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The PMHNP as a Psychotherapist

As a Psychiatric-Mental Health Nurse Practitioner (PMHNP), I strongly believe in the value and importance of psychotherapy. While medications can effectively manage mental health symptoms, psychotherapy offers a unique and essential component of holistic care that society often misunderstands or devalues. PMHNPs are first and mainly educated in psychotherapy and pharmacological therapies. They comprehend mental health diseases’ complex biological, psychological, and social causes. This gives them a unique viewpoint for successful counseling. Psychotherapy allows people to safely examine their ideas, feelings, and actions (Wesemann & Handrup, 2021). It helps people understand their problems and build coping skills, self-awareness, and positive life improvements. Psychotherapists like the PMHNP help this process. Psychotherapy may treat the root causes of mental health difficulties, not just the symptoms. Medication helps manage symptoms.

Psychotherapy, however, explores an individual’s experiences, relationships, and beliefs to achieve sustainable transformation and well-being. Therapy may promote mental health by helping people understand themselves, their thought processes, and their relationships. Psychotherapy also strengthens the PMHNP-patient relationship (Wesemann & Handrup, 2021). Trust, empathy, and mutual respect make this pooled connection a safe place to discuss ideas and feelings. Psychotherapy experts like the PMHNP may provide direction, support, and affirmation to aid recovery. This therapeutic partnership helps people feel heard, understood, and validated, improving their well-being. Mental illness affects each person differently. Thus, a one-size-fits-all strategy cannot meet mental health patients’ complex and different demands. PMHNPs may customize treatment strategies using psychotherapy. They may tailor treatment using cognitive-behavioral, psychodynamic, and mindfulness-based approaches.

The feasibility of providing psychotherapy at each patient encounter is a complex topic that requires careful consideration of various factors. Psychotherapy should be offered in every encounter, but there are practical issues to consider. Time is a significant issue in psychotherapy. Due to increased patient numbers and demands, practitioners, especially PMHNPs, sometimes have short appointment times (Tanner et al., 2020). Complex mental health concerns need in-depth study and therapeutic approaches, making complete psychotherapy difficult given these time limits. Psychotherapy requires time and effort to form a rapport, analyze, plan, and intervene. These tasks may not fit within a normal appointment.

Many healthcare payment models favor pharmaceutical management over psychotherapy. Insurance firms and third-party payers prioritize pharmacological treatments, limiting therapy visits and reimbursement. PMHNPs with limited finances or financial pressure to prioritize drug management may struggle with this financial element (Tanner et al., 2020). This makes psychotherapy at each patient visit harder. Therapists—including PMHNPs—are scarce. Many rural and underprivileged areas lack mental health experts. Patients may face lengthy waitlists and limited psychotherapy access due to professional shortages. Due to the high number of patients and the shortage of therapists, psychotherapy during each patient visit may be impossible. This illustrates the necessity for collaborative care approaches, where PMHNPs engage with psychologists and professional counselors to ensure patients get the right treatment.

Each session’s therapeutic feasibility depends on the presenting problem. Suicidal thoughts, psychosis, and extreme anxiety are acute crises that need quick attention and stabilization (Tanner et al., 2020). In these circumstances, acute symptoms and patient safety may precede psychotherapy. After the crisis, a psychotherapy-based treatment plan may be created. When the primary goal is intervention and stabilization, lengthy psychotherapy may not be practical or acceptable.

Despite these obstacles, psychotherapy may be provided at each patient visit using various methods. Integrating mental health treatments into primary care may make psychotherapy more accessible. PMHNPs may coordinate medication management and short psychotherapy with primary care doctors. Solution-focused therapy and motivational interviewing may be utilized during primary care visits to integrate psychotherapy into a limited timeframe. Teletherapy and internet platforms may boost psychotherapy availability and feasibility. Virtual treatment offers flexibility and convenience. Asynchronous communication allows patients to participate in therapeutic activities and get advice between face-to-face consultations, saving time and resources.


Tanner, K., Bican, R., Boster, J., Christensen, C., Coffman, C., Fallieras, K., Long, R., Mansfield, C., O’Rourke, S., Pauline, L., Sagester, G., & Marrie, J. (2020). Feasibility and Acceptability of Clinical Pediatric Telerehabilitation Services. International Journal of Telerehabilitation12(2), 43–52.

Wesemann, D. E., & Handrup, C. (2021). Where is the psychotherapy content in PMHNP programs? Perspectives in Psychiatric Care.


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