You Can’t Hide Success with Dr Kathleen McCoy

What if the most powerful tool in psychiatric care isn’t a prescription, but a relationship built with skill, ethics, and presence? We sit down with Dr. Kathleen McCoy to trace a career shaped by Hildegard Peplau’s interpersonal theory—from a 25-cent used book to leading practice, mentoring clinicians, and resetting norms in systems that push for eight-minute med checks.

We talk about building a practice that stands on clear values and measurable outcomes: fewer revolving-door returns, deeper engagement, and care plans that actually fit a person’s life. Kathleen shares how she set time standards, documented with rigor, and earned trust across teams, all while refusing to let psychotherapy get crowded out by coding and speed. She explains how to right-size caseloads, make fast, ethical referrals for higher-acuity needs, and use community connections as clinical infrastructure—case managers, primary care, jobs, child care, and simple resources that stabilize daily life and reduce stigma.

Mentorship runs through every story. Kathleen shows why mastering paperwork and credentialing frees you to focus on people, how precise language shifts culture—moving from adherence to participation—and how to teach interviewing and motivation so patients become advocates for themselves. Finally, she opens up about sustaining the therapeutic self with prayer, color, painting, swimming, dance, travel, and friendships—whole-person living that keeps compassion sharp and burnout at bay.

If you’re a psychiatric nurse, NP, therapist, educator, or anyone trying to deliver human care in a high-pressure system, this conversation offers a grounded roadmap. Subscribe, share with a colleague who needs a boost, and leave a review with the insight or quote that stayed with you.

ISPN Article of the Year 2025: McCoy, K. T., & Williams, K. A. (2024). The Williams and McCoy model of motivational spirited cognitive behavioral change communication. Archives of Psychiatric Nursing, 48, 1-6.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Peplau’s Influence And Early Roots

SPEAKER_02 0:31

Welcome back everybody to Pepla's Ghost. I am super excited today to welcome another wonderful guest. In my mind, another giant in the field of psychiatric mental health nursing, and Dr. Kathleen McCoy. Dr. McCoy comes to us with years of experience and a real passion for caring for people and really kind of keeping what I think all of us in this podcast really want to do is keeping that psychotherapy very relevant and carrying on these traditions that Dr. Poplau really kind of started for us back in a long time ago, we'll say. So Dr. McCoy, you know, obviously is well established here within our community. She's currently at the University of Southern Alabama. She's a fellow in the American Association of Nurse Practitioners, has a dual certification, both in family as well as PMHNP, so nurse practitioner and CNS as adults. So that's really great. And I want to say, too, as the president of ISPN this year, you won the Article of the Year this year. So congratulations on that. That's a huge honor. So in archives in psychiatry, um psychiatric nursing, sorry, yeah, she won the 2025 Article of the Year. So congrats on that. And many other fellowships and other things that she's done. But uh I know you know, most times just get into what Dr. McCoy has to share with us rather than giving her her bio. I am shared again by my friend and colleagues, uh Dr. Kate Molino and Dr. Melissa Chapman-Hayes. So so thanks to you both for being here too. So let's get started. The first thing, and I'd like to do this if if you've, you know, for those of you who listened on these podcasts before, I'd like to kind of you know share a little bit about the first time that uh Dr. McCoy and I met. I don't know if you remember this interaction, Dr. McCoy, and and I do not mean to be offensive in this anyway, but the first time I remember meeting you, we were at an advisory panel for pharmaceutical. So that's kind of an off-beaten path for this podcast, but it was right before the APNA conference. It was down in Florida, and so we were meeting there. And what I will always remember, and and really treasure, I don't mean to say this meanly, but what I always remember is, you know, we're there to talk about drugs, right? You know, pharmaceuticals are paying us to be there. And and I look over, and one of the first comments I remember you talking about is is psychoanalysis, is psychotherapy, and really bringing that forward with the conversation and and and saying how important that is to really how we prescribe medications and things like that. So so maybe that's a good place to start. Is that something that you just find that is just natural for you? You just kind of always find a place and find a way to you know leverage your experience and and your expertise in that way, or or or you mind sharing some of your thoughts on that?

SPEAKER_04 3:04

Well, thank you, Dan, for remembering that because I remember it very clearly.

SPEAKER_02 3:10

Good.

SPEAKER_04 3:10

And I remember there was a big hush in the room when I I mentioned the weaving of the sacred interpersonal interface that must occur in any encounter in order for it to go forward with the intrinsic value of the human at the center. And so I was an associate student in nursing, and I went to the bookstore to buy, you know, the stack of books that we were required to, and I see in the use, because you know, we all needed to save money, I go into the news thing and I'm like tearing through these books because I was raised to go to the bargain rack, right? And there's a book for 25 cents by Hildegard Paplau, interpersonal nursing. I take this thing home and I show my mom, and she's like, Oh, you don't need that, you don't need that. And I'm like, I ate this thing up. If if I could swallow it, it would still be in my being, and it actually is in my cellular integrity. I'm absolutely convinced. I was a critical care nurse for almost 20 years. Cardio, med search, oncology, and PEPLA had been my anchor the whole time. So I knew no matter what I did in nursing, that I was gonna carry her ghost with me. So then when I became a psychiatric mental health clinical nurse specialist, nurse practitioner, we didn't have a cert then, but our school was the second one in the nation that had an NP program. And we were prepared for both. We really didn't do medications, we had one course. So everything was based on the interaction, that sacred interaction between the the nurse who was going to use therapeutic use of self and the participant in care, whether it was passive or active. Because we do know that some patients they can't interact. You know, they don't have the hardware, the software, or the emotional wherewithal, the intellectual wherewithal, whatever it is. Some patients, as Papl well stated, uh just need to be recipients of care. And and they they can only receive, and hopefully we guide them toward as much wellness as is possible. But most patients are able to interact. Whether they are a med surge, cardiac, whether they're oncology, most do respond. Even neonates respond to eye contact and voice, yes, and warmth. So good starting place. I think I've given you the background, you know.

SPEAKER_02 6:00

Yeah, thank you. I I have a question before I turn it over to Kate. Do you still have that book, that 25 cent book?

Making Psychotherapy Central To Care

SPEAKER_04 6:06

You know, I'm sure I do because I would not have given it away. And having having moved over 24 times in my life, I have a full basement of 2,400 square feet that need I need to do some Swedish death cleaning so that my kids, my kids don't find this book and they say, oh, so that's what's right with mom.

SPEAKER_02 6:28

I think it probably is worth something now. So that's that's great. Thank you, Kathleen. That's a great start.

SPEAKER_00 6:34

And it's so wonderful to hear about how how Peblau captivated you, you know, through through her words. And so, you know, we'd love to hear a little bit from you. Many other guests on this podcast. And as educators, we often hear from our students and graduates, you know, people are sort of nurse practitioners, psychiatric nurses are being forced into very short appointments with patients that are, you know, often very heavily medication focused. How do you, you know, sort of keep the spirit alive within those constraints?

Building A Practice Around Ethics

SPEAKER_04 7:06

I learned this as a very, very young clinical nurse specialist, nurse practitioner, that I was the one that was going to have to set the standard of what kind of practice I was going to have. And I I was discovered. You can't hide success. I had the standards. I had the most wonderful professors at uh State University of New York, Stonebook, and they all came out of NYU. And they taught us how to be real, really people focused, and they showed us how to deal with the logistics of an encounter room, how to have a practice that would not put you in touch with the law. And then honestly, we we all knew that we had to go out and forge a path and get our name out there by virtue of the quality of not just what happened in the room, but what happened after they left the room. So our name would get out there, and once we were out there getting ourselves on panels, which takes a couple of years, then we would be found. And it did happen exactly that way. So I got invitations, and I was the very first person in the state of Tennessee, because that is where I went directly after I graduated in '93. Went to the University of Tennessee for a year, and after that I went to the state institute, the local state institute. And physicians of note looked at me and could not believe what was sitting in front of them. And I couldn't believe that they actually saw that I was comporting myself appropriately, and you know, you get no feedback. And at that time, in order to be certified, you had to have a physician certify you. And they were all, no, we're not doing it. So there was this barrier. So I had to show my value. And I did it with my relationships with people. I knew every single adult patient's name on that campus. And I was invited to be part of the medical staff. It was unheard of unheard of. So I joined the medical staff and I was doing evaluations. I was part of the team. And my my my golden moment was my contributions to the joint commission review and what I did with patient advocacy. I was on that committee. So I knew the law inside out. My father was on my PD, so he taught me how to invoke the law. Had no idea that would end up being patient advocacy. It wasn't about parking tickets, it was about protecting patients from themselves and from others and from legal statutes that they had no idea could affect their assets and the rest of their life if they truly were able to manage their own business and their themselves. So forging the role of as a nurse practitioner in the state of Tennessee still is happening. The the the journey was um circuitous. I ultimately opened up my own practice, and I did that because there was again a very wise physician from Lebanon, believe it or not, who was a CPA turned into a psychiatrist. And he loved charts, and we had to have the supervision. So every Friday he realized that I was a person that had worth and could, and he invited me to join the organization. And he actually taught me how to build a practice because he had one, and how to do everything that needed to be done on the inside and paperwork-wise. And I woke up one day and realized he's showing me the way out. He's like, I'm gonna cross the Red Sea here. Anyway, I did it, and when I did it, I upended the entire behavioral health community in like 17 counties in Tennessee because I I did this thing that nobody could believe I up-ended everything, and I did not do it in rebellion, I did it because I could not serve my patients adequately inside of and back then, you know, it was three an hour. That was a luxury. They wanted us to do it in eight minutes with the moot code, and I told them, mm-mm, no. You're gonna see if you give me the time, you're gonna get your money's worth because patients won't be coming back through a revolving door. We'll have some, but we won't have as many if they see me. And it panned out can't hide success. And they saw it, and they all calmed down, and I started to get some cooperation. I was with them for about three years, then I owned my own practice for about four. Well, during that time, things changed because I got my doctorate and then I was recruited. So but that is how you decide what kind of practice you're going to have, whether it be with somebody else as the boss or you as the boss, but you have to be firm and you can't buckle because it's about it's about ethics, it's about ethical care. You have to be able to say hello, figure out what's going in an economical fashion, get this person to know that you care because you do, and then move forward, and then they come back and you assess them and see where you go at that point. Not all people get better right away, and not all people get better ever. You have to know that. You have to roll with these with the tide. But being resilient and leaning into that sacred interpersonal interchange that is between you and the patient, and you and all your internal consumers, which are the nurses' aides, the RNs, the people in the uh front office, everybody doing the billing, the coding. It's everybody. So it's not just you and patient, it's you and everybody. And it, by the way, it works at home too.

SPEAKER_02 13:37

Well, that's great. I think again we found our podcast episode uh title, you know, Can't Hide Success. That's that's inspiring. I'm I think I might get that tattooed on my arm now, too. That's that's amazing. And it's true, it's so true. So thank you. That's that's inspiring.

SPEAKER_03 13:52

Dr. McCoy, I'd like to ask a little bit about navigating the gray areas. So psychology is rarely black and white, and I'd love to hear about a time in your career where maybe clinical guidelines said one thing, but your nursing intuition or the patient's unique story led you in a different direction. How did you navigate that tension, if you can think of an example where that might have happened?

Challenging Time-Limited, Med-Only Models

SPEAKER_04 14:18

There's always tension. As I right now am teaching students, both doctoral and master students, almost everything that we discuss has underpinnings in doing the right thing. And so when there is tension, you've got to know what you believe in and you've got to know what you stand on. And so I come from a Judeo-Christian ethic, but that doesn't mean that other ethics don't have that value. Every single, I'm an ecumenist, so every single culture, we know gang culture has its virtue, right? So you've got to figure out what's the virtue here that needs to be upheld, and how do I go about it without losing the therapeuticity that is required? I gotta back it with documentation. And so I I think of let me see. When I started my private practice, I could not address certain ethical issues that were coming up. So I was working in a federally qualified medical home, and I'm in Tennessee. Well, God love us in Tennessee. Almost everybody's got a Bible under their arm. What do they want to talk about? They want to talk about what they believe in and the trouble that they're having counterbalancing all this in their life. At a gagger rule, I couldn't discuss where they came from and where they wanted to go within the constraints of I can't say this, I can't say that. So I didn't say this, and I didn't say that. I built my own practice, I put my house up as collateral. That is how I navigated that because there was no way out of it. There wasn't any way out of it. So when there is a way out of it, let's see. I can't think of anything right now, and I know it's every day. Can you rephrase? Is there a way that I'm not answering this question? Can you make this a little finer for me?

SPEAKER_03 16:26

Yeah, well, it sounds like it's embedded in everything you do. So I am certain that you have many examples. I was really just kind of if if there's a tension between clinical guidelines, but maybe your intuition or the unique context of the patient says another, just how to navigate that tension, which I think the example you provided did that.

SPEAKER_04 16:46

Okay. There there's stuff every single day. It it doesn't go away. You have to be on your toes, and you really have to you have to do the work. You have you have to know what can I sit with, what can I sit with. And part of that is how you design your practice. For instance, when I designed my practice, I had what I would call a gift for the moderate patient. Therefore, people that were I had SPMI, I did have SP and I, but they had faculties, facilities in which they could work. But those that couldn't work at all like the Floridly psychotic, I would have to refer immediately because they would need something done. So because ethically you have to meet their needs, and in a one-room little practice, you can't meet the needs. You need caseworkers. You you need the mentality that I call mental health is a is a it's a group thing. You know, it's it's a group effort. It can't be one person. You need to involve the entire community. And so I would have to refer patients that were beyond my, not my ability to treat them in the here and the now, but but building those the surrounding safeties and support services that they needed. So patients that were entirely easy, not that I was ever above any of them, but they clutter up the practice when primary care can handle it. So you've got to know, yeah, they're they're a gravy boat, it gets money in the bank. But what is my gift to the community and what does my practice give best? And how can I help distribute the wealth of the big N that's out there that needs services? That and I do that by having well back then I had a Rolodex, right? That Rolodex was full. It was so stuffed up because I honestly knew every single provider in the entire area. Because who needed a mammogram? Who needed a job? I'm serious. Who needed to know whether bananas were cheap? I mean, seriously, who needed to know where the fish were running? The things that I had to know were my husband said that I could have been an employment agency because I had all these stories coming to me all the time. And you know, just parsing out these little bits of information. It's not in my clinical guidelines. But part of my practice has always been building that community.

SPEAKER_03 19:34

Well, you just sound like a connector as well, being able to have that network and then connect others to the network.

SPEAKER_04 19:40

You know, being that connection piece um helps to reduce stigma too. Because when everybody gets together and they all start acting like they're on the same page, they become on the same page and yeah, an orchestration, and people feel supported. And we always want people to feel supported. They come to us, they're often so isolated and stigmatized, and then uh, you know, then they get a job at the local IGA. You know, it's like, oh my goodness, and they find out there's a place where their kids can actually be taken care of that's affordable and safe. And it's in in this little church nook and cranny, or there's a place where their kid can find a homeschool support center. We have lots of that in Tennessee. So yeah, connecting is it's critical. And I think Pet Ploud did that.

unknown 20:30

Yeah.

Navigating Gray Areas And Ethics

SPEAKER_02 20:31

Absolutely. Yeah, absolutely. Thank you. I mean, I think that's always such a great thing. I mean, people take something away from those appointments, and you know, it doesn't always have to. In fact, you know, the more I practice, it's it's less and less important as far as a prescription that I write. It's it's something else I gotta give them and then they take home because that's what they're gonna remember, not that they need a refill. So my next question really, it's gonna kind of feed on just what we've been talking about, I think, but just maybe to kind of take a look towards the future. You've mentored a bunch of different people. And again, at your stage in your career, it's being, you know, so well regarded in the community and in the profession. I, you know, I'm I'm recalled even that uh one of the one of my mentors and colleagues now is uh Dr. Tess Judge Ellis, who who while you're at Tennessee kind of worked with and she spoke very highly of you. And we had her on the podcast a few months ago. And so what is your what thinking about, you know, as you're mentoring now and as you're kind of you know teaching students at the University of Southern Alabama, you know, what how do you how do you guide people into that, into this field, you know, beyond just the technical stuff that they need to do to get on, you know, past their boards? But what what do you what do you tell them about this profession that they're getting into and and and how to kind of move for move it forward?

Right-Sizing Care And Referrals

SPEAKER_04 21:45

Yeah, Dan, I'm I'm really glad that you asked that because uh the guidelines, the accrediting agencies and the uh certifying bodies require this and that and this and that. And when I was on the when I was the chair of the conversation. An expert panel for the ANCC examination for two and a half full cycles, a full eight years, the max of the Department of Labor allows. We had this terrible challenge of what do we do with all this stuff? And we were the ones that were the beta test for all of the exams to put in the body systems and the developmental stages. And we did it. We did it and we did it beautifully. And we had an entire room of eight to ten people at any given time. I've been there over 25 times to Silver Springs, Maryland, and they don't do that anymore. Now it's all online, God bless us. But everybody came in as a feet on the ground person who was an expert. And any one of them could have been the chair. But they all needed mentoring and had no idea, no idea whatsoever that while I had been receiving mentoring from many wonderful, wise people who nurtured me, that there were several of us that were ending up mentoring the entire content expert panel. And we are the ones that decide what everybody gets taught, right? Okay. Almost everybody there went and got a DNP, and there were only two of us in the room when we started inside of the eight years. It was incredible to see that by virtue of our presence alone and how we comported ourselves across all of those different meetings, that there was an osmotic magnetism that occurred. And they would go work and go home, think and decide what they wanted out of their career. So you have to decide what you want out of your career. Do you want money? You won't be happy. Or do you want status? And you won't be happy. We're guilty by association. There is stigma always to be dealt with. Do you want better relationships and health? And most of us want that because I honestly believe that psych nurses were the soul to the earth. When I teach students now, as I have taught students over the last 20 years, I want them not to be caught up with the nuts and the bolts because that's just the machinery. And the machinery is what is cluttering up segmental health nursing and the entire behavioral health field, of course, and all of healthcare while we're at it, but we're focusing on us. I teach students they've got to fulfill their paperwork correctly. They got so mad at me because it's a trudge and it's horrible. But if they don't take care of their paperwork now, they may be in big trouble later because they hadn't learned how to fill out the dots, the circles, and the necessary necessaries to move forward, to get credentialed, to document correctly. You've got to do that stuff. So the psych mental health NP, or all of graduate school, is terribly disciplining. But I say that because it's needed. But then they have to get past that big ouch, swallow it, take it in, you make it a habit, it's no longer work after it becomes a habit. And then they can enjoy the bubbles that come up of interpersonal engagement and the rewards that come out of health that has moved forward. You have to have the mechanisms. Without the mechanisms, we die. We can't work. We can't we can't do what we can do. You have to have them. So we have no choice. We've got to teach them this. We don't teach to a test, we have to cover the material. I say we're teaching them how to become become professional. We're teaching them how to comport themselves to a very high level. We're teaching them to use different verbiage. For instance, we don't use adherence anymore, we use participation. Why? One is stigma-laden and judgment propagating. So we teach them all these little things and they go back. They go back, no, no, no, no, we gotta move forward. No adherence, no non-adherence. Does the patient participate? Ah. If they don't, they might be a psych patient and they might have trouble. So how are you going to teach this patient how to engage? It's your problem, not the patient's problem. So it's turning this whole thing around so that they learn to use the art form of interviewing and motivating people to self-care and self-knowledge. And it's not just, oh, I'll write you phylloxetine with 10 milligrams more. No, no, no, no, no. Patients need to learn how to take care of themselves and be self-advocates. Take care of themselves. They need us less so that they can be more. So this is what I'm hoping to get across to my students. And I do not always get it across well. I struggle. I hope I've answered your question.

SPEAKER_02 27:44

Yeah, no, that's great. I I you know there's so much there too. And I I think that lends us to our maybe our last question, Kate, if you want to kind of go there. That would be great. But it and I also put in the, yeah, it's it's Melissa put in the chat just that our no other, you know, contender for the title is osmotic magnetism. It's that's such a such a skillful use of those words, too. Thank you.

SPEAKER_00 28:05

And yeah, and so Dr. McQuingan, our final question for you. We've talked a lot today about, you know, the principles that Pablao, you know, talked about therapeutic use of self. And we also know that using yourself as the therapeutic tool can be exhausting. And so we're curious to know, you know, how do you replenish your own spirit so that you can continue to show up fully for your patients?

Community Networks As Clinical Tools

SPEAKER_04 28:29

Since I'm four years old, I've always known how to pray, never perfectly, but it helps. So that's that's the first thing. And that's I start every day just like that. And then my hair is on fire. I'm gonna go through and just do what needs to be done. So when I get tired, I'm really into I'm an artist, so I I create. My husband's an artist, so we do a fair amount of painting and woodworking. I'm a colorist, as you can see behind me. This is by design. Yeah, color is wonderful. I I dive into saturated color and light colors, but I also swim and I dance. I believe in total body immersion. You need to be a whole human being, mind, body, spirit. One needs to eat right. I'm always with the apron on, and I run around with a rolling pin because I bake. I do watch the great British baking show. I know how to laugh. I sing. We travel. We take bike rides down Haleakala. We take plane rides to dry Tortogas and watch for sharks and sea turtles. We immerse ourselves in our national parks. We travel extensively, we learn about people and how they communicate and all kinds of cultural richness. My home is filled with beautiful things that remind us of the value of people all over the world. And of course, there's friendships, friendships to nurture and to celebrate. So we we live whole lives. So basically, that's the message. You decide what makes you whole and go for it. Don't miss out on what you love and do what you love, and the money will come. So don't worry so much. You don't need a whole lot of money. You only need so much. And and don't let chasing after a greenback cheat you out of life because the best things in life are free.

SPEAKER_02 30:49

Well, I think we'll let that be the final word. So thank you, Kathleen. Thank you, Dr. McCoy. This has been wonderful. Like I said, so many things you've said that have just resonated with me, and just kind of I will carry it through the rest of this week, if not longer. So thank you very much for inspiring me and hopefully inspiring many people who are listening here too. And so thank you as well for the listeners to listen to another episode of Feploves Ghost. We'll have another episode coming out soon. Thank you so much for everyone, and we'll see you in the next episode of 2020.