Dr. Kate Herts 00:00:00 The Teaspoon podcast is part of the practice of the Practice Network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like am I okay? Imperfect. Thriving and Thursday is the new Friday. Go to warped practice of the practice.com/network. Welcome to the teaspoon podcast. I’m so happy you’re here. Hi, I’m the teaspoon doctor Kate Hertz, a queer millennial health psychologist with ulcerative colitis. I’m here to dish out all the hottest tea about living a connected and meaningful life with chronic illness. I’ll cover everything from how to wear a bikini with scars, to what it feels like to be too sick for chronic illness. Camp. Get comfortable on the couch, grab your furry friend, and let’s get cozy because we have some hot tea to sip on today. Hi everybody, and welcome back to The Teaspoon Why podcast. I’m so happy you’re here. Hi I’m the teaspoon doctor Kate Hertz. I’m a queer millennial health psychologist with all sorts of colitis, as you know, and I hope that you are all settling in with some warm and delicious beverage of your choice. Dr. Kate Herts 00:01:31 Today, I’m really excited to tell you about everything we’re going to talk about today. But before we get to our esteemed mystery guest who is so important and who I’m bringing on for a really special episode, I just want to give you a heads up that this is a particularly special episode, because it will be the last episode of this first season of The Teaspoon new podcast. I am going through some health challenges with ulcerative colitis, as I’m sure you can all relate to. Basically, I’m changing medications and dealing with a lot of side effects and stuff. And so I’m hoping to model for you guys, or at least give you permission to also take care of yourselves and take breaks when you need it. So that’s a little bit about why this episode is so important to me, and we’ll talk more at the end. But I really am really just so excited to get right into it and introduce you to our guest today. this is one of my favorite people, a close colleague and mentor of mine, doctor Danielle Keenan Miller. Dr. Kate Herts 00:02:36 Doctor Keenan Miller is a therapist, a psychological scientist, a consultant, and a clinical supervisor. She completed her PhD in clinical psychology at UCLA and was the director of the UCLA Psychology Clinic for more than a decade. Her research focuses on mood disorders, eating disorders, and effective practices in supervision and training. Doctor Keenan Miller has authored more than two dozen scientific articles and a book entitled The Binge Eating Prevention Workbook. She’s a licensed psychologist in California and New York, where her clinical practice focuses on the integration of the art and science of psychotherapy. Thank you so much for being here, Danny. I’m really excited to have you on the show. Thank you so much for having me. It’s wonderful to be here. I love the podcast. Oh thank you. I’m so glad. and it’s really meaningful to me to have you here as my last guest of the season. And I’m so grateful that after all these years, I don’t know. So I, I’ve met Danny, I think in 2013 when I was a student at the UCLA psychology program, and she was the director at that time. Dr. Kate Herts 00:03:42 So, oh my gosh, it’s been over ten years. That’s wild Yeah. And it’s been so wonderful to stay in touch over the years. And so, you know, we’ve been talking pretty much since the podcast started about how we could bring of one of your particular expertise and interests, and it’s been so obvious from the start to me how it plays into chronic illness. But just to like, first of all, take the blinders off and let everybody in, what we’re mainly going to be talking today is about women’s health transitions that happen during periods of hormonal changes. So starting with puberty, which is often when, conditions like endometriosis or PCOS may start to show symptoms up to when you’re trying to become a mother. We call that presence when you’re doing the transition to motherhood, which can also have a lot of hormonal impact. That might be when you get to know, oh, maybe I have infertility issues that I’m worried about, or maybe this isn’t working the way I want it to. There’s also a lot going on mental health wise, and that’s actually where we’re going to stick today. Dr. Kate Herts 00:04:52 That’s Doctor Camilla’s particular area of expertise. So, Danny, I’d love it if you could kick us off just by telling the our audience a little bit about what got you interested in infertility and what how you see it as an important women’s health and chronic illness issue. Yeah. So my research. Dr. Danielle Keenan-Miller 00:05:13 Background in graduate school was largely around the transition into parenthood, particularly for women, and how that impacted their mental health and how mental health issues impacted that transition in their lives. So I’ve always had a strong interest in this particular period in women’s lives. And then I began to have a specific focus in interest in infertility, actually through my own experience of infertility. When I was 31, I started trying to have a child and found out very unexpectedly that I, was almost in menopause. from a hormonal standpoint, sort of on the borderline of what they call premature ovarian failure, because failure’s always a super. Dr. Kate Herts 00:06:01 Helpful how they describe women, right? Did they tell you also that, your you had like a infirm vagina or something, like all you had a hysterical uterus? That’s what it was. Dr. Kate Herts 00:06:13 Yeah. Right. Right. Yeah. Well, think first of all, I’ll just I’ll just stop you there to say thank you so much for just telling us a little bit about your personal experience, because and I’m really, really sorry that, that that must have been really shocking and a hard thing to learn in your early 30s. And also right when you’re trying to start a family. Dr. Danielle Keenan-Miller 00:06:33 It really was it was a very challenging time, and it was a pretty long period for me to come to the other side of that experience. So I started to try when I was 31. I do have a wonderful, healthy, amazing little girl, but I didn’t have her until I was 35, so that was a pretty protracted period. yeah. And, you know, in my experience during that time, I recognized that there really weren’t a lot of psychologists working in this space who could really have, you know, really, specific knowledge about what the process was like and that, it was such a different experience than other kinds of challenges that I had had in my own lives that women have in their lives leading up to that point, that it felt like once I was on the other side of it, I couldn’t have done this work while I was in the middle of it. Dr. Danielle Keenan-Miller 00:07:25 But once I was on the other side of it, I sort of thought like, wow, that was a lot of suffering to experience. Is there something good that I can cultivate from that? And can I use that experience to try to help others and help, you know, lighten the suffering of people who are facing similar challenges. Dr. Kate Herts 00:07:43 I think that’s so beautifully said, and thank you so much for on behalf of all women for bringing this today, but also for doing this work. And I really relate to the the purpose that you drew from your experience. I think that’s why I’m here today, from being sick as a kid and wanting to really. I’m definitely not on the other side of it, but wanting to, you know, do something good. Right? And I think that it’s really just wonderful that you have an amazing little girl now, and that’s the best outcome that everybody hopes for. But I definitely I think many people go through prolonged periods of infertility. If you are having any problems, it can take a really long time to actually get a results. Dr. Kate Herts 00:08:34 And it’s very demanding and taxing, particularly on the body. Yes. Which as we know is so impactful to the mind. So I’m curious in your practice and in your professional work as you’ve pursued this, what have you seen as the major, impacts not both physiologically, that I think could really parallel a lot of illness symptoms and people have. I think it’s really a big health issue and also psychologically related to that. Dr. Danielle Keenan-Miller 00:09:09 Yeah. Well, we know from research that rates of major depressive disorder in people who are diagnosed with infertility are comparable to those that we see in other forms of chronic illness and even life threatening illnesses like HIV and cancer. So we’re talking about a very significant, mental health challenge. and I think for lots of people, of all genders, it’s also a deep existential threat to think that they are not going to be able to sort of like, carry on their genetic line. People vary in how much having a biologically related child matters to them. But for many people, that is an important piece, and they’re facing the grief of not knowing whether or not that is going to be something they can achieve. Dr. Danielle Keenan-Miller 00:09:55 and there’s also, you know, I think a lot of parallels with other forms of chronic illness in terms of, you know, the the diagnoses are often, extremely unclear. So most infertility is idiopathic, meaning they don’t understand the cause of it no matter how many tests they do. And my gosh, do they do a lot of tests, many of which are very invasive and very, very painful. The treatments themselves are very painful. They’re very time consuming, and they’re very expensive. Many of them are not covered by insurance unless you live in specific states. Shout out Illinois for doing doing well by their, infernal. Awesome. Yeah. but most states offer very little coverage in most health plans, so it’s a tremendous investment of, financial resources, emotional resources, and the physical discomfort of it, which can really vary person to person, depending on the intensity of the treatment, what kind of treatment they’re doing, and, you know, just individual differences. And there are other challenges in their body. Dr. Danielle Keenan-Miller 00:11:02 But lots of these, lots of these treatments are very difficult. They can be very destabilizing emotionally. And they can be, for some people, very, very painful physically. And there can also be a lot of challenges common to what I think is sometimes seen in other forms of chronic illness around social isolation. Dr. Kate Herts 00:11:23 Absolutely. And, you know, I think that’s I want to definitely pick up on that. And also because I think that that is it is such an isolating experience. And I also think that when you talk about like the physical pain and but the existential crisis that it brings up. Right. So I, I don’t know if you know this, but I did three rounds of egg freezing when I was 33 because my best friend is an ob gyn. And when I turned 29, she was like, it’s time, it’s time, it’s time to time. And finally, four years later, I was like, okay, fine. but the reason I should have only had I was fairly young to do egg freezing. Dr. Kate Herts 00:12:02 So they told me, you probably can do one round and you’ll be fine. But in my first round I only got three eggs, which is not enough that they want to tell you you’re done. and I remember feeling like, wow, another thing is just terribly wrong with me. I am never going to have the life I want. Everything’s always going to go wrong. And it really played into my story of myself that being sick as a kid had created. Yes. And I also remember in that time, being on the medications that they give you and going into my therapist’s office and hysterically crying, which is not totally my M.O. sometimes. Now it is, then it wasn’t, but, and feeling like life wasn’t worth living, which is not something I normally feel. And she said, you know, this is the hormones, right, that they’re giving you. And I had an moment of, oh, that’s why I feel so out of my mind. And it really was is so much about like, it’s so much about how you think of yourself in the world. Dr. Danielle Keenan-Miller 00:13:14 Yes. Dr. Kate Herts 00:13:14 You hear like is that the. Yeah. Does that sound like, is that like a broad experience of patience or. Yeah. I’m curious on your take. Dr. Danielle Keenan-Miller 00:13:25 I, I think that is a very generalizable experience. When I was doing my third year practicum, many, many years ago, I was working with an amazing psychologist as a supervisor who was herself undergoing IVF. And she was a very into mindfulness. She was one of the most calming, stable, containing presences I had ever been next to in my life. And I remember at that point I just found her so inspirational, and she pulled me into her office one day and said to me, just so you know, I’m about to undergo IVF and I’ve done this before, and I can tell you I’m not going to be myself If I seem angry at you, if I seem short tempered, if I seem very reactive, like I’m apologizing in advance. And at the time, it was almost unthinkable to me that this person that I really saw as like, so full of grace and equanimity was going to get dysregulated. Dr. Danielle Keenan-Miller 00:14:22 Now, I don’t think she got she worked very hard not to get as dysregulated. Dr. Kate Herts 00:14:25 What incredible like self-awareness and coping ahead professionally to like that is so like goals of maturity and and yes goals. Dr. Danielle Keenan-Miller 00:14:36 Life goals all the time working. But then you know going through it myself and watching other people, both friends and clients of mine, go through it, there is this incredible impact of our hormones on our mood state. There is there can be disruptions to all sorts of other kinds of processes, like sleep. People often lose access to the things they do that healthfully regulate them, like exercise, or often not allowed or not able to exercise during infertility treatments. Even things like taking a super hot bath can be off off limits at times. So people really all the things that, you know, people might turn to to help on a biological level, sort of regulate themselves, often become inaccessible. So that amplifies things too. And then at the same time, people are coping with this very, very deep and primal human fear around not being able to have a child that they want. Dr. Danielle Keenan-Miller 00:15:30 And all of those things in a stew pot together can be, explosive. Yeah, yeah, yeah. Dr. Kate Herts 00:15:39 And so many, I mean, so I worked at Weill Cornell in the Women’s Health Clinic for a number of years, and I still supervised there. And I saw a lot of patients with infertility as well. And I feel like the patients I saw who had done it for multiple years, like you had to do, there’s really a traumatic element to it. Yes. Of repeated not. I think some physical trauma occurs. I think that women’s bodies are not cared for the way that they should be in a lot of cases. And just this disconnect from your body not being your on your team anymore. Yeah. And then that that extended repeated experience happening over and over and over again. And it’s incredible the lengths that I had a patient who had gone through eight years of infertility treatments and was still trying, and we had to balance the this has totally upended your life. Yeah, because this is all you can do and all you can think about. Dr. Kate Herts 00:16:46 And when does when do we say enough? But you can never figure that out if that’s what you have felt in your whole life is something you really. It’s a part of life that you don’t want to miss out on so hard. Dr. Danielle Keenan-Miller 00:17:00 It is so hard. And you know that decision about when to stop or change course. You know, I think a lot of people go into it with a certain expectation around how they’re going to manage that. Like, you know, I know when I did IVF, I was fearing having to do IVF. And then I thought, well, I’ll do one round of IVF. That’s certainly not where it ended for me. It took many, many, many, many, many attempts. for some people, you know, they realise that there are other versions of parenthood that are more accessible to them, whether that means surrogacy for people who are having difficulty carrying or, egg donation, sperm donation or adoption, or choosing to become very involved in the life of a different child. Dr. Danielle Keenan-Miller 00:17:44 That could be a niece or nephew, someone else in their life, that they can live in line with those parenting values without having to themselves be the parent of the child. so I think that there are a lot of places that people end up if parenting really matters to them. Dr. Kate Herts 00:17:58 But certainly I just really love how you brought up parenting values, and I think that’s such a helpful framework for how you can live out who you’re supposed to be, even if it doesn’t look the way that you initially imagined. Can you say a little more about parenting values and how you’ve seen that really be helpful to people to think, yeah. Dr. Danielle Keenan-Miller 00:18:21 I think this is an experience that’s echoed across a number of different kinds of chronic illness, which is things are not going to happen the way that you imagined. So if you have a partner that, you know, the two of you have envisioned a certain way that one of you is going to get pregnant. And usually that’s like a romantic sort of vision or something like that. Dr. Danielle Keenan-Miller 00:18:43 And then, you know, I sort of think of those under the category of like, free babies. They don’t cost anything to make. Dr. Kate Herts 00:18:51 Oh, yeah. Because the cost differential is enormous enough. Dr. Danielle Keenan-Miller 00:18:56 It is. so, you know, if you had a vision of the way that parenthood was going to unfold for you, and certainly infertility isn’t the only reason that that needs to change. But for many people, it’s a it’s a powerful reason that that vision needs to be different. It can be very difficult to accept other versions, but opening up with psychological flexibility around like, what really matters to me here and how do I move towards that? How do I bring that into my life, even if it’s not in the way that I envisioned it was going to happen is really, really important for many people. And it’s also important that, you know, there there is some flexibility in terms of the people around you also being being able to bring them into that new vision of what parenthood is going to look like for you. Dr. Kate Herts 00:19:45 I imagine that that can be part of the social isolation that we didn’t get much of a chance to go back to, because I can imagine. certainly when I was going through egg freezing. Just thinking, I gotta check out a society for these for these particular months. I’m not going to see friends. I’m not. I just have to, like, protect everybody from me. Protect me from myself. But if that’s a prolonged I can imagine that that overlaid then with, okay, let’s say I’m thinking I’m going to adopt and my parents are really not into that, or I’m afraid of how they may respond to that, or I’m not going to have kids because I really it’s not a way that my life can handle. But how is everyone around me going? Am I going to still matter if that was such an important thing for me? And I think that’s so isolating on even a different level. Dr. Danielle Keenan-Miller 00:20:38 It is. Yeah. And, you know, lots of people. Their partners also have strong feelings about what that transition to parenthood should be. Dr. Danielle Keenan-Miller 00:20:45 Their parents, if their parents are still alive, often have very strong opinions about what that transition is going to look like and an investment in some outcomes over others. So I would say it’s really important for anyone, you know, in contemplating fertility who might have an illness. That means that they can anticipate it will be a challenge or for whom? You know, contemplating fertility might mean having to go off a medication that’s really important to managing their chronic illness, or people who find themselves unexpectedly in this broad and actually pretty well populated village of people with infertility. As many as 1 in 6 people face infertility. Dr. Kate Herts 00:21:23 So helpful because it’s definitely one of those things that you don’t you don’t know how many people are in the club because, you know, one raises their hand and says, I’m in the club, right? So I so thank you for for raising your hand being here today because it is it’s so isolating and it is so common. I hear it all the time also, and I think it is really common with chronic illness. Dr. Kate Herts 00:21:47 I was told when I was 28 or 29 by my regular ob gyn visit, you’re going to be a complicated pregnancy. It’s like, okay, thanks. Just just apropos nothing. So it definitely comes up a lot. And it’s something where the invisibility is so isolating. Dr. Danielle Keenan-Miller 00:22:04 The invisibility is very isolating, but there are lots of people around who are having that experience and finding some people who can provide real support that are not personally invested in one outcome or another is really useful. So finding Communities Resolve, which is the National Infertility Network, has amazing peer led support groups that are totally free. You can find other folks who are going through the same experience having a therapist, having friends who have been through it, and who are willing to talk about their experience. All of those things can be very, very helpful and can also counteract some of the very special isolation that often happens in people’s lives, because often they’re facing infertility in the same biological time period as their peers are becoming parents. Yeah. And that can create, 1,000,001 different kinds of problems in social relationships. Dr. Danielle Keenan-Miller 00:23:01 So people are often finding themselves either being pushed away or feeling like they have to pull away from important relationships in their lives, who either are making the transition to parenthood during the time of their own infertility, or who are making comments that are not helpful to their mental health and their well-being overall. Dr. Kate Herts 00:23:23 It’s so, so, so important to have that community and we’ll link to resolve in the show notes. And I think your point about people who are not involved. So people who are not your family, your partner, because they’re having their own experiences of your infertility journey, But a really good therapist who has experience in this, or a close friend who’s been through it, that can be incredibly helpful. And I do think there’s so much automatic shifting of your social circle in your 30s, because some people are having kids, some people are partying like they’re 22, and if you’re not either of those people, then who are you? And it’s it’s just a time when relationships often reorganize anyway. And so then to add this challenge and prolonged period of life, life stage on top of it is really, really hard. Dr. Kate Herts 00:24:17 And it’s often too hard to talk about broadly while you’re going through it. Yeah, I think it’s really great to mention those resources. Is there anything else? for other women who are going through infertility that you would say you wished you had known, or that you recommend to all your patients in terms of making it through emotionally? Dr. Danielle Keenan-Miller 00:24:40 Yeah. first I would say, that you need to relax your expectations of yourself. That people can often feel, very torn between values they have for themselves, let’s say, as a friend and the need to protect their own emotional well-being during this time. So, for example, if a if a friend or a relative is pregnant, are you going to attend the baby shower? Those kinds of questions can feel like they’re pulling people in two different directions. And so I often, you know, like in my imaginary prescription pad, write somebody a note that says, like, you do not have to attend a baby showers. Yeah. you have to protect your emotional well-being. Dr. Danielle Keenan-Miller 00:25:25 And, other people may or may not know how to help you do that. I will say I got I had some amazing people who really showed up in my life in a big way when I was going through this. Who would do things like send, call and say, you know, I’m sending out my baby shower invitations. I don’t expect you to come, but I want you to know that you’re wanted there and you know, people who really can show up. But a lot of the time, you’re going to have to set those boundaries yourself and even set boundaries with friends who are saying things that are actively harmful. yeah. And that can be hard. Dr. Kate Herts 00:25:59 Not. Yeah. And it’s so hard to to, like, find the gray. So it’s not all or nothing Like I can’t be around my sister who’s pregnant versus I can go to the baby shower for an hour, or I can send a nice gift and call her on the phone. Or like you can do, you can modify your expectations of yourself. Dr. Kate Herts 00:26:22 And I think that it doesn’t. It’s hard to think in the gray, but you gave some great examples of how to do that. Dr. Danielle Keenan-Miller 00:26:28 Yeah. So letting yourself think more flexibly, not holding yourself to the same standard you would, but also includes like in your work life, in your relationship that like there might be expectations you have of yourself that you have to relax while you’re putting this amount of pressure on your emotional system and your physical body. Dr. Kate Herts 00:26:47 such a good, important lesson for me. For all of us. For everyone who’s a person. I really think so. Yeah. Yeah. Thank you so much. And what about. I’m so curious to. For the therapists who are listening, if they have a patient walk into their office who is going through an infertility journey, what’s some advice that you would give them or where is a good place to start to learn if they want to? Dr. Danielle Keenan-Miller 00:27:16 Yeah. You know, I would say there are a couple of really good books that are sort of basics of infertility treatment and IVF. Dr. Danielle Keenan-Miller 00:27:23 There’s a lot of terminology. There’s a lot of, shorthand that’s used in the treatment. And I think it’s helpful for therapists who are working with these kinds of clients to just. Dr. Kate Herts 00:27:33 Know all. Dr. Danielle Keenan-Miller 00:27:34 Of those things. and so doing some self-education, I think is really important. And I would say, you know, being aware of other kinds of support networks, if you don’t have any personal experience in this space, how can you help your client get access to folks who can answer questions for them and provide that kind of emotional support? And I would also just say part of being a therapist with clients in this space is that you are standing alongside them through some of the most difficult moments of life, and you might at times be one of the only people who knows. For example, when an embryo transfer doesn’t take or there’s a very early experience of miscarriage, all of these kinds of experiences that can encompass tremendous, tremendous grief and that aren’t recognized socially the way that other kinds of losses often are, that like you have to be able to have the capacity to show up. Dr. Danielle Keenan-Miller 00:28:31 I think there’s something really beautiful in standing next to someone in those moments. I find it really heartwarming work. But, you have to be as a as a therapist. Very careful that you are, not engaging in the avoidance and minimization that clients often experience in other parts of their life. Dr. Kate Herts 00:28:51 That’s so, so incredibly important. And in I, I’ve done a lot of work with patients who have cancer. And in that work we call it witnessing. Yes. And if it’s the end of someone’s life or it’s a really hard period in their life, the act of being incredibly present with them in that whole experience and holding it as another human standing beside them, is is really just so impactful, even above, you know, any tool that you might have. So I think I’m so glad that you brought that up. And, before, I’m just so glad that you’re here today. I think this is so incredibly important, and I’m sure that you are opening up a lot of thoughts and conversations for people. Dr. Kate Herts 00:29:38 And so I’m just really grateful. And before we go, is there anything else that you want to get out of your mind before you go into your life and really, share either for, patients with chronic illness, women with chronic illness who might be concerned about their ability to be parents. Dr. Danielle Keenan-Miller 00:29:58 Yeah. Well, I will give this sort of thing that I always say here, which is if you are someone who intends to become pregnant and and you have not had your hormone levels tested. It is fast. It is not expensive. You should have those AMH levels. You should have as much information as early as you can. If you have other chronic illnesses, you need to be talking to your doctor about how that might impact your ability to get pregnant, to stay pregnant, to carry a healthy baby to term. And you know you information is power here. So, you know, take it into your own hands. And I’ll also just say, on a more personal note, Kate, I’m so glad that you have this podcast. Dr. Danielle Keenan-Miller 00:30:38 I’m so grateful for the work you do. Broadly. There’s something really beautiful about, the, the way that you approach these both as like a human who’s been through a lot of difficult experiences yourself. And as someone who can still hold space for others with the variety of experiences they have. So I’m just so grateful for for you, for your work broadly, for this podcast and for having me. Thanks. Dr. Kate Herts 00:31:02 Oh my gosh. Oh, Annie, that means so much to me. And I have to tell you, I had a really great supervisor at UCLA who taught me a lot about how to. Speaker 3 00:31:13 Still still remember many, many things she taught me. Dr. Kate Herts 00:31:16 So thank you so much for coming here as a human and as really an expert and, just being willing to stand up as part of this invisible population and say, we’re here and you’re not alone and there’s help to be had. So thank you so much. Thanks for being here. All right, everybody. Wow. I’m going to have, just so many good feelings after after getting to talk to my incredible mentor. Dr. Kate Herts 00:31:46 And I hope that you guys do, too, and that you’ve found something in these first episodes of the teaspoon podcast that you can relate to, or that makes you feel less alone and more held? As I mentioned at the beginning of the episode, I’m going to be taking a little break for now. because I am dealing with a lot of stuff with my own health changing medications, as I’m sure some of you are aware, can be an involved and busy process with lots of calls to insurance and everything. So I hope if you are interested in seeing a season two, please reach out and I’m going to think about ways to come back. Feel free to be in touch at any time on Instagram. It’s the teaspoon pod and you can also go to the website The Teaspoon. Com. Give yourselves a break when you need it. And thanks for everything. Bye. Thanks for listening. I’m Doctor Kate Hertz, and for further details on today’s tea, be sure to check out the show notes. To stay connected or carry on the conversation, head over to my website at the teaspoon.com or drop me a DM on Instagram at the teaspoon pod. Dr. Kate Herts 00:33:06 Tune in next week for another serving of piping hot tea. I’ll catch you then. 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