Podcast Transcript

Episode 9: Let’s Get ‘Comfortably Uncomfortable’: Cultural Humility in Eating Disorder Treatment with Paula Edwards-Gayfield

[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. Thank you for joining us again today. We have a very special guest on the show with us today. It is Ms. Paula Edwards-Gayfield LCMHCS, LPC, CEDS-S. She is a Regional Assistant Vice President for the Renfrew Center. Ms. Edwards-Gayfield oversees the clinical and administrative operations of the Atlanta, Georgia, Los Angeles, California, Orlando, Florida, and West Palm Beach, Florida locations. She also serves as co-chair for the Renfrew Diversity and Inclusion Task Force. A licensed therapist or a Licensed Professional Counselor in Oklahoma, and Licensed Clinical Mental Health Counselor Supervisor in North Carolina, she received her Master’s degree in counseling from UNC at Charlotte. Ms. Edwards-Gayfield has extensive experience in the treatment of eating disorders with special interest in women’s issues, relationship concerns, depression and anxiety, self-esteem, and body image. Ms. Edwards-Gayfield is an advocate for the awareness of eating disorders affecting Black, Indigenous and people of color. Ms. Edwards-Gayfield is a frequent presenter at local and national conferences, primarily discussing eating disorders and diversity, and she is a member of several professional organizations, a certified eating disorder specialist and approved supervisor of IADEP, and is the former Co-Chair of the African American Eating Disorder Professionals Committee. She also contributed a chapter in the recently published book Treating Black Women with Eating Disorders, A Clinician’s Guide. So, Paula, thank you for being here! That was so great to hear and read all of your bio.

Paula: Thank you, Ashley. I was thinking as you were reading it, like, “Wow, that’s a mouthful.”

Ashley: Yeah, but it’s awesome. I love that you have all of this experience that you’re bringing in with you. And so, again, just thank you on behalf of Sam and myself for being with us on the podcast today, and we would love to jump in and just kind of ask, how did you get started in the field of eating disorders and how did you make your way to Renfrew? It’s kind of a big question.

Paula: It is, but let’s see, how much time do we have? I would say, like, once I decided that I wanted to be a therapist, I knew that I wanted to work with adolescent girls, young adult women. I, you know, I would frequently observe people stating like, “Oh, they’re just teenagers,” and you know, as if they were being dismissive of sort of like their voice, their emotions, and just overall their experiences in life. And so, sort of that dismissal of “She’s just a teenager” was really like, I wanted to empower them. Because, you know, they’re people too. And wanting that desire to assist in empowering them to honor their voices, and respect their emotions, in an effort to build self-esteem, but also self-acceptance and self-compassion. And so, you know, when I think about those things, they’re like the pillars of body image, like right? And so that was really what my goal and desire was. So, prior to my employment with The Renfrew Center, I attended a body image workshop that was actually presented by The Renfrew Center. And was in that training that I found sort of, like, my calling, my job. I went home and told my partner that “We have to move to Florida because I found my job!” And he is like, “We’re not moving to Florida.” And so, pretty much everyone who knew me knew that that was sort of what I decided I was gonna do. And so, treating eating disorder patients really has given me the opportunity to work with my desired population and to address the concerns that are prevalent, you know, to so many individuals, you know, regardless of age. And that’s sort of what led me to eating disorders and Renfrew.

Ashley: That’s awesome. How long have you been at the Renfrew Center, Paula?

Paula: Goodness gracious. I have been with, let’s say April I just, I guess celebrated my 15th year.

Sam/Ashley: Congrats!

Paula: Thank you, thank you. So yeah, I’m a longtime tenure, like, person now.

Ashley: Yes.

Paula: Yeah, I actually started off as a primary therapist at Renfrew so, yeah.

Ashley: Okay, which location did you work at?

Paula: Charlotte. So, Charlotte’s my home, my baby.

Ashley: Gotcha, yeah.

Paula: I started at the Charlotte site and was there until I relocated in 2015.

Ashley: Gotcha, that’s awesome.

Sam: You know, it’s so interesting, Paula, it caught my attention when you said that you went to a Renfrew training, and it was like a sign or your calling. And I have heard that before.

Paula: Oh, nice.

Sam: I’ve heard professionals say, you know, “I went to a training and then I decided I wanted to work there.” But I’m curious, do you remember anything about that training, or what was it about that training that you’re thinking, “This is where I need to be?”

Paula: Yeah, I um, I believe it’s because it sort of embodied the opportunities that I thought would be present. And so here in my mind, here’s this age population, you know, adolescence into adulthood. Um, but then also, over all general mental health concerns. You know, not only addressing body image, which is sort of what my thought was like, “Body image, self-esteem, self-acceptance,” but also knowing that there was the component of depression, anxiety, other mental health concerns, and it wasn’t just sort of one focus. And I don’t know that I would have said, “Oh, eating disorders is what it was.” But hearing this presentation and sort of thinking about people as a whole, here was this population that I knew, I was like, “Okay, these are the people, you know, that I want to be able to support.”

Sam: Right, right.

Ashley: I love that. I’m thinking of, you know, when we’re in school—I don’t know if you all had this experience when you were in your Master’s program, but I had the experience of at some point in one of the semester one of the professor’s asking us to write a paper, of course, on like our target population. And I just feel like you have no idea. And at the time, I don’t even remember who I wrote about, but I’ve also been in the field for five years and would, I don’t know that I started out thinking, “Yes, eating disorders is who I’m gonna treat.” It kind of came naturally through some of the work that I was doing, and it’s just been an incredible population to work with.

Paula: Agreed, agreed. Yeah. Ashley, I was a teacher in a former life, all for a year and a half. And it was sort of purposeful, the reason that I went and got certified to teach. And I taught high school. And so, it was actually while I was teaching, I had a student who was experiencing some things that I felt limited in my ability to support her as a teacher. And then even though we would make the referral to the, you know, the school counselor, they’re limited in what they can do as well. And so that was one of the things that really solidified, like, why I wanted to work with this population. And again, going back to, “Uh, they’re just teenagers,” and things getting dismissed versus “They are people who have emotions and thoughts and experiences and they need support to.”

Ashley: Yeah, I love that.

Paula: Thank you.

Sam: Paula, you’ve also done a lot of advocacy work, specifically for, you know, with eating disorders and how they affect Black, Indigenous and people of color. I was hoping you could talk a little more about that, especially because, you know, eating disorders, it’s not really covered in grad school very well, in my opinion. There’s more training and education that’s absolutely needed, not only in the mental health field, but in the medical field. And then on top of it, you know, how eating disorders affect certain populations. There’s even less on that and you do a lot of work around that, it would be great to share today.

Paula: Thank you, Sam. Um, I guess I would say I wish I could do more. I know that there’s more to do, and I look forward to those opportunities because you’re absolutely correct—we don’t learn about eating disorders in graduate school. We don’t necessarily focus on specific populations and there is still very much a belief about who eating disorders impact. With respect to the advocacy work, I really appreciate the opportunities that I’ve had within Renfrew to do trainings, I think that’s been definitely one of the primary opportunities to create advocacy. And so, whether that’s via trainings to therapists, dietitians, medical professionals, being able to really connect with them and college, school counseling, you know, everywhere. Just thinking about being able to identify not just sort of eating disorders, but also as you mentioned, Sam, how eating disorders may show up in different populations, especially amongst people of color. So definitely in that way, but I really believe with educating clinicians and dietitians, people who are also doing some outpatient work that helps to increase not only their education and awareness, but access to care amongst, you know, for people of color. I realize that not everyone is able to go into a treatment center, not everyone is seeking treatment, but my hope is that if we can educate, you know, individual who may be meeting with someone for whatever reason, that maybe they’re a little bit more aware of some of the signs and symptoms, you know, that can happen amongst eating disorders or, you know, or at least to make them question a little bit more. The other way, which I’ve been so proud of and happy, is offering a support group to again, to individuals who may question if they have an eating disorder, have also allowed it to be where maybe there’s some significant body image concerns or some disordered eating patterns, but providing this outpatient support group that is available throughout the country and having a space to sort of figure this out, to talk with other people of color, and you know sort of have a place that feels welcoming and inviting. And even though they could be taking a risk sharing this information with someone for the first time, my hope is that then we can get them to a place where they can get the treatment that they need or the support that they need that goes beyond the support group that we’re offering. And then also, again, I think being able to offer not just the trainings to professionals but networking opportunities. I’m gonna call it networking just for lack of a better word. But these opportunities where they can have some difficult conversations and ask questions, you know, that they may have regarding BIPOC individuals. Almost, I suppose, like a peer consultation. And I think creating those opportunities also just, you know, it has been a part of the advocacy opportunities that have been blessed to be a part of.

Ashley: Yeah.

Sam: Yes. So, with these trainings Paula, you know, talking about how training folks to spot how eating disorders might show up differently in certain populations. Could you say more about that? Because I think our audience is probably thinking, “Oh gosh, I don’t know how eating disorders show up differently.” Would you want to share a little bit about that, some of the things you teach?

Paula: Yeah, absolutely. You know, of course identifying sort of the DSM-5 and acknowledging the criteria for each of the diagnoses, and we all are aware that, you know, Other Specified Feeding and Eating Disorders, like the biggest catchment of any eating disorder diagnosis. And part of that is because of potentially, like, subclinical presentations. That they don’t meet criteria, full criteria, for like anorexia, bulimia, or binge eating disorder. And so—but what I believe that may happen amongst people of color—Let me take a step back. It doesn’t mean that people of color don’t get diagnosed with anorexia, bulimia, and binge eating disorder. But when I think about some of those subclinical or maybe they’re not meeting full criteria, is that they may only present with some behaviors. For example, what if they’re just using laxatives and they’re not identifying any binge behaviors. So, they wouldn’t really be looked at as, you know, like a patient that’s struggling with bulimia. But then also, if someone is aware that they’re utilizing laxatives, they may not even think to consider “Is this disordered behaviors? Unhealthy behavior?” It just may be like, “Oh, you need to stop using laxatives, it’s not good for you” sort of response. But really beginning to explore kind of the why they’re using laxatives, the frequency that they’re using laxatives, even if they’re using it part directed, you know, by the box, sort of what’s sort of behind the why they’re utilizing the laxatives or diuretics or diet pills as well. And so, I think once clinicians become aware of some of those things, and again, this should happen in all individuals, not just BIPOC, but just sort of speaking that this is something that I’ve noticed. Um, but having those sort of conversations, and then if you can open up that door about sort of the, “Tell me a little bit more about sort of the what’s happening that you’re utilizing laxatives?” Being able to start exploring maybe their beliefs about food and food related beliefs. What are some of the messages, not only that they’ve adopted societally, but maybe that they inherited via family or support systems as well. And I think if we’re willing to spend a little bit more time ask questions a little bit different way or think about some of our questions outside of the box of what we may typically do in an assessment, that may give a better picture of, “Here’s some disordered patterns that are present.”

Sam: Right, right. Well, the media does such an awful job of perpetuating, you know, the stereotypical eating disorder client. And you might have someone in your office who has OSFED, and it always surprises me that there are a lot of professionals out there, and the public in general, who really don’t know a lot about OSFED. They’re like, “What does that stand for? What’s night eating syndrome? What’s purging disorder? What are these things?” So, it’s really important that you’re doing these trainings.

Paula: Thank you. Thank you. I was thinking as you were talking, and my sister would kill me for saying this, but, you know, it’s sort of that sense of, you know, and I’m sure you all have had this experience. Again, this is not only isolated to BIPOC individuals, but when people learn about what I do, there’s like, “Oh, clearly I don’t have any disorder.” And there’s just to your point Sam about, there’s still just this picture in their mind about what an eating disorder looks like. Um, the reason I said my sister would kill me is because even when I first started working, you know, there is such a diet mentality, and her thought would be like, “Hmm, I wonder what are some of the people doing that, then I could lose weight.” And it’s just like, “You do not want an eating disorder.” Being able to still accept yourself and the body that you’re in is really what’s important. And I think if that’s something that you can focus on versus the desire to lose weight, maybe we’ll get into a different outcome. But that would be one of the things that she would say to me, and I’m like, “You do not want any disorder.” Like people think, but again, they’re still then only picturing that individual who may be struggling with anorexia, which is the smallest subset of all diagnosis.

Ashley: It really is.

Sam: Right.

Ashley: Yeah, I think, I mean, just to go to your point, Sam, I think the media society, I don’t know if we are idolizing that body type, I don’t know if we’re if we can see the dramatic shift and body change quicker, and so that’s why we’re, you know? But we see anorexia as kind of, like, “This is the main one.” And there’s so many other diagnoses. We know binge eating is 3 to 5 times more prevalent than anorexia is, right? And we know OSFED, Sam, like you were saying with these night eating syndrome, purging syndrome, we know that that’s there too. And we know that bulimia is 2 to 3 times as more common than anorexia, too. And so, educating. I mean, I think we all need a little bit more education around this, you know. And just to say what you were saying, Paula, it doesn’t only fall on your BIPOC clients, but it does—I actually have a study that I kind of wanted to read to you and give some statistics to you and just kind of get your thoughts, because we do see it present in our BIPOC population and we also often do not see as much of a diagnosis.

Paula: Absolutely.

Ashley: Right? So, there was a study, NEDA just published this study, so I’m gonna read it just so our listeners know kind of the context. So, it says:

• “When presented with identical case studies demonstrating disordered eating symptoms in white, Hispanic, and African American women, clinicians were asked to identify if the woman’s eating behavior was problematic. So, 44%, so nearly half, identified the white women’s behavior as problematic. 41% identified the Hispanic women’s behavior as problematic, and only 17% identified the Black woman’s behavior as problematic.”

Ashley: And it says, “These clinicians were also less likely to recommend that African American women should receive professional help.”

Paula: Wow.

Ashley: Right? So, like clearly there is a disconnect somewhere.

Paula: Absolutely.

Ashley: And I’m just curious what your thoughts are, specifically in your advocacy work with the BIPOC community and hearing this information, Paula.

Paula: Yeah, so, initial response, it’s just disheartening. It just, it really is. And unfortunately, it reinforces the experiences that BIPOC individuals may have when it comes to health care profession, mental health providers, where there’s not a lot of trust in what they’re stating or even that they would be listened to. And so, here’s like a perfect example of, you know, to find that 44% of these clinicians found the white women’s behavior problematic, exact same clinical presentation, minus race, to say 17%. Yeah, so it is, it feels like a very much an uphill battle. Again, when I’m talking with prospective clients or the public that are not the professional clinicians, it really is trying to encourage them to, in many ways, take a risk, you know, to seek treatment, to talk to a professional, to even advocate for themselves. And being able to say to someone, “I don’t think you’re hearing me.” You know, and if that person isn’t hearing you, “Do you have any referrals?” In addition to, as you mentioned, there’s the National Eating Disorder Association, there’s other professional eating disorder organizations where people could reach out to as well as The Renfrew Center. Even if you don’t know if you have an eating disorder, just maybe, “This is what I’m kind of struggling with, can you point me in the right direction?” When it comes to clinicians, you know, one of the things I’ve just been so appreciative of is the participation and attendance for the different trainings and networking opportunities, and just non-BIPOC individuals, as well as other people of color who may not fall into—I think sometimes not all people of color acknowledge as people of color. And so, but then to acknowledge that even I as a Black woman, I don’t know everything about an Asian person, a person of Asian descent, or someone of Hispanic descent, and so being able to take these risks and have these conversations that may be uncomfortable because it looks as though I don’t know what I’m doing yet, it’s my opportunity to educate myself, learn a little bit more, and make sure that I’m able to adequately support and offer services to the general population.

Sam: Yeah, yeah. That that reminds me of, Paula, I know that during the Renfrew Conference every year, you hosted a conversation, a group, that’s called Comfortably Uncomfortable.

Paula: Yes.

Sam: I love that title.

Paula: Thank you.

Sam: And when Covid hit it went virtual and I know you’ve hosted many of them, I think, throughout the year. And I’m really intrigued by this concept of the difference between cultural competence and cultural humility. Because I think in graduate school, you know, we’re taught, “You have to be culturally competent, you have to be culturally competent,” and it’s and it’s like, “Okay, but there’s a difference between how you’re actually putting that into action in your work, and humility, cultural humility.” So, would be able to share a little bit about the two of the, you know, those two concepts.

Paula: Yes. So I think, well for me, when I think about cultural competence, it’s almost this message of “I’ve learned something and I’m good. I’m done,” you know? And yes, do I think people need to become culturally competent? Maybe I would even change that word to culturally aware? And begin to take advantage of opportunities to learn and educate themselves, and in many ways increase awareness of what they don’t know? So that then it helps to, you know, encourage them maybe to seek opportunities to, you know, increase their understanding. And so, when I think about cultural competence and I think that’s sort of what I kind of think about in general, like, “I went to this training, I’ve learned something and then people may think I’m culturally competent now because I’ve learned this information.”

Sam: Right. Like, as if as if there’s an end point. It’s like, “Yep, check the box, I’m competent, good to go.” But actually there—I don’t think there really is an end point. We’re always learning and always, there’s always that need to reflect on our own biases and the messages we’ve internalized. And that work never ends.

Paula: That’s where cultural humility comes in.

Sam: I see.

Paula: Being willing to acknowledge that I need to continuously learn what I don’t know, but also actively taking advantage and putting yourself into situations where you can learn, where you can grow. And not just relying on your client, or maybe even your peers, if you have peers of color, to just provide that education. It’s you the individual who are seeking those opportunities to learn, to grow, as well as to say, “I don’t know this, how can I continue to immerse myself in trainings and even maybe putting myself physically in a space to really learn what it’s like amongst other people of color.” It’s interesting because also, you know, there are so many terms that are increasingly aware and I’m sure some may go beyond humility, you know, and I’m gonna like kind of say ‘em without defining them—I don’t know if that’s really fair or not—but there are things like, you know, being willing to be culturally respectful, cultural adaptation, maybe even culturally responsive care. When we’re thinking about what we do as clinicians, that confidence would maybe kind of like, “I’ve learned this,” check the box as you mentioned, but really knowing that I need to go beyond that and that to me is the cultural humility. How do I humble myself into, you know, “I don’t know this information.” And if I’m really trying to support any one population, but honestly, even to do clinical work, because I realize you can kind of pick and choose who you work with if you’re in private practice. But, you know, oftentimes that’s not where people land, and so, how can I support the prospective clients that I may have?

Ashley: Yeah, I think that brings up the idea—for me, it brings up the idea that there are these blind spots that we have, right? Both individually as providers, but also collectively, like, thinking about the eating disorder world. Paula, I have been lucky enough to attend multiple of your comfortably uncomfortable conversations.

Paula: Thank you!

Ashley: Specifically at the conference, I’ve gone every year that I’ve gone to the conference, and I always value that. And I think I remember, like, you have pictures and a timeline that you tend to put up, do you know what I’m talking about? Like on the wall, and yeah, and we would have these great, rich conversations. And then I have to tell you I attended one that you did virtually earlier this year, and it struck me, I mean in a way that I don’t know that I had experienced before, you know?

Paula: Okay.

Ashley: And specifically in my group. So, you had broken us out into groups and you had given us concepts to talk about, and I kind of want to share your concepts but I kind of don’t because that’s the whole thing about your, you know, your presentation. I want to respect that because I want people to come.

Paula: They can get a teaser! That’s okay.

Ashley: Okay, yeah, we can talk about some teasers. So well, one was cultural humility versus the cultural competency, and actually specifically within that, the conversation that kind of happened in my group was we talked about some of the blind spots basically. And some of this, I want to say, has never crossed my mind before, and that left me with so many feelings, right? It left me with like “Whoa, where have I been hiding under a rock? Oh my goodness, I need to expand my awareness and my view so much and just kind of that continue—I am never done evolving. I am never done learning,” you know? But some of those points that I just want to bring up because I thought were so interesting was someone brought in the idea of mealtimes, specifically at eating disorder treatment facilities. And specifically mentioned a lot of the meals are catered to just kind of the white, traditional meal, and talked about, you know, can we bring in other cultural influences in mealtimes?

Paula: Yes.

Ashley: Right? Can we bring in different flavors and different spices and different things? And that is something to me that I literally had never even thought about, you know, and I think it’s beautiful, I loved that idea. And I’m trying to think—there was another concept that was brought up. Let’s see, oh looking at the EDE, the EDEG, and how it was really written for cis white females, and how it doesn’t bring in cultural awareness essentially, right?

Paula: Agreed, correct.

Ashley: So, these are huge blind spots that we have. And just even thinking about, you know, the prior question I asked you about not, you know, eating disorder professionals not identifying as many African American women to go into treatment. We have blind spots. And I’m just curious, like, your thoughts about those and obviously the work that you’re doing, this Comfortably Uncomfortable, is just so powerful to me and I thank you so much for doing it. But I’m just curious what your other thoughts about blind spots or have you seen—are there others that you’ve seen? I have only mentioned two. I’m sure there’s more.

Paula: Right. Absolutely, absolutely. Thank you, Ashley, thank you. I really appreciate your appreciation for the conversations. And I would agree with you, even for myself as a participant, just sort of hearing the richness of the conversations as well as the vulnerability amongst the, you know, participants as well to be uncomfortable. And ask, you know, engage in these discussions and share their experiences. Yes, blind spots. Definitely as you mentioned, like looking at how meals are, how do we continue to incorporate, you know, diversity amongst meals, appreciation, even not only just in the treatment milieu that everyone is consuming, but even as our dietitians or our therapist, how are we acknowledging those things and supporting our clients in terms of how, you know, it may fit with whatever it is that we’re working with because we want them to experience and, you know, be connected in their communities. Before I share another blind spot, one of the things that really came up for me, I’ve had a client before who shared they appreciated eating in program with, like, a fork and a knife and things like that because some of the meals that they consume based on their culture was eaten by hand. And so, interestingly eating things with a fork and a knife helped them to really monitor their intake compared to if I was eating with my hand, how can I really notice what I’m picking up? And it was just sort of one of those things were like, “Oh, OH!” you know? And I recall kind of taking that back to our admissions team and really using some of these things as like prompts, that when we’re doing assessments on clients, that again, we can start to ask some of those questions if we’re noticing those things. So, to me that was a significant blind spot, I never would have thought like “I’m trying to portion by using a fork or a knife.” I think other ways that, I mean, gosh, blind spots, I think when we’re talking about size and size diversity, just sort of acknowledging that we all have biases and we all acknowledge or, excuse me, are subjected to stereotypes. As much as we may not want to acknowledge that maybe, “That’s what I kind of believe about a population.” We are a society that labels people, like that’s just what we do. And so oftentimes those stereotypes fall into the labels and the beliefs that we have about any specific group. And so, I think if we’re not willing as professionals to acknowledge that “I may have a bias, I may be responding to this person in a stereotypical way,” that then that to me is a significant blind spot and that goes back to not being diagnosed, but also maybe not even addressing body image issues, you know? Or you know, the way that I talk about body image where I have, I assume, you know that there’s an acceptance of whatever size, shape, weight you may be if you’re a person that’s in a larger body as a Black woman or Latina woman because you know, there’s this belief, “Oh, they’re okay with curves,” or, you know?

Ashley: Yes!

Paula: But yet, you know, could it be a protective factor? Sure. But then we’re still making a blanket statement about a group of people and we really have to individualize everyone’s, you know, experience. I also wanted to state, you had mentioned about the EDE and the EDEQ, you know—yes. A lot of assessments are not normed on people of color and you’re right, it is going to be mostly tested on cis white females. And honestly, Ashley, I would even extend that to a lot of the evidence-based practices. So, when we start talking about, you know, any of the treatment modalities, our best practices for whatever mental health concern again—who? You know, who was that normed on? And so even though I think different assessments and treatment modalities may be great places to start, use them for information. Just sort of acknowledging that if there’s this assessment, some of these questions may be applicable, but only use it for information. But again, being willing to go beyond, making sure that you know the questions in those assessments so that you can kind of like identify where those places are, that it’s not being inclusive of a, you know, the population, that of a BIPOC population. And then also when we’re talking about some of the evidence-based practices, then thinking about “What do you need to marry that with,” you know? Are you looking at, like, a relational cultural approach? Are you thinking about any sort of cultural education and models, like minority stress model or, you know, being able to identify just sort of where you are in your own identity development as a clinician. And I want to state, because we all have culture, like every one of us. And so, I think if we can do that, maybe that will help to create a greater awareness of how we can apply something to the population in which we serve.

Ashley: Yeah. Gosh, I feel like my mind is being blown like by everything and I’m so appreciative of it. But I mean, that makes so much sense, continuing really to evaluate where we are and what we know and don’t know clearly.

Paula: Humility.

Ashley: Yes, humility.

Sam: Right, we don’t know what we don’t know, and that’s a really important realization. Um, wow! So, Paula, you do so much training and educating and supervising, and I’m curious for the sake of this podcast, the eating disorder professionals out there who are listening, what do you think are the big takeaways that you would want them to have when, you know, they shut this podcast off and they walk away from it? What do—I mean, I’m even curious, what are what are some of the common questions that come through when you do trainings? Where do you think the big gaps are? What do you what do you what do you want them to walk away with?

Paula: Um, you know, “Be curious,” I think is probably one of the major things that I would say. Be curious, because I think if we maintain a sense of curiosity then we’re willing to not only ask our clients questions, but also hopefully we’re seeking information, you know, that then we can sort of answer some of the questions that may arise if I am being curious. I think, also, that your client is the expert on them, you know? And so, I really look at treatment or therapy in general as a collaborative approach. I frequently say to my clients, like, “You’re the expert on you and I know what I know, and so we’re gonna work together to sort of figure this out.”

Sam: Yeah!

Paula: And so that’s sort of where I try to approach my work with clients, and I think that then helps me to create that curiosity. But it also helps me to listen a little bit more. I can still, again, I can take the information that I know or what I know about a treatment modality or sort of, you know, what any theoretical orientation may say about, you know, how… whatever it may be develops. But also, it allows me to have a little bit more compassion. And I say that because when I think about, like, and this isn’t to knock CBT by any means, but even when I think about sort of a Cognitive Behavioral approach, or even like what we do at Renfrew, when we’re looking at like our thoughts, our emotional experiences, and acknowledging that our emotions are made up of our thoughts or behaviors as well as our physical sensations, and often times—and I’m gonna speak specifically as a Black woman, so I wanna state that. But I think sometimes when Black individuals or as a Black woman may say something, you know, there’s like, “Well is that true?” It’s almost like this reality testing type of thing that happens. Or maybe there’s the encouragement of like, you know, “This just kind of how it is with radical acceptance,” and I think that’s where you’re gonna lose your client, you know? So, I think that sense of acknowledging, if I am continuing to increase my understanding of BIPOC populations, then my hope is that I’ll start to explore some of the historical stuff that may happen, the intergenerational things that are passed down. Hopefully I’m acknowledging that there is systemic racism, you know, throughout our society. That maybe instead of me going to a place of sort of challenging that client, I can incorporate that into, maybe, how my work may be. I still may want to work with that client on, “Okay, so yes, these have been things that have influenced you and absolutely this can be true. But maybe how is this now impacting your eating disorder? How is this impacting your mood?” And then maybe coming to a place of, you know, we’re working out what’s a more adaptive way of dealing with the emotional experiences that they have, without sort of saying to them that what they believe or what they think isn’t really true. I don’t know, I don’t know if I really answered your question or not, Sam, but I think that’s sort of what drives me when I’m thinking about any of the work with BIPOC clients, clients in general, but definitely BIPOC. Like, trust them, listen to them. Or any sort of marginally diverse population, trust them and listen to them.

Sam/Ashley: Yeah.

Sam: That’s so important.

Ashley: Yeah, I was gonna say, Paula, so this morning I did a training with someone and one of the things I shared with them is that we know research has told us that women that come from less affluent homes are 153% more likely to exhibit bulimia presentations than women that don’t come from lower affluent, lower income homes. And I was talking about that and talking about, just kind of the intersection there of maybe some even food insecurity and how if there is a food insecure home and then um and then payday happens, right? How there—it makes sense to me, the bulimic behaviors, because then with the food insecurity might lead to hoarding once food is available, which could lead to those binge-like behaviors. But then because culturally, like, we don’t—right? Like, we’ve got to get rid of it, then that leads to that bulimic or compensatory behavior, right?

Paula: Absolutely.

Ashley: And so, I was kind of explaining this, and one of the providers I was talking with at the end of the talk came up to me and just kind of thanked me for sharing this information. And she identifies within the BIPOC population, and she mentioned to me that—kind of exactly what you’re saying, she would advocate for herself when she knew she needed treatment. She knew she had some bulimic symptoms. They were very innocently, you know, they kind of innocently came up and I think some of it was from, you know, environment and kind of how she grew up, right? And it was really hard for her to advocate for herself. And so, thinking about her specifically, what would you want anybody listening that is a potential client or a community member, what would you want them to take away from your conversation? Because we know that they might have to fight a little bit harder to advocate for themselves.

Paula: Yeah. You know, that’s really a great question and it’s interesting because I have so many thoughts, but none at all, like at the same time. Because there’s like, I don’t know that there’s just one answer. But I guess what I would say is, “Trust you.” I realize that you may have experiences where you’ve been questioned or they’ve been doubt—and we kind of look at professionals as being the experts, right? And so then if they’re sort of saying “That’s not a problem,” or they’re not asking you, then you can walk away, like, “Okay, I’m just sort of making this up and it’s not as big of a deal as I think it may be.” But be willing to fire that person. I’m sorry, that may not be the best answer.

Ashley: No. I love that!

Paula: But being willing to fire that person. Go to the next person and keep asking, because I really think if you know that something is wrong or something doesn’t feel right, even if it’s not this diagnosable thing, it doesn’t feel right to you. And so to me, that’s what’s important. If I don’t feel right or if I don’t feel great about something that’s happening, I deserve, and so you deserve as a potential person that’s seeking support, you deserve to be heard and listened to. And keep trying, you know, just don’t stop there. Find someone that maybe you feel like is an advocate for you, if you’re open to sharing that information with them about what you’re struggling with. But keep trying. Like, I guess that’s what I would really say, don’t give up. But also to fire that person too. And I say this because—if I can tell just one little story anecdote thing. I had a doctor in Charlotte, and I loved this doctor, I loved her. She was a referral from another, a friend of mine, she loved her, and you know when you go to a new doctor they are asking you all these questions about your history. And she’s asking me these questions and I honestly feel like I am answering them to the best of my ability. But she sort of asked them again, in a little bit of a different way. And so, I sort of felt like, “Does she not believe me? Does she think I’m lying? Does she think I don’t know what I should know? And oh my gosh, I should know these things and I don’t.” And I was sitting there, honestly experiencing some of this, like, “But my friend referred me, she said she was a great doctor,” you know. And so finally I said to this doctor, “I am answering the questions to the best of my ability, and when you’re sort of re-asking them, I’m starting to feel like I’m stupid or something.” And she’s like, “No, I am just so shocked that you know all of this!” So, talk about the two totally different experiences that was happening between me and this doctor. And she was a Black doctor, so it wasn’t even about, you know—but yeah, just the two experiences that were happening. And so, “Speak up” would be the other thing that I would say. Speak up if you don’t feel like you’re heard and listened, then go to the next person.

Ashley: Thank you, next.

Paula: Exactly. Thank you, next.

Ashley: Aww, that’s awesome Paula. Thank you so much.

Paula: Thank you!

Ashley: Yeah, I think we’re kind of coming to the end. I know, let’s see, I’ve got your book here, or the book that you contributed a chapter, Treating Black Women With Eating Disorders, A Clinical Guide. So obviously if you’re a clinician, like definitely go out, get this. Are there any other resources for clinicians or for, like I said, our community members or potential clients that might be listening as well, that just like—that go-to resource that you would suggest.

Paula: Gotcha, yeah. So unfortunately, they’re limited in nature, especially if you’re thinking more of a clinical type of handbook, you know, just for lack of a better term for that.

Ashley: Sure.

Paula: I will acknowledge that, you know, I think that definitely people who’ve written some different books are trying to incorporate information on, you know, diverse populations. But something specific, I would say there’s not enough resources. What I would also say, though, there are people who are writing books, whether it was about their experience, and although I’m frequently reluctant to recommend books that are sort of personal to someone because it’s their story, I just don’t want clients to sort of over-identify with the author, so that’s sort of my personal stance.

Ashley: Okay, yeah.

Paula: I still think maybe if it kind of creates a sense of, “Okay, this can happen or this does happen amongst people of color,” then I would say, you know, maybe there are some of those books that are out there that may be helpful. I don’t know if you were wanting, like, titles of books or—?

Ashley: Any resources you have. I think, I’ve heard, is this a book? The Courage to Be Uncomfortable? I’ve heard about that one, in this. Maybe Developing Our Cultural Humility, but not sure if you’ve heard that book before.

Paula: I’ve not, no. But yeah, there’s definitely books on, as you mentioned, like, developing cultural humility, increasing cultural awareness, even, you know, even things that aren’t clinical that really start to encourage people to think about privilege, unearned advantages, because these are the things that are influencing all of us every single day. And so, I think, absolutely there are books that reference cultural approaches and looking at racial diversity and learning about different populations that absolutely would be supportive.

Ashley: Awesome.

Paula: But for that prospective client, that’s where I would say, you know, “There may be some books that maybe help just normalize what you’re experiencing.”

Sam: I just I wanted to make our audience aware, also, that Paula you’ve written blogs for Renfrew on cultural humility and cultural awareness. So, they can be found right on our website, under the blog section. I often direct—when I do my own trainings for clinicians, I direct them to your blogs. I hope that’s okay, Paula.

Paula: Thank you. Absolutely! It just means I need to do a little bit more.

Sam: That’s right.

Ashley: That’s awesome. Well Paula, thank you so much. This has been so lovely to chat with you, and I hope listeners, I hope this is some good, rich content for you to take away, and just want to thank you all again for being here and joining us today.

Paula: Thank you, Ashley and Sam, it’s been my pleasure. Thank you.

Sam: Yes. Thank you.

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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