Date: Sunday September 17th 2:00-3:30pm
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.
I am a serious fan of perspectives. I had a high school history teacher who was fond of saying that “truth is increasing complexity”, and in both my personal and professional lives, I have found this to be, well, true.
When a client presents me with a truth, about themselves, about an experience, we work to increase complexity. Are you sure that’s true? Has it always been true? What else might be true? What do others in your life believe to be true? Often, in this way, we are able to triangulate, and to move in the direction of deeper knowing, of more true, but also to open space for subjectivity, and breathe some light or humor or next questions into that space.
It is in the spirit of that kind of inquiry that I offer the following blog post by Holly Glenn Whitaker: http://www.hipsobriety.com/home/2015/2/18/why-aa-didnt-work-for-me-my-story-part-1
This is not a prescription. This is not an indictment of AA. It is also not an endorsement of Holly’s sobriety coaching program. It is, however, a perspective. There’s this Buddhist expression, “If you meet the Buddha on the road, kill him!” It speaks to the dangers of making something or someone your god, which is easy to do when you feel as though you have been saved, but the reification of any one concept or any one guru or organization can be fraught with peril.
I work with a lot of clients who struggle with substance abuse because when the world offers you its misogyny, its transphobia, its racisim and its fat phobia (amongst others) to internalize, numbness and escape often sound like the loveliest of sirens. I have folks who come to my office who have found a sober life working an AA program, and it’s glorious. I also work with clients who have found that the language of powerlessness and surrender was inaccessible to them in the context of a history of sexual trauma or internalized hatred and disempowerment, and who echo Holly’s statement that in fact, making the choice to let go of alcohol because you can’t use it and be well is profoundly powerful, and profoundly empowering.
You can’t get sober by yourself, but you’re also the only one who can get you sober. The rooms of AA are one available community within which to do that work, but they are not the only one: could this be a truth?
Somewhere along the line, I read an article that suggested I compare my stated priorities with the list of activities most engaged in. For example, I wouldn’t call checking Facebook a priority, and I frequently express frustration that I haven’t been able to consistently find time to do strength training now that I have two kids. However, I definitely spend 20 minutes per day on Facebook… And guess how long my strength training routine is?
I have since made righting those kind of inconsistencies a priority, which is part of how this blog began to develop a fine layer of dust over it: I love to read, and I decided that when I have a block of time where I can’t be active because my daughter has fallen asleep on my lap and I’m not moving until she wakes up, I wanted to read rather than spend time on a screen doing social media or blogging. I have been increasingly excited about using essential oils to enhance my own wellness and manage my mood (as well as for cleaning, and making food taste awesome), so I’ve been using my “found” formerly wasted on social media time to read and learn as much as I can about the topic (feel free to contact me if you’d like to learn more yourself!).
What I have discovered is that social media is definitely a lower priority than my actions were making it, even though I could have told you that I already believed it was not a priority. However, I did really miss expressing my thoughts and ideas and connecting with folks here on my blog, so I’ve recommitted to posting a bit more frequently than every 48 days.
So, do yourself a favor… Make a list of what you believe your priorities are, and note where you would like to be spending more time e.g. if nourishing yourself well is a priority, and you’re frustrated that you don’t seem to have enough time to do prep tasks like hard-boiling a week’s worth of eggs or getting a week’s worth of snack veggies into Tupperware, that line on your list gets highlighted. Next, for 1-3 days, jot down or note in your phone what you have been doing each hour. Comparing these two lists is a great way to find time you’re wasting on low priority activities without realizing it.
We all get the same 24 hours: how do you want to be spending yours?
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.
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.
The Whole30 I did recently with my partner can definitely be filed under the heading context matters. The program was a no-brainier for him: struggling with IBS, overweight and taking a hit in the self esteem department, he was a prime candidate for a lifestyle change. My context, on the other hand, was a bit different: having spent a good part of my adolescence and 20s struggling with an eating disorder, and breastfeeding our infant exclusively, I was (appropriately) apprehensive about any plan that involved restricting my food intake. But, I am the primary food shopper and menu planner in our family (by inclination and by choice) so I really wanted to find a way to make a Whole30 work because it wasn’t realistic for him to do one without me, and supporting his health is an “I love you” I want to choose every time.
I did my due diligence, including reading and rereading this important article, and talking with friends and a counselor before deciding to take the plunge. The vestigial ghostly eating disordered part of my mind knew that, done mindlessly, this was a perfect chance to accidentally get too skinny, and I had to have daily conversations with that voice to keep myself honest.
I did a number of things in order to intentionally “fail” at losing weight on the Whole30 as a breastfeeding Mama in eating disorder recovery. This was not easy, friends. I had the “perfect” opportunity to relapse, and it required real intentionality to choose self love and health throughout. (I’m bragging right now. I am very proud of myself. Just saying.) I cut out any exercise beyond the babywearing up and down the stairs with laundry variety. I put gobs of coconut milk in my coffee. Breakfast was three eggs, a sweet potato spread with ghee and a palm full of olives. I ate dinner portions 150% larger than my partner, who is five inches taller than me and a former ice hockey player. To steal Melissa Hartwig’s phrase, I ate all the things.
When we weighed ourselves again after the month long program, I had stayed exactly the same weight, which while a disappointment to the ghost, was a victory and a milestone on the path of my ongoing recovery. (My partner, on the other hand, reports that his IBS has literally never been better managed and that he lost a significant and healthy amount of weight.) I did have a number of non-scale victories over the course of the month, by the way. My sleep, digestion and overall energy levels all improved. I broke a nasty MyFitnessPal habit I had developed postpartum. I reset my sweetness meter. I actually made more milk for my baby. Wins.
So why am I sharing this? Because choices. Because mindset. Because motives. These all matter enormously. So often in recovery, it’s not what you’re doing or what’s on your plate, but why. Many people do a Whole30 to lose weight, but it doesn’t have to be about that at all. Same goes for anything else you or I choose to undertake, be it exercise, a relationship, a career change… all of these can be recovery wins or purposeful self-sabotage.
In my last post, I referenced having a long list of things to do to distract and calm myself “that I actually use.” While the list is personal, the concept and potentially some of my options are universal, and so I offer them here.
Marsha Linehan’s DBT manual features a list of “Adult Pleasant Events” in the Emotion Regulation curriculum, and I have often poked fun at the suggestion therein to chop wood, but the reality is that for the right person, that’s a great idea. When you’re overcome by either an overwhelming, extreme emotion or an intense urge to make what my preschool aged son calls “not a safe choice”, finding the right distraction, alternative outlet or self-soothing strategy is key to making it to the other side of the experience without making your life worse.
Before I get to my own list, there’s another DBT concept worth mentioning called Willingness, which is part of Linehan’s Radical Acceptance module in the Distress Tolerance portion of the DBT curriculum. Willingness is set in opposition to Willfulness, and it basically means you have to actually give recovery strategies an open-minded, whole-hearted chance. Example: refusing to try an alternative coping strategy because your special, special pain could never be helped by something as simple as taking a walk. That’s willfulness. Example: sticking to your commitment to actively engage in 15 minutes of a self-soothing strategy that sounds stupid and pointless at the outset before reassessing your desire to give into an urge to binge. That’s willingness. I’m not a huge believer in the magic of the cosmos, but I will say that the number of times I’ve gotten a phone call from a supportive friend at minute 14 of the aforementioned scenario is uncanny. In other words, it’s often not just the calming or uplifting properties of the strategy that gets you through, but rather, the shift in mindset to being willing to make space for recovery that makes the difference.
So, without further ado, here is my (partial) go-to list of Adult Pleasant Events. I’ve chosen my top few tried and true because this post is brought to you by a napping infant who is likely to wake up soon.
Just drink a glass of water and your eating disorder or depression will be cured forever! sounds like an obnoxious article in a self-help magazine, but it’s not the strategies themselves that do the heavy lifting. Yes, it’s useful to find strategies that speak to you and tap into your particular set of memories and preferences, but the real magic comes with cultivating willingness to employ them.