On this episode, Dr. Karen Nelson is joined by Dr. Emily Wacker, PHD, LMFT, licensed clinical therapist at Melrose Center. They will discuss Emily's research around Feminist Protective Factors, an idea and practice that can specifically help women who may be struggling with disordered eating or those who have been diagnosed with an eating disorder.
On this episode, Dr. Karen Nelson is joined by Dr. Emily Wacker, PHD, LMFT, licensed clinical therapist at Melrose Center. They will discuss Emily's research around Feminist Protective Factors, an idea and practice that can specifically help women who may be struggling with disordered eating or those who have been diagnosed with an eating disorder. Click here for a transcript of this episode.
Dr. Karen Nelson [00:00:01] Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center. Welcoming you to Melrose heals a conversation about Eating Disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Dr. Emily Wacker, licensed clinical therapist here at Melrose. Emily and I will talk about her research and the idea of feminist protective factors. These protective factors can specifically help women who may be struggling with disordered eating or those who have been diagnosed with an eating disorder. Now, before I begin, I invite you to take a deep breath and join me in this space. Well, welcome to the podcast, Emily, I am absolutely delighted you're here with me today.
Dr. Emily Wacker [00:01:08] Thank you so much for having me. So excited to be here.
Dr. Karen Nelson [00:01:10] Well, before we get started, I would love it if you could introduce yourself and tell us a little bit about what you do here at Melrose.
Dr. Emily Wacker [00:01:18] Absolutely. So my name is Emily Wacker. I'm a licensed marriage and family therapist. Um, I also have a doctorate in human development and family therapy, and that was where I did my eating disorder research. So here at Melrose, I do mainly outpatient and group work. So, and primarily my focus is teenagers, young adults and their families. So I will do– I run our weekly support group for parents and support of others who are concerned about a loved one. Um, and then I also do some facilitation of what we call our family learning series, which is helping parents who have a newly diagnosed teen with an eating disorder.
Dr. Karen Nelson [00:02:03] So Emily, I remember being in graduate school, and so sometimes when people asked me to share stories about my doctorate degree, I start sweating. So I would love to hear stories about what was it like kind of moving through your doctorate and what was your research on for your doctoral degree?
Dr. Emily Wacker [00:02:22] Yeah, absolutely. So I knew that I really wanted to study feminism. I wanted to study eating disorders, but I was like, how did how do I make that connect? I don't really. I want to find this missing link and I was really interested in recovery, so people that were (had) clinical disorders and had recovered, but there's a ton of really good research already out there. And I was kind of just at the beginning stages of my dissertation, that fun, that fun place where we're just swimming and–
Dr. Karen Nelson [00:02:58] for sure, overwhelmed, yes, right? We were all–
Dr. Emily Wacker [00:03:01] Yeah, good.
Dr. Karen Nelson [00:03:01] All these big ideas, right? And then how do I actually put this into practice
Dr. Emily Wacker [00:03:06] and how do I make this meaningful for people? So. That's right. So I remember having a conversation. I was working at an outpatient setting with a colleague, and she was asking me about my research, as everyone does when you're going through this process and I said, you know, I'm struggling, I'm trying to identify the population within eating disorders. And she said because this was a center that was not specific to eating disorders, it was just a general outpatient clinic. And she said, You know, I've never had a woman come in for an assessment, because we do that assessment in the first session, that I've never had someone come in that doesn't share something related to their body or food, whether it's they're on a diet, whether it's they've had an eating disorder in the past. And so it really made me start thinking about that. There are all of these people that maybe don't meet that clinical level of disordered eating, but they're really, really struggling. And so they're presenting with depression or anxiety or these other things. And what else might be going on with their relationship with food?
Dr. Karen Nelson [00:04:18] What a wonderful question. I mean, what comes up for me is kind of this right? Like this cultural aspect, right? I mean, I'm just thinking about personally, right, like sitting with my girlfriends or, you know, listening to other women chat about maybe being dissatisfied with their body or worried that they ate, you know, one too many cookies, you know, potentially not meeting, you know, full criteria for an eating disorder, but that worry or dissatisfaction or concern about food or body that it sounds like that came up for you and you notice that.
Dr. Emily Wacker [00:04:52] it's such a part of our culture. It is just such a part of how we particularly, I guess, I can only speak to my experience as a woman, but it's how we can connect with each other is around our dissatisfaction about our body. And so I think women really struggle to know what is this just unfortunately normal discontent and when is this really becoming a problem?
Dr. Karen Nelson [00:05:17] So this is an issue. We do see patients here at Melrose who do not meet the exact criteria for an eating disorder or a diagnosable eating disorder. Yet we are able to give them resources or support or referrals to other community resources that could help manage some of those concerns around disordered eating. How do you believe the female body is seen in Western culture?
Dr. Emily Wacker [00:05:44] You know, one of the things I think about is. Working with teenagers and then having the lovely experience of being a teenager myself, I've wanted, you know, which I heard a colleague once say that middle school is what we call a really bad idea
Dr. Karen Nelson [00:06:04] to never do – I never want to go back there.
Dr. Emily Wacker [00:06:08] And so I think about when, like when you ask about, you know, the female body and I think about this as women are or girls are approaching puberty, they are supposed to gain a lot of fat. They are supposed to get curves. They are supposed to become shapely. That is just naturally what their body does. And Western culture is telling us at the same time that actually your body should be smaller. And so there's this –that's where I think, you know, I really feel for teenagers, kind of trying to navigate your biology doing one thing and then your culture is telling you another. And so I must not be worthy if my body is curvy or doing these things. But actually, that's just what your body is supposed to do.
Dr. Karen Nelson [00:07:03] That's right. So do you see the connection? I must not be worthy if I take up space. Oh, it is just so painful when we acknowledge that, whether intentionally or not, those are often the messages that our teenagers receive.
Dr. Emily Wacker [00:07:19] Absolutely literally their body is starting to take up more space because that's what it's supposed to do.
Dr. Karen Nelson [00:07:25] That's the biology, right? That is the biology. Why are so many young women experiencing a lack of healthy, positive relationships?
Dr. Emily Wacker [00:07:34] There's a lot of reasons. I mean, I think we absolutely have to name that COVID has significantly impacted this in the past two years. Being an adult living through COVID was challenging. I cannot imagine what it was like being a teenager or a young adult, so they were just more isolated and forming those healthy relationships, I think, was harder. I also think, what we were talking about before where, particularly for women, there is this language around just talking about their bodies and talking about dieting and just connecting with each other around that. And so I think that that can really get in the way of forming relationships. You know, it's really important, especially in the teenage years that you're forming relationships and you're figuring, you're navigating that. And if during that time, most of your relationships are spent kind of connecting around body image or eating disorders or food or things like that, it's really getting in the way of you forming a kind of healthy relationships.
Dr. Karen Nelson [00:08:45] So that does potentially contribute to maybe some of those topics that you talk about in relationship. Can that contribute to disordered eating?
Dr. Emily Wacker [00:08:55] Absolutely, yes. Not having, I mean, I think we know that there's there's two sides of it. That isolation and not having a strong support system is a huge risk factor for disordered eating. And that's why I was really interested in looking at it in a protective way of what do we do? How do we make sure that people have safe and supportive people in their lives? Because then maybe when they're navigating like, Oh, I want to go on a diet or my friends are talking about this and it doesn't. I don't really. These aren't really my values. At least they have a supportive person in their life that they can talk that through with.
Dr. Karen Nelson [00:09:34] So let's maybe talk about that idea of protective factors. So feminist protective factors, what does that mean?
Dr. Emily Wacker [00:09:42] One way that can be helpful to think about it is we have these two lenses, so we have the social relational sphere and we have the social political sphere. And I'm sure people are like, what? What does that mean? That's right.
Dr. Karen Nelson [00:09:55] I'm already lost and sweating and in the back of the class, Emily, come on.
Dr. Emily Wacker [00:09:59] Yeah, you're having flashbacks.
Dr. Karen Nelson [00:10:01] That's right. That's right.
Dr. Emily Wacker [00:10:03] So have it's kind of like this funnel. So I started with feminist theory and then underneath that, I'm looking at we have the social relational component and then we have the social, political and so on the social relational that those protective factors are connection and support. And then on the social political, those are factors like empowerment, agency and voice. So those are from a feminist perspective, the idea is that when you have those that helps you to be less likely to have issues in your life, you know, whether it's falling into an eating disorder or otherwise.
Dr. Karen Nelson [00:10:49] For sure. So let me get if I just list them, the ones that I heard you name are Empowerment, Connection, Agency. Am I forgetting one voice? Voice, OK,
Dr. Emily Wacker [00:11:00] but the agency and voice can often go together.
Dr. Karen Nelson [00:11:02] OK, wonderful. And so let's maybe break those down a little bit and talk about what almost like giving us some definitions or helping us understand what does empowerment mean and what does connectivity mean?
Dr. Emily Wacker [00:11:17] Sure. Well, I'll start with connection because that one's a little bit easier to understand. So when we think about connection as a protective factor, it's not just about having people in your life, but it's about having relationships that are what we call, and I'll explain this, mutually empathetic, so the person they see you, they get you, they want to understand you. And then it's reciprocal. You want to understand them. So there's this depth of connection. There isn't judgment there. There's this person really sees me. They're attuned to me, they get me. So it's having that, that deep kind of connection with someone.
Dr. Karen Nelson [00:12:05] You bet. It feels like a bestie like I'm going to have a bestie like one of the protective factor. What? So my best friend is a protective factor. Oh my god, I can't wait to call her. Exactly. Okay. So all kidding aside, that connection provides a space, I think, to be heard and seen and validated. Oh, I get it.
Dr. Emily Wacker [00:12:26] Yes. And so when I interviewed folks, I had them focus on, you know, two people in their life that they really felt connected to. And it was across the board, you know, it was a spouse or a parent or a sibling or a best friend. Actually, interestingly, aunts came up a lot for people, and this was age range of 18 to 25 were the women that I was talking to.
Dr. Karen Nelson [00:12:49] Absolutely. So that that connection becomes important to protect us from uncomfortable or potentially disordered interactions around food. And then, so connection is one – empowerment. What does that mean?
Dr. Emily Wacker [00:13:05] Yeah, I think we're starting to hear this word more empowerment, which is great. But then I think we're like, what? You know, what does that mean? And it's really this sense of I have ownership over my life. I can make decisions when something kind of knocks me down like I can pull myself back up. So it's that sense of really not to use the definition in the name of it, but it really is. I have power in this world.
Dr. Karen Nelson [00:13:39] Wow. Absolutely. I love that of kind of believing that I can. Yes. Oh, I get that. And so we talked about Connection, Empowerment, and Agency. Tell me.
Dr. Emily Wacker [00:13:51] So and actually agency and voice kind of go together. So I’ll lump them as the same protective factor. But agency is really about like being able to use your voice. Make decisions feel like you are actively participating in your life versus kind of being this passive recipient. So it is similar to empowerment, but it does have a little bit of a different feel.
Dr. Karen Nelson [00:14:24] The word that pops into my head as you talk about that is like trusting myself.
Dr. Emily Wacker [00:14:30] So it's almost as we're talking through this. I'm almost thinking about empowerment as like an external experience and an agency as an internal. That experience could be one way for sure.
Dr. Karen Nelson [00:14:42] So empowerment is I can go out and do those things and agency as I believe I can.
Dr. Emily Wacker [00:14:46] Yes, I trust myself. I can make decisions.
Dr. Karen Nelson [00:14:49] I love that. And that is similar to voice. You said agency is similar to voice?
Dr. Emily Wacker [00:14:54] Yes, because I think when you feel like you can make your own decisions and you can trust yourself, you use your voice, utilize your voice. So voice is something that came out in the research.
Dr. Karen Nelson [00:15:06] Why would it be important for feminist protective factors to be identified for a patient?
Dr. Emily Wacker [00:15:14] Great question. So one one thing we haven't spoken as much about is what we call the eating disorder voice. So let's kind of explore that a little bit. I'm sure. I'm sure you use this a lot
Dr. Karen Nelson [00:15:31] in an anecdote. That's right,
Dr. Emily Wacker [00:15:34] Karen. That's right.
Dr. Karen Nelson [00:15:36] That's right. You go first.
Dr. Emily Wacker [00:15:38] So one of the things is with the eating disorder voice is if you think about that spectrum that we were talking about before with disordered eating in the middle and then clinical eating disorder on one side, normative discontent on the other. So, what I found in the research is that as people spoke, that were in more of that middle category, they started to speak about their eating disorder as if it was separate from them. It was like it was just this voice that was sort of telling them, Oh, you should diet or, oh, you should do this. But they're what I think is interesting and you've probably experienced this as well, is when we're working with someone with a full blown clinical eating disorder, they have an eating disorder voice, but there's so much overlap like you just they can't. It's they'll just dig their heels in and say, I don't like desserts. That's right. Like, it is me. It is not my eating disorder. They're just there's just no separation, right? And so I think what's really interesting and hopefully helpful for people is that if you fall in that disordered eating kind of middle category is, I think of it as more space. So there's more space between you and the eating disorder voice. And so if we can bring in these protective factors we’re then creating even more space.
Dr. Karen Nelson [00:16:56] I absolutely could not agree more. And I love the way you describe that. Another kind of analogy that will use a lot or descriptor is talking about the eating disorder voice as being almost like a volume control and when they first come to therapy, or maybe they are in-patient or they're just beginning treatment. It's it's it's screaming like the speakers are at a time when it's really loud. I had another guest describe the eating disorder is like a foghorn going off in your brain. And so it's really loud. So it the eating disorder becomes the only voice that I hear. And as I move further away from the eating disorder, you know, I often describe it as eating disorder thinking and then kind of good, you know, my own thinking, can I separate the two and the volume gets turned down over time? That's what we want in treatment. Absolutely. And so people who have more subclinical or disordered eating, they have more space between the volume is down. Does that make sense?
Dr. Emily Wacker [00:18:01] Yeah, there would be multiple ways that you could. Yeah, the volume is a little bit lower. There's more space. Often when I'm working with parents to really help them understand because they'll say, you know, I've I've had this wonderful child, and all of a sudden she hates me and she's screaming at me. And all I'm trying to do is get her to eat a meal. And so for more visual folks will use circles. So I'll just say, you know, here's the circle of your child, and here's the circle of your eating disorder. And right now, they're completely overlapped. So you really just can't see your child, you just see the eating disorder. And so if we think about disordered eating, there's still some overlap between those circles, but there's not as much.
Dr. Karen Nelson [00:18:41] That's right. That's right. I had another guest describe it as, you know, the eating disorder used to live in the same house in my bedroom, slept in my bed. Right. And then as I moved through treatment, it moved, you know, to a different room and then it moved outside. And now it's down the street. And, you know, I still might be able to hear it per se. But it's separate from who I am.
Dr. Emily Wacker [00:19:04] It's that space. Again, it's the creating of the space between you and the way that I talk about it a lot clinically and the way that participants talked about it when I was doing the research was that it was their genuine voice and then their eating disorder voice. So that's what they're trying to make the distinction between.
Dr. Karen Nelson [00:19:22] I love that the genuine voice I love that of of like my ability to kind of care for myself and make those good decisions and nurture my body. That's my good, genuine voice. There may be this disordered voice that says you need to diet. You can only eat lettuce today. That's more of a disordered voice.
Dr. Emily Wacker [00:19:42] Exactly.
Dr. Karen Nelson [00:19:44] So let's maybe talk about the aspect of community involvement. It looks like that seemed to help foster a sense of self-worth outside of appearance or weight. Tell me a little bit more about that. Yeah.
Dr. Emily Wacker [00:19:58] So that was that was a protective factor. So I was using kind of those three connection, empowerment, and agency. And then I would notice other protective factors that would pop up, which was it's so fun about research, all of our research nerds because–
Dr. Karen Nelson [00:20:15] I love that you said so fun that I just really appreciate you, Emily. That is a really beautiful way to describe that.
Dr. Emily Wacker [00:20:23] Thank you, Karen. I feel so seen.
Dr. Karen Nelson [00:20:24] Oh yeah. So more questions to answer, right? OK, so and what did you find?
Dr. Emily Wacker [00:20:31] Yeah. And so community, what I found as I was exploring this with people is that community involvement is actually interesting because it's both the social and it's the political. So socially, you're forming a community. And then politically, it's that involvement in that community and kind of making change. And so I guess I'll backtrack and just say what I found with people is that if they were involved in some sort of community, it was protective and we can we can get so– community can mean so many things. I had someone who was really like, I don't think so. And then she started talking about her softball team and she was like, this is just this is my space and I go, you know? So even that is a community and it she did that sport not to change her weight or shape it because she genuinely enjoyed it. So that was a protective community that was outside of the eating disorder. And so, you know, so it can mean so many things, it could mean what we think of as our traditional community involvement, you know, political activism or it can mean other things like, you know, forming supportive communities. And sort of the link is that when people are engaged in those communities, they're not engaged in the eating disorder. It's like building this community in this life that is outside of the eating disorder voice.
Dr. Karen Nelson [00:22:02] Well, the eating disorder takes up brain space, right? And so if my brain space does focus on the softball team and connection and, you know, interaction literally there isn't brain space for the eating disorder to kind of take over. That is really cool. The other piece that I really hear you talking about is community involvement. The word that popped into my head was a sense of belonging. Yes. Oh, like, I fit.
Dr. Emily Wacker [00:22:29] Yes. Which is why it's also a social protective factor, too, because in social relationships that sense of. One of the reasons that we have those relationships is so that we can feel like we belong, that's a birthright that we need. We need to feel like we belong in order to really thrive.
Dr. Karen Nelson [00:22:48] I love that, that. That makes a lot of sense. If someone has an eating disorder and is listening to this podcast, what could they do to incorporate some of those feminist protective factors that we've been talking about?
Dr. Emily Wacker [00:23:02] Well, I think the first thing to do would be kind of take an assessment of the people in your life and just really think about, you know, who is there a person middle of the night? Something happens, who would be my person? See, if you can identify even just one or two people that would kind of be your safe people and start to build from there. And so I would say start there and think about that support. And then from there, I think everything else builds, then you can start to like, explore those relationships, build those connections. And if you're concerned that you're struggling, you can open up and share with that supportive person. Because what I think was also interesting is that when a really interesting finding was that when people disclosed that they were struggling to support a person, that support person was like, Oh, I used to have an eating disorder or, Oh, I used to have depression. Like, it was really common that the person they opened up to actually had their own mental health struggles. And so I think it just built this vulnerability and this you just keep building from there.
Dr. Karen Nelson [00:24:23] I love that. Well, literally, we say it at the beginning of every podcast that eating disorders kind of live and thrive in secrecy and shame. And when we have those honest conversations or we risk a little bit or we take a leap of faith right with this person that I defined as safe, we often can find healing there of like, Oh my gosh, I'm not alone or I can find safety and talking about some of these really challenging and scary topics. I love that. What has to happen in our culture for these feminist protective factors to be in place for all women or all females?
Dr. Emily Wacker [00:25:04] Oh man, how much time do we have?
Dr. Karen Nelson [00:25:06] Right another free PhD project?
Dr. Emily Wacker [00:25:09] Right? Right. I'll get right on that.
Dr. Karen Nelson [00:25:11] That's right. In your spare time? Sure.
Dr. Emily Wacker [00:25:15] Well, a couple of things. I mean, I do think that we're more we're better able to embrace even just the word feminism and exploring it and and realizing what it is and what it isn't. I think that I don't know if this was kind of quite where the question was going, but it was it was interesting that this research was done in 2015 and 2016, and there is actually so much that has happened even since then in terms of the MeToo movement, and women like giving women space to talk about their experiences or just giving them space to talk and use their voices. And there's been a lot of focus on women in leadership and kind of lifting them up. And so I do think things like that are what I see as continuing to kind of make changes where women feel like they belong in the world, that there's a place for them here.
Dr. Karen Nelson [00:26:23] Literally, this podcast? Yeah, like us talking about it feels really important.
Dr. Emily Wacker [00:26:27] There's a space here.
Dr. Karen Nelson [00:26:28] There's a space. We're taking up space. So important, what would be some practical things that parents or guardians might take away from our conversation today?
Dr. Emily Wacker [00:26:40] Yeah, great question. I run our support group at Melrose, and that is I always say that at the beginning of group, I say, you guys, this is my favorite part of my job because those support people are so important, we cannot recover without them. So there's a lot of things. So one of the first things would be to start to maybe think about your loved one from that eating disorder voice versus their genuine self. I think that's really helpful to start kind of being mindful of am I talking to the eating disorder voice right now? Am I? Is it my loved one? And then I think within the relationship, kind of taking an assessment of does, is this a safe? Have I done what I needed to do in this relationship to for it to feel safe? So that would mean a lot of validation. It would mean not judging. It wouldn't mean your loved one comes to you. Don't try to fix it right away. A lot of my participants said that I just I just needed someone to just say this is really hard. So that, I think, is what I really hope support-people can take away from this. And I know that's so hard. Your loved one is struggling and it's like, I have to do something. But just if I could give any unsolicited advice, I would say be a consistent present in your loved one's presence and your loved one's life. And don't try to fix it. Just let them know that you're going to be there.
Dr. Karen Nelson [00:28:17] That feels so important to identify, and we can appreciate maybe the worry or the panic or the fear that comes up knowing that my loved one is struggling, but also being assured that the power of listening and being present and supporting them, you know, sitting, just sitting and listening, that can be enough. That's enough,
Dr. Emily Wacker [00:28:42] and that they're those support-people are deserving of taking care of themselves as well. I think that if I could offer some tangible things for support-people to do is to also build their own community and think about, you know, so that's why with our support group that we run, we talk a lot about. That is like, we're building this community so that you have like, you can't help your loved one from an empty cup, right? You need to fill up your cup and then give from the overflow.
Dr. Karen Nelson [00:29:11] That's a really important point. Absolutely. So just community all around. Yeah, what I'm hearing everywhere. That's right. All the time. I love it. What do you think it takes to promote or teach or embody feminist protective factors?
Dr. Emily Wacker [00:29:27] That is a beautiful question. Oh yeah. And I'm not just saying that to feel it's just I've never been asked that before, but it's really it's a really beautiful question. I really believe, you know, it's a question that's hard to put into words because I experience it on a day to day basis. You know, I just I live it. And so that's where I think it is. I think women sort of taking these ideas and owning it, like making decisions in their life, using their voice, speaking up when someone is talking down to them. Feeling empowered in their life, so it's about, I think you have to live it and you have to feel it. The other people in your life are going to feel the effects of that. That's right. And it's going to ripple out into the community, but it absolutely has to kind of start internally with you. And that's where the societal, I think it's always looking at it contextually, we have to continue to make sure that our society supports women in giving them space to speak up and listening to them and believing them.
Dr. Karen Nelson [00:30:45] That's right. That's right, that it's a personal journey and through that personal journey that it extends outward through community, through connection that feels really important.
Dr. Emily Wacker [00:30:55] and really and knowing and. And I know we talk about these things like they're so easy to do, but this is why it's important to, you know, work with a therapist and keep reflecting on these things. But just knowing who you are, and I think that is where, when people can separate this is my eating disorder voice and this is my genuine self. It's really cultivating that genuine self. It's and then it's bringing that genuine self out into the world.
Dr. Karen Nelson [00:31:21] I love that. Well, Emily, thank you so much for joining me today. It's been an absolute delight talking with you.
Dr. Emily Wacker [00:31:28] Yes. Thank you so much for having me. It's been great and it was. I feel like we're chatting in the lunchroom.
Dr. Karen Nelson [00:31:33] Oh yeah, I right? Yeah. That's it for today. Thanks for joining me. We've covered a lot, so I encourage you to let it settle and filter in, and as I tell my patients at the end of every session, take notice, pay attention and we'll take it as it comes. I'll talk to you next time. Melrose Heals, a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation.