The Nurse Psychotherapist and a Framework for Practice

Abstract

This chapter begins with the historical context of the nurse's role as psychotherapist and the resources and challenges inherent in nursing for the development of requisite psychotherapy skills. Using a holistic paradigm, the framework for practice presented here is patient-centered and based on resilience and relationship. Mental health and illness are viewed through a cultural lens. The significant role of adverse life experiences in the development, contribution, and maintenance of mental health problems and psychiatric disorders is highlighted. A hierarchy of treatment aims is introduced on which to base interventions using a phase model for psychotherapy. This framework is based on the neurophysiology of adaptive information processing which posits that most mental health problems and symptoms of psychiatric disorders are due to a disturbance or dysregulation in the integration and connection of neural networks that occur in response to adverse life experiences. A case example is presented to illustrate the how to apply the framework proposed for psychotherapy practice. WHO DOES PSYCHOTHERAPY?The various disciplines licensed to conduct psychotherapy, depending on their respective state licensing boards, include psychiatrists, psychologists, social workers, marriage and family therapists, counselors, and advanced practice psychiatric nurses (APPNs) (Table 1.1). APPN is used throughout this book to include psychiatric-mental health clinical nurse specialists (PMHCNS) and psychiatric-mental health nurse practitioners (PMHNP). Educational preparation, orientation, and practice settings vary greatly among and within each discipline of practicing psychotherapists. In addition to basic educational requirements unique for that discipline, there are many postgraduate psychotherapy training programs that licensed mental health practitioners may pursue, such as psychoanalytic, family, eye movement desensitization and reprocessing (EMDR) therapy, cognitive behavioral, hypnosis, and others. Each of these training programs offer certification and require a specified amount of training for licensed mental health professionals: approximately 1 year for EMDR therapy (i.e., 40 academic didactic and 10 consultation hours for basic Parts 1 and 2 training; plus, in order to obtain certification an additional 20 consultation hours, 12 continuing educational units, 2 years' experience with a license in mental health practice, and a minimum of 50 sessions with 25 patients); and for psychoanalytic training 4 to 5 years (i.e., 4 years of coursework and supervision, ongoing practice, and one's own experience in psychoanalysis).Postgraduate training and ongoing supervision are encouraged for APPNs who wish to gain proficiency and deepen their knowledge in a particular modality of psychotherapy.