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How Eating Disorders Affect the LGBTQ+ Community | Embark Sessions
Episode 1027th September 2023 • Embark Sessions • Embark Behavioral Health
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In this episode, Rebekah Tinker, LCSW, returns to “Sessions” to share her experiences treating eating disorders and the intersection of eating disorders with gender and sexuality. Rebekah and Rob emphasize the need for the whole family to be involved in the treatment process, as eating disorders often stem from family dynamics and patterns. Rebekah also highlights the rise of body shame and disordered eating in the LGBTQ community and the need for therapists to address the societal factors that contribute to these issues. Rebekah and Rob discuss the importance of creating a safe and accepting therapeutic environment where clients can explore their relationship with their bodies and work towards self-acceptance. 

Related Blogs:  

LGBTQ+ Mental Health: How To Support Your Youth 

How To Best Support and Accept Your LGBTQ Youth 

Ask a Therapist: How Do You Identify Eating Disorders in Adolescence?Eating Disorders in Teens 

Related Videos: 

What to Know About Eating Disorder Treatment | Embark Sessions 

Eating Disorders: How Parents Can Support Their Child | Roadmap to Joy 

Connect with Embark on Social Media: 

Have a question for our experts? We want to hear from you! Submit your questions to: askatherapist@embarkbh.com

About Rebekah Tinker, LCSW 

Rebekah believes the therapeutic relationship is built from trust and sincerity. Her hope is to hold space for a genuine connection that fosters dynamic self-reflection. Looking deeper into the layers of experience that inform our internal gaze and external lens, and what we intrinsically value and believe. Whether you are looking to unravel patterns of codependency, improve communication with your partner(s), or navigate through body shame and disordered eating, Rebekah sees opportunity for clarity and resolve. 

Her clinical approach holds an intersectional feminist and psychodynamic lens. Each session is focused on deconstructing conscious and unconscious beliefs and behaviors. Weeding out what holds us captive in doubt, while empowering individuality and acceptance of self. 

She specializes in relationships, sex and sexuality, body image, disordered eating, and identity development. She works with couples, adults, and adolescents of all genders and sexualities. 

 

About Rob 

Dr. Rob Gent, Ph.D., is the Chief Clinical Officer and one of the founding members of Embark Behavioral Health. Rob has been with the company for 15 years and has led the Embark organization in the clinical development and growth of numerous programs. He is the lead developer of the proprietary CASA Developmental Framework, which is pervasive throughout Embark’s programs. 

Through his dedication to advancing clinical development, practice, and research, he has become a nationally recognized expert in the field. His specialization in clinical development is enhanced by his therapeutic expertise and has yielded such accomplishments as the development of; The CASA Developmental Framework, Vive Family Intensive Program, Calo Preteens, Canine Attachment Therapy-Transferable Attachment Program, and other specialized programs. 

Transcripts

Rebekah Tinker:

Family Therapy is a must. That is, you cannot

Rebekah Tinker:

treat an eating disorder without family therapy is when an eating

Rebekah Tinker:

disorder an adolescent or kiddo, that is, because majority of

Rebekah Tinker:

the, you know, reasons this child has adopted these patterns

Rebekah Tinker:

are something in the family system going on. And the whole

Rebekah Tinker:

family has to be on board, if we're going to invite true like,

Rebekah Tinker:

deep meaningful change. Because it may very well be that one of

Rebekah Tinker:

the parents at home, has their own disordered eating patterns

Rebekah Tinker:

is in their own, like swirl of diet, culture and kiddos,

Rebekah Tinker:

hearing that and seeing that, right? How are we supposed to

Rebekah Tinker:

create change, we can talk all day in our therapy session about

Rebekah Tinker:

it, but they go home, and they're shown the exact opposite

Rebekah Tinker:

of what we're talking about. We're not going to get

Rob Gent:

good afternoon, everybody. Welcome to Sessions.

Rob Gent:

It's a Friday afternoon for us. We have part two, so glad to

Rob Gent:

have you back. Rebecca, thank you so much for spending time

Rob Gent:

with us. Our Part one was about hearing your story and some of

Rob Gent:

your expertise. And it was so invaluable. And I just

Rob Gent:

appreciate taking some more time to dive in a little bit more.

Rob Gent:

And I know we're going to be focusing on talking about a

Rob Gent:

specific area of your focus and talking about LGBTQ i A and some

Rob Gent:

eating disorder stuff. But certainly welcome.

Rebekah Tinker:

Thank you so much. Glad to be here,

Rob Gent:

Rebecca. Just remember, just give us a little

Rob Gent:

bit of a refresher where you're at. And some of your expertise

Rob Gent:

and what you're doing currently in your practice would be great.

Rebekah Tinker:

Yeah, um, so I'm Rebecca tinker. And I'm an LCSW

Rebekah Tinker:

Ghomeshi her pronouns are located in San Francisco,

Rebekah Tinker:

California. I have a private practice here. And I specialize

Rebekah Tinker:

in eating disorders, and the intersection of eating disorders

Rebekah Tinker:

and gender and sexuality have a lot of adolescents and kiddos on

Rebekah Tinker:

the gender spectrum who are struggling with body image stuff

Rebekah Tinker:

as well as adults on the gender spectrum, and also cisgender

Rebekah Tinker:

individuals who are dealing with body image and an internalized

Rebekah Tinker:

shame.

Rob Gent:

Yeah. Wow. And that's significant. I can only imagine

Rob Gent:

Are you in your experience and your research, I use a seeing a

Rob Gent:

rise in that demographic?

Rebekah Tinker:

Um, well, you know, it's hard to say because

Rebekah Tinker:

I, prior to the pandemic, I was living in New England, in

Rebekah Tinker:

Vermont. And the beginning of the pandemic, I moved to San

Rebekah Tinker:

Francisco and I don't know if it is pandemic related or just San

Rebekah Tinker:

Francisco related versus Vermont related. But yes, I have a

Rebekah Tinker:

massive rise and folks who are non binary or trans or gender

Rebekah Tinker:

non conforming in some way. And also a large increase of body

Rebekah Tinker:

shame and disordered eating. I know from the statistics that

Rebekah Tinker:

are out there, that there's absolutely arise. And eating

Rebekah Tinker:

disorders and body shame. I just was reading something the other

Rebekah Tinker:

day about how the beginning of body shame is typically I'm

Rebekah Tinker:

gonna use the word inherited, but taken on experienced around

Rebekah Tinker:

the age of 13. But more recently, they've been seeing

Rebekah Tinker:

numbers as low as nine years old. So yeah, there's definitely

Rebekah Tinker:

there's definitely a rise for sure.

Rob Gent:

Maybe if you would Rebecca, just define terms. I

Rob Gent:

like to use the term body shame. What do you for those listening?

Rob Gent:

How would you define that?

Rebekah Tinker:

I would define that as feeling ashamed. by our

Rebekah Tinker:

bodies feeling like we're not our bodies aren't enough. I

Rebekah Tinker:

think that that word isn't used as much as should be that word

Rebekah Tinker:

enoughness. feeling unworthy in our body feeling like

Rebekah Tinker:

something's wrong about our body. Again, not feeling enough

Rebekah Tinker:

or feeling too much.

Rob Gent:

I really appreciate it. And the reason I asked you

Rob Gent:

even though the term body seemed seemed what seems obvious, but I

Rob Gent:

asked you that question, because I was we always get in these

Rob Gent:

discussions is that oftentimes shame is not just a cortical

Rob Gent:

rational brain issue is that shame, shame often exists, lower

Rob Gent:

the even down into the brainstem, out of my autonomic

Rob Gent:

nervous system into the subcortical. System. I just

Rob Gent:

wonder if you're seeing if you're referencing some of that,

Rob Gent:

that it's not, we're not talking people out of their body shame?

Rebekah Tinker:

Well, I think that it's pretty impossible to

Rebekah Tinker:

talk people out of body shame when we're in a society that's

Rebekah Tinker:

only preaching body shame. It's a society that's built on body

Rebekah Tinker:

judgment and body hierarchy. And how do we, how do we convince

Rebekah Tinker:

someone to not live in body shame when we're being shown it

Rebekah Tinker:

every single day, you know,

Rob Gent:

and even I know, we've been doing a little bit of

Rob Gent:

research on not to get off track, but social media and how

Rob Gent:

much adolescents are, you know, sort of like holding back the

Rob Gent:

tide being inundated with looking at social media and

Rob Gent:

being faced with all these images and everything that's

Rob Gent:

going on? I wonder, in your practice of that, how relevant

Rob Gent:

that topic is?

Rebekah Tinker:

It's yeah, it's hugely relevant, unfortunately.

Rebekah Tinker:

And also, like, I, yeah, I think that social media is huge in

Rebekah Tinker:

regards to preaching the body that we should have, no matter

Rebekah Tinker:

what gender you align with, or don't align with. There's an

Rebekah Tinker:

image that we're supposed to uphold, or we're supposed to get

Rebekah Tinker:

to, and there's this like cycle of competitiveness, and how we

Rebekah Tinker:

perceive bodies and the cycle of judgments and disrespect towards

Rebekah Tinker:

specific bodies, whether it's a bodies holding disability, like

Rebekah Tinker:

surrounding ableism, surrounding sexism surrounding transphobia,

Rebekah Tinker:

etc. There's just so much or thin privilege, right? There's

Rebekah Tinker:

and racism I make I keep listing off all of these, right? But

Rebekah Tinker:

yeah, it's if if you're someone who's not thin and tall and

Rebekah Tinker:

aligned with gender assigned at birth, you're, you're kind of

Rebekah Tinker:

screwed. I think that there are though, I try and encourage

Rebekah Tinker:

because the reality is, we don't want to say, okay, all kids get

Rebekah Tinker:

off social media, especially when they're in their families

Rebekah Tinker:

home. Still, I think that's actually a really safe place, or

Rebekah Tinker:

it should be a safe place for them to start exploring that.

Rebekah Tinker:

And I think by holding them away from that, then we're setting

Rebekah Tinker:

them off when they go to college, or wherever they go to

Rebekah Tinker:

leave the house where we no longer get to be in a space

Rebekah Tinker:

where we get to communicate with them about what they're seeing.

Rebekah Tinker:

And we get to like, dismantle it all and be curious about it. All

Rebekah Tinker:

right. So I do encourage families who are on the fence

Rebekah Tinker:

around social media to be like, No, let's open it up. But let's

Rebekah Tinker:

point them in the direction of, you know, Instagram handles or

Rebekah Tinker:

individuals or hashtags or whatever to follow that are more

Rebekah Tinker:

affirming. And yeah, expanding the conversation around bodies.

Rob Gent:

Yeah, I really appreciate we're seeing Rebecca,

Rob Gent:

I know that. Yeah, the APA has recently come out with stuff

Rob Gent:

that's been really based in research, but I like it, that

Rob Gent:

they're talking about parents be proactive and know about social

Rob Gent:

media literacy, and even competency, like, be proactive

Rob Gent:

and get on there with them. And because there's some, yeah,

Rob Gent:

there's some been some benefits of actually people feeling

Rob Gent:

supported. And there's, I can find some community within, you

Rob Gent:

know, some social media, if it's done right, and we stay on top

Rob Gent:

of it. Unfortunately, there is some susceptibility to

Rob Gent:

exploitation and other things and exposure to and well, yeah.

Rob Gent:

Yeah.

Rebekah Tinker:

I mean, just because I'm an eating disorder

Rebekah Tinker:

therapist, there's like so many of my Google searches have to do

Rebekah Tinker:

with bodies. And I'm telling you the advertisements that I get on

Rebekah Tinker:

my social media is absolutely disgusting. I can only imagine,

Rebekah Tinker:

like, diet plans and

Rob Gent:

yeah, it's so it's so interesting but such a relevant

Rob Gent:

topic. I mean, like you're saying like, boy, we're, we're

Rob Gent:

seeing across all demographics, body dysmorphia, eating

Rob Gent:

disorders, body shame is really is really on the rise. I'm

Rob Gent:

always curious, what do you what do you identify as some is that

Rob Gent:

the symptom ology of something deeper? How do you identify

Rob Gent:

that?

Rebekah Tinker:

I mean, of course it I mean, that there's

Rebekah Tinker:

so much behind that question I feel, I think it really varies

Rebekah Tinker:

on the individual. But a lot of it is body terrorism. Right. And

Rebekah Tinker:

it's, you know, one way to look at eating disorders just in

Rebekah Tinker:

terms of control. And in terms of like, maybe there was

Rebekah Tinker:

childhood trauma, as we discussed. And in part one,

Rebekah Tinker:

right, like I had experienced loss and sexual assault. And

Rebekah Tinker:

those were two primary indicators for the onset of my

Rebekah Tinker:

own eating disorder. And you see, like, those specific

Rebekah Tinker:

indicators, actually, quite often, you also see, you know,

Rebekah Tinker:

for trans individual or gender non conforming individual, just

Rebekah Tinker:

this body dysphoria, and not feeling like they're in the

Rebekah Tinker:

right body can lead to the onset of disordered eating patterns of

Rebekah Tinker:

wanting to suppress or enhance secondary sexual

Rebekah Tinker:

characteristics. But also body terrorism, feeling like our

Rebekah Tinker:

bodies are constantly being judged, feeling like our bodies

Rebekah Tinker:

are constantly being scrutinized for not being enough, so to

Rebekah Tinker:

speak, I'm being shamed all the time being disrespected, all the

Rebekah Tinker:

time, that can lead to the onset of an eating disorder. So it's,

Rebekah Tinker:

it's like, it's hard to say that there's one answer to that. It

Rebekah Tinker:

really depends on the individual. But I think that, in

Rebekah Tinker:

almost every single case, an eating disorder is the alarm,

Rebekah Tinker:

it's not the fire itself.

Rob Gent:

And the onset of the fire, you're saying could be a

Rob Gent:

whole host of things, it just really depends on the individual

Rob Gent:

and sometimes

Rebekah Tinker:

on like, you know, socio demographic, it

Rebekah Tinker:

depends on like, the environments that they're living

Rebekah Tinker:

inside of, in general, depends on the family systems depends on

Rebekah Tinker:

genetics depends on experiences that they had in early

Rebekah Tinker:

childhood, you know, with sexual assault in early childhood,

Rebekah Tinker:

there's no way around, almost. And that's a generalization, of

Rebekah Tinker:

course, but in my, you know, to, to go with the generalization,

Rebekah Tinker:

there's really no way around that child not thinking that

Rebekah Tinker:

it's somehow their fault. And like, their, their body was the

Rebekah Tinker:

problem. And that's why it happened.

Rob Gent:

As you're describing it, Rebecca, I'm like, there is

Rob Gent:

so much to consider when being, you know, an effective having

Rob Gent:

this specialization talking about eating disorders, but I

Rob Gent:

like that you're saying, you know, it's, it's really got to

Rob Gent:

get to the fire that's underneath, but it takes so much

Rob Gent:

consideration and sensitivity that there's some therapists who

Rob Gent:

might be a bit reductionistic, or a little bit judgmental about

Rob Gent:

what's driving the symptoms.

Rebekah Tinker:

Well, right. And that, you know, and I think

Rebekah Tinker:

that's a really big problem, and disordered eating in disordered

Rebekah Tinker:

eating care, right, is we're not doing enough of our own

Rebekah Tinker:

investigating into what we think is healthy. We're not doing our

Rebekah Tinker:

own investigating into our, like, intersectionalities. We're

Rebekah Tinker:

not doing our own investigating into our, like, the judgments

Rebekah Tinker:

that we hold, right. And we're just like, prescribing this,

Rebekah Tinker:

like one belief that we have, rather than seeing the entire,

Rebekah Tinker:

like systems approach, right. And that definitely needs to be

Rebekah Tinker:

incorporated more into eating disorder. For me, even all of

Rebekah Tinker:

our assessments that we have, are not actually equipped to

Rebekah Tinker:

like fully assessing eating disorder and we don't have an

Rebekah Tinker:

ad. That's why eating disorders are so complicated, and so many

Rebekah Tinker:

people hate working with them, right? It's because it's really

Rebekah Tinker:

hard to get to the to the fire to be like, Well, what why are

Rebekah Tinker:

we here? And so much of it is social and environmental, but in

Rebekah Tinker:

this one individual's case like what was going on, right?

Rebekah Tinker:

Besides the fact that we live in this kind of gross,

Rebekah Tinker:

capitalistic, patriarchal world.

Rob Gent:

Well, I I can only imagine to it's interesting with

Rob Gent:

eating disorders is that there's a certain level, if it gets to a

Rob Gent:

point, we have to move to stabilization before we really

Rob Gent:

try to get to the therapeutic piece. I would think I mean, it

Rob Gent:

needs to happen simultaneously. But I can't imagine if you're,

Rob Gent:

you know, really struggling with certain food intakes and

Rob Gent:

nutritional all this stuff. My gosh, it must be really hard.

Rebekah Tinker:

Yeah, and that's, you know, and when we're

Rebekah Tinker:

talking about stabilization, I think the word talking about

Rebekah Tinker:

that way, like seeing eating disorders only as the extremes,

Rebekah Tinker:

right. And I think that eating disorders is like a huge

Rebekah Tinker:

spectrum, right? And someone can have just as much of an eating

Rebekah Tinker:

disorder, even if they have like, more or less healthy

Rebekah Tinker:

vitals, as someone who is like on a feeding tube, right? It's

Rebekah Tinker:

just that they're engaging in different patterns that are

Rebekah Tinker:

allowing their vitals to be in a different space.

Rob Gent:

Well, I love that you bring that up. It is that yeah,

Rob Gent:

it's not the it's hard not to judge the book by its cover,

Rob Gent:

right? Like, it's the amount of suffering, the maladaptive

Rob Gent:

behaviors can be there. And it's really about exploring and

Rob Gent:

getting underneath it. Yeah. I really appreciate that. Rebecca.

Rob Gent:

Well, can I ask just changing gears a little bit? What led you

Rob Gent:

to work with this certain population? Or have this focus?

Rob Gent:

If you don't mind sharing?

Rebekah Tinker:

No, I don't mind at all. Um, I think it's a few

Rebekah Tinker:

different parts. Um, one is upon moving to the Bay Area, I just

Rebekah Tinker:

got inundated with client referrals of folks on the gender

Rebekah Tinker:

spectrum, who were struggling with disordered eating and body

Rebekah Tinker:

shame. And, and there are a lot of therapists who specialize in

Rebekah Tinker:

eating disorders. So I was like, Well, I guess I need to, I guess

Rebekah Tinker:

I need to, like, really refine my expertise and the queer

Rebekah Tinker:

community and in the gender expansive communities. Because

Rebekah Tinker:

there's, there's a high need for that here. But then also, in

Rebekah Tinker:

recognizing, like in the numbers like this is also very much an

Rebekah Tinker:

underserved community. And a lot of trans and gender non

Rebekah Tinker:

conforming folks, when being assessed for an eating disorder

Rebekah Tinker:

goes missed. Because their symptoms don't align in similar

Rebekah Tinker:

ways to cisgender individuals, especially cisgender, like sis

Rebekah Tinker:

females, right, and sis, white females even more. So I feel

Rebekah Tinker:

like I took the on this specialty in particular, because

Rebekah Tinker:

of the influx of need, for the most part. And because the it's,

Rebekah Tinker:

it's underserved, and, and also, you know, the, because it's

Rebekah Tinker:

underserved well, not just because it's underserved, in

Rebekah Tinker:

part because it's underserved, but also, in part because of the

Rebekah Tinker:

intersection and the comorbidity, so to speak.

Rebekah Tinker:

suicidality rates are so much higher in trans populations than

Rebekah Tinker:

they are and cisgender populations for folks dealing

Rebekah Tinker:

with eating disorders. And that to me, too, is like, that's a

Rebekah Tinker:

crisis. Right? Then someone has people have to show up for that.

Rebekah Tinker:

And if I'm getting, you know, I moved to San Francisco, and all

Rebekah Tinker:

of a sudden I have, you know, 20 referrals for folks who are on

Rebekah Tinker:

the gender spectrum, also dealing with eating disorders.

Rebekah Tinker:

Clearly, you have a problem.

Rob Gent:

And would you say, I would imagine within that

Rob Gent:

demographic is there a higher, you're seeing a higher ratio of

Rob Gent:

those within the population having eating disorders, or, I

Rob Gent:

mean, you mentioned suicide being I think it is higher

Rob Gent:

within that the ratio of suicide is higher and within that

Rob Gent:

population,

Rebekah Tinker:

and it's higher also for non gender

Rebekah Tinker:

nonconforming population who are experienced eating disorders,

Rebekah Tinker:

the suicide rate is tenfold of cisgender individuals with

Rebekah Tinker:

eating disorders. I do know that in one study that I think was

Rebekah Tinker:

the pride study that happened in like 2018 or something. It was

Rebekah Tinker:

saying that folks who had gone to treatment, both gender

Rebekah Tinker:

nonconforming individuals as well as cisgender individuals

Rebekah Tinker:

left treatment and still the suicidality rate for the gender

Rebekah Tinker:

non conforming individuals was the exact same.

Rob Gent:

Wow, no reduction,

Rebekah Tinker:

no reduction. Wow, that is a reduction in some

Rebekah Tinker:

behaviors, but the suicidality was the same and that to me,

Rebekah Tinker:

goes back to the body terrorism.

Rob Gent:

So maybe to find that out little bit when you use the

Rob Gent:

word body terrorism. I would love a good definition of that

Rob Gent:

helpful.

Rebekah Tinker:

Absolutely. Yeah, I'm in my perspective.

Rebekah Tinker:

Body terrorism is when suicide is preferred over living another

Rebekah Tinker:

day being judged and ridiculed and shamed by the society

Rebekah Tinker:

surrounding you.

Rob Gent:

So the terrorism is coming externally, you're being

Rob Gent:

terrorized about my body. And you feel that and in some way,

Rob Gent:

correct me if I'm wrong, it creates a sense of terror inside

Rob Gent:

you.

Rebekah Tinker:

Exactly. Yeah, fear of living another day,

Rebekah Tinker:

under the disrespect and the scrutiny and the judgment toward

Rebekah Tinker:

your body.

Rob Gent:

And I'm just, I, I'm just think I wonder how many

Rob Gent:

people would say, Well, who cares what other people think of

Rob Gent:

you? Right? Like, I mean, how many people want to say, like,

Rob Gent:

just let that go? Who cares what they say, blah, blah, blah. And

Rob Gent:

yet, it's not the way it works?

Rebekah Tinker:

No, it's not at all the way it works, right?

Rebekah Tinker:

Yeah. Yeah, of course, like, we want to come back to a space of

Rebekah Tinker:

self love. And that like radical self love, right? Where it's

Rebekah Tinker:

like going back to the origin of self love. And when I think

Rebekah Tinker:

about that, I'm reminded of Sonya Renee Taylor, are you

Rebekah Tinker:

familiar with her work? No, not so. She wrote about this radical

Rebekah Tinker:

self love, and, and how like, radical. The definition is, like

Rebekah Tinker:

our origin or route, right? And when you imagine yourself as an

Rebekah Tinker:

infant, you were only excited about your body, right? You like

Rebekah Tinker:

discovered your hands, you're like, Oh, my God, I've hands are

Rebekah Tinker:

so cool. Like, I can roll around, and I can like, and I've

Rebekah Tinker:

toes, like there's no comparison, there's no

Rebekah Tinker:

judgement, that's just this, like, complete fascination. And

Rebekah Tinker:

like joy of being in a body. Right. And at least that's the

Rebekah Tinker:

hope. Of course, there's the population of folks who, who

Rebekah Tinker:

didn't feel safe, even as infants in their bodies, right.

Rebekah Tinker:

But for the majority of all of us, we found our hands and we

Rebekah Tinker:

were completely stoked on that are like feeling our bellies

Rebekah Tinker:

like I have my niece is one years old. And she's just like,

Rebekah Tinker:

grabs that her little rolls and is like, thrilled by it, right?

Rebekah Tinker:

And that's that, like, body terrorism takes away. The

Rebekah Tinker:

excitement takes away the joy. Because it's that constant

Rebekah Tinker:

ridicule and judgment of our form. And can we come into a

Rebekah Tinker:

space of that like deep loving that like core base knowledge of

Rebekah Tinker:

how beautiful it can be to be in a body and and like feeling that

Rebekah Tinker:

aliveness. And that enoughness, no matter what other people

Rebekah Tinker:

think. However, at the same time, as you said, when we're

Rebekah Tinker:

being subjected to the onslaught of judgment, and shame, and

Rebekah Tinker:

ridicule, and laws that go against your body, it's, it's

Rebekah Tinker:

pretty hard to cultivate that.

Rob Gent:

Very hard to cultivate that. And I so appreciate this

Rob Gent:

record, because I can't help but think, especially, you know, my

Rob Gent:

own expertise and being an attachment is that this

Rob Gent:

principle, like you're saying, the discovery of the hands for

Rob Gent:

the infant, or the, you know, the toddler, I can't help but

Rob Gent:

think that principle of wonderment and amazement and

Rob Gent:

curiosity is often facilitated because of this interpersonal,

Rob Gent:

social dynamic with a oftentimes a loving, nurturing, reliable

Rob Gent:

caregiver that provides this environment that it's safe

Rob Gent:

enough to be able to have the wonderment to do those things.

Rob Gent:

And what's fascinating is, I hear you saying that social

Rob Gent:

dynamic, there's this interpersonal thing that still

Rob Gent:

carries with us, I mean, we're kind of hardwired for to be

Rob Gent:

social creatures. And just to say, well, like, now, I'll move

Rob Gent:

into self love on an island in a vacuum, right, which is in puff,

Rob Gent:

which is impossible that actually we we need to shift

Rob Gent:

that mentality will just just love yourself enough. And you

Rob Gent:

can overcome all of this stuff. But the reality is, you're

Rob Gent:

saying that no relationships and social engagement and all of

Rob Gent:

this is an essential piece of this process.

Rebekah Tinker:

Right? I feel like there's so much talk about

Rebekah Tinker:

like, you need to love yourself first before you have space to

Rebekah Tinker:

like, love others and to receive love from others. And I actually

Rebekah Tinker:

disagree. I think that we are taught how to love ourselves by

Rebekah Tinker:

others from a very early age. And if we're not given that to

Rebekah Tinker:

Your that or that teaching is taken away by the environments

Rebekah Tinker:

that surround us or the voices that surround us. Or that

Rebekah Tinker:

teaching is, you know, drowned out. I want to know that we can

Rebekah Tinker:

love ourselves, even when that's happening, but it feels that is

Rebekah Tinker:

something that is an anomaly still, to me, I'm not I'm not

Rebekah Tinker:

sure, not sure how to do that. I know that it's possible. But I

Rebekah Tinker:

think that there has to be a bigger uprooting of change in

Rebekah Tinker:

our society for that to be the like, for that deep change to

Rebekah Tinker:

actually occur.

Rob Gent:

Yeah, so it's possible. And I'm even

Rob Gent:

wondering, we're talking about this relational dynamic is so

Rob Gent:

important to us as human beings, certainly. And then, obviously,

Rob Gent:

being terrorized by somebody reflects that we also have the

Rob Gent:

ability to be soothed or accepted by others, to help us

Rob Gent:

integrate that whole process. And I am wondering, often talk,

Rob Gent:

oftentimes we talk about the therapist client relationship,

Rob Gent:

sometimes that's, that can be the catalyst, or the only place

Rob Gent:

or the beginning of where some of these clients feel a sense of

Rob Gent:

acceptance, feel a sense of, you know, gosh, I go to see Rebecca,

Rob Gent:

she's, she's removed some of that judgment, and actually

Rob Gent:

accepts me no matter if I feel shame, no matter if I feel

Rob Gent:

worthy, or not, maybe talk a little bit about them just sort

Rob Gent:

of,

Rebekah Tinker:

I think that just shows to the power of our

Rebekah Tinker:

small connections with people, whether it's at their

Rebekah Tinker:

therapeutic relationship, or whether it's relationship with a

Rebekah Tinker:

person who always checks you out at the grocery store, or whether

Rebekah Tinker:

it's the, you know, random person you see at the dog park,

Rebekah Tinker:

or whatever it is, right. I think that there's something to

Rebekah Tinker:

that. But yeah, the therapeutic relationship, in going back to

Rebekah Tinker:

what you were naming of attachments, right? Like that's,

Rebekah Tinker:

that's an attachment that has to be built. And in my work, I

Rebekah Tinker:

definitely like before we even dive into doing their deep. I'm

Rebekah Tinker:

blending the eating disorder, getting to know the eating

Rebekah Tinker:

disorder, I first want to know that we have an attachment. And

Rebekah Tinker:

that we have like that we both that like they feel safe in the

Rebekah Tinker:

room with me, and that they can open up. And so it's sometimes

Rebekah Tinker:

that means just like, for a couple of Sessions to be like,

Rebekah Tinker:

Hey, what's going on? Like, tell me about your week? How are you?

Rebekah Tinker:

What do you like what's, you know, what have you been

Rebekah Tinker:

thinking about? Like, let's get to know each other's brains. And

Rebekah Tinker:

let's get to know how it feels to sit in the room together. And

Rebekah Tinker:

then once we feel that connection, that safety? Let's,

Rebekah Tinker:

let's go a little bit deeper.

Rob Gent:

Yeah. Well, I liked that establishing that making

Rob Gent:

sure the attachment is there. I wanted to say this to you,

Rob Gent:

Rebecca, just being an eating disorder expert. I was always

Rob Gent:

curious, because I'm not. When we talk about treatment. I'm

Rob Gent:

like, Well, do all the people who are coming to you, is it

Rob Gent:

just overt that they have an eating disorder. And I was

Rob Gent:

talking to somebody else who was in the field? And I said, Well,

Rob Gent:

you know, at Embark we have these programs and blah. And I

Rob Gent:

said we're thinking about getting into eating disorder.

Rob Gent:

And the person looked at me and she laughed, and she said, Rob,

Rob Gent:

you have them in your program? And I'm like, Are you sure?

Rob Gent:

Like, oh, that made sense. But you can't imagine how much of

Rob Gent:

it's unidentified, and it's not over? And it's not like this. So

Rob Gent:

I've always been so curious. I'm like, Well, of course, yes. Yes.

Rob Gent:

You know, how do they come to you? I mean, it's had been

Rob Gent:

identified, or is that something you discover?

Rebekah Tinker:

Sometimes, they, you know, some adolescents, it's

Rebekah Tinker:

parents reaching out being like, Oh, my God, we're realizing our

Rebekah Tinker:

child has an eating disorder, they need help immediately, or

Rebekah Tinker:

it's a physician contacting me or it's a nutritionist

Rebekah Tinker:

contacting me or, or it's an individual themselves,

Rebekah Tinker:

specifically stating, I'm dealing with body image

Rebekah Tinker:

disordered eating, body dysphoria, whatever it might be.

Rebekah Tinker:

And I also have a really large population of clients to who

Rebekah Tinker:

it's not until eight months in three years and three months in

Rebekah Tinker:

whatever it is that they start saying things I'm like, Huh, I

Rebekah Tinker:

wonder, and then I start to, you know, engage in some inquiry

Rebekah Tinker:

around what they're naming in regards to their relationship

Rebekah Tinker:

with food or I'm thinking of a client in this moment who Almost

Rebekah Tinker:

it felt as though they were like almost trying to out themselves

Rebekah Tinker:

without outing themselves by saying, Oh, I just haven't eaten

Rebekah Tinker:

at all yet. And they'd say that in a few Sessions in our, in our

Rebekah Tinker:

appointments at noon, and I'd be like, Huh. And eventually a

Rebekah Tinker:

asked about body image or like, I'm wondering about that. And so

Rebekah Tinker:

it is like, sometimes it comes out much later. And it wasn't

Rebekah Tinker:

the primary reason why they came. According to them,

Rebekah Tinker:

however, a lot of the issues that they came to me with, or

Rebekah Tinker:

maybe stemmed from, like, I don't know what the chicken or

Rebekah Tinker:

the egg is, but, and which comes first anyways, but it is very

Rebekah Tinker:

interwoven with, with the concerns that they originally

Rebekah Tinker:

had. Most of us have body shame. Yeah, judgmental world, or our,

Rebekah Tinker:

the human form is, is constantly being judged, I think that

Rebekah Tinker:

there's an emphasis on a right size, no matter what our gender

Rebekah Tinker:

is, no matter what our pawn structure is, you know,

Rob Gent:

when it gets very confusing with what is healthy,

Rob Gent:

and sometimes that gets a ton of affirmation and recognition for

Rob Gent:

losing weight or putting on muscle mass are doing this, it's

Rob Gent:

like, you know, it gets really tricky. And it's like, yeah,

Rob Gent:

what's healthy versus what is and I would imagine, as a

Rob Gent:

therapist, you have to develop this real attunement, if you

Rob Gent:

will, that you're constantly having to read between the lines

Rob Gent:

and look at the words and what are these subtleties? To let us

Rob Gent:

know that? Yeah, well, and

Rebekah Tinker:

that is something that I'm actually glad

Rebekah Tinker:

you brought up because there is a higher degree of eating

Rebekah Tinker:

disorders now that are being met, missed in the assessments,

Rebekah Tinker:

but are absolutely still just as much eating disorders for folks

Rebekah Tinker:

who are intermittent fasting, for like bulking, like muscle

Rebekah Tinker:

bulking, or on these like liquid diets or like, whatever it is,

Rebekah Tinker:

like, there's such a huge increase of that, actually,

Rebekah Tinker:

recently, from what I'm seeing, and those are going completely

Rebekah Tinker:

missed.

Rob Gent:

And so, do some of those things get fired. Because

Rob Gent:

I'm thinking of, you know, just talking overtly, as you know, in

Rob Gent:

getting on Instagram or whatever it is, you happen to see a lot

Rob Gent:

of muscle building bulking type of things. And it can that be

Rob Gent:

even that doing that be intertwined with body

Rob Gent:

dysmorphia. I mean, and having these

Rebekah Tinker:

Well, again, it goes back to this feeling of not

Rebekah Tinker:

enoughness. Right, and grasping to something outside of you to

Rebekah Tinker:

change with inside of you. Right? And this knee and sure,

Rebekah Tinker:

of course, there can be like healthy ways to navigate this

Rebekah Tinker:

like I am, I'm an athlete, and it took a lot of work to figure

Rebekah Tinker:

out okay, what, what do I need to eat that's actually healthy

Rebekah Tinker:

to make sure that I can do the running that I want to do, and

Rebekah Tinker:

make sure that my running isn't about losing weight, right,

Rebekah Tinker:

which like society has told us Oh, if you're doing these

Rebekah Tinker:

things, it means that you're trying to look that certain way.

Rebekah Tinker:

And so it's really hard for people to unwind from that

Rebekah Tinker:

belief and just to be like, No, I run because I actually love

Rebekah Tinker:

the way the wind feels on my skin and I love feeling the

Rebekah Tinker:

invigoration of like my strength and I love to feel strong and I

Rebekah Tinker:

love to feel like it makes me feel empowered, not because it

Rebekah Tinker:

makes my body look a certain way but because of like, the

Rebekah Tinker:

abilities like being able to like honor and cherish and take

Rebekah Tinker:

advantage of my body's abilities. Right. But so but

Rebekah Tinker:

it's but it is hard to unwind from this like, am I buying into

Rebekah Tinker:

some diet culture or buying into some kind of muscle bulking,

Rebekah Tinker:

culture, whatever so to it becomes materialistic and also

Rebekah Tinker:

capitalistic. Right? And is that is that about feeling alive in

Rebekah Tinker:

my body? Or is that about numbing from something? That's

Rebekah Tinker:

really hard to discern, which is why so again, so many eating

Rebekah Tinker:

disorders go undiagnosed and untreated?

Rob Gent:

Well, as you're describing, I'm thinking about,

Rob Gent:

well, how much of many of us are striving to disconnect from our

Rob Gent:

bodies? Rather than being mindful and present and

Rob Gent:

accepting and how that feels? Well, thank you so much,

Rob Gent:

Rebecca. So if I can ask, what is a typical presentation? Is

Rob Gent:

there a typical presentation for adolescent? You might be

Rob Gent:

inquiring, or a parent calling you up? Is it? Is there some?

Rebekah Tinker:

Um, no, there's not a typical presentation. In

Rebekah Tinker:

general, a lot of my adolescents that I see who are struggling

Rebekah Tinker:

with disordered eating, or highly intelligent are quote

Rebekah Tinker:

unquote perfectionist to some degree, I'm feeling this like

Rebekah Tinker:

constant strive for perfection. Are they have some sort of

Rebekah Tinker:

trauma history or injustice around their body that they've

Rebekah Tinker:

experienced, or that they are currently experiencing. And, or

Rebekah Tinker:

hyper controlling parents. That's, and when you're in a

Rebekah Tinker:

family system, or, or really high achieving parents, and the

Rebekah Tinker:

Chi, the kiddo then feeling like, well, I'm never going to

Rebekah Tinker:

be as smart as them, I'm never going to be as accomplished as

Rebekah Tinker:

them. So I might as well be perfect in this other way. Or,

Rebekah Tinker:

and that's, you know, I will say that's more so speaking to

Rebekah Tinker:

anorexia, right. Or like, but but on the gender spectrum,

Rebekah Tinker:

it's, it really, truly is like, I don't feel aligned with my

Rebekah Tinker:

gender, I want to escape my body, my body is not a safe

Rebekah Tinker:

place to be. I want gender affirming surgery, gender

Rebekah Tinker:

affirming hormones, to be in the body that makes me feel like

Rebekah Tinker:

myself. And when you're in a family system, or the parents

Rebekah Tinker:

aren't ready for you to go into that, or if you're living in a

Rebekah Tinker:

state, where that's not even accessible. There's not much we

Rebekah Tinker:

can do besides like, Yeah, let's sit with the discomfort, right.

Rebekah Tinker:

So yeah, it's a whole spectrum of things. And I don't know if I

Rebekah Tinker:

can say like, these are the primary things, there's a few

Rebekah Tinker:

that are commonalities. But yeah,

Rob Gent:

well, that's super helpful. Because I imagine if

Rob Gent:

you know, therapists, this is a growing field. And not all

Rob Gent:

therapists are experts. So it's good to know that. Yeah, there

Rob Gent:

are some general things we can look for. But it's, you know,

Rob Gent:

there's a bunch of

Rebekah Tinker:

unique Yeah, and I think another thing like

Rebekah Tinker:

common patterns that these individuals engage in would be

Rebekah Tinker:

not wanting to eat in a group setting, cutting their food

Rebekah Tinker:

really small into small little pieces. So it looks like they've

Rebekah Tinker:

eaten a lot more than they actually have. constantly

Rebekah Tinker:

wanting to weigh themselves, or they do the body checks where

Rebekah Tinker:

you put your fingers around your wrist and you put your fingers

Rebekah Tinker:

around your forearm, around your upper arm, making sure your

Rebekah Tinker:

fingers can always touch or, you know, but but something we're

Rebekah Tinker:

not talking about. And this is then binge eating and binging

Rebekah Tinker:

and purging, and there are less of those body checks. And more

Rebekah Tinker:

so of the like, you know, if you were to look at it and ifs,

Rebekah Tinker:

internal family systems lens, the more anorexia type symptoms

Rebekah Tinker:

are more managerial. And the binging and purging are a lot

Rebekah Tinker:

more like the firefighters and internal family systems, right.

Rebekah Tinker:

And the firefighters are numbing out in these other ways that are

Rebekah Tinker:

a little bit more chaotic. And the managers are numbing out and

Rebekah Tinker:

by way of control.

Rob Gent:

So if I can ask how do you view integrating all of

Rob Gent:

these parts? If you're talking about ifs, all these parts of

Rob Gent:

self How do you really view treatment? I mean, from your

Rob Gent:

lens?

Rebekah Tinker:

Well, I think we need to leave space to hear the

Rebekah Tinker:

story of the manager or the firefighter to keep going with

Rebekah Tinker:

ifs, right? We need to leave space to hear the voice of the

Rebekah Tinker:

eating disorder. And I think a lot of treatment modalities,

Rebekah Tinker:

push the eating disorder. voice out and don't allow that to have

Rebekah Tinker:

room to express itself. And we're not going to get anywhere,

Rebekah Tinker:

if it's like managers and firefighters are there to

Rebekah Tinker:

protect an exiled part. But they're not gonna budge unless

Rebekah Tinker:

they feel validated. And we have to first confront what's

Rebekah Tinker:

protecting the exiled part to be able to ever reach the exile.

Rebekah Tinker:

And so it's a it's about understanding, respecting,

Rebekah Tinker:

having compassion for the engagement in these patterns.

Rebekah Tinker:

And then we can get to what's underneath that. But we first

Rebekah Tinker:

have to have to leave room for for the voice of the eating

Rebekah Tinker:

disorder itself. Leave room for the voice that is experiencing

Rebekah Tinker:

that body terrorism, leave room for the voice that wants to just

Rebekah Tinker:

fight back and as angry.

Rob Gent:

So hear hear the voice. I always used the term

Rob Gent:

empathy before strategy, how many want to move towards

Rob Gent:

strategy right away. But that exiled part is it's going to

Rob Gent:

what you resist persists, right? I mean, it's going to if we

Rob Gent:

don't allow that, that aspect and to hear that voice, we can't

Rob Gent:

possibly integrate it.

Rebekah Tinker:

Right, totally, totally. Um, I

Rob Gent:

like the term extinguish it, because I don't

Rob Gent:

know that it ever goes away. But it's, it's about integrating

Rob Gent:

those pieces. So.

Rebekah Tinker:

Right, right, right.

Rob Gent:

So for for you, you go into this treatment mindset of

Rob Gent:

hearing the voice and doing that. And then most parents are

Rob Gent:

probably wondering, well, when do we get to the strategy? When

Rob Gent:

do we get to the coping skills

Rebekah Tinker:

gives us coping skills along the way, right,

Rebekah Tinker:

we're not ignoring the fact that there's a problem we're talking

Rebekah Tinker:

about. And, and also, side note, family therapy is a must. That

Rebekah Tinker:

is you cannot treat an eating disorder. Without family therapy

Rebekah Tinker:

is an eating disorder, an adolescent or kiddo that is,

Rebekah Tinker:

because majority of the, you know, reasons this child is

Rebekah Tinker:

adopted, these patterns are something in the family system

Rebekah Tinker:

going on. And the whole family has to be on board, if we're

Rebekah Tinker:

going to invite true like, deep meaningful change. Because it

Rebekah Tinker:

may very well be that one of the parents at home has their own

Rebekah Tinker:

disordered eating patterns in their own like swirl of diet

Rebekah Tinker:

culture and kiddos hearing that and seeing that, right? How are

Rebekah Tinker:

we supposed to create change, we can talk all day and our therapy

Rebekah Tinker:

session about it, but they go home, and they're shown the

Rebekah Tinker:

exact opposite of what we're talking about, we're not going

Rebekah Tinker:

to get anywhere, right. And I want to also leave space for the

Rebekah Tinker:

parents to learn, okay, we need to back off from telling them

Rebekah Tinker:

exactly what they're supposed to eat exactly how much they're

Rebekah Tinker:

supposed to eat, we need to back off for a minute. And my

Rebekah Tinker:

approach to that is, this part in the majority of cases wants

Rebekah Tinker:

control. And if you take all of its control away, it's going to

Rebekah Tinker:

start coming out another way. So we give it options, we might

Rebekah Tinker:

need them to eat a certain amount of calories, we can say,

Rebekah Tinker:

Hey, these are all the ways in which you can get these calories

Rebekah Tinker:

you you choose to eat it, you can either eat like this entire

Rebekah Tinker:

plate of pasta, or whatever it is, or you can eat this chicken

Rebekah Tinker:

and veggies or you can eat this like, you know, carrot sticks

Rebekah Tinker:

and peanut butter, like whatever it is like here's your here's

Rebekah Tinker:

your menu, choose from as you please, right, and giving them

Rebekah Tinker:

that freedom because so often in treatment, with all the power

Rebekah Tinker:

being taken away from the client, there's no room for the

Rebekah Tinker:

client to actually understand intuitive eating, and to build

Rebekah Tinker:

that skill of intuitive eating. Because they're, they're not

Rebekah Tinker:

inside of their body when they're eating. They're looking

Rebekah Tinker:

at the other person's judgment and perception and critique on

Rebekah Tinker:

Is this enough, or is this not enough? Right? And we want them

Rebekah Tinker:

to start building that interoceptive experience of

Rebekah Tinker:

feeling their body? What does it feel like after five bites? Can

Rebekah Tinker:

we feel a difference in our belly? Like, can we are we

Rebekah Tinker:

tasting the food? What does it even taste like? I'm starting to

Rebekah Tinker:

find more descriptive words. And we can do that in a session.

Rebekah Tinker:

Sometimes I eat with my clients, we have meals together, or

Rebekah Tinker:

snacks together. And we talk about what does it taste like?

Rebekah Tinker:

Why did you bring that snack or another snack? Not why like how

Rebekah Tinker:

come you like that snack? Right? And getting to know what does it

Rebekah Tinker:

even like? What does it feel like to chew that? What does it

Rebekah Tinker:

feel like to digest that? What does that feel like your body

Rebekah Tinker:

wants that's already there now and what does it feel like 10

Rebekah Tinker:

minutes later after having eaten it.

Rob Gent:

So either Oh, that you're saying we've actually

Rob Gent:

create experiences, we will create some of those experience

Rob Gent:

in the session. And I would imagine you're saying family

Rob Gent:

therapy is so essential? How hard is it to break that?

Rob Gent:

homeostasis, if you will, the family system to be because they

Rob Gent:

need to take it home? Right? I mean, they've got to take it out

Rob Gent:

of the office to practice these things. I wonder, in your

Rob Gent:

experience, I would imagine, sometimes it's pretty difficult

Rob Gent:

for the family to change their, their patterns.

Rebekah Tinker:

Yeah, I have worked with many families at

Rebekah Tinker:

this point, and the majority of them trust what I'm doing with

Rebekah Tinker:

their child, but they push back a lot. Um, for the most part,

Rebekah Tinker:

there's like the original push back on, on my inquiry into into

Rebekah Tinker:

their self inquiry, I suppose. There's a lot of pushback and a

Rebekah Tinker:

lot of like, well, it's not us. It's just that men and like,

Rebekah Tinker:

we're not, we're not helping your child. By identifying them

Rebekah Tinker:

as the patient. We cannot just be identifying them as the

Rebekah Tinker:

patient, we have to say we're all in this together, we are all

Rebekah Tinker:

learning new coping skills, we are all learning new ways to be

Rebekah Tinker:

as a family. And you just happen to like, inform us that we all

Rebekah Tinker:

need to be here. And parents eventually get really on board

Rebekah Tinker:

for the most part. But there's a lot of families who push back

Rebekah Tinker:

and a lot of families who just no show in the family therapy

Rebekah Tinker:

sections. And that's a tricky thing to navigate Of

Rob Gent:

course, when the no show perpetuates the problem,

Rob Gent:

right?

Rebekah Tinker:

Exactly. Exactly.

Rob Gent:

Yeah. Can I ask for a therapist and professionals

Rob Gent:

listen to this? What are some? Are there some resources that

Rob Gent:

you give the family I mean, if there's recommendations or any

Rob Gent:

resources that you'd like to recommend?

Rebekah Tinker:

Yeah, I think there are a lot of really

Rebekah Tinker:

awesome books on eating disorders. Shrill by Lindy West

Rebekah Tinker:

is a really good book. The body is not an apology is a really

Rebekah Tinker:

great book by Sonya, Renee Taylor. There's there's also a

Rebekah Tinker:

workbook that comes along with that. The Hayes approach healthy

Rebekah Tinker:

at Every Size. There have a website that has a ton of really

Rebekah Tinker:

awesome resources on it. On my website, there's also a bunch of

Rebekah Tinker:

different books that you can find.

Rob Gent:

So mention that website real quick. So if they

Rob Gent:

if they want to go to

Rebekah Tinker:

maker.com. So our EB kh

Rob Gent:

Great. We'll post that on there too. Yeah, so people

Rob Gent:

can access it.

Rebekah Tinker:

Yeah, yeah. Another really great book that

Rebekah Tinker:

just came out recently. A is I'm glad my mother died.

Rob Gent:

This book, No, it's provocative title.

Rebekah Tinker:

I know. And, but it's really awesome. Because the

Rebekah Tinker:

author, which I'm blanking on her name in this moment, but I

Rebekah Tinker:

can find it in a second. Um, she was a child actress. And so she

Rebekah Tinker:

was very much in that social media world. She was very much

Rebekah Tinker:

in. She's one of the people that we look at to say, That's what

Rebekah Tinker:

our body should, should be right. And she comes out as

Rebekah Tinker:

having an eating disorder. And her mom really enforced her to

Rebekah Tinker:

have the eating disorder so that she could be in this community

Rebekah Tinker:

anyway. It's a it's a really awesome memoir.

Rob Gent:

Incredible. Well, thank you for the resources, I

Rob Gent:

know the those will be helpful for the professionals listening.

Rob Gent:

I always love to ask if I'm a therapist or a professional,

Rob Gent:

what are the top three things I should know about? Doing eating

Rob Gent:

disorders or the LGBT trans community? What would you say?

Rebekah Tinker:

I would say that you have to consider this body

Rebekah Tinker:

terrorism, you'd have to consider the society, the

Rebekah Tinker:

environment and the systems that we're growing up inside of that

Rebekah Tinker:

those cannot go unlocked, because that is the source of

Rebekah Tinker:

validation that the majority of our clients need to hear.

Rebekah Tinker:

Whether it's that the eating disorders onset was from sexual

Rebekah Tinker:

assault, whether the eating disorder onset was from not

Rebekah Tinker:

feeling aligned with their sexual characteristics, or their

Rebekah Tinker:

gender assigned to them, whether it's because of a loss or

Rebekah Tinker:

whatever, they all of these things lead them to not be in a

Rebekah Tinker:

normative space. case, right? And lead them to be more ridic.

Rebekah Tinker:

more apt for ridicule, judgment, shame, etc. And these things

Rebekah Tinker:

always have to be considered, the systems in the environment

Rebekah Tinker:

always have to be considered for the kid or the adolescent to

Rebekah Tinker:

actually feel heard, I think that's the by far the number one

Rebekah Tinker:

thing, and then also the eating disorders don't have a look.

Rebekah Tinker:

Right, they don't look a certain way. You can see a perfectly

Rebekah Tinker:

healthy looking individual come into your office, and they may

Rebekah Tinker:

be one of the sickest clients you have. And, and to also look

Rebekah Tinker:

at your own biases, and your own intersectionalities, and how

Rebekah Tinker:

that are informing your care, because they're always going to

Rebekah Tinker:

be informing your care, and making sure that you're really

Rebekah Tinker:

owning up to all of that and doing your own self inquiry.

Rob Gent:

When I'm even thinking of that this can be the

Rob Gent:

terrorism or the degree cannot be judged, in the sense of, I

Rob Gent:

think of little what might be perceived as little looks or

Rob Gent:

gestures or ridicules or even, you know, jokes or whatever,

Rob Gent:

somebody might not feel like they're a big deal. But like, I

Rob Gent:

mean, they can just be profoundly painful, as they

Rob Gent:

continue to stack up. And there's little, you know, all of

Rob Gent:

these, maybe even more than micro aggressions, but they're

Rob Gent:

all these little things that take place that, you know, we

Rob Gent:

need to grow in our sensitivity, not just as therapists

Rob Gent:

professionals, but as a society that,

Rebekah Tinker:

yeah, absolutely, man, you know, it's

Rebekah Tinker:

like in comedy culture, right? Like, why are we, it's not funny

Rebekah Tinker:

to be making kind of some that make fun of yourself, if you

Rebekah Tinker:

need to make fun of someone, make fun of someone like you, or

Rebekah Tinker:

that is you don't make fun of folks who are disabled, or who

Rebekah Tinker:

are trans or who are females, or like rape culture, or whatever

Rebekah Tinker:

it is like, that's, it's not funny, you did take that away.

Rob Gent:

I appreciate that. So my last question is, Rebecca, is

Rob Gent:

that if I'm a therapist, or professional looking into this

Rob Gent:

eating disorder thing, you know, in the world of psychotherapy,

Rob Gent:

there's all kinds of evidence based modalities that get added

Rob Gent:

every year to SAMSA. I'm just wondering, when it comes to

Rob Gent:

eating disorder, you know, is there a bunch of modalities?

Rob Gent:

What should we consider what's, you know, is there something

Rob Gent:

that are more attuned that others I know that you spoke of

Rob Gent:

intuitive eating happens to be one organized form of this?

Rob Gent:

Maybe just speak a little bit to? Yeah, what is the world of

Rob Gent:

eating disorders? And modality? How do we go about navigating

Rob Gent:

that?

Rebekah Tinker:

I think the majority of system approaches

Rebekah Tinker:

are really great with eating disorders, internal family

Rebekah Tinker:

systems is really awesome working with eating disorders.

Rebekah Tinker:

Also, looking at Health at Every Size, is an awesome model that

Rebekah Tinker:

you can kind of like shift in your own way to meet your

Rebekah Tinker:

specific client. psychodynamic approaches course, also,

Rebekah Tinker:

including like CBD, CBT. So like giving homework and tools and

Rebekah Tinker:

coping skills, right, that's always really important. Yeah,

Rob Gent:

okay. So there's not, I'm not hearing you say there's

Rob Gent:

this one eating disorder modality. No, no, no, it's got

Rob Gent:

to be the DBT of eating disorder is what you have to do. I'm not

Rob Gent:

hearing you say that.

Rebekah Tinker:

Right. And that's, yeah, and I just think

Rebekah Tinker:

that especially like, because, because it is such a systemic

Rebekah Tinker:

issue. And it's, like, issue of inequity in our society that

Rebekah Tinker:

we're dealing with, there's not I don't think any one modality

Rebekah Tinker:

is going to work. I mean, I would encourage folks to move

Rebekah Tinker:

from a more like, liberation psychology lens from like,

Rebekah Tinker:

Health at Every Size lens from internal family systems based

Rebekah Tinker:

lens. Right, but I don't think that ya know, there's not like

Rebekah Tinker:

one modality and I don't know, maybe, maybe there is one out

Rebekah Tinker:

there that I'm unaware of, but I but I highly doubt there's going

Rebekah Tinker:

to be one that fits for everybody, especially when we're

Rebekah Tinker:

thinking about the differences of gender, the differences of

Rebekah Tinker:

symptoms and the differences of experiences that led to the

Rebekah Tinker:

onset, etc. Yeah,

Rob Gent:

great. If I, if I'm a parent, and I suspect my just

Rob Gent:

have, you know, suspect something's going on, what would

Rob Gent:

you recommend? If I'm a parent, where do I go? Who do I talk to?

Rebekah Tinker:

First you got your own therapy. I would say if

Rebekah Tinker:

you and try and have a conversation with your kid in a

Rebekah Tinker:

non shaming way, but by saying like, Hey, how are you doing?

Rebekah Tinker:

Like, be upfront, be confrontational, seek a

Rebekah Tinker:

therapist for them. If you have serious concerns about their

Rebekah Tinker:

vitals, they definitely need to be seeing their primary care

Rebekah Tinker:

physician on a regular basis to be checking in on that. Because

Rebekah Tinker:

this is a deadly disorder, right? But, but don't shame

Rebekah Tinker:

them. Do your own work. Have compassion for their experience,

Rebekah Tinker:

their suffering, right? And remind them about the joy one

Rebekah Tinker:

can feel when being in a body? And show that to them by

Rebekah Tinker:

example. And ask yourself, are you feeling alive in your body?

Rebekah Tinker:

And if not, maybe figure out ways in which you can start

Rebekah Tinker:

doing that and showing your kid that aliveness and, and having

Rebekah Tinker:

your kid join in on you join in with you on those activities or

Rebekah Tinker:

experiences. reminiscing on that joy that maybe you once felt or

Rebekah Tinker:

that you saw your kiddo once feeling and returning to that

Rebekah Tinker:

together.

Rob Gent:

Super so helpful. I keep saying the last thing to

Rob Gent:

say but this is lesson musei. I wonder if people say are you

Rob Gent:

ever cured? Or is it remission? Is it? How do we talk about this

Rob Gent:

thing? Because you know, when it comes to alcoholism, people say

Rob Gent:

it's not a cure. It's a maintenance. I don't know, how

Rob Gent:

is it with eating disorder.

Rebekah Tinker:

I have fluctuated, but I don't think

Rebekah Tinker:

that it's a cured. I think that it's at one point, the voice is

Rebekah Tinker:

in the driver's seat. And then maybe the voice moves to the

Rebekah Tinker:

passenger seat. And then maybe at some point, the voice gets to

Rebekah Tinker:

move to the way, way back. But it's something that likely is

Rebekah Tinker:

always like in our van, so to speak, or driving this like

Rebekah Tinker:

really long fan. Hopefully it's in the way, way back. And we

Rebekah Tinker:

might hear a pipe up every once in a while. We might have little

Rebekah Tinker:

memories of its voice if we can't hear it any longer. But

Rebekah Tinker:

it's there. And it's a part of our past and in our past doesn't

Rebekah Tinker:

just stop existing. It's always a part. It's always informing

Rebekah Tinker:

who we are today. You know.

Rob Gent:

Wonderful answer. Rebecca, thank you so much. And

Rob Gent:

I want to say to all the listeners, I mean, it has been

Rob Gent:

an absolute I've learned so much from having Rebecca on her

Rob Gent:

podcast. I'm so grateful to you. This has been Sessions with

Rob Gent:

Rebecca tinker. And yeah, please access podcasts wherever you get

Rob Gent:

those and access though and we just really love having you. So

Rob Gent:

Rebecca, thank you so much. Appreciate it so much.

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