March 8, 2025 • 27 mins
Macelli Pascal Rodriguez--Owner and provider at Transformations
https://ruma.transformationhealthservices.com/team/
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 welcomeback everyone.
Speaker 2 (00:18):
Um, here we are another episode of peplau's
ghosts.
Thank you so much for joiningand listening.
Um, I think we're actually upto number 16 episode.
So we've been rocking androlling.
This is good.
Hopefully it's just a beginningas well.
But I am joined with my esteemedcolleagues Dr Sean Convoy from
Duke, soon to be Dr Kate Molinofrom University of California,
(00:42):
san Francisco, and Dr MelissaChapman up in Minnesota.
I'm really thrilled to have ourguest here.
I can't say enough thank you tohim for giving us the
foundation for this podcast, theintro music and outro music
that you've all listened to, asyou've listened to Pep Lau's
Ghost yeah, it's here and thisis the person who created that.
(01:04):
This is the brilliant mind thatit came from, and so really
excited to welcome MarcelliPascal Rodriguez to our podcast
here and really excited to havehim talk about his own business,
(01:28):
transformations, which is anaesthetic and wellness spa, and
so let's kind of get right intoit and just kind of get talking
to Marcelli.
So, marcelli, my first questionout of the gate what got you
interested in doingpsychotherapy and maybe kind of
expand it, just kind ofnon-pharmacological type of
stuff for people with mentalhealth problems.
Speaker 3 (01:50):
Yeah, hey, everyone, I'm so happy to be here.
Thanks for having me.
But as far as like getting intolike psychotherapy, I kind of
chose the mental health field, Iwould probably say medical
field.
At four years old, I had a youknow, a sick grandmother.
I said I would, you know, takecare of her.
As time went on, she passedprior to, of course, me
finishing school, but in highschool, I would say that's where
(02:10):
it really stuck out.
You know, I saw a lot ofsubstance abuse.
You know I saw a lot of likejust issues with self-worth,
self-esteem.
You know, it was just a lotgoing on in high school that I
can remember and I was like, youknow, maybe I could help people
out just by finding what theroot of the problem is, you know
(02:32):
, kind of from there, and then Iwent to school, I kept going to
school and then I met Dr Convoy, who really lit a fire under me
to keep going when it came topsychiatry.
Speaker 2 (02:45):
So what kind of propellant did he use to light
that fire?
I mean, I just I'm sorry, goingwith that metaphor a little bit
, maybe All right.
So what was it that tried to?
He did that, you know, becauseobviously the fire was probably
there, right, he just kind ofstoked it a little bit.
Speaker 3 (02:58):
He just kind of stoked a little bit.
Yeah, so I think you know oneof the things that I find in
psychiatry is a lot of what wego through is stemmed in trauma,
whether it's like perceived orsomething that you actually
experienced.
(03:18):
So you know, coming from abackground that you know, I've
had some trauma, like we allhave, and Dr Convoy kind of
what's the word he kind ofvalidated things without even
knowing that's what he was doing, Right.
So it was one of the thingslike for me, I grew up kind of
like a perfectionist because Iwas raised to be such, and Dr
Convoy made it where it was okayto not be a perfectionist and
(03:39):
to understand that whatever youhave to offer is what the world
needs, you know.
So, yeah, I would say himDefinitely.
Speaker 4 (03:49):
Well, it's really hard to mobilize a question
after that comment.
Thank you, sir, I'm going to.
I want to take you kind ofafter school and you're now in
clinical practice and you'redoing it right and you're doing
it well.
I want you to think was therean experience you had with a
patient or a family that kind ofmade you realize that, wow,
(04:09):
spending more time than just 15minutes with a patient adjusting
meds does something special?
And if so, can you de-identifyand tell us that story?
Speaker 3 (04:21):
So my practice, we don't even do 15 minute med
checks.
They're not even allowed, um,to be honest with you, and part
of that is because it's just notenough time.
You know, and a lot of times ittakes time for someone to even
truly verbalize what they'regoing through and how they're
feeling, and if they feel likethey're in a time crunch,
they'll never get the truth.
So we have all our, all of ourmed checks are based on a 30
(04:46):
minute increment and we even gofurther, like longer, if we have
to.
So we get everyone to fill out,like the PHQ-9s, the GAD-7s, we
do the mood disorderquestionnaires and we kind of
like really tap into the person.
So when I say that, you know, wepay attention to how they
walked in, what was theirinteraction, you know when they
(05:08):
sit down, like you know theirclothing, you know how's their
hair, you know their makeup,that type of thing, eye contact,
are they looking at us?
When you know we're talking tothem, we catch up on hey, you
know how was your weekend or howwas your week, how's work your
children?
You know, before we even getinto meds, we're having a whole
conversation about just them asa person.
(05:30):
You know, and also, like I tellmy staff that we can't look at
people like they're a number.
You know I want them to get toknow, even when they come in to
be checked into the practice.
You know I want you to greetthem by their name, their
preferred name, if you know thatin that case and you know,
check in with them like how arethings going?
(05:55):
It starts there, you know.
So I know I went on a littlebit of a tangent with that, but
I'm very passionate about, youknow, taking the time that's
needed with people, because amed check is just not enough.
Speaker 2 (06:05):
Have you ever had an experience with the 15?
I'm guessing probably throughclinicals and other experiences,
you've had the 15 and like whendid you feel like that wasn't
going to work for you?
Speaker 3 (06:14):
I hated it.
To be honest with you Insurancecompanies they tell us oh, you
have this amount of time getthem in and out.
But I don't look at people aslike financial gain.
You know, it's really abouthelping people.
So if I have to take more time,then that's just what I do.
But the 15 minute med check alot of people I could tell when
they were leaving.
It was like they would sendmessages like oh, I forgot to
(06:38):
say, or hey, I didn't get achance, can we still change the
medication?
You know, a lot of times whenyou do 15 minute med checks
they're like oh, everything'sgood.
Yeah, same med, just samepharmacy, thanks.
And they leave.
Speaker 5 (06:50):
You know, yeah yeah, you know, um marshall, before we
started taping, when we werejust chatting, you had mentioned
that you know you obviously domedication management in your
practice, but you usepsychotherapy techniques as well
and you kind of modulate it tothe particular client based on
what you assess that they need.
(07:10):
I'm wondering if you could givesome examples of how you decide
to do that and what types oftechniques you use.
Speaker 3 (07:18):
Yeah, so I was just saying before we started.
Actually I don't really stickto a modality.
I know there's like CBT and allthose different things you can
use.
I really just let you knowwhatever the conversation is,
kind of guide the path and wherewe're going.
So a lot of times if it's, youknow, negative thoughts or like
intrusive thoughts someone ishaving, I try to find what the
root cause of that is, you know.
(07:39):
So what I'm finding in mypractice is, like I was saying
earlier, a lot of things arejust rooted in trauma, you know
so, feelings of not being goodenough or not belonging, or
perfectionism or, you know, justinadequacy.
All that stuff really stemsfrom when we were growing up,
you know.
So I just had a client the otherday who has like a a sexual
(08:02):
addiction, right, so we weretalking about that.
He was like, you know day whohas like a sexual addiction
Right, so we were talking aboutthat.
He was like you know, my wifesays is an addiction.
So I was, I was trying tofigure out.
I was like, ok, so define to mewhat exactly is happening that
you?
You know that you're linking itwith an actual addiction.
So he was talking about some ofthe things.
And so I said to him at whatpoint, like how is your
(08:23):
relationship with your mom?
You some of the things?
And so I said to him at whatpoint, like how is your
relationship with your mom, youknow?
And he told me we didn't have areally good relationship, you
know.
I'm like, okay, well, whatabout?
What about your father?
He was like there was a lot ofabuse in the home, you know.
And so then it went from okay.
So growing up, were you like oneof the popular kids?
Did you play sports or were youkind of a loner?
And he said I was really aloner, I wasn't one of the
(08:45):
popular kids.
And he said, you know, I canthink back when I was a kid and
I would, you know, do these actsgrowing up because I wanted to
be cool.
And now he's 35 years old, he'sstill doing the same thing that
he's been doing since he was 15or 16.
And so he said to me he said Inever thought about, like any of
this stuff or how it could belinked to you know, what's
(09:07):
happening in my relationship,you know, especially the
relationship with my mom, thehistory of what I was doing
prior.
And he was like I really needto go to therapy and I was like
you do, you know.
So it's one of those thingswhere I referred him to someone
that can really like betterassist in that arena.
But I spent a lot of time likejust talking to people trying to
(09:27):
figure out what's going on withthem before I, you know, send
them to someone who's morespecialized to help.
Speaker 5 (09:34):
I love that example, you know.
It's just such a good exampleof how you know, using these
sort of engagement strategies isreally just holding up a mirror
to patients, right Like youstay curious and you present the
opportunity for them to reflectand figure things out.
That's great.
Speaker 3 (09:49):
Yeah, definitely, because I mean, it really is
just about guiding, you know,the individual through whatever
they're going through andthere's no judgment, you know.
So I always tell people like,regardless to whatever you
experienced, I want to knowbecause that's the only way I
can really help.
Speaker 6 (10:05):
Yeah, yeah, so I'd love to hear your thoughts on
nursing, being a leader andperforming psychotherapy.
What are the yeah, what are theaspects to consider there?
Speaker 3 (10:21):
so I think nursing I think there's nothing better
than a nurse to be honest withyou, no shot to any physicians
or anything.
But I think when it comes tolike just being bedside and more
hands on, that's something thatyou know, we've just been
trained to do.
So I think it makes us morerelatable and I feel like people
(10:43):
trust us more, you know.
So I think like nurses at theforefront of psychotherapy is
something that the worlddefinitely needs and we need to
probably spend more time doingthat training, even in these
courses that we're taking.
You know, I wish VCU had moreof a psychotherapy perspective
when I was going I mean, drConvoy definitely played a part
(11:05):
in that but maybe even like acourse where that's all we learn
, you know.
Thank you, marcel.
Speaker 2 (11:11):
I mean where that's all we learn, you know.
Thank you, marcel.
I mean it's a great questionand I appreciate Melissa
bringing it up because I mean Ican see you know all the
potential that you have, justkind of listening to you for
your first time, and you couldhave been a psychologist, you
could have been a physician, butsomething chose you to say
nursing fits me best, you know,fits my worldview, and even
(11:33):
going all the way back to youknow, helping your grandma when
you know four years old andthings.
So do you have any concernabout psych, mental health
nurses doing psychotherapy or isthere any anything that kind of
you know you mentioned, kind ofyou know you need more of this,
but does any concern come upwhen you think about that as far
as nurses doing therapy?
Speaker 3 (11:51):
I don't think so.
I think it would be a greatthing, you know, to be honest
with you.
I mean, I don't take away fromany other specialty.
So you know, like LCSWs, lpcs,I mean, everyone plays an active
role in helping the clients,you know.
So I think it's really good ifwe look at it from a community
perspective, where we all kindof come in and the common goal
(12:13):
is what?
To help people.
You know.
So if it's something where,like, I could extend that
service and actually bill for it, you know, I wouldn't mind
doing that because I'm doing itanyway and I'm not billing for
it.
Essentially, you know it anywayand I'm not billing for it,
essentially, you know.
But then there's people thatcan, if they specialize in
(12:36):
something, then it's like, okay,well, you may specialize in
eating disorders.
So I'm going to send thisperson to you.
But just the over, likeoverview or overall look of it,
I think it would be good if wecould offer it.
Speaker 2 (12:46):
Yeah, that's great, I think I share always.
What a mentor of mine, drHoward Butcher, kind of showed
to me is like the nurse, youthink of everybody that and
again, this is very Midwest, soforgive the kind of thing.
But a potluck, when peoplebring things to potluck they
bring their, their trays, andnursing brings a tray, and you
mentioned LCPCs bring a tray,physicians bring a tray, we all
(13:08):
kind of bring a tray.
We're all kind of in that samemeal but we all kind of bring
something special.
Speaker 3 (13:16):
So thanks, I appreciate your perspective on
that, yeah, definitely,definitely, marcel.
Speaker 4 (13:18):
I'm going to go off script a little bit.
I'm going to ask you a slightlydifferent question.
You are building a prettysignificant footprint in the
Hampton Roads area of Virginia.
I'm interested, as you're kindof looking on the horizon are
there particular subpopulationsyou're super interested in
serving, and why so?
Speaker 3 (13:37):
I always root for the underdog.
So whatever you know whoeverthat is.
But right now we're in VirginiaBeach and we're also in
Richmond, so we have about 15providers and the end of this
month will probably be up to 18.
And then we're going to expandhopefully to Newport News in
Chesapeake within the next likesix months.
(13:59):
But my practice I just look fordiversity, like everyone's
inclusive, as far as likeinvited to come, you know.
So we see a lot of the LGBT,qia plus population.
We see a lot of military youknow, active duty and vets.
We see I mean children, I loveto see children.
(14:23):
So ages four and up, we don'ttypically start medication that
early, but we do still see thoseclients.
So you know, I really don'thave like a subset of people, I
just want everyone to come, youknow.
Speaker 5 (14:36):
Thank you.
Speaker 3 (14:37):
Yeah.
Speaker 5 (14:38):
I love that and you know, to piggyback on that a
little bit, you're talking to aroom full of educators here.
You know, from your perspective, as you know as someone who has
been a student and alum and nowrunning your own practice, what
types of skills or modalitiesdo you think we need to be
teaching our students in orderto meet the needs of all these
(15:00):
diverse groups of folks?
Speaker 3 (15:04):
So a lot of it is what I find especially with,
like, the LGBT population isthere's no safe space for those
individuals.
So I actually have a contractwith the LGBT Life Center and so
we see a majority of thoseindividuals in Hampton Roads,
(15:24):
but what I always hear is thatwe don't feel welcome.
You know, people will call andlike cancel appointments or and
cancel appointments or they'llmisgender, and that really sets
someone back if you don't usethe right gender terms or
pronouns or even names.
So that's very important.
(15:45):
I think that would be good toincorporate in training.
Also, just meeting people withcompassion.
I always tell people like it'snot about the diagnosis for me
it never is.
We have to document it, yes,but what we're treating is what
you're experiencing.
So people get caught up inlabels and I find a lot of
(16:05):
clinicians will say, oh, you'rebipolar too, and a client will
come to me like what doesbipolar two mean?
I'm only one person.
You know they don't, they don'tunderstand.
So it's like we sit down and wego through these things and
it's like, oh well, that's whatit means and I'm like don't,
don't worry about the label,worry about how you're feeling
in the moment, you know.
So I think that's the biggestthing Knowing things like oh,
(16:31):
you know CBT, dbt, you know acttherapy, play therapy all that
stuff is great, but really justmeeting individuals where they
are and just having somecompassion.
Speaker 6 (16:44):
Well, what do you see as barriers to more PNHMPs
using psychotherapy in practice?
Speaker 3 (16:53):
barriers to more PNHMPs using psychotherapy in
practice.
Well, one of the barriers I cansee is some kickback from you
know therapists saying you'renot therapists, so stop doing it
.
But as far as like time, thetime constraints would probably
be the biggest thing, because Iknow for therapy, you know
individuals are seen for like 60minutes, but how do you
incorporate therapy and medmanagement in the same visit?
(17:16):
And still a lot for the amountof time that the individual
needs.
Speaker 2 (17:24):
So that would be the only thing that would probably
be more difficult to manage.
Yeah, can I ask kind of further, because I don't know if I've
asked, and maybe Sean, kate,melissa, please feel free to
jump in.
But this is one of the thingsthat I sometimes talk to my
colleagues who are just, youknow, doing therapy.
This idea between you know a 30minute appointment, which I
think, marcelli, if I heard youright, that's kind of primarily
(17:46):
what you've got scheduled.
You see them as much time asyou need, but that's kind of
what's on your kind of calendar.
I mean, do you see anydifference between, I mean,
doing a 30 versus a 60 minutes,you know, appointment?
Obviously there are differentbilling codes here, but I mean,
I guess I've always thought thatthere is utility definitely in
a 30 minute therapy appointment,but sometimes I get some
(18:06):
pushback on that.
I'd love your thoughts on that,maybe, and anyone else.
Speaker 3 (18:11):
Yeah.
So for some clients, you know,30 minutes I think is beneficial
because they're used to like 15minute check-ins, right.
But there are some clients thatare slower to feel comfortable
or like kind of warm up thatthat 60 minutes gives them
enough time to deal with theanxiety of coming, having to
discuss what they have going on,kind of get comfortable.
(18:33):
What I see is like at the 20minute mark.
That's where people kind oflike sit back and relax some,
you know.
So if you only go for the 30minutes, then like you have 10
minutes of like real engagementwhere I'm comfortable, Whereas
the full 60, I think would bemore beneficial.
Speaker 4 (18:51):
Yeah, it's kind of cool.
I want to build off of that.
I think you know your questionis really cool because it made
me think about OK, what is my,what is my thinking about how I
coordinate this.
And for me it's, I think earlyon in the therapeutic
relationship more time is neededto kind of galvanize the
therapeutic relationship.
But when you get into thispoint in time as a team between
a patient and provider, youstart to fire really effectively
(19:13):
together.
A patient and provider, youstart to fire really effectively
together.
You can probably shrink it downand unless we're dealing with
somebody with serious mentalillness, the goal is for our
patients to fire us for the bestof reasons because they don't
need us anymore, right?
So maybe that decrease infrequency but also duration of
encounters is kind of thebuilding process to
disengagement.
Speaker 3 (19:32):
Yeah, I agree with that too.
Speaker 5 (19:36):
Yeah, I'll just share too again, since you asked.
You know that made me reflectas well.
I'm currently practicing on ahouse calls team.
I'm seeing mostly geriatricpatients who are nearing the end
of life, and although I do have60 minute appointments, but
mostly I do 30 because folks getvery tired and so I think there
can also be a huge burden ofengagement, right.
(19:58):
So tailoring that to thepatient population can be really
important too.
Speaker 3 (20:02):
Yeah, that's a great point.
Speaker 4 (20:06):
Well this has been great.
Speaker 2 (20:08):
Sorry, go Sean.
Speaker 4 (20:09):
So, marcellia, I'm thinking about, like some
possible registered nurses whoare in your geographic area who
are like I want to do what he'sdoing, so can you give them
they're hopefully listeningright now some anticipatory
guidance about what they need todo to be able to be successful
and would be transitioned frombeing a registered nurse to an
(20:30):
advanced practice nurse inpsychiatry?
Speaker 3 (20:33):
Yeah, first thing I would say is learn everything
you can Right.
So always be a student.
A lot of times, when you'realready like in you have your
like degree in registerednursing, it's just like, oh, I
know how to do that.
But, yeah, you have to reallylisten and learn right.
The second thing I would say ismake sure you write everything
(20:54):
down so, like I know, when I wasin school I had a preceptor,
yes, but I still made aspreadsheet of all the
medication that you know, themechanism of action, the ages
that you can use it, and I usethat as a guide so I could learn
everything, not just from whatI was being told, but also how
it was in, like stalls, or howit was written, so that also you
(21:17):
know it's under.
It's understandable that youhave to work to make money, but
you also have to make sure thatyou take the time to study.
So you know, kind of havingsome of that time out to make
sure that you can do that andalso kind of working in an
environment that, wherever, like, you're trying to enter into.
(21:38):
So if it's psych, findsomewhere that you can learn
more about psych.
So if you can work on a psychunit that can be beneficial
Outside of that, just being opento, like you know, critique and
criticism.
I have a lot of students thatcome in and they're just like
you know they sit there.
I have a lot of students thatcome in and they're just like
you know, they sit there and I'mlike are you sure you want to
(21:59):
learn?
Like this is really what youwant to do?
Because you're not as engagedas you know I would think that
you would be.
I was very engaged when I was astudent.
So that's another thing.
You know, just if you love it,then it's going to work for you.
Don't just go to somethingbecause you know you hear psych.
Oh, I can make all this moneyin psych, but it's not about the
(22:20):
money, it's about the people.
So go where you love, likeworking and what you love doing.
You know whatever your purposeis.
So that's, that's the biggestthing for me.
Speaker 2 (22:32):
That's awesome.
Yeah, Again, I, you know, justlove doing these podcasts.
I hope people listening kind offind a reason.
But it seems like every episodeI get a little bit of a little
tingly and it's.
It's a good feeling.
And here we're recording on aFriday afternoon, that's, that's
the best time to have thesefeelings to launch us into the
weekend.
So I got one more question,Marcelli if you wouldn't mind
(22:54):
kind of sharing your story alittle bit about the, about the
song that you developed and madeand and and thankfully didn't
license, so we didn't have topay you any money.
That might've been a mistake onyour end, Sorry.
Speaker 3 (23:07):
It's all good.
It's one of those things that Ihated, like writing a
discussion board sorry, drConvoy.
So I was like you know what?
I'm just going to wrap them all.
Music, kind of, was like myfirst love.
So you know, that was how Iexpressed myself and that's how
I kind of dealt with what lifewas handing me.
(23:27):
And I think music is universal,so like everyone can relate to
it, no matter what walk of lifeyou come from.
So that was the biggest thing.
But when I sat down and wrotethe song, it was kind of like
what have you experienced, whathave you seen, you know?
So I put it in there, like wehave these beliefs that are
embedded in us, whether it'sfrom, like, how we were raised
(23:49):
or what society tells us who weshould be or how we should act,
you know.
So these intrusive thoughts, alot of times that we have a lot
of it, you know, has to do withwhat I can't even say.
It's like it's not even who weare.
A lot of times it's just likerandom thoughts that come in
because of how we felt, likegrowing up, or like
(24:12):
relationships that went wrong,and there's just so much to it,
and I could talk about that allday.
But that's where the song camefrom.
It kind of came from like thefeelings I was having in the
moment and then having to do adiscussion board about it.
I was just like I'll just putit into words that way yeah,
reminds me of like a painter.
Speaker 2 (24:30):
You know they can't use words, they have to put it
into you, have to draw it on acanvas or something it sounds
like for you.
It's just, it has to come outin song, it has to come out in a
, in a lyrical beat.
So yeah, and it's still thatway.
Speaker 3 (24:42):
It's still that way now.
Yeah, even with my clients.
You know we do like poetry.
They, you know, like my youngerclients, still write music.
I mean music is still a bigpart of like what I do now Love
it.
Speaker 4 (24:55):
And I'll add that, you know, while Marcelli is
under undervalued his cognitiveformal therapy skills, if you
listen to the song, he talksabout guided discovery,
cognitive distortions.
So there's a, there's acognitive therapist wheeling out
of his body.
He realizes that or not.
Speaker 2 (25:17):
Oh man Love it.
Well, thank you again forMarcelli Pascal Rodriguez.
Thank you so much.
Owner and provider atTransformations in Virginia
Beach, virginia.
I will be linking your website,so hopefully you'll get a bunch
of people.
I might be one of them.
As I say, in all the servicesyou provide, I think a little
tweaking might not be a bad ideatoo.
But uh and I hear virginiabeach is a nice place for
(25:39):
vacation.
So thank you, marcelli, forthis and thank you all for
listening.
Uh, please again like subscribecomment.
Uh look forward to anotherepisode coming up, coming out
soon, and uh take care all right, thank you, I appreciate you
all.
After dark with Pep Louse.
Speaker 3 (25:54):
Ghost, I think it went well.
I don't know How'd it go.
Crystal Sounds good to me.
Thank you again.
Yeah, thank you.
I appreciate you all, and Ithink Dr Convoy, where'd he go?
I can't see him.
He's still there, okay, cool.
(26:16):
So I was going to say pleaseget with us about the
hypnotherapy breath work.
I actually just went to aretreat and did that.
I've done some sessions withsome clients already and I'm
going to be honest with you, Ididn't think that breathing was
going to be so effective.
Speaker 4 (26:31):
Cool, cool, cool.
I've already.
I'm in contact with her, so Iwill.
I will circle the loop on thatwith you, I promise.
Okay, cool, thank you.
Speaker 1 (26:40):
Too much seasoning.
Speaker 2 (26:42):
They feel it.
Thanks everybody.
Speaker 1 (26:44):
Work hard until those thoughts are finally leaving,
so you can be you.
They feel it If all is true.
Work hard until those thoughtsare finally leaving, so you can
be you.
yeah, just my take on things.
My answer number two welcomeback everyone.
Speaker 2 (00:18):
Um, here we are another episode of peplau's
ghosts.
Thank you so much for joiningand listening.
Um, I think we're actually upto number 16 episode.
So we've been rocking androlling.
This is good.
Hopefully it's just a beginningas well.
But I am joined with my esteemedcolleagues Dr Sean Convoy from
Duke, soon to be Dr Kate Molinofrom University of California,
(00:42):
san Francisco, and Dr MelissaChapman up in Minnesota.
I'm really thrilled to have ourguest here.
I can't say enough thank you tohim for giving us the
foundation for this podcast, theintro music and outro music
that you've all listened to, asyou've listened to Pep Lau's
Ghost yeah, it's here and thisis the person who created that.
(01:04):
This is the brilliant mind thatit came from, and so really
excited to welcome MarcelliPascal Rodriguez to our podcast
here and really excited to havehim talk about his own business,
(01:28):
transformations, which is anaesthetic and wellness spa, and
so let's kind of get right intoit and just kind of get talking
to Marcelli.
So, marcelli, my first questionout of the gate what got you
interested in doingpsychotherapy and maybe kind of
expand it, just kind ofnon-pharmacological type of
stuff for people with mentalhealth problems.
Speaker 3 (01:50):
Yeah, hey, everyone, I'm so happy to be here.
Thanks for having me.
But as far as like getting intolike psychotherapy, I kind of
chose the mental health field, Iwould probably say medical
field.
At four years old, I had a youknow, a sick grandmother.
I said I would, you know, takecare of her.
As time went on, she passedprior to, of course, me
finishing school, but in highschool, I would say that's where
(02:10):
it really stuck out.
You know, I saw a lot ofsubstance abuse.
You know I saw a lot of likejust issues with self-worth,
self-esteem.
You know, it was just a lotgoing on in high school that I
can remember and I was like, youknow, maybe I could help people
out just by finding what theroot of the problem is, you know
(02:32):
, kind of from there, and then Iwent to school, I kept going to
school and then I met Dr Convoy, who really lit a fire under me
to keep going when it came topsychiatry.
Speaker 2 (02:45):
So what kind of propellant did he use to light
that fire?
I mean, I just I'm sorry, goingwith that metaphor a little bit
, maybe All right.
So what was it that tried to?
He did that, you know, becauseobviously the fire was probably
there, right, he just kind ofstoked it a little bit.
Speaker 3 (02:58):
He just kind of stoked a little bit.
Yeah, so I think you know oneof the things that I find in
psychiatry is a lot of what wego through is stemmed in trauma,
whether it's like perceived orsomething that you actually
experienced.
(03:18):
So you know, coming from abackground that you know, I've
had some trauma, like we allhave, and Dr Convoy kind of
what's the word he kind ofvalidated things without even
knowing that's what he was doing, Right.
So it was one of the thingslike for me, I grew up kind of
like a perfectionist because Iwas raised to be such, and Dr
Convoy made it where it was okayto not be a perfectionist and
(03:39):
to understand that whatever youhave to offer is what the world
needs, you know.
So, yeah, I would say himDefinitely.
Speaker 4 (03:49):
Well, it's really hard to mobilize a question
after that comment.
Thank you, sir, I'm going to.
I want to take you kind ofafter school and you're now in
clinical practice and you'redoing it right and you're doing
it well.
I want you to think was therean experience you had with a
patient or a family that kind ofmade you realize that, wow,
(04:09):
spending more time than just 15minutes with a patient adjusting
meds does something special?
And if so, can you de-identifyand tell us that story?
Speaker 3 (04:21):
So my practice, we don't even do 15 minute med
checks.
They're not even allowed, um,to be honest with you, and part
of that is because it's just notenough time.
You know, and a lot of times ittakes time for someone to even
truly verbalize what they'regoing through and how they're
feeling, and if they feel likethey're in a time crunch,
they'll never get the truth.
So we have all our, all of ourmed checks are based on a 30
(04:46):
minute increment and we even gofurther, like longer, if we have
to.
So we get everyone to fill out,like the PHQ-9s, the GAD-7s, we
do the mood disorderquestionnaires and we kind of
like really tap into the person.
So when I say that, you know, wepay attention to how they
walked in, what was theirinteraction, you know when they
(05:08):
sit down, like you know theirclothing, you know how's their
hair, you know their makeup,that type of thing, eye contact,
are they looking at us?
When you know we're talking tothem, we catch up on hey, you
know how was your weekend or howwas your week, how's work your
children?
You know, before we even getinto meds, we're having a whole
conversation about just them asa person.
(05:30):
You know, and also, like I tellmy staff that we can't look at
people like they're a number.
You know I want them to get toknow, even when they come in to
be checked into the practice.
You know I want you to greetthem by their name, their
preferred name, if you know thatin that case and you know,
check in with them like how arethings going?
(05:55):
It starts there, you know.
So I know I went on a littlebit of a tangent with that, but
I'm very passionate about, youknow, taking the time that's
needed with people, because amed check is just not enough.
Speaker 2 (06:05):
Have you ever had an experience with the 15?
I'm guessing probably throughclinicals and other experiences,
you've had the 15 and like whendid you feel like that wasn't
going to work for you?
Speaker 3 (06:14):
I hated it.
To be honest with you Insurancecompanies they tell us oh, you
have this amount of time getthem in and out.
But I don't look at people aslike financial gain.
You know, it's really abouthelping people.
So if I have to take more time,then that's just what I do.
But the 15 minute med check alot of people I could tell when
they were leaving.
It was like they would sendmessages like oh, I forgot to
(06:38):
say, or hey, I didn't get achance, can we still change the
medication?
You know, a lot of times whenyou do 15 minute med checks
they're like oh, everything'sgood.
Yeah, same med, just samepharmacy, thanks.
And they leave.
Speaker 5 (06:50):
You know, yeah yeah, you know, um marshall, before we
started taping, when we werejust chatting, you had mentioned
that you know you obviously domedication management in your
practice, but you usepsychotherapy techniques as well
and you kind of modulate it tothe particular client based on
what you assess that they need.
(07:10):
I'm wondering if you could givesome examples of how you decide
to do that and what types oftechniques you use.
Speaker 3 (07:18):
Yeah, so I was just saying before we started.
Actually I don't really stickto a modality.
I know there's like CBT and allthose different things you can
use.
I really just let you knowwhatever the conversation is,
kind of guide the path and wherewe're going.
So a lot of times if it's, youknow, negative thoughts or like
intrusive thoughts someone ishaving, I try to find what the
root cause of that is, you know.
(07:39):
So what I'm finding in mypractice is, like I was saying
earlier, a lot of things arejust rooted in trauma, you know
so, feelings of not being goodenough or not belonging, or
perfectionism or, you know, justinadequacy.
All that stuff really stemsfrom when we were growing up,
you know.
So I just had a client the otherday who has like a a sexual
(08:02):
addiction, right, so we weretalking about that.
He was like, you know day whohas like a sexual addiction
Right, so we were talking aboutthat.
He was like you know, my wifesays is an addiction.
So I was, I was trying tofigure out.
I was like, ok, so define to mewhat exactly is happening that
you?
You know that you're linking itwith an actual addiction.
So he was talking about some ofthe things.
And so I said to him at whatpoint, like how is your
(08:23):
relationship with your mom?
You some of the things?
And so I said to him at whatpoint, like how is your
relationship with your mom, youknow?
And he told me we didn't have areally good relationship, you
know.
I'm like, okay, well, whatabout?
What about your father?
He was like there was a lot ofabuse in the home, you know.
And so then it went from okay.
So growing up, were you like oneof the popular kids?
Did you play sports or were youkind of a loner?
And he said I was really aloner, I wasn't one of the
(08:45):
popular kids.
And he said, you know, I canthink back when I was a kid and
I would, you know, do these actsgrowing up because I wanted to
be cool.
And now he's 35 years old, he'sstill doing the same thing that
he's been doing since he was 15or 16.
And so he said to me he said Inever thought about, like any of
this stuff or how it could belinked to you know, what's
(09:07):
happening in my relationship,you know, especially the
relationship with my mom, thehistory of what I was doing
prior.
And he was like I really needto go to therapy and I was like
you do, you know.
So it's one of those thingswhere I referred him to someone
that can really like betterassist in that arena.
But I spent a lot of time likejust talking to people trying to
(09:27):
figure out what's going on withthem before I, you know, send
them to someone who's morespecialized to help.
Speaker 5 (09:34):
I love that example, you know.
It's just such a good exampleof how you know, using these
sort of engagement strategies isreally just holding up a mirror
to patients, right Like youstay curious and you present the
opportunity for them to reflectand figure things out.
That's great.
Speaker 3 (09:49):
Yeah, definitely, because I mean, it really is
just about guiding, you know,the individual through whatever
they're going through andthere's no judgment, you know.
So I always tell people like,regardless to whatever you
experienced, I want to knowbecause that's the only way I
can really help.
Speaker 6 (10:05):
Yeah, yeah, so I'd love to hear your thoughts on
nursing, being a leader andperforming psychotherapy.
What are the yeah, what are theaspects to consider there?
Speaker 3 (10:21):
so I think nursing I think there's nothing better
than a nurse to be honest withyou, no shot to any physicians
or anything.
But I think when it comes tolike just being bedside and more
hands on, that's something thatyou know, we've just been
trained to do.
So I think it makes us morerelatable and I feel like people
(10:43):
trust us more, you know.
So I think like nurses at theforefront of psychotherapy is
something that the worlddefinitely needs and we need to
probably spend more time doingthat training, even in these
courses that we're taking.
You know, I wish VCU had moreof a psychotherapy perspective
when I was going I mean, drConvoy definitely played a part
(11:05):
in that but maybe even like acourse where that's all we learn
, you know.
Thank you, marcel.
Speaker 2 (11:11):
I mean where that's all we learn, you know.
Thank you, marcel.
I mean it's a great questionand I appreciate Melissa
bringing it up because I mean Ican see you know all the
potential that you have, justkind of listening to you for
your first time, and you couldhave been a psychologist, you
could have been a physician, butsomething chose you to say
nursing fits me best, you know,fits my worldview, and even
(11:33):
going all the way back to youknow, helping your grandma when
you know four years old andthings.
So do you have any concernabout psych, mental health
nurses doing psychotherapy or isthere any anything that kind of
you know you mentioned, kind ofyou know you need more of this,
but does any concern come upwhen you think about that as far
as nurses doing therapy?
Speaker 3 (11:51):
I don't think so.
I think it would be a greatthing, you know, to be honest
with you.
I mean, I don't take away fromany other specialty.
So you know, like LCSWs, lpcs,I mean, everyone plays an active
role in helping the clients,you know.
So I think it's really good ifwe look at it from a community
perspective, where we all kindof come in and the common goal
(12:13):
is what?
To help people.
You know.
So if it's something where,like, I could extend that
service and actually bill for it, you know, I wouldn't mind
doing that because I'm doing itanyway and I'm not billing for
it.
Essentially, you know it anywayand I'm not billing for it,
essentially, you know.
But then there's people thatcan, if they specialize in
(12:36):
something, then it's like, okay,well, you may specialize in
eating disorders.
So I'm going to send thisperson to you.
But just the over, likeoverview or overall look of it,
I think it would be good if wecould offer it.
Speaker 2 (12:46):
Yeah, that's great, I think I share always.
What a mentor of mine, drHoward Butcher, kind of showed
to me is like the nurse, youthink of everybody that and
again, this is very Midwest, soforgive the kind of thing.
But a potluck, when peoplebring things to potluck they
bring their, their trays, andnursing brings a tray, and you
mentioned LCPCs bring a tray,physicians bring a tray, we all
(13:08):
kind of bring a tray.
We're all kind of in that samemeal but we all kind of bring
something special.
Speaker 3 (13:16):
So thanks, I appreciate your perspective on
that, yeah, definitely,definitely, marcel.
Speaker 4 (13:18):
I'm going to go off script a little bit.
I'm going to ask you a slightlydifferent question.
You are building a prettysignificant footprint in the
Hampton Roads area of Virginia.
I'm interested, as you're kindof looking on the horizon are
there particular subpopulationsyou're super interested in
serving, and why so?
Speaker 3 (13:37):
I always root for the underdog.
So whatever you know whoeverthat is.
But right now we're in VirginiaBeach and we're also in
Richmond, so we have about 15providers and the end of this
month will probably be up to 18.
And then we're going to expandhopefully to Newport News in
Chesapeake within the next likesix months.
(13:59):
But my practice I just look fordiversity, like everyone's
inclusive, as far as likeinvited to come, you know.
So we see a lot of the LGBT,qia plus population.
We see a lot of military youknow, active duty and vets.
We see I mean children, I loveto see children.
(14:23):
So ages four and up, we don'ttypically start medication that
early, but we do still see thoseclients.
So you know, I really don'thave like a subset of people, I
just want everyone to come, youknow.
Speaker 5 (14:36):
Thank you.
Speaker 3 (14:37):
Yeah.
Speaker 5 (14:38):
I love that and you know, to piggyback on that a
little bit, you're talking to aroom full of educators here.
You know, from your perspective, as you know as someone who has
been a student and alum and nowrunning your own practice, what
types of skills or modalitiesdo you think we need to be
teaching our students in orderto meet the needs of all these
(15:00):
diverse groups of folks?
Speaker 3 (15:04):
So a lot of it is what I find especially with,
like, the LGBT population isthere's no safe space for those
individuals.
So I actually have a contractwith the LGBT Life Center and so
we see a majority of thoseindividuals in Hampton Roads,
(15:24):
but what I always hear is thatwe don't feel welcome.
You know, people will call andlike cancel appointments or and
cancel appointments or they'llmisgender, and that really sets
someone back if you don't usethe right gender terms or
pronouns or even names.
So that's very important.
(15:45):
I think that would be good toincorporate in training.
Also, just meeting people withcompassion.
I always tell people like it'snot about the diagnosis for me
it never is.
We have to document it, yes,but what we're treating is what
you're experiencing.
So people get caught up inlabels and I find a lot of
(16:05):
clinicians will say, oh, you'rebipolar too, and a client will
come to me like what doesbipolar two mean?
I'm only one person.
You know they don't, they don'tunderstand.
So it's like we sit down and wego through these things and
it's like, oh well, that's whatit means and I'm like don't,
don't worry about the label,worry about how you're feeling
in the moment, you know.
So I think that's the biggestthing Knowing things like oh,
(16:31):
you know CBT, dbt, you know acttherapy, play therapy all that
stuff is great, but really justmeeting individuals where they
are and just having somecompassion.
Speaker 6 (16:44):
Well, what do you see as barriers to more PNHMPs
using psychotherapy in practice?
Speaker 3 (16:53):
barriers to more PNHMPs using psychotherapy in
practice.
Well, one of the barriers I cansee is some kickback from you
know therapists saying you'renot therapists, so stop doing it
.
But as far as like time, thetime constraints would probably
be the biggest thing, because Iknow for therapy, you know
individuals are seen for like 60minutes, but how do you
incorporate therapy and medmanagement in the same visit?
(17:16):
And still a lot for the amountof time that the individual
needs.
Speaker 2 (17:24):
So that would be the only thing that would probably
be more difficult to manage.
Yeah, can I ask kind of further, because I don't know if I've
asked, and maybe Sean, kate,melissa, please feel free to
jump in.
But this is one of the thingsthat I sometimes talk to my
colleagues who are just, youknow, doing therapy.
This idea between you know a 30minute appointment, which I
think, marcelli, if I heard youright, that's kind of primarily
(17:46):
what you've got scheduled.
You see them as much time asyou need, but that's kind of
what's on your kind of calendar.
I mean, do you see anydifference between, I mean,
doing a 30 versus a 60 minutes,you know, appointment?
Obviously there are differentbilling codes here, but I mean,
I guess I've always thought thatthere is utility definitely in
a 30 minute therapy appointment,but sometimes I get some
(18:06):
pushback on that.
I'd love your thoughts on that,maybe, and anyone else.
Speaker 3 (18:11):
Yeah.
So for some clients, you know,30 minutes I think is beneficial
because they're used to like 15minute check-ins, right.
But there are some clients thatare slower to feel comfortable
or like kind of warm up thatthat 60 minutes gives them
enough time to deal with theanxiety of coming, having to
discuss what they have going on,kind of get comfortable.
(18:33):
What I see is like at the 20minute mark.
That's where people kind oflike sit back and relax some,
you know.
So if you only go for the 30minutes, then like you have 10
minutes of like real engagementwhere I'm comfortable, Whereas
the full 60, I think would bemore beneficial.
Speaker 4 (18:51):
Yeah, it's kind of cool.
I want to build off of that.
I think you know your questionis really cool because it made
me think about OK, what is my,what is my thinking about how I
coordinate this.
And for me it's, I think earlyon in the therapeutic
relationship more time is neededto kind of galvanize the
therapeutic relationship.
But when you get into thispoint in time as a team between
a patient and provider, youstart to fire really effectively
(19:13):
together.
A patient and provider, youstart to fire really effectively
together.
You can probably shrink it downand unless we're dealing with
somebody with serious mentalillness, the goal is for our
patients to fire us for the bestof reasons because they don't
need us anymore, right?
So maybe that decrease infrequency but also duration of
encounters is kind of thebuilding process to
disengagement.
Speaker 3 (19:32):
Yeah, I agree with that too.
Speaker 5 (19:36):
Yeah, I'll just share too again, since you asked.
You know that made me reflectas well.
I'm currently practicing on ahouse calls team.
I'm seeing mostly geriatricpatients who are nearing the end
of life, and although I do have60 minute appointments, but
mostly I do 30 because folks getvery tired and so I think there
can also be a huge burden ofengagement, right.
(19:58):
So tailoring that to thepatient population can be really
important too.
Speaker 3 (20:02):
Yeah, that's a great point.
Speaker 4 (20:06):
Well this has been great.
Speaker 2 (20:08):
Sorry, go Sean.
Speaker 4 (20:09):
So, marcellia, I'm thinking about, like some
possible registered nurses whoare in your geographic area who
are like I want to do what he'sdoing, so can you give them
they're hopefully listeningright now some anticipatory
guidance about what they need todo to be able to be successful
and would be transitioned frombeing a registered nurse to an
(20:30):
advanced practice nurse inpsychiatry?
Speaker 3 (20:33):
Yeah, first thing I would say is learn everything
you can Right.
So always be a student.
A lot of times, when you'realready like in you have your
like degree in registerednursing, it's just like, oh, I
know how to do that.
But, yeah, you have to reallylisten and learn right.
The second thing I would say ismake sure you write everything
(20:54):
down so, like I know, when I wasin school I had a preceptor,
yes, but I still made aspreadsheet of all the
medication that you know, themechanism of action, the ages
that you can use it, and I usethat as a guide so I could learn
everything, not just from whatI was being told, but also how
it was in, like stalls, or howit was written, so that also you
(21:17):
know it's under.
It's understandable that youhave to work to make money, but
you also have to make sure thatyou take the time to study.
So you know, kind of havingsome of that time out to make
sure that you can do that andalso kind of working in an
environment that, wherever, like, you're trying to enter into.
(21:38):
So if it's psych, findsomewhere that you can learn
more about psych.
So if you can work on a psychunit that can be beneficial
Outside of that, just being opento, like you know, critique and
criticism.
I have a lot of students thatcome in and they're just like
you know they sit there.
I have a lot of students thatcome in and they're just like
you know, they sit there and I'mlike are you sure you want to
(21:59):
learn?
Like this is really what youwant to do?
Because you're not as engagedas you know I would think that
you would be.
I was very engaged when I was astudent.
So that's another thing.
You know, just if you love it,then it's going to work for you.
Don't just go to somethingbecause you know you hear psych.
Oh, I can make all this moneyin psych, but it's not about the
(22:20):
money, it's about the people.
So go where you love, likeworking and what you love doing.
You know whatever your purposeis.
So that's, that's the biggestthing for me.
Speaker 2 (22:32):
That's awesome.
Yeah, Again, I, you know, justlove doing these podcasts.
I hope people listening kind offind a reason.
But it seems like every episodeI get a little bit of a little
tingly and it's.
It's a good feeling.
And here we're recording on aFriday afternoon, that's, that's
the best time to have thesefeelings to launch us into the
weekend.
So I got one more question,Marcelli if you wouldn't mind
(22:54):
kind of sharing your story alittle bit about the, about the
song that you developed and madeand and and thankfully didn't
license, so we didn't have topay you any money.
That might've been a mistake onyour end, Sorry.
Speaker 3 (23:07):
It's all good.
It's one of those things that Ihated, like writing a
discussion board sorry, drConvoy.
So I was like you know what?
I'm just going to wrap them all.
Music, kind of, was like myfirst love.
So you know, that was how Iexpressed myself and that's how
I kind of dealt with what lifewas handing me.
(23:27):
And I think music is universal,so like everyone can relate to
it, no matter what walk of lifeyou come from.
So that was the biggest thing.
But when I sat down and wrotethe song, it was kind of like
what have you experienced, whathave you seen, you know?
So I put it in there, like wehave these beliefs that are
embedded in us, whether it'sfrom, like, how we were raised
(23:49):
or what society tells us who weshould be or how we should act,
you know.
So these intrusive thoughts, alot of times that we have a lot
of it, you know, has to do withwhat I can't even say.
It's like it's not even who weare.
A lot of times it's just likerandom thoughts that come in
because of how we felt, likegrowing up, or like
(24:12):
relationships that went wrong,and there's just so much to it,
and I could talk about that allday.
But that's where the song camefrom.
It kind of came from like thefeelings I was having in the
moment and then having to do adiscussion board about it.
I was just like I'll just putit into words that way yeah,
reminds me of like a painter.
Speaker 2 (24:30):
You know they can't use words, they have to put it
into you, have to draw it on acanvas or something it sounds
like for you.
It's just, it has to come outin song, it has to come out in a
, in a lyrical beat.
So yeah, and it's still thatway.
Speaker 3 (24:42):
It's still that way now.
Yeah, even with my clients.
You know we do like poetry.
They, you know, like my youngerclients, still write music.
I mean music is still a bigpart of like what I do now Love
it.
Speaker 4 (24:55):
And I'll add that, you know, while Marcelli is
under undervalued his cognitiveformal therapy skills, if you
listen to the song, he talksabout guided discovery,
cognitive distortions.
So there's a, there's acognitive therapist wheeling out
of his body.
He realizes that or not.
Speaker 2 (25:17):
Oh man Love it.
Well, thank you again forMarcelli Pascal Rodriguez.
Thank you so much.
Owner and provider atTransformations in Virginia
Beach, virginia.
I will be linking your website,so hopefully you'll get a bunch
of people.
I might be one of them.
As I say, in all the servicesyou provide, I think a little
tweaking might not be a bad ideatoo.
But uh and I hear virginiabeach is a nice place for
(25:39):
vacation.
So thank you, marcelli, forthis and thank you all for
listening.
Uh, please again like subscribecomment.
Uh look forward to anotherepisode coming up, coming out
soon, and uh take care all right, thank you, I appreciate you
all.
After dark with Pep Louse.
Speaker 3 (25:54):
Ghost, I think it went well.
I don't know How'd it go.
Crystal Sounds good to me.
Thank you again.
Yeah, thank you.
I appreciate you all, and Ithink Dr Convoy, where'd he go?
I can't see him.
He's still there, okay, cool.
(26:16):
So I was going to say pleaseget with us about the
hypnotherapy breath work.
I actually just went to aretreat and did that.
I've done some sessions withsome clients already and I'm
going to be honest with you, Ididn't think that breathing was
going to be so effective.
Speaker 4 (26:31):
Cool, cool, cool.
I've already.
I'm in contact with her, so Iwill.
I will circle the loop on thatwith you, I promise.
Okay, cool, thank you.
Speaker 1 (26:40):
Too much seasoning.
Speaker 2 (26:42):
They feel it.
Thanks everybody.
Speaker 1 (26:44):
Work hard until those thoughts are finally leaving,
so you can be you.
They feel it If all is true.
Work hard until those thoughtsare finally leaving, so you can
be you.
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