Therapist On Call

By Staff

Athletic Management, 15.4, June/July 2003,

The University of Tennessee has always been a leader in meeting the sports medical needs of its female athletes, and this year, administrators took their efforts a step further by adding a full time therapist, Kristen Martin, to their staff. The addition may not seem like a giant step, but it’s turned out to be a key component of the department’s Team ENHANCE program.

Team ENHANCE—an acronym for Enhancing Nutrition, Health, Athletic Performance, Networking, Community, and Education—was started a decade ago to help Lady Vol athletes deal with the pressures that being an elite female athlete can bring on. The program initially focused on nutrition and eating disorders, but has since expanded to address drug and alcohol abuse, stress, mental illness, date rape, sexual trauma, childhood abuse, pregnancy, depression, anxiety, stress related to athletic injuries, and sexual orientation issues.

“If there’s a mental or emotional aspect to it, we handle it,” says Jenny Moshak, Assistant Athletic Director for Sports Medicine, who directs the program.

Female student-athletes can be at greater risk than non-athletes for problems like eating disorders, depression, and low self-esteem, Moshak believes, because the personality traits that help them in athletics can also push them toward less healthy tendencies. “Perfectionism, wanting to please, being a high achiever, obsessing over their performance and their bodies—all of those things are present at higher rates in athletes, and they also correlate with a higher risk for eating disorders and other addictive behaviors,” she says. “It’s also more socially acceptable within athletics to be obsessed with eating and with weight control.”

The program has always drawn on the expertise of many different professionals (e.g., sports psychologists, nutritionists, exercise physiologists) from both within and outside the school. Now, by hiring a full-time therapist, Moshak says the program has been able to serve athletes in a much more timely and effective way. For starters, because Martin is on salary at the school, student-athletes who use her services don’t have to file health insurance claims. That gets around one of the biggest stumbling blocks they encounter when they need counseling.

“When they access their health insurance, their parents find out,” Moshak explains. “Many times, it’s family issues that they’re dealing with in the first place and they have a lot of work to do before they can tell their parents. With a therapist on staff, it’s an ‘incognito’ situation.”

Martin’s presence also means athletes don’t have to get a referral and make an appointment in advance in order to get help. “If a student-athlete is in crisis, Kristen can meet with her every day,” Moshak explains, “and she can work around the crazy schedules these kids have. They can really establish a relationship with her, since they’ll be seeing the same counselor over the course of four years.”

Coaches are very supportive of the program and Martin’s presence. “If a coach notices that something’s not right with one of their athletes, they can say, ‘Let’s get you to Kristen so you can talk about what’s going on,’” Moshak says. “Once coaches realize that they don’t have to deal with issues they aren’t trained to handle and that there are people in place to help them, they are very relieved.”

But Moshak says it did take some time to get coaches totally on board. The key, she says, was giving them input into the program and starting slowly. “Our coaches now realize that when an athlete is happy and healthy, she’s going to perform her best,” Moshak says.

Head Swimming Coach Dan Colella has appreciated Team ENHANCE’s inclusion of coaches and the way the program was delivered. “The administration didn’t put a program in place and then tell us, ‘This is what you’re going to do,’” says Colella. “It’s been a collaboration from the beginning, and we’ve definitely had some good debates. That’s what makes the program successful—it’s all of us working together to help our female athletes be the best they can be.”

Moshak says she also had to break through people’s natural reluctance to talk about personal issues. “Some of these topics are very difficult, even for our coaches, because they generate fear,” she explains. “We had to start by simply discussing issues so that they became commonplace.”

Now, coaches use Team ENHANCE as a recruiting pull. “We meet with parents,” Moshak says, “and tell them, ‘We’re going to take care of your daughter from head to toe—not just make her a great player, but take care of her overall well being.’ It’s been a big sell to some of our athletes and their parents.”

Student-athletes are introduced to the program as soon as they get to campus. Along with their pre-participation physical and drug screening, they answer a questionnaire about sports medical, nutrition, and mental health problems they have experienced in the past. “It always amazes me how brutally honest they are in their answers,” Moshak says.

Based on the questionnaire and the team physician’s observations, student-athletes are sorted into two categories: “no risk” or “possible risk.” No risk student-athletes are offered nutrition education and ongoing seminars and team talks under the Team ENHANCE program.

“However, if they indicate that they’ve had an eating disorder or a chemical dependency issue, or they’ve been on antidepressants—anything like that—we consider them ‘possible risk’ and get them into the system immediately,” Moshak says. “They have direct access to individual and group therapy, a variety of support programs, and in-patient treatment if necessary.

“Word has spread that if people come to us for help, there will be confidentiality,” she continues. “They also realize they’re not going to lose their scholarships or playing time. We’ve had student-athletes in the system for four years whose coaches never knew they were coming to us. As long as they follow the program, no one needs to know.

“If schools build it, their female student-athletes will come. These problems exist everywhere. Even if you think they’re not present in your school, they are. You just aren’t aware of it yet.”