All right. Hello, and welcome to another episode of thoughtful counselor Podcast. I'm so excited. We have two guests on the show today, we have Kaila Hattis, who is actually the second time on the show. Welcome back. When we first we first started talking about having you on here, the original call was to have you here for two for two episodes. But I could not have dreamed that you would be bringing back your your colleague, your associate, and partner in crime Emily Behrs. Welcome to the podcast for your very first time.
You so nice to be here. Thanks for having us. Of course.
You know, I little kind of behind the scenes. When Kaila and I first met for our episode that released, gosh now, it was a few weeks ago, on working with the families of teens. One of the big I think maybe it felt like an elephant in the room for me. But you know, this specific issue that teens face, much more commonly now that we're aware of, which is extreme pressure, under unrealistic beauty standards. And so Kaila, and I had kind of talked about that, like, how are we going to integrate this into the conversation. And we ultimately decided to save that for today. And I'm so excited that we are because now having you here, here, Emily, with some, you know, strong specialization and a background and eating disorders body image, you know, healthy body image. Now, we can actually deep dive into that conversation and hear hear from two specialists and hopefully give our audience a better sense of what it's like to work with young people with eating disorders and some strategies to be helpful and supportive to young people in their families who are who are struggling with this issue. So yes, thank you for being here. I guess maybe the best place to start is to ask you both to tell us to tell the audience a little bit about what brought you into working with teens working with teens with eating disorders.
Kaila, do you want to start?
I can definitely start. Oh, well, I always knew that to when I started graduate school that I wanted to work with kids and teens. And I think I was only one of maybe one other person wanted to work with teenagers in the program. And there was you know, maybe like one or two classes that were focused on working with kids and teens and families. And I really was always so passionate about providing, you know, really quality excellent care. I talked pretty openly about having gone to therapy as a teen myself and how transformative and helpful it was for me and my family. And I remember a therapist being like, I think you're going to be a therapist when you grow up.
So validating when you hear that you're like, Oh, my suspicions were correct.
I remember thinking there's no way because I don't like school and no way I'm going to so much school but you know, here we are. Yeah. Many years later, and I love being a therapist, but yes, so I think any any therapist that is going to be working with teens and families is of course gonna come across some kind of level of disordered eating or some red flags surrounding it and body image and self esteem and you know, fad diets and talking about what is a balanced lifestyle with exercising and you know, influences friend influences, peer influences, and of course, like their own family dynamics with Eating and what that looks like. So, yeah, that's that's, I guess a little bit about me. But Emily, I'll let you kind of jump in.
Thanks, Kaila. Yeah, so mine kind of working with teens was, like, a little different than what Kayla said, I am in grad school, I had a professor tell me that he was like, I think you're going to work with teens after after school. And I was like, No way. Like, I'm strictly adults. I don't want to do under 18 Like, no, thank you. I want to work with adults who really want to be in therapy and motivated and will boy, I was wrong. I started working at an eating disorder treatment center that took teen so, you know, like 13 and older, was the age range. And I just, I fell in love with working with these, like young minds that are so impressionable, and that have a lot like what Kayla was saying to just a lot of pressures right now. In our society, I mean, thinking just about social media, what they're exposed to, all day, every day for multiple hours a day. And I was really noticing this, especially, you know, pre and post pandemic, but especially post pandemic, a huge increase in teens with disordered eating, or eating disorder diagnoses, and how much social media had a huge influence on them, and needing that extra support. So it kind of kind of guided myself into this, you know, area working with teens, but I love it, it's something I'm so passionate about. And if we can have these conversations with, you know, younger, younger clients, it's, it's gonna make a world of difference.
Yeah, I so I'm really thankful that you brought in or that are framing this conversation, also, within the context of the pandemic, I think, you know, considering how much all of our screentime increased during the pandemic, where, you know, regardless of your age, it tracks, right that, that young people and, you know, people of all ages are being inundated with these messages coming through their devices at levels that are simply almost incomparable to pre pandemic levels. And this is also a time as you said, we're, you know, especially at the beginning of shelter during our shelter in place, people were disconnected from mental health services in a way that we had not yet seen before. And so you see this spike and, you know, anxiety, stress at home, exposure to social media, and a feeling of loss of control, loss of peer support, and this decrease of community connected this, this decrease to your, you know, whatever supports you have through school, whether it's your teachers, your school counselor, the school nurse, right, like you're just losing all of those opportunities to be connected with a mental health, mental health professional. So it's, yeah, we're we're kind of in a, like, this uncharted territory. Right now, in terms of what what are we dealing with? That, yeah, so do you? Do you have a sense of kind of what like, what the state of at least the US looks like, right now, in terms of eating disorders in within, you know, kind of young young people?
I would say, I mean, I think it's an epidemic truthfully. And that I do think that a lot of times this especially in our society, even even more so, before the pandemic, and especially after, we live in such a diet, culture, society, right, where we're constantly inundated with messaging about how to improve how to change how to also reverse time, right? Like, try this anti aging cream or fix yourself, right? We become our society has allowed us to become these kind of like guinea pigs to, you know, change and fix ourselves. And so I definitely think, especially, you know, during the pandemic, there was kind of this like, loss of control, right, like no one really knew what was going to happen. No one No one knew what to expect, right? We were all kind of just hit with the quarantine and Um, something that kind of took off. And so I do think that a lot of people really focused on okay, what do I have control over? And a lot of the times it's, you know, your body and also food, right, your basic needs. And so I think that people really latched on and said, Okay, I'm going to take this quarantine and fix myself and have a glow up, right? That's like the hearing pains, especially like, you know, pandemic glow up. And I think that that kind of fueled this, especially this increase in folks getting diagnosed with eating disorders and having it really be a big mental health epidemic.
Yeah, I had multiple teams that I had to get into eating disorder treatment centers, and over the over the course of the past year and a half, and in the Bay Area, they all had waiting lists. So I don't know, I don't, I don't know, like, if I can speak to the greater, you know, what, the entire United States but just our little microcosm here in California, in the Bay Area, it is an even actually, I should say, because of telehealth there was access to programs IOP, which is like intensive outpatient or PHP, Partial Hospitalization programs in other parts of the state. Even if they lived, you know, 300 miles away for no miles, if they were working with a doctor and a nutritionist, you know, up here, they could still be a part of a program in Southern California. So that was also kind of an interesting part of it was that you could get on waitlist. Everywhere, the state, kind of interesting. And that being said, they were all booked every single one. Yeah.
So yeah, yeah, you're talking about this simultaneous, you know, kind of like influx of young people looking for treatment, and also an increase in access somewhat. And it's been interesting to see how that increase in access has kind of, you know, the pattern or path that it's taken since the beginning of shelter in place, because I think at first, I don't know, at least my observation was that as in person, in treatment centers, agencies were attempting to pivot it was just it was a huge learning curve, lots of folks that had no training or background in telehealth were all of a sudden, you know, moving their entire caseload to, to online. And it's just, I, I don't know about you guys. But I haven't seen a lot of research about the effectiveness of telehealth, in working with folks struggling with eating disorders. So this will be a really interesting time as we kind of track what's happening right now. And and like, what are the what are the short and long term effects? This type of treatment?
And you know, I don't have the answer to the research, but I think, and maybe this kind of is a segue, but I think when you work with any, anybody with disordered eating, there's so many other parts, so many other components of their mental health, that are, you know, key factors in their treatment. And it's not sometimes it's not just the eating disorder, right, you have a session, and maybe in the beginning, you check in about the meal plan? And are they tracking, you know, their, what they need to input in their, you know, Tracker? Or, you know, how did their session with their nutritionist go? And are they you know, who's making sure that, you know, are they taking pictures of them all the things, but then, you know, this session could focus on their relationships. And yeah, Emily brought up this really amazing point of control and what you have control over what you don't and at its core, that is, I think, in my experience that the, like, nugget of what if this what stems from eating disorders is I have control over this and I don't have control over the people in my life, my relationships, the outcomes of, you know, maybe where I stand academically or where I stand with my job or the pandemic as was such a time of uncertainty. And so talking about how to be effective in relationships, how to manage anxiety, how to manage sleep, living a balanced lifestyle, those are the things that become focused big focal points and in session, not just talking about, you know, that disordered eating.
I like to I had a mentor tell me once that eating disorders are disorders of communication and relationship. And I think that that really speaks to to what you were saying about how, you know, especially in session, right, we don't just focus on the food aspect, but it's really about how the eating disorder served, right? Or how is serving a, a relationship, a comfort, a sense of control security, to express your needs to communicate what you what you're not getting, or what you're not receiving. And so, yeah, I think it's, it's so important, especially in session to talk about those underlying things, right, those underlying issues around control relationships, how you're communicating, expressing yourself expressing your needs.
This is kind of reminding me what supervisors have kind of said to me in the past, which is, you know, eating disorders, and in many cases, addiction, it's, it's not the root, it's not the root cause, you know, it's a symptom of a constellation of experiences and trauma. And, yeah, you know, it attachment issues, and family conflict, and, you know, other diagnoses, like, anxiety, depression, these are all contributing factors that are part of that big tapestry of how and why eating disorders manifest. And I think one of the things that is, you know, the, the field of counseling and therapy is kind of slowly coming around to is to move from that very much like singular focus of disordered eating very behavioral approaches to now this more trauma, informed, holistic, understanding that this is just a symptom of such a larger, more complex issue. And so wondering if maybe both of you could talk a little bit about that, maybe how you understand eating disorder treatment, what that might look like.
I'm so curious, Emily, what, what your perspective is on that?
Yeah, I think, um, I think, for eating disorder treatment, it's really important to consider and focus on the whole person, right mind body, spirit connection with movement, I think that's a really big one that Kaila mentioned earlier, forming your relationship, like with exercise with movement, and keeping in mind, like trauma informed care. Of course, that's, I think that's so like, vital to eating disorder treatment is I would say, just in my experience, most most to all of my clients have experienced some some form of trauma in their life. And you know, use their eating disorder again as their way to to cope to survive right to like, that's, that's their means of survival after they've experienced something traumatic or been through something traumatic. So, yeah, I think for treatment, it's so important to really focus on all of those aspects. And also, I do like to sometimes focus on what what has the eating disorder done for you, how has it served, you know, life rather than it being this, like, bad, you know, like, shame on the eating disorder kind of thing, because, again, it's really been someone's best friend, it's been someone's comfort, their means of control and safety. So how can we look at what has the eating disorder done for you, and maybe how we can, you know, take those maladaptive right coping skills from the eating disorder and and look at the strengths right and turn them into more healthy coping skills, rather than utilizing the eating disorder as the main one. Hope that answers your question Kaila would have activated
I love that kind of externalizing the eating disorder and I often ask clients question similarly like how is your anxiety helping you? How is this panic attack trying to help you and how can we pull out the the good that your body is trying to do for you even if it's doing so much you no harm in the moment there is something that your body is responding to on a very primal level an eating disorders are that that control again like that word, just I keep coming? back to it because it's so it's so powerful to feel like we have perceived control. And I say that, you know, perceived control because it it is perceived, does anybody really have control over?
Especially, especially when we're under the age of 18? Before we have actual legal autonomy, it's all of the decisions are made for us. Yeah.
And I think too, it's going back, I don't know if this is kind of a full circle, it's this social media component to this is so big, the highlight reel of life, and people perceiving that others have a better or more valued life than somebody else, based off of how they look online. An adult brain can barely perceive the difference versus a brain that is not fully developed. And just thinking, you know, I mean, I didn't grow up with social media, in the same way that it is today. It's going to be I think, very interesting, Megan, you're talking about the future research that's gonna come out the research in the future about what this if somebody's 1314 Right now, what, how are they going to perceive themselves at 25, 30, 40? After growing up with social media,
and the other, the inner, right, and the intersection there between, you know, thinness and also youth, right, and how you age, especially for people, yeah, who were who were kind of born with a screen in their hands and have been flooded with this messaging, the message that Emily that you shared earlier, which is like, you know, we're aging in reverse, and, you know, how to how to shed yours off off of, you know, your, your body and your face and all of this stuff. And so it's yeah, like, what do we, what do we do when we finally confront the fact that at 40, our bodies look and feel different than than we do at 20? And, and so I do see the topic of today as such a broader topic as well. I mean, we're talking about young young people, but we also know through the research that young people who struggle with this also continue to struggle with this as adults, and it's generally can be, is experienced by people as a lifelong chronic issue that that is ever present in their, in their psyche, in their in their lives. And I'm also I also have no I'm not currently working with this population right now. So maybe my optimism is not substantiated. So I want both of you guys to check me on this. But I'm also feeling a little bit of hope from witnessing this amazing body positivity and body neutrality movement, where it's just, I it may not be 5050 but when I'm scrolling on Instagram, I have 50% like kind of toxic Body Fitness influencers you know, all of this stuff. And then 50% body positivity or body at least body neutrality where people are being like, why are we talking about bodies literally a body's a body like let it just be the way it is. Which I kind of love that in contrast to body positivity I'm like do we have to feel positive about bodies why can't we just feel nothing and bodies or bodies let them live but yeah, and so I that is something that as an adult I did not have access why I did not have access to that as a teen like this body positivity conversation is a game changer and I talking with young people I see how that has empowered them in ways that Jeez 16 year old me wanted so bad to just be have a different body a different face a different different hair, just you name it. It was self scrutiny to the max and I you guys are nodding your head right now. I think that's a, you know, a very familiar experience of femininity. And I was talking to a young woman a few months ago, who was just like, had internalized the body positivity messaging. So much was just feeling feeling herself and feeling the bodies of others and I was just like you're a freaking ex like Inspiration. And it is because of like, I think like seeing these voices and seeing these experiences, hopefully is offering a counter narrative to the one that is also so prevalent around toxic beauty and toxic thinness.
Absolutely, I mean, I, I'll just jump in, because I, I think that we are definitely having more of a conversation. And I think that's like I do think eating disorders are they stem from a social justice standpoint, like we have to change the system, right, we have to have these conversations and have this messaging, especially for young minds that are staring at the screen and scrolling and seeing all of those influencers that have unrealistic beauty standards, you know, that are just are so easily influenced. So I hold hope, just like you we can do, that we can continue to have these conversations and also implement in school, I think is a really good place to start I in high school, I started like a body positivity group, like a club, at lunchtime with a few with a few of my friends. And we would just kind of talk about, you know, again, we didn't really have like social media like we do now. But just the conversations, right, of being a teenager and having comments made about our bodies, from friends from, you know, significant others from family and just being able to host a space, a safe space where we can have those conversations. So yeah, I'm a big, I'm a big believer in really starting the conversations early.
That was so powerful. And also, I attach us so nicely with what you said earlier, which I'm going to have you remind me in the audience, you said the eating disorders are disorders of communication, and relationships. I also hear this and Gabor Mate speaks about addictions this way. But addiction is a disease of social isolation. And I hear that parallel here so strongly where it's like, if young people can build community in, you know, in find spaces where they're allowed to exist outside of these really rigid beauty standards or like make sense of it, navigate it lean on each other for support to find different narratives. Just as seems so powerful, right? Then being alone, in your bedroom. Scrolling on tick tock, and seeing over and over and over again, how flawed you are. Yeah,
I think it's, it's what you were also talking about in this hope this, like, this piece of about there, there absolutely is help and treatment does work. And there is more and more representation in the media, of all kinds of all body sizes of all races of all ethnic backgrounds, of all ages, shapes, sizes, right? Male, female, non binary, right? Like, there, there is no one right way to be a human and the influences that we get online. It does shape our perception of what is the standard and in from media. I guess not just online I should say like television and movies and TV and what we watch on Netflix for constantly even cartoons, right? There was like a I was just reading like a thing that cartoon dads are now being sexualized. Like, there's all like they're making cartoon dads more attractive, because typically the stereotype of cartoon dads whereas like, you know, Homer Simpson, Homer Simpson, overweight, balding and like not very present. And now there's this whole movement that, you know, in in kids cartoons, what does the dad represent? There's so much changing. And of course, kids are getting those messages from a young age. This is part going back, sorry, took a tangent about hope that there's now I think, to this standard, that it's not just the NES now there's a like having the perfect hip to waist ratio, having the right size, you know, bra size right having the right exercise like you were saying there's this the whole fitness industry is very I think it's, it's intense to look at. And, and it's not always in the category of health.
Yeah, no. And I think, again, maybe my, my pollyannic hope is coming from the fact that we are seeing on social media people I want to say being canceled that they weren't canceled, but people being really called to account for selling flat tummy tea and having you know, a sponsored post on their pages that are, you know, that that are giving airspace to these toxic diet products. And people actually, you know, coming in and saying, Yeah, you're right, I shouldn't do that, like I'm gonna, I'm making a vow to my followers right now that I'm not going to do that anymore. And so there is, you know, I think people are started, specifically celebrities are starting to feel pressure, necessary pressure around being intentional with the types of products that they that they promote on their pages, which, again, growing up in the 90s in early aughts, like we could have never, we, you know, we could have never anticipated that that that that would happen, right? The celebrities were force feeding it down our throats and still are. But there's a there's an accountability piece to this now that I wanted to also I circle back to something, Emily, that you said about eating disorder treatment being a social justice issue, I think what we have seen, which is truly remarkable is that when we equip not just young people, but when we equip people with this language of social justice, we see that it is a strong protective factor around developing and you know, chronic eating disorders, and certainly leaning being able to lean into self acceptance, as, you know, this radical transformative thing. And I was wondering if either of you could really talk about that it as you know, for our clinicians who are listening, who are looking for ways to maybe help their their clients develop that social justice language, I was just wondering if you had any ideas or tips for I'm going to use me use, like my critical race theory. terminology here, but this critical consciousness, right, this sense where they see themselves within this greater political system, I don't know if you if that's, if either of you have ideas about that.
I, you know, I think that just I, for especially clinicians that are listening to I think it's, you know, I, I've, again, I'm not I can't speak to how much like, of my own work that I've done, but I do think it's so important to, like, look inward, and notice, like where you're maybe I'm going to use the word like fatphobia comes into play, right, and how that could show up in a session. I think that's something especially again, on this, like, kind of social justice, or lens, right, is that we we don't we're taught and we're, you know, influenced that not all bodies are good bodies, right, that folks that are fat or or living in larger bodies that they are seen as lesser than or unhealthy. And so I think, you know, just kind of bring it back as clinicians and supporting people that are going through their own eating disorder, disordered eating body image issues, it's really important to kind of turn inward and look at our own influences. And in fat phobic narratives, right, that we that have been ingrained in us as clinicians, and how we can support our clients and also do some of the work on our end to be a clinician that can show up in that non judgmental space. I hope that answers your question. Went into a tangent there, but I yeah, I really think it's important to look inward in our in our own
thing, that's a that's an anthem for every kind of therapy is that every therapist needs to do their own work. And it's so important, what you just said it's so important.
One of the interesting things here is that for a lot of for a lot of us a lot of just people living in the world, but also for a lot of therapists is the They're whatever body biases they have, that are kind of steeped and ingrained in this culture of fatphobia. Like you mentioned, they can hide from us really easily, because oftentimes, they exist in us as just like, healthy lifestyle stuff. And we can, you know, we can subtly say to ourselves, when we look in the mirror, like, Oh, I've gained a couple pounds this week, I'm gonna, you know, I'm going to, or, you know, I'm going to stop eating this, or I'm going to change this and God, look at you look how much your body has changed over the pandemic. And we can say these things to ourselves, and just have it under the guise of like, oh, no, I'm just I'm prioritizing my health. And it's like, Is that Is that helping you feel? Well, that kind of talk, right? And so I think, for me understanding, even just being able to figure out what those biases were was a process because I was untangling that from, you know, the fatphobia that comes out of the medical community. I was untangling that from Yeah, just expectations of this unchanging, an aging body that I had, right? It was just like, Oh, my God, I, I it was one day that someone had looked at me and was sayinsg, you know, anytime you want to make a comment about yourself and your body, I want you to imagine saying it to me first, would you ever see, you know, would you ever say that to me? And that was such a helpful reframe, for me, in my own relationship with my body is being like, wow, where do we get the language to say such mean things to ourselves, when we would never say those things to the people in our life, we would never feel that way about the people in our life, right. But we can do that with ourselves. That was kind of part of the undoing process that you mentioned, and how slippery it can be. And maybe to your point, what I wanted to share was the importance of expanding as clinicians intentionally expand, where you get your information from who you follow on Instagram, and tick tock the types of conferences that you attend, because, you know, take it from me and take it from, maybe you all can, both of you can support this idea as well. But these biases are slippery, and we don't necessarily realize how they can impact our clients and our you know, our young clients or older clients. In that, that's something that we have to keep in mind. Because working with clients with eating disorders, they they are going to hear any internalized bias we have around this Yeah, they have very strong bullshit meters and and so if we're not checking the type of language that we're using, we could be proliferating these ideas and our clients, we could be, you know, confirming their suspicions about some of these ideas, and we could be harming them. Yeah. So we are we still have a little bit of time left in the podcast today. And I was wondering, now I'm, like springing this on you, I was wondering if you could, if we could kind of share with our listeners, maybe a case study, and then the three of us talk through kind of maybe step by step some of the questions or, or, or, you know, different actions that you might take working with this with this fictional client. Where would you go? How would y'all feel about that? Sure. Okay. Okay, cool. So, I'm gonna, I'm gonna actually list out a fictional client.
Based on a television show that I've watched, I'm not going to share what it is. So you have a client that comes into your office upon recommendation from their parents. She is a cisgender young woman, she's 18 years old. And she's just graduated from high school, but did so online. When she was in high school. She was varsity cheerleader all four years. And since the pandemic has gained about 15 pounds, doesn't have a regular workout schedule, and is in that transition period where they're kind of just waiting to see what happens with college. In the past four or five months, this young woman has started heavily weighted restricting their food. And the parents suspected she's binging. But they don't know. So they've referred her to you to for help. Yeah. I don't know if you have any other questions I can. I'm happy to share those with you. But so what are your first, just thoughts about this client? What questions come to mind? Kaila,
do you have? So right off the bat, I see your wheels. Spinning? I'm like, wait, I'm so curious for you. I mean, I think assessment is so it's so key here, right. Like, the hardest part, I think about that first session with a teen. And if they're coming in by, you know, it depends on how her view of therapy and meeting with a therapist and how she feels about her parents. You know, linking sometimes teens naturally are very these days, this is the therapy generation, they'll say I need to talk to a therapist, they recognize it. They know what anxiety is. They know what depression is. They know what trauma is they know it, you know, I am noticing that I'm doing this thing with my eating. I know I need to talk to somebody
therapy tick tock is amazing.
So, yes, okay, I guess that would be my first question is, Is she coming in open to talking to a therapist? Or is it? Is she in trouble? Is it like a consequence to talk to a therapist? And that would frame my approach to building rapport? And
I've heard you talk about this before Kaila. Thank you. You describe this? I hate to use this word, because it's not fair. But this like kind of dumbing down approach to therapy? And you're just like, Oh, yeah. You you say it, but the way that you talked it to young people about therapy is so brilliant, because you don't over intellectualize it, you can you bring in a sense of humor to describe it?
Absolutely. And I am not an expert in their life. And I love that teens know themselves. They know they are, I know what I need, I know what I want. I know what I feel about my family, like they're so assured in whatever they're coming in with. And so at the end of the day, it's just a conversation. Of course, I'm gathering information, and what's the best way to gather information is to be as disarming and easy to talk to and real, like genuine. I think you said Megan, earlier, you know, teams are BS detectors. And they can tell if you're not being genuine, you know, what are you going to tell my family? Like, let's start there. Let's start with a super honest conversation about what does this look like, if I have to talk to your family about some of the things that you are going to bring up. And at the same time, let's talk about how I can talk to your family, I you can be in the room when we do it. I can do it by myself, you know, without you in the room, you can write out how you want me to say it what you want me to say if it has to include the things that would mandate me breaking confidentiality. And just because I have to break confidentiality, does not mean that you don't deserve help. So I want you to get the help that you need. And I am going to advocate for that because you are here. You made it. This is the hardest part. And guess what? Nobody's going to be surprised. Like, we're already here. Your parents are not gonna be surprised. We already know what's going on. And then they're like, oh, yeah, you know, oftentimes, they're, they're kind of the see the, you know, the secrets by the time they get into the therapy office, or if there's some other big thing that happened that needs to be discussed. Of course, like, you know, as much tact and as, as I think cautiously and respectfully as possible, because I think you said something earlier that really resonated with me about they're not in control of their life yet anybody under 18 and that's his sensitivity because it's such a time of life where you are craving that independence and you're craving that support and wanting to be close but also do your own thing you know, you want you still need the support and the love and that to know you're unconditionally accepted and valued but also you're like, you know, wanting to break free and make your own decisions and not have your parents breathing down your throat and There's really nuance with that, okay? That's my tangent.
Thinking and Pandemic conditions just exacerbate that because people can literally not, you know, not leave their house or not move out of their parents house. So they're continue to feel that.
And that assessment process of like, how to build rapport, and also assassin assets, really challenging questions, and I say, if you don't feel comfortable answering, you know, put a finger in the air tell me you don't want to answer whatever it is, give me the indication that you don't want to answer that question. And I'll move on, you know, the more information I have, the more I can help you. And this is day one, you don't know me, I'm a stranger. So I get it. Yeah. And I'm going to talk to your family like so as in, like, do an assessment with the family assessment with the team, not just tell them everything now break confidentiality, right. I'm going to hear what your parents have to say to what do you think they're gonna say about you?
I think I would just add, and I love Kaila's just again, how she navigates the assessment when her and I were talking. And I think that's why I feel so grateful to be a part of Pacific because therapeutic Kaila, because she just, she brings in that kind of like warmth and empathetic like space right off the bat. And I think that is so important, just thinking back to this case, right? That we're kind of going into together like that would be that would be exactly how I would want to approach it with this, this client too, is like, bringing that warmth, bringing that non judgmental space where she could really feel like, this is really uncomfortable to talk about, right, like talking about my body talking about my transition from, you know, being the varsity cheerleader and transitioning into college and the pressures. I mean, there's so much like shame rooted right probably in there. And so, just really creating a gentle, warm, non judgmental, shame free space for her to be able to talk about the things that are really uncomfortable. And having it you know, be a zone that's, hey, like, nothing is off, you know, off limits here. Let's let's talk about some of these things. Together. we're in it together. So that'd be the only thing I would add.
I I'm surprised we haven't talked about shame.
I know. I you know, maybe we have we haven't labeled it shame. But I think we've definitely talked on that internalized bullshit. The fields Yeah, yeah, for sure. So one of the maybe, maybe finally, in our final minutes, I I'd love for you guys to talk just a little bit about referrals and working with kind of multidisciplinary team. So maybe even just using this case study, let's say you got to the point where you you recognize that she would really benefit from talking to a medical health professional, and nutritionist. So what would that process look like in working with her
um, I think in Kaila definitely mentioned this in the beginning of the episode, but that it is so important, especially working with teens, it with eating disorders to have a team in place because again, treating the whole body right the whole system, the mind, body, spirit, it's so important to be medically monitoring how things are going. I mean, eating disorders are, they're a silent killer, it's, it's so incredibly scary, how quickly and how fast things can happen. Medically speaking, with someone who is is suffering from an eating disorder, so you know, having a doctor on board, psychiatrist, psychiatrists, and then also having like a dietitian, nutritionist to support you know, from the eating disorder lens, I also think is really important. Someone who is aligned with the same type of, you know, treatment or Health at Every Size, anti diet provider,
really is huge. So we have to do our homework before we figure out our referrals. Right, we have to be certain that the people that we are referring our clients to aren't going to further harm or further promote the, you know, thin gold standard. Yeah,
absolutely. And it's often a systemic, you know, like probably like the family doesn't know what the meal plate is supposed to look like. And yeah, oftentimes the the people who are expert and experts in this field and they're in their scope, I think scope is a really important thing to bring up here, because I can't advise on that. But I can refer you to somebody who is an expert on what your plate of food needs to look like for every kind of meal and what your snacks need to look like. And can do mythbusting around different things we've heard like protein, and you know how much this you need, how much that you need. And it's, it's so cool when the whole family gets that education, and they make it a part of the curriculum that the family needs to know. So it's not just the teen, I know, there's a lot of for the, you know, therapists out there, there's like the identified patient, you know, that, okay, they come in, right this this, for example, like what you're saying this, this kid comes in, and she has been, you know, brought in by her family. But with eating disorder treatment, one of the great parts about it is that it is it can be the whole family, and the whole family is often included in the recovery. And that's really a cool part about it is, you know, that everybody gets education. And for and because as Emily was saying, it is really scary, and they're somebody could look so healthy. And actually, you know, their organs could be shutting down. So, or they could be orthostatic, or their heart, you know, you can't tell just from looking at somebody that their brain and heart and organs are functioning in the way that they should be. And so that's, I think, a big caveat for therapists to know. It's not just about them, this eating disorders come in all different kinds of, you know, that doesn't look one way.
Thank you for bringing that point. And just as we're closing today, like it, it just seems to me that the assessment around disordered eating, generally comes up, I think, for most therapists, if they're sitting in front of someone who looks remarkably thin, right? That's when it comes up. Or, you know, they may just wait until the client says something first to do the assessment. And what I hear both of you saying is, this should be happening with all of our clients at any age, just on your intake assessment, ask questions about what is your relationship with your body? How do you feel in your skin? What has aging been like for you? Just to do that quick temperature check to see okay, like, what kind of language is the person sitting in front of me using to describe themselves using to describe their body. And if we hear some of that toxicity, some of that shame, then we know to bookmark it to you know, literally, doggy, hear that and come back to it and make you know, make body and nutrition, wellness, an ongoing assessment, in our work with clients do not wait for your clients to say that they have a problem, because then you will be the last person to know.
They don't know. Oh, absolutely. Oh, absolutely. That what they're presenting with is unhealthy, right, like running six miles a day, and then not eating afterwards. Like some people think that that's healthy and normal. And there's all the, you know, kinds of sports in high school that promote that, right that that dancers and cheerleaders and wrestling and all the different kinds of sports where gymnastics, like they have to weigh in and certain size and muscle composition. And so there's, I think, you know, people internalize that as this is healthy, and they don't actually know. And their family doesn't know that this is actually pretty scary. So, yes, that's fine.
I'm already feeling like we could have this become another two part episode because I'm also thinking about what came up earlier that we really didn't get to spend too much time talking about was just like how fatphobia influences the way that we treat our clients. And so a part of this conversation too is when a client comes in, who is fat or has a larger body? We may tiptoe around these questions out of, you know, not wanting to be uncomfortable or what? No, we have, you know, asking these questions is a is a right you know, it's like a ethical imperative for all of our clients and it is harmful to assume that someone's sitting in front of us with a bigger body He also doesn't struggle with disordered eating. It is, you know, there's no assumptions, no assumptions here. There are relationships with our bodies are complicated. And when you occupy a larger body in the society, you are also experiencing more of that. Those disconnections social isolation that we that lies at the heart of disordered eating. So if we're not factoring in the systemic discrimination factor in this conversation, we're really missing a huge, a huge part of the equation.
For sure, Snaps to that
I'm captivated by what you're saying, Megan? Yes, I want to listen to that episode.
You both have been such a joy. Thank you so much for being on the thoughtful counselor podcast. This is the first time that I've had two people on an episode and I so I was, I was just like, you know, I am really excited for this because I'm not not going to have to do as much talking. So you guys are both so lovely. And to be here and representing Pacific Coast therapy, and the amazing work that you're doing here in Santa Cruz, California. It's just I it's such a gift to have you on and to be sharing with our listeners, your expertise and working with teens and eating disorders. This is such an important area and just feeling a lot of gratitude for having you both on the show. So thank you so much.
Thank you for having me.
Thank you so much Megan for for sharing the space and allowing us to be here today.
Absolutely.
The Thoughtful Counselor is, Désa Daniel, Raissa Miller, Aaron Smith, Jessica Tyler, Stacey Diane Arañez Litam, and me, Megan Speciale. Find us online at concept.paloaltou.edu. Our funding is provided by Palo Alto University’s Division of Continuing and Professional Studies. Learn more about them at concept.paloaltou.edu. The views and opinions expressed on The Thoughtful Counselor are those of the individual authors and contributors and don’t necessarily represent the views of other authors and contributors or of our sponsor Palo Alto University. So, if you have an idea for an episode, general feedback about the podcast, or just want to reach out to us, please drop us a line at thethoughtfulcounselor@gmail.com. Thanks for tuning in and we hope to hear from you soon.
