I took the GRE once, did horribly on it. Didn't
really know how to study for it. Forced myself
to try and study again for it. Did it again and
barely got a better score. I was just... I felt
completely ill -equipped after studying German
for nine years and living there for a year. I
wasn't planning on opening a private practice.
When I finished training in 2021, I had done
roughly half my training, all ironically under
the supervision of psychiatrists. It just worked
out that way where all of my mentors through
graduate training were psychiatrists. After finishing
school, I ended up not working there, but there
was another, the Behavioral Health Hospital in
Montana. The main one was opening a clinic in
Bozeman, actually. And so I applied for that,
got the job and was working exclusively with
children and adolescents for the first year.
Immediately get a release of information, call
the therapist up and just explain who I was and
what my role is that I was looking forward to
working with them. And people have to be ready.
You know, I mean, just like coming to treatment
for anything, people have to be ready for it.
And not everybody is. Welcome back to No Prior
Off. I'm sitting down with Ben Egbers this week.
Ben is a psychiatric nurse practitioner at Access
Integrated Mental Health in Colorado, where he
runs some of the most intensive treatments in
the field, deep TMS and ketamine, while believing
something that sounds almost contradictory, that
the goal is the least medication a person needs,
not the most. Ben came to this work the long
way. a psychology and German degree back in 2000,
years as a case manager, teaching abroad, surviving
an avalanche, and his own recovery from alcohol
use disorder. And he didn't finish his nursing
doctorate until 2021. He's open about all of
it, and it shapes how he sits with people. I
think this is his first podcast, so let's get
into it. Welcome, Ben. Thank you so much, Lindsay.
That was quite the intro and absolutely accurate.
Okay, amazing. Other things I'm excited to hear
about from you are the fact that you once were
in private practice, your own private practice
in Montana, right? And you are no longer. Correct.
And you're also really interested in psychodynamics
and how that can play a part in your psych NP
role. So I want to hear about the fellowship
you're in and just more about your journey because
it seems really unique. So I'm excited for people
to learn more about you. So just to kick things
off, tell us a little bit about just you as a
person and kind of what got you into becoming
a psych NP. Yeah, well, thanks again for having
me. It's great to be here. So yeah, to your point,
going through your previous episodes, which were
wonderful, I felt myself thinking I'm a bit of
an outlier here just because everybody's running
very successful group practices and that sort
of thing. So yeah, like I said, I'm honored to
be here and get to tell a little bit about my
story and journey. What got me into psychiatric
nursing as far as like as a provider, you know,
intro, my background was actually in psychology
and my original career goal was to become a clinical
psychologist, actually. So my first aspirations
were either a Ph .D. or a Psy .D. and became
fascinated by manic depressive illness slash
bipolar disorder. back in 2020 when i read k
redfield jameson's memoir an unquiet mind and
that really was a life -changing book that really
cemented my um what i wanted to do research on
which was psychosocial interventions for the
treatment of bipolar disorder and um So that
was my original path. And yeah, doing I wanted
to similar to nursing where a lot of nurses will
go out and kind of cut their teeth, so to speak,
metaphorically speaking, on med surge. I did
in community mental health. So graduating with
an undergraduate degree in psychology, you don't
have a lot of clinical training at that point.
And so, you know, I really wanted to get some
hands on experience working in. So I worked with
primarily at the severe and persistent mental
illness population in community health, community
mental health. And it was an amazing experience.
I still somehow remember the names of those clients
26 years later. But especially after all the
drinking, which we'll get into later. Yeah, it
was just a very transformative experience. And
at the same token, a very exhausting experience
to the point where after about, you know, I worked
for that organization for about three years and
eventually I just had to, actually I took the
GRE, had everything set up. You know, I was ready
to apply to this program in Florida of all places,
which is part of the story. And I had just fallen
in love with rock climbing at the time and mountaineering
and kind of the mountain sport lifestyle. And
I took the GRE once, did horribly on it, didn't
really know how to study for it, forced myself
to try and study again for it, did it again and
barely got a better score and just wasn't really
confident in the ability that it was going to
be. what I needed it to be to get me into the
program even though I had already talked to the
advisor the person I was going to do research
for but I it just and the fact that I was looking
at a six -year plus commitment in Florida of
all places and there are no mountains no skiing
no rock climbing you know to my knowledge at
that point so I decided to pivot to plan b which
was to use my German degree and so I traveled
through Europe for the summer climbing and hostilling
my way across Europe with one of my best friends,
climbing partner who was in the avalanche with
me years later. And yeah, decided to just stay
in Europe and teach English, stay in Germany.
So I did that and then came back to the States
after a year and floated around. I didn't really
have a plan at that point. Nursing was the furthest
thing from my radar. Worked in the outdoor industry
for a little bit to kind of explore that and
then started a master's program in German studies
here in Colorado actually I relocated when I
came back from Europe I moved to Colorado my
actually one of my best friends who is my climbing
partner at the time and the guy that I mentioned
regarding the avalanche he was doing his PhD
in physics here and he said hey if you want a
great landing pad Boulder is an amazing spot
it's a great climbing town it's a great singles
town it's great weather You know, I came to visit
and stayed here, saw it. And so, yeah, kind of
floated around. And then, yeah, I started this
master's program in German because I had always
wanted to go to graduate school. And that was
that seemed like an easy entry into graduate
work. And I knew after one semester, boy, this
is the absolute wrong decision for me. I was
just completely. ill -equipped after, you know,
studying German for nine years and living there
for a year. So I came home for Christmas break
that year. This was 2000 and sort of in 2008.
And I talked to my mom, who was a nurse at that
time, was kind of nearing the end of her career
and was talking to her about my, you know, kind
of quandary of what to do. She said, well, there's
always nursing. It's a very, you know, flexible
career. You can support yourself. You can do
anything. And that was enough to convince me.
So I came back and started told my German advisor,
hey, I'm quitting the program. I'm going to pivot
to nursing and started Prereqs. And then that
January, I think it was January 6th of 2008,
my friend Mike and I were backcountry skiing
and an avalanche ripped loose above us in the
backcountry. And he was buried. I had to rescue
him, dig him out. We were the only two out there.
I sustained pretty severe injuries myself. He,
you know, both of us survived, but he was fully
buried and, you know, probably would have not
survived. Um, so, so yeah, we, yeah. So, uh,
came back and I remember starting my prereqs
in a, in a, a cast sling cause I had torn one
of my extensor tendons. My snowboard had come
off my pack and sliced through one of my tendons
and I couldn't write. So I had one of my, um,
the TA was actually doing calculations for me
in this intro chemistry class. And, um, so, uh,
so anyways, um, Yeah. Got into nursing. Yeah.
It was, uh, it's quite the story. So, um, anyways,
got into nursing school, um, went through a divorce
at the time. Uh, and then, um, yeah, nursing
for me, I thought I was going to be this, you
know, pardon the term, badass ER nurse, you know,
and, um, high adrenaline and all of that and
got out of nursing school and um got into med
surg and knew immediately like boy the medical
side is really not my forte and i found myself
just wanting to get out of clinical care so i
did a bunch of different things outside in industry
and um infusion pharmacy uh so the first thing
i did was i worked as a clinical like liaison
type so i was doing bedside education for a an
infusion pharmacy so patients who were going
home on iv antibiotics for example i would teach
them how to use their pick lines and how to use
these different drug delivery devices and that
sort of thing and then i was also liaising with
discharge planners so there was a sales component
to it i remember Very clearly laying awake at
two or three in the morning when I was on night
shift and just hating every minute of my med
surg existence. And I was like, I have to get
out of here. So I found this clinical position.
I was like, this sounds like a perfect exit.
So it was weekends. It paid better. All that
really got sucked into clinical education in
the pharmaceutical industry, which was high paying,
which was also. you know uh intriguing to me
um as a nurse yeah as a nurse still as a nurse
yeah and then eventually i hit this point where
i was just miserable honestly i was making a
ton of money but the work itself felt very meaningless
you know i mean i was trying to um in great it
felt like i was trying to ingratiate myself to
you know, nurse practitioners and physicians
to log these calls that I was getting paid for
and that sort of thing. And yeah, I know you
interviewed Danny Carlat, and that was part of
what inspired him to kind of start. Carlat Publishing,
right, was this sort of the inside knowledge
of how things really are, you know, not to disparage
the pharmaceutical industry too much, but it
just wasn't for me. I mean, I know a lot of colleagues
and friends actually really enjoy their work.
For me, it wasn't the right path. So I called
my nursing school advisor and she was like, time
for grad school. I was like, I think you're right.
So, and I was, I interviewed a bunch of different
NPs. you know, FNPs, AGNPs. Ironically, I didn't
interview a psych NP, but I knew after talking
to the AGNP and the FNPs that that way of working
with patients really wasn't going to be working
for me. And what I really recalled most fondly
about my patient interactions as a nurse was
getting to sit down and hear their stories and
hear about their difficulties and their struggles
and how they made it through them. And, you know,
looking into psychiatry, it's like that really
that fits the bill, so to speak. So I took a
huge pay cut, like 50 or 60 grand a year pay
cut and went back to bedside nursing in inpatient
psychiatry. So started working as a traveler,
local contracts, worked in residential eating
disorders and then worked in inpatient acute
psych, applied. program, the University of Washington
DNP program. This was in 2018 that I started.
And then COVID hit, the world shut down. And
yeah, so that was a little bit, that was a long
-winded answer into what got me into or got me
back into mental health or behavioral health.
Okay. Well, that's, wow, quite a journey you've
had. And I know at the beginning you mentioned
you know, I'm an outlier compared to the other
guests that you've had on. And that is kind of
the point of why I asked you to be on. And also,
you know, I want this podcast to be about more
than just private practice, you know, because
the truth is private practice isn't the answer
for many people. And so, you know, the fact that
you had also had a private practice and walked
away from it. I wouldn't have known that if we
hadn't hopped on that quick call after connecting
on LinkedIn. But I just thought that was interesting.
Could you speak to that a little bit? Because
I do think many people just kind of have private
practice on a pedestal of sorts, kind of like,
and there are benefits, right? And downsides,
but I'd just be curious to hear about your experience.
Yeah, absolutely. I wasn't planning on opening
a private practice, honestly. When I finished
training in 2021, I had done roughly half my
training, all ironically under the supervision
of psychiatrists. It just worked out that way
where all of my mentors through graduate training
were psychiatrists. And so half of it was with
adult psychiatrists and all outpatient. And then
the other half was with child and adolescent.
And part of that was very much intentional on
my part. My wife and I knew that we wanted to
relocate to Montana and get out of the busyness
of Seattle. And so I interviewed with a or kind
of networked with a private practice in Bozeman.
And there was a child psychiatrist there, Raven
Lipmanson, who I became a mentor. And she was
one of my. supervisors. And, you know, we were
talking about plans after school. And she said,
well, you know, we'd certainly have a need for
someone who's willing to work with children and
adolescents. And so, yeah, thought, hey, you
know, it's nothing, it's something I'd never
really given much thought to. But after working
with her as a student, it really became a enjoyable
and kind of natural fit for me and so uh after
finishing school um ended up not working there
but there was another the the behavioral health
hospital in montana uh the main one uh was opening
a clinic in bozeman actually and so i applied
for that got the job and was working exclusively
with children and adolescents for the first year
and then you know Montana is a very rural state
and there's a huge dearth of providers overall.
And it felt like I really wanted to be able to
serve patients across the lifespan. And the only
way to do that was to open a practice. And so
I did that just one, I think it was like one
half a day a week I started and then grew from
there. And then eventually the clinic, the child
and adolescent clinic actually closed. And so
I pivoted. to the practice full time. And I was
also, our family was getting insurance through
my child and adolescent clinic job. So I took
a teaching position actually with Montana State
University. One of my colleagues who I'd spoken
with about a year before, who was another nurse
practitioner in Bozeman, but was also on faculty
at Montana State University, Wade Hill, who's
a wonderful individual. really a well -respected
leader in that community. He said, well, we always
have, you know, we're always looking for, you
know, people who would be great for the teaching
role here. And I think you'd be great. And so
he had me interview and we, I started teaching
in the DNP program there on the clinical side.
So, so yeah, that was sort of how, and so I was,
at one point I had all three jobs and then the,
clinic, the child and adolescent clinic closed.
And then it was down to two jobs, but both of
them very much felt like full -time jobs, you
know? And so, yeah, it was a lot to manage. And
in my practice, Wade was kind of my mentor as
far as private practice. And so I'd sort of followed
his playbook and he did everything himself. So
he's in private practice. He's in private practice.
Yeah, he's currently still in private practice.
He's since then retired from his teaching position
because he's been with the university for many,
like many years. But yeah, so I ended up using
the same EHR as him. Which, what was that? That
was, it was called Icon Notes, which is this
very, I mean, I was using, again, I was trying
to do everything on the cheap as far as. the
lowest overhead possible, which in the end, looking
back on it, may have not been the smartest decision.
But again, I was just sort of following his lead
and he seemed to think it was good enough for
him. And so I thought, well, if he's using it,
you know, it must be fine. So, and it was, again,
it served its basic purposes. It hadn't integrated.
Clearinghouse, which I knew nothing about. Clearinghouse
is about the CMS 1500 forum about how nurse practitioners
get paid in practices, billing codes, all that
stuff. I kind of learned that all on the fly.
Okay. Wow. Wow. Are you familiar with Eric Arzubi?
I am. Actually, I've I'm connected with him on
LinkedIn and he runs Frontier, who actually one
of my students when I was teaching now works
for works with Eric at Frontier. So. Oh, really?
That's cool. Yeah. That was a connection that
like a warm intro that Dr. Carlisle had made
for me. And so I was just kind of curious. Yeah.
An interesting. provider. And also it's been
hard for me to find providers to connect with
like psych NPs and psychiatrists in Montana for
some reason. So that just like intrigued me that
that's where you were from and, you know, are
kind of familiar with the community. Yeah. I'm
happy to, I know several more, so happy to connect
you with those. Heather Zalewski was the medical
director at the time of the hospital that I worked
for. And she was my main supervisor in the beginning.
And she's wonderful, very knowledgeable and,
yeah, a driving force in psychiatry in Montana.
Would you have a child? Three and a half year
old. Fremont. Yeah, her son Fremont. Oh, that's
awesome. That's really cool. So, you know, the
balance of parenting and being a clinician and
everything like that. I was going to ask just
like my last question about the private practice
experience. What was like your favorite part
of private practice and the thing you didn't
like the most about it? And would you ever consider
it in the future? Yeah, I would consider it in
the future, certainly. You know what that what
that may look like in the future, I'm not quite
sure. But the thing that I I think the thing
that I like the most about it was the the community
engagement and the partnering with. I mean, I
didn't I never had a psychology today profile.
It was all through networking, primarily with
therapists that I had collaborated with before
with patients. I mean, that's probably one thing
that I. value the most in the work that we do
is the partnerships that we you know i mean psychology
or psychiatry is a team sport right and um yeah
to me it is yeah no absolutely any practical
tips when it comes to networking with therapists
because i think you're exactly right and i think
there's an art to kind of making those connections
and collaborating and i was just curious if you
had any practical suggestions or ways that you've
practiced that have worked for you and led to
good patient referrals and whatnot? Yeah. I mean,
I feel like my intention usually when I start
working with a new patient, if they're already
set up with a therapist and they have a wonderful
working relationship with the therapist, I immediately
get a release of information and just explain
to the person. the work that you're doing with
that therapist is invaluable. And, you know,
I always kind of used to joke with people that,
like, the therapists are doing the heavy lifting,
so to speak. I mean, they're with those patients
week in, week out, you know, for hours and hours.
You know, for most of us in psychiatry, we're
doing 30 -minute med checks. And, you know, we
can do supportive psychotherapy in that time,
certainly, but oftentimes we're not getting into
the real depth of what what the person is struggling
with. And, um, so I would, yeah, immediately
get a release of information, call the therapist
up and just explain who I was and what my role
is that I was looking forward to working with
them and really wanting to work, um, collaboratively
together and make sure that we're not like working
against each other in strange ways or, you know,
that we're, that we're aligned and certainly
are, you know, our, uh, diagnostic formulations
and our clinical conceptualization of what the
core issues are with the patient. So, um, so
that was, that was probably the thing that I
enjoyed the most was building those partnerships.
And, um, and I think the work that we do, uh,
that's probably the best advertising we can get
because if, you know, this person is, probably
going to be more likely to, if one of their clients
comes to them and say, oh, you know, I think
I'm ready to try medicine. They're, you know,
they're going to think of you of being this like,
oh, this, this, I should send this person to,
you know, this provider because they really,
they are, they're, they're willing to work together.
I've heard lots of therapists tell me, you're
the first psychiatric provider to reach out to
me. I mean, this person's had multiple psychiatrists
and other nurse practitioners. And for whatever
reason, They just tend to not want to reach out.
And that's always surprising and, you know, somewhat
disheartening to hear. Yeah. And are you picking
up the phone or are you? Oh, yeah. Yeah. OK.
I think that's also a big differentiating factor.
You know what I mean? That like, yeah, you're
willing to take the time to reach out. I think
that goes a long way. Yeah. OK, so. Yeah. The
thing that I disliked most about it. Was the
billing. I mean, I spent countless hours on the
phone with various payers trying to sort out
why this claim didn't get paid. And sometimes
it was like, oh, you forgot to add the GT modifier
to the 99214. And that's why we, you know, that's
why we didn't pay. And then you have to go through
this whole process of claim resubmission and
doing it in a certain way. And that part, just
that sort of. killed any desire to to do it again
so yeah that makes sense that makes a lot of
sense um talk to us a little bit if you don't
mind about just your journey your journey in
recovery and just how that's been as a provider
um because i think it's really brave and important
when clinicians who have dealt with that, um,
are willing to share more about their stories.
Yeah. And I think, yeah, you can really help
that population a lot, a lot of times, even more
so I would say. Yeah. Yeah. Um, so yeah, I mean,
actually it'll be the 20th this month that I'm
celebrating 10 years of sobriety. Um, thanks.
Yeah. Uh, hard, hard to believe. Um, And I was
just talking to another friend, actually, who's
struggling with their drinking. And, yeah, I
was just kind of reflecting on like how crazy
it's been that it's been 10 years. But it was
not planned. I mean, it was something that I
had always, you know, grew up in a family where
there was problematic drinking and alcohol use
disorder. Yeah, just sort of fell into it myself,
you know, started drinking in high school that
progressed through college. And I was always
a very functional drinker, you know, so, you
know, was always employed, didn't have any legal
problems. So I had this this this sort of idea
that it was under control or it wasn't a problem.
And yet at the same time, have countless memories
of thinking, well, I got to slow down. I should,
you know, I'm getting too old for this. So on
and so forth. All the things that lots of people
go through in their journey. And what, you know,
the stopping part was totally unplanned. I mean,
it was really one. It was actually Father's Day
of 2013. 2016. Yeah. And I remember waking up.
That weekend was a big drinking weekend for me.
Big drinking Friday night. A graduation party.
A friend of mine graduated from dental school
Saturday night. Late night, Saturday night. And
I woke up Sunday morning, hung over and was just
like, I can't do this anymore. Like it was that
sort of, you know, in AA you hear the term surrender
a lot. And it was kind of this surrender moment
where I was just like. can't do this. I don't
know. I don't have a plan. I don't know what
I'm going to do, but I just can't do this anymore.
And so I called a therapist that I'd seen about
a year prior who was, had a history working in
the substance use industry or world. And when
I saw her, it was through an employee assistance
program. And she was like, well, I'm not, if
you're going to be drinking while I'm seeing
you, I won't see you because, you know, if you're
going to, if I'm going to work with you, you
need to be not drinking while I'm seeing you.
And I was like, sure. I can do eight sessions
and not drink over the course of those eight
weeks. No problem. And I did. And then as soon
as the eight weeks were up, I went right back
to it. You know, and I'd heard various things
from various therapists over the years, like,
oh, if you can quit drinking for 30 days, you
don't have a problem. Or if you can quit for
90 days, you don't have a problem. And I would
always make it to like 87 days or. you know,
29 days and throw the towel in like that was
like, oh, that's good enough. I don't have a
problem. And so anyways, I went back and she
said, I said, I think I'm ready to quit. She's
like, oh, good. When are you going to go to treatment?
And I was like, whoa, whoa, whoa, whoa, treatment.
I'm a high end beer snob. Like I'm a home brewer.
You know, I was really big into the brewery scene
in Seattle. I was like, I don't need treatment.
I'm not like. drinking pop off vodka out of the
handle, you know, and she's like, it's going
to be harder for you than you're anticipating.
And I think if you try to do this on your own,
you're not going to be successful. And I was
like, OK, I paused and, you know, thought about
it and looked into my insurance and was like,
all right, well, you know, if this person who
has clearly more experience in this world than
I do, I'm willing to. you know, take her at her
word. So I found an intensive outpatient. So
that was during my pharmaceutical role. So I
was traveling a lot and I needed something that
was flexible. So I found this intensive outpatient
program that was in Seattle that was in the evenings,
more holistically based. They, you know, used
yoga and meditation and that kind of stuff and
that. That is, uh, I'm a practicing Buddhist
and wasn't at that time, but meditation is something
that was always, um, interesting to me and something
that I wanted to explore more. And so, uh, so
I started that program and, um, yeah, did that
for about 11 months. So, wow. Quite, quite a
journey that you've had. Um, and. How has it
been? Like, do you find that that's a population
you really enjoy helping now? Or how does it
affect like your kind of current day psych NPE
practice, I guess? Yeah. And then we'll pivot
to psychodynamic stuff because I want you to
educate me on that because I'm really I don't
know that much. Yeah, yeah, yeah. How it shows
up or how. How I approach it in practice is,
you know, I try to use, I mean, it's part of
our everyday assessment, right? Like that's part
of, should be one of the main questions we're
asking in a psychiatric interview is, is there
any substance use that could be contributing
to these symptoms that you're coming to me with?
Because if that's the case, then that needs to
be addressed. You know, I think I have I have
a unique perspective in that I've kind of walked
through that fire myself. And, you know, I think
it it gives me a unique perspective as to what
the person might be struggling with. And I wouldn't
say that I'm someone who actively seeks out.
people who are actively struggling with substance
use disorder. And part of that is because I think
people have to be ready. You know, I mean, just
like coming to treatment for anything, people
have to be ready for it. And not everybody is.
And certainly I think the people who are ready
for it, who in some degree or another, it's a
little, there's a little bit more to work with
there. You know, I mean. Motivational interviewing,
sure, is wonderful and very important. Trying
to assess where people feel like they're at with
regards to their substance use intake, you know,
substance intake. But I think the people that
I really, really that I've found to be. I guess
the most. ready for treatment are the people
who are at that point where they're like, I know
this is a problem and I really want help on this.
I just don't know what to do. And yeah, sometimes
I will self -disclose, you know, if I think it's
going to be helpful to the person and let them
know, hey, this is, these are some options out
there and I can speak from experience that. You
know, if you're not an AA person and you don't
want to go to AA, then don't go to AA. There
are other options. And AA can be really helpful
for some people, even people who are resistant
to the idea or freaked out about the whole God
thing. You know, that's usually a big sticking
point. It's like, I don't believe in God or whatever,
or I don't want to be told what to do. You know,
so through exploring that, you can kind of tell.
maybe who might benefit from it more so than
others. So I don't know if that answers your
question or not. It does. It does. It absolutely
does. That's insightful. So tell us how you got
into the psychodynamic world. And yeah, just
talk to us about that. And again, I don't know
a ton about it. So just keep it basic for those
of us who aren't really familiar as psych NPs,
what it means to practice in that. in that way.
Yeah. So, I mean, everybody's heard of Freud
and Freud was sort of the modern originator of
modern psychotherapy, right? He kind of developed
the talking cure. And I hesitate to speak too
authoritatively on this because I'm not an expert
by any means. I'm still very much in the beginning
stages of learning about this. But I mean, I
remember learning about psychodynamic principles
and unconscious back as a, you know, psychology
major. And I think through that program and through
even through nursing, you know, psychodynamic,
the psychodynamic approach, I think, is experiencing
a bit of a renaissance right now. I think it's,
you know, I mean, on LinkedIn, I certainly and
maybe it's just who I follow, but. I'm seeing
a lot more interest in it and a lot more psychoanalysts
posting about it. But at its basis, you know,
it's really about this idea that, you know, there's
this thing called the unconscious, right? This
part of the mind called the unconscious that
is kind of, I don't want to say, it exists. That's
where these things like wishes, like drives,
like defenses exist, you know, defense mechanisms.
And, you know, I think the general, as I understand
it, this general principle is these symptoms
that people come to us with, it's a way that
the mind is communicating something that's going
on that the person's not aware of. Um, and, and
everything has meaning. I mean, everybody's heard
the term, the Freudian slip where, you know,
we mistakenly say something that we didn't mean
to that, you know, maybe some underlying meaning,
um, but dream slips, um, you know, behaviors,
um, body language, uh, all of that has meaning
and, uh, and it, it's a way of the mind communicating.
into sort of the outside world, what's going
on that the person's not aware of. And through
psychodynamic therapy and psychoanalysis, which
is a much more intensive form of psychodynamic
therapy, where the person's seeing their analyst
four to five, somewhere between three and five
times a week for 45 minutes. And the basis for
all of this really is, you know, the idea that
early childhood experiences and early childhood
relationships, oftentimes with the person's primary
caregiver, something went maybe awry in one of
the developmental phases that the child goes
through and really through adolescence and even
into adulthood. But those formative experiences
early in life, based on the relationship with
the caregiver, the parent, oftentimes the mother,
sometimes the father, sometimes both, Something
is amiss, and as a result, the person becomes
developmentally arrested to a certain degree
in that phase. And that plays out in future relationships.
And so as the analyst or the therapist is listening
to this person in therapy, they start to recognize
patterns in relationships. job changes and things
like that. And then through asking about the
person's experience in early childhood, oftentimes
these insights can come about. And so the other
piece of it is really to help the person understand
how their mind works. And it's much less focused
on the diagnosis according to the, you know,
current DSM system. I mean, I'm looking, actually,
my laptop is stacked on top of a very thick book
called the Psychodynamic Diagnostic Manual, who's
partially written by Nancy McWilliams, who if,
you know, viewers are interested, she is a wonderful
resource if people are interested in learning
more about psychodynamic therapy. theory, Nancy
McWilliams is, you know, she's just very readable.
She breaks things down into very digestible pieces
that are very easily, more easily understood.
I would say don't start with original Freud if
you're interested in psychodynamic theory. It
can be complex. Yeah, absolutely. This is kind
of a random question. And if you don't want to
answer it, you don't have to. But have you ever
been through it on the patient side of things?
Not a full analysis. I mean, my therapist that
I see now is a psychoanalyst and. I think down
the road, there's certainly an interest there.
I mean, I have my own hangups and baggage and
issues and things that I struggle with in my
life and marriage and being a parent. And I'm
sure that a lot of it kind of harkens back to
my own childhood. And so, I mean, right now I'm
just doing psychodynamically oriented therapy
once a week with my therapist. I'd like to eat
twice a week. And the general, you know, the
other piece there is the relationship that forms
between the therapist or the analyst and the
patient. It tends to, can take on this almost,
I mean, everybody's heard of the term transference
encounter, or maybe not everybody, but countertransference
and transference. Transference is the reaction
that the patient has to the therapist. And countertransference
is the reaction that the... the therapist has
to the patient or the feelings that are brought
up in session. And that relationship can very
much take on or can assume this, I don't want
to say parental type role, but if the initial
injury that the person sustained in childhood
was between themselves and their parent, the
therapist's role is to kind of take on this parental
type figure so that that person can kind of act
out and explore these dynamic issues in a safe,
contained space. Ultimately, you know, sort of
try, I don't want to say triumph, but heal from
those, those experiences early on with the therapist
kind of functioning in that pseudo parental.
So. Okay. Interesting. So what would you say
to psych nps who are still in school or maybe
they just graduated as far as the realm of psychodynamics
um like do you think that this is something that
all psych nps should know a little bit a lot
of a bit like what resources to go to like yeah
i think it feels kind of like out of reach or
if that makes any sense yeah yeah no it does
i mean i You know, if you look at, and I don't
want to compare it to medical education, but
I mean, psychiatrists, psychiatric residents
oftentimes will get psychotherapy training in
cognitive behavioral therapy, psychodynamic therapy,
and then like interpersonal therapy oftentimes.
I think it's important to be at least aware of
psychodynamic principles because inevitably in
our work with patients, they will evoke feelings
in us with them. And we kind of feel like, gosh,
why am I getting irritated by this person? Or
I really just want to run out of the room right
now. Like this person is putting me on edge.
I'm feeling, I don't know. I'm feeling suspicious.
I'm feeling, you know, like, so that's all counter
-transference, you know, and these, these patients
will be. And we'll be doing the same thing with
them. You know, I mean, we'll be interacting
with certain ways in certain ways with them and
they'll seem to, they'll respond to us in certain
ways. And I think one of the beautiful things
about the psychodynamic approach is it really
digs into that. And so informing ourselves on
basic principles and ideas like transference
and countertransference and the frame, you know,
setting the frame, which. is kind of its own
skill, the treatment frame. I think there are
certain aspects to, it doesn't mean you have
to go all in and go on for full psychodynamic
training, but I think it's certainly helpful,
just like it's helpful to know about the CBT
triangle and be able to explain that to patients.
Have a handful of DBT skills that we can help
people with who are struggling with emotional
dysregulation or interpersonal ineffectiveness,
you know. So I think it can be really helpful
for as a skill set. Yeah. OK, that's helpful.
My listeners want me to keep these episodes shorter,
so I'm going to wrap up in the next. But I still
I still really want to hear just briefly about
like. you're in this Brooks fellowship and then
also you're getting ready to go into something
else. Can you just tell us about those real quick?
And then, yeah. A plug for Brooke Finley's psychodynamic
psychotherapy fellowship. So I, I found, I think
I remember hearing about it a while back just
through following her on LinkedIn. And then a
friend of mine who's another, you know, nurse
leader, Rowan D 'Erico, he reached out to me
and said, hey, are you doing Brooks Fellowship?
And I hadn't planned on it. And then doing a
little bit more research, it just sort of, I
was like, yeah, I think this is a really great
next. educational step. And so it's been a wonderful,
incredibly informative nine months where we gather
once a week and there's, yeah, there's a reading
assignment for the week and we get together and
discuss that and discuss. Brooke is a really
wonderful teacher and is incredibly experienced
in that field and is a leader in, you know, herself.
And so That has been a great jumping off point
for more training for me anyways. And actually,
per her recommendation, the program. So I decided
to go on for another two year combined didactic.
So Brooks Fellowship is primarily didactic in
nature. There isn't any clinical supervision
or anything associated with it. But the program
that I'm going into, which is the Contemporary
Freudian Society. psychodynamic psychotherapy
training program, which is a two -year program
with didactic as well as clinical components.
There's included supervision. It's expected that
you're going to be doing psychodynamic therapy
with patients. So that, yeah, I think that's
the next step. And whether I go on for full analytic
training, I'm not quite sure down the road, but
that's a whole another undertaking of a significantly
more time commitment but um you know i'll start
with this to start mixing it into my practice
and yeah see how it goes that's really cool thank
you so much for sharing more about that i definitely
want to have you on for like a part two episode
because i feel like we just scratched the surface
with some of this stuff um but i totally understand
people you know liking those shorter episodes
um one last question i ask all of my guests what
does the term no prior auth mean to you yeah
after watching your other episodes i was like
i need to come up with some really deep witty
answer about this uh so i i i think i woke up
at like four in the morning this morning like
wandering that very question i was like boy you
gotta come up with something oh that cracks me
up So I think, you know, a couple things came
to mind. One was it's easier to ask for forgiveness
than it is permission sometimes. And, you know,
I think the other sentiment that comes to mind
is, you know, yeah, we shouldn't have to ask
for permission to practice. according to our
values and to do what we feel is right for the
patient, you know, and sometimes that is a segue
for part two in terms of transition away from
the interventional side of psychiatry, which
I've been practicing in for the last year to
more of a, you know, what feels like a little
bit more authentic for me as a You know, working
in a group practice, but getting to do a lot
more therapy. Right. OK, awesome. Yeah, we will.
We definitely will want to hear more about that,
too. So, well, thank you so much, Ben. And we're
looking forward to having you back for another
episode down the line. Sounds great. Look forward
to it.