March 4, 2025 • 27 mins
Dr Kristi Foster email: kristin-j-foster@uiowa.edu
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 to number twodecrease until they cease.
Stop that discovery.
Speaker 2 (00:13):
Welcome back everybody to another episode of
Pep Lau's Ghost.
So happy for you to be hereAgain, keep getting these
wonderful guests for the podcastand so very grateful that
(00:37):
they're able to volunteer theirtime and be here with us.
We are joined today by DrChristy Foster, who I'm super
excited to get to know and getto kind of.
You know it's one of thoseinteresting things for the
podcast is that Dr Fosteractually went through our
program I was her academicadvisor which you know feels
(00:57):
like yesterday probably doesn'tto Christy.
She's probably like, oh, thatwas a nightmare and the doctoral
work is just, it's anexperience of itself.
But we don't get this chance ofjust kind of talking and seeing
where your clinical expertisehas lied and the kind of cool
work you're doing.
So again, appreciate your timeand just kind of look forward to
(01:17):
this opportunity to get to knowa little bit more.
And again, as we like to do inPepalow's Ghosts is really
highlight the importance ofusing psychotherapy within the
PMHNP role.
So I'm going to get going rightat it and kind of ask you our
first question we like to askmost of our guests when did you
first start getting interestedin doing psychotherapy or where
does that interest kind of comefrom?
Speaker 3 (01:38):
Yeah, so you know.
First and foremost, thanks somuch for having me today.
It was an honor to be asked andI am always excited to share my
career trajectory and how Iended up here.
So the truth is, when I was inundergraduate nursing school, if
someone had told me I would endup as a psychiatric mental
health provider of any kind, Iactually would have adamantly
(02:00):
said that's not true.
It was actually something atthe time that I didn't think I'd
have the skill set for, and Ididn't.
You know the individuals I wasmeeting I was interested in, but
I felt like I wasn't sure youknow how I would know how to
help them really, and the drivebehind me being a nurse which I
(02:22):
think is true for so many nursesis we just want to help people,
and so I felt like that wasn'tclear to me, and it's been an
interesting evolution as to howit became clear to me that
mental health care was somethingthat was not only something
that I was capable of, but was atrue skill set of mine.
So I actually began my nursingcareer in a unit that had
(02:45):
multidisciplinary types ofservices.
Oncology was one of them, so Iwas very medical as a staff
nurse ultimately decided tobecome a pediatric nurse
practitioner.
So my first nurse practitionerbackground is pediatric primary
care, which also soundsinteresting because I was
working with oncology patients.
But at the time I reallythought that I would.
(03:12):
What I loved about oncology wasthe continuity and the
relationships with families andI thought I want to be able to
do that for a more expansivepopulation.
But then the more I steppedaway from oncology, the more I
realized that that was in factwhere I wanted to be.
So I honed in a lot of mytraining specifically from
oncology the more I realizedthat that was in fact where I
wanted to be.
So I honed in a lot of mytraining specifically with
oncology and ultimately thatfirst step as a nurse
practitioner was in pediatrics.
(03:33):
I've done oncology the entiretime as a pediatric nurse
practitioner and I was a medicalcare provider in the field for
many years I think it was abouteight before I made the
transition and so in those timesI was, you know, managing
chemotherapy and the medicalaspects of cancer care.
(03:54):
But you, you know, working withsomeone who is diagnosed with
cancer, and in my field,particularly in PEDS, these
people are allowing you to whatis probably the most, if not at
least one of the most vulnerablemoments of their entire lives.
And so while I was managingthese medical things, I also was
(04:16):
developing these really strongreports with people, and I think
, in reflection, even beforepsychotherapy training, I was
integrating some things that Ijust didn't even really know
were some natural componentsthat I just needed more skill
sets built on, and within thatthen I began to.
(04:38):
One of the things that is trueof me is that I constantly see
gaps in care, and when I seegaps in care, I feel like we got
to figure out how to makethings better, because the
patient is always the drive forme.
So I had this amazing privilegeof helping build several
programs, including thesurvivorship program, the
adolescent adult cancer program,things that were really being
(05:00):
structured to help improve thecare overall, and when we were
working with those adolescentand young adults about what do
you need in an AYA programwithout fail, it didn't matter
what topic we talked about.
They always brought it back topsychosocial aspects and mental
health care concerns, and thatwas the moment that they changed
(05:21):
my life right, and so my firstinteraction with Dr Weisman was
actually people at theUniversity of Iowa hospital
saying you should connect withthe following people.
I didn't know in the moment Iwas going to go back to become a
PM and HP, but that's where theroad drove me and I had
initially thought to myself well, this is so specific.
(05:43):
You know, caring for mentalhealth in cancer patients is so
specific.
You know, caring for mentalhealth in cancer patients is so
specific.
I don't know if I need theentire training.
And, as it turns out, you knowwhat my mentors at the time were
trying to tell me was you'reprobably going to need the whole
shebang.
They were right.
And even though I work withchildren, I'm so glad that it
was a lifespan, because whenyou're working with children,
(06:04):
you'm so glad that it was alifespan, because when you're
working with children, you'reworking with a whole family unit
, right.
So you have to be able tounderstand all of those dynamics
and if someone a parent isexperiencing mental health
concerns, you actually have to.
I might not be the one that'streating them, but you have to
be able to navigate it.
So, as I was going through allof that training and structuring
a program here that was goingto serve not just the AYAs but
(06:26):
all the pediatric and adolescentpatients treated at Stead
Family Children's Hospital onlevel 11, I started to
conceptualize what that reallymeant and I knew from the get-go
that the approach was proactiveand it actually wasn't going to
be medicine that was neededmost often.
But I knew that a major gap wasthat we didn't have anyone to
(06:49):
prescribe mental healthmedication.
So I knew that would that wouldbe something that I did.
But the predominant aspect ofthe nurse practitioner role in
what is now a formalized programis assessing all of the
components of the social,emotional and cognitive aspects
of cancer care and the key isactually to plug people in with
(07:12):
the resources they need, withthe large scale hope that if we
can avoid medicine, that wouldbe ideal.
But very early on in me makingthis transition I knew that even
if medicine was indicated, itwould always only be the bandaid
and the bandaid would be there.
But we needed to have the otheraspects psychotherapy, a huge
(07:35):
piece of this to make sure theylearned how to cope with the
reality of the situation theyfaced.
Sure they learned how to copewith the reality of the
situation they faced.
And you know my pathway inlearning psychotherapy was so
interesting because even beforeI was back in the PNHP program I
was taking courses on CBT,going to training sessions and
(07:58):
and learning the nuts and boltsof thinking.
How do I put this?
For example, how do I take CBT,where the goal is to reframe
thoughts that maybe aren't trueand say have somebody use that
when they're actually fearingthat their cancer might come
back, when we can't say thatthat's actually definitively not
(08:18):
a true thought?
So it was interesting to getdifferent experience and
expertise from different placesand as this program grew I
realized that when I thoughtmostly my job was going to be
assessment and medicine, whatmany of these individuals
actually needed was the briefintegration of therapy, because
(08:42):
so many people are scared at theidea of therapy.
So if I were to immediatelyrecommend let's get you
connected with a therapist thatcan help you cope with this, I
actually often got told no.
And when I gained skills andbecame more, you know, effective
with the actual skill sets Iwas using, not just using
(09:05):
something that came natural tome, I then was able to say,
after we had this great rapportbuilt and we had done therapy
that that this 16 yearold didn'treally recognize we were doing,
and then I suggest let's try toget you connected with somebody
that has the capacity to seeyou weekly, because I think this
(09:28):
would be helpful.
They will still say I don'tthink I need a therapist and I
can say let me ask you what itis you think we've been doing
and I educate them right.
And so it's been a coolevolution of how you integrate
this, how powerful it is and andhow this proactive approach
(09:48):
where you can briefly integratetherapy strategies and get
somebody to be more on boardwith really accepting those
pieces as really criticalcomponents of their care, has
been neat to see and it's reallyhelped structure things.
Speaker 2 (10:05):
Christy, I hear your passion just pouring out of you.
It's amazing, and you're right.
This is such a vulnerablepopulation and again, it's you
know it's.
It's like being a being a partof the club that no one ever
wants to be a member of, and sothis is, you know, a parent's
worst nightmare in a lot of ways.
And so, yes, being able to, tobe there in that moment as you
(10:26):
were talking, I just kind of waslike.
You know the person I hearright now, I would love to take
a time trip and go back to thatundergrad student and be like,
no, just take some morepsychology classes.
Speaker 4 (10:41):
You're going to love it.
It's going to be good, sothat's great, thank you.
Yeah, you bet.
I would love to hear more abouta time that you perform
psychotherapy.
That's memorable so maybe it'sthe first time, or maybe it's
just you know.
Stands out for some particularreason, a story that you might
want to share about performancepsychotherapy.
Speaker 3 (10:57):
Yeah, you know, I mean there are so many great
snippets that have, and again, alot of it goes back to the, to
the brief integration, where youknow individuals who are
proactively visiting with mebecause you know it's, it's a
part of your cancer care.
We have to just make sure thatthese cognitive pieces are, you
(11:17):
know, okay, you're not startingto struggle with learning or
focus attention.
So much of it is about the ideathat I can educate these
individuals about just some ofthe strategies that we've been
doing, not in a way that likeI'm trying to trick them and do
therapy and not know it, butjust you know they are engaging
(11:39):
with me and finding thingshelpful.
So so many of them are aresmall snippets in time where it
wasn't a 60 minute psychotherapysession, I think sometimes as
nurse practitioners we forgetthat.
Right you, 15 minutes of.
Of.
You know structuredpsychotherapy work can be so
impactful and and so I thinkthose things are so amazing.
(12:04):
But because I dabbled in somany different types of therapy
as I was trying to learn, one ofthe types of therapy that I
have found very impactful,especially in survivors of
pediatric cancer, is narrativetherapy, and there's actually an
adolescent adult journal thathas been made for survivors by a
(12:26):
nonprofit organization calledElephants of Tea, and this
journal actually has promptsthat are meant for narrative
therapy to be done eitherindependently by the person or
with a professional to guide you.
So I took a course on that andhave utilized it with only a few
individuals, because with mycapacity I often don't have the
(12:51):
ability to do really frequentsessions that are dedicated to
therapy.
And that's just with thestructure of our program.
But these are individuals thatthere was no other way in which
they were willing to open up,and most of them they have an
(13:11):
artistic flair and so just kindof getting to know the person
right, and saying, all right,what kind of thing is going to
be effective for you?
And the one individual that Ican think of that really has
been impactful is that this isnow a young woman who's in her
mid twenties, and when she shewas diagnosed, when she was a
(13:33):
senior in high school and sheliterally wanted nothing to do
with me when we first met and sowe meet people where they are
we kind of backed off.
The proactive approach isreally to plant seeds and
eventually she actually circledback herself and it did not
begin with therapy straight outof the gates.
(13:54):
It began with thisuncomfortable question of I know
, I know that my friends so andso and so and so have worked
with you, which I obviouslycan't acknowledge.
I just listen, right, and theysay it's really helpful because
you understand things aboutcancer care, and so then she had
to start to sort of open up.
But she still had this block,like I can't talk about cancer,
(14:17):
but I know that's what I'm hereto do.
And so we engaged her with theseprompts and the way that she
(14:38):
opened up, based on thesenarrative therapy prompts, which
then also resulted in thisbeautiful you know I had her go
out and purchase something thatwas going to become the forever
the theoretical let's process itand put it on the shelf, and
she could physically do that,and that was very helpful for
her.
And the journal is in a stylein which I really like.
They have holding on to promptsand letting go prompts, so it
(15:00):
allows people to see some of thebeauty that occurred, the
positives they gained throughoutthe experience, and the things
that we want to let go of, andit alternates them so that you
are not hammering in on the allof the things that were so
overwhelming.
You are actually finding thegratitude and finding the you
(15:25):
know, the silver linings withinwhat has thus far been the worst
experience of your life thatyou haven't even been able to
talk about.
So I've seen some reallybeautiful things unfold, and
that young woman in particularwill be one of those that you
never forget how it all happenedmy goodness, thank you for
sharing.
Speaker 2 (15:45):
I just could feel myself physically like
responding when you shared thatyeah, yeah, thank you, christy,
it's, uh, yeah, I mean it's,it's one of those things.
I mean it's, it's um, I wouldsay it's a privilege to be a
part of someone's journey, but Imean, you know, the delicate
time that you're dealing withthese people has just got to be
you know if it's something, andagain hear your passion coming
(16:06):
up through the screen or throughthe screen, through the,
through the audio.
It's definitely there.
But the next question I'd liketo ask it, cause you've kind of
you know we talked a little bitabout your different forms.
You had CBT and narrative,which is great, and I'm sure
you're kind of expanding on thattoo.
But what about nursing?
Kind of, how do you see nursingas as kind of you know, a
leader in doing psychotherapy oryou know even talk about within
(16:28):
your program that you do workwith?
I mean, do you see?
I mean, how do you see nursingbeing kind of just ideal as a
profession for that work?
Speaker 3 (16:36):
Yeah, absolutely.
You know, I think the vastmajority of nurses enter the
career because by nature of whowe are, we are people who care
right.
So oftentimes that component ispresent, which is something you
can't teach to people right.
And so I think nursing as afield because it is so often
(17:02):
that the person just has thosenatural elements of what it
takes to understand the socialcues, understand when it's time
to push and when it's time topull back, those things I think
are what makes psychotherapy sosuccessful, because if you don't
(17:24):
know how to ebb and flow those,then you may lose your client
pretty quickly.
So I think, just you know, thegeneral individuals that tend to
lean into the world of nursinghave some of those natural
qualities that make a reallygreat psychotherapist a really
(17:48):
great psychotherapist.
The other thing that I think andyou know my passion certainly
you know started off in theoncology world.
But what I've realized now and Iactually tell many of my
patients to date that if I ruledthe world I would have everyone
go to therapy at least onceevery two weeks, because we all
have something to process andtalk about and of course I'm
usually telling people who arestill on the stage or they're
(18:10):
rolling their eyes at the ideaof, you know, going to therapy.
But I think when you think aboutwhat I do in cancer, it is
really relevant to all chronicillness and the vulnerability
and fears that come with it, andI think that's true across the
(18:32):
entire lifespan.
But PEDS has always been mypassion, so my deeper goal is to
not only build what's happeningon oncology here but also
replicate it for additionalpediatric chronic illnesses,
because I think one of thethings that is very relevant
(18:54):
from a nursing perspective anddelivering therapy in chronic
illness is that we also speakthe language of you know.
We know what it is when you getstuck in the hospital for three
days and we know what isolationmeans and we know like we can
speak some of those like yourblood gases were down.
(19:17):
One is that I've tried that andI just need somebody who I
don't have to explain what I'vebeen through to just know they
understand.
And that's what happens hereand I think that is something
(19:39):
that nurses by and large canoffer individuals, especially in
the chronic illness domain.
Speaker 4 (19:48):
So then, thank you for sharing that.
On the other side, do you haveany concerns about PMH nurses
using psychotherapy?
Speaker 3 (20:00):
And if so, what would those concerns be?
You know, I'm not sure I haveany concerns other than the idea
that I know that programsacross the country are really,
you know, developing and makingsure they're getting the right
components in.
The only concern I would haveis that I think nurses have the
natural skill sets to do this,but they need to be able to know
how to do it in a structuredway.
(20:21):
You know you need the education, right?
So, like I said, I think I wasnaturally implementing some
things, but I didn't know theevidence behind it.
I didn't even know I was doingsome of the things, and so I
think we have to be able tolearn that and understand the
(20:41):
impact that it has for people,because sometimes I think I was
doing it and I didn't know theimpact it was going to have, and
it's possible that the impactwas negative, right.
And so I think that learningthe skills and making sure that
we have the correct training todo so would be the only concern.
(21:02):
But you know, I'm at theUniversity of Iowa and not only
have we come, you know, so farin the moment, I first met Dr
Wiesman, but now I'm facultyover at the College of Nursing
as well, teaching people aboutthe amazing world of being a
nurse practitioner, and what Isee is that, at least at Iowa,
that's being focused on verymuch is we have, you know, a PM,
(21:26):
and HP has the skill sets to dothis.
They have the training and wehave the ability to integrate it
into our practices, but we needto be sure that people aren't
integrating it into practicewithout the training behind it,
and so that would probably bethe only concern that really
comes to my mind.
Speaker 2 (21:43):
So I guess I'm going to Venmo you $20 for the plug.
I appreciate that.
Yeah, no, it's been fun to kindof keep getting to know you as
you move into kind of a facultyrole here too.
So again, appreciate all yourtime here.
Just kind of maybe finish upwith a question.
Pull out your crystal ball.
(22:04):
What do you see as the futureof using psychotherapy within
the role of the PMHNPs?
Maybe you know whatopportunities are there, what
barriers continue to be?
You know, what do you see fromyour vantage point and your
population that you serve?
Speaker 3 (22:18):
Yeah, oh man, the opportunities are so big, right.
If you rewind, 10 years ago, Ididn't know that nurses did
psychotherapy.
I didn't know that any of thiswas a thing.
I was finding gaps and doingthings over here medically, and
now it's like the future can beso bright.
(22:40):
Gosh, I don't know.
I mean, I think as long asprograms structure in the
appropriate training or giveindividuals guidance on how to
get additional training beyondschool so that they stay savvy
in their skills, I think whatyou will see is that right now
(23:05):
it seems to me I don't know ifyou remember this, dr Wiesman
when I was in school I was like,wait a minute.
Are you saying that I canactually, in the same visit,
acknowledge the service time Ihave spent on both assessment,
medication and therapy?
And I think that while maybePMHPs are coming out of programs
(23:25):
know that I'll tell you rightnow.
I had to teach the Department ofPediatrics what codes I needed.
I had to teach them that I aregoing to be able to teach the
(23:49):
psych mental health world that,while we still need all of us to
holistically care, we have beena missing link for a long time.
You hear me say that aroundhere a lot, because what I
learned as I was structuringthis program was a psychologist
has different ways that they'reable to provide services, you
(24:13):
know, submit things to insurancecompanies.
A licensed independent socialworker has different ways and a
nurse practitioner has differentways.
Chime in on all of our top tierskill sets right, using your
scope of practice to its max,and be able to create what then
becomes very sustainableprograms.
(24:35):
Because the number one thingthat the institution here was
concerned about, with me movinginto the mental health space,
was that there was no way wewould be able to sustain it.
We, you know it would besomething that we would be able
to sustain it.
We, you know it would besomething that we would have to
have grant funding, and thatactually has not been true at
all.
Speaker 2 (24:55):
That's great.
I mean again that thathighlights your again.
I think people just feel yourpassion.
But you have, you're driven,and so people pick up on that
too.
But I definitely have to goback.
You know, if, if, if anybodysays you know, the future is so
bright, they got to say I got towear shades, and so that
statement just has to be said.
Anybody listening with a birthdate, with a one nine in front,
(25:17):
you get it.
If not, then you probably needto go Google that.
But but yeah, no, I like howyou said this, chrissy.
I mean all the, all thedisciplines need to be
complementary here.
I mean there's plenty of workout there.
I mean Dr Sean Convoy, who'spart of this podcast times two,
that's what he's.
You know there's no need tokind of compete for the patients
.
I think that you know patient Ais going to maybe do well with
(25:40):
a psychologist, patient B isgoing to do well with a social
worker, patient C is probablygoing to do well with the PMHMP.
So it's our job to kind of, youknow, line those patients up to
find the right providers.
But we're all doing the samework.
We're all kind of on this funride.
But again, thank you very much,christy.
It's been a pleasure.
I wish we had more time.
Maybe we can come back for apart two, who knows?
(26:02):
But thank you so much again andthank you all for listening to
Pep Lau's Ghost.
Get ready for another episodecoming to you soon and feel free
to subscribe, like and comment.
We do listen to that and we dolike hearing from you.
So have a great day.
Thank you again, dr Foster, andtake care everybody else.
Speaker 1 (26:42):
Thank you.
Reframing your mind negativethoughts release these cognitive
distortions decrease until theycease.
Yeah, gotta discoveryIdentifying, challenging your
beliefs.
Reframing your mind negativethoughts release these cognitive
distortions decrease until theycease.
Yeah, just my take on things.
My answer to number twodecrease until they cease.
Stop that discovery.
Speaker 2 (00:13):
Welcome back everybody to another episode of
Pep Lau's Ghost.
So happy for you to be hereAgain, keep getting these
wonderful guests for the podcastand so very grateful that
(00:37):
they're able to volunteer theirtime and be here with us.
We are joined today by DrChristy Foster, who I'm super
excited to get to know and getto kind of.
You know it's one of thoseinteresting things for the
podcast is that Dr Fosteractually went through our
program I was her academicadvisor which you know feels
(00:57):
like yesterday probably doesn'tto Christy.
She's probably like, oh, thatwas a nightmare and the doctoral
work is just, it's anexperience of itself.
But we don't get this chance ofjust kind of talking and seeing
where your clinical expertisehas lied and the kind of cool
work you're doing.
So again, appreciate your timeand just kind of look forward to
(01:17):
this opportunity to get to knowa little bit more.
And again, as we like to do inPepalow's Ghosts is really
highlight the importance ofusing psychotherapy within the
PMHNP role.
So I'm going to get going rightat it and kind of ask you our
first question we like to askmost of our guests when did you
first start getting interestedin doing psychotherapy or where
does that interest kind of comefrom?
Speaker 3 (01:38):
Yeah, so you know.
First and foremost, thanks somuch for having me today.
It was an honor to be asked andI am always excited to share my
career trajectory and how Iended up here.
So the truth is, when I was inundergraduate nursing school, if
someone had told me I would endup as a psychiatric mental
health provider of any kind, Iactually would have adamantly
(02:00):
said that's not true.
It was actually something atthe time that I didn't think I'd
have the skill set for, and Ididn't.
You know the individuals I wasmeeting I was interested in, but
I felt like I wasn't sure youknow how I would know how to
help them really, and the drivebehind me being a nurse which I
(02:22):
think is true for so many nursesis we just want to help people,
and so I felt like that wasn'tclear to me, and it's been an
interesting evolution as to howit became clear to me that
mental health care was somethingthat was not only something
that I was capable of, but was atrue skill set of mine.
So I actually began my nursingcareer in a unit that had
(02:45):
multidisciplinary types ofservices.
Oncology was one of them, so Iwas very medical as a staff
nurse ultimately decided tobecome a pediatric nurse
practitioner.
So my first nurse practitionerbackground is pediatric primary
care, which also soundsinteresting because I was
working with oncology patients.
But at the time I reallythought that I would.
(03:12):
What I loved about oncology wasthe continuity and the
relationships with families andI thought I want to be able to
do that for a more expansivepopulation.
But then the more I steppedaway from oncology, the more I
realized that that was in factwhere I wanted to be.
So I honed in a lot of mytraining specifically from
oncology the more I realizedthat that was in fact where I
wanted to be.
So I honed in a lot of mytraining specifically with
oncology and ultimately thatfirst step as a nurse
practitioner was in pediatrics.
(03:33):
I've done oncology the entiretime as a pediatric nurse
practitioner and I was a medicalcare provider in the field for
many years I think it was abouteight before I made the
transition and so in those timesI was, you know, managing
chemotherapy and the medicalaspects of cancer care.
(03:54):
But you, you know, working withsomeone who is diagnosed with
cancer, and in my field,particularly in PEDS, these
people are allowing you to whatis probably the most, if not at
least one of the most vulnerablemoments of their entire lives.
And so while I was managingthese medical things, I also was
(04:16):
developing these really strongreports with people, and I think
, in reflection, even beforepsychotherapy training, I was
integrating some things that Ijust didn't even really know
were some natural componentsthat I just needed more skill
sets built on, and within thatthen I began to.
(04:38):
One of the things that is trueof me is that I constantly see
gaps in care, and when I seegaps in care, I feel like we got
to figure out how to makethings better, because the
patient is always the drive forme.
So I had this amazing privilegeof helping build several
programs, including thesurvivorship program, the
adolescent adult cancer program,things that were really being
(05:00):
structured to help improve thecare overall, and when we were
working with those adolescentand young adults about what do
you need in an AYA programwithout fail, it didn't matter
what topic we talked about.
They always brought it back topsychosocial aspects and mental
health care concerns, and thatwas the moment that they changed
(05:21):
my life right, and so my firstinteraction with Dr Weisman was
actually people at theUniversity of Iowa hospital
saying you should connect withthe following people.
I didn't know in the moment Iwas going to go back to become a
PM and HP, but that's where theroad drove me and I had
initially thought to myself well, this is so specific.
(05:43):
You know, caring for mentalhealth in cancer patients is so
specific.
You know, caring for mentalhealth in cancer patients is so
specific.
I don't know if I need theentire training.
And, as it turns out, you knowwhat my mentors at the time were
trying to tell me was you'reprobably going to need the whole
shebang.
They were right.
And even though I work withchildren, I'm so glad that it
was a lifespan, because whenyou're working with children,
(06:04):
you'm so glad that it was alifespan, because when you're
working with children, you'reworking with a whole family unit
, right.
So you have to be able tounderstand all of those dynamics
and if someone a parent isexperiencing mental health
concerns, you actually have to.
I might not be the one that'streating them, but you have to
be able to navigate it.
So, as I was going through allof that training and structuring
a program here that was goingto serve not just the AYAs but
(06:26):
all the pediatric and adolescentpatients treated at Stead
Family Children's Hospital onlevel 11, I started to
conceptualize what that reallymeant and I knew from the get-go
that the approach was proactiveand it actually wasn't going to
be medicine that was neededmost often.
But I knew that a major gap wasthat we didn't have anyone to
(06:49):
prescribe mental healthmedication.
So I knew that would that wouldbe something that I did.
But the predominant aspect ofthe nurse practitioner role in
what is now a formalized programis assessing all of the
components of the social,emotional and cognitive aspects
of cancer care and the key isactually to plug people in with
(07:12):
the resources they need, withthe large scale hope that if we
can avoid medicine, that wouldbe ideal.
But very early on in me makingthis transition I knew that even
if medicine was indicated, itwould always only be the bandaid
and the bandaid would be there.
But we needed to have the otheraspects psychotherapy, a huge
(07:35):
piece of this to make sure theylearned how to cope with the
reality of the situation theyfaced.
Sure they learned how to copewith the reality of the
situation they faced.
And you know my pathway inlearning psychotherapy was so
interesting because even beforeI was back in the PNHP program I
was taking courses on CBT,going to training sessions and
(07:58):
and learning the nuts and boltsof thinking.
How do I put this?
For example, how do I take CBT,where the goal is to reframe
thoughts that maybe aren't trueand say have somebody use that
when they're actually fearingthat their cancer might come
back, when we can't say thatthat's actually definitively not
(08:18):
a true thought?
So it was interesting to getdifferent experience and
expertise from different placesand as this program grew I
realized that when I thoughtmostly my job was going to be
assessment and medicine, whatmany of these individuals
actually needed was the briefintegration of therapy, because
(08:42):
so many people are scared at theidea of therapy.
So if I were to immediatelyrecommend let's get you
connected with a therapist thatcan help you cope with this, I
actually often got told no.
And when I gained skills andbecame more, you know, effective
with the actual skill sets Iwas using, not just using
(09:05):
something that came natural tome, I then was able to say,
after we had this great rapportbuilt and we had done therapy
that that this 16 yearold didn'treally recognize we were doing,
and then I suggest let's try toget you connected with somebody
that has the capacity to seeyou weekly, because I think this
(09:28):
would be helpful.
They will still say I don'tthink I need a therapist and I
can say let me ask you what itis you think we've been doing
and I educate them right.
And so it's been a coolevolution of how you integrate
this, how powerful it is and andhow this proactive approach
(09:48):
where you can briefly integratetherapy strategies and get
somebody to be more on boardwith really accepting those
pieces as really criticalcomponents of their care, has
been neat to see and it's reallyhelped structure things.
Speaker 2 (10:05):
Christy, I hear your passion just pouring out of you.
It's amazing, and you're right.
This is such a vulnerablepopulation and again, it's you
know it's.
It's like being a being a partof the club that no one ever
wants to be a member of, and sothis is, you know, a parent's
worst nightmare in a lot of ways.
And so, yes, being able to, tobe there in that moment as you
(10:26):
were talking, I just kind of waslike.
You know the person I hearright now, I would love to take
a time trip and go back to thatundergrad student and be like,
no, just take some morepsychology classes.
Speaker 4 (10:41):
You're going to love it.
It's going to be good, sothat's great, thank you.
Yeah, you bet.
I would love to hear more abouta time that you perform
psychotherapy.
That's memorable so maybe it'sthe first time, or maybe it's
just you know.
Stands out for some particularreason, a story that you might
want to share about performancepsychotherapy.
Speaker 3 (10:57):
Yeah, you know, I mean there are so many great
snippets that have, and again, alot of it goes back to the, to
the brief integration, where youknow individuals who are
proactively visiting with mebecause you know it's, it's a
part of your cancer care.
We have to just make sure thatthese cognitive pieces are, you
(11:17):
know, okay, you're not startingto struggle with learning or
focus attention.
So much of it is about the ideathat I can educate these
individuals about just some ofthe strategies that we've been
doing, not in a way that likeI'm trying to trick them and do
therapy and not know it, butjust you know they are engaging
(11:39):
with me and finding thingshelpful.
So so many of them are aresmall snippets in time where it
wasn't a 60 minute psychotherapysession, I think sometimes as
nurse practitioners we forgetthat.
Right you, 15 minutes of.
Of.
You know structuredpsychotherapy work can be so
impactful and and so I thinkthose things are so amazing.
(12:04):
But because I dabbled in somany different types of therapy
as I was trying to learn, one ofthe types of therapy that I
have found very impactful,especially in survivors of
pediatric cancer, is narrativetherapy, and there's actually an
adolescent adult journal thathas been made for survivors by a
(12:26):
nonprofit organization calledElephants of Tea, and this
journal actually has promptsthat are meant for narrative
therapy to be done eitherindependently by the person or
with a professional to guide you.
So I took a course on that andhave utilized it with only a few
individuals, because with mycapacity I often don't have the
(12:51):
ability to do really frequentsessions that are dedicated to
therapy.
And that's just with thestructure of our program.
But these are individuals thatthere was no other way in which
they were willing to open up,and most of them they have an
(13:11):
artistic flair and so just kindof getting to know the person
right, and saying, all right,what kind of thing is going to
be effective for you?
And the one individual that Ican think of that really has
been impactful is that this isnow a young woman who's in her
mid twenties, and when she shewas diagnosed, when she was a
(13:33):
senior in high school and sheliterally wanted nothing to do
with me when we first met and sowe meet people where they are
we kind of backed off.
The proactive approach isreally to plant seeds and
eventually she actually circledback herself and it did not
begin with therapy straight outof the gates.
(13:54):
It began with thisuncomfortable question of I know
, I know that my friends so andso and so and so have worked
with you, which I obviouslycan't acknowledge.
I just listen, right, and theysay it's really helpful because
you understand things aboutcancer care, and so then she had
to start to sort of open up.
But she still had this block,like I can't talk about cancer,
(14:17):
but I know that's what I'm hereto do.
And so we engaged her with theseprompts and the way that she
(14:38):
opened up, based on thesenarrative therapy prompts, which
then also resulted in thisbeautiful you know I had her go
out and purchase something thatwas going to become the forever
the theoretical let's process itand put it on the shelf, and
she could physically do that,and that was very helpful for
her.
And the journal is in a stylein which I really like.
They have holding on to promptsand letting go prompts, so it
(15:00):
allows people to see some of thebeauty that occurred, the
positives they gained throughoutthe experience, and the things
that we want to let go of, andit alternates them so that you
are not hammering in on the allof the things that were so
overwhelming.
You are actually finding thegratitude and finding the you
(15:25):
know, the silver linings withinwhat has thus far been the worst
experience of your life thatyou haven't even been able to
talk about.
So I've seen some reallybeautiful things unfold, and
that young woman in particularwill be one of those that you
never forget how it all happenedmy goodness, thank you for
sharing.
Speaker 2 (15:45):
I just could feel myself physically like
responding when you shared thatyeah, yeah, thank you, christy,
it's, uh, yeah, I mean it's,it's one of those things.
I mean it's, it's um, I wouldsay it's a privilege to be a
part of someone's journey, but Imean, you know, the delicate
time that you're dealing withthese people has just got to be
you know if it's something, andagain hear your passion coming
(16:06):
up through the screen or throughthe screen, through the,
through the audio.
It's definitely there.
But the next question I'd liketo ask it, cause you've kind of
you know we talked a little bitabout your different forms.
You had CBT and narrative,which is great, and I'm sure
you're kind of expanding on thattoo.
But what about nursing?
Kind of, how do you see nursingas as kind of you know, a
leader in doing psychotherapy oryou know even talk about within
(16:28):
your program that you do workwith?
I mean, do you see?
I mean, how do you see nursingbeing kind of just ideal as a
profession for that work?
Speaker 3 (16:36):
Yeah, absolutely.
You know, I think the vastmajority of nurses enter the
career because by nature of whowe are, we are people who care
right.
So oftentimes that component ispresent, which is something you
can't teach to people right.
And so I think nursing as afield because it is so often
(17:02):
that the person just has thosenatural elements of what it
takes to understand the socialcues, understand when it's time
to push and when it's time topull back, those things I think
are what makes psychotherapy sosuccessful, because if you don't
(17:24):
know how to ebb and flow those,then you may lose your client
pretty quickly.
So I think, just you know, thegeneral individuals that tend to
lean into the world of nursinghave some of those natural
qualities that make a reallygreat psychotherapist a really
(17:48):
great psychotherapist.
The other thing that I think andyou know my passion certainly
you know started off in theoncology world.
But what I've realized now and Iactually tell many of my
patients to date that if I ruledthe world I would have everyone
go to therapy at least onceevery two weeks, because we all
have something to process andtalk about and of course I'm
usually telling people who arestill on the stage or they're
(18:10):
rolling their eyes at the ideaof, you know, going to therapy.
But I think when you think aboutwhat I do in cancer, it is
really relevant to all chronicillness and the vulnerability
and fears that come with it, andI think that's true across the
(18:32):
entire lifespan.
But PEDS has always been mypassion, so my deeper goal is to
not only build what's happeningon oncology here but also
replicate it for additionalpediatric chronic illnesses,
because I think one of thethings that is very relevant
(18:54):
from a nursing perspective anddelivering therapy in chronic
illness is that we also speakthe language of you know.
We know what it is when you getstuck in the hospital for three
days and we know what isolationmeans and we know like we can
speak some of those like yourblood gases were down.
(19:17):
One is that I've tried that andI just need somebody who I
don't have to explain what I'vebeen through to just know they
understand.
And that's what happens hereand I think that is something
(19:39):
that nurses by and large canoffer individuals, especially in
the chronic illness domain.
Speaker 4 (19:48):
So then, thank you for sharing that.
On the other side, do you haveany concerns about PMH nurses
using psychotherapy?
Speaker 3 (20:00):
And if so, what would those concerns be?
You know, I'm not sure I haveany concerns other than the idea
that I know that programsacross the country are really,
you know, developing and makingsure they're getting the right
components in.
The only concern I would haveis that I think nurses have the
natural skill sets to do this,but they need to be able to know
how to do it in a structuredway.
(20:21):
You know you need the education, right?
So, like I said, I think I wasnaturally implementing some
things, but I didn't know theevidence behind it.
I didn't even know I was doingsome of the things, and so I
think we have to be able tolearn that and understand the
(20:41):
impact that it has for people,because sometimes I think I was
doing it and I didn't know theimpact it was going to have, and
it's possible that the impactwas negative, right.
And so I think that learningthe skills and making sure that
we have the correct training todo so would be the only concern.
(21:02):
But you know, I'm at theUniversity of Iowa and not only
have we come, you know, so farin the moment, I first met Dr
Wiesman, but now I'm facultyover at the College of Nursing
as well, teaching people aboutthe amazing world of being a
nurse practitioner, and what Isee is that, at least at Iowa,
that's being focused on verymuch is we have, you know, a PM,
(21:26):
and HP has the skill sets to dothis.
They have the training and wehave the ability to integrate it
into our practices, but we needto be sure that people aren't
integrating it into practicewithout the training behind it,
and so that would probably bethe only concern that really
comes to my mind.
Speaker 2 (21:43):
So I guess I'm going to Venmo you $20 for the plug.
I appreciate that.
Yeah, no, it's been fun to kindof keep getting to know you as
you move into kind of a facultyrole here too.
So again, appreciate all yourtime here.
Just kind of maybe finish upwith a question.
Pull out your crystal ball.
(22:04):
What do you see as the futureof using psychotherapy within
the role of the PMHNPs?
Maybe you know whatopportunities are there, what
barriers continue to be?
You know, what do you see fromyour vantage point and your
population that you serve?
Speaker 3 (22:18):
Yeah, oh man, the opportunities are so big, right.
If you rewind, 10 years ago, Ididn't know that nurses did
psychotherapy.
I didn't know that any of thiswas a thing.
I was finding gaps and doingthings over here medically, and
now it's like the future can beso bright.
(22:40):
Gosh, I don't know.
I mean, I think as long asprograms structure in the
appropriate training or giveindividuals guidance on how to
get additional training beyondschool so that they stay savvy
in their skills, I think whatyou will see is that right now
(23:05):
it seems to me I don't know ifyou remember this, dr Wiesman
when I was in school I was like,wait a minute.
Are you saying that I canactually, in the same visit,
acknowledge the service time Ihave spent on both assessment,
medication and therapy?
And I think that while maybePMHPs are coming out of programs
(23:25):
know that I'll tell you rightnow.
I had to teach the Department ofPediatrics what codes I needed.
I had to teach them that I aregoing to be able to teach the
(23:49):
psych mental health world that,while we still need all of us to
holistically care, we have beena missing link for a long time.
You hear me say that aroundhere a lot, because what I
learned as I was structuringthis program was a psychologist
has different ways that they'reable to provide services, you
(24:13):
know, submit things to insurancecompanies.
A licensed independent socialworker has different ways and a
nurse practitioner has differentways.
Chime in on all of our top tierskill sets right, using your
scope of practice to its max,and be able to create what then
becomes very sustainableprograms.
(24:35):
Because the number one thingthat the institution here was
concerned about, with me movinginto the mental health space,
was that there was no way wewould be able to sustain it.
We, you know it would besomething that we would be able
to sustain it.
We, you know it would besomething that we would have to
have grant funding, and thatactually has not been true at
all.
Speaker 2 (24:55):
That's great.
I mean again that thathighlights your again.
I think people just feel yourpassion.
But you have, you're driven,and so people pick up on that
too.
But I definitely have to goback.
You know, if, if, if anybodysays you know, the future is so
bright, they got to say I got towear shades, and so that
statement just has to be said.
Anybody listening with a birthdate, with a one nine in front,
(25:17):
you get it.
If not, then you probably needto go Google that.
But but yeah, no, I like howyou said this, chrissy.
I mean all the, all thedisciplines need to be
complementary here.
I mean there's plenty of workout there.
I mean Dr Sean Convoy, who'spart of this podcast times two,
that's what he's.
You know there's no need tokind of compete for the patients
.
I think that you know patient Ais going to maybe do well with
(25:40):
a psychologist, patient B isgoing to do well with a social
worker, patient C is probablygoing to do well with the PMHMP.
So it's our job to kind of, youknow, line those patients up to
find the right providers.
But we're all doing the samework.
We're all kind of on this funride.
But again, thank you very much,christy.
It's been a pleasure.
I wish we had more time.
Maybe we can come back for apart two, who knows?
(26:02):
But thank you so much again andthank you all for listening to
Pep Lau's Ghost.
Get ready for another episodecoming to you soon and feel free
to subscribe, like and comment.
We do listen to that and we dolike hearing from you.
So have a great day.
Thank you again, dr Foster, andtake care everybody else.
Speaker 1 (26:42):
Thank you.
Reframing your mind negativethoughts release these cognitive
distortions decrease until theycease.
Yeah, gotta discoveryIdentifying, challenging your
beliefs.
Reframing your mind negativethoughts release these cognitive
distortions decrease until theycease.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.