Ginny the RD may ask, “What if I (and they!) can’t work out why they [the parent] are resistant to change?”
Here is a checklist of things you need to have done, as a prerequisite to working with resistance.
- Have you identified any misperceptions regarding nutrition?
- Have you identified any misperceptions regarding weight?
- Do you know intake is sufficient? It may not be, and you need to know why.
- Do you have a good understanding of the child’s history, including neonatal?
- Are you aware of the parents’ relationship with food?
- Do you have a sense of the home environment?
- Have you used the ‘whole child lens’ [link to WP] to identify external factors like food insecurity?
Resistance to change is a clue. Rather than seeing it as opposition or as a sign that you are not doing your job very well, look underneath it and see what it tells you.
Maybe you need to dig deeper beneath the misperception
In feeding work, we can separate misperceptions into three distinct categories: conscious, unconscious, and inconsistent.
An unconscious misperception is one where the client is not seeing their belief with any criticality – they are holding onto it. For example, the parent of a child in a bigger body may be certain that their child ought to be on a low-calorie diet, even when the RD (working responsively and from a weight-neutral perspective), has reassured them this is not the right course of action.
A conscious misperception is where the parent recognises that they have a belief which is contradicted by the evidence available to them. For example, they may have a worry that their child needs more protein, even when they have seen evidence of the latest science on children’s protein requirements. Parents with conscious misperceptions may say things like: “I know you are right! It just feels so hard not to persuade her to eat another bite of fishfinger…”.
And the third category – inconsistent misperceptions – is where parents flip-flop between these two positions. Human beings are not neat – our psychological processes are messy. Parents often move between feeling strongly that something is right, to embracing an alternative perspective, and then back again. An example of this type of misperception is the parent who seems resolved to change their feeding practices in sessions, and seems to really understand the rationale for making a change. But when they go home and try to implement your advice, they find those beliefs returning and come back to the next session challenging your recommendations.
Unconscious misperceptions are hardest to work with; it can be best to set them aside for a while and work on something else, such as parental acceptance or understanding of the child’s relationship with food. Unconscious misperceptions may be very deeply entrenched beliefs, impacted by powerful social or personal factors such as diet culture or trauma in the parents’ life. If you push back hard against an unconscious misperception, you risk the relationship deteriorating as you enter ‘combat’ mode.
Conscious and inconsistent misperceptions require skill and patience to process, but this can be rewarding and powerful work. If you’d like to add a tool to your toolkit to support this, you’ll love our webinar: The Hot Cross Bun: a practical psychology tool for working with parent anxiety, available now on-demand.
Maybe there are maintaining factors that you’ve missed
This is a hard thing to wonder when you’re faced with a parent in distress, because it can feel lacking in empathy and compassion. But the truth is that we sometimes continue with behaviours that are unhelpful because they are actually meeting another, not always obvious need.
For example, a client who is struggling to get her youngest to transition from the bottle at the age of three, may in fact be getting something from ‘babying’ her last child (Katja shares how she fed her daughter a bottle before bed beyond the recommended 12 months because it was an important time for her to enjoy rare cuddles with her often squirmy baby). The parent who spoon feeds a child who can actually meet their requirements through self-feeding, may be satisfying their need to feel needed, or their desire to mitigate choking fears. A parent who is anxious about vegetable consumption may cling to bribing with sweets to get that one bite in, because it temporarily reduces her anxiety and gives her a sense of accomplishment in an otherwise defeating dynamic.
Approach this kind of speculation with caution and sensitivity – if you have a strong relationship with your client you can ask gentle questions like: “How do you think it would be if you didn’t do X behaviour – is there anything you may lose?”
Maybe the client wasn’t ready
Readiness and motivation for change is a major area of study in the field of human behaviour. In the next post in this series, we’ll be considering a well-used model of change that reveals how change has several stages. Clients are often some way from being ready to take action.
It is all too easy to feel impatient or frustrated as a clinician (not being known for my patience, I’ve certainly been there) when we can see that a change in feeding practices could have a significant positive impact on a child. But that doesn’t mean that we should rush our clients. The old adage about the horse and the water is so true. Think of it as bringing the client to the well and spending some quality time there, rather than grabbing the bucket and tipping the water over their heads!
A related point here is the speed of change. Be open to the idea that your client may need to take things more slowly than you had hoped or expected. If you can break a change down into smaller component parts, this can make it seem less daunting. The best way to do this is collaboratively. If a parent is telling you it feels like too much too soon, work with them to figure out what feels manageable.
Transfer the skills you have in relation to children. What do we do with a child who isn’t ready for change? We create an environment where new experiences are supported and facilitated WHEN (and if) intrinsic motivation kicks in. That environment, as it relates to parents working with you, is your relationship with them. If they are resisting change, you can continue to build trust by listening and being alongside them as they grapple with the challenges of feeding their child.