Lisa Graziano, MS (Masters of Science), PMHNP-BC (Psychiatric-Mental Health Nurse Practitioner, board-certified), is a highly experienced and caring therapist. She is also an ANCC (American Nurses Credentialing Center) Board Certified nurse practitioner, and she has been practicing nursing for over thirty years. Her role at Explore What’s Next is to provide counseling and therapy to patients, as well as prescribe medications for all the patients who come through the doors at EWN.
I recently had the privilege to meet with Lisa over video chat and discuss with her some of the events in her life that led her to where she is today.
Tell me about your role as a psychiatric mental health nurse practitioner at Explore What’s Next.
Is it a good fit for you? Why?
Well, I’m a psychiatric mental health nurse practitioner. I fit in well at Explore What’s Next because I can do assessments, I can diagnose, I can perform therapy, and I can provide medication management. It’s pretty uncommon for a private practice to be able to offer both therapy as well as provide medication. I prescribe the medication, and clients receive therapy from either myself or one of my colleagues. One of the nice things about being able to do both is that I am able to form more of a rapport with my patients. I’m seeing them for more than once every three months for their medication. I’m also seeing them for therapy maybe every week or every-other-week.
Now during COVID-19, I’m doing things from my basement! But the neat thing I have found is that by meeting my clients over secure video chat, I have been able to see so much more into their lives. Especially in the cases of teenage and college-aged clients, they tend to be a little more reserved in the office – but now they feel free to open up a bit more from the comfort of their own homes. Some patients were reluctant to use video at first, but most people were very happy to figure it out, and it works out pretty well. It’s given people who are working (whether they are working at home or outside the home) a lot more flexibility – because I can see them at almost any time. I’ve seen some people at 6 in the morning if that’s what they needed.
Of course, I have seen a spike in cases of anxiety and depression. And unfortunately, I think it’s only going to get worse as people start returning back to their lives. In the beginning, it wasn’t too bad because people weren’t feeling the immediate effects – but now there’s the financial burden, and the isolation weighing on them. But even with all of that, they’re still safe. But once they go back out into the world, I’m afraid the depression and anxiety will really skyrocket.
But the quality of services we can provide has not changed, and we are still able to offer professional care to those who need it. If I have a patient that needs to have their blood pressure taken, they can do that when they go to the grocery store, or they can do it at home with their own cuff. The same assessments can be done over video chat that have previously been done in-person.
How long have you been a therapist?
I graduated a year ago with my Psychiatric Mental Health Nurse Practitioner Degree from uns, allowing me to become a nurse practitioner, but I’ve been a nurse for over thirty years. I got my master’s degree in Nursing Executive Leadership from Daemen College between there, as well. My dissertation was on “Necessary Practices for Effective Nursing Leadership”. I used Kouzes and Posner’s (2002) theory of five practices of exemplary leadership and conducted a study exploring the leadership behaviors of other nursing administrators. At the time, I was in a nursing administrative position, and I wanted to study the practices and habits other nursing administrators were utilizing to become most effective.
I worked in high school and college clinics for ten years, where I was doing quite a bit of one-on-one interactions with students with a lot of mental health issues. That’s when I decided to go back and finish my master’s degree so that I could do more. That way, I could prescribe, and I could do more assessments. So formally, I’ve been a therapist for a year, but I’ve been counseling patients for over thirty years.
In your opinion, what are some things that make Explore What’s Next unique as a therapeutic practice?
Not many counseling and therapy practices have a prescriber on-site. A lot of similar practices are made up of only psychiatrists. At Explore What’s Next, I’m the only prescriber among the therapists and psychologists. I get a lot of my referrals from the other therapists, and I get some from outside sources as well.
Another thing that makes us unique is that prior to the pandemic, we had the Studio @ Explore What’s Next open, where patients could come in and do things like yoga, which was a huge benefit – people were able to come in and not only take care of their mental health but also their physical health as well.
What is your relationship like with your co-workers at Explore What’s Next?
They’re awesome! It’s really a great group of people. I started as an intern with Dr. Aletta, and I interned for a year. During that time, they welcomed me right on board. It’s a very comfortable place. The physical setting is beautiful, and everyone is more than happy to assist you with anything. I get a lot of my referrals from the other therapists, so we work really well together. Besides that, personally, they’re really just a great group of people. I am the envy of most of my peers because I have such awesome co-workers.
Is there anything specific about your job that you love the best?
Since Explore What’s Next is a client-focused practice, I love being able to do my own scheduling. That way, I can set my schedule according to my client’s needs. Some people may find scheduling to be a hassle, but I really don’t – I like finding ways to be accommodating to my patients. When we’re in the office, I have some medical people that I see at 6 in the morning, and if I were working for a larger group I wouldn’t have that ability. I can go in on Sunday if that’s what a patient needs. I have a lot of flexibility, and I think that is probably one of the biggest benefits of my job. We are an out-of-network practice, so we don’t have the restraints of the big insurance companies, such as how long we are able to hold our sessions and where we hold them. We submit to them, but we don’t have the same issues with them that other practices do.
During this coronavirus pandemic, our lives have been turned upside down; what are some ways talking to a therapist like you can help with anxiety and stress
Speaking to anyone in a therapy role will help to decrease anxiety. In my particular situation, I have thirty years of medical experience behind me, so I’m able to also offer guidance on the medical facts behind this pandemic. A lot of it is fear. A lot of people are scared to death – they don’t know what to believe, they don’t know how safe it is to go out… Part of the benefit of speaking to a counselor such as myself is that I have the ability to integrate my medical background with my mental health background and give clients additional help to alleviate some of their anxiety. Depression can be difficult during this time because of the isolation, but I have lots of tools that I am able to give patients – such as apps they can use and online socialization that can help them from feeling too isolated.
Are you listed on any professional websites outside of Explore What’s Next, and do you belong to any other professional organization?
I’ve been in Psychology Today, GoodTherapy, Google Business, the American Association of Nurse Practitioners, The Nurse Practitioner Association of New York State, the American Psychiatric Nurses Association, the American College Health Association, the American Nurses Association, and the Sigma Theta Tau International-Honor Society of Nursing.
When and how did you know you wanted to be a therapist AND a psychiatric mental health nurse?
I think it came to me during my nursing. I knew I wanted to be a nurse from the time I was a little kid. I always enjoyed counseling and speaking with patients when I worked as a nurse. I would say it was in the last ten years that I really saw the need and decided I was going to go back to school, finish my master’s degree, and become a psychiatric nurse practitioner. I was seeing so many cases – especially with the high school and college kids – where they weren’t coming into my office because of headaches and stomach aches anymore, they were coming in because they were anxious and depressed. Some of them were suicidal. Some of them had eating disorders. The numbers were really growing. So it’s been probably within the last ten years that I decided I wanted to go back and finish my degree so that I could do more to help.
What was your schooling like? Did you enjoy it?
I’m a professional student! I’m older than the traditional student… my kids laugh at me because, for the past ten years, I’ve been the oldest student in the class. I finished my master’s in 2011, and that was in organizational leadership in nursing. I finished my bachelor’s degree right out of high school. I got my BSN (Bachelor of Science in Nursing) from Niagra University in Niagra Falls, NY. I worked for a number of years after that before going back to receive my first master’s degree from Daemen College in Amhurst, NY in Nursing Executive Leadership. I wrote my dissertation on “Necessary Practices for Effective Nursing Leadership”. Utilizing Kouzes and Posner’s (2002) theory of five practices of exemplary leadership, I conducted a study to explore the leadership behaviors of other nursing administrators. I utilized Kouzes and Posner’s Leadership Practices Inventory (LPI). It is a questionnaire that measured personal best leadership behaviors. At the time, I was in a nursing administrative position, and I wanted to study the practices and habits other nursing administrators were utilizing to become most effective.
I then went back for my Psychiatric Mental Health Nurse Practitioner Degree, which is a post master’s certificate degree from D’Youville College in Buffalo, NY. When I was in administration running the health clinics in the high schools and colleges, I was seeing a huge mental health need. The majority of my day was spent administering mental health care to the students, and at that time I was seeing such an increase in need that I decided to return to school to complete my degree to be able to formally administer mental health medications and provide therapy.
I would go back to school tomorrow if I could get it paid for! I love school. I love learning. I’m constantly taking online courses and getting more certifications. I really enjoy it.
What are some things you learned in school that made the biggest impact on you?
In studying for my Psychiatric Mental-Heath Nurse Practioner degree, I learned about the different kinds of therapy, different modalities, and all of the different kinds of criteria for a diagnosis. There were so many different things that I had learned from nursing for so many years, but I was able to go more in-depth and learn about the actual therapy process. I really enjoyed learning more about the medications and the neuroscience behind it all.
Was there anyone throughout your time in school that was an especially good influence?
I would have to say the dean of my program, who was Dr. Caughill, and Dr. Aletta. I think I was the only one in three classes – the class before me, after me, and the class I was in – that was able to do a full internship in psychotherapy. Everyone else was doing strictly medications. To date, out of all of my colleagues, I’m the only one who’s able to do both. Most of them are doing just medication visits, fifteen minutes in and out.
Working with Dr. Aletta was such an inspiration to me. When she asked me if I wanted to stay on at Explore What’s Next after my internship, there was no doubt in my mind that I wanted to stay.
What is it like living in Western New York?
I grew up in the Southtowns of New York (we refer to it as the Southtowns and the Northtowns). Currently, I live in East Amherst which is very close to the Buffalo office. The only other places I’ve lived (Cleveland and Syracuse) are very similar to Buffalo and Western New York in terms of weather and people. I will say, that we have better colors for our sports teams here! Cleveland was orange and brown, and Syracuse was orange and blue, so thank goodness I came back to Buffalo where there was no orange! But I really do love the seasons here. I love winter sports. On Mother’s Day this year, we had snow – then yesterday we broke a record when the thermometer hit 92 degrees! So in Buffalo, you learn to keep both your winter coat and your bathing suit out until the middle of May. One day it was snowing, and then within three days, we were swimming! You definitely have to want the four seasons if you’re going to live here, because they can come all in one day.
This is where family is for me. I went to school in Western New York for all of my degrees It’s nice being so close to Canada, we can go right over and see all of the beautiful attractions up there. It’s a very beautiful area.
Are there any outside clubs and affiliations that you’re involved in?
The past few years, it’s been mostly stuff for my kids. My youngest has just graduated from high school, so most of the stuff I’ve been involved with have been parent associations and things like that. But there’s also the Western New York Nurse Practitioner’s Association, which is probably the organization that I’m most involved with at this point.
What are some of the ways you give yourself the best self-care – especially during this time when so much of life is shrouded in uncertainty?
Getting outside. There are not many places we can go, so I’m fortunate that we have a nice pool. I’ve spent a lot of time relaxing out there. It’s tough because we can’t get out and do the self-care things we enjoy, like getting our nails and hair done. Here, everything is still shut down in terms of massage or salons. I’ve used a lot of apps lately – Headspace, Calm – things that we are able to do while we’re isolated and in quarantine. I’ve definitely been meditating, getting outside and enjoying nature as much as I can, walking… things like that. And then there are my kids. The four of us in my family – myself, my husband, and my two kids – even though this has been hard on all of us, we have spent a lot more time together as a family, which we haven’t been able to have over the last few years with all of our busy schedules. So in a way for us, this has been a blessing in disguise. I’ve definitely enjoyed that part of it.
What are some of the accomplishments – professional, educational, or personal – that you’re most proud of?
Personally, I’m very proud of my children and their accomplishments. They’re really wonderful kids. Professionally, I just keep going back to school. Finishing a post-master’s certificate (my Psychiatric Mental-Health Nurse Practitioner Degree, or PMHNP-BC) in my late 50s – I’m really proud of that. The Board exams (United States Medical Licensure Exams) were difficult, and a lot of my younger classmates were not able to pass them on their first try. I would say that going back to school and accomplishing those things later in life was really rewarding. I’m so happy that I’m now a psychiatric mental health nurse. There were three people in my house in college at once, and that was fun. We could compare notes! So I would have to say that my family and my education are some of the greatest accomplishments in my life so far.
Lisa Graziano is an exceptionally caring person and therapist. In speaking to her, I was able to see how sincere she was as she talked about the things that have driven her to become the mental health professional that she is today.
In this time of uncertainty and fear, it is especially encouraging to know that people like Lisa can be there for us when we need them. And even though things are constantly changing in this world, Explore What’s Next continues to offer high-quality counseling services for all those in need.
written by: Julia Rael
Julia is a young, enthusiastic writer whose love for music is threatened by only one thing: her love for coffee. She is currently a choral music student and barista in Los Angeles, where she likes to spend her free time bullet journaling, hiking, and laughing at her two English Bulldogs – Emma and Charlie