Ep. 048 | Music Therapy & Eating Disorder Recovery

Today, we chat with guest, Kathrine Lee, a board-certified music therapist, about her work in eating disorder recovery.

CONTACT KATHRINE

Rhythmic Heart Music Therapy: https://www.rhythmicheartmusictherapy.com

TRANSCRIPT

Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we chat with Kathrine Lee about her work in eating disorder recovery.

Kathrine is a board-certified music therapist living and working in Boise, Idaho. She has been working within eating disorder recovery for about 3 years, and is passionate about this work. Kathrine owns and operates Rhythmic Heart Music Therapy, dedicated to serving the eating disorder community and beyond.

[Podcast intro music plays]

Erica: Welcome to the podcast, thanks so much for being here. I’m excited to talk about eating disorder recovery, and music therapy, and the intersection of the two. Yeah, so let’s just jump right on in. Can you tell us how did you originally become interested in being a music therapist?

Kathrine: Yeah, absolutely. Um, first, I just wanna say thank you for being here - I’m excited as well. Um, so I, after high school, had no idea what I wanted to do with my life, and went to a community college to explore that - and really became even more passionate about music than I already was. In high school I was always in choir. And also knew that I did not want to be an educator - for a number of reasons. And I love the people who are, but it was not for me. And so I went to a career search and looked up what I could do in music as a profession. And the words music therapy popped up on my screen, and I went down a little rabbit hole, and everything I was reading sounded exactly what I wanted to do. I wanted to serve people, I wanted to use music, and it just sounded too perfect not to try to pursue. And so that’s where it all started.

Erica: Yeah. I think we have similar stories. In real time, when somebody’s listening to this, this episode would’ve already come out, but we did an episode about like how I got into music therapy, and it was very similar to like I just didn’t want to be an educator —

Kathrine: Yeah —

Erica: And I did a Google search and then like started figuring that whole thing out, and —

Kathrine: Yeah. We did a like a career exploration in one of my high school like humanities classes.

Erica: Mmm.

Kathrine: And I went back to that website [chuckles] that we used in high school and was looking up the careers. ‘Cause you did like an aptitude test and all of that.

Erica: Yeah.

Kathrine: And in high school, it was like: physical therapist - and like, still in kinda the same field. But being able to add that music into it was just the cherry on top.

Erica: Yeah, Absolutely, yeah. Yeah. How did you start working in eating disorder recovery?

Kathrine: So, living in Idaho as a music therapist is a challenge sometimes. There’s not a lot of music therapy jobs and/or awareness really in this area. And so, when I passed my boards, I was always looking for a music therapy job. Right, like that’s the dream - that’s what I wanna do. I didn’t wanna move again - I was committed to staying in Boise.

And, tada! A music therapist position in Boise, Idaho just got posted. What?! Um in an eating disorder center - in a brand new eating disorder treatment center that was opening in Boise and expanding from Utah. And I thought, why not? Never in my schooling did I think I would end up in any form of mental health work. But it was a music therapy job, and it was something I wanted to do because of that —

Erica: Mmm —

Kathrine: And I - I applied, and I interviewed, and I was very honest in that I did not have experience/that I was an eager and willing learner, and love music therapy and know how to adapt music therapy. And they - they accepted it, and they were willing to help me learn about what I didn’t know.

Erica: Um, so can you tell us about what what did your work look like? What would a room look like? Who were you seeing? All that jazz.

Kathrine: Yeah, absolutely. So, like when you talk to any music therapist, they will tell it you it looks different every time. It’s different with every population you serve, which is also true in this work. So I worked all groups um at this center, and sometimes it was a group of one, sometimes it was a group of 6, sometimes it was a group of 12, sometimes a group of 2. It was always different so it became very flexible work - um, you kind of knew what you were walking into, but also: somebody might have needed a session and needed to get pulled or - so you gotta be flexible.

A lot of the work that was done there was exploratory. So exploring emotions again, exploring self-expression again, um exploring their authentic voice, through lyrics sometimes, through instrument play, through asking each other questions musically. So it really was a lot of exploration, a lot of adapting to what the group needed in that time. One of my favorite things that we did was a lot of lyric-based work. So I learned, with our group as they adapted, finding the words was challenging sometimes - knowing what to say to express how they felt. And sometimes they didn’t know how they felt until they found the words. SO using lyrics, using manipulation of lyrics, putting them in different ord - different orders, pulling them pulling them out of different types of songs. And really helping them to find their words through that was a really big part of that - and using it as a way to express themselves, to tell their stories, without them having to say it sometimes.

So, sessions look different, but also they - they grew and adapted; every time. I did an intervention, if I did it, if never looked the same twice - even if the same patient was doing it again. It never looked the same for them.

Erica: Mmm. And, were you seeing teens and adults? inpatient/outpatient?

Kathrine: Yeah. So we were an um - it was a partial hospitalization program and intensive outpatient. So that means that there - it’s like a day program - um it was outpatient day program work. And we had um teens to older adults, all in the same group. So that presented another challenges, you know, making sure that we are hitting all of the needs of these age ranges - the age ranges, and the music preferences, and the needs of the different types of recovery that they were in.

Erica: Mmm. Yeah. When you have that breadth of age, you have so many people on so many different parts of the life span, dealing with different developmental things to do with the lifespan - just different stages of like what you’re doing when you’re 20 and may look different from what you’re doing when you’re 40. And um, the other context that comes with a person, beyond their age - and like gender, and race, and disability , and like all of that - eating disorders don’t discriminate to just one particular segment —

Kathrine: They do not —

Erica: Of people. Yeah.

Kathrine: Yeah. And that was - it - it brought a level of integrity to the work for me, because I really had to serve who was in front of me, and serve what they had been through, regardless of if they were a teenager - or if they were 40 or 50. Because, if I have a teenager in front of me in this process, they’ve been through some stuff - uh, maybe not as much as - as the older patients, but they are still here - they are still doing this work. And that needs to be honored in the same way as the people who have been doing this work for sometimes 20-30 years and are still here - and are still showing up to do this work.

Erica: Yeah. Yeah. How did you address the - the trauma that’s associated with eating disorders? How did you address the like disparity of like health - health income or inequity of like treatment for health outcomes based on a long list of like different points of oppression? But like, how did you grow in that, and like what are things that you were doing to work through that?

Kathrine: Trauma is a big piece. Trauma, anxiety, depression - eating disorders never show up alone. They are - there’s something that’s coming with it, and it’s in the room, and we need to address that. And for me, as a music therapist - as someone who knows how expressive music can be - always being aware of how my patients are taking it in - and knowing that in the room as well is numbing - seeing them numb of I’m not gonna feel it - I don’t wanna go through this right now. And so, being aware that we’re gonna bring in a song, and it might trigger - and it might go somewhere that we don’t want it to go - but I want that to happen here so that we can work through that —

Erica: Mmm —

Kathrine: And we can address that. And then we can address that in a space where, if it’s not in music therapy, I have a counselor and your therapist downstairs, and we can continue, and we can get you in a spot where you can continue your day. That being able to address that trauma and address those triggers that sometimes they don’t know are there - in that space where they feel able to go there, instead of in the community and they don’t know what’s going on - being able to address that and support them through that.

And I won’t lie: the first time I had a patient triggered in my group, I kind of shut down. Because I - you know, I’ve been trained, and I have training of how to support a patient and how to guide them through as needed - but I also kinda sat there and was like, I don’t know what to do right now. You know, and that’s - and that’s why we have a team - you know, to say, hey, can you - can you step in, and let’s get this patient where they need. But it’s - it’s real. And And there’s no way - you can’t ignore it. And so you embrace it, and you say, it’s part of it, it’s here —

Erica: Yeah —

Kathrine: And we’re gonna  - gonna treat it like it’s here. Because that’s what we’re here to do —

Erica: Right —

Kathrine: We’re here to address these things, and call them out, and feel them. Even though it’s uncomfortable. We’re gonna sit in that suck —

Erica: Mmhmm —

Kathrine: For a little bit.

Erica: Yeah.

Kathrine: And then we’re gonna take a step.

Erica: Yeah. I think there’s a lot of  invisibility that happens, with a lot of different types of trauma. ‘Cause - this is not about me - without going too far into like my own personal experiences like, I know that certain eating disorders um, especially ones that impact people that are living in larger bodies, where public misconception is that, because you’re fat, you can’t starve, or you can’t be malnourished, or you can’t have an eating disorder.

There’s a lot of invisibility that happens - and there’s so much emotional labor that happens in the identification of a disorder, in the initial treatment of the disorder. And than in the lifelong act of recovering, because unlike certain other types of substance abuse - which, eating disorders are not substance abuse - but, just that I’m only saying that because food - you have to eat to survive. You could abstain from alcohol, you could abstain from drugs um but still survive. And there’s an emotional labor and mental labor that happens every time that somebody has to encounter food - and that doesn’t mean just at meal time, that means when you pas a pantry, when you pass a fridge, when holidays are coming up - any social engagement that involves food. Um, so there’s so much more to the mental health side of eating disorders beyond the act of eating or not eating.

Kathrine: Absolutely.. Yeah, it’s - it’s more than food. Like I said, they never show up alone. There’s so many things that play into this, and that misconception of you need to be a stick to have an eating disorder, right, you have to look like you have an eating disorder. There is no eating disorder look. I would tell my friends, you know, if you walked into my clinic, you know, and nobody had a name tag on, you wouldn’t know whose the patient and who’s the staff. They look like people you see every day. There’s no - there’s no size, there’s no age, there’s no gender. It’s every body. And it’s more than one or two times - it becomes that addictive behavior sometimes. It becomes part of your control. Maybe that’s the only thing you can control.

And working in eating disorder recovery is understanding that. Understanding that this person in front of you is showing up with more than a diagnosis on a piece of paper - they are a full person. And they have - they have stuff, just like anyone else has stuff —

Erica: Mmm —

Kathrine: And they’re gonna show up sometimes and it’s gonna suck sometimes. But they’re here. They have gone through, like you said, that emotional labor of even just receiving a diagnosis, and now have accepted treatment. And those 2 steps alone are tough. Now the - now the even tougher work starts of unpeeling those things that come with it.

Erica: Absolutely, yeah. And your clients at the center were so fortunate to have a music therapist on staff. Because we talk about this somewhat frequently, that music has such a unique capability in working through trauma. I’m coming to a new um perspective on trauma - that trauma isn’t necessarily always going to be healed, because there are things that are reoccurring, but I do believe in like working through, and moving through, and creating coping mechanisms for when reoccurring trauma happens. And we’ve talked a little bit about the brain science of music, and how the nonverbal capabilities create um visceral experiences for clients, and that’s - that’s very cool.

Kathrine: Absolutely. Yeah, and it is the same thing in eating disorder recovery. Like you said, food is always gonna be there - we need food to survive - our bodies are made to survive on substance. So it’s that constant adjustment/that constant acknowledgement. And it can be a cycle sometimes - you know, we do see patients come back, because it is that constant, you know, I do need this, and I do need to build those coping skills, and build those tools that are going to be helpful. And as you go through that lifespan, those tools are gonna change. And so, maybe yeah, you do need another step of treatment to decide how am I gonna adjust these coping skills? How am I gonna continue to adapt to this constant thing that’s in my life?

Erica: Mmm, yeah. Because you entered into this role not really anticipating that this was the work that you were going to do, how did you grow - as a therapist/as a person In - in the course of your time with the center?

Kathrine: I grew, first of all, to love this work - t be in awe of, really, what music therapy could do - and how - how many ways we could manipulate it to fit their needs. And so, as a therapist, I grew a lot in being able to adapt, and to create different types of interventions of, you know, this was really successful, how could we tweek it a little bit to make it even more successful? How could we tweek it to make it fit a different need that is presenting? And really having those moments of, okay, well this worked, what if we do this?

Because in music therapy, we don’t talk about eating disorder treatment a lot. There’s not a lot out there to pull from like there is on music therapy with neurodiversity or music therapy with older adults. And so, really, you’re kind of building it as you go. So being able to be successful in that, and continue to grow as a therapist was amazing. And then, just continuing to have this passion to serve this community - because, as we know as music therapists, it’s emotive, it’s expressive, it really can provide a lot. And so to be able to continue to serve in Boise, Idaho, where mental health doesn’t get talked about a lot - where music therapists sure don’t get talked about a lot, you know, And being able to really expose the greater eating disorder community to this type of work has just been amazing.

Erica: Um, you should write a paper, just FYI. Um [chuckles] —

Kathrine: I want to [chuckles]

Erica: Um, what is something that surprised you?

Kathrine: I think my biggest surprise working in eating disorders was the lack of conversation.

Erica: What do you mean by that?

Kathrine: I mean, the lack of conversation in music therapy world - the lack of conversation, even in mental health world. I feel like we have the mental health world, and the eating disorder world, and that sometimes gets put into the mental health world, and then they don’t really want it. And they leave it out, and so it’s - it feels like sometimes that eating disorder conversation - eating disorder treatment is something that we shouldn’t talk about - is something that - maybe it - it only exists for, you know, those size people like you talked about - those people that fit that image. But it doesn’t. Why are we not talking about it? Why are we not normalizing it the same way we’re trying to normalize mental health? Why are we not serving these people who are going through even more than maybe a quote unquote general mental health diagnosis?

Erica Yeah.

Kathrine: Why are we not talking about it?

Erica: Yeah - yeah. I have so many thoughts. Without getting too far on my soap box about it - just the pull of diet culture is so strong. Diet culture is so pervasive —

Kathrine: Yes —

Erica: In western culture. If you are listening, and unfamiliar with the phrase diet culture/health at every size paradigm, I highly recommend Body Respect by Linda Bacon - I highly recommend reading that book. There’s some other books and websites that I will link in the episode notes if you are curious and would like to know more. Um, you’re always welcome to contact us directly - us being the Music Project - me, I can forward you on to Kathrine. We will talk to you about it.

Kathrine: Absolutely.

Erica: But diet culture’s so strong, and really, that comes down to: people want to be accepted. They want to belong, they want to be loved. And we’ve created - there’s a system that exists that says that you have to do certain things/look a certain way to get those things. And that’s just —

Kathrine: And we normalized that —

Erica: And it’s so normalized, people don’t know that they’re participating in that system anymore. I have a huge soap box about it [chuckles]. So —

Kathrine: I do too - I do too.

Erica: Yeah. Um, but that ‘s why - that’s why that - that exists. That’s why it’s not normalized to talk about eating disorders, and yeah.

Kathrine: Yeah.

Erica: So, yeah.

[Erica and Kathrine chuckle in agreement].

Erica: I don’t remember what you said that triggered me to think of that, but absolutely, like —

Kathrine: It’s —

Erica: Yeah. There’s just not enough literature. And I’m so glad we’re having this conversation today to talk about music therapy and eating disorders. Music therapists should absolutely be working in eating disorder recovery - and art therapists, and drama therapists, and all of the creative arts should be represented in eating disorder recovery.

Kathrine: Yes! Music therapy can support that whole span of treatment and recovery.

Erica: It’s so cool.

Kathrine: How unique is that? Like it’s - why are we not taking advantage of this? Not take advantage —

Erica: Well, just - advocating for it —

Kathrine: Exactly.

Erica: What inspires you during the hard moments?

Kathrine: The patients. The clients - they - they are showing up. They are doing the hard work. I can show up for them. Looking at the moments of them, when they get to say, I can make noise, and I don’t care who hears. And I can make noise, and people wanna hear it. And I have the words to express to my family, to my sibling, to my partner - I can express myself in a way that feels good, and feels like me. That doesn’t feel like my eating disorder. That feels like my authentic self. And seeing them have those moments makes up for the tough ones. And that’s what inspires me.

Erica: If listeners would like to know more about work, or just know more about you, where can they find you? Where are you at? All that stuff.

Kathrine: Yeah, so I, like I said, live in Boise, Idaho. I have recently started my own private practice, specifically to serve the eating disorder community here in Idaho um called Rhythmic Heart Music Therapy. Uh, my website is RhythmicHeartMusicTherapy.com. And there’s information on there about who I am, where I’m at, um my services. There’s also bundles on there of lyric poems that people can do and take for themselves to be able to help serve people who aren’t in my state - even clinicians maybe who wanted to experience a different way of practice. Like I said, having the conversation, being passionate about sharing, and being willing to have these conversations - I’m always willing to have these conversations. So shoot me an email, find me on my website. Let’s talk about it!

Erica: [Chuckles] Awesome. So, listeners, I will put Kathrine’s information/her website on our website.

You can find that, the other resources I will list about eating disorders, and the transcripts of this episode are available at S C - S as in Sam - C as in cat.- Music Project dot org (scmusicproject.org). Um encourage you to follow on social media @SCMusicProject - all the places. If you want to follow along and receive notifications when new episodes are released, we encourage you to subscribe or follow - depending on which app you’re using. Share with family and friends.

Thank you, Kathrine, again, so much, for chatting with me today. I really appreciate it - appreciate all the work you do for the music therapy community. And you’re awesome.

Kathrine: Thank you so much for having me and for having this conversation. Let’s keep it going.

Erica: Absolutely.

Thank you, listeners, for listening. And we will talk to you next time.

[Podcast outro music plays].