May 19, 2025 • 41 mins
Have we lost the art of truly seeing our patients? In this profound conversation with Cheryl Puntil, a psychodynamic psychotherapist who recently retired as Chief Nursing Officer at Austin Riggs Center, we explore the unique power nurses bring to therapeutic relationships after her remarkable 43-year career in psychiatric mental health nursing.
Cheryl shares why she chose nursing over other professions, calling it "the best profession ever" for its unique integration of psychology, medicine, and social work perspectives. With passionate conviction, she explains how nurses observe patients in contexts no other providers witness, creating unparalleled opportunities for meaningful connection and healing.
The conversation ventures into fascinating territory as Cheryl describes how psychodynamic principles operate not just in individual therapy but throughout entire organizations. She reveals the concept of "parallel process" – how themes emerging in staff meetings mysteriously appear in patient community meetings, creating unconscious connections throughout therapeutic communities.
Perhaps most compelling is Cheryl's concern about the future of psychodynamic nursing. Despite overwhelming evidence that combined therapy and medication approaches work better than either alone, healthcare systems increasingly devalue nurse psychotherapists who don't prescribe. Meanwhile, educational foundations weaken as non-psychiatric specialists teach mental health content in nursing programs, and many students never experience psychiatric clinical rotations.
The episode concludes with an inspiring tour of Austin Riggs Center's unique approach – an open-setting residential treatment facility where patients lead community meetings, engage in creative programming, and receive intensive psychodynamic psychotherapy four times weekly. This 100-year-old model stands as living proof that relationship-based care produces transformative results.
For anyone concerned about the direction of mental healthcare or seeking to deepen their therapeutic approach, this conversation offers both validation and a roadmap forward. What might our healthcare system look like if we truly valued knowing our patients?
CLARIFICATION FROM THE EPISODE
Mrs Cheryl Puntil does have a certificate in psychodynamic approach but is NOT a psychodynamic therapist as she does not provide direct care to patients in her role as CNO.
Also the the Austin Riggs Center opened in 2019 not 2017.
Please reach out with any other questions or comments to Mrs. Cheryl Puntil at cherylpuntil@gmail.com
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 I thinkwe're recording.
Speaker 2 (00:27):
Welcome back everybody to peplau's ghost.
Another episode so excited.
Uh, I'm thrilled for our nextguest here, um cheryl putinil.
I hope I'm pronouncing thatright uh, puntil, thank you
thank you.
Cheryl puntil will be joining usand sharing her experiences and
really excited about the summerwe've got lined up here on Pep
(00:48):
Lau's Ghost.
You know kind of to give alittle background with Cheryl.
She actually approached usabout being on the podcast.
So I'm super excited about thisidea that the podcast is
actually reaching people thatare interested and want to be on
here.
So really encourage you, ifyou're listening to this right
now and you like this podcast,like this content, reach out to
myself, dr Kate Molino, dr SeanConvoy, any of the people that
(01:10):
are here on the podcast andreally just kind of reach out
and say, hey, I want to be onhere and hey, we'll probably
allow you to be on here.
We're not very picky.
We want to kind of have people,we want to generate that
interest and really kind of movethat needle and keep keeping
psychotherapy within the rolehere.
So my quick introduction withCheryl Puntil here is that she
(01:31):
is, or was recently retired, theCNO, the chief nursing officer
at Austin Riggs Center, which isa psychodynamic facility in
Massachusetts, and has practicedas a PMH CNS.
Melissa, I know you're going toask me what that means.
That's a psych, mental healthcertified clinical nurse
specialist.
She's practiced for 43 years,so congratulations, cheryl.
(01:56):
You must've got yourcertification when you were 12.
Does that sound right?
Speaker 3 (01:59):
Yeah, in 1998, that was a long time ago.
Speaker 2 (02:04):
It's a minute, so that's great.
She's also certified as apsychodynamic psychotherapist
and again really excited to kindof get to know her experience
in using these forms ofpsychotherapy.
So my privilege of asking thefirst question is when did you
first get interested in doingpsychotherapy?
What was your first foray intoit and really maybe what got you
(02:26):
hooked?
Speaker 3 (02:27):
So I have a certificate in psychodynamic
psychotherapy, which was atwo-year program that I did
after my master's in clinicalnurse specialist at UCLA and at
that time California UCLA know,the UCLA split, the NP.
You could go into either the NPor the CNS, so I chose to go to
(02:50):
the CNS.
I didn't particularly want toprescribe and so, but I did
learn because I think UCLA wasso biologically motivated you
know the approach was verybiologic that I learned a lot
about medications and you knowthat, and I felt like I needed a
(03:12):
little more understanding ofwhat drives people, what
motivates people, what are their.
You know a lot, I believe thatpatients or people have, you
know, the unconscious, arethings that you know.
How do we get their unconsciousinto awareness, to be more
self-aware so they can makebetter decisions, et cetera?
(03:33):
So I did the two-year programat the Southern California
Psychoanalytic Institute and Idid actually do psychotherapy at
that time with four patientsthat were older.
I worked in geriatric psychiatryand I did that for most of my
profession.
But I also take thepsychodynamic piece into
(03:58):
supervision, into leadership,into working with patients in
the inpatient setting, workingwith students, working in
organizations, et cetera,because I think that that's,
it's just, you know consumes mein a way that I it's just the
way that I think dynamically andyou know.
(04:19):
So, in terms of psychotherapy,I use the patient relationship
and the nursing therapeuticrelationship as a way to
communicate with the patientsand to develop a rapport and to
help the patient find their wayto self-determination.
So, yeah, that's just Great.
Speaker 2 (04:43):
Well, I appreciate that.
I mean, I think what reallykind of stood out a little bit
to me too is is the idea thatyou use this within
organizations as well.
I think that's a if I can saythis I mean that's a very CNS
kind of thing to do.
I mean, I think you think notjust of the person, but you
think of populations, you thinkof organizations and how you can
apply that.
Do you mind sharing maybe anexample of that, how you applied
(05:03):
psychodynamic approaches to anorganization, or can you think
of something just off the top ofyour head?
Speaker 3 (05:09):
Well, it was interesting that because, you
know also, the community is veryimportant, right?
What's going on in the communityand in a residential center,
treatment center, where peoplelive, where patients live and
staff are involved in thetherapeutic community, what I
find happening unconsciously isthat the patients or the staff
(05:33):
will reflect it'll be likeparallel process.
We'll be in a meeting and youknow, and go through the same
kind of issues or discussionsabout, let's say, threat to the
organization or whatever, andthen we'll go into the community
meeting and the patients willbe speaking about the same thing
as well and it just seems like,wow, we just talked about that.
(05:54):
And so it's this dynamic, sortof unconscious way of thinking
in an organization that onegroup affects another group.
Whether we, you know, it's notso obvious, but until you know,
we have to look for that.
There's threads that affect thecommunity as well as the
(06:16):
professional, et cetera.
So there's a lot of links thereand I just felt that that was
fascinating.
You know, that was fascinating.
Thank you for sharing that.
That was, you know, veryinsightful, so that that was
fascinating.
Speaker 2 (06:23):
you know that was fascinating.
Thank you for sharing that.
That was, you know, veryinsightful, so appreciate that,
kate.
I think you got the nextquestion.
Speaker 4 (06:29):
Yeah, it also makes me think, Cheryl, about how, you
know, I do groups provisionwith my psych and peace students
and often we talk about howyou'll have a day in clinic
where everyone is bringing upthe same stuff.
Right, there are these sort ofinvisible threads that are woven
, that weave us together.
So thank you for that.
Speaker 3 (06:46):
Well, I remember one of the analysts that I was
supervised by while I was in LosAngeles.
He told me think of the commonthread, like you know, in a
weaved, you know in a rug that'sweaved.
Where is that common threadthat's being weaved through the
(07:07):
whole rug?
Or the patient, or the staffnurse, or the CEO, or me myself?
Right, what are the commonthings?
That's the thread that you haveto follow and that will lead us
, I think.
Look at that and evaluate itand really try to understand it.
Speaker 4 (07:33):
Yeah, and, and so my question for you is you know, if
you can, we love to ask here onthe podcast people to share
stories of maybe maybe the firsttime you performed
psychotherapyotherapy or maybe asession you had with someone
where it was kind of like a ahamoment happened and it really
taught you something.
Is there any situation likethat that comes to mind that you
(07:53):
could share with our listeners?
Speaker 3 (07:55):
well, you know, it's not.
It's not while I was doingpsychotherapy, it was while I
was, I think, as a nurse and ain a in a geriatric psychiatric
nurse.
You, you have to really try tobe a detective.
And and um, we had a patientonce that was very young, who
(08:18):
had um, she had come onto theunit and she was neurologically
felt.
We felt that the nursing stafffelt that it was, she was
neurologically impaired, meaningthat something had happened to
her physically or medically, andthere was other people who
thought that this was allpsychiatric and that she was
(08:38):
having a break, a schizophrenicbreak, and it was being a
detective, it was interviewing.
You know, like I think hilliardpeplow was the one that talked
about knowing your patient you,you have to know your patient
and it's how you ask questionsand who you ask the questions to
(08:59):
, because you're not going toget the, the answers that you
want.
Well, the answers that you want, well, the answers that you
want, I mean, or the answers,depend on the questions you ask,
right?
And so I thought that and Italked, it was a puzzle as to
what was happening with thisperson, and one of the nurses
told me she said Cheryl, I thinkshe's worse with the medication
(09:21):
.
And then I kind of put two andtwo together and I talked to the
family and the history and wefound out that she had a sore
throat in, you know, a sorethroat that was never really
treated and I, we, we got her astrep titer and she had the
(09:42):
biggest, the highest level thatthey had seen.
And we found out that she hadthe pediatric on pandas, you
know, the pediatric autoimmuneneurological disorder, and and
and it was so interestingbecause the team that saw her as
an adult, like the neuro teamthat saw her as the adults, said
one thing completely differentthan the infectious disease team
(10:05):
in in peds infectious diseasebecause she was, she was young,
she was right on the edge ofadult, you know, adolescent, and
completely same, same person,same manifestation of the
symptoms, but completelydifferent assessment.
And so you need to look at thepatient as well as the family
(10:28):
and the context of when thingswere, how things happen in the
context, and so that's that wasan aha moment for me about how
important it is to be thorough,to really know your patient, to
listen to everybody, listen tostaff, to look at your patient.
I don't think the staff now arenot staff, but sometimes you're
(10:50):
not looking at.
When I go to my primary careprovider and get my physical,
they don't necessarily even lookat my.
Listen to my heart.
They don't have me on dressanymore, and so are you really
looking at your patient?
That's, that's what I wouldthink.
In terms of psychotherapy, youknow there's always therapeutic
(11:10):
moments.
Every interaction should betherapeutic one, or with
intention.
That's how I kind of see it,and you know so.
I don't know if that answersyour question, but I think so.
Speaker 5 (11:26):
I'm seeing some nods.
Thank you for sharing.
I would love to pivot just alittle, although I hear aspects
of what might come out in yourresponse to this next question
how do you see nursing?
Speaker 3 (11:43):
being a leader in performing psychotherapy.
Psychotherapy.
Well, you know, nursing isreally for me.
People ask me how come youdidn't become a doctor, how come
you didn't become whatever?
I think nursing is, for me, thebest profession ever, because
it's a conglomeration of a lotof different things, of social
work, of psychology, of a lot ofdifferent things of social work
(12:07):
, of psychology, of medicine, ofphysical therapy, of you know,
and it really what I feel isthat the nurse's role is trying
to assist the person become lessill, I guess, or move towards
wellness, either because as aresponse to their illness or as
(12:29):
a response to a perceived orthought of their illness or to
the treatment of that illness.
And so we have a and we see thepatients more in terms of
spending time with the patients,more than any other profession,
I think.
And so, as a nurse, we have alot of impact, we can have a lot
(12:49):
of impact and we're in chargeof the milieu, we are their eyes
and ears, the physician's eyesand ears or the provider's eyes
and ears, and can see patientsin the context of their behavior
, you know, because there aremany.
In many ways the patient willact very differently with the
(13:10):
therapist An hour.
You know it rigs, they, theytake, um, they get very
intensive psychodynamic orpsychoanalytic psychotherapy
four times a week and then therest of the time the patient is
in programs or in communitymeetings or socializing, or
they're in their activityprograms and just doing
(13:31):
activities but so, and or elsethey're just kind of hanging out
with the nursing staff or withthe therapeutic community staff,
and that is when we can gain alot of information about about
the patient and what they'rethinking and what they're
experiencing and what they'restruggling with, and we can make
an impact then as well.
(13:51):
And I also think that you knowwe meet nursing staff.
They meet with patients.
You know, even when I was on aninpatient unit, on our unit,
when I first started, we hadcommunity meetings, you know,
and excuse me, and everybodyattended, everybody.
(14:13):
It wasn't just this one person.
You go to one appointment andthen you go to another
appointment and then you go toanother appointment and no one,
you know, and and the patient isseeing, all the staff are there
too.
So I remember that and that wasreally, really important.
That seems to have gotten lostin the inpatient settings, the
community meetings, and then wealso have teams.
(14:38):
You know where there'scontinuity.
I know for the nurse in theinpatient setting.
We did primary nursing when Iwas at UCLA and also when I was
at Mayo.
We did primary nursing and alsoat Rush when I was at Rush and
the continuity was so importantbecause you really got to know
(15:00):
your patient, know your patientand if the patient also kind of
knew what the limitations wereor what the boundaries were, the
frame you know was in therelationship, um too, and we
have to keep keep repeating theboundaries of the relationship
or the frame of the relationship, so you know um well, the
(15:23):
relationship keeps coming out inthese examples and the
humanness andmultidimensionalness of a person
, of the patient, the patient,but as on, like a human level,
with our limitations as well andwe try to clarify that with
patients.
(15:46):
I think the patient has a senseof what a nurse should be and
that needs to be clarified rightin the beginning of the
relationship, when you're in theorientation phase, when you're
trying to develop what thepatients, collaborate with the
patient and build on thealliance.
And what are we doing togetherNot what am I doing to you and
build on the alliance and whatare we doing together, not what
(16:08):
am I doing to you?
I think as a psychotherapist,you know one of the biggest
roles is trying to understandthe person and in many ways I
don't think patients havedifficulty.
I'm using the word patients andI know it's interchanged with
clients, but I use the wordpatients and they may have a
hard time communicating oridentifying what they're feeling
(16:30):
or what they're thinking or whythey're thinking there, or
managing or tolerating their,their feelings.
And I think the therapist orthe nurse can help them, help
them with that, so they can kindof calm down their system, to
really try to, I guess, acceptor understand or make more
(16:56):
choices or be more responsiveversus reactive.
I think that that's really,really important.
It's a big part of nursingstaff being with patients, you
know, being with them, not doingfor them unless they can't do
it for themselves.
And then you know and alsothinking about is it
(17:17):
developmentally, what are wedoing in terms of our
interventions that are helpingthe person developmentally or to
mature is, as peplow would say,you know, um, it's a maturing
force.
You know we're not, weshouldn't, um, I guess we can
impact that in positive ways.
So the person grows, you know,like maybe their personality or
(17:40):
their thoughts could be lessrigid, or we can open up, be
more curious about what ishappening so they, the patient,
can talk about it versus rightand be open in it and let allow
the patient to be who they areand free to you know, free to
explore with a person, with atherapist.
Speaker 2 (18:04):
I love it, Cheryl.
I mean this is, yeah, I'm alwayswondering too, because I mean
I'm assuming all the nurseslistening are just getting
goosebumps, like I am, but I'mwondering how other professions
kind of hear this message,Because I, I agree, I think you
know nurses within healthcaresystems maybe this is, you know
it's, it's one of those thingswhere we're a profession that
gets undervalued and and ignoreda lot but we're the kind of the
(18:27):
glue of an organization, right,we, we make it, we make it all
happen, and it's one of thosethings that you know we don't
get represented well, like on abilling form.
People don't kind of, you know,when they're in trouble, ask
for a nurse specifically, butthen a nurse is always there.
Right, it's, a nurse is alwaysgoing to be there because
they're they're just everywherethroughout a hospital system.
(18:47):
So so maybe that's my question,maybe to kind of lean that
towards my next item, to maybethink about or hear your
perspective on.
You know, or do you have anyconcerns about psych, mental
health nurses usingpsychotherapy, either now or in
the future?
Speaker 3 (19:06):
I have concerns.
Well, I, I don't.
I hope that they're gettingtrained.
That's that's one thing thatI'm getting a little bit
concerned about right, that Iget concerned that people are
not trained in the way or getsupervision, because that's so
(19:31):
important, that have to havethat space to think and to be
self-reflective, space to thinkand to be self-reflective, and
that I'm.
I hope that that still isvalued or or that we can bring
that back into.
I mean nursing staff.
They're running from what?
They're short staff, they'rerunning from one space to the
(19:51):
next and they don't really get agood.
They may not get supervision.
I hope that they are gettingsupervision with the nurse
practitioners.
I'm not sure, but they'reexpected to be prescribing.
I know that I, I I'm actuallyit's interesting that I'm
looking for psychotherapy to beto me, to be more psychotherapy
(20:13):
jobs, and I'm not finding.
If I'm not a nurse practitioner, forget it.
They don't want me, which I've,which is really, and I've said
to them I just think you'remaking a big mistake because I
think that I can provide a lotmore, especially in, like, maybe
, primary care settings.
You know where, where the youneed an adjunct person who
understands medical and medicaland psych, and I do understand
(20:37):
the medications and sort of theactions and side effects and
contraindications, et cetera,and indications I just can't
prescribe and so I'm discounted.
So just much like I think maybethe psychotherapist a nurse
psychotherapist might betherapist might be undervalued.
(20:59):
I also think that if you'represcribing there's a huge you
know Dr Mintz at Riggs.
He wrote a book onpsychodynamic prescribing,
psychopharmacology, and there'sso much about the patient's
relationship to the medicationsand what it means and what they
(21:21):
think it might do for them ornot do for them or how they're
attached to the medication.
That really needs to bediscussed and I hope that the
nurse practitioners are usingthat also as a way to develop a
relationship and enhance theeffects of the medication.
Because I think we know what isit?
(21:42):
33% effective rate formedications yeah, yeah, right.
Speaker 2 (21:51):
Guiltiest charge.
I think we say yeah, right, Imean, it's right yeah.
Speaker 3 (21:55):
So we can't just be prescribing, we have to be doing
both and I hope that that getsemphasized in nursing programs
and advanced practicepsychotherapy programs.
And I do hope that there is apiece.
I'm not sure because I haven't.
I remember when I was in gradschool that I did have an
(22:15):
analyst, a nurse analyst,teaching my psychotherapy class,
and I think that's when I firstgot interested in the
psychodynamic piece.
Her name was Rose Vasta.
I remember her specifically andshe said you have to like your
patient, find one thing that youlike about them and connect to
(22:38):
them.
And connection is so important,right For for healing and for,
um, even suicide prevention.
How important connection is.
Uh.
So this she, she sort of got mevery, very interested in the
psychodynamic piece.
And there are nurses that areinterested in being analysts to
(23:00):
the programs and I hope that theprograms are more willing to
accept nurses as analysts,because we have a very big, nice
big perspective.
We have the psych perspective,we have the medical perspective,
we have family, we see patientswith families perspective.
We have family, we see patientswith families, we know family
dynamics, systems.
I mean I just think you knowit's the response to the
(23:28):
person's illness or the person'sthe treatment of that illness,
that we that nursing, that's thenursing role and we can impact
the person so much.
So yeah, I don't know if I'manswering your questions or just
going off on a tangent?
Speaker 2 (23:40):
That's, that's what I hope really.
I mean, tangents are good,we're accepting of tangents here
.
We're not going to, we're notgoing to look to prescribe
anything for that.
But yeah, I know, I think Ithink what you said too is
important because you know theundervalued.
I think I've shared a storybefore where I interviewed for a
job once and asked about myability or capacity within this
role to do psychotherapy and theperson interviewing me just
(24:02):
kind of really strangely andalmost kind of chuckled a little
bit, like that's why we gotsocial workers, I mean.
So I just knew right at thatpoint the interview was over and
I wasn't going to be comingthere.
But it is something that you'reright, it's not advertised and
it's.
And it's interesting toobecause and maybe share your
perspective on this too becausewe did a study, you know, as
(24:23):
part of this team, where welooked at you know what forms of
psychotherapy PMHMP programsare utilizing and I'm sorry to
say that psychoanalysis was kindof far down on the list.
You know it was CBT, it wasmotivational interviewing, those
kinds of things, those kind of,you know, bread and butter kind
of forms of psychotherapy.
And so again, thinking aboutthat undervalued approach here,
(24:46):
undervalued as a therapist andundervalued as a analyst and our
dynamic approach.
Do you kind of, do you have aperspective on that and why that
undervalued?
Speaker 3 (24:56):
is there or yeah, do you have a perspective on that
and why that undervalued?
Is there?
I think, coming from apsychodynamic perspective, you
have to.
It's harder.
I shouldn't say that, butthere's no manual.
I mean, really, is there amanual?
(25:17):
Is there?
You're the tool.
You are the tool that has to berefined and self-reflective and
responsive to the patient andhold oneself in.
You know, ethically, morally,and come from a perspective of
(25:38):
really understanding the patient.
I think that's wherepatient-centered is.
It's not doing whatever thepatient wants you to do.
That's not patient-centered.
It's really addressing the coreproblems, the core issues with
the patient, and that takes alot of work and it's not trying
(26:00):
to get rid of a problem.
It's not.
It's not it's.
It's it's helping the patientunderstand where that, where the
, where that issue is comingfrom and the repetitiveness of
it and the compulsive, thecompulsive nature of it and the
rigidity of it.
And it's working throughsomething over and over and over
(26:24):
and over again again and comingto it with a perspective that,
okay, we're doing this again,we're doing this again and it's
okay, it's okay.
Okay, because the patient needstime and they need the
relationship and they need thespace, and that I don't think
that's what I'm afraid of isthat the there's not enough time
(26:46):
.
There's not enough.
The expectation is I have thisproblem, I want to get rid of it
, and if you can do it for mequickly, that's great.
And that's just not the waythat psychodynamic therapy works
.
Speaker 4 (27:00):
I don't think at all so and Cheryl, I think what
you're saying is so interestingand important because it makes
me think about how many of usare working within health care
systems that see working overthe same thing over and over
again as a failure.
They want to see concrete,measurable, billable outcomes
(27:21):
for everything that we do.
And that's very hard toquantify what you're describing,
and I think so much of thissort of emphasis on CBT and MI
and stuff is because it's briefintervention, that is, you know,
measurable in some way.
And so you know there's a bitof a mismatch right between our
very quantitative system andthis very qualitative work.
(27:42):
And so, you know, on that note,I kind of want to ask you our
final question, which is youknow, given that and given
everything you say, what do yousee as the future of
psychotherapy for PMHMPs oradvanced practice psychiatric
nurses?
Speaker 3 (28:03):
Well, first of all, before I answer that question, I
think there's a place for thefor when someone is really
really in distress and andsuicidal and, you know, for like
, even for patients that need tobe have electroconvulsive
therapy, which was veryeffective, so they can kind of
get into a place where they cando the psychodynamic piece.
So that's just one thing that Iwant to say.
(28:26):
There is a place for that.
So what's the future?
I think we hopefully can domore educating of those that
hold up our purse strings.
I guess that people that wereout there doing it, who are
(28:47):
doing psychotherapy, can educateand inform patients and
insurance companies and even geton insurance companies to try
to make like, even even get onsome of the regulatory bodies
(29:09):
like Joint Commission andDepartment of Mental Health and
try to enter in, involvethemselves and integrate these
principles to, uh, to allow usto practice up to our you know,
our highest authority.
I think that that's that's,it's, you know that that's what
we need to do.
(29:30):
It's just an open door.
There's a lot of opportunities.
So that's one thing and, um, Ithink for also for faculty, you
know, for I'm is, you know, justfrom the undergraduate level,
because I've taught.
I taught at Hawaii CommunityCollege, but also I taught at
UCLA and I taught et cetera.
But but what I'm seeing is that,like, med surge nurses are
(29:53):
teaching psych and that thatshouldn't, were someone else is
teaching or they're expecting meto teach.
I mean I can teach fundamentalsand and go to the nursing home,
because I was in geriatricpsychiatry, things like that.
But if you want me in labordelivery or ICU, I don't, you
know, I don't think that's goingto work.
(30:14):
Or a med surgeon is teachingpsych and that's accepted
because of the limitations ofnot, maybe not not a lot of us
around.
The pay isn't that great.
I mean, I feel like I'm a dyingbreed really, you know, and when
you, when you're an educatorand really value and passionate
(30:40):
about psych, mental health,nursing, I'm how many?
I don't know how many peopleare willing to do the clinicals
as well, you know they're not alot of people that are willing
to do that.
So I, in that way, I'm afraid,I'm afraid for, for for the
psych mental health nurse, forfor the psych mental health
(31:01):
nurse, and I also think we needto advocate for psychotherapy as
being effective or necessary inalso combined with, maybe,
medicaid.
You know with medication thatthe two together work much
better than either one, maybeeither one separately.
Speaker 2 (31:17):
Yeah.
And that's what the data says.
Right, and I appreciate youtalking about this upstream
issue of you know undergraduatesand I know so many college
nursing programs I know of thistoo.
You know where they make you dothose four core classes.
You know med, psych, geropedes,and you know, and you have to
(31:38):
do two of them.
So so many students don't evenget psych in their undergrad and
then, unfortunately, they gointo grad school, you know,
after discovering their passionfor it, and so then they don't
have that foundational skillstoo.
So I appreciate you bringingthat up.
That's something you're rightadministratively and getting on
those boards.
You know we need to kind ofspeak up for this sort of thing,
cause if it don't it'll justdie on the on the vine, like
(32:00):
you're saying.
So, um, one thing I and againthis isn't kind of some of our
standard questions, but I thinkthis is kind of I'm going to
call this kind of our after darkpart of our podcast today,
after dark with Peplow's ghostUm, because I wanted you to kind
of be able to highlight yourorganization, austin Riggs
(32:21):
Center.
You know this is an organizationthat sounds like you devoted
most, you know, several years ofyour life at least to and again
thinking about it.
As far as you know, notavailable to everybody.
You know I will say I'm fromthe University of Iowa.
You know, finding apsychodynamic facility to send
some of my patients is verychallenging.
I pretty much have to send themto Chicago to find some sort of
(32:44):
Adlerian type of approach whichis, you know, psychodynamic in
nature.
But you know, one of thequestions I do have about your
facility, if you wouldn't mindkind of just talking about a
little bit, you know, kind ofbrag on it a bit, but also kind
of share.
Why is it called Austin Riggs?
Because I will share kind of.
A facility that I worked at wascalled the Robert Young Center.
(33:05):
I'm not old enough, but Iunderstand that they also.
I'm sorry, robert Young was anactor on a very wildly popular
show for a while and he's aphysician and so it was
interesting that he actuallycame it was like from California
.
He came to the middle of thecountry to get psychiatric care
and got better and so donated alot of money and that's how this
(33:25):
our, you know, one of our localcommunity mental health centers
was developed, and named afterRobert Young Center is the name.
So so it just, if you wouldn'tmind, cheryl, just kind of
sharing a little bit about theAustin Riggs center and, uh um,
how it got named and what you'remaybe most proud of it for.
Speaker 3 (33:42):
Well, I, I can do a little bit of that.
Uh, and he, austin Fox Riggs,was a psychiatrist, american
psychiatrist, and apparently hecame to the Berkshires, which is
(34:03):
the western part ofMassachusetts, and landed in
Stockbridge and formed theAustin Riggs Center, and it's
100, it was formed, I believe,in 1917, I think it was, and so
in 20, was it 1907?
I think, or no, it was 1917.
(34:26):
I'm sorry.
So I think in 2017, we had our100-year anniversary.
In 2017, we had our 100 yearanniversary, you know, and it's,
and what I want to tell more,too, though, is, and there are
there is the emphasis on, uh,the residential piece, or
residential treatment centers,which I don't think are, are, um
(34:48):
, are valued or even known.
A lot of the residential, ifyou think of substance use, the
28-day substance use program butthere are residential treatment
centers that are popping up allover.
Menninger has one now, mcleanhas many, and I think that that
might be a really good place fora nurse practitioner or a psych
(35:12):
, mental health or, you know,dnp, to get involved in that and
to use a psychodynamic approachthere, because you have people
there for a long period of timethat are really trying to.
You can develop a relationshipwith them.
The other thing about austinriggs, which I think is um,
which I think is another issuethat is problematic, not when I
(35:33):
think boston riggs, I think ofthe open setting.
There are no locked doors.
They are their patients, arethere voluntarily, on their own
will doesn't mean that they havedon't have crises and things
like that they do.
But we work through that withpeople and we build on the
(35:54):
alliance you know thetherapeutic alliance with, and
then they're in a very intenserelationship with their
therapist.
So that's sort of like thecentrality of it.
And then we social work,psychologists, et cetera,
nursing staff, therapeuticcommunity staff, et cetera,
(36:15):
nursing staff, therapeuticcommunity staff also work very
diligently and intimately withthe patient right, and they're
on team.
So there's continuity.
But the other thing about thiscenter is that you know it's an
open setting.
There is a very robust patientgovernment.
So they have community meetingsthat are led by patients Monday
(36:37):
through Friday.
They have representatives fromfacilities, from the, you know,
from gym, from the activitiesdepartment, and then there's
also an activities department.
That is really quite, I think,beautiful in terms of it's a
non-therapeutic space.
(36:57):
So they hire artists.
We have a person who's thedirector of Shakespeare and
Company, who does?
They do two plays a year.
One is a Shakespeare play, Ican imagine, and the patients
get involved and you knowthere's also a greenhouse,
there's ceramics, there's ummusic as well and we try to get
(37:22):
people um to.
You know, there's so muchcompetence, so much competence,
and you know people have leftRiggs and gone and done you
artwork and been artists andbeen been actors and and that
has been a huge part of the ofthe treatment as well.
You know the creative side thatsomeone needs to explore and
(37:46):
value and embrace, and so that'sthat's really important.
And so there's also a veryrobust therapeutic community
staff so they're hired to be inthe community, they work with
the patients.
In terms of the differentprograms that the patients are
in, there's a, there's a nursingprogram that the patients
(38:08):
reside at the inn, which is,which has like 40 beds, and they
are a group program, whichthere's groups that the
therapists, that the analysts,the therapists run as well as
nursing staff run, as well asthe therapy community staff run.
And then there's differentgroups that focus on living in a
(38:30):
smaller home, you know, butstill on campus, that focus on
how do you live in a family, howdo you be a civilian, you know,
a community member, what kindof community do you want?
So there's a lot of freedom inthat.
And then there's also, then,you know, trying to get more
into the community, into theStockbridge community or to the
(38:52):
Berkshire community, maybe goingback to school or working or
you know, and then kind oftransitioning out, all still
getting the four days a weekintensive psychodynamic
psychotherapy which is the core,you know, central piece of the
treatment.
So and they also get, they havea psychopharmacologist or a
psychiatrist or a provider, aphysician who provides
(39:16):
medications, who could be theirtherapist or they could be
separate, you know, they getmaybe an MD and a therapist.
So they have a huge team, avery consistent team and a
dedicated team to the, to theperson as well.
So it just is the it works, butthe, you know, and the minimum,
(39:37):
the length of the minimumlength of stay is six weeks
where there's an evaluationperiod and at the end of that
there's a case conference.
Everybody weighs in, includingnurses, about what, how their
work, they showcase their workwith patients.
So you know it's probably oneof the last open setting
residential.
(39:57):
Well, yeah, you know, you usedto have Shepard Pratt Chestnut
Lodge.
You know, I don't know ifpeople knew about them, but
Austin Riggs has been around along time.
Speaker 2 (40:22):
But Austin Riggs has been around a long time and I
think it's because the approachthat we use is very, very
helpful for patients.
They transform themselves.
They get to let their livesback, log off before that to
find out about those experiences.
But thank you for just sharingthat and giving us a peek inside
the doors, a little bit ofAustin Riggs.
But thank you for the listeners.
This is the end of our podcast.
We're going to come back withanother podcast next week and so
(40:44):
super excited to have anotherguest and continue to get people
excited about this topic.
So please like subscribe, put acomment in there and we'll be
back next week, take care.
Speaker 1 (40:57):
They feel it.
Therefore, it's true Work harduntil those thoughts are finally
leaving so you can be you.
They feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving so you can beyou.
You've got a discovery Identifyand challenge in your beliefs,
reframing your mind Negativethoughts.
Release these cognitivedistortions.
Decrease Until they cease.
(41:18):
God of discovery, identifying,challenging your beliefs,
reframing your mind.
Negative thoughts.
Release these cognitivedistortions, decrease Until they
cease.
Yeah, just my take on things.
My answer number two I thinkwe're recording.
Speaker 2 (00:27):
Welcome back everybody to peplau's ghost.
Another episode so excited.
Uh, I'm thrilled for our nextguest here, um cheryl putinil.
I hope I'm pronouncing thatright uh, puntil, thank you
thank you.
Cheryl puntil will be joining usand sharing her experiences and
really excited about the summerwe've got lined up here on Pep
(00:48):
Lau's Ghost.
You know kind of to give alittle background with Cheryl.
She actually approached usabout being on the podcast.
So I'm super excited about thisidea that the podcast is
actually reaching people thatare interested and want to be on
here.
So really encourage you, ifyou're listening to this right
now and you like this podcast,like this content, reach out to
myself, dr Kate Molino, dr SeanConvoy, any of the people that
(01:10):
are here on the podcast andreally just kind of reach out
and say, hey, I want to be onhere and hey, we'll probably
allow you to be on here.
We're not very picky.
We want to kind of have people,we want to generate that
interest and really kind of movethat needle and keep keeping
psychotherapy within the rolehere.
So my quick introduction withCheryl Puntil here is that she
(01:31):
is, or was recently retired, theCNO, the chief nursing officer
at Austin Riggs Center, which isa psychodynamic facility in
Massachusetts, and has practicedas a PMH CNS.
Melissa, I know you're going toask me what that means.
That's a psych, mental healthcertified clinical nurse
specialist.
She's practiced for 43 years,so congratulations, cheryl.
(01:56):
You must've got yourcertification when you were 12.
Does that sound right?
Speaker 3 (01:59):
Yeah, in 1998, that was a long time ago.
Speaker 2 (02:04):
It's a minute, so that's great.
She's also certified as apsychodynamic psychotherapist
and again really excited to kindof get to know her experience
in using these forms ofpsychotherapy.
So my privilege of asking thefirst question is when did you
first get interested in doingpsychotherapy?
What was your first foray intoit and really maybe what got you
(02:26):
hooked?
Speaker 3 (02:27):
So I have a certificate in psychodynamic
psychotherapy, which was atwo-year program that I did
after my master's in clinicalnurse specialist at UCLA and at
that time California UCLA know,the UCLA split, the NP.
You could go into either the NPor the CNS, so I chose to go to
(02:50):
the CNS.
I didn't particularly want toprescribe and so, but I did
learn because I think UCLA wasso biologically motivated you
know the approach was verybiologic that I learned a lot
about medications and you knowthat, and I felt like I needed a
(03:12):
little more understanding ofwhat drives people, what
motivates people, what are their.
You know a lot, I believe thatpatients or people have, you
know, the unconscious, arethings that you know.
How do we get their unconsciousinto awareness, to be more
self-aware so they can makebetter decisions, et cetera?
(03:33):
So I did the two-year programat the Southern California
Psychoanalytic Institute and Idid actually do psychotherapy at
that time with four patientsthat were older.
I worked in geriatric psychiatryand I did that for most of my
profession.
But I also take thepsychodynamic piece into
(03:58):
supervision, into leadership,into working with patients in
the inpatient setting, workingwith students, working in
organizations, et cetera,because I think that that's,
it's just, you know consumes mein a way that I it's just the
way that I think dynamically andyou know.
(04:19):
So, in terms of psychotherapy,I use the patient relationship
and the nursing therapeuticrelationship as a way to
communicate with the patientsand to develop a rapport and to
help the patient find their wayto self-determination.
So, yeah, that's just Great.
Speaker 2 (04:43):
Well, I appreciate that.
I mean, I think what reallykind of stood out a little bit
to me too is is the idea thatyou use this within
organizations as well.
I think that's a if I can saythis I mean that's a very CNS
kind of thing to do.
I mean, I think you think notjust of the person, but you
think of populations, you thinkof organizations and how you can
apply that.
Do you mind sharing maybe anexample of that, how you applied
(05:03):
psychodynamic approaches to anorganization, or can you think
of something just off the top ofyour head?
Speaker 3 (05:09):
Well, it was interesting that because, you
know also, the community is veryimportant, right?
What's going on in the communityand in a residential center,
treatment center, where peoplelive, where patients live and
staff are involved in thetherapeutic community, what I
find happening unconsciously isthat the patients or the staff
(05:33):
will reflect it'll be likeparallel process.
We'll be in a meeting and youknow, and go through the same
kind of issues or discussionsabout, let's say, threat to the
organization or whatever, andthen we'll go into the community
meeting and the patients willbe speaking about the same thing
as well and it just seems like,wow, we just talked about that.
(05:54):
And so it's this dynamic, sortof unconscious way of thinking
in an organization that onegroup affects another group.
Whether we, you know, it's notso obvious, but until you know,
we have to look for that.
There's threads that affect thecommunity as well as the
(06:16):
professional, et cetera.
So there's a lot of links thereand I just felt that that was
fascinating.
You know, that was fascinating.
Thank you for sharing that.
That was, you know, veryinsightful, so that that was
fascinating.
Speaker 2 (06:23):
you know that was fascinating.
Thank you for sharing that.
That was, you know, veryinsightful, so appreciate that,
kate.
I think you got the nextquestion.
Speaker 4 (06:29):
Yeah, it also makes me think, Cheryl, about how, you
know, I do groups provisionwith my psych and peace students
and often we talk about howyou'll have a day in clinic
where everyone is bringing upthe same stuff.
Right, there are these sort ofinvisible threads that are woven
, that weave us together.
So thank you for that.
Speaker 3 (06:46):
Well, I remember one of the analysts that I was
supervised by while I was in LosAngeles.
He told me think of the commonthread, like you know, in a
weaved, you know in a rug that'sweaved.
Where is that common threadthat's being weaved through the
(07:07):
whole rug?
Or the patient, or the staffnurse, or the CEO, or me myself?
Right, what are the commonthings?
That's the thread that you haveto follow and that will lead us
, I think.
Look at that and evaluate itand really try to understand it.
Speaker 4 (07:33):
Yeah, and, and so my question for you is you know, if
you can, we love to ask here onthe podcast people to share
stories of maybe maybe the firsttime you performed
psychotherapyotherapy or maybe asession you had with someone
where it was kind of like a ahamoment happened and it really
taught you something.
Is there any situation likethat that comes to mind that you
(07:53):
could share with our listeners?
Speaker 3 (07:55):
well, you know, it's not.
It's not while I was doingpsychotherapy, it was while I
was, I think, as a nurse and ain a in a geriatric psychiatric
nurse.
You, you have to really try tobe a detective.
And and um, we had a patientonce that was very young, who
(08:18):
had um, she had come onto theunit and she was neurologically
felt.
We felt that the nursing stafffelt that it was, she was
neurologically impaired, meaningthat something had happened to
her physically or medically, andthere was other people who
thought that this was allpsychiatric and that she was
(08:38):
having a break, a schizophrenicbreak, and it was being a
detective, it was interviewing.
You know, like I think hilliardpeplow was the one that talked
about knowing your patient you,you have to know your patient
and it's how you ask questionsand who you ask the questions to
(08:59):
, because you're not going toget the, the answers that you
want.
Well, the answers that you want, well, the answers that you
want, I mean, or the answers,depend on the questions you ask,
right?
And so I thought that and Italked, it was a puzzle as to
what was happening with thisperson, and one of the nurses
told me she said Cheryl, I thinkshe's worse with the medication
(09:21):
.
And then I kind of put two andtwo together and I talked to the
family and the history and wefound out that she had a sore
throat in, you know, a sorethroat that was never really
treated and I, we, we got her astrep titer and she had the
(09:42):
biggest, the highest level thatthey had seen.
And we found out that she hadthe pediatric on pandas, you
know, the pediatric autoimmuneneurological disorder, and and
and it was so interestingbecause the team that saw her as
an adult, like the neuro teamthat saw her as the adults, said
one thing completely differentthan the infectious disease team
(10:05):
in in peds infectious diseasebecause she was, she was young,
she was right on the edge ofadult, you know, adolescent, and
completely same, same person,same manifestation of the
symptoms, but completelydifferent assessment.
And so you need to look at thepatient as well as the family
(10:28):
and the context of when thingswere, how things happen in the
context, and so that's that wasan aha moment for me about how
important it is to be thorough,to really know your patient, to
listen to everybody, listen tostaff, to look at your patient.
I don't think the staff now arenot staff, but sometimes you're
(10:50):
not looking at.
When I go to my primary careprovider and get my physical,
they don't necessarily even lookat my.
Listen to my heart.
They don't have me on dressanymore, and so are you really
looking at your patient?
That's, that's what I wouldthink.
In terms of psychotherapy, youknow there's always therapeutic
(11:10):
moments.
Every interaction should betherapeutic one, or with
intention.
That's how I kind of see it,and you know so.
I don't know if that answersyour question, but I think so.
Speaker 5 (11:26):
I'm seeing some nods.
Thank you for sharing.
I would love to pivot just alittle, although I hear aspects
of what might come out in yourresponse to this next question
how do you see nursing?
Speaker 3 (11:43):
being a leader in performing psychotherapy.
Psychotherapy.
Well, you know, nursing isreally for me.
People ask me how come youdidn't become a doctor, how come
you didn't become whatever?
I think nursing is, for me, thebest profession ever, because
it's a conglomeration of a lotof different things, of social
work, of psychology, of a lot ofdifferent things of social work
(12:07):
, of psychology, of medicine, ofphysical therapy, of you know,
and it really what I feel isthat the nurse's role is trying
to assist the person become lessill, I guess, or move towards
wellness, either because as aresponse to their illness or as
(12:29):
a response to a perceived orthought of their illness or to
the treatment of that illness.
And so we have a and we see thepatients more in terms of
spending time with the patients,more than any other profession,
I think.
And so, as a nurse, we have alot of impact, we can have a lot
(12:49):
of impact and we're in chargeof the milieu, we are their eyes
and ears, the physician's eyesand ears or the provider's eyes
and ears, and can see patientsin the context of their behavior
, you know, because there aremany.
In many ways the patient willact very differently with the
(13:10):
therapist An hour.
You know it rigs, they, theytake, um, they get very
intensive psychodynamic orpsychoanalytic psychotherapy
four times a week and then therest of the time the patient is
in programs or in communitymeetings or socializing, or
they're in their activityprograms and just doing
(13:31):
activities but so, and or elsethey're just kind of hanging out
with the nursing staff or withthe therapeutic community staff,
and that is when we can gain alot of information about about
the patient and what they'rethinking and what they're
experiencing and what they'restruggling with, and we can make
an impact then as well.
(13:51):
And I also think that you knowwe meet nursing staff.
They meet with patients.
You know, even when I was on aninpatient unit, on our unit,
when I first started, we hadcommunity meetings, you know,
and excuse me, and everybodyattended, everybody.
(14:13):
It wasn't just this one person.
You go to one appointment andthen you go to another
appointment and then you go toanother appointment and no one,
you know, and and the patient isseeing, all the staff are there
too.
So I remember that and that wasreally, really important.
That seems to have gotten lostin the inpatient settings, the
community meetings, and then wealso have teams.
(14:38):
You know where there'scontinuity.
I know for the nurse in theinpatient setting.
We did primary nursing when Iwas at UCLA and also when I was
at Mayo.
We did primary nursing and alsoat Rush when I was at Rush and
the continuity was so importantbecause you really got to know
(15:00):
your patient, know your patientand if the patient also kind of
knew what the limitations wereor what the boundaries were, the
frame you know was in therelationship, um too, and we
have to keep keep repeating theboundaries of the relationship
or the frame of the relationship, so you know um well, the
(15:23):
relationship keeps coming out inthese examples and the
humanness andmultidimensionalness of a person
, of the patient, the patient,but as on, like a human level,
with our limitations as well andwe try to clarify that with
patients.
(15:46):
I think the patient has a senseof what a nurse should be and
that needs to be clarified rightin the beginning of the
relationship, when you're in theorientation phase, when you're
trying to develop what thepatients, collaborate with the
patient and build on thealliance.
And what are we doing togetherNot what am I doing to you and
build on the alliance and whatare we doing together, not what
(16:08):
am I doing to you?
I think as a psychotherapist,you know one of the biggest
roles is trying to understandthe person and in many ways I
don't think patients havedifficulty.
I'm using the word patients andI know it's interchanged with
clients, but I use the wordpatients and they may have a
hard time communicating oridentifying what they're feeling
(16:30):
or what they're thinking or whythey're thinking there, or
managing or tolerating their,their feelings.
And I think the therapist orthe nurse can help them, help
them with that, so they can kindof calm down their system, to
really try to, I guess, acceptor understand or make more
(16:56):
choices or be more responsiveversus reactive.
I think that that's really,really important.
It's a big part of nursingstaff being with patients, you
know, being with them, not doingfor them unless they can't do
it for themselves.
And then you know and alsothinking about is it
(17:17):
developmentally, what are wedoing in terms of our
interventions that are helpingthe person developmentally or to
mature is, as peplow would say,you know, um, it's a maturing
force.
You know we're not, weshouldn't, um, I guess we can
impact that in positive ways.
So the person grows, you know,like maybe their personality or
(17:40):
their thoughts could be lessrigid, or we can open up, be
more curious about what ishappening so they, the patient,
can talk about it versus rightand be open in it and let allow
the patient to be who they areand free to you know, free to
explore with a person, with atherapist.
Speaker 2 (18:04):
I love it, Cheryl.
I mean this is, yeah, I'm alwayswondering too, because I mean
I'm assuming all the nurseslistening are just getting
goosebumps, like I am, but I'mwondering how other professions
kind of hear this message,Because I, I agree, I think you
know nurses within healthcaresystems maybe this is, you know
it's, it's one of those thingswhere we're a profession that
gets undervalued and and ignoreda lot but we're the kind of the
(18:27):
glue of an organization, right,we, we make it, we make it all
happen, and it's one of thosethings that you know we don't
get represented well, like on abilling form.
People don't kind of, you know,when they're in trouble, ask
for a nurse specifically, butthen a nurse is always there.
Right, it's, a nurse is alwaysgoing to be there because
they're they're just everywherethroughout a hospital system.
(18:47):
So so maybe that's my question,maybe to kind of lean that
towards my next item, to maybethink about or hear your
perspective on.
You know, or do you have anyconcerns about psych, mental
health nurses usingpsychotherapy, either now or in
the future?
Speaker 3 (19:06):
I have concerns.
Well, I, I don't.
I hope that they're gettingtrained.
That's that's one thing thatI'm getting a little bit
concerned about right, that Iget concerned that people are
not trained in the way or getsupervision, because that's so
(19:31):
important, that have to havethat space to think and to be
self-reflective, space to thinkand to be self-reflective, and
that I'm.
I hope that that still isvalued or or that we can bring
that back into.
I mean nursing staff.
They're running from what?
They're short staff, they'rerunning from one space to the
(19:51):
next and they don't really get agood.
They may not get supervision.
I hope that they are gettingsupervision with the nurse
practitioners.
I'm not sure, but they'reexpected to be prescribing.
I know that I, I I'm actuallyit's interesting that I'm
looking for psychotherapy to beto me, to be more psychotherapy
(20:13):
jobs, and I'm not finding.
If I'm not a nurse practitioner, forget it.
They don't want me, which I've,which is really, and I've said
to them I just think you'remaking a big mistake because I
think that I can provide a lotmore, especially in, like, maybe
, primary care settings.
You know where, where the youneed an adjunct person who
understands medical and medicaland psych, and I do understand
(20:37):
the medications and sort of theactions and side effects and
contraindications, et cetera,and indications I just can't
prescribe and so I'm discounted.
So just much like I think maybethe psychotherapist a nurse
psychotherapist might betherapist might be undervalued.
(20:59):
I also think that if you'represcribing there's a huge you
know Dr Mintz at Riggs.
He wrote a book onpsychodynamic prescribing,
psychopharmacology, and there'sso much about the patient's
relationship to the medicationsand what it means and what they
(21:21):
think it might do for them ornot do for them or how they're
attached to the medication.
That really needs to bediscussed and I hope that the
nurse practitioners are usingthat also as a way to develop a
relationship and enhance theeffects of the medication.
Because I think we know what isit?
(21:42):
33% effective rate formedications yeah, yeah, right.
Speaker 2 (21:51):
Guiltiest charge.
I think we say yeah, right, Imean, it's right yeah.
Speaker 3 (21:55):
So we can't just be prescribing, we have to be doing
both and I hope that that getsemphasized in nursing programs
and advanced practicepsychotherapy programs.
And I do hope that there is apiece.
I'm not sure because I haven't.
I remember when I was in gradschool that I did have an
(22:15):
analyst, a nurse analyst,teaching my psychotherapy class,
and I think that's when I firstgot interested in the
psychodynamic piece.
Her name was Rose Vasta.
I remember her specifically andshe said you have to like your
patient, find one thing that youlike about them and connect to
(22:38):
them.
And connection is so important,right For for healing and for,
um, even suicide prevention.
How important connection is.
Uh.
So this she, she sort of got mevery, very interested in the
psychodynamic piece.
And there are nurses that areinterested in being analysts to
(23:00):
the programs and I hope that theprograms are more willing to
accept nurses as analysts,because we have a very big, nice
big perspective.
We have the psych perspective,we have the medical perspective,
we have family, we see patientswith families perspective.
We have family, we see patientswith families, we know family
dynamics, systems.
I mean I just think you knowit's the response to the
(23:28):
person's illness or the person'sthe treatment of that illness,
that we that nursing, that's thenursing role and we can impact
the person so much.
So yeah, I don't know if I'manswering your questions or just
going off on a tangent?
Speaker 2 (23:40):
That's, that's what I hope really.
I mean, tangents are good,we're accepting of tangents here
.
We're not going to, we're notgoing to look to prescribe
anything for that.
But yeah, I know, I think Ithink what you said too is
important because you know theundervalued.
I think I've shared a storybefore where I interviewed for a
job once and asked about myability or capacity within this
role to do psychotherapy and theperson interviewing me just
(24:02):
kind of really strangely andalmost kind of chuckled a little
bit, like that's why we gotsocial workers, I mean.
So I just knew right at thatpoint the interview was over and
I wasn't going to be comingthere.
But it is something that you'reright, it's not advertised and
it's.
And it's interesting toobecause and maybe share your
perspective on this too becausewe did a study, you know, as
(24:23):
part of this team, where welooked at you know what forms of
psychotherapy PMHMP programsare utilizing and I'm sorry to
say that psychoanalysis was kindof far down on the list.
You know it was CBT, it wasmotivational interviewing, those
kinds of things, those kind of,you know, bread and butter kind
of forms of psychotherapy.
And so again, thinking aboutthat undervalued approach here,
(24:46):
undervalued as a therapist andundervalued as a analyst and our
dynamic approach.
Do you kind of, do you have aperspective on that and why that
undervalued?
Speaker 3 (24:56):
is there or yeah, do you have a perspective on that
and why that undervalued?
Is there?
I think, coming from apsychodynamic perspective, you
have to.
It's harder.
I shouldn't say that, butthere's no manual.
I mean, really, is there amanual?
(25:17):
Is there?
You're the tool.
You are the tool that has to berefined and self-reflective and
responsive to the patient andhold oneself in.
You know, ethically, morally,and come from a perspective of
(25:38):
really understanding the patient.
I think that's wherepatient-centered is.
It's not doing whatever thepatient wants you to do.
That's not patient-centered.
It's really addressing the coreproblems, the core issues with
the patient, and that takes alot of work and it's not trying
(26:00):
to get rid of a problem.
It's not.
It's not it's.
It's it's helping the patientunderstand where that, where the
, where that issue is comingfrom and the repetitiveness of
it and the compulsive, thecompulsive nature of it and the
rigidity of it.
And it's working throughsomething over and over and over
(26:24):
and over again again and comingto it with a perspective that,
okay, we're doing this again,we're doing this again and it's
okay, it's okay.
Okay, because the patient needstime and they need the
relationship and they need thespace, and that I don't think
that's what I'm afraid of isthat the there's not enough time
(26:46):
.
There's not enough.
The expectation is I have thisproblem, I want to get rid of it
, and if you can do it for mequickly, that's great.
And that's just not the waythat psychodynamic therapy works
.
Speaker 4 (27:00):
I don't think at all so and Cheryl, I think what
you're saying is so interestingand important because it makes
me think about how many of usare working within health care
systems that see working overthe same thing over and over
again as a failure.
They want to see concrete,measurable, billable outcomes
(27:21):
for everything that we do.
And that's very hard toquantify what you're describing,
and I think so much of thissort of emphasis on CBT and MI
and stuff is because it's briefintervention, that is, you know,
measurable in some way.
And so you know there's a bitof a mismatch right between our
very quantitative system andthis very qualitative work.
(27:42):
And so, you know, on that note,I kind of want to ask you our
final question, which is youknow, given that and given
everything you say, what do yousee as the future of
psychotherapy for PMHMPs oradvanced practice psychiatric
nurses?
Speaker 3 (28:03):
Well, first of all, before I answer that question, I
think there's a place for thefor when someone is really
really in distress and andsuicidal and, you know, for like
, even for patients that need tobe have electroconvulsive
therapy, which was veryeffective, so they can kind of
get into a place where they cando the psychodynamic piece.
So that's just one thing that Iwant to say.
(28:26):
There is a place for that.
So what's the future?
I think we hopefully can domore educating of those that
hold up our purse strings.
I guess that people that wereout there doing it, who are
(28:47):
doing psychotherapy, can educateand inform patients and
insurance companies and even geton insurance companies to try
to make like, even even get onsome of the regulatory bodies
(29:09):
like Joint Commission andDepartment of Mental Health and
try to enter in, involvethemselves and integrate these
principles to, uh, to allow usto practice up to our you know,
our highest authority.
I think that that's that's,it's, you know that that's what
we need to do.
(29:30):
It's just an open door.
There's a lot of opportunities.
So that's one thing and, um, Ithink for also for faculty, you
know, for I'm is, you know, justfrom the undergraduate level,
because I've taught.
I taught at Hawaii CommunityCollege, but also I taught at
UCLA and I taught et cetera.
But but what I'm seeing is that,like, med surge nurses are
(29:53):
teaching psych and that thatshouldn't, were someone else is
teaching or they're expecting meto teach.
I mean I can teach fundamentalsand and go to the nursing home,
because I was in geriatricpsychiatry, things like that.
But if you want me in labordelivery or ICU, I don't, you
know, I don't think that's goingto work.
(30:14):
Or a med surgeon is teachingpsych and that's accepted
because of the limitations ofnot, maybe not not a lot of us
around.
The pay isn't that great.
I mean, I feel like I'm a dyingbreed really, you know, and when
you, when you're an educatorand really value and passionate
(30:40):
about psych, mental health,nursing, I'm how many?
I don't know how many peopleare willing to do the clinicals
as well, you know they're not alot of people that are willing
to do that.
So I, in that way, I'm afraid,I'm afraid for, for for the
psych mental health nurse, forfor the psych mental health
(31:01):
nurse, and I also think we needto advocate for psychotherapy as
being effective or necessary inalso combined with, maybe,
medicaid.
You know with medication thatthe two together work much
better than either one, maybeeither one separately.
Speaker 2 (31:17):
Yeah.
And that's what the data says.
Right, and I appreciate youtalking about this upstream
issue of you know undergraduatesand I know so many college
nursing programs I know of thistoo.
You know where they make you dothose four core classes.
You know med, psych, geropedes,and you know, and you have to
(31:38):
do two of them.
So so many students don't evenget psych in their undergrad and
then, unfortunately, they gointo grad school, you know,
after discovering their passionfor it, and so then they don't
have that foundational skillstoo.
So I appreciate you bringingthat up.
That's something you're rightadministratively and getting on
those boards.
You know we need to kind ofspeak up for this sort of thing,
cause if it don't it'll justdie on the on the vine, like
(32:00):
you're saying.
So, um, one thing I and againthis isn't kind of some of our
standard questions, but I thinkthis is kind of I'm going to
call this kind of our after darkpart of our podcast today,
after dark with Peplow's ghostUm, because I wanted you to kind
of be able to highlight yourorganization, austin Riggs
(32:21):
Center.
You know this is an organizationthat sounds like you devoted
most, you know, several years ofyour life at least to and again
thinking about it.
As far as you know, notavailable to everybody.
You know I will say I'm fromthe University of Iowa.
You know, finding apsychodynamic facility to send
some of my patients is verychallenging.
I pretty much have to send themto Chicago to find some sort of
(32:44):
Adlerian type of approach whichis, you know, psychodynamic in
nature.
But you know, one of thequestions I do have about your
facility, if you wouldn't mindkind of just talking about a
little bit, you know, kind ofbrag on it a bit, but also kind
of share.
Why is it called Austin Riggs?
Because I will share kind of.
A facility that I worked at wascalled the Robert Young Center.
(33:05):
I'm not old enough, but Iunderstand that they also.
I'm sorry, robert Young was anactor on a very wildly popular
show for a while and he's aphysician and so it was
interesting that he actuallycame it was like from California
.
He came to the middle of thecountry to get psychiatric care
and got better and so donated alot of money and that's how this
(33:25):
our, you know, one of our localcommunity mental health centers
was developed, and named afterRobert Young Center is the name.
So so it just, if you wouldn'tmind, cheryl, just kind of
sharing a little bit about theAustin Riggs center and, uh um,
how it got named and what you'remaybe most proud of it for.
Speaker 3 (33:42):
Well, I, I can do a little bit of that.
Uh, and he, austin Fox Riggs,was a psychiatrist, american
psychiatrist, and apparently hecame to the Berkshires, which is
(34:03):
the western part ofMassachusetts, and landed in
Stockbridge and formed theAustin Riggs Center, and it's
100, it was formed, I believe,in 1917, I think it was, and so
in 20, was it 1907?
I think, or no, it was 1917.
(34:26):
I'm sorry.
So I think in 2017, we had our100-year anniversary.
In 2017, we had our 100 yearanniversary, you know, and it's,
and what I want to tell more,too, though, is, and there are
there is the emphasis on, uh,the residential piece, or
residential treatment centers,which I don't think are, are, um
(34:48):
, are valued or even known.
A lot of the residential, ifyou think of substance use, the
28-day substance use program butthere are residential treatment
centers that are popping up allover.
Menninger has one now, mcleanhas many, and I think that that
might be a really good place fora nurse practitioner or a psych
(35:12):
, mental health or, you know,dnp, to get involved in that and
to use a psychodynamic approachthere, because you have people
there for a long period of timethat are really trying to.
You can develop a relationshipwith them.
The other thing about austinriggs, which I think is um,
which I think is another issuethat is problematic, not when I
(35:33):
think boston riggs, I think ofthe open setting.
There are no locked doors.
They are their patients, arethere voluntarily, on their own
will doesn't mean that they havedon't have crises and things
like that they do.
But we work through that withpeople and we build on the
(35:54):
alliance you know thetherapeutic alliance with, and
then they're in a very intenserelationship with their
therapist.
So that's sort of like thecentrality of it.
And then we social work,psychologists, et cetera,
nursing staff, therapeuticcommunity staff, et cetera,
(36:15):
nursing staff, therapeuticcommunity staff also work very
diligently and intimately withthe patient right, and they're
on team.
So there's continuity.
But the other thing about thiscenter is that you know it's an
open setting.
There is a very robust patientgovernment.
So they have community meetingsthat are led by patients Monday
(36:37):
through Friday.
They have representatives fromfacilities, from the, you know,
from gym, from the activitiesdepartment, and then there's
also an activities department.
That is really quite, I think,beautiful in terms of it's a
non-therapeutic space.
(36:57):
So they hire artists.
We have a person who's thedirector of Shakespeare and
Company, who does?
They do two plays a year.
One is a Shakespeare play, Ican imagine, and the patients
get involved and you knowthere's also a greenhouse,
there's ceramics, there's ummusic as well and we try to get
(37:22):
people um to.
You know, there's so muchcompetence, so much competence,
and you know people have leftRiggs and gone and done you
artwork and been artists andbeen been actors and and that
has been a huge part of the ofthe treatment as well.
You know the creative side thatsomeone needs to explore and
(37:46):
value and embrace, and so that'sthat's really important.
And so there's also a veryrobust therapeutic community
staff so they're hired to be inthe community, they work with
the patients.
In terms of the differentprograms that the patients are
in, there's a, there's a nursingprogram that the patients
(38:08):
reside at the inn, which is,which has like 40 beds, and they
are a group program, whichthere's groups that the
therapists, that the analysts,the therapists run as well as
nursing staff run, as well asthe therapy community staff run.
And then there's differentgroups that focus on living in a
(38:30):
smaller home, you know, butstill on campus, that focus on
how do you live in a family, howdo you be a civilian, you know,
a community member, what kindof community do you want?
So there's a lot of freedom inthat.
And then there's also, then,you know, trying to get more
into the community, into theStockbridge community or to the
(38:52):
Berkshire community, maybe goingback to school or working or
you know, and then kind oftransitioning out, all still
getting the four days a weekintensive psychodynamic
psychotherapy which is the core,you know, central piece of the
treatment.
So and they also get, they havea psychopharmacologist or a
psychiatrist or a provider, aphysician who provides
(39:16):
medications, who could be theirtherapist or they could be
separate, you know, they getmaybe an MD and a therapist.
So they have a huge team, avery consistent team and a
dedicated team to the, to theperson as well.
So it just is the it works, butthe, you know, and the minimum,
(39:37):
the length of the minimumlength of stay is six weeks
where there's an evaluationperiod and at the end of that
there's a case conference.
Everybody weighs in, includingnurses, about what, how their
work, they showcase their workwith patients.
So you know it's probably oneof the last open setting
residential.
(39:57):
Well, yeah, you know, you usedto have Shepard Pratt Chestnut
Lodge.
You know, I don't know ifpeople knew about them, but
Austin Riggs has been around along time.
Speaker 2 (40:22):
But Austin Riggs has been around a long time and I
think it's because the approachthat we use is very, very
helpful for patients.
They transform themselves.
They get to let their livesback, log off before that to
find out about those experiences.
But thank you for just sharingthat and giving us a peek inside
the doors, a little bit ofAustin Riggs.
But thank you for the listeners.
This is the end of our podcast.
We're going to come back withanother podcast next week and so
(40:44):
super excited to have anotherguest and continue to get people
excited about this topic.
So please like subscribe, put acomment in there and we'll be
back next week, take care.
Speaker 1 (40:57):
They feel it.
Therefore, it's true Work harduntil those thoughts are finally
leaving so you can be you.
They feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving so you can beyou.
You've got a discovery Identifyand challenge in your beliefs,
reframing your mind Negativethoughts.
Release these cognitivedistortions.
Decrease Until they cease.
(41:18):
God of discovery, identifying,challenging your beliefs,
reframing your mind.
Negative thoughts.
Release these cognitivedistortions, decrease Until they
cease.
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