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Many college institutions and universities offer the opportunity for students to study a semester abroad in a foreign country. This is an invaluable experience for a young person to learn and grow both academically and personally. This topic of discussion has come up in my sessions working alongside college-aged students in eating disorder recovery. The decision to study abroad is a commitment that requires an extended amount of time away from family, friends, and other sources of support. I utilize these evaluative questions to explore with my client their readiness to travel abroad in recovery:

• Are my symptoms managed well? Am I able to regulate using healthy coping skills? Do I have a relapse-prevention plan in place?
• Is my physical and mental health stabilized?
• Have I been making progress in recovery for a continual amount of time?
• Do I feel properly supported?
• Does the thought of travel bring joy and excitement (not fear or anxiety)?

How Do I Know I Am Ready to Study Abroad?
From traveling long hours on a plane, exposure to different foods, adjustments to time zones, experiencing a new culture and way of daily living – the choice to study abroad would be carefully considered and discussed with a treatment team (primary therapist, registered dietician, medical provider, etc). Considering the costs and benefits of the timing of the trip abroad is also important – a person should ideally be at an outpatient level of care, medically and psychologically stable and solidly in recovery. With guidance from a treatment team, realistic expectations and goals can be met if planned out accordingly.

Maintaining Mental and Physical Health Abroad:
Choose with recovery in mind. Traveling abroad for the first time in recovery is not the time to push or challenge too much. I encourage clients to be mindful in choosing a location and/or program type that will be aligned with maintaining recovery (i.e. access to appropriate dietary needs, ability to maintain contact with support network) – reminding them that there will be other opportunities to explore different destinations in trips to come.

Engage in self-care. Ah, the infamous s-word. Taking care of basic health needs is a fundamental way to preserve any type of recovery. Upholding a regular sleep schedule, proper nutrition, limiting alcohol, taking daily medications, journaling before bed or beginning the day with a meditation; whatever works in day-to-day life in America should be translated abroad to incorporate stability into the new and potentially changing environment.

Stay connected. Traveling or studying abroad can feel isolating at times, especially when navigating a different culture. Staying connected to various sources of support is important. This can be met through an online eating disorder support group, emails from a treatment team member or regular scheduled FaceTime or phone calls with a loved one.

 

Cassy Taverna, MSW, LCSW-A currently sees individual clients and facilitates S.O.A.R (Staying Open about Recovery), a support group for college-aged women who are making strides to positively stay on track with eating disorder recovery. Her clinical interests include the treatment of eating disorders, trauma, anxiety/mood disorders and LGBTQIA issues. Cassy loves to travel as she presented her research on Disordered Eating Among Newly Bereaved Spouses at the International Conference on Community Mental Health in Bangalore, India during her graduate studies at the University of North Carolina at Wilmington.



“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” – Theodore Roosevelt, the Man in the Arena. Delivered at the Sorbonne (Paris) on April 23rd, 1910.

I wanted to dedicate a blog post to a topic I have encountered numerous times in sessions with clients, as well as wrestled with myself as a developing therapist continuing to explore her therapeutic style and sense of self; external and inner criticism. When covering this ground, I turn to the work of Brene Brown. Brown is an American scholar, author, and public speaker, who is currently a research professor at the University of Houston Graduate College of Social Work. She has spent over a decade researching courage, vulnerability, shame, and empathy and is the author of four #1 New York Times bestsellers and her labor has been featured on PBS, NPR, TED, and CNN.

In one of her presentations entitled, “Why Critics Aren’t the Ones Who Count” delivered in front of an audience at the 99 Conference, she covers this topic and highlights:
• Why (creative) human beings must embrace their vulnerability
• How to handle (external and inner) criticism and public scrutiny that accompanies exposure
• Which feedback matters, and which does not, in the “public arena”

Criticism can stifle creativity and can anchor people from daring greatly and taking risks. Brown poses the question: What would you try if you knew people wouldn’t say ___ (fill in the blank) about you? She explores the benefits of not allowing fear of criticism to inhibit the display of one’s own work. Brown conceptualizes this through “the arena.” When a person is thinking about or preparing to enter the arena, there is fear, self-doubt, comparison, anxiety, uncertainty, and shame. People tend to “armor up” emotionally and psychologically and when they do, they shield themselves from vulnerability. Vulnerability is the birthplace of love, joy, belonging, trust, empathy, creation and innovation.

When a (courageous) person chooses to enter the arena, they are greeted with rows of seats and people. The three seats that will always be filled in the arena are: shame, scarcity, and comparison – 1). Shame (which Brown describes as a “universal human emotion”), 2). Scarcity (Does this matter? Is this important or original?) and 3). Comparison. The fourth seat is reserved for a teacher, ex-coworker, family member. Brown summons the audience to recognize that the critics will be there and to invite them in, however one may not be interested in their feedback. Brown believes by taking the stance that unless your critics are also exposing themselves and exhibiting vulnerability, their opinions and feedback are extraneous – using the dialogue: “I see you, I hear you, but I am going to show up and do this anyway.” In addition, Brown shares that we are often our own worst critic, so she advises us to save a seat in the arena for ourselves. Brown says, “We orphan the parts of us that don’t fit the ideal… leaving only the critic. On the contrary, the person (or the part of us) who believes in what we are doing and why we are doing it should be in that chair.”

Choosing to be seen in the arena is no easy feat. Brown encourages a clarity of one’s own values and having a support person that is willing to pick them up and dust them off when they fail or make mistakes. Brown notes, “if one isn’t making mistakes, then one isn’t really showing up!” She explores why “not caring what people think” sends a huge red flag as human beings are “hard-wired for connection.” However, when a person becomes defined by what their critics think, they lose their willingness to be vulnerable.

Is it petrifying to show up and be seen? Yes, absolutely. But remember to make space in the arena for the people and part of you that values courage and creativity.

Disclaimer: Some profanity is used in the following video.
Brene Brown; Why Your Critics Aren’t the Ones Who Count:

Brene Brown’s Official Website: http://brenebrown.com/

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“Your body cannot heal without play. Your mind cannot heal without laughter. Your soul cannot heal without joy.” – Catherine Rippenger Fenwick

Sure, it’s fun to have a good laugh, but did you know it can improve your health? I’m not joking! Laughter can “strengthen the immune system, improve mood, reduce pain, and protect from the damaging effects of stress.” As children, we used to laugh on average over 200 times daily, but as we age into adulthood, life tends to be more serious and laughter more infrequent. To counteract this barrier, it is important to intentionally seek out more opportunities for humor and laughter in everyday life, and that includes in the therapy setting. Mental health professionals can safely incorporate tools such as psychodrama and other experiential exercises in session that extract humor to address the mental, physical and emotional needs of clients.

The Science Behind Laughter & Humor

When a person is depressed, neurotransmitters in the brain [dopamine and serotonin] are reduced and the ‘mood control circuit of the brain’ is impaired. Laughter can repair malfunction by fluctuating dopamine and serotonin activity. Laughter can also alleviate the effects of stress by decreasing stress-making hormones and serum levels of cortisol and epinephrine found in the blood steam. Humor and laughter can shift perspective and change the way the mind views or experiences an event. Looking at a problem from a different perspective can create psychological distance. help diffuse conflict, feelings of being overwhelmed and even increase objectivity and insight.

Laughter & Humor in the Therapeutic Environment

Laughter Yoga

Laughter Yoga was created by Indian physician Dr. Madan Kataria in collaboration with his wife Madhuri, a yoga teacher in 1995. Its principle follows a “body-mind approach” to laughter by inviting participants to laugh for no reason”, which sometimes entails faking a laugh until it becomes real. This is possible since the body can functionally laugh regardless of what the mind has to say. A few studies have examined the effects of laughter yoga applied in the workplace and nursing home facilities, and the results show that engaging in exercises that simulate laughter can “increase self-efficacy in employees and reduce depression in the elderly.”

Click this link to hear more from Dr. Kataria and join in on some laughing exercises! https://www.youtube.com/watch?v=5hf2umYCKr8

Improvisation

Improvisation, or improv, has more recently been applied to group therapy for the treatment of psychological issues and provide opportunities for personal growth and exploration. The benefits of practicing aspects of improv comedy in group therapy include, “active listening,” “risk-taking,” and “group-mind” (Steitzer, 2011). Comedic improv therapy (CIT) a group therapy model inspired by the practice of improv comedy, provides the therapeutic elements of “group cohesiveness, play, exposure, and humor.” Operating in collaboration with The Second City Training Center in Chicago, Mark Pfeffer and Becca Barish have facilitated a program known as Improv for Anxiety for the treatment of social anxiety disorder in adults and adolescents. Improv for Anxiety involves participants meeting twice a week for a period of 8 weeks. Each weekly session provides an opportunity for participants to engage in a traditional improv comedy class led by skilled improvisers at The Second City Training Center and mental health professionals experienced in group facilitation that utilize the proposed CIT model, in combination with other empirically-based models of therapy. They also provide psycho-education about unhelpful thinking styles and discuss methods of restricting negative cognitions. The response from the program’s participants has been positive, and is currently being empirically evaluated by the University of Chicago using the Liebowitz Social Anxiety Scale.

 

References:

Phillips Sheesley, A., Pfeffer, M., & Barish, B. (2016). Comedic Improv Therapy for the Treatment of Social Anxiety Disorder. Journal of Creativity in Mental Health, 11(2), 157-169.

Panksepp, J. (2000). The riddle of laughter: Neural and psychoevolutionary underpinnings of joy. Current Directions in Psychological Science, 9(6), 183-186.

Steitzer, C. (2011). The brilliant genius: Using improv comedy in social work groups. Social Work with Groups, 34(3-4), 270282.

Yim, J. (2016). Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. The Tohoku journal of experimental medicine, 239(3), 243-249.

 

 

 


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With attempted suicide rates on the rise, it’s imperative to spotlight the transgender and gender nonconforming (TGNC) community. Prejudice against TGNC people often manifests in forms of denial (in health-care services), harassment, bullying and physical assault. TGNC people may be further marginalized by other microaggressions, such as racial and ethnic identity, socio-economic status, and age. Individuals’ external reactions towards TGNC people may be aggressive as the result of explicit and/or covert fears about what it means to deviate from gender norms. TGNC people are often perceived as “Other,” not “fitting” into a particular box. By challenging constructs, clinicians can provide and advocate for the TGNC population.

Challenging Constructs

Gender has been perceived as a binary construct with mutually exclusive groupings of male or female. Blue or pink. Trucks or dolls. These groupings create an assumption that gender identity is always in alignment with sex assigned at birth. However, for TGNC people, gender identity differs from sex assigned at birth to varying degrees. Gender identity is defined as “a person’s deeply felt, inherent sense of being a girl, woman, or female; a boy, a man, or male; a blend of male or female; or an alternative gender.” To provide the most affirmative care, a non-binary understanding of gender is essential. Whenever I am greeting a client, I always ask them, “How would you like to be addressed? Do you have preferred pronouns you’d like me to use?” Simple, but by using their preferred identification, their self-identity and sense of self-worth is validated.

Trans-Affirmative Care

I wanted to provide the following list that offers a very general overview of language used within the TGNC+ community, and it’s important to emphasis that these terms are constantly evolving. Language is powerful. Staying updated and informed as a clinician will nurture open and collaborative discussions around experience through the lens of the TGNC person. It will also support the TGNC person in the least confusing and dishonorable way. Modelling an “acceptance of ambiguity” may be helpful as TGNC people develop and discover aspects of their gender expression, especially in adolescence and early adulthood. TGNC identities include but are not limited to: transgender (TG), female-to-male (FTM), male-to-female (MTF), transgirl or transboy, they/them, bigender, gender fluid(ity), drag queen or king, gender queer, transqueer, queer, cross-dresser, androgynous.

Research in the Field

It’s important to highlight the progressive work being done by Dr. Diane Ehrensaft and her colleagues at the Child and Adolescent Gender Center in San Francisco, California. They are utilizing what is called the “Gender Affirmative Model” which encourages clinicians against labeling TGNC individuals as “dysphoric” and instead view their varying gender expressions as “fluid.” This deconstructs the concept of gender being binary and stagnant. The ability to respectfully interact in a trans-affirmative manner can help improve TGNC people’s quality of life and experience in therapy overall. By supporting TGNC people to articulate their authentic truth, clinicians can strengthen the therapeutic alliance and cultivate a safe environment to explore gender identity and  gender expression.

 

References

American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70(9), 832-864.

 

Cassy is a Licensed Clinical Social Worker-Associate who is passionate about transformative justice and advocacy for contemporary social issues. In addition to providing individual counseling, Cassy also enjoys facilitating groups. She currently provides group support for patients who have recently undergone bariatric and weight-loss surgery and a group for young women called SOAR (Staying Open about Recovery), who are making strides to positively stay on track in eating disorder recovery.

 

 


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