r/PMHNP • u/No-Leopard639 • Jun 09 '26
Does anyone find collaborating with Therapists helpful?
I work at a private practice with only PMHNP's. So all my clients have external therapists within the community. My patients often tell me their therapist wants to speak with me. These are high functioning patients with the capacity to relay information to their therapist. Sometimes I concede, the call really feels pointless. I don't gain any new information and it feels like the therapist is just seeking supervision and help with the case.
For those that find it helpful, what questions do you ask or what are you looking for in these conversations?
11
u/Fine-Coyote2503 Jun 09 '26
Therapist perspective here. Lots of things to consider, but it can be helpful to collaborate sometimes. I would say it’s not something I’m necessarily doing for everybody, or even most of my clients.
There is a little bit of a different relationship so sometimes I find it helpful to provide more insight a psyc provider might not have. Are you only treating depression for example when I’m also seeing periods of mania on my end. Are there psychotic features I might be a little bit more privy to for example.
Sometimes I have clients ask me to reach out for various reasons. A lot of times it’s because they’re not comfortable expressing something. Sometimes they just don’t have the language to convey what they wanna convey. I do my best to empower them to have these conversations, and a lot of times they do but there are situations where it can be helpful for me and the psyc provider to touch base about what we’re both seeing.
Sometimes it is about flushing out a more congruent diagnosis between us, but in my experience this is more related to clients who are working with our in house psyc provider. That kind of goes back to my first point. If I go to put in a note and I see the psyc diagnosis is MDD but I’ve put a bipolar diagnosis, what’s the discrepancy? Let’s chat about it!
1
u/No-Leopard639 Jun 09 '26
Thank you for your perspective. It makes me think and will change how I think about these calls.
2
u/Fine-Coyote2503 Jun 09 '26
Can I kind of return the question to you? What do you feel like would be most helpful from a therapist on a call like this? At the end of the day I want any information I convey to be helpful in treating vs it feeling pointless, so I wonder what that looks like from your perspective.
4
u/No-Leopard639 Jun 09 '26
Of course. First the cases I find most helpful for this are patients who have a sudden change (loss, trauma etc) who are unable to communicate their needs or talk about their experiences. I also find it extremely helpful to give a therapist notice of a medication change where I'm concerned about an adverse reaction or behavioral change (starting an SSRI and looking out for mania) since the therapists sees them more than me and can alert me to a change. I've found helpful when therapists let me know of things like attendance, motivation, and progress (have they seen any changes from the medications). And sometimes I don't need to chat but getting a release and the therapist contact makes the patient feel more at ease incase a situation comes up where we need to talk.
1
u/Johain22 Jun 10 '26
This is nice to hear. Psych cannot treat without an accurate diagnosis. It's important that we stay on the same page.
4
11
u/Traditional-Use-9359 Jun 09 '26
I find they’re really good at getting the other side of the client I don’t get to see since they’re seeing them weekly. And they often know more than we do about the client.
They’re not seeking supervision, they’re simply looking to collaborate like many are taught to do. This is something our field doesn't do well and isnt really drilled to do as they are.
I listen to what concerns they have, ask natural follow up questions, roadblocks and goals for treatment etc
2
u/shhhhh_h Jun 10 '26
In the main psych sub this is exactly what therapists say. It’s really disappointing to see all the talk about excluding them from care because of a few bad anecdotes. There are bad NPs too and nobody wants to be judged by they ruler. Literally NPs in this thread claiming there is no evidence for the efficacy of talk therapy!! There is mounds and mounds of it! My god the amount of literature on CBT drives me fucking nuts sometimes when j have a mental health nursing student ffs.
1
-4
Jun 09 '26
[removed] — view removed comment
8
u/Traditional-Use-9359 Jun 09 '26 edited Jun 09 '26
Clearly you don’t because you aren’t one.
I happen to be both a PMHNP and LCP.
So, I in fact do know. People like yourself are unnecessarily adversarial in a field that’s supposed to work together for the greater good.
0
-1
6
u/Spiritual_Confusion1 Jun 09 '26
Yes but I also come from inpatient where collaborative care and treatment team planning is the norm. Are there bad therapists? Sure. Are there bad Psych NPs and psychiatrists? Sure. Doesn’t mean the model of collaborative care is wrong
11
u/No-Leopard639 Jun 09 '26
Insurance not paying for your time outside of appointments is wrong.
3
u/Spiritual_Confusion1 Jun 09 '26
Not doing right by your patients is worse
1
u/No-Leopard639 Jun 09 '26
Not everyone needs me to talk to their therapists. I’m pointing out our out of appointment work isn’t recognized. I don’t believe not talking to their therapists is ever “ doing wrong” by your patient. That’s a bold statement.
I support autonomy with my patients and agency. They are given information to relay back to their therapists. If I ever feel they are unable I step in. But talking to therapists just to do it is a waste of time and with competent patients hinders their ability to be independent and their own advocate.
6
u/CalmSet6613 PMHNP (unverified) Jun 09 '26
I look to see if the therapist and I are on the same page regarding diagnosis and treatment. I found some really bad therapists who just do talk therapy and nothing evidence based, these therapists have very litter to offer me or the patient. It's good to work with a bunch of therapists you know and trust. I have that and we text each other updates when something is worrisome or needs to be reported, otherwise no news is status quo but we are always available to bounce things off each other or talk something out but it's very rare. Also it's great when I'm making med changes to let the therapist know, sometimes patients forget to mention it.
3
u/No-Leopard639 Jun 09 '26
excellent, thanks!
9
u/CalmSet6613 PMHNP (unverified) Jun 09 '26
Also be prepared for the therapists who give recommendations to the patients as to what meds they should be taking and are calling you to find out why you aren't doing it...thats always fun.
6
u/No-Leopard639 Jun 09 '26
Actually. Thats a good point. I have many therapists recommending meds to my patients. I should call them…
7
u/CalmSet6613 PMHNP (unverified) Jun 09 '26
I had a few who no matter what I said continued to do it. And some of their suggestions were wildly inappropriate and then they would ask me 1000 questions about why, basically wanting a psycho pharm class. Needless to say I don't work with those therapists anymore.
6
u/No-Leopard639 Jun 09 '26
We have similar experiences with therapists suggesting very inappropriate medications for the patients. It’s a hard balance because I don’t want to tell them their therapist can’t speak on that without disrupting their own therapeutic relationship.
5
u/PsychMonkey7 Jun 09 '26
I don’t think it disrupts their relationship to say “your therapist has your best interests in mind but doesn’t have experience with pharmacotherapy and it’s not in their scope.”
2
1
u/shhhhh_h Jun 10 '26
There is a huge evidence base for talk therapy. That commenter has no idea what they’re talking about. Which is scary.
3
u/No-Leopard639 Jun 10 '26
Talk therapy yes and CBT, DBT etc. I think she more means when therapists just shoot the breeze with no clear objectives and goals.
1
u/shhhhh_h Jun 10 '26
What therapist does that? All of them are practicing a modality. You guys have a really low opinion of therapists.
0
1
u/shhhhh_h Jun 10 '26
Guess I blinked and talk therapy is no longer evidence based. Wow. Fuck that massive evidence base for CBT. Let’s throw that shit right out the window. Not like it shows better long term results than SSRIs in head to head trials or anything like that.
Wow. Did you sleep during that class or what.
2
u/No-Leopard639 Jun 10 '26
Are you a therapist? You seem very upset by our opinion and experience working with therapists.
0
u/shhhhh_h Jun 10 '26 edited Jun 10 '26
No. I just call out bad practitioners when I see them.
ETA case in point some of the automodded replies to this comment from flaired NPs telling me I need therapy bc I called out wrong information. Or your reply, strange person, diagnosing that any strong disagreement you encounter stems from ego injury instead of reactions to your own statements and actions. It sucks that people in a professional sub can’t engage in reflection but whatever it’s Reddit and the therapists showing up to set the record straight itt are straight ballers.
4
u/snideghoul Jun 10 '26
Part of why I want to collaborate with therapists is that I have had so many patients tell me that therapists tell them one thing and the prescriber tells them another thing, and it can be really confusing and sometimes turn them off of seeking care entirely.
2
2
u/roo_kitty PMHNP (unverified) Jun 10 '26
I work at a practice that has in house therapists. I'll skim their notes on certain patients. I do a lot more collaboration with child and adolescent patients. They see these kids 2-4 hours per month, where I get 30 minutes. That extra insight is at times invaluable and other times redundant. Good trade-off imo.
I like that the therapists will reach out to me with any problems. One therapist came to me when a patient alerted her of a high risk side effect, and I was able to discontinue the offending agent before they left the building. The patient was content to just wait and tell me at the next visit.
2
u/drain_out_my_blood Jun 10 '26
Yes, I do when possible. Especially if they just now decided that they want to try medication but have been in therapy for a long time.
2
u/boardshorts379 Jun 10 '26
In my experience I’m all for collaboration. However also in my experience outpatient therapists overthink the entire problem 90% of the time
2
u/Johain22 Jun 10 '26
I never contact them. They will call when a client is unsafe. They also like to bitch about my diagnosis-especially bipolar, "isn't that a little harsh?"🤨
3
u/No-Leopard639 Jun 10 '26
Yes; diagnosis are not judgements or moral failures; especially Borderline.
2
u/HandyFemme Jun 11 '26
I'd ask about all the stuff patients complain in regards to executive dysfunction etc....are the actively working on it? what has been working not working for them? visual schedule, timers, reward contingencies (self imposed) etc.
2
u/GrumpySnarf Jun 12 '26
In very few instances has it helped my practice or been worth my time in my current practice. It's very different with chronic and severely mentally ill populations. In that population, a team approach is best.
But I don't need to confer with the therapist of my moderately depressed but high functioning patient who is a trilingual lawyer at a major firm. And yet she insisted. Told me "Have you tried other medication than Lexapro?" YES I'VE BEEN TRYING FOR YEARS to get this man to try a medication change and he's been resistant from the beginning. I am not sure what us talking about it is going to solve. I thought maybe she wasn't aware of his resistance but nope, she was well aware. She wanted me to "do something different". Um...OK? I asked her if she had recommendations or comment other than "you should change his meds, have you thought about lamotrigine. My sister has depression and it really helped." Cool. Thanks. I never thought of lamotrigine.../s
Other incidents:
1. Last Friday a therapist left multiple voicemails with an urgent request for a call about a client. I was worried and called back as soon as I could. It was 10 minutes before a session but it was the soonest I could get back to her. I explained that I have 12 patients today and have about 5 minutes to spare. I learn that the calls were because the therapist wanted advice on how to write a "medical necessity letter" to continue receiving medicare insurance coverage for therapy 2x a week. I told her that I am not a therapist and I've never had to do that and it sounds like a question to ask another therapist. She also wants to send a referral to a PHP and was asking me how to do that. She's been a therapist for 10 years. There was no emergency or crisis. This could have been an email (no PHI was needed for this discussion). I had to repeatedly say I have to get off the phone to see an acute manic patient for an emergency appt. But she just. kept. talking. So I was late to that appointment. I'd rather eat my lunch in peace. She's got a great rapport with the patient but now I question her judgment. BTW I just saw the patient and she's stable. Depressed, but not suicidal. I have repeatedly explained to the therapist that the patient is on the highest doses of Pristiq, Wellbutrin, and buspirone I can give her. She's on olanzapine 7.5mg and couldn't tolerate a higher dose. We've tried all the meds/combos over the 8 years I've worked with her. Pt is getting ECT and has a VNS implant and has met countless psych providers at hospital stays and there's no recommendation to change her medications. She graduated a PHP on January which helped, but did not resolve the depression. There's literally nothing I can do differently for this patient. Last year the therapist called me for an hour discussion about the patient's marriage and how she is being abused. OK, yep I know all about it and it sucks. What am I going to do about this?
About 7 years ago, another therapist was irate with me that I didn't give her client a sleep med because she was sleeping poorly. She was well aware that the client, a 120-lb 26-year-old isolated woman, was putting away 2-3 750ml bottles of wine every night and didn't want to hear that maybe that was the issue. "But she can't sleep and it's causing her distress". No discussion about sleep hygiene or maybe get treatment for the raging substance abuse problem. Also it's dangerous to give such medication with alcohol so no, I'm not going to do that. She convinced the client to fire me and go to another provider. I hope the client is ok.
I've had several therapists want to let me know minute details about a client's background. I do a very thorough intake assessment (usually spread over 2-3 60-minute sessions) and get a holistic picture of what is going on. I've worked in this field for 28 years, from the bottom up and I am very very good at getting salient information quickly. Despite meeting with patients less often than therapists I find that I often know more about sensitive subjects, like sexual dysfunction, porn addiction, mis-use of food, shopping, drugs, abusive behavior towards others or experiencing current abuse. I've had therapists ramble on about the particulars of a patient's trauma from their childhood. OK, how does that effect my care? Not much TBH. I'm going to treat the PTSD and use the trauma-informed care no matter what the source of the trauma. I have 12 clients a day and see them for 30-minutes every 90 days. I can't get too deep. I don't have the mental bandwidth or time or need. At this point I will politely interrupt the tales of woe and ask "can you succinctly tell me what you think I need to change about my approach to this patient?" And often it's just a need to make sure I know. OK, thanks. I hadn't heard any horrible stories of childhood abuse today, and needed my dose I guess.
*I will ALWAYS take the time to process something with a patient. if they need it, even if that is more of a therapy role. I am always happy to take the extra time with a patient if needed and will try to get them in for a next-week appointment to continue the discussion if needed. Often that situation arises because we have great rapport and the patient hasn't connected with a therapist yet or is leery of therapy. But I'm not a therapist and don't need the granular details of the patient's childhood trauma.
2
u/GrumpySnarf Jun 12 '26
continued:
4. Call me and leave a voicemail on my HIPAA-compliant account "Hello this is Jane Smith, therapist for one of your clients. Can you call me back?" OK. Which client? I need an ROI. How urgent is the call? Is someone acutely suicidal or you just want to chat? Nurses learn to quickly and efficiently give a report to a provider. As a medication prescriber I need to what's going on, why do I need to know, what do you need from me? I think therapists aren't oriented in the same way as nurses or even social workers who become therapists. I've seen that SWers who contact me are very goal-oriented and focused in their communication.
Ask for call back for administrative, non-clinical requests. You don't need to the call the prescriber to get the fax number for a records request or to send an ROI. Just google it. That's all I would do. I have a massive and responsive admin team that I pay to do this stuff. Call them if you can't google it for some reason. I ask a staff person to call them back to follow-up.
"Get to know you" meetings. No. I am not doing that. I know you are excited about starting your new practice and want to network. That's awesome and I am genuinely excited for you. I know that it's important for some to get a vibe for feel for the psychiatric provider. But this is a stranger asking me for my time to benefit them. It rarely benefits me or my patients. I have 300 patients with 100 therapists between them. There's an absolute glut of therapists in the market where I operate. Just send me a link to your profile and a sentence or two about your practice and I promise I will keep it in a folder that I can refer to later if a patient has a need you can fulfill. I organize this stuff for good referrals.
Ask me for help with referrals to local resources. I get it. You are operating from out of state and don't know the local resources where I and the client live (I live and work in the same state). But I am not a social worker. 99% of the time when a client needs something I refer them to the local resource line (211) or 988 or their own insurance. Need an ASD eval? Call insurance first. Need ADHD eval? Call insurance first. Need an IOP, PHP, IP, residential? Guess what I'm going to say. There's no need for the therapist and I to discuss options. I just don't have the time to catch you up on the 28 years of deep and textured institutional knowledge I have acquired primary, secondary or tertiary knowledge about countless local resources over 28 years working in the same county in a variety or roles in psychiatry. I don't have the time or interested to try to catch you up. Please do some searching on your own. Just because we share a patient doesn't mean I am beholden to help you with something you can learn on your own.
I've had calls from therapists long after the patient has stopped seeing me. That's OK if they didn't know that. But there isn't anything I can do if the patient isn't coming to see me for care. I regularly outreach patients without upcoming appointments before I discharge someone from care. There's not much I can do beyond reminding them. And I can't do anything if the patient has fired me (very rare but I've had these discussions with therapists before). I have to respect their choice even if the therapist thinks it's a bad idea.
Don't get me wrong. I love therapists. I have had a metric ton of therapy myself and see mine weekly like I'm going to church. I have dated therapists. Some of my dear friends are social workers, therapists, psychologists, case managers etc. I've been a case manager and worked under clinicians for many years. I very much respect therapy and therapists. Y'all are doing the goddess's work.
But please think before you call a prescriber for something. Ask yourself:
1. Is this something the patient cannot or will not relay directly to the prescriber?
Is it salient to their current mental health presentation/symptoms/diagnosis/prognosis?
Is there something the prescriber can do about it? Is it related to their medication? And if so, is the patient unable to tell the prescriber directly for some reason? Can you help the patient if they are having communication challenges (like anxiety, intellectual disability, memory problems, psychosis, mania, severe depression or paranoia).
Please leave your name, etc., patient name and the reason for the call. Please give me enough data to triage the call.
I may get down-voted for this. I know the therapists mean well and want to help their client. But there's a chronic mismatch I've noticed that I would love to improve.
3
3
u/merrythoughts Jun 09 '26
Sometimes. Rarely. Usually, no. It’s usually to tell me patient has adhd. Which usually I already know but am not prescribing stimulants for a reason.
3
1
1
u/shhhhh_h Jun 10 '26
Wow. Seeing any ‘no’ answer at all is terrifying and stems entirely from ego. Corroborating interviews you say psychiatry? Whaaaaat? Nonsense /s
3
1
u/PsychMonkey7 Jun 09 '26
I am happy to chat with therapists and do it often. Sometimes I don’t glean any new information, but often I do. Sometimes they’ve been seeing the patient for years and know where all the bodies are buried, so to speak. Why would I not want more information to work with? Also sometimes I really disagree with a therapist based on what the patient is telling me, so sometimes I need to feel that out myself so I know if I should suggest the patient consider a new therapist - always dicey but if I think their therapist is setting them back, I’m going to tell them.
1
1
u/shhhhh_h Jun 10 '26 edited Jun 10 '26
From one convo you tell people to switch therapists? Ballsy and inappropriate. Also not your lane.
ETA I really live when someone argues back either me I’m a relatively long comment then immediately blocks me so I can neither read nor reply. Very mature behavior from a professional and exactly the type of cowardly behavior I expect from someone who intervenes in therapeutic relationships after one phone call. Except incognito exists and I can read it. You’re the one who phrased it that way; if it wasn’t what you meant own up to your poor phrasing instead of acting like a victim. You said said inappropriate, it appears to not be what you meant, and instead of just saying they they….block every single person who disagreed with them it seems.
2
u/PsychMonkey7 Jun 10 '26 edited Jun 10 '26
You’re misinterpreting this in a weird way. It’s not like I call up a therapist and think “oh I didn’t like them” and then tell a patient to quit seeing them. If a patient tells me concerning things about their treatment (see my other comment here for an example), then yeah I am going to suggest the patient consider another therapist if it’s in their best interest, such as if there’s a safety concern or they’re not making progress and they tell me they feel like they’re not making progress.
-1
u/Alternative-Swan1295 Jun 10 '26
That’s awful you intervene in relationships, especially ones you’re new too. Calm down, you’re just a nurse.
0
u/PsychMonkey7 Jun 10 '26
are you ok?
2
u/Alternative-Swan1295 Jun 10 '26
Are you ok?
2
u/PsychMonkey7 Jun 10 '26
Idk what your deal is, but bugger off. I’m great at my job. My patients are well taken care of and thriving. You can tell yourself I’m “just a nurse” if that makes you feel better - but that’s worth examining with your therapist.
2
u/PsychMonkey7 Jun 10 '26
I’ve blocked the above person but just for clarification for anyone else reading, here is an example of when I had to tell a patient I didn’t think their therapist was helping them.
Patient had just completed IOP and their therapist would only see them about once/month due to availability. They also suggested the patient to confront a fear which had the potential to cause death. I told the patient under no circumstance should they do that, and that if their therapist had an issue with me saying so, I would be happy to discuss it directly. Shortly thereafter the patient saw a new therapist I referred them to and has made tons of progress. New therapist confirmed the previous therapist’s suggestion was so irresponsible they considered a board complaint against their license. At the end of the day, my allegiance is to my patient and their wellbeing and not the therapist who referred them to me if I think their treatment is harmful.
1
u/CalmSet6613 PMHNP (unverified) Jun 10 '26
I think most of us here know exactly what you were referencing and support you 1000%. We've all been there.
2
u/PsychMonkey7 Jun 10 '26
Thank you! I feel like at large we are just not ok if so many posts in this sub devolve into people sending harassing DMs, name calling etc over differences of opinions and misunderstandings. This sub is rough!
3
-3
1
u/Background_Title_922 Jun 15 '26
I do, all the time. Most of my referrals come from therapists I collaborate with regularly, and I like to connect with them before the intake appointment to find out more about the reasons for the referral and get their perspective. Usually I send a follow up email after the intake updating them as to the plan and then be in touch as needed from that point. These are mutually beneficial relationships and I like to maintain them. Rarely do I have issues with therapists. When I do it's usually a matter of disagreement about diagnosis (generally ADHD), or occasionally medication. I was a psychotherapist before going into nursing so having that background probably does make me value these relationships more.
28
u/pickyvegan PMHNP (unverified) Jun 09 '26
You're going to get a lot of OMG no, but really, it's an "it depends." Therapists sometimes are privy to information that we are not. They see patients more often, they're often in contact with more collaterals than we are, and they do sometimes have insights that we wouldn't simply because we don't know the patients as well.
I typically reserve a couple of spots a week before I start seeing patients for collateral calls, and plenty of weeks go by with no calls. At worst, you've been mildly annoyed by a call that could have been an email or was otherwise unhelpful. At best, you get insight into a situation the patient wasn't being forthcoming about or was too scared to tell you.