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  • Dina Cohen

Whaddaya Want From Me Already?!

Updated: Oct 4, 2021

If you've ever felt frustrated by your dietitian's policies or requests, please read on. A little look behind the scenes can go a long way!

Dear Client,

I know I may not be your favorite person. After all, I ask you to do hard things. But still, I'm honored to be your dietitian and I'm proud to know you, you brave person who is making changes!

My goal is to help you achieve a healthier relationship with food and body ASAP. It's not to boss you around. Really! But because I realize that it might seem that way sometimes, I figured it might help for you have a behind-the-scenes look at why dietitians do the things they do. I hope these explanations will help make your journey toward food peace just a bit less angst-y.

1) Why I ask you to come regularly (and why I have a cancellation policy):

You can have the best intentions in the world, and yet without regular sessions, those intentions may never get you anywhere. Accountability and support are critical for making changes, especially when those changes involve uprooting long-held thoughts and behaviors. This is not just nutrition education, where you learn some new things and go on your merry way. This is about facing your fears, managing your emotions, and literally restructuring your brain. That's A LOT to do on your own. Of course, the goal of nutrition counseling is for you to maintain a state of wellness on your own, but I am there to help you with all the messy stuff along the way.

Coming for regular sessions (weekly, biweekly, or whatever is determined to be most helpful for you) allows you to make steady progress and build upon it, rather than having to start from scratch each time. There is nothing more frustrating than working hard and feeling like what you build just crumbles to dust. This is a feeling that may arise when you attend sessions irregularly or too infrequently. Doing so does not allow for consistent progress, which is needed in order for you to reach your goals. When you don't give yourself enough sessions, it turns out to be a "short road that is long". It'll end up being more costly and time-consuming and it will definitely feel more discouraging.

Now you can see how a cancellation policy helps support your progress. A policy that requires you to pay for sessions that are missed without adequate notice helps ensure that you prioritize your sessions, which in turn helps you make progress faster. It also helps prevent the "I had a bad week so won't go to my appointment" phenomenon, which is a really bad move for your recovery. When you had a "bad" week, that's when you need support the most! It's a lot more likely that you'll get back on track if you go to your appointment than if you hang out in a puddle of shame all on your own. :(

Together, we need to work out a schedule of sessions that is most effective for you AND also feasible for you. I am not there to push you into more sessions than you need, and I derive no joy out of keeping you in nutrition counseling any longer than necessary. I want to see you healthy, happy, and successful as quickly as possible.

2) Why I may ask you to keep daily records:

If you've ever been on a diet, you might cringe even reading the words "daily records". Maybe you called them food logs, or a food diary, or something of the sort.

The record-keeping I'm talking about may seem similar, but it's really a whole different animal. Keeping a record of what you eat and other related details, such as where, when, and how you feel before and after eating, can be a fabulous tool. It can also be incredibly triggering. That's why any kind of record you keep should be tailored to you and your individual circumstances. Sometimes a jotting down a few lines about your eating each day is all that I suggest, but please know that even that can be really useful. Having a record of how things went for you in between sessions enables us to really maximize those sessions. It also helps you stay connected to your goals, which helps you do better. With your input, we can find creative record-keeping methods that only help you and do no harm. If we determine that it's not the right time for you to keep records at all, we can develop other ways for you to stay connected to your goals.

3) Why I communicate with your doctor/therapist:

No, it’s not PTA. It’s about making sure we’re all on the same page so that you don’t get mixed messages or harmful advice. We don’t want to accidentally give conflicting recommendations because each of us is only seeing one part of the picture. When treatment providers communicate, it helps ensure that no important information relating to your treatment gets lost in the shuffle. More clarity about what’s going on for you means faster, more effective treatment. It makes our work easier, it makes YOUR work easier, and it makes the whole process smoother and safer.

4) Why I may want to communicate with family:

You might be wondering, "If this is about my food and my body, why does anyone else in my life need to be involved?" This might feel especially true if you live alone.

Changing the way you approach food is no simple matter, particularly if you struggle with an eating disorder. If support is available, why not use it? Nobody else can change FOR you, but if there is someone in your life who can help with food shopping, meal prep, distracting activities, or just moral support, let’s bring in that person. If you have someone close to you (family member, friend, mentor, etc.) who would love to help you out but just doesn’t know how, it would be very wise to include this person in a session or even in a phone call. Giving permission to include a support person can be a tremendous help.

5) Why I continue to have faith in you:

I know you want to give up sometimes. I know that you sometimes feel I'm falsely optimistic. Especially if you've had a long road so far, you may think that I don't get it, that you'll never be able to change. Yes, I believe in miracles, but I also believe in the power of determination, hard work, and the human spirit. Oh - and also timing! Your circumstances may change. New people may walk into your life. We may add a new medication or therapy to your plan. You might move or get a new job. Things are always shifting and changing and your circumstances today may not be your circumstances tomorrow. All of these factors mean that how you feel right now does not determine your future.

I won't keep believing things can change because of some fluffy philosophy; I believe it because I've seen it. I know better than to give up when things seem to be going south, because I've seen clients take hairpin turns in the process of recovery. I've seen them rise up out of some pretty desperate situations. You could be such a client, and I will keep believing in you.


Your dietitian

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