Diversity: A Mirasol Panel Discussion
The stereotype persists that eating disorders affect primarily upper middle class young white females, but Mirasol's clients represent a kaleidoscope of ages, races, ethnic backgrounds and sexual orientation. Is it harder to get treatment — and is recovery more difficult — if you're LGBTQ or from a different racial or ethnic background? What if you're older, and have had the disorder for decades?
- Diane Ryan, Executive Director
- Maeve Shaughnessy, Clinical Director
- Katie Klein, Director of Utilization Review and Special Projects
- Anne Ganje, Nutrition Director
- Allison McCabe, Primary Therapist
- Sharon Davis, DBT Therapist
- Rachel Nelson, Art Therapist
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Moderator: "I'm going to jump in with an observation that came to me on our last camping trip, which is that for a small facility, we seem to have a very diverse population. An age range of about 40 years, and all kinds of different racial and ethnic backgrounds, and a lot of diversity in sexual orientation. And so one of the questions I have is, 'Is it harder to get a diagnosis, is it more complicated to access treatment, if you're from a different background?'"
Diane Ryan: "Without a doubt. I think to take people out of the context of their world view is always a mistake, and I think that we miss a lot if we don't consider where people are coming from in terms of their background. And since eating disorders are so much about core identities and beliefs it's really imperative for us as staff to understand where people are coming from on an individual basis."
Moderator: "How do we become more aware of our own cultural biases? How do we look out for that in dealing with clients who may be from a different background, or who may be from the same background? Can we disclose that we may share something with them that they didn't know about?"
Sharon Davis: "I think it's up to the clinician, where their boundaries are and what they feel personally comfortable with. And a large piece of it to consider would be, 'Am I sharing this because I want to, or am I sharing because it would benefit the client?'"
One of the things we do exceptionally well here at Mirasol is really meeting clients where they are. So we, as a staff, treat people as equals. We don't come from a place where we feel like we have all the answers. We believe that each client has the answer within them, and it's our job to facilitate that and to guide them to discover their own solutions.
Diane Ryan: "In terms of all these different diversities, there's a power differential that happens, especially between clinicians and what are sometimes called 'patients', but whom we prefer to call 'clients'. One of the things we do exceptionally well here at Mirasol is really meeting clients where they are. So we, as a staff, treat people as equals. We don't come from a place where we feel like we have all the answers. We believe that each client has the answer within them, and it's our job to facilitate that and to guide them to discover their own solutions."
Moderator: "Can you think of any specific differences that we need to be aware of in working with populations that don't fit the normal profile?"
Diane Ryan: "Asian clients are much more reluctant to talk about emotions. There's a different level of communication and a different level of trust. It's interesting because we have people that come from, say, Great Britain, where they're used to more explicit class system. And we have that here, but it's just not as readily acknowledged. So we have clients who come from poverty and different social situations where they're used to being treated in a different way. The other thing that I think is really important for us to talk about is weight bias. There's a clear preference for non-overweight clients that pervades the whole system from insurance down. "
Moderator: "What about age? What about having clients all the way from their 20s to their 60s? How is it different treating a client who may have had the disorder for maybe 40 years?"
Anne Ganje: "In nutrition counseling, I would say the number one thing is increased compassion for those who have held onto it for 20 or 30 years, because that's 20 or 30 years of additional time where they weren't sharing this openly. And certainly that many years ago there wasn't as much discussion in public. There weren't as many places to seek treatment. So really in session just building the rapport and helping our clients understand that not only is it okay to reach out for support, but there's tons of support available."
Moderator: "I know we've had some clients who are black, who were wondering 'Well, what's that going to be like for me here? Am I going to be the only one? Am I going to feel out-of-place?' What can we do about that? What do we do about that?"
I think one of the most important things we can do if a client is struggling with differences ... is to be sensitive to those differences, to acknowledge and recognize that experience, to not minimize what that might bring up for them and to welcome that kind of processing into therapy.
Alison McCabe: "I think one of the most important things we can do if a client is struggling with differences, whether it be race or gender identity, and they're feeling alienated within the community because of that, the support that we can offer is to be sensitive to those differences, to acknowledge and recognize that experience, to not minimize what that might bring up for them and to welcome that kind of processing into therapy. I think part of the appeal of treatment at Mirasol is the holistic approach that we take, that we are paying attention to the whole person. When I'm working with clients, I always remind them that they are the experts of their experience and their selves. I can bring my own expertise within the eating disorder specialization to the table, but they have grown up with their experiences, with their families and their culture, so I ask them to tell me what that's like, and that's the place that we start."
Moderator: "What about different religious backgrounds? I'm not sure we can fulfill the need to go to different religious services for all of the different denominations that might be represented by our clients. So how do we accommodate all those different backgrounds and be respectful of traditions that may be very different from our own?"
Alison McCabe: "I think religion is another example of how we're open to different supports, and how support can look very different for different clients. We have a spiritual integration practitioner who works as part of our treatment team and who meets with clients and who can talk about things like how faith might play into their recovery, how faith might be a support that they could turn to. So while we as an organization are not ascribing to a particular faith, we're certainly open to clients who might come in with a strong background in that or who might be looking to develop faith."
Diane Ryan: "We had some really interesting challenges with clients who had a more fundamentalist perspective and LGBTQ clients because some of those religious beliefs preclude those kinds of lifestyles. So sometimes we have active conflict between clients whose lifestyle doesn't agree with somebody else's religion. It's really a wonderful opportunity for people to get to know each other as individual human beings, and it mirrors the recovery process. How are we going to accept things within ourselves that we can't accept in others, and to work through this in terms of accepting that everybody has differences and yet we can all still support each other in our recovery." "
Katie Klein: "A few years ago I had a Native American client, and I knew very little about that culture, and she would not look me in the eye, and I remember thinking 'Why is she being so disrespecful?' and 'What am I doing wrong?' and 'Why won't she look at me?'. And then come to find out that that's just part of her Native American culture. There again it was an area where I needed to read up and ask questions and not make assumptions."
Rachel Nelson: "Every client — even if they're the same race, gender and sexuality as me — I don't presume to know them, and their beliefs and their values. I think the cool thing about art is that it's a universal language. So everybody speaks differently and the same in that way."
Moderator: "All the arts can bridge a lot of cultural gaps. I know Diane and I always say that we know that one of our hiking or backpacking trips has been a success when all the clients are singing on their way down the mountain."
Music: "Montmarte," by Jahzzar, from the Free Music Archive.Subscribe to Our Newsletter