WEBVTT 00:00:00.000 --> 00:00:03.000 I took the GRE once, did horribly on it. Didn't 00:00:03.000 --> 00:00:05.599 really know how to study for it. Forced myself 00:00:05.599 --> 00:00:09.099 to try and study again for it. Did it again and 00:00:09.099 --> 00:00:13.480 barely got a better score. I was just... I felt 00:00:13.480 --> 00:00:17.660 completely ill -equipped after studying German 00:00:17.660 --> 00:00:20.000 for nine years and living there for a year. I 00:00:20.000 --> 00:00:21.859 wasn't planning on opening a private practice. 00:00:21.940 --> 00:00:24.600 When I finished training in 2021, I had done 00:00:24.600 --> 00:00:27.359 roughly half my training, all ironically under 00:00:27.359 --> 00:00:29.739 the supervision of psychiatrists. It just worked 00:00:29.739 --> 00:00:31.879 out that way where all of my mentors through 00:00:31.879 --> 00:00:34.939 graduate training were psychiatrists. After finishing 00:00:34.939 --> 00:00:37.679 school, I ended up not working there, but there 00:00:37.679 --> 00:00:40.740 was another, the Behavioral Health Hospital in 00:00:40.740 --> 00:00:45.600 Montana. The main one was opening a clinic in 00:00:45.600 --> 00:00:47.460 Bozeman, actually. And so I applied for that, 00:00:47.500 --> 00:00:50.060 got the job and was working exclusively with 00:00:50.060 --> 00:00:51.780 children and adolescents for the first year. 00:00:52.079 --> 00:00:54.679 Immediately get a release of information, call 00:00:54.679 --> 00:00:57.840 the therapist up and just explain who I was and 00:00:57.840 --> 00:00:59.740 what my role is that I was looking forward to 00:00:59.740 --> 00:01:01.640 working with them. And people have to be ready. 00:01:01.719 --> 00:01:03.640 You know, I mean, just like coming to treatment 00:01:03.640 --> 00:01:06.060 for anything, people have to be ready for it. 00:01:06.079 --> 00:01:10.280 And not everybody is. Welcome back to No Prior 00:01:10.280 --> 00:01:13.299 Off. I'm sitting down with Ben Egbers this week. 00:01:13.400 --> 00:01:15.920 Ben is a psychiatric nurse practitioner at Access 00:01:15.920 --> 00:01:18.939 Integrated Mental Health in Colorado, where he 00:01:18.939 --> 00:01:21.140 runs some of the most intensive treatments in 00:01:21.140 --> 00:01:24.379 the field, deep TMS and ketamine, while believing 00:01:24.379 --> 00:01:27.900 something that sounds almost contradictory, that 00:01:27.900 --> 00:01:30.799 the goal is the least medication a person needs, 00:01:30.959 --> 00:01:33.900 not the most. Ben came to this work the long 00:01:33.900 --> 00:01:36.870 way. a psychology and German degree back in 2000, 00:01:37.269 --> 00:01:40.750 years as a case manager, teaching abroad, surviving 00:01:40.750 --> 00:01:43.849 an avalanche, and his own recovery from alcohol 00:01:43.849 --> 00:01:46.409 use disorder. And he didn't finish his nursing 00:01:46.409 --> 00:01:49.849 doctorate until 2021. He's open about all of 00:01:49.849 --> 00:01:52.650 it, and it shapes how he sits with people. I 00:01:52.650 --> 00:01:54.810 think this is his first podcast, so let's get 00:01:54.810 --> 00:01:58.469 into it. Welcome, Ben. Thank you so much, Lindsay. 00:01:58.549 --> 00:02:02.489 That was quite the intro and absolutely accurate. 00:02:03.500 --> 00:02:06.680 Okay, amazing. Other things I'm excited to hear 00:02:06.680 --> 00:02:10.780 about from you are the fact that you once were 00:02:10.780 --> 00:02:13.620 in private practice, your own private practice 00:02:13.620 --> 00:02:17.560 in Montana, right? And you are no longer. Correct. 00:02:17.699 --> 00:02:22.900 And you're also really interested in psychodynamics 00:02:22.900 --> 00:02:27.460 and how that can play a part in your psych NP 00:02:27.460 --> 00:02:30.729 role. So I want to hear about the fellowship 00:02:30.729 --> 00:02:33.870 you're in and just more about your journey because 00:02:33.870 --> 00:02:36.770 it seems really unique. So I'm excited for people 00:02:36.770 --> 00:02:40.150 to learn more about you. So just to kick things 00:02:40.150 --> 00:02:43.870 off, tell us a little bit about just you as a 00:02:43.870 --> 00:02:47.449 person and kind of what got you into becoming 00:02:47.449 --> 00:02:51.909 a psych NP. Yeah, well, thanks again for having 00:02:51.909 --> 00:02:57.210 me. It's great to be here. So yeah, to your point, 00:02:57.349 --> 00:03:02.210 going through your previous episodes, which were 00:03:02.210 --> 00:03:07.229 wonderful, I felt myself thinking I'm a bit of 00:03:07.229 --> 00:03:09.389 an outlier here just because everybody's running 00:03:09.389 --> 00:03:13.569 very successful group practices and that sort 00:03:13.569 --> 00:03:19.129 of thing. So yeah, like I said, I'm honored to 00:03:19.129 --> 00:03:20.750 be here and get to tell a little bit about my 00:03:20.750 --> 00:03:25.490 story and journey. What got me into psychiatric 00:03:25.490 --> 00:03:31.569 nursing as far as like as a provider, you know, 00:03:31.569 --> 00:03:34.629 intro, my background was actually in psychology 00:03:34.629 --> 00:03:38.610 and my original career goal was to become a clinical 00:03:38.610 --> 00:03:42.310 psychologist, actually. So my first aspirations 00:03:42.310 --> 00:03:47.509 were either a Ph .D. or a Psy .D. and became 00:03:47.509 --> 00:03:50.270 fascinated by manic depressive illness slash 00:03:50.270 --> 00:03:54.979 bipolar disorder. back in 2020 when i read k 00:03:54.979 --> 00:03:57.900 redfield jameson's memoir an unquiet mind and 00:03:57.900 --> 00:04:01.360 that really was a life -changing book that really 00:04:01.360 --> 00:04:05.219 cemented my um what i wanted to do research on 00:04:05.219 --> 00:04:07.280 which was psychosocial interventions for the 00:04:07.280 --> 00:04:11.710 treatment of bipolar disorder and um So that 00:04:11.710 --> 00:04:14.849 was my original path. And yeah, doing I wanted 00:04:14.849 --> 00:04:17.509 to similar to nursing where a lot of nurses will 00:04:17.509 --> 00:04:19.810 go out and kind of cut their teeth, so to speak, 00:04:19.870 --> 00:04:23.610 metaphorically speaking, on med surge. I did 00:04:23.610 --> 00:04:26.449 in community mental health. So graduating with 00:04:26.449 --> 00:04:29.810 an undergraduate degree in psychology, you don't 00:04:29.810 --> 00:04:31.829 have a lot of clinical training at that point. 00:04:31.850 --> 00:04:34.430 And so, you know, I really wanted to get some 00:04:34.430 --> 00:04:38.810 hands on experience working in. So I worked with 00:04:38.810 --> 00:04:42.550 primarily at the severe and persistent mental 00:04:42.550 --> 00:04:44.829 illness population in community health, community 00:04:44.829 --> 00:04:48.389 mental health. And it was an amazing experience. 00:04:49.269 --> 00:04:52.589 I still somehow remember the names of those clients 00:04:52.589 --> 00:04:59.250 26 years later. But especially after all the 00:04:59.250 --> 00:05:04.879 drinking, which we'll get into later. Yeah, it 00:05:04.879 --> 00:05:07.699 was just a very transformative experience. And 00:05:07.699 --> 00:05:12.459 at the same token, a very exhausting experience 00:05:12.459 --> 00:05:15.720 to the point where after about, you know, I worked 00:05:15.720 --> 00:05:17.839 for that organization for about three years and 00:05:17.839 --> 00:05:20.259 eventually I just had to, actually I took the 00:05:20.259 --> 00:05:23.860 GRE, had everything set up. You know, I was ready 00:05:23.860 --> 00:05:26.540 to apply to this program in Florida of all places, 00:05:26.579 --> 00:05:30.970 which is part of the story. And I had just fallen 00:05:30.970 --> 00:05:34.370 in love with rock climbing at the time and mountaineering 00:05:34.370 --> 00:05:38.189 and kind of the mountain sport lifestyle. And 00:05:38.189 --> 00:05:42.410 I took the GRE once, did horribly on it, didn't 00:05:42.410 --> 00:05:46.610 really know how to study for it, forced myself 00:05:46.610 --> 00:05:50.189 to try and study again for it, did it again and 00:05:50.189 --> 00:05:54.949 barely got a better score and just wasn't really 00:05:54.949 --> 00:05:57.569 confident in the ability that it was going to 00:05:57.569 --> 00:06:01.120 be. what I needed it to be to get me into the 00:06:01.120 --> 00:06:03.019 program even though I had already talked to the 00:06:03.019 --> 00:06:05.220 advisor the person I was going to do research 00:06:05.220 --> 00:06:08.300 for but I it just and the fact that I was looking 00:06:08.300 --> 00:06:11.160 at a six -year plus commitment in Florida of 00:06:11.160 --> 00:06:13.139 all places and there are no mountains no skiing 00:06:13.139 --> 00:06:16.100 no rock climbing you know to my knowledge at 00:06:16.100 --> 00:06:19.579 that point so I decided to pivot to plan b which 00:06:19.579 --> 00:06:22.920 was to use my German degree and so I traveled 00:06:22.920 --> 00:06:25.759 through Europe for the summer climbing and hostilling 00:06:26.189 --> 00:06:28.709 my way across Europe with one of my best friends, 00:06:28.910 --> 00:06:31.110 climbing partner who was in the avalanche with 00:06:31.110 --> 00:06:37.769 me years later. And yeah, decided to just stay 00:06:37.769 --> 00:06:40.670 in Europe and teach English, stay in Germany. 00:06:40.810 --> 00:06:43.470 So I did that and then came back to the States 00:06:43.470 --> 00:06:47.170 after a year and floated around. I didn't really 00:06:47.170 --> 00:06:49.810 have a plan at that point. Nursing was the furthest 00:06:49.810 --> 00:06:53.790 thing from my radar. Worked in the outdoor industry 00:06:53.790 --> 00:06:57.579 for a little bit to kind of explore that and 00:06:57.579 --> 00:07:00.860 then started a master's program in German studies 00:07:00.860 --> 00:07:04.600 here in Colorado actually I relocated when I 00:07:04.600 --> 00:07:06.920 came back from Europe I moved to Colorado my 00:07:06.920 --> 00:07:09.399 actually one of my best friends who is my climbing 00:07:09.399 --> 00:07:11.860 partner at the time and the guy that I mentioned 00:07:11.860 --> 00:07:15.459 regarding the avalanche he was doing his PhD 00:07:15.459 --> 00:07:17.459 in physics here and he said hey if you want a 00:07:17.459 --> 00:07:20.120 great landing pad Boulder is an amazing spot 00:07:20.120 --> 00:07:22.519 it's a great climbing town it's a great singles 00:07:22.519 --> 00:07:25.889 town it's great weather You know, I came to visit 00:07:25.889 --> 00:07:30.110 and stayed here, saw it. And so, yeah, kind of 00:07:30.110 --> 00:07:33.430 floated around. And then, yeah, I started this 00:07:33.430 --> 00:07:36.670 master's program in German because I had always 00:07:36.670 --> 00:07:40.290 wanted to go to graduate school. And that was 00:07:40.290 --> 00:07:43.410 that seemed like an easy entry into graduate 00:07:43.410 --> 00:07:46.470 work. And I knew after one semester, boy, this 00:07:46.470 --> 00:07:50.110 is the absolute wrong decision for me. I was 00:07:50.110 --> 00:07:54.920 just completely. ill -equipped after, you know, 00:07:54.920 --> 00:07:56.899 studying German for nine years and living there 00:07:56.899 --> 00:08:01.720 for a year. So I came home for Christmas break 00:08:01.720 --> 00:08:05.939 that year. This was 2000 and sort of in 2008. 00:08:07.160 --> 00:08:11.439 And I talked to my mom, who was a nurse at that 00:08:11.439 --> 00:08:13.939 time, was kind of nearing the end of her career 00:08:13.939 --> 00:08:18.860 and was talking to her about my, you know, kind 00:08:18.860 --> 00:08:22.939 of quandary of what to do. She said, well, there's 00:08:22.939 --> 00:08:25.199 always nursing. It's a very, you know, flexible 00:08:25.199 --> 00:08:27.899 career. You can support yourself. You can do 00:08:27.899 --> 00:08:31.339 anything. And that was enough to convince me. 00:08:31.399 --> 00:08:35.220 So I came back and started told my German advisor, 00:08:35.519 --> 00:08:39.779 hey, I'm quitting the program. I'm going to pivot 00:08:39.779 --> 00:08:42.779 to nursing and started Prereqs. And then that 00:08:42.779 --> 00:08:45.220 January, I think it was January 6th of 2008, 00:08:45.440 --> 00:08:48.019 my friend Mike and I were backcountry skiing 00:08:48.019 --> 00:08:51.299 and an avalanche ripped loose above us in the 00:08:51.299 --> 00:08:55.039 backcountry. And he was buried. I had to rescue 00:08:55.039 --> 00:08:57.820 him, dig him out. We were the only two out there. 00:08:58.580 --> 00:09:02.100 I sustained pretty severe injuries myself. He, 00:09:02.220 --> 00:09:05.059 you know, both of us survived, but he was fully 00:09:05.059 --> 00:09:08.559 buried and, you know, probably would have not 00:09:08.559 --> 00:09:14.799 survived. Um, so, so yeah, we, yeah. So, uh, 00:09:14.860 --> 00:09:17.919 came back and I remember starting my prereqs 00:09:17.919 --> 00:09:21.340 in a, in a, a cast sling cause I had torn one 00:09:21.340 --> 00:09:25.120 of my extensor tendons. My snowboard had come 00:09:25.120 --> 00:09:27.460 off my pack and sliced through one of my tendons 00:09:27.460 --> 00:09:30.460 and I couldn't write. So I had one of my, um, 00:09:30.700 --> 00:09:33.720 the TA was actually doing calculations for me 00:09:33.720 --> 00:09:37.480 in this intro chemistry class. And, um, so, uh, 00:09:37.519 --> 00:09:41.840 so anyways, um, Yeah. Got into nursing. Yeah. 00:09:42.440 --> 00:09:46.080 It was, uh, it's quite the story. So, um, anyways, 00:09:46.159 --> 00:09:49.159 got into nursing school, um, went through a divorce 00:09:49.159 --> 00:09:54.059 at the time. Uh, and then, um, yeah, nursing 00:09:54.059 --> 00:09:57.600 for me, I thought I was going to be this, you 00:09:57.600 --> 00:10:02.080 know, pardon the term, badass ER nurse, you know, 00:10:02.100 --> 00:10:05.019 and, um, high adrenaline and all of that and 00:10:05.019 --> 00:10:09.490 got out of nursing school and um got into med 00:10:09.490 --> 00:10:11.789 surg and knew immediately like boy the medical 00:10:11.789 --> 00:10:15.210 side is really not my forte and i found myself 00:10:15.210 --> 00:10:18.789 just wanting to get out of clinical care so i 00:10:18.789 --> 00:10:20.750 did a bunch of different things outside in industry 00:10:20.750 --> 00:10:26.590 and um infusion pharmacy uh so the first thing 00:10:26.590 --> 00:10:29.929 i did was i worked as a clinical like liaison 00:10:29.929 --> 00:10:34.480 type so i was doing bedside education for a an 00:10:34.480 --> 00:10:36.659 infusion pharmacy so patients who were going 00:10:36.659 --> 00:10:41.379 home on iv antibiotics for example i would teach 00:10:41.379 --> 00:10:43.440 them how to use their pick lines and how to use 00:10:43.440 --> 00:10:48.580 these different drug delivery devices and that 00:10:48.580 --> 00:10:50.679 sort of thing and then i was also liaising with 00:10:50.679 --> 00:10:53.840 discharge planners so there was a sales component 00:10:53.840 --> 00:10:58.059 to it i remember Very clearly laying awake at 00:10:58.059 --> 00:10:59.860 two or three in the morning when I was on night 00:10:59.860 --> 00:11:02.879 shift and just hating every minute of my med 00:11:02.879 --> 00:11:06.200 surg existence. And I was like, I have to get 00:11:06.200 --> 00:11:10.259 out of here. So I found this clinical position. 00:11:10.419 --> 00:11:12.240 I was like, this sounds like a perfect exit. 00:11:12.379 --> 00:11:15.500 So it was weekends. It paid better. All that 00:11:15.500 --> 00:11:19.139 really got sucked into clinical education in 00:11:19.139 --> 00:11:21.179 the pharmaceutical industry, which was high paying, 00:11:21.399 --> 00:11:25.360 which was also. you know uh intriguing to me 00:11:25.360 --> 00:11:29.120 um as a nurse yeah as a nurse still as a nurse 00:11:29.120 --> 00:11:32.379 yeah and then eventually i hit this point where 00:11:32.379 --> 00:11:35.460 i was just miserable honestly i was making a 00:11:35.460 --> 00:11:38.779 ton of money but the work itself felt very meaningless 00:11:38.779 --> 00:11:43.740 you know i mean i was trying to um in great it 00:11:43.740 --> 00:11:45.879 felt like i was trying to ingratiate myself to 00:11:47.070 --> 00:11:49.149 you know, nurse practitioners and physicians 00:11:49.149 --> 00:11:51.870 to log these calls that I was getting paid for 00:11:51.870 --> 00:11:56.690 and that sort of thing. And yeah, I know you 00:11:56.690 --> 00:12:00.529 interviewed Danny Carlat, and that was part of 00:12:00.529 --> 00:12:03.230 what inspired him to kind of start. Carlat Publishing, 00:12:03.289 --> 00:12:07.370 right, was this sort of the inside knowledge 00:12:07.370 --> 00:12:09.769 of how things really are, you know, not to disparage 00:12:09.769 --> 00:12:12.429 the pharmaceutical industry too much, but it 00:12:12.429 --> 00:12:14.409 just wasn't for me. I mean, I know a lot of colleagues 00:12:14.409 --> 00:12:16.690 and friends actually really enjoy their work. 00:12:17.049 --> 00:12:20.730 For me, it wasn't the right path. So I called 00:12:20.730 --> 00:12:23.309 my nursing school advisor and she was like, time 00:12:23.309 --> 00:12:26.210 for grad school. I was like, I think you're right. 00:12:26.370 --> 00:12:29.309 So, and I was, I interviewed a bunch of different 00:12:29.309 --> 00:12:35.779 NPs. you know, FNPs, AGNPs. Ironically, I didn't 00:12:35.779 --> 00:12:40.259 interview a psych NP, but I knew after talking 00:12:40.259 --> 00:12:44.659 to the AGNP and the FNPs that that way of working 00:12:44.659 --> 00:12:47.299 with patients really wasn't going to be working 00:12:47.299 --> 00:12:50.960 for me. And what I really recalled most fondly 00:12:50.960 --> 00:12:52.919 about my patient interactions as a nurse was 00:12:52.919 --> 00:12:56.139 getting to sit down and hear their stories and 00:12:56.139 --> 00:13:00.029 hear about their difficulties and their struggles 00:13:00.029 --> 00:13:03.710 and how they made it through them. And, you know, 00:13:03.730 --> 00:13:06.929 looking into psychiatry, it's like that really 00:13:06.929 --> 00:13:10.669 that fits the bill, so to speak. So I took a 00:13:10.669 --> 00:13:14.690 huge pay cut, like 50 or 60 grand a year pay 00:13:14.690 --> 00:13:18.870 cut and went back to bedside nursing in inpatient 00:13:18.870 --> 00:13:21.429 psychiatry. So started working as a traveler, 00:13:21.610 --> 00:13:24.129 local contracts, worked in residential eating 00:13:24.129 --> 00:13:26.029 disorders and then worked in inpatient acute 00:13:26.029 --> 00:13:30.779 psych, applied. program, the University of Washington 00:13:30.779 --> 00:13:34.460 DNP program. This was in 2018 that I started. 00:13:34.519 --> 00:13:38.600 And then COVID hit, the world shut down. And 00:13:38.600 --> 00:13:41.639 yeah, so that was a little bit, that was a long 00:13:41.639 --> 00:13:45.000 -winded answer into what got me into or got me 00:13:45.000 --> 00:13:47.659 back into mental health or behavioral health. 00:13:48.240 --> 00:13:51.679 Okay. Well, that's, wow, quite a journey you've 00:13:51.679 --> 00:13:53.539 had. And I know at the beginning you mentioned 00:13:54.409 --> 00:13:56.610 you know, I'm an outlier compared to the other 00:13:56.610 --> 00:13:59.009 guests that you've had on. And that is kind of 00:13:59.009 --> 00:14:03.330 the point of why I asked you to be on. And also, 00:14:03.450 --> 00:14:07.370 you know, I want this podcast to be about more 00:14:07.370 --> 00:14:09.350 than just private practice, you know, because 00:14:09.350 --> 00:14:11.889 the truth is private practice isn't the answer 00:14:11.889 --> 00:14:16.870 for many people. And so, you know, the fact that 00:14:17.240 --> 00:14:18.960 you had also had a private practice and walked 00:14:18.960 --> 00:14:21.220 away from it. I wouldn't have known that if we 00:14:21.220 --> 00:14:23.240 hadn't hopped on that quick call after connecting 00:14:23.240 --> 00:14:27.100 on LinkedIn. But I just thought that was interesting. 00:14:27.360 --> 00:14:30.159 Could you speak to that a little bit? Because 00:14:30.159 --> 00:14:34.519 I do think many people just kind of have private 00:14:34.519 --> 00:14:37.620 practice on a pedestal of sorts, kind of like, 00:14:37.659 --> 00:14:41.120 and there are benefits, right? And downsides, 00:14:41.120 --> 00:14:43.580 but I'd just be curious to hear about your experience. 00:14:44.409 --> 00:14:46.809 Yeah, absolutely. I wasn't planning on opening 00:14:46.809 --> 00:14:49.070 a private practice, honestly. When I finished 00:14:49.070 --> 00:14:52.750 training in 2021, I had done roughly half my 00:14:52.750 --> 00:14:55.129 training, all ironically under the supervision 00:14:55.129 --> 00:14:57.629 of psychiatrists. It just worked out that way 00:14:57.629 --> 00:14:59.830 where all of my mentors through graduate training 00:14:59.830 --> 00:15:04.909 were psychiatrists. And so half of it was with 00:15:04.909 --> 00:15:08.429 adult psychiatrists and all outpatient. And then 00:15:08.429 --> 00:15:10.210 the other half was with child and adolescent. 00:15:10.409 --> 00:15:12.669 And part of that was very much intentional on 00:15:12.669 --> 00:15:15.190 my part. My wife and I knew that we wanted to 00:15:15.190 --> 00:15:18.529 relocate to Montana and get out of the busyness 00:15:18.529 --> 00:15:22.970 of Seattle. And so I interviewed with a or kind 00:15:22.970 --> 00:15:26.129 of networked with a private practice in Bozeman. 00:15:26.710 --> 00:15:29.870 And there was a child psychiatrist there, Raven 00:15:29.870 --> 00:15:33.370 Lipmanson, who I became a mentor. And she was 00:15:33.370 --> 00:15:38.419 one of my. supervisors. And, you know, we were 00:15:38.419 --> 00:15:41.559 talking about plans after school. And she said, 00:15:41.620 --> 00:15:45.080 well, you know, we'd certainly have a need for 00:15:45.080 --> 00:15:46.639 someone who's willing to work with children and 00:15:46.639 --> 00:15:51.019 adolescents. And so, yeah, thought, hey, you 00:15:51.019 --> 00:15:52.559 know, it's nothing, it's something I'd never 00:15:52.559 --> 00:15:55.419 really given much thought to. But after working 00:15:55.419 --> 00:16:02.700 with her as a student, it really became a enjoyable 00:16:02.700 --> 00:16:06.480 and kind of natural fit for me and so uh after 00:16:06.480 --> 00:16:10.120 finishing school um ended up not working there 00:16:10.120 --> 00:16:12.720 but there was another the the behavioral health 00:16:12.720 --> 00:16:18.360 hospital in montana uh the main one uh was opening 00:16:18.360 --> 00:16:20.480 a clinic in bozeman actually and so i applied 00:16:20.480 --> 00:16:23.519 for that got the job and was working exclusively 00:16:23.519 --> 00:16:25.679 with children and adolescents for the first year 00:16:25.679 --> 00:16:29.549 and then you know Montana is a very rural state 00:16:29.549 --> 00:16:32.129 and there's a huge dearth of providers overall. 00:16:32.970 --> 00:16:36.950 And it felt like I really wanted to be able to 00:16:36.950 --> 00:16:40.190 serve patients across the lifespan. And the only 00:16:40.190 --> 00:16:43.669 way to do that was to open a practice. And so 00:16:43.669 --> 00:16:45.889 I did that just one, I think it was like one 00:16:45.889 --> 00:16:50.029 half a day a week I started and then grew from 00:16:50.029 --> 00:16:53.330 there. And then eventually the clinic, the child 00:16:53.330 --> 00:16:55.549 and adolescent clinic actually closed. And so 00:16:55.549 --> 00:17:00.190 I pivoted. to the practice full time. And I was 00:17:00.190 --> 00:17:02.049 also, our family was getting insurance through 00:17:02.049 --> 00:17:06.130 my child and adolescent clinic job. So I took 00:17:06.130 --> 00:17:09.150 a teaching position actually with Montana State 00:17:09.150 --> 00:17:11.809 University. One of my colleagues who I'd spoken 00:17:11.809 --> 00:17:13.789 with about a year before, who was another nurse 00:17:13.789 --> 00:17:17.730 practitioner in Bozeman, but was also on faculty 00:17:17.730 --> 00:17:19.890 at Montana State University, Wade Hill, who's 00:17:19.890 --> 00:17:24.279 a wonderful individual. really a well -respected 00:17:24.279 --> 00:17:27.519 leader in that community. He said, well, we always 00:17:27.519 --> 00:17:30.200 have, you know, we're always looking for, you 00:17:30.200 --> 00:17:35.319 know, people who would be great for the teaching 00:17:35.319 --> 00:17:37.940 role here. And I think you'd be great. And so 00:17:37.940 --> 00:17:40.420 he had me interview and we, I started teaching 00:17:40.420 --> 00:17:45.680 in the DNP program there on the clinical side. 00:17:45.839 --> 00:17:50.160 So, so yeah, that was sort of how, and so I was, 00:17:50.220 --> 00:17:52.500 at one point I had all three jobs and then the, 00:17:52.910 --> 00:17:55.029 clinic, the child and adolescent clinic closed. 00:17:55.069 --> 00:17:57.849 And then it was down to two jobs, but both of 00:17:57.849 --> 00:18:00.210 them very much felt like full -time jobs, you 00:18:00.210 --> 00:18:04.990 know? And so, yeah, it was a lot to manage. And 00:18:04.990 --> 00:18:08.970 in my practice, Wade was kind of my mentor as 00:18:08.970 --> 00:18:11.970 far as private practice. And so I'd sort of followed 00:18:11.970 --> 00:18:16.950 his playbook and he did everything himself. So 00:18:16.950 --> 00:18:19.049 he's in private practice. He's in private practice. 00:18:19.089 --> 00:18:21.170 Yeah, he's currently still in private practice. 00:18:21.190 --> 00:18:23.269 He's since then retired from his teaching position 00:18:23.269 --> 00:18:25.670 because he's been with the university for many, 00:18:25.690 --> 00:18:30.029 like many years. But yeah, so I ended up using 00:18:30.029 --> 00:18:33.849 the same EHR as him. Which, what was that? That 00:18:33.849 --> 00:18:37.109 was, it was called Icon Notes, which is this 00:18:37.109 --> 00:18:40.529 very, I mean, I was using, again, I was trying 00:18:40.529 --> 00:18:44.220 to do everything on the cheap as far as. the 00:18:44.220 --> 00:18:47.180 lowest overhead possible, which in the end, looking 00:18:47.180 --> 00:18:50.680 back on it, may have not been the smartest decision. 00:18:50.880 --> 00:18:55.599 But again, I was just sort of following his lead 00:18:55.599 --> 00:18:57.440 and he seemed to think it was good enough for 00:18:57.440 --> 00:19:00.180 him. And so I thought, well, if he's using it, 00:19:00.559 --> 00:19:04.259 you know, it must be fine. So, and it was, again, 00:19:04.339 --> 00:19:06.460 it served its basic purposes. It hadn't integrated. 00:19:08.000 --> 00:19:10.200 Clearinghouse, which I knew nothing about. Clearinghouse 00:19:10.200 --> 00:19:14.180 is about the CMS 1500 forum about how nurse practitioners 00:19:14.180 --> 00:19:17.200 get paid in practices, billing codes, all that 00:19:17.200 --> 00:19:20.440 stuff. I kind of learned that all on the fly. 00:19:21.099 --> 00:19:26.559 Okay. Wow. Wow. Are you familiar with Eric Arzubi? 00:19:27.049 --> 00:19:30.809 I am. Actually, I've I'm connected with him on 00:19:30.809 --> 00:19:34.990 LinkedIn and he runs Frontier, who actually one 00:19:34.990 --> 00:19:37.430 of my students when I was teaching now works 00:19:37.430 --> 00:19:41.569 for works with Eric at Frontier. So. Oh, really? 00:19:41.710 --> 00:19:44.470 That's cool. Yeah. That was a connection that 00:19:44.470 --> 00:19:46.609 like a warm intro that Dr. Carlisle had made 00:19:46.609 --> 00:19:50.789 for me. And so I was just kind of curious. Yeah. 00:19:50.910 --> 00:19:54.670 An interesting. provider. And also it's been 00:19:54.670 --> 00:19:57.029 hard for me to find providers to connect with 00:19:57.029 --> 00:20:00.029 like psych NPs and psychiatrists in Montana for 00:20:00.029 --> 00:20:03.190 some reason. So that just like intrigued me that 00:20:03.190 --> 00:20:05.450 that's where you were from and, you know, are 00:20:05.450 --> 00:20:08.170 kind of familiar with the community. Yeah. I'm 00:20:08.170 --> 00:20:11.710 happy to, I know several more, so happy to connect 00:20:11.710 --> 00:20:15.650 you with those. Heather Zalewski was the medical 00:20:15.650 --> 00:20:18.650 director at the time of the hospital that I worked 00:20:18.650 --> 00:20:21.329 for. And she was my main supervisor in the beginning. 00:20:21.369 --> 00:20:23.349 And she's wonderful, very knowledgeable and, 00:20:23.390 --> 00:20:28.470 yeah, a driving force in psychiatry in Montana. 00:20:29.750 --> 00:20:34.650 Would you have a child? Three and a half year 00:20:34.650 --> 00:20:37.910 old. Fremont. Yeah, her son Fremont. Oh, that's 00:20:37.910 --> 00:20:40.390 awesome. That's really cool. So, you know, the 00:20:40.390 --> 00:20:44.650 balance of parenting and being a clinician and 00:20:44.650 --> 00:20:47.150 everything like that. I was going to ask just 00:20:47.150 --> 00:20:48.890 like my last question about the private practice 00:20:48.890 --> 00:20:51.109 experience. What was like your favorite part 00:20:51.109 --> 00:20:54.549 of private practice and the thing you didn't 00:20:54.549 --> 00:20:56.990 like the most about it? And would you ever consider 00:20:56.990 --> 00:21:00.829 it in the future? Yeah, I would consider it in 00:21:00.829 --> 00:21:06.640 the future, certainly. You know what that what 00:21:06.640 --> 00:21:08.420 that may look like in the future, I'm not quite 00:21:08.420 --> 00:21:11.380 sure. But the thing that I I think the thing 00:21:11.380 --> 00:21:14.420 that I like the most about it was the the community 00:21:14.420 --> 00:21:17.099 engagement and the partnering with. I mean, I 00:21:17.099 --> 00:21:19.640 didn't I never had a psychology today profile. 00:21:21.099 --> 00:21:24.900 It was all through networking, primarily with 00:21:24.900 --> 00:21:30.220 therapists that I had collaborated with before 00:21:30.220 --> 00:21:32.480 with patients. I mean, that's probably one thing 00:21:32.480 --> 00:21:36.769 that I. value the most in the work that we do 00:21:36.769 --> 00:21:39.910 is the partnerships that we you know i mean psychology 00:21:39.910 --> 00:21:43.769 or psychiatry is a team sport right and um yeah 00:21:43.769 --> 00:21:47.609 to me it is yeah no absolutely any practical 00:21:47.609 --> 00:21:50.190 tips when it comes to networking with therapists 00:21:50.190 --> 00:21:52.450 because i think you're exactly right and i think 00:21:52.450 --> 00:21:56.289 there's an art to kind of making those connections 00:21:56.289 --> 00:21:58.849 and collaborating and i was just curious if you 00:21:58.849 --> 00:22:02.500 had any practical suggestions or ways that you've 00:22:02.500 --> 00:22:05.740 practiced that have worked for you and led to 00:22:05.740 --> 00:22:09.420 good patient referrals and whatnot? Yeah. I mean, 00:22:09.500 --> 00:22:15.539 I feel like my intention usually when I start 00:22:15.539 --> 00:22:19.119 working with a new patient, if they're already 00:22:19.119 --> 00:22:21.960 set up with a therapist and they have a wonderful 00:22:21.960 --> 00:22:24.359 working relationship with the therapist, I immediately 00:22:24.359 --> 00:22:26.519 get a release of information and just explain 00:22:26.519 --> 00:22:29.400 to the person. the work that you're doing with 00:22:29.400 --> 00:22:33.000 that therapist is invaluable. And, you know, 00:22:33.019 --> 00:22:35.240 I always kind of used to joke with people that, 00:22:35.279 --> 00:22:37.299 like, the therapists are doing the heavy lifting, 00:22:37.420 --> 00:22:40.059 so to speak. I mean, they're with those patients 00:22:40.059 --> 00:22:43.420 week in, week out, you know, for hours and hours. 00:22:44.119 --> 00:22:46.980 You know, for most of us in psychiatry, we're 00:22:46.980 --> 00:22:50.220 doing 30 -minute med checks. And, you know, we 00:22:50.220 --> 00:22:52.240 can do supportive psychotherapy in that time, 00:22:52.279 --> 00:22:54.400 certainly, but oftentimes we're not getting into 00:22:54.400 --> 00:22:58.369 the real depth of what what the person is struggling 00:22:58.369 --> 00:23:02.289 with. And, um, so I would, yeah, immediately 00:23:02.289 --> 00:23:05.190 get a release of information, call the therapist 00:23:05.190 --> 00:23:08.170 up and just explain who I was and what my role 00:23:08.170 --> 00:23:10.029 is that I was looking forward to working with 00:23:10.029 --> 00:23:14.490 them and really wanting to work, um, collaboratively 00:23:14.490 --> 00:23:16.390 together and make sure that we're not like working 00:23:16.390 --> 00:23:20.349 against each other in strange ways or, you know, 00:23:20.349 --> 00:23:23.490 that we're, that we're aligned and certainly 00:23:23.490 --> 00:23:26.720 are, you know, our, uh, diagnostic formulations 00:23:26.720 --> 00:23:30.019 and our clinical conceptualization of what the 00:23:30.019 --> 00:23:34.519 core issues are with the patient. So, um, so 00:23:34.519 --> 00:23:36.839 that was, that was probably the thing that I 00:23:36.839 --> 00:23:38.819 enjoyed the most was building those partnerships. 00:23:39.200 --> 00:23:43.940 And, um, and I think the work that we do, uh, 00:23:44.160 --> 00:23:46.400 that's probably the best advertising we can get 00:23:46.400 --> 00:23:54.880 because if, you know, this person is, probably 00:23:54.880 --> 00:23:58.099 going to be more likely to, if one of their clients 00:23:58.099 --> 00:23:59.740 comes to them and say, oh, you know, I think 00:23:59.740 --> 00:24:01.559 I'm ready to try medicine. They're, you know, 00:24:01.559 --> 00:24:03.460 they're going to think of you of being this like, 00:24:03.599 --> 00:24:06.480 oh, this, this, I should send this person to, 00:24:06.539 --> 00:24:09.619 you know, this provider because they really, 00:24:09.700 --> 00:24:13.059 they are, they're, they're willing to work together. 00:24:13.220 --> 00:24:15.960 I've heard lots of therapists tell me, you're 00:24:15.960 --> 00:24:18.500 the first psychiatric provider to reach out to 00:24:18.500 --> 00:24:20.799 me. I mean, this person's had multiple psychiatrists 00:24:20.799 --> 00:24:22.740 and other nurse practitioners. And for whatever 00:24:22.740 --> 00:24:26.420 reason, They just tend to not want to reach out. 00:24:26.500 --> 00:24:30.779 And that's always surprising and, you know, somewhat 00:24:30.779 --> 00:24:33.759 disheartening to hear. Yeah. And are you picking 00:24:33.759 --> 00:24:38.059 up the phone or are you? Oh, yeah. Yeah. OK. 00:24:38.160 --> 00:24:41.819 I think that's also a big differentiating factor. 00:24:41.980 --> 00:24:43.420 You know what I mean? That like, yeah, you're 00:24:43.420 --> 00:24:45.400 willing to take the time to reach out. I think 00:24:45.400 --> 00:24:51.200 that goes a long way. Yeah. OK, so. Yeah. The 00:24:51.200 --> 00:24:55.200 thing that I disliked most about it. Was the 00:24:55.200 --> 00:24:58.599 billing. I mean, I spent countless hours on the 00:24:58.599 --> 00:25:03.079 phone with various payers trying to sort out 00:25:03.079 --> 00:25:06.519 why this claim didn't get paid. And sometimes 00:25:06.519 --> 00:25:08.859 it was like, oh, you forgot to add the GT modifier 00:25:08.859 --> 00:25:12.519 to the 99214. And that's why we, you know, that's 00:25:12.519 --> 00:25:15.779 why we didn't pay. And then you have to go through 00:25:15.779 --> 00:25:18.200 this whole process of claim resubmission and 00:25:18.200 --> 00:25:21.220 doing it in a certain way. And that part, just 00:25:21.220 --> 00:25:26.359 that sort of. killed any desire to to do it again 00:25:26.359 --> 00:25:30.079 so yeah that makes sense that makes a lot of 00:25:30.079 --> 00:25:34.000 sense um talk to us a little bit if you don't 00:25:34.000 --> 00:25:37.099 mind about just your journey your journey in 00:25:37.099 --> 00:25:42.859 recovery and just how that's been as a provider 00:25:42.859 --> 00:25:48.259 um because i think it's really brave and important 00:25:48.259 --> 00:25:52.480 when clinicians who have dealt with that, um, 00:25:52.759 --> 00:25:56.299 are willing to share more about their stories. 00:25:57.539 --> 00:25:59.539 Yeah. And I think, yeah, you can really help 00:25:59.539 --> 00:26:02.859 that population a lot, a lot of times, even more 00:26:02.859 --> 00:26:08.900 so I would say. Yeah. Yeah. Um, so yeah, I mean, 00:26:08.900 --> 00:26:11.019 actually it'll be the 20th this month that I'm 00:26:11.019 --> 00:26:15.400 celebrating 10 years of sobriety. Um, thanks. 00:26:15.660 --> 00:26:21.079 Yeah. Uh, hard, hard to believe. Um, And I was 00:26:21.079 --> 00:26:22.920 just talking to another friend, actually, who's 00:26:22.920 --> 00:26:28.279 struggling with their drinking. And, yeah, I 00:26:28.279 --> 00:26:31.619 was just kind of reflecting on like how crazy 00:26:31.619 --> 00:26:35.240 it's been that it's been 10 years. But it was 00:26:35.240 --> 00:26:37.440 not planned. I mean, it was something that I 00:26:37.440 --> 00:26:41.519 had always, you know, grew up in a family where 00:26:41.519 --> 00:26:44.640 there was problematic drinking and alcohol use 00:26:44.640 --> 00:26:50.289 disorder. Yeah, just sort of fell into it myself, 00:26:50.589 --> 00:26:54.150 you know, started drinking in high school that 00:26:54.150 --> 00:26:59.450 progressed through college. And I was always 00:26:59.450 --> 00:27:05.309 a very functional drinker, you know, so, you 00:27:05.309 --> 00:27:08.410 know, was always employed, didn't have any legal 00:27:08.410 --> 00:27:12.869 problems. So I had this this this sort of idea 00:27:12.869 --> 00:27:16.369 that it was under control or it wasn't a problem. 00:27:17.359 --> 00:27:21.420 And yet at the same time, have countless memories 00:27:21.420 --> 00:27:23.819 of thinking, well, I got to slow down. I should, 00:27:23.940 --> 00:27:26.819 you know, I'm getting too old for this. So on 00:27:26.819 --> 00:27:29.019 and so forth. All the things that lots of people 00:27:29.019 --> 00:27:35.759 go through in their journey. And what, you know, 00:27:35.799 --> 00:27:39.720 the stopping part was totally unplanned. I mean, 00:27:39.720 --> 00:27:42.859 it was really one. It was actually Father's Day 00:27:42.859 --> 00:27:50.319 of 2013. 2016. Yeah. And I remember waking up. 00:27:50.339 --> 00:27:52.859 That weekend was a big drinking weekend for me. 00:27:52.940 --> 00:27:56.519 Big drinking Friday night. A graduation party. 00:27:56.680 --> 00:27:58.640 A friend of mine graduated from dental school 00:27:58.640 --> 00:28:02.859 Saturday night. Late night, Saturday night. And 00:28:02.859 --> 00:28:05.480 I woke up Sunday morning, hung over and was just 00:28:05.480 --> 00:28:08.500 like, I can't do this anymore. Like it was that 00:28:08.500 --> 00:28:11.720 sort of, you know, in AA you hear the term surrender 00:28:11.720 --> 00:28:14.019 a lot. And it was kind of this surrender moment 00:28:14.019 --> 00:28:17.319 where I was just like. can't do this. I don't 00:28:17.319 --> 00:28:18.799 know. I don't have a plan. I don't know what 00:28:18.799 --> 00:28:22.640 I'm going to do, but I just can't do this anymore. 00:28:22.859 --> 00:28:25.380 And so I called a therapist that I'd seen about 00:28:25.380 --> 00:28:28.519 a year prior who was, had a history working in 00:28:28.519 --> 00:28:32.859 the substance use industry or world. And when 00:28:32.859 --> 00:28:34.980 I saw her, it was through an employee assistance 00:28:34.980 --> 00:28:37.920 program. And she was like, well, I'm not, if 00:28:37.920 --> 00:28:39.279 you're going to be drinking while I'm seeing 00:28:39.279 --> 00:28:41.440 you, I won't see you because, you know, if you're 00:28:41.440 --> 00:28:42.500 going to, if I'm going to work with you, you 00:28:42.500 --> 00:28:44.160 need to be not drinking while I'm seeing you. 00:28:44.200 --> 00:28:46.440 And I was like, sure. I can do eight sessions 00:28:46.440 --> 00:28:49.359 and not drink over the course of those eight 00:28:49.359 --> 00:28:51.619 weeks. No problem. And I did. And then as soon 00:28:51.619 --> 00:28:53.259 as the eight weeks were up, I went right back 00:28:53.259 --> 00:28:56.359 to it. You know, and I'd heard various things 00:28:56.359 --> 00:28:57.980 from various therapists over the years, like, 00:28:58.000 --> 00:29:00.099 oh, if you can quit drinking for 30 days, you 00:29:00.099 --> 00:29:01.900 don't have a problem. Or if you can quit for 00:29:01.900 --> 00:29:05.279 90 days, you don't have a problem. And I would 00:29:05.279 --> 00:29:08.660 always make it to like 87 days or. you know, 00:29:08.680 --> 00:29:11.980 29 days and throw the towel in like that was 00:29:11.980 --> 00:29:14.140 like, oh, that's good enough. I don't have a 00:29:14.140 --> 00:29:18.059 problem. And so anyways, I went back and she 00:29:18.059 --> 00:29:22.400 said, I said, I think I'm ready to quit. She's 00:29:22.400 --> 00:29:24.940 like, oh, good. When are you going to go to treatment? 00:29:25.079 --> 00:29:27.220 And I was like, whoa, whoa, whoa, whoa, treatment. 00:29:28.099 --> 00:29:30.839 I'm a high end beer snob. Like I'm a home brewer. 00:29:31.420 --> 00:29:34.859 You know, I was really big into the brewery scene 00:29:34.859 --> 00:29:36.579 in Seattle. I was like, I don't need treatment. 00:29:36.759 --> 00:29:40.549 I'm not like. drinking pop off vodka out of the 00:29:40.549 --> 00:29:43.930 handle, you know, and she's like, it's going 00:29:43.930 --> 00:29:46.589 to be harder for you than you're anticipating. 00:29:46.789 --> 00:29:49.130 And I think if you try to do this on your own, 00:29:49.170 --> 00:29:51.509 you're not going to be successful. And I was 00:29:51.509 --> 00:29:54.609 like, OK, I paused and, you know, thought about 00:29:54.609 --> 00:29:58.230 it and looked into my insurance and was like, 00:29:58.309 --> 00:30:00.250 all right, well, you know, if this person who 00:30:00.250 --> 00:30:02.650 has clearly more experience in this world than 00:30:02.650 --> 00:30:06.319 I do, I'm willing to. you know, take her at her 00:30:06.319 --> 00:30:10.279 word. So I found an intensive outpatient. So 00:30:10.279 --> 00:30:15.400 that was during my pharmaceutical role. So I 00:30:15.400 --> 00:30:18.079 was traveling a lot and I needed something that 00:30:18.079 --> 00:30:20.220 was flexible. So I found this intensive outpatient 00:30:20.220 --> 00:30:22.660 program that was in Seattle that was in the evenings, 00:30:22.720 --> 00:30:26.500 more holistically based. They, you know, used 00:30:26.500 --> 00:30:28.920 yoga and meditation and that kind of stuff and 00:30:28.920 --> 00:30:33.130 that. That is, uh, I'm a practicing Buddhist 00:30:33.130 --> 00:30:36.990 and wasn't at that time, but meditation is something 00:30:36.990 --> 00:30:40.109 that was always, um, interesting to me and something 00:30:40.109 --> 00:30:43.829 that I wanted to explore more. And so, uh, so 00:30:43.829 --> 00:30:46.849 I started that program and, um, yeah, did that 00:30:46.849 --> 00:30:50.849 for about 11 months. So, wow. Quite, quite a 00:30:50.849 --> 00:30:55.920 journey that you've had. Um, and. How has it 00:30:55.920 --> 00:30:58.000 been? Like, do you find that that's a population 00:30:58.000 --> 00:31:01.200 you really enjoy helping now? Or how does it 00:31:01.200 --> 00:31:05.779 affect like your kind of current day psych NPE 00:31:05.779 --> 00:31:08.819 practice, I guess? Yeah. And then we'll pivot 00:31:08.819 --> 00:31:11.839 to psychodynamic stuff because I want you to 00:31:11.839 --> 00:31:14.559 educate me on that because I'm really I don't 00:31:14.559 --> 00:31:18.359 know that much. Yeah, yeah, yeah. How it shows 00:31:18.359 --> 00:31:23.960 up or how. How I approach it in practice is, 00:31:24.160 --> 00:31:29.900 you know, I try to use, I mean, it's part of 00:31:29.900 --> 00:31:32.900 our everyday assessment, right? Like that's part 00:31:32.900 --> 00:31:35.259 of, should be one of the main questions we're 00:31:35.259 --> 00:31:38.180 asking in a psychiatric interview is, is there 00:31:38.180 --> 00:31:39.799 any substance use that could be contributing 00:31:39.799 --> 00:31:41.799 to these symptoms that you're coming to me with? 00:31:43.240 --> 00:31:46.559 Because if that's the case, then that needs to 00:31:46.559 --> 00:31:55.150 be addressed. You know, I think I have I have 00:31:55.150 --> 00:31:57.970 a unique perspective in that I've kind of walked 00:31:57.970 --> 00:32:04.450 through that fire myself. And, you know, I think 00:32:04.450 --> 00:32:07.390 it it gives me a unique perspective as to what 00:32:07.390 --> 00:32:12.650 the person might be struggling with. And I wouldn't 00:32:12.650 --> 00:32:16.450 say that I'm someone who actively seeks out. 00:32:16.880 --> 00:32:19.200 people who are actively struggling with substance 00:32:19.200 --> 00:32:25.619 use disorder. And part of that is because I think 00:32:25.619 --> 00:32:29.000 people have to be ready. You know, I mean, just 00:32:29.000 --> 00:32:31.240 like coming to treatment for anything, people 00:32:31.240 --> 00:32:33.799 have to be ready for it. And not everybody is. 00:32:33.960 --> 00:32:35.880 And certainly I think the people who are ready 00:32:35.880 --> 00:32:41.380 for it, who in some degree or another, it's a 00:32:41.380 --> 00:32:43.559 little, there's a little bit more to work with 00:32:43.559 --> 00:32:46.359 there. You know, I mean. Motivational interviewing, 00:32:46.519 --> 00:32:49.299 sure, is wonderful and very important. Trying 00:32:49.299 --> 00:32:52.400 to assess where people feel like they're at with 00:32:52.400 --> 00:32:56.180 regards to their substance use intake, you know, 00:32:56.200 --> 00:32:59.960 substance intake. But I think the people that 00:32:59.960 --> 00:33:08.099 I really, really that I've found to be. I guess 00:33:08.099 --> 00:33:13.319 the most. ready for treatment are the people 00:33:13.319 --> 00:33:16.339 who are at that point where they're like, I know 00:33:16.339 --> 00:33:19.119 this is a problem and I really want help on this. 00:33:19.220 --> 00:33:24.460 I just don't know what to do. And yeah, sometimes 00:33:24.460 --> 00:33:27.740 I will self -disclose, you know, if I think it's 00:33:27.740 --> 00:33:32.240 going to be helpful to the person and let them 00:33:32.240 --> 00:33:35.480 know, hey, this is, these are some options out 00:33:35.480 --> 00:33:39.470 there and I can speak from experience that. You 00:33:39.470 --> 00:33:42.789 know, if you're not an AA person and you don't 00:33:42.789 --> 00:33:46.089 want to go to AA, then don't go to AA. There 00:33:46.089 --> 00:33:49.769 are other options. And AA can be really helpful 00:33:49.769 --> 00:33:53.230 for some people, even people who are resistant 00:33:53.230 --> 00:33:55.490 to the idea or freaked out about the whole God 00:33:55.490 --> 00:33:57.349 thing. You know, that's usually a big sticking 00:33:57.349 --> 00:34:01.069 point. It's like, I don't believe in God or whatever, 00:34:01.210 --> 00:34:05.150 or I don't want to be told what to do. You know, 00:34:05.150 --> 00:34:07.670 so through exploring that, you can kind of tell. 00:34:08.090 --> 00:34:10.570 maybe who might benefit from it more so than 00:34:10.570 --> 00:34:13.670 others. So I don't know if that answers your 00:34:13.670 --> 00:34:16.050 question or not. It does. It does. It absolutely 00:34:16.050 --> 00:34:18.849 does. That's insightful. So tell us how you got 00:34:18.849 --> 00:34:26.130 into the psychodynamic world. And yeah, just 00:34:26.130 --> 00:34:28.090 talk to us about that. And again, I don't know 00:34:28.090 --> 00:34:30.869 a ton about it. So just keep it basic for those 00:34:30.869 --> 00:34:33.929 of us who aren't really familiar as psych NPs, 00:34:34.030 --> 00:34:38.389 what it means to practice in that. in that way. 00:34:38.730 --> 00:34:43.989 Yeah. So, I mean, everybody's heard of Freud 00:34:43.989 --> 00:34:48.010 and Freud was sort of the modern originator of 00:34:48.010 --> 00:34:51.150 modern psychotherapy, right? He kind of developed 00:34:51.150 --> 00:34:56.389 the talking cure. And I hesitate to speak too 00:34:56.389 --> 00:35:00.130 authoritatively on this because I'm not an expert 00:35:00.130 --> 00:35:03.449 by any means. I'm still very much in the beginning 00:35:03.449 --> 00:35:07.849 stages of learning about this. But I mean, I 00:35:07.849 --> 00:35:10.769 remember learning about psychodynamic principles 00:35:10.769 --> 00:35:14.690 and unconscious back as a, you know, psychology 00:35:14.690 --> 00:35:22.789 major. And I think through that program and through 00:35:22.789 --> 00:35:24.570 even through nursing, you know, psychodynamic, 00:35:24.869 --> 00:35:29.170 the psychodynamic approach, I think, is experiencing 00:35:29.170 --> 00:35:31.570 a bit of a renaissance right now. I think it's, 00:35:31.570 --> 00:35:33.789 you know, I mean, on LinkedIn, I certainly and 00:35:33.789 --> 00:35:36.599 maybe it's just who I follow, but. I'm seeing 00:35:36.599 --> 00:35:40.460 a lot more interest in it and a lot more psychoanalysts 00:35:40.460 --> 00:35:45.179 posting about it. But at its basis, you know, 00:35:45.199 --> 00:35:50.219 it's really about this idea that, you know, there's 00:35:50.219 --> 00:35:52.039 this thing called the unconscious, right? This 00:35:52.039 --> 00:35:55.079 part of the mind called the unconscious that 00:35:55.079 --> 00:36:02.570 is kind of, I don't want to say, it exists. That's 00:36:02.570 --> 00:36:05.309 where these things like wishes, like drives, 00:36:05.469 --> 00:36:10.369 like defenses exist, you know, defense mechanisms. 00:36:10.650 --> 00:36:14.570 And, you know, I think the general, as I understand 00:36:14.570 --> 00:36:19.309 it, this general principle is these symptoms 00:36:19.309 --> 00:36:23.650 that people come to us with, it's a way that 00:36:23.650 --> 00:36:27.130 the mind is communicating something that's going 00:36:27.130 --> 00:36:33.800 on that the person's not aware of. Um, and, and 00:36:33.800 --> 00:36:36.699 everything has meaning. I mean, everybody's heard 00:36:36.699 --> 00:36:39.019 the term, the Freudian slip where, you know, 00:36:39.019 --> 00:36:40.980 we mistakenly say something that we didn't mean 00:36:40.980 --> 00:36:45.079 to that, you know, maybe some underlying meaning, 00:36:45.179 --> 00:36:50.360 um, but dream slips, um, you know, behaviors, 00:36:50.699 --> 00:36:55.059 um, body language, uh, all of that has meaning 00:36:55.059 --> 00:36:59.840 and, uh, and it, it's a way of the mind communicating. 00:37:00.570 --> 00:37:03.050 into sort of the outside world, what's going 00:37:03.050 --> 00:37:07.449 on that the person's not aware of. And through 00:37:07.449 --> 00:37:12.889 psychodynamic therapy and psychoanalysis, which 00:37:12.889 --> 00:37:16.730 is a much more intensive form of psychodynamic 00:37:16.730 --> 00:37:20.510 therapy, where the person's seeing their analyst 00:37:20.510 --> 00:37:23.010 four to five, somewhere between three and five 00:37:23.010 --> 00:37:27.230 times a week for 45 minutes. And the basis for 00:37:27.230 --> 00:37:29.610 all of this really is, you know, the idea that 00:37:30.190 --> 00:37:32.389 early childhood experiences and early childhood 00:37:32.389 --> 00:37:34.909 relationships, oftentimes with the person's primary 00:37:34.909 --> 00:37:40.369 caregiver, something went maybe awry in one of 00:37:40.369 --> 00:37:43.190 the developmental phases that the child goes 00:37:43.190 --> 00:37:46.670 through and really through adolescence and even 00:37:46.670 --> 00:37:49.329 into adulthood. But those formative experiences 00:37:49.329 --> 00:37:54.329 early in life, based on the relationship with 00:37:54.329 --> 00:37:56.670 the caregiver, the parent, oftentimes the mother, 00:37:56.730 --> 00:37:59.719 sometimes the father, sometimes both, Something 00:37:59.719 --> 00:38:05.460 is amiss, and as a result, the person becomes 00:38:05.460 --> 00:38:07.820 developmentally arrested to a certain degree 00:38:07.820 --> 00:38:14.659 in that phase. And that plays out in future relationships. 00:38:14.760 --> 00:38:17.960 And so as the analyst or the therapist is listening 00:38:17.960 --> 00:38:21.119 to this person in therapy, they start to recognize 00:38:21.119 --> 00:38:28.690 patterns in relationships. job changes and things 00:38:28.690 --> 00:38:33.429 like that. And then through asking about the 00:38:33.429 --> 00:38:37.570 person's experience in early childhood, oftentimes 00:38:37.570 --> 00:38:40.869 these insights can come about. And so the other 00:38:40.869 --> 00:38:43.409 piece of it is really to help the person understand 00:38:43.409 --> 00:38:49.750 how their mind works. And it's much less focused 00:38:49.750 --> 00:38:55.130 on the diagnosis according to the, you know, 00:38:55.150 --> 00:38:59.789 current DSM system. I mean, I'm looking, actually, 00:38:59.829 --> 00:39:02.949 my laptop is stacked on top of a very thick book 00:39:02.949 --> 00:39:05.550 called the Psychodynamic Diagnostic Manual, who's 00:39:05.550 --> 00:39:10.090 partially written by Nancy McWilliams, who if, 00:39:10.090 --> 00:39:14.829 you know, viewers are interested, she is a wonderful 00:39:14.829 --> 00:39:17.030 resource if people are interested in learning 00:39:17.030 --> 00:39:21.500 more about psychodynamic therapy. theory, Nancy 00:39:21.500 --> 00:39:25.800 McWilliams is, you know, she's just very readable. 00:39:25.920 --> 00:39:29.639 She breaks things down into very digestible pieces 00:39:29.639 --> 00:39:33.760 that are very easily, more easily understood. 00:39:34.019 --> 00:39:36.699 I would say don't start with original Freud if 00:39:36.699 --> 00:39:39.519 you're interested in psychodynamic theory. It 00:39:39.519 --> 00:39:44.739 can be complex. Yeah, absolutely. This is kind 00:39:44.739 --> 00:39:46.659 of a random question. And if you don't want to 00:39:46.659 --> 00:39:48.559 answer it, you don't have to. But have you ever 00:39:48.559 --> 00:39:51.980 been through it on the patient side of things? 00:39:53.079 --> 00:39:55.820 Not a full analysis. I mean, my therapist that 00:39:55.820 --> 00:40:02.599 I see now is a psychoanalyst and. I think down 00:40:02.599 --> 00:40:04.719 the road, there's certainly an interest there. 00:40:05.019 --> 00:40:10.059 I mean, I have my own hangups and baggage and 00:40:10.059 --> 00:40:12.059 issues and things that I struggle with in my 00:40:12.059 --> 00:40:16.800 life and marriage and being a parent. And I'm 00:40:16.800 --> 00:40:19.920 sure that a lot of it kind of harkens back to 00:40:19.920 --> 00:40:26.320 my own childhood. And so, I mean, right now I'm 00:40:26.320 --> 00:40:28.619 just doing psychodynamically oriented therapy 00:40:28.619 --> 00:40:31.659 once a week with my therapist. I'd like to eat 00:40:31.659 --> 00:40:34.559 twice a week. And the general, you know, the 00:40:34.559 --> 00:40:37.519 other piece there is the relationship that forms 00:40:37.519 --> 00:40:39.739 between the therapist or the analyst and the 00:40:39.739 --> 00:40:44.280 patient. It tends to, can take on this almost, 00:40:44.519 --> 00:40:48.480 I mean, everybody's heard of the term transference 00:40:48.480 --> 00:40:50.800 encounter, or maybe not everybody, but countertransference 00:40:50.800 --> 00:40:52.820 and transference. Transference is the reaction 00:40:52.820 --> 00:40:57.619 that the patient has to the therapist. And countertransference 00:40:57.619 --> 00:41:01.070 is the reaction that the... the therapist has 00:41:01.070 --> 00:41:02.730 to the patient or the feelings that are brought 00:41:02.730 --> 00:41:07.670 up in session. And that relationship can very 00:41:07.670 --> 00:41:12.530 much take on or can assume this, I don't want 00:41:12.530 --> 00:41:15.630 to say parental type role, but if the initial 00:41:15.630 --> 00:41:18.650 injury that the person sustained in childhood 00:41:18.650 --> 00:41:21.889 was between themselves and their parent, the 00:41:21.889 --> 00:41:26.030 therapist's role is to kind of take on this parental 00:41:26.030 --> 00:41:29.389 type figure so that that person can kind of act 00:41:29.389 --> 00:41:33.909 out and explore these dynamic issues in a safe, 00:41:33.909 --> 00:41:38.489 contained space. Ultimately, you know, sort of 00:41:38.489 --> 00:41:42.349 try, I don't want to say triumph, but heal from 00:41:42.349 --> 00:41:47.449 those, those experiences early on with the therapist 00:41:47.449 --> 00:41:50.570 kind of functioning in that pseudo parental. 00:41:51.010 --> 00:41:55.829 So. Okay. Interesting. So what would you say 00:41:55.829 --> 00:42:00.889 to psych nps who are still in school or maybe 00:42:00.889 --> 00:42:05.329 they just graduated as far as the realm of psychodynamics 00:42:05.329 --> 00:42:08.469 um like do you think that this is something that 00:42:08.469 --> 00:42:12.929 all psych nps should know a little bit a lot 00:42:12.929 --> 00:42:16.929 of a bit like what resources to go to like yeah 00:42:16.929 --> 00:42:20.750 i think it feels kind of like out of reach or 00:42:20.750 --> 00:42:24.449 if that makes any sense yeah yeah no it does 00:42:24.449 --> 00:42:27.869 i mean i You know, if you look at, and I don't 00:42:27.869 --> 00:42:29.710 want to compare it to medical education, but 00:42:29.710 --> 00:42:32.070 I mean, psychiatrists, psychiatric residents 00:42:32.070 --> 00:42:35.610 oftentimes will get psychotherapy training in 00:42:35.610 --> 00:42:38.489 cognitive behavioral therapy, psychodynamic therapy, 00:42:38.730 --> 00:42:41.329 and then like interpersonal therapy oftentimes. 00:42:42.630 --> 00:42:47.829 I think it's important to be at least aware of 00:42:47.829 --> 00:42:53.019 psychodynamic principles because inevitably in 00:42:53.019 --> 00:42:58.099 our work with patients, they will evoke feelings 00:42:58.099 --> 00:43:02.820 in us with them. And we kind of feel like, gosh, 00:43:02.880 --> 00:43:05.219 why am I getting irritated by this person? Or 00:43:05.219 --> 00:43:08.199 I really just want to run out of the room right 00:43:08.199 --> 00:43:10.360 now. Like this person is putting me on edge. 00:43:10.460 --> 00:43:13.820 I'm feeling, I don't know. I'm feeling suspicious. 00:43:14.039 --> 00:43:16.159 I'm feeling, you know, like, so that's all counter 00:43:16.159 --> 00:43:18.659 -transference, you know, and these, these patients 00:43:18.659 --> 00:43:21.840 will be. And we'll be doing the same thing with 00:43:21.840 --> 00:43:23.719 them. You know, I mean, we'll be interacting 00:43:23.719 --> 00:43:26.119 with certain ways in certain ways with them and 00:43:26.119 --> 00:43:28.579 they'll seem to, they'll respond to us in certain 00:43:28.579 --> 00:43:31.659 ways. And I think one of the beautiful things 00:43:31.659 --> 00:43:33.780 about the psychodynamic approach is it really 00:43:33.780 --> 00:43:39.099 digs into that. And so informing ourselves on 00:43:39.099 --> 00:43:43.460 basic principles and ideas like transference 00:43:43.460 --> 00:43:47.099 and countertransference and the frame, you know, 00:43:47.119 --> 00:43:50.480 setting the frame, which. is kind of its own 00:43:50.480 --> 00:43:56.820 skill, the treatment frame. I think there are 00:43:56.820 --> 00:43:59.260 certain aspects to, it doesn't mean you have 00:43:59.260 --> 00:44:02.159 to go all in and go on for full psychodynamic 00:44:02.159 --> 00:44:05.820 training, but I think it's certainly helpful, 00:44:05.940 --> 00:44:08.480 just like it's helpful to know about the CBT 00:44:08.480 --> 00:44:10.719 triangle and be able to explain that to patients. 00:44:12.030 --> 00:44:14.809 Have a handful of DBT skills that we can help 00:44:14.809 --> 00:44:17.030 people with who are struggling with emotional 00:44:17.030 --> 00:44:20.530 dysregulation or interpersonal ineffectiveness, 00:44:20.730 --> 00:44:23.889 you know. So I think it can be really helpful 00:44:23.889 --> 00:44:28.010 for as a skill set. Yeah. OK, that's helpful. 00:44:28.610 --> 00:44:31.329 My listeners want me to keep these episodes shorter, 00:44:31.409 --> 00:44:33.750 so I'm going to wrap up in the next. But I still 00:44:33.750 --> 00:44:36.289 I still really want to hear just briefly about 00:44:36.289 --> 00:44:39.849 like. you're in this Brooks fellowship and then 00:44:39.849 --> 00:44:41.630 also you're getting ready to go into something 00:44:41.630 --> 00:44:44.550 else. Can you just tell us about those real quick? 00:44:44.710 --> 00:44:50.030 And then, yeah. A plug for Brooke Finley's psychodynamic 00:44:50.030 --> 00:44:55.019 psychotherapy fellowship. So I, I found, I think 00:44:55.019 --> 00:44:57.880 I remember hearing about it a while back just 00:44:57.880 --> 00:45:00.199 through following her on LinkedIn. And then a 00:45:00.199 --> 00:45:02.400 friend of mine who's another, you know, nurse 00:45:02.400 --> 00:45:06.500 leader, Rowan D 'Erico, he reached out to me 00:45:06.500 --> 00:45:08.320 and said, hey, are you doing Brooks Fellowship? 00:45:08.320 --> 00:45:12.039 And I hadn't planned on it. And then doing a 00:45:12.039 --> 00:45:13.880 little bit more research, it just sort of, I 00:45:13.880 --> 00:45:15.380 was like, yeah, I think this is a really great 00:45:15.380 --> 00:45:18.960 next. educational step. And so it's been a wonderful, 00:45:19.099 --> 00:45:22.940 incredibly informative nine months where we gather 00:45:22.940 --> 00:45:26.280 once a week and there's, yeah, there's a reading 00:45:26.280 --> 00:45:28.800 assignment for the week and we get together and 00:45:28.800 --> 00:45:32.199 discuss that and discuss. Brooke is a really 00:45:32.199 --> 00:45:35.840 wonderful teacher and is incredibly experienced 00:45:35.840 --> 00:45:41.559 in that field and is a leader in, you know, herself. 00:45:41.760 --> 00:45:47.360 And so That has been a great jumping off point 00:45:47.360 --> 00:45:52.480 for more training for me anyways. And actually, 00:45:52.519 --> 00:45:55.679 per her recommendation, the program. So I decided 00:45:55.679 --> 00:46:00.699 to go on for another two year combined didactic. 00:46:00.699 --> 00:46:02.920 So Brooks Fellowship is primarily didactic in 00:46:02.920 --> 00:46:05.199 nature. There isn't any clinical supervision 00:46:05.199 --> 00:46:09.019 or anything associated with it. But the program 00:46:09.019 --> 00:46:11.039 that I'm going into, which is the Contemporary 00:46:11.039 --> 00:46:14.619 Freudian Society. psychodynamic psychotherapy 00:46:14.619 --> 00:46:17.079 training program, which is a two -year program 00:46:17.079 --> 00:46:22.820 with didactic as well as clinical components. 00:46:23.000 --> 00:46:28.059 There's included supervision. It's expected that 00:46:28.059 --> 00:46:30.559 you're going to be doing psychodynamic therapy 00:46:30.559 --> 00:46:35.659 with patients. So that, yeah, I think that's 00:46:35.659 --> 00:46:39.380 the next step. And whether I go on for full analytic 00:46:39.380 --> 00:46:41.619 training, I'm not quite sure down the road, but 00:46:41.619 --> 00:46:47.170 that's a whole another undertaking of a significantly 00:46:47.170 --> 00:46:50.530 more time commitment but um you know i'll start 00:46:50.530 --> 00:46:53.150 with this to start mixing it into my practice 00:46:53.150 --> 00:46:57.789 and yeah see how it goes that's really cool thank 00:46:57.789 --> 00:47:00.949 you so much for sharing more about that i definitely 00:47:00.949 --> 00:47:03.750 want to have you on for like a part two episode 00:47:03.750 --> 00:47:07.329 because i feel like we just scratched the surface 00:47:07.329 --> 00:47:10.110 with some of this stuff um but i totally understand 00:47:10.780 --> 00:47:13.119 people you know liking those shorter episodes 00:47:13.119 --> 00:47:17.099 um one last question i ask all of my guests what 00:47:17.099 --> 00:47:20.480 does the term no prior auth mean to you yeah 00:47:20.480 --> 00:47:22.659 after watching your other episodes i was like 00:47:22.659 --> 00:47:25.239 i need to come up with some really deep witty 00:47:25.239 --> 00:47:30.579 answer about this uh so i i i think i woke up 00:47:30.579 --> 00:47:32.599 at like four in the morning this morning like 00:47:32.599 --> 00:47:36.119 wandering that very question i was like boy you 00:47:36.119 --> 00:47:38.300 gotta come up with something oh that cracks me 00:47:38.300 --> 00:47:46.400 up So I think, you know, a couple things came 00:47:46.400 --> 00:47:50.280 to mind. One was it's easier to ask for forgiveness 00:47:50.280 --> 00:47:55.860 than it is permission sometimes. And, you know, 00:47:55.900 --> 00:47:59.119 I think the other sentiment that comes to mind 00:47:59.119 --> 00:48:03.219 is, you know, yeah, we shouldn't have to ask 00:48:03.219 --> 00:48:08.900 for permission to practice. according to our 00:48:08.900 --> 00:48:14.219 values and to do what we feel is right for the 00:48:14.219 --> 00:48:19.480 patient, you know, and sometimes that is a segue 00:48:19.480 --> 00:48:23.960 for part two in terms of transition away from 00:48:23.960 --> 00:48:27.500 the interventional side of psychiatry, which 00:48:27.500 --> 00:48:30.179 I've been practicing in for the last year to 00:48:30.179 --> 00:48:33.719 more of a, you know, what feels like a little 00:48:33.719 --> 00:48:37.599 bit more authentic for me as a You know, working 00:48:37.599 --> 00:48:39.460 in a group practice, but getting to do a lot 00:48:39.460 --> 00:48:43.059 more therapy. Right. OK, awesome. Yeah, we will. 00:48:43.139 --> 00:48:44.840 We definitely will want to hear more about that, 00:48:44.840 --> 00:48:48.659 too. So, well, thank you so much, Ben. And we're 00:48:48.659 --> 00:48:52.440 looking forward to having you back for another 00:48:52.440 --> 00:48:55.820 episode down the line. Sounds great. Look forward 00:48:55.820 --> 00:48:56.039 to it.