Tip #153 Using Technology in the Service of the Counseling Process

First find out how the client uses technology. It can be tempting to suggest the latest app or a technology that works well for you. Instead offer to use it in ways that fit for this person and support her journey to health and a healthy relationship with food. Here are some examples.

It was when I found out I could make mistakes
that I knew I was on to something.
Ornette Coleman

The art of being wise
is knowing what to overlook.
William James

Recording food, activity, mood and thoughts: This can work well for clients who already use their phone or other device regularly for other tasks. There are many apps to choose from and most are free. Some clients prefer to use a simple note-taking app. As with any journaling, what is recorded is best tailored to the person and the stage of change. Caution: Clients can become obsessed with these apps, or use them to support restricting and/or over-exercising. The weight-focused apps can encourage a continued focus on weight and calories and on external, rather than internal, cues for eating. For example, many apps prompt the person to enter his weight daily. With a client who wishes to move away from weight-focused dieting, perhaps explore whether this app is a good fit. Whenever a client is using an app, it is a good idea to revisit its usefulness periodically.

Reminders: Some clients find it difficult to remember to do the behaviors that they planned with you. Setting an alarm can help. For example, if a client gets busy at work and forgets to stop for a snack that will allow her to have an appropriate appetite when arriving home, she can set an alarm for midafternoon. Caution: It is easy to become acclimated to alarms and ignore them. Check in with the client to see how it’s going. She can decide when she no longer needs them or needs to change them in some way.

Sharing food records. This could be sending you pictures of meals or food and activity records. Some clients find it useful to send an email or text to “bookend” a meal. This would mean a message before the meal about the client’s plan and then another one afterward to report on how it went and anything that was learned. This can support accountability for clients who find it useful. Cautions: Responding to what is sent can be tricky (see Tip 67 for more on effectively responding to food records). In addition to the risk that our responses can be inadvertently shaming or encourage good/bad thinking, any written response runs a higher risk of being misinterpreted than one in person. With the use of email and text, we also run the risk of confidentiality breaches. Many of our clients share information of a sensitive nature and we must take care to secure it. There is another concern for us if we choose to do a lot of this kind of communication with clients. It can take a lot of your time. Consider what you are willing to do and adjust your policies as needed.

Questions and information between sessions: Clients often have questions that come up randomly. People are more accustomed these days to getting answers right away. Text and email allow us to be available to our clients. Cautions: Misunderstandings can occur without voice tone and body language to rely on. This is particularly true with eating disorders. Another concern is the time it takes to respond to these questions. Notice your “resentment meter.” There is more on resentment in Tip #122.

Your notes: Many of us now take our notes on computers or tablets. This is convenient for us and allows us to spend less time completing any necessary documentation after the session. Caution: It can be disruptive to engagement with the client. In Tip #127, I talk more about how note-taking can be effectively integrated into a session.

Sharing resources with clients: For clients who wish to save resources digitally it’s easy to share a handout by email. Clients value your opinion about websites, so staying up to date on the best ones for your area of practice is a good idea. Some of us use a digital newsletter system or blog to stay in touch with clients. This allows you to share the latest nutrition news as well as remind past clients of your services. Numerous apps support self-care, mindfulness and other health behaviors. You can offer to check out apps and sites that your clients like and give your professional opinion. Caution: Revisit use of apps and sites by clients. Have they turned out to be as useful as anticipated? Have the clients become obsessed with the sites, or is it too easy for the clients to ignore them? With clients struggling with obsessive-compulsive disorder or eating disorders, you may need to discuss appropriate use of sites since this can become obsessive and support disordered behaviors.

Follow-up and support: A while ago, a dietitian in the Boston area, Shirley Brown, shared with me how she uses email during sessions. “While the client is with me, I compose notes highlighting the action steps as we discuss them with the client looking at the screen as I type. I then send the email during the session.” Another option is to send text or email reminders to a client. These reminders can be seen as “training wheels” that will support the client until the behavior is second nature. Caution: This runs the risk of losing the spirit of collaboration (Tip #38) and client autonomy that are central to Motivational Interviewing. Make sure that any action steps are freely chosen by the client and that you have permission to send emails and reminders.

Video or phone sessions: This can be useful for contact while on vacation or when you or the client moves. Some clients are in a remote area or need your specialty that does not exist in their area. Distance sessions are also used by RDs who wish to consult with experts in an area of practice they are new to. For example, many RDs new to eating disorders search out those who have the CEDRD credential for supervision. Caution: Use a HIPA-compliant platform. Virtual sessions are not appropriate for anorexia unless the client is far enough into recovery to be honest about weight. There is more on these concerns in Tip #89.

This Tip is a work in progress. I welcome feedback from others about how they use technology with their clients. Email me.


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