Mythbusting: What is therapy really like?

I think this question is on the minds of lots of potential therapy clients: what will it really be like to be in therapy? If we’re not fortunate enough to know someone who is open about their own experiences in therapy and how it has helped them, we may have very little information about what the therapy process is like. And while therapy is often portrayed in tv shows or movies, the depiction of therapists is often designed to entertain more than be a realistic account of therapy. This could be potentially off putting to potential clients who may wonder - Is therapy really like that?.

For example, in one episode of the tv show Insecure, the character Molly visits a therapist who  listens to what she says, then connects her words to an overall general pattern by linking it to similar thoughts she had expressed in past sessions. This represents a fairly typical example of what happens in therapy. However, then therapist then talks for a long time while the camera focuses on Molly’s face as she looks disinterested. For me, if a client looked this disinterested in what I was saying, I would want to check in and ask about her response to my feedback. Instead of checking in with her, Molly’s therapist then asks “same time next week?” to which Molly responds “I’ll call you.” Again, this would be a major red flag for me and I would want to check in with my client about how she is experiencing therapy. In general, therapists want their clients to have a good experience in therapy, and talking about ways in which the therapy is not going well is an important part of being able to course correct and ensure the experience is a helpful one.

An even worse therapy experience comes from early seasons of the show Mad Men, where Betty Draper’s therapist literally sits and says nothing throughout her sessions. This actually did happen in therapy at one time, when it was believed that a therapist should be as quiet as possible to serve as a “blank screen” for fear of “influencing” the client. This is very far from the current philosophy in therapy, as now is it is widely held that therapy should be a collaborative process between the client and a therapist, not just a client talking without any input from the therapist. Even worse, the therapist also tells Betty’s husband about the content of sessions. This is a serious violation of confidentiality, as therapists are not allowed to discuss the content of sessions or even confirm that someone is a client without the client’s express permission. If a therapist violates this ethical standard, there are serious consequences, including fines and the possibility of having the therapist’s license being revoked so that they are no longer able to provide therapy.

So, are there any good representations of therapy in the media? Ironically enough, I think the SNL “Friendos” skit, (warning - adult language in link) imagining what would happen if a hip hop group went to therapy together, comes closest to the feel of an actual therapy session.  Although the skit is clearly tongue-in-cheek, and not everything that happens feels realistic - the therapist calling one of the men “bitch” after he refers to her as such hopefully does not happen in any therapy sessions! - other moments ring true. For example, the therapist encourages each person to participate, to use “I feel statements” and to listen to each other, and she offers interpretations (“You looked for him, and he was gone”) in hopes of clarifying emotional content.

Ultimately, it’s hard to make sweeping generalizations about what therapy is like, since there are so many different types of therapy and therapists. Some may provide “homework” and be directive, others may let the client take the lead. Some may go back into the client’s past, and some tend to focus on what’s happening in the present. It’s often very helpful to “shop around” for therapists, meeting with different therapists so you can get a feel for what therapy is like with different therapists before deciding on one . And regardless of the type of therapy or therapist, a good therapist treats client with respect and empathy, listening to their point of view, and working together with them to achieve a positive therapy experience.

You already have your “beach body”

Your “beach body” is simply your own body, right now, as it is.

The beginning of July ushers in summer, and sadly summer is often a season when our bodies are targeted by criticism and discrimination. We can feel bombarded by articles and news stories about getting your “beach body” or “how to tone up for summer” or by diet talk among colleagues, family and friends. Few of us can escape this barrage without feeling that we are not enough, that we are lacking in some essential way necessary to be loved or feel worth, with those in marginalized bodies particularly targeted by our culture’s obsession with a thin, white able-bodied ideal. 

I am not here to tell you that you are not enough, that you need to change yourself.  I am here to add my voice to those saying, you are enough, you are more than enough and always will be. So please, dear one, let’s move away from the airbrushed, photoshopped images, from the impossible standards, from the fatphobic voices voicing their discrimination loudly. Let’s try something else.

I’m going to borrow an exercise that was brought up at a recent talk by the inspiring duo behind Be Nourished, Hilary Kinavey, MS, LPC and Dana Sturtevant, MS, RD - please check them out at BeNourished.org for more on their amazing body trust work! They asked those of us lucky enough to be in the audience to answer a question - if you could live in a world without fatphobia or discrimination, where all bodies were treated with worth regardless of size or color or ability, what would you do for self-care? And I asked the same to you - what would you do to care for your body if you didn’t try to have to change it? 

NEDA week: Myth-Busting

Since this week, Feb 26th - March 4th, is Eating Disorders Awareness Week, I thought now would be a good time in engage in some myth busting around eating disorders:

Myth #1: Only white women get eating disorders

Reality Check:

If you look only at media representations of eating disorders, you might come away with the message that eating disorders affect only white, thin (more on that below), cis, middle class women. For example, the recent movie "To The Bone" centers on an extremely thin, white woman, and almost every other character in the film dealing with eating disorders is also a white woman. This can lead to eating disorders being overlooked in other populations, such as people of color, men and trans or gender non conforming folks.

For people of color, racism and colonialism and the resulting discrimination, oppression and historical trauma create a perfect situation for feeling alienated from and ashamed of one's body.  To learn more abut the ways in which racism, colonialism, and historical trauma can set the stage for an eating disorder, check out Becky W Thompson's book A Hunger So Wide and So Deep or go to www.nalgonapositivitypride.com to enroll in the online Decolonizing Series, pick a book from the recommended reading list or find an event near you to hear the amazing Gloria Lucas talk (if you live in LA, there is a free talk for NEDA week on March 2nd https://www.facebook.com/events/2068874630017916/).

Trans and gender non-conforming folks can also develop eating disorders as well. For trans folks, manipulating weight can be a way to change their appearance to be more in line with their gender identity, which might provide an important sense of safety in the light of frequent trans-phobic violence. So eating disorder behaviors can play a particularly important role in providing a sense of safety and security, and can therefore be particularly hard to challenge, in folks who do not identify as their assigned gender. For more support or information, check out http://www.transfolxfightingeds.org/.

Men (cis and trans alike) also develop eating disorders. Some sports like wrestling and cycling can promote weight cycling and using unhealthy means to impact weight that can lead to eating disorder behaviors in young men. Our culture's emphasis on "fitness" can also lead to unrealistic expectations regarding being muscular that can lead to restrictive eating and use of dangerous supplements.

Myth 2: Only thin people have anorexia nervosa, fat people have binge eating disorder (or some version of this theme)

Reality check:

People of all different shapes and sizes develop eating disorders including fat folks (note: I'm using the word as a descriptor and not in a derogatory sense). This is something that mental health professionals need to recognize as well because it is unfortunately all too common for a mental health professional to ignore restricting behavior in a fat person or treat compensatory eating as an objective binge without assessing for the difference (note: compensatory eating occurs when you eat a considerable amount due to restricting earlier, while an objective binge is eating an objectively large amount of food - two meals worth - in a short amount of time with feeling of loss of control).

No matter what you weigh, you cannot subsist off just fruits and vegetables. And yet all too often this fact is missed in fat folks, and the fact that they are eating more to compensate later on (ie, late at night) becomes labeled as binge eating disorder without acknolwedging the restriction that occured earlier as problematic. The reality is that folks do not have to have a low BMI (which is an extremely problematic and unreliable measure anyway) or a low weight to be qualify as restricting their intake or be diagnosed with anorexia nervosa if that weight represents a low weight for them.

For more information, check out the Health at Every Size Movement by visiting https://haescommunity.com/ or reading Linda Bacon's book, Health At Every Size.

Important note: This post is the result of many, many people's amazing work to de-stigmatize eating disorder for marginalized populations. None of these ideas are my own original thoughts, and my hope is share some of my learning with a wider audience and then connect folks with the original sources. I've included links above to the primary sources so please do follow up and support these important organizations, as well as additional sources below.

Additional sources:

Sand Chang, PhD Transgender, Gender Affirming Care and Eating Disorder Treatment. Presentation given at Eating Disorder Recovery Support Conference, Jan 2018.

Gloria Lucas. Historical Trauma and Modern Day Oppression: How Does This Relate to Eating Disorders? Presentation given at Eating Disorder Recovery Support Conference, Jan 2018.