Child and Adolescent Transgender Center for Health at the Boston Medical Center: A resource to know about!

As part of the Department of Pediatrics at Boston Medical Center, CATCH provides support and care to children, adolescents, and young adults who identify as transgender, gender non-conforming, or are gender exploring and looking for additional support. First time patients can expect their initial visit to last between 60-90 minutes. During this visit, medical history, gender history, and patient and family goals will be reviewed, followed by a discussion around gender affirming care options offered at the clinic. Individual treatment plans are created based on individual patient and family goals. Additionally, all first time patients will undergo a complete psychological assessment.

CATCH aims to see new patients within 4-6 weeks. To schedule an appointment, please call 617.414.4841.

Offered services include:

  • Education around gender identify and development
  • Individual and family therapeutic support
  • Access to hormone blockers, including injection and implant available onsite
  • Gender-affirming medication therapy, including hormones (estrogen and testosterone)
  • Transition to adult care and other services through the Center for Transgender Medication and Surgery (factoring in where the patient is in terms of medication and process, pubertal status, and age.)

https://www.bmc.org/center-transgender-medicine-and-surgery/clinical-services/child-and-adolescent-transgender-center

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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.

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?

Health At Every Size

ASDAH: HAES® Principles.

The above is a link to the Health at Every Size website, and details the principles of that movement. It’s important to me professionally to ensure that folks know that I’m not in the business of telling people to lose weight, although I sometimes reference weight management or body composition changes because those are things I support clients with when it’s medically or personally warranted. For example, if my client loves to kayak, and her body size is interfering with her ability to participate in that activity, and she wants to take a look at food choices, sleep, exercise and stress management (all of which impact body size), we’re going to do that. Another example would be if my client has a lifestyle related disease such as diabetes or chronic joint problems. If, however, she’s eating well, sleeping well, managing stress well and functioning well in her professional and personal life, but just doesn’t like the the way she looks, we’re going to have a very different conversation and a very different set of goals related to acceptance and body image.

If you’re living in a body that’s larger than some theoretical image of how you think you “should” look, ask yourself:

Is my body healthy, in terms of how systems function, my energy levels etc? Is my mind healthy? Do the thoughts I think support my well being and ability to move through the world with ease?

Because health truly is possible at every size, and to be frank, it’s far more common for me to encounter folks who are unhealthy and unhappy because they are trying to force their bodies to remain (even slightly) underweight by making impoverished nutritional choices and overexercising.

On a related note, try this. If you’re hungry, go eat something. You’ll feel better. If you’re sad, food’s not really a related phenomenon (unless you’re actually sad because you’re not eating enough dietary fat which does a number on the brain and tends to give rise to feelings of depression and anxiety) and a snack probably isn’t what you need. Just saying.

 

Prioritize Your Priorities.

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?

From my Inbox:

I subscribe to emails from Jen Comas Keck of http://www.beautyliesinstrength.com because I have found that witnessing the journeys of other women who are trying to figure out the whole food/body/soul/self equation in a multitude of ways is super helpful. This was a recent offering of hers. Note that Jen is a nutrition coach, former figure competitor and power lifter, which is not my context or perspective, and likely isn’t yours either, and that she’s not addressing eating disorders per se, but rather the low grade body image concerns and disordered relationships women often have with food regardless of diagnosis. Her words follow:

“Should I Lose Weight?”

“Should I try to lose weight? Sometimes I wonder if I should try to get leaner.”

I was at Sushi Samba in the Palazzo in Vegas a couple of weeks ago with an amazing group of people. There was never a lull in the conversation, which ranged from business, to religion, and then training, and on to food, which inevitably led to …

Body composition.

Dieting.

Fat loss.

It seems to be a hot topic when I’m around, and with both Molly and I sitting there, it wasn’t a surprise that it came up. Helping women become healthier, stronger, and feel better is our jam. While we never initiate these types of conversations, people often want to talk to us about our work, and are interested in hearing our opinions.

But, back to our girlfriend.

Let me tell you a little bit about her, because as you know, context always matters, and this scenario is no different.

First off, she is a beautiful woman both inside and out.

She is a Professor for not one, but two, Master’s courses at a University, all while working on her thesis for her PhD that is due later this year.

She is married, very involved with her community, and cherishes her social life.

To say she is busy would be putting it mildly.

She consistently makes time for exercise, and makes really solid nutrition choices the overwhelming majority of the time. She is healthy, radiant, and fit.

Even though she is healthy, she still had that niggling question in the back of her mind that so many women do:

Should I try to lose some weight?

I followed up to her question with one of my own, “Why?”

“I don’t know…” she told me. “I just feel like maybe I’m supposed to. But the thing is, I’m already eating pretty well, and I exercise consistently.”

“What kind of changes do you think you could make to get results?” I asked her.

She paused for a moment, and then, with the saddest face I’ve ever seen, said, “I guess I could give up my weekly dinner and wine night with the girls. And I suppose I could stop going to breakfast with my husband on the weekends….”

Stop. Stop. Stop.

We are talking about a woman who is healthy and fit. One that is so richly scheduled that her weekly dinner and wine night with her girlfriends, and weekend breakfasts with her husband are the highlight of her week. Are we seriously going to pull the plug on those things so she can lose – maybe – four or five pounds?

NO.

Instead of voicing my opinion as strongly as I did above, I asked her the following question:

“What is going to bring you more overall happiness? Continuing to have dinner and wine with your girls once a week, and breakfasts out with your husband on the weekend, or really having to buckle down to lose a few measly pounds?”

“Well, the dinners and breakfasts, for sure.” she said. “Thank you. I had never looked at it that way.”

When it comes to setting our goals, it’s important to figure out the why.

Do you need to lose fat to feel better and improve your health? If so, that is completely understandable, and you know that I’m an ardent supporter of improving quality of life.

But… if you’re trying to lose a bit of body fat just because it’s what you think you’re “supposed” to do, or that is what society thinks you should be doing, eff that.

Shooting you straight,

always and forever,

Jen

PS. Go to Happy Hour at Sushi Samba next time you’re in Vegas. Trust me.

 

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.