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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 who 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:
Counselor tells parents that their fears related to food allergies are irrational
Counselor talks about the likelihood of food allergy reactions without accurate knowledge, and therefore, makes the parent feel like they're overreacting in many scenarios where an elevated level of caution is warranted
Counselor interprets food avoidance behaviors as connected to an eating disorder when in reality, it's the fear of anaphylaxis that is causing the unhealthy food behaviors
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.
The Anxiety is Real & 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 eats 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 anxiety has layers of causes rather than just one simple "cause and effect" nature. The anxiety and fear begin at diagnosis and are 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 impact 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 affected, 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 afterward, 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.
Stay tuned for parts 2-4 of the "4 Things Counselors Should Know About Working With Food Allergic Clients" series!
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