[Razzleberry]

I like them both, a lot, so far. I've been going to my therapist since April 1st, and my psych nurse since April 24th, once a week for each of them.

But my psych nurse said at our last session, that she could offer medication management or therapy, or both , but if I'm just going to her for the medication side, she would have to cut our appointments to 15 minutes from now on, and bi-weekly instead of weekly, for my insurance to approve the visits. And I can't see both her and my therapist for therapy, the insurance won't pay for both.

She left it for me to decide - whether to go to her for both meds & therapy, or continue going to my therapist for therapy and just see her for meds.

I'm conflicted! I like them both. But I'm not sure I want the shorter sessions with my pnurse.

I guess I'll just keep going to both for a while, and see how it goes with the shorter med appointments.

But in some ways it would be a lot more convenient & cost-effective to just see my pnurse, and not the therapist. I would only be paying one copay a week, not two. That saves me $50/month. And then it's just one appointment I have to fit into my schedule, which also helps since I work and have classes on Fridays & Saturdays.

But then...I do like my therapist, and he can do hypnotherapy, my pnurse does not do hypnotherapy. I do want to see what that's like, just see if I like it or not - never tried it. Curious about hypno-birthing too if I ever have another child, and if I try hypno-therapy I could learn the techniques to use for that later. And, he works in his wife's physical therapy clinic, so he will allow me to use their gym to work out, for free!! That is a huge bonus that you rarely get with a T!! He will even be my personal trainer if I want.

But...(ok...lots of buts!) if I continue to see both of them, then I'm not really "saving" any money by using his gym vs. singing up for the YMCA. It would be $30 bucks a month to use the YMCA gym - versus at least $50 a month more in copays to see both of them. And I didn't ask him this, but I assume he would want me to pay him if I used him as a personal trainer.

And...money may be tighter for us now, because I'm going to go part-time at work from now thru July. And I have to pay for the hotel stays & gas to get to my CPA review courses (they are in a bigger city, 3 hour drive away). Gas is $4 bucks a gallon now, and my Subaru gets decent mileage but it's no hybrid! Boss paid for the tuition and test fees, but won't pay for the travel since I chose to do the in-class version instead of the online or CD version of the course. I did in-class so I could stay on track - I always procrastinate and slack off if I'm studying on my own.

Gosh, I just don't know. What would you do? Keep seeing both for a while? Go to the pnurse for therapy, quit seeing my therapist?

[(JD)]

I suggest - and this is just my opinion - that you continue with both. If you cut out your visits to your T entirely, it might be tough to get back in to see him, not only physically with his appointment schedule, but emotionally after not seeing him for a while..and having to play "catch up." If you keep both, then you will be on track just as you are now... and I'm sure you can sneak in a comment or two with your pnurse if you need it. It's easier to see if it will work for you that way, and change your mind later (if you see both still, though cutting back on pnurse) than if you cut out one completely and then change your mind, don't you think?

Personally, I do not think you should be using your T as a personal trainer and a T. This to me is a dual-relationship and while it is NOT a friendship or romantic relationship, there is another element involved outside the therapy relationship, which could introduce all kinds of problems.

I think you need to ask yourself what you want to get from therapy. Why do you feel you need hypno-therapy (and please don't say to recover memories because that is a huge no-no)?
That seems to be the only therapy reason you are suggesting sticking with your T and not going to your pnurse (besides the gym)

Your last post about your meeting with your pnurse was extremely positive and it seemed that you were beginning to connect with her on a therpeutic level....Beginning to trust her. What about your T?

[Razzleberry]

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Riptide said:
Personally, I do not think you should be using your T as a personal trainer and a T. This to me is a dual-relationship

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Good point. I hadn't really thought of that. But he did say I could use the gym even when he's not there, he'd just show me how to use some of the equipment. But yeah....good point.

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Why do you feel you need hypno-therapy

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I don't think I "need" it per se, just thought it would be interesting to try and see if that helps. I'm willing to try any technique to help figure out my issues and work thru them all.

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Your last post about your meeting with your pnurse was extremely positive and it seemed that you were beginning to connect with her on a therpeutic level....Beginning to trust her. What about your T?

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Well, they both have a very different "style". My Pnurse was an ER nurse for something like 15 years before she got her MSW and became a psych nurse. And, she's a woman. She just has a lot more of the caring, compassionate, I-want-to-help-you kind of style.

My therapist, on the other hand, is very...hmm, what's the word? Academic? He's always explaining the research behind different theories. Not so much the kind of person who would give you a hug - but the kind who would tell you which chemicals in your brain will react to a hug.

Does that make sense?

Anyway, I do like both of them. But cost is one issue, and if for some reason my pnurse doesn't work out, or whatever, I would have a backup at least on the therapy side.

Hmm...just something to consider. I have until next Thursday to decide.

[sunrise]

I vote for the pnurse as you seem to like her, connect with her, and will be able to get one stop shopping for your therapy and your meds. Seeing your pnurse for therapy may aid her in choosing the right meds for you. I understand why she doesn't think you should have regular therapy with 2 different therapists.

Maybe you can see the other therapist occasionally, like once every couple of months if you want to keep contact and avail yourself of what he can provide. And then you would have him in your back pocket in case after a while you decide that the pnurse was not the best choice for therapy.

If it turns out you do choose the pnurse for therapy, and the two of you decide you need hypnotherapy, she can refer you out just for that service to the other therapist or to someone she is used to working with.

I'm curious, Razzleberry, how does your pnurse's fees compare to your therapist's? (And how do her fees compare to a pdoc?) I am going to be seeing a pnurse next week and I have been wondering about that.

[Razzleberry]

I'm not totally sure on the fees. I just pay my copay for insurance. I know my therapist charges $90 an hour without insurance. I'm not sure of my pnurse's rate.

A Psych Nurse will always be less money than a Psychiatrist.

And a Social Worker / Therapist without a PhD will always be less money than a Psychologist.

I don't know about pnurse versus social worker/therapist - I would assume they are about the same per hour.

[(JD)]

I also considered the dual relationship aspect, but considering you are in Oregon, and I guess it could be a smaller than usual town, and with the APA allowing for some dual relationships in that respect, I figured your T wouldn't have brought it up if it were inappropriate.

IDK he might be needing to utilize it to get part of you to trust him better That's up to you.

[sunrise]

Thanks, Razzleberry. My T told me to expect the intake appointment with the pnurse to be about $250. I think a pdoc around here charges about $400 for the same service. The brief, regular appointments for both that come later would be less, of course, but I have no idea how much. My T is $125/50 minutes. I'm very curious about the fees of the pnurse as I don't know where she fits into the hierarchy. My regular family doctor charges $125 for a brief appointment (~15 minutes), so I would guess the pdoc would be more and perhaps the pnurse less? Well, kind of off topic--sorry. I don't think I've seen much posting on pnurses before so I was curious as that's who I'm seeing too.

[Razzleberry]

You know what, I just remembered....2 years ago my old psych nurse sent me a bill for $600 after we realized she wasn't on my insurance...long story...but that was for 4 visits, including the first big visit. So...if the first one was maybe $250 then the rest were maybe around $125 each? I don't know for sure, and that was 2 years ago in a different state.

I know - I also don't see much on Psych Nurses on here. Thought maybe I was weird that I was going to one. I had a really horrible experience with a psych nurse 2 years ago, so that clouded my judgment.

But I don't know...I think I was almost "meant" to find the psych nurse I'm seeing now. I was actually trying to get an appointment with the Psychiatrist that works in her same office, but she was booked out for a long time. So she offered this psych nurse. At first I resisted, heck probably almost a month that I thought no, a nurse won't be good enough. But I finally went to her when I was almost suicidal and I really needed meds. She has been a godsend for me. Maybe literal. I don't know what I believe, but I really think things happened for a reason here.

Okay so after that paragraph maybe it's clear!! I really love my pnurse. I think part of it is that I don't want to insult my therapist, he was doing a really great job, and he squeezed me into his schedule three weeks earlier than the pnurse (in april), since I was in so much distress at the beginning. He has been very accomodating with scheduling.

Hmm...another thought I just came up with. Just go to my therapist for PHYSICAL therapy (exercise) and go to my psych nurse for meds & therapy?! That just might work. Hmm....ok I think I made a decision!! I'm going to call my therapist and ask about the exercise stuff.

Seriously, these meds are working wonders. I've made several good, rational, BIG decisions in the past few days. It's strange, but I'm really doing so well. Thank you pnurse!!

well... personally i have a bias *against* pnurses altogether so i cant give a fair opinion on her really... BUT.. i would suggest both as well. My inclination is toward a seperation of med and therapy... and that is what i have for myself. i really like it that way. i find the therapeutic relationship can be really tough to handle at times... overwhelming and we cover a lot of really sensitive stuff... i would have a harder time with the med side of things if my T were doing that.

maybe T did nnot mean he would be your regular PT.... and honestly, it doesnt mean a dual relationshipp anyway. Many T's here have pain management as part of their practice for example... they have gymns attached to their office complexes and will do some physical exercises with clients. i firmly believe in whole person wellness approaches... afterall, exercise helps with depression, no? Using exercise as an adjacent sort of treatment (doesnt HAVE to be depression) is a great idea i think. It would be dual if he were suiting up to go work out with you at the Y.

razz... have you noticed the tendency towards putting yourself into rock and hard place type decision making? Nothing bad intended.. just noticed it... so i would suggest you just not make that a thing you have to waffle over.. set it aside. You don't *have* to make this decision right away and you have so much else to think about. $50 isn't worth working yourself into a knot at this moment... decide to decide later.

oh.. one last thing... touches on the bias i have, but i'll be brief and *try* not to be judgemental toward her (not you... you're fine ). Remember that she is a psych *nurse*... which is cool and she has training, etc.. not trying to diss.. BUT.. she is NOT a psychologist with all the training associated there with, nor a psychiatrist. She consults with a psychiatrist when she is uncertain and does reporting regularly... i'm preeeeetty sure the same is not true with the psychologist aspect.

now.. before anyone gets mad... no, a T does not have to be a PhD, mine is an MSc. The definition of "therapist" is pretty open. The definition of "psychologist" is not. But if you are dealing with multiple issues, meds, etc... and Razz, in your case, a very complicated behavioural problem set.. personally i would choose the trained psychologist, rather than the pnurse. In just my own opinion... if you are considering intensive treatment, etc... would you not want the major portion of your treatment to be handled by the person with the specific direct training indicated?

(please.. no one get upset... therapy can work with other sorts of T's, i'm just speaking specifically about Razz's issues and the possibility of needing deeper training than someone other than a psychologist might have)

not saying razz that you are messed up more or anything.. just that your problem right now is delicate and complicated.

[Razzleberry]

Jello, thanks, and I think you're right. Not offended, I know I have issues.

My therapist has a PhD but he's not a psychologist - he got his PhD in something else (which I keep forgetting what it was!) But yes, he is much more knowledgeable about the "why's" behind certain moods and emotions. My pnurse is just more of a shoulder to cry on and uplifting compassionate person.

My opinion on pnurses was also fairly low until I met her. I actually refused to see her the first time that psychiatrist recommended it. The Psychiatrist was booked for more than 2 months, and she offered this pnurse that I"m seeing now. Now - I'm glad that I got this pnurse. But at the time, I was not very happy about it because of my prior experience with some less-than-competent pnurses.

Ok, I think you're right. Keep seeing my T for therapy, AND see my pnurse for med management, just see her less often. And if for some reason I decide I don't like my T, I can always switch that around.

[sunrise]

That sounds like a good solution, Razzle. It is so rare to find mental health professionals that we like, can connect with, and we think are good, so it is totally wonderful that you have found two such people!

The pnurse-practitioner I will be visiting (first time) is also a master's level therapist. Even though I won't be seeing her for therapy, I actually really like that she is a therapist too. It makes me think she will take a more holistic approach since she is not just a meds person. Who knows, but I shall see.