Many tears are shed in my office - tears that ultimately lead to healing. It’s absolutely fascinating how much emotion comes up when we are talking about eating and body image. (Which is why I couldn’t do what I do without the therapists I team with - you guys rock!).
Clients often come to their initial nutrition appointment unsure what to expect. Some assume that I’ll be telling them what they’re doing “wrong” with their eating, and will give them a prescription for what to eat and not eat. Others assume that I’ll be putting them on a bunch of supplements and recommending they cut out processed food and sugar (don’t even get me started on this). Then there are the clients who have seen an RD in the past and have those preconceived notions about what I do, which may or may not be accurate depending on the type of RD they saw.
Alas, it’s important to me that clients understand what they’re signing up for when they work with me. So much of it is to be discovered, together, along the way.
I want to give you a little “behind the scenes” look at what is going on in my head when I’m sitting with you, dear client.
Setting the stage
I was very intentional when I decorated my office. I want your brain to immediately recognize that this isn’t going to be a threatening experience. It is a place where healing occurs. Therefore, I wanted it to have a cozy and non-institutional, non-clinical feel. You also won’t see any pictures of produce hanging on the wall or plastic models of food sitting around.
What you will see when if comes to food is a basket of snacks, from which I hope you will take one if you are hungry. You’ll also see me drinking and sometimes eating while we are together. I do that on purpose too. I want you to see me nourishing my body, and to normalize it for you.
As much as I dislike it, I do have a scale in my office. It is set up for doing blind weights - so the read out of the number faces away from you. On the wall above the scale, I hung a picture of the sun peeking through the clouds. A symbol of hope for your healing, and a reminder that your worth is not contingent upon the number on the scale. It is simply a piece of data that I factor into the bigger picture, and I don’t even use it for every client.
We settle in and get comfy on one of the couches or the cushy armchair. If you’re chilly, there are blankets to use. My goal is to make you as comfortable as you can be in a situation that is often inherently uncomfortable.
As we start talking, I always want to know what’s been going on in your life since we last met. That’s because I genuinely care about you as a human being, AND because your eating struggles occur within the context of your daily living. So it’s important that we look at the backdrop in which your eating occurs.
My hope is that you’ll tell me the good, the bad, and the ugly. I want to know what has been going well, and what has been hard. I 100% believe that we learn more from the struggles - so let’s talk about them. I’m never judging you for these struggles.
What I’m listening for
As we talk, my ears are perked up, listening for what’s between and underneath your words. I’m listening to both what you’re saying and what you’re not saying. My body is attuned to yours, and I am sensing with my own body how you’re feeling.
I am listening for your True Self vs the eating disorder. I can usually tell the difference, even when you can’t yet. The eating disorder is full of judgment and uses shame against you. Your True Self is your inner wisdom. I want to help strengthen your True Self.
I am listening for misconceptions or distortions about food, nutrition, health, metabolism, body size/shape, recovery, etc. I won’t always correct all of these in the moment if I sense that doing so won’t serve a therapeutic purpose. But I do make note of these things so we can address them at some point if needed. Interestingly, often these distortions clear up on their own as the True Self becomes stronger and the ED has less power.
I am listening for extremes. Thinking or acting in extremes is not going to promote healing. This is true whether we are talking about nutrition, sleep, work, relationships - pretty much any area of your life. If I am hearing something that seems extreme, I just might point that out to you. Our culture normalizes extremes, so often times people don’t realize that they are thinking this way until we reflect it back to them. Recovery is about learning to live in the gray area, rather than black and white.
I am listening for hidden or deeper meaning in what you say and do. Eating and body issues aren’t about food, weight or shape. Those things are the symbols of or metaphors for the true underlying emotional needs. This is where I think we can learn a lot from the field of psychoanalysis, which is why I have been studying this area a lot lately.
I am listening for your pain and shame. After all, that’s why you came to me in the first place - to help you heal from your pain. Now, that healing very well may look different than you thought it would. Our culture tells us that “controlling” your eating and weight is the ultimate path to happiness. I can tell you without a shadow of a doubt that isn’t true.
Talking about your hurts and struggles is extremely powerful. Our brains are literally connecting to each other and our mirror neurons are firing, and over time this is healing. People who recover from eating disorders consistently report that it was the relationship with their treaters, not any specific interventions, that helped them get better. It is the dynamic between us, and the way that your pain can be spoken of and witnessed that will heal your deepest wounds.
When you are telling me about the guilt you feel for what you ate or what you weigh, I know that you are also telling me about your shame. You are telling me that you somehow aren’t good enough. I am here to help you discover that you are the same wonderful person, regardless of what you eat or weigh. And I will hold on to that belief until you can hold it for yourself, as long as it takes.
I am listening for your true needs. When you tell me that you ate because you were overwhelmed, or that you restricted because you were anxious, I hear that beneath those food behaviors there were underlying needs that weren’t being met. I want to help you connect these dots. I want to help you learn to recognize your true needs, and to be able to honor them with compassion. This will take lots and lots of practice.
I am listening for healing. I am listening for the days when you no longer need to come in and lament about the food, weight, body image, exercise that you did or didn’t do. I am listening for when the broken pieces inside have healed. I am listening for your True Self’s knowledge that your work together has come to an end, at least for the time being.
It’s always bittersweet when our time together comes to a close. After all those hours spent together talking about some really deep and vulnerable stuff, I miss you. But I know I have done my job when you can confidently say that you don’t need to schedule with me anymore. And that’s something to celebrate.
Working with people who struggle with eating and body image issues is truly an honor. The fact that my clients trust me with their stories is a privilege and responsibility that I don’t take lightly.
I want you to know, dear client, that your story makes a profound impact on my life, and I hope that I can make a positive impact on yours.