Disordered Eating in Dance with Josh Spell, LICSW, and Guest Co-Host Jennifer Milner

[00:35] Dr. Linda Bluestein: Welcome back, every bendy body. This is the Bendy Bodies Podcast, and I'm your host and founder, Dr. Linda Bluestein, the Hypermobility MD. This is going to be a great episode, so be sure to stick around until the very end so you don't miss any of our special hypermobility hacks. As always, this information is for educational purposes only and is not a substitute for personalized medical advice. Today we are so excited to have Josh Spell, social worker, therapist, dancer, plant enthusiast, and lover of the arts with us. But before I welcome Josh, let me introduce my friend and yours, Jennifer Milner, former professional ballet and Broadway dancer who trains hypermobile artists to work to their fullest potential. She knows a thing or two about being a bendy body. We are so fortunate to have Jen here today co-hosting this episode. Hey Jen, it's so great to see you again and to have you here.

[01:41] Jennifer Milner: Hi, thanks for having me back. Always happy to jump in and be part of the conversation.

[01:46] Dr. Linda Bluestein: Yay, I'm so excited. And Josh has been working in the mental health field for nearly a decade. He has experience working with clients facing depression, anxiety, PTSD, bipolar disorder, grief, suicidality, anorexia, bulimia, and more. Josh is currently the consulting mental health therapist with the Pacific Northwest Ballet and the owner of Flexible Mind Consulting, offering one-on-one counseling and workshops worldwide. Josh, hello and welcome to Bendy Bodies.

[02:15] Josh Spell, LICSW: Hello, thank you so much for having me.

[02:20] Jennifer Milner: We are really excited to have you today because we want to talk about eating disorders, which, as you know, can come up a lot in the dance population and can also come up in the hypermobile population because there's a lot of overlay. We know that people with hypermobile disorders are 7 to 8 times more likely to struggle with anxiety, with depression, with OCD, eating disorders. So we already know that this community is at risk. And then we know that dancers are at even greater risk, and that there is a higher percentage of hypermobile people in the dance population than there is in the general population.
[02:58] So that's what we want to explore today — eating disorders and how they kind of overlap there. In your practice, and I know this can come across as a silly question, but how commonplace is it for you to encounter someone with disordered eating or an eating disorder?

[03:15] Josh Spell, LICSW: Yeah, I would say probably about 50%, and that's in my practice that is non-dancer and dancer alike. If I'm thinking about my specific work with dancers, I would still say about 50%, but it may go up a little bit — it might be a little bit higher just because of the nature of the aesthetic sport and the relationship with body.

[03:45] Jennifer Milner: That's a fair number. Do you think that number is so high because these are the people who are seeking you out for help already and know that they're struggling with something, or how do you think that number translates to the population that we're talking about?

[04:03] Josh Spell, LICSW: Well, I think just in general, diet culture is so pervasive — non-dancer, dancer. So it's everywhere. We see advertisements about how to lose weight or how to be healthy or things like that, and so we're already exposed to that. And then when we add the layer of dancer, and how much time is spent in a studio, in leotards, in front of a mirror, it just sort of exacerbates that and elevates, I think, the emphasis on body.

[04:36] Dr. Linda Bluestein: Yeah, definitely. And do you see very many people with either known or suspected hypermobility disorders or connective tissue disorders like one of the Ehlers-Danlos syndromes?

[04:49] Josh Spell, LICSW: Yes, actually. So my non-dancers — I have not really seen hypermobility. But when working with dancers, yes, EDS is definitely a diagnosis that I am familiar with. I'm not sure of the others, but EDS is something that I have acknowledged. I have helped a couple of dancers, and again, that overlap that you're describing with increased anxiety and other mental health concerns, and then specifically eating disorders, it makes sense to me just because there is this emphasis on, "Why is my body giving out? What can I do to sort of compensate for what's happening?"

[05:43] Jennifer Milner: Well, and you used an interesting word there that we're going to get to in a second — control — because there are a lot of myths surrounding eating disorders, right? Like dancers are doing it just to be thin. Or you have to be thin in order to have an eating disorder. Like you should be able to look and see — if you're not dangerously underweight, then it doesn't really count as an eating disorder. And in reality, an eating disorder is a mental illness, and you can't just see it by looking at someone. So can you help us understand a little bit more about eating disorders?

[06:16] Josh Spell, LICSW: Yes, so I talk about eating disorders as a psychological injury, because dancers have experienced injury before. So it's a way of relating. And it's not just about body — I think that's the main thing. It's often a coping mechanism. It's a coping strategy, either to control, like you said, or to avoid — avoid difficult emotions, avoid failure, avoid chaos, and avoid being exposed to stress.
[06:54] So dancers often find this sense of control, or it can also be a numbing sensation. When we get into overwhelm in our nervous system, we need to find some way of relief and just space from all of the mental chatter or from the stressors of the dance world. Sometimes eating disorders are what emerge from that.
[07:27] Another way to see this is as a kind of psychological or relational distress. Like, for example, with restriction — think about the pandemic. There was a lot that was taken from us. It felt like we could not have the freedom, the flexibility that we were used to before. And so sometimes individuals who restrict emotion or maintain a very clear, safe way of interacting with the world — restricting behavior, restricting social engagements — we can often see this parallel with something like anorexia nervosa.
[08:20] But that can also be the case with binge eating, perhaps — feeling this out-of-control nature. Or maybe there was exposure to really restrictive meal times, or maybe there was food scarcity, this inability to procure food. So all of a sudden we have individuals in this cycle of overeating, binging. And that's a way, again, to make sense of those restrictive experiences that have emerged in their life.
Also, binge-purge behavior can be a way of wanting to rid the body of unhelpful stressors or difficult emotions. So again, it is so important to see that it is not just about wanting to be thin. It's really about, "How am I making sense of what's happening to me?" Just like other coping responses — like alcohol, or shopping, or other behaviors — eating disorders are sort of a response. And most of the time, in the beginning, they make individuals feel better. But we all know, eventually, that honeymoon phase subsides.

[09:55] Jennifer Milner: Yep. And it's interesting to think about the two sides of that coin. On one side is the control, and on the other side is the avoidance. Dancers and other artists feel so helpless. We don't have a lot of choices in our everyday life. We figure out what pointe shoes work best for us, and those are the pointe shoes we wear. We have a little bit of freedom in what we wear in the dance studio, but not a lot. We have no control over our schedules. We have no control over casting.
There are so many things that we feel like we don't have control over. And that mirror — I can see control being one way to deal with having to face the mirror, and I can see avoidance being another way to deal with having to face the mirror. Both are us trying to find some way, as you said, to make sense of our lives and to frame it in a way that we can cope with.
[10:54] As we talked about, people with hypermobility are so much more likely to have OCD, anxiety, depression. In your practice, do you see connections between eating disorders and other mental health issues like anxiety, depression, and OCD?

[11:09] Josh Spell, LICSW: Definitely. There is a lot of intersection, and there are a lot of co-occurring disorders that are happening simultaneously with eating disorders. Anxiety, OCD, depression — I see all of that. And especially when working at a higher level of care in eating disorder work, often we see individuals who all of a sudden have a lot more space from their eating disorder — the eating disorder voice is softer — but then all of a sudden we have the anxiety spike or the OCD spike. And so it becomes this whack-a-mole situation where we have to address similar factors.
[12:01] Things like eating disorders and OCD — perfectionism is definitely a part of this as well and upholds some of those behaviors. We can definitely see the crossover. There's this obsessive body checking, and when we don't check, the anxiety spikes. Or if we see something we don't like, we get very upset about who we are, very down, our self-worth is challenged.
[12:35] So there's so much and so many directions to go, which is why I think eating disorders are so difficult — because it's not just one singular behavior. It's not just, "If you just eat, you'll be okay." There are a lot of reasons why individuals cannot, or why they are using food in a different way, not just the restrictive aspect.

[13:00] Jennifer Milner: And I think that's one of the important things you just said — it's not just, "If you'll just eat, you'll be okay." That's often the first line of attack with a family with a younger dancer, or with a company with an older dancer: "Let's just get you eating again." And as you said, you're addressing what people see but not the underlying issues — the anxiety, the depression, the need for control, the OCD that enjoys counting calories and organizing foods. It is a much more complicated issue than a lot of people really understand.
[13:38] You mentioned the pandemic and how things have changed and how it could have contributed to disordered eating in dancers. What do you see right now as far as dancers and their self-image? With the social justice issues that have come up and dancers starting to find their own voices, have we seen a change for the better? Have we seen a change for the worse because of the uncertainty of the pandemic and so many ballet companies stressing about funding? What have you noticed with dancers and self-image?

[14:05] Josh Spell, LICSW: I think we are in a very different place than ever before in the dance world in terms of acknowledging all of these concerns. There's more space to explore what is coming up for individuals, but I also think there's some fear in the overall structure that sometimes makes it difficult to challenge things like body image.
I still see this very perfectionistic tendency where dancers are holding themselves to very, very high standards. That feeling of wanting to perfect the machine — treating our body as this mechanism for our art — I think dancers are always wanting to push that, which sometimes takes them out of their own reality and out of listening to their bodies. And it's not always just in pursuit of losing weight or manipulating the body. But there is that desire to be the best version of what a dancer can be.
[15:41] We're always working to improve. That's what class is about, that's what rehearsal is about. So there's constantly pointing out things that aren't working. And I think sometimes dancers' sense of self becomes more focused on the things they need to work on versus: "What are you actually bringing to the space? What is your unique body able to do with this lexicon of steps and this repertory? What can you do that is uniquely you?" — versus, "I need to fit this very specific mold of the dancer ideal."

[16:29] Dr. Linda Bluestein: Yeah, that makes a lot of sense. And in terms of trends you've been noticing recently — obviously a lot of us are spending more time on various video platforms or social media. Have you been seeing any changes there, with dancers struggling with these kinds of problems?

[16:54] Josh Spell, LICSW: I think definitely for the younger generation, social media is a huge component of this. When I was dancing, I did not have access to someone's feed right away, or YouTube even. I watched videos on VHS tapes.

[17:15] Jennifer Milner: Yeah, we probably all did, right?

[17:20] Josh Spell, LICSW: I remember that Don Quixote with Cynthia Harvey and Mikhail Baryshnikov — of course, yes. But that's how I got the exposure. Now we have all different styles, genres, dancers who are out there, and I think there is a lot of comparison. Like, "I need to push myself to the extreme because if I see this person doing it, then why can't I do it?" There's that unrealistic acknowledgement that I can control my body, I can push my body past these warning signs.
[18:03] But also — you mentioned Zoom, and even right now, if we were talking in a room in person, I don't think we would be able to see our reflections. With Zoom, people do see themselves. Of course there's the option to hide the speaker view, but I think we've never really had to consider seeing ourselves all of the time.
And then there's the influence of diet culture, which we can't ignore — it sort of smuggles in this idea that you can change your body through discipline, through diet, through exercise. Now there's this whole conversation about weight loss drugs, which again is just placing even more responsibility onto individuals versus being able to say, "Hey, we all have different genetics, we all look different." For dancers, we want our bodies and our instruments tuned to the highest level possible. However, we have to acknowledge that it's not that easy. It's not a quick fix. It's not something where we can just snap our fingers and suddenly have control.

[19:44] Jennifer Milner: Right. And not only is diet culture saying you can do this, but it's saying you should want to do this. And that's what makes you feel that little extra spark — like if you're satisfied, you must be missing something. If you're content with yourself.

[20:03] Josh Spell, LICSW: Exactly. And that shows up with the self-criticism piece too. There's this belief that you have to be hard on yourself in order to be a successful dancer. And part of being hard on yourself is almost sacrificing. I remember at the School of American Ballet, everyone was on some sort of — I don't know if it was a diet, we didn't use that word — but there was some sort of sacrifice being made. Like, "I have to eat a certain way," or "I have to jump on the bandwagon." And that just complicates things. I don't think it has to be that way. A lot of what I talk about is: we don't just have to freely accept that we have to struggle with our bodies in order to be a good dancer.

[21:03] Jennifer Milner: Well, I tell my dancers: as a dancer, you will have to sacrifice in some ways. You may have to live in a cheaper apartment than you would like to. You may have to rent books from the library instead of buying them. There will be sacrifices that most people have to make to pursue a career in dance. But you should never have to suffer. That's the pivot point for me — we sacrifice, say, being able to go out at night when our friends get to do fun stuff because we have a show the next day. There are things we do have to give up. But they should not feel like suffering, and they should not feel like, "I must go through this in order to be a real dancer." Would you agree with that?

[21:45] Josh Spell, LICSW: Exactly. There's a difference, like you're saying, between suffering and sacrificing. That whole idea of the dancer identity — being very focused on this pursuit of becoming a dancer — can sometimes bring up difficulties for individuals who think, "Wait a second, I don't want to sacrifice. On a Friday night, I might not be able to go to homecoming because I have a rehearsal or I'm getting ready for Nutcracker."
[22:27] But the main thing is: our self-worth is not contingent on how good a dancer we are, or how thin we are, or our ability as a dancer. We have to really make sure — and this is what I do with a lot of my clients — how am I nurturing that sense of self-worth? A self-worth that can acknowledge, "I can't go to a football game or hang out with other people," and recognize that as not a personal deficit, but just the reality of choosing to pursue a career as a dancer.

[23:06] Jennifer Milner: Yep. And I think this generation especially — as you were mentioning with social media — they're also judged and have themselves put in front of themselves on a daily basis. So many of my students will do a class and a private lesson to work on a solo, and then it's filmed at the end, and then they stand there and immediately watch the video, and the teacher picks apart and shows them everything they did wrong.
[23:31] I think I was probably not nearly as good of a dancer as I thought I was, but there's no video proof around for me to know — because I didn't have to watch myself, I'm safe with my fantasies in my head. But these dancers are confronted every day with videos of themselves. Not just YouTube and social media to aspire to, but having to look at themselves. And 10-year-olds are getting in-depth critiques from multiple judges at every competition they go to: "You need to do this, fix that, fix that." At a very early age, they're being critiqued and judged purely based on who they are as a dancer.
[24:05] So obviously that's going to feed into eating disorders. And the bigger picture is: are studios, directors, and companies contributing to this idea of a higher identity as a dancer? Are they fostering the sense of, "You must be a dancer first, you must sacrifice"? Are you noticing that, or does it feel like it's starting to even out?

[24:34] Josh Spell, LICSW: I still notice that messaging. Maybe it's not as overt, but even when a teacher gives an example — "When I was dancing, I didn't get to go to the movies" or whatever — to me, that is a flavor of, "You have to be all in here." So I do see that.
[25:05] I think, again, we're having conversations now, not just with dancers but also with administrators and teachers. And it's getting over the hump of, "Wait a second, but that's not how it was when I was dancing." There are a lot more resources available for dancers now, and a lot of the messaging is around how having outside interests actually bolsters who you are in the studio — it's actually needed in the studio. We can still emphasize that dedication piece, and for a lot of dancers that was their favorite identity. But it doesn't mean you can't explore other parts of yourself.
[26:09] And I also don't think teachers should put a dancer's dedication into question if they do choose to do something extracurricular. Because that circles back to that restrictive nature — feeling like my life is being restricted because of dance. And so I will find my freedom, I will find my outlet for who I am, through something like an eating disorder.

[26:47] Jennifer Milner: Right — that avoidance. Well, let's assume we're in an ideal world. A great company or a great studio where teachers are giving positive feedback, nurturing the dancer to be more than just a dancer, their social media is curated — all the things are lining up correctly. And yet a teacher, a company member, or a director is concerned about a dancer and suspects they are developing an eating disorder. It's a really helpless feeling, because your instinct — my first instinct — is to just say, "Go eat," even though you know that's wrong, because you're so worried about them.
[27:31] So what can that side of the table do? What steps can directors and schools take if they suspect a dancer has an eating disorder?

[27:48] Josh Spell, LICSW: Yeah, so this is going to look different across different dance settings. But taking your ideal scenario — I think there would be someone like a therapist or a dietitian or a doctor that a person can go to right away, someone in-house who knows the work with dancers, has education around eating disorders, has some sort of special interest. That would be the ideal scenario: the teacher, the director, maybe a colleague or a fellow dancer, can bring it to that person who is a little bit more removed.
[28:37] Because we don't want a teacher or a peer to out someone in front of everyone. That really does not help the eating disorder at all — it could actually fuel it in a way, because it's been acknowledged. So the main thing is: how do we bring awareness, interrupt some of what is already happening, and then get some professional help and support?
[29:13] But also, if that kind of resource is not readily available, we have to be compassionate and look at the individual for who they are versus just the eating disorder. Being able to acknowledge the whole person and just say, "I'm concerned, I care about you, I'm worried." Or, "I have a really great resource — let's talk to a dietitian."
[29:48] Because a lot of times what I have seen with underfueling is there's just a lack of knowledge or a lack of understanding. That's often how things start, and then it snowballs. Being able to acknowledge it right away is so important — research says that the sooner we're able to catch an eating disorder, the more benefit treatment has. That early intervention piece is crucial.
[30:23] A lot of times people think, "Oh, someone's probably dealing with that, someone's probably already helped that dancer, they probably already know." So they say nothing. But eating disorders — like all mental illness — thrive in secrecy. So we really want to be able to say, "Hey, I see you. Here is a resource. Here is a space of support."
[31:01] We can't force someone into treatment, but I did have some feedback this summer from an administrator who heard directly from a dancer about how a suspected eating disorder was acknowledged in the space. Because Pacific Northwest Ballet has a protocol, that set up space for the dancers to trust the system — to trust that the person is getting some sort of help and they don't have to be concerned, because it's been acknowledged that this is not okay. We're not just going to accept that dancers can freely dance with eating disorders. So they don't feel like they have to step in, because there's already a system in place.

[32:04] Jennifer Milner: Yeah, so if I'm hearing you correctly, when we're talking about people in positions of authority — many times, most of the time, these people have no mental health training. They're not mental health professionals. They're wearing 18 different hats as janitors and costume makers and teachers and all that stuff. So one of the best things they can do is have a plan in place before they need one, so that there is a protocol to fall back on.
[32:33] Something else I think you said was: not confronting them in public, not making it public, and not having them confronted by a teacher or someone who works closely with them as a mentor — trying to find someone who's a little more distanced. Having that contact list, that Rolodex, before it's needed, so you can reach out and find a person who is already somewhat familiar with the school or the studio. Because you can feel really helpless as a teacher.
[33:05] And I think even as a dancer — so if you suspect a loved one, whether it's a parent, a sibling, or you're a 14-year-old and you think your best friend has an eating disorder — what can you do? What can your next steps be?

[33:21] Josh Spell, LICSW: I would reach out to an adult. I would see if there's someone that I feel comfortable talking to. I'm putting myself into the 14-year-old's shoes — is that what you're asking?

[33:35] Jennifer Milner: Yes.

[33:35] Josh Spell, LICSW: Okay. Just wanted to clarify.
[33:40] I would not hold this information to myself, because a 14-year-old is not expected to know how to treat someone or what to do. So bringing someone else into the mix — whether that is your parent, a teacher at the school, the school principal, a therapist in the school, or a dietitian if you have access to those resources — that would be my first step. I am concerned, I don't know what is going on. We never want to be accusatory, because we don't know what's happening for an individual. But bringing in that extra layer of support — this is a team effort.
[34:32] Oftentimes individuals who have been diagnosed with an eating disorder have a full team: medical doctors, a dietitian, a therapist, maybe milieu support. It's not ever really treated with one sole provider, because there are so many nuances present. So getting the ball rolling would really be the best first step.
[35:04] And being able to just listen as a friend — you're allowed to check in and say, "How are you doing? I care about you. Is everything okay? I'm here if you need to talk." But if that individual says, "Yes, I'm struggling with an eating disorder," there could be that feeling of urgency: "Oh no, what am I supposed to do?" And that's why we have preventative measures in place — so it doesn't have to be so frantic, and it can take some of that nervousness off of that 14-year-old.

[35:47] Jennifer Milner: And I know from my personal experience that that 14-year-old feels the burden to help their friend — they're worried about them and may be scared to approach the parent or the dance teacher. I have been approached many times by my dancers saying they are worried about another dancer. And the burden you see lifted from their shoulders after they tell me — because they know their friend needs help, they don't know what to do, they have found a safe adult — it's like, "Now I don't have to stress about it anymore." Because they shouldn't have to stress about it, and they shouldn't have to fix it.
So I'm glad you encouraged them to find that safe adult to talk to, because they shouldn't have to try to figure out how to fix their friend. Let's drill down one more step. If you think that you yourself are struggling with an eating disorder, I imagine there's going to be a fair amount of conflicting feelings — maybe denial, not wanting to acknowledge it. But maybe deep down you know there's something. Maybe you don't want to talk to anybody about it because you feel shame that you can't control yourself, or you're embarrassed that you didn't achieve whatever result you thought you needed to achieve, or any of those really isolating and lonely feelings. So if you suspect that you are struggling with an eating disorder, what can you do?

[37:06] Josh Spell, LICSW: First, I want to extend some compassion to that part of ourselves — the eating disorder part that feels very ashamed, very guilty, very isolated. Being able to just acknowledge that this is not your sole identity, being able to create a little bit of separation from the eating disorder. I want to say that first.
[37:34] But now we have things like hotlines and text lines. We have the ability to be a little bit more anonymous, so we can maybe take that first step. Because it is courageous to take a step towards healing, towards recovery. And the eating disorder does not like that — so it needs these incremental steps available. Being able to text something like the crisis line, being able to call the eating disorder hotline — I know there are a couple of eating disorder hotlines now available. That really would be my first step.
[38:23] And eventually, that initial step forward can open the door to getting resources like a therapist or a dietitian or other clinicians who may be able to support an individual. Also, having that initial conversation may build some tolerance to then be able to tell someone in your life — someone you trust, someone you know supports you unconditionally.
But recognize that there's a reason the shame is present. There's a reason that desire to shut everyone out is present. Because it's scary. It's not easy. So baby steps — dipping the toe. Finding just these preliminary steps that eventually can lead to more assertive care.

[39:31] Jennifer Milner: I love that the first step is finding compassion for that part of yourself. If we're dealing with an eating disorder, there is an emotional reason that we've developed it, and finding some self-compassion for that is so important. And I think it's very comforting to a lot of people, as you said, to have the anonymity of these hotlines.
[39:53] I know there's the 988 National Crisis Hotline, which is not just for people with suicidal thoughts but is for people in any sort of crisis. It's such an easy number to remember — 988. And if the person you speak with thinks you need to be pointed in another direction, they will have a great conversation with you and help you find the other help you need. But I know there are a few other crisis hotlines. Do you know names of them off the top of your head? Because I can't remember them.

[40:17] Josh Spell, LICSW: I don't have them off the top of my head, but I will find that—

[40:23] Jennifer Milner: We'll find them and we'll put them in the show notes for sure, so people have those.

[40:27] Josh Spell, LICSW: Because it's almost like thinking about it as triage, right? Having someone in the medical field, or someone in the eating disorder field, or just having knowledge — that removes a barrier to reaching out. I think that's one of the number one reasons individuals don't reach out: there are a lot of obstacles in the way that make it difficult.
[40:56] I am a therapist, and it is difficult to find other therapists. I know what I'm looking for, I understand super bills, I understand all of those insurance aspects, and it's still challenging for me. So I want to normalize for everyone listening: feeling that initial, "I don't know what to do and I feel very stuck" — you're not alone in that. And that's why things like these hotlines open the door and allow for more work and more networking to be possible.

[41:39] Dr. Linda Bluestein: That's really helpful, because I think for a lot of people it's just really hard to know where to start — even if they do acknowledge that they need the help, which of course is a huge first step.

[41:52] Josh Spell, LICSW: Yes.

[41:55] Dr. Linda Bluestein: Did we miss any questions, or do you have any final thoughts before we ask about the hypermobility hacks?

[42:03] Josh Spell, LICSW: I have so many thoughts just in terms of this podcast and the specificity with hypermobility and how all of these things intersect. But I don't have one clear thread to follow right now. I feel inspired having this conversation, I have to say.

[42:28] Jennifer Milner: Well, we feel the same way, and I feel like we pulled a fair amount of threads. You were very gracious in helping us chase them down and fill us in. So thank you for that.

[42:40] Josh Spell, LICSW: My pleasure.

[42:43] Dr. Linda Bluestein: Okay, so we always like to finish with where people can find you — but before we do that, your favorite hypermobility hacks.

[42:55] Josh Spell, LICSW: Yeah, I'm thinking about eating disorders and what I have learned along the way. And I think the biggest hack would be giving your eating disorder a persona essentially, and being able to separate these multiple layers of who you are from the eating disorder itself.
[43:22] "I am Josh and I have an eating disorder" — that feels really overwhelming. But if I can say, "I am Josh, and there is a part of me that struggles with an eating disorder," I can get to know all of the stressors that maybe activate that eating disorder. I can get to know all of the emotional pain that the eating disorder is trying to protect me from, because most of the time we develop these types of mental health challenges as a response to conditioning, to stressors like we talked about earlier.
So creating some space is so helpful, because then even when we are ashamed of this part, we don't have to be ashamed of who we are as a human being. And therefore it may be just a tiny bit more accessible to offer understanding, to offer self-compassion, to offer care and support to this part.
[44:48] In my treatment with individuals who struggle with eating disorders, a lot of times we go on this journey of: What's the eating disorder's name? How do they talk? How do they walk? How do they dress? What do they want you to know? What would happen if they did soften back? And all of a sudden it's like, "Well, there would be chaos and I would have no sense of control and the ballet studio would be even more overwhelming if I didn't have it." And it's like — well, great. That is really helpful information. That is amazing noticing. So yeah, that's my biggest hack.

[45:26] Jennifer Milner: That's a great hack. I love that.

[45:29] Dr. Linda Bluestein: I do too. That's really great. And where can people find you online?

[45:37] Josh Spell, LICSW: You can go to my website, which is flexiblemindcounseling.org. I also have an Instagram handle, spellbound20. And you can find me on LinkedIn as well.

[45:57] Dr. Linda Bluestein: Okay, great. And we will make sure to have all of those links in the show notes. So thank you so much for that.
[46:00] Well, Josh, this has been such a great conversation, and I want to remind everyone that you've been listening to the Bendy Bodies with the Hypermobility MD Podcast. Our guest today was Josh Spell, social worker, therapist, dancer, plant enthusiast, and lover of the arts. I love how you had that in your bio — I had to include all of it. Josh, thank you so much for coming on the Bendy Bodies Podcast and sharing your incredible wisdom and knowledge with us.

[46:31] Josh Spell, LICSW: Thanks so much for having me. It was such a pleasure to talk and just explore these really important topics.

[46:40] Jennifer Milner: Thank you so much, Josh. I always love hearing what you have to say because you've got so much wisdom in this area.

[46:46] Dr. Linda Bluestein: Thank you for listening to this week's episode of the Bendy Bodies with the Hypermobility MD Podcast. Visit our new website at bendybodiespodcast.com where you can now view guest profiles and show notes with links to products and journal articles. Leave me a comment, sign up for updates, leave a review or a voicemail, and access the podcast on your favorite player, all directly from our website. You may hear your voicemail in a future episode where we answer your question or dive into your gracious feedback.
[47:16] Follow us on Instagram at bendy_buddies. We love seeing your posts and stories, so be a buddy and engage our community by using the hashtag bendy buddy — that's hashtag B-E-N-D-Y B-U-D-D-Y. You can also find me, Dr. Linda Bluestein, on Instagram, Facebook, Twitter, or LinkedIn at HypermobilityMD. Visit hypermobilitymd.com for information about medical services and one-on-one coaching.
[47:43] This podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. Do not disregard or delay obtaining medical advice for any medical condition you have. Opinions shared are that of the guest and do not necessarily represent the views of the host or any particular organization. Sponsorship of the podcast does not necessarily mean an endorsement. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.