Sometimes I imagine that people see the word “Dietitian” and instantly conjure images of a woman in a white lab coat, making notes on a clipboard, while doling out rigid advice about what not to eat to improve health outcomes. But I can’t think of a role farther from what I hope to achieve as a Registered Dietitian Nutritionist practicing through a psychodynamic ( or “relational”) lens. Some people might be surprised to learn that sessions about food often turn into conversations around a wide variety of unexpected topics that, while seemingly unrelated, almost always tie-in to food and body image.
And perhaps that is the keyword: Conversation. I invite my clients to come with their own agendas, asking them “Where should we begin today? What should we be discussing?” and letting the dialogue flow from there. I pay close attention to what the client is saying and describing, and equal attention to what I am feeling - what is being “stirred up” in the session. If someone says they don’t have much to talk about, but they happen to mention a recent meal with a parent or sibling, and I feel tension in the room, I might inquire how that meal went. What was it like to eat with that person? What was the conversation like? How did they feel afterwards? How did it impact their appetite and how much food they were actually able to take in? It usually leads to a larger conversation about the context of the meal and how it might be informing their reticence in our session that day, far beyond the nutritional content of the meal itself.
Other times, a conversation about anxiety over weight loss or weight gain might prompt me to ask what the client’s anxiety level is like when we talk in session. This allows them to put words to what is happening in the moment and understand how weight fears can be tied to relational fears. In short, it’s using the clinical relationship as a “proxy” for what is happening with the client’s relationship with food and body. In another example, a client might come to session feeling desperate to lose weight, trying many different diets and extreme measures, in an attempt to reduce the desperation. I might ask about what it’s like to not receive a diet plan or diet advice from me, and allow them to put words to their desperation, wanting something so badly and arriving at disappointment and helplessness that I cannot give them what they request. But perhaps I can offer them something else, and sit with them in their despair so they can tolerate it in relationship.
I think it bears considering that most, if not all, of people’s relationships with food and body are born in relationship to other people, usually the parents or caregivers, so it stands to reason that relationships with food and body will also be healed in relationship, with clinicians and sometimes with other clients in group settings. And while I am a Dietitian who can and does provide concrete recommendations around meal and snack ideas, nutrient and energy needs, and strategies for grocery shopping and feeding oneself, I find it far more effective to simultaneously refer back to the clinical relationship in order for any real, meaningful change to occur. Otherwise I could simply give clients worksheets and books and other learning materials and send them on their way - God knows there are enough materials out there! But it is the unique bond, the “therapeutic third” in the room that allows for something more, something intangible that invites the client to cultivate deeper meaning beyond behavioral change alone.
So if talking about food is really talking about desperation, hopelessness, fear, disappointment, grief, and so much more, it would only make sense that I invite these feelings into the room too, naming what is happening between myself and the client, and allowing equal space to digest food and feelings.