19| Vanessa Gorelkin, occupational therapist and mental health expert: "You can understand your body just by living in your body."
Vanessa's bio
A retired runner and gym rat, who now prefers walking, hiking, and swimming, Vanessa Gorelkin is is an occupational therapist with a telehealth practice that helps people access their unique and inherent strengths and connect their notions of body and mind to enhance their quality of life.
Before moving to Arizona, where she lives with her husband and teenage son, Vanessa served as an administrator of Orthopedic Surgery at NYU Medical Center and as Senior Vice President of Operations at Planned Parenthood. She returned to direct clinical practice in 2014 when she joined the Mayo Clinic in Arizona as a licensed Occupational Therapist. There, she worked in an outpatient clinic where she helped patients with chronic illness and other stressors regain their prior level of function. She was appointed Instructor in Physical Medicine and Rehabilitation at the Mayo Medical School in 2015 and is an Associate in the Mayo Clinic Academy of Academic Excellence.
In addition to her extensive clinical and leadership experience, Vanessa is one of the most entertaining OT’s on TikTok right now.
Connect with Vanessa
Website:https://vanessagorelkin.com
Instagram: http://instagram.com/therapist_in_arizona
TikTok: https://www.tiktok.com/@vanessa_gorelkin_ma_otr
(Trigger warning: weight loss, diets, etc.)
In this episode, we talked about…
Being on a diet since the time Vanessa was a child
Discovering HAES (Health at Every Size) and intuitive eating
How far she’s come since a friend suggested she was an exercise bulimic and she took it as a compliment
The flaws of the body positivity movement and why Vanessa prefers body neutrality
Why it can be damaging to compliment another person’s weight loss
Working on the depressive disorders unit as an occupational therapy student while experiencing her first major depressive episode
The medical and non-medical interventions that help Vanessa cope with depression
Setting boundaries around talking about calorie counting, weight loss, and diets
Throwing away the scale
On “losing her religion” when she gave up dieting
What is occupational therapy? What do OT’s do? Who do we help? How do we do it?
We geeked out on theories of human occupation, Vanessa shared her clinical reasoning processes.
Helping people to learn to feel their feelings, rather than distract themselves and why this matters
How occupational therapists are uniquely positioned to help people cope with anxiety and depression
How having a baby changed Vanessa’s exercise habits
Her path from using exercise to shrink her body to using it as a form of self-care
Tips on what’s worked for growing her telehealth occupational therapy practice
Quotes
From the time I was small, I don't think there was ever a time I can remember not being on a diet. And I thought that was totally normal.
I had a friend, after graduate school who said to me, you know, I wonder if you're an exercise bulimic… And I thought that was a compliment.
It's kind of like what Maya Angelou said, and I say this to my patients a lot: When you knew better, you did better.
Body neutrality seems to me to be a really nice place to try to land that you don't hate your body, that you work to find things that are good about your body, but you also don't force yourself to love every single thing about your body that you may have been criticizing over a lifetime. And that takes the pressure down.
I went to my internist at the time and the medical assistant who didn't know any better was like, “ “Oh my God, you lost 25 pounds. That's amazing. How did you do it?” And I was like, do you really want to know how I did it? I didn't say anything, but it was not a place where I felt like I could say, well I was basically thinking, it might be better to not be alive anymore. So food didn't really seem interesting to me at all. I was just basically trying to survive.
Please do not say congratulations to someone who has lost weight. Don't comment on people's bodies. If I can advertise that to y'all no matter what compliment somebody's wonderful vocabulary or the fact that they're a kind person let's not do this anymore.
I said, I think I'm depressed. And so we found me a psychiatrist. I began medication and then that was like the beginning of the journey of therapy and medication to find just the right fix. And it took about a month or two for the medication to even start working.
And I do remember the day that it did, I was laying down on my couch in my living room. And I was like, it was like the clouds parted. I was like, oh my God, there, I might live. But it was really. Incredible, very chemical. Anyone who says that somewhat, that people with depression are making it up is very, very foolish.
The psychiatrist said you're really in very bad pain. And I said, what? Like, I didn't even have a vocabulary for the pain that I was experiencing, but it was pain. He was right.
I have set some very serious boundaries. Do not comment on my body, do not comment about my weight, do not comment on my appearance.
These are good people in my life, but my recommendation is that you begin with clear boundaries, know what your boundaries are first, know what you don't want people to talk about with you. And what's okay. And also what things you think are triggering to you that make you sick in your head?
When the chips are down, are you talking about what you weigh and what you look like? Or are you talking about deeply personal, important things that matter to you about having your life?
You can understand your body just by living in your body.
I better be in the clothing that is the size of my body as I am.
if you go to a place where there's tons of food that you like, and you allow yourself to eat anything you want, like at that great potluck at your work or the church buffet or whatever, You eventually stop eating. There is not a time that you don't stop eating. So I started to tune into that like, oh, I can allow myself to just eat and enjoy, and I will stop when I'm full.
We then examine their life and figure out what do we need to add? What do I need to train you to do? What do I need to teach you to do, to be able to really unlock the quality of life that you're looking for.
People want to do anything but have a feeling.
And so we watch TV. We do our phone, we scroll through tick-tock. We, we make videos ourselves. We call a friend. We, we do, we cook, we clean you name it. Just no feelings, please. So really learning to tolerate being in a moment that is often really frankly uncomfortable and having the resources to be able to live through that moment and understanding what feelings are like.
As I've aged, I've just like gotten really tired of hurting myself from exercise, but also feeling very, very, attached to exercise as a thing that makes me feel really good.
It went from being all about changing the size and shape of my body to just taking care of my body.
I feel like I'm much more at peace with the size of my body and my eating.
Links/Resources
Intuitive Eating by Elyse Resch and Evelyn Tribole
Health at Every Size by Lindo Bacon
My IG post on a SUP in a bikini
A peer-reviewed study that talks about the extent to which weight is about as immutable as height
Model of Human Occupations Theory (MOHO)
Dialectical behaviorial therapy
My interview with Christine DeFilippis on Breaking Body Biases
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