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:
Have you ever thought about how your child learns best?
Maybe your child has been lucky enough to have a teacher that identifies learning styles and preferences. Or maybe you've been able to identify it yourself. If so, that's great information to keep handy and incorporate into food allergy education sessions. If not, check out the links at the end of this post for additional information on identifying learning styles.
The 4 basic learning styles that have been identified are:
Now, let's think about how we typically educate our kids about food allergies. Many either use books or talking to explain to kids how to keep themselves safe. Both are great methods to convey information of course, but what are other ways we can educate kids on these topics - alternative ways that may align better for those kids who learn best via different methods? Below are food allergy education ideas, one for each type of learning style....
Role Playing (great for kinesthetic learners)
In addition to reading or talking about various food allergy scenarios, consider role playing or acting them out. Have your child role play as themselves first, so that they get the chance to think about how they would handle the situation as it's happening. Then switch roles so that you are your child. You might even want to intentionally handle the situation poorly, which gives your child the ability to see how not to navigate it. After you've both taken turns and given feedback, try the same scenario again, adjusting based on the feedback. If they're really into it, role-play additional scenarios. (Check out these great tips for parents on how to set up and teach about role playing).
Example scenario: Eating out at a restaurant
Role Playing Method: Set up a mock restaurant at home, which adds an extra layer of fun. Maybe even get the whole family involved, with another sibling acting as the waiter. Let your child look at an online menu from a restaurant you actually visit or hope to go to, and have them try ordering their meal. Before switching roles, talk about what went well and what might need to be tweaked if you were actually going out to eat. Then when it's your turn, intentionally "mess up", perhaps by forgetting to tell the waiter about your allergy or not asking to talk to the manager. When you talk about how that round went, encourage your child to identify areas where you could have done better. By acting out the scenario and then watching you act it out, it adds a variety of different "doing" ways of learning for your child.
Music/Songs (great for auditory learners)
Do you have a little Beethoven on your hands, always singing and dancing around? Do they know all of the words to the songs from the latest Disney movies or the top 10 songs on the radio today? You've likely got an auditory learner on your hands. In that case, seek out food allergy songs, such as Kyle Dine's catchy tunes. Even better, create your own songs and lyrics together!
Example Scenario: Navigating snack time at school
Music and Songs Method: It might feel daunting to try and come up with lyrics on the spot, so start by listing what your child needs to know about how to navigate this scenario. Next, start coming up with rhyming words to help get your creative juices flowing. What rhymes with snack? Pack, Jack, tack, crack....keep going. Listen to some music for inspiration or pick a tune to sing your song to. Have fun and be silly while teaching them all about food allergy safety. Before you know it, you'll both have the song stuck in your head! (Bonus points if you create a dance to go along with the song!)
Puzzle Time (great for tactual learners)
Have you ever seen those puzzles you can personalize either with photos or by writing on them? Consider buying some of these and either writing or drawing food allergy information on them. Jumble up the pieces after you've done that, and sit with your child and work together to put the puzzle together to uncover the food allergy message.
Example Scenario: What to do if they're having a reaction
Puzzle Time Method: On the blank puzzle, write the emergency action plan steps out in age-appropriate language (or draw them out for the very young kids). Once you've completed the puzzle, discuss each step. If your child also likes to learn by doing, you can then role play a reaction scenario, again, switching roles so your child gets practice being himself as well as seeing how others might navigate it - and then of course, discuss.
Writing Stories (great for visual learners)
If your child learns best by seeing things, you could watch shows or movies that illustrate food allergy scenarios, talking afterwards about what was good or bad about how it was portrayed. Another option is creating a story together. Break out the crayons, colored pencils, and stencils. Come up with a character, a plot, and something that goes wrong for the character to navigate. Or perhaps you and your child can write a story for kids younger than them to help educate them about food allergies, since you've already navigated that phase.
Example Scenario: What foods your child is allergic to
Writing Stories Method: Talk about what foods your child is allergic to, including what common foods the allergens are often an ingredient of. Choose whether the book will be a fiction or non-fiction book. Decide on the details together. Get creative with the illustrations - draw them, cut pictures out of magazines, print them out from websites, etc. Maybe your story is even one in a series of stories!
No matter what methods you use to teach your kiddo about their food allergy, don't forget to also teach them that they have choices in many situations. Choices on how to navigate (or exit) the situation. Choices on how to think about various scenarios. Empowerment should always be a part of all food allergy education, a statement which JJ, aka The Land of Can creator, so perfectly shares:
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