Who is Kate Engbert?
In 2011, I was lucky enough to be admitted into the Couple and Family Therapy Program at the University of MD at College Park. One of the students who helped interview and select candidates from my eventual cohort was Kate Engbert. She was a senior to me in the program and while we never took any cases together, when it came time for her graduation, she transferred one of her clients to me. I got to sit with her in the room as she said goodbye to this mother-son family. It was truly moving being a part of that moment. As it happens, she would not go on to become a psychotherapist. Kate is now see clients in Bethesda working as a Psychiatric Mental Health Nurse Practiotioner. I sat down with her this week to learn more about her journey. Here’s what happened:
What’s your origin story, how did you get into mental health?
I’d always been fascinated by psychology, had a lot of interest in the mind and behavior. I majored in psychology and did an internship in the clinical psychology department working in the crisis center on campus at the University of Florida. It was great exposure working with people. I got to my senior year and knew I needed to go to graduate school. A family friend recommended the CFT program at University of MD. I took the exam and became licensed to practice marriage and family therapy, but I never went into practice.
While I was in the program at Maryland I was more intrigued by the psychopathology coursework, and clients I worked with who would ask about medication, we would often discuss how there was a lack of providers available for those needs. After I graduated, I ended up getting a job at a healthcare research company in Rockville for a few years. During that time, I started exploring options for where to go next. I considered going to medical school, and becoming a psychiatrist. I considered getting a PhD in clinical psychology and becoming a PA. Finally, I landed on the nurse practitioner track at Vanderbilt.
What were your experiences like on rotation as a nurse?
I fell in love with the field of nursing. It worked out in the end that my favorite rotation, even more than my psychiatry rotation was the OB rotation where we got to be there for births and we got to work in the nursery. It was really amazing! And it’s an experience that you don’t usually get to have. It was also nice to have a more general background on everything medical so that I have an idea of things that are going on when I’m sick or when a family member is sick.
How do you notice your Marriage and Family Therapy training getting incorporated in your patient care?
The thing that has been most helpful from the MFT background is being able to develop rapport with people and really sit with people when they’re talking about difficult stuff. As a Psych NP, we can technically provide therapy services with our license; But, I can tell you I would not have felt comfortable doing therapy coming out of the program because we didn’t get thorough training in it. I am very grateful that I did have the MFT background – just when there are things that are really tough to talk about and I don’t have to just say, “Nope, we’re only talking about medication.” If someone needs to be able to talk through something, I am able to talk through things, why things might be happening, why behaviors might be happening. I’m really grateful to have had that training.
Was there a moment where you felt particularly called to the work you’re doing now?
There was one case in particular, where I was seeing a kid, he just really, really needed medication. I was so frustrated, because his parents really needed to find someone, and they couldn’t. There was no one – they would be calling and couldn’t get calls back, and I even tried calling for him to try to get them in somewhere. Part of that was that they wanted to be able to find someone on insurance, and there just wasn’t any openings anywhere. So that was really kind of a lightbulb moment for me. It seems like there are a lot of therapists right now and I don’t know why I can’t find anyone to see my patient for medication, and that just stuck with me.
What do you do to decompress?
My biggest self-care is definitely running. I’m a naturally pretty anxious person and so running for me is the time when my brain is finally shut off. That’s definitely my big thing. I’m a long distance runner, and I haven’t really been able to do that as much recently. I like to train for marathons, and once I got pregnant I cancelled the one I had scheduled for last December. And then with Covid there aren’t any in-person marathons so I haven’t been able to do that recently; But I run a lot. I live right by the Capital Crescent Trail which is awesome. So when I do long runs I can even run down to Georgetown or the National Mall. It’s my happy place, for sure.
How much do you prescribe lifestyle changes?
There are a lot of things that I go over in most appointments. The biggest thing is sleep. If you’re not sleeping you’re not giving your brain enough time to regenerate your neurotransmitters that you need to balance out your anxiety and your mood. If you’re going to take a medication and then not sleep, it’s not going to do anything. It might help a little bit, but the best thing that you can do for yourself is sleep. So I spend a lot of my appointments talking about sleep and sleep hygiene.
And I always try to give a plug for exercise. It’s one of those things that’s easier said than done and I think a lot of people get annoyed hearing that they need to exercise, so I try to feel the patient out and see where they are with that. I try to remind people, even if it’s just a walk outside – especially right now when it’s so easy to be stuck inside and not leave the house – you can really kill two birds with one stone mental health-wise taking a walk around outside for 30-minutes. Being outside is going to significantly decrease your anxiety, and getting a good exercise in has been shown to decrease anxiety and improve mood, and help with sleep! So it all kind of comes together.
What meds can you get behind and what meds concern you?
I’m a fan of a lot of different medications because I’ve seen so many success stories. The SSRI family of medications are just amazing. They are found to be super effective with very minimal side effects. There’s no long-term negative effects on growth or on any of your vital organs, just generally speaking very safe and effective for treating anxiety and depression. They’re also really cheap because they’ve been around for a while by now so there are generic forms of all of them. And you can be on them long-term if you need to or they are pretty easy to get off of if you want to come off of them in a certain time. So that’s really my favorite class of medications. And similarly, SNRIs do the same thing but they also work on an additional neurotransmitter. And same thing with them, very safe and very effective.
There are a couple of mood stabilizers that may have more intense side effects, but amazing results that you can see from them with people that would be struggling with bi-polar which can be really debilitating, but then they get on this medication and it can totally change their lives.
Antipsychotic medications, like I said, just so rewarding seeing someone that … I can only imagine how terrible it would be to be constantly hearing voices in your head, or seeing things that weren’t there and how terrifying that would be and distracting from everything else that you’re trying to do … so then to be able to have a medicine that could stop that; With them there are some more intense side effects, so it’s good and bad. There can be a huge benefit but there can be risks involved. But, for all of the medications that I prescribe there’s obviously more benefit than risks to them.
The medications that I’m more hesitant to prescribe, or if I know someone personally that is on them – I say to take them cautiously – would be benzodiazepines. I’m sure you’ve heard of Xanax or Valium; They have a benefit. They can be really helpful for people that have panic disorder. It’s really life changing to be able to have something that when you’re going to that place of panic can stop that panic disorder from happening. But they are highly, highly addictive. We used to not know how addictive they were and so they were prescribed a lot looser, for daily use very frequently. That gets really dangerous, because if you’re taking a benzodiazepine daily your body gets to a point where you don’t really get the anxiety benefit from it – so you’re not going to have reduced anxiety from taking it – but your body is going to start to depend on it to a point where you can’t function without it. So it’s not helping you anymore, but you still have to take it, and you have to take more and more to get the effect. Like I said, they do have a place, they can be really great for emergency use or very short-term use for someone who is going through a difficult time.
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