Today we are joined by Adam Holman, LCSW. Adam has recently left his full time clinical practice in Arizona to join our Feeling Great app team here in San Francisco. I think you’ll be delighted by his warmth and wisdom. Although he works with us full-time, he still practices one day per week and specializes in X depression, anxiety, and screen addiction(e.g. video game addiction and more.) He has appeared on two previous Feeling Good Podcasts, # X and # Y.

We are delighted to have Adam as the honored guest on today’s Ask David podcast!

Today’s questions come all the way from North Macedonia!

Dear Dr. Burns,

Thank you so much for your kind response. I’d be truly honored if my questions could be considered for a future episode of your Ask David podcast. Your work has been a key influence in my research on perfectionism and its cognitive-behavioral aspects.

Here are a few brief questions I’m currently exploring:

1. How has your view of perfectionism evolved since Feeling Good?

2. What strategies have you found most effective for challenging perfectionistic thinking in therapy?

3. Is perfectionism often rooted in a fear of not being “good enough”?

4. How does it typically manifest in academic or professional environments?

If you happen to include any of these in a future episode, I’d be grateful if you could let me know so I can tune in.

Thank you again for your time and for the lasting impact of your work.

Warm regards,

Mitko Toshev

Doctoral Student

Faculty of Pedagogy

University “St. Kliment Ohridski” – Bitola

North Macedonia

David’s Reply

Yes, this will make for an excellent podcast with a refresher on perfectionism, featuring questions from Mitko and a spirited discussion with Adam, Rhonda and yours truly! We had an in depth discussion of all the latest bells and whistles in the treatment of perfectionism with TEAM CBT. This included the two very different but complementary approaches to treating depression or any of the 23 common Self-Defeating Beliefs.

So, if you’ve ever struggle with the thought that you’re not good enough, or that you SHOULDN’T have made this or that mistake, this podcast will be right up your alley!

Thanks, Mitko!

david

Today we hear from Rachel Sewell, M.D., a Stanford pediatric endocrinologist who provides medically necessary care for transgender and gender diverse young people. She shares how in a time when there is a lot of inaccurate information being spread about this vulnerable population she will continue to advocate for them by providing education and accurate information, including by being a guest on this podcast.

She says:

When I was a medical student, I wasn’t initially sure what type of medical practice I would pursue. However, I always knew I’d be an advocate for LGBTQ+ patients . As a first-year medical student, I trained and worked in the emergency room. I quickly realized, as did my mentors, that I enjoyed and was excellent at working with children, so I focused on pediatrics. That summer I had the chance to do research in endocrinology which is the study of all hormones. Think of hormones as messages that travel throughout our bodies delivering important information. Hormones are responsible for so many important functions including keeping our bones healthy, helping us grow, using the energy from our food, and causing kid bodies to change into adult bodies.

My work with transgender and gender diverse children and teens involves providing evidence-based holistic care with a skilled team of clinicians. More than anything, my patients want to be respected, heard, and allowed to thrive. . In providing them care,I bear witness to intense conversations, emotional highs and lows, as well as the purest examples of joy. Throughout it all, it is my privilege and pleasure to provide them gender affirming care.

During this episode we reviewed definitions of gender identity vs the sex assigned to someone at birth. We review the common times when young folks share their gender identity with the people in their lives as well as what it means to be cisgender vs transgender. We discuss sexual orientation and gender identity and how these are complicated and independent aspects of everyone’s sense of self.

Rachel continued,

Medically necessary care for transgender and gender diverse patients is life-saving. Imagine, you know you are male but your body has a period every month. This can be profoundly distressing and results in gender dysphoria. Gender dysphoria is the intense discomfort that results from your identity not aligning with your body and negatively impacts people’s everyday lives. Now imagine being told that there are safe and effective ways to avoid experiencing that distress. I have had numerous patients say that the care they receive has saved their life.

When people hear gender affirming care it often leads them to think of care provided to transgender and gender diverse people but everyone deserves access to gender affirming care. Because it is simply a model of care that recognizes the importance of and validates people’s identities and experiences. Other examples of gender affirming care include being able to take a medicine to help prevent hair loss on your head or undergoing a breast reconstruction surgery after having breast tissue removed in the fight against cancer.

When discussing possible ways to support a patient’s identity I tell families that there is no one size fits all. Everyone’s journey is completely unique. For some patients, having their legal documents align with their chosen name is the most important thing. For others, they alter their gender expression, aka the way they present themselves to and interact with the world around them with things like hair changes, makeup, clothes etc. to align with their identity. For some folks it is important to pursue hormone therapy. And for some they will end up pursuing surgical interventions when they are adults. I also discuss that the timing of sharing your gender identity if it does not align with your sex assigned at birth varies tremendously. But regardless of age, gender-affirming medical care always makes a tremendous difference in peoples’ lives!

Rhonda and I are deeply grateful to Rachel for giving us this wonderfully patient and clear education in a field that was not even covered, to the best of my knowledge, when I was a medical student at Stanford. We hope your voice today, Rachel, will be heard by many, and will hep to bring greater peace, acceptance, love and understanding to our many podcast fans.

Thanks!

Rachel, Rhonda, and David