June 16, 2025 • 32 mins
Ever wondered how psychiatric nurse practitioners seamlessly blend talk therapy with medication management? In this illuminating conversation, we're joined by Dr. Kate Wheeler (lovingly dubbed "East Coast Kate") who shares her journey of maintaining a vibrant psychotherapy practice even after retiring from academia.
Dr. Wheeler offers a candid look at her approach to therapy, particularly her specialization in EMDR for trauma patients. With refreshing honesty, she explains why she prioritizes psychotherapy over medication management: "My goal is always to get people off of stuff rather than starting a medication." Her practical insights on patient screening, managing therapeutic relationships during extended absences, and documentation practices provide valuable guidance for practitioners at any stage.
Meanwhile, Dr. Kate Melino ("West Coast Kate") provides a fascinating contrast with her work in a home-based primary care setting. Her approach to therapy with homebound adults, many facing end-of-life issues, demonstrates how narrative therapy and existential approaches can be adapted to serve unique patient populations.
The conversation takes an enlightening turn when the hosts discuss documentation requirements, with Dr. Wheeler candidly sharing her preference for process notes over insurance-driven progress notes in her cash-based practice. This sparks a valuable discussion about balancing clinical needs with regulatory requirements.
Whether you're a psychiatric nurse practitioner looking to incorporate more therapy into your practice, a student wondering about the practical aspects of psychotherapy integration, or simply curious about the intersection of talk therapy and medication management, this episode delivers practical wisdom from clinicians who've successfully navigated these waters.
Want to learn more about bringing psychotherapy back to psychiatric practice? Subscribe to Peplau's Ghosts for more insightful conversations on advancing psychiatric mental health nurse practitioner practice.
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 Alright,we're recording.
Decrease until they cease.
It's not a discovery.
(00:24):
Identify a challenge in yourbeliefs, all right we're
recording.
Speaker 2 (00:30):
Welcome back to Pep Lau's Ghosts.
Great to have another episodehere, Super excited about our
guest here back a first timehere for Pep Lau's Ghosts to
actually bring back a guest.
But before I get to that maybecreate a little suspense here I
am continue to be joined by DrMelissa Chapman Hayes and Dr
(00:53):
Kate Molino, who we will call,probably a little bit in this
podcast, West Coast Kate, andmaybe that's a little sneak peek
on who we've got back.
But it's exciting to have DrKate Wheeler, who I will say I
lovingly call my East Coast Kate.
So thank you, kate, for comingback to talk on Pep Lau's Ghost.
(01:13):
It's exciting to kind of haveyou and your perspective and
your leadership here and, youknow, keeping the psychotherapy
a part of the role of the PMHMPand such.
So I think what we were talkingabout right before we started
recording is maybe kind ofsharing a little bit.
This is going to be maybe ahow-to podcast, so how to do
(01:34):
psychotherapy within thepractice, and I know both Kate
and myself do some psychotherapywithin our clinical role and
Melissa can maybe kind of jumpin and kind of make sure that we
don't get too jargony andthings like that but also
helping us kind of, you know,understand some of the questions
that obviously on a podcast wecan't ask.
So so, kate, maybe I'll justkind of throw it to you and just
(01:57):
kind of maybe get you going.
You know, for you, you knowthinking back or thinking kind
of even today, you know I knowyou've you've retired from your
academic role but you stillmaintain a clinical practice.
You know, why did you want tokeep that?
Why did you want to kind ofhold on to those patients and
still still do psychotherapy,and and, and what is the?
What is the pragmatics ofkeeping that practice or part of
(02:19):
your daily, weekly live going?
Speaker 3 (02:30):
daily, weekly live going.
Um well, I didn't think at allabout stopping that because I
really enjoy it and have likedpsychotherapy you know my whole
career and I didn't want to seemore people than a few days a
week.
So I have about 12 to 15patients a week, a lot of them,
you know, I get a few referrals,but a lot of them have been
(02:52):
with me for a while.
So it's just to me it's fun.
And, to condense, it is evenmore fun because the days I
don't have people, it is evenmore fun because the days I
don't have people, I'm just likehappy, because I'm like what am
(03:13):
I going to do today, which issuch a novel feeling.
Since I've been retired, Inever had time and I always felt
like I wasn't doing stuff thatI was supposed to do and I was
always trying to.
I don't want to say get out ofstuff, but if you're in academia
, everybody wants you, please beon this committee, do this, do
that.
So I think it was time for meto retire because I was getting
(03:33):
crabby about that and then I waslike um, realizing that wasn't
fair.
You know to be um trying to getout of stuff.
So, anyhow, yeah, what did yousay?
So I, there wasn't never aquestion of not continuing to
(03:54):
see my patients.
The challenge now is I just tooka long vacation.
It was a little over a month,maybe five weeks and then you
know telling people I don't seepeople that are in crisis.
Usually my folks are like justkind of normal neurotic, anxious
(04:15):
or depressed people so, and Ialways have somebody that covers
for me.
You know, somebody needs a medrefill or they do have a crisis,
but I don't think I've ever hadanybody had a crisis while I'm
gone, so I'm not worried aboutit.
But they all came back, youknow, on top, so exciting,
(04:38):
because you know I wasn't surehow that would play out in terms
of you know the transferenceand you know who would be
annoyed that they were abandoned.
But you know, if you talk about,you know how did it feel to not
come.
You know for the past month andyou know explore that it's much
(04:59):
better to put it out there thanto just pretend like that
elephant isn't in the room.
Do you know what I mean?
Because people that haveabandonment issues are going to
be, you know, feeling that.
So that's always interesting.
Not that you have to apologizefor it, but, I think, getting
(05:20):
their take on the whole thing,and most people were like
pleased that they did so.
Well, you know they and nobodyquit because of it, cause I
thought, well, they're going tosee that they don't need to come
anymore, hell with you.
But um, they all hung in thereand, um, you know, there was not
a problem.
Speaker 2 (05:40):
Um, so that that makes me remember one of my um
uh mentors that's retiredrecently.
She said she knew it was timeto retire because she was on a
plane and had started somebodyon depakote and the patient was
calling her urgently to try andget that something about the
medication that was having aside effect or something.
She was like, okay, that's,that's too much and time to go.
(06:01):
So I think that kind of speaksof that.
You get get a little cranky andjust kind of done with things.
But maybe talk more about that,because I think that's one of
those sticky things in practicetoo.
When we want to take vacations,self-care is very important and,
like you said, that's kind ofan extended time away of five
weeks, which is amazing.
But how do you handle thosepatients that maybe struggle
(06:24):
with that countertransferenceand don't think you can?
You know they won't survive forfive weeks without you and how
do you, how do you plan for that?
Or how do you kind of you knowaddress that you mentioned, kind
of they did survive and theythey learned from it.
But do you do any prep work onthat or kind of get them?
Speaker 3 (06:39):
ready.
Well, I ask them you know I'mgonna'm going to stay to that
day, you know.
And then I tell them way aheadof time and then you know, ask,
reminding them again and askingthem how they feel about it.
And when I was in analytictraining, most of the analysts
always took August off, so itwas just like not a question.
(07:03):
And yeah, so you know, I thinkit's surprising, there I had
more I don't know pushback,maybe because I didn't know what
I was doing.
But also I may have been seeingpeople with more serious
problems than I see people outof my home.
(07:24):
So serious problems, then I seepeople out of my home.
So you know, I'm not likeseeing people with significant
psychiatric problems, seriousmental illness.
So that probably makes adifference to where I was in
analytic training.
I was just seeing, you know,folks that came into the clinic
and some of them with you know,big attachment disorders.
(07:47):
So I think that probably made adifference too.
But I think preparing peopleand just using their response is
kind of grist for the mill,saying about it and tell me more
about how you feel, and not tobe, uh, you know, afraid of
(08:07):
getting anything negative back.
You know, because everybody.
We all like to be liked andmaybe they won't like you, you
know, because also it could stirup envy.
You know who are you to get totake all this time off and you
know I'm struggling here, so butanyhow, I was pleased that you
(08:31):
know that wasn't an issue.
I have a very good person thatcovers for me.
As the years have gone on, I doless medication and more therapy
and my goal is always to getpeople off of stuff rather than
starting a medication.
So, and I don't prescribe thatmany like Depakote or mood
(08:57):
stabilizer or an antipsychoticOkay, I'll do an SSRI, but I'm
not I don't really no offenselike reading psychopharm
articles.
I'd much rather read apsychotherapy article and I
think if you're going to do agood job, you've got to keep up
(09:17):
with the psychopharm and I don'twant to keep up with the
psychopharm because it's soboring to me, the psychopharm,
because it's so boring to me.
So I just stick with mostly thetherapy piece.
And then you know, somebodyneeds a refill.
My colleague takes care of thatand I cover for her when she
leaves.
She's a psych MP that you knowlives nearby.
Speaker 4 (09:42):
And you know, kate, I'm curious if you would
describe a little more, becauseit sounds like you know you have
, you know, been veryintentional about the type of
clients you want to work withand what your parameters are for
working with them.
And I imagine you have somekind of like screening process
or, you know, conversation whenthey're first interested in
(10:03):
working with you, about how agoodness of fit might happen.
And I'm wondering if you coulddescribe for our listeners a
little bit about how you goabout doing that.
Speaker 3 (10:12):
Well, I get, you know , a lot of referrals for EMDR or
trauma.
So it could be EMDR could couldbe like a very short-term
therapy.
It doesn't mean they're goingto be.
They might kind of reallybelong to somebody else.
(10:33):
You know not my patient if it'sfrom another therapist that's
not EMDR trained and they justheard that I do EMDR trainings
or something or I know how to doit I'll call them and we'll
(10:53):
talk about it.
I like it if the person comesjust to me while we're doing
EMDR and then they go back,because otherwise it just seems,
you know, like they're going tocome in and tell me what's
happening and if they gotsomebody else they're going to
go in and tell them what'shappening.
(11:15):
You know it's a kind of a wasteto have two therapists.
You're kind of updating on youractivities and also it builds
more trust than if you know Isee them over time and make sure
(11:37):
they're kind of together enoughto do EMDR.
So, assessment wise, I giveeverybody the dissociative
experience scale to see you knowhow dissociative they are and
(11:57):
not that that's like 100%accurate, but if they score, you
know, like more than 30, thenI'm thinking, okay, it could be,
you know, complex trauma.
This might not be like a onceand done situation and maybe
they just come in, they were ina car wreck and they want EMDR
for that.
But I want to know, you know,like, how much preparation do we
(12:17):
need so this person doesn'tdestabilize with EMDR?
So you know, we'll do some safestate and some imagery stuff
and you can kind of tell fromthat.
I've had people that you knowdon't even have a safe state.
(12:38):
They, you know, it's kind oflike oh you know, this, this
might not be a good candidatehere, and so I explain.
If the person says like, youknow, how long is this going to
take?
I tell them if they've had alot of childhood trauma, it
could take a while and I explainthat to their referring
therapist, but if it's just onehorrible thing, it could just be
(13:02):
a few sessions.
So I'll get a sense from just.
I don't spend a lot of time onthe phone with the patient
because I want them, you know,to be in person.
I mean, I'll tell them what Icharge if I don't take insurance
, so I'll make that clear.
(13:23):
If they don't have out ofnetwork provider benefits, well
they need to find out about that.
Tell them my fee and then youknow, tell them if you know if
they're still interested.
You know kind of how to gethere, but a lot of times they
want you know me to say how longit's going to take or something
(13:45):
.
So that's where you know.
I said, well, I can get a betteridea once you come in and you
know we discuss it.
So then I try to, you know, geta pretty good history about
what you know.
Have they been in therapybefore?
What are they here for?
What are they like?
The question is, how are yougoing to know this therapy works
(14:08):
?
What's going to be differentfor you?
So that's going to help usfigure out some collaborative
goals.
So, yeah, if somebody comes andthey weren't referred by,
they're not in therapy, then youknow that's fine.
And you know I kind of do thesame in terms of assessing.
(14:31):
You know their stability.
If they're on psychiatricmedication, you know they.
If they're on like a benzo orsomething, you know.
I explain that if we're goingto do you know when we're ready
to do EMDR, they shouldn't takethe benzo that morning, because
(14:51):
we want them to be activated andI have them.
I always give them someliterature.
I have a really good book Ilove.
That was written a few yearsago Every Memory Deserves
Respect by Debbie Korn and shewrote it with a guy that's a
photojournalist.
So there's some fabulouspictures and it's like you could
(15:13):
read it in an hour.
So I'll recommend that ifthey're interested in you know,
because he, the guy that thephotojournalist, was the patient
and Debbie Korn then writesafter he says his thing in one
chapter she then explains kindof what's going on.
(15:33):
So it's like this you know dogand pony show thing that is so
engaging I think.
Um, it's.
It's not that, you know,theoretical or hard for anybody
to understand.
So anyhow, they want but noteverybody wants to read about it
.
So if somebody is, you know,actively in crisis, you know I
(16:03):
had one girl come.
She was had a car accident.
She was really dissociated andshe kind of walked in the office
like a zombie and normally Idon't see people that
dissociative.
But she was referred.
A friend of mine knows thisgirl's mother and so my friend
(16:36):
told me about her and I thoughtI could work with her because
you know the supportive familyshe had and she had been a
daughter of a bipolar mom whokind of completely ruined this
girl as a child, not on purpose,but you know she was really
raised under adversecircumstances.
So I kind of knew the familyhistory from my friend who was
(16:57):
friends with them and so she,you know it was a matter of
active.
She was in really dorsal, vagal,shutdown, totally zombie like
(17:18):
shut down, totally zombie-like,and it took a while to get her
activated.
But there was some trust therebetween me because of my friend
and this family.
So anyhow she, you know, Idon't know why I'm talking about
her, but she was.
But I think because she was sobad off I was like, oh my God.
So she got much better and Iworked with her, you know, every
(17:40):
week, probably over it mighthave been a year and she
eventually I mean she was phobicof driving after she, you know,
came to from the accident.
So we worked on that and sheeventually bought her own car
and she's like spiffing aroundin this nifty car.
(18:02):
So it was really fun to see hercome alive and come into her
own as her own person and yeah.
Speaker 2 (18:14):
So that's great and I know Kate you're, you know
you've got a lot of expertise indoing EMDR, you've done some
training and you know, ifanyone's interested, definitely
look Kate up.
She can still, you know,connect you with someone to kind
of get that EMDR training.
So I love the kind of theformalized kind of just really
focused on trauma, and that'skind of where your therapy is
really kind of taking you.
(18:34):
I'm actually kind of a littlecurious.
I know I'll call her West Coast.
Kate, you know, I know you'redoing something.
Do you have a process in whichyou kind of screen people for
therapy?
Because I know that's somethingthat came up at a conference
once.
Somebody asked you know, whenyou see in a patient, you know
how do you make thedetermination?
Do this person need meds or dothey need therapy, or do they
need both?
You know, and so, kate, do youhave any kind of or do you just
(18:57):
shoot from the hip, kind of likeI do?
Yeah, yeah, well.
Speaker 4 (19:00):
I'm happy to talk a little about that.
So I work in a very differentsetting than Dr Wheeler.
My current practice is on,actually as the psychiatric
provider for a primary carehouse calls team, actually as
the psychiatric provider for aprimary care house calls team.
So we, our care is forhomebound or bedbound adults, so
many of our patients are older,but certainly not all of them
(19:20):
are, and so you know we drivearound the city providing care
to folks.
So my referrals come from theprimary care providers and so
you know, when I started at thispractice there was no sort of
formal, you know, referralscreening whatsoever.
So it was always kind of a youknow bag of surprises, whatever
(19:41):
I would show up and get.
But I did develop one, actuallyin consultation with we got
access as well to a licensedclinical social worker who can
also provide some therapy, notin home but over the phone.
So the two of us work together.
So you know, some things wewanted the primary care
providers to let us know aboutin the referral was yes, you
(20:04):
know, does this person have anyprevious psychiatric diagnoses,
you know, similar to Dr Wheeler?
Are they in crisis or can theybe safely managed?
You know, in an outpatientsetting where you know I'm only
part-time with the clinic, sothere has to be safety there.
You know, what type of therapydo you think they might benefit
(20:24):
from, like time-limited or moreof sort of an ongoing thing,
like any goals for care?
And then you know the socialworker and I look through the
patient's chart and thengenerally I will go out and, you
know, do an assessment visitand you know, sometimes after
that assessment visit I will sayyou know, actually I think you
and the social worker will be areally good fit together.
(20:44):
Or often I will take on, youknow, that patient myself.
And so for most of thoseclients I'm doing both
medication management andpsychotherapy, although it is
mostly psychotherapy and it isgiven the patient population.
The average life expectancy of apatient who enrolls in the
(21:05):
program is about four years.
So you know, so it's a lot oflike narrative therapy, act.
You know some CBT, but you knowpeople are facing end of life
and some, you know, existentialtype of issues.
So you know, I've had lots ofpatients say to me like, well, I
don't know about therapy, Idon't want to talk to you about
my mother.
You know I'm 92 years old.
(21:26):
That's old, you know, and I say, well, we don't have to.
There's, you know, and I say,well, we don't have to.
You know, there's lots of waysthat we can work together.
Speaker 3 (21:38):
So, yeah, so that's, that's a very different type of,
I think, you know screening andpractice when your referrals
are coming from a veryparticular source.
Yeah, you're sort of like rightat the thick of it.
They're trying to figure out.
You know what's going on, whereI kind of have people that you
know I feel like they're not.
You know, I'm not like throwninto these situations trying to
figure it out.
Speaker 4 (22:00):
Sure, yeah, and then Dan, I think you're kind of
somewhere in the middle maybe.
Speaker 2 (22:04):
Yeah, maybe.
I mean I was just gonna saythat reminiscent therapy is yeah
, I did some work in a nursinghome once and that was that's so
rewarding, that's yeah.
So you don't need to talk aboutmother and get all Freudian on
people, but yeah, it's so fun tokind of just bring that and
really kind of support theirpositivity and things.
But but yeah, my practice ismore we call it a hospital based
clinic and so, um, so yeah, youknow thinking about you know
(22:27):
what is my, you know screeningprocess.
It's thinking about you knowwhat is my, you know, screening
process.
It's probably just at thispoint, you know, just because of
my time and limited, I'm onlyseeing patients about a day and
a half a week.
You know it's just that I'm notgetting a lot of referrals
because I just can't, you know,maintain those kind of patients
and getting a lot of referrals.
But it really becomes down tokind of you know a therapist
walking down the hall and saying, hey, I've got somebody
(22:49):
interesting.
I'm like, oh yeah, it soundsgood.
So you know, that's a realformal.
You know a very highly evolvedkind of screening process.
Unfortunately not, but it butit kind of works, you know, and
and and it gets into.
You know, I think we've saidthis before in the podcast and
you know, kind of my, my bend, Iguess, is always that people
that everyone needs therapy.
I mean it's you know, whywouldn't you do therapy?
(23:10):
You know, even if you're on sixmedications, I mean that's
maybe maybe even more of a callto say you need therapy and
things.
So so yeah, and I and Iappreciate you, dr Wheeler, kind
of saying you know that thisidea that therapy can actually
maybe work people offmedications, I know Dr Sean
Conboy, that's his big thing of.
You know therapy andpolypharmacy and you convoy,
that's his big thing of.
(23:30):
You know therapy andpolypharmacy and you know how
that can be a real tool to kindof, you know, get people off too
many medications and thingslike that.
But but yeah, so I, I just havethe bend.
You know, if I'm going to dosome medications with you, if
they're not seeing a therapistalready, I'm probably going to
get into some therapy with them.
Um, you know, kind of thatintegrative type of thing.
You know, med management,psychotherapy appointments in
(23:51):
which you can kind of do thosemultiple billing codes and
things like that.
So you know, and maybe kind ofwrapping up today.
You know again, kind of wantedto think, maybe just like a
pragmatic episode here but youknow, for each of you, what do
you?
Let's talk just aboutdocumentation.
You know what are some of thethings you know, kate.
(24:12):
I know in your, in yourtextbook, you know you've got a
whole chapter on this.
So you know, maybe we'replugging your, your textbook
again, which is great, but butyou know in reality, what you
know.
What do you include in therefor my?
You know, this is somethingthat I think students that I see
in my program get reallyintimidated by.
Like you know, what do I needto have in there?
So you know, so I don't get,you know, called to the carpet
and have to repay any monies andthings.
(24:33):
So so, kate, for you, what,what is you know in your mind,
what are the kind of theessentials that you need to have
in your documentation for yourtherapy patients?
Speaker 3 (24:43):
I don't have anybody like checking me or looking over
my shoulder.
Speaker 2 (24:46):
Oh right, Because you're cash yeah.
Speaker 3 (24:48):
I'm like more interested in process notes,
like I'll write aboutcountertransference or a couple
of notes about what we talkedabout and where questions that
came up for me.
But if it ever gets subpoenaedthen I have to go back and do
progress notes, not processnotes.
(25:09):
So I'm not the good person to,you know, be a role model for,
because I really don't likedoing the progress notes and I
don't have to unless somebodywants them, and I'm not, you
know, in a system that's makingme so so tell me about what.
Speaker 2 (25:30):
What do you have to add to the process note to make
it a progress note?
Speaker 3 (25:34):
uh, well, I do.
You know I would do soap notes.
I maybe one time somebodywanted something and it was a
pain in the butt to go back anddo all these soap notes and and
I figured out you know sort ofmy template and I did do it
because I had to, but you knowthat was probably the only time
(25:54):
I had to.
So I think about it in terms ofis it going to be more trouble
for me to do a progress noteevery session or is it going to
be more trouble on the rareoccasion that I get called for
those notes and so I have optedto just do it my way, which is
(26:17):
process notes.
So I wouldn't tell students that, though you know I would tell
them they need to do itaccurately and succinctly for
whatever their agency or, youknow, insurance company wants,
and I used to do all thoseinsurance forms.
So I understand it's a pain,but you kind of have to do good
(26:40):
documentation.
But I do it now more you knowin terms of what I think the
process is going on in therapyand you know if the patient, if
I feel like we're gettingsomeplace and where I need to go
next, and then I'll putquestion marks for myself.
(27:01):
So I'm not like thinking I knowit all or I'll go look up
something.
So that's probably not you know.
I would just tell you guys that.
Speaker 2 (27:13):
No, I appreciate it.
I think that's one of thosethings.
Again, I always try to tell mystudents it's not as
intimidating as you think it is.
Again, I think writing a notefor medications is obviously
much more intimidating and youknow much more detail on the
medical processes, you knowreview of systems and things
like that.
That's just not required, Idon't think, for those kind of
psychotherapy notes.
(27:33):
So maybe I'll turn it to you,to the West Coast, kate.
You know what?
What do you think?
What do you have in your inyour notes that you know make it
a therapy notes and and what doyou add to that?
Speaker 4 (27:44):
Yeah, well, I'll touch wood because it hasn't
bounced back to me yet.
But so far you know what Iinclude is time spent, obviously
, the types of therapy ortherapeutic techniques that I'm
using during this session.
You know generally the topicsthat we are discussing, without
going into detail, which I thinkis can be, you know, a bit
(28:05):
nuanced maybe for students, butI think vague is better for
those billable notes.
And then, of course, you dohave to assign a diagnosis in
order for it to be paid for.
So you know if you can outlineany types of changes and
symptoms.
That would be sort of a briefsentence or two.
So I agree with Dan, I thinkthe onus is much less on.
Speaker 2 (28:27):
Yeah, yeah, and I totally agree.
I think the big thing thatcatches people that usually I
don't put, well, it depends onthe medication.
Sometimes people do put time,but that is, you know, that is,
I think, essential because againthose codes require you to put
how much time you're spendingwith a patient where EM codes
you can bill by, you know,degree of complexity, and so you
(28:48):
don't always need the time.
So I think if that's a burden,then that's something that
people have to get used to.
The thing I always try to focuson too is, you know, trying to
kind of in most senses I try tokind of, and, again, not always
super great on this, so pleasedon't audit my notes but it's
you know I try to have a focusof how long this treatment's
going to be.
So so you know this isn't likeforever treatment.
(29:11):
You know this isn't going.
I'm not going to see him forfive years, or at least that's
not what I'm planning on whenI'm, when I'm writing the notes.
So I'm kind of trying toreflect that they're going to
you know they're eight sessionsand then maybe make another goal
to work on for another six,eight sessions.
So so that's kind of that'sbesides what you said, kate.
Yeah, that's kind of the onlyother thing I I think with my
(29:32):
note and and again that's for methat's really easy just to kind
of layer into an EM code and EMnotes and so so again I, I
again hope that's, you know,something that I try and I'm
happy to share those kind ofthings If anyone's listening
want to kind of reach out.
You know kind of my template ofwhat I use.
I think like, like you, kate, Ihaven't been called on the
(29:54):
carpet yet, so haven't been.
And sometimes I do hear that Imean I don't know.
I mean I actually was having apsychiatrist who is using a lot
of, you know, em codes withpsychotherapy and and got
audited and had to pay back abunch of money.
So you do have to follow someformat if you're billing
insurance because they will kindof look at you.
And I know I've talked topeople at the University of
(30:16):
Illinois at Chicago.
They've had kind of randomaudits through different
insurance companies.
They see a lot of codes.
They see a lot of those 90833s,that add-on code for
psychotherapy.
They see a bunch and it wasstrange because they saw it not
just for one provider but likethe whole clinic was doing it,
and so they kind of swept in andkind of did this whole you know
(30:36):
making sure that they aredocumented.
And they were, of course.
It's just, you know, I don'tknow not to bash on insurance
companies too much, but you knowit's a scare tactic to kind of
make sure we stay in our lane,which I don't think PMHNPs stay
in their lane very well, butthat's a good thing, I think.
Yeah, well, we're coming up ontime.
(30:56):
Melissa, I felt like we kind ofleft you out there.
Is there anything that you'rewondering or this conversation
has got you thinking about?
Speaker 5 (31:05):
I can't speak to the practice, so that made sense to
me.
I feel like I was a listenertoday and that is okay.
I think hearing about you knowwhy a practitioner might not go
through insurance which I kindof knew from friends who have
also made that decision ishelpful though.
And what goes on in the on thebackend.
So I appreciate theconversation today.
(31:26):
Thank you all.
Speaker 2 (31:30):
Yeah, it kind of goes into that.
You know, staying in your lane,I think you know that's why a
lot of people are going out intoprivate practice and doing what
you're doing.
Dr Wheeler is just kind ofreally trying to, you know, do
what you want to do, do what youknow is going to be helpful to
patients.
So, yeah, you know, find yourvoice and make sure you stick
with your voice and uh, um,that's the powerful thing here
(31:51):
too.
So, all right, well, we'll wrapup our never the guest here and
so look forward to moreepisodes coming out this summer
and, uh, thank you so much.
Please like, comment andsubscribe to the peplau's ghost
and we'll see you next episode.
Speaker 3 (32:04):
Bye thank you for including me thank you you, Dr
Wheeler.
Speaker 1 (32:07):
Take care Bye.
Work hard until those thoughtsare finally leaving, so you can
be you.
Guided discovery Identifyingchallenge in your beliefs.
(32:29):
Reframing your mind.
Negative thoughts release thesecognitive distortions.
Decrease Until they cease.
Guided discovery Identifyingchallenge in your beliefs.
Reframing your mind.
Negative thoughts release thesecognitive distortions.
Decrease Until they cease.
Yeah, just my take on things.
My answer number two Alright,we're recording.
Decrease until they cease.
It's not a discovery.
(00:24):
Identify a challenge in yourbeliefs, all right we're
recording.
Speaker 2 (00:30):
Welcome back to Pep Lau's Ghosts.
Great to have another episodehere, Super excited about our
guest here back a first timehere for Pep Lau's Ghosts to
actually bring back a guest.
But before I get to that maybecreate a little suspense here I
am continue to be joined by DrMelissa Chapman Hayes and Dr
(00:53):
Kate Molino, who we will call,probably a little bit in this
podcast, West Coast Kate, andmaybe that's a little sneak peek
on who we've got back.
But it's exciting to have DrKate Wheeler, who I will say I
lovingly call my East Coast Kate.
So thank you, kate, for comingback to talk on Pep Lau's Ghost.
(01:13):
It's exciting to kind of haveyou and your perspective and
your leadership here and, youknow, keeping the psychotherapy
a part of the role of the PMHMPand such.
So I think what we were talkingabout right before we started
recording is maybe kind ofsharing a little bit.
This is going to be maybe ahow-to podcast, so how to do
(01:34):
psychotherapy within thepractice, and I know both Kate
and myself do some psychotherapywithin our clinical role and
Melissa can maybe kind of jumpin and kind of make sure that we
don't get too jargony andthings like that but also
helping us kind of, you know,understand some of the questions
that obviously on a podcast wecan't ask.
So so, kate, maybe I'll justkind of throw it to you and just
(01:57):
kind of maybe get you going.
You know, for you, you knowthinking back or thinking kind
of even today, you know I knowyou've you've retired from your
academic role but you stillmaintain a clinical practice.
You know, why did you want tokeep that?
Why did you want to kind ofhold on to those patients and
still still do psychotherapy,and and, and what is the?
What is the pragmatics ofkeeping that practice or part of
(02:19):
your daily, weekly live going?
Speaker 3 (02:30):
daily, weekly live going.
Um well, I didn't think at allabout stopping that because I
really enjoy it and have likedpsychotherapy you know my whole
career and I didn't want to seemore people than a few days a
week.
So I have about 12 to 15patients a week, a lot of them,
you know, I get a few referrals,but a lot of them have been
(02:52):
with me for a while.
So it's just to me it's fun.
And, to condense, it is evenmore fun because the days I
don't have people, it is evenmore fun because the days I
don't have people, I'm just likehappy, because I'm like what am
(03:13):
I going to do today, which issuch a novel feeling.
Since I've been retired, Inever had time and I always felt
like I wasn't doing stuff thatI was supposed to do and I was
always trying to.
I don't want to say get out ofstuff, but if you're in academia
, everybody wants you, please beon this committee, do this, do
that.
So I think it was time for meto retire because I was getting
(03:33):
crabby about that and then I waslike um, realizing that wasn't
fair.
You know to be um trying to getout of stuff.
So, anyhow, yeah, what did yousay?
So I, there wasn't never aquestion of not continuing to
(03:54):
see my patients.
The challenge now is I just tooka long vacation.
It was a little over a month,maybe five weeks and then you
know telling people I don't seepeople that are in crisis.
Usually my folks are like justkind of normal neurotic, anxious
(04:15):
or depressed people so, and Ialways have somebody that covers
for me.
You know, somebody needs a medrefill or they do have a crisis,
but I don't think I've ever hadanybody had a crisis while I'm
gone, so I'm not worried aboutit.
But they all came back, youknow, on top, so exciting,
(04:38):
because you know I wasn't surehow that would play out in terms
of you know the transferenceand you know who would be
annoyed that they were abandoned.
But you know, if you talk about,you know how did it feel to not
come.
You know for the past month andyou know explore that it's much
(04:59):
better to put it out there thanto just pretend like that
elephant isn't in the room.
Do you know what I mean?
Because people that haveabandonment issues are going to
be, you know, feeling that.
So that's always interesting.
Not that you have to apologizefor it, but, I think, getting
(05:20):
their take on the whole thing,and most people were like
pleased that they did so.
Well, you know they and nobodyquit because of it, cause I
thought, well, they're going tosee that they don't need to come
anymore, hell with you.
But um, they all hung in thereand, um, you know, there was not
a problem.
Speaker 2 (05:40):
Um, so that that makes me remember one of my um
uh mentors that's retiredrecently.
She said she knew it was timeto retire because she was on a
plane and had started somebodyon depakote and the patient was
calling her urgently to try andget that something about the
medication that was having aside effect or something.
She was like, okay, that's,that's too much and time to go.
(06:01):
So I think that kind of speaksof that.
You get get a little cranky andjust kind of done with things.
But maybe talk more about that,because I think that's one of
those sticky things in practicetoo.
When we want to take vacations,self-care is very important and,
like you said, that's kind ofan extended time away of five
weeks, which is amazing.
But how do you handle thosepatients that maybe struggle
(06:24):
with that countertransferenceand don't think you can?
You know they won't survive forfive weeks without you and how
do you, how do you plan for that?
Or how do you kind of you knowaddress that you mentioned, kind
of they did survive and theythey learned from it.
But do you do any prep work onthat or kind of get them?
Speaker 3 (06:39):
ready.
Well, I ask them you know I'mgonna'm going to stay to that
day, you know.
And then I tell them way aheadof time and then you know, ask,
reminding them again and askingthem how they feel about it.
And when I was in analytictraining, most of the analysts
always took August off, so itwas just like not a question.
(07:03):
And yeah, so you know, I thinkit's surprising, there I had
more I don't know pushback,maybe because I didn't know what
I was doing.
But also I may have been seeingpeople with more serious
problems than I see people outof my home.
(07:24):
So serious problems, then I seepeople out of my home.
So you know, I'm not likeseeing people with significant
psychiatric problems, seriousmental illness.
So that probably makes adifference to where I was in
analytic training.
I was just seeing, you know,folks that came into the clinic
and some of them with you know,big attachment disorders.
(07:47):
So I think that probably made adifference too.
But I think preparing peopleand just using their response is
kind of grist for the mill,saying about it and tell me more
about how you feel, and not tobe, uh, you know, afraid of
(08:07):
getting anything negative back.
You know, because everybody.
We all like to be liked andmaybe they won't like you, you
know, because also it could stirup envy.
You know who are you to get totake all this time off and you
know I'm struggling here, so butanyhow, I was pleased that you
(08:31):
know that wasn't an issue.
I have a very good person thatcovers for me.
As the years have gone on, I doless medication and more therapy
and my goal is always to getpeople off of stuff rather than
starting a medication.
So, and I don't prescribe thatmany like Depakote or mood
(08:57):
stabilizer or an antipsychoticOkay, I'll do an SSRI, but I'm
not I don't really no offenselike reading psychopharm
articles.
I'd much rather read apsychotherapy article and I
think if you're going to do agood job, you've got to keep up
(09:17):
with the psychopharm and I don'twant to keep up with the
psychopharm because it's soboring to me, the psychopharm,
because it's so boring to me.
So I just stick with mostly thetherapy piece.
And then you know, somebodyneeds a refill.
My colleague takes care of thatand I cover for her when she
leaves.
She's a psych MP that you knowlives nearby.
Speaker 4 (09:42):
And you know, kate, I'm curious if you would
describe a little more, becauseit sounds like you know you have
, you know, been veryintentional about the type of
clients you want to work withand what your parameters are for
working with them.
And I imagine you have somekind of like screening process
or, you know, conversation whenthey're first interested in
(10:03):
working with you, about how agoodness of fit might happen.
And I'm wondering if you coulddescribe for our listeners a
little bit about how you goabout doing that.
Speaker 3 (10:12):
Well, I get, you know , a lot of referrals for EMDR or
trauma.
So it could be EMDR could couldbe like a very short-term
therapy.
It doesn't mean they're goingto be.
They might kind of reallybelong to somebody else.
(10:33):
You know not my patient if it'sfrom another therapist that's
not EMDR trained and they justheard that I do EMDR trainings
or something or I know how to doit I'll call them and we'll
(10:53):
talk about it.
I like it if the person comesjust to me while we're doing
EMDR and then they go back,because otherwise it just seems,
you know, like they're going tocome in and tell me what's
happening and if they gotsomebody else they're going to
go in and tell them what'shappening.
(11:15):
You know it's a kind of a wasteto have two therapists.
You're kind of updating on youractivities and also it builds
more trust than if you know Isee them over time and make sure
(11:37):
they're kind of together enoughto do EMDR.
So, assessment wise, I giveeverybody the dissociative
experience scale to see you knowhow dissociative they are and
(11:57):
not that that's like 100%accurate, but if they score, you
know, like more than 30, thenI'm thinking, okay, it could be,
you know, complex trauma.
This might not be like a onceand done situation and maybe
they just come in, they were ina car wreck and they want EMDR
for that.
But I want to know, you know,like, how much preparation do we
(12:17):
need so this person doesn'tdestabilize with EMDR?
So you know, we'll do some safestate and some imagery stuff
and you can kind of tell fromthat.
I've had people that you knowdon't even have a safe state.
(12:38):
They, you know, it's kind oflike oh you know, this, this
might not be a good candidatehere, and so I explain.
If the person says like, youknow, how long is this going to
take?
I tell them if they've had alot of childhood trauma, it
could take a while and I explainthat to their referring
therapist, but if it's just onehorrible thing, it could just be
(13:02):
a few sessions.
So I'll get a sense from just.
I don't spend a lot of time onthe phone with the patient
because I want them, you know,to be in person.
I mean, I'll tell them what Icharge if I don't take insurance
, so I'll make that clear.
(13:23):
If they don't have out ofnetwork provider benefits, well
they need to find out about that.
Tell them my fee and then youknow, tell them if you know if
they're still interested.
You know kind of how to gethere, but a lot of times they
want you know me to say how longit's going to take or something
(13:45):
.
So that's where you know.
I said, well, I can get a betteridea once you come in and you
know we discuss it.
So then I try to, you know, geta pretty good history about
what you know.
Have they been in therapybefore?
What are they here for?
What are they like?
The question is, how are yougoing to know this therapy works
(14:08):
?
What's going to be differentfor you?
So that's going to help usfigure out some collaborative
goals.
So, yeah, if somebody comes andthey weren't referred by,
they're not in therapy, then youknow that's fine.
And you know I kind of do thesame in terms of assessing.
(14:31):
You know their stability.
If they're on psychiatricmedication, you know they.
If they're on like a benzo orsomething, you know.
I explain that if we're goingto do you know when we're ready
to do EMDR, they shouldn't takethe benzo that morning, because
(14:51):
we want them to be activated andI have them.
I always give them someliterature.
I have a really good book Ilove.
That was written a few yearsago Every Memory Deserves
Respect by Debbie Korn and shewrote it with a guy that's a
photojournalist.
So there's some fabulouspictures and it's like you could
(15:13):
read it in an hour.
So I'll recommend that ifthey're interested in you know,
because he, the guy that thephotojournalist, was the patient
and Debbie Korn then writesafter he says his thing in one
chapter she then explains kindof what's going on.
(15:33):
So it's like this you know dogand pony show thing that is so
engaging I think.
Um, it's.
It's not that, you know,theoretical or hard for anybody
to understand.
So anyhow, they want but noteverybody wants to read about it
.
So if somebody is, you know,actively in crisis, you know I
(16:03):
had one girl come.
She was had a car accident.
She was really dissociated andshe kind of walked in the office
like a zombie and normally Idon't see people that
dissociative.
But she was referred.
A friend of mine knows thisgirl's mother and so my friend
(16:36):
told me about her and I thoughtI could work with her because
you know the supportive familyshe had and she had been a
daughter of a bipolar mom whokind of completely ruined this
girl as a child, not on purpose,but you know she was really
raised under adversecircumstances.
So I kind of knew the familyhistory from my friend who was
(16:57):
friends with them and so she,you know it was a matter of
active.
She was in really dorsal, vagal,shutdown, totally zombie like
(17:18):
shut down, totally zombie-like,and it took a while to get her
activated.
But there was some trust therebetween me because of my friend
and this family.
So anyhow she, you know, Idon't know why I'm talking about
her, but she was.
But I think because she was sobad off I was like, oh my God.
So she got much better and Iworked with her, you know, every
(17:40):
week, probably over it mighthave been a year and she
eventually I mean she was phobicof driving after she, you know,
came to from the accident.
So we worked on that and sheeventually bought her own car
and she's like spiffing aroundin this nifty car.
(18:02):
So it was really fun to see hercome alive and come into her
own as her own person and yeah.
Speaker 2 (18:14):
So that's great and I know Kate you're, you know
you've got a lot of expertise indoing EMDR, you've done some
training and you know, ifanyone's interested, definitely
look Kate up.
She can still, you know,connect you with someone to kind
of get that EMDR training.
So I love the kind of theformalized kind of just really
focused on trauma, and that'skind of where your therapy is
really kind of taking you.
(18:34):
I'm actually kind of a littlecurious.
I know I'll call her West Coast.
Kate, you know, I know you'redoing something.
Do you have a process in whichyou kind of screen people for
therapy?
Because I know that's somethingthat came up at a conference
once.
Somebody asked you know, whenyou see in a patient, you know
how do you make thedetermination?
Do this person need meds or dothey need therapy, or do they
need both?
You know, and so, kate, do youhave any kind of or do you just
(18:57):
shoot from the hip, kind of likeI do?
Yeah, yeah, well.
Speaker 4 (19:00):
I'm happy to talk a little about that.
So I work in a very differentsetting than Dr Wheeler.
My current practice is on,actually as the psychiatric
provider for a primary carehouse calls team, actually as
the psychiatric provider for aprimary care house calls team.
So we, our care is forhomebound or bedbound adults, so
many of our patients are older,but certainly not all of them
(19:20):
are, and so you know we drivearound the city providing care
to folks.
So my referrals come from theprimary care providers and so
you know, when I started at thispractice there was no sort of
formal, you know, referralscreening whatsoever.
So it was always kind of a youknow bag of surprises, whatever
(19:41):
I would show up and get.
But I did develop one, actuallyin consultation with we got
access as well to a licensedclinical social worker who can
also provide some therapy, notin home but over the phone.
So the two of us work together.
So you know, some things wewanted the primary care
providers to let us know aboutin the referral was yes, you
(20:04):
know, does this person have anyprevious psychiatric diagnoses,
you know, similar to Dr Wheeler?
Are they in crisis or can theybe safely managed?
You know, in an outpatientsetting where you know I'm only
part-time with the clinic, sothere has to be safety there.
You know, what type of therapydo you think they might benefit
(20:24):
from, like time-limited or moreof sort of an ongoing thing,
like any goals for care?
And then you know the socialworker and I look through the
patient's chart and thengenerally I will go out and, you
know, do an assessment visitand you know, sometimes after
that assessment visit I will sayyou know, actually I think you
and the social worker will be areally good fit together.
(20:44):
Or often I will take on, youknow, that patient myself.
And so for most of thoseclients I'm doing both
medication management andpsychotherapy, although it is
mostly psychotherapy and it isgiven the patient population.
The average life expectancy of apatient who enrolls in the
(21:05):
program is about four years.
So you know, so it's a lot oflike narrative therapy, act.
You know some CBT, but you knowpeople are facing end of life
and some, you know, existentialtype of issues.
So you know, I've had lots ofpatients say to me like, well, I
don't know about therapy, Idon't want to talk to you about
my mother.
You know I'm 92 years old.
(21:26):
That's old, you know, and I say, well, we don't have to.
There's, you know, and I say,well, we don't have to.
You know, there's lots of waysthat we can work together.
Speaker 3 (21:38):
So, yeah, so that's, that's a very different type of,
I think, you know screening andpractice when your referrals
are coming from a veryparticular source.
Yeah, you're sort of like rightat the thick of it.
They're trying to figure out.
You know what's going on, whereI kind of have people that you
know I feel like they're not.
You know, I'm not like throwninto these situations trying to
figure it out.
Speaker 4 (22:00):
Sure, yeah, and then Dan, I think you're kind of
somewhere in the middle maybe.
Speaker 2 (22:04):
Yeah, maybe.
I mean I was just gonna saythat reminiscent therapy is yeah
, I did some work in a nursinghome once and that was that's so
rewarding, that's yeah.
So you don't need to talk aboutmother and get all Freudian on
people, but yeah, it's so fun tokind of just bring that and
really kind of support theirpositivity and things.
But but yeah, my practice ismore we call it a hospital based
clinic and so, um, so yeah, youknow thinking about you know
(22:27):
what is my, you know screeningprocess.
It's thinking about you knowwhat is my, you know, screening
process.
It's probably just at thispoint, you know, just because of
my time and limited, I'm onlyseeing patients about a day and
a half a week.
You know it's just that I'm notgetting a lot of referrals
because I just can't, you know,maintain those kind of patients
and getting a lot of referrals.
But it really becomes down tokind of you know a therapist
walking down the hall and saying, hey, I've got somebody
(22:49):
interesting.
I'm like, oh yeah, it soundsgood.
So you know, that's a realformal.
You know a very highly evolvedkind of screening process.
Unfortunately not, but it butit kind of works, you know, and
and and it gets into.
You know, I think we've saidthis before in the podcast and
you know, kind of my, my bend, Iguess, is always that people
that everyone needs therapy.
I mean it's you know, whywouldn't you do therapy?
(23:10):
You know, even if you're on sixmedications, I mean that's
maybe maybe even more of a callto say you need therapy and
things.
So so yeah, and I and Iappreciate you, dr Wheeler, kind
of saying you know that thisidea that therapy can actually
maybe work people offmedications, I know Dr Sean
Conboy, that's his big thing of.
You know therapy andpolypharmacy and you convoy,
that's his big thing of.
(23:30):
You know therapy andpolypharmacy and you know how
that can be a real tool to kindof, you know, get people off too
many medications and thingslike that.
But but yeah, so I, I just havethe bend.
You know, if I'm going to dosome medications with you, if
they're not seeing a therapistalready, I'm probably going to
get into some therapy with them.
Um, you know, kind of thatintegrative type of thing.
You know, med management,psychotherapy appointments in
(23:51):
which you can kind of do thosemultiple billing codes and
things like that.
So you know, and maybe kind ofwrapping up today.
You know again, kind of wantedto think, maybe just like a
pragmatic episode here but youknow, for each of you, what do
you?
Let's talk just aboutdocumentation.
You know what are some of thethings you know, kate.
(24:12):
I know in your, in yourtextbook, you know you've got a
whole chapter on this.
So you know, maybe we'replugging your, your textbook
again, which is great, but butyou know in reality, what you
know.
What do you include in therefor my?
You know, this is somethingthat I think students that I see
in my program get reallyintimidated by.
Like you know, what do I needto have in there?
So you know, so I don't get,you know, called to the carpet
and have to repay any monies andthings.
(24:33):
So so, kate, for you, what,what is you know in your mind,
what are the kind of theessentials that you need to have
in your documentation for yourtherapy patients?
Speaker 3 (24:43):
I don't have anybody like checking me or looking over
my shoulder.
Speaker 2 (24:46):
Oh right, Because you're cash yeah.
Speaker 3 (24:48):
I'm like more interested in process notes,
like I'll write aboutcountertransference or a couple
of notes about what we talkedabout and where questions that
came up for me.
But if it ever gets subpoenaedthen I have to go back and do
progress notes, not processnotes.
(25:09):
So I'm not the good person to,you know, be a role model for,
because I really don't likedoing the progress notes and I
don't have to unless somebodywants them, and I'm not, you
know, in a system that's makingme so so tell me about what.
Speaker 2 (25:30):
What do you have to add to the process note to make
it a progress note?
Speaker 3 (25:34):
uh, well, I do.
You know I would do soap notes.
I maybe one time somebodywanted something and it was a
pain in the butt to go back anddo all these soap notes and and
I figured out you know sort ofmy template and I did do it
because I had to, but you knowthat was probably the only time
(25:54):
I had to.
So I think about it in terms ofis it going to be more trouble
for me to do a progress noteevery session or is it going to
be more trouble on the rareoccasion that I get called for
those notes and so I have optedto just do it my way, which is
(26:17):
process notes.
So I wouldn't tell students that, though you know I would tell
them they need to do itaccurately and succinctly for
whatever their agency or, youknow, insurance company wants,
and I used to do all thoseinsurance forms.
So I understand it's a pain,but you kind of have to do good
(26:40):
documentation.
But I do it now more you knowin terms of what I think the
process is going on in therapyand you know if the patient, if
I feel like we're gettingsomeplace and where I need to go
next, and then I'll putquestion marks for myself.
(27:01):
So I'm not like thinking I knowit all or I'll go look up
something.
So that's probably not you know.
I would just tell you guys that.
Speaker 2 (27:13):
No, I appreciate it.
I think that's one of thosethings.
Again, I always try to tell mystudents it's not as
intimidating as you think it is.
Again, I think writing a notefor medications is obviously
much more intimidating and youknow much more detail on the
medical processes, you knowreview of systems and things
like that.
That's just not required, Idon't think, for those kind of
psychotherapy notes.
(27:33):
So maybe I'll turn it to you,to the West Coast, kate.
You know what?
What do you think?
What do you have in your inyour notes that you know make it
a therapy notes and and what doyou add to that?
Speaker 4 (27:44):
Yeah, well, I'll touch wood because it hasn't
bounced back to me yet.
But so far you know what Iinclude is time spent, obviously
, the types of therapy ortherapeutic techniques that I'm
using during this session.
You know generally the topicsthat we are discussing, without
going into detail, which I thinkis can be, you know, a bit
(28:05):
nuanced maybe for students, butI think vague is better for
those billable notes.
And then, of course, you dohave to assign a diagnosis in
order for it to be paid for.
So you know if you can outlineany types of changes and
symptoms.
That would be sort of a briefsentence or two.
So I agree with Dan, I thinkthe onus is much less on.
Speaker 2 (28:27):
Yeah, yeah, and I totally agree.
I think the big thing thatcatches people that usually I
don't put, well, it depends onthe medication.
Sometimes people do put time,but that is, you know, that is,
I think, essential because againthose codes require you to put
how much time you're spendingwith a patient where EM codes
you can bill by, you know,degree of complexity, and so you
(28:48):
don't always need the time.
So I think if that's a burden,then that's something that
people have to get used to.
The thing I always try to focuson too is, you know, trying to
kind of in most senses I try tokind of, and, again, not always
super great on this, so pleasedon't audit my notes but it's
you know I try to have a focusof how long this treatment's
going to be.
So so you know this isn't likeforever treatment.
(29:11):
You know this isn't going.
I'm not going to see him forfive years, or at least that's
not what I'm planning on whenI'm, when I'm writing the notes.
So I'm kind of trying toreflect that they're going to
you know they're eight sessionsand then maybe make another goal
to work on for another six,eight sessions.
So so that's kind of that'sbesides what you said, kate.
Yeah, that's kind of the onlyother thing I I think with my
(29:32):
note and and again that's for methat's really easy just to kind
of layer into an EM code and EMnotes and so so again I, I
again hope that's, you know,something that I try and I'm
happy to share those kind ofthings If anyone's listening
want to kind of reach out.
You know kind of my template ofwhat I use.
I think like, like you, kate, Ihaven't been called on the
(29:54):
carpet yet, so haven't been.
And sometimes I do hear that Imean I don't know.
I mean I actually was having apsychiatrist who is using a lot
of, you know, em codes withpsychotherapy and and got
audited and had to pay back abunch of money.
So you do have to follow someformat if you're billing
insurance because they will kindof look at you.
And I know I've talked topeople at the University of
(30:16):
Illinois at Chicago.
They've had kind of randomaudits through different
insurance companies.
They see a lot of codes.
They see a lot of those 90833s,that add-on code for
psychotherapy.
They see a bunch and it wasstrange because they saw it not
just for one provider but likethe whole clinic was doing it,
and so they kind of swept in andkind of did this whole you know
(30:36):
making sure that they aredocumented.
And they were, of course.
It's just, you know, I don'tknow not to bash on insurance
companies too much, but you knowit's a scare tactic to kind of
make sure we stay in our lane,which I don't think PMHNPs stay
in their lane very well, butthat's a good thing, I think.
Yeah, well, we're coming up ontime.
(30:56):
Melissa, I felt like we kind ofleft you out there.
Is there anything that you'rewondering or this conversation
has got you thinking about?
Speaker 5 (31:05):
I can't speak to the practice, so that made sense to
me.
I feel like I was a listenertoday and that is okay.
I think hearing about you knowwhy a practitioner might not go
through insurance which I kindof knew from friends who have
also made that decision ishelpful though.
And what goes on in the on thebackend.
So I appreciate theconversation today.
(31:26):
Thank you all.
Speaker 2 (31:30):
Yeah, it kind of goes into that.
You know, staying in your lane,I think you know that's why a
lot of people are going out intoprivate practice and doing what
you're doing.
Dr Wheeler is just kind ofreally trying to, you know, do
what you want to do, do what youknow is going to be helpful to
patients.
So, yeah, you know, find yourvoice and make sure you stick
with your voice and uh, um,that's the powerful thing here
(31:51):
too.
So, all right, well, we'll wrapup our never the guest here and
so look forward to moreepisodes coming out this summer
and, uh, thank you so much.
Please like, comment andsubscribe to the peplau's ghost
and we'll see you next episode.
Speaker 3 (32:04):
Bye thank you for including me thank you you, Dr
Wheeler.
Speaker 1 (32:07):
Take care Bye.
Work hard until those thoughtsare finally leaving, so you can
be you.
Guided discovery Identifyingchallenge in your beliefs.
(32:29):
Reframing your mind.
Negative thoughts release thesecognitive distortions.
Decrease Until they cease.
Guided discovery Identifyingchallenge in your beliefs.
Reframing your mind.
Negative thoughts release thesecognitive distortions.
Decrease Until they cease.
Popular Podcasts
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.