What happens when the art of psychotherapy gets pushed aside in favor of medication management? In this thought-provoking episode, we're joined by Dr. Tari Dilks (taridilks@gmail.com), retired full professor and past president of the American Psychiatric Nurse Association, who shares wisdom from her remarkable 50-year journey in psychiatric nursing.
Dr. Dilks takes us through her evolution from mental health technician to licensed professional counselor to advanced practice nurse, revealing how the therapeutic relationship became her north star. "Psychotherapy is curative," she asserts, recounting a 15-year journey helping a patient with dissociative identity disorder achieve full integration—a powerful testament to therapy's transformative potential.
The conversation delves into the challenges facing psychiatric mental health nurse practitioners today, where employers often hire advanced practice nurses solely for medication management rather than comprehensive care. Dr. Dilks worries that the art of psychotherapy in nursing could disappear under financial pressures, despite research clearly showing patients benefit most from combined approaches.
Perhaps most moving is her candid discussion about working with suicidal patients when other providers refused. "Who does then?" she asks, sharing a poignant story about giving a chronically suicidal patient and her family "extra years" together. This perspective challenges us to reconsider how we approach risk, liability, and the true meaning of patient-centered care.
For clinicians, Dr. Dilks offers practical wisdom: develop an eclectic therapeutic approach, recognize when you need your own therapy, and find powerful ways to disconnect (like her preference for scuba diving where "nobody can talk to me underwater"). For educators, she emphasizes the critical need to help students experience psychotherapy's power firsthand.
Whether you're a psychiatric nurse practitioner, mental health professional, or simply interested in the therapeutic relationship, this conversation reminds us that beneath all our clinical tools and interventions lies the fundamental healing power of human connection.
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
yeah, just my take on things.
My answer number two welcomeback everyone.
(00:24):
Thank you so much for joining.
Speaker 2 (00:26):
Welcome back everyone .
Thank you so much for joiningPeplau's Ghost again another
week and another fabulous guestthat we get to talk to a little
bit here on our Friday afternoonFor us, kind of sending us into
a glorious weekend that we hopeis finding you in the same
condition.
So I want to say thanks againfor all those who are listening
and subscribing, commenting toour podcast.
(00:49):
I think we're getting close toa thousand downloads, so I'm
really excited about that number.
We've been kind of coming outweekly here in 2025.
We're going to take a littlebit of a break.
We're going to have a couple ofweeks here.
I'll be doing some travelingand so we'll have be coming back
in a few weeks.
So those of you who aredesperate and dying for the next
episode, hang on there.
We're going to come back to yousoon, but without any further
(01:12):
delay.
I'm going to introduce our nextguest here, dr Terry Dilks.
Dr Dilks is a well-establishedpsych, mental health nurse
practitioner Very similar tomyself.
She kind of came into nursingshe was a therapist before she
found nursing I always say foundthe light and just kind of
stayed here and has been just anamazing professional and
(01:38):
academic.
I don't have much of anintroduction for her, but maybe
she can kind of share some ofher experiences.
But I will share that.
She is currently a retired fullprofessor and also was the past
president for the AmericanPsychiatric Nurse Association.
So that is a big feat in mymind and takes a lot of things
to do and, yeah, I'd love tohear some more stories about all
(02:01):
the things that you wentthrough in the APNA presidency
and so, as I'm kind of movinginto my own presidency and ISBN,
so exciting and yeah so, butlet me get started with our
question right out the gate whendid you first get interested in
psychotherapy?
Speaker 3 (02:18):
Well, I started in nursing first, then went to
therapy and then went back toadvanced practice nursing.
So when I was in nursing schoola long, long time ago, we had a
, we were at an adultpsychiatric facility and one of
our instructors decided to dosome drama therapy with us and I
(02:42):
was just like, wow, this is socool.
You know, this is.
I wonder if this is somethingthat you know I could learn to
do at some point.
And so that kind of piqued myinterest there and, as I, you
know, thank God for psychiatricnursing, because I didn't really
(03:02):
want to be a nurse.
I just, when I foundpsychiatric nursing, it was like
, yes, I was home.
And so my whole career but withvery few interruptions has been
in the field of psych, startingas a mental health technician
and then moving my way up, youknow, to a head nurse, to a
director of nursing, to gettinga master's degree in psychology
(03:30):
which was focused onpsychotherapy, and I have
dropped into so many things.
Louisiana decided to go with anLPC, a licensed professional
counselor.
I had not completed my degreequite yet, but I had all of the
classes I needed to have and Ihad the experience.
(03:51):
So I was licensed as an LPC for35 years.
I just gave it up a couple ofyears ago, so great fun.
Speaker 2 (04:00):
Awesome, I'm sorry about mixing up your timeline.
I apologize for that, but verysimilar.
Like I said myself, I had tocome to nursing I guess I
started off in getting my MSWand very similar to you kind of
let the license go and, yes,thank goodness for psych nursing
.
So, yeah, so, thank you so much.
(04:20):
Appreciate it and I am going toapologize again the second time
.
Maybe I'll do this a number ofother times, but I didn't
introduce Dr Sean Convoy fromDuke, who's here, so we're going
to hear from him next.
So sorry about that, sean.
Speaker 4 (04:32):
All good.
My friend, terry Dan, asked youa question kind of big picture
about kind of your experiencesprofessionally.
I'm going to ask you to kind offocus your lens a little bit on
an experience with a patientthat kind of illustrated to you
that what we believe here inthis podcast to be the secret
sauce of psychotherapy Was there, a unique experience that told
(04:54):
you, oh my God, this islightning in a bottle.
Speaker 3 (04:58):
It.
Yes, I mean there were many,there were many, I mean there
(05:20):
were many, there were many, youknow, but the ones that stand
out are the ones I did withfolks who had disassociative
identity disorder, you know, andso you had to pivot very
quickly to different types ofpsychotherapy, that diagnosis.
Of course, people eitherbelieve in it or don't believe
in it.
But once you've seen it, you'veseen it, Psychotherapy is
curative and that to me was anamazing thought that you know I
(05:40):
could cure this person withtheir help, or they could cure
themselves of dissociativeidentity disorder.
And one of the ones I workedwith for the longest took 15
years, but then she totallyintegrated.
I hear from her periodically.
She got a bachelor, no, anassociate degree, a bachelor's
(06:02):
degree and a master's degreewhile we were working in therapy
.
She had had to relearn somethings because she had a couple
alters that wanted to hold backand not let her have information
like basic math.
So it was.
It challenged me in so manyways, you know.
(06:24):
It was like well, like well, Ididn't.
I had never been trained in howto work with this, so I had to
look it up, I had to research,um, but I, there was nobody who
was doing that type ofpsychotherapy near, so it was.
It burned me out in the longrun, but man, it was good work
terry I, I, I.
Speaker 4 (06:45):
I'm gonna bring this back to Dan and let him know
that we just found the taglinefor this podcast around the line
Psychotherapy is curative.
Yeah, yeah, let's kick it backto you, my friend.
Speaker 2 (06:58):
Thanks, sean.
Yeah, no, can we kind of maybekind of spend, because I know
that's one of your areas ofexpertise is working with people
with dissociative identitydisorder you mentioned.
You know you have to be veryflexible in kind of moving your
approach depending on the altarand things.
Is there any you know like oneor two forms that you found to
be most beneficial?
(07:18):
You have to be just a real kindof I was going to say magician,
but you know kind of reallyhave to be very skillful in kind
of picking and choosing theform of therapy that works best
for that individual at thatmoment.
Speaker 3 (07:32):
Right, right, my background is in Rogerian
psychotherapy, so a humanisticapproach, and for me that is the
basis of how I interact withpatients.
You know, just this acceptanceof who they are, where they are.
And it bothered some of mypatients because I wasn't
directive enough, you know.
(07:53):
So I wasn't going to fix thembecause I didn't tell them what
to do.
And you know, in humanisticpsychotherapy you don't do that.
And as I grew as a therapist, Iadded in CBT, emdr, you know,
some other types ofpsychotherapy that you know that
(08:14):
I just everybody is different,everybody that you see is
different.
So you can't have a one sizefits all approach and you also
have to recognize that you maynot be the right person for that
particular patient at thatparticular point in time.
You know.
(08:34):
So when I didn't fix this, theone that just keeps ringing back
in my head, you know you're nottelling me what to do it.
It meant, you know, let's referthis person on to something
else and somebody else.
So, but the rewards are justincredible.
The rewards are incredible withthis.
Speaker 2 (08:56):
Yeah, I I have been fired more than once for a
patient to wanting to be alittle more directive and tell
them what to do.
Yeah, it is kind of a thing.
It's a shift for people, right.
They sometimes come in theyexpect you to kind of take all
their problems and just kind ofgive them like a new car, Like
you know, it's like I'm gonnagive you a whole tune up and
then you're gonna go out thedoor and you're gonna.
(09:17):
It's a very, you know, somepeople it's a shift, Some to
shift, Some people it's not.
They come in kind of ready andknowing it's a.
I think that's why I alwayslike to say it's a great time to
be a PMHMP, because, I mean, Ithink people have a better
understanding than they everhave of the importance of mental
health and taking care ofthemselves, so, so that's great.
That eclectic approach is, yeah, very valuable.
Speaker 3 (09:39):
I told people I had several magic wands and a couple
of crystal balls which I do.
People I had several magicwands and a couple of crystal
balls which I do and none ofthem work.
You know, it's that we have towork together and I always see
psychotherapy as a joint journey.
Right, it's not being in thefront, it's not being in the
back, it's, you know, the guy onthe side, kind of colloquialism
(10:00):
, but that's what it is, what itis, you know.
And other piece to that islearning not to take it home
with you.
You know, because you, you havethat journey, you're privileged
to be a part of that journey,and sometimes the stories can be
(10:22):
overwhelming.
And so, you know, one of thethings that I've learned is I go
back to therapy periodically,you know, because I really think
that, you know, all of us needit at some point in time, but
also to take really goodvacations.
You know, like one of myfavorite things to do is scuba
(10:44):
dive, and I tell people it'sbecause nobody can talk to me
underwater, right, I just hearthese rhythmic bubbles going up.
And so I think that's importantfor anybody who does
psychotherapy, both of thosethings to recognize when you
need to go back into therapy andnow there's so much available.
(11:06):
You know it's hard to go totherapy in the town that you
live in because you knoweverybody, so but with the
internet now and you knowvirtual experiences, that really
helped me a lot the last time Iwent into therapy.
(11:27):
You know it's important.
Speaker 4 (11:31):
Terry, I am thinking about.
You know your lens, as both aclinician as well as an academic
.
I'm interested to kind ofunderstand from your perspective
.
I mean, we all recognize thatthis is part of our skill set as
advanced psychiatric nurses butwe recognize intra
professionally that's notnecessarily always accepted,
(11:52):
necessarily always accepted.
Do you think we can kind ofhelp fortify the next generation
of advanced practicepsychiatric mental health nurses
to be able to kind of practiceat the top of their scope where
psychotherapy is as formidable atool as their prescriptive?
Speaker 3 (12:07):
You know, I think that we don't spend enough time
on it.
I mean, I had a certain numberof hours and that was with me
kicking and screaming and sayingthis has to happen, you know,
and I think the other thing isthat our, our students Hopefully
they realize it, that this isimportant.
(12:29):
I used to have them get aself-help book because I
couldn't make them go to therapy, right, and they worked through
the self-help book and it wasamazing how many students said
that was the best part of thewhole program.
And one of them told me hedidn't do the assignment.
He said I didn't realize I'dhave to look at myself.
(12:50):
Well, you know, that's theheart and soul of psychiatric
nursing is knowing who you areand knowing what it can do for
you.
So I think we have to be betterat getting people engaged in it
and finding ways to get thestudents involved in seeing the
(13:10):
power of it, but also reallytelling them that because you
have a license to do it doesn'tmean you're qualified, that you
need to go seek furthercertification and then practice
it.
You know a lot of our students.
I don't know about y'all, butour students were hired to do
med management.
(13:30):
I mean, that's really the onlything that they wanted to do.
I mean, that's really the onlything that they wanted to do,
but it's so important, Even medmanagement, you can incorporate
psychotherapeutic skills and youmay not choose to be the
(13:52):
primary psychotherapist for apatient.
I couldn't stop doing it, youknow, I just, I just could.
I tried to do the real quickmed management visits and it was
like no, no, no, I have to dothe therapy part of it, at least
get engaged a little bit in it.
So I don't, you know those ofus that have sought further
(14:13):
training and have becomequalified.
I think that that becomes apart of who we are.
And there's just, I was at anart class yesterday taking some
watercolor classes, and thislady across the table said to me
she said it kind of creeps meout that you're in psychotherapy
stuff because I think you'rejust analyzing all of us.
(14:36):
I'm sure y'all have gotten thatkind of reaction before.
Speaker 4 (14:41):
I do, and I commonly tell them no, I'm really just
considering what I am getting atCostco later.
So the world does not revolvearound you.
Speaker 3 (14:51):
Right, and I told her unless you're paying me, I
don't do that.
Speaker 4 (14:54):
There you go.
I want to just kind ofhighlight and elevate you made
reference to the idea about, youknow, students and nurse
practitioners getting their ownexperience in psychotherapy.
Thank you, thank you, thank you.
I think we are the biggestcynics in the world.
We don't think we could benefitfrom that which we actually
provide ourselves.
So thank you for thatobservation.
Speaker 2 (15:15):
Yeah, thanks, I mean this has been great.
I love this conversation whereit's going.
It's, you know, because it is.
And one of the things I thinkthat we have been for myself
even kind of on my own journeyjust recently is beginning to
think of psychotherapy not justas an intervention but also as a
tool that we use for ourassessment, we use for our
outcomes.
You know, it's a framework,it's the.
(15:38):
I think, like you said, terry,it's just kind of how it's
everything you do, I mean it'severything kind of goes through
that lens, and I've had thosekinds of experiences too.
You know, you kind of talk topeople and it's like oh no, I
don't do psychotherapy, I don'tcommunication, and so so I think
(15:59):
we've been talking about this alittle bit, but I've just kind
of maybe kind of draw a finerpoint to the question.
You know, are you concerned atall about psych, mental health
nurses using psychotherapy inany way?
Or maybe, what do you see asmaybe the barriers of psych,
mental health nursepractitioners using
psychotherapy?
Speaker 3 (16:14):
the barriers of psych mental health nurse
practitioners usingpsychotherapy.
The barriers are the employersfor sure, because really they're
hiring psych mental healthnurse practitioners just to do
psychopharmacology.
And then also whether or not weas educators get through to
them about how important it is.
The other thing is I have seenpeople who just decide they're
(16:40):
going to do psychotherapy andthey don't seek any further
training.
So yeah, I'm going to do CBT.
Or, for instance, the dramatherapy I was talking about
earlier.
I had a nurse that worked on anaddiction unit that was doing
that with the patient.
She had no training, zeroinsight into what she was doing
(17:01):
and of course she caused some abreactions and she just shut it
down, you know, and that is notfair to people.
Or you have therapists or psychNPs that say, well, I can't
work with this person, they'resuicidal, I don't want to be
responsible for them committingsuicide.
Well then, who does?
(17:22):
You know?
It's we.
I had a patient one time thatevery person I consulted with
about her said to drop her, saidto fire her, and when she came
to me she told me that, um, thatshe had been fired by every
psych provider she'd ever had.
And I thought, well, I told her, I said, you know well, I'm,
(17:44):
I'm gonna work with you as longas you're willing to work, you
know, and and for some peopleyou know that willingness to
work means they get stagnant fora little bit.
And and that's kind of what shedid.
And I referred her to atherapist.
She was one of the people Iknew would kill themselves at
some point in time, you know,and I referred her to a
(18:07):
therapist who fired her becauseshe was suicidal, you know, and
was worried about getting suedfor it.
And the story I've told thisstory, this story, dan, you
might have heard it already.
She ultimately did kill herself, ultimately, and I worked with
her for three or four years andat her funeral, both her husband
(18:31):
and her father came up to meand thanked me for giving them
those extra years.
And so you know, it's kind ofit's hard to have a patient that
chooses to kill themselves, butit also is, you know, sometimes
we just put it off for a whileand that's okay.
You know to be okay with that.
Speaker 2 (18:54):
Thank you, Terry, for sharing that.
That's wow, yeah.
And again, this is hitting hometo me too.
I mean, yeah, I've had a.
I remember a psychologist I usedto work with.
She would say that I don't wantto be that person's last
provider and it's just kind oflike that's an interesting way
to frame the idea that you don't.
Yeah, I mean you're going totake extra precaution or maybe
you're going to kind of referthem out when things get too too
(19:17):
deep and things that's um,that's interesting.
And then I rememberpsychiatrists used to work with
who wouldn't restart theirmedications because they
overdosed on my medicine, Um, sokind of taking it as a personal
affront that they overdosed onthis prescription that they
wrote, so, um, which I've neverkind of, you know, it just
doesn't, I guess, click with meand I, I love it.
It is one of those things wetalk to our students about this
(19:38):
a lot is that you, you do thiswork.
You're going to.
It's not a matter of you know,if it's when you're going to,
you're going to work withsomeone who, unfortunately,
either very closely attempts tosuicide or they actually
complete it.
Speaker 3 (19:51):
So Right, and didn't that psychite?
That sounds like so much apatient blaming to me.
You know, I go on these kicksof whether they're compliant or
noncompliant and I tell people,I told all my students, you know
, when you get in that space,the person that's noncompliant
(20:11):
is you, not your patient.
You know, to reframe it, thatthere's something that we're not
doing right to help them.
We haven't figured it out yet,we haven't walked in their shoes
enough to know what they mightbe willing to do.
You know, and so it's.
I really hate those words, youknow, but I really think it's a
(20:36):
challenge to us as providersthat when we get that person
that you know, we continue towork.
You know why are we justdumping people off?
Just because we're afraid ofwhat they're going to do or that
they're not following throughwith what you say they need to
do?
Speaker 4 (20:55):
Yeah, I agree, terry.
I think in many regards thesequela of patient-completed
suicide is better conceptualizedas provider countertransference
.
Yeah, and that's an opportunityfor us to kind of do our own
work, to kind of get betterinsight and understanding mental
health clinical nursespecialists over the years who
(21:17):
said that you know, if you are,if you can't control outcomes,
you're not necessarilyindependently responsible for
said outcomes.
That you know, at bestsometimes we have the
possibility of influencingpatient behavior but we don't
get to control them and if youcan't control them you can't
take disproportionateresponsibility for that.
Speaker 3 (21:37):
Right, right, because it really hits home sometimes.
You know, I'm sure you allremember the first patient that
you worked with that killedthemselves, and then thinking
about what do you do with thoseemotions.
You know what do you do andyou're right, it's a kind of
transference.
It's I have failed in some wayand and you haven't.
(22:01):
This, this field.
That's just one of the thingsin this field that if you, if
you go through a whole career,like I realized recently I've
been in this field 50 yearstoday, or this, this year, yeah,
um, if you go through it andyou don't have a single person
kill themselves and want youknow that, I just I think that
(22:25):
means you're throwing people off.
Speaker 4 (22:27):
You know, just to me, I'll throw this message out to
the audience If you have notread before or when you're
interested in this discussion,that Dr Diltz has taken us.
A wonderful, wonderful bookthat significantly influenced my
thinking around suicide issomething called Night Falls
Fast from Kay Redfield Jamison.
She's kind of a premier thoughtleader in this area of
(22:51):
understanding suicide and Iremember in her book she talked
about this idea that we try totake disproportionate control
over the decision.
Right, we recognize sometimespatients who are psychiatrically
hospitalized.
There's a peak in completionsof suicide post discharge
because we go from hyper controlto no control.
(23:11):
So her philosophy isn'tnecessarily to fight that
control, it's just merely toshift the risk to the right to
look for other opportunitiesbefore you make that declarative
decision.
Because ironically, asclinicians we try to take
control of that decision andthat's kind of a fateful
decision because, quite frankly,unless we're going to view with
them and keep them in thehospital for the rest of their
(23:32):
life, we can't control thatright.
So, what you're talking aboutseems to be really kind of
pattern after what I've readfrom Redfield Jamison.
That's high praise in my book,my friend.
Speaker 2 (23:44):
Yeah, I'll just kind of piggyback.
I mean it has a lot of thoughtfor me too about, unfortunately
and again, if somebody in theaudience is listening to this as
well, just take care ofyourself.
As you mentioned, terry, too,when this happens, again, as we
mentioned, make sure you takecare of yourself, because
unfortunately I've had thoseexperiences where the system
doesn't very well take care ofthat provider.
(24:05):
I've known again a psychiatristwho was working inpatient where
a person was actually able tohang themselves in an inpatient
unit and I remember kind of theadministration and the system
really came down hard on thispsychiatrist and it was, and I
just felt so bad.
I mean I wasn't in a positionto kind of offer much help for
that person.
But you know, it was one of myregrets a little bit of why I
(24:27):
didn't kind of reach out atOlive Branch and say are you
okay?
Because this is, you know,obviously a personal journey.
But then we have thisprofessional idea of you know,
how do we, how do we take careof this?
Speaker 3 (24:36):
And so, yeah, it's and the liability is, you know,
is there and you know.
So from a hospital systemstandpoint, they have to have
somebody point the finger atright and it you can't control
it, you know, you just can'tcontrol it.
Speaker 2 (24:57):
Yeah, and one of the things that shifted for me a
little bit and you know, thisdoesn't this isn't the whole
journey, but it is somethingthat I think about now more
often too is that, you know,only in psychiatry I feel like
we blame the clinician or weblame the patient.
You know, if we're treatinglike an oncology, you know we
administer a chemotherapy,radiation.
If they don't respond to that,we don't blame the patient.
(25:19):
You know, maybe we do sometimesand say they should be eating
or exercising more.
But but really I mean we lookat, well, they had the wrong
chemo or they had the wrongradiation, or you know that just
didn't, that type of cancer,just didn't work, yeah, yeah.
And sometimes they pass awayright, I mean, and then so it's
a very it's a lot of's, a lot ofparallels in my mind and again,
that idea that we may beproviding the best care, the
(25:41):
perfect care for that patient.
Patient may not be ready, or ormaybe we're not, maybe we're
not the right person, maybe theythey live in rural Iowa where
they you know providers are 90,100 miles away, and so, yeah, so
it's one of those things.
Speaker 3 (26:01):
One of those things and you know, one of the things
that COVID did do was it hadhospital systems looking at how
could they support their nursesor you know the people that are
there, and so they began toprovide a place for nurses to
either have therapy or to talkabout it or to try to work
through those feelings, and Idon't know that that has
(26:21):
continued.
But that was a real blessingfor some of those nurses.
You know, to have so manypeople die and not be able to do
anything, you know, so to me itwas a little bit of a parallel
that we get with patients whokill themselves.
But I hope that they continuethat, because I really think
(26:46):
that nurses, no matter what kindof nurse you are, that they
need some support and they needto work through some of the
things that they see with theirpatients.
Speaker 2 (26:56):
Absolutely yeah, their patients, absolutely yeah.
I cynically say always when Iand I've got several nurses that
I'm currently seeing aspatients, I would say nurses
make the worst patients.
But that doesn't mean weabandon them and kind of turn
our backs.
That means, just like you'resaying, we need more services,
we need to, you know, meet themwhere they are.
You know kind of have thosecounselings for those third
shifters and you know secondshifters where you know it's,
(27:18):
you know second shifters whereyou know it's, you know helping
out.
And again, I think telehealthhas been one of those things.
I steal this line from SeanBefore telehealth, you know
telehealth was a bus and if youdidn't run on the bus you're
going to get run over by it.
Now it's.
That's a foregone conclusion,right?
I mean we're in that bus andthat we're just trucking down
the road with telehealth, whichis in one of those silver
linings of COVID in my mind.
(27:39):
So we're kind of wrapping up ontime.
But I got one more question foryou, terry.
What do you see as the futureof psychotherapy within psych,
mental health, within nursing,and what's your crystal ball?
You mentioned crystal ballsthat you've got.
What are they telling you?
Speaker 3 (27:53):
I'm worried that it will go away.
I'm really worried about that,that this know to me the
psychotherapeutic aspect, thetherapeutic communication,
that's the art of nursing, and Iworry that we're going to miss
or get you know, be made to notdo psychotherapy anymore because
(28:18):
it's not financially viable.
You know it, just as I workedas a therapist, you know I had
these 50-minute hours and it wasgreat, but I didn't make as
much money as somebody seeingpatients for PsychoPharm where
(28:39):
they could see 15, 20 patients aday or more.
Some people are being forced todo more, and so I'm worried
about it.
I'm very, very worried about it.
It's, you know, pills are notalways the answer.
They help with some, but if youdon't combine it with
(29:00):
psychotherapy I mean, we knowthe research the research says
that people do better with both,you know.
And so how can we?
I think we just have to keepbeating the drum and telling you
know, our nurses, that this isimportant.
This, more than the psychopharm, is what's going to make, make
(29:21):
or break you.
Because if you don't have that,if you don't have those
connections with the patients,they're not coming back, you
know.
So you lose the financialincentive there.
I don't know if that made senseat all.
Speaker 2 (29:32):
But you know, no, yeah, thank you, I think that
made perfect sense.
I mean, it's, I think you're in, you're in good company here.
I think we're all terrified ofthat kind of future of you know
where does this go, I think,when you talk to people, though,
it's, you know, as we get moreinto more AI and how AI is going
to be incorporated into healthcare, I think we need to kind of
(29:53):
continue to urge against thisidea that we do get relegated to
like a kiosk, this idea that wedo get relegated to like a
kiosk.
You know, you don't just comeinto the office, or even on your
iPad, just kind of, how are youfeeling today?
One to 10, blah, blah, blah.
And okay, we're sending yourscript to this pharmacy.
There's more to it than that.
I saw that.
Look, sean, that was a growl.
I saw it.
That's good, but yeah, it is.
(30:14):
Yeah, thank you, terry.
I appreciate this and Iappreciate everybody kind of
hanging on listening to this.
I've gotten to some deep stuffand please make sure that you
like subscribe, send comments.
Love to hear from you and youknow any future topics people
want to talk about as well.
Love to hear from that as well.
So thanks so much and take care.
Speaker 3 (30:35):
I appreciate the invitation.
Thank you.
Speaker 1 (30:54):
Thanks, sarah.
Challenging your beliefs orbeliefs frame in your mind,
negative thoughts release.
Let it go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discovery.
yeah, just my take on things.
My answer number two welcomeback everyone.
(00:24):
Thank you so much for joining.
Speaker 2 (00:26):
Welcome back everyone .
Thank you so much for joiningPeplau's Ghost again another
week and another fabulous guestthat we get to talk to a little
bit here on our Friday afternoonFor us, kind of sending us into
a glorious weekend that we hopeis finding you in the same
condition.
So I want to say thanks againfor all those who are listening
and subscribing, commenting toour podcast.
(00:49):
I think we're getting close toa thousand downloads, so I'm
really excited about that number.
We've been kind of coming outweekly here in 2025.
We're going to take a littlebit of a break.
We're going to have a couple ofweeks here.
I'll be doing some travelingand so we'll have be coming back
in a few weeks.
So those of you who aredesperate and dying for the next
episode, hang on there.
We're going to come back to yousoon, but without any further
(01:12):
delay.
I'm going to introduce our nextguest here, dr Terry Dilks.
Dr Dilks is a well-establishedpsych, mental health nurse
practitioner Very similar tomyself.
She kind of came into nursingshe was a therapist before she
found nursing I always say foundthe light and just kind of
stayed here and has been just anamazing professional and
(01:38):
academic.
I don't have much of anintroduction for her, but maybe
she can kind of share some ofher experiences.
But I will share that.
She is currently a retired fullprofessor and also was the past
president for the AmericanPsychiatric Nurse Association.
So that is a big feat in mymind and takes a lot of things
to do and, yeah, I'd love tohear some more stories about all
(02:01):
the things that you wentthrough in the APNA presidency
and so, as I'm kind of movinginto my own presidency and ISBN,
so exciting and yeah so, butlet me get started with our
question right out the gate whendid you first get interested in
psychotherapy?
Speaker 3 (02:18):
Well, I started in nursing first, then went to
therapy and then went back toadvanced practice nursing.
So when I was in nursing schoola long, long time ago, we had a
, we were at an adultpsychiatric facility and one of
our instructors decided to dosome drama therapy with us and I
(02:42):
was just like, wow, this is socool.
You know, this is.
I wonder if this is somethingthat you know I could learn to
do at some point.
And so that kind of piqued myinterest there and, as I, you
know, thank God for psychiatricnursing, because I didn't really
(03:02):
want to be a nurse.
I just, when I foundpsychiatric nursing, it was like
, yes, I was home.
And so my whole career but withvery few interruptions has been
in the field of psych, startingas a mental health technician
and then moving my way up, youknow, to a head nurse, to a
director of nursing, to gettinga master's degree in psychology
(03:30):
which was focused onpsychotherapy, and I have
dropped into so many things.
Louisiana decided to go with anLPC, a licensed professional
counselor.
I had not completed my degreequite yet, but I had all of the
classes I needed to have and Ihad the experience.
(03:51):
So I was licensed as an LPC for35 years.
I just gave it up a couple ofyears ago, so great fun.
Speaker 2 (04:00):
Awesome, I'm sorry about mixing up your timeline.
I apologize for that, but verysimilar.
Like I said myself, I had tocome to nursing I guess I
started off in getting my MSWand very similar to you kind of
let the license go and, yes,thank goodness for psych nursing
.
So, yeah, so, thank you so much.
(04:20):
Appreciate it and I am going toapologize again the second time
.
Maybe I'll do this a number ofother times, but I didn't
introduce Dr Sean Convoy fromDuke, who's here, so we're going
to hear from him next.
So sorry about that, sean.
Speaker 4 (04:32):
All good.
My friend, terry Dan, asked youa question kind of big picture
about kind of your experiencesprofessionally.
I'm going to ask you to kind offocus your lens a little bit on
an experience with a patientthat kind of illustrated to you
that what we believe here inthis podcast to be the secret
sauce of psychotherapy Was there, a unique experience that told
(04:54):
you, oh my God, this islightning in a bottle.
Speaker 3 (04:58):
It.
Yes, I mean there were many,there were many, I mean there
(05:20):
were many, there were many, youknow, but the ones that stand
out are the ones I did withfolks who had disassociative
identity disorder, you know, andso you had to pivot very
quickly to different types ofpsychotherapy, that diagnosis.
Of course, people eitherbelieve in it or don't believe
in it.
But once you've seen it, you'veseen it, Psychotherapy is
curative and that to me was anamazing thought that you know I
(05:40):
could cure this person withtheir help, or they could cure
themselves of dissociativeidentity disorder.
And one of the ones I workedwith for the longest took 15
years, but then she totallyintegrated.
I hear from her periodically.
She got a bachelor, no, anassociate degree, a bachelor's
(06:02):
degree and a master's degreewhile we were working in therapy
.
She had had to relearn somethings because she had a couple
alters that wanted to hold backand not let her have information
like basic math.
So it was.
It challenged me in so manyways, you know.
(06:24):
It was like well, like well, Ididn't.
I had never been trained in howto work with this, so I had to
look it up, I had to research,um, but I, there was nobody who
was doing that type ofpsychotherapy near, so it was.
It burned me out in the longrun, but man, it was good work
terry I, I, I.
Speaker 4 (06:45):
I'm gonna bring this back to Dan and let him know
that we just found the taglinefor this podcast around the line
Psychotherapy is curative.
Yeah, yeah, let's kick it backto you, my friend.
Speaker 2 (06:58):
Thanks, sean.
Yeah, no, can we kind of maybekind of spend, because I know
that's one of your areas ofexpertise is working with people
with dissociative identitydisorder you mentioned.
You know you have to be veryflexible in kind of moving your
approach depending on the altarand things.
Is there any you know like oneor two forms that you found to
be most beneficial?
(07:18):
You have to be just a real kindof I was going to say magician,
but you know kind of reallyhave to be very skillful in kind
of picking and choosing theform of therapy that works best
for that individual at thatmoment.
Speaker 3 (07:32):
Right, right, my background is in Rogerian
psychotherapy, so a humanisticapproach, and for me that is the
basis of how I interact withpatients.
You know, just this acceptanceof who they are, where they are.
And it bothered some of mypatients because I wasn't
directive enough, you know.
(07:53):
So I wasn't going to fix thembecause I didn't tell them what
to do.
And you know, in humanisticpsychotherapy you don't do that.
And as I grew as a therapist, Iadded in CBT, emdr, you know,
some other types ofpsychotherapy that you know that
(08:14):
I just everybody is different,everybody that you see is
different.
So you can't have a one sizefits all approach and you also
have to recognize that you maynot be the right person for that
particular patient at thatparticular point in time.
You know.
(08:34):
So when I didn't fix this, theone that just keeps ringing back
in my head, you know you're nottelling me what to do it.
It meant, you know, let's referthis person on to something
else and somebody else.
So, but the rewards are justincredible.
The rewards are incredible withthis.
Speaker 2 (08:56):
Yeah, I I have been fired more than once for a
patient to wanting to be alittle more directive and tell
them what to do.
Yeah, it is kind of a thing.
It's a shift for people, right.
They sometimes come in theyexpect you to kind of take all
their problems and just kind ofgive them like a new car, Like
you know, it's like I'm gonnagive you a whole tune up and
then you're gonna go out thedoor and you're gonna.
(09:17):
It's a very, you know, somepeople it's a shift, Some to
shift, Some people it's not.
They come in kind of ready andknowing it's a.
I think that's why I alwayslike to say it's a great time to
be a PMHMP, because, I mean, Ithink people have a better
understanding than they everhave of the importance of mental
health and taking care ofthemselves, so, so that's great.
That eclectic approach is, yeah, very valuable.
Speaker 3 (09:39):
I told people I had several magic wands and a couple
of crystal balls which I do.
People I had several magicwands and a couple of crystal
balls which I do and none ofthem work.
You know, it's that we have towork together and I always see
psychotherapy as a joint journey.
Right, it's not being in thefront, it's not being in the
back, it's, you know, the guy onthe side, kind of colloquialism
(10:00):
, but that's what it is, what itis, you know.
And other piece to that islearning not to take it home
with you.
You know, because you, you havethat journey, you're privileged
to be a part of that journey,and sometimes the stories can be
(10:22):
overwhelming.
And so, you know, one of thethings that I've learned is I go
back to therapy periodically,you know, because I really think
that, you know, all of us needit at some point in time, but
also to take really goodvacations.
You know, like one of myfavorite things to do is scuba
(10:44):
dive, and I tell people it'sbecause nobody can talk to me
underwater, right, I just hearthese rhythmic bubbles going up.
And so I think that's importantfor anybody who does
psychotherapy, both of thosethings to recognize when you
need to go back into therapy andnow there's so much available.
(11:06):
You know it's hard to go totherapy in the town that you
live in because you knoweverybody, so but with the
internet now and you knowvirtual experiences, that really
helped me a lot the last time Iwent into therapy.
(11:27):
You know it's important.
Speaker 4 (11:31):
Terry, I am thinking about.
You know your lens, as both aclinician as well as an academic
.
I'm interested to kind ofunderstand from your perspective
.
I mean, we all recognize thatthis is part of our skill set as
advanced psychiatric nurses butwe recognize intra
professionally that's notnecessarily always accepted,
(11:52):
necessarily always accepted.
Do you think we can kind ofhelp fortify the next generation
of advanced practicepsychiatric mental health nurses
to be able to kind of practiceat the top of their scope where
psychotherapy is as formidable atool as their prescriptive?
Speaker 3 (12:07):
You know, I think that we don't spend enough time
on it.
I mean, I had a certain numberof hours and that was with me
kicking and screaming and sayingthis has to happen, you know,
and I think the other thing isthat our, our students Hopefully
they realize it, that this isimportant.
(12:29):
I used to have them get aself-help book because I
couldn't make them go to therapy, right, and they worked through
the self-help book and it wasamazing how many students said
that was the best part of thewhole program.
And one of them told me hedidn't do the assignment.
He said I didn't realize I'dhave to look at myself.
(12:50):
Well, you know, that's theheart and soul of psychiatric
nursing is knowing who you areand knowing what it can do for
you.
So I think we have to be betterat getting people engaged in it
and finding ways to get thestudents involved in seeing the
(13:10):
power of it, but also reallytelling them that because you
have a license to do it doesn'tmean you're qualified, that you
need to go seek furthercertification and then practice
it.
You know a lot of our students.
I don't know about y'all, butour students were hired to do
med management.
(13:30):
I mean, that's really the onlything that they wanted to do.
I mean, that's really the onlything that they wanted to do,
but it's so important, Even medmanagement, you can incorporate
psychotherapeutic skills and youmay not choose to be the
(13:52):
primary psychotherapist for apatient.
I couldn't stop doing it, youknow, I just, I just could.
I tried to do the real quickmed management visits and it was
like no, no, no, I have to dothe therapy part of it, at least
get engaged a little bit in it.
So I don't, you know those ofus that have sought further
(14:13):
training and have becomequalified.
I think that that becomes apart of who we are.
And there's just, I was at anart class yesterday taking some
watercolor classes, and thislady across the table said to me
she said it kind of creeps meout that you're in psychotherapy
stuff because I think you'rejust analyzing all of us.
(14:36):
I'm sure y'all have gotten thatkind of reaction before.
Speaker 4 (14:41):
I do, and I commonly tell them no, I'm really just
considering what I am getting atCostco later.
So the world does not revolvearound you.
Speaker 3 (14:51):
Right, and I told her unless you're paying me, I
don't do that.
Speaker 4 (14:54):
There you go.
I want to just kind ofhighlight and elevate you made
reference to the idea about, youknow, students and nurse
practitioners getting their ownexperience in psychotherapy.
Thank you, thank you, thank you.
I think we are the biggestcynics in the world.
We don't think we could benefitfrom that which we actually
provide ourselves.
So thank you for thatobservation.
Speaker 2 (15:15):
Yeah, thanks, I mean this has been great.
I love this conversation whereit's going.
It's, you know, because it is.
And one of the things I thinkthat we have been for myself
even kind of on my own journeyjust recently is beginning to
think of psychotherapy not justas an intervention but also as a
tool that we use for ourassessment, we use for our
outcomes.
You know, it's a framework,it's the.
(15:38):
I think, like you said, terry,it's just kind of how it's
everything you do, I mean it'severything kind of goes through
that lens, and I've had thosekinds of experiences too.
You know, you kind of talk topeople and it's like oh no, I
don't do psychotherapy, I don'tcommunication, and so so I think
(15:59):
we've been talking about this alittle bit, but I've just kind
of maybe kind of draw a finerpoint to the question.
You know, are you concerned atall about psych, mental health
nurses using psychotherapy inany way?
Or maybe, what do you see asmaybe the barriers of psych,
mental health nursepractitioners using
psychotherapy?
Speaker 3 (16:14):
the barriers of psych mental health nurse
practitioners usingpsychotherapy.
The barriers are the employersfor sure, because really they're
hiring psych mental healthnurse practitioners just to do
psychopharmacology.
And then also whether or not weas educators get through to
them about how important it is.
The other thing is I have seenpeople who just decide they're
(16:40):
going to do psychotherapy andthey don't seek any further
training.
So yeah, I'm going to do CBT.
Or, for instance, the dramatherapy I was talking about
earlier.
I had a nurse that worked on anaddiction unit that was doing
that with the patient.
She had no training, zeroinsight into what she was doing
(17:01):
and of course she caused some abreactions and she just shut it
down, you know, and that is notfair to people.
Or you have therapists or psychNPs that say, well, I can't
work with this person, they'resuicidal, I don't want to be
responsible for them committingsuicide.
Well then, who does?
(17:22):
You know?
It's we.
I had a patient one time thatevery person I consulted with
about her said to drop her, saidto fire her, and when she came
to me she told me that, um, thatshe had been fired by every
psych provider she'd ever had.
And I thought, well, I told her, I said, you know well, I'm,
(17:44):
I'm gonna work with you as longas you're willing to work, you
know, and and for some peopleyou know that willingness to
work means they get stagnant fora little bit.
And and that's kind of what shedid.
And I referred her to atherapist.
She was one of the people Iknew would kill themselves at
some point in time, you know,and I referred her to a
(18:07):
therapist who fired her becauseshe was suicidal, you know, and
was worried about getting suedfor it.
And the story I've told thisstory, this story, dan, you
might have heard it already.
She ultimately did kill herself, ultimately, and I worked with
her for three or four years andat her funeral, both her husband
(18:31):
and her father came up to meand thanked me for giving them
those extra years.
And so you know, it's kind ofit's hard to have a patient that
chooses to kill themselves, butit also is, you know, sometimes
we just put it off for a whileand that's okay.
You know to be okay with that.
Speaker 2 (18:54):
Thank you, Terry, for sharing that.
That's wow, yeah.
And again, this is hitting hometo me too.
I mean, yeah, I've had a.
I remember a psychologist I usedto work with.
She would say that I don't wantto be that person's last
provider and it's just kind oflike that's an interesting way
to frame the idea that you don't.
Yeah, I mean you're going totake extra precaution or maybe
you're going to kind of referthem out when things get too too
(19:17):
deep and things that's um,that's interesting.
And then I rememberpsychiatrists used to work with
who wouldn't restart theirmedications because they
overdosed on my medicine, Um, sokind of taking it as a personal
affront that they overdosed onthis prescription that they
wrote, so, um, which I've neverkind of, you know, it just
doesn't, I guess, click with meand I, I love it.
It is one of those things wetalk to our students about this
(19:38):
a lot is that you, you do thiswork.
You're going to.
It's not a matter of you know,if it's when you're going to,
you're going to work withsomeone who, unfortunately,
either very closely attempts tosuicide or they actually
complete it.
Speaker 3 (19:51):
So Right, and didn't that psychite?
That sounds like so much apatient blaming to me.
You know, I go on these kicksof whether they're compliant or
noncompliant and I tell people,I told all my students, you know
, when you get in that space,the person that's noncompliant
(20:11):
is you, not your patient.
You know, to reframe it, thatthere's something that we're not
doing right to help them.
We haven't figured it out yet,we haven't walked in their shoes
enough to know what they mightbe willing to do.
You know, and so it's.
I really hate those words, youknow, but I really think it's a
(20:36):
challenge to us as providersthat when we get that person
that you know, we continue towork.
You know why are we justdumping people off?
Just because we're afraid ofwhat they're going to do or that
they're not following throughwith what you say they need to
do?
Speaker 4 (20:55):
Yeah, I agree, terry.
I think in many regards thesequela of patient-completed
suicide is better conceptualizedas provider countertransference
.
Yeah, and that's an opportunityfor us to kind of do our own
work, to kind of get betterinsight and understanding mental
health clinical nursespecialists over the years who
(21:17):
said that you know, if you are,if you can't control outcomes,
you're not necessarilyindependently responsible for
said outcomes.
That you know, at bestsometimes we have the
possibility of influencingpatient behavior but we don't
get to control them and if youcan't control them you can't
take disproportionateresponsibility for that.
Speaker 3 (21:37):
Right, right, because it really hits home sometimes.
You know, I'm sure you allremember the first patient that
you worked with that killedthemselves, and then thinking
about what do you do with thoseemotions.
You know what do you do andyou're right, it's a kind of
transference.
It's I have failed in some wayand and you haven't.
(22:01):
This, this field.
That's just one of the thingsin this field that if you, if
you go through a whole career,like I realized recently I've
been in this field 50 yearstoday, or this, this year, yeah,
um, if you go through it andyou don't have a single person
kill themselves and want youknow that, I just I think that
(22:25):
means you're throwing people off.
Speaker 4 (22:27):
You know, just to me, I'll throw this message out to
the audience If you have notread before or when you're
interested in this discussion,that Dr Diltz has taken us.
A wonderful, wonderful bookthat significantly influenced my
thinking around suicide issomething called Night Falls
Fast from Kay Redfield Jamison.
She's kind of a premier thoughtleader in this area of
(22:51):
understanding suicide and Iremember in her book she talked
about this idea that we try totake disproportionate control
over the decision.
Right, we recognize sometimespatients who are psychiatrically
hospitalized.
There's a peak in completionsof suicide post discharge
because we go from hyper controlto no control.
(23:11):
So her philosophy isn'tnecessarily to fight that
control, it's just merely toshift the risk to the right to
look for other opportunitiesbefore you make that declarative
decision.
Because ironically, asclinicians we try to take
control of that decision andthat's kind of a fateful
decision because, quite frankly,unless we're going to view with
them and keep them in thehospital for the rest of their
(23:32):
life, we can't control thatright.
So, what you're talking aboutseems to be really kind of
pattern after what I've readfrom Redfield Jamison.
That's high praise in my book,my friend.
Speaker 2 (23:44):
Yeah, I'll just kind of piggyback.
I mean it has a lot of thoughtfor me too about, unfortunately
and again, if somebody in theaudience is listening to this as
well, just take care ofyourself.
As you mentioned, terry, too,when this happens, again, as we
mentioned, make sure you takecare of yourself, because
unfortunately I've had thoseexperiences where the system
doesn't very well take care ofthat provider.
(24:05):
I've known again a psychiatristwho was working inpatient where
a person was actually able tohang themselves in an inpatient
unit and I remember kind of theadministration and the system
really came down hard on thispsychiatrist and it was, and I
just felt so bad.
I mean I wasn't in a positionto kind of offer much help for
that person.
But you know, it was one of myregrets a little bit of why I
(24:27):
didn't kind of reach out atOlive Branch and say are you
okay?
Because this is, you know,obviously a personal journey.
But then we have thisprofessional idea of you know,
how do we, how do we take careof this?
Speaker 3 (24:36):
And so, yeah, it's and the liability is, you know,
is there and you know.
So from a hospital systemstandpoint, they have to have
somebody point the finger atright and it you can't control
it, you know, you just can'tcontrol it.
Speaker 2 (24:57):
Yeah, and one of the things that shifted for me a
little bit and you know, thisdoesn't this isn't the whole
journey, but it is somethingthat I think about now more
often too is that, you know,only in psychiatry I feel like
we blame the clinician or weblame the patient.
You know, if we're treatinglike an oncology, you know we
administer a chemotherapy,radiation.
If they don't respond to that,we don't blame the patient.
(25:19):
You know, maybe we do sometimesand say they should be eating
or exercising more.
But but really I mean we lookat, well, they had the wrong
chemo or they had the wrongradiation, or you know that just
didn't, that type of cancer,just didn't work, yeah, yeah.
And sometimes they pass awayright, I mean, and then so it's
a very it's a lot of's, a lot ofparallels in my mind and again,
that idea that we may beproviding the best care, the
(25:41):
perfect care for that patient.
Patient may not be ready, or ormaybe we're not, maybe we're
not the right person, maybe theythey live in rural Iowa where
they you know providers are 90,100 miles away, and so, yeah, so
it's one of those things.
Speaker 3 (26:01):
One of those things and you know, one of the things
that COVID did do was it hadhospital systems looking at how
could they support their nursesor you know the people that are
there, and so they began toprovide a place for nurses to
either have therapy or to talkabout it or to try to work
through those feelings, and Idon't know that that has
(26:21):
continued.
But that was a real blessingfor some of those nurses.
You know, to have so manypeople die and not be able to do
anything, you know, so to me itwas a little bit of a parallel
that we get with patients whokill themselves.
But I hope that they continuethat, because I really think
(26:46):
that nurses, no matter what kindof nurse you are, that they
need some support and they needto work through some of the
things that they see with theirpatients.
Speaker 2 (26:56):
Absolutely yeah, their patients, absolutely yeah.
I cynically say always when Iand I've got several nurses that
I'm currently seeing aspatients, I would say nurses
make the worst patients.
But that doesn't mean weabandon them and kind of turn
our backs.
That means, just like you'resaying, we need more services,
we need to, you know, meet themwhere they are.
You know kind of have thosecounselings for those third
shifters and you know secondshifters where you know it's,
(27:18):
you know second shifters whereyou know it's, you know helping
out.
And again, I think telehealthhas been one of those things.
I steal this line from SeanBefore telehealth, you know
telehealth was a bus and if youdidn't run on the bus you're
going to get run over by it.
Now it's.
That's a foregone conclusion,right?
I mean we're in that bus andthat we're just trucking down
the road with telehealth, whichis in one of those silver
linings of COVID in my mind.
(27:39):
So we're kind of wrapping up ontime.
But I got one more question foryou, terry.
What do you see as the futureof psychotherapy within psych,
mental health, within nursing,and what's your crystal ball?
You mentioned crystal ballsthat you've got.
What are they telling you?
Speaker 3 (27:53):
I'm worried that it will go away.
I'm really worried about that,that this know to me the
psychotherapeutic aspect, thetherapeutic communication,
that's the art of nursing, and Iworry that we're going to miss
or get you know, be made to notdo psychotherapy anymore because
(28:18):
it's not financially viable.
You know it, just as I workedas a therapist, you know I had
these 50-minute hours and it wasgreat, but I didn't make as
much money as somebody seeingpatients for PsychoPharm where
(28:39):
they could see 15, 20 patients aday or more.
Some people are being forced todo more, and so I'm worried
about it.
I'm very, very worried about it.
It's, you know, pills are notalways the answer.
They help with some, but if youdon't combine it with
(29:00):
psychotherapy I mean, we knowthe research the research says
that people do better with both,you know.
And so how can we?
I think we just have to keepbeating the drum and telling you
know, our nurses, that this isimportant.
This, more than the psychopharm, is what's going to make, make
(29:21):
or break you.
Because if you don't have that,if you don't have those
connections with the patients,they're not coming back, you
know.
So you lose the financialincentive there.
I don't know if that made senseat all.
Speaker 2 (29:32):
But you know, no, yeah, thank you, I think that
made perfect sense.
I mean, it's, I think you're in, you're in good company here.
I think we're all terrified ofthat kind of future of you know
where does this go, I think,when you talk to people, though,
it's, you know, as we get moreinto more AI and how AI is going
to be incorporated into healthcare, I think we need to kind of
(29:53):
continue to urge against thisidea that we do get relegated to
like a kiosk, this idea that wedo get relegated to like a
kiosk.
You know, you don't just comeinto the office, or even on your
iPad, just kind of, how are youfeeling today?
One to 10, blah, blah, blah.
And okay, we're sending yourscript to this pharmacy.
There's more to it than that.
I saw that.
Look, sean, that was a growl.
I saw it.
That's good, but yeah, it is.
(30:14):
Yeah, thank you, terry.
I appreciate this and Iappreciate everybody kind of
hanging on listening to this.
I've gotten to some deep stuffand please make sure that you
like subscribe, send comments.
Love to hear from you and youknow any future topics people
want to talk about as well.
Love to hear from that as well.
So thanks so much and take care.
Speaker 3 (30:35):
I appreciate the invitation.
Thank you.
Speaker 1 (30:54):
Thanks, sarah.
Challenging your beliefs orbeliefs frame in your mind,
negative thoughts release.
Let it go.
These cognitive distortionsdecrease until they cease.
Yeah, got a discovery.
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