Laura Schoenfeld: As far as the type of clients that I typically attract, the ones that have disordered eating, for me, at least, have typically that kind of disordered orthorexic-type behavior, where they’re overly concerned with eating a perfect diet and doing the perfect amount of exercise and having a perfect body and all these things. It’s mostly women. I do have a few men that are like this, but most of the women that I work with have this kind of overwhelmed and a little bit neurotic pattern of eating, and that has been something, as far as a population is concerned, that I’ve cultivated through a lot of the blog posts that I’ve written, a lot of the things I’ve talked about on my podcast with Kelsey, so that’s how I attract that particular audience. The reason that I started working with those people is because a lot of the people I was getting referred to from the naturopath that I share an office with and people from Chris and Amy’s practice, a lot of them have these disordered eating habits even if they don’t realize that they do. So I realized that there was a need there and that I wanted to help with that because my philosophy on nutrition is that, yes, it’s important and, yes, it’s very helpful, and it’s important to try to eat a healthy diet to be healthy, but there’s a lot of women that take it way too far and then end up causing more harm than good. That can turn into an actual eating disorder, or it can just be a disordered relationship with food that affects a person’s health.
As far as resources for this population, that’s a tough one because I think for me a lot of the education I’ve gotten on disordered eating has been more from experience, which I know sounds a little strange, but the more I’ve worked with people with disordered eating, the more I can figure out how to help them move past the disordered eating. It’s something that I personally think I struggled with in college and maybe even in grad school a little bit, nothing crazy, but just enough that the obsession with trying to get the perfect diet was disruptive, and so there is some level of empathy that I can bring to the table when I’m working with a person like that. It really depends on what kind of problem you’re trying to solve because, Laura, it sounds like you might potentially have patients that have more of like a binge eating approach to their food, which can definitely be a disordered relationship with food. A lot of times women who want to lose weight have a very roller coaster history of dieting and then being off the diet and gaining weight and losing it and all that stuff.
One of the things that I think could be really helpful for you to get trained in is something called motivational interviewing, which is not specifically designed for people with eating disorders, but it is something that’s been really helpful in my counseling ability. The person that I was trained by is a woman named Molly Kellogg, and she’s a registered dietitian that has also a master’s of social work, as far as her degree is concerned. She runs motivational interviewing seminars around the country, and I went to a weekend seminar with her to learn about motivational interviewing. If you who are listening are not familiar with motivational interviewing, it’s basically a style of counseling where you ask a lot of open-ended questions and try to get the patient to come up with their own solution to the problem, which sounds very opposite of what we’re learning in this course, where we’re learning how to fix the problems for the patient, which I think is important to know. Obviously we all want to know how to actually solve health problems for people that have complicated cases, but I think it’s really important to also know how to talk to a patient who’s struggling with implementing changes because I think that is a very challenging factor of working with people one on one. Even if you know exactly how to help them, you know exactly the kind of diet they should be following, you know the specific lifestyle changes that would be helpful for them, it’s very rare to have a client that’s just 100 percent, right off the bat motivated and adherent to the recommendations that you’ve made, so motivational interviewing is basically a strategy for getting the patient to come up with ways to adhere to your recommendations on their own. Maybe that means they’re not actually going to follow all your recommendations, but maybe they can figure out some of the ones that you’ve made about their diet and lifestyle that will work for them. So if you have someone who is overeating because they’re bingeing or they have food addiction or they have a disordered relationship with food, try to ask some open-ended questions that can get to the root of what drives that behavior. Now, what I find with a lot of the people I work with is that the disordered eating comes from a deep-rooted self-worth issue, which can get a little heavy, obviously, if you’re trying to help people with their health and you start getting into these really deep psychological issues that people have, but usually when someone is either overeating because they’re addicted to food or undereating because they have more of an orthorexic-type disordered eating behavior, there’s definitely a deeper reason for that, and trying to help the client identify that, not identifying it for them, but using motivational interviewing to help them identify it for themselves, can really be helpful to get them kind of aware of what their reason is for why they’re making these decisions. They’re coming to you, they obviously want to be helped, they want to be healthy, they want to deal with either this diabetes issue or this disordered eating issue, and trying to figure out what the root cause of that behavior is is going to require a lot of digging on your part. I’d say motivational interviewing is a great thing to learn how to do, and that really could apply to any population. It doesn’t have to be a disordered eating population for that to be helpful.
Now, as far as the disordered eating side of things is concerned, for me, I try to avoid working with anyone who has a serious, actually diagnosed eating disorder because those types of clients can be very, very challenging to work with. The reason for that, I believe, is because there are a lot of deeper psychological issues that make it very hard for them to recover. Especially anorexia has one of the lowest recovery rates of any mental illness. There’s a lot of confusion as to what causes anorexia or bulimia, those kinds of behaviors. There’s a lot of theory about it being gut health related, which I think makes a lot of sense. There are a lot of clients I work with that have a lot of gut issues, like IBS and different types of gut discomfort that is associated with eating, and then that can lead to disordered eating. As far as someone who has a binge eating habit, a lot of times with those patients, again, it comes down to, are they self-medicating with food? Do they have any sort of neurotransmitter issues? Is there a history of cyclic dieting that they’re trying to break out of that you can help them with? The topic is really broad, and I would say that if you wanted to work with actual eating disorders, that’s going to be an extra level of training that you would want to go under, but if you’re just working with people who have a level of disordered eating that is causing their health problems, which is very common and I’m sure you’ve seen a lot of it, I think the motivational interviewing thing is going to be a lot more helpful to you than trying to get too deep into the eating disorder treatment, because again, that’s kind of a whole other ball of wax, and it’s not really going to apply to people who are just having a disordered relationship with food.
Like I said, the name of the person that I recommend, her name is Molly Kellogg. I’m going to type that into the chat box. If you want to check her out, definitely look into that. She does live trainings, which are really nice, and she also has a couple of books that are pretty helpful.