Your ED Friend: Six Years Later

[Obvious TW is really glaringly obvious.]

“I had an eating disorder.”

“I guessed.”

We were juniors, boyfriend and girlfriend, officially. Up late and texting, doing that flirting thing where you demand each others deepest secrets and pretend you’re giving yours away.

Except I did give mine away.

“I had an eating disorder.”

I was lying, of course. It wasn’t the past tense–it was the second year of an eating disorder, one that would get worse, more disorganized, and wreak much more havoc on my sanity in the coming four years.

But it was the first step.

And he had guessed–known, really, for months. He’s my best friend now, far and away in Texas. In this month, marking six years since I developed what would reach clinical-level anorexia, I asked him about it.  He doesn’t remember when he figured it out, really. It was, according to him, always part of how he knew me.

And I don’t think he’s wrong. It’s been six years ago, as of this month, since the behavioral side of anorexia started. Every time I’ve looked back and tried to think “back when I was stable/normal/didn’t have an eating disorder”…I realize I’m looking back at times when I was actually worse, when I wasn’t eating, when I couldn’t go ten minutes without invasive, obsessive thoughts about food.

Six years. More than a quarter of my life.

There’s this thing they talk about in therapy some times: grieving for the normal self. Because even were your disorder to remit entirely…you wouldn’t go back to being Old You. Your brain learns things. You grow and bend and shape yourself around coping mechanisms and triggers and ways of responding to the world. Old You is just gone. And Old You was a whole person, with plans and potential and places to go and things to do and ways of looking at the world. Maybe a little more optimistic, a little shinier and fresh-faced. You get to have all those things again, those plans and that potential, it’s true. But sometimes they’re a little dusty, a chipped, in pieces.

And I really liked Old Kate.

Therapy was a eulogy, stories of when I could look in mirrors, and dancing and days when I could just throw on clothes in the morning.

And now, finally, I think I’ve laid that Kate to rest.

A photographer friend took this for me--a lasting reminder that I can be happy in this body.

A photographer friend took this for me–a lasting reminder that I can be happy in this body.

I’m…this Kate.

I have this weird alternate life where I write things on the internet and people read them. On weekends I go to conferences and go by a different name, and on Monday the coach turns into the best pumpkin ever and I work at Fabulous Unspecified Internship.

I’ve gone skinny-dipping. I’ve gone skinny-dipping in Lake Michigan in the middle of winter. (Note: REALLY cold.)

I am emotionally able to care for another animal and I know this because I’m doing it right now.

I live in a city that I love. I’m in love.

I don’t dance anymore, and it hurts. But sometimes I actually see New Kate in the mirror, and that makes me think that someday I’ll go back into a studio.

I’ve learned some of two different languages, and I get to take classes about bioethics and astronomy and artificial intelligence and and and…and each day ends with just wanting more more more. More books, more research, more people who want to know anything about everything and everything about anything.

There’s something they don’t tell you about eating disorders. About how much you want more than anything to wake up and be in a different skin, how much you don’t want to feel your own body, to notice what space you take up.

But New Kate is still here, taking up space.

I’d like to keep doing that.

Training Therapists: We’re Doing It Wrong.

Becoming a therapist should not take two degrees. If we want to create a program to train therapists, it needs to be one degree that actually intends to make good counselors. We need a vocational school styled approach, explicitly focused on licensing in four years or less.

Getting a grab bag of undergraduate psych experience–which may or may not relate to counseling people, and a year of graduate school before you start interning (read: doing therapy with supervision) is useless. It’s expensive, it limits who can become a therapist in the wrong ways, and lets people who should not be practicing slip through the cracks and emerge with a license.

So We Can Stop Making Therapy a Wealthy Person’s Privilege

Look, the cost of an undergraduate degree is really high. The average public university costs per year is $15,918 [source]. So you go there for four years, and you have a degree in psychology. That’s great, except you can’t do therapy with that.

So you need a graduate degree. That’s $6,000-$15,000 [source] per year in tuition again for two years (assuming a Masters program). Of course, you also have living expenses–even assuming that you don’t have kids or a partner or a car accident or a major illness–the majority of therapists start out in debt. So what they charge for services matters. They can’t afford to spend time giving away therapy sessions, because they need food on their table. It’s harder to do sliding scale sessions if that’s not how your repayment plan works. (Sliding scale is a pay-as-you-can model.) Therapists want to be on an insurer’s list, so they can get a stream of clients.

So therapy costs money, and cheap(er) therapy requires insurance. See the problem here?

Burnout/Weeding Bad Therapists Out:

Premise: Some people who want to be therapists will actually make terrible therapists.

Arguments? No? Okay.

Undergraduate psych isn’t a lot about actually working in psych services. It’s “Look at this cool brain thing! And what about this one?!” “Stroop tasks!” “Neurons!”

And I like all of those things. I like them a lot. But they don’t tell you about how much paperwork comes from being a counselor. Or what the hours look like (hint: it’s not a 9-5). You don’t spend hours practicing how to listen and think and avoid asking “Why?” questions* all at the same time. Not everybody can do this, and that’s fine. But maybe we shouldn’t make everybody figure that out on their own. A program that mirrors the practice of mental health care lets those who can’t do it drop out early (before they get a an expensive set of degrees, hate it, feel obligated to use their education, irritate and harm clients, and then burn out.)

In undergrad, psychology is an ‘easy’ major. Being a counselor is not easy. Let’s match the training to the reality.

Intersectionality & Real Life.

I learned a lot of things about brains and people and microskills and heuristics and biases and writing a concise abstract in my major. I like all these things–I don’t like psychology just because I want to be a therapist. I love statistics and reading research and neuroscience.

You know what I didn’t learn about, beyond a passing mention that they exist?`

Gender & sexuality minorities

Why most people return to abusive situations.

Harm reduction

What systemic poverty looks like

Incest

Rape

Child abuse

What the foster system looks like in practice

Chronic illness as it relates to mental health

Bullying

Suicide prevention

Psychopharmocology (Psych medication)

Asexuality

How to ask for preferred pronouns/getting used to gender neutral pronouns

Polyamory

…or how any of these can intersect.

I would have liked to.
I want budding counselors to begin their education by learning about ALL kinds of people and systems. I want to stop assuming that living in the world gives you enough life experience to counsel anyone. Because you know who can afford to go to college for two degrees, who are encouraged and supported in doing so? Mostly privileged people. Do you know who we’re really bad at providing mental health services for? The underprivileged.

What Psych Services Jobs Can You Do With A Psych Undergrad Degree?

Seriously. Somebody.

You can work at a crisis center or hotline or be a research assistant or or or…yup, I’ve got nothing.

Tracked Classes Are Better Than Pick ‘N Choose

Psychology majors usually have a basket system for major completion. This isn’t a terrible idea, and it’s how most humanities majors work. You get some intro level classes, some intermediate classes, a handful of special seminars, and a few required things like statistics  and Writing a Paper a Specific Way That Will Be Quickly Outdated (aka Research Methods. Yes, I’m bitter). You don’t really have to get them in any order, except you might need Intro Psych first, and research seminars might need you to understand statistics and paper writing. Other than that, you take what you want, in whatever order works for you class schedule.

On the whole, this doesn’t seem unreasonable. You don’t really need to understand 200-level Social Psychology to understand 200-level Cognitive Psychology. I do, however, think you should take Developmental Psychology before you take Developmental Psychopathology. You should also take Psychopathology before you take Counseling, and you should know a little bit about neuroscience, developmental problems, and brain injuries before that too. You should definitely take more than one class about counseling people, and the second, third, and fourth classes should build on each other.

I want a program that plans classes, that puts them in the most useful order, that builds on knowledge to create a well rounded counselor by intention, not by accident.

Look, I’m going to get my two degrees and become a therapist. I would hope that I’ll be a good one. But we need to create a system that makes that the most common outcome, that doesn’t put potential therapists into debt, and that treats mental health work like a career with real requirements in terms of personality, skills, and devotion.

*With the exception of Rational Emotive Behavioral Therapy, therapists are highly discouraged from asking questions that begin with “Why…”, because they come across as implicitly judgmental, even if that’s not the intent.