Dietitian Seasonings And Therapist Reasonings

Wondering what a hackle is? Listen on! If you are coming into the field as a "first career" you might be in your mid 20s or younger. This can bring up questions from parents or clients such as "how old are you?" And this can bring up a clinician's own counter transference (either positive or negative) which is your own internal  reaction in the session. This may bring up feelings of incompetence (understanding that we are all continuing to learn) for example. Meredith and Jill explore typical questions that might be asked, what this means and how you might respond. 

Meredith and Jill review the diagnosis of OSFED. Often times clients actually have AN or BN even though based on the DSM-V criteria, the client falls in the OSFED diagnosis based on BMI for example. Jill reviews looking at BMI vs the client's "normal" weight for the individual client. Jill also reviews the medical complications that may arise as well even though the client is at a "normal BMI."  Meredith also encourages looking at the length of time with the disorder and traits the client.  What about clients that might fall into BED but actually have BN as the binge eat and then follow a 1200-1500 calorie diet. What if they need HLOC? What facilities would be a good fit? 

Meredith and Jill discuss their experiences working in higher level of care (HLOC) and also now as out patient (OP) providers. They discuss what their clients may experience going from one level of care to the other. What might your client experience? What should they expect? How about the clinician? What is the clinician's experience in a HLOC vs OP setting? What might be helpful transitions for the client and the clinician and the client moves from one level of care to the other?  Interested in general consultation or supervision to obtain your CEDS or CEDRD? Contact us at www.acollaborativeapproach.com/supervision for group, individual and dyad supervision opportunities. 

Often times individuals might think all dietitians do in a session is provide a meal plans: a beautifully laid out breakfast, lunch, dinner and snack option meal plan and "poof" the client magically decides to follow it. All in one magical session! Right?  Mmmmm, not so much. Meal planning is a small portion of the activities and responsibilities of a Registered Dietitian Nutritionist on an eating disorder treatment team. Jill reviews the various interventions, questions and nutrition therapy practices dietitians must be trained in to effectively support a client on their journey to developing a healthy relationship with food.  

What is the function of a therapist in the treatment of eating disorders? Don’t they just give good advice? In this episode Meredith and Jill explore the role of a therapist and how they are trained to help and support individuals through the process of therapy. Therapist employ strategic questions and pull on evidenced based theories while providing counseling to clients. During a therapist’s internship, a therapist is learning what theory they are more drawn to. Questions and answers that the therapist provides to a client is based on a particular theoretical orientation. Clients want black and white answers. Therapy allows clients to learn to live and work in the grey. Increasing confidence of the client and building self-efficacy of a client is a huge reason why therapist do not “just give advice.”

How do you handle, work through or stay on the same page with a clinician (whether it be a dietitian, therapist, doctor or psychiatrist) who might have a different style or approach than you? Meredith and Jill explore the complexities of staying on the same page with your treatment team when the client may experience a different approach or style from different clinicians. They discuss the importance of frequent communication and collaboration. Meredith and Jill also explore how to provide feedback to another clinician if that individual’s style may collide with yours. Be careful though! At times a client will say that a clinician is not a "good fit" due to more avoidance. Make sure you "dig a little deeper" when you hear a client wants to switch treatment team members. Also be careful not to just refer to "your friend" and make sure the clinician you are referring to has the approach or style you feel the client needs. 

When do you know your client is ready for intuitive eating when they have been in the throws of an eating disorder? Please welcome our first guest on our podcast Ms. Evelyn Tribole, the registered dietitian who co-authored THE book Intuitive Eating A Revolutionary Program that Works! Meredith and Jill had the opportunity of interviewing Evelyn for this part 2 of a 2 part interview. Evelyn discusses how working as a team in the eating disorders field and emphasizes the important of consistent communication, allows each team member the freedom and latitude of discussing IE while staying in their scope of practice. What about groups? Should IE groups only be led by the therapist. Emotions and self care concepts are discussed. What about dietitians? Should this profession only lead groups on IE? Food and eating are discussed.  What about higher level of care? Should IE be discussed in RTC, PHP or IOP when a client is in the throws of an eating disorder? If YES, then HOW? Evelyn describes what her program would lo

When do you know your client ready for intuitive eating when they have been in the throws of an eating disorder? Please welcome our first guest on our podcast Ms. Evelyn Tribole, the registered dietitian who co-authored THE book Intuitive Eating A Revolutionary Program that Works! Meredith and Jill had the opportunity of interviewing Evelyn for this part 1 of a 2 part interview. In this episode Evelyn discuses  the importance of supervision for clinicians when providing guidance to their clients on the concepts and implementation of the intuitive eating process. What Evelyn describes as important to the client knowing they have something to “recover to.” Supervision is imperative as knowing how to provide guidance to your client goes well beyond any intellectual knowledge that you have (many have read her book); supervision provides guidance around the experience of supporting your clients during this process. Intuitive Eating has a few very small studies around the implementation with eating disorders. Much

In preparation for some upcoming topics for 2020, Jill and Meredith have reposted a topic of importance: the function of meal plans in the treatment of those struggling with eating disorders. Listen on and be refreshed! We are excited about season 2 coming up! Stay tuned.

Meredith and Jill explore what it might be like working with an client that shares the same field you do. We focus more on treatment of those clients with eating disorders, but regardless working with someone in your field can feel intimidating, a sense of pressure to "say the right thing" or even feelings of being judged for not being a "good therapist or dietitian."  We also explore working in the field of eating disorders and how going to therapy yourself can be helpful as a form of self-care and/or for struggling with mental illness as a clinician. They hope this podcasts helps with normalizing this often common occurrence. 

Control is one small aspect that those with eating disorders struggle with on a day to day basis.  Often those newer to the field or those who do not treat eating disorders on a regular basis can feel "control" is the underlying issue an individual with an eating disorder is struggling with. Control however is just the surface of deeper concerns that have to do with malnutrition and emotion dysregulation. Eating disorders go way beyond the need "to control." Meredith and Jill explore what "deeper" issues could be lurking beneath. 

Meredith and Jill discuss various ethical dilemmas that can occur when working with clients struggling with eating disorders. Ethical concerns can occur due to several reasons such as a long length of time working with clients and building strong relationships. These relationships without ethical consideration can sometimes develop into dual relationships if strong boundaries are not established or there is a lack of understanding of one's ethical code within their profession. Meredith and Jill emphasize the importance of consistent supervision to support the clinician through any ethical considerations that may arise. 

Meredith and Jill explore and discuss how to conceptualize clients that appear with restrictive eating disorder behavior and those who present with compulsive eating disorder behavior. These behaviors are often expressed through temperament and personality traits. What are the skills and patterns of interventions needed and knowledge base for clinicians working with these clients? Many clients have common comorbidities and are often best supported through therapies such as DBT and RO-DBT. Learn more about these important interventions and much more. 

Meredith and Jill discuss the ins and outs of holiday management for clients. Food can be a huge struggle with emotions and clients being around food they have not been around for over a year. Meredith explores helping clients deal with relationship struggles as well that tend to arise during the holiday season. They also discussed missed appointments and "crisis" management that can arise due to chronically missed appointments or cancellations.   

Meredith and Jill address how to incorporate, address and discuss faith or religious based practices when working with clients in eating disorders recovery. Both nutrition counseling and therapy are both important areas to address often controversial practices when a client is working on their eating disorder recovery. Where do you start? How do you address practices that are often "covered up" eating disorder behavior without offending a clients faith and faith practices? You will hear both how the dietitian and therapist can both be important avenues and of course the importance of collaboration as a team. 

Meredith and Jill review and talk about keeping boundaries with clients and yourself. Because most in the the field of eating disorders are care givers, it is easy to allow clients to overstep your boundaries. This can involve over scheduling yourself because the client states they only have a specific date and time they can be seen. This might also involve a client wanting to give you a gift, say around the holiday times. How do you handle these situations? As always, seek supervision if you feel you might need more guidance in this area. 

With scope of practice boundaries, dietitians and therapists at times "cross over" to the other's area of expertise. We call this boundary a "white picket" fence. Dietitians may talk about skill work to enhance what the therapist reviews in session and a therapist may gently talk about meal planning concepts. Meredith and Jill strongly believe that to be a well rounded clinician one must "learn outside" their typical practice area. This allows each clinician to enhance each other's work with the client. Be careful though of going outside of scope of practice boundaries. 

Meredith and Jill review how to treat clients that struggle with Orthorexia vs traditional "anorexia." Often these clients are more concerned about the health aspects of food (causing a low intake of food and reduction in body weight) and their body composition (fat vs muscle) and may be less concerned about how much they weigh. What does the presentation feel like? How might your interventions look differently? What is the role of the dietitian vs the therapist in the treatment of these clients? Listen on!

Meredith and Jill spend a little time expressing gratitude for the comments, support and reaching distances far, far away! Thank you for listening! Thank you for your support! Also Meredith and Jill will be in Denver Colorado for Eating Recovery Centers Annual Conference. We hope to see you there!