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(If you're reading this, you've likely already read Part 1, Part 2, and Part 3 of the "4 Things Counselors Should Know About Food Allergies" series. If not, I'd suggest you read those first).
In the previous three posts, I covered topics focused on the many layers of food allergy-related anxiety and fear, food labeling concerns, and the lack of support that many find from schools and families. The final post in this series has to do with the counseling considerations that counseling professionals should be aware of when working with clients managing food allergies.
A Collaborative Team Approach Is Crucial...And Be Mindful With Exposure Therapy Techniques
A Collaborative Team Approach is Crucial
Ideally, those diagnosed with food allergies would routinely see their allergist, as well as their GP doctor, but they would also be given referrals to allied healthcare professionals in case they may be useful. This list might include counseling professionals, dietitians, dermatologists, gastroenterologists, and even educational consultants w/food allergy knowledge. Some larger medical hospitals and institutions already take a truly collaborative team approach within their food allergy departments, including having a counseling professional on staff. However, you'll typically be working with food-allergic clients in your own office and therefore, will need to create your own collaborative team approach with your client's medical doctors and other allied healthcare professionals.
Food allergic clients typically visit their allergist annually (or more often, if necessary). Allergists will determine or confirm food allergy diagnoses, and help their clients establish emergency action plans and safety guidelines. Therefore, at the very least, you'll want to connect with your food-allergic client's allergist for continuity of care if the client allows it. Sometimes perceptions and statistics don't align when it comes to evaluating risk factors. Therefore, especially if you're not well-versed in food allergies, being able to reach out to their allergist will prove useful in situations where you may want to clarify the likelihood of reactions or other food allergy facts, as they pertain specifically to your client. Additionally, the allergist will find it useful to know what may be causing the client's increased food allergy fears, anxiety, or emotional distress, as well as the progress being made and overall goals for counseling.
A Few Words on Specific Counseling Concepts and Goals
While exposure therapy type of techniques may benefit many clients presenting with specific fears and anxiety, even those with food allergies, you'll need to be mindful of one very important point: The goal of counseling should never be to work up to exposing the person to their allergen in order to eliminate food allergy fears! Any allergen exposure needs to be determined by the client and their allergist together, not the counselor, and done in a safe environment. After all, the core of food allergies lies within the medical realm.
With that being said, a counselor can still be very helpful in guiding the client through the progression of food allergy appointments, testing, treatments, and fears. For those managing food allergies, appointments can include skin tests, blood draws, and even food challenges, where people actually ingest their allergen if deemed appropriate (this is typically based on lab results and determined by the allergist).
Many, especially kids, may have fears or anxiety about these appointments, so helping them develop coping strategies and tools to navigate these scenarios is a great counseling goal. Clients managing food allergies would benefit from Cognitive Behavioral (CBT) work, which will help them identify and manage stress, acknowledge unhealthy (and healthy) thoughts and behaviors that may play a role, and learn how to challenge them and establish new ones.
However, CBT isn't the only type of counseling that will help clients with food allergies. A variety of counseling theories and techniques may be useful in working with food allergies, as long as they're proving effective with the client.
Here is a sampling of other clinical counseling goals you may establish when working with food allergic clients (goals will vary widely depending on the client):
Kids:
Help the child learn how to talk about their food allergies with friends, and advocate for their own needs among peers and even adults, such as teachers
Work through specific anxieties, fears, and extreme avoidance behaviors relating to their food allergies
Navigate various school and social scenarios (i.e. discussing, preparing, and role-playing to help the child gain confidence). Be mindful that the child (and even the parents) may feel excluded or bullied at times, but also be looking for positive supportive scenarios, too.
Help kids (and parents) process feelings after anaphylactic reactions, as this may result in new or renewed excessive anxieties, fears or other feelings and behaviors
Older Kids/Teens (topics in addition to those listed above):
Learn how to manage their own food allergy precautions so that they can gain increased independence from parents
Address how food allergies impact dating, kissing, group outings without adults, employment/jobs, traveling with friends, going to college, etc.
Parents:
Help parents educate their child on food allergies in an age-appropriate manner (i.e. choosing terminology that isn't too scary for each age, but prepares them)
Guide parents on how to manage their own feelings about food allergies, and educate them on how those feelings may impact how their child feels about his/her own food allergies. Help them understand the typical thoughts and feelings associated with food allergies in order to validate their own.
Find support networks and help them establish self-care routines
Deal with stress/burnout from managing food allergies
Navigate the family system with food allergies (i.e. siblings without food allergies; family members managing different food allergies; family members not respecting food allergy protocols, etc)
Move through the stages of development and still allowing their kids to meet typical developmental milestones while living with food allergies (i.e. taking steps towards giving teens more independence)
FINAL THOUGHTS...
Living with food allergies can be an extremely emotional experience, so there will be many opportunities where you'll need to help the client reality test to find a balance between emotions and facts. Balance is a key necessity for living with food allergies, since it's a marathon and not a sprint. Balance of emotions, balance of facts, balance of coping strategies. As food allergies threaten to throw that balance off kilter, sometimes on a daily basis, it's crucial to think about the bigger picture when working with food allergic clients. The work will be hard and gut-wrenching at times, but extremely rewarding, especially when you see a child or its family learning how to live an empowered life with food allergies as a direct result of the work you've done together.
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:
Managing Food Allergies in Schools: Guidance for Parents (FARE)
From Doubt to Confidence: Exploring Vulnerability & Food Allergies (Exploring FA Families podcast, May 2020)