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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My way or the highway.

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?

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.

Answering this Question is Key to Recovery

Today’s Food for Thought, from Anne Cuthbert, M.A. of http://www.foodisnottheenemy.com

“What does disordered eating and body image protect you from? Do the constant thoughts distract you from thinking about or feeling about other parts of your life? Does it keep you in a safe world that you can control? Does it give you a good excuse to not go somewhere or be with someone in which you feel uncomfortable? There is always a reason for it. What is it for you?”

You Have to Do It.

During my time out of the office, I’ve been reflecting quite a bit on success. As in, who have I worked with who has really nailed it and made a major improvement in their quality of life and functioning? What has been necessary to drive my own ongoing success in recovery? And how can I boil those answers down to help others better?

What I come back to, time and again, is action. For myself, and others, insight is great because it can provide valuable data regarding why a pattern or behavior started and is entrenched, but it’s basically useless if you don’t act. It’s entirely possible to spend years in therapy making insight after insight and seeing absolutely no change in how it feels to live your particular life. 

For example: Thanks to insight gained in my own treatment, I know exactly why being home alone makes me vulnerable to the siren song of eating disordered urges. However, learning that did nothing for my recovery until I learned to turn the knowledge into action. Now, not only can I predict when those ugly urges will surface, but I work to a. Minimize the likelihood that I’ll be faced with them b. Decrease my sensitivity by actively cultivating positive associations with being home alone and c. Having a long list of things to do to distract and calm myself that I actually use.

This is not groundbreaking information, but it makes a huge difference in outcome, and a surprisingly small number of folks actually approach the work this way. Why? Well, for one, it’s hard, especially at first. Acting on your insights often requires a kind of brute force, blind faith approach at the beginning because the action is often uncomfortable, new and scary, and probably runs counter to a lot of (distorted) beliefs. However, the discomfort wears off fairly quickly once you start to do your insights because evidence builds up that the new actions are working in your favor. 

In other words, you have to take a leap. The classic metaphors here are about letting go of one trapeze to grab the next, or letting go of your leaky life boat to grab a solid buoy – in both cases, there’s a deeply scary moment where you’re holding onto nothing. 

The question I ask, in my office and of myself is, how is that leaky raft working for you? We have the illusion that there’s a choice, to act on our insights and behave in new ways, or to stay in the current patterns. The reality is, you’re drowning. If the new raft is leaky, too, you were going down anyway, which while not exactly cheery, makes my point that, scary or not, you’ve got nothing to lose and everything to gain by taking action based on insight.

But, you have to do it.

What would it be like to start now?

All or Nothing.

In case my clients hadn’t mentioned it enough this month, an excellent article about “All or Nothing” thinking showed up in my inbox a few days ago that sealed the deal on me writing about this topic.

For the uninitiated, All or Nothing thinking goes something like this: “I just ate x, which was not on my strict list of safe foods for my special and restrictive New Year’s resolution diet, and therefore I have ruined my day and I’m going to eat several more servings of x, as well as anything else I happen to encounter that is off-limits.” Other variants include the belief that an A minus is a bad grade, and since you just got one, you’re never going to do your homework again because what’s the point if you’re just going to fail, or that because you did not get this particular job, you are clearly unemployable and are never putting yourself through the humiliation of sending out a resume again.

There are a lot of problems with this kind of thinking. As my handy-dandy examples suggest, one of the most significant is that it tends to lead to quitting, inertia, anxiety, depressive thoughts and other totally fun experiences. The actions that flow from All or Nothing thinking are usually the opposite of effective. Otherwise known as ineffective.

Let’s take our poor sad friend on the All or Nothing diet who has “cheated” or “failed”: she’s really extra screwed because the rules of her diet were written by All or Nothing thinkers to start with, but beyond that, if the goal of the diet was to, for example, eat fewer treats, then responding to eating a treat by deciding she has failed and eating a whole bunch more treats is pretty counter-productive.

Here’s an alternative. (And for the sake of argument, let’s say it’s reasonable that the dieter has decided her health or self esteem or chronic headaches or whatever it is would be ameliorated if she ate fewer treats.) Rather than taking the All or Nothing path of deciding that all treats are off limits at all times forever (and therefore if she has one, she is a failure, and off the diet, and should “take advantage” of already having “ruined the day” and squash in as many treats as possible), she could think a more helpful, more effective thought. Something like “I’m going to pick one treat per day to really savor and enjoy to support myself in eating fewer treats overall. If I have a moment or day where I eat more treats, I’ll use that as a learning experience to see if there are any ways my plan needs to be adjusted.”

Now, if she eats an extra treat, she hasn’t failed, she has stumbled upon a piece of data that is a total gem because it’s going to help her figure out a more effective plan e.g. “Oh, I see that it’s not a good idea to eat my special treat when I’m distracted by paperwork because I won’t really savor it and I’ll be more likely to want more. Excellent! Good to know.” (Her therapist might have had to support her in re-framing things that way, but hey, it’s cool to ask for help.)

Similarly, with the A minus, and the job that doesn’t pan out, if the goals are academic success and employment, and the disappointment is a perception that these outcomes might not work out, quitting all together is only going to take our All or Nothing thinkers farther away from their goals. (Also, an A minus is a really good grade, and perfectionism is very All or Nothing.)

All or Nothing thinking isn’t logical by it’s nature because it’s usually driven by a strong emotion (shame, fear, remorse, despair, euphoria), which is the primary way to identify that you might be in the throes of it. Any action that you’re drawn to while experiencing a strong emotion is suspect, and worth putting through the All or Nothing test. And wouldn’t you know it: Mindfulness helps here. Holding awareness of your emotional state provides the opportunity to catch yourself in those heightened moments when you’re vulnerable to distorted thinking, which provides you with the opportunity to review your thoughts and action plans before tumbling down the All or Nothing rabbit hole.

Like so much of what I recommend to folks, this is hard work, but it’s a way easier path than holding yourself hostage to a cycle of unrealistic standards and constant feelings of failure. At least, I think so.