February 22, 2025 • 32 mins
This episode emphasizes the integration of psychotherapy within nursing as a vital component of holistic patient care. We explore personal experiences, barriers to practice, and the future potential for nurses in psychotherapy while underscoring the importance of therapeutic relationships.
• Importance of integrative nursing
• Personal journey into psychotherapy
• The need for a holistic approach in care
• Challenges faced in early therapy sessions
• Diverse therapeutic styles and their applications
• Barriers nurses encounter in psychotherapy
• The allure of prescribing medications
• Future directions for psychotherapy in nursing
• Emphasizing the therapeutic alliance for effective care
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 Discovery,identifying challenge in your
beliefs, framing your mind,negative thoughts release,
cognitive distortions decrease.
Speaker 2 (00:20):
Welcome to another episode of Peplow's Ghost.
I'm your quote-unquote host, drDan Wiesman, from Iowa.
I'm joined by my esteemedcolleague, dr Melissa
Chapman-Hayes, and I am reallyexcited the podcast is going
international, in my opinion.
So really excited to get totalk to Gisli, who is from the
(00:43):
University of Minnesota and alsois from Iceland.
Speaker 3 (00:49):
Yeah, that's where I live now.
Yeah, I'm a professor at theUniversity of Akureyri, which is
in the north of Iceland, so Ilive kind of on the 66th
latitude.
Speaker 2 (01:02):
Wonderful.
Speaker 3 (01:03):
That's where I am now .
Speaker 2 (01:05):
My wife is from Minnesota and so she always
reminds me and correct me if I'mwrong in thinking about this,
but Iceland is green andGreenland is more ice.
Is that a common acronym, or isthat a common stereotype or
bias, or am I way off on that?
Speaker 3 (01:20):
Yeah, I don't know.
Sure, I mean, it's a littlewarmer in Iceland, we have the
cold stream and we're a littlebit more to the south and we're
not as uh, proportionally not ascovered in ice.
So yeah, but it's still a roughplace.
It's uh, yeah, I've uh, youknow, as far as islands are
concerned, this is a, it's a.
(01:42):
It's a rough place to stay.
Really Wonderful.
Speaker 1 (01:47):
I don't know about that, so I lived here.
Speaker 3 (01:49):
I lived in Iceland for 10 years now.
I moved back in 2014.
But I still have adjunctfaculty positions at the
University of Minnesota andteach a course there at the
Center for Spirituality andHealing and things like that.
Speaker 2 (02:05):
Thank you, yes.
So yeah, I was seeing and I waskind ofity and Healing and
things like that.
Thank you, yes.
So yeah, I was seeing and I waskind of doing a little bit of
internet snooping on you andseeing kind of some of your work
and your history and I wasreally impressed with the work
you've done with integrativecare and integrative nursing and
the paper you wrote back in2015 kind of laying out, kind
kind of the principles ofintegrated nursing, which was
(02:25):
really impactful.
I really kind of loved kind ofthe wording and kind of just
really hit home for me.
It just really kind of seemedlike and again, I think you know
, for those listening, you knowit's obviously Pet Plows Ghost
is one of those podcasts that'smeant to highlight the use of
psychotherapy and you know,continue to utilize that in a
nursing role.
So I think that for me and I'mhappy to you know, kind of hear
(02:49):
your thoughts on that too youknow, integrative nursing using
holistic approaches, treating,you know, the person
individually and not kind oflumping people into those
medical models.
I think that this podcast iswarm and receptive to that.
So, again, very much appreciateyou joining us today, so I get
the.
We're kind of as we dotypically with our podcast.
(03:10):
We kind of go back and forthasking questions, so I would get
the first question us goingwhen did you first get
interested in doing or, you know, being involved with
psychotherapy?
Speaker 3 (03:22):
Well, I think back in maybe 2004, when I graduated
from the School of Nursing atthe University of Iceland and I
started working in psych.
I got interested in that andthat's why I pursued a graduate
degree at the University ofMinnesota back in 06.
And so I was interested indoing psychotherapy and
(03:45):
developing that role.
Then, as many of the listenersare going to be familiar with,
in advanced practice, especiallyin the US, you know you get the
prescription pad as well and itpays a little better to do that
.
So you have to fight for yourrole as a psychotherapist.
But it really has been from thevery start I've been interested
(04:11):
in the psychotherapy orpsychotherapist role.
Speaker 2 (04:15):
Yeah, thank you, kind of a follow-up.
Sorry, kind of jumping onMelissa's toes, but I guess one
of the questions came up just abit thinking about that response
.
I guess one of the questionscame up just a bit thinking
about that response Did theUniversity of Minnesota offer
kind of some educationalopportunities for you that the
University of Iceland did not?
Or why did you choose to cometo the United States to kind of
develop those skills?
Or were there not thatopportunities at the University
(04:37):
of Iceland?
Speaker 3 (04:39):
Well, I don't know if you guys know this, the US is
not best at everything.
I don't know if you guys knowthis, the US is not best at
everything, but the US is prettyadvanced when it comes to
advanced clinical nursing.
Other countries are gettingbetter Australia, netherlands,
(05:01):
uk, ireland but when it comes toadvanced practice mental health
nursing, back in 2005, when Iwas looking at this, the US had
the most exciting clinicaldegrees In Iceland.
It was really more theoreticalstuff, and so I didn't just want
to learn how to think, I alsowanted to learn how to do.
(05:21):
I also wanted to learn how todo, and so you know.
So that's why I came toMinnesota and decided to go to
the United States to get mygraduate degree, so I could get
an advanced practice degree, notjust a theoretical, you know
degree.
Speaker 2 (05:39):
Thank you.
Yeah, that's good.
I appreciate that and Iappreciate you calling us out
and I say right, we're not thebest at everything, so thank you
, but you are best.
Speaker 3 (05:49):
You're kind of the best at this though, so you know
that's pretty cool.
Speaker 2 (05:52):
We'll hang the hat.
Yeah, thank you.
Speaker 4 (05:56):
Speaking of practical , it would really be fascinating
to hear about a session thatreally taught you something so
it could be early on or reallyany point in your career, just
kind of looking for an exampleof a session that really stood
out to you and why.
Speaker 3 (06:11):
Well, there's a couple of things I mean.
One of the requirements towhich is cool at the University
of Minnesota is that,historically speaking and I
don't want to get into the wholeCNS versus NP versus DNP thing
we kind of wrote up I'm one ofthe co-editors of a book called
Advanced Practice Mental HealthNursing a European Perspective
(06:34):
for those interested in morekind of discussion on this.
But at the University ofMinnesota there's a long kind of
a long tradition of producingCNSs, until the consensus back
in 2015 where we all decidedwe're going to be NPs and so I
took that licensure back in 2015as well, but anyway.
(06:56):
So when I was starting out atthe University of Minnesota, we
were in a CNS program, althoughit had a lot of what we would
call now NP competencies.
I don't know if I lost like allthe audience now and Melissa is
like losing- Differentcertifications, I mean I do know
what they stand for?
I don't know.
Speaker 4 (07:16):
Yeah.
Speaker 3 (07:16):
The different competencies.
Speaker 4 (07:17):
Yeah.
Speaker 3 (07:18):
It's a whole thing, you know, anyway.
So one of the requirements wasto do psychotherapy, and so I
did that.
I started psychotherapy in 2006, and I've been doing
psychotherapy and clinicalsupervision as well since that
time.
So it's almost 20 years now andI've tried all kinds of
(07:39):
different approaches anddifferent things, different
approaches and different things.
But one of the things that stoodout is the first session I
attended is I really felt theneed to explain to everybody
else in the waiting room that Idid not have a diagnosable
mental illness and I was like,really, gisli, mr, non-bias,
(08:04):
non-preditous, you know, like,hey, good for you, like I just
want to.
You know, there was a part ofme who would stand up in the
waiting room and says I know,all you people are here, you
know, because you have a mentalillness.
I'm just here for school, youknow, and I just want you.
So that was a big revelationfor me, because I that this bias
is so deeply rooted in me thatI thought I was fine, you know.
(08:28):
So that was an early wake upcall for me, where I was like,
oh, really, hmm, and I have had,I've had many since that time.
One of the more interestingthings that happened to me is I
I've I did clinical supervisionwith a, with a great and and and
(08:49):
uh.
You know, as a psychiatrist Iworked with uh and he's a.
He was probably 72 or 74 orsomething when I started working
with him and uh, he was justgreat, coming from uh kind of
different, different andbackground, coming from the East
Coast and thinking about thingsa little bit differently.
And so once I was doingclinical supervision with him
(09:12):
and I asked I've been workingthere for a year.
It was a pretty hardcore kindof community mental health
center I was working in and Iasked you know his name is Jerry
Kroll.
So I said Dr Kroll, do youthink I worry too much about
things?
You know?
Am I too neurotic about youknow patients and all these
things?
And he said well, not, untilyou asked me that question.
Speaker 2 (09:37):
You fooled him until you asked the question.
I love it.
I know we give ourselves away,don't we?
Speaker 3 (09:44):
And I was like damn it, yeah, I love it.
Speaker 2 (09:48):
That's great.
Speaker 3 (09:51):
Yeah, I've had a few of those, but those are two
early ones that were kind ofinteresting.
Speaker 4 (09:56):
I appreciate the self-reflection in particular,
which that was powerful.
Speaker 2 (10:01):
Yeah.
Speaker 3 (10:02):
Yeah.
Speaker 2 (10:03):
Yeah, very good, you were hinting at this.
So this is a little bit more ofa kind of a technical question
we like to ask but what forms oftherapy or what types of
therapy are you kind of drawn to?
I mean, maybe kind of what didyou first fall in love with and
what are you kind of doing now,or how are you'd like to answer
that question?
Speaker 3 (10:20):
Well, my first of all , I am a very poor drinker of
Kool-Aid.
That is that's.
It's really not.
I just don't like to guzzleguzzle the stuff.
You know, it's really not.
I just don't like to guzzle thestuff.
So I don't really get these.
I don't get enamored bydifferent philosophies and
approaches where I feel likethis is going to work for
(10:41):
everything.
It's like nothing works foreverything except oxygen and
water.
It's like it just doesn't.
I've never been able to.
I often envy people who are ableto get really kind of dogmatic
about different psychotherapies.
It's like, what am I doingwrong?
Why can't I believe in this somuch?
(11:02):
So I'm really, you know, I justlike stuff that works for
people.
So I have training and mylatest kind of is EMDR, which is
, you know, evidence-based forPTSD, where I do a lot of part
working with parts as well as apart of that.
So I like that.
(11:24):
But I also like supportivepsychotherapy a lot.
I think it's undertaught, Ithink it's taken for granted.
I think the components thathelp us build up the therapeutic
alliance are often neglectedand we think they're going to
come for free.
If we learn a new, shinytherapy, the therapeutic
(11:44):
alliance is just going to comefor free somehow, that we're
just going to get it becausewe're doing a, a shiny, fancy
manualized therapy.
I don't believe in that.
I think we really need to workat supportive psychotherapy, get
training in that, and that'swhat we do in our program in
iceland.
We developed, where wedeveloped, a clinical training
program, you know, with, uh,with a lot of clinical hours,
(12:07):
which was one of the reasons Iwent to the states because there
was none in iceland.
But you, so I like supportivepsychotherapy too and I urge
people to look at that becauseit's so honest about just we're
going to work with what worksfor the therapeutic alliance.
Basically, we're going to dostuff that works for that and
then not going to do stuff thatdoesn't.
And a lot of the work we'redoing, especially with people
(12:29):
with significant impairment orsignificant symptoms or in a
crisis mode, we're doing a lotof supportive psychotherapy.
And why not be intentionalabout it and honest with
ourselves and other people?
What we're doing here, right?
Why do we always need to callit something else?
I mean, it has good evidence.
There's clinical manuals, youcan train it, you can teach it,
(12:50):
you know you can define it, canteach it, you know, you can
define it.
So, yeah, I like supportivepsychotherapy.
I like motivational interviewingas well.
I've had some training in thatand it just re-re-upped on my
training this last year and I Ifeel that fits really well with
uh, supportive, I like somethingcalled the, and people can
gluco that if they want to.
(13:10):
I like the y model ofpsychotherapy, of teaching
psychotherapy if you heard aboutthat uh, where the stem of the
y is really stuff likesupportive psychotherapy,
motivational interviewing,therapeutic alliance, and then
psychodynamic is on one thingand cpt is on the other branch
of the y and and that's.
(13:31):
You know, it's such a cool wayto kind of think about this.
And the most complex cycle.
Even I and I do some CPT, youknow, for depression and
generalized anxiety as well,nothing more specialized than
that, but I still use it quite abit.
And I've gotten training innarrative therapy too, which
(13:51):
came out of me.
I got training in narrativetherapy too, which came out of
me.
You know I'm a big white dudefrom Iceland and I just didn't
have tools to work with peoplecoming from different
backgrounds and I didn't havethe framework really to do it.
So I did a couple of years ofnarrative therapy training,
which you know that was back along time ago and it was, I
(14:12):
don't know, around 2010, 12,something like that.
That's really stuck with me too.
So different things, differentthings I've been interested in.
Of course, my PhD is aboutadapting mindfulness practices.
Or mindfulness-basedintervention for people with
traumatic brain injury andsubstance use disorders.
Or mindfulness-basedintervention for people with
(14:34):
traumatic brain injury andsubstance use disorders.
So mindfulness is always bigwith me too, although that can't
be a part of psychotherapies.
I was into mindfulness, likesome other people, probably
listening before.
It was cool.
Speaker 2 (14:50):
Before the psychologist realized it was
cool and wanted to own it.
It kind of clicked right.
Speaker 3 (14:54):
Yeah, there's a lot of clicky stuff with mindfulness
, yeah all of a sudden, likeit's a part of all kinds of
stuff and I'm like, well, I'veknown it, it works, for quite
some time, but thank you.
So, yeah, you know there'sdifferent things, but I really
have this really strangephilosophy about trying to use
the approach that works for thepatient, not just what I know
(15:25):
how to do or what I think isshiny today.
So trying to meet the patientwhere he's at and not just
saying, well, if you don't wantto do EMDR, but EMDR, buddy, you
know, go over there, and if myapproach doesn't work, there's
something wrong with you.
I think a big part of what we dowith psychotherapy sometimes
especially I think nurses have atendency to do this because of
the strange power differentialwe kind of work with.
(15:46):
But I think other professionswho do psychotherapy do it too.
Is we like to blame people ifour therapy doesn't work?
Who do psychotherapy do it too?
Is we like to blame people ifour therapy doesn't work, like,
oh, he wasn't ready fortreatment or, you know, like any
other explanation other than usor our method or approach
didn't work for that person?
Like we never like to kind of,because it's painful to do, and
(16:09):
so so I like to be kind of of,kind of open and and sometimes I
refer people out to do otherthings like especially specified
cpt I have a lot of respect for, and not a lot of people have
that training.
I mean, people that use cpt maynot have this specific like ocd
uh, cpt for ocd training or youknow whatever it is.
(16:31):
So you know, but so so I have afew different.
How can I say this?
I've had affairs but I've nevergotten married to one of these
things.
Do you know what I mean?
They're always kind of.
I don't.
Speaker 2 (16:45):
as I said, I'm a poor drinker of kool-aid that that
might be the title of thisepisode the poor drink drinker
of Kool-Aid.
I love it, that's.
That's a great analogy, thankyou.
Speaker 4 (16:56):
The question I was going to ask actually segs
really nicely from what you saidand I was on mute but laughing
when you talked about likepsychologists picking up
mindfulness because my trainingis in psychology, yeah.
But my question is so like why?
Speaker 3 (17:17):
in what ways is nursing a leader in providing
psychotherapy?
I don't know if there's, yeah,I don't know, or can they be?
Yeah, I don't know.
Yeah, I mean for me, I meanthere's no evidence that one
profession does psychotherapybetter than another profession.
I mean you can let me just sendme the articles if you've seen
(17:38):
them.
I haven't seen any data tosuggest that, as long as there's
adequate training, of course,and supervision involved and and
so I don't, I don't really, tobe honest with you I think it's
just good that we have differentphilosophical underpinnings of
people providing psychotherapy.
I think, uh, just everybodycoming from kind of a same
school of thought is not good.
I think if we only had nursepsychotherapists, that wouldn't
(18:00):
be good.
And I think having somebodycoming, you know, everybody
coming like that's kind of thecase in Iceland, where most
psychotherapy is done frompsychologists, which is great,
but it's very hard to dosomething else, get something
else than CPT, and I don't knowif you heard this, but there are
other things that work formental illness, you know, except
(18:20):
for CPT.
I mean, cpt works, I mean, andfor some things it works best,
but it doesn't work foreverybody all the time Because,
like I said earlier, nothingworks for everybody except
oxygen and water.
So I think I don't really seeit like that no-transcript.
(18:41):
What do you call it?
Like a Venn diagram, kind ofalmost like a thing where you
know psychotherapy is a sharedcompetency between some
different professions andproviding they have the right
kind of education and background, you know that quality is
assured.
I don't think one is going todo, I think it, and I probably
think it's going to be more.
When we look at data or if wewould look at data, I think it's
(19:03):
probably going to be more whenwe look at data or if we would
look at data.
I think it's probably going tobe more personal you know
difference than than profession.
You know what profession you'recoming from, but I think
diversity is important when itcomes to this.
So I I do think nursepsychotherapy is important, but
I don't think it's moreimportant than other kind of
psychotherapy.
Yeah, I'm sorry, yeah, I, andI'm sorry about I just don't
(19:26):
route for nursing like a sportsteam.
I don't Like I route for thepatients.
I mean I don't want to befacetious or pretentious here,
but it's really the sports teamI route for is the users or
service users or the patientswe're working with.
I don't really care so muchabout.
(19:46):
I mean I don't want us to doanything that's not.
You know, that doesn't benefitthem, you know, and I don't, I
don't, yeah.
Speaker 2 (19:55):
No, I appreciate it Does that make sense yeah.
It makes perfect sense and Ilove the diversity and the
embracing of, you know, multiplefield, multiple professions can
do psychotherapy.
I, I agree, I mean evenphysicians, you know they
they've done it as well.
Um, so it's not unique.
I I will kind of maybe givesome background on that question
.
It's just kind of you know,what sprung board a little bit
of this podcast is the idea thatyou know there is, you know,
(20:16):
some of us here in the UnitedStates, nurses, especially psych
, mental health nursepractitioners, who are concerned
about the loss of use ofpsychotherapy within nursing,
and so I think that's why weasked the question.
But I love your answer and lovethat you root for the patients.
So my next question kind ofspins off that a little bit Are
you concerned at all about psych, mental health and nurses using
(20:38):
psychotherapy or what are your?
Yeah, I mean you mentioned kindof you know everybody's got the
same, you know similarapproaches and things like that.
But is anything about nursingthat concerns you being a
psychotherapist or what are your?
Speaker 3 (20:52):
thoughts on that.
No, as long as we just have.
You know, we have the samedemands on nurses as we have on
other professions providingpsychotherapy, and I think it
benefits people, some people, tomeet somebody who has more kind
of a can I say like a medicalbackground or has some more
knowledge of physical stuff,medications and things like that
.
I think we have people withchronic illnesses, for example,
(21:14):
that benefit often from seeingsomebody that has some insight
and experience with that andother things, people that are on
more complex medications, sideeffects, etc.
Where I think aneuropsychotherapist would come
in handy sometimes and wouldprovide some deeper
understanding in some areas.
(21:35):
And then it's vice versa withother things.
So no, there's no concern.
I haven't seen any evidence toindicate cause for concern.
I haven't seen any evidence toindicate cause for concern.
It's more that the prescriptionpad is so alluring, it's so
(21:55):
tempting and I wrote about thisin one of the articles that I
did and you probably read that,one of the articles that I did
and you probably read that whereit's just so easy to get to
forget about other things.
You know, and we get paid moreto prescribe medications and
(22:16):
there is this feeling oflegitimacy, of course, because
we get some of the glow frommedicine on us as we do that as
well.
There's legitimacy, and a lotof nurses are looking for
legitimacy for very, very kindof legit reasons, uh, so.
So I think there's uh, there'sa little bit of a it's, it's
(22:38):
almost like a, you know it's so.
It's so tempting to reach forthat and it's such a powerful
tool.
So, you know, I think it wasvery helpful for me, because I
can't prescribe in Iceland.
I don't have prescriptiveprivilege this year, and so when
I moved back in 2014, I had tokind of reinvent myself a little
(22:59):
bit.
I had done, you know, narrativetherapy training and basic
training in some of theseinterventions.
I'd done narrative therapytraining and basic training in
some of these interventions, butI got advanced training in a
couple of different things afterI moved home and it was good
and I saw that I started tothink things a little
differently.
And you know, again, theproblem is it's not.
(23:21):
You know, I use medicationsquite a bit in my team and I
advise on it and, and so it'snothing against that, but we
know that when you have a hammer, everything starts to look like
a nail, you know.
And so that's why I think it'simportant for us I mean in our
training programs, both in ineurope and around the world and
in the us that we continue tohave psychotherapy as a core
(23:44):
competency and using somethinglike the y, that we continue to
have psychotherapy as a corecompetency and using something
like the Y model, where we teachpeople, you know, supportive
psychotherapy in the very leastand some basic principles of
some other things, and then theycan go out and get additional
training and certification, likeoften is done with these
evidence-based interventions.
Speaker 2 (24:03):
We did find one, found a concern, and I agree I
mean I totally agree that allureof, like you said, everything
looks like a nail when you got ahammer in your hand and the
hammer of a prescription pad isquite an alluring thing, as you
mentioned as well.
So, thank you, Appreciate thatperspective.
Speaker 4 (24:22):
Yeah, what do you see as the barriers for more pm
hnps using psychotherapy inpractice?
Speaker 3 (24:30):
reimbursement.
That's, of course, the mainthing, I think you know.
First of all, lack of trainingin some of these programs.
You know where people are kindof either don't have a
competency like that althoughthey should, of course but kind
of pay up Like there's a nod toit but it's not serious, and so
(24:51):
the students don't feel they'reready to do anything else except
for prescribe and do thosethings when they crisis
management, those things whenthey graduate.
So that's one barrier.
And the other barrier isreimbursement.
As we know, I had to kind offight for being able to do
(25:11):
psychotherapy and you have tokind of nudge things a little
bit and your clinic has to giveyou 30 minutes.
You get 30 minutes and then the30 minutes are kind of on the
house and so that's a big issuetoo.
So you don't have these hourappointments, you do 30 minutes.
(25:31):
You can get good at supportivepsychotherapy though through
that and you can use some basicinterventions.
But doing in-depthpsychotherapy with these
evidence-based models, it'sgoing to require some
differences.
And I talk about reimbursementbecause we, you know it's
sometimes it may seem expensiveto the institution to have us
(25:59):
prescribers providepsychotherapy, and the
psychiatrists or colleagues inpsychiatry feel the same way.
I know many of them.
They're pigeonholed into, youknow, out of psychotherapy, and
these are maybe most of thebrilliant and best educated
psychotherapists.
We have sometimes A lot ofclinical training, a lot of
(26:21):
in-depth stuff, clinicaltraining, a lot of in-depth
stuff.
And our mom, you know, and uhthe uh, the system doesn't allow
them to to practice their art,if you will so, and it happens
to nurses as well no, I thankyou again and again.
Speaker 2 (26:36):
I'm really appreciative that this kind of
international perspective, atleast from two different
countries, um, because that'sthe answer I would give as well,
um, for the united states, andonly having that experience.
So I'm assuming in Iceland issocialized medicine or do you
have private insurance and such?
Speaker 3 (26:50):
Yeah, it's socialized medicine.
It's less pressing for usbecause we don't prescribe, but
we still need so many nurses andso it's a little bit hard
sometimes to sell that role.
So we have to make sure that wegive them adequate training and
there's always a little.
(27:10):
Psychologists are kind of newin Iceland compared to other
countries, and so they'refighting for legitimacy and
standing and power as well, andsometimes we underestimate the
power of nursing.
I mean we're really like I don'twant to offend anybody, but
we're really like cockroachesthroughout the entire healthcare
system.
I mean we are everywhere and weoften, you know we have power.
(27:35):
So I think I have empathytowards professions that are not
as established in the system aswe are, because often when
there are cutbacks and thingsneed to change, they're the
first ones to go and oh, we'rejust going to keep the nurses
and the physicians.
So I mean I have empathytowards that, but I do think
(28:00):
it's important because sometimeswe're the only ones that are
there.
Sometimes, especially in ruralareas, especially when people
are dealing with all kinds ofcomplex chronic illnesses, and
there's a need for that kind ofholistic understanding of health
that we have that it'simportant to have some nurses
that know how to dopsychotherapy as well.
Speaker 2 (28:21):
Yeah, so again, appreciate your time.
I'm kind of running up on our alot of time here, so I've got
one more question to kind of getyou out the door.
So what do you see for thefuture of psychotherapy within
psych, mental health, nursing?
What's your crystal ball?
Tell you where, where are weheading or where are we growing?
Where do we need to kind ofprotect?
What are your thoughts on that?
Speaker 3 (28:42):
Well, the Royal College of Nursing defines kind
of four main pillars of theadvanced practice role and I
think with the advent of the DNPprograms we have in the US and
maybe that will become an entryinto advanced practice in a
couple of years, I don't know,in a few years at least, what we
have is the opportunity to makesure that the psychotherapy
competencies are held true inthese programs and with
(29:09):
three-year programs we shouldhave the time to do it.
So, you know, I think we needto fight for that, not fight,
you know, other people.
We need to fight ourselves, weneed to fight our programs.
We need to kind of fight forhaving that understanding,
because I think it matters tothe patients.
I think it matters that we havesome core competencies and
(29:31):
basic knowledge and maybeadvanced knowledge in some cases
.
I think it matters for careerdevelopment that we can pivot,
like I was able to pivot intopsychotherapy.
That's my main role today and Ido a lot of EMDR with people
and I do a lot of supportivepsychotherapy as well, some
basic CPT.
I use quite a bit ofmotivational interviewing, so
(29:52):
different evidence-basedpractices.
Narrative therapy is alwayskind of playing in the
background.
So you know, I think it'simportant all kinds of reasons
that we keep those competenciesin there and as well.
Supportive psychotherapy is themost complex of psychotherapies.
(30:15):
I mean we use that with thepeople that have most symptoms
and are the most complex to workwith.
Often, and although it's notnew and shiny and fancy and the
other kids don't envy us becauseof it it's still often the most
complex work I do and I know acouple of shiny things, but
(30:36):
still the supportivepsychotherapy bit is under.
It's often poo-pooed and lookeddown upon and I think it's a
very important competency tohave as well.
So I think that's the future iswe need to focus on the
therapeutic alliance and I thinkwe need to focus on teaching
(30:56):
people how to establish that,maintain that, and if they're
able to do that, it's easy forthem to add other competencies
on top of that and they'll begood psychotherapists in
whatever direction they chooseto steer themselves, and they're
also going to be betterprescribers and better crisis
management people and betterevaluators and better at
(31:17):
anything that has to do with thepatient.
Speaker 2 (31:21):
Yeah, thank you.
Thank you for your perspective.
This has been great.
Your perspective, this has beengreat.
Um, yeah, this has been.
I hope anyone out therelistening gets as much out of
this as I do.
So please like, subscribe.
Drop comments.
Um, happy to kind of sharethose information.
If there's a couple ofreferences that dr giesli
mentioned, I'm happy to kind ofshare those as well.
So, but, thank you so much forjoining us and, uh, look forward
(31:43):
to another episode coming yourway.
Speaker 1 (31:45):
Beliefs Core beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, just my take on things.
My answer number two Discovery,identifying challenge in your
beliefs, framing your mind,negative thoughts release,
cognitive distortions decrease.
Speaker 2 (00:20):
Welcome to another episode of Peplow's Ghost.
I'm your quote-unquote host, drDan Wiesman, from Iowa.
I'm joined by my esteemedcolleague, dr Melissa
Chapman-Hayes, and I am reallyexcited the podcast is going
international, in my opinion.
So really excited to get totalk to Gisli, who is from the
(00:43):
University of Minnesota and alsois from Iceland.
Speaker 3 (00:49):
Yeah, that's where I live now.
Yeah, I'm a professor at theUniversity of Akureyri, which is
in the north of Iceland, so Ilive kind of on the 66th
latitude.
Speaker 2 (01:02):
Wonderful.
Speaker 3 (01:03):
That's where I am now .
Speaker 2 (01:05):
My wife is from Minnesota and so she always
reminds me and correct me if I'mwrong in thinking about this,
but Iceland is green andGreenland is more ice.
Is that a common acronym, or isthat a common stereotype or
bias, or am I way off on that?
Speaker 3 (01:20):
Yeah, I don't know.
Sure, I mean, it's a littlewarmer in Iceland, we have the
cold stream and we're a littlebit more to the south and we're
not as uh, proportionally not ascovered in ice.
So yeah, but it's still a roughplace.
It's uh, yeah, I've uh, youknow, as far as islands are
concerned, this is a, it's a.
(01:42):
It's a rough place to stay.
Really Wonderful.
Speaker 1 (01:47):
I don't know about that, so I lived here.
Speaker 3 (01:49):
I lived in Iceland for 10 years now.
I moved back in 2014.
But I still have adjunctfaculty positions at the
University of Minnesota andteach a course there at the
Center for Spirituality andHealing and things like that.
Speaker 2 (02:05):
Thank you, yes.
So yeah, I was seeing and I waskind ofity and Healing and
things like that.
Thank you, yes.
So yeah, I was seeing and I waskind of doing a little bit of
internet snooping on you andseeing kind of some of your work
and your history and I wasreally impressed with the work
you've done with integrativecare and integrative nursing and
the paper you wrote back in2015 kind of laying out, kind
kind of the principles ofintegrated nursing, which was
(02:25):
really impactful.
I really kind of loved kind ofthe wording and kind of just
really hit home for me.
It just really kind of seemedlike and again, I think you know
, for those listening, you knowit's obviously Pet Plows Ghost
is one of those podcasts that'smeant to highlight the use of
psychotherapy and you know,continue to utilize that in a
nursing role.
So I think that for me and I'mhappy to you know, kind of hear
(02:49):
your thoughts on that too youknow, integrative nursing using
holistic approaches, treating,you know, the person
individually and not kind oflumping people into those
medical models.
I think that this podcast iswarm and receptive to that.
So, again, very much appreciateyou joining us today, so I get
the.
We're kind of as we dotypically with our podcast.
(03:10):
We kind of go back and forthasking questions, so I would get
the first question us goingwhen did you first get
interested in doing or, you know, being involved with
psychotherapy?
Speaker 3 (03:22):
Well, I think back in maybe 2004, when I graduated
from the School of Nursing atthe University of Iceland and I
started working in psych.
I got interested in that andthat's why I pursued a graduate
degree at the University ofMinnesota back in 06.
And so I was interested indoing psychotherapy and
(03:45):
developing that role.
Then, as many of the listenersare going to be familiar with,
in advanced practice, especiallyin the US, you know you get the
prescription pad as well and itpays a little better to do that
.
So you have to fight for yourrole as a psychotherapist.
But it really has been from thevery start I've been interested
(04:11):
in the psychotherapy orpsychotherapist role.
Speaker 2 (04:15):
Yeah, thank you, kind of a follow-up.
Sorry, kind of jumping onMelissa's toes, but I guess one
of the questions came up just abit thinking about that response
.
I guess one of the questionscame up just a bit thinking
about that response Did theUniversity of Minnesota offer
kind of some educationalopportunities for you that the
University of Iceland did not?
Or why did you choose to cometo the United States to kind of
develop those skills?
Or were there not thatopportunities at the University
(04:37):
of Iceland?
Speaker 3 (04:39):
Well, I don't know if you guys know this, the US is
not best at everything.
I don't know if you guys knowthis, the US is not best at
everything, but the US is prettyadvanced when it comes to
advanced clinical nursing.
Other countries are gettingbetter Australia, netherlands,
(05:01):
uk, ireland but when it comes toadvanced practice mental health
nursing, back in 2005, when Iwas looking at this, the US had
the most exciting clinicaldegrees In Iceland.
It was really more theoreticalstuff, and so I didn't just want
to learn how to think, I alsowanted to learn how to do.
(05:21):
I also wanted to learn how todo, and so you know.
So that's why I came toMinnesota and decided to go to
the United States to get mygraduate degree, so I could get
an advanced practice degree, notjust a theoretical, you know
degree.
Speaker 2 (05:39):
Thank you.
Yeah, that's good.
I appreciate that and Iappreciate you calling us out
and I say right, we're not thebest at everything, so thank you
, but you are best.
Speaker 3 (05:49):
You're kind of the best at this though, so you know
that's pretty cool.
Speaker 2 (05:52):
We'll hang the hat.
Yeah, thank you.
Speaker 4 (05:56):
Speaking of practical , it would really be fascinating
to hear about a session thatreally taught you something so
it could be early on or reallyany point in your career, just
kind of looking for an exampleof a session that really stood
out to you and why.
Speaker 3 (06:11):
Well, there's a couple of things I mean.
One of the requirements towhich is cool at the University
of Minnesota is that,historically speaking and I
don't want to get into the wholeCNS versus NP versus DNP thing
we kind of wrote up I'm one ofthe co-editors of a book called
Advanced Practice Mental HealthNursing a European Perspective
(06:34):
for those interested in morekind of discussion on this.
But at the University ofMinnesota there's a long kind of
a long tradition of producingCNSs, until the consensus back
in 2015 where we all decidedwe're going to be NPs and so I
took that licensure back in 2015as well, but anyway.
(06:56):
So when I was starting out atthe University of Minnesota, we
were in a CNS program, althoughit had a lot of what we would
call now NP competencies.
I don't know if I lost like allthe audience now and Melissa is
like losing- Differentcertifications, I mean I do know
what they stand for?
I don't know.
Speaker 4 (07:16):
Yeah.
Speaker 3 (07:16):
The different competencies.
Speaker 4 (07:17):
Yeah.
Speaker 3 (07:18):
It's a whole thing, you know, anyway.
So one of the requirements wasto do psychotherapy, and so I
did that.
I started psychotherapy in 2006, and I've been doing
psychotherapy and clinicalsupervision as well since that
time.
So it's almost 20 years now andI've tried all kinds of
(07:39):
different approaches anddifferent things, different
approaches and different things.
But one of the things that stoodout is the first session I
attended is I really felt theneed to explain to everybody
else in the waiting room that Idid not have a diagnosable
mental illness and I was like,really, gisli, mr, non-bias,
(08:04):
non-preditous, you know, like,hey, good for you, like I just
want to.
You know, there was a part ofme who would stand up in the
waiting room and says I know,all you people are here, you
know, because you have a mentalillness.
I'm just here for school, youknow, and I just want you.
So that was a big revelationfor me, because I that this bias
is so deeply rooted in me thatI thought I was fine, you know.
(08:28):
So that was an early wake upcall for me, where I was like,
oh, really, hmm, and I have had,I've had many since that time.
One of the more interestingthings that happened to me is I
I've I did clinical supervisionwith a, with a great and and and
(08:49):
uh.
You know, as a psychiatrist Iworked with uh and he's a.
He was probably 72 or 74 orsomething when I started working
with him and uh, he was justgreat, coming from uh kind of
different, different andbackground, coming from the East
Coast and thinking about thingsa little bit differently.
And so once I was doingclinical supervision with him
(09:12):
and I asked I've been workingthere for a year.
It was a pretty hardcore kindof community mental health
center I was working in and Iasked you know his name is Jerry
Kroll.
So I said Dr Kroll, do youthink I worry too much about
things?
You know?
Am I too neurotic about youknow patients and all these
things?
And he said well, not, untilyou asked me that question.
Speaker 2 (09:37):
You fooled him until you asked the question.
I love it.
I know we give ourselves away,don't we?
Speaker 3 (09:44):
And I was like damn it, yeah, I love it.
Speaker 2 (09:48):
That's great.
Speaker 3 (09:51):
Yeah, I've had a few of those, but those are two
early ones that were kind ofinteresting.
Speaker 4 (09:56):
I appreciate the self-reflection in particular,
which that was powerful.
Speaker 2 (10:01):
Yeah.
Speaker 3 (10:02):
Yeah.
Speaker 2 (10:03):
Yeah, very good, you were hinting at this.
So this is a little bit more ofa kind of a technical question
we like to ask but what forms oftherapy or what types of
therapy are you kind of drawn to?
I mean, maybe kind of what didyou first fall in love with and
what are you kind of doing now,or how are you'd like to answer
that question?
Speaker 3 (10:20):
Well, my first of all , I am a very poor drinker of
Kool-Aid.
That is that's.
It's really not.
I just don't like to guzzleguzzle the stuff.
You know, it's really not.
I just don't like to guzzle thestuff.
So I don't really get these.
I don't get enamored bydifferent philosophies and
approaches where I feel likethis is going to work for
(10:41):
everything.
It's like nothing works foreverything except oxygen and
water.
It's like it just doesn't.
I've never been able to.
I often envy people who are ableto get really kind of dogmatic
about different psychotherapies.
It's like, what am I doingwrong?
Why can't I believe in this somuch?
(11:02):
So I'm really, you know, I justlike stuff that works for
people.
So I have training and mylatest kind of is EMDR, which is
, you know, evidence-based forPTSD, where I do a lot of part
working with parts as well as apart of that.
So I like that.
(11:24):
But I also like supportivepsychotherapy a lot.
I think it's undertaught, Ithink it's taken for granted.
I think the components thathelp us build up the therapeutic
alliance are often neglectedand we think they're going to
come for free.
If we learn a new, shinytherapy, the therapeutic
(11:44):
alliance is just going to comefor free somehow, that we're
just going to get it becausewe're doing a, a shiny, fancy
manualized therapy.
I don't believe in that.
I think we really need to workat supportive psychotherapy, get
training in that, and that'swhat we do in our program in
iceland.
We developed, where wedeveloped, a clinical training
program, you know, with, uh,with a lot of clinical hours,
(12:07):
which was one of the reasons Iwent to the states because there
was none in iceland.
But you, so I like supportivepsychotherapy too and I urge
people to look at that becauseit's so honest about just we're
going to work with what worksfor the therapeutic alliance.
Basically, we're going to dostuff that works for that and
then not going to do stuff thatdoesn't.
And a lot of the work we'redoing, especially with people
(12:29):
with significant impairment orsignificant symptoms or in a
crisis mode, we're doing a lotof supportive psychotherapy.
And why not be intentionalabout it and honest with
ourselves and other people?
What we're doing here, right?
Why do we always need to callit something else?
I mean, it has good evidence.
There's clinical manuals, youcan train it, you can teach it,
(12:50):
you know you can define it, canteach it, you know, you can
define it.
So, yeah, I like supportivepsychotherapy.
I like motivational interviewingas well.
I've had some training in thatand it just re-re-upped on my
training this last year and I Ifeel that fits really well with
uh, supportive, I like somethingcalled the, and people can
gluco that if they want to.
(13:10):
I like the y model ofpsychotherapy, of teaching
psychotherapy if you heard aboutthat uh, where the stem of the
y is really stuff likesupportive psychotherapy,
motivational interviewing,therapeutic alliance, and then
psychodynamic is on one thingand cpt is on the other branch
of the y and and that's.
(13:31):
You know, it's such a cool wayto kind of think about this.
And the most complex cycle.
Even I and I do some CPT, youknow, for depression and
generalized anxiety as well,nothing more specialized than
that, but I still use it quite abit.
And I've gotten training innarrative therapy too, which
(13:51):
came out of me.
I got training in narrativetherapy too, which came out of
me.
You know I'm a big white dudefrom Iceland and I just didn't
have tools to work with peoplecoming from different
backgrounds and I didn't havethe framework really to do it.
So I did a couple of years ofnarrative therapy training,
which you know that was back along time ago and it was, I
(14:12):
don't know, around 2010, 12,something like that.
That's really stuck with me too.
So different things, differentthings I've been interested in.
Of course, my PhD is aboutadapting mindfulness practices.
Or mindfulness-basedintervention for people with
traumatic brain injury andsubstance use disorders.
Or mindfulness-basedintervention for people with
(14:34):
traumatic brain injury andsubstance use disorders.
So mindfulness is always bigwith me too, although that can't
be a part of psychotherapies.
I was into mindfulness, likesome other people, probably
listening before.
It was cool.
Speaker 2 (14:50):
Before the psychologist realized it was
cool and wanted to own it.
It kind of clicked right.
Speaker 3 (14:54):
Yeah, there's a lot of clicky stuff with mindfulness
, yeah all of a sudden, likeit's a part of all kinds of
stuff and I'm like, well, I'veknown it, it works, for quite
some time, but thank you.
So, yeah, you know there'sdifferent things, but I really
have this really strangephilosophy about trying to use
the approach that works for thepatient, not just what I know
(15:25):
how to do or what I think isshiny today.
So trying to meet the patientwhere he's at and not just
saying, well, if you don't wantto do EMDR, but EMDR, buddy, you
know, go over there, and if myapproach doesn't work, there's
something wrong with you.
I think a big part of what we dowith psychotherapy sometimes
especially I think nurses have atendency to do this because of
the strange power differentialwe kind of work with.
(15:46):
But I think other professionswho do psychotherapy do it too.
Is we like to blame people ifour therapy doesn't work?
Who do psychotherapy do it too?
Is we like to blame people ifour therapy doesn't work, like,
oh, he wasn't ready fortreatment or, you know, like any
other explanation other than usor our method or approach
didn't work for that person?
Like we never like to kind of,because it's painful to do, and
(16:09):
so so I like to be kind of of,kind of open and and sometimes I
refer people out to do otherthings like especially specified
cpt I have a lot of respect for, and not a lot of people have
that training.
I mean, people that use cpt maynot have this specific like ocd
uh, cpt for ocd training or youknow whatever it is.
(16:31):
So you know, but so so I have afew different.
How can I say this?
I've had affairs but I've nevergotten married to one of these
things.
Do you know what I mean?
They're always kind of.
I don't.
Speaker 2 (16:45):
as I said, I'm a poor drinker of kool-aid that that
might be the title of thisepisode the poor drink drinker
of Kool-Aid.
I love it, that's.
That's a great analogy, thankyou.
Speaker 4 (16:56):
The question I was going to ask actually segs
really nicely from what you saidand I was on mute but laughing
when you talked about likepsychologists picking up
mindfulness because my trainingis in psychology, yeah.
But my question is so like why?
Speaker 3 (17:17):
in what ways is nursing a leader in providing
psychotherapy?
I don't know if there's, yeah,I don't know, or can they be?
Yeah, I don't know.
Yeah, I mean for me, I meanthere's no evidence that one
profession does psychotherapybetter than another profession.
I mean you can let me just sendme the articles if you've seen
(17:38):
them.
I haven't seen any data tosuggest that, as long as there's
adequate training, of course,and supervision involved and and
so I don't, I don't really, tobe honest with you I think it's
just good that we have differentphilosophical underpinnings of
people providing psychotherapy.
I think, uh, just everybodycoming from kind of a same
school of thought is not good.
I think if we only had nursepsychotherapists, that wouldn't
(18:00):
be good.
And I think having somebodycoming, you know, everybody
coming like that's kind of thecase in Iceland, where most
psychotherapy is done frompsychologists, which is great,
but it's very hard to dosomething else, get something
else than CPT, and I don't knowif you heard this, but there are
other things that work formental illness, you know, except
(18:20):
for CPT.
I mean, cpt works, I mean, andfor some things it works best,
but it doesn't work foreverybody all the time Because,
like I said earlier, nothingworks for everybody except
oxygen and water.
So I think I don't really seeit like that no-transcript.
(18:41):
What do you call it?
Like a Venn diagram, kind ofalmost like a thing where you
know psychotherapy is a sharedcompetency between some
different professions andproviding they have the right
kind of education and background, you know that quality is
assured.
I don't think one is going todo, I think it, and I probably
think it's going to be more.
When we look at data or if wewould look at data, I think it's
(19:03):
probably going to be more whenwe look at data or if we would
look at data.
I think it's probably going tobe more personal you know
difference than than profession.
You know what profession you'recoming from, but I think
diversity is important when itcomes to this.
So I I do think nursepsychotherapy is important, but
I don't think it's moreimportant than other kind of
psychotherapy.
Yeah, I'm sorry, yeah, I, andI'm sorry about I just don't
(19:26):
route for nursing like a sportsteam.
I don't Like I route for thepatients.
I mean I don't want to befacetious or pretentious here,
but it's really the sports teamI route for is the users or
service users or the patientswe're working with.
I don't really care so muchabout.
(19:46):
I mean I don't want us to doanything that's not.
You know, that doesn't benefitthem, you know, and I don't, I
don't, yeah.
Speaker 2 (19:55):
No, I appreciate it Does that make sense yeah.
It makes perfect sense and Ilove the diversity and the
embracing of, you know, multiplefield, multiple professions can
do psychotherapy.
I, I agree, I mean evenphysicians, you know they
they've done it as well.
Um, so it's not unique.
I I will kind of maybe givesome background on that question
.
It's just kind of you know,what sprung board a little bit
of this podcast is the idea thatyou know there is, you know,
(20:16):
some of us here in the UnitedStates, nurses, especially psych
, mental health nursepractitioners, who are concerned
about the loss of use ofpsychotherapy within nursing,
and so I think that's why weasked the question.
But I love your answer and lovethat you root for the patients.
So my next question kind ofspins off that a little bit Are
you concerned at all about psych, mental health and nurses using
(20:38):
psychotherapy or what are your?
Yeah, I mean you mentioned kindof you know everybody's got the
same, you know similarapproaches and things like that.
But is anything about nursingthat concerns you being a
psychotherapist or what are your?
Speaker 3 (20:52):
thoughts on that.
No, as long as we just have.
You know, we have the samedemands on nurses as we have on
other professions providingpsychotherapy, and I think it
benefits people, some people, tomeet somebody who has more kind
of a can I say like a medicalbackground or has some more
knowledge of physical stuff,medications and things like that
.
I think we have people withchronic illnesses, for example,
(21:14):
that benefit often from seeingsomebody that has some insight
and experience with that andother things, people that are on
more complex medications, sideeffects, etc.
Where I think aneuropsychotherapist would come
in handy sometimes and wouldprovide some deeper
understanding in some areas.
(21:35):
And then it's vice versa withother things.
So no, there's no concern.
I haven't seen any evidence toindicate cause for concern.
I haven't seen any evidence toindicate cause for concern.
It's more that the prescriptionpad is so alluring, it's so
(21:55):
tempting and I wrote about thisin one of the articles that I
did and you probably read that,one of the articles that I did
and you probably read that whereit's just so easy to get to
forget about other things.
You know, and we get paid moreto prescribe medications and
(22:16):
there is this feeling oflegitimacy, of course, because
we get some of the glow frommedicine on us as we do that as
well.
There's legitimacy, and a lotof nurses are looking for
legitimacy for very, very kindof legit reasons, uh, so.
So I think there's uh, there'sa little bit of a it's, it's
(22:38):
almost like a, you know it's so.
It's so tempting to reach forthat and it's such a powerful
tool.
So, you know, I think it wasvery helpful for me, because I
can't prescribe in Iceland.
I don't have prescriptiveprivilege this year, and so when
I moved back in 2014, I had tokind of reinvent myself a little
(22:59):
bit.
I had done, you know, narrativetherapy training and basic
training in some of theseinterventions.
I'd done narrative therapytraining and basic training in
some of these interventions, butI got advanced training in a
couple of different things afterI moved home and it was good
and I saw that I started tothink things a little
differently.
And you know, again, theproblem is it's not.
(23:21):
You know, I use medicationsquite a bit in my team and I
advise on it and, and so it'snothing against that, but we
know that when you have a hammer, everything starts to look like
a nail, you know.
And so that's why I think it'simportant for us I mean in our
training programs, both in ineurope and around the world and
in the us that we continue tohave psychotherapy as a core
(23:44):
competency and using somethinglike the y, that we continue to
have psychotherapy as a corecompetency and using something
like the Y model, where we teachpeople, you know, supportive
psychotherapy in the very leastand some basic principles of
some other things, and then theycan go out and get additional
training and certification, likeoften is done with these
evidence-based interventions.
Speaker 2 (24:03):
We did find one, found a concern, and I agree I
mean I totally agree that allureof, like you said, everything
looks like a nail when you got ahammer in your hand and the
hammer of a prescription pad isquite an alluring thing, as you
mentioned as well.
So, thank you, Appreciate thatperspective.
Speaker 4 (24:22):
Yeah, what do you see as the barriers for more pm
hnps using psychotherapy inpractice?
Speaker 3 (24:30):
reimbursement.
That's, of course, the mainthing, I think you know.
First of all, lack of trainingin some of these programs.
You know where people are kindof either don't have a
competency like that althoughthey should, of course but kind
of pay up Like there's a nod toit but it's not serious, and so
(24:51):
the students don't feel they'reready to do anything else except
for prescribe and do thosethings when they crisis
management, those things whenthey graduate.
So that's one barrier.
And the other barrier isreimbursement.
As we know, I had to kind offight for being able to do
(25:11):
psychotherapy and you have tokind of nudge things a little
bit and your clinic has to giveyou 30 minutes.
You get 30 minutes and then the30 minutes are kind of on the
house and so that's a big issuetoo.
So you don't have these hourappointments, you do 30 minutes.
(25:31):
You can get good at supportivepsychotherapy though through
that and you can use some basicinterventions.
But doing in-depthpsychotherapy with these
evidence-based models, it'sgoing to require some
differences.
And I talk about reimbursementbecause we, you know it's
sometimes it may seem expensiveto the institution to have us
(25:59):
prescribers providepsychotherapy, and the
psychiatrists or colleagues inpsychiatry feel the same way.
I know many of them.
They're pigeonholed into, youknow, out of psychotherapy, and
these are maybe most of thebrilliant and best educated
psychotherapists.
We have sometimes A lot ofclinical training, a lot of
(26:21):
in-depth stuff, clinicaltraining, a lot of in-depth
stuff.
And our mom, you know, and uhthe uh, the system doesn't allow
them to to practice their art,if you will so, and it happens
to nurses as well no, I thankyou again and again.
Speaker 2 (26:36):
I'm really appreciative that this kind of
international perspective, atleast from two different
countries, um, because that'sthe answer I would give as well,
um, for the united states, andonly having that experience.
So I'm assuming in Iceland issocialized medicine or do you
have private insurance and such?
Speaker 3 (26:50):
Yeah, it's socialized medicine.
It's less pressing for usbecause we don't prescribe, but
we still need so many nurses andso it's a little bit hard
sometimes to sell that role.
So we have to make sure that wegive them adequate training and
there's always a little.
(27:10):
Psychologists are kind of newin Iceland compared to other
countries, and so they'refighting for legitimacy and
standing and power as well, andsometimes we underestimate the
power of nursing.
I mean we're really like I don'twant to offend anybody, but
we're really like cockroachesthroughout the entire healthcare
system.
I mean we are everywhere and weoften, you know we have power.
(27:35):
So I think I have empathytowards professions that are not
as established in the system aswe are, because often when
there are cutbacks and thingsneed to change, they're the
first ones to go and oh, we'rejust going to keep the nurses
and the physicians.
So I mean I have empathytowards that, but I do think
(28:00):
it's important because sometimeswe're the only ones that are
there.
Sometimes, especially in ruralareas, especially when people
are dealing with all kinds ofcomplex chronic illnesses, and
there's a need for that kind ofholistic understanding of health
that we have that it'simportant to have some nurses
that know how to dopsychotherapy as well.
Speaker 2 (28:21):
Yeah, so again, appreciate your time.
I'm kind of running up on our alot of time here, so I've got
one more question to kind of getyou out the door.
So what do you see for thefuture of psychotherapy within
psych, mental health, nursing?
What's your crystal ball?
Tell you where, where are weheading or where are we growing?
Where do we need to kind ofprotect?
What are your thoughts on that?
Speaker 3 (28:42):
Well, the Royal College of Nursing defines kind
of four main pillars of theadvanced practice role and I
think with the advent of the DNPprograms we have in the US and
maybe that will become an entryinto advanced practice in a
couple of years, I don't know,in a few years at least, what we
have is the opportunity to makesure that the psychotherapy
competencies are held true inthese programs and with
(29:09):
three-year programs we shouldhave the time to do it.
So, you know, I think we needto fight for that, not fight,
you know, other people.
We need to fight ourselves, weneed to fight our programs.
We need to kind of fight forhaving that understanding,
because I think it matters tothe patients.
I think it matters that we havesome core competencies and
(29:31):
basic knowledge and maybeadvanced knowledge in some cases
.
I think it matters for careerdevelopment that we can pivot,
like I was able to pivot intopsychotherapy.
That's my main role today and Ido a lot of EMDR with people
and I do a lot of supportivepsychotherapy as well, some
basic CPT.
I use quite a bit ofmotivational interviewing, so
(29:52):
different evidence-basedpractices.
Narrative therapy is alwayskind of playing in the
background.
So you know, I think it'simportant all kinds of reasons
that we keep those competenciesin there and as well.
Supportive psychotherapy is themost complex of psychotherapies.
(30:15):
I mean we use that with thepeople that have most symptoms
and are the most complex to workwith.
Often, and although it's notnew and shiny and fancy and the
other kids don't envy us becauseof it it's still often the most
complex work I do and I know acouple of shiny things, but
(30:36):
still the supportivepsychotherapy bit is under.
It's often poo-pooed and lookeddown upon and I think it's a
very important competency tohave as well.
So I think that's the future iswe need to focus on the
therapeutic alliance and I thinkwe need to focus on teaching
(30:56):
people how to establish that,maintain that, and if they're
able to do that, it's easy forthem to add other competencies
on top of that and they'll begood psychotherapists in
whatever direction they chooseto steer themselves, and they're
also going to be betterprescribers and better crisis
management people and betterevaluators and better at
(31:17):
anything that has to do with thepatient.
Speaker 2 (31:21):
Yeah, thank you.
Thank you for your perspective.
This has been great.
Your perspective, this has beengreat.
Um, yeah, this has been.
I hope anyone out therelistening gets as much out of
this as I do.
So please like, subscribe.
Drop comments.
Um, happy to kind of sharethose information.
If there's a couple ofreferences that dr giesli
mentioned, I'm happy to kind ofshare those as well.
So, but, thank you so much forjoining us and, uh, look forward
(31:43):
to another episode coming yourway.
Speaker 1 (31:45):
Beliefs Core beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
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