A psychiatric nurse practitioner shares tips for therapy, part 2

Last in a series. Read part one.

In my last column, I wrote about mental health issues and shared some advice from Alexis Ryan, a psychiatric nurse practitioner that my wife, Jill, sees to help her cope with Huntington’s disease. In part two of the series, I inquired about the importance of having a therapist who empathizes with their patients. Excerpts of my conversation with Alexis follow.

CB: In addition to therapy, you also manage medications. Jill likes that she doesn’t have to see multiple specialists to care for her mental health. Why is that an advantage?

AR: Nurses are trained to focus on the person first and to assess their symptoms within the context of their full personhood. The more holistic and patient-centered the approach to care, the more it resonates with me.

A psychiatric nurse practitioner is able to do a little bit of everything. We can think and assess like a nurse, prescribe and diagnose like a physician, but then we also get to strategize and coach like a therapist. And the most effective treatment for any pathology is always medication management, plus behavioral or lifestyle changes. The fact that I practice telehealth so you can meet me in your pajamas doesn’t hurt, either!

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How important is it to connect with your patients? Being open about yourself puts Jill at ease and makes her want to be open with you.

Empathy is integral to who I am. I consider myself extremely lucky to have been raised by a mother who unreservedly loved the people around her. And in my childhood, not only was I able to model her ability to express — in abundance and with great variety and joy — her affection for others, but as a near-constant recipient of her affection my whole life (lucky me), I was also able to develop the arguably rarer skill of receiving it comfortably and without self-doubt.

I would say that I learned from my mother how to love with ease. And now in adulthood, it is my default starting point with people. In my work in psychiatry, I truly begin each session with each patient already loving them. Whatever we discuss over the next hour will just help illuminate why.

I’m not a mother, but my professional role feels like a kind of motherhood. I have an unconditional love for my fellow humankind, and certainly for my patients. They may be hurt. They may be traumatized. They may be difficult or toxic or mean or hateful. But there are always reasons why. It’s my job — and my privilege — to learn the reasons why, and I promise you the reasons why are always there. They’re discoverable, if you know where to look, and perfectly logical and understandable, and never, ever, ever cause to retract love. In fact, it’s the opposite. To learn the story of someone else’s pain, for me, is to immediately love them more.

Jill shares the fact that you are nonjudgmental and feels like she can share anything with you. Why is that important?

There is perhaps no principle that I live by more than the practice of radical nonjudgment. This is immensely helpful in my personal life. It is imperative in my professional life. We only lie when we fear that our truth will not be accepted. If I can demonstrate to my clients that they will not be judged by me, then I am making it safe for them to tell me the truth. And I promise I’m not faking my acceptance of them to trick them in to spilling their secrets (which sounds exhausting). I truly do not judge.

I feel honored to briefly inhabit their intimate spaces, to walk with them through the fire of their grief, through whatever they are willing to share with me. I think one of the greatest gifts we can give to another person is the comfort and freedom to be themselves. We do this by not judging them and not judging ourselves.

Though it might scare me sometimes to do so, I delight in sharing my own vulnerability with my clients, and I delight in showing them how fierce and absolute my acceptance of it is.

What are some touchstones of a successful therapist-patient relationship?

Humor helps. Jill and I probably laugh about 50% of each session. I like to be clear about expectations and flexible to any changes in them over time. I like a lot of input from my clients and direct communication. I like to be fully transparent, not saying one thing during a session while thinking the opposite. I think the single most important aspect of a successful therapist-patient relationship is an equal partnership — truly equal and collaborative — with mutual respect and a two-way flow of information. Oh, and kindness.

Note: Huntington’s Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Huntington’s Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Huntington’s disease.