seventies or something,and they basically this one
woman.
She was a real patient and shewas interviewed by by three
different famouspsychotherapists who had their
own modalities, right, and heand so Carl Rogers had, you know
(05:05):
, 30 minutes or something, um,to conduct a, an interview and
find out what was going on withher.
And you know, she, she had, shehad a lot to share and it was
very vulnerable and I was ableto see gosh when he interviewed
her.
It just she, she opened up andthen I saw her interviewed by
some of the otherpsychotherapists and she just
(05:25):
clammed up and was very stressedout, and so I was like, wow, I
kind of like this, and so Ithought, okay, maybe, maybe a
Rogerian approach is is rightfor me, which, aligned with who
I am as a person.
I'm sort of a walking talkinghuman care bear.
So it really seemed to fit,because you know his, you know
(05:50):
that that approach, you knowwe've been to have a have a
technical term for loving yourpatient, which is having
unconditional positive regard,right.
So I that that that worked forme and so I.
So I started kind of bringingthat approach into what I was
doing.
And when I went out to startworking, I took a job with, with
(06:14):
an assertive communitytreatment team that was
providing this wraparound, youknow multidisciplinary services
to people with severe mentalillness who'd been chronically
homeless.
And so, and I, you know,instantly had a panel of I don't
know 95 patients or so you knowfresh out of school, and
(06:36):
they're all you know some of theyou know sicker outpatients in
that whole County.
And I was like, oh boy, okay.
And so I thought, what am Igoing to do?
So I start doing somesupportive psychotherapy and
then with certain patients I wasable to go a little bit deeper
and I was able to use a Rogerianapproach.
(06:57):
But I did struggle a little bitbecause I didn't encounter very
easily training resources.
So I read books and that kindof thing to try to try to
develop the skills.
But I only went so far withthat Um.
And then fast forward abouteight years later, um, I took a
(07:19):
job, um, with uh, with UCSF, inone of the primary care clinics.
I was asked to start a pilotprogram, provide integrated
mental health care in this kindof medium-sized primary care
clinic, which was an excitingopportunity because I had gotten
(07:40):
the whole growth curve fromcaring for people with severe
and persistent mental illness.
I knew my, my antipsychoticsbackwards and forwards, you know
, et cetera and so, but you know, hardly ever got to prescribe
medicines for ADHD, for example,because a lot of people you
know they were using meth orwhatever and you know it just
(08:01):
wasn't appropriate.
So this was a differentpopulation.
They were generallycommercially insured or they had
Medicare.
Those were the folks I was ableto see and I knew going in.
I wanted to develop a specificskill set for them and I had
(08:22):
gotten interested in CBT justover the years because when I
was back at the other program,occasionally I would have a
patient that you know justseemed to be so appropriate for
for CBT and I just I was likewow, you just can't get access
to this.
It's so difficult, right?
We, there was, was there wasone place that would take, that
(08:44):
would take patients, uh, forkind of sliding scale or low,
low-cost services.
Um, it's the right Institute inthe East Bay, but I had a.
But I had a bipolar patientthat got turned away, um, you
know, and it just was sad.
So I was like, wow, I, how do Iactually get this to my patient
(09:06):
?
So I was like I better gettrained myself.
Okay, so that's, that's what Idid.
So this, this was right aroundwhen place and everything.
I I looked into some classes andstarted and I got signed up for
(09:28):
for some of the fundamentalcourses with Beck Institute.
So you know, so how to provide,you know, cbt for depression
and anxiety, another course, soa few things.
So I got, I got going withthose and I just loved it.
I thought it was so fantastic.
And then I would nerd outsometimes on like old, like
(09:50):
Aaron Beck videos, um, and youknow him talking about like how
he discovered automatic thoughtsof this one, like I love that
story which I can tell if youwant it's.
It was just so exciting to meand so I developed that.
(10:10):
And then and then when I startedpracticing at, you know, at the
primary care clinic, you know Iwould just communicate to
patients that had that I coulddo this.
And you know, more and morepeople, people got interested
and I developed a little spieland an approach to doing it.
So much so that I eventuallydeveloped a sort of a training
(10:34):
module for how to performcognitive restructuring in sort
of a busy clinic setting and sothat I presented at a few
conferences setting, and so thatI presented at a few
conferences and I've also beentraining the UCSF students on
that pretty much every year forthe past several years, and then
now training students in theonline multi-campus program that
(11:00):
we're doing at the Universityof California too, in this, in
this approach, and what I reallylike is that it enables people
who've learned in theirschooling, right, some
principles of CBT but theyreally don't know where to start
and how to really implement it.
(11:22):
So I, you know, so I did zeroin more on.
You know, cbt is very big,right, so I narrowed it down to
like, let's focus on thecognitive restructuring part of
it and let me teach that, right,because that's like the core,
sort of beating heart of youknow, the cognitive side of CBT,
right?
So, in my opinion, correct meif you think differently,
(11:45):
Melissa, but that's how I see it.
So, yeah, so I started teachingthat and I've just loved the
excitement that students getwhen they grasp it.
It's just, you know, wonderful.
So I teach it as a usually athree hour workshop and then
(12:07):
space it out by two weeks or soand then do another two hours,
and so they learn like a step bystep process.
And then they do partnerpractice using like simulated
cases.
I have them do a thought recordin that interim, two weeks for
themselves, right, and then theypair up in the last one and
(12:31):
then they work with their ownmaterial, you know, trading off,
and so they really get theexperience of what's it like to
be the patient when you're doingcognitive restructuring, how
does it feel right when you'redoing cognitive restructuring,
how does it feel Right, and andthen what's it like to provide
it in this sort of friendlysetting.
Speaker 2 (12:51):
Thank you, chelsea, that's, that's amazing.
I love this story.
I, you know.
Two thoughts come to mind andmaybe just one to kind of follow
up with is you know, it'sinteresting how you start off in
pharmacology, I guess, and kindof that's a different type of
you know way to approachpatients and to care for them
and such.
Maybe, in asking, you know,thinking back on that time, was
(13:14):
there something maybe kind of inthe back of your head or
something kind of maybe just alittle dissatisfied with what
you were doing, that kind ofdrove you back to school and
maybe kind of pushed you in thisdirection that you're so
passionate in now?
Or was it just happen, chanceand things like that?
Speaker 3 (13:32):
I mean, my path into this has many different threads.
We can get into some of them.
I think one of the biggestdrivers was feeling like I just
wanted a more diverse toolbox,right?
Because when all you have is ahammer, all you see are nails,
(13:57):
and you know, I think it's justbetter to um for both, for me,
as a practitioner, to be able tofeel like I'm doing more than
pushing pills, cause that's notwhat I am trying to bring to my
practice, right, I I want tohave a, you know, an
(14:19):
encyclopedic understanding ofall of the medicines and be able
to use them as as as needed, asneeded and as fit right.
But psychotherapy is different.
It is more potentially curativethan our medicines are.
Right, and what I love aboutCBT, right, is that you're
(14:39):
actually training the person tobe their own therapist, and so
that has long-termsustainability.
You know, once you teachsomeone to fish, so to speak,
right, they can feed themselves.
So I liked that and I foundthat it also was a way you know
(15:00):
it's like, by using, likepsychotherapy, add-on codes, to
have longer visit times, alittle bit longer visit times
with my patients, and that was ahuge plus too, because you know
when you.
When you do that, you almostdouble your RVUs, your
productivity, and so I didn'thave to see, you know, 16
patients a day.
(15:21):
I, you know I could see 10, andthat was good for me and as
well as for the patients.
So it started kind of allfitting together like that.
But I remained very passionateabout psychopharmacology as well
, and on the faculty at UCSF,like Andrew Penn and I are
(15:45):
always kind of nerding out aboutit, and so I I wouldn't say
I've, you know, I just I triedit.
Speaker 2 (15:56):
They're sort of like equal, I think, to me yeah, no,
thank you, and I guess you knowjust kind of seeing, because it
is a life change Right, I mean,and I think it takes a lot of
courage to kind of, you know,listen to your own kind of inner
voice.
I think, in a sense, because Ithink you were saying that you
just felt like the pharmacology,while it did a lot, and again,
meds save lives, I definitely.
(16:16):
You know, I always want to talkabout these sort of things.
I don't want people to skewlike it's either psychotherapy
or it's meds, it's, it's bothRight, I mean, that's the best,
you know, that's the besttreatment for our patients.
But but again, just, yeah,maybe just want to highlight I
want to turn it over to Kate toobut I mean just that idea of
(16:37):
listening to your own innervoice to to make that change and
go back to school.
Speaker 3 (16:40):
I mean that's not easy to do, that's, that's quite
a leap of if I can.
And that's just that.
When I was doing working inresearch, I was, you know, this
was an entry level job I was, Iwas a research coordinator and
so I got trained on a lot ofpsychiatric, you know,
structured instruments so that Icould do those at a very high
(17:01):
level of reliability.
Very high level of reliability,you know I got, I was working
on like 10 different studies atone point.
So I was doing, doing a lot andit was really great center that
I was working.
But as a research coordinator,like you know, you're actually
performing diagnostic interviewsbut what you can say and do
(17:21):
right is very like predefinedright, uh, very, very structured
.
You're going to go through thesame same steps and so I was
able to use, like, um, you know,to be supportive of patients,
right, and have some, um, youknow the way that I would
outreach and greet them andeverything provide, like you
(17:44):
know, sort of support.
Uh, because I, you know, myempathy was activated right with
all the folks that I was I wasworking with, uh, but yeah, but
I couldn't, you know, I reallyit was like I can't do anything
that's like remotely likepsychotherapy here, right?
So, um, yeah, so thatdefinitely made me excited about
(18:04):
a career as a psych MP, becauseI'll get to choose what I'm
doing right.
I have a lot more options.
I get to direct the plan andimplement it.
Speaker 4 (18:16):
Absolutely.
And, Chelsea, it's so much funto hear about your trajectory
and all the different sort ofphases and how one very much led
to the next, and also what Ireally hear in what you're
sharing is how much yourrealization about what patients
need in this given setting kindof informed your next steps in
(18:40):
your own professionaldevelopment.
It's so cool and I love whatyou said about how CBT is really
about training the patient toeventually become their own
therapist.
So that's really where I wantto focus.
My next question for you is I'mwondering if you can maybe
describe for our audience, thinkabout a patient you've worked
with, or you know a specificthing you worked with a patient
(19:03):
on and how that kind of unfoldedas a success story.
Speaker 3 (19:09):
Okay.
So I'm going to think back tomy practice in that primary care
clinic because I just had a lotof opportunity to have kind of
like nice clean cases, I guessin that setting.
And so I would say that some ofthe most exciting work was with
(19:40):
people were very invested,right, they.
They once, once they got, theyheard the spiel, right, you know
, they got excited about doingdoing CBT.
Some of them, oh my goodness,it was so lovely working with
people who are kind of later intheir life, right, they're in
their seventies, sometimes evenin their eighties doing
psychotherapy with them.
(20:01):
Right, and the the way thatdoing cognitive restructuring
like changed their relationshipwith themselves, right With with
with the way that they think.
So I, so I had people who I'mthinking of a patient who'd
received, you know, reallynegative messages from their
(20:22):
parents and, you know, haddeveloped some very negative
opinions of themselves, right asas a parent, and had struggled
in some different ways.
I'm just trying to keep itgeneral right here, but but it
was, it was really great becausethis patient was very organized
(20:45):
.
I was able to really bring herinto the process.
So, you know, over time, as youwork with someone in CBT, you
develop what's called a, youknow, cognitive
conceptualization diagram, andshe became part of working on
the diagram, like with me, right, and she was having her own
realization diagram, like withwith me, right, and she was
(21:05):
having her own realization.
She was doing doing this, youknow, impromptu, as thoughts
came up right, related to whoshe was as a parent, and so it
was really cool to see thisprogress toward a more gentle
(21:26):
relationship with herself andhow she was able to reframe the
past as something, as a, as atime when she was really doing
her best.
It might not be as good as whatshe, she wanted, right, but
nonetheless she, she really wasdoing her best and she has the.
And seeing that now, in thepresent moment, right, she has
the opportunity to do evenbetter, right, as she, as she
(21:49):
learns, learns into the deeperstuff, into core beliefs, into,
(22:09):
you know, conditionalassumptions, right, because,
like I said, if you believe thatyou're not good enough, right,
then you're going to developrules of living, right, so that
you will kind of be okay, right?
So if I'm not good enough, thenif I do everything perfectly,
(22:29):
then I'll be okay.
If I do everything people askof me, I'll be okay, right, and
these are very rigid and youknow, ultimately, like, take a
huge toll on people over time.
And so being able to, you knowwork on, you know individual,
like automatic thoughts and thesituations that prompt them, and
(22:50):
you know the, the feelings thatcome from that and the
behaviors that follow that,right, and you do that for a few
different situations and thenyou're like, wow, there's some
common themes here.
You know, if this automaticthoughts through true, what does
it mean about you?
Right, and then you startgetting to the core beliefs and
(23:10):
then you can perform like asimilar process on the core
belief, right, but you can't dothat until you crack the surface
Right by, because, people, youcan't just tell people that
their thoughts are not always100 percent true, right, you
know the brain's very literaland that's that's something that
I people, you can't just tellpeople that their thoughts are
not always 100% true, right, youknow the brain's very literal,
and that's that's something thatI explain to patients.
(23:31):
Like the things that you say toyourself, right, you might know
that they're only partly true,but when you say that to
yourself, your brain isn'tgetting that right, it's
actually taking everythingliterally.
So if you say to yourself, youknow I'm at, I'm such a failure,
right.
Your brain's going to be like,oh, we're a failure, right, we
(23:54):
need to feel awful, right.
And then you feel awful.
And then you know you're,you're, you're despairing,
you're disappointed in yourself,right, you know.
And then it's going to affectyour behavior, right.
So so you have to start, youknow, observing that process to
(24:21):
see, ok, well, I mean, I failedat this thing, but not at that,
right.
And so just getting to thatplace of, like, realistic
thinking, which, when you have arealistic thought, like you
meet it with a shrug usually,rather than than putting your
face in your hands, right, sothat's just like the power of it
.
I love that.
It's just about being realisticand it's.
You know, life is less painfulwhen you're not making these
(24:43):
dramatic over generalizationsright in our, in our minds.
Speaker 2 (24:47):
Um, so anyway, um I'm gonna steal that chelsea.
I I've never heard it that waythat that solid you know brains.
I you know I'm gonna be alittle crass here and say your
brain is kind of autistic insome way.
It doesn't see sarcasm.
But that I'm gonna steal that.
I'm sorry, I'll quote you andexcite you on that, but that's
(25:08):
great.
I've never heard it kind of putthat way, so thanks.
Speaker 4 (25:10):
Yeah, and I want to say too, I really, really
appreciate how you're describinghow this all works, because I
think sometimes one of the ideasthat people have about CBT
maybe not knowing too much aboutit or haven't applied it yet is
that it really is all veryintellectual and, uh, it very
much stays up here I'm pointingto my head right now, um, but in
fact, these, this whole processis very, actually, heartfelt.
(25:33):
In the end, it very muchaffects our emotions and our
whole sense of well-being, um,and so I just appreciate how you
are making it so clear thatit's infused with that too.
Speaker 3 (25:44):
Yeah, yeah, you know, I, I, I just love how, how life
changing this this has been,and I also love just the way
that cognitive restructuring canbe used as this like pretty
general tool.
Right, you can use it forepisodic treatment of mental
health problems, right, and solike even you know.
(26:08):
So, whatever diagnosis you knowthat might be associated with
it, right, it's something thatyou can just have in your pocket
, you know, and be ready to helppatients with, and I've just
found it really makes peoplefeel like they're getting
something from psychotherapyright.
A lot of people really do likethe option of something
(26:31):
structured.
It's not that that's alwaysmaybe what's needed, but a lot
of times it is.
And it's a nice entry point, Ithink, to psychotherapy for
people who are, who are new toit, because, uh, you know,
they've, they've heard, oh, youknow, psychotherapists.
They just say, you know, theyask you about your mother and
(26:53):
whatever.
They or they just repeat backwhat you said to them.
And you know, they've heard ofpeople like I don't really get
much out of therapy, so, um, sothis is, this is sort of a
corrective experience, I think,for people to have like, okay,
oh, this is little thing and Ialso I don't use like worksheets
(27:13):
.
You know things like that thatare often associated with CBT.
You know, kate, kate knows mystyle, which is generally like
getting a white sheet of paperand just like folding in a
certain number of quadrants orsections and then each section
like means something and youfill it in.
(27:34):
I started doing that years agoand it's just stuck with me.
So I like giving people thefeeling like you could start,
you know, a cognitiverestructuring cycle anytime.
Right, you just grab a sheet ofpaper, we're going to get going
, right, and yeah, I just feelit's empowering.
(27:56):
And then for people who doactually need meds, like after
they make some effort inpsychotherapy, right, and they
see, oh wow, I was able to makeprogress in this, but I still
have trouble with this.
They feel like they've, likemeds, become more like of a
reasonable option because youknow it's like you, you, you,
you try.
I've had that experience alsodoing like, like sleep
(28:23):
restriction, right For insomnia.
I had a patient that wasstruggling and they didn't want
to take medicine.
So, okay, so we did astructured approach to sleep
restriction and that was very,very difficult, right, and you
know, some progress occurred.
But eventually the patient waslike okay, let's talk about meds
(28:43):
now.
Sure, let's do that right, butyou feel like you kind of came
to it the right way for them,you know.
Speaker 4 (28:55):
I love these examples .
Speaker 5 (28:57):
These examples are so great and you are, like Kate
said, making this so accessible.
I feel like I'm going throughthe process with you and I
appreciate that my question is alittle bit of a different level
.
I'd like to we'd like to hearyour opinions on how you see
nursing being a leader inperforming psychotherapy.
Speaker 3 (29:18):
Yeah, well, I think there's a great opportunity
because what we see elsewhere,right in the, in the psychiatric
provider, like landscape, um,is people, you know, the more
trained you are, the furtheraway you know that you're
(29:39):
getting from psychotherapy,right, so many psychiatrists
feel very hemmed into like ameds only practice, for example,
when that was not historicallythe case, right, they were
providing psychoanalysis and soon.
So it's really, you know, it'ssad to see that, but it's also,
(30:00):
you know, sort of a functionsometimes of the pay scale and
everything.
So, nurse practitioners, right,you know, you know, depending
on where you are, you know itcan be a, you know, reasonably
compensated profession, but it'sstill, like, not quite at the
scale of psychiatry.
So, you know, it's not ascostly for you to spend a little
(30:24):
extra time with the patient.
You know, by comparison, right,and you can treat people who
have Medicare which, like, forexample, here in California,
people who have Medicare have alot of trouble and particular or
Medicare and Medicaid will havea lot of trouble accessing
(30:48):
psychotherapists because there'swhole classes of
psychotherapists that are not,like, permitted or might not be
contracted, right, so you know.
So, if you're so, if you are aclinical psychologist, right, or
if you are, you know, apsychiatrist or a psychiatric
nurse practitioner or a licensedclinical social worker, like
(31:10):
you might be, those are like theoptions.
You can't be, you know, an LCSWor an LMFT, for example, right
or or associate level to toprovide those services.
So I'm just like, so we and wealso are able to train people in
larger numbers.
(31:31):
You know, like you know a lotof times right so the so the
program that you know that Kateand I are, you know, like you
know a lot of times right so theso the program that you know
that Kate and I are, you know,connected with right, we'll
train, you know, over over 20people you know, in a cohort,
right and they, you know they'redoing a two, three year program
, right, so you know we've beenover 30 before right In the past
(31:53):
.
You know you know we've beenover 30 before right In the past
.
You know, and you talk aboutthose numbers with with, you
know, department of Psychiatryand the number of people they're
training is so much smaller andtheir numbers are like,
restricted by, you know, by somesome of the federal like rules,
I, if I recall correctly, soit's it, it's's tough, um, so we
(32:17):
have.
So there's this gap, kind of,and so nurse practitioners can
step into this.
They just need the, thetraining and the um to and and
enough to build their confidence, um, and to get enough feedback
so they, you know, really canfeel oh yeah, I'm doing this,
right, um, they just have tohave that.
And then also, like I said this,this strategy with the
(32:39):
cognitive restructuring Idesigned really so that if you
only have five minutes to dosome cognitive restructuring in
a session, which might be itright, you can do that and then
you're gonna, and then you'regonna take pick it up the next
time.
You see the patient, right, andthey're going to do some, some
work in between.
So, and it actually becomeseven more powerful sometimes
(32:59):
when you separate it out,because people have a chance to
sort of think and ponder and dosome work in between, and so
sometimes it's even deeper.
So I think we we have thatopportunity, you know, for a
variety of reasons.
And I mean, and I'm like sortof a frontier that I'm very
curious about is actuallywhether primary care nurse
(33:24):
practitioners since they doprovide primary mental health
care to a lot of people, rightof people, right, they're the
ones who are prescribing, youknow, you know, antidepressants
and anti-anxiety medicines andand so on.
To, to to a lot of people.
Right, at what point do we takesomething like, you know,
(33:46):
cognitive restructuring and sortof step-by-step approach right
and enable them to do it right,because there's a, you know,
we're teaching patients how todo it themselves, right?
They're not licensedpsychotherapists, right, you
know?
And a lot of primary care nursepractitioners have a lot of
(34:06):
like, a lot of soft skills interms of how they're relating to
patients.
So that's been sort of aquestion in my mind, like can
you know at what point you knowscope of practice wise, like you
know, could we start puttingthis in the hands of those folks
to to further expand access?
You know they might not have,you know, the depth of training
(34:27):
right in in CBT but andpsychotherapy in general.
But, like I said, this, Ireally would view this as
primary right mental health care, and so it you know there's a
case to be made, I guess.
Speaker 2 (34:45):
Yeah, no, that's yeah , and you may be aware, you know
there's, there's literature outthere using interpersonal
psychotherapy and nurses overthe telephone they would call
patients and do you know,obviously not a full session or
full, kind of robust eight to 12sessions.
But you know, yeah, like yousaid, picking apart little
pieces of those theories andapplying it so and that's even
you know RN levels.
You know kind of doing thosekind of things.
So I think you know we're kindof we're coming up on time here
(35:08):
a little bit for our podcast,but I think you've led into kind
of.
The next question is just kindof thinking about the future of
psychotherapy.
Where do you kind of see it?
What's your crystal ball?
Tell you, you know what's where.
If you ran, if you had a timemachine, went back and were able
to talk to Chelsea from thepast and you know what, would
you tell her to?
Kind of, you know, start goingthis way or that way, what do
you think?
Speaker 3 (35:50):
Gosh, I would like.
My dream really is thatpsychiatric nurse practitioners,
like you know, and psychiatricCNSs, like all over the country,
you know, like get trained bythe Beck Institute so that we're
, you know, and it's not likeyou know it costs something, but
it's not like you're notspending thousands and thousands
of dollars, it's not like that,right, it's, they're reasonable
, they're very reasonable peopleat the Institute and you know
(36:11):
to, if, if everyone was gettingthat and if this kind of
material was being featured,like in a lot of the training
programs.
Right, I would just love if youknow if, when people think of,
like where can we get, see,where can this patient get cbt,
be like, oh, let's send them toa psychiatric nurse practitioner
.
They're all trained, you know.
Um, you know, because Iguarantee, right, if you're
(36:38):
getting treated at a federallyqualified health center or
something like that, if theyhave psych services, they're
probably provided by Psych NP.
If you're working for you know,you're being served by a small
community-based organization,right, it's probably a psych MP,
and so we actually have thishuge opportunity to like expand
(36:58):
access.
So I think, and this, I thinkthat would be unexpected and
wonderful.
So that's, that's the kind ofthing I would like to see in the
future.
Speaker 2 (37:08):
Very great.
Thank you, chelsea, so much forthis time.
I agree it just you know thistime has flown by.
I can't believe we're on up ontime and things like that.
But thank you for sharing yourexpertise.
Wonderful to hear from yourexperience.
I think you have so much moreto share.
I hope you can maybe come backfor a future podcast.
That would be amazing.
Speaker 3 (37:27):
Oh, I'd love to Thank you so much.
Speaker 2 (37:29):
Yeah, but thank you all for listening, appreciate it
.
Another episode will be comingout shortly and look forward to
having many more episodesthroughout this summer.
So have a great day and like,subscribe and please comment.
Speaker 1 (37:41):
All right, take care, bye too much salt like this,
too much seasoning.
They feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving, so you can beyou.
Uh, they feel it before.
It's true, work hard untilthose thoughts are finally
leaving, so you can be you.
Uh, they feel it before.
It's true, work hard untilthose thoughts are finally
leaving, so you can be.
You got a discovery identifyingchallenging your beliefs or
(38:03):
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discoveryidentifying challenging.
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