You’ve shared with parents why pressure is unhelpful; you’ve explained that the idea that pressure makes eating harder and outcomes worse is underpinned by research; you’ve highlighted common feeding practices which can be experienced by children as pressure; you’ve helped parents observe how their child reacts to and resists pressure…
And yet… your client is still finding it nearly impossible to stop persuading their child to eat.
This is a common roadblock that responsive feeding professionals come up against, so we thought it might be useful to explore some ideas on how to handle it. Rather than one long post, we’ll explore the topic in a series of related posts, of which this is the first.
From combat to understanding
A common pitfall when you are met with resistance, is to see things in terms of ‘right’ and ‘wrong’. Even if you wouldn’t articulate it in these terms, it can feel like you are right because you’re suggesting that pressure is not a constructive strategy, and the parent is wrong because they are challenging the idea that they can and should stop pressuring. While you are seeing things in this way, you are in ‘combat mode’; however respectfully you proceed, you are fundamentally trying to change your client’s mind.
Can you shift to ‘understanding mode’? This is where your main task is to try to get an accurate sense of what your client is experiencing. This will involve asking open questions and checking that you are along the right lines in your interpretation of what the client is saying.The following two dialogues between Sue (a parent) and Ginny (an RD) illustrate this distinction.
Sue: I just don’t feel ok not telling him he has to eat at least a reasonable amount of his safe foods.
Ginny: But this is still pressure, even if he usually eats those foods.
Sue: I just don’t see it that way. It’s what I need to do as Sam’s mother, to help him eat enough.
Ginny: I’ve had a really close look at his food record. Sue – I’m very comfortable that he is more than meeting his needs and we can relax and see what happens without pressure.
Sue: I’m sorry, I don’t buy it. It doesn’t feel right to me.
Ginny: There is a whole lot of research showing that pressure makes eating worse. It really does! Just give it a try for a week or so, I bet you’ll see some positive change.
Sue: Hmm, I’ll think about it.
Sue: I just don’t feel ok not telling him he has to at least a reasonable amount of his safe foods.
Ginny: Can you tell me more about that?
Sue: Well, it leaves me sick with worry. I can’t sleep if he hasn’t eaten well at the evening meal. It takes me right back to the early days.
Ginny: Ah, when he was home from the NICU and you had to feed him on a rigorous schedule?
Sue: Yes. It was such a stressful time, then when he was out of the woods, I was so busy getting to grips with being a new mom, I don’t think I ever processed it properly.
Ginny: This all makes sense. So what you’re telling me is that when Sam doesn’t eat as much as you feel he should at the evening meal, it brings back some of those difficult memories and those feelings of anxiety from his first weeks?
Sue: Yes, exactly.
Understanding, Acknowledgement, Validation, and Acceptance
This process of hearing and holding space for clients can be broken down into steps:
Understanding: As described above, the task is to listen with humility, and do your best to get an accurate sense of what it was like for your client.
Acknowledgment: Having invited your client to share their experience so that you can begin to better understand it, you can let them know that you have heard them.
Validation: You can go beyond simply understanding what they are telling you, to conveying a sense that they have a right to feel that way – that their experience is valid. In fact, the very act of being listened to without judgment is validating.
Acceptance: Once you’ve done some work on understanding and validating the clients’ experience, you can help them accept where they are. Your acceptance of where they are opens the door for their own acceptance of where they are.
When you give advice that parents are not ready to action…
Often, parents are actually quite conflicted, even if they appear to be resisting what you suggest. They are stuck between a rock and a hard place; following your advice feels bad, rejecting your advice feels bad. You’re a professional, and there is power and authority attached to that, however much you try to approach your work from an egalitarian perspective. More often than not, and what I observed in my research, this inner conflict ends in self-blame. Sue might be thinking: “I can’t get behind what the dietitian is telling me. I wish I could give it a go, but it feels wrong. I’m such a bad mother. This is hopeless.”
As part of validating Sue’s experience, Ginny could tell her that it is totally understandable that she has all these emotional responses left over from those traumatic early weeks (not to mention the subsequent years of concern about Sam’s eating, and the impact of multiple professionals telling Sue that she had to get him to eat). Ginny could even suggest that Sue seek out some personal therapy so she can process her experiences. She can name what is happening for Sue, without judging. She can accept Sue’s current deeply felt need to control and monitor Sam’s intake.
“When Sam was so fragile and vulnerable, monitoring and ensuring intake felt critical to his well-being. It’s really hard for you to shake off that sense that you need to ensure he eats enough.”
“Paradoxically, this kind of acceptance of people as they are seems to free them for change, whereas insistent nonacceptance (“You’re not okay; you have to be different”) immobilizes the change process.”
(Miller and Rollnick, Motivational Interviewing) *
Once you have understood, acknowledged, and validated what is happening for your client, and helped them accept where they are, you can then begin to work collaboratively with them to introduce change at a pace that doesn’t feel threatening. This may be best broached at a subsequent session when they have had some time to reflect on their resistance and barriers to stopping mealtime pressure.
You might be surprised when they come back to see you next – the deepening of the working relationship that comes from genuinely listening to your client, coupled with the new insights into what is making change so difficult, may very well have altered how they feel about following your advice.
A Helpful Resource
And if you’re thinking, “But I need to explain why pressure is unhelpful and that this is an evidence-based perspective, how do I do this without entering combat mode?” Yes, you do need to share good quality information and explain the rationale behind your advice and get to some of the beliefs and misperceptions parents have about feeding strategies. A great way to do this is to briefly go over the basics, then follow up with a handout that parents can review in their own time.
- can reduce the chances of eliciting a defensive reaction
- gives clients time to absorb what can feel like challenging information
- offers something they can refer back to when they feel tempted to pressure
- when they’ve fallen back into encouraging and pressuring, a handout can be a tangible thing at home they can look to to help them get back on track
- gives you the “backup” of additional expert voices, and a few specific studies to reinforce your message
- could be shared with other medical or therapy professionals involved in their child’s care
- could be shared with adults involved in feeding the child (daycare, family, babysitters…)
DOWNLOAD THE HANDOUT HERE: You Don’t Have to Work So Hard to Get Your Child to Eat
We hope our parent handout will be useful. Please feel free to share it with colleagues and print it off or email it to clients. Not all parents will be comfortable with written information, so enquire about whether the handout is a resource they would welcome.
None of This is Easy
Supporting parents to stop using pressure is HARD. It takes time. It takes patience. It takes a solid working relationship, with a lot of trust between them and you. And ultimately, if a family isn’t ready to do things differently, this is outside your control. And, if the above process of understanding, validation and flexibility feels like a stretch, don’t worry. In my supervision sessions, I commonly hear, “This sounds a lot like therapy – isn’t it a little outside my scope of practice?” Tune in for part 2: next week’s post on boundaries and ethical practice.
Additional resources for families:
www.yourfeedingteam.com (affordable online support for parents)
Helping Your Child With Extreme Picky Eating (Katja Rowell and Jenny McGlothlin)
* Miller and Rollnick, Motivational Interviewing: Preparing People for Change, 1991