When Dr. Howard Butcher discovered a brochure about psychiatric nursing while studying biology, it changed the trajectory of his life. "I didn't know nurses could be therapists," he recalls, setting him on a path that would lead to becoming both a practicing nurse therapist and an influential nursing theory scholar.
The pull between theory and practice forms the heart of this compelling conversation. Dr. Butcher articulates why nursing theory isn't just academic posturing—it's the foundation that gives psychiatric mental health nurses their unique voice in healthcare. Using the vivid metaphor of a "potluck dinner" where different disciplines each bring their dish to the mental health treatment table, he asks the crucial question: "What's in the nurse's dish that gives us a seat at the table?"
The answer lies in nursing's holistic perspective. While psychiatrists may focus primarily on biology and psychologists on behavior or cognition, nurses integrate biological, psychological, social, cultural, and spiritual dimensions. This comprehensive lens isn't just nice to have—it's essential for truly understanding patients' experiences and helping them find meaning in their struggles.
Dr. Butcher warns against the "seductive" biological model that reduces mental health care to medication management. He advocates instead for approaches like narrative therapy and existential-phenomenological methods that align with nursing's holistic foundation. These approaches help patients reconstruct their stories and find meaning, something Dr. Butcher incorporated into his own research on therapeutic journaling.
Looking toward the future, he offers an optimistic vision. While online therapy platforms and AI may supplement mental health care, they cannot replace the human connection at the heart of nursing practice. "The human compassion and empathy, the human touch and the human heart—those things are simply not replaceable," he asserts.
Want to understand what makes nurse therapists unique? Listen now to discover how nursing theory creates a distinctive lens that transforms psychotherapy practice and offers patients something no other discipline can provide.
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 decreaseuntil they cease.
It's not a discoveryIdentifying challenge in your
(00:27):
beliefs.
Speaker 2 (00:27):
I think we're recording.
Welcome back everybody to PepLau's Ghost.
Thank you for coming back.
So much appreciated, reallyexcited about our next guest
here.
Dr Howard Butcher is with usand, as I was just saying before
we started recording, drButcher has a very special place
in my heart as he was actuallymy professor I was getting my
PMHNP when I was at theUniversity of Iowa so it's been
(00:51):
a pleasure to keep knowing himand to know him past graduation
and was a colleague of his atthe University of Iowa for a
while before he decided to go onfor greener grasses in Florida
and such.
So.
But again very happy to havehim on the podcast, as always, I
should say.
I'm joined by my esteemedcolleagues Dr Sean Convoy, dr
Kate Molino and Dr MelissaChapman, and so we're here to
(01:14):
kind of talk on peplau's ghostand so let's get to it.
I got a quick introduction here.
Don't like to drag out theseintroductions too much, but did
want to say that, dr HowardButcher, you're in Florida
teaching.
Still, one of your areas isreally bringing nursing theory
into practice, education anddeveloping further research, and
(01:34):
Sean is raising the roof.
So that's love that that he'sgoing to kind of get into that
too.
I was reading your bio a littlebit.
You are and I knew this, youare a Rogerian scholar, which I
always have to kind of make surethat we.
That's not Carl Rogers, that'sthe Rogers science of unitary
human beings.
So I believe you got yourmaster's and your PhD in that
(01:57):
focus.
Yes, yeah so, and I believeyou've had some mid-level
theories, at least your biomentioned.
You had some mid-level theoriesthat you developed based on
that as well, and you are stillthe editor for the Nursing
Intervention Classification, orNIC, which I think is in its
eighth edition, if your bio iscorrect.
We just had a meeting thismorning, just working on ninth
(02:18):
yeah, that's how it goes right.
So, so, lots of internationalcollaborations you know working
on, you know expanding Nick as aframework of what you know
understanding what nurses do,which sometimes, well, a lot of
times, gets overlooked.
So so again, thank you, drButcher, for being here with me
and us on the podcast here, andso I'll get the ball rolling and
(02:40):
kind of our focused, you know,really kind of looking at maybe,
cause I know, again, you're aresearcher and you're very much
focused on nursing theory.
But I know, based on you knowyour time with you know both
working together, as well as youbeing my professor, you have
done therapy and I hope youstill are, but you've done it
definitely and you've got a vastexperience in that.
So when did you first startgetting interested in doing
(03:02):
psychotherapy?
Speaker 3 (03:04):
Well, it's interesting because it goes all
the way back to why I chose tobecome a nurse to begin with.
Because I was actually abiology major and I was going to
teach.
I was going to be a high schoolbiology teacher and I was my
girlfriend at the time was innursing school, but I always had
a real strong interest inpsychology, even in high school.
I was reading all kinds ofpsychology books about
(03:27):
psychotherapy, and I was readingthat stuff in high school and I
wanted to be a teacher.
In high school I wanted to be ateacher.
I didn't think about becoming atherapist until I went to the
infirmary on campus.
I was at Lebanon Valley Collegeand I saw a brochure sitting on
the table that described therole of a clinical nurse,
specialist in psychiatric,mental health nursing and the
(03:49):
brochure was from the Universityof Pennsylvania.
It was their program and when Isaw that I thought to myself
gosh, I didn't know that nursescan you know, can be therapists.
And I was thinking I was, youknow, changed my major.
Well, I didn't change my major.
I was a biology major but Iwould settle on becoming a
biology teacher because theydon't teach psychology at most
(04:10):
high schools.
So that was kind of like asecond choice.
And then when I saw thisbrochure, I thought well, wait a
second, I can be a therapist bybeing a nurse.
I became more and moreinterested in nursing as I was
learning more and more what mygirlfriend at the time was doing
, because we would study in thelibrary together and I would say
, gosh, you know, you're workingwith patients and you're making
a difference in people's lives.
(04:31):
And what am I doing?
I'm like in the chemistry labfor four hours in the bio lab
dissecting, you know, sharks andcats and things that weren't
even alive.
And I thought, you know, I'dmuch rather work with people.
(04:52):
So once I saw there was a pathfor me, my goal from the very
beginning was to be a nursetherapist, and that's why I
changed my major to nursing.
And when I finished that degreein biology I could have it was
in the beginning of my senioryear I could have, you know,
changed my major then.
But then in six years I wouldhave come out with one degree.
But I found out there wereprograms, bsn programs you can
get into with only two yearsbecause you, you know, you
(05:14):
transfer in at the junior yearlevel.
So that's what I did so.
I went to Jefferson and in sixyears came out with two degrees,
instead of six years only onedegree if I had changed my major
.
And then in my BSN program, allthe way through I focused on
psychosocial issues.
I just I knew that that's whatI wanted to do and so, whatever
kind of clinical, whateverpopulation we were working with,
(05:35):
I always made sure that myassignment and papers were kind
of like looking at thepsychosocial aspect and I knew I
wanted to get a master's degree, because that's degree, because
that's the aim was, to get aBSN, so I can go to a master's
program and become a clinicalnurse specialist and become a
nurse therapist.
So that whole thing is allintertwined together.
Speaker 2 (05:58):
Yeah, thanks.
I guess you know it all goesback to studying in the library
with a girlfriend, I mean that'sa classic start to a lot of
stories, right?
Follow your heart, and that'lltake you a long way.
So thank you, howard.
Speaker 4 (06:12):
Howard, I'm going to play to your strength and I'm
going to shift the question overto kind of focus a little bit
on the theory here.
You know, all of us teach tosome great capacity with
students on a regular basis andwe typically have kind of this
split with our students.
Some half of the cohort arevery theory-minded, the other
half feel like a resistance toit.
(06:33):
That is undefinable.
Thinking about advancedpractice psychiatric mental
health nursing, is there one ortwo theories that you just keep
in your left pocket that youthink are translatable in almost
every situation andcircumstance?
Speaker 3 (06:48):
as an advanced practice psychiatric mental
health nurse, yes, theredefinitely is, but let me step
back a little bit and talk alittle bit about theory.
First of all, you can'tseparate theory from practice.
People may not think thatthey're using theory or they
have a divergent theory, butthey're coming from some sort of
interpretive framework, right,and it may not be explicit, it
(07:11):
may not be scientific, becauseit's something that they mix up
in their own mind, but everybodyhas a lens through which they
look at the world and that issome form of a theory.
That is some form of a theory.
I've always believed thatnurses and all practitioners
need to be basing their practiceon a scientific theory, which
(07:34):
means then using the theory asit's designed.
I think when you start becomingeclectic and start combining
things together, that's notreally a scientific process, you
know.
So you can use differenttheories for different
situations, but you need tounderstand that some theories
don't really jive togetherbecause they have, they're based
on assumptions that are inconflict with one another, for
(07:57):
example.
So my whole career has beenbased around, you know really,
about nursing science andnursing theory, because all
professions are identified bytheir unique body of knowledge.
If nursing didn't have a uniquebody of knowledge, then we
(08:21):
really don't have a profession,because one of the criteria for
a profession is to have a uniquebody of knowledge.
Now, that doesn't mean that wedon't use theories and knowledge
, and certainly in psych, mentalhealth we use theories.
We learn about theories frompsychology and different, you
know mostly from psychology.
But if you have a really stronggrounding in a nursing
(08:43):
perspective, a nursing lens,when you learn about
psychoanalytic, you know gestalt, existential, phenomenological
theory.
You, for me, it's the idea isto understand those theories
through a nursing lens.
And when you see things, justlike you're seeing things
through a prison, it transformsthe theory when you're looking
(09:05):
at a theory through a nursinglens.
And so for me, the choices oftheories that I gravitate to are
ones that are, first of all,are philosophically compatible
with my nursing perspective,meaning that you know theories
that are holistic, theories thatI'm more of an existential.
(09:29):
I believe that, for example,nursing, part of my nursing lens
is that being holistic is whatmakes us unique as a discipline,
and so those theories that are,you know, holistically oriented
are ones that I gravitatetowards.
I also believe that nursingoccurs more on the interpersonal
(09:50):
relationship level and not onthe cellular genetic level.
So those theories it's not thatI reject biological
explanations for mental healthconditions, but it has to be
complemented with aninterpersonal sort of level of
(10:13):
understanding of what theperson's condition is.
So theories that areexistential phenomenological,
for example, I gravitate tobecause as a profession we're
interested in human experiences.
If we can't understand ourpatients' experiences, then how
is it that we can really helpthem right?
(10:35):
So those theories they get at,the human experience is what's
relevant to me.
And so existentialphenomenology is the research,
is a philosophy and a researchmethod that fits with what
nursing, I believe, is primarilyabout at the relationship level
, to understand the experienceso we can help them.
And so there's therapies thatcome from that philosophy of
(11:01):
existential phenomenology.
So meaning-making and theoriesthat are oriented towards
meaning-making approaches topsychotherapy are things that I
gravitate to.
I find meaning-making essentialactually to all realms of
nursing practices, helpingpatients understand the meaning
and the experience that they'regoing through.
So narrative therapy, forexample, is one of those realms
(11:26):
of therapies that really, for me, fit really well.
I actually my program ofresearch came out of my interest
in narrative therapy, becausejournaling is one of the main
modalities that is used innarrative therapy.
It's like it's often the, youknow, you reconsider.
The person is talking to youabout their story Everybody
(11:47):
lives a story and then narrativetherapy is looking at that
story and reframing reframingthe story and finding new
meaning in your life by bycreating a new story.
And so my, my research ended upbeing on journaling and the
therapeutic benefits ofjournaling.
So I was able to tie myinterest in a particular therapy
um to my program of research,and so narrative therapy is one
(12:13):
of those areas that really meana lot to me.
Existential phenomenologicalapproaches so I'm well-versed
with Heidegger, but also RolloMay, there's a bunch of folks,
humanistic approaches, carlRogers, so those I think are
consistent with thatrelationship level and fit with
(12:33):
my view of who we are as nurses,more holistically oriented.
So those end up being thetherapies that I gravitate
towards.
And then I have a wholephilosophical base that's all
grounded in it and that'sconstructivism.
So I would start with that isthat you know I believe that
(12:59):
people construct their ownrealities and I believe in the
principles of constructivism.
And narrative therapy andexistential phenomenology are
therapies that fit within thatconstructivist philosophy of
science perspective.
So I try to be consistent andcongruent with my therapeutic
approaches and my chosentheories, with my philosophy, my
values and my grounding innursing science.
Speaker 4 (13:23):
That helps.
Thanks a lot.
Speaker 2 (13:25):
Wow, I just I had some flashbacks just remembering
time.
That was Dr Butcher's lecture.
You want more of that follow?
Him up where he's teaching now.
But that was great, thank you.
Speaker 3 (13:37):
I did a presentation in class about narrative therapy
.
I remember doing that and Iprinted out the slides for that,
in case I needed to refer tothose that, how we are
storytellers and that nurses arestory gatherers and in our
therapy is where you'regathering the patient's story of
what they're.
You know what they're coming toseek help about.
Speaker 5 (13:57):
Yeah, yeah, and I just wanted to note that while
you're speaking, dr Boucher,everyone's face on this podcast
turned into the emoji with theheart eyes.
This is amazing and I think, topiggyback on the last thing
that you just said, maybe if youcould expand on that a little
bit more, how do you see nursingbecoming a leader in performing
(14:21):
theory-informed psychotherapy?
Speaker 3 (14:28):
this metaphor.
I guess it's a metaphor, ananalogy, of a potluck dinner
where everybody brings a dish tothe party, and to me that's a
metaphor of themultidisciplinary team.
So, because as therapists, asnurse therapists, we work with
folks from multiple disciplines.
(14:49):
Right, we have psychiatriststhat some of them have some
therapeutic background, but mostof them are fairly biologically
oriented.
But we have social workers todo therapy, we have
psychologists to do therapies.
So the thing is, you know, sowe're in an area where we're
working with multipledisciplines and everybody brings
something to the table.
Right?
And my question has always beenwell, what gives us a place at
(15:10):
the table?
And you can't be a nursingleader unless you have a place
at the table right, and myquestion has always been well,
what gives us a place at thetable?
And you can't be a nursingleader unless you have a place
at the table.
So what gives us a seat at thetable is what's in our dish,
that's what we bring to thetable.
And my question throughout mycareer has been well, what's in
the nurse's dish?
Like, I know what's in thesocial worker's dish, I know
(15:31):
what's in the psychologist'sdish and I know what's in the
physician's dish.
You know they all bring theirarea of expertise to the table.
The question to me has been well, what is the nurse bringing to
the table that gives them a seatand a voice, that makes a
contribution to theunderstanding of the patient
that other disciplines are notaddressing?
(15:53):
You know, because if we're allbringing the same dish, we're
all bringing a salad, thenthere's no diversity, there's
nothing new.
So while I believe in themultidisciplinary team and
transdisciplinary perspectives,you still have to have a
disciplinary perspective to havea seat at the table.
So being at the table is notsimply buying into and accepting
(16:18):
and practicing from theperspective of other disciplines
.
It's like bringing something tothe table that is unique.
And what is unique is ournursing science perspective.
When our perspective isinformed by nursing science and
I'm talking about nursingtheories, I'm talking about our
nursing classification systemsthen we have something to offer
(16:42):
and bring to the table.
That puts us in a leadershipposition, because we are
offering a perspective that isnot often seen by other
disciplines.
None of them are holisticallyoriented for one.
So everybody's dealing with apiece of the patient's situation
and only the nurse to me hasthat integrated perspective and
(17:05):
can fill in the gaps where otherpeople have these blind spots
of what's really going on withthe patient's situation.
So I think being grounded innursing science is what makes
you a nursing leader.
It brings you something tooffer to the patient's
perspective and they don't needanother physician, another
psychologist or another socialworker.
What patients need is a nurse.
(17:27):
Every patient needs a nurse.
So that's why I think thatteaching from the ground up
nursing education, teachingnurses what nursing is and how
we're unique and distinct, thatit becomes just a part of their
way of seeing, it's theiridentity of who they are, you
(17:48):
know.
So for me it's learning thosedifferent nursing theories and
seeing how they inform, how theycan be formed to patients with
psychological, mental healthissues.
And there are particularnursing theories that fit well
with particular approaches thatare from psychology.
(18:08):
For example, I think Roy'sadaptation model is a nice model
that fits with cognitivebehavioral therapies and so you
can reframe cognitive behavioraltherapy within Roy's framework,
because she talks about theregulator and the cognator and
it's all about behavior andstimuli, which is very much this
kind of behavioral approach.
(18:29):
So you just reframe that withina nursing perspective.
So you just reframe them withinour nursing models and nursing
(18:58):
perspective and then I have aplace at the table that nobody
else is looking at it from thatperspective.
Speaker 6 (19:06):
Thank you for that and I'm really curious, based on
what you've shared so far, ifyou are concerned or have any
concerns about PMH nurses usingpsychotherapy or in what cases
you might have concerns, if youdo it's at the advanced practice
(19:33):
level.
Speaker 3 (19:33):
One To be a therapist is, you know, at the advanced
practice level.
So I think that if we have, ifwe're educating in our graduate
programs that are preparing DNPsto be nurse therapists, and
they have an education, you know, that prepares them to be
cyclotherapists and to betherapists, then that's my only
(19:56):
concern is whether or not theyhave the educational base.
And I know that, like at Iowa'sprogram, we had a course in
cyclotherapy.
Now it's not as rigorous asperhaps people that do, you know
, if they're doing some sort ofin psychology, they can take
extensive courses inpsychotherapy when I was at the,
(20:18):
just to give you an example.
So I do want to move away fromyour question, because I just
the answer to your question isis that when nurses are educated
and prepared to be therapists,then they're qualified and I
don't have any concerns aboutthem being therapists.
When I did my master's degree atthe University of Toronto, I
specialized in consultation,liaison, therapy.
(20:41):
Consultation, liaison is asubspecialty in psychiatry.
Well, we had a.
We had a psychiatric instituteat the University of Toronto and
I took electives inpsychotherapy, both in
psychoanalytic therapy and inpsychosynthesis.
Psychosynthesis was a biginstitute there at the
(21:02):
University of Toronto.
So I took it upon myself toprepare myself to be a therapist
by getting educated, takingformal courses in my program
that prepared me to do therapyand then as therapists.
I think and I was part of agroup we were in Iowa I think it
was in Iowa, I don't think itwas in Toronto but there was a
(21:24):
nurse practitioner group ofnurse therapists I'm pretty sure
this was Iowa and they had oncea month meetings where they
would just talk about patients.
It was kind of like, you know,kind of like nurses, like a
support group for psychiatric,mental health nurses, and all of
(21:45):
them were taking courses anddoing extra certification
programs to improve theirpractice, to improve not about
prescribing medicine ormedications, but on how to
improve being a therapist.
So I think that being anadvanced practice nurse
therapist, you need tocontinually build your knowledge
(22:07):
base and your skill base bycontinuing your education in
being a therapist and actuallyhaving somebody else that you
have as a.
You know, I can't think of theword right now, but when you
know every therapist should havesomebody who you talk to.
What is it?
What do they call that person?
I forget now.
Like you have your owntherapist as a nurse therapist.
Speaker 6 (22:29):
That's all I'm thinking of.
Every therapist needs their owntherapist.
Speaker 3 (22:31):
Yeah, yeah.
Speaker 2 (22:32):
Like a consultant or supervisor.
Speaker 3 (22:34):
Yeah, yeah, I think it's supervision.
It's like that.
You have supervision, you havesomebody that you go to and
that's another way of improvingyour practice right when you
have someone that you can talkto about the patients that
you're working with and whetheror not you're having
transference, or you know ifyou're going to the psychotropic
model, any transference andcountertransference issues or
(22:55):
things that are personallyinterfering with your
therapeutic process to have thatsupervision.
So if you're doing those kindsof things, I think that then
you're, you're, you're.
You are maintaining the skilllevel to be effective as a nurse
therapist.
Speaker 2 (23:13):
Very cool.
Yeah, and it's one of thosethings too.
I forgot to mention a littlebit that uh from the university
of Toronto I I saw Kate light upa little bit.
Yes, we also have a anotherCanada connection here with uh,
dr Molino, and as well she's uh.
Were you born and raised inCanada?
I forgot Kate.
Speaker 5 (23:28):
I was and I did my.
I did two undergraduate degreesat U of T, so yes, I know, I
know the Institute you'respeaking of Well and that.
Speaker 3 (23:37):
So that is where my life was transformed by,
honestly so when?
So, because I had that degreein biology.
The truth is is that when Iwent into my undergraduate
program in nursing, I had a verybiological view and I did think
that nursing was like a subsetof medicine.
I didn't see it as distinct.
I didn't have that nursing lensperspective.
(23:58):
I think they really worked hardat trying to transform that in
my BSN program because atJefferson in Philadelphia it was
, we learned a lot about wholism, but I didn't understand.
I didn't really understand theimplications of this wholistic
perspective they kept on talkingabout and the first year was
all focused on health, so therewas this real health focus and
(24:22):
then the year two or a finalyear, our senior year, was more
illness, like what are thedeviations from health?
And but it wasn't until I got tothe University of Toronto, when
I took the nursing theorycourse there, that my life was
transformed, because then Ibecame, I came to realize that
nursing had its own theoreticalbase, that it wasn't just
(24:45):
grounded in medicine.
And I remember arguing withfolks, as you know, when I was
in my nursing program, saying,oh, everything is going to be
explained at the geneticcellular level, and I really had
that perspective.
And then when I was atUniversity of Toronto, I
realized wait a second, thatmight be the view of other
(25:05):
disciplines.
Maybe, and you know, that mightbe the view of other
disciplines, maybe, in you know,geneticists feel that way and
and biochemists and those folks,medicine which builds heavily
on that.
But from nursing perspective,that's only one piece.
So, like when you have abiopsychosocial, cultural,
integrated person, right, thenthe biological component is
(25:26):
viewed within these otherdimensions, that they're all
unified, they're all connected.
So any physiological orbiological event or explanation
is only part of the puzzle fromour perspective that we need to
work with the patient, not onlyunderstanding their condition in
all these five areas, but alsoour treatments need to be
holistic too.
(25:47):
So what are we doingspiritually?
What are we doing with theperson, you know,
psychologically and socially,and their ability to function in
roles, all of that sort ofstuff?
Knowing that the person is notseparated from their environment
is very much a part of whatnursing is.
So, rather than you know, welook at people in their context
and their context matters.
(26:08):
So that's what the environmentis, their context, the cultural
and that social part, and so weneed to consider all those
things when we're dealing withour patients, from understanding
what their mental health issueis.
It's not just mental, you know,it's all of these things all
together.
Speaker 2 (26:25):
I love it Beating the drums.
I just kind of, yeah, let's,let's get more nurses to nursing
and yeah, know what we'rebringing to the table.
My next question is going tokind of piggyback on what
Melissa talked a little bit moreabout, and I think this is kind
of one of the reasons why wehave the podcast is, you know,
what are your thoughts on, whatare the barriers why more PMHMPs
aren't using psychotherapy intheir practice?
Speaker 3 (26:48):
Well, think that the biological medical model is very
seductive and to me it limitsour practice.
So if you're going to reduceyour practice down to
prescribing medicine andunderstanding things from just a
biological perspective, thenyou're not really contributing
(27:10):
something that's unique anddifferent and what the patient
really needs.
So I do think that it's alwaysan uphill battle for us to have
our perspective appreciated andaccepted because, like I said,
the biological model is veryseductive and so I think a lot
of advanced practice nursesoften are not grounded in that
(27:32):
holistic perspective and thentheir practice becomes reduced
down to a biological explanationthat depression is just a
chemical imbalance in the brain.
So what we need to do is givemore medication, but we know
that the best treatment is acombination of psychotherapy and
medication.
So I'm not saying that we needto dismiss anything.
(27:54):
We need to know what physiciansare doing, we need to
understand the biologicalperspective, we need to
understand genetic perspective,all that.
But that's just part of ourpractice, and so we need to have
this broader view and it's notthe dominant view.
You know it's more complex,right?
Not, it's it's.
It's more complex, right, it'sthe simple thing is the
prescribed medication.
The more complex thing is tolook at.
(28:16):
Well, what are the underlyingpsychosocial causes,
environmental cause, and that'sthat's kind of like the area
that we're at.
So, and it's also harder toresearch those kinds because
there's so many there's how doyou?
You know, how do you do theseresearch studies in the real
world?
It's really easy to do aclinical trial on medication,
see which medication does best,and then the cost also
(28:37):
associated with reallyaddressing the psych, our social
issues, the social problemswithin our environment.
But this is really what we wedon't want to be influenced by
that.
We need to continue to believeand, and, and and to show how
our holistic perspective ismaking a difference in patients
lives, and patients prefer towork with nurses anyway, and I
(28:58):
think that's the reason whywe're really good at
communicating and listening towhat people have to say.
Our ethical values are, youknow, not telling patients what
to do, but I believe that theyknow on some level what is best
for them.
So really it's about empoweringempowering them to make the
best decisions that they canmake for themselves.
So it's a whole differentperspective to me and we just
(29:22):
need to keep on.
Keep on what we're doing.
Speaker 4 (29:26):
Great Howard.
I'm going to ask one lastquestion.
It's broken into two subsets soI'm sorry if it feels like a
test question.
We ask people a lot in thispodcast about being a
prognosticator and looking intothe future, about psychotherapy.
I'm going to ask you what isyour vision for what do you
think is going to happen to thepractice of psychotherapy and
(29:49):
advanced practice nursing in thefuture, and what's your hope?
So your pragmatic vision andwhat's your hope.
Speaker 3 (29:56):
Well, it seems to me that the online therapy is, is,
is something that is out therenow and there's a lot of people
that are gravitating to ashaving a therapist who is online
.
And now I'm hearing that thereare AI, artificial intelligence,
(30:17):
that there's therapy that'sbeing done, you know, through AI
, and I don't see these asreplacements for what you can do
at the interpersonal level froma human to human.
I think they're adjuncts andthey're supplements and they're
options for patients that don'thave access or can't, or maybe
(30:38):
those become more affordable,but I don't see them as
replacing the human to humancontact and the kind of therapy
that occurs on an interpersonallevel.
I just don't think that AI isever going to be able to replace
that.
But I do think that we, astherapists, looking towards the
(30:58):
future, need to grapple withthis idea.
And how can we use these onlinemodalities and AI to complement
our own practices, so that weare advancing our practice but
not replacing it throughsomething that I would say could
(31:19):
never replace what a human isable to do?
So, and I'm optimistic in thatway, that I'm optimistic that
therapy is not and nursing, bythe way and, by the way, I'm not
the only one that's saying this.
So Gates, and Gates is onlyrepeating what this person by
the name of Pinker there's thisbook out there called A Whole
(31:41):
New Mind, and it's about it'snow about, I guess, about 12
years old, and he talked aboutthe kinds of mind that we need
in the future in order to youknow that we're moving out of
the information age and we'removing into the conceptual age
is what he talks about.
We're moving the conceptual age, and so he talked about the
skills that are needed to besuccessful and the kinds of
(32:04):
careers that are going to besuccessful in the conceptual age
, and nursing was one of thosethat were mentioned.
That is not going to bereplaced in the future, because
empathy and because, you know,empathy is one of having empathy
and compassion is one of thoseskills that is needed for the
future.
And Gates said the same thingthat those professions that are
(32:28):
the interpersonal, at theinterpersonal level, at the
empathy and the compassionatelevel, are things that human
nature craves for, and this iswhat we provide as nurse
therapists.
So, and that's not, that's notgoing to be able to be replaced
by a machine that kind of humancompassion and human empathy and
understanding and the humantouch and the human heart, those
(32:53):
things I mean.
So I have an optimistic view ofour profession for the future.
That we're actually going tobecome more in demand because of
what we have to offer is notreplaceable.
It's just simply notreplaceable.
It's just simply notreplaceable.
Some aspects of what we do isreplaceable, but not that
human-to-human contact, thecommunication, the listening and
(33:17):
the bond that really is createdin the nurse-patient
relationship, which is what Pepotalked about.
That nurse-patient relationshipis not going to be replaced by
a machine.
I'm positive about that and Idon't think anybody really
thinks that that's going to bethe case.
Speaker 4 (33:33):
That's helpful.
Speaker 2 (33:34):
Thank you, that's amazing.
Yeah, that's the wholetingly-feely type of thing.
We'll definitely end there,because that's a great place to
end.
So thank you again, dr HowardButcher, for joining us and look
forward to another episode ofPep Lowe's Ghost coming out soon
.
Please make sure that yousubscribe, like and comment.
We look forward to coming backto you soon, so take care.
Speaker 1 (34:04):
Bye Before it's true.
Work hard until those thoughtsare finally leaving, so you can
be.
You Got a discovery Identifyingchallenge in your beliefs Core
beliefs Reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discoveryIdentifying challenge in your
beliefs, core beliefs Reframingyour mind.
(34:26):
Negative thoughts release, letit go.
These cognitive distortionsdecrease until.
Yeah, just my take on things.
My answer number two decreaseuntil they cease.
It's not a discoveryIdentifying challenge in your
(00:27):
beliefs.
Speaker 2 (00:27):
I think we're recording.
Welcome back everybody to PepLau's Ghost.
Thank you for coming back.
So much appreciated, reallyexcited about our next guest
here.
Dr Howard Butcher is with usand, as I was just saying before
we started recording, drButcher has a very special place
in my heart as he was actuallymy professor I was getting my
PMHNP when I was at theUniversity of Iowa so it's been
(00:51):
a pleasure to keep knowing himand to know him past graduation
and was a colleague of his atthe University of Iowa for a
while before he decided to go onfor greener grasses in Florida
and such.
So.
But again very happy to havehim on the podcast, as always, I
should say.
I'm joined by my esteemedcolleagues Dr Sean Convoy, dr
Kate Molino and Dr MelissaChapman, and so we're here to
(01:14):
kind of talk on peplau's ghostand so let's get to it.
I got a quick introduction here.
Don't like to drag out theseintroductions too much, but did
want to say that, dr HowardButcher, you're in Florida
teaching.
Still, one of your areas isreally bringing nursing theory
into practice, education anddeveloping further research, and
(01:34):
Sean is raising the roof.
So that's love that that he'sgoing to kind of get into that
too.
I was reading your bio a littlebit.
You are and I knew this, youare a Rogerian scholar, which I
always have to kind of make surethat we.
That's not Carl Rogers, that'sthe Rogers science of unitary
human beings.
So I believe you got yourmaster's and your PhD in that
(01:57):
focus.
Yes, yeah so, and I believeyou've had some mid-level
theories, at least your biomentioned.
You had some mid-level theoriesthat you developed based on
that as well, and you are stillthe editor for the Nursing
Intervention Classification, orNIC, which I think is in its
eighth edition, if your bio iscorrect.
We just had a meeting thismorning, just working on ninth
(02:18):
yeah, that's how it goes right.
So, so, lots of internationalcollaborations you know working
on, you know expanding Nick as aframework of what you know
understanding what nurses do,which sometimes, well, a lot of
times, gets overlooked.
So so again, thank you, drButcher, for being here with me
and us on the podcast here, andso I'll get the ball rolling and
(02:40):
kind of our focused, you know,really kind of looking at maybe,
cause I know, again, you're aresearcher and you're very much
focused on nursing theory.
But I know, based on you knowyour time with you know both
working together, as well as youbeing my professor, you have
done therapy and I hope youstill are, but you've done it
definitely and you've got a vastexperience in that.
So when did you first startgetting interested in doing
(03:02):
psychotherapy?
Speaker 3 (03:04):
Well, it's interesting because it goes all
the way back to why I chose tobecome a nurse to begin with.
Because I was actually abiology major and I was going to
teach.
I was going to be a high schoolbiology teacher and I was my
girlfriend at the time was innursing school, but I always had
a real strong interest inpsychology, even in high school.
I was reading all kinds ofpsychology books about
(03:27):
psychotherapy, and I was readingthat stuff in high school and I
wanted to be a teacher.
In high school I wanted to be ateacher.
I didn't think about becoming atherapist until I went to the
infirmary on campus.
I was at Lebanon Valley Collegeand I saw a brochure sitting on
the table that described therole of a clinical nurse,
specialist in psychiatric,mental health nursing and the
(03:49):
brochure was from the Universityof Pennsylvania.
It was their program and when Isaw that I thought to myself
gosh, I didn't know that nursescan you know, can be therapists.
And I was thinking I was, youknow, changed my major.
Well, I didn't change my major.
I was a biology major but Iwould settle on becoming a
biology teacher because theydon't teach psychology at most
(04:10):
high schools.
So that was kind of like asecond choice.
And then when I saw thisbrochure, I thought well, wait a
second, I can be a therapist bybeing a nurse.
I became more and moreinterested in nursing as I was
learning more and more what mygirlfriend at the time was doing
, because we would study in thelibrary together and I would say
, gosh, you know, you're workingwith patients and you're making
a difference in people's lives.
(04:31):
And what am I doing?
I'm like in the chemistry labfor four hours in the bio lab
dissecting, you know, sharks andcats and things that weren't
even alive.
And I thought, you know, I'dmuch rather work with people.
(04:52):
So once I saw there was a pathfor me, my goal from the very
beginning was to be a nursetherapist, and that's why I
changed my major to nursing.
And when I finished that degreein biology I could have it was
in the beginning of my senioryear I could have, you know,
changed my major then.
But then in six years I wouldhave come out with one degree.
But I found out there wereprograms, bsn programs you can
get into with only two yearsbecause you, you know, you
(05:14):
transfer in at the junior yearlevel.
So that's what I did so.
I went to Jefferson and in sixyears came out with two degrees,
instead of six years only onedegree if I had changed my major
.
And then in my BSN program, allthe way through I focused on
psychosocial issues.
I just I knew that that's whatI wanted to do and so, whatever
kind of clinical, whateverpopulation we were working with,
(05:35):
I always made sure that myassignment and papers were kind
of like looking at thepsychosocial aspect and I knew I
wanted to get a master's degree, because that's degree, because
that's the aim was, to get aBSN, so I can go to a master's
program and become a clinicalnurse specialist and become a
nurse therapist.
So that whole thing is allintertwined together.
Speaker 2 (05:58):
Yeah, thanks.
I guess you know it all goesback to studying in the library
with a girlfriend, I mean that'sa classic start to a lot of
stories, right?
Follow your heart, and that'lltake you a long way.
So thank you, howard.
Speaker 4 (06:12):
Howard, I'm going to play to your strength and I'm
going to shift the question overto kind of focus a little bit
on the theory here.
You know, all of us teach tosome great capacity with
students on a regular basis andwe typically have kind of this
split with our students.
Some half of the cohort arevery theory-minded, the other
half feel like a resistance toit.
(06:33):
That is undefinable.
Thinking about advancedpractice psychiatric mental
health nursing, is there one ortwo theories that you just keep
in your left pocket that youthink are translatable in almost
every situation andcircumstance?
Speaker 3 (06:48):
as an advanced practice psychiatric mental
health nurse, yes, theredefinitely is, but let me step
back a little bit and talk alittle bit about theory.
First of all, you can'tseparate theory from practice.
People may not think thatthey're using theory or they
have a divergent theory, butthey're coming from some sort of
interpretive framework, right,and it may not be explicit, it
(07:11):
may not be scientific, becauseit's something that they mix up
in their own mind, but everybodyhas a lens through which they
look at the world and that issome form of a theory.
That is some form of a theory.
I've always believed thatnurses and all practitioners
need to be basing their practiceon a scientific theory, which
(07:34):
means then using the theory asit's designed.
I think when you start becomingeclectic and start combining
things together, that's notreally a scientific process, you
know.
So you can use differenttheories for different
situations, but you need tounderstand that some theories
don't really jive togetherbecause they have, they're based
on assumptions that are inconflict with one another, for
(07:57):
example.
So my whole career has beenbased around, you know really,
about nursing science andnursing theory, because all
professions are identified bytheir unique body of knowledge.
If nursing didn't have a uniquebody of knowledge, then we
(08:21):
really don't have a profession,because one of the criteria for
a profession is to have a uniquebody of knowledge.
Now, that doesn't mean that wedon't use theories and knowledge
, and certainly in psych, mentalhealth we use theories.
We learn about theories frompsychology and different, you
know mostly from psychology.
But if you have a really stronggrounding in a nursing
(08:43):
perspective, a nursing lens,when you learn about
psychoanalytic, you know gestalt, existential, phenomenological
theory.
You, for me, it's the idea isto understand those theories
through a nursing lens.
And when you see things, justlike you're seeing things
through a prison, it transformsthe theory when you're looking
(09:05):
at a theory through a nursinglens.
And so for me, the choices oftheories that I gravitate to are
ones that are, first of all,are philosophically compatible
with my nursing perspective,meaning that you know theories
that are holistic, theories thatI'm more of an existential.
(09:29):
I believe that, for example,nursing, part of my nursing lens
is that being holistic is whatmakes us unique as a discipline,
and so those theories that are,you know, holistically oriented
are ones that I gravitatetowards.
I also believe that nursingoccurs more on the interpersonal
(09:50):
relationship level and not onthe cellular genetic level.
So those theories it's not thatI reject biological
explanations for mental healthconditions, but it has to be
complemented with aninterpersonal sort of level of
(10:13):
understanding of what theperson's condition is.
So theories that areexistential phenomenological,
for example, I gravitate tobecause as a profession we're
interested in human experiences.
If we can't understand ourpatients' experiences, then how
is it that we can really helpthem right?
(10:35):
So those theories they get at,the human experience is what's
relevant to me.
And so existentialphenomenology is the research,
is a philosophy and a researchmethod that fits with what
nursing, I believe, is primarilyabout at the relationship level
, to understand the experienceso we can help them.
And so there's therapies thatcome from that philosophy of
(11:01):
existential phenomenology.
So meaning-making and theoriesthat are oriented towards
meaning-making approaches topsychotherapy are things that I
gravitate to.
I find meaning-making essentialactually to all realms of
nursing practices, helpingpatients understand the meaning
and the experience that they'regoing through.
So narrative therapy, forexample, is one of those realms
(11:26):
of therapies that really, for me, fit really well.
I actually my program ofresearch came out of my interest
in narrative therapy, becausejournaling is one of the main
modalities that is used innarrative therapy.
It's like it's often the, youknow, you reconsider.
The person is talking to youabout their story Everybody
(11:47):
lives a story and then narrativetherapy is looking at that
story and reframing reframingthe story and finding new
meaning in your life by bycreating a new story.
And so my, my research ended upbeing on journaling and the
therapeutic benefits ofjournaling.
So I was able to tie myinterest in a particular therapy
um to my program of research,and so narrative therapy is one
(12:13):
of those areas that really meana lot to me.
Existential phenomenologicalapproaches so I'm well-versed
with Heidegger, but also RolloMay, there's a bunch of folks,
humanistic approaches, carlRogers, so those I think are
consistent with thatrelationship level and fit with
(12:33):
my view of who we are as nurses,more holistically oriented.
So those end up being thetherapies that I gravitate
towards.
And then I have a wholephilosophical base that's all
grounded in it and that'sconstructivism.
So I would start with that isthat you know I believe that
(12:59):
people construct their ownrealities and I believe in the
principles of constructivism.
And narrative therapy andexistential phenomenology are
therapies that fit within thatconstructivist philosophy of
science perspective.
So I try to be consistent andcongruent with my therapeutic
approaches and my chosentheories, with my philosophy, my
values and my grounding innursing science.
Speaker 4 (13:23):
That helps.
Thanks a lot.
Speaker 2 (13:25):
Wow, I just I had some flashbacks just remembering
time.
That was Dr Butcher's lecture.
You want more of that follow?
Him up where he's teaching now.
But that was great, thank you.
Speaker 3 (13:37):
I did a presentation in class about narrative therapy
.
I remember doing that and Iprinted out the slides for that,
in case I needed to refer tothose that, how we are
storytellers and that nurses arestory gatherers and in our
therapy is where you'regathering the patient's story of
what they're.
You know what they're coming toseek help about.
Speaker 5 (13:57):
Yeah, yeah, and I just wanted to note that while
you're speaking, dr Boucher,everyone's face on this podcast
turned into the emoji with theheart eyes.
This is amazing and I think, topiggyback on the last thing
that you just said, maybe if youcould expand on that a little
bit more, how do you see nursingbecoming a leader in performing
(14:21):
theory-informed psychotherapy?
Speaker 3 (14:28):
this metaphor.
I guess it's a metaphor, ananalogy, of a potluck dinner
where everybody brings a dish tothe party, and to me that's a
metaphor of themultidisciplinary team.
So, because as therapists, asnurse therapists, we work with
folks from multiple disciplines.
(14:49):
Right, we have psychiatriststhat some of them have some
therapeutic background, but mostof them are fairly biologically
oriented.
But we have social workers todo therapy, we have
psychologists to do therapies.
So the thing is, you know, sowe're in an area where we're
working with multipledisciplines and everybody brings
something to the table.
Right?
And my question has always beenwell, what gives us a place at
(15:10):
the table?
And you can't be a nursingleader unless you have a place
at the table right, and myquestion has always been well,
what gives us a place at thetable?
And you can't be a nursingleader unless you have a place
at the table.
So what gives us a seat at thetable is what's in our dish,
that's what we bring to thetable.
And my question throughout mycareer has been well, what's in
the nurse's dish?
Like, I know what's in thesocial worker's dish, I know
(15:31):
what's in the psychologist'sdish and I know what's in the
physician's dish.
You know they all bring theirarea of expertise to the table.
The question to me has been well, what is the nurse bringing to
the table that gives them a seatand a voice, that makes a
contribution to theunderstanding of the patient
that other disciplines are notaddressing?
(15:53):
You know, because if we're allbringing the same dish, we're
all bringing a salad, thenthere's no diversity, there's
nothing new.
So while I believe in themultidisciplinary team and
transdisciplinary perspectives,you still have to have a
disciplinary perspective to havea seat at the table.
So being at the table is notsimply buying into and accepting
(16:18):
and practicing from theperspective of other disciplines
.
It's like bringing something tothe table that is unique.
And what is unique is ournursing science perspective.
When our perspective isinformed by nursing science and
I'm talking about nursingtheories, I'm talking about our
nursing classification systemsthen we have something to offer
(16:42):
and bring to the table.
That puts us in a leadershipposition, because we are
offering a perspective that isnot often seen by other
disciplines.
None of them are holisticallyoriented for one.
So everybody's dealing with apiece of the patient's situation
and only the nurse to me hasthat integrated perspective and
(17:05):
can fill in the gaps where otherpeople have these blind spots
of what's really going on withthe patient's situation.
So I think being grounded innursing science is what makes
you a nursing leader.
It brings you something tooffer to the patient's
perspective and they don't needanother physician, another
psychologist or another socialworker.
What patients need is a nurse.
(17:27):
Every patient needs a nurse.
So that's why I think thatteaching from the ground up
nursing education, teachingnurses what nursing is and how
we're unique and distinct, thatit becomes just a part of their
way of seeing, it's theiridentity of who they are, you
(17:48):
know.
So for me it's learning thosedifferent nursing theories and
seeing how they inform, how theycan be formed to patients with
psychological, mental healthissues.
And there are particularnursing theories that fit well
with particular approaches thatare from psychology.
(18:08):
For example, I think Roy'sadaptation model is a nice model
that fits with cognitivebehavioral therapies and so you
can reframe cognitive behavioraltherapy within Roy's framework,
because she talks about theregulator and the cognator and
it's all about behavior andstimuli, which is very much this
kind of behavioral approach.
(18:29):
So you just reframe that withina nursing perspective.
So you just reframe them withinour nursing models and nursing
(18:58):
perspective and then I have aplace at the table that nobody
else is looking at it from thatperspective.
Speaker 6 (19:06):
Thank you for that and I'm really curious, based on
what you've shared so far, ifyou are concerned or have any
concerns about PMH nurses usingpsychotherapy or in what cases
you might have concerns, if youdo it's at the advanced practice
(19:33):
level.
Speaker 3 (19:33):
One To be a therapist is, you know, at the advanced
practice level.
So I think that if we have, ifwe're educating in our graduate
programs that are preparing DNPsto be nurse therapists, and
they have an education, you know, that prepares them to be
cyclotherapists and to betherapists, then that's my only
(19:56):
concern is whether or not theyhave the educational base.
And I know that, like at Iowa'sprogram, we had a course in
cyclotherapy.
Now it's not as rigorous asperhaps people that do, you know
, if they're doing some sort ofin psychology, they can take
extensive courses inpsychotherapy when I was at the,
(20:18):
just to give you an example.
So I do want to move away fromyour question, because I just
the answer to your question isis that when nurses are educated
and prepared to be therapists,then they're qualified and I
don't have any concerns aboutthem being therapists.
When I did my master's degree atthe University of Toronto, I
specialized in consultation,liaison, therapy.
(20:41):
Consultation, liaison is asubspecialty in psychiatry.
Well, we had a.
We had a psychiatric instituteat the University of Toronto and
I took electives inpsychotherapy, both in
psychoanalytic therapy and inpsychosynthesis.
Psychosynthesis was a biginstitute there at the
(21:02):
University of Toronto.
So I took it upon myself toprepare myself to be a therapist
by getting educated, takingformal courses in my program
that prepared me to do therapyand then as therapists.
I think and I was part of agroup we were in Iowa I think it
was in Iowa, I don't think itwas in Toronto but there was a
(21:24):
nurse practitioner group ofnurse therapists I'm pretty sure
this was Iowa and they had oncea month meetings where they
would just talk about patients.
It was kind of like, you know,kind of like nurses, like a
support group for psychiatric,mental health nurses, and all of
(21:45):
them were taking courses anddoing extra certification
programs to improve theirpractice, to improve not about
prescribing medicine ormedications, but on how to
improve being a therapist.
So I think that being anadvanced practice nurse
therapist, you need tocontinually build your knowledge
(22:07):
base and your skill base bycontinuing your education in
being a therapist and actuallyhaving somebody else that you
have as a.
You know, I can't think of theword right now, but when you
know every therapist should havesomebody who you talk to.
What is it?
What do they call that person?
I forget now.
Like you have your owntherapist as a nurse therapist.
Speaker 6 (22:29):
That's all I'm thinking of.
Every therapist needs their owntherapist.
Speaker 3 (22:31):
Yeah, yeah.
Speaker 2 (22:32):
Like a consultant or supervisor.
Speaker 3 (22:34):
Yeah, yeah, I think it's supervision.
It's like that.
You have supervision, you havesomebody that you go to and
that's another way of improvingyour practice right when you
have someone that you can talkto about the patients that
you're working with and whetheror not you're having
transference, or you know ifyou're going to the psychotropic
model, any transference andcountertransference issues or
(22:55):
things that are personallyinterfering with your
therapeutic process to have thatsupervision.
So if you're doing those kindsof things, I think that then
you're, you're, you're.
You are maintaining the skilllevel to be effective as a nurse
therapist.
Speaker 2 (23:13):
Very cool.
Yeah, and it's one of thosethings too.
I forgot to mention a littlebit that uh from the university
of Toronto I I saw Kate light upa little bit.
Yes, we also have a anotherCanada connection here with uh,
dr Molino, and as well she's uh.
Were you born and raised inCanada?
I forgot Kate.
Speaker 5 (23:28):
I was and I did my.
I did two undergraduate degreesat U of T, so yes, I know, I
know the Institute you'respeaking of Well and that.
Speaker 3 (23:37):
So that is where my life was transformed by,
honestly so when?
So, because I had that degreein biology.
The truth is is that when Iwent into my undergraduate
program in nursing, I had a verybiological view and I did think
that nursing was like a subsetof medicine.
I didn't see it as distinct.
I didn't have that nursing lensperspective.
(23:58):
I think they really worked hardat trying to transform that in
my BSN program because atJefferson in Philadelphia it was
, we learned a lot about wholism, but I didn't understand.
I didn't really understand theimplications of this wholistic
perspective they kept on talkingabout and the first year was
all focused on health, so therewas this real health focus and
(24:22):
then the year two or a finalyear, our senior year, was more
illness, like what are thedeviations from health?
And but it wasn't until I got tothe University of Toronto, when
I took the nursing theorycourse there, that my life was
transformed, because then Ibecame, I came to realize that
nursing had its own theoreticalbase, that it wasn't just
(24:45):
grounded in medicine.
And I remember arguing withfolks, as you know, when I was
in my nursing program, saying,oh, everything is going to be
explained at the geneticcellular level, and I really had
that perspective.
And then when I was atUniversity of Toronto, I
realized wait a second, thatmight be the view of other
(25:05):
disciplines.
Maybe, and you know, that mightbe the view of other
disciplines, maybe, in you know,geneticists feel that way and
and biochemists and those folks,medicine which builds heavily
on that.
But from nursing perspective,that's only one piece.
So, like when you have abiopsychosocial, cultural,
integrated person, right, thenthe biological component is
(25:26):
viewed within these otherdimensions, that they're all
unified, they're all connected.
So any physiological orbiological event or explanation
is only part of the puzzle fromour perspective that we need to
work with the patient, not onlyunderstanding their condition in
all these five areas, but alsoour treatments need to be
holistic too.
(25:47):
So what are we doingspiritually?
What are we doing with theperson, you know,
psychologically and socially,and their ability to function in
roles, all of that sort ofstuff?
Knowing that the person is notseparated from their environment
is very much a part of whatnursing is.
So, rather than you know, welook at people in their context
and their context matters.
(26:08):
So that's what the environmentis, their context, the cultural
and that social part, and so weneed to consider all those
things when we're dealing withour patients, from understanding
what their mental health issueis.
It's not just mental, you know,it's all of these things all
together.
Speaker 2 (26:25):
I love it Beating the drums.
I just kind of, yeah, let's,let's get more nurses to nursing
and yeah, know what we'rebringing to the table.
My next question is going tokind of piggyback on what
Melissa talked a little bit moreabout, and I think this is kind
of one of the reasons why wehave the podcast is, you know,
what are your thoughts on, whatare the barriers why more PMHMPs
aren't using psychotherapy intheir practice?
Speaker 3 (26:48):
Well, think that the biological medical model is very
seductive and to me it limitsour practice.
So if you're going to reduceyour practice down to
prescribing medicine andunderstanding things from just a
biological perspective, thenyou're not really contributing
(27:10):
something that's unique anddifferent and what the patient
really needs.
So I do think that it's alwaysan uphill battle for us to have
our perspective appreciated andaccepted because, like I said,
the biological model is veryseductive and so I think a lot
of advanced practice nursesoften are not grounded in that
(27:32):
holistic perspective and thentheir practice becomes reduced
down to a biological explanationthat depression is just a
chemical imbalance in the brain.
So what we need to do is givemore medication, but we know
that the best treatment is acombination of psychotherapy and
medication.
So I'm not saying that we needto dismiss anything.
(27:54):
We need to know what physiciansare doing, we need to
understand the biologicalperspective, we need to
understand genetic perspective,all that.
But that's just part of ourpractice, and so we need to have
this broader view and it's notthe dominant view.
You know it's more complex,right?
Not, it's it's.
It's more complex, right, it'sthe simple thing is the
prescribed medication.
The more complex thing is tolook at.
(28:16):
Well, what are the underlyingpsychosocial causes,
environmental cause, and that'sthat's kind of like the area
that we're at.
So, and it's also harder toresearch those kinds because
there's so many there's how doyou?
You know, how do you do theseresearch studies in the real
world?
It's really easy to do aclinical trial on medication,
see which medication does best,and then the cost also
(28:37):
associated with reallyaddressing the psych, our social
issues, the social problemswithin our environment.
But this is really what we wedon't want to be influenced by
that.
We need to continue to believeand, and, and and to show how
our holistic perspective ismaking a difference in patients
lives, and patients prefer towork with nurses anyway, and I
(28:58):
think that's the reason whywe're really good at
communicating and listening towhat people have to say.
Our ethical values are, youknow, not telling patients what
to do, but I believe that theyknow on some level what is best
for them.
So really it's about empoweringempowering them to make the
best decisions that they canmake for themselves.
So it's a whole differentperspective to me and we just
(29:22):
need to keep on.
Keep on what we're doing.
Speaker 4 (29:26):
Great Howard.
I'm going to ask one lastquestion.
It's broken into two subsets soI'm sorry if it feels like a
test question.
We ask people a lot in thispodcast about being a
prognosticator and looking intothe future, about psychotherapy.
I'm going to ask you what isyour vision for what do you
think is going to happen to thepractice of psychotherapy and
(29:49):
advanced practice nursing in thefuture, and what's your hope?
So your pragmatic vision andwhat's your hope.
Speaker 3 (29:56):
Well, it seems to me that the online therapy is, is,
is something that is out therenow and there's a lot of people
that are gravitating to ashaving a therapist who is online
.
And now I'm hearing that thereare AI, artificial intelligence,
(30:17):
that there's therapy that'sbeing done, you know, through AI
, and I don't see these asreplacements for what you can do
at the interpersonal level froma human to human.
I think they're adjuncts andthey're supplements and they're
options for patients that don'thave access or can't, or maybe
(30:38):
those become more affordable,but I don't see them as
replacing the human to humancontact and the kind of therapy
that occurs on an interpersonallevel.
I just don't think that AI isever going to be able to replace
that.
But I do think that we, astherapists, looking towards the
(30:58):
future, need to grapple withthis idea.
And how can we use these onlinemodalities and AI to complement
our own practices, so that weare advancing our practice but
not replacing it throughsomething that I would say could
(31:19):
never replace what a human isable to do?
So, and I'm optimistic in thatway, that I'm optimistic that
therapy is not and nursing, bythe way and, by the way, I'm not
the only one that's saying this.
So Gates, and Gates is onlyrepeating what this person by
the name of Pinker there's thisbook out there called A Whole
(31:41):
New Mind, and it's about it'snow about, I guess, about 12
years old, and he talked aboutthe kinds of mind that we need
in the future in order to youknow that we're moving out of
the information age and we'removing into the conceptual age
is what he talks about.
We're moving the conceptual age, and so he talked about the
skills that are needed to besuccessful and the kinds of
(32:04):
careers that are going to besuccessful in the conceptual age
, and nursing was one of thosethat were mentioned.
That is not going to bereplaced in the future, because
empathy and because, you know,empathy is one of having empathy
and compassion is one of thoseskills that is needed for the
future.
And Gates said the same thingthat those professions that are
(32:28):
the interpersonal, at theinterpersonal level, at the
empathy and the compassionatelevel, are things that human
nature craves for, and this iswhat we provide as nurse
therapists.
So, and that's not, that's notgoing to be able to be replaced
by a machine that kind of humancompassion and human empathy and
understanding and the humantouch and the human heart, those
(32:53):
things I mean.
So I have an optimistic view ofour profession for the future.
That we're actually going tobecome more in demand because of
what we have to offer is notreplaceable.
It's just simply notreplaceable.
It's just simply notreplaceable.
Some aspects of what we do isreplaceable, but not that
human-to-human contact, thecommunication, the listening and
(33:17):
the bond that really is createdin the nurse-patient
relationship, which is what Pepotalked about.
That nurse-patient relationshipis not going to be replaced by
a machine.
I'm positive about that and Idon't think anybody really
thinks that that's going to bethe case.
Speaker 4 (33:33):
That's helpful.
Speaker 2 (33:34):
Thank you, that's amazing.
Yeah, that's the wholetingly-feely type of thing.
We'll definitely end there,because that's a great place to
end.
So thank you again, dr HowardButcher, for joining us and look
forward to another episode ofPep Lowe's Ghost coming out soon
.
Please make sure that yousubscribe, like and comment.
We look forward to coming backto you soon, so take care.
Speaker 1 (34:04):
Bye Before it's true.
Work hard until those thoughtsare finally leaving, so you can
be.
You Got a discovery Identifyingchallenge in your beliefs Core
beliefs Reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discoveryIdentifying challenge in your
beliefs, core beliefs Reframingyour mind.
(34:26):
Negative thoughts release, letit go.
These cognitive distortionsdecrease until.
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