Latest / All Bodies. All Foods. / 27. Eating Disorder Support is Available for Everybody: A Conversation on Treatment and Care With Queer and TGNC Folx

Transcript

27. Eating Disorder Support is Available for Everybody: A Conversation on Treatment and Care With Queer and TGNC Folx · All Bodies. All Foods.

• 0:01
  Hey,
• 0:01
  I'm Sam.
• 0:02
  Hi,
• 0:02
  I'm Ashley.
• 0:03
  And you're listening to All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
• 0:09
  We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
• 0:19
  We believe that all bodies and all foods are welcome.
• 0:23
  We would love for you to join us on this journey.
• 0:26
  Let's learn together.
• 0:29
  Hi,
• 0:29
  everybody.
• 0:30
  Welcome back to another episode of All Bodies.
• 0:33
  All Foods,
• 0:34
  Ashley and Sam are here and we are joined today by a very special guest,
• 0:39
  Hannah Coakley.
• 0:40
  They them is queer non-binary RDN registered dietician nutritionist who specializes in supporting queer and TGNC clients through recovery from eating disorders and or disordered eating from a trauma informed body affirming and anti-racism framework.
• 0:59
  They received their Masters of Science and Public Health Nutrition from Johns Hopkins University and completed their dietetic internship within the VA hospital system in 2015.
• 1:11
  Other formative experiences for them include time as a food justice program coordinator in New York City,
• 1:18
  as a monastic resident of UAA Zen Center in Santa Fe,
• 1:22
  New Mexico as the farm manager of a small vegetable farm in Colorado and is the outpatient director of a trauma informed Eating disorder treatment center in Memphis,
• 1:34
  Tennessee.
• 1:35
  Um So h welcome.
• 1:37
  We are so excited you are here and I just want to say to you and to everybody else out there listening to us.
• 1:44
  I'm like smiling so huge right now because I was reading your experiences.
• 1:49
  Absolutely.
• 1:51
  I'm so fascinated by everything that you've been involved in.
• 1:55
  Yeah.
• 1:55
  Yeah.
• 1:56
  Eclectic.
• 1:56
  Eclectic is the word I think would be a good descriptor.
• 2:01
  Yeah.
• 2:01
  Uh I would love to just like give the floor to uh let you introduce yourself,
• 2:06
  give us a little bit of your background if you want and maybe even share with us and our listeners how you found your way.
• 2:15
  Um Working as a dietician,
• 2:17
  um working as a dietician within the eating disorder field and then also specifically supporting queer and TGNC folks.
• 2:24
  So I'll let you take it away.
• 2:26
  Oh,
• 2:26
  wow.
• 2:27
  OK,
• 2:27
  great.
• 2:28
  Um Yeah.
• 2:29
  So I was uh raised outside of Baltimore and then I went to um New York City for my undergrad program.
• 2:37
  And towards the end of that,
• 2:40
  I had the opportunity to study abroad in Ghana,
• 2:44
  in West Africa.
• 2:46
  And at the time I I that,
• 2:49
  that uh kind of intersected with my feelings about potentially doing nutrition internationally.
• 2:56
  Um So I started actually studying nutrition uh from like a population level,
• 3:03
  potentially international level.
• 3:05
  I was also um an urban studies major so all about like the development of cities and as I was studying,
• 3:13
  as I was getting my DPD so the qualifications to be uh to go into an internship.
• 3:21
  So because I didn't major in nutrition as an undergraduate,
• 3:24
  I had to stay um for,
• 3:26
  for another like half a year to get those.
• 3:30
  And at that point,
• 3:32
  I realized that I,
• 3:34
  yeah,
• 3:34
  I wanted to pursue something in public health potentially.
• 3:38
  And so I,
• 3:39
  I was in like a clinical nutrition program.
• 3:41
  So I left that and went to Hopkins for my master's um and had never even really,
• 3:50
  I had done this like this nutrition secondary additional degree.
• 3:55
  And I never really even thought about being a dietician.
• 3:58
  And yeah,
• 4:00
  and then I um the,
• 4:03
  the internships,
• 4:04
  the va internships are very competitive.
• 4:07
  And so I,
• 4:07
  I had kind of a backup plan and I thought,
• 4:10
  you know,
• 4:10
  if I get in,
• 4:11
  I'll go be a dietician and if I don't,
• 4:14
  I'll go do something else.
• 4:16
  Um And so I got in so I actually went to Memphis first as a dietetic intern.
• 4:23
  And then I left there and went back to New York and did um still working at the population level.
• 4:30
  I was really interested in like food access.
• 4:32
  Um That's what I had also studied as a graduate student um and shifted my focus to domestic um like with a lot of like soul searching and yeah,
• 4:45
  and so I had done some food justice work,
• 4:47
  um,
• 4:48
  that I really enjoyed.
• 4:50
  Um,
• 4:50
  it was AmeriCorps work so I needed something that would,
• 4:54
  um,
• 4:54
  pay more.
• 4:55
  So I,
• 4:56
  then I started doing,
• 4:57
  um,
• 4:58
  a,
• 4:58
  a program that was like nutrition oriented but international.
• 5:02
  So I actually got a little bit of an opportunity to see what that was like.
• 5:06
  Um,
• 5:07
  yeah,
• 5:08
  and so then I ultimately,
• 5:11
  I had a big reckoning in my late twenties.
• 5:14
  I think a lot of people have that like the Saturn return age.
• 5:17
  And I was thinking really hard about what I wanted to do with these degrees.
• 5:22
  And with my life,
• 5:23
  I had some,
• 5:24
  some things that had happened in my life that that led me to really reconsider.
• 5:29
  And I said,
• 5:31
  you know what I need to reset.
• 5:33
  And I went uh to this,
• 5:36
  this Zen Buddhist program.
• 5:40
  I just like I heard a podcast by this woman named Joan Halifax and I knew she had a,
• 5:44
  a Zen program and I had started meditating.
• 5:46
  So I went there with the intention of staying for like three months,
• 5:50
  just like as like a little break and I stayed for a year and a half.
• 5:53
  Um Yeah,
• 5:55
  and it was really,
• 5:56
  I mean,
• 5:56
  it changed the,
• 5:58
  it changed who I am and I,
• 6:00
  I was nearing the end of that time and I actually was um recruited off of indeed to go to an eating disorder treatment center in Memphis.
• 6:09
  So I had never thought about doing eating disorders even though I have a history of living in my family,
• 6:14
  even though like,
• 6:15
  I've had my own personal history of what I would say is a spectrum,
• 6:19
  right?
• 6:19
  So,
• 6:19
  like disordered eating,
• 6:21
  um nothing that I ever had formal treatment for,
• 6:23
  but definitely like disrupted my life.
• 6:26
  And so this opportunity just sort of showed up and just to clarify,
• 6:30
  I wasn't the outpatient director,
• 6:32
  like overseeing it,
• 6:33
  I was just nutrition.
• 6:34
  I was just overseeing outpatient nutrition.
• 6:37
  And I was there for about a year and it was very intense.
• 6:41
  Um And ultimately that setting,
• 6:44
  I kind of,
• 6:45
  I got a lot of experience and a lot of training,
• 6:47
  it was uh trauma focussed,
• 6:49
  trauma specialization.
• 6:52
  And I stepped away from that intense intensity and realized,
• 7:00
  you know,
• 7:00
  I know about food at the population level.
• 7:03
  And now I'm doing this like individual counseling and I have no idea how we grow food or how we get food.
• 7:08
  I don't know anything about that.
• 7:10
  So I should,
• 7:10
  it's important to learn.
• 7:13
  And I also really missed a big part of uh being a monastic is like working with your hands.
• 7:17
  There's a lot of like labor,
• 7:19
  right?
• 7:19
  And labor is a way to sort of like clear your mind.
• 7:21
  And so I missed that.
• 7:23
  And so I thought,
• 7:24
  well,
• 7:24
  what combines all those things?
• 7:25
  Like,
• 7:25
  maybe I can see if I can work at a farm.
• 7:28
  So I um similar story I met,
• 7:33
  I thought I was gonna go for like five months.
• 7:35
  I wound up being there for two years and end up like being uh working with the owner the second year as like the manager of the farm.
• 7:43
  So I overseeing like the logistics and the running of the farm.
• 7:46
  And then I was actually wanting to improve my Spanish.
• 7:51
  So I had originally planned to do a totally separate program in Chile.
• 7:56
  Um And that was supposed to start March of 2020 obviously that doesn't happen.
• 8:01
  So I was in New York with my,
• 8:03
  with my partner that was like supposed to be a short term thing.
• 8:07
  And my plan had always been to go do this program,
• 8:10
  strengthen my Spanish and then potentially start,
• 8:12
  I missed eating disorders,
• 8:14
  but I wanted to do it in an outpatient level.
• 8:16
  I really missed that work.
• 8:17
  And so I said,
• 8:20
  let me just try now,
• 8:22
  just start my practice.
• 8:23
  Like I have nobody is going anywhere and people are seeking like virtual assistance.
• 8:29
  And so I just started building it and I was doing like virtual,
• 8:33
  just like regular nutrition counseling uh with like a telehealth program,
• 8:37
  people get through their insurance.
• 8:39
  And yeah,
• 8:40
  and I think um like a lot of people over the course of the pandemic,
• 8:44
  I was really able to find language for my own gender identity,
• 8:47
  which is why I identify as non binary.
• 8:50
  I had come out many years ago uh as queer.
• 8:55
  And so as I started getting to know more about the space as particularly the outpatient space.
• 9:02
  Like I realized there's just not a lot of providers who share those identities and that there's lots and lots of people queer folks,
• 9:10
  transgender,
• 9:11
  nonconforming folks who are looking for that type of specific assistance.
• 9:16
  So I didn't really like try,
• 9:18
  I didn't really like market myself.
• 9:19
  It was just like people,
• 9:21
  you know,
• 9:21
  were finding me.
• 9:23
  Um And yeah,
• 9:26
  and so it just kind of uh it kind of evolved naturally and then just under a year from being able from going full time in this,
• 9:33
  which is really cool.
• 9:34
  So I went full time with this in May of last year.
• 9:37
  And that's a very brief summary of what I could do.
• 9:42
  This is,
• 9:43
  this is fascinating.
• 9:45
  I have so many questions.
• 9:46
  I'm not even sure where to start,
• 9:47
  but ok,
• 9:48
  so yeah,
• 9:49
  so as you,
• 9:49
  like you said,
• 9:50
  very eclectic,
• 9:52
  I mean,
• 9:52
  you've been like all over the world,
• 9:55
  like East as a farm or West as a farmer,
• 9:58
  East as a food justice program.
• 10:01
  Like I'm not even sure what that means.
• 10:03
  I would love to know more about food.
• 10:05
  Um And I love,
• 10:07
  well,
• 10:07
  also I love that you're interested in food access and many people are surprised to discover that,
• 10:12
  you know,
• 10:12
  food insecurity is a risk factor for eating disorders.
• 10:16
  Um But I'm curious,
• 10:17
  you know,
• 10:17
  all of these different experiences,
• 10:19
  what do you think you've learned from each one?
• 10:22
  And how does it sort of,
• 10:24
  how do you integrate that wisdom into the work that you do?
• 10:29
  Yeah,
• 10:30
  that's a great question.
• 10:31
  I think.
• 10:31
  Um I think certainly the food justice,
• 10:35
  food access aspect of the work that I do.
• 10:39
  Um I think,
• 10:40
  like,
• 10:40
  really raise my consciousness in an activist sense.
• 10:43
  Um It made me think a lot about,
• 10:47
  you know,
• 10:48
  food,
• 10:49
  food access is being also like a political issue and a um like,
• 10:56
  and also a financial issue of like,
• 10:58
  how people are able to afford food,
• 10:59
  how we subsidize food.
• 11:00
  That was another reason why I was interested in the farm.
• 11:03
  Um And understanding that part of,
• 11:06
  you know,
• 11:07
  how people are able to get food.
• 11:09
  And so I think that definitely affects how I do my work.
• 11:14
  I think my work is very much tied up in,
• 11:16
  in activism.
• 11:17
  I would say,
• 11:18
  um I also view this work as like public health work.
• 11:21
  Um And I would say that the,
• 11:26
  the Zen Center,
• 11:27
  I mean,
• 11:27
  it's,
• 11:28
  it changed my orientation to like how I am as a person,
• 11:31
  which obviously is gonna affect how I work.
• 11:33
  But it enables me to,
• 11:36
  you know,
• 11:36
  kind of add,
• 11:37
  I guess a layer of like mindful awareness to how I work with my clients.
• 11:41
  Um It also helps me in terms of how I am in session,
• 11:45
  like my ability to like be aware of my own mental state or like what's arising within me.
• 11:51
  Um And trying to like,
• 11:53
  bring a lot of like presence and also trying to bring um perspective.
• 11:58
  Um because that's a lot of what uh at least the practices that I was exposed to are about,
• 12:02
  that's about um understanding that there are multiple perspectives to everything.
• 12:09
  Um And so,
• 12:12
  yeah,
• 12:12
  so I think those are two aspects that really inform the way that I work.
• 12:16
  And I think the farm,
• 12:18
  yeah,
• 12:18
  it's harder to like give like a direct um correlation there.
• 12:23
  But I think,
• 12:25
  I think the biggest,
• 12:25
  actually,
• 12:26
  the biggest thing that,
• 12:26
  that the farm was helpful with is that it's a very,
• 12:29
  it's a business.
• 12:30
  So I learned a lot of like,
• 12:32
  I think comparable skills around how to run a business.
• 12:35
  Um um and how complex it is and,
• 12:38
  and how many,
• 12:39
  you know,
• 12:40
  farms,
• 12:40
  especially small farms are or all farms actually like are very complex.
• 12:45
  Um especially when it's just,
• 12:47
  you know,
• 12:47
  a couple of people running it.
• 12:48
  And so you're having to do all of the logistics of the business,
• 12:51
  but then you're also doing all of the logistics of like crop rotation and planting and weeding and water management.
• 12:59
  And so you're doing like,
• 13:00
  I mean,
• 13:00
  tons of things every day.
• 13:02
  Um Yeah,
• 13:03
  so I think that was another aspect that I brought in the work and I think just being exposed to so many different parts of the country,
• 13:12
  so many different kinds of people.
• 13:14
  Um I think it just helped me.
• 13:17
  Yeah.
• 13:17
  Uh,
• 13:18
  it was very humbling,
• 13:20
  I would say.
• 13:20
  Um,
• 13:21
  and it helped me get out of the bubble of my own upbringing and things like that.
• 13:27
  Yeah,
• 13:29
  I'm curious.
• 13:30
  So you start,
• 13:31
  you said you started your practice essentially in 2020.
• 13:35
  But,
• 13:35
  yeah,
• 13:36
  what,
• 13:37
  what a time?
• 13:38
  What,
• 13:39
  what,
• 13:39
  I,
• 13:39
  I'm just curious,
• 13:40
  what was that like for you even?
• 13:43
  Like,
• 13:43
  kind of you,
• 13:44
  you weren't a new clinician dietician at this point.
• 13:48
  However,
• 13:49
  it sounds like it was the first time,
• 13:51
  maybe like doing something on your own.
• 13:54
  What was that dichotomy like for you?
• 13:57
  Like providing services but also kind of having your own experience.
• 14:03
  Yeah.
• 14:04
  Yeah,
• 14:05
  it was,
• 14:05
  it was,
• 14:06
  I mean,
• 14:06
  definitely as far as like with like the gender piece,
• 14:09
  you know,
• 14:09
  like it was interesting because I feel like in parts I was learning along with my clients or my clients would say something and I wouldn't like,
• 14:16
  say this out loud and then,
• 14:16
  then I'd be like,
• 14:17
  oh my gosh,
• 14:17
  you feel that way too?
• 14:18
  Well,
• 14:19
  maybe I should think about this.
• 14:21
  Um So it's really helpful.
• 14:22
  Actually,
• 14:23
  I feel like I learned a lot from my clients um particularly my non-binary clients but from,
• 14:28
  you know,
• 14:28
  all of my uh like gender diverse clients um in that regard,
• 14:33
  I think I learned something from all of my clients.
• 14:35
  Um But yeah,
• 14:38
  so I think that was,
• 14:40
  yeah,
• 14:40
  that was really powerful um to sort of have this two way uh interaction that,
• 14:50
  you know,
• 14:51
  as my clients are talking to me about their experiences that's actually causing me to go back and reflect on my own experiences and things that I sort of always knew to be true or had been thinking about for a couple of years prior,
• 15:03
  I'd say like 2018 is when I really first started thinking about like,
• 15:06
  what does non-binary mean?
• 15:08
  What would that mean for me?
• 15:10
  Um Yeah,
• 15:11
  so that was really powerful.
• 15:12
  Um And I think just from the business perspective,
• 15:16
  yeah,
• 15:16
  I mean,
• 15:17
  it was,
• 15:17
  it was wild.
• 15:19
  So it was wild but in some ways it was like helpful because people were really like seeking assistance and like it was,
• 15:32
  it was very easy obviously to like get something virtual started because everybody was wanting to be virtual.
• 15:37
  So um I think the hardest part was actually not being able to build community with other providers because I couldn't meet anyone in person and like all of that kind of stuff.
• 15:48
  So,
• 15:48
  yeah,
• 15:49
  but it was,
• 15:50
  I mean,
• 15:51
  I'm,
• 15:51
  I'm glad I did it.
• 15:54
  I don't regret it.
• 15:55
  I'm very happy.
• 15:56
  I really like my work.
• 15:57
  Yeah.
• 15:58
  You know,
• 15:59
  the pandemic,
• 16:00
  we saw a sky like really eating disorders and disordered eating just sort of skyrocketed.
• 16:05
  And I was curious,
• 16:06
  did you,
• 16:07
  was that your experience in your practice?
• 16:09
  Were people coming to you primarily for that?
• 16:11
  And why do you think that was?
• 16:14
  Yeah,
• 16:14
  I mean,
• 16:15
  yes,
• 16:15
  my So my practice is,
• 16:16
  is almost exclusively like the range of disordered eating disorders to disordered eating.
• 16:21
  I treat all eating disorders.
• 16:22
  I do work.
• 16:23
  I'm getting more so now a little bit into like supervision and like working with clinicians a little bit now that I've had a fair amount of time.
• 16:31
  I feel like I can,
• 16:31
  I actually have something to,
• 16:32
  like,
• 16:32
  offer.
• 16:33
  Um,
• 16:34
  you know,
• 16:35
  um,
• 16:35
  so that's starting to be a part of my practice now.
• 16:38
  But yeah,
• 16:39
  I mean,
• 16:39
  it's hard for me to perceive a dis difference since I started it in like July of 2020.
• 16:45
  So I don't necessarily know what it was like before.
• 16:49
  Um But yes,
• 16:50
  I remember that a lot of my clients including now um will describe like when we do like an intake or when we just kind of talk through their history,
• 17:00
  they talk about how the pandemic or the start of the pandemic was like a huge um the activator trigger or whatever,
• 17:08
  you know.
• 17:09
  Um Either for like the start of something,
• 17:10
  the resurgence of something and there's a million different reasons why.
• 17:14
  But yes,
• 17:15
  absolutely.
• 17:16
  That comes up all the time in the ways that,
• 17:18
  that some of my clients have been experiencing.
• 17:21
  Um Yeah,
• 17:22
  like a resurgence of maybe some like some latent stuff um due to the stress of what we all went through to varying degrees.
• 17:30
  Yeah.
• 17:31
  Yeah.
• 17:31
  And that I remember the food scarcity at that time.
• 17:34
  It's like you went to the grocery store and there was all the shelves were empty.
• 17:37
  It was sort of like mass panic.
• 17:40
  So,
• 17:41
  I'm so,
• 17:41
  I'm so glad that came up today.
• 17:42
  Food insecurity and food scarcity is huge.
• 17:46
  Yeah.
• 17:46
  And we don't talk about it enough.
• 17:48
  We don't talk about it.
• 17:49
  And then that's something that,
• 17:50
  um uh like I always ask when I do intakes.
• 17:53
  Um,
• 17:54
  it's something that first came to my attention from Whitney Trotter who I actually worked with in Memphis.
• 17:59
  So she was a keynote at our conference.
• 18:01
  I know.
• 18:02
  Yeah,
• 18:02
  she's doing big things.
• 18:03
  Yeah.
• 18:04
  And that she,
• 18:05
  she had really brought that into,
• 18:07
  I mean,
• 18:07
  that was a question that I had reckoned with in food access,
• 18:10
  but she really um pointed that out in terms of how that plays into this space.
• 18:15
  And so now that's always a question that I ask and then we continue to discuss,
• 18:20
  you know,
• 18:21
  um because a lot of this work is also identity work,
• 18:24
  right?
• 18:24
  So,
• 18:24
  racial identity,
• 18:25
  sexual identity,
• 18:26
  gender,
• 18:26
  identity,
• 18:27
  income,
• 18:28
  um ability,
• 18:29
  disability,
• 18:30
  like there's all of these layers that then affect a person's relationship with their body and with food for sure.
• 18:36
  Yeah,
• 18:36
  exactly.
• 18:38
  Yeah.
• 18:38
  So I've got a question for you.
• 18:40
  Um I was reading an article by Healthline that you were quoted in and they put out a statistic and I was just curious if you could speak to it.
• 18:49
  Um They said more than 15% of trans people surveyed reported eating disorder diagnoses compared with 0.55% of cisgender,
• 19:01
  heterosexual men and only 1.85% of cisgender heterosexual women.
• 19:08
  Um So I was curious,
• 19:10
  could you speak to what are some of the risk factors that trans people might be facing?
• 19:15
  And what are you seeing kind of walk in your door?
• 19:19
  Yeah,
• 19:19
  I mean,
• 19:20
  I think there's a,
• 19:21
  a slew of them.
• 19:23
  Um I think,
• 19:25
  you know,
• 19:25
  you're looking at obviously tremendous amount of social stigma,
• 19:30
  right?
• 19:31
  Like that's not hard to see in our current um legislation.
• 19:36
  And so that is something that obviously like trauma and stigma and stress have a huge effect on risk,
• 19:44
  eating disorder,
• 19:44
  risk.
• 19:45
  Um I think,
• 19:47
  you know,
• 19:47
  you can,
• 19:47
  you can see other studies that,
• 19:49
  you know,
• 19:49
  um transgender,
• 19:50
  nonconforming folks also tend to be much more financially insecure.
• 19:53
  So and like housing insecure so that with it is gonna bring food insecurity,
• 19:59
  higher risk or trauma or needing to put yourself maybe in an unsafe situation to be able to access food or housing.
• 20:06
  Um And then I think you just have what's happening in the body.
• 20:10
  So if you're having um dysphoric symptoms feelings,
• 20:16
  particularly when you're quite young with the development of like secondary sex characteristics,
• 20:20
  right,
• 20:21
  then you might be developing various strategies to say prevent the onset of puberty or to limit the dysphoria.
• 20:29
  Um On the other side,
• 20:31
  you al you may also be seeking ways to kind of like mask your body so that it feels more safe or more.
• 20:38
  Um so that you feel more safe within your body.
• 20:41
  Um So that can also lead to like wanting to appear more androgynous.
• 20:46
  Um And yeah,
• 20:49
  so I think that that's gosh,
• 20:51
  that's like not a comprehensive list,
• 20:53
  right?
• 20:53
  And then we also have to think about like the intersectionality,
• 20:56
  right?
• 20:57
  That like,
• 20:58
  you know,
• 20:58
  transgender,
• 20:59
  nonconforming experiences vary a lot depending on whether you're white or a person of color.
• 21:04
  But I think when you have all of those risk factors,
• 21:09
  it's not hard to see why a much higher percentage of folks report eating disorder symptoms.
• 21:16
  Um Yeah.
• 21:18
  Yeah.
• 21:19
  Well,
• 21:20
  I'm curious,
• 21:21
  do you work with families as well?
• 21:24
  Um Not usually because I primarily work with adults.
• 21:27
  Um I do work with partners.
• 21:30
  Um And then I also work with uh fed up the organization fed up um as the facilitator of their support group for support people.
• 21:40
  So I am exposed to families in that way.
• 21:43
  Um Yeah,
• 21:45
  so I,
• 21:46
  yeah,
• 21:47
  I mostly I,
• 21:47
  but I do have experience working with like people's partners for sure.
• 21:51
  Yeah,
• 21:51
  I'm just,
• 21:51
  I,
• 21:52
  I'm sure we have listeners out there who maybe have a loved one who's part of this community.
• 21:56
  And I'm curious if you have any guidance.
• 22:00
  If their loved one is struggling with food or body image,
• 22:04
  how can they support,
• 22:06
  how can they better support their loved one?
• 22:09
  Yeah.
• 22:10
  So I mean,
• 22:11
  I think,
• 22:12
  um,
• 22:12
  a big part of that would be access to gender affirming care,
• 22:16
  whatever that looks like.
• 22:18
  Um,
• 22:19
  and I think unfortunately that then we're also looking at like,
• 22:22
  policy.
• 22:23
  Right.
• 22:24
  And,
• 22:25
  um,
• 22:25
  finances.
• 22:27
  So,
• 22:27
  I think,
• 22:29
  I mean,
• 22:30
  really talking to the person that,
• 22:31
  you know.
• 22:33
  Right.
• 22:34
  Um,
• 22:34
  I think also,
• 22:35
  uh,
• 22:35
  acceptance so being able to kind of practice acceptance and,
• 22:39
  and curiosity,
• 22:40
  um,
• 22:42
  I think that's a huge thing because I think folks need to feel safe.
• 22:45
  Um And to feel like they can be safe to be who they are.
• 22:49
  I think you can support um someone that you love through.
• 22:52
  Yeah.
• 22:53
  Um helping them look for uh clothing by even,
• 22:59
  you know,
• 22:59
  if you're this person doing reading um getting yourself more educated.
• 23:04
  Um Yeah,
• 23:06
  that's where I would,
• 23:07
  that's where I would start for sure,
• 23:10
  acceptance validation and then just like support if they're trying to navigate a really difficult insurance situation where they want to look up additional sources of funding or they need someone to help call doctors offices to make sure those doctors are affirming clinicians like things like that.
• 23:26
  Absolutely.
• 23:26
  Yes.
• 23:27
  Oh,
• 23:27
  that brings me to my next question.
• 23:28
  So,
• 23:29
  you know,
• 23:29
  we talk about competency in this field a lot and you know,
• 23:34
  what does it mean to be competent?
• 23:37
  You know,
• 23:37
  we talk about cultural competency.
• 23:39
  We had a whole episode on the difference between cultural competency and cultural humility,
• 23:44
  for example.
• 23:46
  So,
• 23:46
  but you know,
• 23:47
  I'm sure,
• 23:47
  you know,
• 23:48
  there's a lot of providers out there who they have their websites or their ads on psychology today and they'll say that they're competent to work with trans folks or non-binary folks,
• 23:59
  nonconforming.
• 24:01
  But really what does that mean?
• 24:02
  Because I have a feeling that there are providers out there who have totally different definitions of what it means to be competent.
• 24:09
  But to you,
• 24:10
  what does it mean?
• 24:11
  And what does it take to,
• 24:13
  to be able to say I'm competent to work with these folks?
• 24:18
  What do we need to know as,
• 24:19
  as providers?
• 24:20
  How can we do better?
• 24:21
  I just would love your thoughts on that.
• 24:24
  Yeah,
• 24:24
  I mean,
• 24:25
  oh,
• 24:25
  there's a inside that question.
• 24:26
  Yeah.
• 24:26
  So I would say that,
• 24:30
  you know,
• 24:30
  to me,
• 24:31
  yeah,
• 24:32
  competency,
• 24:33
  I mean,
• 24:33
  yes,
• 24:33
  I agree.
• 24:34
  I,
• 24:34
  I prefer cultural humility.
• 24:35
  Um I think that would look like um doing trainings uh trainings provided by trans gender,
• 24:45
  nonconforming providers,
• 24:47
  more supervision,
• 24:49
  uh supervision group.
• 24:51
  Um I think,
• 24:53
  and this extends to,
• 24:54
  you know,
• 24:54
  also like doing trainings and with,
• 24:57
  with bipap providers or like queer trans people of color,
• 25:01
  right?
• 25:02
  Um So I think uh educating oneself and like really,
• 25:08
  yeah,
• 25:08
  doing kind of more hands on training with folks who share those identities.
• 25:13
  Um I think supervision particularly if you do have uh queer transgender,
• 25:19
  nonconforming clients.
• 25:22
  Um I think,
• 25:24
  yeah,
• 25:24
  reaching out for supervision would be really important,
• 25:26
  especially if that is not an identity that you share.
• 25:30
  I think um spending time reading books,
• 25:34
  um looking at,
• 25:36
  you know,
• 25:36
  educate,
• 25:37
  like listening to podcast,
• 25:38
  like all those sorts of things.
• 25:40
  And I think um yeah,
• 25:42
  I mean,
• 25:42
  just trying to like diversify your community,
• 25:47
  right?
• 25:47
  So like,
• 25:47
  how,
• 25:48
  how can you get involved in some of these issues?
• 25:51
  Right?
• 25:51
  Like even if it's not,
• 25:53
  even if you're not transgender,
• 25:54
  not conforming,
• 25:55
  like what are ways that you can get involved?
• 25:57
  So I think competency is a sense of um learning being open,
• 26:06
  like that humility piece like being open to learning,
• 26:09
  being open to um uh soliciting feedback um from other peers and from clients honestly.
• 26:19
  Um Yeah,
• 26:20
  I think uh over time,
• 26:23
  right?
• 26:23
  Like having more and more clients with those identities,
• 26:26
  I think obviously grows your ability to,
• 26:28
  to understand.
• 26:29
  But I think it's a lot of like taking the time and effort to,
• 26:35
  to have a grasp right,
• 26:37
  on a community that,
• 26:38
  that maybe you're not inherently a part of so that you can better serve them.
• 26:43
  Hm That's great advice.
• 26:45
  Yeah.
• 26:47
  Um I have a question for you.
• 26:49
  So kind of going back.
• 26:51
  Um I think we were talking about um risk factors and I,
• 26:56
  I believe you mentioned body dysphoria.
• 27:01
  Um So there's body dysphoria,
• 27:03
  body dysmorphia,
• 27:04
  all things that,
• 27:05
  that we might see with our disordered eating and eating disorder clients.
• 27:09
  I was curious if you could maybe define those for our listeners.
• 27:13
  And then um maybe tell us a little bit about what you see showing up in your office.
• 27:19
  Mhm Yeah,
• 27:20
  totally.
• 27:20
  And this is,
• 27:21
  I want to carry on this by saying this is,
• 27:23
  this is a very hard line to define.
• 27:25
  So I don't know if I can like give you like some sort of like,
• 27:28
  I mean,
• 27:28
  you could look in a textbook and like find the definition.
• 27:30
  But I think what I discern as the difference is um so say,
• 27:39
  for example,
• 27:39
  I have a client who is a trans woman.
• 27:42
  It's just for example,
• 27:43
  right?
• 27:44
  OK.
• 27:44
  So I would say dysphoria is around the the various ways that client uh maybe has a relationship to her body that feels like it's far from being a woman,
• 27:58
  right?
• 27:59
  So maybe that has to do with her face shape,
• 28:04
  maybe that has to do with her clothing,
• 28:06
  maybe,
• 28:06
  you know,
• 28:07
  various and sort of things,
• 28:08
  right?
• 28:08
  That require perhaps hormones,
• 28:10
  perhaps the medical intervention perhaps.
• 28:13
  Yeah,
• 28:13
  like I said,
• 28:14
  dressing differently,
• 28:15
  having your hair different,
• 28:16
  all these sorts of things.
• 28:18
  Now say that client has transitioned,
• 28:21
  right?
• 28:22
  And she feels that she needs to be very thin because of how she feels that she sees certain models,
• 28:34
  right?
• 28:36
  So that I think is more informed by dysmorphia,
• 28:40
  right?
• 28:41
  So that is more informed by maybe and like how she feels that she looks,
• 28:45
  right?
• 28:46
  So she feels she nitpicks certain parts of her body and she compares them to um like a celebrity that she's telling me about.
• 28:55
  So that to me is a more clear,
• 28:59
  like,
• 29:00
  uh,
• 29:00
  dysmorphia moment because then we're talking about like this idea of kind of like one way or one desirable way for a woman's body to be,
• 29:11
  for example.
• 29:12
  Now you can also want to be thin because it feels safer.
• 29:17
  Right.
• 29:17
  Maybe you can't afford confirming surgery and,
• 29:21
  um,
• 29:21
  um,
• 29:21
  being in a body with a reduced chest feels safer to you because then it's perhaps uh it's more androgynous,
• 29:28
  right?
• 29:29
  Um So that's like where we could see a delineation there.
• 29:33
  Um I think dysmorphia also can sometimes come in uh around this idea of like what someone sees themselves as versus like how everybody else sees them in terms of body size,
• 29:45
  just like straight up size of their body.
• 29:47
  Um So that's like the first thing that comes to mind.
• 29:50
  I mean,
• 29:51
  I,
• 29:51
  I do better when I talk in examples versus definitions but like trying to because as you can see it's really interwoven,
• 29:59
  right?
• 29:59
  But I,
• 30:00
  I view dysmorphia as kind of like a modulated experience where you're kind of interacting.
• 30:08
  It's maybe how others see you,
• 30:10
  it might be how you see yourself like in a mirror,
• 30:12
  for example,
• 30:12
  or in a photo.
• 30:14
  Um And so it kind of lives in this middle space of like comparison and like external concepts,
• 30:22
  right?
• 30:23
  Whereas I find dysphoria is like a very internal experience that someone maybe doesn't even have the language for when they're young.
• 30:31
  It's just like I don't like this,
• 30:33
  I don't like the way this and I'm gesturing to my body because nobody can see me except for y'all like there's something about this that isn't right.
• 30:41
  Um And it,
• 30:43
  and I,
• 30:44
  and I need so it's a very like internal experience and I think that's true for um myself as well.
• 30:50
  Um You know,
• 30:52
  I,
• 30:52
  I,
• 30:53
  and I think from the folks that I talked to,
• 30:55
  of course,
• 30:55
  I'm sure there's gonna be folks who listen to this and that's not their experience,
• 30:58
  but a lot of people I speak to like that would be one another way of kind of examining that experience and that is super helpful.
• 31:05
  Thank you for kind of labeling that and,
• 31:07
  and even sharing that example,
• 31:09
  I mean,
• 31:10
  honestly,
• 31:10
  I feel like we probably do have listeners or loved ones of listeners that might fall into kind of everything that you just mentioned.
• 31:20
  So I really appreciate you labeling that.
• 31:23
  Um really so that someone doesn't feel other and so that someone knows that there's community and,
• 31:30
  and support um if they have their certain feelings.
• 31:34
  Mhm Yeah.
• 31:35
  Yeah.
• 31:35
  And that's a big part too and that's what's so powerful about um Yeah,
• 31:39
  about people finding other people who have these because it is different and it does create a different um it,
• 31:47
  the treatment then is different,
• 31:48
  how you,
• 31:49
  how you talk about it,
• 31:50
  how a provider talks about it,
• 31:51
  how you,
• 31:52
  what kind of interventions you're looking at and like how you just like hold space for the experience is gonna be different.
• 31:57
  Um Yeah.
• 31:59
  So yeah,
• 32:00
  it's important that somebody feels like they all parts of them are um seen and yeah,
• 32:07
  yeah.
• 32:08
  So when you have a client come to you who is experiencing body dysphoria and they're coming to you because they are looking for gender affirming care from a dietician.
• 32:21
  What can they expect from someone who is gender affirming compared to maybe someone who is not familiar with or competent in that work.
• 32:31
  What's different and what should people expect when they're getting those services?
• 32:37
  Yeah.
• 32:38
  So,
• 32:38
  I mean,
• 32:38
  I think if you're looking for gender affirming care,
• 32:41
  I mean,
• 32:42
  if you want a provider who like is using your pronouns and it's not like,
• 32:49
  so like just just start,
• 32:51
  right?
• 32:51
  Like,
• 32:52
  yeah,
• 32:52
  using your pronouns using your,
• 32:54
  the name that you are using.
• 32:56
  Um not asking you like personal and invasive questions about um things that you maybe just don't want to share,
• 33:04
  right?
• 33:04
  Um I'm also basing this on some of the horror stories that people have told me.
• 33:10
  Oh,
• 33:10
  no.
• 33:11
  Yeah.
• 33:12
  Yeah.
• 33:12
  Uh I think also um affirming care as in like,
• 33:17
  again,
• 33:17
  really understanding this dysphoria,
• 33:20
  dysmorphia,
• 33:21
  right?
• 33:21
  So like not saying like,
• 33:24
  oh,
• 33:24
  well,
• 33:25
  you know,
• 33:25
  if you're saying to the client or if you're saying to your provider,
• 33:28
  like,
• 33:28
  yes,
• 33:28
  you know,
• 33:29
  so part of this is that like I do behavior because it helps my,
• 33:34
  it helps me feel more androgynous and then to have that provider sort of steamrolling and be like,
• 33:40
  no,
• 33:40
  no,
• 33:40
  no,
• 33:40
  that's just because you saw too many movies,
• 33:42
  right?
• 33:42
  Like,
• 33:43
  that's not helpful,
• 33:45
  right?
• 33:45
  Because you're conflating two things that are different and also apologizing it.
• 33:50
  I mean,
• 33:51
  that,
• 33:51
  that's an issue to say like,
• 33:52
  oh,
• 33:52
  well,
• 33:52
  that thought's distorted.
• 33:53
  It's like,
• 33:54
  no,
• 33:54
  it's not like I,
• 33:55
  this is not my gender,
• 33:57
  my body doesn't match my gender.
• 33:59
  That's real.
• 33:59
  Exactly.
• 34:00
  Exactly.
• 34:01
  Yes.
• 34:02
  Um And I think,
• 34:04
  you know,
• 34:04
  right.
• 34:04
  So like,
• 34:05
  also not,
• 34:06
  I've heard about clinicians who kind of like,
• 34:08
  overlay their experience or yeah,
• 34:11
  they'll just kind of like,
• 34:12
  I kind of ignore their client what their client is telling them.
• 34:16
  Um So even like an a,
• 34:18
  a signed female at birth,
• 34:19
  non binary client,
• 34:20
  I've heard people have like cc women clinicians who are like,
• 34:24
  well,
• 34:25
  you know,
• 34:25
  as women,
• 34:25
  we just like,
• 34:27
  but no,
• 34:28
  that doesn't,
• 34:29
  that doesn't work for me.
• 34:30
  Yeah,
• 34:30
  that's a problem.
• 34:31
  Right?
• 34:32
  And just like,
• 34:33
  I mean,
• 34:33
  as a dietician,
• 34:34
  like you need,
• 34:35
  you know,
• 34:35
  because you're holding more of a um physiological piece,
• 34:38
  like an understanding of like,
• 34:40
  how do these hormones work?
• 34:41
  Like,
• 34:41
  what do they do?
• 34:42
  How do they affect appetite?
• 34:44
  Like,
• 34:44
  how do they affect metabolic?
• 34:45
  Like,
• 34:46
  just understanding how this stuff works.
• 34:49
  Um So I think he would want to find a clinician who who seems to be versed,
• 34:53
  who seems to,
• 34:54
  like,
• 34:54
  be versed in this stuff,
• 34:55
  um and is listening to you and is,
• 35:00
  um,
• 35:01
  you know,
• 35:01
  asking uh sensitive questions,
• 35:05
  but also making a point to try to like,
• 35:08
  clarify things they don't know.
• 35:10
  And then also I would say,
• 35:12
  rather than,
• 35:13
  you know,
• 35:13
  and who,
• 35:14
  maybe if they've been,
• 35:15
  maybe if you're,
• 35:15
  you're offering a term they've never heard before,
• 35:18
  like making it clear that like,
• 35:21
  they're like,
• 35:22
  uh going back in the meantime and like understanding that term more.
• 35:26
  So,
• 35:26
  like not asking you to explain things about your,
• 35:28
  about like being a transgender,
• 35:30
  nonconforming person to them,
• 35:31
  but maybe being like,
• 35:32
  oh OK,
• 35:33
  can you like,
• 35:33
  give me the name of that?
• 35:34
  I want to do a little bit more research on that term that you're using.
• 35:37
  Um So that I think that I've heard that as like a positive experience that people have had with his clinicians.
• 35:43
  Um Yeah,
• 35:45
  and I think on the other side as like a transgender nonconforming clinician,
• 35:49
  you're also like,
• 35:49
  not,
• 35:50
  you don't want to over identify,
• 35:51
  right?
• 35:51
  So that's I think something that every clinician runs into the trap of,
• 35:56
  of like,
• 35:56
  well,
• 35:56
  because we share this identity,
• 35:58
  our experiences are the same and that's I think the other important side um especially when you get into intersectionality,
• 36:04
  right?
• 36:04
  So like as a white clinician,
• 36:05
  I have a transgender nonconforming client who's a person of color,
• 36:08
  like not also over identifying our experiences or even with,
• 36:12
  you know,
• 36:12
  another white person.
• 36:14
  So,
• 36:14
  um yeah,
• 36:16
  so it cuts both ways,
• 36:17
  right?
• 36:17
  It's not just the folks who need to be paying attention.
• 36:20
  Oh,
• 36:20
  they're engaging.
• 36:21
  Yeah,
• 36:21
  that's a good point.
• 36:23
  Good point.
• 36:24
  Thank you.
• 36:25
  So how do you,
• 36:26
  can you share like how you might work with,
• 36:30
  um,
• 36:30
  so with eating disorders,
• 36:31
  you know,
• 36:32
  we often work in teams.
• 36:34
  Um,
• 36:34
  so what does your role look like in working with the therapist of a client?
• 36:40
  The psychiatrist of a client?
• 36:42
  Can you kind of share that?
• 36:43
  Yeah,
• 36:44
  absolutely.
• 36:45
  Yeah.
• 36:45
  So I do work,
• 36:46
  I usually work most closely with therapists.
• 36:48
  Um Also because that's usually the person that someone's seeing most frequently.
• 36:53
  Um And I think uh usually how I work is,
• 36:56
  yeah,
• 36:56
  it just kind of like a from a,
• 36:58
  a collaborative,
• 36:59
  like,
• 36:59
  it's obviously,
• 37:00
  as y'all know,
• 37:01
  being part of like a treatment center is extremely or like a collective,
• 37:04
  a therapist collective,
• 37:05
  there's gonna be a lot more.
• 37:07
  Um which is the one thing I do miss is like that really easy access to other clinicians and like a dedicated space where we're talking through um together with someone.
• 37:18
  Um So talking through together like,
• 37:21
  uh you know,
• 37:22
  the care for someone.
• 37:22
  I mean,
• 37:23
  so I think what we do primarily is,
• 37:27
  you know,
• 37:27
  coordinate over the over calls and just sort of make sure that our approaches are aligned.
• 37:35
  I'm really lucky that the therapists I work with Um,
• 37:39
  I've had overall extremely good experiences with the therapist that I work with.
• 37:43
  Um,
• 37:44
  and yeah,
• 37:46
  and most of them are,
• 37:47
  are cys theists.
• 37:48
  So,
• 37:49
  um,
• 37:50
  yeah,
• 37:50
  and I,
• 37:51
  I really appreciate it and sometimes they will come to me and,
• 37:53
  like,
• 37:53
  ask me questions which I think is totally appropriate.
• 37:55
  Um,
• 37:56
  and it really,
• 37:56
  like,
• 37:56
  impresses me that they're doing what I just said,
• 37:59
  which is like trying to figure out more or learn more.
• 38:02
  Um Yeah,
• 38:04
  so that's really how I see it.
• 38:06
  You know,
• 38:06
  I see the realm of what I do is like really being it has very much therapeutic qualities,
• 38:12
  right?
• 38:13
  But it is very,
• 38:14
  it's also very tangible because I'm looking at,
• 38:16
  you know,
• 38:17
  I,
• 38:17
  I'm kind of involved with the food directly and like,
• 38:21
  how do we,
• 38:22
  how do we eat?
• 38:22
  How do we talk about how we're eating?
• 38:24
  How do we cook?
• 38:25
  How do we purchase,
• 38:26
  you know,
• 38:26
  all the various things and body image I think depending on the therapist is sometimes sort of shared between me and the therapist.
• 38:33
  So just kind of making sure that like the therapist is also aware of what I'm like working on with the client and vice versa.
• 38:40
  Sounds super supportive.
• 38:42
  Really if,
• 38:43
  if someone was able to have both of you,
• 38:46
  um you know,
• 38:47
  on their team,
• 38:48
  how incredible would it be to,
• 38:50
  you know,
• 38:50
  maybe process with the therapist and body image issues but also come see you and process some stuff coming up,
• 38:56
  especially as maybe the the meal choices are changing or,
• 39:00
  or different things are occurring.
• 39:02
  So I love that.
• 39:04
  Yeah,
• 39:05
  a big part of,
• 39:06
  of also that collaborative process is like,
• 39:09
  for me is getting the client's consent.
• 39:11
  So like the client always knows that I'm gonna speak with their clinician.
• 39:15
  Like that's a big thing,
• 39:16
  especially,
• 39:17
  well,
• 39:17
  really for anybody um making sure that they,
• 39:21
  they know what's going on.
• 39:22
  They don't feel like their providers are kind of having conversations without them.
• 39:25
  Um So,
• 39:26
  yeah,
• 39:27
  that was the other thing.
• 39:27
  I was gonna say it's so important.
• 39:29
  Yes.
• 39:30
  Unfortunately,
• 39:31
  I'm noticing we're running out of time.
• 39:33
  Oh my gosh.
• 39:34
  Yeah,
• 39:34
  I know that went by so quickly.
• 39:37
  Um But in closing,
• 39:40
  I'm just wondering what might be a takeaway.
• 39:45
  You would want folks listening.
• 39:47
  If they were only gonna take away one thing,
• 39:49
  what would that be?
• 39:52
  Um that it is so vitally important to respect the autonomy of the person that you're caring for and respect the truth of their lived experience.
• 40:10
  So maybe that's two things,
• 40:11
  but it's one sentence.
• 40:14
  I love it.
• 40:15
  Yes.
• 40:16
  That's beautiful.
• 40:17
  How can our listeners continue to connect with you and learn from you?
• 40:21
  Where can they find you?
• 40:23
  Yeah.
• 40:24
  So I have a very uh a very nonactive Instagram.
• 40:29
  Um The best way to reach me is um Yeah.
• 40:33
  Uh So my,
• 40:34
  my handle is at Pando Pando Wellness.
• 40:39
  People think it's panda.
• 40:40
  It's not,
• 40:41
  it's Pando it's a really cool thing.
• 40:44
  Google the Pando.
• 40:45
  It's awesome.
• 40:46
  Um Yes,
• 40:49
  it's named after an organism in Southern,
• 40:51
  in uh the borders Utah and Colorado.
• 40:54
  It's one of the world's oldest and largest interconnected living organisms.
• 40:58
  Um So,
• 40:59
  yeah,
• 40:59
  so people can find me at Pando Wellness or my website Pando wellness dot org.
• 41:05
  So,
• 41:06
  those are the best ways to reach me.
• 41:08
  Uh Yeah,
• 41:10
  probably the website.
• 41:11
  Wonderful.
• 41:13
  Well,
• 41:13
  thank you so much for being on here today.
• 41:15
  I think this was so informative and valuable.
• 41:18
  Thank you so much.
• 41:21
  Thank you for listening to All Bodies All Foods.
• 41:24
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• 41:29
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• 41:30
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• 41:45
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• 41:49
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• 41:53
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• 41:57
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• 42:04
  Thank you for listening with us today on All Bodies.
• 42:07
  All Foods presented by the Renfrew Center for Eating Disorders.
• 42:11
  We're looking forward to you joining us next time as we continue these conversations