Season 2 Episode 7: Understanding & Treating Eating Disorders featuring Cindi Miller

Cindi Miller, LMHC (IN), LCMHC (NC) is an eating disorder specialist and shares her knowledge and expertise on what is needed to assess for eating disorders and the down side of referring out too quickly. 

Cindi is a mental health counselor licensed in North Carolina and Indiana. She is a coach at heart and was a collegiate volleyball coach for 7 years prior to becoming a therapist. This is where Cindi’s passion for mental health and exploring the roots of perfectionism began. She saw countless athletes struggling with body image, poor relationships to food and exercise, and full blown eating disorders. Cindi then began working in a residential and PHP treatment center to further her education around eating disorders and is a loud and persistent advocate for body acceptance, reducing shame and stigma around body size, and educating on the dangers of eating disorders and their parallels to “being healthy” and diet culture. Cindi also provides psychoeducation and coaching around anxiety, depression, burnout, boundaries, and perfectionism to athletic departments, teams, corporations, and individuals.

OFFERS & HELPFUL LINKS:

• Counseling Community TikTok
• Jennifer Agee coaching page
• Counseling Community Facebook community
• Counseling Community Instagram
• Alaskan Cruise: Experiential Therapeutic Intervention Training for Therapists June 3-10, 2023

Portugal Marketing Retreat October 2-7, 2023

Transcript

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Jennifer Agee: Hello, hello, and welcome to Sh*t You Wish You Learned in Grad School. I'm your host, Jennifer Agee, and with me today is Cindi Miller. Cindi is a licensed mental health counselor and a confidence and boundary coach. So, welcome to the show. 

Cindi Miller: Thanks for having me. 

Jennifer Agee: Cindi and I are gonna be talking about a topic that intimidates the crap out of a lot of therapists, so I'm glad she's here. We're gonna be talking about eating disorders. So, thank you so much for coming on, and for being willing to kind of help us understand this topic a little bit better. 

Cindi Miller: Yeah, absolutely. I think that, um, you know, "scares the crap out of a lot of people" is a common thing to hear, especially if you are newer in the field or even seasoned. Um, I always tell this story of I had a super-, uh, I guess it wasn't a supervisor, a professor who worked in the prison system and worked with, you know, the quote-unquote worst of the worst, right? Like the, um, people who had, um, committed murder and these sorts of things. And, uh, one day we were chatting just after class, and he told me, he was like, I would never do what you're gonna do. Like, I am so just, like, thankful for someone that goes into eating disorder work because, like, it is a really hard avenue to, to go into. And that scared the crap out of me. Speaking of that, of like, oh my gosh, what am I missing? Um, and, and I think that a lot of therapists stray away from eating disorders. One, because they're told to. If you don't have knowledge, experience, education around it, um, then refer out. And as you and I spoke before, that is one of the biggest things that I think, um, hinders our growth as, um, a therapeutic community to be able to support people who have disordered eating, um, negative relationships to their body and food, um, that maybe don't meet, um, classic criteria of an eating disorder per our DSM, but are still struggling with the same things that can lead to that. And, um, how do you learn, but by doing and, and, and reading and doing your own research. So, um, I got into eating disorders because I saw it so much in the work that I do. Um, I work with athletes. I was a coach before I became a therapist. And, um, eating disorders are at least four times higher, um, in the athletic population than in the general population. Um, specific jerseys, body, aesthetic expectations, um, striving for perfection... All of these traits kind of make sense. Um, and so I think that eating disorders, in and of themselves, um, also have a medical component. It is the second deadliest, uh, mental health disorder, um, right now. And it was first before the opioid pandemic or epidemic that has happened. Um, and so, a lot of people, I think, stray away from that. Like, it is a dangerous mental health disorder because of the medical complications that can come in. Um, I will stop talking to see if you have any questions, or I could just keep rambling. 

Jennifer Agee: No, that's super helpful. Because I do, I do think, um, people stray away from eating disorders because it's intimidating, especially if you have not had lived experience with disordered eating, or you know you have disordered eating and you're not ready to look in the mirror yet and, and kind of deal with that. And I know, if I'm being perfectly honest here, which I try to be on this podcast, um, I am like medium to larger body size, right? And I've always felt pretty confident in who I am and, and all of that stuff, but I also was always aware that I wondered what my physical presence in the room would feel like to someone who was really struggling in those areas. And, and that was kind of my own part of... that, kind of held me back from really looking at this, this part of the field for a while. 

Cindi Miller: Mm-hmm. And something that you just mentioned about, like, either not having experience in it or not having lived experience. The alternative is that I think every single human on this planet, at least in the United States of America, because that's where I have gathered, uh, you know, my, my research, um, has lived experience with conflicting values around food, body, um, our body expectations, our body. Um, what is chic, what is in, fluctuates as much as fashion trends. Um, we are seeing that right now with some of the most prominent body-focused celebrities, the Kardashians. Um, they went through a span of thicker is better, look at my big butt, like these sorts of things. And all of them have now, are on, are trending downward in a weight loss. Um, and, you know, that is part of this system that I think that we are all impactful, and so on, impacted by. And, and so, you speaking to, like, also some unresolved stuff, I think clinicians, therapists have, um, there is almost like a hierarchy and um, of goodness that we, if I am doing this, this, this, and this, then I am good. If I am eating healthy, if I am exercising X times a week, if I am doing these things. Um, all of those things are great. We know, I think a lot of the times when I speak from a health at every size framework, which is the lens that I, one, do my work by and, two, live my life by, a lot of people push back. So, like, you're saying that I can just eat whatever I want? Like, yeah. 

Jennifer Agee: Mm-hmm. 

Cindi Miller: Yeah. I, I am. And like our bodies, we don't give our bodies enough credit to do what they do, and we're going to, you know... So, I think that there is a little bit, I've seen, um, lots of like, can I walk on a treadmill while doing therapy? Can I, like, how do you guys get exercise? How do y'all get exercise? How do like– This obsession with movement during the workday or during while I'm supposed to be present with my clients, I will admit it activates something in me because I know that I would fire a therapist if they were walking on a treadmill while I was trying to like pour my heart out to them, because I would read that as their exercise is more important. Um– 

Jennifer Agee: I would too. 

Cindi Miller: Yeah. Okay. And because on the flip side, I know there's a lot of people who, you know, have fidget toys and are neurodivergent and this sort of thing, and so, from that aspect, like, I'm not saying, like, I play with putty 90% of the time, but it is under my camera, and it is so I can focus. And the correlation between treadmill and the world in which we live is weight loss, is move like movement, 10,000 steps, like all of these things. And therapists, just because we have awareness to this being a potential problem, doesn't equate to being fully healed and our own journey towards that. 

Jennifer Agee: Yeah, and, and I think, you know, thinking back on just my own relationship with food and stuff is if, if you're not anorexic or bulimic, that doesn't mean that you d-, that you have a healthy relationship with food. Right? And I think, again, feeling intimidated to really walk into that space of working with people who struggle in this area, because I've not been anorexic or bulimic. I remember distinctly when I was in, I think, eighth grade, I decided I wanted to be anorexic because thin was in, like, big time, right? And I was just always, I'm curvy. Like, I'm a curvy girl. And, uh, I thought, okay, I'm, I'm gonna do this, right? And I lasted—it was like on a Sunday—I lasted until after church and my dad made, like, Frito pies, and he is like, you want one? I smelled it. And I was, like, yep. So, I mean, it was like four hours of a decision. I just couldn't stick with it. And I'm like, hmm, you know? And, and just realizing that disordered eating and, and eating disorders are not just anorexic and bulimia, anorexia and bulimia. Can you talk a little bit more about that? 

Cindi Miller: Yeah. Yeah. And so, one of, like, so, um, binge-eating disorder is also a very, um, common eating disorder and it is also oftentimes misdiagnosed, uh, for people who are in larger bodies. Are quite often given the diagnosis of binge-eating disorder, where they actually might suffer from anorexia, what we call in the DSM. And I could go into this about the fat phobia of the, the criteria. There has to be a BMI. Uh, again, that's a whole other hour of, of ranting from me. Um, but most people who binge eat have restrictive tendencies. Um, whether it's mental or actual physical, like, restricting, um, breakfast, lunch, dinner, and then gorging yourself at night. Like, oh my gosh, I'm so out of control. Yeah, 'cause your body's hungry. Like, your body's doing its job. Your body's protecting you. And so, I think that, you know, anorexia is the, is the most prominent one we see. Like, when we see it in movies, when we hear it, read it in books, when we talk about somebody with an eating disorder, you imagine emaciated, frail, um, starving. And there are, um... I'm gonna go blank on the exact 'cause I tie in, there's otherwise specified feeding and eating disorders, and most people fall into that category because the criteria is so harsh and like exact for bulimia or for anorexia that otherwise specified is there's purging disorder, there's atypical anorexia, um, there's like the binge eating disorder. There's just so many different feeding and eating disorders that I, I wish and I'm hopeful that we're in this push for, um, all body sizes experienced eating disorders. Um, all people, all genders, all, um, socioeconomic status, all– Everybody is impacted by this world in which we live, which we call diet culture, and how one should live. Um, and, and so, anorexia is, like I said, the keynote, is the one that everybody is aware of, um, but it's actually not the most prominent or most often diagnosed. Um, one of the leading pushes for a new diagnosis that's been coined but not quite into the DSM yet is called orthorexia, and ortho meaning straight. So, orthorexia is the obsession with clean eating. Um, this is where that falls into, um, mental health and body and physical health come into play a lot, because if I eat perfectly, then my body will be better. And this is where I think like the mental health overlap happens where some harm can be done by clinicians is food is not medicine, food is, you know, not going to fix your depression, exercise is not going to fix your body image issues. Um, I think that a lot of the times those things are thrown out, and then they become obsessive. So, that is kind of where I see a, an overlap or a conflicting experience with, like, mental health and physical health.

Jennifer Agee: Yeah. Well, and some of what you're talking about even I think has, has flavors of OCD to it. And I think our relationship with food is, it's complicated, right? Because it's necessary for our survival and also, especially, I can just speak as an American 'cause that's what I am, um, food is associated with almost every major event in your life that has both positive and negative, uh, emotions attached to it, right? When you have a birthday, you get special, you get to pick what you want to eat, and you get a special treat. When you graduate, you, you know, there's always food involved. If you go to a funeral, like... There's so many things that are paired with strong emotion are also paired with comfort and food. Food, comfort.

Cindi Miller: Mm-hmm. 

Jennifer Agee: Like, and so, we have been doing this all of our life, you know, making that pair in the brain and in the body. So, when people say, how could I end up with this issue? I'm like, well, your brain has been making this pairing forever to go to food for comfort. So, why would your brain not go to where it's gone to before to feel better? Like– 

Cindi Miller: Mm-hmm. 

Jennifer Agee: That part isn't rocket science to me. 

Cindi Miller: Sure, and you're spot on, and it is a global experience. Food is communion, food is collective, food is something that we do exactly like you said. Like, you move into a new house; your neighbors bring you a treat. Someone in your family dies; people bring you food. You have a new baby; people bring you food. Like, it is a, it is a collective experience. And I once had somebody tell me that food to them was spiritual, and I thought that was so profound because the way they explained it was the people that they're around, like, enjoying the food that they had prepared together and how, like, that brought them together. And, you know, food being emotional, I, like, that's like I emotionally eat, and we feel so taboo about saying that. That is what food is supposed to do. Like, from an evolutionary standpoint, if food didn't taste good, if food didn't make us feel good, we probably wouldn't have eaten it as much. 

Jennifer Agee: Right. 

Cindi Miller: We probably would not have survived, right, because we weren't constantly seeking out, like, ways to nourish our bodies from a, like I said, like from, like, an evolutionary standpoint. And I think that that ultimately where diet culture comes in is like perfecting food or like the calculations, macro counting, all of these are teetering on disordered eating because at the end of the day, food is the thing that we have to do to keep us alive. This is another reason why eating disorders is so hard. Um, you know, I work with, I've worked with addictions and eating disorders separate, like substance use addiction. And, um, even though it is hard and it is not an easy task by any means, you can avoid your substance.

Jennifer Agee: Mm-hmm. 

Cindi Miller: You can. And like I said, it is not an easy feat by any means, and eating disorders, you have to face your food, your, your fear, this, this feeling, up to six times a day in like a, an avid recovery sense of where we're trying to keep blood sugars high and, and all of that. So, it is, when you talked about like the OCD trait, like, eating disorder recovery is, um, exposure therapy, every single day, multiple times a day. And it can feel really overwhelming. 

Jennifer Agee: Mm-hmm. That, that makes perfect sense to me. I think women get associated more with having eating disorders, but I know plenty of men who have highly disordered eating or um, body dysmorphia and things like that. Can you talk a little bit about, about some of the differences of what you see men and women coming to treatment for, or who, who doesn't reach out, and what should we be looking for? What assessments should we give? 

Cindi Miller: Yeah. Um, I think that every, um, every intake should have questions regarding food intake. Um, are you drinking water? Are you eating food? What would you say your relationship to food and exercise is? Um, and oftentimes, when I ask about exercise, I mean, I'm, I'm looking for disordered, like, obsession when I ask that question. And when I ask that question, I, I kid you not most of the time, I see people go, I don't. I see their like, I don't exercise. I'm bad. I'm unhealthy. 

Jennifer Agee: Shaming. 

Cindi Miller: Shame. Like, it is an assumption that because I'm asking about their exercise, and I genuinely, like I said, the work that I do, people are coming to me oftentimes with an obsession over, like, their body or that sort of thing. So, I'm asking it from the lens of are you obsessed with it? Is it becoming a problem? Is it unhealthy? And they often see like, not as much as I should. It is so quick. So, I think that you can learn a lot about people's experience when you ask about, um, food, movement, um, and their bodies. What is your... There are, um, assessments out there. There's the EAT-26. That's a good overall one. Um, and, but most of the time, I think that, like, checking in on the disordered eating, the maybe like negative body image, or, um, correlation to their body can just be done in the intake of asking questions. Um, and then there's, recently, I took on, um, uh—I guess it wasn't recent—uh, a client who, it was anxiety that was the main, and, um, I only genderize it because it is important to the topic is that, um, he was not interested in body image work. 

Jennifer Agee: Hmm. 

Cindi Miller: And we started to get more comfortable talk and that sort of thing. And what came to was that severe negative body image. Like, so much so that it was preventing this person from doing the thing that they wanted to do, where they just thought it was basic old anxiety, like just fear of, like, of what was happening. Um, but then we got into there's some social anxiety that comes up with negative body image a lot, fearing what other people are gonna think of you. So, I always, like, challenge people if you notice like really high social anxiety, is it because of how they feel about themselves in their body, as well, is a good question to ask. And so, and then men, um, more so, or male-identifying, uh, folks, oftentimes, are not the ones to seek out treatment. And if they are, they're the first ones, I work primarily with athletes, so they're the first ones on their team. Or they, um, don't talk about it with anyone else, so they, you know, reach out to me. So, it can be their one space. Um, but there are expectations on, um, male-identifying folks just as much as women. Uh, just as much as questionable. Just as much, we have, you know, we still live in a patriarchy. It's like all of the, the broader sense of the thing. Um, but I think a lot of the times because of that, men who struggle don't reach out.

Jennifer Agee: Mm-hmm. 

Cindi Miller: Because that's a female problem, or only women deal with that, or that's a, you know, I shouldn't have this problem. 

Jennifer Agee: Mm-hmm. What do you think drives most people to finally reach out for eating disorders?

Cindi Miller: Um, usually family or friends are starting to notice, and starting to point it out. Uh, because nobody starts—you kind of gave your story a little bit—nobody starts out with starving themselves. I think that's another misconception is that tomorrow I'm never going to eat again. Because, one, our bodies aren't made to do that. Like, you're going to, you know, significantly feel exhausted, fatigue, like, quickly. Um, but also, a lot of people are trying to do it secretly, and trying to, and that eating disorder brings up a lot of shame. Um, and so, it's done in secret. It's done, you know, cutting out breakfast because nobody's around or these sorts of things. So, a lot of the times it's once it has become a problem that they reach out. Um, and that's where I like to, like, shout through my megaphone that if you don't have a healthy relationship to food and your body, it's worthy of care. And I think that for a therapist, like, that process is not out of your scope of practice. It is more than, you know, it is figuring out who someone is in their relationship in that, in that tie. So, um, yeah. 

Jennifer Agee: How do you recommend people start to make that distinction, right, if someone's in your office of, based on our relationship, I think I should continue to see them 'cause I think I can help and I think I might need to refer out? What are the things that, that you think we need to look for to make that decision? 

Cindi Miller: Uh, so I think that, one, educating yourself on the diagnoses and in the DSM, like, learning about eating disorders. We know 10% of people have a diagnosable eating disorder, and those are the only ones that are reaching out. So, we know that that number is higher. And so, the likelihood that one in ten of your clients probably has, you know, a, like, distinct, um, issue with food or their body. Um, so, first of all, educating yourself on what that looks like, um, and, and knowing that it's not just complete starvation or that it's just people who show up in small bodies. Um, people in all body sizes. Again, this is kind of a, um, way in which it gets missed a lot is, um... and then also educating yourself. There are so many good books out there, um, written by good clinicians. There's, um, "Eating in The Light of The Moon." There's "The Body's Not an Apology." It's one of my absolute favorite books. Sonya Renee Taylor, um, just kind of really speaks to—and here's my cat joining us for the, for the last bit—um, "The Anti-Diet" by Dr. Christie Harrison. She's actually just coming out with a new one called "The Wellness Trap," and I am beyond excited to see, um, what that is going to read. Um, and there's just a lot of texts out there that I think everyone should read.

Jennifer Agee: Mm-hmm. 

Cindi Miller: Um, and by the should part of, because you don't know if someone has an eating disorder by looking at them, by first initial consult, by assessment. It's not something that's usually asked on the 15-minute consult. 

Jennifer Agee: Mm-hmm. 

Cindi Miller: How's your relationship with food is not generally a question. Um, and so education, one, and then the referring out piece, I think it becomes around confidence. And if you feel like it is out of your scope, instead of just automatically like, nope. Eating disorder. Nope. Like, oh, you don't like your body. Like, nope, can't do it. Gotta refer out. Because, personally, there's not a lot of clinicians who see eating disorder clients, and I think there needs to be more. And I think that it needs to be something that we're not, um, you know, so afraid of and, and quite honestly, I think, gatekeeping a little bit in the world of eating disorder treatment because if you are not living, breathing in a treatment facility every day, like, where are you gonna get that information? And so, um, I think just checking your own bias too. Like, if you are putting out, if you're feeling uncomfortable because of what they're sharing, maybe that's a time to refer out. Um, if you feel like they need a higher level of care, um, and what that, you know, there's breakdowns from the APA that give you step-by-step instructions on what is a higher, what is required for a higher level of care. And you know, from that outpatient up, another outpatient provider that, that sees eating disorders specifically might be more helpful in that sense because then they're gonna have connections to dieticians and primary care doctors and psychiatrists who also are a little bit more informed. Um, so, I feel like it just shouldn't be like a gut reaction of like, oh, they aren't eating; I'm gonna refer out. I think that it should be something that is communicated with, and, and discussed, and then really processed. Um, I think that was in some recent, uh, episode that you had on countertransference?

Jennifer Agee: Yes. Uh-huh. 

Cindi Miller: Yes. That is huge on what you have, like, how you have created, um, your own relationship and how is that showing up if someone is saying they're doing X, Y, Z and you don't think that they should be doing that. Like, you know, how are you potentially projecting that onto them, instead of, like, allowing their journey to be theirs?

Jennifer Agee: Absolutely. And, you know, I love that you brought in the fact that you are wanting to work with a community of surrounding people with kind of a tribe that's there for their good, primary care physicians, dieticians, and things of that nature. I forget the statistic. Man, I wish I could just pull it outta my brain 'cause it's in there somewhere. But how many people, especially after COVID, did not want to go to the doctor because they had to get on the scale? And so, doctor's offices, it was so noticeable that people, that they started making these like little infomercial things, like, you can say, I don't wanna be weighed today. You can say that and still come in to get your blood work done and different things like that. But, you know, um, having, having a good relationship with your doctor where you can speak honestly about what's going on in your body can be helpful, because sometimes you get into unhealthy relationships with food or your body's holding weight or whatever because there are physical components. There are, there are physiological things that are happening that are afoot that, you know, talking is not gonna, it's, it's only gonna get you so far if something physiological is taking place that needs to be addressed by, uh, you and your doctor.

Cindi Miller: Yeah. Yeah. I think that's where, you know, advocacy is so important and something that, you know, in my place of my journey at this point, like, I could care absolute less what my weight is. Um, and it does not impact me to see it on the scale. 

Jennifer Agee: Mm-hmm. 

Cindi Miller: And I still refused to be weighed at my doctor. I'm a yearly doctor's appointment because I wanna make it more accessible to people who are shamed and who are, um, given the, the up-down look, uh, when they're asking to not be weighed, um, and to make it more normal. And I can't tell you how many times I've had people of all body sizes try to refuse to be weighed and be shamed by it by nurses, the med assistant or, like, medical assistant, the... And, you know, it is just one metric of, of a vitals, of a over- overlooking thing. I also, I think that nobody should have a weight, a scale in their house. Like, what is the point of that? There is no medical, uh, issue that requires like a daily, weekly weigh-in. There isn't. There's not. There are medical conditions that drastic weight loss or gain, absolutely, that's going to be at your doctor's appointment on a yearly or every, you know, twice a year, um, cycle. And you know that you can refuse. I think that is something that's really important. Because, like, to think about going to the doctor and being shamed for your weight and I can imagine people are sitting here uncomfortable with that because your first thought might have been, well, they shouldn't be that big then if they're worried about their weight.

Jennifer Agee: Mm. 

Cindi Miller: And that is our first thought because of the society that we're in. Even if you're the nicest person in the whole wide world and you're like, oh my gosh, like I would never say that to someone, if that was your first thought, you probably have some work of unlearning of what we believe or deem to be healthy.

Jennifer Agee: Yeah. Well, I, um, I heard a doctor—now it was on TikTok; they are a medical doctor, but it was on TikTok—um, but the doctor was saying the reason that you, your weight is always discussed with you if you're over a certain BMI is that after your weighed, the insurance company requires that they provide you information about obesity, um, in order for them to be reimbursed for that office visit. I was like, what the actual beep, you know? Come on now. Come on. 

Cindi Miller: Yeah. Our insurance companies are like the farthest behind in, um, in body diversity in and of itself. And, um, and it is really sad. And I, like, that, I know specifically with people in eating disorder recovery who have found a place of contentment who have not stepped on a scale in years, um, to be then sent a pamphlet in the mail after their doctor visit that was about a sore throat, saying like, you're obese and that's a problem, um, spiraling into, you know, a traumatic relapse. Because this is a place that's supposed to be safe and, like I said, I think I touched on BMI and that sort of thing earlier, and that could be like a whole, uh, in of itself. But it shows how, and that's one of the reasons why eating disorders are so hard to work with. Because we live in a, um, very, very, um, discriminatory world for people in larger bodies. Um, and so, to say like, hey, you, you know, your body might want to recover in a place that's bigger than maybe you've ever been is really freaking hard. 

Jennifer Agee: Mm-hmm. 

Cindi Miller: And like, understandably so. Like, here I am telling you like, hey, well, that's where your body might wanna be. And you're like, yeah, but I can't fit into the doctor's office chairs because they have arms on them. I can't fit. You know, our world doesn't support health at every size and body diversity. And so, I think that is a big proponent of like, why it's so hard to recover. 

Jennifer Agee: You just brought up a point I want to, to kind of snake in here, which is, as a clinician, make sure your office is friendly for bodies at different sizes, at every size, right? So, like in our waiting room, we have, um, we have a loveseat, there are some chairs; there's, there's different options, so people can sit where they feel comfortable. Um, because again, you want them, from the beginning, to know that your place is a place of healing. They're not having to then think about, I, I wanna show up just as soon as she's gonna open the door because I don't wanna have to stand because there's people around and they don't, what if I don't fit?

Cindi Miller: Absolutely. And I think that for clinicians in and of themselves, it is not your job to police bodies. 

Jennifer Agee: Hmm. 

Cindi Miller: And that is oftentimes, I, I went on a big rant a couple of months ago because I got bombarded with a how to treat obesity training that is in our world. And it blew my mind that we are still in a place that, that we think that is within our scope. And, you know, helping people to reach goals. And this is a lot of people like do not know, I work with people who are like, Cindi, I am trying to lose weight. 

Jennifer Agee: Mm-hmm. 

Cindi Miller: And you may not like that and X, Y, Z, and they, it's, I tend to have some pretty jovial relationships with the people I work with. Um, and, and the thing is, is if you think that's going to make you happy, That's your choice. It should never come from the clinicians. Maybe if you lost weight, you'd be happy. Like, it should never come from a professional's, um, own idea book or perspective. Like, that is when that countertransference, that is when your own bias is showing up. Um, because someone may not even think about their body, and then you're like, well, have you tried exercising? Like, maybe if you tried moving a little bit, like, then maybe you'd be ha-, you know? There's just a, an expectation there. So, I, I am grateful that your office has that and that you've been conscientious about that because I think that is so important. And a lot of people ask for like chair recommendations and that sort of thing. And it is important and people who, I think that it's not just, like, well, now we're just like appeasing people in larger bodies. Like, what if someone wants to, like, put their legs up because they're neurodivergent, or they wanna have their legs crossed because they fidget too much. Like, all of these things come into play when we think about, like, a welcoming and safe place. 

Jennifer Agee: Absolutely. Yeah. And I, you know, none of us get into this because we wanna be jerks, right? Most of us get into this as helpers and healers because we genuinely care for people. And I think a part of what I hope this, uh, takeaway from this conversation is, is that if this is an area where you are in the needs improvement category, right, for your knowledge base, don't be intimidated by it. You do not have to have been through it yourself. You don't have to actively work at a treatment center to work with eating disorders. But you do need to get yourself some education so that you are not doing harm as a part of, of doing your work with people. Reach out for consultation if you want to. I mean, think of how many things at the beginning of your career you did not know until you went to a training, and you sought out consultation and different things like that. This is one more area, and I agree with Cindi, we need more clinicians who understand eating disorders so that when it comes in our door, we can, in a relational way that we've already built with the client, help the client as far as we can. And if we need to refer out, we refer out. But it does not have to be an automatic refer out just because they happen to share with you something about disordered eating. Thank you so much for being on the show today. How can people get in touch with you? 

Cindi Miller: So, my, um, uh, Facebook and Instagram, @sportsfoodandmentalhealth is where all of my good stuff lies. And if anyone has any questions about what we talk today, I, like I said, I've shared with you many times, I could talk about this, I often joke, getting on my soapbox. Okay, I'll get off my soapbox now. Because it is something that is so deeply ingrained in us, and I think a lot of clinicians do genuinely think they're doing a service when they're actually potentially doing harm. Like, this will be good for you, maybe, right? 

Jennifer Agee: Mm-hmm. Mm-hmm. Thank you so much again, and if you'd like to connect more with me or the podcast, counselingcommunity.com. That's the same on all the socials. But get out there and live your best dang life.