I'm Melanie, a Psychiatric Nurse Practitioner since 2020 with over 10 years in the mental health field, practicing in government healthcare and also seeing clients in private practice. In my first year as a PMHNP my training gave me confidence in diagnosis and medication. The therapy side was a different story. I wanted to do more than supportive conversation. Supportive conversation has its place but it does not promote lasting change. That is where structured therapy comes in. But not every client has time for formal therapy. Some are not ready. Some finished and gradually slipped back into old patterns and need a way back in. School did not teach me how to address any of that inside a medication visit. Everything I found assumed hour-long sessions, a therapy-only caseload, and the time and money to invest in training that was never designed for how we practice.