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Family-Owned, Patient-Focused: The Renfrew Center Difference

Podcast Transcript

Episode 36: Breaking Free of Systems & Symptoms: A Conversation With a Certified Eating Disorder Specialist

[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: Hello, everyone and welcome back to another episode of All Bodies. All Foods. Sam and Ashley are here and today we are joined by a special guest, Dr. Catherine Devlin (she/her/hers), she’s a licensed clinical psychologist, Certified Eating Disorder Specialist and IAEDP-Approved Consultant (CEDS-C), and the owner of Birch Tree psychotherapy. She opened her practice in the Lakeview neighborhood of Chicago in 2012. She maintains her small group practice focused on providing personalized outpatient care to people with eating disorders, disordered eating and body image concerns and now has locations in the Chicago Loop and the Northwest Chicago suburbs. She provides individual group and family therapy, student training, supervision, and professional lectures. In her clinical work, Dr. Devlin focuses on applying behavioral therapies within a feminist and help at every size or HAES framework. She has a strong interest in women’s relationships with their bodies and the relationships among childhood experiences with food, social learning, and weight concerns. She works within a feminist lens to help people understand both social and personal contributions to these relationships and create meaningful change within them. As a HAES therapist and advocate for size inclusivity and body liberation. She is passionate about helping people with eating disorders and body image concerns, learn to love and accept their bodies. She is also particularly interested in working with clients with co-morbid eating disorders and diabetes. Both type one and type two. Dr. Devlin has had type one diabetes since childhood and also identifies as living in a larger body. D. Devlin, thank you so much for being with us today.

Dr. Devlin: Thank you for having me.  I’m so excited to be here.

Ashley: So, we met earlier this year at a conference, and I think you may have attended one of the events we were hosting, and it was so nice to meet you. And after connecting, I knew that it would be awesome to have you on the show. So, thank you for joining us and being willing to come on and talk to us. Could you share with us a little bit about your professional background and what got you to where you are today?

Dr. Devlin: Sure. So as you stated, I’m a psychologist. I kind of always knew from adolescence that I wanted to be a therapist. I had my own therapist. I really liked her. She was like one of the best things in my life and I really wanted to like, give that to other people. And I thought I wanted to work with adolescents. And my whole idea back then was I really wanted to focus on working in families in which the kids were demonstrated kind of borderline type characteristics and work on studying the role that family therapy would play in kind of preventing some of the negative mental health outcomes later on. So that was my vision and it’s been a sharp left turn, but that was kind of where I started. But I sort of serendipitously happened upon working and eating disorders. And then I just kind of found I really fell in love with the work I loved doing the family work that I was able to do. I loved kind of working with people on like behavior chaining and figuring out like what’s the function of this behavior and working with real tangible skills on like, how do we change this behavior? It really appealed to my um my analytic inclinations. when I went into private practice, I started with kind of like a broader framework of like, I’ll try like eating disorder, self-injury, kids, adults, like, let me kind of see where, where I end up landing. I really did enjoy still working with, people with borderline personality traits and bringing in a lot of DBT and doing some training in that area. And then at some point I just started focusing more on eating disorder work and I really liked working with adults. I felt like I actually think I’m better with adults than with teens. If I’m being totally honest, I think I might be good with little kids and with adults. Um, but, you know, teens generally I think, find me a little cringe and nerdy and not in an endearing way. So I have some who I still see that I really like.

Dr. Develin: So early in my training and eating disorders they really talked about in working with like binge eating, how you work on stabilizing it and then once their binge eating is stable, then you can focus on weight loss. And so that was kind of the framework I’d been provided with sort of early on. And, you know, I kind of like chatting with colleagues, like, but no one really ever gets to the point where they’re like, ‘ready to work on weight loss’. And when they do, they seem to relapse. I felt like what we’re being taught kind of seems wrong. And then I heard Margit Berman speak. She does this like full day training at APA on using acceptance-based interventions for people with weight concerns. And that was when I learned about Health At Every Size.  And I felt like in the way she like laid out all of the data step by step, I think it was like a whole day long workshop and like why weight loss interventions are ineffective and why they’re unethical and what you can do instead to help these clients just like a light bulb went off for me. And it was so nice to finally have like a framework or like what I kind of knew but didn’t have words for and also faced a lot of pushback in the community about. So that’s when I kind of brought HAES into my practice and, you know, just started focusing more and more on eating disorders and open the second location. So that’s not very like linear.

Ashley: No, that’s great, the growth of it.

Sam: So, for our audience members who are hearing this word HAES and probably seeing this word HAES on the profiles of clinicians, and they might be wondering, what is that? I was wondering if you could say a little more about HAES and also body liberation because I know those two concepts are really important to you and embedded in your work.

Dr. Devlin: Yeah, absolutely. So, you know, I think growing up in diet culture and just sort of having the lived experience both with myself and with my clients, weight loss interventions just don’t work. I really resonated with these types of frameworks and what Health At Every Size is, it’s primarily a social justice paradigm. It was developed by the Association For Size, Diversity and Health. I think it was in the eighties or nineties. It’s been around for a while longer than it’s been kind of a public buzzword. And basically, it was based on the idea that fat people deserve the same rights as everyone else deserve access to healthcare, deserve to be treated as human beings and don’t deserve to be subjected to weight discrimination. So, it is above all else, a social justice movement. And then within that framework, there are certain principles like that everyone has the right to access healthcare interventions, independent of their body size, respectful care, intuitive movement, eating for wellbeing, etc. And so this is kind of the framework through which I think it’s helpful to provide care and also think of our own lives in terms of like I can work to improve my overall wellbeing, I can pursue my goals and I don’t have to lose weight to get there. And so, you know, whatever you’re wanting from your life, if you view weight as the barrier, then that just becomes insurmountable. But if we view weight stigma and oppression as more of the barrier, like those are actually things we can work around to figure out how do we get the life we want. And so, a lot of its figuring out how to like work in the current system or resist the current system to the degree that it’s helpful in the body you have to get the life that you want and to be sort of more agnostic towards changes in body size. So, I tell people all the time they’re like, you know, my clients are often afraid I’m going to make them fat, or if I eat this, I’m going to get fat and like, well, you know, I, I don’t know, you might lose weight, you might gain weight, you might stay the same. But I think that what we really need to focus on is like your symptoms, your wellbeing. Are you nourishing yourself? Are you doing what you want to do? And if your restrictive diet, for example, is making it so that you’re so busy counting points, it’s hard to focus on work that’s not really moving you towards the life you want. And then that word body liberation, I think for me, particularly women’s bodies get hit with so much uh objectification and where our value really comes down to how we look and just sort of generally our ability to appeal to the male gaze. And that’s not really what people are about. Like our worth is not in how pleasant it is to look at our bodies, our bodies are like a tool through which we live and experience our lives. And so, for me, body liberation and this probably isn’t like, uh you know, I don’t know, someone else might have a different definition, but for me, it’s sort of a social justice movement and philosophy in which we let go of this idea of objectification, work on freeing and respecting our bodies. And not feel like we have to align with expectations for how our body should look.

Ashley: I’m hearing you talk and I’m thinking like how I’m wondering about your clients and maybe if this is the first time that they’re hearing some of this material and you mentioned, like, you might have somebody in here quote unquote that comes in and says you’re going to make me fat, right? And I’m using the air quotes and it’s like even with that concern, if you will like a teaching them about what weight stigma is and what body liberation is, I mean, even that concern of theirs, I think shows how much weight stigma directs our culture and informs us about really everything. And so, I’m just curious how your clients like, do you see these like light bulb moments go off? You know, when you start explaining what HAES and body liberation is to them.

Dr. Devlin: I do, and I also see a lot of fear.

Ashley: Yeah.

Dr. Devlin: Because I think that what we really ask our clients to do is let go of the fantasy of being thin. And I think there’s a lot of grief and a lot of fear that comes with that. And if someone is in a smaller body and they have a lot of access to privilege from living in that body, I think there’s a fear of losing access to privilege, which is fair and it’s reasonable and sometimes there’s a grief process. Um but it, I wish it were as clean as like you just explain it and they’re like, OH OK, I would throw out my diet, but I do think it’s definitely a process and you know, we always say in uh the recovery world uh progress isn’t linear. It takes a while to really kind of not only internalize it but then let that internalizing match with your actions.

Ashley: Right. I mean, it’s shifting. I love what you said, there’s so much value in that it is shifting our entire framework, stuff that we’ve been taught our entire lives and, and I can imagine it not going from like, right, like if, if we’re talking about body positivity or body liberation or anything, like it might be really hard for someone to go from like I hate my body to I love my body. Right? And, and so there’s so much in between there and that’s what the healing journey is and that’s what the supportive journey is that you’re taking your clients on.

Dr. Devlin: Yeah. And you know, for me, I really don’t love the word body positivity either. I think that when I say love your body, I don’t mean like love, like feel a lot of fondness towards it. I, I more, I think I maybe respect and care for would be more appropriate. Just because I think a lot of clients expect as I work in treatment, I shouldn’t have negative feelings about my body anymore and everybody has negative feelings about their bodies. And so, we can’t have the expectation that those feelings are going to be removed. And it’s more like how do we not let those feelings control us? I think that’s kind of the liberation of like we all have this really internalized fatphobia and how can I let go of the hold that has on my life?

Ashley: So, when you’re teaching this kind of framework to your clients, do you ever have moments where you incorporate this within the family? Like if they’re bringing in their support people or their partners.  Is there ever an opportunity for you to kind of explain this new framework to the family system? And, if so, how does that help your client?

Dr. Devlin: I try to, and my clients try to. I think certain folks are more ready to hear it than others. And certainly, for support people kind of understanding set point and Health At Every Size and the importance of letting go of weight loss interventions. I do think it helps them support their family member more, especially because you know, people who are struggling, they will tend to go to their family members and say like, oh, I feel terrible about my body if I could just lose this, if I could just do that. And it’s really helpful if the family members can say, oh, it sounds like you’re eating disorders really loud today or I’m really sorry, you’re struggling with these thoughts today as opposed to like, well, have you thought about, you know, asking your doctor for a prescription for whatever or going to Weight Watchers or like those comments are not helpful. So, to the degree that family members are open to hearing the information, I do think it helps them support their family member or loved one a lot more. I think it can be hard. You know, a lot of family members have a lot of their own eating disorder issues or body image issues. You know, we’re all drinking the same fatphobic Kool-Aid and it’s going to be hard to support a family member if you haven’t done the work yourself. Uh And so sometimes, like when working with teens, a big part of it is trying to get the parents to do their own work on their own mental health and relationship with food. And I’ve actually had some cases where a kid was demonstrating some disordered eating behaviors and I just really focused with the parents on implementing more of the, like Ellen Satter’s work with the division of responsibility in feeding at home and adopting a more weight neutral attitude at home and actually having pretty good outcomes without even seeing the kids and just kind of doing parent coaching in that way.

Ashley: That’s great.

Dr. Devlin: But these are parents who are looking for it and want to hear it and I think that makes a huge difference.

Sam: I’m so curious about all the different interventions that you try with your clients and families too. I saw that you offer an intuitive movement group. Is it a group or is it an intervention?

Dr. Devlin: It’s a group.

Sam: I was hoping you could say more about that. We talk a lot about intuitive eating on this podcast, but intuitive movement, what is it? And how does it help with body image or disordered eating or mental health?

Dr. Devlin: So, great questions. This is a project that we were so excited to roll out this year. So, one of my clinicians on staff, Kimmy Morrison, who’s amazing, was really interested in starting up this group. So many of our clients struggle in their relationship with movement. And the most common thing I see is this that especially if they have a history of being like a division one athlete or a teen athlete and then they abandon movement completely or sometimes over exercise. And so just as we see in clients, the binge/restrict cycle, I see a lot of cycling between overdo it with movement and complete avoidance. And then particularly for people who have lost some physical fitness, who may be in a larger body whose physical fitness ha has really changed since their athletic days, there can be so much shame around that. And then every time you try to move, every time you try to do something, it’s uncomfortable that triggers the shame. And so you avoid doing it. So I would say the intuitive movement group is kind of a, a work in progress where we’re working on kind of that joyful movement component of intuitive eating. And initially, we had called it the Joyful Movement group. But then, we got the feedback that this wasn’t actually very joyful because it was actually really uncomfortable to slow down and focus on breathing and how our body feels. And so, in that group, we partner with a personal training studio in Chicago and then Kimmy and the personal trainer facilitate the group and it’s really focused on like doing some movements, being mindful of how it feels, processing how it feels, coping with the emotions that come up and working on trying new things. And I know Kimmy’s got like big goals for the group we’re planning on like she wants to do it more like a rotation style where each week has a different theme. Like where some weeks we might do like salsa and another week we might do like roller skating, for example. These are just like the random examples don’t hold me to any of those. But so, we’re, we’re really, we’re kind of working on how we’re going to do it. And I think we’re probably rolling out another version sometime next year will be our next section of it.

Sam: And how do you think this group changes your client’s relationship with movement? I mean, what are your hopes?

Dr. Devlin: Well, my hope is that people will get more comfortable slowing down and learning what makes their body feel good, what helps them with some of their functional movement goals, what brings them joy and instead be able to find like some, some balance in their life and enjoyment. And hopefully the goal is that they will be able to connect with the joy of movement, but it might not be there at the beginning.

Sam: I think that’s so important when we’re up against the fitness world that’s telling us what we should and shouldn’t be doing. And it’s sort of like we forget what’s going on internally for us. You know, how does this actually make me feel physically and emotionally? Is this something that I enjoy or is making me feel good? I think we lose sight of that in this culture.

Dr. Devlin: 100%!

Sam: Yeah, I think a group like that would be so valuable.

Dr. Devlin: Yeah, my hope is that it’ll really help a lot of people with that and that they’ll be able to kind of repair some of that damage done.

Ashley: That ability to learn how to sit with their bodies and be with their bodies while their bodies are moving. I can imagine that can be so scary but also such beautiful, beautiful work because bodies deserve to take up space and to exist. And so, I think that that’s a really cool offering that you all have.

Dr. Devlin: Oh, thank you. Yeah, we’re pretty excited about it, especially because the so for so many people, the idea of movement and weight becomes so intertwined that it’s like, well, if I’m not trying to lose weight, why am I going to move? And we know that movement has so many benefits for physical and mental health and movement is really essential if you want to continue to maintain the functioning that you have enjoyed. And so, when we avoid movement, like there can be real decreases in our ability to just kind of go about our daily lives. Like people, you know, I get out of breath when I go up the stairs to take the train or I want to be able to play with my kids or like, I want to be able to hike and not be in a lot of pain. And so, I think that if we focus on like what can movement actually bring you in your life and that you can get that without, you know, getting your heart rate in whatever zone. If your goal is you want to be able to hike, okay, we can work on strengthening your legs and back and building endurance the way that you’re going to be able to do what you want to do but you might not lose weight. And so, you have to let go of that for it to feel worthwhile to try it.

Ashley: So, Dr. Devlin, I have another question about comorbidities and eating disorders specifically. You mentioned that you’ve worked with the diabetic community and that you yourself have experience with diabetes. And so, I’m curious how you work with those clients that you might encounter that both have the diagnosis of diabetes and an eating disorder. What comes up for them, especially if a medical provider is putting them on a particular meal plan and we’re trying to incorporate all foods fit and Health At Every Size. I’m just curious if you could speak to, someone who might have that experience.

Sam: It reminds me also of the hot topic that we hear in the media so much, Diabulimia, which is not in the DSM necessarily, but so many folks struggle with it. And I was wondering if you’ve had experience working with folks who restrict insulin as well.

Dr. Devlin: Yeah, I have, I’ve worked with people with various presentations of diabetes, and it is a really, it, it is a very, uh, near and dear to my heart topic. We do know that people who are placed on restrictive diets, even for medically necessary reasons are at a higher risk for developing eating disorders. And I think particularly among the type one diabetic community or type one diabetes community, there can be a lot of fatphobia because being in a larger body is often associated with having type two diabetes and particularly as people with type one start to age into adulthood, there’s a lot of fear of the stigma of type two diabetes being put on them. And so, I think that can lead to even more fat phobia. Now it’s actually kind of a misconception that you can’t eat whatever you want with diabetes. Like there, there are no restrictions on what you can eat with diabetes. Like you can have anything. They, the thing that I really work with clients on is it’s the when and the how and the with what that we focus on. And so, I think a lot of people think I got type two diabetes because I ate too much sugar. Or if I have type one diabetes, I can’t eat sugar. And, well, first of all, these are two, like really different disease processes. So it’s a little cumbersome that they both have the same name. But you know, be that as it may, people with type one diabetes can absolutely eat sugar. You just have to take insulin to cover it and you have to know your body enough to know how to take that insulin appropriately. And then with type two diabetes, you can’t get diabetes from eating sugar. That’s not how it’s caused. It’s a hormonal issue, it’s insulin resistance and it’s a very complex issue but people didn’t do it to themselves. And I think we over focus on behaviors and when we’re talking about type two diabetes. So, going back to how do we manage then, what can feel like restrictive meal plans? I think Michelle May talks about it in her book on intuitive eating with diabetes and bringing it back to that intuitive eating piece and when you have diabetes, you have to add into it, how does this food in this way at this time, etc. affect my glucose? How does my glucose feel right now? What are my numbers? And so being able to like, spread your carbs out throughout the day rather than restricting them is actually really consistent with what we work on in intuitive eating. And then another big thing in diabetes management is food pairings and that helps with blood sugar stability. Well, it’s the same thing we work on in intuitive eating, right? Like any, anything that’s just like one type of nutrient is not going to bode well for blood sugar and it’s probably not going to bode well for most people in terms of like the sensory experience of satiety and sustaining your energy. The one thing that’s hard for people with type one is you have to carb count and that’s kind of one of those things you can’t get away from. And so I do find that a lot of folks with type one end up having a lot of shame and judgment about eating higher carb foods. And so we have to work a lot on like viewing it with neutrality and like you just have to take enough insulin to cover it. And there is like the full diagnosis of diabulimia and then there’s also like some people who just underdose themselves with insulin because either they’re afraid of low blood sugar, the number that they feel like they need to take seems too big or carb counting is overwhelming and so they don’t do it. And so they end up underdosing which can be a problem.

Sam: Thank you for explaining all that. I think it’s so helpful to our audience. Diabulimia, the media picks up stories about it all the time. We don’t talk about it enough and I think it’s misunderstood and I think it’s very helpful to think of this on the spectrum. I mean, these are behaviors that, can show up in a lot of different ways. It reminds me I’m thinking of other co-occurring disorders. I know you also work with eating disorders and OCD. And this is another very common comorbid diagnosis. What have you noticed working with folks with OCD and eating disorders. How do you work with it?

Dr. Devlin: So, you know, as I said earlier, I really come from a very strong behavioral training. And so, I think that’s what kind of attracted me to working with OCD. A lot of the ERP, Response Prevention ACT stuff, it’s all very behavioral. It makes a lot of sense to me. I love doing it with people and when we really distill down eating disorders and OCD to their components, there’s sort of a common underlying process of difficulty with distress, tolerance and engaging in a behavior or absence of behaviors to try to mitigate that distress, that behavior ends up creating a problem. And so foundationally, a lot of what I work with when folks who have and a lot of people with eating disorders, their eating disorder would also be OCD, like they’re kind of like, there’s a very huge functional overlap. They may also have OCD about other things but a lot of times, you know, if we think about like a very classic anorexia picture like that in and of itself is indistinguishable from OCD in terms of like the why and the how and there’s actually a really high comorbidity. There are certain personality traits that tend to go along with that type of presentation. And so, it’s really about in both or all of these diagnoses just working with a person on like, how do we tolerate feeling uncomfortable and how do we not engage in self-destructive behavior when we feel uncomfortable and how we make choices that move us towards our values when we feel uncomfortable. And there are a lot of different kind of techniques to get you there. But I like to really make sure that I understand the whys and the hows and what’s the common thread. And it also helps a lot with, you know, symptom swapping, which we can see a lot in different conditions. And it’s like, well, all of these symptoms all have the same function. And so, if we kind of know what that function is, we can, we can really attack it. And so, I would say like in treatment, it’s really important that everyone work with their therapist and understanding like what’s the, what’s the core issue here? What’s my, what’s the common function of this and why am I not able to meet that need in a way that’s more healthy and adaptive for me?

Sam: Targeting that common denominator, you end up treating a lot of different things across the board.

Ashley: So, Dr. Devlin to um kind of circle us back to the body liberation piece and the HAES framework that you spoke about at the beginning of our episode, if someone is interested in, in learning more about this or like it, it really piqued their interest. Where would you suggest they start? What materials would you suggest someone look into and, and maybe even giving you guys a call? But where, where would you suggest someone starts?

Dr. Devlin: So, I think there are a lot of really great resources, you know, definitely ASDAH is a great resource. They have a lot of research and resources available on their site to check out. I also love Ragan Chastain Substack. I love data and science so much. And so, the fact that she actually brings in citations and debunks articles, I really love that and its appeals to me a lot and I think a lot of our more analytical clients too. Um and then, you know, just kind of a good primer right now, I’m really loving Christy Harrison’s book, Anti Diet. I think that’s a good one. I also, I love Laura Thomas, Just Eat It and then her workbook that she has coming out or that she’s come out with, we really love that. Um, and, you know, some of the ones that I really enjoyed when I was trying to dig into the literature, Lessons from the Fat-o-sphere. But that was a really good one.

Ashley: That’s a great title.

Dr. Devlin: Yeah. And we have a lot of them linked on our resources page too on our website.

Ashley: Awesome and we will share your socials and resources when we put the show out.

Sam: I’m so glad you brought up Reagan Chastain because we’re so lucky to have her as one of our, panelists this year at the Renfrew Conference.

Dr. Devlin: That’s so amazing.

Sam: We agree with you wholeheartedly. I’m wondering in closing, what might be a takeaway you would want our audience members to receive.

Dr. Devlin: There are a lot of takeaways, but I think for the, for the sake of parsimony, just remembering what your body is here for, why it exists and that it’s not your body’s job to look a certain way and that your body is here for your life and that you have to take care of it. And treat it with love even if you don’t always feel love towards that, to make it through this life and to get what you want out of it.

Sam: I love that. How can our audience members connect with you?

Dr. Devlin: So, they can follow me on the social media. They can also email me at [email protected] or check out our website. There’s also a contact form on the website they can fill out.

Sam: Thank you so much for being with us today, Dr. Devlin. This was so informative, and I think our audience members will really appreciate all of this information, body liberation. We talked about comorbid diagnoses so much. So, thank you for sharing your wisdom with us today.

Dr. Devlin: Thank you for having me. I really appreciate it.

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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