“So….what is it you DO exactly?”
I often hear this question from clients or other professionals when trying to explain the way I approach my work. I understand the confusion – the common conception of a dietitian is someone who tells other people what to eat. As an RD grounded in the Health at Every Size and intuitive eating frameworks, I almost never tell my clients exactly what to eat. Nor do I prescribe diets, give people lists of foods to avoid, or assume I know more than my clients about what is best for them when it comes to their eating.
Another phrase I often hear from clients during the course of our work together is: “this feels a lot like therapy”. When I first started getting this feedback, my initial response was panic. I was terrified of practicing outside my scope, something considered unethical and potentially harmful to clients. I spent many a tearful session in supervision grappling with a lot of uncertainty. I knew prescribing food plans did not work to help people heal or gain a deep knowing of how to feed themselves. But I was learning more and more how much our eating practices are tied up in past trauma, emotion, cognitions, and relationships. And wasn’t that the domain of therapy?
When clients tell me “this feels like therapy”, I have learned that what they really mean is –
- I feel safe with you
- I don’t feel judged
- I feel like I have a say in this process; we are working as a team
- I feel heard and seen
- I feel fully accepted just as I am
This is what I hope all of my clients feel like in the course of our time together. Whether the work is about healing our relationship with food and body or with the deeper emotional issues that are better addressed in therapy, the importance of creating an environment of safety, non-judgment, and partnership crosses all helping professions.
Unless we are hired by robots, the clients we work with will bring difficult emotions into the room and into the work. Disordered or non-attuned food behaviors often arise in response to emotional or traumatic experiences; when we ask people to change their food behaviors, we may be taking away some of their only coping tools and, by extension, totally turning their world upside down. As a dietitian, I need to be very aware of the context in which I am asking clients to make change, and the significance of that change. I also need for them to feel enough trust and safety to allow me to ask them to do things that are very difficult and often uncomfortable in the service of healing.
HAES represents, in part, a shift away from the medical model when it comes to how we approach eating behaviors. This necessitates a shift away from the medical model for dietetics as a whole. Holding the big picture, and how food fits into it, requires a much wider lens than the ones RDs are traditionally given in our educational programs. And so a much broader skillset; one that includes working with clients relationally and therapeutically. In that context sustainable change is much more possible.
Please note, I highly recommend supervision and continuing education to be properly trained and supervised in therapeutic modalities! Also, it is important to know when a mental health therapist is needed on the team and to be able to refer clients to appropriate resources.