Over and over I hear:
- “What should I do when family members or friends ask for nutrition advice?”
- “I want to start a practice and figure I’ll start by counseling friends.”
- “My cousin eats too much. How can I talk with her about it?”
Feeling hopeless and
being hopeless are
two different things.Thom Rutledge
Remember that not getting what you want
is sometimes a wonderful stroke of luck.The Dalai Lama
How best to approach these situations? It can be useful to remember that if you choose to provide nutrition counseling, whether formally or informally, you will then be in a “dual relationship” with this person. I wrote about such relationships in Tip #13 (available in the Practice Workbook, Vol 1). I will summarize the important points here and provide more guidance on handling these sticky situations.
Let’s use the example of taking on the role of nutrition counselor for your mother. The relationship you had will be changed and may be harmed, and the counseling relationship will be less effective than if she had met with another dietitian. It may be difficult for you to shift back into the daughter role. You may find yourself pointing out her poor food choices at a family gathering. As you discuss her diet with her, you will find it difficult to maintain a professional demeanor and may not be able to bring up tough issues effectively. On your mother’s side, she will not have the privacy she would if she met with someone else and therefore might hold back important details. These are just some of the issues that may come up.
I hear a clear trend in my workshops and on e-mail chats. As dietitians have more years in practice, they are less apt to counsel family and friends. We learn from experience that it just doesn’t work well and we become more comfortable making referrals.
Over and over I hear from new dietitians that they plan to begin their practice with family and friends. It does seem easy to begin with a ready supply of clients among acquaintances. But there are several pitfalls in addition to the ones mentioned above. It takes considerable experience and skill to successfully navigate a dual relationship. Most dietitians beginning a practice do not have much experience and are understandably focused on the content of the sessions. It takes months or years of experience to begin to be able to focus on process. This focus on process is a necessary element of handling a successful dual relationship. Another reason to begin with strangers has to do with developing a professional style. With friends it is difficult to use professional language, to talk about the fee, to assert your professional opinion and other aspects of taking on the role of a competent professional. As an example, think of the awkward shift it would take to assert your professional opinion to your grandmother, who still thinks of you as her “cute little girl.”
Some ideas for responding when people close to you ask you to counsel them: “I am so glad you have decided to work on your eating/health. I have found that it gets too confusing to be your dietitian and also your friend/niece. I’d rather remain just your friend/loving niece. I know a great dietitian at the hospital. She is an expert in diabetes/weight management/oncology. Here is how to contact her.”
Sometimes the setting is more informal. Where do you draw the line when a friend asks a simple question about the latest fad diet or your aunt with diabetes asks if it is OK to order the French toast? Some of us take the position that we are “off duty” and just don’t answer. One of my colleagues says, “Oh, I left my dietitian hat at the hospital.” If this seems too extreme, you could clarify the narrow question, answer it and then change the subject. It may be useful to review the format for giving advice in Tip #59.
It can be painful to watch loved ones eating in ways that you know jeopardizes their health. Becoming their dietitian is not the solution. As with any other behavior that concerns you, the most appropriate response is a clear and respectful expression of concern followed by offering resources and then backing off. Tip #48, Assertiveness (available in Practice Workbook, Vol. 2), has some useful language.
In summary, refer!
Nutrition is a common concern, and those around us naturally turn to us for advice. We want to intervene when we notice the nutrition mistakes of those dear to us. Even if you are the very best nutrition counselor there is, you are not the best one for your friends and family members. The best one is a colleague whom you have faith in. Since you know your friend or family member well, you can carefully choose whom to refer to based on personality and specific needs.