Episode 15: Fat Bodies & Eating Disorder Treatment with Jessica Elwart, LCAT, RDT
[Bouncy theme music plays.]
Sam: Hey, I’m Sam!
Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. 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.
Sam: We believe that all bodies and all foods are welcome, we would love for you to join us on this journey. Let’s learn together.
Ashley: Alright. Hello, everyone! Welcome back to another episode of All Bodies. All Foods. Ashley and Sam are here, and we have a wonderful special guest with us today. Jessica Elwart-Konkel is a licensed creative arts therapist in drama therapy in the State of New York. She works with clients on their relationship with their bodies, with a special concentration working with Binge Eating Disorder as well as Anorexia and Bulimia. She’s anti-diet, anti-fitness industry, and anti-BMI focused. She works on body acceptance and fat liberation, and offers in-person therapeutic cooking classes, which I really am interested in learning more about. So, Jessica, thank you so much for joining us today! We’re so excited to have you with us!
Sam: Welcome!
Jessica: Thank you so much for having me. I’m really glad to be here.
Sam: Yeah. So, Jess, could you start us off by telling us a little bit about yourself and what got you interested in the mental health field and why eating disorders?
Jessica: Yeah, I found drama therapy at a time in my life where being a working actor in New York City wasn’t working, and I discovered a way to bring together the things that I believed so deeply in, inside of the art of performance, which was an opportunity for education, and an opportunity for creativity. And bringing that together inside of the mental health field has really been—I had an interesting relationship with food and eating my whole life, personally. And also, just witnessing in my family and with my friends, and people in my life, that same interesting relationship with food and eating, brought me to the idea of eating disorder work. And drama therapy is such a specific modality that really works with embodiment, and I think bringing the work to the body for someone with an eating disorder who is inherently disconnected from their body, really is just like a no brainer. So, I really was like, “I can’t say no to either of these options.” And it really has proven to be, for me, a healing journey from my own experience as a clinician, but also watching my clients and the patients that I’ve worked with over the years who, you know, sort of feel like drama therapy is weird, and it kind of feels like out of the box, and sometimes it doesn’t even feel like therapy. And then all of a sudden there’s this therapeutic intervention that sort of sneaks up and it, it always works.
Ashley: Yeah.
Sam: Wow! So, for our listeners out there, I know there are probably folks out there thinking, “What is drama therapy?”
Ashley: Yeah!
Sam: Yeah. Would you be able to just, maybe, describe it? Like if I, if I came in for a session with you, like, what would that even look like?
Jessica: Yeah, people ask that a lot, like, ‘What is drama therapy?” I don’t always know either, from moment to moment. It really, it really metamorphosizes itself in the work as it’s happening. So, I guess, like, the elevator speech, if we got in the elevator and we’re going up to, like, the fifth floor and it’s like, “Jess, what do you do for a living?” And I say, “I’m a drama therapist.” And somebody says, “What is that?” The coin is, it is a therapeutic intervention tool that brings anything creative to the process. So, what we wouldn’t ordinarily might sit across from each other and chat about and process through language in traditional therapy settings, we as a drama therapy intervention might do something a little bit more metaphor based. We might do something with imagination, we might do something that pulls things back into the body. We might work with something like imagery, or we might go completely wacky, I’m a big puppet person, so we might work with puppets. We might also do stuff with written text. If you’re a person who sings and you’re really interested in using your voice as a way to understand therapeutic change, we’ll do that. So, it sort of is like an all hands on deck, kind of big grab, of whatever feels important or available. And then, let’s say you’re a person who doesn’t do creative, right? My mother has always been a person who says, “I’m not very creative,” which is a lie. And that’s also okay, you don’t have to be a creative person to find creativity. We as children, and it really goes back to when you are a child, right? So, when you are a child using play as your work, play as your way of understanding the world, it’s kind of going back to that rudimentary understanding to find therapeutic understanding for today.
Ashley: Yeah. I was gonna say, Jess, I’ve done a lot of work in play therapy, and worked a lot with young ones, and a lot of what you’re saying sounds a lot like what we’ve done, you know? And just kind of what you’re saying, whatever different type of creative avenue, you know, you have to—
Jessica: Right, yeah. And it doesn’t have to be for kids either. That’s another thing that I hear a lot, is like, “Oh, this would be really great for children.” And it is!
Ashley: Yeah.
Jessica: I personally don’t work with children. And I’m working with a client right now who really is struggling with like accessing emotions and loves to draw. So, what are we doing? We’re drawing things that represent emotion, and then using them as a way to find relationship between the emotions, putting them on top of each other, these drawings, right? So, there’s this idea of, like, projecting the experience outside of the self, that actually gets you more control so that you can then be far more challenged inside what you’re trying to discover.
Sam: It makes the emotional experience much more manageable.
Jessica: Yes, it does. And it’s beautiful.
Sam: That’s fascinating.
Jessica: Yeah, and it also makes the body more manageable, right? So, if we’re gonna talk about this under the lens of bodywork, or under the lens of working with folks in fat bodies, it allows the accessibility of the instrument that I have been disconnected from for decades, right? As a patient, it allows me to then feel like I can touch into it a little bit, find a little bit of home, find a little bit of safety and security inside of this instrument that has been demonized, villainized, scrutinized my whole entire life if I’m a person who has been in this marginalized community.
Sam: Right, right. Would you say, Jess, is there sort of an ideal client that would really benefit from drama therapy? Or do you really feel like it could benefit anyone if they’d be open and willing to give it a chance?
Jessica: It really is honestly available to anybody. I think sometimes it can feel a bit like a hard nut to crack for someone who is particularly rigid in their presentation, or someone who is overly intellectual in their approach to therapy. But I know my drama therapists would be like, “That’s a perfect person to bring into drama therapy because that’s like—there’s a real breakdown that can happen inside of that.” But yeah, it really is accessible for any and all populations, and any age, any ability as well. And it really allows for the patient or the client to drive the work too, right? So, it’s not me prescribing a modality onto someone. It’s not, you know, where it’s like— CBD and DBT is wonderful and it works really well, and it’s a bit of a prescription, right? “So, here we’re gonna use this idea and this theory and we’re gonna try—” Whereas I’m like, “What are you into? Oh, you really like, you know, Pokémon? Great. Let’s use that.” Or “Wow, you really like the Jonas Brothers,” or “You’re really into planting.” Whatever you’re into, I’m going to create something out of that to work with you on, as opposed to “I want to prescribe something at you.”
Sam: So individualized, I love that. And flexible, too. I love the flexibility.
Jessica: And fun! It’s actually—
Sam: And fun! It does sound fun, I want to try some of it. So, Jess, you are anti-diet, anti-BMI, and, you know, I thought maybe this— I was hoping we could talk about specifically eating disorders and fat bodies. I know that’s sort of a passion of yours. And I’m wondering, we know that eating disorders can happen to anyone, but there’s certain populations that have different experiences with getting assessed, getting treatment, getting recovery. And so, given your expertise, what do you feel the biggest challenges are for fat bodies who are on their recovery journey, specifically getting assessed and getting a diagnosis? Maybe we can start there.
Jessica: Yeah.
Sam: What do you see as the biggest challenges? And what can we do, you know, mental health providers, what can we do to improve?
Jessica: First, I want to start by saying that I use the word “fat” as a reclaiming term. I—for those of you who aren’t noticing me—I live in a fat body. I have most of my life. And I have decided to personally reach in, grab that word, and keep it for myself. A lot of people have different terms that they use to describe their bodies—none of them are wrong. And my experience with fatness has brought me to be using this term. So, I’m gonna continue to use it throughout our conversation, and I just want to make sure that people understand my platform as I’m talking about it.
Ashley: Yeah.
Jessica: I think some of the biggest challenges, obviously, are even just being believed, that I have, as a person in a fat body, that I have an eating disorder. And that’s in both directions, right? So, not only does that come from the medical community, or from family and friends, but it comes from the self, as well. There are so many people who live in fat bodies and have experienced fatness throughout their lives, and we all know the narrative: “It’s your fault. Something you’ve done, or haven’t done, or didn’t do well enough, or forgot, or failed at, that has brought you to this place. And shame on you.” So, the next step is for you to try again, and then try again, and try again, and try again, right? And so, what we are learning in both the clinical aspect, but also as fat humans in the world, is how much of this is really our own responsibility and how much of it isn’t, and what that line is. And for most folks, that line comes inside of the relationship with food and eating. And there is a— there’s a common misconception of what, of course, an eating disorder looks like, right? So, if I close my eyes and I think about someone with an eating disorder, we have a particular view in mind, right? Traditionally, it is a younger woman, female presenting, in a small body, right? Emaciated body, who doesn’t eat. And may be over exercises or abuses laxatives, right? That’s the traditional understanding of an eating disorder.
Sam: And affluent, usually is the—
Jessica: Yes, yes.
Sam: The misconception.
Jessica: And then— and usually she’s white, right? So, this is also a disease of privilege.
Ashley: Well, and were saying “she” a lot, too. “Usually it’s a ‘she’.”
Jessica: Exactly.
Sam: Right, Exactly.
Jessica: Right? So, we’re also recognizing and demanding that there be recognition that this experience comes in many different forms. And so, if we’re talking about the fat body in particular, we also have to talk about bodies in Black, Indigenous, and Persons of Color communities, right? So that’s also a very big piece inside of the Fat Liberation Movement, right? We, as people in fat bodies, have also our own hierarchy of bodies, right? When we talk about bodies, everybody’s got one. Everybody has one, it’s the common denominator, right? Sonya Renee Taylor, she talks about the body hierarchy, and it’s important understanding because it is the common denominator that we all have as humans. And then we start to make sense of it in this sort of ladder system.
Ashley: Yeah.
Jessica: And the ladder system is about my body being more able or less able than the next body. My body being bigger or smaller, my body being more athletic, my body having more capability, my body having more privilege. And inside the Fat community, that’s the same thing, right? We now have different terms for “fatness.” There’s Super Fat, Small Fat, Big Fat, Infinity Fat, and people having less access depending on their fatness. And we owe it to the Fat community to make sure that we’re putting out, and putting in front, the voices that need to be heard. And those are those people in Black, Indigenous, and Person of Color bodies. And it’s really important to hear their stories, and to hear about how fatphobia is rooted in racism, and running away from these bodies that we were, at one point, as Eurocentric individuals, deeming as villain.
Sam/Ashley: Mhm.
Jessica: So, that’s kind of like the basis inside of this. But then on top of that, we have the diet community.
Ashley: Yeah.
Jessica: Which is an industry that is so enormous, and has so much money, and so many big hands, and so many deep pockets, that we feel, and we are, sort of up against a big monster. I often feel, when I’m working with folks in fat bodies in my work, like I’m dismantling their own internalized fatphobia. We all have it, it is systemic. And I think when we talk about it from a clinical perspective, like, “What can someone in a small body who is in a clinician, what can they do inside of this relationship,” is to look at their own experience of fat phobia, right? Where, where is it for you? How do you see fatness? And be honest with yourself. Do you associate it with socioeconomic status? Do you associate it with disgust? Do you associate it with an epidemic? And if you do, how do you dismantle that for yourself? So that when you show up in these spaces, you can also acknowledge your own privilege? And it’s not enough to just say, “I’m privileged in this white, thin body. It’s nice to meet you. How can I support you and your eating disorder?” It’s not enough to say that. There is an inherent mistrust inside of communities, in fat bodies, to be with someone who doesn’t live in a fat body, because you don’t understand. You don’t get it, you don’t know, you can’t— you can’t even fathom. And so, you have to, as a person in a thin body, in a clinician role, recognize that you’re gonna be in the room with that, nine times out of 10.
Ashley: Yeah.
Jessica: I had a client recently who, we were looking for a dietitian for them, and the prerequisite was, “I will not work with a dietician who is in a thin body. I will not, because I just— I can’t step over that, can’t sidestep that. That’s a piece of this puzzle. I have to have somebody who, when I look at them, I see myself.” And I get it. And it is a representation that is few and far between in the community. There aren’t a lot of fat clinicians.
Ashley: Yeah. And specifically in the RD community, registered dietitian.
Jessica: Correct.
Ashley: I mean, yeah, yeah. That can be quite the challenge to find.
Sam: It’s really important to have these conversations with your client, to be able to speak openly about these issues.
Jessica: It is.
Sam: And I’m so glad you brought up internalized weight stigma. And then I was thinking to myself, on top of it, some folks have internalized Binge Eating Disorder stigma that they’re trying to unlearn.
Jessica: Yeah. You know, I also— there’s an opportunity inside of this challenge to challenge the internalized phobia of your thin clients as well. Sometimes, you know— not all of my clients live in fat bodies. And I’ll have conversations with them where we’re talking about, you know, fatness, and we’re talking about the villainization of it, or what fatness really means, or “What it would really mean if I lived in a larger body than the one that I do.” And I bring my own fatness into that conversation. And I say, you know, “What would it— what does it feel like for you to have this conversation with me, a person living in a fat body?” Right? And I think that that is also a piece inside of the collective treatment process that needs to be recognized and talked about. When we have combined communities in different body sizes, and there’s a lot of conversation in those group therapy experiences around fatness, recognizing that there are fat community members who are embodying the thing that the rest of the community is actively running away from.
Sam/Ashley: Yeah.
Jessica: And how do we, as a clinical staff, hold space for that? Make room for that conversation? Let it be known so that it can be supported and held appropriately? I think that’s really an important piece. The other thing that I think is important inside of internalized fatphobia, is to insist, and this is a bit— I’m gonna be a bit controversial for a second— is to insist that when somebody is talking about their experience of their own body and how they have all rules for themselves internally, right? Like, “It’s okay for you to be fat, it’s okay for you— I admire that you can have that kind of experience in your life and be successful and confident in your fat body. I can’t do that for me.” And this idea that it is separate is not true.
Sam/Ashley: Mhm. Yeah.
Jessica: That it is not true. It is not true that you can have different phobia and rules for your own body that are up against fatness, and not let that be true to your fat friend. The reality is it is the same, and you have to come to terms with that. And it is a hard truth to come to terms with, because you don’t want to be that, you don’t want to be that judgmental, or that rude, or that mean, or that villainous against someone’s fatness. But your fat friend is embodying the thing that you are saying isn’t good enough for you.
Ashley: Yeah, yeah.
Sam: Mhm.
Jessica: So, that is a piece inside of the process that I think is super, super important. And it’s controversial, and people don’t really like me when I talk about it in that way, but I am okay with that. It’s just really, it’s key. I think it’s really key.
Ashley: Well, I would say, you know, if people don’t like you— we don’t talk about this enough. I’ve been working within the eating disorder industry now for five years, and that— I was a clinician that really worked in trauma prior to kind of coming into this field— that was a piece of just even working with my own internalized messaging. I live in a fat body, too, Jess, and like— and always have, my whole life. And so, I know messages that I’ve given myself, I know messages that I’ve heard in the community, cultural messages, diet messages. And I was shocked at the work I had to do to come to the place to authentically work with my clients and whatever body size they were, right? Like, it’s so imperative for us as the clinicians, as the ones that are providing this safe space, to be honest, and authentic, and transparent with ourselves and the messaging and the experiences that we’ve had that have brought us to this point.
Jessica: It’s not fair, and fair is a term we made up as humans, but it isn’t. It’s not fair to ask someone across the room, who’s sitting on your couch, to do work you haven’t been willing to do yourself. I’m really authentic in that way, I’ve never asked anyone to participate in something that I, either I’m not actively participating in my own personal life, or have already participated in and feel really strongly about, right? So, having those big boundary conversations with your family, when your family is talking about your body, or your family is making comments about food on your plate. I tell them, “These are the boundaries that I have personally been able to use in my life, this is the way it has worked for me. Give it a shot, see how it works for you.” And I think that’s a piece that is also really crucial inside of the treatment process for folks and fat bodies, is how to really support after treatment ends and they walk back into the world still in a fat body.
Ashley: Yeah, yeah.
Jessica: There’s this disconnect that happens when you finish treatment and you’re in a more recovered space in a thin body, walking out into the world, and when you are in a recovered space, walking out in the world in a fat body. Because immediately when you step out, there is automatic oppression, there is automatic stigma, there’s automatic anti-fat bias that is reminding this person on a regular basis that what they’re experiencing in their life is wrong. And there’s a piece inside of that treatment process, I think that we owe them. It’s almost like an added layer of protection and armor, literal terms and words that they can use. I find that when I work with clients in fat bodies and we talk about statistics, and I give them, like, actual— “When somebody says this, say this. Give them these words in this order. That will help support you intellectually, that will help support you in the language.” Because when we talk about this, much like when we talk about trauma, right, we need language to be able to feel like we can understand what we’ve been through and how to say it to other people in a way that is full of confidence and security. So, giving language to our patients and our clients so that they can say, “Oh, right when my mom makes that comment about, you know, the salad that she had because she hasn’t eaten all day, right? I can make this comment and I can be— I can feel better about my recovery as a result of this line that I learned.”
Ashley: Right.
Sam: That’s so helpful.
Ashley: So, I’m curious if we can, like, kind of do an example of that. So, I know all three of us have, kind of, we’ve had experience both in outpatient private practice setting. We’ve all had experience in higher levels of care which, for our listeners, that might mean IOP, intensive outpatient, day treatment, or residential. So, let’s say we have a client, Jess, who maybe came in because she was experiencing moments of both binge eating and moments of restriction, because the world has told her that she needs to restrict and kind of create a different body. And she’s in a fat body, alright, and maybe I’m particularly thinking of a client I’ve worked with in the past. But— and by that I mean I definitely am. So, she discharges and has done incredible work in, you know, treatment, and kind of, like, claiming herself, and understanding her body, and understanding who she is. And mom and dad are at home, and mom and dad really thought that that this eating disorder treatment was going to also teach her how to lose weight, because she was going to stop binging.
Jessica: Ahh, that old chestnut. “You’ll get out and be smaller!”
Ashley: I know, right? What might be some language we could give her, specifically?
Jessica: Great question. So, my first suggestion is a very large and definitive clear boundary, and the first one is, “No more comments about my body, and no comments about the food that I put on my plate.” Those are the first two. So, what that means is, you don’t tell me that my body looks good, you don’t tell me that my body looks bad. There’s no body comment at all. You can say, “That sweater looks nice.” You could say, “I really like how you did your hair today. I really love those glasses, or those earrings,” or “Those pants are really great tweed,” whatever. But we’re not going to talk about that, “You look good, you look bad. You look fat, you look thin.” No more of that, and also no more comments about my food, right? So, how much I put on my plate, when I last ate, what I am eating, why didn’t I eat, why am I eating again. “Didn’t you just finish?” No comments about food. So, those are the first two that are, like, out of the gate, absolute no more.
Ashley: Mhm.
Sam: Yes.
Jessica: And the other thing that I think is really important to teach and remind, is how poor people are at respecting boundaries. They suck at it. And the way that I like to describe it is like, if you’ve ever had a kid, it’s like when you’re trying to teach your kid how to sleep on their own after you’ve rocked them and, you know, held them for a certain time, right? For anybody who’s had a baby, that is hell. When you are trying to get to that part where the kid can sleep on their own, right? There’s these boundaries that you have to put, and the kid is going to scream and wile out about it. People will also mess up, whether that’s intentionally or unintentionally, with boundaries. So, what I suggest is, after you making those two very clear boundaries, that you remind the person, “You’re probably gonna forget and that’s okay. I will be here to remind you.” And then, reminding them. So, next day, I’m having a bowl of cereal, my mother says to me, “I really think, blah, blah, blah—” “Hey, I just want to remind you, we had this conversation, no comments about my food.” And the reason that that is also really important is because people truly do not realize how often they make comments to fat people about food, and eating, and their bodies.
Sam: Mhm.
Jessica: They really don’t know because it’s such an internalized and stigmatized, systematic thing. It’s like breathing. Also, people think that they’re doing it out of health concern, and people think they’re doing it out of being kind. My mother used to say things to me like, “Oh, you look like you’ve lost whatever weight or something.” And I’m like, “I haven’t, and also don’t say that.” And she’s like, “I thought it was a compliment.” It isn’t. So, just a gentle reminder, I just— “Hey, I want to remind you, remember we had that conversation. Here I am reminding you again.” And the other thing about boundaries that’s really important, is to make sure that your voice stays the same, right? So, when I have that conversation about my body, or I have that conversation about food, you’ll notice that my tone doesn’t change. I’m not putting any energy into it, I’m not putting any emotion into it. There’s something about when you place a very firm boundary and you make it very specific, if you don’t change your tone, it seems to hit different. I don’t know why, I’m sure there’s research about it. But it really works. So, those are the two big, like, out of the gate, do these two things.
Ashley: Yeah.
Jessica: Okay, the other thing that I think is important inside of this is the understanding of microaggressions. First of all, the term microaggression, that’s a term that is new to a lot of people, an understanding of what that actually looks like inside of a relationship with someone with a fat body. I’ll give you an example from my own life. There was a day I was out walking with some friends, and I was really struggling because I was having some problems with one of my joints. And I was like, “I don’t really think I can make this walk guys, I really—” You know, and just sort of like a little bit of conversation about it. And someone in a thin body wanted to know more information about what was going on, and I didn’t really want to talk about it. And then that conversation was talked about more, and insisted some more, and then when I finally told them what was going on, then it was a conversation about, “Oh, yeah, I know, that happens to me too because of XY and Z.” So, there was this idea of, like, “I’m experiencing this fat body experience and now you are going to take that experience and make it about you and your thin body,” right? So, then it became this, like, switch around that didn’t feel good to me, because then it made me feel like what I was experiencing wasn’t real, honest, or valid. I didn’t— I mean, 10 years ago, I would have never had that kind of language to understand that. I would have just walked away from that being like, “Well, that felt kind of crappy and I don’t really know why.” But then I had the language to then go back to the person later and say, “Hey, can we have that conversation where we talk a little bit about that interaction we had and how it made me feel. What it did to my experience, and how wrong that is.” So, that’s another piece here, is to be able to know when it’s happening.
Ashley: Yes.
Jessica: We in fat bodies—
Sam: Awareness.
Jessica: Exactly. We don’t necessarily know what’s happening either because it’s been happening our whole lives. It’s in the air that we breathe, it’s the water we’re swimming in. So, to be able to understand in our lives when that is occurring, and then how to go back and talk about it. And then the last thing that I want to offer is, if we’re in a culture in the family where talking to elders is not on the table, right? So, I come from the Midwest, I’m a white girl— giving boundaries to my mom, not a problem. In my culture, that is absolutely lifted up and encouraged. In other cultures, it is not. So, to be really understanding of that as well, and flipping the script a little bit. So, what I’ve been able to do with some of my clients who live in cultures where it is not appropriate to say anything to grandma, to mom, to auntie, to anybody who’s older than me, about my body, right? Is to understand how it’s their own internalized experience of fatphobia. And so that’s an internal boundary of how can I, as a person, internally protect myself from whatever someone is saying about body, about food, about my body, because it is not appropriate for me to say something to my great aunt at this, you know, family reunion, because it’s disrespectful.
Ashley: Right.
Jessica: So, I’m not gonna say anything to her, but what I am going to do is internally and emotionally, I’m taking a step back and looking at her life, her experience, what she’s commenting on inside of her own fatness or her own body awareness, and realize it’s a projection onto me and I don’t have to take it.
Ashley: Yeah, I love that so much that I feel like you just kind of blew my mind there with that internal boundary. I mean, that— I hope that that is a tool that somebody today, listening to this, can start implementing that has those experiences.
Jessica: Yeah, it’s really— it’s really key because, you know, you don’t want to not go to the family reunion, and you certainly don’t want to continue to hold resentment towards your great aunt who has fatphobia, right? So, how do you continue to have that relationship, and be authentic inside of it, and also not go up against what you believe is the culture of your family?
Ashley: Right.
Jessica: Because that’s taking on a lot.
Ashley: That is, yeah.
Jessica: When all you really want is just the potato salad and be left alone, right? Like, eat the potato salad, feel left alone inside of it, and continue to have that relationship with your family that’s so important.
Ashley: Right.
Sam: This reminds me of so many the other episodes we’ve had, Ashley, on cultural humility and how important it is. We just had an episode recently with Fatema on eating disorders and Muslim populations and, you know, that those direct boundary setting techniques are just not— it’s really not the way to go. And we have, yeah, we have to take culture into consideration. So, thank you for bringing that up. It’s so important.
Ashley: Yeah.
Sam: Speaking of families, you know, there are times, you know, we talked before about, you know, the family members who they— it’s kind of tricky because they try to shift the focus on health, saying, “Well, I just want you to be healthy.” And there’s this belief, that it’s like you have to lose weight to do that. And there’s such a push with that. And I’m just curious how you might work with family members in a family therapy type setting if that’s what’s coming up.
Ashley: And is that something that you do, do you bring in the family as well? Specifically kind of in your private practice? And what does that even look like?
Jessica: Begrudgingly I’ll bring in family. Families always give me a lot of angina and… because there’s just so much going on, I really love to empower my clients to do it on their own. And, of course, if it’s necessary, it’s necessary. So, inside of that, I have noticed, firstly, that when you bring in a family experience, then and only then do I really feel the hierarchal experience inside of the clinician patient relationship? When a family comes in it can go either way, where they either feel superior to your expertise or they feel inferior to your expertise. And as a result, there’s really this, like, absolute divide between “us” and “them.” And I feel like that can be used to your advantage as the clinician in the space, to really hook elbows with your patient or your client and be speaking from a very clinical lens sometimes about what we’re talking about and why we are approaching this in this way. And also, what we end up doing, essentially, is throwing up a mirror to the family legacy of fatphobia and the need and necessary evil of having to look at their own relationship with fatness and their bodies. And that can take a lot of, you know, dismantling. But outside of that, I find that giving all of the tools to the client and the patient is key, and not saving any of it for yourself, right? So, I want my patient or client to walk away feeling just as much of an expert inside of it as they think I am?
Ashley: Yeah.
Jessica: I don’t feel like I need to save anything for me. If I find an article that’s really interesting, and it’s really, you know, bolstering up this theory that I have about body set point, I’m giving it to all my clients. “Read this. I just learned this. Highlight this thing, say this and that,” right? I want them to have all the tools that I have, so that they can be an expert in their own recovery and an expert in their own fat liberation. I think that’s really important because people are always looking for statistics, people are always looking for, you know, the science of it all. Which is laughable because all of diet culture is based in science that has so many holes in it anyway.
Sam: Mhm!
Jessica: But, you know, I think empowering the patient inside of the family relationship is key. And then inside of— outside of that, is to really just continue to champion the theory that you can be healthy even when you’re fat. And to talk about what health really means. So, if a family is coming to talk to me, a mom, a dad, a spouse even, right? Or a partner? And they’re like, “I’m worried about my loved one’s health.” “Great! Exactly what are you worried about?”
Sam/Ashley: Mhm!
Jessica: “What health marker are you worried about?” Because the thing that’s cool about Renfrew is we have all the health markers, right? So, let’s talk, are we talking about cholesterol? Are we talking about kidneys? Are we talking about blood work? Are we talking about, you know— what exactly are we referring to? Because nine times out of 10, it’s not really what you’re talking about. You’re really talking about something else. And it’s really encouraging to be able to… just sort of knock those things down. And that’s another piece that I think is really important, is if you’re gonna sit inside of these conversations, to really be clear, consistent in your messaging, and confident in what you’re saying. If that means that you have to have notes, have notes. Because, again, you are pushing up against decades and decades of messaging in a different direction. And also, a lot of times you’ll end up meeting a family member who has an undiagnosed eating disorder.
Sam/Ashley: Mhm!
Jessica: In which case, that’s, you know— and so we as clinicians who work in eating disorders knows what it means to be in the room with an eating disorder, right? So, you’ll feel it show up inside of the, you know, family member as well. And to understand when you are negotiating with the disorder and when you are actually giving fact.
Sam: Mhm. Such a good point.
Ashley: I just want to say, I think that that’s really helpful and, you know, I’m thinking about just my experiences even bringing the family into the room. And sometimes I’ve done, I mean, you all probably have done this too, we’ve done meals with the families. Just one particular family in general, and you can really see even what comes up in that respect as well. And just that the education piece I think is so critical because, I mean, you know, often they want to know— they— well, and I mentioned that I worked with kids before this, too, but like, I would work with kids, you know, back in— earlier in my career, and it would sometimes feel like the parents would bring the child in and kind of say, “Fix them,” right? And it’s like, “Oh, there’s so much here…”
Jessica: Yes.
Ashley: “There’s so much in this family system.” So, I like what you said about putting the mirror up, really, to the family system and educating them. Not from a place of, like, contention or frustration with them, educating them because the messaging that we’ve all received for years, like you said, decades and decades, has been rooted in this kind of, like, weight stigma, fatphobia place. So, the education I think is just critical to them.
Jessica: It is, and you know, you brought up family meals, and I really love sometimes working with that with my clients around, “What is a meal? What does the family meal look like? What do you remember your family meals to look like? What did mealtime, like, what was the whole vibe going on there? And, like, how much information can we glean just from the vibe?” Right? And then, “How can we adjust that?” I often see, you know, working with adult clients, I’ll see how it’s rooted in their childhood, how they experience mealtime now as an adult. You know, “I don’t really cook that often, and I don’t really keep food in the house that much.” And we talk about the family experience, and there’s this realization that, “Wow, like, we didn’t really have food in the house growing up.” Like, you know, “Where’s that stem and how do we break that legacy,” I think is super important to the process. And also, we talk about therapeutic cooking, there’s a real baseline inside of that which starts with, “What do you know? What is comfort to you?” You know, there’s a lot of shame inside of the ability or lack thereof to cook in the eating disorder treatment process. “I don’t know how to cook.” “I only know how to make three things.” “I don’t want to know how to cook.” “I don’t like cooking.” And, you know, offering an opportunity to be like, “You teach me a recipe that you love, something that means something to you. Even if it is this cereal, with this bowl, in this, you know, room with this kind of milk. Great. Let’s start there.” And so, I find when I first start with the therapeutic cooking, “You tell me, and you’re gonna show me, and I’m gonna be the student, and I’m gonna learn.” Because you learn so much about what their understanding is and where their emotions are inside of that process. And then, how do we build off of that? How do we add skill, and comfort, and accessibility to what cooking is? And what it can be for you as a person in recovery from the stigma.
Ashley: Yeah. And I just want to say, when you take that role as the student and as the learner from the client, that also gives them voice to their experience, that what they know is okay. Like, what they’re doing— like, they’re not doing anything wrong, right?
Jessica: Right.
Ashley: Like, they’re not being wrong inherently because they only know this dish, or whatever.
Jessica: Yeah. And also to that point, when I’ve worked with folks in fat bodies inside of that experience, right? There’s this inherent shame inside of “What I’m eating.” And to tear down the shame and find the nostalgia and the comfort in it, is also really empowering. I have this sandwich that I used to make when I was a kid, and it’s peanut butter, honey, and dill pickles. And it was just stuff that I had found around the house when I was in middle school, and it sounded really good to me. And it is a sandwich to this day that, like, if I’m feeling particularly homesick, or I’m feeling really nostalgic, or I want something really homey, I will make myself this sandwich. And it probably sounds gross to some folks, or it might sound, you know— whatever it is. But there’s something about my— at that time in my life when I was experimenting with food, when I was learning how to do stuff on my own, when I was finding my independence and finding comfort, that means a lot. And it’s all wrapped up in a sandwich. And what that also does, is it dismantles the idea for folks in fat bodies that food is just supposed to be fuel. That’s not true. It can’t be that way, it isn’t that way. And how do we allow it to also be passionate, and fun, and exciting, and okay, and without the shame inside of, “I’m really excited about this cupcake.” Be excited about the cupcake. You’re allowed to have joy inside of eating and be fat.
Ashley: Yeah. I love that so much. I do.
Jessica: Yeah, it’s cool.
Sam: I can’t believe we’re out of time!
Ashley: I know!
Sam: I’m so upset about this because there are so many other questions we have, maybe for another season. But thank you so much, Jess. This was a wonderful conversation.
Jessica: Thank you both! I loved it.
Sam: I hope you come back, maybe in another season.
Jessica: Mhm!
Sam: So, thank you, and thank you, our listeners, for joining today. This was a really informative episode. And if you found any value in it, or you loved this episode, you can support us by subscribing, rating, leaving a review, or sharing with others. If you want more, follow us on Facebook, Instagram, Twitter and TikTok. Our handle is @RenfrewCenter. For free education, events, trainings, webinars, resources, and blogs, head over to our website, www.renfrewcenter.com. And if you have any comments or questions you’d like us to answer in a future episode, be sure to email them to [email protected]. I hope you join us next time on All Bodies. All Foods.
Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.
Sam:We’re looking forward to you joining us next time as we continue these conversations.
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