I distinctly remember the day as a hospital dietitian that totally changed my perspective on my profession. I had received a consult for a gentleman who had suffered a heart attack and underwent open heart surgery. With my educational materials in hand, I went to his room and knocked on the door. “Come in,” he said.
I explained, “My name is Katy and I’m one of the dietitians. I’m here to talk to you about your eating. Your doctor wanted me to go over some information with you before you go home.” The next thing he said shocked me. “You can tell it to my wife. She does all the cooking.”
With my poker face I said, “Ok, sure,” and went on to provide the cardiac nutrition education to his wife, hoping that the patient would overhear it and learn something himself. I couldn’t understand why he didn’t care.
In hindsight, I can now empathize with what he was going through. It must have been shocking and terrifying to suffer a heart attack, and very painful to have open heart surgery. The food on the cardiac diet at the hospital probably didn’t taste that great. He needed some time to wrap his mind around what happened, and to take a personal inventory of the changes he needed to make in his life. Then, when he was ready, he would be more appropriate for nutrition education. Hearing me preach to him in the hospital wasn’t going to be helpful.
The thing that was so shocking to me about this encounter was that I had been operating under the assumption that my patients always wanted my help. Especially after something as life-altering as a heart attack. I couldn’t understand why he had no apparent interest in hearing the information, or why he was dumping all of the responsibility for his eating on his wife.
It was my first real insight into the psychology of working with people as a dietitian. How could it be that they didn’t want to hear what I had to say and do what I told them to do? [gasp]
Then I started working with clients who have eating disorders and it was like a slap in the face. Talk about people who don’t want to do the things you suggest. If you’ve never stood toe-to-toe with an eating disorder, it’s hard to imagine what it’s like. The best analogy I have is to compare it to a parent telling their child no they cannot stay up late, or no you cannot touch the hot stove, or yes you need to brush your teeth - and the kid spins into a wild rage, lashing out, saying “NO!” or “I hate you!” The parent is doing these things for their child’s own good, but the child doesn’t like it. Eating disorders are much the same way. The person’s true self secretly feels safe and secure (hopefully) that their dietitian is telling them what’s best for their body, but the eating disorder doesn’t like it and will lash out.
Things I’ve been told by clients with EDs:
- I don’t like you.
- F&*$ you!
- I don’t see the point in coming to these sessions.
- I’ve always hated dietitians.
- I honestly don’t want to be here.
- My parents/therapist/doctor made me come but I don’t really think I need it.
- I already know everything about nutrition.
- There’s nothing you can do that will help me.
- I don’t trust you.
On the surface, these statements may sound really offensive, and I have to admit that the conflict-avoidant and sensitive part of me always cringes a little bit, but these statements aren’t about me as a person. They are about the threat that I represent to the eating disorder. (And if it is about me not being a good personality fit for the client, that’s fine, I’m happy to get them hooked up with another RD, but this isn’t usually the case with this type of defensiveness and rage.)
The dietitian is the person on the treatment team who is asking you to disobey your eating disorder. The person who is challenging the eating disorder's lies. The person who is helping you see the ways in which the eating disorder is destroying your body. The dietitian is asking you to do the thing you are most afraid of - to eat according to what your body needs, and to cope with your emotions in alternate ways. This may mean gaining weight. It may mean letting go of the fantasy that if you just ate xyz foods and weighed X pounds then your life will somehow be better.
I get it. It’s uncomfortable, challenging, scary, and often outright infuriating to see a dietitian. So, it’s ok to kinda hate your dietitian. We understand and we try not to take it personally. At the end of the day, I’m not here to be your BFF. I am here to help you recover. And if I’m never making the eating disorder mad, then I’m probably not doing my job.
What I can promise you is that I am not fragile, and I will not crumble under the wrath of your eating disorder. My office is a safe place to let out your emotions. And no matter how angry and intimidating your eating disorder gets, I will still be here to fight the fight along side you. You can hate me AND I will still be your cheerleader and advocate for recovery. Maybe someday that hate will turn into gratitude and mutual respect. Many people who recover will say in hindsight that their dietitian was the most challenging member of their treatment team to work with, but was absolutely essential to their recovery.
So, even if you hate seeing your dietitian, keep an open mind. She (or he) is there to guide and support you through the difficult process of recovery.