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On Collaborating with a Patient's Team: A Conversation with Courtney Joachim

Today, Alannah & Courtney dig into how Courtney, Windhorse's in-house Certified Psychiatric Mental Health Nurse Practitioner, collaborates with a patient's existing team - from therapists, primary care physicians, and school counselors to a patient's friends and family. Courtney delves into how these relationships greater serve a patient's mental health journey and informs her work as a patient considers medication.

Courtney also discusses how her field is shifting to a more holistic, human-oriented model. Read the conversation below and be sure to stay tuned for additional interviews with Windhorse Counseling collaborators.

ALANNAH: Can you describe the overlap in your work with a client's primary therapist, whether they work at Windhorse or not?

COURTNEY: I usually ask for clients’ permission to speak to their therapist first.

If a client is at a point where a therapist is suggesting medications or at least a consultation to learn more about the process, usually they've been working together for a while. If they have been working together and have a good relationship, their therapist may be able to offer me a sense of what they feel is going on and we can collaborate from there.

I like to touch base with their therapist and care team before we prescribe anything. Speaking with a physician can offer a more comprehensive picture of what’s going on. If we move forward, I let the therapist know what we're prescribing and what we're trying to look for in terms of changes. I let a patient’s therapist know they can communicate with me as easily as my patients.

I touch base with people's therapists at least once a month. Anytime a patient is coming into my office, I make sure to see if they're still showing up to therapy, if they're still doing the work, and still engaging with it. Medications can't work on their own. Medication can raise the bar a little bit, but it cannot bring us to the next level without the additional work we do in therapy. Oftentimes a therapist is seeing a patient more often than I am, so if they have concerns or notice anything different, they know they can reach out to me.

It's helpful to have a larger care team. Each team member has an understanding of a patient’s goals but from different contexts. When I see patients once a month, progress seems a little bit different than someone who's seeing them every single week.

When our visits are spaced out a little bit more, it's a little bit easier for me to say, “Hey, actually you're doing a much better job than our previous meeting and we’re seeing improvements.” But, when you're in it every day, it's kind of harder to see that larger-scale progress. And the reverse is also true. When a therapist is seeing one of my clients monthly, a lot of times the progress that they see helps me calibrate.

ALANNAH: Are there other specialists you love to collaborate with on behalf of a patient?

COURTNEY: I love collaborating with patients’ medical teams. There are a lot of mental health disorders that can either be exacerbated by a biomedical condition or a medical condition that can be presenting as anxiety or depression. I believe that our physical and mental health are totally entwined. So, if a patient’s PCP is up for being in the loop, I’m all about that. Together, we can track physical symptoms, how a patient is taking care of their mental health, and even determine if their physical health is making it harder to care for their mental health.

It’s also rewarding and exciting to work with a patient’s family. Facilitating conversations that might feel difficult can be really helpful and allows family, friends, and partners to understand how to support a patient.

In terms of our adolescent clients, working with a school counselor is really helpful. It’s similar to therapists because school counselors are often meeting with kids more frequently. They can see patterns that I'm missing or often valuable intel before my own monthly meetings with a patient.

ALANNAH: There are definite shifts currently happening in your field. How are you growing and adapting to those changes and how does that change the work you do with your clients?

COURTNEY: I try to be a little bit different than the run-of-the-mill psychiatrist. There’s a valid assumption that, during psychiatry appointments, patients will sit in a stuffy room, describe their current side effects, receive a change in dosage, and be on their way.

These medications often make patients nervous and for a good reason. I believe professionals in this field need to honor patients by asking more questions, explaining what to expect and how to prepare, and making patients feel comfortable and supported. I want patients to feel comfortable with me and feel like I'm supporting them through this journey instead of just like saying, “here’s your prescription - I'll see you next month.”

I encourage patients to email me between appointments, ask for an earlier appointment date, reach out with questions. It can be scary to start taking medications and feel like you’re on your own.

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