The Praxis Planner

When we talk about service in healthcare, we often think about access, affordability, or follow-through. And those things matter. But to me, being of service starts somewhere more foundational: with listening. Deeply listening.

For mothers, especially those in the perinatal period, being truly heard can feel radical. Many come to our initial appointment feeling dismissed, labeled, or overlooked by systems that moved too fast to ask the right questions. Sometimes the deepest need isn’t for a new medication or referral, but for someone to pause, and ask “Tell me about your story. About your journey to motherhood.”

Because psychiatric care that actually serves moms doesn’t start with a checklist. It starts with connection.

Mental Health Care That Honors the Story, Not Just the Symptoms

What looks like anxiety might actually be vigilance—an alert, primal scanning for threats to a tiny life they grew inside their body for 40 weeks. It might be hesitance—not about love, but about stepping into connection with a brand-new human who feels at once familiar and entirely unknown.

What appears as anger could be grief for the birth she imagined but didn’t get to have. Beneath the rage, there might be years of quiet self-abandonment—people-pleasing, accommodating, pushing down needs—that now erupt under the weight of postpartum demands. There’s a friction between who she has always been and who she is becoming—a mother practicing boundaries in a new way, not just for herself but to fiercely protect what is hers.

Joy, too, is layered. It may show up as awe—an enchantment with this tiny being, with her own capacity to endure, nurture, soften, and rest. She may feel proud—of her resilience, of her body, of surviving what felt unsurvivable. And maybe, in rare and sacred moments, she feels validated. Not for what she accomplishes like she has worked for in the past, but for simply being. In those moments, she is centered. Empowered. Capable.

Even something as simple as “I don’t feel like myself” or “Today was a good day” deserves more than a checkbox—it deserves curiosity. Because beneath every feeling is a story, and mothers deserve space for their full humanity to be seen, heard, and honored. When I meet with patients, our longer appointment times aren’t just a luxury—they’re a clinical necessity. They create room for what’s not on the intake form: their feelings about the changing nature of their relationship with their partner, the intrusive thoughts no one wants to admit out loud, the unprocessed trauma that’s resurfacing in the early hours of new motherhood or as they watch their child experience challenges at the same age they recall experiencing something similar.

When we take the time to hear the full context, our treatment plans become not just more accurate—but more human.

Everything I’ve shared here comes from years of listening—really listening—to mothers: my patients, my colleagues, my friends and family, and stories from other women that sit on my bookshelves. Their stories, their fears, their quiet joys, and their unspoken griefs have shaped the way I practice and the way I understand motherhood.

I’m currently pregnant with my first child. And while I bring to this moment the lens of a psychiatric provider, therapist, and lactation counselor, I also know: I may know the theory, but motherhood is something you live. No one is exempt from the vulnerability of becoming.

Since sharing my pregnancy with patients, I’ve often heard, “Oh, you’ve got this—you know all of this already. You’re [fill in the blank with the degrees or roles listed in my email signature]” And my answer has remained the same: “No one lives through motherhood without being transformed–and deeply humbled.”

So I offer these reflections not as someone speaking from the other side, but as someone walking alongside—bringing my own layered story of femininity, fertility and conception, loss, and hope. I carry the education, yes—but more importantly, I carry the willingness to keep becoming.

Psychodynamic Roots: Hearing the Unspoken

My background as a therapist shapes everything about how I practice psychiatry. I was trained to listen not just to the words, but to what’s beneath them. A flat affect might hide exhaustion, or grief, or protective detachment. A quick “I’m fine” often signals someone who has learned that their needs won’t be met, so why even name them?

When a mother says, “I’m just overwhelmed,” I hear that. But I also ask: What kind of overwhelm? Is it the kind that comes from lack of sleep and decision fatigue—or the kind that comes from feeling invisible in her own life?

This is the work of listening deeply: tracking not just symptoms, but meaning. Holding space for the mother’s inner world—not just her role, her function, or her diagnosis.

In doing so, we help her reconnect with the parts of herself that may feel buried under the weight of motherhood.

Honoring the Full Emotional Landscape of Motherhood

One of the greatest disservices in maternal mental health is the pressure to keep things tidy. The smiling baby photos, the “you’re so lucky,” the subtle messaging that any deviation from joy is a personal failing.

But motherhood is vast and contradictory. It holds love and fear, joy and grief, hope and rage…sometimes all before breakfast.

At Praxis Mental Health, I work to create a space where mothers can speak their full truth. Where they can say, “I love my baby, but I miss my old life,” or “I kind of like being back at work; does that make me a ‘bad mom’ ?” and not be judged. Where they can cry over a traumatic birth, or feel disconnected from their partner, or admit that breastfeeding makes them feel trapped. Where they don’t have to rush to fix it or make it sound okay.

Because emotional honesty is not pathology. It’s humanity.

When we honor the full range of emotion—without minimizing or overpathologizing—we invite real healing. We remind mothers they are allowed to be whole.

Listening as a Radical Act of Service

Listening sounds simple. But in a system that rewards speed and output, deep listening is a radical act.

It means slowing down in a culture of urgency. It means presence in a field often shaped by productivity. It means being willing to hear the messy, nonlinear, emotional truth—without rushing to clean it up.

And it changes everything.

When a patient feels heard, she opens up. She shares the real story. She’s more likely to engage with the treatment plan we create together. She’s more likely to believe in her own capacity to heal. The medication may be the same, but the outcome is different—because the relationship is different.

Rooted in Service: A Model That Honors, Not Silences

If we want to serve mothers, we must listen to them.

We must build systems that allow for nuance, complexity, and emotional truth. We must create spaces where mothers are not treated as vessels or patients to be managed, but as full human beings in a sacred and often overwhelming transition.

This is what being of service looks like in maternal mental health. Not just offering treatment, but offering ourselves—our time, our attention, our presence.

And it starts with listening first.

I didn’t set out to become a psychiatric nurse practitioner. In fact, for a long time, I didn’t even know the role existed. My first experience with a nurse practitioner was in dermatology—I saw him for years and just assumed he was a physician. I remember being surprised (and impressed) to learn I had been seeing an NP all along. Even then, I had no idea NPs could specialize in psychiatry.

It wasn’t until I was deep in my Marriage and Family Therapy program that a quiet curiosity started to grow. I remember sitting in my clinical diagnosis class—memorizing the DSM, learning clinical assessment, and generating differential diagnoses—and wondering if there was another path that blended the medical and psychological aspects of care. I had a quick “should I have gone to med school?” moment, but I stuck with the three-year program I was already in. I went on to complete the 3,000 clinical hours required for licensure, working in both community mental health and private practice.

But something shifted during those 3,000 clinical hours, when one of my long-term therapy clients—after months of feeling stuck—agreed to try Zoloft following several conversations about a psychiatry referral. Six weeks later, she came in and said, “I can actually use the tools we talk about now.” It was a pivotal moment. I started to realize that insight and change often require more than one modality—and that understanding neurobiology, pharmacology, and brain-based treatment approaches could amplify therapeutic outcomes in a powerful way.

At the same time, my husband, who was working as a medical assistant, mentioned a provider in his community clinic who wasn’t doing typical primary care—instead, she focused on motivational interviewing and behavioral health. I looked her up—she was a psychiatric nurse practitioner—and I was immediately intrigued. Still, it wasn’t until later, when my husband started nursing school, that something really clicked. I became obsessed with his coursework. I couldn’t stop asking questions, diving into what he was learning, and the thought came rushing back: What about that psych NP?

He encouraged me to go back to school, and once the idea took hold, there was no letting it go. One thing about me — when I feel deeply inspired and a path truly aligns, I move. Fast. Within days, I had signed up to retake all of the prerequisite science classes I had completed in undergrad but had since expired. I gathered all my application materials for Case Western’s MN to MSN Psychiatry program, knowing my husband planned to stay in Ohio and work in the Cleveland Clinic CVICU. It all made sense. It all lined up. And there was no question in my mind about wanting to be a Psych NP.

I completed my training at Case Western Reserve University’s MN to MSN Psychiatric NP program. It was an intense 3.5 years, but it gave me the clinical depth I had been craving—the ability to approach psychiatry not only through the lens of neurobiology and pharmacology, but with the nuance of someone trained to understand human behavior, relational dynamics, and the unconscious. My background as a licensed therapist had taught me how to attune, how to sit with complexity, and how to understand the deeper roots of distress. But stepping into the psych NP role allowed me to integrate that insight with the medical knowledge needed to diagnose, prescribe, and treat from the whole picture—mind, brain, and body.

For me, becoming a psychiatric nurse practitioner wasn’t just about expanding my scope; it was about bridging the art of psychotherapy with the science of psychiatry. It gave me the missing link I needed to offer care that’s deeply relational, evidence-informed, and grounded in both clinical precision and human connection.

Scholarship isn’t something I do on the side—it’s core to how I care for my patients. I’m constantly reading, studying, and translating complex research into tools that people can actually use in real life. Whether it’s understanding the latest findings on ADHD, reviewing neuroimaging research on trauma, or debunking myths around psychiatric medication, I believe that staying curious and informed is a way to show up more fully for the people I serve.

In my practice, I don’t just prescribe—I collaborate, educate, and adapt care based on what the research says and what each patient uniquely needs. Because at the end of the day, scholarship isn’t about collecting knowledge. It’s about making that knowledge meaningful.

(AKA – Rule #1: you have to like your psychiatric provider)

Research consistently shows that the quality of the therapeutic relationship is an even stronger predictor of treatment success than the specific modality used by a psychotherapist. When we talk about psychiatric medication, we often focus on the pharmacology—the mechanism of action, side effects, dosage, and clinical efficacy. These are, of course, vital elements of care. But what often gets overlooked is something less tangible, yet profoundly impactful: the therapeutic relationship between the patient and provider.

Medication Works, But Context Matters

Psychiatric medications have changed countless lives. Antidepressants, mood stabilizers, antipsychotics, and other medications can be essential tools in the treatment of mental health conditions. But mounting research shows that how these medications are delivered—and by whom—can significantly influence their effectiveness.

A 2011 study by Roter et al. found that patients who felt emotionally supported by their providers reported better adherence to medication and, notably, better outcomes. In fact, the perceived warmth and competence of the provider were strong predictors of treatment success. Similarly, a meta-analysis published in Psychotherapy (Norcross & Wampold, 2011) emphasized that the quality of the therapeutic alliance is as predictive of outcomes as the specific treatment modality—including pharmacotherapy.

The Power of Liking and Trust

Simply put: people are more likely to take medication from someone they like. When a patient feels that their provider genuinely listens, understands, and respects them, this fosters trust. That trust then becomes the foundation for better engagement, honest communication about side effects or hesitations, and a stronger commitment to the treatment plan.

Consider two providers prescribing the same medication. One takes the time to listen, validate the patient’s concerns, and offers psychoeducation in an empathetic, collaborative manner. The other delivers the same prescription quickly and with minimal dialogue. Despite the identical pharmacology, the outcomes may differ significantly. The difference lies not in the pill, but in the relationship around it.

Integrated Skills: Why Psychotherapy Skills Matter in Psychiatry

While not every psychiatric visit is a full psychotherapy session, providers who bring therapeutic skills into medication management visits often enhance outcomes. Empathic listening, reflective responses, motivational interviewing, and other psychotherapeutic techniques can transform a brief med check into a meaningful interaction. This not only strengthens rapport but also deepens insight and supports behavior change.

Psychiatric providers trained in psychotherapy are better equipped to hold space for complexity. They can recognize when symptoms are rooted in unresolved trauma, relational patterns, or existential distress—and they can integrate this understanding into a more holistic medication strategy.

The Power of Listening: Lessons from “Every Patient Tells a Story”

Dr. Lisa Sanders, in her book Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, illustrates how listening to the patient’s story is often the single most important factor in arriving at the correct diagnosis. Sanders, who also served as a consultant for the TV show House, M.D., emphasizes that while diagnostic tests and technology are valuable, they are no substitute for the human narrative. She writes that a careful, detailed history is responsible for the majority of accurate diagnoses in clinical settings.

This aligns with my practice philosophy. I do not rush the intake and assessment process. My longer session times allow space for listening—not just to symptoms, but to the context in which those symptoms arise. I incorporate a thorough mental health assessment and, when applicable, a targeted physical examination, because they are foundational to building an accurate diagnostic picture.

Unfortunately, insurance models often fail to account for this. They prioritize speed and volume over accuracy and relationship. But this short-term mindset misses the long game: proper diagnosis leads to proper treatment, which leads to faster symptom remission, reduced suffering, and ultimately lower long-term healthcare costs. Listening saves lives—and money.

Conclusion: Medication and Relationship Go Hand-in-Hand

Medications are powerful. But they do not exist in a vacuum. The context in which they are prescribed—especially the therapeutic rapport between provider and patient—can dramatically shape their effectiveness. When patients feel seen, heard, and valued, they are more likely to engage meaningfully in their care.

As mental health professionals, we do not just prescribe medications. We offer ourselves as part of the healing process. And that makes all the difference.

References:

• Roter, D. L., et al. (2011). The impact of patient-centered communication on patients’ decision making and evaluations of physicians: A randomized study of medical consultations. Patient Education and Counseling, 84(3), 386-392.
• Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102.
• Kelley, J. M., et al. (2014). The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 9(4), e94207.
• Sanders, L. (2009). Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis. Broadway Books.

Since I began practicing as a therapist over seven years ago, I have always believed that the insight gained in therapy must lead to action for lasting change. My appreciation for insight stems from my training in psychodynamic psychotherapy. In essence, this approach is about understanding why we feel and respond the way we do.

Much like a wind-up music box, where the beautiful melody comes from hidden gears and springs working together inside, our feelings and behaviors often come from hidden parts of our minds—those internal parts shaped by early relationships and experiences, both known and unknown to us. In psychodynamic therapy, we “open the lid” to explore those internal gears and notice how our “gears,” or past experiences, memories, and unconscious thoughts, work. By understanding how these hidden parts influence the “music” of our emotions and actions, we gain insight into ourselves.

However, just knowing how the music box functions isn’t enough to change the melody. We also need to adjust how we wind it up and care for it. This is where action and behavior change come in; they are like turning the key differently or playing a new melody. Just like our minds, music boxes need occasional tune-ups to keep playing their melodies. Some music boxes from over 100 years ago still work, although their music may sound a bit off-key due to dust, rust, wear, and tear. With a correct assessment and understanding of what needs care,  we can adjust and mend the internal parts – they can then continue to play us their tunes.

In psychiatry, we do this as well. We use therapy and insight to explore the “dust” of past experiences and the “wear and tear” of how old patterns or untreated dis-ease impact our life. Through action – whether behavior change, medication, lifestyle adjustments – all within the context of a relationship with a provider we trust we can keep the inner music playing. By using our insights to make real changes in how we respond and behave, we can create new, more harmonious “music” in our lives. The new name, Praxis, reflects our commitment to helping you gain insight and create lasting change through action.