Hi, friends! 
   So there has been a lot of hype about the Netflix movie To The Bone. If you haven't heard about it, click here to see the trailer. This film is about eating disorders, or more specifically, anorexia nervosa. Since I'm the friendly, neighborhood intersectional feminist as well as the friendly, neighborhood art therapist, I thought I'd watch it and give y'all my two cents. The three things I'm mainly going to look at are race, class, and gender. Additionally, I'll talk a little bit about successes and failures of the film as well as implications. And sprinkled throughout will be my thoughts as a therapist who works with people diagnosed with eating disorders. Obviously don't read this if you want to watch the film for yourself. I'm totally going to give away the ending so consider yourself warned! 

   Before I dive in I'm going to include some resources. If you or someone you know needs support due to dealing with an eating disorder, you are not alone. You can call the NEDA (National Eating Disorder Association) help line at 1 800 931 2237. If you aren't really a phone person (I'm not), NEDA has a click-to-chat option. Click here. Additionally, there is a crisis text line where you can text with a therapist. Text "start" to 741 741.

   So, just to start out let's be clear that all not eating disorders mean anorexia. This association makes people with other eating disorders pretty invisible. That's really not okay. The DSM-5 recognizes MULTIPLE eating disorders. The classic ones that everyone knows are anorexia and bulimia, but there is also binge eating disorder, feeding or eating disorders not elsewhere classified (abbreviated OSFED, equivalent to EDNOS, eating disorder not otherwise specified in DSM-IV), PICA, and avoidant/restrictive food intake disorder or ARFID, and orthorexia. For more information on types of eating disorders and specific criteria, click here or consult a copy of the DSM-5. 

    

 Race 
   Not surprisingly but not any less disappointingly, the film does a pretty terrible job in the race department. There are precisely 4 people of color and they are all in supporting roles. The roles are as follows: a Latina woman is a housekeeper (obviously), a black woman who is a therapist and has less than 3 lines, a black woman who is a direct care staff person at a treatment center, and a young black girl who is a patient at the treatment center. Of the seven patients in the treatment center, 6 are white and 6 are female. Let's be very clear here. Eating disorder are 13% of women of 50 years old (source) and a harrowing FIFTY PERCENT of girls of color (source). Do we see either women over 50 or women of color represented here? No! The one person of color with an eating disorder is a bigger black girl who has binge eating disorder. This is pretty racist. Obviously women of color have eating disorders and obviously they don't just have binge eating disorder. Anybody who is woke will recognize that it's not accident that the only black patient in the film has binge eating disorder. And the black person with the biggest role is a direct care staff person. Direct care are pretty low on the totem pole in a treatment center. God forbid the psychiatrist or primary therapist be black, latina, asian, native american, or middle-eastern. (The psychiatrist and primary therapist were both white, and the psychiatrist was, you guessed it: a white man). 
    According to NEDA (the National Eating Disorder Association), exact statistics on the prevalence of eating disorders among women of color aren't available due to our historically biased view that eating disorders only affect white women. Relatively little research has been conducted utilizing participants from racial and ethnic minority groups. However, analysis of the Minnesota Adolescent Health Study found that dieting was associated with weight dissatisfaction, perceived overweight, and low body pride in all ethnic groups (source). 
    All in all, looking at race in this film is disheartening to say the least. I'm not sure it's any worse than any other film made by white people but that's not really praise. Aren't we trying to do better? 

 Class 
    As NEDA has observed and many of us can attest to, it's not just rich, white women who have eating disorders. It's actually not just rich women, and not even just women. We'll get to the gender stuff shortly. Anyway, there's a societal perception that eating disorders only affect privileged women. This simply isn't true and it's harmful for at least two reasons that I can think of, and maybe others that I haven't thought of. Reason 1: What purpose does it serve to categorize something as only affecting rich, white women? Are they not worth saving? Are they not worth living without a disorder that ruins lives? Reason 2: If eating disorders are "rich, white woman's disease" what does that mean for men and people of color with eating disorders? Do they now have to bear the shame of having a mental illness but also have a "white" illness? Do y'all see what I'm saying? It's simply further stigmatization in general to continue to view eating disorders in such a limited capacity. Let me be very clear here: I fully acknowledge that white women have not only participated but initiated racism and stigmatization against women of color and I do not condone that. But the point is no one deserves to suffer, and we should all be aware of that and working towards de-stigmatizing all sorts of things to achieve a world without oppression. 

 Gender
    The one male patient in this film is white and also a ballet dancer. For the only eating-disordered male to be a ballet dancer is reinforcing a problematic narrative about males and eating disorders. By the one man being a ballet dancer the film is sort of suggesting that only effeminate men or men engaged in feminine things like ballet are vulnerable to eating disorders. This is just false. Many men with eating disorders are athletes but I literally have never met one that was specifically a dancer. One sport or active discipline isn't more susceptible to eating disorders then the other. This idea only shames men who have eating disorders. It's true that statistically more women are affected, but it's also more men than you might guess. In the United States 10 million men will suffer from a clinically significant eating disorder at some point in their lifetime (source). And we haven't even talked about men of color, who are there is exactly one study one that I could find. 
    Additionally, there are no gender-fluid characters in the film or even mention of gender fluidity. However, 16% of transgender college students are affected by eating disorders (source). 
    There are other things missing from the film too, such as people over the age of 25 having eating disorders, people with different physical abilities having eating disorders, etc. There's just a lot left out unfortunately. My point is eating disorders don't discriminate. And this film sort of makes it seem like there's a specific "type" which is false and dangerous. Let's be very clear about how dangerous eating disorders are: they are the most deadly of the mental illnesses (source). THE MOST DEADLY. You have a better chance of surviving depression, anxiety, schizophrenia, bipolar disorder, etc. This isn't to be taken lightly. Please understand that if you or someone you know is suffering with an eating disorder you don't have to bear that shame alone, and hopefully you'll learn you don't have to bear it all. Films like this are dangerous because they reinforce narratives that create barriers to people getting the help they need. 

    This is getting so long, you guys. But, if I'm going to do this I'm going to do it right. Here's what the film gets right and wrong about eating disorders: 

 RIGHT 
- Some people will need several rounds of treatment before they can live at home or in the community for an extended period of time 
- Eating disorders are not about the food - Having a severe, untreated eating disorder WILL kill you. The film actually holds this pretty okay. Not great, but pretty okay. 
- Some people will leave treatment because they aren't ready for it and return to it when they are. As long as they are medically stable, this is generally okay and can actually be good to get some perspective.
 - According to the white man psychiatrist "looking for one reason" that caused a person's eating disorder "is a losing battle. It's never that simple." I agree with this. 

 WRONG
 - People with eating disorders aren't going to see their body the way you might. In the film, the protagonist Eli has this sort of transcendental moment where she sees how emaciated her body is and it saddens her. She immediately goes to treatment after this experience. This is not real life. People with eating disorders DO NOT see their body they way others do. Trying to get them to see how thin they are is not going to work. Generally when a person with an eating disorder acknowledges that they were unhealthily thin it's after they've been in recovery for a good long while. Not being able to be realistic about your body IS part of an eating disorder, so people can't just see how thick or thin they might be and then want to change.
 - All the race, class, and gender stuff I already mentioned 
-"In-patient" does not look like living in a house with a staff person and other patients. That's residential care. True in-patient care is in a hospital.
 - In my humble opinion, it would never in one million years work to let patients choose the foods they will eat. Of course patients should have options and choices and as much autonomy as they can handle to pick their own meals, but it would not work to let them choose from literally anything and to agree to accommodate any requests. (In the film the rule is you can eat whatever you want as long as you are gaining weight). Those of us that do this work know how absurd this is. People with eating disorder severe enough to need treatment are not able to choose their own foods. Additionally, for their own safety and to ensure that nutritional needs are being met, they plan their meals with a dietitian. There were no dietitians in the film and they are a key player in eating disorder treatment. 

  Alright friends, I think that about covers it. Actually it doesn't, there's one more thing I want to write about but we'll call that part 2. Get out there and use your critical thinking skills as well as your compassion. 

 Much love,
 Veronica

Hello, everyone! 

 Yesterday I attended Mount Mary University's Spring Art Therapy Symposium and had such a great experience! I wanted to write about the things I attended and also just review the conference as a whole. Overall, this was a great conference. I feel like I learned a lot and I left all of the sessions that I attended just feeling really excited that this is my field. 

  Mount Mary's campus is gorgeous. It did make me feel like a kid in church since it's a catholic university so that was interesting but the buildings were really stunning. 

  My sweet friend K and I drove up to Milwaukee after class on Thursday (I love car trips so this was great!). We pretty much just talked the whole time. We stayed with a lovely family we found via Airbnb. Driving though Illinois at sunset was gorgeous. Even though I've lived in the midwest for a few years now I still can't get over the sunsets or just the sky in general, I've never seen so much of either before moving here. 

 Creative Collective Action | Holly Feen-Calligan | Keynote
   So Holly is from Detroit and her presentation was about service learning projects for art therapy students in Detroit and how participating in service learning is hugely beneficial to both the students and the organizations that participate. She was really interesting to listen to and kind of got my community arts brain fired up. Some research she shared that I put in my notes was "Service learning facilitates multicultural skills or intercultural experiences (Backos & Sanders, 2015) and contributes to professional identity. She shared a quote at the end that I loved, I didn't catch who she was quoting though. "Movements aren't born of critical mass, but critical movement." 

Art-Making as Resistance Against Oppression | E. Hlavek | Workshop

   This workshop was essentially about the presenter's research. She was in the doctoral program at Mount Mary. So her research was studying art work made in concentration camps and ghettos during the Holocaust. This was an extremely powerful and intense thing to hear about but it also felt really important. The presenter started out by sharing that there were 4 categories of cultural resistance against oppression and then talked about each one. The categories were resistance against annihilation, resistance against dehumanization, resistance against propaganda, and resistance against future genocides.  
  Elizabeth, the presenter, went through each of the 4 categories and we looked at artwork that was representative of each one. This was very interesting and also heartbreaking. In the first cateogory, resistance against annihilation, we mainly looked at portraits. Each portrait had a great deal of detail and line work that would have taken a very long time. They were intricate and graceful. The same detail was not at all present in subject's clothing though, which was curious. We talked about how the de-emphasis on the uniforms/clothing preserved personal identity. She said she found that people in the concentration camps and wanted to sit for portraits just to leave something behind that indicated their existence. Portrait work is 25% of all the artwork made during this period, which is an astounding percentage. It's the largest single category. The presenter quoted a museum in Israel where come of the portraits are housed: Portraits are "imbued with intense individuality and a dignity utterly denied to the sitters in real life." A Holocaust survivor who had a portrait done is quoted as saying "We want to be among the living at least on paper." Halina Olmucki
  Another thing Elizabeth shared that I did not know is that Edith Kramer, before coming to the United States, worked with a woman (I did not get her name) who worked with children making art in the Terezin ghetto. Coming from an immigrant family myself and just thinking a lot about that with the current political climate I love that one of the founders of our field was an immigrant and that she had roots in art making as care and resistance and preservation of humanity.
   The next part of the workshop we made art. It was essentially response art but she also gave a directive. I don't remember what it was because I didn't really need it. I was ready to just jump right in. Here's some photos of my art process. 

  So her presentation just made me think of trauma. I just thought about having something and then having it ripped up and having to put it back together. All of the pieces are there, but they'll never in the same order or exact spot as before. It's really a totally different piece. It resembles what it used to be in some ways but only in snippets at a time. The last step was writing on it. There was so much resilience evident in the portrait makers and sitters which I think we can all agree that resilience is a positive thing but they just should never have had to be that resilient. None of this should have happened to them. Looking at the art work that Elizabeth presented Bruce made the comment that this is kind of art work is happening in Syria at this very moment. That was really sobering for me.

   Lunch was a sack lunch type of thing, Sandwich, brownie, potato salad, sprite. Some people were whining about it but I thought it was nice not to have to leave for lunch and I'm used to AATA where lunch isn't provided and the closest lunch is $12.

Art Therapy Through a Trauma Informed Lens for Addiction Treatment | J. Albright | Workshop

   This presenter, Jennifer I think is her first name, was also a Mount Mary doctoral candidate and she was also really great. I've only known one person to go through Mount Mary's doctoral program but this conference made me see a lot more of what is coming out of that program which was really cool. Between this session and the previous one there's some pretty amazing work happening that will benefit us a lot as a field.
   This session started with Jennifer going through some light neurobiology and art therapy and also talking about 12 step groups and addiction treatment. Of course everyone in the room is at least slightly interested in art therapy if not an art therapist already so she didn't really have to pitch to us but one of the things that she said that I just thought was very succinct and useful was "art therapy helps with processing top down and bottom up and can be inserted wherever." Wherever people are functioning in their brain it can meet them there. Of course we all know this but her way of explaining it was really great. Art making can help with people who are just working at a sensory and kinesthetic level but also reaches people who are in abstract thought and higher order thinking really well. I knew I was going to like this presenter when she started talking about Bruce Perry, Bessel van der Kolk, and Katherine Skaife.
   Anyways, back on track, Jennifer spoke about how interconnected trauma work and addiction work are and how some complex questions come up when working with clients who need both. Examples of these questions where What if treating trauma causes relapse? What if not treating trauma causes relapse? and stuff like that. She also talked about steps 4 and 5 in the Big Book which are as follows: Step 4. Made a searching and fearless moral inventory of ourselves and Step 5. Admitted to god, ourselves, and another human being the exact nature of our wrongs. Jennifer said these steps are really reminiscent of trauma work. She also talked about how relapse was related to going through these step(s) without proper support after causes relapse and not going through them at all also causes relapse. It was really interesting.
  So in this one we used watercolors and first did a piece about our best day high or using. People who didn't have that experience were just supposed to imagine it or think of a client. I don't personally have the experience so I just tried to go off of what I've heard from others who have.

I just thought of this mental space where everything is right in the world, everything is beautiful, you're kind of floating with not a care in the world. You're like removed from all problems and issues and just able to appreciate the present moment that doesn't have any concerns in it. It's like a break from every day life. 

   We talked about these and the next part was paint (same materials) your worst day sober. This one was a little bit easier for me to be connected to.  Since addiction isn't part of my story as a personal experience I took this as "paint your worst day in recovery or your worst day with your mental illness or symptoms."

  For this one I just through of being on the floor. That was the first thing that came to mind, just being down. And everything being more real. Like the floor is real, table is real, the chair is real, the shining light is real. Like viscerally, tangibly, painfully real. And there's a glimpse of your best day in view (through the window) but you aren't super close to it. Even though this was a more difficult place and certainly a more unpleasant one, I still preferred this place to the first drawing. My thought this is uncomfortable and painful but it's certain, and I still prefer than the chaos of the first drawing. 

  We talked about these as well and looked at them together. We also talked about how to use this specific idea with clients and what the outcomes might indicate and stuff like that. I feel like I'm cheating you guys a little in not writing about all that here but I'm losing steam and still have one more section to add! If you are interested just email me or leave me a comment and I'll send you the rest of my notes from this talk. I left this session really excited and slightly more confident in both trauma and addictions work so that's awesome. It was a good feeling. 

  

   The last presentation that I attended was the one where I was presenting. Probably most of you reading this know the presentation because you've seen it but in case you haven't I was presenting a spoken-word dialogue that I wrote while I was in the process of working on my literature review or my research project (thesis equivalent). I interspersed snippets of my own story in narrative form with pieces of research that describe the experience of a wounded healer. 

  Immediately before the presentation I was freaking out. I think I was pretty collected on the exterior but in my head I was kind of losing it. I got really uneasy when I saw the room where I was presenting, it was essentially a chapel. It was beautiful. I wish I had asked someone to take a picture but that was not important at the time. So I asked for a volunteer, one volunteered and off we went. It went really well. I had it memorized but found myself looking at my paper just for comfort. I memorize it so that I can make eye contact with people as I'm talking but I've found that that gets intense and I need something a little more neutral to rest my eyes on in between meeting gazes. 

  

 I definitely am glad my support people were there. I had K, who I drove up with. S, a friend who graduated last year and now lives in Madison and came to the conference. And C, one of my art therapy heroines who I traveled to Africa with. I haven't talked to them about including them in my blog so I'm concealing their identities. Sort of, most of my readers are people who know all of them but still. I looked at them several times and just felt better with them there. It went really well. People had a lot of questions and I just tried to be really genuine and transparent and honest. I talked a bit about my research since there is some overlap but mostly people asked me questions or commented on parts of my story. It was pretty lovely. 

  After that, S, K, and I decided we were sort of conferenced out for the day so we went to get some dinner. There was one more hour-long session we could have attended but we were all pretty spent at that point. After dinner K and I went back to our Airbnb and pretty much immediately fell asleep. I woke up around 10:30 and did some homework and stuff and then went back to bed around 2. We woke up this morning and our host made us an awesome breakfast and then we hit the road. It was nice to drive during the day this time. The sun was pretty intense and we were quite warm but I am not complaining. 

  All in all it was an awesome experience. Congrats to Mount Mary for putting together a great conference. It was well organized and I loved all the sessions I attended. Also, thank you to them for letting me present. It was a great experience all around. While eating dinner S, K, and I all mentioned what a great conference it was and that we felt like we learned a lot for a one day thing. 

 I feel really grateful for my people and this community. I am so motivated to do everything I need to to finish school because I'm just really excited to keep on this path and be an art therapist. 

 Thanks for reading everyone! 

Emily rolled over in bed too quickly, bringing on a wave of nausea. She held her breath until it passed and then exhaled slowly. Breathing too quickly would bring it back. This was the eighth morning in a row of waking up this way. Emily knew she was either pregnant or dying and it was time to figure out which. In the bathroom she reached for a tan grocery bag on the bottom shelf that contained a pack of two home pregnancy tests. She bought them a few days ago but was hoping it would end up being a purchase made in vain. She followed the instructions, washed her hands and then waited. While waiting she didn’t allow herself to think about the “what if’s” she only focused on pregnant or not.  After the correct amount of time, plus thirty seconds for good measure, she peeked at the stick: two lines. Positive. Pregnant.  The second test she took came back the same. I’ve heard of false positives she thought, maybe I should go somewhere and do one of those tests just to be sure.

Back in her room she began looking for some clothes to wear. She settled for a maybe clean pair of jeans, definitely clean v-neck tee and her blue fleece. Walking through her living room there were remnants of several tasks begun but since abandoned; the deep-teal kitchen table held her transcripts and application for graduation, the couch several books she was supposed to be reading, and on the floor laid a large 6’ X 10’ stretched and primed canvas. So far her final painting as an undergrad was a white cow eating snow on a cloudy day. In the corner of the room there was a man’s ball cap. It was maroon and embroidered with VT for Virginia Tech, next to a signature scribbled in faded Sharpie. The sight of the cap drained the blood from her face and everything peaceful from her veins. She shoved it in the coat closet, under a porcelain white horse with a gold mane that, as a child, had always been on her dresser. It was one of those things that was a nursery decoration for a new baby and somehow had never been thrown out, boxed up, or given away.

Emily’s apartment was just east of downtown in progressive Decatur. She had heard there was a Women’s Health Center around somewhere and she knew they did free pregnancy tests. A quick google on her phone gave her the address of said center, as well as advertised free pregnancy testing at this location. While Emily was driving she wondered what the likelihood was of a place that offered free pregnancy tests operated by people who had taken a vow of silence. She really didn’t want to talk to anyone, nor did she want anyone talking to her. Just as the city was meeting the suburbs Emily followed a few small roads to her destination. According to her GPS she had arrived, but this didn’t look right. She was on a street with nothing but houses. This is a neighborhood, she said in her head. In the lawn of an old looking yellow house, she saw a sign that was barely bigger than the bushes around it that confirmed she was in the right place.

Emily breathed in a tense breath. She looked down at her abdomen. What will I do? She thought of Ben and anxiety filled her. Not able to sit with the angst, she left her car. Before reaching the front door of the little house, Emily reached into her pocket and slid her grandmother’s engagement ring onto her left ring finger.

Judging by the fancy camera doorbell Emily guessed this wasn’t the kind of place you just walk into. The huge lock and door knob made her uneasy; who were they trying to keep out of this place anyway? Emily rang the doorbell and someone answered through a speaker a few seconds later.

“Welcome to WHC, do you have an appointment?” the female voice asked.

“No.” Emily said. The website didn’t say anything about appointments. Emily’s thoughts came down hard. You should have thought to call and make an appointment, this is an agency. No one is going to believe you don’t need any help if you show up for a pregnancy test with no appointment. Great job handling this, Emily, really great job. As she was turning to leave, she heard the door click and unlock. Feeling so small, she opened the door and entered what she guessed was the living room when this was a house. It was probably a waiting room now. A petite young woman with blonde hair came through a door on the opposite end of the room. Emily became anxious as she realized that there were some holes in her five-second Google research via her phone.

“Hi, I’m Lindsey,” she said, putting a face to the voice from the speaker outside. Lindsey had honey-colored hair and green eyes. She was petite, just barely five feet tall. “What can we help you with today? Can I get you a bottle of water or anything? We have coke and diet, too.” She smiled eagerly and waited for Emily to answer.  

“No, I’m okay, thanks though.” Emily said, answering the easier question first. “I saw online that I could get a free pregnancy test here?”  

“Yep, that’s correct.” She said, temporarily relieving Emily’s anxiety. “We use the same tests that doctors’ offices use, and there is no charge. Did you want to take one today?”

“Um, yes, I do.” Emily answered. She felt like she was lying. She really didn’t want to. The question should have been “Do you need to take one today?”

“Okay no problem, I’ll let Liz know, she’ll be the one working with you. Just take a seat while I find her and get you some water, in case you need it for the test.” She smiled as she finished talking and exited the waiting room. Emily sat down on an old, dingy couch and began to absorb this house-turned-business. All of the furniture looked as though it crossed the line between antique and ancient a long time ago. The white walls were mostly bare, except for one with a few run-of-the-mill flower paintings.  Emily had a theory that there was one huge warehouse filled with ordinary flower paintings in dull colors where people who decorated offices always shopped. These were no exception. A few minutes later Lindsey came back in and handed Emily a bottle of cold water and a small napkin.

“Here you go! Okay, let me go find Liz and she will be right with you.” Lindsey said. Emily didn’t have time to say thank you before Lindsey was gone again, through a doorway on the other side of the room this time. Emily’s thoughts were pulled from orthodox flower paintings to what lay ahead. Soon her anxiety was the only thing in the room. The tension started to rise from her core again. She hoped it would be distracted with a sip of water. The cold water bottle clutched in her left hand made the ring on finger even looser. It rested on her finger at an angle, two degrees from droopy. Her hand looked like that of a teenage girl imagining her engagement with her mother’s jewelry.

A slender, red haired woman emerged from the same doorway Lindsey had just gone through. “Hi Emily, my name is Liz. Why don’t you come on back and we’ll talk for a minute while you finish your water?” Liz did not wait for Emily to answer her before she turned on her heels and lead Emily back to her office.

“Nice to meet you.” Emily said. She suddenly felt hurried and stood quickly to follow Liz around the corner and into a small office.

“Sit anywhere you like, Emily,” Liz said. Emily sat in the old brown chair closest to the door. There was a little end table next to it and another old brown chair on the other side. Liz sat in a comfy looking office chair across from Emily. “Lindsey mentioned that you came in for a pregnancy test...Is that right?”

“Yes,” Emily answered. She was starting to relax a little. Maybe she wouldn’t have to divulge information and details about her life she’d rather keep pushed away. Was it because of the ring? Or did they just want to get her in and out of here as quickly as possible like a doctor’s office? Liz certainly seemed like she had stuff to do.  

“If it’s alright with you, I have a few questions. It’s important to consider any reasons why the test may be inaccurate. If I ask you anything that seems too personal, please do not feel like you have to answer. Of course anything you say is confidential, and I won’t ask you anything just to prod. Okay?”

“Sure, okay.” She answered Liz’s awkward questions about cycles and contraceptives and it wasn’t long before she finished her water and was leaving a cup with her “specimen” on the counter in the bathroom across the hall. After washing her hands, she stopped to examine herself in the mirror. At first she saw a glimpse of a fairly pretty young girl who had peace behind her dark brown eyes and happiness wrapped up in her ponytail. But it was only a glimpse. She wasn’t that girl anymore. Her ponytail didn’t hold happiness, it held exhaustion, and behind her eyes there were only things she didn’t recognize. Angry with herself, she wiped her tears with her sleeve so hard that the skin around her eyes stung. She returned to the small office and saw Liz standing by her chair. Emily took her seat again.

“Let me run the test real quick and I’ll be right back, honey.” Liz said, leaving the room. Honey?  Emily didn’t have Liz pegged as the “honey” type of lady but it was Georgia after all. Liz came back a few minutes later and took her seat again. “It will take about five minutes to get the results.” She said. ” Emily, can I ask you a few questions about the father?” Liz said, paying no attention to the ring on Emily’s finger. Emily’s movements ceased completely and her insides tightened, her eyes stayed fixed on the last thing she had been studying. Without meeting Liz’s eyes, Emily offered an answer she hoped would end the conversation.

“He’s just an old friend.” She said dismissively, her body still tense. That was one way of describing Ben.

“Does he know that you suspect you are pregnant?” Liz asked,

“No.” Emily crossed her legs and her arms in front of her. Liz was starting to cut a little close.

“Do you plan to tell him the results of the test?” Liz asked. Just then, the timer dinged. Liz rose from her seat, excused herself and went back to the bathroom. Emily was slightly relieved at being released from answering this question, but she knew she was not in the clear yet. There was the bigger question of the fate of her womb still in the air.

  Her thoughts wandered to Ben, the man she hated to love.

 Good evening, friends!

    I hope this finds all of you well and warm. I've been itching to write since the semester ended but wasn't sure what I wanted to write about.  Lately I've also been thinking a lot about being connected to others via physical touch and thinking through my experiences with this. In order to try to organize my thoughts, I wrote briefly about three different experiences I've had that make me think more about physical touch and connection. So, here we are. Hope this resonates with you. As always, thanks for reading. <3

  Because of the drugs I was unable to fully open my eyes and because of the pain plus the drugs I was unable to move. I'd been in this ER in pain for hours, I still didn't know what was wrong, and I was alone. I was trying to be a good patient. I didn't complain about my pain even though it had not improved after two IV doses of meds. When I threw up it was quietly and in the trashcan. I did not make a mess or cause a scene. But I couldn't be quiet anymore, it hurt so bad and now I was feeling all of the effects of the drugs except for pain relief. Defeated and in excruciating pain, I laid on the hospital stretcher and sobbed. I heard someone crying loudly and thought "someone is crying really loud." And after another second I realized it was me crying really loud. In my head I thought I was just whimpering but after hearing it I knew I was wailing. A figure in navy scrubs came in my "room."  I couldn't make out her face but saw a brunette silhouette. "Shhhh, shhhh, shhhh" she said. It wasn't like an old, mean librarian shushing the loud patron, it was like a caregiver shushing a fussy baby. I felt her hand touch  my wrist and hold it gently. Instantly I felt a little calmer. She continued to shush and she maybe even softly said something? "Everything's going to be okay." I don't know? I can't really remember. And I felt her thumb move across the inside of my forearm. I felt myself get quieter and my breathing slow and deepen. I laid very still just feeling her hand on my wrist, her thumb on my forearm. This connection, to this person who I can't even see their face, soothes me and I relax. I feel the pain in my abdomen ease slightly, and I find myself hoping this mystery comfort person won't leave me. Eventually, I nod off. 

   "Hang in there, take care of yourself," My therapist said to me as I was exiting her office at the end of our session. "Ouch," I thought to myself. She tells me to "hang in there" whenever she knows I'm depressed but adding "take care of yourself" means she thinks I'm in bad shape. She's not wrong. The weight of how I'm going to survive the next four months and then get a job where I'm the therapist is crushing me to the point that my shame for how inadequate I feel prevents me from wanting to ever leave my apartment. The hopelessness is so real and so strong. I feel it in my chest sitting on my heart as I exit the building and walk to my car. My face is still wet from the session and the tears are still coming. Noticing my crying makes me wonder if I'll see one of my best friends, Leslie, in the parking lot today. We have the same therapist and sometimes our appointments are back to back and we say hi in the parking lot or leave notes on each other's car's. I love Leslie but I don't want to see her today because I am still crying. I look up and see her car parked right next to mine. I see that she's inside but when she didn't get out I took this opportunity to get in my car. I turn on the car, buckle up, and wipe my eyes. She still hasn't gotten out of her car. Do I want to see her? Or do I just want to go? I can't decide. Instinctively I reach for my phone. She's already texted me. 

 We text back forth, as you can see, for a few minutes. Even in my misery and embarrassment the idea of our cars being right next to each other with each of us in our own texting each other is almost comical to me. I realize Leslie is respecting my space. She won't force herself on me even though I assume she's concerned, but she will sit in her car right by my car and text me. After realizing this  I decide I do want to see her and I ask for a hug. When I see her she has this look on her face that says "come here, everything's going to be okay." We embrace and I lightly sob into her shoulder for a few seconds. I feel like I should let go of her because we are well past the time that is socially acceptable to hug. But it feels good, and I don't want to. I feel her thumb moving gently on my back. She holds me tight and I just cry. After a few seconds everything in my body slows. I'm crying a little less and my hear is not beating quite so fast. I can feel her arms around me and can feel her shoulders between my arms. Again it occurs to me that I should let go but I hold it still, I don't want to, this feels good. After a few more seconds I let go. I think I said thank you? I tell her I'm not going to buy new shoes and we laugh together. We say goodbye and I get in my car for good this time. As I'm driving I realize I feel better. The hug really helped. 

   "Find a partner and sit on the ground facing away from each other," the facilitator instructs. The translator repeats the instructions in Kiswahili. Inside myself I feel a pang of shame for whoever has to be my partner. A college-age man who is shorter than I am but has nice eyes makes eye contact with me. We smile at each other and this seals our fate as partners. This is the best we can do since neither of us are fluent in both english and Kiswahili. As we sit my eyes wander out the window to look at the ocean. The coast of Tanzania is beautiful, and though we've been here for days it's still surreal to me that I'm even here. Immediate anxiety pulls me away from the sea and back into the room. We are to sit facing away from each other with our backs touching. I immediately feel so sorry for my partner, I'm so gross today. And I'm sweating because it's hot. I feel sorry that he doesn't have a better partner. The facilitators walk us through a series of exercises where we breathe deeply with our backs touching. I can feel his warm back pressed against mine. I have no way of asking him if he is okay, if he is comfortable, if I'm hurting him. We breathe together and through my back I can feel his breath go down his spine and deep into his core. We do this for several minutes in addition to some other exercises, our backs touching all the while. I try to be connected to this moment, to him, to the room but it's so hard to breathe deeper than my anxiety. I'm ashamed that he has to touch me, uncomfortable that I can't check-in with him to make sure he's okay, and anxious to be touching someone and not know how they are. I want to sit out on this activity, but if I do I'll leave him without a partner. Plus I can't tell him I want to sit out and I don't want to hurt his feelings by just getting up and disappearing. The exercise ends and we separate. During the processing time he raises his hand to share and I'm immediately embarrassed. While he is sharing people look at me. I don't know what he's saying. I imagine it's something like "My partner was terrible. She's gross, she did it wrong. I'm disappointed and it would have been better if I could be with someone else." As he finishes I look to the translator who says "He says that it was very interesting to feel some one else's breath. I felt such connection and calm." I am astounded at his comments, and then saddened that my shame and anxiety kept me from ore fully connecting with him. He wasn't hating me like I thought, he was reaching for me by being genuinely engaged and present during our time together. I missed being connected because I was being critical, that seems kind of tragic somehow, right? 

  Hello friends,

   On this stormy Friday night I find myself feeling disconnected from the world and wanting to reach out.  I'm also processing a lot and itching to write about a situation I had with the counseling center on campus and I want to share that and the conclusions it brought me to with y'all.

  As a wounded healer I'm just now arriving at the point where I'm integrating my "wounded" and "healer" parts. There are some days and things where I am definitively wounded and some days and things where I am definitively healer. One of my definitively wounded things is that for the last 3 semesters I've been a member of the survivors of sexual violence group through the university counseling center at my school. It's been a really challenging-in-all-the-right-ways experience. It has definitely illuminated many things for me as well as provided a space to sit with my identity as a survivor of sexual violence and what that means. Because of some staff transitions and maternity leaves and such the group for the current semester will be run by different staff counselors than in the past. At the end of the last group the facilitators brought in one of the counselors who will be co-facilitating the group the next time it runs. It turns out that I knew this person, we'd had a class together just the previous semester. This person did a practicum with the counseling center as part the clinical psych program on campus and then was hired on. Because I'd talked to this person before when we were in class together I knew that one of their interests was sexual violence. I imagine that's why they inquired about the group.

   So here's the thing about therapy and therapy groups-confidentiality is really important. So important that it's sacred, it's considered a foundational principle of therapy. It's so important that it transcends all theoretical orientations and modalities of therapy. It's literally the one thing all mental health professionals can agree on. By hiring a person who was literally weeks ago a student of the university that the counseling center serves, the counseling center puts itself in a situation where they need to consider the ethical implications at play including confidentiality, dual relationships, power dynamics etc. And not to be a bitch but they really failed here. They were remiss in their calculation a former grad student would be a good fit as a facilitator considering the groups are mixed between undergrads and grads and also considering what a small university it is. Please understand that I'm not saying they should have known I'd had a class with this person. I'm saying it's clear that they were remiss in thinking through what the potential outcomes are of hiring someone who again, literally weeks ago, attended this school are. My position is not that this person should not have been hired, it's that there should have been more thought around what ethical implications might be on the horizon with them as an employee. I'm just saying all they had to do was think about it.

  When I saw this person walk in the room and initially made eye contact with them my heart sank and I felt so ashamed. I had sat in class with this person for a whole semester. While I am somewhat open about my history of trauma it has to be my choice to do so, and my very presence in this group tells all others present something about me. I consented to being in the group, I did no consent to that information being shared with anyone unless I was the one doing the sharing. In short, it felt awful. Tears of embarrassment and shame for needing help pooled in my eyes and I let my hair cover my face. I looked at the floor until they left the room. I felt totally silenced and so ashamed.

  This was weeks ago. I made a mental note not to do group in the fall, obviously, and just pushed all this under the rug. I just didn't want to talk about it, I guess I was too upset. Fast forward to the beginning of the semester and the other co-facilitator emails me and asks me if I'm interested in group. In my head I'm immediately like "NOPE." But as I think about it I become angry. I like this group, I was here first. I don't want to not go, and I'm still hurt about them exposing me as a group member. I made the choice to talk to someone I'm close to about it and she advised me to advocate for myself and tell the counseling center what happened. I ended up doing it but I didn't want to. I waned to just quit and not tell them why. But I did it, I made an appointment with the person that contacted me and I told her what happened and how I felt. I hated doing it, all leading up to it I felt like I was going to throw up. The 20 meeting threw off my entire day because I was so anxious both before and after. She apologized, and she understood how I felt.
Just writing this is making my stomach churn again.

   Anyway, she mentioned that a possible option was having the new practicum student (from WashU, not our school) co-facilitate the group instead of my former classmate. While I sincerely appreciated her efforts to try to make group something I wanted to do, I became angry at the idea of a practicum student co-facilitating the group. In my head I was like "I'm a practicum student. That's weird." First they mess up and expose me as an sexual trauma survivor, and now they want to add a practicum student? Yuck. Then I immediately flashed to people in mental health saying they want to work with trauma. That narrative of people sort of glamourizing diagnoses and pathologizing people's experiences presented itself. Only this time I wasn't experiencing this narrative as a metal health professional/peer, I was experiencing it as a client. And I became enraged that my personal experience and my need for a therapy group would be in relationship with someone's education and clinical interests. And then I considered that I'm a huge hypocrite, because I am also a practicum student and I also have clinical interests and I also have clients who are teaching me. I have even sought out clients because I wanted to work with their specific diagnosis. Mentally I immediately begged the universe to forgive me for participating in mental health in this way.

  Being on the receiving end of services in these ways- being exposed by my therapists and then potentially participating in a group co-lead by a practicum student- has been eye opening and very humbling. It's also made me very ashamed. Not just because I was exposed, but also for the way that I have acted. It has given me a sense of gratitude for my clients who have shared their hearts with me, even when they understood that I was in-training. Recognizing the narrative of pathologizing and the sort of voyeurism that exists around certain diagnoses (Dissociative Identity Disorder, for example) has been disturbing me for several months but it all came to a head when I felt like I was on the receiving end. It's never felt right to me to use the word "population" to describe people and I always feel so out of place when I'm asked what kind of work I want to do post-graduate school. Thinking about all of this I sort of have an answer. The truth is that I want to be with people. I want to be with people, expand their coping skills, hear their stories, feel their pain with them, feel peace with them. I just want to be with people, I just want to connect.

 So, be careful out there friends. Remember that the people who seek services are people, as cliche as as that sounds. Not a diagnosis, not a set of symptoms you might find interesting or hate. And their willingness to be with you and to trust you even at the most basic level, like showing up to your session, is a big deal and it shouldn't be taken for granted. It takes a lot to even begin to let someone in. For me this whole experience has been a very pointed reminder that there is virtually no difference between me and my clients. I have grown in my gratitude for their trust and also grown in my respect for them. I happen to be the therapist, they happen to be the client. In other circles in my life I am client, and someone else is the therapist.

Good night friends, thanks for reading <3

 

 

     As I approach the last year of grad school (is this real life?) and mark my one year at my current job I have lots of thoughts on working in mental health. Not in any particular order, here are 5 thoughts I have every single shift and every day at practicum:


1. Why is the world such a terrible place and why do terrible things happen to people? 

There is a strong correlation between adverse life experiences and prevalence of mental illness in a person's life. Honestly sometimes the things that I hear make me want to curl up in the fetal position because it just hurts so much knowing that someone has had to experience such difficult things. Sometimes I'm just at a complete loss. Like why? Why does this have to happen? Why does it continue to happen? Will we ever be able to stop it?

2. Am I helping? Like at all? 

One time one of my professors said "Therapy is such a crap chute sometimes. You never know who you help, if you help at all." I was actually very relieved to hear this, as it reflects my own experience for sure. Sometimes I get home from practicum or work and wonder if I did anything that mattered that day. It's not that I need to know for sure that I helped someone or that I need to be recognized for doing that, it's that it's important to me to both push and support my patients and my clients in the right ways. I don't always know what's right. Sometimes you just come home thinking you didn't do anything right that day and at best the world is no better off than before you came in. It's a sucky feeling.

3. What if this person doesn't make it? 

I think about this a lot. By "make it" I mean in physical sense and an emotional one. Working with eating disorders (the most deadly category of mental illness) definitely introduces the idea that some of our patients will die due to the extreme stress of the disorder on their bodies. But I also mean "make it" as in be happy, have a life you want that's not hijacked by anxiety or trauma or depression or whatever it might be. To be very honest with you, this thought is the one that disturbs me the most. I have to push it out of my head and just proceed as if everyone I interact with will make it, even though I know that statistically that's unlikely. I think this is such a big thing for me because I have a lot of fear around what my life would be like if I hadn't made it to recovery. I physically wouldn't be here, and even if I was I'd be just a ball of anxiety, depression, panic, and self-loathing, Or in other words not happy in the slightest and not the least bit satisfied with my life. Nothing I would ever wish on anyone and something I'll forever be working to avoid.

4. I just want to take you home. 

I think this all the time. Not about every patient and client, of course, but there are some that just tug at your heart strings. And it's not just kids either. This past school year I had a client who was older than I was and way taller, and yet I just wanted him to be mine to care for. This happens at work too. Sometimes I want to take people home with me because I feel like their families/support systems suck and I don't think their parents are even worthy of them. And I think I can do a better job supporting them. And sometimes it has nothing to do with their support system and it's just because I really love this patient/client because they have a great personality and I genuinely love being in their presence. And sometimes it's both. I think I have this fantasy that I'll take people home and everything will just be okay. Then I remember two things: 1. I can't even get myself to shower every day so I really have no business being responsible for other humans and 2. I can only give what I can give, and what I can give is enough even though I often want to give more. And I also know that doing this, even if I could, would likely not solve any problems.

5. Am I going to be able to do this?  

Kind of in the same vein as #3, I often wonder if I can handle this. I especially wonder this on the hard days or days where triggering things are happening. I wonder about my own recovery and if I'll be able to maintain it. How will the stress from work affect me? Have I worked my own stuff enough to be able to be present for others as they work through their stuff? What do I need to be okay doing this work? What are the indicators that I need to ask for help? And how will I do this and who will I ask? What are the consequences of ignoring my cues? While I'm at work/practicum I compartmentalize. If things start coming up for me I wall it off in my head and focus on my clients and patients. This works extremely well. The problem is I get home and kinda freak out cause all the levees break in my head. Over time this builds up. When I'm in the moment with people, this question doesn't come to me. It comes to me when I'm forced to be present with my own emotional reactions to tough situations. And sometimes this thought occurs when you just feel defeated and like nothing your doing is making any difference at all.

It's tough this field we're in. You never know if you're going to a get a day where things are going alright and the world seems like an okay place or if it's a day where it's just all gone to hell and we should just stop it somehow before things really get bad. Either way these are the questions I'm often asking myself.

Thanks for reading, friends!

       Based on a conversation from earlier today, I started thinking about the closet full of ghosts that all therapist's have. This ghost closet is conceptually similar to a skeleton closet, though not exactly. It's not really a skeleton closet in the sense that this is where all of our past bad deeds or moments of questionable judgment are kept. But the ghost closet is that space within us where we keep all of clients that we didn't get to say goodbye to, all of the clients for whom, for whatever reason, there wasn't a proper termination.

     My career so far has been short, (arguably it hasn't begun at all) but still I have several ghosts of client's that haunt me. I have moments where I remember these clients and remember that we never got to say goodbye and I feel this pang that makes my heart slightly fold in on itself. I don't have these moments so much that I am unable to be present or unable to connect with new clients and those around me, but I have them frequently enough to never really forget the clients the ghosts represent either. For me, these clients are in limbo; gone from my practice and from my physical world but nowhere near gone from my heart or mind. I find this discrepancy deafening. This phenomenon of the ghost closet often takes on physical form because we're art therapists and frequently left with the art work of our clients.

     As a student therapist I sometimes observe that I seem to feel things bigger than the professionals in my field. I just seem more sensitive, more likely to feel surprised, and more likely to feel in general. It's not that over time people learn to care less, they just gain experience with all of the potential outcomes of a therapeutic relationship with a client. Since I'm new at this, I don't have much experience, I'm only just becoming aware of what the different outcomes are. And every time one of them plays out it's usually the first time that's happened to me. Even in my inexperienced state, I know that clients coming and going without notice is par for the course. I know that this could always be your last session with a client. While I have internalized this, no amount of knowing that it could always be your last session prepares you for when you find out it actually was your last session.

     I feel like generally speaking I get really close to my clients. Yes, it's very boundaried and yes we're close in very specific kinds of ways but close is close. In order to fully connect with them I must be unequivocally connected to myself. This connection loop, that starts with me to myself and then extends to my client, makes you get close. We're basically in a trust loop. I trust me, I'm inviting you to trust me too, and to trust yourself while I trust you. These connections are powerful and raw, and when they suddenly end it's sort of tragic and maybe even traumatic. As the therapist in the loop I'm left with this feeling of un-finishedness, sadness, and grief. Yes, I can do my own work and settle my feelings as much as I can about the abrupt end, but there is some part of me that will always grieve these clients more than the ones that I got to properly terminate with. There's something about those clients that stays with me in this place that they can never move out of because our connection was still present, still live, when they left. Neither of us had time to properly tuck in our connecting parts and say our goodbyes.

  It's like holding hands with someone. When you're actively holding someone's hand your fingers are interlaced or your hands formed around theirs. When you let go your hand returns to a resting position. But what if one hand was suddenly just gone, if it suddenly disappeared? At first, the remaining hand would still be molded to the hand that disappeared. The remaining hand may search for the other hand, the newly exposed skin might feel a slight breeze. For me, this is what it feels like to not get to say goodbye. My "hand" is still in the position it was in when we were holding hands. And in some ways, it will always be that way. There's some part of me that will always be waiting for the other hand. There's some part of me that will always be wanting to plan letting go of each other instead of one hand just disappearing. Because I'll always be waiting, these clients don't live in the same place in my head or my heart as the clients that I planned to let go and planned to let go of me.

  So what do you do when you don't get to say goodbye? I cry. A lot. And I draw. And I find myself wanting to talk about it. I find myself wanting to tell my mentors and supervisors about my client and the work we did, about how it feels now that they're gone and about the hope that I have for them. I find myself wanting to sit in my thoughts of my client and be with them that way. I fantasize about expressing my anger to the person that represents the circumstances under which my client had to leave. I recite in my head all the things I would have said if I'd known it was our last session. And then I cry some more.

   I'm writing all this because I'm trying to figure out how to be okay with being vulnerable and authentic in relationships that are fairly unstable. I'm worried that if I can't learn to comfort myself and cope with the grief of unexpected termination then I won't make it as a therapist. I don't want to burn out because I never learned how to cope with not getting to say goodbye, because unexpected termination is a reality in the field we're in. So while I'm getting used to the reality that this is going to happen, I'm far from it not affecting me. It seems like the only thing I can do to keep myself balanced is to be true to all of these feelings when they occur. Acknowledge those painful, heart-folding moments and then spend some time remembering why it hurts. Don't expect to feel better and do learn how to hold that this wound may bleed for a while. I think I'll be more worried about myself  if I ever don't have a response to an unexpected termination than I am right now. Because if I don't care that someone's gone then something has gone awry. When I think about it like that I'm okay with continuing to work on this. My supervisor at school told me that if I'm feeling disappointed that the relationship is ending (or in this case has ended), then it was good work. There's rapport and connection there. So that's something to hold on to. It was good work. But I didn't get to say goodbye. I didn't get to package our work and review all of the gains. And I didn't get to convey that it was truly an honor to be with this client. And that's the part that stings.