Foucault, and stuff (this is a piece I wrote for a newsletter on social justice informed practice)

When clients come into my office for psychotherapy, they are usually focused inward, potentially seeking a diagnosis, and often asking “what’s wrong with me?” Yes, the majority of my clients are working through gender dysphoria or pursuing recovery from an eating disorder, and while these are indeed conditions I can diagnose, much of the work I do with folks is about exploring the ways in which structural oppression related to their sexual orientation, gender expression or race is causing distress, both directly and in its internalized forms. In other words, we shift from asking “what’s wrong with me?” to “why do I think something’s wrong with me?”

From a social justice perspective, one of the most insidious ways oppression in the form of patriarchy, misogyny, class bias and racism (among others) does its work is through internalization. When people internalize these structures of power and disempowerment, the self hatred and self doubt that ensue wreak all kinds of havoc in terms of beliefs that impact behavior and emotional experience, which then often leads to the development of some form of psychopathology. I vividly recall a professor at the Smith College School for Social Work stating: “The greater the oppression, the greater the depression” and I have seen this to be true over and over again in the lives of the people who walk through my office doors.

There was a time (and in some cases, that time is now) when people in my chosen profession, social work, were largely tools of oppressive structures. In the words of Michel Foucault: “The judges of normality are present everywhere. We are in the society of the teacher-judge, the doctor-judge, the educator-judge, the social worker-judge.” For example, as the majority of my clients are transgender or gender non-conforming people, many require authorization from me for their insurance companies that they are “trans enough” to receive gender affirming hormone therapies or surgeries. Many of these folks also experience profound depression and/or anxiety: how would you feel if your fate, your ability to live a life as yourself, was in the hands of an ostensible expert, deemed more expert than you about your own self-hood by virtue of their social position and capital?

My work, as a social justice oriented feminist relational psychotherapist, is kaleidoscopic. I work to support my clients in identifying the ways in which they’ve internalized oppressive structures. We work together to identify the ways they’re policing themselves and warping their sense of self through these lenses, and then we work to dismantle the problematic internalized beliefs that are setting them up for emotional distress and behavioral dysregulation. In other words, I sincerely look forward to a day when I become obsolete.

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Transgender patients and informed consent: Who decides when transition treatment is appropriate?

“Informed consent is a medical provider laying out your risks and benefits, and the most current information they have about those risks and benefits, and giving you the choice about what to do with your own body. For me this is a basic human right, a matter of bodily autonomy,” Abernathey said.

Source: Transgender patients and informed consent: Who decides when transition treatment is appropriate?

While I subscribe, personally, to the informed consent model of managing hormone therapy (HRT), I am available in instances when a provider requires a therapeutic “gatekeeper” to work with a client before providing HRT, as well as being available to work with folks on the feelings of alienation, depression and/or anxiety that can often emerge when gender dysphoria is present.

One Size does not (fill in the blank).

So, I highly recommend you go read this http://www.danikabrysha.com/blog/dear-danika-food-addiction-stress-management-and-how-im-finally-finding-peace-and-freedom, knowing that the author is someone I choose to follow on social media and in her blog even though I have specifically chosen not to follow the path she has used to address her eating disorder, and our very definitions of eating disorder and recovery diverge. Here’s why:

1. What if her path is right for you or one of my clients? I have found that I don’t stay on the healthy side of the blurry line between OA and restriction very long, and so it’s not my scene, but recovery is individual.

2. If it’s not your scene either, can you engage with her words as an act of empathic connection with someone whose struggles you share? We’re so quick to judge, and it keeps us separate in our own food and body prisons, rather than forging the community and connections we need to feel seen, heard and not totally nuts.

3. It’s worth it purely for her insight into the absolute brain drain (and effort of futility) that is dieting.

4. Because I’m choosing to put my energy into pumping breast milk these days, rather than blogging much, but I still want you to have good things to read.

[Re-blog] Anne’s Food for Thought: Body Image – 

“What’s in a Number? Hint: Nothing! BMI and/or the number on your scale mean nothing about your health! How can it? Health is so much more than just your height and weight. We are just too complex for such simplicity! Do your body and mind a favor and stop weighing yourself (or letting others weigh you). That scale number is only a measure of your self-worth. Please stop checking your self-worth on the bathroom scale! A better measure would be to ask a good friend why they value you. That is way more meaningful than any information a scale will tell you!”

Source: http://www.foodisnottheenemy.com

Caught red handed.

I recently received the following feedback from another eating disorder treatment professional regarding my approach as she perceived it from reading this blog:

“It appears [we have] a differing philosophy in treating eating disorders. We don’t help clients to lose weight or make that part of our treatment plan. We help them regulate eating and discovering the underlying issues driving the ED behavior. Sometimes that results in weight loss. In addition, we have found that keeping the focus on weight and a restrictive diet maintains the ED. We do not recommend elimination diets such as the Whole30 as this is another way the ED stays active.”

I had rather a lot of feelings upon reading her response.

The first of these was the hot flush of shame, and thoughts that I’d been caught doing something wrong by an authority. Incidentally, shame and a fundamental belief in my own “badness” is one of the “underlying issues driving the ED behavior” that I unearthed in my own early treatment experiences. This was followed by a roller coaster of anger and defensiveness. So, first I dealt with the feelings: 73 deep breaths, a draught of lavender essential oil, a big glass of cold water and a long walk with my partner to talk it out. Thus soothed, I returned to my critic’s words for some reflection.

Going back over the feedback line by line, from a less emotionally reactive place, I made an interesting discovery: what she wrote has absolutely nothing to do with me or my treatment philosophy. In the words of Byron Katie, her response is not my business.  The feedback I received was the author’s reaction to my blog, which reflects her thoughts, her beliefs and her agenda, none of which are my business.

What is my business are my reactions in thought and feeling to the feedback I received and what I choose do with those. I could rant and rant here about how my post about the Whole30 virtually insisted eating disordered clients not do a Whole30. I could be all righteous and s@#t, but the only person ingesting that vitriol and raising her cortisol levels would be me.

Historically, I would have reacted to these kinds of difficult thoughts and feelings with a cascade of eating disordered behavior, but I’ve learned that the core of recovery is to employ mindfulness in order to be on guard for my triggers and access alternative coping strategies accordingly. In terms of treatment philosophy, this is also what I teach my clients, and what I have intended for this blog to reflect.

Here’s an another potential twist on things: my initial response to the feedback was an angry and defensive “That’s not true! I know what I’m ‘supposed’ to do in this field and I do it!” But what if, for the sake of argument, everything she wrote is accurate? Would that be bad? While the author of the comment reflects the conventional wisdom of our field, I am not entirely conventional in my approach.

While I certainly don’t make weight loss a part of every treatment plan, depending on the context and goals of my client, it’s sometimes included. For example, if I’m working with an obese binge eater who is trying to avoid knee surgery by losing weight, and that goal is the only thing that’s motivating her to work for recovery, then I’m going to honor that goal. We’re still going to need to explore the underlying issues supporting the eating disorder, and regulate eating, but in my experience not every person who wants to lose weight wants that from a disordered or distorted place. To my way of thinking, this is not dissimilar from noting that weight restoration is a goal for an anorexic client.

So.

This is me. This is my blog. These are my words. These are my beliefs. Some people won’t like them, and that’s ok. Some people will like them, and that’s ok, too. Ultimately, neither of those things are my business; my business is to make sure that I am ok with what I put out onto the interwebs, and for today, I am.

 

 

Here’s What Happens When A Man Spends Two Weeks Eating Nothing But Food Made For Women

“Why is this strategy (or, as my wife calls it, “the bullshit I’m subjected to”) so dumb? Because at best, even when these food products are fortified, the nutrients are seldom present in “enough quantity to actually do anything,” an expert said recently. And at worst, they minimize half the population by constantly calling them fat and turning them into a species that requires its own type of food.”

via Here’s What Happens When A Man Spends Two Weeks Eating Nothing But Food Made For Women.