Aimee: I’m Aimee Becker and I’m currently the Chief Operating Officer for the Gaudiani clinic. We have been open for almost 2 years now. Which is incredible. I moved here to open the clinic from working in the field for a little over 10 years at a group of treatment centres primarily in California but through the United States.

T: What led you to be doing this work?

A: That’s a good question. So I remember the exact moment I was in my apartment in New York where I was living with my partner and I was serving at a wonderful restaurant in Times Square and taking classes to learn how to do wine, a sommelier, I was very interested in that. I was sitting at my computer thinking, I don’t think I want to do this for the rest of my life. I would say I was recovered by actions but not sort of all the way embodying recovery as I know it now. I looked up on my computer, what did I search? Feminist eating disorder recovery. (laughs) And Monte Nido popped up in California it was the first one and I said, how interesting. I know someone in California. So I clicked on the link and one of the things that I saw, it was small, it was only one or two centres at that point. One of the things I saw was, are you interested in this study group call the admissions office and speak to them.

So I called and this wonderful woman answered, so I said my name is Aimee and I’m really interested in being a part of Monte Nido and potentially interested in these study groups. And she said Oh Aimee we would love to have you at the study group. And I said, fantastic. So I packed up all of my belongings and I broke up with my partner whom I love dearly to this day and I moved to California. I shipped 6 boxes to a friend of mines house, I borrowed a car, I got to Monte Nido in my business suit and I think I might have even had a briefcase, which is very unlike me and I was a part of this study group and it was brilliant.

It was beautiful, it was probably 7 or 8 professionals and it was led by Carolyn Costin and at the time Norah Wynne and I loved every single thing that came out of their mouth. I was just astounded, like I have made the most perfect move. This is going to be great, this is going to start my next chapter and so after the study group I went up to Carolyn and said this is just wonderful where do I go for the job? And so she said the job? I was like yes the job! And she said, I’m not sure, I guess go upstairs and talk to Norah. So I traipsed upstairs and said to Norah I’m here for the job and she said we don’t have a job. My stomach just fell, I was like well that’s interesting. (laughs) OK, so I ran down the stairs and said to Carolyn, they said they don’t have a job this is just terrible news, I’ve moved. She goes, you moved? I said yes, I moved, this is the perfect place for me I know it. And she said well that’s interesting, yeah OK well go upstairs and talk to Jack.

So I walked upstairs and knocked on the door and Norah answered again and she said we still don’t have job, I was like right but Carolyn told me to speak with Jack so, she’s like OK but we don’t have a job. Long story short, there was a program co ordinator which sort of was receptionist, admin and it was part time job available and I was in a study group with the wonderful clinicians who also went upstairs and we’d really like to volunteer at Monte Nido and he was like would you also like to volunteer? I was like oh no, I most certainly have to get paid to be here and he was great, he did sort of what I now know to be a group interview with these two other interns and myself and the interns were saying we are part of an ANAD group we just graduated from our clinical psych program and all of these things. He said and how about you, and I was like, I don’t know what ANAD is but I really like it here and I would really, I think I would fit in very well. That was sort of my pitch. I still to this day and he and I have spoken about this quite a bit, he gave me the job, he gave me the part time program coordinator job. Almost 2 years I did program coordinator in the morning and then I served at night and so I remember the exact moment where I felt like becoming a part of the recovery community felt like the right place for me.

T: So now you’re working for Doctor Gauliani so you’ve been a part of the eating disorder community as well and I guess the advocacy community as well as the recovery community. You’re recovered yourself yes?

A: Yes I identify as recovered. Now I’m working for Doctor G and I do the (inaudible) for the clinic and one of the things that I told Doctor G when I got here was that something that was really important to me was being able to continue my advocate work both for eating disorders but particularly the intersection of eating disorders and LGBTQ community. Which is very close to my heart, I used to lead groups for gender and sexuality and I never wanted to be somewhere where I didn’t get to do that and she was not surprisingly enthusiastically approving of such adventures. She said I have no idea how you’d do that but I support you, tell me what you need from me to continue being in that community. So I feel really blessed to have done that.

T: So then what does that look like? What does being an advocate for both those things look like?

A: Fair, so the first thing I would say it means is having conversations. Bringing it up, creating spaces where it’s at the forefront. For example we have all gender restrooms and so when people come into this space in particular they see that this is a welcoming, I guess a safe space, I would say a safe space to be able to do that. It looks like that, it looks like speaking at conferences about eating disorders and LGBTQ population, it means telling my understanding and I identify as a lesbian so I certainly don’t speak for all lesbians and I can’t speak for any of the other letters from personal experience but I do my best voice what I hear and be an ally to those communities.

Oh yeah, there’s a couple of things, so I talked about the all gender restrooms but also having books in the office about those things, making sure that I put material in front of Doctor G, which she’s very receptive and welcoming of. We use an EMR when I first started here it was sex/gender M/F the options ever week for three months I was just writing the company and saying this is wrong, this needs to be changed, it needs to be expanded and it recently has been. So advocating for even our records that are more able to appropriately reflect the population feels really important to me.

T: What do you think are some of the things that maybe clinicians and you know broadly clinicians may do or not do that is potentially hurtful, harmful, not helpful. What would be the main things that you think come up a lot in the community as this keeps on happening?

A: Thank you for asking the question, one of the things that I talk about is something that I noticed is particularly on psychology listings for example, I see that there are all those checkboxes for what your specialities are or the types of patients that you treat and there’s one box for LGBTQ and number of other letters and I think that clinicians often times check that box thinking you know I’m not homoist and I’m not afraid of these people so I’m OK with it and they check the box. But that box doesn’t mean I’m not an asshole (laughs)

The box means that I am competent and qualified to help you through and understand issues that you might be facing and the number of people that check eating disorders and LGBTQ I think is out of proportion. So that’s the first thing that I would say that check yourself before you check yourself, oh I just made that up!

T: (laughs)

A: Erm, so yes I would do that. I would make sure that you’re competent. There are a couple of great resources, Sean Baker has a great competency checklist that I would recommend just to make sure you understand what you’re getting yourself into and you are telling these people that you are a clinician that is competent to treat. That would be one thing. I would also encourage everyone to become competent there’s a huge overlap and I think that there is such limited research in this area but they are starting to do the research and we are seeing such incredible overlap of eating disorders and now LGBTQ and the queer community so I would encourage people to become competent and recognise that if you consider yourself a great clinician then this community needs you to also be a great social justice advocate.

T: What do you think, with that whole checkbox thing, so you’re saying it’s more like people think well I don’t have a problem with that community so therefore should be qualified to…

A: Yes and I certainly don’t mean to suggest that everyone who checks the box is not qualified to treat this community but I do think that a lot of people who check, at least in my lived experience having conversations with people, oh I see that you’ve ticked that box, I’m that person that I call and if I recommend a clinician to some of our patients who are struggling with issues that require that specific competency so I’ll call and I’ll say, I see that you have this box checked, can you explain what that means and they are just like well I’m just open to that community and that’s just not helpful.

T: And so when you say that to them, just so that maybe people who are listening who might be looking for somebody who specialises and just might want to work out how do they know if someone’s checked a box, how do they know if that person actually knows what they are talking about or not? What might be some of the things that you might look for or ask a clinician?

A: That’s a good question, I’m not sure that I would tell the patient to do that work. I think it’s a big brave step to pick up the phone to begin with and then to have to make sure that that person is qualified to treat your specific issues might be really hard it’s an inherent power dynamic right? The therapists are already in this power position, you just want to hope that if that box is checked and you go to see them then when you use, here are my pronouns then that isn’t something that’s confusing or you know so I’m not sure that I’d put that on the patient to be honest. I would say that there’s probably, hopefully if somebody is checking that box, I might say to look for additional information in that listing so if I checked off that I’m an eating disorder professional I might say here’s where I trained and I’m a specialist and here’s long I’ve been in the community and here’s my IAEDP certification, things that I might list that also might give you some feeling that it’s not just a box that I checked but this is real.

T: Yes.

A: I would say to look for those things, that if someone really is a specialist and that box is really something that is an interest, a passion and a competency of theirs then they are listing other things. They are qualified and capable. I would look for other clues in the listing rather than just the box.

T: Yes, do you think it’s important that if somebody has an eating disorder and they are lesbian or trans or gay, that they actually look for a therapist, is that going to make, do you think a substantial difference to them.

A: That’s a great question. It didn’t for me but it might for them. So maybe, you know if someone is trans and struggling with an eating disorder as a means for coping or controlling or handling, for lack of a better word and I’m careful of my language around this, but gender dysphoria then maybe and that might not be something that’s even known if it is known then I would say, yeah! Someone who has that overlap is going to be really important. But I always make the joke that if I go to a therapist and I tell them all the things about me, I have a dog and my parents were divorced and I’ve been recovered from an eating disorder and I’m married to a woman and they stop and go oh, OK. You know, you’re married to a woman, we’ve got a lot to talk about! I’m sort of like, o-kay!

T:(laughs)

A: That whole idea of assuming you know what the problem is, my biggest problem in that might be the dog.

T: Yes

A: You never know, the hardest thing, the client might or might not know but maybe it wasn’t for me.

T: Yes, for some people it certainly might be helpful. So it really depends on persons, individual situations and what they think they actually need understanding in mostly. Yes. So you said that you spoke at a conference and I know what you spoke on recently but maybe, what did you speak on recently? (laughs)

A: Sure, well it was a pretty, I can’t remember the name of the talk now which is hilarious because I was so nervous I probably read it 137 times, my poor co-workers. But it was the intersection between eating disorders and the LGBTQ population and one of the things that has always been a real passion of mine is I love being a part of conversations that I call level 10, which are really philosophical and in depth and for folks who have really entrenched knowledge of the community and the issues that we might be faced with and social justice awareness and all of that. And there is sort of the level 1. The difference between sex and gender. And something that’s really passionate to me is that I’ve seen talks that spend a lot a lot a lot of time on level 1 and a lot a lot a lot a lot of time on level 10 which is all very important but something that I really wanted to do was make sure that everyone in that room had a really good base for understanding about level 1 gender and sex and sexuality and the difference between gender and sex.

And the difference between was has historically been called orientation, sexual orientation that I believe to be more a romantic and or sexual attractions and the spectrum’s and the ideas that they are not binary and then how those all may or may not relate to eating disorders and body dysmorphia and gender dysphoria and you know I’ve seen so many people go into really wonderful topics and come out and go so sex and gender and really just have skipped over that which makes it, they are building blocks. Yes so my talk did a  lot of that. It did a lot, I wouldn’t call them basic concepts necessarily but the foundational concepts for what I believe to be the issues for these intersections.

T: So then people can take those and then they’ve got the foundations because maybe if they don’t have the foundations and they are listening to the level 10 part of the conversation but they’re not truly understanding it because they don’t have that context.

A: Yes. It happened to me. We all start somewhere and it happened to me, listening to things and I’m like this is brilliant, I’m so interested in this, I don’t understand it. Until I did. It took a lot of foundation to do that so I really wanted to spend time on that. I did throw in what I call, I categorised it by level 1, 2,3 and then I threw in what I call level 3 seeds which were questions I asked the audience about for example this idea that I think we have particularly in the States about men and women. Men are like this and women are like this and if women likes the masculine things we call her a masculine woman. So I was talking about these constructs and one of my level 3 seeds was, who do you think benefits to keep these constructs so strict? You know which if I hadn’t described constructs and if I hadn’t talked about masculine and feminine and where that came from then that question comes out of nowhere.

T: Can you give me an example of something where people might get confused if they don’t have, an example of a type of concept or a conversation that somebody might get confused if they don’t have that fundamental knowledge.

A: Sure, one of the, it’s a great question again and thank you for asking these things. One of the pictures that I put up was of a transwoman, so a individual who was assigned male at birth who lives their life as a woman, their gender identity is identified as a woman and the quote and I don’t have in front of me so if I mess it up then I’m sorry and I also don’t have it in front of me to give credit where credit is due but, the quote I believe said something like I’m a woman with a scrotum, so what? Which is really interesting because I think, speaking to your question specifically one of the issues that I’ve seen happen a lot is that people assume that all trans folks want to change their bodies. Which is just not true, there are some trans folks who live in a masculine or feminine presentation or identity who have no interest in changing their body. And then there are folks who absolutely have interest and are very harmed by being in a body that doesn’t feel like it aligns with their chosen identity or what they believe to be their identity.

And so that was one of the points, I got a lot of questions about, they were like so hold on, do we still call that trans? And any time I get a lot of questions or see confused looks in the audience I feel like I’m doing the community a service. Oh good your confused, let me help because I can.

T: Then in that sort of presentation where did the eating disorder relevance come in?

A: So and again and this is not for everyone and not true always, I really try not to speak in always or never but in an example like that or someone who is in a body that doesn’t feel right to them if you think about it this way. If you think about if I’m born a female but I don’t feel like a female or like woman and I want to live my life as a male and a man an eating disorder can often times be a really effective intervention for alleviating my body dysmorphia. So if you think about things like hips that we attribute to females or breasts that we attribute to females and if my periods happen and that feels bad to me, restricting my food helps with a lot of those things. So I talked a lot about how mindfully therapists should engage in this conversation about just eat your food.

If I’m an eating disorder therapist I’m sort of really focused on alleviating eating disorder symptoms which might make body dysmorphia and gender dysphoria much much worse and then it’s sort of whack a mole. There are patients who very well might chose to have an eating disorder rather than feel that in their body from a gender/sex perspective. So the overlap happens in that way and I think it happens a lot. I think being aware of those things, I’ve heard that, you know we know that for many many years that amenorrhoea was a symptom of an eating disorder and when someone menses came back was something that we viewed as a success, if for this particular patient if they are getting their period, that might be really harmful, what I view as a success as an eating disorder clinician, that voice might not need to be the voice that’s centred for the patients healing.

T: Yes, that’s fascinating, well if you’re in the field you will probably understand all of that stuff but I think that many people don’t. Which is why we need to talk about it right? I’ve always felt Aimee that there’s just not very, to my mind there’s not a load of resources for I don’t know if I just do a search on eating disorders and LBGTQ I don’t find a lot and that feels really worrying. I might just be looking in the wrong places and it might be that once you get a little bit more involved you can find things. But even then that’s a bit too hard isn’t it?

A: Yes, it’s not easy. There are quite a few organisations, TFFED is great, Trans Folx Fighting Eating Disorders and they actually have quite a few resources on their website, for around the country. Here in Denver where I am there is Queer Asterisk which is not eating disorder specific but is an amazing organisation which has many queer and trans therapists which like I said a little Whack-a-mole trying to find someone who can do both but finding someone who understands an aspect of it that feels important to you like what I said to you, that it wasn’t something that I necessarily needed but starting there is a good place to begin.

But you’re not wrong there are decent of clinicians but yeah there’s not a huge overlap that I have seen and part of that I think is due to the lack of research that we have to say that this is big of a problem as I believe it to be.  Problem meaning not finding the resources, I’m not labelling the community as a problem just to be clear! But yeah it’s definitely an issue it’s why my certain message over and over again is if you are an eating disorder clinician and you have any interest in this, if you did check the box that I’m not an asshole, then do the work you know? Become competent and be a resource for that community.

T: Is there any, are there any resources for clinicians that are interested in learning more and actually getting better educated.

A: Yes, both of the resources that I said and I’m sorry that I don’t know cross country but I’m happy  to provide you with some links afterwards. But TFFED and Queer Asterisk both do trainings, they do trainings for clinicians they have done a training for EDF here in Denver so for organisations they do it as well as individual clinicians. So you can find the training, there’s an LGBT centre. There are resources for the LGBTQ community. So if you go as an eating disorder clinician you don’t need help being an eating disorder clinician you need a help being a competent resource for the community.

If you are a position of management at your company, it’s something that I fought really hard for, I think that one of the push backs of large companies is this sort of, well how many patients do we have that we need to be competent for? I’ve heard that, when you sort of have to prove that this is a need and I would say 0-1 is enough. Ever. You know? You might not know that you’ve got people calling your admissions office and saying I’m seeking admission for which program? This program, well we only take women in this program, great well I’m a woman, well but what’s your genitalia?

T: (laughs)

A: So even that right? You are talking to someone, your first point of contact needs common sense competency so that you’re not doing harm.

T: Yes

A: So you train your employees as a manager.

T: Okay can you think of anything else that would be relevant?

A: Absolutely, hundreds of thousands of things I can talk about this stuff for hours and hours and hours but I think that your podcast is only so long. I guess something that I would add for anyone listening is that, and people ask me, patients or clients in my past, how did you recover? And I can’t imagine how many times you must get that Tabitha, something that I always say is how I recovered has nothing to do with how you might recover. Period. Full stop. New paragraph.

How I recovered, it was my relationships and I think the relationships that I had then, the relationships that I have now that keep me in the counter cultural bubble in my social justice awareness that I keep fighting for. So I suppose I wouldn’t want to end without making sure that I imparted that one piece of wisdom, that relationships, relationship to self, relationship our friends, family, partner were important to me. It kept me accountable you know? More than anything. If I was able to be honest with people I cared the most about and again, this is just for me and having those people like standing in front of the bathroom, like no, take my hand and you know? And not that that’s proof that the eating disorder is gone but was certainly something that I can’t imagine recovered without it.

T: Huge thank you to Aimee for taking the time talking to me on this podcast. I think this is a big big topic and I see this conversation, this is the first podcast that I have done on the LGBTQ community. That’s kind of sad isn’t it? I’m part of the problem guys! So we need to change that, we need to change this. We need to have Aimee back and other people as well. If you have a question, or a topic, or a theme that you want me to talk to Aimee about then tell me cause I can make her come back on the podcast and we can talk about this more. It’s a huge huge topic area, we can’t cover it all in one podcast and we shouldn’t even try cause it deserves the airtime. So send in your questions that you have to me at info@tabithafarrar.com and you can tweet at me on twitter it’s @love_fat_ Thanks for listening, cheers and until next time cheerio.