Dietitian Seasonings and Therapist Reasonings: Recent Episodes
Jill Sechi and Meredith Riddick
Whether you are just starting out in the field of eating disorders or a seasoned, wise clinician, everyone needs support, guidance and advice once in awhile. Welcome to dietitian seasonings and therapist reasonings, hosted by therapist Meredith Riddick and dietitian Jill Sechi, eating disorders specialists supervisors with A Collaborative Approach. This podcast is intended to support, educate, and validate clinicians in the eating disorders field; emphasizing the team approach as best practice and encouraging evidence based care.
Dear Followers:
This will be the last podcast of Dietitian Seasonings & Therapist Reasonings......we have served our community for two years and are ready to close this chapter of our work in the eating disorder community.
We hope this podcast was helpful in your journey in understanding eating disorders through the encouragement and process of supervision concepts (vs just education).
You can still find us! Through A Collaborative Approach we will continue to offer dual sessions to clients that desire to have both a dietitian and therapist in session: www.acollaborativeapproach.com.
Meredith Riddick is continuing to provide supervision and webinars (with even continuing education credits by 2021) at www.harmonytherapygroup.com
Jill Sechi is continuing to provide supervision as well as offering a residency program at www.wcandnt.com or www.jsechinutritiontherapy.com
Jill and Meredith review basics about digestive issues that one often sees when working with clients that are struggling with an eating disorder.
There are some great podcasts that cover more in depth- stomach issues- which often clients want to focus on food to change or eliminate. Do you have clients with "IBS" or "constipation, diarrhea, or vomiting" or perhaps struggle with sleep?
Today Jill and Meredith discuss how these digestive issues might come up in session and are more often than not due to handling emotions in effectively (ie, not actually dealing with them but attempting to numb or distract from emotions one feels challenging).
Meredith encourages looking at the client as a "whole" person and not just seeing their issues as "all in their head." Jill discusses the nutritional issues that impact digestive issues. Often digestive issues (up to 40% of IBS cases) are due to the "mishandling" of emotions through eating disorder behaviors and or malnutrition through elimination of foods, food groups over and under eating. Often this process and helping clients "connect the dots" can take up to a year or longer.
We're back! Yes, right before Thanksgiving Day to boot!
Today Jill and Meredith discuss countertransference. This information is from Lisa Ferentze. Check out her resources at the Ferentze Institute .
Have you ever seen a movie or TV show that had a therapist role. Were they ethical? Would YOU do this in session? Lisa Ferentze discusses Wilson and Lindy's models of countertransference. Listen on as Meredith and Jill will highlight a few areas from this training.
What is countertransference? How can it be helpful and perhaps hurtful in sessions. KNOW YOURSELF and use SUPERVISION to process your countertransference when it comes up!
Watch this clip from Good Will Hunting for a little background or go watch the movie.
We will cover these aspects of countertransference:
1-Empathic disequilibrium: Feel a little ineffective with clients?
2-Empathic withdrawl: Feeling distant from your client for your own safety?
3-Empathic enmeshment: Feeling highly related to a client's story leading to inappropriate boundaries?
4-Empathic repression: Feeling overwhelmed with a client's emotional experience by rationalizing or minimizing or not coming back with a follow up session?
Jill takes the stage this week to discuss the importance of understanding macronutrients. The current "diet" trend is for clients to be "counting macronutrients." What are macronutrients? What do you mean by "counting them?" Jill discusses the very basics of macronutrients. What they are and how they are described in nutrition and dietetics. She also goes through basic functions of macronutrients.
Here are a few links/resources for your clients:
Having difficulty getting your client to see a specialized dietitian (ED RD): https://www.jsechinutritiontherapy.com/post/why-is-it-important-to-see-a-dietitian-that-specializes-in-eating-disorders
Yep, we are a bit behind on recording but have several new episodes coming up! We decided to repost this important episode. Enjoy! Be tuned in to next Monday for a new episode.
Meredith and Jill discuss the words one uses in conversation with clients and also in conversations between colleagues and professionally.
What words are we talking about? For example saying "completed suicide" vs "committed suicide." Calories vs energy? How about "obesity" which is often referred to as the "O" word within the ED community.
Listen on as Meredith and Jill discuss the WORDs we use and how they can hold deep meaning. Do you want to be "right" or do you want to be "effective?" Know your audience and work on strong skills of communication and persuasion.
Jill goes on a rant and Meredith goes in more detail about the importance of not crowd sourcing to get support with clients on social media.
There are many issues about posting detailed information to seek consultation on difficult cases on social media platforms!
What's available instead? Paid consultation with a supervisor (who you get to determine level of of experience and expertise). We encourage you to form a peer consultation group within your community of ED professionals. There are also many resources on iaedp that provide monthly supervision (have to be a member): peer consultation group and also one for a focused BIPOC perspective. Another resource more specifically for dietitians is EDRDPRO. And of course there are supervisors (like Meredith and Jill) and others that provide paid consultation groups throughout the United States.
Meredith and Jill review higher level of care recommendations presented by the American Psychiatric Association guidelines.
There are basically 5 levels of care ranging from out patient to inpatient. The chart helps reflect on key points to consider.
As always, seek supervision or peer consultation when you need more support with the client or understanding the complexities of helping a client with this decision.
We are reposting a past season episode as we are preparing for several new episodes coming down the pike!
Meredith and Jill discuss the challenge of treating clients with eating disorders. How do you hold support and understanding yet also provide accountability during the eating disorder recovery process?
If you have not heard this episode, listen on or listen again as we discuss how to not align with the eating disorder which may bring about difficult discussions and uncomfortableness in the room.
Jill takes the wheel this week with the focus of metabolism and how eating disorders effect the metabolism process of the body.
Jill goes through very basic concepts of metabolism, function and how eating disorders can lower or "rev up" the body's metabolism (during refeeding).
Is metabolism as simple as "calories in vs calories out?" Mmmmm, no. Listen on!
As you listen to this episode, Jill hopes you understand the importance of using a dietitian. If you struggle getting a client to see a specialized dietitian, this article may help.
Dr. Guadiani also has some great articles on metabolism to share with clients or understand more details about our amazing machine: the human body.
This is a bit of a somber episode. Meredith and Jill discuss their personal experiences losing a client or a client in their practice. How do you handle this as a clinician? As Meredith states "we build relationships with clients and we genuinely care about them." It makes sense they we will be affected by their passing or that may be worried that they might pass away.
Here are some resources that might be supportive to you if you have experienced the death of a client.
Article
Coping with a Clients Suicide
Jill begins this episode with a client's letter to her ED. A letter of "goodbye."
How do you know when to discharge a client or decrease frequency of appointments. Do you use your gut feeling? What behaviors are you hoping to see?
Often in the ED field, clients are seen for a longer length of time. Now this may be more known from a therapist point of view. In particular to a dietitian, a dietitian may see a client for several years which is different for the "traditional" nutrition field.
Listen on as Meredith and Jill discuss timelines, what to look for and why some clients need support longer than others before it's time for discharge.
Haven't heard of Julie Dillon's podcast, Love, Food? Click here to enjoy those episodes!
We've decided to repost and episode from season 1 on body image. Meredith and Jill discuss body image when working with clients, their own body image, and what the treatment provider roles are and how to address them.
This is the second part of our series on Trauma and EDs. Meredith reviews the concept of fight, flight or freeze and gives descriptions of various characteristics of these behaviors.
Meredith emphasizes the importance of diagnosing accurately as there are may characteristics of trauma that seem to be other psychiatric diagnosis. For example some clinicians feel that Borderline Personality Disorder is actually the "result" of complex trauma. Also, there are many behaviors that result in eating disorder behaviors as well.
Our title is based off a very good book that we recommend you read: The Body Keeps the Score: Brain, Mind and Body In the Healing of Trauma by Bessel Van der Kolk, MD.
Please note that this podcast episode does not replace the importance of more indepth understanding and training often required to effectively treat clients with trauma.
This session (and maybe the next) will be some Meredith time! She reviews basic aspects of trauma. What is trauma? How does this occur? When we say someone has trauma, what does this mean? Meredith also discusses various interventions therapists may use.
Our title is based off a very good book that we recommend you read: The Body Keeps the Score: Brain, Mind and Body In the Healing of Trauma by Bessel Van der Kolk, MD.
Please note this podcast episode does not replace the importance of more indepth understanding and training if this is an area you are interested in supporting clients through.
We are working on some new episodes so please tune in next week! Remember to sign up for our newsletter to receive some extra bonus materials such as role plays. As we are busy behind the scenes, listen to one of our previous episodes where we talk about the importance of obtaining supervision.
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).
We would love to support you in this process. Interested in supervision? Visit our website at www.acollaborativeapproach.com/supervision
We are so excited to get requests for topics! Today's podcast is covering compulsive exercise in relationship to eating disorder recovery. Meredith and Jill first review the difference between athletes and compulsive "exercisers." An excellent resource is Dr. Kate Bennett's website: Athlete Insight. Meredith reviews aspects of exercise that a therapist and dietitians in the field of eating disorders can focus on in the assessment process. Athletes, compulsive exercise and "over" exercise aspects are reviewed. Think INTENT and MOTIVATION.
Other resources: Dr. Brian Cook Guidelines for the Use of Exercise in Eating Disorders Treatment
Welcome Becky Henry to this weeks podcast. Read more about Becky Henry here. Becky discusses a bit of her own story about how she was first a parent of a child in the throws of an eating disorder. She discusses what was helpful for her as she was supporting her child in the recovery process. Becky also discusses the perspective of the parent and the process she went through in order to effectively support her child.
Becky currently has a successful parent coaching program and reviews some of the process she uses to support current parents that are going through similar situations. Parents and caregivers are a vital part of the treatment team. How do we get them on board when often the parent is overwhelmed or not understanding the treatment process?
Other resource: Recovery Roadmap Specialists
This is an episode addressing a requested topic: "How to handle clients whose trauma involves a lot of foods (either specific types of foods or certain settings or preparing foods) as an RD (ie how to do your work while staying in your lane?)"
Meredith and Jill discuss their thoughts and opinions on how to address when clients struggle with trauma specific to food concerns (such as abuse, food insecurity, etc).
Meredith discusses grounded skills and validation that can be helpful that dietitians absolutely need to know and can support a client with in session.
Also dietitians often have not been taught how to "handle emotions." Jill discussed the importance of holding space and learning the skills of validation.
Interested in supervision? Visit our website and sign up for our monthly newsletter!
Follow us on our socials: Facebook and IG: @acollaborativeapproach
Meredith and Jill discuss the difficulties that can occur when working with clients that are 18 or older and their usually very concerned parents. There are of course laws and guidelines with age however with eating disorders, malnutrition can affect an individual's brain. Working with the most "nourished" brain in the room is often needed (the parent).
Listen on as they explore what might be helpful in sessions, what Meredith and Jill often do in their sessions working with this transitional group of clients.
Interested in supervision? Visit our website.
Follow us on social media: we are on Facebook and IG ! @acollaborativeapproach
Links for Becky Henry and Beth Ayn
Meredith and Jill discuss their thoughts and opinions about Episode 25 with Dr. Ralph Carson: What's weight got to do with it? We hope you found his presentation thought provoking, powerful and informative. As Dr. Carson says, he's the messenger and all of what he presented was research as we currently know.
Meredith and Jill emphasized the importance of "openess" and importance of being able to hear what the current health care providers are supporting as way of promoting dialogue to "bridge the gap" between the the eating disorders field and the healthcare industry. As well with new clinicians in the field or to inform current clinicians about eating disorders, it is vital to have positive and open discussion between us all. Enjoy!
If you are interested in supervision please visit us at www.acollaborativeapproach.com/supervision.
In this episode Meredith and I have the opportunity of speaking with Dr. Ralph Carson, RDN, CEDRD for a full hour and a half. Dr. Carson provides more of a presentation with question and answers towards the end. The focus of this podcast is bridging the gap between healthcare recommendations and focus of weight loss vs the recommendations by eating disorders professionals which is often "let go of weight loss" to repair your relationship with food and body. Dr. Carson feels that both are discussing "two sides of the same coin" and feels ED treatment and obesity medicine do not have opposing agendas. Dr. Carson also reviews perspectives of the Corona Virus and "weight" connection.
We encourage you to listen to the podcast more than once as this is pack full of information. Dr. Carson first starts with the perspective and "view point" of the medical community and then dives into the recommendations and focus of the eating disorders community. Finally Dr. Carson discusses how we might "bridge the gap." Meredith and Jill have a brief discussion after with various perspectives.
Please check out our website for references for the presentation. We encourage you to sign up for our monthly newsletter for our supervision times and upcoming podcasts. Enjoy!
In preparation for our upcoming episode to be released on July 6, 2020, with Dr. Ralph Carson, RD, CEDRD, LD we wanted to share a role play that we published (video version) in our June newsletter. You can sign up here to receive our newsletter and for the special bonuses we will be providing from Dr. Carson's discussion (powerpoint video version of the podcast for those visual learners!).
Jill and Meredith role play from a therapist and dietitian perspective how to work with a client with a strong desire to lose weight either through chronic dieting or in the throws of an eating disorder (such as binge eating). Enjoy!
Hi all! In preparation for our July 6, 2020 podcast, Meredith and I wanted to re-post a previous podcast topic: The Role of the Dietitian in Eating Disorder Treatment. Listen on and be refreshed. Dietitians play an essential role in the treatment of eating disorders. They also have a deep understanding of health and wellness and can blend this knowledge and understanding as they work as a vital component on the treatment team. We are very excited about Episode 25 which will be released on July 6 along with additional special add ons. Please sign up for our newsletter to receive some special bonuses and additional resources to improve your skills as a well seasoned clinicians or a "newbie" in the field of eating disorders. Stay tuned!
In this episode Meredith and Jill discuss their personal perspectives about Douglas Bunnell, PhD, FAED, CEDS-S's interview on Episode 23. Meredith reflects on the anxiety of clinicians that are new in the field and seasoned in the field and how this develops through personality types and also training in graduate school.
Jill discusses the difficulty dietitians carry having to develop "thick skin" and bring up difficult (avoid, avoiding) topics and behavioral challenges.
The function of education and supervision in the field of eating disorders is emphasized.
In this episode, Meredith and Jill have the opportunity to interview Dr. Bunnell. Through his 30 years of experience in the ED field, he shares his clinical wisdom and generally describes the 14 qualities or characteristics of effective therapists/clinicians. There are more and more clinicians entering the ED field. However, there lacks adequate training and supervision. How do we nourish and grow new talent in the field of EDs and accelerate the process of learning and professional development? How do you teach "clinical wisdom?"
1-Interpersonal skills (you don't need to be "technically good")
2-capacity to create trust
3-build alliance with your client
4-provide a clear explanation for what you are doing
5-provide a plan that is consistent with your explanation (aka, "treatment planning")
6-influential, persuasive and convincing
7-monitor progress authentically
8-flexible and willing to adapt
9-AVOID avoidance
10-conveying hope and optimism
11- EMBRACE complexity (resisting the urge to be reductionistic of EDs on how they start and what maintains the ED itself in each client)
12- ability to factor in the clinician's emotional reactions and use these to guide your communication, reaction and conceptualization
13- greater self awareness and CONSTANTLY looking to improve your skills and understanding
14- ability to THINK "outside the box:" don't get locked into one treatment modality and READ and UNDERSTAND outside your scope of practice and the ED field (substance use for example)
EDs are complex illness. Even clinicians can get in the trap of "knowing what is coming" and you must stay humble with each client you serve. Dr. Bunnell encourages those clinicians that feel they need a high level of clarity and confirmation in the work they are doing is effective you might be in the wrong niche or area. Developing faith that the the clinician has set something in motion and develops the ability to tolerate ambiguity is a must in the ED field.
All of these twos! This was not planned. In this session Jill and Meredith discuss the education component in dietitian sessions. Dietitians have a huge role in eating disorder support by providing education to clients. Often most client "know" a lot however they "know" a lot of misinformation. A dietitian helps dispel these food and nutrition myths, helps a client unlearn and then learn evidence based information.
Meredith and Jill also discuss the concept of education or psychoeducation being a "clinician block." If you do not know about clinician blocks, check out Dr. Adele LaFrance's work around Emotion Coaching Family Therapy or EFFT. Meredith discusses the concept, "Knowbody cares about what you know unless they know that you care!"
Meredith and Jill provide reduced rate informal consultation or formal supervision from a dietitian and therapist perspective. If interested, check out our website and to learn more. Sign up for our newsletter for monthly "freebies!"
Do you provide education in your sessions? Most clients that struggle with eating disorders need to "unlearn" misinformation that they have heard from youtubers, the internet or Netflix "shockumentaries." Often those newer in the field provide much more nutrition and psychoeducation in sessions than those that are more seasoned. But for those that are seasoned, are you providing "enough" education now that your clinical skills are more fine tuned?
In part 1, Meredith discusses her experience providing the delicate balance of therapy and psychoeducation as a therapist. Watch for part 2 next week!
In this episode Meredith and Jill discuss the "Stay At Home" (due to the Covid 19 Pandemic) challenges that have demanded many clinicians in the eating disorders field to see clients via video or phone. During this pandemic, have clients been able to transition smoothly from in person to "virtual?" Do you you prefer or do you struggle with the virtual platform?
For some clinicians this may be the first time that you are seeing clients "not in person." For others, this may be the only platform one uses.
Meredith and Jill discuss the pros and cons they have experienced providing telehealth as their only platform. Listen on for validation, empathy and encouragement!
In part 2 of our interview with Robyn Goldberg, RDN, CEDRD-S, Robyn discusses some content in her book regarding supporting and helping caregivers in supporting their loved one during eating disorder recovery. She discusses the importance of emphasizing not "envying" their loved one's eating disorder. Robyn encourages the awareness of their loved one's body language and their body language in addition to what is asked or stated.
How does a clinician redirect a physician's recommendation who is not specialized in eating disorders while supporting the caregivers worries and concerns? As a dietitian, Robyn discusses the edge she has as a seasoned dietitian with experience in general clinical nutrition as well as eating disorders. Meredith emphasizes the importance of new therapists receive experience in a higher level of care first or learning more depth of common occurring mental health issues associated with eating disorders.
Robyn also explores how she has been an advocate for those with eating disorders, how she markets herself to be known as an eating disorders specialist.
Resources discussed in this podcast:
Medical Care Standards Guide - The Purple Book https://www.aedweb.org/resources/online-library/publications/medical-care-standards
Learn more about Robyn Goldberg, RDN, CEDRD-S:
www.askaboutfood.com
Learn more about Robyn Goldberg's new book:
The Eating Disorder Trap at
www.theeatingdisordertrap.com
Interested in supervision? Visit www.acollaborativeapproach.com/supervision
Meredith and Jill would love to work with you to build your skills and knowledge in the eating disorders field through both the dietitian and therapist lens!
Robyn Goldberg joins Dietitian Seasonings & Therapists Reasonings with the release of her new book The Eating Disorders Trap for a two part series.
Part begins with Robyn discussing a case with a clinician who referred a very sick client to her. The clinician has minimal knowledge about eating disorders. Robyn's role became one of educating the clinician about eating disorders with the attempt of having the clinicians help and not harm the client.
Robyn, Jill and Meredith explore the process, experience and education clinicians need in order to be effective in the field of eating disorders. Robyn discusses through her 23 years of practice that most of what she has learned about the field has been through experience, mistakes and learning from them and strong mentoring relationships.
How do you develop your confidence in speaking to others that may have more experience than you but you have more experience in the eating disorders field?
Meredith and Jill talk about when and how to incorporate nutrition topics and concerns when a client has heart disease, diabetes, or abnormal lab values, etc. when they are in the throws of eating disorder recovery.
They review when a client is in the the "early stages of recovery" as well as when they have had a year or two of recovery "under their belt." How do you respond to your client's concerns yet keep their recovery a priority?
In this podcast Meredith and Jill provide a role playing scene that is often common in the dietitian's and therapist's sessions. Often times parents want to try to bargain and negotiate their child's weight goal that usually the dietitian sets through a full assessment and review of weight history.
We also have this on video as well on A Collaborative Approaches YouTube channel. Please sign up for our free monthly newsletter to also see the role play as a video version.
Kari Anderson joins us for another podcast on the subject of desire for weight loss or for clients who call themselves compulsive "overeaters" and "addicted to food." These clients often do not realized they may even be struggling with an eating disorder. How do we allow clients to talk about a strong desire to lose weight. As clinicians in the field of eating disorders, we learn more about our own bias and how to approach treatment in HAES and "weight neutral movement." Are we beginning to become close minded?
Kari discusses that she find supervising clinicians, clinicians begin to feel afraid to discuss the topic of weight loss and often times the clinician may "shut down the client." Kari emphasizes the importance of learning to "speak your clients language" first and foremost. Perhaps what we say needs to shift as we "sit" in our clients discomfort. Most are not content and at peace with their bodies when they enter treatment.
Welcome Kari Anderson to our podcast! You can learn all about her at www.myeatingdoctor.com. She has also written a book and has a new one coming this year. Kari, Jill and Meredith discuss new interventions that continue to emerge that can be used in the treatment of eating disorders as well as established interventions.
What reason do new interventions and modalities perhaps not interest newer practioners in the field of eating disorders? What reason are "older" interventions and modalities not encouraged or used anymore (they are but actually often "repackaged" as often in the field? How can we incorporate all of them, even as one practioner? CBT, DBT, ACT, IFS, RO-DBT, etc. There are so many amazing tools to place in a clinicians tool box. Listen on, on how to take risks to support clients in their recovery.
Have you heard about Dr. Adele LaFrance and her work with Emotion Focused Family Therapy (EFFT)? If not, Meredith and Jill encourage you to seek training in this very helpful intervention for those with eating disorders (and other mental health disorders as well). Meredith and Jill attended to 3 day training in Virginia. In this episode we review very basic concepts of EFFT and how both therapists and dietitians can use this intervention to support those in eating disorder recovery.
Jill has a story to tell. We'll let you listen to hear. Meredith and Jill discuss the HAES (Health At Every Size) Movement and how our clients can advocate for themselves during physician appointments. Often clients have weight "issues" brought up in a medical appointments without their consent. Their weight is brought up out of context to why they are seeking medical support. How can we support our clients through these experiences? How do we allow space on our appointments so they can feel heard, understood and validated? How can you grow and learn from ALL perspectives?
What are some leading causes that may contribute to clinician burnout in the field of eating disorders? Those that treat eating disorders experience the highest burnout of other clinicians. What we do is hard work!
What are helpful interventions to prevent or reduce burnout? Owning burnout and actually attempting to curve burnout can be a difficult decision for a clinician. Burnout can cause lack of energy in the clinician, affect your clinical work with a client or affect the clinician's own mental health. Listen on as Meredith and Jill review strategies to reduce burnout and discuss contributing factors.
In our part 2 interview with Amanda Holben (which is a very different subject matter!), Meredith and Jill hear from Amanda what her experience has been like with starting a family after a very fulfilling 20 year career in the field of eating disorders and a huge choice she made to stay at home with her daughter. This can often be a challenge for practitioner: stay home? Continue to work and balance being a parent and continuing in the field of eating disorders. Amanda discusses her experience and decisions she made.
Meredith and Jill have the opportunity of interviewing Amanda Holben, RDN in part one of two interviews. Amanda spent a good part of her career at the once Remuda Ranch in residential programming and then several years in outpatient nutrition counseling in Houston Texas before she decided to devote the majority of her time raising her child.
Amanda discusses aspects of being new in the field, looking back as a newer clinician compared to her skill level and knowledge base now. She reflects on areas of training and understanding of eating disorders she would recommend newer dietitians in the field understand and know to support them in the field of eating disorders. Have you ever had an abnormal psychology class? How about learning from your clients? Listen on and soak up Amanda's words of wisdom.
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.
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.”
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.
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 look like if she were to design a program.
Please visit www.acollaborativeapproach.com to find other resources and information on where to learn more about and implement IE as a clinician.
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 more studies need to be performed! So where do you start?
Questions to ask your clients: “What are they capable of doing?” Can the client know and “listen” to their own body? Can they adequately respond to their body? Those in the throws of their eating disorder need a nutrition rehabilitation meal plan. BUT you can provide some insight into concepts of intuitive eating when they are on more structure. Questions you might ask your client” “How does this food feel in your body?”
Generally a client needs structure. Evelyn described this as the body being ravaged by the eating disorder and they need a CAST first to stabilize their eating behaviors.
Read more in our show notes at www.acollaborativeapproach.com/podcast
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 review various concepts of starting and running groups. Groups in the eating disorders field are typically support groups, process groups or educational groups. Groups can be all three concepts as well. Reviewing how groups are formed, expectations, benefits, and difficulties are all reviewed. Groups are a powerful way to provide connection to clients, to see your client in a different "light" and can also be a more affordable option that just individual nutrition or therapy sessions. Thinking about starting a group? Listen on as Jill and Meredith review aspects to think about that may be helpful and their own experiences running groups.
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!
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.
In this episode, Meredith and Jill talk about their first five commandments of collaboration. If you are thinking about implementing a more collaborative approach in your practice, this is a great episode to listen to. They talk about five different "commandments" that they live by in their private practices in order to maintain a healthy relationship with the client and other clinicians on the treatment team. Meredith and Jill go into how communication, respect, honor, and honesty are all used throughout the commandments. They go into what each commandment means, importance and how to avoid "disobeying" each commandment. We hope that you leave this podcast with a little direction on how to begin your collaborative approach, but we hope to give you more direction in our next Episode 3: Part 2 of the Ten Commandments.
“Team communication and collaboration are essential to prevent confusion and misunderstandings and to reinforce a unified message (Alexander & Treasure, 2012, p.146)." In episode 1, therapist Meredith Riddick and dietitian Jill Sechi dive into their take on a collaborative approach and why it is important to promote a unified message. They talk about how having a collaborative team approach can be very beneficial, and how not having a collaborative approach can end up being problematic. Meredith and Jill also go into the different challenges when trying to collaborate with different clinicians, and how to face those challenges head on while still "staying in your lane." They also discuss the different themes of collaborating and how to utilize these themes in your practice daily. We hope you get an understanding of why we are A Collaborative Approach, and hope to spike your interest into our next Episode 2: Part 1 of the Ten Commandments.
In this episode (episode 0), we introduce therapist Meredith Riddick and dietitian Jill Sechi, certified eating disorders specialist supervisors with A Collaborative Approach. Meredith and Jill share their story of when they first met and began collaborating together in the field of eating disorders. Meredith introduces Jill and Jill introduces Meredith elaborating on work experience, time in the field and how they developed their expertise in the field of eating disorders. This is a brief episode where we hope you get to know Meredith and Jill a little better as they begin their journey in the podcast world.