You did it!
You finally opened up your eating disorder private practice and have your first new client on your schedule. Pat yourself on the back and congratulate yourself for your courage! Now what? How do you successfully conduct an eating disorder initial session? How do you assure your environment feels safe for clients and your compassion is shining through?
This blog post is for dietitians who are either a) newly working with eating disorder clients, b) struggling with getting clients to come back or c) hoping to fine tune the ways they are conducting an initial session.
I remember my very first eating disorder client.
I was so excited. But definitely more nervous than excited. I was worried I would say the wrong thing. I was worried they wouldn’t come back. And I was worried I’d get fired from my job (at the time, I worked for a private practice, not on my own).
Looking back, that initial session went better than I could have imagined. I (thankfully) easily connected with the client, and we wound up working together for about a year or so, until she moved. I’m glad my first session went well, but that’s not to say every initial after went beautifully.
I certainly struggled through many. Some of those clients came back and some didn’t. I try not to dwell too much on the ones who didn’t come back. But, I do like to think I grew as a clinician from those experiences. I learned how to more effectively communicate my message with my clients. How to more effectively communicate that I could and would support them in achieving their recovery goals. And also, how to assure clients they could trust me. I wanted my clients to feel heard and feel like I could offer hope - a way out of their eating disorders. Which can be tough to do with just meeting someone for the first time!
Below are 5 tips to fine tune your initial counseling session.
Block off more time
At my practice, we block off 90 minutes for an initial eating disorder session and 60 minutes for follow ups. 50 minutes for the session and 10 minutes for charting. I would not recommend less time, at least for an initial session. There is just SO much to learn about the client, and you definitely do not want to feel rushed.
More often than not, our clients are super anxious when they walk through the door (or these days, log onto Zoom). We want to take our time with them. For their benefit and for ours. We will have a better understanding of what our clients are going through if we take out time to learn from them. In turn, we can better support them in recovery. Plus, you want to make sure to have time if any surprises pop up. The client is running late, mom or dad asks tons of questions (which is totally understandable and normal), you have to provide information about treatment center options...etc.
Go through forms ahead of time
And take notes. When I first started seeing eating disorder clients, I would print out the initial registration forms. I would highlight things I had questions about. For example, if the client wrote “I started to do X behavior when my ED started.” I might remind myself to ask more questions about this. Where did they learn X behavior? How often did they start doing it? Did friends/family know about X behavior?... etc. Our registration forms are pretty long, probably 7-8 pages. Some clients write novels, others put one word answers, and some don’t fill them out at all.
Be curious
“Be curious” is one of my favorite phrases when it comes to counseling. I keep this phrase in the back of my mind at all times, especially when first meeting a client. While we may be able to relate to our clients on some level, we definitely don’t know what it’s like to be them.
“Be curious” reminds me to never make assumptions about my clients’ relationships with food. It reminds me to ask more questions if something isn’t clear to me. Asking questions allow our clients voices to be heard. And allows us to better understand them and better guide them toward recovery. That being said: avoid asking rapid fire questions. You still, of course, want to have a conversation with the client.
Some phrases I like to use before a question are… “I’m wondering a little more about X.” “You mentioned X in your forms, can you tell me a little more about that?” “That’s interesting, I’m curious about what you just said, can you tell me more?”
Validate, validate, validate
Validation can go a really long way! Our clients want to feel heard and understood. If we validate, we can show them we are listening and we are understanding them. Reminder: validation doesn’t mean you are agreeing. You’re telling them you’re hearing them. Some phrases to use. “Wow, that sounds really hard.” “I could totally understand why you felt X.” “I’m hearing you say, you felt X, does that feel right?”
Provide feedback, but not too much
The initial session is a “get to know you” session. It’s not really a time to provide meal plan information and discuss recovery tools in depth. This is for a few reasons. 1) It’s often overwhelming for our clients to discuss their ED history with someone new. 2) We, as the clinician, have so much to learn about our new client and little time to learn it.
Discussing nutrition in depth will take away from that. That being said, it’s still important to provide some feedback because our clients want to hear from us about how we might approach their recovery. We also want to be clear about our nutrition philosophies. So, throughout the conversation with your new client, find places where you know you can help them. Be sure to tell them you can! And possibly tell them how. Let them know you can talk about it in follow up sessions.
What to do about virtual sessions?
At the time I’m writing this blog, most of us are living in a virtual world. I’m curious to see how this will affect telehealth in the future. Thankfully, most clients are open to virtual sessions. In my experience, I haven’t found the transition to decrease the quality of my client care. One last tip about initial sessions, and this is related to virtual sessions. Be clear about instructions with logging on to whatever virtual platform you use (I use Zoom) AND have a back-up plan. I send out a Zoom link about a week before the session. Now, my zoom link is actually in my signature for clients to easily find it! Additionally, my back up plan is a phone call or if the client is comfortable, FaceTime.
There you have it. A few tips for fostering a beneficial initial session for both you and your clients. If you’d like more support surrounding your business and client consults, I offer business coaching and supervision. Contact me at alex@couragetonourish.com for more information!
Alex Raymond, RD, LD, CEDRD is an eating disorder dietitian in private practice in College Park and Columbia, MD. Alex specializes in treating individuals struggling with anorexia, bulimia, and binge eating disorder. She offers national business coaching and supervision for dietitians hoping to grow their practice and fine tune their counseling skills. Whether you’re first starting out in private practice, just beginning to see eating disorder clients or looking for a fresh look on client cases, Alex can help. Alex co-founded Courage to Nourish with Bobbi Boteler. Within 9 months, Alex and Bobbi hired 3 dietitians to join their team. Alex can provide valuable feedback on starting and growing a nutrition practice. Contact Alex by visiting www.couragetonourish.com/contactus or follow her on Instagram: @courage.to.nourish