As counseling professionals, we aren't supposed to know how to work with *every* kind of client. Rather, many of us have specific areas of focus or client populations with whom we work. As a food allergy mom and family therapist, one of my focuses is working with those trying to navigate the emotional aspects of living with food allergies.
But even working within our focus areas, there are still times when clients come into our offices presenting with situations or conditions that we're not very familiar with. When that happens, it's up to us to either educate ourselves, or if necessary, refer out to someone skilled in that particular area.
When you have a client managing food allergies, but you only know the basic information that you may have learned through a friend with allergies, your child's school, or the occasional article, it's necessary to gain more insight. In general, clients managing medical conditions have many layers added on top of the typical presenting problems list, and food allergic clients are no different.
I've come across anecdotal stories of food allergy families seeking counseling from mental health professionals that don't know much about the condition. While many felt that the therapist was helpful, despite the lack of food allergy knowledge, there is unfortunately a large number of reported experiences where clients shared that they left counseling feeling very misunderstood, unheard, not helped, and in some cases, worse.
Some reported scenarios I've come across are:
I admit - before I had a child with a food allergy, I may have viewed clients with food allergies very differently. My counseling goals would still have been to help them navigate the emotions and scenarios, but if I only knew the very basics about food allergies, I'm sure I would have missed some key pieces to the puzzle, which could likely result in my clients feeling that I was missing the mark.
In an effort to help my fellow counseling peers understand some of the nuances their food allergic clients are dealing with, I'm outlining, in a four-part series, four crucial things to know about those living with food allergies. Additionally, these posts will contain resources to gain further education on each topic and on food allergies in general (these are linked within the article or at the end). After all, with 1 in 13 kids being diagnosed and around 15 million Americans presenting with food allergies, you're bound to have clients with food allergies at some point in time.
#1 - The Anxiety is Real, Layered & Different Than Generalized Anxiety
These days, most people know the basic facts about food allergies and typically think it's this simple: If a person is allergic to a food and they eat it, they will get very sick and could potentially even die. Therefore, they should just avoid it; simple as that. Unfortunately, the reality is that it's not that simplistic when you're actually living with food allergies.
If you're working with clients managing food allergies, then it's important to know that the anxiety has layers of causes rather than just one simple "cause and effect" nature. The anxiety and fear begins at diagnosis and is woven through every experience for that child and the parents/caregivers. Understanding that those directly impacted by food allergies *will* have anxiety is key, because that anxiety will be a constant, even if its levels rise and fall. Food allergy-related anxiety isn't just about the fear of death. Rather, at its core, it has a whole host of causes, as Gia Rosenblum, PhD so eloquently wrote in her recent article "Food Allergy Death Is Not Our Only Fear".
The anxiety and fear typically impacts each member of the core family and not just the allergic child, as they all witness and are active participants in the day-to-day management required to keep that family member safe. Parents/caregivers often have a constant feeling of fear, even if latent at times, which is frequently connected with the concerns of accidental exposure, as everyone has varying threshold levels with their allergen. Quality of life, especially for parents/caregivers, is often negatively effected, even if they feel empowered to navigate situations. The food allergic child may develop anxiety for a variety of reasons, such as: fear of a reaction or death; fear of eating around others in case of accidental exposure; anxiety about being different, being left out, or being bullied (outright or even covertly). Additionally, if a person has had an anaphylactic reaction, even if they had low levels of anxiety previously, the fear, anxiety, and PTSD-like feelings are typically high for an extended period of time afterwards, adding on additional layers.
Of course, this is just a basic sampling of the food allergy-related anxiety layers, but it starts to paint a picture of just how much this condition potentially impacts the mental health of all of the family members. The primary counseling work needs to be focused on helping the family accept the anxiety, develop the ability to reality test in order to determine if anxiety levels are appropriate for each situation, and create a plan on how to navigate the developmental phases with the added layers of anxiety, fear, and food allergy guidelines. To help with these goals, in addition to utilizing counseling techniques grounded in CBT, Mindfulness, Solution-Focused, and Narrative theories, consider checking out FARE's list of food allergy books for all ages, or Allergic Child's books and magazine suggestions to assist. Additionally, look for a future post with further insights on working with food allergic clients with anxiety.
Subscribe, bookmark, or stay tuned for parts 2-4 of the
"4 Things Counselors Should Know About Working With Food Allergic Clients" series!
If you're working with a client who has food allergies and feel you need more information to educate yourself, check out the following resources, in addition to the links within this post:
As a licensed professional counselor trained in family therapy, I am always curious about how various factors impact family systems. The family is like a mobile in which everyone plays a role in its stability. So it's no surprise that the balance can be thrown off by even the simplest of changes.
The addition of a food allergy into a family system often results in major changes that affect most members of the unit. There have been studies done about the impacts on quality of life for parents/caregivers who care for a child with a food allergy, such as SOAAR's research studies on these and related topics. However, I was curious specifically how non-food allergic siblings felt about having a sibling with food allergies.
In order to gain some insight on this topic, I created an informal and anonymous survey* with these seven questions (listed with results below), which was completed by 25 participants:
(Parents were allowed to complete the survey on behalf of those too young to complete it themselves)
How old are you?
How many siblings with food allergies/related illnesses do you have?
What do you do to help with your sibling's food allergy? (Sample of answers):
Do you worry about your sibling because they have a food allergy?
What other feelings do you have about having food allergies in your family? (Sample of answers):
Do you ever feel you get less attention because you don't have a food allergy?
Please share anything else you'd like to about food allergies being part of your family. (Sample of answers):
Conclusions and Thoughts....
Food allergies, as well as any chronic illnesses, are a family disease - it impacts each member of the family in different ways, both positively and negatively. Some sibling impacts were highlighted by this brief, informal survey.
Read More On This Topic:
*THANK YOU TO THOSE WHO VOLUNTARILY COMPLETED THIS SURVEY. Those who took the anonymous survey were informed on this writer's professional counseling background, the purpose of the survey being for educational purposes, and how the survey results would be utilized in educational materials, such as a blog post. They were told they could reach out to this writer for results if they were interested.
It's hard when friends don't understand or follow your family's food allergy rules, but it's even harder (and more disappointing) when your own family members don't get it. Unfortunately, it's a frequent topic in food allergy social support groups, so it seems to be a common scenario.
Whether the rule-breakers are your in-laws or extended family members, navigating this scenario can be tricky.
Here are a few suggestions to help you deal with these down-right frustrating dilemmas:
The reality is that no matter how it’s handled, discussing this topic with non-compliant family members may cause ripples, as well as overwhelming feelings, which you'll need to work through. But ultimately, you have to do what’s best for your family. In doing so, not only are you putting your child's safety first, you're also modeling how to navigate tough scenarios, even if the outcome isn't ideal. (Comment below with what solutions have worked for your family in these situations. Your suggestions may help a fellow family with food allergies!)
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