Alleviating Anxiety with Jo-Anne La Flèche

[00:11] Jennifer Milner: Because I have no control on what's going to come up tomorrow. I have absolutely no control. So I'm trying to have control on things that I can't control.

[00:32] Jennifer Milner: Welcome back to the Bendy Bodies Podcast, where we strive to improve well-being, enhance performance, and optimize career longevity for every bendy body. This is co-host Jennifer Milner here with the Hypermobility MD, Linda Bluestein.

[00:47] Dr. Linda Bluestein: We are so glad you are here to learn tips for living your best bendy life. This information is for educational purposes only and is not a substitute for medical advice.

[00:57] Jennifer Milner: Our guest today is Jo-Anne La Flèche, a clinical and performance psychologist with an MA in dance and graduate studies in somatics. She's the resident psychologist at l'École supérieure de ballet du Québec, a professional dance school based in Montreal. She teaches performance psychology to students and psychopedagogy to dance educators, and she gives counseling sessions to students in need. She's written several articles and informational papers on dancer mental health issues. Jo-Anne, hello and welcome to Bendy Bodies.

[01:28] Jo-Anne La Flèche: Hi, I'm thrilled to be here today.

[01:31] Dr. Linda Bluestein: We're super excited to chat with you.

[01:34] Jennifer Milner: We are. We want to dig into this topic that is so near and dear, unfortunately, to so many artists' hearts. But before we do, could you tell us just a little bit about yourself?

[01:46] Jo-Anne La Flèche: Hello everybody. I'm really thrilled to be here. I'm a clinical and dance psychologist, as Jennifer mentioned, which means that I have a general practice with people from all walks of society. I work with teenagers right up to people of a certain age who come with all kinds of mental health issues and adaptive problems of all sorts. And that gives me an awful lot of insight on what people go through in life. So I love my job.
[02:23] I also teach psychology, and parallel from that, I've always danced. For a long time in my life, psychology and dance were on two parallel tracks. At one point, I decided to go back to school and try to merge those two passions together. I eventually got an MA in dance with somatic studies, and I started working as a resident psychologist, and that gave me another perspective completely — more, I would say, psychosocial — where I began to get into the dance world not as a performing artist myself. I've never danced professionally, though I have semi-professionally, but to really understand, with dance science, what goes on, and to listen to an awful lot of other artists as well. So that gives me that double perspective on things: individual, psychosocial, and cultural.

[03:29] Jennifer Milner: That's fantastic. And it's great that you can come at it from that point of view. As a clinical psychologist, you have that one-on-one skill, but as a dance psychologist, you see the cultural aspect of it, and you see that big picture as well. That's so valuable for someone working with dancers — to be able to move back and forth between the macro and the micro level.
[03:52] We want to talk today about anxiety, and I know that sometimes anxiety and stress can often get confused. So let's start by defining what is anxiety, what is stress, and what's the difference between them?

[04:07] Jo-Anne La Flèche: That's a very good question. Stress is an instinctive body response to a perceived threat to your well-being. I say perceived because sometimes we can feel threatened by situations that actually are not really dangerous, but for us they are. And usually that accompanies a situation where we feel challenged in some way. So stress responses are global — they're in our body all over the place in our sympathetic system, which means that everything fires off. We'll get tense, our heart will start pounding, our head starts buzzing, and we've got all these bodily responses, which actually are very adaptive because that gives us extra energy to face the polar bear that we think is there and that we need to fight. So that is a really very adaptive response that we've had for millions of years. And then usually, once we have satisfied the need or the situation has been resolved, that stress signal will come down and we'll go back to our normal bodily response.
[05:29] However, sometimes we can be going through a lot of stress factors — and especially dancers, because God knows how dance is a challenging passion and you go through all kinds of difficult situations. When those stress factors add up, we can face different mental health issues. One of those mental health issues is anxiety. Contrary to the instinctive and global body response, anxiety is a specific reaction that we have both mentally and emotionally to an anticipated future. We are fearful of something that has not yet happened, that may not yet exist, or may not even be likely to exist. But in our own minds, we have the impression that we are facing a problem.
[06:32] Anxiety disorders are very common right now, especially with the COVID years and all the challenges financially — wars, pollution, you name it. Anxiety has become one of the major mental health issues in the Western world. And obviously, anxiety can exist on quite a spectrum of intensity. But imagine when you couple that with the dance world, which is objectively stressful. Most dancers at one point will experience anxiety as a very normal emotion — whether it be before an audition, before a dance exam, or a show that is particularly important to them. So does that give you a sense of the difference?

[07:45] Jennifer Milner: Yes, that's exactly it — that's fantastic. And as you said, the dance world is objectively stressful. You have given many lectures and done guest workshops on mental health in the dance world for dancers, dance teachers, directors, and more. You've been very active in the dance community on the issue of mental health for years. So what have you observed in the dance world in regards to anxiety?

[08:18] Jo-Anne La Flèche: First of all, you've got to understand how anxiety works. That's the best way to start working on your own anxiety — to understand what's going on for yourself and what is generating that anxiety outside of yourself as well. It's like a systemic network going on. I like to have this systemic view on things. It makes it more complete, and that way I can understand myself, but I can also at the same time be in touch with the waters in which I am swimming in the fishbowl.
[09:02] Otherwise we get disconnected. As a dancer, I've got to realize that there are a lot of physical and mental factors that can trigger anxiety. Physically, there are a lot of chemical changes going on inside the brain. If you're starting to feel hyper about something and worried about something, that may trigger an awful lot of hormones in your body — stress hormones and physical responses. You may either want to fight something, you may want to flee something, or — the worst situation — you may freeze. You're on stage, and you're just invaded with anxiety, and you may just freeze there and not know what to do, even if you know exactly the routine and everything.
[10:12] You may also have family predispositions. Maybe you come from an anxious family, because anxiety as a trait is hereditary. That can be something to look at and to start reflecting on, especially as far as prevention is concerned, because it means you are more likely to get hyped up about something than other people. That may trigger different perceptions — you may blow things out of proportion or get really worried or anxious about something. Also, you can be anxious because of medication you're taking. If you've taken drugs, alcohol, or excess caffeine, those are all things that can also trigger anxiety symptoms.
[11:25] Psychologically, your family comes from a certain background of values and experiences. Nothing's ever perfect in families and nothing's ever perfect in social life either. Maybe in your family you've learned to deal with stressful situations, but in other families you haven't. And unfortunately, in certain families, dancers have gone through adverse childhood experiences that can also add an awful lot of anxiety to everyday living, never mind what's going on in the dance world.
[12:19] So when I'm feeling anxious, that means I'm being very worried about something. I'm dramatizing something, pulling things out of proportion, or maybe I've got this all-or-nothing kind of vision about things. I've made one mistake and I'm sure that my life as a dancer is finished, or I'm over-focusing on how people are reacting to me. Those things can help you realize that you're getting a bit too worried about something and you've got to work on it.
[13:04] By staying in tune with your bodily sensations — if you're feeling tense and you're having difficulty breathing — you've got to start asking yourself, okay, what's going on inside? What are my feelings? What are my bodily states? How am I reacting to something? Sometimes we have behaviors that actually reinforce our anxiety. For example: I'm sure my best friend is angry at me. She hasn't said anything, but I'm sure about that. And then I start kind of fleeing contact and not talking to her as much because I'm fearful about how she's going to tell me she doesn't want to relate with me anymore. And then by withdrawing, things are going to get worse in my mind. So we've got to really reflect on what's happening inside and how we're reacting to that — which may help or may hinder our well-being.

[14:25] Jennifer Milner: Absolutely, you are making sense. I love that. And I appreciate diving into how we can see these things happening within ourselves as they first start and how we can begin to recognize them.
[14:38] So we've looked at the piece where, whatever the circumstances, anxiety might come up and might start to manifest itself. Before we go further, though, we're talking about the dance world specifically — and in a broader sense, all artists. What about the outside things that we don't have control over? Why is anxiety a hot topic in the dance world specifically right now? Mental health in general is a hot topic, but you mentioned the state of the world and a fair amount of anxiety coming up in general. In the dance world, anxiety seems to be skyrocketing as well. What have you observed over the past few years about what the dance world is contributing to anxiety?

[15:20] Jo-Anne La Flèche: First of all, we've got to look at the dance culture — what are the values that are shared in the dance world? Most of the time it's implicit, like a silent code going on. But as in any performing art, dance attracts passionate people. And it's a never-ending story of trying to get on top of things — but by definition, you can't. And that's what makes a performing art such a passionate thing. It's a never-ending story. We can always do better. Artists normally want to do better, want to be better. And most of the time, artists are quite hard on themselves. They'll be focusing an awful lot on what wasn't okay, what could be better, rather than what worked.
[16:30] The dance culture works that way too, because for centuries, mentors were first pupils, and they received that perfectionistic education. They received the stoicism about facing hardship — how we've got to survive, the survival of the fittest. The show must go on. Some dancers have even learned from the dance world to hide or conceal discomfort or pain because they fear being judged, being perceived as not as motivated or not as tough as other people. So striving for perfection and being harsh with ourselves is certainly part of that culture. Typically, once dancers become mentors, research shows that many times dance educators — unless they've gone through other kinds of training — will teach the way they've been taught. Part of that is certainly very good, but not always and not on all things.
[18:17] That adds tremendously to the stress and generates an awful lot of performance anxiety — the fear of not being at par with the artistic challenges we have to face. That's a subjective fear. No matter how talented we are, we may feel that fear because we want to do good and because we will be judged. Dance as a performing art is also judged by the public. Directors and teachers judge us, but the audience is there too, and the dancer will interact with that audience. The audience has certain expectations. When you go to a show and you've paid for your ticket, you are expecting something. So the dancer — or the musician or the vocalist — wants to please, wants to communicate with that audience and share something. So that adds stress as well.
[19:38] One major factor is also that while the calling attracts many people, the number of real contracts or artistic possibilities is relatively rare compared to the number of people who train in dance. That opens the door to a lot of competition — some of it healthy and uplifting, but some of it really, really toxic. And then there's financial insecurity, because there aren't many contracts, and dance and all the performing arts are typically the least well-paid compared to other fields. Dancers will often have to wait tables or do other things just to make ends meet. That can add an awful lot of stress on a personal level. And then there's the fear of being injured — or an actual injury — which is also stressful. If you are stressed and very anxious, that can raise the injury risk. So all those things add on to a dancer's stress and may generate anxiety.

[21:14] Jennifer Milner: That is fantastic. Thank you. I think you hit on so many of the things that a lot of dancers talk about so casually and just can't put into words the way that you just did. So that's great. Thank you.

[21:27] Jo-Anne La Flèche: You're most welcome.

[21:28] Dr. Linda Bluestein: I think we get used to it too. We're so used to that being the culture. And oftentimes we started when we were so young that we don't realize anything different.

[21:40] Jo-Anne La Flèche: We're like fish that can't see the water we're swimming in. If I start reflecting on what those waters are made of and what I am made of in the dance world — but also outside of that — well, that can help me to start pinpointing and identifying what's going on, and eventually to prevent needless anxiety and needless stress.

[22:07] Dr. Linda Bluestein: Yeah, it seems like anxiety is more the rule than the exception in the dance world. And especially — our podcast is designed specifically for people who have hypermobility, and we know that people with hypermobility are at greatly increased risk of having anxiety. So I think it's really important that you're explaining how to identify these things, and I think it takes away some of the self-blame that can happen. Because people feel anxious about being anxious and get upset with themselves about that. Is there any time that anxiety can actually be helpful? Is there such a thing as good anxiety, or times when having some worry or uncertainty can give you a helpful edge?

[22:51] Jo-Anne La Flèche: That's a great question, Linda, because yes, definitely. When we have a certain amount of stress or arousal and that generates anxiety — I start worrying about what's going to happen — that can really give me an added edge about a situation that is challenging for me and that I want to be at par with. We call that performance anxiety, which is a social anxiety where I fear not being quite at par with the artistic expectations or with social expectations.
[23:38] For example, if I'm preparing for a show or for a dance exam, I will probably be more motivated if I have that performance anxiety. I'll be more motivated to be better prepared. I may review my work a little more than I would have if I felt completely cool and confident about something. I'll really work on my stuff and do my homework. And then after that, maybe I'll be asking for outside help — can you correct me on something? Either from the mentor or even with peers. So that gives me that added motivation to really feel that I am a prepared warrior for what's going on.
[24:33] Another way I may react positively to that stress is by saying to myself, I've got to really take care of myself. I'm going to go to bed early, I won't be too much on social media, I'll eat right, I'll hydrate properly — all those self-care measures that will help me be the best that I can at that time.
[25:05] When I get on stage or into the dance studio, if I'm auditioning for something, that performance anxiety — because I'm feeling aroused to a certain degree — will make me physically more conscious about everything going on. When I'm a little bit stressed out, everything lights up. My brain becomes like a lit-up light bulb. That gives me added concentration, added energy. I'll feel in my muscles that I'm ready to go. So I'll have all that extra energy that I'll be able to use, and I'll be very aware about what's going on around me. That will be a challenge and an added ace to my card game.
[25:54] And typically, performance anxiety will lower during the performance and after — it won't stay there. As soon as I dance, for example, if I'm in the wings and I hear the music coming on, and I've got all these butterflies in my stomach and I feel like urinating and I say, oh my God, what am I doing here, why do I dance? Once the music starts and I go on stage, all that anxiety goes down.
[26:27] But if I'm completely overwhelmed by my anxiety — if I'm worrying and saying negative things to myself, telling myself I'm not as good as anybody else and I'm sure I'm going to fall off pointe or fall on my face — then I can be overwhelmed, and that's when I'll start freezing. So there's a certain optimal degree of arousal for peak performance levels.

[27:11] Dr. Linda Bluestein: That makes perfectly good sense. So for the dancers who are at the higher end of that and maybe really having more challenges with anxiety, are there some ways that they can lower their levels of anxiety on their own?

[27:27] Jo-Anne La Flèche: Definitely. There's a lot of self-care practices that can help. The first, most basic thing is breathing. Typically, if I'm fearful about something, the first reflex that's going to happen — if I feel that there's a polar bear coming at me and I'm their next lunch — I'm going to stop breathing. And once I do that, I'm even more tense. So the thing I've got to do is maybe train daily to breathe deeply and calmly: breathe in for 5 or 6 seconds through the nose, breathe out through the nose for maybe 5 or 6 seconds as well, really getting calm so that my nervous system starts settling down. Then I can feel myself more grounded and more at ease, and the tension is going to let go. Especially work on letting go of your body weight while you're exhaling — that is so, so important. And visualize that you're like a big rock just sinking into sand.
[28:59] You can use all kinds of imaging, which is another thing you can do — produce soothing, calming images that can help you. You can imagine a safe space while you're breathing: beside the sea, on top of a mountain, in the middle of the woods, in your house, wherever. And you just breathe calmly and deeply.
[29:27] Now, breathing and meditation and relaxation is something that needs training, just like dance. If you try to just breathe the day before a dance show or a dance event, that won't necessarily be very effective. That's the same thing as starting to train for an audition the day before. You've got to do it on a daily basis. I generally advise people to do it before they go to bed — it helps them calm down and initiates a more restful night by getting the system down a little bit. And you can also use it as a pre-performance routine. Very often dancers' pre-performance routines are focused almost entirely on getting the muscles warm, but the first thing to do is to start breathing and calming down.
[30:44] I would say positive self-talk is also very important. When I'm anxious, I'm doing negative self-talk. I'm saying, the audience won't like this, I'm catastrophizing, I'm anticipating things that will probably not happen. So I've got to switch that around into positive sentences: I'll do my best. I'm capable of doing this. Positive affirmations can help an awful lot.
You can also use imaging for mental rehearsal — seeing yourself dancing in a positive and competent way and sensing it in your body as you go through it step by step. That will make you feel more secure and add focus and attention to what you're doing. If you do that several weeks before a performance, and keep on doing it, right up until just before you go on stage or into the studio, that's most likely to help you.

[32:59] Jennifer Milner: Yes. And I know we talk a lot about imagery as a training tool. So we've talked about breath and positive self-talk, which I think is so important for dancers because we practice negative self-talk all the time. I always tell the dancers in my class — if you're going to snap for a fellow dancer after she does a great pirouette, why don't you snap for yourself? You snap for your friends, and then when you finish your dance, you tell yourself all the things you did poorly. So positive self-talk, so important. Breathing, so important.
[33:34] But you also referenced something earlier about the fishbowl and separating the fish from the water. Is there value in looking at the situation and examining what is the worst-case scenario? Sort of bringing a reality check to yourself? Is there value in examining the water when it comes to anxiety?

[33:58] Jo-Anne La Flèche: Certainly. We're talking in those circumstances about mindfulness. When I'm in that breathing, I start by connecting to the here and now, because anxiety is related to the future.
[34:15] Depression is related to the past — that's a simple way of putting things. And the present moment is the only place to be. A certain amount of anticipation is an adaptive response — it's useful to know I've got something to do tomorrow because that way I'm going to get ready for it. But when I'm more in the future than in the present moment, I'm generating anxious feelings because I have no control over what's going to come up tomorrow. I have absolutely no control. So I'm trying to have control over things that I can't control.
In mindful practice — taking time to meditate, taking time to breathe — I also take a stance of being a witness instead of being a judge to my own experience. Dancers are very used to judging themselves. You just talked about that, Jennifer — judging themselves, judging other people, comparing themselves, which generates an awful lot of anxiety and negativity. Instead of being in that judge position, I try to be in the witness position. I calm myself down and let my thoughts go by as if they are clouds. I reflect on my thoughts, but not as reality — I say to myself, those are my thoughts. But I am not my thoughts, and my thoughts are not necessarily reality. They come from me, but I can change them if they're not helping me.
[36:14] That will help me to see what's happening in the fishbowl. What kind of water am I swimming in? What's happened this week? That's going to help me find the triggers of my anxiety. Why am I more anxious this week?
[36:35] As you said before, Linda, dancers will have a certain baseline of anxiety they just can't eliminate — it goes with the territory, especially if you're hypermobile. But after that, what's the added stuff? If I'm breathing and I'm in this mindful set of thinking, not judging anything, just reflecting on what's happening, I'll be able to say to myself, okay, my teacher said this, my mother told me such a thing, my lover said something, I'm disappointed in myself — whatever. And from there, I can say to myself: if what's making me anxious is all this negative talk, how could I replace that negative thought with something more realistic, maybe more constructive?
[37:49] That can help me develop what we call self-compassion — being my own best friend. What would I say to my best friend if they came to me with certain things? Would I say they're a terrible dancer who will never succeed? I don't think so. So what could I say instead? I'll try to find something less all-or-nothing: I haven't succeeded my pirouette yet. Putting a "yet" there, reminding myself that I'm in evolution. Or: how do I feel today? What was something I liked about myself today? Feeling grateful, looking at what I did correctly, where I'm proud of myself — or what can I say thank you for, either from myself to other people or to situations? That makes me less focused on the nitty-gritty I didn't succeed at or the things I'm anticipating.

[39:23] Jennifer Milner: That makes a lot of sense. Those are all great ways that dancers can work on their anxiety themselves and try to recognize it and practice for it ahead of time. As you said, you don't start preparing for an audition the day before. So we start preparing our anxiety practice and our self-care before we need it, hopefully. But are there signs that a dancer may want to seek help in dealing with their anxiety and not try to handle it all themselves?

[39:54] Jo-Anne La Flèche: Yes. I think if you feel anxious most of the time and that's been lasting — I would say 6 months — that can be an important criterion. I say 6 months because sometimes we can be in an objectively difficult situation, and we'll talk more about adjustment disorders at that time. Remember that anxiety is on a spectrum of intensity, and on the lighter end are adjustment disorders: I've just moved, I've entered a new dance company, I just left my friends behind, I've had an injury. Normally, adjustment disorders will subside after a few months once I get into sync with things. So that's something really important to consider.
[41:05] Is it most of the time that I'm feeling anxious? Am I waking up most mornings with a rock in my stomach, asking myself how I'm going to get through the day? That's something important to look at. And is it chronic?
Have eating patterns been affected? Either I'm eating compulsively or I'm not eating at all or not eating enough. Have I become hyper-aware of what I'm eating? Am I checking my body weight three times a day? Most compulsive disorders are also related to anxiety disorders. Have I been withdrawing socially? I've stopped calling my friends, I've stopped calling my family. The gang goes out and has dinner together after a show, but I don't go. I feel like I have to go home.
Are my sleeping patterns changing? Am I sleeping less? Sleeping more? Sleep deprivation is something very serious that has an awful lot of impact on mental health and physical health. It can become a vicious circle — I'm anxious, so that affects my sleep, but because my sleep is affected, I get more anxious.
Am I feeling overwhelmed and not in control? Am I feeling shame? Am I saying negative things to myself all the time? Do I have outbursts of tears? Am I angry, aggravated, screaming most of the time? We've all had bad weeks. But if that's going on over time, then you've got to ask for help. You won't get out of that alone.

[43:31] Jennifer Milner: And I think, as you said earlier, dancers are so reluctant to admit that they are in pain or that they are struggling.

[43:36] Dr. Linda Bluestein: Yeah.

[43:37] Jennifer Milner: Because we don't want to seem weak. We don't want to be looked over for casting. And so a step that a lot of dancers will take before they seek outside help will be to try to self-medicate in some way — compulsive behavior, self-mutilation, disordered eating, turning to depressants or stimulants to help. And sometimes we'll do that without even realizing it. It'll just be instinctive, trying to self-manage.
[44:05] But some of those things don't work the way that we think they would. So if someone is self-medicating with alcohol, for example, they may think that the alcohol is actually helping in the situation. But what actually could be going on when somebody is drinking alcohol and also has anxiety?

[44:25] Jo-Anne La Flèche: That's a very lethal combination, because alcohol is a depressant. At first, you're going to feel more relaxed. That gives you immediate, immediate soothing. So that reinforces your behavior — you've just had an emotional candy saying, oh, I feel so much better.
[44:55] But alcohol is a depressant. So after a drink or two, the depression kicks in, and then I'm going to start catastrophizing even more, or I'm going to feel even more tired, or I'll withdraw even more. I get into that vicious circle where eventually I don't feel as much energy and then my performance is being affected. I can't concentrate as much. I'm forgetting my routines. And then I get into that vicious circle with anxiety — I'm fearful of not being at par because I forgot my dance routine, and my teacher or director told me that in front of everybody else, and I'm feeling humiliated. So that's not a good idea.
[45:50] Which is very different from having a beer or a glass of wine on a Saturday night — that's fine.

[45:57] Jennifer Milner: Which is again an example of everybody has a bad week. So we all have these moods. There's a huge difference between having a glass of wine on a weekend night and trying to self-medicate. So if we've hit that point, we realize we need something more than ourselves, we've tried self-medicating and realized that's not the place for it — what comes next? Is there a place for therapy?

[46:24] Jo-Anne La Flèche: I think that if you're feeling that everything you've tried before is not really working, then it's time to ask for help. Depending on your situation — if in your dance company, for example, you have a wellness team — maybe you can go and consult them and just talk about how you're feeling. In certain circumstances, that may be enough. A few counseling sessions with somebody on the wellness team, to sort things out and get a little plan about what you can do, may be sufficient. Maybe the counselor will propose that the person does some journaling or other self-care measures they haven't thought about, or help them reflect on positive thinking. For certain people, it may be enough.
[47:33] Sometimes dancers will stop confiding in other dancers, and the counselor will say, if you talked about how you're feeling a bit more, that would help. Or: you haven't talked to your family that much in the last few months — why don't you reconnect with them? There are certain counseling tools that maybe the dancer needs at that time because things are missing from their toolbox. It can also involve resources — reading resources, educational resources on mental health can help as well.
[48:19] But at a certain point, if general counseling has not worked and resources have not really worked enough, then it's time for psychotherapy. The person should try to find a certified psychologist who is specialized in psychotherapy.
And very often I will also suggest a physical exam at the same time, to see if there's something physical going on. For example, maybe the dancer has a RED-S syndrome, where they're practicing so much and working so hard that — they may not have a disordered eating pattern, but for all kinds of circumstances they're not taking in enough energy. They're not sleeping enough, they're not eating enough compared to all the energy they're spending, and they're not realizing it. That can generate an awful lot of symptoms as far as the endocrine system and the nervous system are concerned. So it's important to get that checkup so the psychologist and the physician can work together, because body, soul, and mind are all connected — it's not little boxes. We've got to treat the person in that systemic mode. Remember the fishbowl and all that? So I would suggest that also.

[50:02] Dr. Linda Bluestein: That's a great suggestion. And we know that sometimes, depending on a person's circumstances, they may have difficulty finding a therapist. You mentioned finding someone who is licensed to do psychotherapy. Do you have any suggestions for how someone can find a therapist who's a good fit? I sometimes have patients who'll say, oh, I tried that and it didn't work, and I tell them it's like dating — you don't always find the right person on the first try. And I also tell them, you deserve to have a therapist. You deserve to work with a counselor. Do you have any suggestions for how someone could find someone who's going to be a better fit for them?

[50:49] Jo-Anne La Flèche: I think that starts with strategic shopping for a therapist. One thing that can certainly be a plus is if that psychologist not only has a clinical background but has also worked in performing arts — or I would say in sports psychology, because athletes and artists often share a lot of the same major issues. So trying to find out about the background of that person can certainly help.
[51:27] Also, asking yourself — if you want to save time — start by reflecting before you go see a psychologist. What are your goals? What's the problem, what are the symptoms, what do you want to work on? And you write that down on a piece of paper. That can be really helpful because first of all, it makes you reflect. It gets you into that witness position — trying to figure out what's going on. And that way, when you shop around for a therapist, you'll be able to meet that person and tell them right off the bat what you need. So you can evaluate pretty soon — maybe in one or two sessions — whether that person is the right fit.
I've had patients in the dance world and outside who will tell me, I really like working with you, Jo-Anne, because we're in an interactive mode. I've seen other psychologists who just don't say anything, and I feel alone, and that doesn't work for me. But for other people, it's the opposite — they need to blurt it out and they don't need somebody to react too much. So we're not all the same. We've got to ask ourselves what our expectations are of that psychologist.
[53:17] Some psychologists have specific tools and always work the same way and don't adjust to the patient — the patient has to adjust to them. Other psychologists will do the reverse. I'm mostly like that — I will adjust to what I feel is the need of the person. So those are things that can help you shop around.
[53:46] Your metaphor is so relevant, Linda. Shopping for a psychologist is exactly like dating — who am I and who are you and can we work together? It's as simple as that. And that has nothing to do with bad faith on the part of the artist seeking help, and nothing to do with a judgment call on the psychologist's competence. It's just a question of fit. So it's worthwhile to shop around.

[54:31] Jennifer Milner: Absolutely.

[54:32] Dr. Linda Bluestein: Yeah, definitely. And I really like the suggestions you make for how to help find that good fit. That's really smart.
[54:42] As we're getting ready to wrap up here — if a person is feeling like they've tried a lot of the self-help things, they understand about self-medicating and recognize that's not a good idea, and maybe they're not working with a therapist but are wondering whether medications might be helpful — there are times when medications are important, and those can be prescribed by a variety of doctors. That might be your PCP, might be a psychiatrist — kind of depends on what's going on.

[55:19] Jo-Anne La Flèche: Exactly. That's why for me it's so important to work in collaboration between the psychotherapist or the psychologist and the physician, who can be a general physician or a psychiatrist — it depends. But yes, in some circumstances, especially if you come from an anxious family and you have that hereditary makeup, it's possible that you will need that little medication that will help you.
[55:53] A lot of patients see that negatively, as a sign of weakness. And I say to them, for certain people, medication for anxiety or for depression is like taking a vitamin for the brain. Some brains are lacking as far as neurotransmitters are concerned, and they need that kind of adjustment. That may also come from dance practice, because we secrete an awful lot of brain hormones while we're dancing — that's why dancing makes us feel good and elated at times. But sometimes we need that little boost.
[56:36] I'm not saying everybody needs medication, but I'm not saying nobody does either. It's really case by case. That's why you need that double evaluation.

[56:46] Jennifer Milner: That was so much information to take in and process and think about and try to put together. I really appreciate the image of the fish in the fishbowl from so many points of view, because I have been thinking about that since you first mentioned it — partly because dance is such a fishbowl world anyway. We feel like we're in this complete glass container and everybody's staring at us and we're going nowhere, trying to do the same thing over and over again and never succeeding.
[57:16] But also the importance of separating ourselves from the water, learning the things we can control and the things we can't. So that's hugely helpful. Thank you for talking through the difference between situational anxiety like performance anxiety and more of a generalized, long-term anxiety; ways that we can practice self-control and self-care; signs that we may need to look for someone to help us; signs that we may be self-medicating unsuccessfully; and ways to find a good person who can help us. There's been so much richness in here and I really appreciate you sharing your expertise on all of this. Is there anything you wanted to add that we did not cover?

[57:54] Jo-Anne La Flèche: You have a couple of hours? But I think at this point, there's something that I often say to dancers that I see either individually or in groups: no matter how passionate you are about your dance, no matter how good it makes you feel, no matter how much you've loved this practice — and I hope that you will have dance in your life for the rest of your life — you must keep in mind that you are much more than your dance.
[58:38] That's part of a reflection that will help you at times to get out of the fishbowl and into that witness stance. Am I happy in this? And that's fine. And if I'm not happy, I could do something else, or I can do it another way, or I can do it at another time. But I'm much more than that.
[59:04] To preserve balance, it's so important that you do and think and talk about other things than dance, because that keeps it healthy. It keeps you in a harmonious passion instead of becoming obsessive about dance. So I encourage you to have non-dancer friends, and that when you talk to your family, you're talking about something else and not forever looking at dance videos or talking shop with your dancer friends. Talk about knitting, talk about other things and do other things.
[59:49] Most dancers, because they get so overwhelmed in their dance, consider that whatever is outside the dance world is a waste of time. That is a very, very stressful way of thinking. It makes us off balance, and that generates an awful lot of anxiety because my expectations towards my dance are multiplied by a hundred because I have nothing else. I have the impression that all my identity is fused with my dance, and that will make performance anxiety and perfectionism skyrocket. So it's very important. Walk in nature. Do other things. It's so important.

[1:00:39] Dr. Linda Bluestein: That is really fabulous. When I stopped dancing, I think it was particularly hard because so much of my identity was wrapped up in dance. I imagine that's true for a lot of people. And so what you're talking about is really kind of inoculating — it's like a vaccine for the day that may come when you're going to be doing something different in your life, and really preparing yourself and making yourself a well-rounded person.

[1:01:03] Jo-Anne La Flèche: And I would say that what you do as a dancer outside of dance makes you dance better. It's not something that is taking you away from dance. It's getting you back into shape because you're balancing yourself with other things. So that's really, really important as far as rest and recovery are concerned — physically, but also mentally, emotionally, spiritually. Just keep in mind that yes, you're much more than that. It gives you that healthy perspective of the fishbowl, even if you enjoy what you're doing tremendously.

[1:01:53] Dr. Linda Bluestein: That's brilliant. And this has been such a great conversation. I've learned so much, and I know our listeners are just going to really love getting to learn from you. Is there a place where they can find out more about the work that you're doing, articles that you've written, and that kind of thing?

[1:02:11] Jo-Anne La Flèche: I encourage them to go on the Healthy Dancer Canada website. There's an awful lot of informational papers that I wrote, but many other people have written also, on all kinds of subjects. That can be very helpful physically and mentally. The more dancers are informed, the more that can help alleviate anxiety — just by saying, okay, this is normal, or I can do this or that. The more equipped I feel, the less anxious I'm going to be. And if I realize that a lot of other dancers are experiencing the same thing, I won't get so overconscious about things.
I would also say the Dance/USA informational papers written by the task force members on dancer health. I've written and co-authored several articles there. So those are things you can look out for. You can also look at Dance Magazine or Dance Current — there are more and more very good articles on mental health that can really help you reflect on things and talk about subjects with other dancers. That helps take away the culture of silence that's in dance. We don't talk about things, which just generates even more turmoil and injury risk. Journaling can help an awful lot as well, to get my emotional states into perspective by putting them on paper.

[1:04:07] Dr. Linda Bluestein: Great. Are you taking on new clients at all? If people wanted to work with you directly, is that an option, or is your practice — I'm sure your practice is super busy, but I think people are going to ask that question.

[1:04:28] Jo-Anne La Flèche: That's really sweet of you as far as the vote of confidence is concerned. But I would say above all other considerations, there are ethical considerations — mental health practitioners have licenses only for the states or countries where they practice. I'm under Quebec jurisdiction, so technically I cannot have a patient from Ontario or British Columbia. And it's the same thing for different states. I can give a workshop, I can be on a podcast, I can do things like that, but not clinical work. So they would have to find resources in their own state or province.

[1:05:20] Dr. Linda Bluestein: And I'm really glad you brought up workshops, because I would love to have you teach a workshop for Bendy Bodies for our audience — where we could dive in even deeper and maybe into subcategories like trauma, which we wanted to talk about more today but is such a big topic on its own. We could talk about that for a couple of hours. So if you're listening to this podcast and you think, gosh, I would really be interested in a workshop like that, please let us know — you know how to reach us — because we would love to put that together if people are interested.

[1:05:58] Jennifer Milner: Absolutely.

[1:05:59] Jo-Anne La Flèche: That's possible. Obviously, it's just like a podcast — a workshop does not replace psychotherapy.

[1:06:08] Dr. Linda Bluestein: Right.

[1:06:08] Jennifer Milner: Absolutely. Yes.

[1:06:09] Jo-Anne La Flèche: But it can really help identify issues, sometimes put things in perspective, and from there you can decide what you need.

[1:06:23] Dr. Linda Bluestein: Very good. This has been such a fantastic conversation. You've been listening to Bendy Bodies with the Hypermobility MD. Our guest today was Jo-Anne La Flèche. Jo-Anne, we have just loved chatting with you. Thank you so, so much for coming on and sharing your vast wisdom with our listeners.

[1:06:41] Jo-Anne La Flèche: It was my pleasure. Always a pleasure.

[1:06:44] Jennifer Milner: Thank you so much.

[1:06:47] Dr. Linda Bluestein: We loved it. If you loved what you learned, follow the Bendy Bodies Podcast to avoid missing future episodes. Screenshot this episode and tag us in your stories so you can connect. Our website is www.bendybodies.org, and follow us on Instagram at bendy_bodies. Leaving a review, following the Bendy Bodies Podcast, and sharing the podcast helps spread the word about hypermobility and associated conditions. This information is not intended to diagnose, treat, cure, or prevent any disease. The information shared is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. We'll catch you next time on the Bendy Bodies Podcast.