Pop Therapy

Ep. 34 "I am often not speechless but..." (W/Cate Hickey)

• Season 2 • Episode 34

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0:00 | 57:07

Hello and welcome everyone! Eating disorders and disordered eating are topics that are often misunderstood so today we have an eating disorder specialist with us to help us grow our understanding, awareness, and compassion as it relates to this disorder. Join us as we discuss the difference between an eating disorder and disordered eating as well as some myths and misconceptions and eating disorders. 

Work with Cate: https://www.catehickeytherapy.com/  

Therapy den:https://www.therapyden.com/therapist/cate-hickey-new-york-ny

Psychology today: https://www.psychologytoday.com/us/therapists/cate-hickey-new-york-ny/304624


Follow me on Instagram: https://www.instagram.com/haveyoutriedtherapy/

Follow the podcast on instagram: https://www.instagram.com/poptherapythepod/

Photo by Daniel Seung Lee: https://danielseunglee.com/

Cover design by Bryan Barham: https://www.bryan-barham.com/

Leave a voicemail: https://www.speakpipe.com/PopTherapy


Omar:

Well, well, well, I knew you'd be back I knew you'd come crawling back to this podcast. Hi, it's me Omar your friendly neighborhood therapist. I have been watching euphoria. Yeah, duh, obviously I feel like most people are. I do feel like most people are hate watching it at this point though, but that's neither here nor there. That's just something that I'm observing. I do not feel compelled to talk about whether or not I think this season is good or bad or whether the performances are good or bad, although I do think they're pretty good. But, I'm not really here to comment on that. I did want to comment on a particular scene that took place. Oh, and if you haven't watched any of the episodes spoiler alert, just a heads up spoiler alert. I'm gonna reveal some plot points. So in uh, one of the episodes, I think it was the latest episode, Nate and Cassie have their wedding and that's sort of like the event that the beginning of the season, at least was like building up to this, this big wedding that's supposed to happen. And there is an exchange between Hunter Schaefer's character, Jules, and Nate's dad, uh, Cal, played by, uh, Eric Dane, who sadly passed away earlier this year. So there's a particular scene between the two of them, Jules and Cal. Now for a little bit of context, history, uh, a reminder, Cal is a sexual predator. He is a sex offender. They make that very clear and Cal had, sex with Jules season one when Jules was a minor. Okay. So Cal is again, a sexual predator and what really kind of. Confused me, weirded me out, made me feel kinda gross, um, like, grossed me out, was that the exchange between them was relatively pleasant. yes, it was a little uncomfortable, it was, like, a little awkward because of the whole sexual assault thing, but, eh, I don't know, it still felt relatively lighthearted, relatively pleasant, and I was just, I found myself asking myself, like, oh, why am I, why do I not like this scene, why am I kind of grossed out by this scene, why does this feel, I don't know, like, unnecessary, or, um, just, like, not, I don't know, just, like, missing the point, missing the mark, just way off, and, and I think it's because the scene feels like an abuser's fantasy, it feels like the scene was was for the abuser, that, that he was centered here, it, like, lets him off the hook, you know what I mean, like, here's a sexual predator who is having an exchange with one of his, victims, and they're, like, kinda making jokes, and they're laughing a little bit, and, and maybe even flirting a little bit, I mean, am I crazy, it felt like they were flirting a little bit in that scene, and I was just, like, oh, this is every abuser's fantasy, to abuse someone, to sexually assault someone, and then see them years later, and it's, like, fine, and the person, the, the person is fine, I mean, Jules looked just gorgeous, and, and, and was, like, laughing, and smiling, and it just really, it, it, it lets Cal off the hook, it lets the abuser off the hook, is how it felt for me, was that the intention, I have absolutely no idea, is my media literacy maybe way off, and I'm completely misreading the scene, I'm not sure, but I felt it necessary to share with y'all, I don't know, and if anyone else who watched that scene felt the same way, or if anyone wants to re-watch that scene, through this particular lens, yeah, let me know, I might be crazy, I might be nuts, you know what I mean, I may have misread the entire thing, but it felt really, really strange to me, for that reason, um, I will continue to watch, you know, for better or for worse, there is no, uh, smooth segue to go from that scene in Euphoria that felt really like it was missing the mark, to disordered eating, but here we are, and I was thinking about pop culture, and its depictions of eating disorders, and I was trying to take kind of like an inventory, trying to take stock of what are the pieces of pop culture, whether it's media, or whether it's, you know, arts, or what have you, like, what, I was trying to take inventory, like, what, what am I familiar with, what storylines, what pieces of art am I familiar with, that talk about, that touch on eating disorders, and there were a few, I don't know if I would say that there were a ton of references that I had, but there were, there were a few, and then, I was thinking on it a little bit more, and I was trying to remember, oh, what, like, what is my earliest memory of something in pop culture that touched on eating disorders, and I immediately, it's so fascinating, my brain immediately remembered watching the, uh, HBO TV movie, and HBO, I thought, I thought it was Lifetime, I had to look it up, but the HBO, TV movie, it is with Calista Flockhart, and it was in 1992, and it's, uh, it was called The Secret Life of Mary Margaret, Portrait of a Bulimic, and I remember, you know, I don't remember many scenes, I remember a couple, but what I really instantly remember, I guess my, my body remembers the heaviness of that TV movie, just the, like, the, the panic and the deep, deep sadness and the, like, like, control, the, like, need for control, and, I think it was a good performance, right? I mean, I'm pretty sure-- I think she-- I think Calista Flockhart, you know, regular--nah, maybe not regularly, but when that TV movie is brought up, I think she is talked about as having done a good job of portraying this character, uh, who-- who is battling bulimia. And, and--and I started also just sort of, like, then thinking about the fact that it's still--even me, as a mental health professional, feel like there's so much that we don't know and understand about disordered eating. And so I am so happy to introduce my next guest to help us navigate this conversation and, you know, it's gonna be heavy, right? And so if you, uh, wanna pause and maybe come back to this episode another day, by all means, check in with your own capacity, with your own bandwidth. If this is something you're up for listening to, um, again, there's nothing wrong with saying, you know what? Not today. And turning this off. And so I'm just gonna be-- uh, and turning this off and doing something else. So please keep that in mind. Take care of yourself. Um, but I am, uh, happy to introduce our next guest. I often introduce them by telling people, uh, if I hadn't already worked with them, if I didn't already know them, this is who I am. And so I'm just gonna be-- Uh, and I'm just gonna be happy to introduce our next guest. I often introduce them by telling people, uh, if I hadn't already worked with them, if I didn't already know them, this is who I would go to for therapy. I would go to for therapy. It's very, like, Chapel Rhone. Um, when she said, like, she used to say, like, I'm your favorite artist's favorite artist. It's like very, it's like very that, like, this is your favorite therapist, favorite therapist. Please welcome into your hearts, my friend and my colleague, Kate Hickey. Hi.

Cate:

Hi, wow. What I am often not speechless, um, but this is quite--

Omar:

I mean,

Cate:

Uh,

Omar:

I-- I'm being totally earnest. That's like a hundred-- I don't know if I've said that to you, like, to your face, but that is

Cate:

behind--

Omar:

often

Cate:

I mean, just now.

Omar:

How I talk about you, I'm like, oh, if I didn't know Kate already, that is who my therapist would be. That is who I would go to for therapy.

Cate:

Wow, well, let me just sit up a little taller

Omar:

Yeah,

Cate:

after

Omar:

yeah.

Cate:

that. Well, now I can't really-- you-- Live

Omar:

Did

Cate:

up to the

Omar:

Um,

Cate:

hype.

Omar:

have you watched Euphoria, uh, by any chance? Are you watching it?

Cate:

No,

Omar:

N--

Cate:

I-- I would be hate-watching

Omar:

Yeah.

Cate:

it. I-- I hate-watched the first couple episodes of the first season,

Omar:

Uh-huh.

Cate:

and I was like, this is just like trauma porn.

Omar:

Yeah,

Cate:

guess. This

Omar:

I

Cate:

is like-- Uh, yeah, I'm-- I'm surprised at the-- at the like, uh, the cult following of it because it's just so intense, but people love it. I think it's probably really cathartic to watch these things. Um, unfold.

Omar:

Right.

Cate:

Um, but no, it's not for me.

Omar:

Yeah, I-- fair enough. And so, in talking about this 1992 Calista Flockhart movie, did that ring any bells for Are you familiar with this TV movie from-- this HBO TV movie that I'm referencing?

Cate:

I-- I think so. I think so, especially as you were describing, like, some-- a bit of it in detail. I can't, like, pull it off the tip of my tongue, but I-- I can so relate to the many portrayals of eating disorders in the media,

Omar:

Yeah.

Cate:

and they're-- they tend to be kind of a pretty specific portrayal. Um, and this sounds like that-- that movie fits-- fits that bell, too.

Omar:

Yeah.

Cate:

Thin, struggling, alone, white--

Omar:

Yes.

Cate:

Um,

Omar:

Yeah.

Cate:

yeah, young woman.

Omar:

So, when you think of the way eating disorders are portrayed in pop culture, what comes up for you? Do you think of pieces of media, or are there books that come up for you? Or are you-- is it more clinical when you think about pop culture and eating disorders in general? What comes up for you? What comes to mind?

Cate:

Yeah, I mean, I think it's, like, the clinical, of course, is there because I know so much about it, and I think people are really fascinated by the, by eating disorders and want to try to tell the story, and I think some people really try earnestly to do it, and there's just so much that you can't capture. and I think more and more I'm seeing a little bit more, trying to, not to celebrate, like, oh my god, look at how bulimic this person is, but more of, like, trying to tell a story of, like, what is it like to love your body, which is not eating disorder related, but I think is in response to people, like, the culture of being obsessed with, like, thinness, which we can get into, for sure. Um, but yeah, my favorite, like, even conversations related to eating disorders and body is actually, I really love that show, Shrill, on Hulu.

Omar:

Oh, with, um, Adi.

Cate:

The SNL, yes, exactly, Adi Bryant,

Omar:

Oh,

Cate:

yeah.

Omar:

my

Cate:

Um.

Omar:

gosh, I loved that freaking show. Yeah, that

Cate:

Yeah.

Omar:

was.

Cate:

Yeah, which is not really, I want to be really careful here, that's not a conversation about eating disorders,

Omar:

Right.

Cate:

but that's, like, a conversation. Of, like, fat positivity and body, and, like, welcoming all bodies, and, like, letting someone be the main character, love interest. Um, yeah, and so it's, again, it's not totally eating disorder related, but, like, that's more the content that I'm, like, happy to take in,

Omar:

Yeah.

Cate:

like. Side of it.

Omar:

Uh, the other side of that conversation. What, I guess, I mean, it's probably wise slash fair for us to start with talking about what is disordered eating? What is an eating disorder? If you can talk a little bit about that, please, that would be great.

Cate:

Totally. Yeah, I mean, I think an eating disorder is a clinical diagnosis, right?

Omar:

Mm-hmm.

Cate:

People have disordered eating. People have difficulty with their body image. That doesn't mean that somebody has an eating disorder. An eating

Omar:

Mm-hmm.

Cate:

disorder is when somebody's relationship with food, their body image, and their relationship with, like, themselves, really, become so distorted that it's their function is impacted.

Omar:

Right.

Cate:

And with eating disorders, especially with anorexia and bulimia, it can, it can really hurt your body. Um,

Omar:

Yeah.

Cate:

I don't, I don't know if you might know this, a mark toward clinician, but, like, a lot of people don't really know this, is that, anorexia is the second most deadly mental health disorder in the DSM.

Omar:

Wow. Yeah. I

Cate:

Yeah.

Omar:

knew it was up there. I did not know it was number two. Yeah.

Cate:

Yeah. Yeah. yeah. Second only to, bipolar, because you, you're really in the danger zone when you are very, very manic.

Omar:

Right.

Cate:

Especially transitioning from mania into depression, um, from a depressive state into mania. Anyway, that's, that's that. But yeah, it can really, really hurt you. Um, so that's kind of a long answer to your question of when somebody's relationship with food and their body becomes so. Um, unhealthy and

Omar:

Yeah.

Cate:

unstable that it impacts their functioning. And I can answer that.

Omar:

Yeah. And I was, I know, I just wanted to say thank you for drawing a distinction between an eating disorder as a clinical diagnosis and disordered eating, which is not a clinical diagnosis. but certainly, I mean, I guess something that's not necessarily pathological, but like an issue. Is that how you would describe the two or differentiate the two?

Cate:

Hmm. I mean, I think they both deserve a lot of like thoughtful care and attention. Creation. I make that distinction at the top because I don't want to pathologize people responding to very real social pressure.

Omar:

Yeah.

Cate:

Um, and I think people can suddenly feel very defensive and very scared to talk about it. If you, if we start to have a conversation about eating disorders and we mentioned things that many people. Do right now. And that does not make an eating disorder, but I still think it's really worth having the conversation about body image and relationship with self. but also to say like, it doesn't necessarily mean eating disorder,

Omar:

Right.

Cate:

it also might.

Omar:

And what are some myths and or misconceptions about eating disorders or disordered eating that you think a lot of people miss or don't understand, Are there things that come up in your own sessions with clients? Like what would you, what, what are some of those myths and misconceptions?

Cate:

Yeah. Oh my gosh. So many.

Omar:

I bet.

Cate:

the first couple that come to mind is that, like, only white women have eating disorders.

Omar:

Yeah, yeah.

Cate:

that feels like a really, really big one.

Omar:

Mm-hmm.

Cate:

Which I think has a lot to do with the, like......storytelling that's been done.

Omar:

Mm.

Cate:

and I think there are a lot of white women with eating disorders, don't get

Omar:

Of

Cate:

me

Omar:

course.

Cate:

wrong, and the idea of, like, that's the only people who, who experience this, I think,

Omar:

Right.

Cate:

is that. And I think related to that, too, is this, like, this idea that, like, men don't deal with eating disorders.

Omar:

Mm-hmm.

Cate:

The research is telling us more and more that men, in very growing, alarming numbers, are really dealing with this in a huge way, and people don't even tend to look at it and think about it as an eating disorder. They might be like, oh, you know, strange relationship with exercise, maybe some body dysmorphia, but the, like, noise, the food noise really, like, impacts a lot of men, too.

Omar:

Oh, yeah, yeah. That's, a really good point that there's this gendered component that comes up a lot. this idea that men don't have eating disorders or that men don't struggle with their relationship to food. like, why, and I know you talked about this a little bit. You touched on the fact that the storytelling sort of has helped shape this idea that only women struggle with this. I'm wondering if you have any other ideas as to why it's so gendered, why people, um, misunderstand that, why people think that it's only something women deal with.

Cate:

I think the beauty standards for sure were this expectation that women, when they are their most ideal and most beautiful, are thin.

Omar:

Yeah.

Cate:

And men, when they are their most ideal and most beautiful, are fit and muscular and strong.

Omar:

Yeah.

Cate:

And, I mean, this is happening, this is changing even now with this whole idea of looks maxing

Omar:

Right.

Cate:

and... Clavicular, hammer face, whatever. Like, the men are really under scrutiny now.

Omar:

Yeah.

Cate:

And

Omar:

Of

Cate:

I don't mean to even talk about this as men versus women. Obviously, people across all the gender spectrums

Omar:

course.

Cate:

face this in their own way. But I think, anyway, to tighten it up, the beauty standards of, like, women are thin and petite to be beautiful. And men, of course, have their own beauty standards, but not under so much scrutiny. The ideal isn't to be as small and dainty as possible.

Omar:

Right. Right. That's a really good point, especially, I think, the looks maxing. Every time I see something about that or every time I am listening to someone who partakes in looks maxing, whatever that even means, I'm always like, oh, this sounds like an eating disorder. Or this sounds like, or at the very least, I'm like, oh, this sounds like disordered eating or even like addiction. Like, hearing some of these young men doing meth to stay thin or to help with weight management. I'm like, oh, my gosh, this is, you know, obviously, I can't diagnose them from my phone screen. But this sounds like an eating disorder or like addiction. And I remember thinking, like, how much attention this is getting now. I'm kind of like of two minds about it. On one end, I'm like, okay, I'm glad this is getting attention. I'm glad, like, we're thinking about, oh, my gosh, what is this all doing to, like, teenage boys? Like, we never considered that before. Maybe we should consider that. Let's talk about it. On the other end, I'm kind of like, yeah, this is what, gay men have been doing this since the dawn of time. Why does it matter now? So there's like a little bit of, like, resentment on my end? A little bit, you know?

Cate:

Totally fair. Yeah. I think it's affecting straight men now.

Omar:

Yeah. Right.

Cate:

And another thing I wanted to add on to about this idea of beauty standards in general is, like, it's all the white. It's white

Omar:

It's

Cate:

beauty.

Omar:

white. Yeah. Yeah.

Cate:

And you'll see this now. I see it now, not you. Like, I'm, like, the pursuit is, like, just, like, European

Omar:

Yeah.

Cate:

male beauty standard. And for what I said before of, like, thinness as the beauty ideal, that's a very white. Like white centric

Omar:

Right.

Cate:

beauty ideal because certainly like, you know, other cultures, folks of color, like beauty is so vast and there's so many different ways to appreciate and like

Omar:

Mm-hmm.

Cate:

express beauty, but for whatever reason, we are obsessed with this like white standard.

Omar:

With like white Euro centric, yeah, standard of beauty. Do you, in, in your own work, do you notice eating disorders present differently amongst, uh, or throughout different populations or does it show up? Is there a lot of overlap, um, across genders, across socioeconomic statuses or does it show up pretty consistently, fairly, uh, for lack of a better word, like uniform? How, how do you see it presenting across different populations?

Cate:

Yeah. Oh my God. Great question. Definitely not uniform.

Omar:

Okay.

Cate:

Um,

Omar:

Yeah.

Cate:

I mean, you'll know this with your own clients, like every person is different and everyone can. Excuse me, like present, you know, anxiety doesn't look the same in any person. Um, and because eating disorders are so varied, like you can have someone who's doing a lot of restricting. You can have binging and purging. You can have someone who is like working out, out a ton and like letting themselves eat, but like really like working out and working out and working out to the point that it would still be considered like a cat, like.

Omar:

A deficit.

Cate:

Yeah. Deficit. Yeah. Deficit. Thank

Omar:

Yeah.

Cate:

you. Um, and I think people have different cultural backgrounds too. Like there's different pressures to, to

Omar:

Mm-hmm.

Cate:

adhere to these body image standards. And so the stakes, I think sometimes can feel higher for different types of folks.

Omar:

Mm-hmm.

Cate:

who are like using disordered eating or who are, you know, relating to their bodies in this disordered way to try to fit in with white culture. Like

Omar:

Yeah.

Cate:

I, I think about like folks of color trying to emulate like thinness in a way that their bodies just like aren't ever gonna look like

Omar:

Uh,

Cate:

their, their genetics would, would, would limit this, like ability to look super, super thin. And it feels like there's so much on the line trying

Omar:

Mm-hmm.

Cate:

to. Like look a certain way.

Omar:

Yeah. I, I also am thinking of folks in, um, entertainment when thinking about the stakes and, and I'm thinking about like, Oh, I, I have worked with clients who are, or grew up as like athletes and folks in entertainment where the stakes feels very, very high for them. Not, not just them, obviously. But that's like one, I guess, like subset of folks that I've worked with. where it's felt again like so important like so urgent to maintain a certain physique or to maintain a certain like a calorie diet or what have you um and so for you when you're talking about the steaks can you talk a little bit more about um what those steaks are and and how they show up for different people um a little bit more

Cate:

yeah i think it's like social acceptance whether it's i'm going to fire island this summer and i want to be able to have my shirt off at tea with everybody else and

Omar:

oh

Cate:

i will do

Omar:

yeah

Cate:

anything i will do anything to do that

Omar:

right oh my gosh you you are like you're just you're like oh god you're like like speaking to my heart i'm just like oh god i know i know that i know that voice i'm intimately familiar with that voice yeah

Cate:

yeah and it's so real because on one hand like i want to say like oh my gosh it feels like the stakes are so high how can we help you know take some of the urgency out but

Omar:

yeah

Cate:

the reality is there is a social consequence for not embracing this that we can say and talk on this podcast like yeah it's really disordered it's really concerning but the reality is i think people still do aspire to it even even without realizing that they're glorifying it yeah

Omar:

Right. And what, what fascinates me, what intrigues me is I have noticed a lot of individuals and I'll stick with individuals, I won't say Gaiman specifically, but I do notice a lot of folks who know that what they're doing might be unsafe or unhealthy. Like there is an awareness, like, yeah, I, I know this isn't quote unquote healthy or good for my body. And yet I understand the, the social benefits that I understand like that there's social currency here. And so I'm still going to, despite knowing like, yep, being this restrictive is not good for my body. Despite knowing that I am still going to aspire, right. Because the social currency is like

Cate:

yeah

Omar:

intoxicating or valuable.

Cate:

Yeah. And I think like the short term sacrifice, short term consequence, medium term benefit. I think that, I think that's like diet culture to a T, right. That's what we were telling.

Omar:

Totally

Cate:

Young women and girls. Like, I don't know, Omar, if you were in this soup, but when I was growing up, the special K diet was like a thing that women were really told was going to change their which is if you replace two meals a day with one bowl like a bowl of cereal like a small bowl of cereal so you skip breakfast and lunch you have two bowls of special k you have one very low calorie no carb dinner the special k diet like do it for a short period of time and then you'll have this benefit

Omar:

and

Cate:

kind of yo-yoing

Omar:

right

Cate:

that is diet culture because you can't sustain you cannot sustain weight loss long term like

Omar:

right

Cate:

your body cannot sustain a calorie deficit um it just can't

Omar:

yeah it's it's also not what it was built to do it wasn't built to sustain a calorie deficit forever for months or or years how do you help clients and and maybe there's multiple ways of doing this or maybe we're all still trying to figure it out but how do you help clients sort of like lower the stakes is that what some of the work is for you in helping clients um manage an eating disorder or disordered eating is it is a lot of the work about like let's lower the stakes a little bit

Cate:

yeah totally let's lower the stakes and let's also try to understand together what else is driving this part because we can look at like the external beauty standards all day long and the reality is is that 100 of us are exposed to these beauty standards but 100 of us do not have eating disorders

Omar:

bingo

Cate:

and so there is always other there are other always other ingredients in the soup that set someone up to be like predisposed for this kind of thing

Omar:

yeah

Cate:

and i think helping people understand what that is can be really helpful because then someone under understands like what is it within me instead of like diet culture i can't help but be around it i i am like a victim to diet culture

Omar:

yeah

Cate:

we not to be dramatic we all are

Omar:

right right

Cate:

um but like what else is going on what is it in your upbringing what is it in your family history what is it in your kind of system in your other parts um so that's really the bulk of it actually

Omar:

i like the idea of thinking the phrase you use other ingredients in the soup i like that what are some of the other ingredients in the soup uh besides culturally right what we're being exposed to i think that's such a good point that it is worth saying again right like we are all exposed to these beauty standards a hundred percent of us are exposed to these expectations and these standards but not a hundred percent of us having eating disorder or disordered eating so what else is going on within said person or client that is um that that is presenting itself in this particular way or that is activating them in a particular way could you talk a little bit more about what yes what are the other some of the other ingredients you're finding

Cate:

totally yeah i mean i think first and foremost like symptoms of an eating disorder symptoms of disordered eating also serve as an immediate um an immediate point of access for emotion regulation

Omar:

totally

Cate:

if someone is really stressed out and they're

Omar:

totally

Cate:

feeling out of control or anxious or scared, people can turn to a workout, a binge, a purge, um, uh, a food rule that can help things feel less overwhelming.

Omar:

Yeah.

Cate:

Um, and so to emotionally regulate, and, and I feel like we could talk for, you know, five hours about all the ways that that can show up, but needing a way to emotionally regulate or not knowing other ways to regulate. Ways to emotionally regulate people can turn to like relationship with food and exercise as.

Omar:

Coping.

Cate:

Like one of the. Yeah,

Omar:

Yeah,

Cate:

coping.

Omar:

yeah. Which I think, well, let me ask you, would it be fair to say that that is another sort of misunderstanding or myth about eating disorders? Um, that, that, that it's emotional often, or many times it's about emotional regulation. It's not, it's not just, I want to look a certain way. that it is many times actually about navigating anxiety or sadness or heaviness rage. rage. Oh my gosh. Oh my gosh. Yeah. Rage. Is, is that something that in your work that you, you notice a lot of people don't quite understand or haven't understood or is it, or do you think it's something that more and more people are getting, are becoming like wise too?

Cate:

I think people who live it know straight up

Omar:

Yeah.

Cate:

that that's what's

Omar:

on.

Cate:

going

Omar:

Totally.

Cate:

They, they know that this is their, this is their, this is their number one coping skill.

Omar:

Yeah. Yeah.

Cate:

I think culture at large. I don't think so. I think that's why there's often this focus of like thinness when we like talk about eating disorders, even when you and I started this conversation, it's where we started. Um, but yeah, no, I think the deeper internal voice of an eating disorder that relates to like coping mechanisms is like, I think that's the number one driver.

Omar:

You know, so not surprisingly, I'm a gay man and the conversations around body image and food do come up at some point with all of my gay male clients. what are those, what have those conversations been like for you in your, in your practice with gay men specifically? I'm curious.

Cate:

Hmm. Yeah. Yeah. Yeah. It's, it's actually, sometimes like kind of tricky with my gay man, gay male clients, my gay boys, because they are so success driven.

Omar:

Hmm.

Cate:

And they're often so successful. Some of the most successful people I've ever worked with

Omar:

Yeah.

Cate:

are like my gay boys.

Omar:

Yeah.

Cate:

Um, they're so hardworking. They're so dedicated. They're so used to working hard and making sacrifices for payoff and gain.

Omar:

Right.

Cate:

Which I think is patriarchy. I think is

Omar:

Yep.

Cate:

gender dynamics. I think is homophobia where we need to kind of compensate and be like twice as good three times as fast.

Omar:

Right. Right.

Cate:

And so getting in my experience, like getting like gay men to open up about this and like, let themselves be vulnerable or acknowledge that this is actually really hard and painful.

Omar:

Hmm.

Cate:

It's tough. It's

Omar:

Yeah.

Cate:

really, really Um,

Omar:

there's so much

Cate:

but

Omar:

tied to, to, to your point, there's so much tied to success for, for, and, and let's be clear. This is not a gay men. Don't have a monopoly on being driven and wanting success and right. And, but I can I can see very clearly in hearing you talk about it, I can see the connection between like, oh, this is a part of my success story, and this is, this is a skill or like, maybe even like a coping strategy, like being driven and working really hard. And so I'm going to apply that not just to the work setting, I'm going to apply it to all these other areas in my life, like with food, and I'm going to approach I'm going to approach it similarly, with like the same kind of like strategy and like,

Cate:

Mm.

Omar:

like you said, you got to work two times as hard and be three times as fast, and it's like a similar, it's like a similar skill that is maybe useful in other areas in their life that they're applying to food. when navigating how, how do you have tricky conversation with them, right? Because I could, I would imagine that on some level they might be thinking, is, is Kate telling me to fail at this? Is Kate telling me not to work hard? Not to, not to care about this? And I could, I could, I would, I could imagine a little, a little bit of maybe like defensiveness coming up,

Cate:

Mm.

Omar:

right? Like,

Cate:

Totally.

Omar:

hey, I'm more, I'm a hard worker, don't take this away from me.

Cate:

Yeah.

Omar:

How do you help them kind of like land the plane soft softly, or how do you help them approach this softer?

Cate:

Yeah. Don't take this away from me is such thing in eating disorder work. Like, like I, I feel like I, I say that so often, like, I'm not going to take this away from you.

Omar:

yeah,

Cate:

Like, it's not like, sometimes I wish I could, but I will, I promise you, I will not take this away. You keep it as long as you need it. And then.

Omar:

Oh, powerful.

Cate:

Yeah. And when, yeah, yeah, Yeah. how do I help land the plane with, with some of my game and specifically, yeah. I mean, I, I do a lot of like empathizing, like it makes so much sense that you have this really this really well-developed muscle, um, in, you know, meaning met in all the ways possible, this really well-developed muscle strategy and success and game plan. Look, look at how this has kept you safe at work, family system with. And can, can we also look at how this might be hurting you when this is the only muscle you have or the only tool you have in your toolkit?

Omar:

Yeah.

Cate:

Um,

Omar:

So getting them to talk a little bit more about how it's hurting them, how it's painful is, is one of the ways in which you sort of help them approach this topic delicately. I would also imagine that across, all populations and across the gender spectrum that telling any client, I am not here to take this away from you. You keep it as long as you need must be, I mean, I would imagine it's like one of the first times, if not the first time a client struggling with an eating disorder has heard that what, what, what, what does that do to our client to hear that from you? How, how, how do they receive that?

Cate:

Yeah. I think it can be really shocking because, because people,

Omar:

Totally.

Cate:

especially because I am an disorder specialist when people come in to me, come in to work with me on some level, they're seeking out for a reason

Omar:

out for a reason. Yeah.

Cate:

And at the same time, it's scary to imagine giving up this thing that you've like, probably for so many people at their longest relationship, right? They've had this since puberty,

Omar:

right?

Cate:

so I think it gives a little bit of control and power back to someone

Omar:

Right.

Cate:

like you keep this as long as you need, I'm not going to force you. You get to decide you're in the driver's seat like that kind of messaging, not even messaging. Cause that seems like that's really what I

Omar:

really

Cate:

mean. I

Omar:

want

Cate:

people to understand they get to be in charge. I think it's a really necessary frame to work within because so often, you know, we turn to disordered eating when we don't feel in

Omar:

we're

Cate:

charge, when scared or we feel out of control. And so building that association of eating disorder treatment is you get to be in charge.

Omar:

Yeah. I could also imagine like to your point, because it disordered eating and eating disorders can show up in as a response to feeling out of control or as a response to feeling dysfunction in one's life to hear a specialist say, you are in the driver's seat, you are in control here, you decide, right? Must feel... Scary, but also powerful at the same time. Right. And I really appreciate I really appreciate that because it comes from a place of understanding how important this coping technique is, right? Like you are not, you are not treating it like that's finger wagging, right? Like that's bad and we need to stop. And this is really unhealthy. And you're coming from a place of, Hey, like I get it. I understand that this is so important to you. I understand that it helps in a lot of ways. It helps you deal with rage. It helps you deal with, uh, feeling out of control. It helps you deal with like fill in the blank. Right.

Cate:

that.

Omar:

And it comes from that understanding, that awareness that this is like a, it's a tool, right? It's, um, a coping technique, a strategy. And, and again, that there, there's utility and that maybe not necessarily, maybe not function, right. Like especially long-term it's not functional because you can't sustain that forever and ever and ever, but there is utility in the strategy. Was that fair to say?

Cate:

Actually, I think you were really onto something before. Like I, I think it absolutely is functional in, in, in so many ways. Like being thin is functional. Being, being, being extremely fat is functional.

Omar:

Yeah.

Cate:

Like being

Omar:

super

Cate:

in

Omar:

muscular.

Cate:

Super muscular

Omar:

Yeah.

Cate:

being

Omar:

Yeah.

Cate:

emaciated being, you know, and it's, there's this really like darker side to an eating disorder that is really hard to put into words, but like being able to prove to yourself that you are disciplined and like essentially like strong enough willed to destroy your own body. Like that is very self satisfying to someone who was very.

Omar:

Totally. Totally. The, I guess it goes back to the like, I can, I can control this. Like I can really, I mean, even at the expense of my own life or health, I can, it's almost I don't know if anyone's ever described it to you this way, or if you've thought about it this way, but it's like, I can beat genetics. Like I can, I can beat nature. There's something in hearing myself say that there's something like, oh yeah, I can totally understand why that would be satisfying. Why it's like, oh, not even genetics can, can get me down. You know what I mean? Or not even genetics can, can beat me quote unquote. And so I can see that would be so satisfying, especially for just to like draw the, yeah, just to draw the, make the connection and like really reinforce the point you were making about success and the importance of success and the importance of, um, like proving

Cate:

how

Omar:

some, something, maybe it's your worth or value or what have you like, it all feels connected. Does this idea, this relationship to success, do you all, do you notice it across the gender spectrum or do you notice it more acutely or intensely or obviously explicitly with, men and gay men?

Cate:

I, again, I think eating disorders and the pursuit of excellence go hand in hand, and

Omar:

totally

Cate:

so

Omar:

pursuit of

Cate:

like,

Omar:

excellence. Yeah. Yeah. Yeah. Yeah. Yeah. Okay.

Cate:

Yeah. So like for sure, gay men and also like everybody,

Omar:

Everybody.

Cate:

everybody

Omar:

Totally.

Cate:

like a peep. And I think also like my aspect, like a sub specialty of mine is like gender expansive folks and eating disorders, because on one hand, when somebody transitioned, there is this intention to change your body in a very visible, observable way. There's a really intense strategic sometimes, route of like changing your body's shape and muscle and fat distribution that is not disordered and getting from A to B or A to Z or A to Q. Like it's a lot more sticky.

Omar:

Yeah. Yeah. To, to put it mildly. Yeah. A lot more sticky.

Cate:

For sure.

Omar:

Yeah. How, how, how does that work with gender expansive folks? How does your approach change or differ? cause it sounds it has to, right? Like, it sounds like if you want to be intentional and if you want to be understanding that, that the approach does have to shift a little bit more. Can you speak to the, how you shift the treatment a little bit?

Cate:

Yeah, I think that the thing that, to me, is the most interesting, and the most, like, gratifying for me as a therapist, is being able to, like, walk a path, like, shoulder-to-shoulder with somebody who is trans, and help them understand that, like, as they move through their transition, like, their external presentation is gonna change,

Omar:

Hmm.

Cate:

but their internal experience of themselves is gonna change.

Omar:

Mm,

Cate:

And so if you are someone assigned male at birth, and you have never been in the dressing room of the women's department in JCPenney, you haven't had that experience

Omar:

yeah,

Cate:

yet, and you're starting to,

Omar:

right.

Cate:

and helping people start to understand what it is like to move, like, with a feminine, like, with a feminine mind, or move as a woman, or move as someone who is neither man or woman.

Omar:

Right.

Cate:

And that relationship to self, and, like, okay, how do you wanna present your self, is so meaningful to let people really, like, understand what they want, not what they think they need to present to be likable, but what they want, um, is really a huge piece of it, um, for my gender.

Omar:

Yeah, yeah, it sounds like, across the board, a lot of the work is about helping them understand their relationship with themselves, right? Like, that, at the core, it's

Cate:

Totally,

Omar:

almost...

Cate:

yep.

Omar:

And this might be like, well, duh, Omar, but I think it's worth saying, but it almost sounds like, uh, like, couples therapy, but, like, with your body, or couples therapy, like, with your relationship to success. Like, it's like, you are maybe repairing a relationship, or at least trying to repair a relationship between these two, uh, entities, right? Like, these two, like, almost like factions at war, or something like that. Is that how it feels for you sometimes, like, that kind of repair work, that it's, it's akin to couples therapy, or similar to couples work?

Cate:

For sure, yeah, because it's so, it's a relationship with self. And so when you said couples work, I'm like, oh, totally, you're working on the relationship 100% of the

Omar:

Yeah.

Cate:

time. So, relationship with self. And there's, like, a lot of really cool stuff in, like, DBT, that's all about, like, can you help people to hold two truths, or hold

Omar:

Yeah,

Cate:

two...

Omar:

right,

Cate:

Can you

Omar:

right.

Cate:

be, yeah, can you be happy and, you know, scared at the same time?

Omar:

Yeah.

Cate:

Angry and disappointed. And can you still love this person who disappointed you and made you angry? And then, like, handing them a mirror and being, like, yeah, can you be angry and disappointed and have love for yourself?

Omar:

And for anyone that is unfamiliar, DBT is dialectical behavioral therapy. It's a therapeutic intervention. That is, like, super, it's been shown to be, like, really, really helpful for a lot of folks, especially when, in regards to holding multiple truths, conflicting truths, at the same time. And it sounds like, in eating disordered work, that that is also, a lot of the conversation is around holding multiple truths at the same time, as well.

Cate:

Yep.

Omar:

Like,

Cate:

Yep.

Omar:

yes, you know, one, for example, is, like, that I would imagine you said a million times, like, yeah, you do get more attention when your body looks a certain way. You're right, like, you are getting hit on more. More people are sliding into your DMs. You are getting asked, like, yep, that's true, 100%. And this is hurting you.

Cate:

Yeah. And, like, what did you give up to get? What toll and tax did you pay to get that attention?

Omar:

Right.

Cate:

Did you miss a birthday dinner? Did you miss a work promotion? Did you lose out on sleep? Did you feel really uncomfortable? Did your injury take longer to heal?

Omar:

you

Cate:

Did

Omar:

lose

Cate:

out on sleep? And just helping people understand, like, yeah, I really could get more attention if I look a certain way, and it will cost me.

Omar:

And it will. Yeah, yeah. how comfortable in your experience have folks been to talk about the cost? Do you find that to be particularly difficult, or are folks pretty game to have that conversation?

Cate:

I feel like there are two camps of people who are so grateful and desperate to talk about it. And that when they finally get invited, and have kind of, like, the red carpet rolled out for them to discuss this.

Omar:

Yeah.

Cate:

People are so grateful to be like, you're right, this

Omar:

Ugh.

Cate:

is, this is so hard.

Omar:

Yeah.

Cate:

And that is so, like, beautiful and heartbreaking to watch, because it's like, you see somebody who's been, like, suffocating, and you, like, put on, give them an oxygen mask, and they're like, oh, my God.

Omar:

Uh,

Cate:

Yeah. uh, and then I think there's another camp where people are really scared to admit how much they sacrifice for it because I think there's this fear of if I admit like how hard or how damaging this has been for me, I'm gonna lose it and if I lose it, I'm gonna lose everything that I associate with the achievement, or our quotes here

Omar:

Yeah,

Cate:

from the podcast.

Omar:

yeah, yeah, the, the, the achievement, the success, the, uh, yeah, the, the whatever they get from that experience, the, the, the part, whatever, whatever they, um, whatever the benefit, yeah, the, the quote unquote benefits are or whatever it is that they get from that, that they find helpful, they're afraid of losing that. And so is a lot of the work then after that or during helping them develop like, okay, so there are some other ways that we can navigate anger. There are, there are other coping strategies that we can use. And is that like a lot of the work, like helping them build a, like, you know, pun intended, like another muscle, like we're now we're going to like help build this other muscle. And does that also vary from client to client, like the, the, the, the different coping skill or the different, the different muscle or, or, or, or, yeah, I'll let you speak on that a little

Cate:

Um,

Omar:

bit.

Cate:

yeah, I mean, I think it's like, yes, yes. And like different clients need different tools. And there's often like just such a through line of like relationship with self and like self acceptance and self love, which sounds like a little bit cheesy, but like if, if we can kind of help somebody build up a more positive relationship with self,

Omar:

Yeah.

Cate:

so much of the other things can fall into place. Like, you know, it's, you know, being willing to invest and find another hobby to spend a little bit of money on yourself, being willing to set a boundary with that friend who really takes from you emotionally

Omar:

Yeah.

Cate:

and saying, I'm not actually willing to do that anymore.

Omar:

Yeah.

Cate:

Being willing to stand up for yourself at work, like that stuff becomes possible when you start to help someone build a better relationship with themselves.

Omar:

Yeah.

Cate:

And that stuff is impossible if relationship with self is off.

Omar:

Yeah. Yeah. how do you define and talk about with clients, this concept of self love? I feel like we hear it on social media, especially we hear it so much and, you know, you know, and on TV, you know what I mean? But like we hear that we hear that a lot, self love, how do you define it? And how do you introduce the topic and how do you talk about what is self love?

Cate:

it's really like fun and easy to just like bring in a little bit of humor. Like, also we're talking about the queers, talking about the gays. And so I like, thank God for RuPaul who has given us like, the line,

Omar:

yeah,

Cate:

the

Omar:

Yeah.

Cate:

line. And it's like a way to laugh about it and then be like, oh yeah, damn. Like, that's true. Like,

Omar:

Yeah.

Cate:

if you can't love yourself, how in the hell are you going to love anybody else? So it's like fun to start high level, like hee hee ha ha.

Omar:

Yeah.

Cate:

And then also like, yeah, what would it look like? What would loving, and then like to talk to people before there, before there's any prescriptive change, what would it loving yourself look like? What would it look like if you were 10% kinder to yourself? Hypothetically speaking.

Omar:

Like, of course, hypothetically, we don't have

Cate:

For

Omar:

to.

Cate:

sure.

Omar:

Just

Cate:

For

Omar:

as

Cate:

sure.

Omar:

a brain, a thought experiment. Yeah. Yeah.

Cate:

Yeah. And people will tell you, it's incredible. Sometimes I'll ask clients that question and I'll think they'll say something like, well, it would mean standing up to my boss. Like, I'll think they'll say something like that.

Omar:

Yeah.

Cate:

And then they'll say something so fucking profound. Can we say that on here?

Omar:

Yeah.

Cate:

Okay.

Omar:

Oh, oh.

Cate:

Okay. They'll say something so profound, like I would be kinder to myself.

Omar:

Yeah.

Cate:

I like wouldn't beat myself up for like, don't know, like skipping that extra rep at the gym. Like

Omar:

I

Cate:

something so small.

Omar:

Yeah. Right.

Cate:

And then I'm like, oh, right. You beat yourself up because you skip a rep at the gym. What's that like to say out loud? And then you like slow everything down. And it's just like, oh.

Omar:

Yeah. Oh, man. Kate, you're doing God's work. God. Thank goodness for folks like you. So, Kate, there's this one question that I

Cate:

Totally.

Omar:

ask every single guest, which is

Cate:

Yeah.

Omar:

what is one piece of advice or wisdom that you've gotten from the mental health world that you live and or swear by? So this can be something you learned in your own therapy. This can be something you, uh, read in a book or heard on a podcast, anything like that. But what is that one thing from the mental health world that you swear by?

Cate:

I, this is not necessarily eating disorder specific, but it is a boundary is a bridge, not a wall.

Omar:

Ooh, hell yeah.

Cate:

Yeah,

Omar:

Hell

Cate:

yeah. And

Omar:

yeah.

Cate:

so, like, having boundaries doesn't isolate you and pull you away from people and goals. It is a path to get to more closeness and more safety with

Omar:

Ah, well said. Uh, a lot of folks tend to think of boundaries and, you know, it's in the word boundary, right? And so it's, I don't think it's, um, it's by no means, it's not like it's our I guess is what I'm trying to say. Or rather, it's understandable why folks would hear the word boundary and think this is a wall. This is something that separates. This is a fence. This is a, right? Like this is something that is separating multiple things from one another. And so I don't think it's to no fault of our own. it is what, what it is in actuality is a bridge to closeness, right? And so like, how can we help you feel more connected and close and closer to your friends, to your community, to your partner? That is what a boundary actually is. And can you talk a little bit about the ingredients of a boundary? What a really well-constructed boundary look like?

Cate:

Ooh, love this. I'm going to start with what a boundary is not

Omar:

Hell yeah.

Cate:

first. Which is

Omar:

Hell

Cate:

a

Omar:

yeah.

Cate:

boundary, a boundary is not you dictate another person's behavior.

Omar:

Right. That's right. Can you please say that one more time, Kate, for the cheap seats in the back? What a boundary

Cate:

5,000%.

Omar:

is what?

Cate:

A boundary is not dictating somebody else's behavior.

Omar:

Amen.

Cate:

Yeah. I feel like I have had to do that so many times. Like I need to hold your hand as I say this. Boundary is not telling your mom that she can't call you anymore.

Omar:

Right. Right, right. Yeah.

Cate:

Yeah. And so anyway, I guess to kind of like turn that on its head, I think the ingredients of a good boundary are understanding where your limit is. Like self-understanding of like, ooh, I have overextended or I am not getting my need met. An understanding of like what someone needs. And then an ability to like describe that to another person.

Omar:

Yeah.

Cate:

I feel disrespected when you show up 20 minutes late every time I hang out with you. Like letting, being able to say like, I feel disrespected as opposed to like your inconsiderate

Omar:

Right.

Cate:

friends, like being at like, oh, and I feel disrespected

Omar:

Right.

Cate:

or I feel frustrated, like owning that feeling and then being able to understand what, what you can do as the person who's setting the boundary, what you can do to protect your energy.

Omar:

Right.

Cate:

Like if you show up 20 minutes late, I'm going to leave after 10. I'm not going to wait 20

Omar:

Right.

Cate:

minutes. Instead of saying to a friend, you can't show up late anymore.

Omar:

Right.

Cate:

It's not a boundary.

Omar:

Right.

Cate:

That's a criticism.

Omar:

That's a criticism. Or, or, you know, what I also tell clients is that might be an expectation.

Cate:

Yeah. There it is.

Omar:

Do

Cate:

That's what.

Omar:

that. Right. Like fair enough. The expectation is that they show up on time. Fine. And expectations, we all have them and fine. But to your point, it is not a boundary because the focus on good, but the, the, the main character of, of the boundary is you. Right. And so

Cate:

Yes.

Omar:

it's like, oh. You

Cate:

Yeah.

Omar:

are responsible for your own behavior and a boundary is a reflection of what that is going to look like, right? Which is why, like you said, trying to use a boundary to dictate someone else's longer, then it's not a boundary anymore. It's the, now you are just trying, just trying to, eh, maybe that's, maybe saying just trying to, but is unfair, but you are trying to someone else's behavior. And that is a slippery, slippery slope, folks.

Cate:

Yeah, it can feel so, disempowering.

Omar:

Yeah,

Cate:

Uh,

Omar:

yeah.

Cate:

and so I think boundaries really help to have people hold onto their power in a real way.

Omar:

Well said. Thank you so much, Kate. I really appreciate you taking the time. I know how busy you are. So I really appreciate you taking the time to chat with where can folks find you if they wanted to reach out and work with you or if they just wanted to follow along on your journey of?

Cate:

Uh,

Omar:

where can folks, uh, find you or reach out to you?

Cate:

people can find me, like, kind of like the usual therapy places.

Omar:

Yeah,

Cate:

I'm on Therapy Den. I'm on Psychology Today. and my website is katehickeytherapy.com.

Omar:

Wonderful. Again, thank you so, so much. as you know, I am a therapist. Kate is also a therapist, but this podcast is no substitute for good old-fashioned therapy. So, take what's useful, leave the rest, and don't forget, therapy makes you hotter. Bye.