Sage Bierster

I am a Licensed Clinical Social Worker living in Key West, where I work at the Guidance/Care Center as a therapist. I’m bilingual in English and Portuguese, and I speak enough Spanish to get by but not enough to be fluent. A lot of what I do as a therapist is grounded in trauma-work, cognitive therapies, and mindfulness. I am also trained in EMDR therapy and want to pursue certification as a sex therapist. In my current job I work with men whose primary diagnoses are substance use-related and are involved in the criminal justice system. I did not always know I wanted to be a therapist – I went in a lot of different directions before I found this one. It was actually after I went to therapy as a client that I started to think about pursuing it as a career. I’m a believer in the value of therapy because it has helped me throughout my adulthood to deal with things like anxiety. Self-care is also something I emphasize with my clients because I know how important it is for me personally.

I grew up in Daphne, Alabama, which is on Mobile Bay near the Gulf coast, with my parents and siblings. I come from a blended family and age-wise I am the third out of six. I am the classic middle-child: independent, empathetic, and a peacemaker. Growing up my hometown was very small, homogenous, and insular. I was a smart kid but always felt out of place. I was creative and loved writing and reading. I started getting into local community theater, then applied to a public arts high school in Birmingham called the Alabama School of Fine Arts. I started there in the Theater Program in 9th grade. It was a huge change because I had to live four hours away from my family in the school dormitory. I learned to take care of myself – make meals, do homework, get up on time – without any oversight from my parents starting at 14. It was also a small school – maybe 50 students per grade. It helped me develop a strong sense of self after feeling sort of overlooked amongst my siblings. Back then the school was a haven for queer and POC kids who were into the arts. Making friends who were different from me was mind-blowing. I was so sheltered up to that point. It was the first time I was exposed to that level of diversity. Going to school there opened my eyes to the possibilities of the world outside my small town.

After that I went to Middlebury College in the Green Mountains of Vermont, which might as well have been another continent. It was so different – literal ivy-covered buildings made of gray stone set amongst the changing leaves in Fall. Snow was mostly a concept to me before I moved there but I was soon wading through three-foot drifts to get to class. Winter in Vermont is no joke! My experience there was so rewarding and I treasure that time in my life. I made amazing friends within the first few days of my freshman year who I still speak with every day. I got involved in the college radio station and had my own show every semester, and became the Program Director my senior year. One of the reasons I went to school there was because it has amazing language and study abroad programs and I really wanted to travel. I took Portuguese and moved to Rio de Janeiro when I was 20. Another invaluable experience that I cannot say enough about. It’s an incredible, beautiful place. I returned the following year to complete a research project at a children’s shelter that became my honors thesis in International Studies and Anthropology.

I moved to New York City after graduation and waited tables until I got a job at a Brazilian company based in Manhattan, first as the receptionist and then as an events producer. I worked there for four years until I was let go when my department was restructured. This was at the end of a year where I had several big losses, and I felt totally unmoored. That’s when I first went to therapy and tried yoga. The combination pulled me out of a depression and into the next step of my journey. After about a year of soul-searching, traveling, and completing yoga teacher training, I felt better than I ever had in my whole life.

The first time I had the thought, “I want to be a therapist,” was after taking a yoga class. It wasn’t like, “Maybe I could…” or, “Should I try…” but very clear, as in, “That’s what I am going to do with my life.” Everything clicked into place very quickly and by the next year I was moving to New Orleans to attend the Tulane University School of Social Work. It was a great place to live and to start my career. I was lucky to have many fantastic teachers and mentors during my years there. I miss the culture so much – the food, the music, the people. I met my fiancé right before I started school and he actually moved to New Orleans to be with me. Then when he had a job opportunity here in the Keys I figured I owed him one. We moved here mid-2018. He works at TSN Architect and is about to sit for his licensure exams. We miss NOLA but I’d say we have an overall higher quality of life here. It’s really amazing to live in this tropical place and have so much access to nature.

In terms of my future I’d like to say I have it all figured out, but as John Lennon once wrote, Life is what happens when you are making other plans. My fiancé and I have been together over five years and got engaged before moving here. I am not what one might call an enthusiastic wedding planner and we’ve had so much going on professionally since our engagement that we haven’t so much as set a date. Now with the ongoing pandemic it is clear a big wedding is not in our future. We want to elope as soon as we feel safe enough to travel, but we may end up just going to City Hall. We don’t have any plans to move as I just signed a contract with the federal government to stay at my job for at least three more years in exchange for repayment of all my student loan debt, which is such a gift. I enjoy working in a community setting for now because there is such a need for quality mental health and substance use treatment in this area. However I do hope to start a small private practice on the side within the next year. Earlier this year I passed my licensure exam, which was a huge accomplishment. My biggest career goal is to find a better balance between work and other areas of my life. Of course I want to be the best possible therapist I can be, but at the end of the day I’m human and need to take care of myself so that I can still do my job well. It’s very hard work, so finding a balance that makes the career more sustainable will allow me to acquire more skills and ultimately be a better clinician.

It’s easy for me to get deep in the weeds with this topic, so let me start by saying that I want to define “women’s issues” broadly enough to include cisgender, transgender, and queer women, because I don’t want to reduce anyone to just their body and I certainly don’t want my identity to be centered on whatever meaning society ascribes to my body. Point being, conversations about women’s issues need to be more inclusive. That said, feminism is really the term I think about when I hear this phrase “women’s issues.” Feminism to me is all about solidarity with the oppressed, and that can take many forms, whether it be people of color, immigrants, incarcerated populations, etc. When women outside of these specific groups can make common cause with women and others who exist within these populations, we strengthen those movements. And when we can act in solidarity with these groups, we can make progress towards dismantling patriarchal structures that keep women as well as men trapped in a very damaging system.

There are so many issues I could touch on, but one I have been thinking about a lot recently is social media. Personally I don’t look at social media or maintain a presence on any platform and haven’t for several years, which is a choice I make for my mental health. I worry about what it is doing to our society. I don’t think it is a coincidence that partisanship jumped into hyperdrive once everyone and their dog got on Facebook, Twitter, and Instagram. There are a lot of people I don’t agree with out there and even some people I strongly dislike, but social media seems to make it easier to dehumanize those who don’t think the way I do. And I don’t want to lose my ability to see someone else’s humanity no matter how unacceptable I think their views or actions are. And the more we fight and belittle each other, the harder it becomes for us to find common ground to address major issues that are catching up to us quickly, like climate change. This is also evident in the way people talk about the COVID-19 pandemic. I was at Fort Zachary Taylor park recently and overheard someone on their phone saying something to the effect of, “People are just going to have to die because we all need to move on and get back to normal.” To me that attitude is really troubling, because I don’t want to forget that the people are dying are real, not just numbers, and it also gets us nowhere as a society when it comes to finding workable solutions.

I’m very passionate about my work and as I’ve mentioned mental health is really important to me personally. There is a saying that goes something like, “Mental health problems aren’t your fault, but they are your responsibility.” It encapsulates the approach I take as a therapist. We all have to do what we can to take care of ourselves in the present, regardless of what has happened to us in the past. At a societal level the issue is much more complex because research shows that a lot of the mental health crises we see in this country are driven by social and environmental factors such as racism, poverty, and environmental degradation, and exacerbated by lack of access to healthcare and resource disparity. All these issues connect back to mental health. There is an important concept called “Maslow’s Hierarchy of Needs,” which is illustrated graphically as a pyramid with five levels, the first four representing different areas of individual needs, and the top level representing personal growth. It shows how if the base of our pyramid is not secure – if we don’t have shelter, if we are not safe, if we have no resources – then the rest of the pyramid is unstable. How can we connect with our families or create art when we are hungry and tired? Can we make our community better if don’t know where we will sleep at night? It’s a challenge for people to work on their mental health when they have a lot of other needs at the base of the pyramid. That is especially true here in the Keys and I see it with a lot of my clients. I find that many want to improve their mental health – after all, who wants to feel depressed or anxious or angry all the time? – but their social and environmental circumstances are massive barriers to that. And as wealthy as our community is, there are not nearly enough resources devoted to shoring up the base of that pyramid. Then we wonder why there are so many people living outside and in their cars, cycling in and out of the hospital, and drinking themselves into a stupor, and we judge them rather than turn that judgment inwards and ask if we are OK living in a society that let’s that happen to people. As I move forward in my career I’d also like to become an advocate for closing the gap in pay disparity between mental health jobs and other healthcare careers. I had almost as much debt as a medical student when I finished my degree but my expected pay as a social worker will never be anywhere near what a doctor will make. We undervalue mental health treatment but yet we expect professionals in this field to do an inordinate amount of work while also struggling to pay their bills and deal with the base of their own pyramids. There are reasons why so many social workers burn out, and why we see so much turnover in these jobs.

Middlebury College, Middlebury, Vt. – Bachelor of Arts Degree – International Studies and Portugese. Magna Cum Laude. Minors: Latin American Studies, Sociology/Anthropology
Honors Thesis: Os Meninos da Casa Dom Bosco: Coming of Age in a Shelter – February 2008
Tulane University, New Orleans, La. – Masters Degree in Social Work; Thesis: LGBTQIA+ Inclusivity in Sexual Education

Memberships: Phi Alpha Honors Society, Social Workers United for Reproductive Freedom

Volunteer Medical Advocate, Sexual Assault Unit, University Medical Center, New Orleans, La.
Vinyasa Yoga Teacher
Volunteer at Casa Dom Bosco, Rio De Janeiro, Brazil

PRESENT: Currently, I am working as the Outpatient Behavioral Health Therapist for the Other Side of the Fence Program at the Guidance/Care Center in Key West. I work with men ages 18+ with substance use, mental health and mental health problems, high-risk behaviors, and criminal justice issues.

PAST: I was a full time counselor at the Bridge House/Grace House Residential Treatment Program in New Orleans, LA. I worked with women ages 18+ with substance use and mental health disorders in a long-term residential treatment facility. Prior to that I worked as the Utilization Review Coordinator at the same facility. At the start of my career I interned as a clinical counselor at the University of New Orleans Student Counseling Services.