Claire Ellerbrock is a psychiatric nurse practitioner and the founder of Stress-Free Psych NP - an educational platform she built because the support she needed when she started out simply didn't exist. We talked with her on the Berries podcast about the gap between training and practice, and what actually helps clinicians find their footing on the other side of it.
Her story is a useful one, not because it’s exceptional, but because it reflects the path many clinicians take.
Lesson 1: The First Years Are Harder Than Anyone Says
Claire's entry into practice was community mental health - outpatient care and a crisis stabilization unit, managing patients with schizophrenia, complex PTSD, and complicated medication regimens, with high patient volume and limited clinical support.
She was doing what most new clinicians do: working hard, absorbing everything, and quietly questioning whether she had made the right decision. What strikes you hearing her describe it is how ordinary that experience is, and how rarely it gets acknowledged. The entry point for most new providers - whether therapists or nurse practitioners - tends to be community mental health, which also happens to be one of the most acute settings in the field.
Claire found her footing by seeking out supervision on her own, meeting weekly with a psychiatrist she had connected with during training. That relationship made a real difference, but it also required a level of individual resourcefulness to access something as basic as clinical guidance - and that part shouldn't be on the clinician alone.
Lesson 2: Structure Is What Makes the Unpredictable Manageable
One of the most practically useful things Claire teaches is a framework she describes as assess, diagnose, treat - three steps that sound obvious until you notice how often they get compressed under pressure.
The pull to prescribe quickly is real; patients arrive in distress and want relief, new clinicians arrive wanting to help. The first session can become a pressure cooker, and reaching for a prescription can feel like the fastest path to both. But Claire is direct about where that leads: symptom-based prescribing instead of diagnosis-based prescribing, followed by polypharmacy, followed by patients who aren't improving and clinicians who aren't sure why.
Her argument is that slowing down at the start saves time overall. A careful assessment - even across multiple sessions - gives a treatment plan something solid to stand on. Patients, she notes, tend to appreciate the thoroughness more than providers expect, and not having to undo a treatment decision that shouldn't have happened in the first place is its own form of efficiency.
This translates beyond psychiatry. Therapists face the same pressure: to offer something quickly to a person who is suffering. The clinical skill of holding space for a diagnosis to emerge, rather than filling that space prematurely with an intervention, takes time to develop - and rarely gets named explicitly in training.
Lesson 3: Small Documentation Habits Create Real Clarity
Among the practical tools Claire shares, one stands out for its simplicity: the History of Presenting Illness one-liner - a single sentence placed at the top of a clinical note that captures the essential picture of a patient.
The structure is straightforward: a patient's age, gender, relevant psychiatric and medical history, and the reason for the visit, condensed into one sentence. In follow-up visits, or when a heavy caseload makes it hard to hold every patient clearly in mind, that sentence brings immediate context without having to excavate the full chart. It's also useful for any provider who takes over the caseload and needs a quick, accurate orientation.
This is something that comes up often with clinicians using Berries: when documentation captures the right information efficiently, providers can show up to each session more prepared and more present. The goal isn't just compliance - it's continuity of care.
Lesson 4: Progress Rarely Looks the Way We Imagined It Would
One of the lessons Claire reflects on from her years in practice is one that took time to internalize: a patient's progress is not a direct measure of how good a provider you are.
Most clinicians enter the field with some version of the belief that skilled care produces clear outcomes. That equation isn't wrong, but it's incomplete; patients bring years of history, complicated environments, and variables that no clinical relationship can fully resolve. A meaningful win might be seven days of sobriety for someone who has never sustained that before. Progress that doesn't look like the goal you had in mind can still be real movement.
Claire didn't arrive at this easily; she pursued a year-long CBT certification hoping that broader therapeutic skill would lead to better outcomes - and found that the outcomes were still more complicated than that. The reframe she eventually landed on is both honest and generous: you are part of the equation, not all of it. Offer the best possible care, hold the relationship, and recognize progress in the form it actually takes.
Lesson 5: The Way You Prescribe Matters as Much as What You Prescribe
Claire describes attending a grand rounds psychiatry lecture where she encountered research on how the relational dimension of prescribing affects patient outcomes. The finding was striking: two providers can prescribe the same medication, and outcomes can diverge based on tone, eye contact, the confidence and education offered in that conversation.
This isn't surprising to therapists, who understand deeply that how something is communicated shapes what a client can receive. But it's a meaningful reminder in psychiatric prescribing, where the focus often stays on the pharmacology itself. The relational layer doesn't disappear when medication enters the room, and presence is a clinical variable regardless of discipline.
Lesson 6: Knowing What You Don't Have to Do Is Its Own Skill
One of the most useful things Claire articulates is a short list of things she wishes someone had told her when she started: you don't have to prescribe at the first visit, you don't have to know everything, and you don't have to see patients back to back without any breathing room in between.
Each of these sounds obvious, yet each is genuinely hard to hold onto inside a system that rewards speed and is uncomfortable with uncertainty.
Protecting a few minutes between sessions to finish a note, reset, and arrive fully for the next person isn't a workflow preference - it's a clinical practice. The courage to say "I need more information before I know what's right here" is also a clinical practice. These aren't small things. They're the conditions that make sustainable care possible, and they almost never get taught.
A Final Thought
What Claire built - an educational platform, a community of NPs, a library of resources she wished had existed - came directly from the experience of not having those things when she needed them most.
The themes she returns to are ones that cross disciplines: the value of structure inside uncertainty, the importance of communities where struggle can be named without stigma, the quiet recognition that caring for others well requires being genuinely supported yourself.
For clinicians somewhere in those first years, or in a stretch where the work has grown heavier than expected: her story is a reminder that the difficulty you're feeling is real, that seeking better support is not a weakness, and that building something better from that experience - for yourself and for others - is entirely possible.
Listen to the full conversation with Claire Ellerbrock on the Berries Podcast:
Berries Blog · Apple Podcasts · Spotify · YouTube
Connect with Claire Ellerbrock:
stressfreepsychnp.com · Free Resources · Instagram
Professional Disclaimer: This article is for informational purposes only and is not a substitute for professional clinical judgment, supervision, or continuing education. Therapists should consult current clinical guidelines and use their professional discretion when applying this information to individual client cases.