April 4, 2025 • 28 mins
Dr. Tess Judge-Ellis shares her journey from family nurse practitioner to psychiatric mental health specialist, highlighting the power of nurse-led psychotherapy in rural communities and beyond.
• Starting as a family NP in a town of 1,000 people before adding psychiatric specialization
• Creating accessible mental health services through a designated "counseling room" that reduced stigma
• Using interpersonal psychotherapy (IPT) and motivational interviewing to help patients with grief and substance use disorders
• Emphasizing that every nursing encounter has psychotherapeutic potential from the first moment
• Comparing psychotherapy to "physical therapy for the brain" - small exercises that create lasting change
• Advocating for nursing education that strengthens psychotherapy skills beyond medication management
• Addressing barriers including time constraints and reimbursement systems that limit therapeutic interaction
Join our next episode in a few weeks as we continue exploring psychotherapy in nursing practice, including upcoming interviews with nurses who trained directly under Hildegard Peplau!
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.
Welcome back everyone.
Decrease until they cease.
You're stuck at a discovery,Identifying a challenge in your
(00:26):
beliefs.
I think we're recording.
Speaker 2 (00:29):
Welcome back everyone to Peplow's Ghost.
All right, another episode.
Hopefully everybody was dyingfor this episode, as we had the
two-week break.
I'll call it that it was ourspring break, although we didn't
really rest or anything.
But we're great to see you backor hear you back.
Hopefully we're talking outinto the ether, so hopefully
somebody's listening to this aswell.
I am joined with my esteemedcolleague, dr Sean Convoy from
(00:53):
Duke.
Dr Kate Molino that is, dr KateMolino from University of
California, san Francisco, justcompleted her PhD.
Dr Melissa Chapman-Hayes, fromMinnesota, and then we love to
have our guest here.
Dr Tessman Hayes, fromMinnesota, and then we are love
to have our guest here, dr TessJudge-Ellis, one of my
colleagues from the Universityof Iowa.
So looking really forward togetting to know her.
(01:13):
So let's get into it.
I always like kind of askingthese questions, especially from
a guest that knows me.
Tess, do you remember the firsttime that we met?
Speaker 3 (01:21):
Probably when you took health assessment course,
Dan, was that it?
Speaker 2 (01:25):
I you know.
I don't know if that's thefirst time, but that is what I
remember.
Speaker 3 (01:28):
I do too, you were my faculty.
You were destined for greatnesseven then.
Speaker 2 (01:32):
You are too kind, yeah, but I remember that I got
done with my assessment of kindof my final project and you
pulled me aside and you're likeyou should be an FNP.
I'm just like I'm okay, but I,you should be an FMP.
I'm just like I'm okay.
But but I always appreciatethat and it's a you know,
privilege to be working with younow.
So so thank you so much forjoining us here.
I'll get us started with ourfirst question of the podcast
(01:56):
when did you first startedgetting interested in
psychotherapy.
Speaker 3 (01:59):
Well, I think that you know, I think as a nurse
you're always, or at least kindof having a psych bent, as a
nurse is interested in thetherapeutic process that goes on
between people.
But I think probably when Ifirst got interested in
psychotherapy was when I was inmy psych NP program and met a
(02:20):
therapist then who supervised methen doing interpersonal
psychotherapy as a modality, andso I was able to do this with
two clients, and so then Istarted to be interested.
It was in my psych program.
You know I started as a familynurse practitioner and so always
kind of had this bent towardspsychiatry, but it was really in
(02:40):
the PMHMP program.
Speaker 2 (02:43):
So what made you go back and get your certificate?
I've never kind of talked toyou about that.
Speaker 3 (02:47):
It's all psych Dan.
Speaker 2 (02:49):
I know.
Speaker 3 (02:49):
It's all psych.
Speaker 2 (02:51):
We're all psych right .
Speaker 3 (02:52):
Nurses are all psych right it is, and I think you
know I probably always had alens towards mental health in
addition to family practice.
I really enjoy family practiceas well.
I do both addition to familypractice.
I really enjoy family practiceas well.
I do both, and so it was justnatural when I went back to get
my DNP the University ofTennessee Health Science Center
(03:12):
in Memphis they were because itwas really early.
I got my DNP in 2008,.
Before there were only like twoor three programs in the
country and so they had onewhere, if you were already a
nurse practitioner, you'd goback and pick up your psych
post-grad.
And so I was like, wow, thatsounds perfect for me.
Speaker 2 (03:31):
Yeah, that might date you, because now there are all
these programs popping upeverywhere, it's the number one
growing post-grad certpopulation.
So yeah, thanks, tess.
Speaker 4 (03:41):
So, tess, before I ask you a question, I'm just
going to throw out a challengeto future guests on this podcast
.
Particularly, kate and Melissaand I are looking for an
opportunity for somebody toshare a really unsavory story
about the first time they metDan, because I think we need to
kind of change the dynamic alittle bit.
So we'll see who dials intothat, ok, so, tess, let me?
(04:02):
Dan asked you a questionspecifically about the idea,
about you know, psychotherapy.
I'm going to ask you a morespecific question about can you
reflect on your experiencethrough the lens of
psychotherapy, and is there aparticular case or encounter
that crystallized the power ofpsychotherapy for you, and can
(04:23):
you perhaps de-identify andshare that story with us?
Speaker 3 (04:26):
Sure, when I was, I practiced for a long time in a
small town of a thousand.
I was first a family nursepractitioner and then I picked
up the psych post-grad, so theprogram, so the clinic, became a
real nurse-led, kind of nurserun what are you here for today?
And I ended up doing quite a lotof psychotherapy and counseling
(04:49):
and that's where I did some ofmy interpersonal psychotherapy
work, but probably working witha couple of individuals who had
traumatic grief and was able topull in and see them for, you
know, brief sessionsInterpersonal psychotherapy is
designed to be like a 12 to 15week session and to see them for
(05:12):
a brief time to walk throughthe process of grief with them.
Those were amazing experiences,especially in a town of a
thousand where people can justcome in and do that.
But then I also remember onedoing more supportive
psychotherapy with a woman whohad just been newly sober and
(05:36):
from alcoholism and I workedwith her for about a year on a
weekly or every other weeklybasis, didn't do any medication
adjustments but just walked withher as she was in this recovery
process once a week in thistown of a thousand.
So those are, you know, justdramatic encounters, lots of.
Yeah, those are probably two ofmy more favorite encounters,
(06:00):
yeah.
Speaker 4 (06:01):
Thank you.
Speaker 2 (06:02):
Yeah, thanks, tess, and again owners yeah, thank you
.
Yeah, thanks, tess, and againprobably need to cut me off guys
, but I mean I just so I knowabout this clinic and I guess
you know I imagine when you'rekind of having somebody you know
, a small town of a thousandpeople, you know, the idea of
going to a mental health clinicis really kind of threatening.
So was it, was it easier forthe clients that you saw, just
because you were a family nurse?
You know it was just kind of amedical clinic, or or was it?
Speaker 3 (06:26):
Yeah, we had it set up so it had a.
There was an office that didn'thave a sink in it that we
called the counseling room andso it was just had a table with
some comfortable chairs in itand you know it was a.
Yeah, I just had a.
It was interesting because ifsomebody came in for a med
(06:46):
management check or a follow upand they said, you know, tess,
I'm doing just fine with this,but you know, I think I've got
an ear to move and shift intosomething else.
So it was really quiteinteresting to have that kind of
flexibility and I do thinksmall towns to have that
(07:10):
available there without havingto drive and without the like
everybody knows my car as it'spulling up to the mental health
clinic, kind of thing.
Speaker 5 (07:19):
So reducing that and just kind of normalizing it too
just, I appreciate that I grewup in rural areas and have a lot
of family in very small towns,like 500 people, so to hear that
there is that access, um, withsome of those barriers reduced,
it's really cool.
Um, and I know you've mentioneda couple of kinds of
(07:41):
psychotherapy that you've usedin those encounters.
But are there forms or types ofpsychotherapy that you're drawn
to kind of more recently, or doyou, you know, draw from a kind
of like a range of differentapproaches?
Speaker 3 (07:54):
I probably draw from more of a range of approaches.
At this point I just I, mypractice has shifted from that
small town to where I work withpeople who have been formerly
homeless, chronically homeless,and so there's a lot of
substance use disorder andengagement needing, just people
needing to be engaged.
So I do quite a lot ofmotivational interviewing and I
(08:17):
think MI is great.
And then supportivepsychotherapy, just being
present with people and workingon their strengths and being
present with them.
And then I don't really use toomuch IPT anymore because the
population isn't really lendingitself to it.
But it really informs my aspecton attachments because IPT has
(08:40):
such a strong attachment base toit with Boldy.
So I think about folks and whenthey have trouble with making
attachments or coming in.
So it kind of contributes to alens that I see people through.
Speaker 5 (08:57):
Thank you.
Speaker 6 (08:59):
And Tess, it's so great to hear about your
experience, and something thatreally strikes me is just how
the areas that you focus on andwork on are so incredibly
relevant, like these areas offolks with substance use and
using supportive therapy and MIto help them, folks who have
traumatic grief and thinkingthrough the COVID pandemic and
people coping with all thesethings going on in the world.
(09:21):
So my question for you isreally how do you see nursing,
being a leader in performingpsychotherapy?
Speaker 3 (09:30):
Well, I mean, I think it gets back to the basic.
Well, first of all, I think thatwe have to continue to see that
every encounter has a potentialto be psychotherapeutic, and so
that is part of our engagement.
I mean, when we and if webelieve in the nurse patient
(09:52):
relationship that starts fromthe very minute, the minute you
meet somebody in a therapeuticencounter, then I think that
that the opportunity for apositive psychotherapeutic
encounter happens all the time,and the more that we can pull
into that as nurses, I think,the more that we can lead.
(10:13):
I remember doing the IPTtraining and it was mostly with
psychotherapists, and I rememberthe supervisor that I had, or
the psychologist that supervisedme, said well, you nurses never
have any problem establishingrapport, and I think that that's
just a big aspect of nursingtoo is that people can relate
(10:35):
and we understand how to relateto one another.
It's just the relationship isso fundamental into providing
any sort of nursing care that Idon't know if I'm getting at the
answer to your question, but Ithink that nurses, I mean even
just the action of you knowdistributing medications if
you're a bedside nurse or youknow, we bring something to the
(10:58):
table, a high level skill in thenurse patient relationship and
seeing that encounter that Ithink that we discount as part
of our skill set.
So I think the more we have toown that.
Speaker 2 (11:15):
Yeah, I've always learned from you, tess, is you
know that you always find aplace where nursing can be
inserted into the healthcaresystem because we're the largest
, you know, healthcareprofessionals in the healthcare
system, and so it's alwaysfascinating how nursing gets
left out of certain things.
You know boards, interventionsand things like that.
So I always kind of taken fromyou, you know, find a place
where nursing can be, and Ithink psychotherapy is one of
those places sometimes, as weget kind of not thought of as
(11:37):
being able to do those kind ofthings.
And so I guess my next questionis maybe to kind of think of
you know the flip of what Katejust asked.
You know or do you have anyconcerns about psych, mental
health nursing?
You know nurses usingpsychotherapy?
I mean, you know, is thereanything that comes up that you
think about, any concerns orapprehension you have about
psych, mental health, nursesusing psychotherapy?
Speaker 3 (12:00):
No, I don't think so.
I think you know, from anadvanced practice lens, we're
going to fall into that trap ofbeing a medical manager or
medication manager and thedeveloping relationship and that
therapeutic relationship takestime.
And when we're reduced toseeing people in a 15-minute or
(12:21):
even 20-minute encounter, itstill is therapeutic and
psychotherapeutic but it reallyinhibits the ability to really
practice good nursing care, Ithink.
And so to that end, I thinkthis reliance on medications as
solving everybody's problem anddiscounting what goes on in the
(12:42):
encounter with the nursepractitioner, the psych MP that
is, I think we have a risk thereand that's probably through
employers and you knowreimbursement systems.
But I think the more that we doyou know programs like this and
the work that you guys havedone on psychotherapy in
(13:02):
practice and in curriculums andstuff like that then I think
that it's going to stay alive.
But I do think there's a risk.
I don't know so much.
You know I used to kind of getconcerned about the amount of
post-grad people coming in thatare nurse practitioners with
primary care background oranesthesia background coming in.
That they are.
(13:24):
I think that there's this ideathat, and some may be attracted
to the counseling component, butoftentimes it's more of a
medical model.
I think I always have to coachthat.
You have to put on your therapyhat.
I mean, your therapeutic use ofself is an advanced practice
(13:46):
skill, just like writing aprescription for a psychotropic
agent is a skill set.
So I don't know if there's arisk, but I think that programs
need to are going to havedifferent strengths as they're
pulling people into the programsthat are post-grad certs and
because this kind of therapeuticuse of self and the kind of
(14:10):
lens of psychotherapy is not apart of all the programs you
know and certainly not a part ofwhat people are coming into
psychiatry for sometimes.
Thanks, Tess.
Does that get at?
Your answer yeah, okay.
Speaker 4 (14:27):
Tess, I'm thinking of a Robert Frost poem of two
roads diverged in a path right,and one path is where you want
the future of psychotherapy foradvanced practice nursing to go
and the other path is where youthink it's going to go.
Can you speak to both paths?
Speaker 3 (14:47):
Where do I think it's going to go?
I think that we need to havemore programs in our post-grad
education that gets advancedpractice nurses more prepared
and confident in deliveringpsychotherapy.
It was really great.
I just went to a CBTI orcognitive behavioral therapy for
(15:10):
insomnia for our workshop,which was perfect to go to and
to be able to incorporate that.
So I think that the more wehave those things available and
see that, so I think that that'slike an opportunity for that
and I can't remember the otherroad that you asked the first
(15:31):
road you identified.
Speaker 4 (15:32):
Really well, it's the one you want us to go down yeah
what's the road you suspectwe're going to have to go to?
Speaker 3 (15:39):
wow, um, I don't know .
I guess I'm optimistic thatthat you know, you know, don't
know.
I think that the I don't know,that we are becoming well.
I think I'm a little optimistictoo, because I do think that
(16:00):
there's more nurse practitionersbuilding their own practices
and I think that there can beopportunity for counseling and
supportive, you know,incorporating counseling and
psychotherapies into theirpractices that way.
So I don't think I'm going togo down the negative route,
except that you know who knowswhere medications are going to
(16:23):
go to.
But I mean they can't be theonly use to that.
I mean there's no.
I mean I think we just have tokeep reinforcing that, that as
nurses we have this relationshipbased practice.
These interactions arepsychotherapeutic.
I mean too many patients.
I mean you leave the office.
They come back to you the firstvisit and they said I left my,
(16:45):
I left the office feeling somuch better and they never took
another pill.
They didn't take a pill butthey felt better because of that
therapeutic interaction.
A good, sound plan for movingforward.
So I think that we just need tokeep reinforcing that we are
psychotherapeutic and thatpicking up different
psychotherapeutic modalities orcounseling skills is just a part
(17:06):
of, you know adding tools tothe toolbox, so I'm not sure I'm
going to go down that road.
Sean, too far.
Speaker 4 (17:13):
Thank you, and your answer was perfectly Rogerian in
its answer.
Speaker 3 (17:16):
Okay, all right.
Speaker 2 (17:24):
I think she got cooking there.
She was, yeah, she was getting.
She wasn't going to go downthat road for you, sean, that's
great, that's awesome.
Speaker 3 (17:31):
Well, I think eventually in the poem both
roads get back together again,don't they?
Speaker 4 (17:35):
Yes, just a little bit further down the road.
Speaker 2 (17:37):
That's right.
So optimistic, that's great.
Yeah, no-transcript.
(17:58):
And psych isn't all about justlearning how to prescribe
Seroquel.
Speaker 3 (18:10):
And that's.
That's something that Iremember you've always said is,
you know that's not the onlything you're coming to school
for, so that's great.
I remember a psychiatrist Iused to work with and we were
talking about the differentperspectives of delivering care
and he said well, you know, tess, I know how to nod, you know,
and I was like what you know howto nod?
Well, this is, you know, whatwe do is more than just nodding
at the thing.
There's a lot that goes on inthere and you know people come
(18:35):
in with distress and it's morethan you know.
You approach it in a much, Iguess it's just much broader.
I mean, we all need to be goodat what we do from a prescribing
standpoint, if that's whatwe're going to do, but we need
to acknowledge that encounterand what the other people, what
they bring to the table, whatpatients bring to the encounter.
Speaker 5 (18:59):
And so we've talked about medication and just the
perception of the over-relianceon medication, sometimes as a
barrier as well as maybeunderstanding.
I've heard you sayunderstanding it's more than an
odd in terms of this work, butmaybe in addition to that, or
maybe you want to expand onthose points about what you see
(19:20):
as barriers for more PNHMPsusing psychotherapy in their
practice.
Speaker 3 (19:26):
Well, I think it probably starts with the
schooling.
I think we probably could do abetter job of listening to
recordings of students andgiving them feedback and helping
them see that they aredeveloping these basic skills
and the such.
And I think, as they're goingout and getting mentored,
(19:49):
finding a mentor who wants towork with them and provide them
with some structured support forpursuing extra certification, I
think that it's you know,there's no way to really say,
unless you're going to putsomebody through their PMHMP
program and say you're going tobecome a specialist, like I did
(20:11):
and sought out extra support forinterpersonal psychotherapy,
you're really preparing them tobecome good therapists.
But I think that we need moreofferings in addition to what
goes on in their graduateprograms.
Speaker 2 (20:31):
Couldn't agree more yeah.
I think that's what we talkabout a lot here too.
It starts at the educationlevel, and there's a vicious
cycle that can occur.
If there's not good faculty outthere ready to teach these
skills or keep this importantskill set in the program, then
that's going to be the problemtoo.
So thanks, tess, appreciate it.
(20:51):
I just really want to thank youfor joining us.
Anybody any other questions?
And we got some time here.
Yeah, tess a question for you.
Speaker 4 (21:01):
One of the things we hope to do.
You know, one community we hopeto reach with this podcast are
future psych NPs, right?
So if I threw a question to youabout what's a message or two
you want to send to students whoare thinking about applying to
a psych nurse practitionerprogram in the lane of
psychotherapy, what are somemessages you would want to relay
(21:25):
to them?
It sounds like.
Speaker 2 (21:28):
Sean made this an assignment for his students, say
.
Speaker 3 (21:37):
What are some messages that I'd want to relay
to somebody about psychotherapyand being a psych nurse
practitioner who's thinkingabout it?
I guess that they enjoy, dothey enjoy the lived experience
of somebody you know and they'recurious about the way people
interact when you.
I also think that the one thingabout being in nursing which is
(21:58):
really great is how we define.
Health is so much broader thanjust the absence of disease.
You know it's a, you know justthis forward movement of
creative energy and towardsbecoming more fully human.
I mean, we can define it inmultiple different ways from all
of our great theorists.
But I think you have to beexcited about the brain and I
(22:21):
think the other thing I thinkabout psychotherapy and I'll
explain it to patients sometimestoo is it's like physical
therapy for the brain, and soyou know you enter into.
I mean, physical therapy is allabout doing what I call these
stupid little band exercisesthat make you exercise these
(22:43):
really small muscles and it'slike hard to do.
And I think the same is truewhen you go into psychotherapy.
The therapist, nurse therapistis asking you to make really
small but painful little stepsof moving forward in insight.
Or you know, homeworkassignments, examining
(23:06):
encounters and that sort ofthing and it's really small work
.
But over time and I mean a lotof times you're in physical
therapy for two to three monthsyou make small changes and
sometimes there's big ahamoments right at the beginning.
But if you can make a smalltrajectory of change and build
on that over time and givepeople skills we all know that
(23:28):
therapy skills you know lastlonger than medication and we
know that psychotherapeuticinterventions are longer lasting
.
I mean you can give somebodyibuprofen for two weeks for a
shoulder injury or you can sendthem to physical therapy for two
or three months and thatphysical therapy exercise is
going to last longer.
So I think it's exciting tohave those you know therapy
(23:50):
skills in your toolbox.
Speaker 4 (23:53):
Thank you very much.
Speaker 2 (23:56):
Awesome Super job.
And again, just looking ahead,looking at our schedule, we will
be back in a few weeks.
We've got some again.
I don't want to call it springbreak number two, but we're
going to be off a couple ofweeks, so we'll be back here too
, and we've got a bunch of greatguests coming up.
If you're really excited aboutthis podcast, we're actually
lining up people to be speakingwith them, who actually they had
(24:18):
Hildegard Peplau as aninstructor.
They are students directlyunder them, so real excited
about having those people on thepodcast as well.
So before we sign off, I wantto kind of go back to this idea
of spring break After dark withPeplow's ghost.
What'd you guys do over yourspring break?
(24:39):
Do anything fun.
I'm looking at somebody inparticular here on the podcast.
Anything exciting to report?
Kate.
Speaker 6 (24:45):
Well, I traveled to beautiful Edmonton, alberta in
Canada, to defend mydissertation at the University
of Alberta.
So, as Dan graciously mentionedat the beginning of the episode
, I am now Dr Kate Molino, sovery, very pleased to join this
esteemed group of folks inhaving my terminal degree.
That is so awesome, kate, thankyou.
Speaker 4 (25:08):
And I can't beat that with anything that I've done
during spring break Nothing,really, not a thing.
No, can't even touch that.
Speaker 2 (25:17):
Yeah, right, can't even touch that right, melissa,
anything.
Speaker 5 (25:23):
I'm out with my kids.
Did some work paid in abathroom, so nope, kate wins
well, I was going to mention,you know, test.
Speaker 2 (25:32):
you mentioned going to um, this conference where you
learned about cbti, um.
So I was at that conference.
Uh, it's the internationalsociety of psych nurses.
We held it down in new orleansand somebody that you might know
got induced as the president ofISPN.
So that was fun.
I do say it's a heck of a lotof weight, but I'm really
(25:54):
excited about this next year and, for those of you listening out
there on the podcast, we'd loveto hear from you about how your
experience with ISPN and maybehow ISPN can help you help your
practice.
These are challenging times, tosay the least, a lot of chaos
going on at the federal levelwith ISPN and maybe how ISPN can
help you help your practice.
You know these are these arechallenging times, to say the
least a lot of chaos going on atthe federal level.
You know organizations are theplaces to come, and so we're
(26:15):
really looking forward to we'reactually going to start to
implement some listeningsections, listening sessions
through ISPN.
So, again, you know a lot ofthings going on, a lot of things
that are unfortunatelyaffecting how we care for our
patients, how we do research,education, policy, development.
All those things are beingaffected by what's going on in
the world today.
So I want to hear from you.
I want to hear how you'redealing with that and would
(26:37):
welcome you to ISPN to find awarm home for that.
So, all right, that's my littlespiel.
Sorry, guys took it over that.
Speaker 6 (26:46):
So all right, that's my little spiel.
Sorry, guys took it over, notat all.
Congrats, dan, and you know Iwould say you know, in times of
turmoil like these, we're soglad to have people like you.
You know leading our profession, so we're so proud of you.
Speaker 4 (26:57):
Absolutely.
Yeah, you know, margaret Meadsaid it perfectly.
She said never underestimatethe power of a small dedicated
group of people to change theworld, because it's the only
thing that ever has, that asmall dedicated group of people
to change the world, becauseit's the only thing that ever
has.
Speaker 2 (27:07):
That's right.
Love it, and I think we'll wrapit up there.
Very well said, sean.
Nice Thanks again to Dr TessJajelis here.
Look forward to another episodein a couple of weeks and, yes,
like, subscribe, comment to thepodcast.
We'll see you then.
Speaker 1 (27:21):
Bye reasoning.
Too much salt like this, toomuch seasoning.
They feel it.
Therefore, it's true work harduntil those thoughts are finally
leaving so you can be you.
Uh, they feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving so you can beyou.
Guided discovery identifying,challenging your beliefs,
reframing your mind.
(27:42):
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, discovery identifying,challenging your beliefs, core
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, just my take on things.
My answer number two I thinkwe're recording.
Welcome back everyone.
Decrease until they cease.
You're stuck at a discovery,Identifying a challenge in your
(00:26):
beliefs.
I think we're recording.
Speaker 2 (00:29):
Welcome back everyone to Peplow's Ghost.
All right, another episode.
Hopefully everybody was dyingfor this episode, as we had the
two-week break.
I'll call it that it was ourspring break, although we didn't
really rest or anything.
But we're great to see you backor hear you back.
Hopefully we're talking outinto the ether, so hopefully
somebody's listening to this aswell.
I am joined with my esteemedcolleague, dr Sean Convoy from
(00:53):
Duke.
Dr Kate Molino that is, dr KateMolino from University of
California, san Francisco, justcompleted her PhD.
Dr Melissa Chapman-Hayes, fromMinnesota, and then we love to
have our guest here.
Dr Tessman Hayes, fromMinnesota, and then we are love
to have our guest here, dr TessJudge-Ellis, one of my
colleagues from the Universityof Iowa.
So looking really forward togetting to know her.
(01:13):
So let's get into it.
I always like kind of askingthese questions, especially from
a guest that knows me.
Tess, do you remember the firsttime that we met?
Speaker 3 (01:21):
Probably when you took health assessment course,
Dan, was that it?
Speaker 2 (01:25):
I you know.
I don't know if that's thefirst time, but that is what I
remember.
Speaker 3 (01:28):
I do too, you were my faculty.
You were destined for greatnesseven then.
Speaker 2 (01:32):
You are too kind, yeah, but I remember that I got
done with my assessment of kindof my final project and you
pulled me aside and you're likeyou should be an FNP.
I'm just like I'm okay, but I,you should be an FMP.
I'm just like I'm okay.
But but I always appreciatethat and it's a you know,
privilege to be working with younow.
So so thank you so much forjoining us here.
I'll get us started with ourfirst question of the podcast
(01:56):
when did you first startedgetting interested in
psychotherapy.
Speaker 3 (01:59):
Well, I think that you know, I think as a nurse
you're always, or at least kindof having a psych bent, as a
nurse is interested in thetherapeutic process that goes on
between people.
But I think probably when Ifirst got interested in
psychotherapy was when I was inmy psych NP program and met a
(02:20):
therapist then who supervised methen doing interpersonal
psychotherapy as a modality, andso I was able to do this with
two clients, and so then Istarted to be interested.
It was in my psych program.
You know I started as a familynurse practitioner and so always
kind of had this bent towardspsychiatry, but it was really in
(02:40):
the PMHMP program.
Speaker 2 (02:43):
So what made you go back and get your certificate?
I've never kind of talked toyou about that.
Speaker 3 (02:47):
It's all psych Dan.
Speaker 2 (02:49):
I know.
Speaker 3 (02:49):
It's all psych.
Speaker 2 (02:51):
We're all psych right .
Speaker 3 (02:52):
Nurses are all psych right it is, and I think you
know I probably always had alens towards mental health in
addition to family practice.
I really enjoy family practiceas well.
I do both addition to familypractice.
I really enjoy family practiceas well.
I do both, and so it was justnatural when I went back to get
my DNP the University ofTennessee Health Science Center
(03:12):
in Memphis they were because itwas really early.
I got my DNP in 2008,.
Before there were only like twoor three programs in the
country and so they had onewhere, if you were already a
nurse practitioner, you'd goback and pick up your psych
post-grad.
And so I was like, wow, thatsounds perfect for me.
Speaker 2 (03:31):
Yeah, that might date you, because now there are all
these programs popping upeverywhere, it's the number one
growing post-grad certpopulation.
So yeah, thanks, tess.
Speaker 4 (03:41):
So, tess, before I ask you a question, I'm just
going to throw out a challengeto future guests on this podcast
.
Particularly, kate and Melissaand I are looking for an
opportunity for somebody toshare a really unsavory story
about the first time they metDan, because I think we need to
kind of change the dynamic alittle bit.
So we'll see who dials intothat, ok, so, tess, let me?
(04:02):
Dan asked you a questionspecifically about the idea,
about you know, psychotherapy.
I'm going to ask you a morespecific question about can you
reflect on your experiencethrough the lens of
psychotherapy, and is there aparticular case or encounter
that crystallized the power ofpsychotherapy for you, and can
(04:23):
you perhaps de-identify andshare that story with us?
Speaker 3 (04:26):
Sure, when I was, I practiced for a long time in a
small town of a thousand.
I was first a family nursepractitioner and then I picked
up the psych post-grad, so theprogram, so the clinic, became a
real nurse-led, kind of nurserun what are you here for today?
And I ended up doing quite a lotof psychotherapy and counseling
(04:49):
and that's where I did some ofmy interpersonal psychotherapy
work, but probably working witha couple of individuals who had
traumatic grief and was able topull in and see them for, you
know, brief sessionsInterpersonal psychotherapy is
designed to be like a 12 to 15week session and to see them for
(05:12):
a brief time to walk throughthe process of grief with them.
Those were amazing experiences,especially in a town of a
thousand where people can justcome in and do that.
But then I also remember onedoing more supportive
psychotherapy with a woman whohad just been newly sober and
(05:36):
from alcoholism and I workedwith her for about a year on a
weekly or every other weeklybasis, didn't do any medication
adjustments but just walked withher as she was in this recovery
process once a week in thistown of a thousand.
So those are, you know, justdramatic encounters, lots of.
Yeah, those are probably two ofmy more favorite encounters,
(06:00):
yeah.
Speaker 4 (06:01):
Thank you.
Speaker 2 (06:02):
Yeah, thanks, tess, and again owners yeah, thank you
.
Yeah, thanks, tess, and againprobably need to cut me off guys
, but I mean I just so I knowabout this clinic and I guess
you know I imagine when you'rekind of having somebody you know
, a small town of a thousandpeople, you know, the idea of
going to a mental health clinicis really kind of threatening.
So was it, was it easier forthe clients that you saw, just
because you were a family nurse?
You know it was just kind of amedical clinic, or or was it?
Speaker 3 (06:26):
Yeah, we had it set up so it had a.
There was an office that didn'thave a sink in it that we
called the counseling room andso it was just had a table with
some comfortable chairs in itand you know it was a.
Yeah, I just had a.
It was interesting because ifsomebody came in for a med
(06:46):
management check or a follow upand they said, you know, tess,
I'm doing just fine with this,but you know, I think I've got
an ear to move and shift intosomething else.
So it was really quiteinteresting to have that kind of
flexibility and I do thinksmall towns to have that
(07:10):
available there without havingto drive and without the like
everybody knows my car as it'spulling up to the mental health
clinic, kind of thing.
Speaker 5 (07:19):
So reducing that and just kind of normalizing it too
just, I appreciate that I grewup in rural areas and have a lot
of family in very small towns,like 500 people, so to hear that
there is that access, um, withsome of those barriers reduced,
it's really cool.
Um, and I know you've mentioneda couple of kinds of
(07:41):
psychotherapy that you've usedin those encounters.
But are there forms or types ofpsychotherapy that you're drawn
to kind of more recently, or doyou, you know, draw from a kind
of like a range of differentapproaches?
Speaker 3 (07:54):
I probably draw from more of a range of approaches.
At this point I just I, mypractice has shifted from that
small town to where I work withpeople who have been formerly
homeless, chronically homeless,and so there's a lot of
substance use disorder andengagement needing, just people
needing to be engaged.
So I do quite a lot ofmotivational interviewing and I
(08:17):
think MI is great.
And then supportivepsychotherapy, just being
present with people and workingon their strengths and being
present with them.
And then I don't really use toomuch IPT anymore because the
population isn't really lendingitself to it.
But it really informs my aspecton attachments because IPT has
(08:40):
such a strong attachment base toit with Boldy.
So I think about folks and whenthey have trouble with making
attachments or coming in.
So it kind of contributes to alens that I see people through.
Speaker 5 (08:57):
Thank you.
Speaker 6 (08:59):
And Tess, it's so great to hear about your
experience, and something thatreally strikes me is just how
the areas that you focus on andwork on are so incredibly
relevant, like these areas offolks with substance use and
using supportive therapy and MIto help them, folks who have
traumatic grief and thinkingthrough the COVID pandemic and
people coping with all thesethings going on in the world.
(09:21):
So my question for you isreally how do you see nursing,
being a leader in performingpsychotherapy?
Speaker 3 (09:30):
Well, I mean, I think it gets back to the basic.
Well, first of all, I think thatwe have to continue to see that
every encounter has a potentialto be psychotherapeutic, and so
that is part of our engagement.
I mean, when we and if webelieve in the nurse patient
(09:52):
relationship that starts fromthe very minute, the minute you
meet somebody in a therapeuticencounter, then I think that
that the opportunity for apositive psychotherapeutic
encounter happens all the time,and the more that we can pull
into that as nurses, I think,the more that we can lead.
(10:13):
I remember doing the IPTtraining and it was mostly with
psychotherapists, and I rememberthe supervisor that I had, or
the psychologist that supervisedme, said well, you nurses never
have any problem establishingrapport, and I think that that's
just a big aspect of nursingtoo is that people can relate
(10:35):
and we understand how to relateto one another.
It's just the relationship isso fundamental into providing
any sort of nursing care that Idon't know if I'm getting at the
answer to your question, but Ithink that nurses, I mean even
just the action of you knowdistributing medications if
you're a bedside nurse or youknow, we bring something to the
(10:58):
table, a high level skill in thenurse patient relationship and
seeing that encounter that Ithink that we discount as part
of our skill set.
So I think the more we have toown that.
Speaker 2 (11:15):
Yeah, I've always learned from you, tess, is you
know that you always find aplace where nursing can be
inserted into the healthcaresystem because we're the largest
, you know, healthcareprofessionals in the healthcare
system, and so it's alwaysfascinating how nursing gets
left out of certain things.
You know boards, interventionsand things like that.
So I always kind of taken fromyou, you know, find a place
where nursing can be, and Ithink psychotherapy is one of
those places sometimes, as weget kind of not thought of as
(11:37):
being able to do those kind ofthings.
And so I guess my next questionis maybe to kind of think of
you know the flip of what Katejust asked.
You know or do you have anyconcerns about psych, mental
health nursing?
You know nurses usingpsychotherapy?
I mean, you know, is thereanything that comes up that you
think about, any concerns orapprehension you have about
psych, mental health, nursesusing psychotherapy?
Speaker 3 (12:00):
No, I don't think so.
I think you know, from anadvanced practice lens, we're
going to fall into that trap ofbeing a medical manager or
medication manager and thedeveloping relationship and that
therapeutic relationship takestime.
And when we're reduced toseeing people in a 15-minute or
(12:21):
even 20-minute encounter, itstill is therapeutic and
psychotherapeutic but it reallyinhibits the ability to really
practice good nursing care, Ithink.
And so to that end, I thinkthis reliance on medications as
solving everybody's problem anddiscounting what goes on in the
(12:42):
encounter with the nursepractitioner, the psych MP that
is, I think we have a risk thereand that's probably through
employers and you knowreimbursement systems.
But I think the more that we doyou know programs like this and
the work that you guys havedone on psychotherapy in
(13:02):
practice and in curriculums andstuff like that then I think
that it's going to stay alive.
But I do think there's a risk.
I don't know so much.
You know I used to kind of getconcerned about the amount of
post-grad people coming in thatare nurse practitioners with
primary care background oranesthesia background coming in.
That they are.
(13:24):
I think that there's this ideathat, and some may be attracted
to the counseling component, butoftentimes it's more of a
medical model.
I think I always have to coachthat.
You have to put on your therapyhat.
I mean, your therapeutic use ofself is an advanced practice
(13:46):
skill, just like writing aprescription for a psychotropic
agent is a skill set.
So I don't know if there's arisk, but I think that programs
need to are going to havedifferent strengths as they're
pulling people into the programsthat are post-grad certs and
because this kind of therapeuticuse of self and the kind of
(14:10):
lens of psychotherapy is not apart of all the programs you
know and certainly not a part ofwhat people are coming into
psychiatry for sometimes.
Thanks, Tess.
Does that get at?
Your answer yeah, okay.
Speaker 4 (14:27):
Tess, I'm thinking of a Robert Frost poem of two
roads diverged in a path right,and one path is where you want
the future of psychotherapy foradvanced practice nursing to go
and the other path is where youthink it's going to go.
Can you speak to both paths?
Speaker 3 (14:47):
Where do I think it's going to go?
I think that we need to havemore programs in our post-grad
education that gets advancedpractice nurses more prepared
and confident in deliveringpsychotherapy.
It was really great.
I just went to a CBTI orcognitive behavioral therapy for
(15:10):
insomnia for our workshop,which was perfect to go to and
to be able to incorporate that.
So I think that the more wehave those things available and
see that, so I think that that'slike an opportunity for that
and I can't remember the otherroad that you asked the first
(15:31):
road you identified.
Speaker 4 (15:32):
Really well, it's the one you want us to go down yeah
what's the road you suspectwe're going to have to go to?
Speaker 3 (15:39):
wow, um, I don't know .
I guess I'm optimistic thatthat you know, you know, don't
know.
I think that the I don't know,that we are becoming well.
I think I'm a little optimistictoo, because I do think that
(16:00):
there's more nurse practitionersbuilding their own practices
and I think that there can beopportunity for counseling and
supportive, you know,incorporating counseling and
psychotherapies into theirpractices that way.
So I don't think I'm going togo down the negative route,
except that you know who knowswhere medications are going to
(16:23):
go to.
But I mean they can't be theonly use to that.
I mean there's no.
I mean I think we just have tokeep reinforcing that, that as
nurses we have this relationshipbased practice.
These interactions arepsychotherapeutic.
I mean too many patients.
I mean you leave the office.
They come back to you the firstvisit and they said I left my,
(16:45):
I left the office feeling somuch better and they never took
another pill.
They didn't take a pill butthey felt better because of that
therapeutic interaction.
A good, sound plan for movingforward.
So I think that we just need tokeep reinforcing that we are
psychotherapeutic and thatpicking up different
psychotherapeutic modalities orcounseling skills is just a part
(17:06):
of, you know adding tools tothe toolbox, so I'm not sure I'm
going to go down that road.
Sean, too far.
Speaker 4 (17:13):
Thank you, and your answer was perfectly Rogerian in
its answer.
Speaker 3 (17:16):
Okay, all right.
Speaker 2 (17:24):
I think she got cooking there.
She was, yeah, she was getting.
She wasn't going to go downthat road for you, sean, that's
great, that's awesome.
Speaker 3 (17:31):
Well, I think eventually in the poem both
roads get back together again,don't they?
Speaker 4 (17:35):
Yes, just a little bit further down the road.
Speaker 2 (17:37):
That's right.
So optimistic, that's great.
Yeah, no-transcript.
(17:58):
And psych isn't all about justlearning how to prescribe
Seroquel.
Speaker 3 (18:10):
And that's.
That's something that Iremember you've always said is,
you know that's not the onlything you're coming to school
for, so that's great.
I remember a psychiatrist Iused to work with and we were
talking about the differentperspectives of delivering care
and he said well, you know, tess, I know how to nod, you know,
and I was like what you know howto nod?
Well, this is, you know, whatwe do is more than just nodding
at the thing.
There's a lot that goes on inthere and you know people come
(18:35):
in with distress and it's morethan you know.
You approach it in a much, Iguess it's just much broader.
I mean, we all need to be goodat what we do from a prescribing
standpoint, if that's whatwe're going to do, but we need
to acknowledge that encounterand what the other people, what
they bring to the table, whatpatients bring to the encounter.
Speaker 5 (18:59):
And so we've talked about medication and just the
perception of the over-relianceon medication, sometimes as a
barrier as well as maybeunderstanding.
I've heard you sayunderstanding it's more than an
odd in terms of this work, butmaybe in addition to that, or
maybe you want to expand onthose points about what you see
(19:20):
as barriers for more PNHMPsusing psychotherapy in their
practice.
Speaker 3 (19:26):
Well, I think it probably starts with the
schooling.
I think we probably could do abetter job of listening to
recordings of students andgiving them feedback and helping
them see that they aredeveloping these basic skills
and the such.
And I think, as they're goingout and getting mentored,
(19:49):
finding a mentor who wants towork with them and provide them
with some structured support forpursuing extra certification, I
think that it's you know,there's no way to really say,
unless you're going to putsomebody through their PMHMP
program and say you're going tobecome a specialist, like I did
(20:11):
and sought out extra support forinterpersonal psychotherapy,
you're really preparing them tobecome good therapists.
But I think that we need moreofferings in addition to what
goes on in their graduateprograms.
Speaker 2 (20:31):
Couldn't agree more yeah.
I think that's what we talkabout a lot here too.
It starts at the educationlevel, and there's a vicious
cycle that can occur.
If there's not good faculty outthere ready to teach these
skills or keep this importantskill set in the program, then
that's going to be the problemtoo.
So thanks, tess, appreciate it.
(20:51):
I just really want to thank youfor joining us.
Anybody any other questions?
And we got some time here.
Yeah, tess a question for you.
Speaker 4 (21:01):
One of the things we hope to do.
You know, one community we hopeto reach with this podcast are
future psych NPs, right?
So if I threw a question to youabout what's a message or two
you want to send to students whoare thinking about applying to
a psych nurse practitionerprogram in the lane of
psychotherapy, what are somemessages you would want to relay
(21:25):
to them?
It sounds like.
Speaker 2 (21:28):
Sean made this an assignment for his students, say
.
Speaker 3 (21:37):
What are some messages that I'd want to relay
to somebody about psychotherapyand being a psych nurse
practitioner who's thinkingabout it?
I guess that they enjoy, dothey enjoy the lived experience
of somebody you know and they'recurious about the way people
interact when you.
I also think that the one thingabout being in nursing which is
(21:58):
really great is how we define.
Health is so much broader thanjust the absence of disease.
You know it's a, you know justthis forward movement of
creative energy and towardsbecoming more fully human.
I mean, we can define it inmultiple different ways from all
of our great theorists.
But I think you have to beexcited about the brain and I
(22:21):
think the other thing I thinkabout psychotherapy and I'll
explain it to patients sometimestoo is it's like physical
therapy for the brain, and soyou know you enter into.
I mean, physical therapy is allabout doing what I call these
stupid little band exercisesthat make you exercise these
(22:43):
really small muscles and it'slike hard to do.
And I think the same is truewhen you go into psychotherapy.
The therapist, nurse therapistis asking you to make really
small but painful little stepsof moving forward in insight.
Or you know, homeworkassignments, examining
(23:06):
encounters and that sort ofthing and it's really small work
.
But over time and I mean a lotof times you're in physical
therapy for two to three monthsyou make small changes and
sometimes there's big ahamoments right at the beginning.
But if you can make a smalltrajectory of change and build
on that over time and givepeople skills we all know that
(23:28):
therapy skills you know lastlonger than medication and we
know that psychotherapeuticinterventions are longer lasting
.
I mean you can give somebodyibuprofen for two weeks for a
shoulder injury or you can sendthem to physical therapy for two
or three months and thatphysical therapy exercise is
going to last longer.
So I think it's exciting tohave those you know therapy
(23:50):
skills in your toolbox.
Speaker 4 (23:53):
Thank you very much.
Speaker 2 (23:56):
Awesome Super job.
And again, just looking ahead,looking at our schedule, we will
be back in a few weeks.
We've got some again.
I don't want to call it springbreak number two, but we're
going to be off a couple ofweeks, so we'll be back here too
, and we've got a bunch of greatguests coming up.
If you're really excited aboutthis podcast, we're actually
lining up people to be speakingwith them, who actually they had
(24:18):
Hildegard Peplau as aninstructor.
They are students directlyunder them, so real excited
about having those people on thepodcast as well.
So before we sign off, I wantto kind of go back to this idea
of spring break After dark withPeplow's ghost.
What'd you guys do over yourspring break?
(24:39):
Do anything fun.
I'm looking at somebody inparticular here on the podcast.
Anything exciting to report?
Kate.
Speaker 6 (24:45):
Well, I traveled to beautiful Edmonton, alberta in
Canada, to defend mydissertation at the University
of Alberta.
So, as Dan graciously mentionedat the beginning of the episode
, I am now Dr Kate Molino, sovery, very pleased to join this
esteemed group of folks inhaving my terminal degree.
That is so awesome, kate, thankyou.
Speaker 4 (25:08):
And I can't beat that with anything that I've done
during spring break Nothing,really, not a thing.
No, can't even touch that.
Speaker 2 (25:17):
Yeah, right, can't even touch that right, melissa,
anything.
Speaker 5 (25:23):
I'm out with my kids.
Did some work paid in abathroom, so nope, kate wins
well, I was going to mention,you know, test.
Speaker 2 (25:32):
you mentioned going to um, this conference where you
learned about cbti, um.
So I was at that conference.
Uh, it's the internationalsociety of psych nurses.
We held it down in new orleansand somebody that you might know
got induced as the president ofISPN.
So that was fun.
I do say it's a heck of a lotof weight, but I'm really
(25:54):
excited about this next year and, for those of you listening out
there on the podcast, we'd loveto hear from you about how your
experience with ISPN and maybehow ISPN can help you help your
practice.
These are challenging times, tosay the least, a lot of chaos
going on at the federal levelwith ISPN and maybe how ISPN can
help you help your practice.
You know these are these arechallenging times, to say the
least a lot of chaos going on atthe federal level.
You know organizations are theplaces to come, and so we're
(26:15):
really looking forward to we'reactually going to start to
implement some listeningsections, listening sessions
through ISPN.
So, again, you know a lot ofthings going on, a lot of things
that are unfortunatelyaffecting how we care for our
patients, how we do research,education, policy, development.
All those things are beingaffected by what's going on in
the world today.
So I want to hear from you.
I want to hear how you'redealing with that and would
(26:37):
welcome you to ISPN to find awarm home for that.
So, all right, that's my littlespiel.
Sorry, guys took it over that.
Speaker 6 (26:46):
So all right, that's my little spiel.
Sorry, guys took it over, notat all.
Congrats, dan, and you know Iwould say you know, in times of
turmoil like these, we're soglad to have people like you.
You know leading our profession, so we're so proud of you.
Speaker 4 (26:57):
Absolutely.
Yeah, you know, margaret Meadsaid it perfectly.
She said never underestimatethe power of a small dedicated
group of people to change theworld, because it's the only
thing that ever has, that asmall dedicated group of people
to change the world, becauseit's the only thing that ever
has.
Speaker 2 (27:07):
That's right.
Love it, and I think we'll wrapit up there.
Very well said, sean.
Nice Thanks again to Dr TessJajelis here.
Look forward to another episodein a couple of weeks and, yes,
like, subscribe, comment to thepodcast.
We'll see you then.
Speaker 1 (27:21):
Bye reasoning.
Too much salt like this, toomuch seasoning.
They feel it.
Therefore, it's true work harduntil those thoughts are finally
leaving so you can be you.
Uh, they feel it.
Therefore, it's true, work harduntil those thoughts are
finally leaving so you can beyou.
Guided discovery identifying,challenging your beliefs,
reframing your mind.
(27:42):
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, discovery identifying,challenging your beliefs, core
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
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