Dietitian Seasonings And Therapist Reasonings

Meredith and Jill tackle the importance of the initial assessment or intake with a client. Properly conceptualizing your client is vital for treatment planning, providing evidenced based care and building your confidence as a clinician. Meredith and Jill discuss what case conceptualizing your client will typically look like as a therapist and a dietitian. What questions are important for you to ask? What observations of your client are important to be aware of? Listen on a Meredith and Jill discuss this important concept!

Meredith and Jill discuss when treating clients with eating disorders it is easy to start colluding with the eating disorder. Through compassion we are able to connect with a client and express concern but we have to make sure that we are still able to "push" or "hold accountable" the client during the eating disorder process. How do we not "align" with the eating disorder. At times this will be from our own fear of losing a client or perhaps causing an "uncomfortable" situation in the room.  Meredith and Jill discuss the differences and what to look for (if you are starting to collude) to be an effecting eating disorder clinician. 

Meredith and Jill discuss the supervision process for the certified eating disorders specialist designation (CEDS or CEDRD). Meredith describes supervision for the therapist which is required for one to obtain a LPC or LCSW. Jill discusses how the supervision process is new and unfamiliar for a dietitian as they are not required to go through supervision to obtain their RD status.  Jill and Meredith discuss the general current requirements to obtain the certified eating disorders specialist designation (as of Fall 2019 through iaedp). 

What do jumbo shrimp and intuitive eating meal plans have in common? They are both oxymorons! Jill reviews the basic function of meal plans in the eating recovery process and discusses when intuitive eating concepts are appropriate. Most clients need solid structure (meal plans) when they discharge from a higher level of care, usually for 6 months or longer. Also they are helpful as a recovery protection plan when a major life event might occur (Houston Flood, divorce, marriage, etc!). 

Choosing to work in the eating disorders field, you are choosing to work with often complex clients with various struggles outside of just an eating disorder. When is the best time to narrow down who you decide to see in either your private practice or even perhaps in a higher level of care? If you are new to the field and become narrow to quick, you may lose the opportunity to build a skill set. If you have been in the field awhile and are dreading a certain type of client in your practice, is it time to start narrowing who you see?  Meredith and Jill explore their own experiences and what helped lead them to narrowing down and working with their "ideal client." 

Meredith and Jill tackle a difficult subject of bariatric surgery with eating disorders, disordered eating and weight concerns. Do you take on a client in your office if you are a health at every size/intuitive eating dietitian or therapist when the client tells you they need help preparing to have bariatric or weight loss surgery? If you have a current client that has an eating disorder or concerns about their weight and decides to have bariatric surgery, do you convince them otherwise? How about if they have already had bariatric surgery and begin developing an eating disorder, how do you treat them?  Listen on as Jill and Meredith explore perhaps a controversial topic.

In this Episode Jill and Meredith discuss working with clients that are Vegan or Vegetarian during the ED recovery process. Jill reviews the basics of what is vegetarianism vs being being "vegan." Meredith reviews the role of the therapist in helping clients decipher their intent and motivation and how their decision affects their relationship with others. If a client is Vegan and using a leather purse and shoes, how do you approach this? What if a client is deciding to be vegetarian or vegan for "ethical" reasons? Is a client able to fully recover from an ED when eliminating meat as a major food item? Listen on and learn how the therapist and dietitian collaborate together on this very decisive topic!

Meredith and Jill touch on a difficult topic of knowing when a clinician (either dietitian or therapist) who has recovered or is in recovery with an eating disorder is ready to be in the field. Many who have developed an eating disorder (it is estimated that 50% of nutrition major have or are currently struggle with eating issues) want to work in the field to give back and help others on their journey. When is the best time? 2, 3, 5 years? Or perhaps is a few years and you have been able to go through a major even (marriage, divorce, etc) without reverting back to eating disorder behavior. What if you notice a colleague in the field that is currently struggling? Meredith and Jill explore this touchy topic in hopes of providing guidance and supevision to those entering the field.

Meredith and Jill discuss dealing with dieting parents, spouses, siblings, etc. when treating a client with an eating disorder. Often an adolescent or client with an eating disorder's biggest support system is their parent, sibling or spouse. What if their biggest support system is also dieting? How do you get a sport system on the same page? Do you convince the parent for example to stop dieting and embrace intuitive eating? What if they question buying challenge foods to have in the house? What is the dietitian's role? How might a therapist handle a situation like this? Meredith and Jill discuss cases and examples of an often frequent scenario in the treatment of eating disorders. 

Meredith and Jill delve into the various aspects of resistance when working with client 'struggling' with eating disorders. Jill discusses methods she has learned through motivational interviewing skills and Meredith enlightens Jill that therapists actually do not have the easiest job in the world and are "taught to expect resistance" in their sessions. What does resistance sound like in session? How do you "let go of the rope" and use other skills to help a client work through their ambivalence of wanting to stay in their eating disorder and also work towards recovery? Listen on and learn to let go of "being the expert" in the room. 

Jill does all the talking in this podcast! Meredith does all the listening! Dietitians play a vital role in helping a client reengage with their own biology. Meal planning is a huge vehicle a dietitian uses to support a client on their journey back towards normalized eating. Jill discusses the various types of meal planning methods to help new dietitians in the field understand various interventions (just as a therapist usually does not just use CBT!). Meredith discusses her perspectives as a therapist when working with dietitians in the past and her understanding of various meal plan interventions dietitians use. Learn some basics as a dietitian new to the field or just a good basic review. Understand the role the dietitian plays for therapists that are just understanding the role of the dietitian on the treatment team. 

Meredith and Jill explore the difficult subject of terminating a client. Jill and Meredith discuss how they have handled terminating a client in the earlier parts of their career and how they handle making the decision to continue working with a client (or not) now that they are more seasoned "wise" clinicians. What if a client needs a higher level of care? Do you continue seeing them? What if you are the "last" one standing on their treatment team because they are refusing to see anyone else but you? Meredith and Jill discuss various options to take, "following your gut," knowing your own limits as a clinician, honoring scope of practice and knowing your ethical boundaries and requirements in your profession. Listen on as Meredith and Jill discuss some heavy podcast material! 

In this episode Meredith and Jill discuss the similarities and differences of those clients with Anorexia Nervosa and OCD. Why? Because clients can sometimes present with both mental illnesses. Review episode 8 again if you do not understand the diagnostic criteria for Anorexia Nervosa. Meredith discusses what you typically see in the diagnosis of OCD. As a wise clinician understanding co-occurring mental illnesses that are often seen with eating disorders is vital. What is the treatment for OCD. Is it the same or different for Anorexia Nervosa? What role does the dietitian play and what role does the therapist play? How can a dietitian or therapist accidentally collude with a client struggling with OCD? How can you work together in A Collaborative Approach to help a client that may present with both mental illnesses? Check out our website for additional references and education materials as well that will be helpful to read and understand. We hope you enjoy this episode!

Often the diagnosing process of eating disorders can feel like clients are being labeled or judged. Meredith and Jill discuss the importance of diagnosing a client, what criteria (basic) to look for specifically for those with avoidant restrictive food intake disorder, other specified feeding and eating disorder (atypical anorexia nervosa for example) and unspecified feeding and eating disorders. Properly diagnosing a client allows the clinician to know what treatment modalities are most evidenced based. What eating disorders fall under OSFED? What if a client has lost a large amount of weight, yet "still has a normal body weight?" And many other questions explored in this episode!We discuss a few cases as well for conceptualization. 

Often the diagnosing process of eating disorders can feel like clients are being labeled or judged. Meredith and Jill discuss the importance of diagnosing a client, what criteria (basic) to look for specifically for those with anorexia nervosa, bulimia nervosa and binge eating disorder. Properly diagnosing a client allows the clinician to know what treatment modalities are most evidenced based. Is the dietitian allowed to diagnose? Should you tell a client what eating disorder they might be struggling with? What are ways clients restrict when they have anorexia nervosa? These are just a few questions that will be touched on in this episode!

In Episode 7, Meredith and Jill discuss how eating disorders affect intimacy. Intimacy may be in the form of physical or emotional intimacy. Intimacy can be defined as actual physical sex but also how one might be able to be vulnerable with someone or even open and honest in a therapist's session. Often in the dietitian's session intimacy may often be discussed as wanting to lose weight to be attractive or to date (body image). In a therapist's session you might a significant lack of connection both physically and emotionally in a client's long term committed relationship for example. 

Welcome to episode 6. In this podcast Meredith and Jill explore what to expect when working with a client with an eating disorder who also struggles with anxiety, depression or both. Meredith discusses basics of anxiety and depression, what to look for and general ways you might treat a client from a therapy perspective. Jill discusses what a dietitian may "experience" in the room and how a dietitian may interact differently which each diagnosis during nutrition therapy. As always, anxiety and depression have the best outcomes when there is a full team approach (including psychiatry and medical) which address the therapy and nutritional aspects of these very common co-occuring disorders in eating disorders treatment. 

Welcome to episode 5. Jill and Meredith explore "being fired" from a client. We discuss the natural reactions and experiences a clinician might feel with good ol' validation. We also explore the "signs" you might receive from a client that is about to escort you to the firing range. Do you offer a "closure session?" What if you have just started in private practice and they are 1 of 3 clients you only have on your case load? Tune in to hear more.

In this episode, Jill and Meredith dive deep into body image and even divide into three different parts. They both discuss body image when working with clients, their own body image, and what the treatment provider roles are and how to address them. Meredith and Jill both go into the attitudes and emotions around body image; when to address body image in your sessions, what to engage in, and how to engage from a dietitian's and therapist's perspective. When discussing their own body image, they talk about how they personally deal with body image in the client/clinician relationship. They also go into clinician's roles and the education that is helpful to provide depending on their scope of practice. Do you as a clinician know how to handle body image? Is it realistic to always have a positive body image? Listen to our take on body image and how we as seasoned clinicians deal with body image in the field of eating disorders.

In this episode, Meredith and Jill talk about their second half of the Ten Commandments for Collaboration. They continue to go into what each commandment means, , how to apply, and how to avoid "disobeying" each commandment. If you missed the first half of the Ten Commandments of Collaboration Meredith and Jill talked about those in Episode 2. If you have already listened to the first five, give this podcast a listen to get the full picture and learn how to put all the commandments together. Meredith and Jill strongly believe in and practice these Ten Commandments for Collaboration, and use them as their backbone in their practices. Stay tuned for Episode 4 as they dive deep into Body Image from a dietitian and therapist perspective.