Podcast Transcript

Renfrew Conference Mini-Series Episode 1: Asian Identified University Students and Eating Disorders

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INTRO

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.

INTRODUCTION TO THE EPISODE

Sam: The college environment can be a very challenging time for any young adult. It’s not uncommon for a life transition like this to become the triggering event for a clinical eating disorder. But minority students may be even more vulnerable to mental health concerns as they navigate compounding stressors, barriers, and unique risk factors, on top of it all. Like Asian identified students experiencing microaggressions, minority stress or acculturation. Despite the fact that eating disorders can happen to any race or ethnicity, minorities continue to be underrepresented in research and in the development of assessment tools and therapeutic modalities. As mental health providers, we know the importance of cultural humility, which is why continuing education on specific populations is so important. At the 2023 Renfrew Conference, we invited three presenters from the University of Southern California Student Health Center, Dr. Dani Gonzales, PsyD, Tiffany Nakamura, LPCC, LMHC and Jo Jo Lee, LPCC, NCC to share their training with us titled: Within Our Reach: Navigating Eating Disorders with Asian-Identified University Students. Join us for the highlights.

EPISODE

All right, everyone, welcome back. We are joined by three of our presenters today, Jo Jo Lee, a licensed professional clinical counselor in California, and a national certified counselor, Dr. Dani Gonzalez, the licensed clinical psychologist and the Associate Director of Eating Disorders within the Department of Psychiatry at the University of Southern California and Tiffany Nakamura, is a dual licensed professional clinical counselor, and a national certified counselor. I also wanted to say this too, Tiffany, for nearly a decade, you were the senior Eating Disorder clinician and researcher at the UC San Diego Eating Disorder Treatment Center, right?

Tiffany: Yes, one of the researchers. (laughter)

Ashley: Well, thank you all so much for joining us today. And I’m just curious, how’s the conference been for you so far?

Dani: Oh, wonderful. Really fun.

Jo Jo: Other than the jet lag.

Ashley: Right, the west coast jet lag.

Tiffany: Very excited to be here.

Ashley: Thank you all so much for joining us.

Sam: We appreciate you being speakers at this conference. And one of the unfortunate things about the conference is that you can’t go to every single workshop like that’s the one downside. So, one of the reasons why we wanted to make this episode was if someone couldn’t attend your workshop, they could learn maybe a little from this episode. So, you have a workshop titled: Within Our Reach: Navigating Eating Disorders with Asian Identified University Students. And if you’re an eating disorder professional, you probably know college students are at an elevated risk, period of transition and change, there’s a lot going on. What is unique about the experience of an Asian identified student?

Jo Jo: I can speak a little bit about that. First of all, we are representing two different university here. So, there is University of Southern California and University of California San Diego. So, within these two universities, we actually have a pretty large population of Asian students within our own university. And it makes it really unique because the Asian populations, as you all probably know, it’s very diverse even within the population. And there is no one cookie cutter way of working with it. And at the same time, that does not mean that we shouldn’t bring awareness of how to work with this population because of its uniqueness. And because of that, we want to kind of like bring this to the table and let our colleagues who learn, what does it look like to work with such diverse populations in the college setting.

Dani: I’ll expand on that too. Working with college students at university, it may be the first opportunity to get evidence-based treatment or have accessibility to working with specialized providers. And so, one of the beauties of each of our work working in Higher Ed is that not only do we get to educate students but hear from them what’s been a barrier or maybe work through some things that from a pathological standpoint may have not been observed in their home countries of origin and also help them navigate if they’re going to be returning home for winter break or summer break and how to have a blend of both healthy and effective ways of approaching eating and the relationship with their bodies.

Tiffany: I want to echo both of my colleagues. I don’t necessarily anything more to add as far as the uniqueness of this population. But I do think the importance of having cultural humility with this population ultimately is the thing we aim to bring to the conversation with evidence-based care and treatment of eating disorders within this population. Given all the barriers that exist to reaching Asian students, Asian identified students, in the college setting is kind of the take home point here.

Sam: What are those barriers?

Dani: Well, as we talk about evidence-based treatment, you know, it’s no secret that not a lot of treatments have been uniquely studied within different subcultures and populations. And so, part of our lens is working with students where we may be the experts in the treatment, the experts in the field, but we need to learn how to modify it for the unique needs of the populations we serve. And I think some of the things that we see particularly to Los Angeles, San Diego is that there’s not a lot of providers in the field who come from the same origins of our students. And so being able to navigate those experiences with them, talk about the diversity of our own food and what types of food are available on campus for some students. Sometimes navigating a dining hall can be very daunting. There may be food beliefs that they come with from their country of origin or foods that are more familiar for them and being in a different country, those aren’t as readily available for them. So those can be barriers as far as the food. And then I think with different idealized forms of beauty that we hope to cover in our presentation too, we know that as expansive as Asian identities can be, so are their cultures and beauty ideals. And so, we hope to cover that and know that not one stands for them all. And recognizing that, how do you make sense of that while being in western schools where there may be different beauty ideals or different forms of those pressures.

Tiffany: I think one thing to add is the acculturation piece, exactly just that, when working with this population being able to kind of delineate the nuances between the different cultures, to be able to hold a space where they can feel okay to share more about what they might feel a lot of shame around coming from one culture to a different one and then understanding some of the sort of communication familial dynamics that are kind of unique to their cultures, to their family of origin, to their dynamics just within their immediate families can be all sort of influencing factors in what they struggle with, with an eating disorder, with body image, with their relationship with food. So, I think all of those things are barriers to really good care.

Jo Jo: I want to add on to it is that one of the barriers depends on exactly what acculturation piece an international student is going to present very differently than a first-generation immigrant to a third-generation immigrant family. Even navigating within those differences, like how family going to be involved with it. Our presentations also touch based on Asian values. It depends on the individual, how much they carry that Asian values when they move forward in the higher education setting, even with choosing their own major, like, is it because they like to be in this major or is because there is family influence to it? And that’s just one important piece. And we’re talking about another very important piece which is medication, often time within the Asian culture they don’t want to take westernized medication because there is a particular stigma to it and, and it’s very important when we want to involve family members. Are they going to be, how effective and how can we make family members and loved one involvement become a more effective way versus become the barrier, our student’s treatment.

Ashley: Jo Jo, I was actually going to ask specifically about that. And what I’m hearing is that there, there are so many nuances within each individual student that you work with, right? So, this isn’t necessarily going to be a generalized answer for each student. One, I’m so thankful that all three of you exist on these campuses to support our students. Second, how do we then navigate working within the family system or what are some of the tools that you all encourage the students to take home with them when they’re going back for those breaks and things like that?

Dani: Well, I want to speak to sometimes before they’re able to go back or work with their families, we’ve got to help them navigate the landscape of college and that means working with other campus departments like OSAS if it’s seeking accommodations, if it’s international living situation. As we’re talking about a barrier I was reminded of, you know, sometimes students can’t go to higher levels of care of treatment because of their visa status. And it’s helpful if they have a provider who’s informed, willing to document and advocate for them in these college campuses. If it’s a financial barrier, you know, having someone who’s versed in the eating disorder world too, knowing how to look for scholarships or financial support, how to look for more additional meal swipes or basic needs to as part is crucial to their treatment to get better. So, I wanted to talk about those resources first, before we talked about family and external caregivers help as well.

Jo Jo: I think a lot of psychoeducation becomes extremely important for family members and loved ones because even within our conversations, we talk about there’s a lot of like intergenerational trauma when we work with in the Asian populations, Asian American populations, depends on where they’re at in their acculturations. They might already be carrying a lot of their own biases about their relationship with food or the eating culture itself. So, when as a provider, sometimes we have to be very mindful of what am I introducing to the student and their family members? Am I just bring the westernized lens of telling you that like, hey, this is what you need to do, this is the medications that we recommend, these are the food that you should follow on your meal plan versus being like, look, this is what your normal diet looks like and let’s talk about how can we incorporate this in a healthier way so that we’re not becoming the barrier as being a provider. So, a lot of them is a little bit like a collaborative work with family members understanding where they’re coming from. And I, and I think psychoeducation is such a huge, huge piece when working with this population is kind of what Dani mentioned. Like this is a population, maybe this is the first time ever receiving treatment at all.

Dani: And if we’re lucky enough, we actually get to have a call with our parents and explain to them what we’ve been doing. And I also think a little bit too that we often talk about is looking at what the recommendations are made in the Western States and modifying that, right. So, we typically talk about three meals and two snacks doesn’t really exist outside of the United States. So how are we blending that? Are we talking about, you know, 5 to 6 small meals a day? Does that sound doable? When you’re traveling, how can you still listen to those hunger fullness cues or maybe mechanically eat while you’re going out and about? And then just preparing them for comments that they may already know they’re going to experience when they return home. You know, it’s a very real fear of becoming American fat and as me as a non-identified Asian provider, I think it’s kind of fun to play around with that because they’re fearful of saying it. Are you waiting for you know, your parents to make this comment? And how can we navigate some comments that are going to be made to you and still actively attend to your recovery?

Ashley: So, you know, we’re at the conference, we’re surrounded by professionals. Hopefully they’re going to take all of this information back and apply it where it needs to be applied. From each of you, what would be like a key takeaway you would want… I know it’s kind of a big one. I see you smiling Jo Jo, what would be something that you want them to understand and take away.

Sam: If they could only take away one thing…

Tiffany: Tough question. (laughter)

Sam: We like to ask the tough questions. (laughter)

Tiffany: I think it’s a loaded question and I think that’s a great question. So, I think you’re talking about for clinicians, what they could take away, right? When working with this particular population, I would encourage cultural humility. So, coming into conversations really extra mindful of our own biases and to be very open and receptive to the students and their experience and to not just jump to sort of assumptions that this is pathological in nature or not, and that’s not just, you know, in the eating realm that is a family dynamic, that is a cultural practice, that’s a religious belief. So whatever feels may be a little bit uncomfortable from a clinician standpoint, especially if you don’t share the cultural experience or you are unaware of, you know, what is practiced in the culture to be more exploratory and curious as opposed to assumptive and, you know, think that this is wrong. That would be my one thing to take away.

Sam: Well, I love that because I’m so glad you brought up cultural humility. We have a whole episode on the difference between cultural competence and cultural humility and really that cultural competence, it’s not like something you ever, it’s not like an event that you arrive at, you know, cultural humility is just ongoing forever.

Tiffany: Even for us. I mean, as someone that identifies with a minoritized population, it’s still an ongoing learning process. And as someone who’s second generation, it’s, you know an acculturation process of my own journey that’s constantly influencing, you know, my perceptions and beliefs.

Dani: I have two things I’ll say today, I’ll give Jo Jo some more time to think. I think for loved ones, caretakers, you know, friends of folks who are struggling, it’s helpful and for providers, it’s helpful to know that how the student is performing academically is not a good insight into how they’re performing internally with their eating disorder. And that’s often something I hear amongst my providers at my institution, like, oh, well, they’re still doing really well, or they haven’t, like, experienced those quote unquote consequences yet. And I’d love for providers to be more mindful that academic performance does not equate to medical and physical wellbeing. And the other thing I’d like for providers just to take away from this conference or this podcast is just knowing too that as we work with students and international students as well, it may not be their first treatment episode. And I know a lot of times providers are really motivated to have the best approach, the best level of care be as effective and if our students aren’t ready, because this is a fully new experience to them, just creating that positive experience that they can return when things get worse or when they’re starting to make those insights of this isn’t working for me. So, I hope providers take that with them as well.

Ashley: Thank you.

Jo Jo: I don’t even know what to add on what after what Tiffany and Danny mentioned because to me, I really like what Tiffany mentioned about the cultural humility. And I interpreted that as flexibility, which like all practitioners, providers we thrive to be, how to be more flexible and be where the clients at at that point. Because this is the population, they’re young, they are trying to absorb all information, they can in a pretty highly competitive environment. So, one thing that I want to emphasize is that let’s create a space that like we can all make a mistake. And the goal here is not about we have to find the perfect strategy in the first session. It is about okay; I don’t know everything about your culture because you are the expert of your own experience. How about let’s work this together and create a space where you can call me out and the practitioner can also be like, please let me know if I make something that is not accurately reflecting on what you’re sharing when it comes to working with college student and specifically Asian Americans. My personal experience is that it’s a lot of coaching about self-advocacy because this is not something that within the culture that is not something that we were taught. When speaking from personal experience, I was taught to be like, be humble. Like, don’t be the spotlight. So that to me is a very important piece when it comes to eating disorder treatment is like, let’s not take every single thing your therapist say, your doctor say as like this is the golden standard. Let’s advocate for yourself and we can walk through this together. So, I feel like that’s where the flexibility kicks in.

Ashley: I love that. Thank you all so much for sharing and, and I’m just thinking with your students in particular Jo Jo and just hearing you say that that piece on flexibility and the piece on… I’m just thinking of the practitioners here like practicing the cultural humility but like not imposing their expectation of what healing or growth or recovery looks like, right? Like that partnership is so important. Thank you all so much. It’s been so lovely meeting you and having you on the show. We’d love to invite you back for a full episode. So, we’ll be in touch with that. But thank you so much for coming and talking with us today.

All: Thank you for having us.

OUTRO

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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