Oregon therapists dig into athletes’ mental health in ‘Sports Shrinks’ podcast

With the Olympic trials wrapping up and the Paris competition on the horizon, sports are top of mind for many people this summer. The pressures of athletic performance will once again be on full display for the world, sparking conversations about athletes’ physical – and mental – prowess. The conversation around athletes and mental well-being has only grown over the past few years as high-profile athletes like Simone Biles and Naomi Osaka have taken breaks to focus on their mental health.

Oregon therapists Tiffany Brown and Katie Steele focus specifically on this issue. Their podcast “Sports Shrinks” digs into the different ways competition can impact athletes’ mental health. They also recently co-authored their first book, “The Price She Pays: Confronting the Hidden Mental Health Crisis in Women’s Sports — from the Schoolyard to the Stadium.”

Brown and Steele join us to talk more about their projects and the importance of mental health care at all levels of sport, from youth programs to professional athletics.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. With the Paris Olympic Games on the horizon, the pressures of athletic performance will once again be on full display for the world. They’re likely to spark conversations about athletes’ grit – both physical and mental. These conversations have only grown over the last few years, as superstars like Simone Biles and Naomi Osaka have taken breaks to focus on their mental health.

Katie Steele and Dr. Tiffany Brown say this reckoning is a good start, but that systemic changes are needed at all levels of athletics. They are both licensed marriage and family therapists in Oregon. They’re also the hosts of the podcast “Sports Shrinks,” that premiered a couple months ago, and the authors of the new book, “The Price She Pays.” The book focuses on what they call the hidden mental health crisis in women’s sports, from young kids up to professional athletes. Tiffany Brown and Katie Steele, welcome to Think Out Loud.

Tiffany Brown: Thank you for having us.

Katie Steele: Thank you. Great to be here.

Miller: It’s great to have both of you on; Tiffany, first. How were you introduced to sports?

Brown: Oh, that’s such a great question. I feel like, looking back, it was definitely in my day-to-day life, growing up super close to my grandpa. We would spend a lot of time with each other, with him teaching me anything and everything that was on TV – whether it be a boxing match or golf.  We watched a lot of football back then, but it was really a way for us to build a connection. Then, I just tuned into sports for myself, knowing how much it meant to him.

Miller: Katie, what about you?

Steele: As a family, we always did activities. It was the way, early, early in life, that we bonded and we created conversation and learned about my parents’ values. So from an itty bitty age, I remember movement being a means of connection.

Miller: And when you say “movement,” that overlaps with sports, but it’s not necessarily the same thing?

Steele: I think it’s one of my hopes, I guess, especially for parents who are working so hard to figure out what is best for sports. And there’s this big emphasis on sports and leagues. I hope that as we look at early introduction to sport, that it’s really about movement, connecting your body, more deeply connecting to yourself and letting … sports that unfold as sports are going to unfold for each individual, and that looks different for every single human.

Miller: Katie, as you’ve written about – and now talked about on the podcast – you were a high-level runner in high school, went on to the University of Oregon and then after that, Florida. You’ve also written and talked about the fact that you’re one of the survivors of abusive treatment by the once hallowed and now disgraced coach Alberto Salazar, and the endocrinologist Jeffrey Brown. They gave you medications for a thyroid condition that you did not have. And as you’ve recounted, you’re still dealing with the physical and the emotional effects of that abuse.

How did your own experiences spur you to focus on supporting athletes’ mental health?

Steele: It was the catalyst for the emphasis and specialization of working with athletes and parents and athletic systems. It’s funny, for exactly the question you just asked. When you use the word “abuse,” I notice a little twinge in my stomach. It’s taken me a long time and still, I don’t think I fully embraced the language for what it is. It felt really important that I know that’s what it was.

I was mistreated. I was given medication that I didn’t need, that has had implications that I’ll never know exactly what was, because of the medication, what was not. However, I know that even now, hearing you say those words, it elicits a response. My hope is that we can begin to normalize and name this for future generations so that they don’t have to question or wonder if the treatment they’re receiving from athletic systems, or parents for that matter, is appropriate or not.

Miller: Can you help us understand this? So, the flinch that you felt, even though you’re saying, “Yes, I did experience abuse,” but when you hear that word, there’s a part of you that flutters a bit – what is that tied to? Why do you think that it’s hard to attach that label to what you experienced?

Steele: I think that’s an excellent question, and it looks different for everybody. But what I can say for myself is that I don’t feel like a victim. And I don’t want to sound like a martyr or a whiner or ... and then, we heard this actually from a lot of the gals that we interviewed. So I think it’s reconciling that it doesn’t mean you are weak or you did something wrong in the fact that you experienced abuse. So that internalization of, “oh, yes, I know that is what it was,” it’s still tough to reconcile, though. Absolutely.

It represents a period of its own. And to be honest, for those who haven’t read the book – and this is laid out in the book – I didn’t know my medical history until 10 years after it happened. So there’s parts of it that I’m still trying to piece together. What we know about healing from trauma is that part of relearning that story and filling those gaps, and rewiring some of the systems that have served a purpose over time that no longer are working, it’s a process. It’s a process to heal. It’s a process to do the work.

Tiffany, jump in, but I think one of the greatest privileges of the work we do as clinicians is that people are willing to dive into hard things and to grow and change, because it is not easy. And those that are willing to do it and open to do it really are those that are most courageous, because it’s hard to do the work. And so all of the gals that shared their story, I bow down to them because they are motivated to make a change. And that was the catalyst for the book. We can change this. We can prevent the suffering that people are experiencing by naming it and drawing awareness.

Miller: Tiffany, you both have highlighted what, to me, was an eye opening fact that I hadn’t seen before, that came from the American Academy of Pediatrics, from I think just earlier this year – 70% of kids completely stop playing any team sport, any organized sport by the age of 13.  What are the ways that you explain that?

Brown: Isn’t that such a staggering statistic? And it leaves us, I think, our clinical brains and the part of us that wants to understand context, it leaves us really curious. You know, 70% of kids are … maybe some of them are doing sports and then decide, “Oh, I don’t really want to do it.” And that’s normal. We would expect that. But this number is so high. And through the interviews that Katie and I have done and the work that we do in our clinical practice, we know that a lot of people – young kids – are leaving sports because it’s too intense, it’s not focused on just the love of game and movement and connection with other kids. It’s a brutal time, in terms of competition for young people, that just seems really unnecessary when you look at it from the outside.

Also a big part of it is young girls are up against this time for themselves in terms of puberty, where their bodies are changing, their moods are changing. All these things we already know are part of that time period, and they’re navigating this really difficult time in a system that doesn’t make space for that. I had a conversation with a coach during the Olympic trials, who was a track coach actually, and was in town. And he came by – we were selling our book – and was talking about how badly he wanted to read our book because he noticed there was a chapter about puberty. He just looked me straight in the eye and said, “I have no idea what I’m doing.” And it was almost like it was a confession. And for me, all I could do is applaud him for his willingness to just say that, and how much he’s trying to figure out what to do as a coach.

Knowing that it is such a high time for young girls to leave sports, our mission, truly, is to have the decision to stop playing sports be because I got into something else, or I wanted to explore other endeavors, or it just wasn’t fun for me anymore. But not because they feel mistreated or misunderstood, or that their puberty and all the things that come with that is a barrier to exploring the part of them that is athletic and creative in terms of sports.

Miller: Katie, you both said that one of your goals is to foster a lifelong love, or maybe more importantly, participation in some kinds of athletic activity – one that goes past the age of 13 and to the age of 73, or whatever. If you were designing a system from scratch, starting at early ages, of participatory sports, what are some of the hallmarks of what you would include? I guess I’m wondering how different it would look from the ground up?

Steele: Oh, I love this question! I hope we can bring it to reality, maybe all of us together. And as a parent, I have three young kids. Our oldest is nine and we have twin 5-year-olds. So we’re in it with little kids, and seeing the landscape of kids who are 9 years old, what is being asked of them and how they’re asked to choose a sport. There’s a lot of specialization happening and emphasis on athletics. And it breaks my heart to see, because we’re taking away this purity of the opportunity that sport gets to be a hobby, and it gets to be about play and fun.

And Tiffany can attest to this. There are probably very few people in the world who are more intense or objective-chasing than me. I love a goal. I love a goal. So I don’t want to see sport get softer by any means. However, I also want to protect that purity as the entry point, because what we’re seeing is kids are then losing confidence, and that’s scary – really, really scary. They’re losing trust in themselves to be able to have maneuverability or take a risk and try something new. And that’s what we need to see a dramatic increase with, so that kids are able to have this expansiveness. So that at puberty, rather than stop playing, they’re able to say, “You know what, I don’t like soccer anymore, but I think I’m really into softball. I’m just gonna change gears.” Rather than, “Shoot, I’ve been playing soccer since the time I was five and all the eggs have been in this basket. And there’s no way I’m gonna be able to move to softball now.”

But we know, through some of the studies that the American Association of Pediatrics have done, that those who are playing Division I sport, they are no longer playing the sport that they first started with. So we need the entry point of when kids are getting the sport. I hope we can allow them to just explore and develop and evolve. And then post-puberty, begin making choices if they’re wanting to decrease the amount of activities they’re involved in for more of the specialization approach. But I hope that we can let kids spread their wings for a longer period of time. Let it just be fun and playful, and enjoy it from a place of enjoyment and passion. Let them fall in love with sport. And their talents will take them where it’s supposed to go, if that’s what is in the cards for them.

Miller: Tiffany, it seems that one of the challenges that you’re up against here is a financial one. For a not-insignificant number of families, they see the limited number of tickets to either a free or a highly discounted, otherwise super expensive education – they see athletics as a version of that. And in this way, I think the U.S. is pretty unique in the world, both because higher education is so ridiculously expensive, and because athletics is so tied to college in a way that doesn’t exist in most of the rest of the world, as far as I know. What would it take to divorce those? Because that’s an added incentive that is really important for a lot of families.

Brown: I think that’s the question we have to wrestle with, and not only as parents and family members. Even in our jobs as therapists, being willing to ask those questions to our clients. But I think it’s also about being fans of sports. There’s such a “pay-to-play” model that kids and families are having to pay, on average, I think it’s like close to $1,000 for one sport. And like you’re saying, you put that money into practice and being part of a sport, then you want to see a return on your investment. And what a capitalist way to look at it, as we are so accustomed to.

We need to be able to look at how important it can be for kids and young people, even teenagers, to be able to be involved in sports for all the reasons that Katie just mentioned. You’re building connections, you’re finding what it means to have some kind of sportsmanship, you’re figuring out how you’re going to wrestle with wins and losses. There’s so many life lessons that are a part of that. And neither Katie nor I would say that we shouldn’t push kids hard and we shouldn’t be able to have competitive leagues, but it shouldn’t only be competitive. It should be “competitive and …”

If we’re unwilling to have those conversations, then when kids get to the end of their high school years, and they’re looking ahead and they’re seeing dollar signs in terms of, “I gotta go D1 so then I can be in the NBA,” or “I gotta be D1 so I can make it in the National Soccer League” – whatever the thing is, it is all of those eggs in one basket, rather than really looking at what is possible in terms of love of sport, personal wellbeing and the possibility of being competitive.

So we really have to divorce those expectations that we see so often in kids’ sports. Katie said this recently – we were talking about some people we know, and whether or not it was a litmus test of, if you understand youth sports, and if you don’t, go to the sidelines of any youth competition on a weekend and watch the variability of adults that are on the sidelines. You see some adults who are really positive and cheering kids on and wanting them to expand all the possibilities within themselves to play. Then you do have parents or caregivers or coaches, who are coming from a place of, “If you mess up now, you’re never going to make a D1 team…”

We’ve heard it, we’ve heard those pressures, we’ve heard those expectations, and it’s frightening. So, to your question, what is the answer? There’s not an exact answer right now, except we’ve got to understand and be OK with the fact that the way we’re doing it is not working. And the more that there’s acknowledgment of that, we can expand the possibilities, so that kids aren’t in a position to be burned out and see that the only way to take care of their family is to push, push, push, push, push. Because it’s frightening … that way of being is really frightening.

Miller: Katie, Tiffany was just talking about looking at sidelines of kids’ sporting events. I want to play a clip from the podcast, one of the episodes that came out recently, where you’re recounting a conversation you had with one of your kids – your son – after you had said at a lacrosse tournament that you don’t get nervous before his games.

Steele [recording]: I said, “Hey, buddy, we were talking about nervousness at breakfast this morning. I’m wondering what you took from that conversation?” And without missing a beat, he goes, “Yeah, you don’t care about my sports.” I was like, “Oh, my gosh, buddy, I am. How interesting, I’m so glad we’re having this conversation. I love your sports. I love watching you. I love you getting excited. I know you’re doing the best you can and your coaches are there coaching you.” And he says, “Yeah, actually I see that now because you are smiling on the sidelines and you look excited, but you’re not yelling like a lot of the parents. You’re just smiling, and the coach is telling us what to do. So you don’t need to be telling us what to do.”

I’m so grateful that we got the opportunity to clarify that because otherwise, if he interpreted that I just then don’t care about his sports, I could see him equating that to, then I don’t care about him.

Miller: There’s so much in that. I mean, one of the things is the idea that, if a parent, if a loved one, is not yelling, then they’re not invested, that they don’t care about what’s happening, which is such an understandable but scary lesson to draw. I’m wondering, Katie first – and Tiffany, if you want to respond to this as well – what you see as positives, what the best ways that parents can support their athletes?

Steele: I think the first very first step is checking with your athlete. This kid of mine is 9 years old. He’s tiny, he’s a little guy, but he was able to put language to it, and there was a lot of representation there. And when he first started playing sports. I asked him, “How do you want us to be supportive?” And he was very clear, “I don’t want yelling.” In fact, his very first little league game, he was like, “If you’re gonna cheer, you can cheer for the team, but please don’t say my name.”

So if we can start by asking our kids, “What do you need from me? How can I be supportive?” And even if they don’t have an answer, it can be a question you can keep coming back to with them and revisiting, because their needs are going to change as they develop and evolve in sport. But including them in that process … rather than just placing pressure and expectation, ask them, “What do you need from me? This is your thing. What do you want from me?”

There was a gal we interviewed – Emily – in “The Price She Pays,” and her parents did something that was phenomenal that I think is a good takeaway for all parents. She ended up being a D1 swimmer. Throughout her whole youth, her parents would check in with her and say, “Hey, you know what? We’re driving the bus, but we will get off any time. We’re only driving it if you want us driving it.” And I think that level of attunement to your kid is the most important thing. Are you doing what they want you to be doing?

Miller: Tiffany, the example that we’re more familiar with imagining is the super aggro dad or mom who’s pushing their kid hard. What about the opposite scenario where it’s a kid, maybe even a young one, who says at an early age, “I want to only specialize in this sport. I’m all in for this.” And they bring their own intensity and they’ve communicated that. So this is after you’ve had the conversation that Katie has just described. And the kid’s response is, “I’m really intensely focused on this thing.” What kinds of things should parents think about?

Brown: I think that scenario is really common, so I appreciate you asking the question. I think part of it is really understanding what that means for that kiddo. What does it mean to be all in? How do you want that to look? And it’s not about just cutting it off and saying, “No, we’re not doing that,” but hearing them out. Why is that important? Have they been getting messages from coaches, other parents, other teammates, that — the common thing is – the only way to become D1 is if you’re doing basketball all year round or hockey all year round. So I want to know more about that first, before I really do anything as a parent.

Then, the next part of that is really talking about how we know – I think what Katie was naming a little bit ago. We know that most kids who have gone D1, have not gone D1 in the sport that they started with, and that they were super focused on early on.

Miller:  I should say, D1 – meaning Division I, the largest and most competitive …

Brown: Yes. The NCAA is the largest, exactly. So being able to talk with kids about their passion and how cool it is that they want to focus on that sport. Let’s not shake it out of them, but let’s help them redirect that.

Shout out to my best friend. She had a conversation with her son who was in high school basketball, and she thought that he’d be really great at track. And really brought it to him as, “What do you think about doing this to stay conditioned for your basketball season?” He thought about it and went ahead and did that, and the next thing we know he’s now running in college on a scholarship for his track and field prowess. So, would he have loved to go to school for basketball? Absolutely. And he was all in, in every kind of form of that, in terms of camps and what he did after school.

But we’ve got to meet kids in that passion and not take that passion from them. [We need] to help them kind of zoom out, look at all the other possibilities, and know that sports doesn’t mean that you have to be absolutely the best at every sport you do. Maybe that basketball team is your focus, but maybe there’s things you can do in those off seasons to get exposed to other things, other types of coaching, and to really expand your passion for sports in general. And the more that parents and caregivers can do that, the more that we’re taking that pressure off, of going, “Oh, this is what you want to do? Now, we better do it.”

Miller: Katie, in your new book, “The Price She Pays,” in one of the first chapters, you write about the conversations you had with a number of elementary school girls who said that they like basketball, but the boys monopolize the courts at recess and tease them for mistakes if they do play. How do we, as a society, create space for girls at those very earliest stages?

Steele: I know this is the radio, but I’m smiling because that was one of my very favorite parts of the book-writing process, because these 7-year-olds had profound insight, and were able to name something that most all of us as adults had no idea was even occurring. So we kept moving out our zone of, “Is this just an Oregon thing?” Nope. OK. Now we’re in the middle of the country, and now we’re on the east coast, and we’re continuing to hear the same themes from young, young kids. The way in which they’re getting conditioned early is significant.

Talking to little kids … and quite frankly, when we were first starting that conversation, Tiffany, Aaron and I were saying, “Let’s talk to elite athletes, what it was like to be a kid growing up, and how they got to where they are.” And then we paused and said, “Wait a sec, we all rewrite the narrative and have a different story. Let’s actually talk to 7-year-olds.”

One of the things I hope that we can do as a society is talk to 7-year-olds, or talk to girls, or talk to women, and then believe them. And to really bring it full circle is how a lot of the interviews ended. When we asked these gals, 7-year-olds to elite athletes, “What is one thing you wished would be changed within the system?” And every single one said some version of, “I wish people would believe us, I wish somebody cared.” And I think if we can turn towards that, it would be the biggest impact we could possibly make.

Miller: Katie, I imagine there’s a lot of self-selection among folks who seek out your podcast or read your book, that many of them don’t need to be convinced of the importance of focusing on mental health. But I’m wondering if you have gotten pushback from people who say that prioritizing mental health somehow softens athletics, or it means you’re not going to get the results that you need if you really want to compete.

Steele: Absolutely. Actually, this is maybe my second favorite piece, you’re touching on all my favorite components. From a shocking amount of coaches, we heard that exact feedback: “You’re trying to make sport soft.” And we would be curious, “Help us understand that perception.” Because that is the notion – “this generation is soft, they need to just pull themselves up by their bootstraps. It’s always been uncomfortable, they just need to work harder…”

Miller: And “if you coddle them, you’ll give them an excuse and they won’t be their best selves,” right? I mean, sort of a version of that?

Steele: Absolutely. Yep. And what we’re trying to help illuminate is that actually, when mental health is considered – and prioritized, ideally – there can be higher expectations, because the person is going to be able to have earlier interventions instead of waiting until symptomatology is really acute. We’re able to intervene sooner, which means the athlete is going to be able to push themselves harder.

But that paradox of what is required to be an elite athlete and what is required for optimal mental health is where people get tangled. What we’re really working to do through all this work is illuminate that those two things can coexist, by teaching athletes how to change gear strategically. It’s not gonna be in key training blocks, it’s not gonna be in competition, but it will be in rest and recovery period so that they’re then able to show up to be able to better perform in these key moments.

Miller: Tiffany, what do you think fans’ roles in all this is? We talked about fans and parents on the sidelines, but what about all the way up to professional athletics? In what ways are we, as fans, complicit in this?

Brown: Significantly. We play a part, and it’s as small and large as when Simone Biles took time off and stated what was happening. If you jumped into some of those comments about her decision, back when different networks were posting interviews on things she was saying, it was a gruesome place. It was sad to watch the expectations of fans – this constant belief that athletes are superhuman, and that they should just be able to do whatever we want them to do because we’re paying for it, or we’re fans, or whatever the case may be.

And when Simone Biles went back to competition in the way that she did – and this is the burden of a therapist mind, I guess – but all I kept thinking was, she’s back in this place that was incredibly traumatic for her. To be in that zone around the same smells and the same sights and the same expectations is what triggers trauma responses. So there was no surprise on our part that she had the experience that she had, but the response from people was really sad. And on the flip side, there were a lot of people that were incredibly supportive, which is what we want more of.

But as fans, I think we have to do better in understanding that there’s so much more to an athlete than what we watch them do in competition. They have the same stressors, they have the same life events, they have bad days and that’s gonna mean sometimes that they’re not at their absolute perfect best every time we want them to be. As we’re fans of sports, we also understand that sometimes our teams don’t perform how we want them to, otherwise my teams would have a lot more national championships than we do right now. But it comes with the territory.

So it’s almost like when we hear that it’s a mental health thing or a response to something that seems, as you were just asking about, soft or weak, rather than like, “Oh, of course, they can’t play, they tore their ACL,” it’s almost that we give permission for that in such a different way. There was an interview that Elle St. Pierre did just recently – or it was part of an interview – where she is a huge track star, back to competition. She’s going to the Olympics after about a year and a half, after having a baby. And she said she got her period for the first time the week of the trials, for the first time after giving birth. And she was stating what women have to go through to show up.

It was a reminder to me about, in that case, there was so much going on behind the scenes that nobody knew about. Our job as fans isn’t necessarily to always know that. It’s personal information athletes can share with us if they want to or not. In her case, she shared this in an interview. But when athletes decide not to compete or they decide to tap out of something, we have got to be much better at our support for that, and believe them that they’re making that decision because it’s the best thing for them. In order to love athletes, we also have to support them in what they’re doing, and that’s on us as fans.

Miller: Tiffany Brown and Katie Steele, thank you very much.

Brown / Steele: Thank you.

Miller: Dr. Tiffany Brown and Katie Steele are both licensed marriage and family therapists in Oregon. They are also the co-authors of the new book, “The Price She Pays,” and co-host of the new-ish podcast – I think it debuted in March – “Sports Shrinks.”

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