PMHNP, 12 years of experience
I have been a Psychiatric Nurse Practitioner providing evaluation, diagnosis, and medication management since 2012. Most of my prescriptive practice has been in outpatient settings and evolved from in-person work to 100% remote telehealth in 2020. As a member of the LGBTQ community, I am keenly aware of the influence that social oppression, trauma, and the questioning of one’s own sexual orientation and/or gender identity have on a person’s well-being.
Your first appointment is an intake/evaluation lasting approximately 60 minutes. We discuss your current concerns, general life situation, and relevant history. I give you my diagnostic impression based on the information gathered, to ensure that we are on the “same page” (typically the case). We review the potential benefits and risks of medications and can decide to begin pharmacological treatment. An existing treatment that is safe, effective, and well-tolerated can be continued “as-is,” and adjustments can be made as needed. Clients typically feel that they are listened to without judgment and that their needs and concerns are heard and understood. The session is a safe space where clients are encouraged to ask questions, learn more about their treatment, and voice when part of it is not working or is not well-tolerated so that it can be adjusted and improved. Recommendations/referrals for more intensive psychotherapy, such as trauma work, are made when appropriate.
Having a broad educational background, specifically a Bachelor of Art (BA) in English from Regis College, Master of Theological Studies (MTS) from the University of Notre Dame, and a Master of Science in Nursing (MSN) from Boston College, helps me to see the whole person (mind, body, and spirit) and recognize psychosocial factors that affect clinical presentation, clarify diagnosis, and inform the ongoing evaluation of the appropriateness of pharmacotherapy. My extensive clinical experience in outpatient settings has been invaluable in my long-term care for persons who have complex cases with overlapping diagnoses. I have seen mood disorder, ADHD, and PTSD diagnoses overlap about as often as they occur separately. I have a strong sense of integrity and commitment. I do not stop trying to improve upon a client’s treatment until they are satisfied with its effectiveness and sustainability. If they desire, their medication regimen can be adjusted until it helps them as much as can reasonably be expected given their condition, baseline level of functioning, and life situation. For more information on my practice and background, see my profile on Psychology Today: https://www.psychologytoday.com/us/psychiatrists/david-martino-boston-ma/1303800
My ideal client feels lost and misunderstood. They know intuitively that something is missing. They feel like they have been going around in circles, with or without professional help. Their treatment for related issues might be ineffective, partially effective but inadequate, effective for a time but not any longer, or intolerable due to side effects. And then, there is trauma. Trauma, past or ongoing, can be a predisposing, precipitating, or perpetuating factor for any person’s presenting problem. I see diagnoses overlap as often as they occur separately; seeing them is the first step in treating them. Much progress is possible for clients who are willing to explore and approach their mental health differently than they have in the past. A treatment failure is often the result of an incorrect or incomplete diagnosis. As a transgender person who does not easily fit into predetermined categories, I am not tempted to oversimplify another’s experience. It is worth spending the additional time and effort to formulate a more complete picture of what we are treating and determine the root(s) of those difficulties to prioritize our treatment targets.
I provide supportive therapy during every medication management visit and recommend a separate psychotherapist for more in-depth/intensive therapeutic work (i.e., trauma work).