student nutrition association
First off, could you tell us a little bit about what your path has been like?
Mine has been a linear path. I'm one of the rare ones. When I looked at colleges, I looked for both kinesiology and nutrition tracks because I wasn't sure which one I liked more. I happened to take nutrition first and I loved it because I had an amazing professor who I still hold very dear to me. She actually went over eating disorders in her class. Until this point, I didn't really know what an eating disorder was. I had heard about them but I didn't know about them and never had any experience with them, other than my own experience of going into college and my body's stress response which was to shut down and not get hungry. I recognized that if this can happen to me, and I'm pretty aware, this is probably happening to a lot of people. So going into that class set the tone for everything else. I loved eating disorders; pretty much everything I did in my nutrition undergrad was eating disorder focused, and that's when I learned about Monte Nido and what dietician do in the field. And looking at Monte Nido's website and saw Bastyr pop up in one of the RD's background and that was right at the time when they opened up their dual track program and at the time the NEDA headquarters were in Seattle so I decided it was time to go to Seattle!
And where did you start?
Las Vegas. I went to UNLV and did my internship down there. And then came up to Bastyr and did the dual track because that first professor, the best advice she ever gave me was if you want to do this work, you need to understand and really have a firm hold in the psychology side. You'll drown if you don't. So that was really helpful and drove me to the program. I kicked and screamed my way through the program, because apparently my brain had a different expectation. And now that I've been through it, I'm happy I did it. If I could do it again, I would do it very differently and actually soak up more of it. That got me exactly where I wanted to be. I've always been the type to say "I know what I want, and I'm gonna get it, and get out of my way."
And how much would you say your RD background or work plays into your work versus the CHP part?
My entire goal with the CHP program was to become the best dietician I could be with eating disorders. And so, it's really 50/50. In session, I'm a more therapeutic dietician, so my focus is to augment the therapy work and use that language and those techniques in helping the client understand that it's not about the food. I really go in with that angle and support the body image work that they are doing. Nutrition education...yes, that happens, but these clients can often school me in their knowledge! So really, it's more about challenging the rigidity of their thought process and helping them be more flexible and have some fun with food, instead of taking out all of their life stress on it.
What was it like to come out of Bastyr with a specific food philosophy of whole foods and then go into working with eating disorders, where you're dealing with restrictive mindsets?
I have never been fully enclosed in the Bastyr bubble. Before coming up to Seattle, I worked with WIC. So I knew, already, the healthy suggestions that I even learned in undergrad...you gotta just make it work. So that wasn't a shock to me, at all. But there are two schools of thought. There are some treatment programs that do have a very whole foods, organic approach because they support giving these individuals the best nutrition that they can possibly get while their bodies are healing and rebuilding. I get that part. However, their brain is the biggest part of it. And we can support that full body healing with the mental healing of "all foods fit," and really support that a muffin is a muffin...it doesn't matter if it's a whole grain, gluten free, vegan, oat thing, or if it's from Costco. Emotionally, they are the same. And so, that's our take - the emotional focus. Because the physical will happen. And with the rise of orthorexia, especially in Seattle and the PNW, I don't even want to touch that. If I see clients choosing quinoa or brown rice over white rice or couscous, I push that button right away. And I start nudging them and getting them to think, "why am I doing this? Is there fear or anxiety there?" If there is, then fear and anxiety has no place with food unless it's poisonous. The programs that focus on sustainability and organic...that works for them, but not every client is ready for that. Some of our clients get very rigid with their exchange system, so to try to help them develop flexibility while giving them this really kind of outwardly appearing rigid philosophy, doesn't seem like it would be as effective.
It sounds like you love working with people with eating disorders, but I imagine that it can be stressful. I'm curious how you balance that stress. Many of us as students are facing similar work/life balance issues. What are the best ways you've found balance?
Still trying! And at the different levels of care it's very different stress levels and very different stressors. What I find most stressful about the residential level is the pace. It's very rapid. While it's great because it's challenging and never the same, I have also fallen into kind of always feeling like I'm forgetting something. I want to be able to do really quality work, and I don't feel like I always have the time to do it. What helps most is just the basics: making sure I'm sleeping. Watching out for the red flags which for me are having no desire or interest in shopping or cooking - that's a big, giant red flag that I've let this go too far. And quality time with people. Being an introvert, that's really hard because I usually get home after talking to people all day at work and I usually just want to read, and getting myself to break break that is important, even when I don't want to. I've teamed up with friends to running in the afternoons, and get the nervous energy out that way. Going on walks with my husband. Volleyball - that is my anger management! And working in this field has really been a test in boundaries. I've always prided myself on really being available for the house and there have been times where I have to battle feeling guilty when I say no, I have to leave here by 4 so I can make it in time to do this care thing for myself. It's getting easier, and after I started practicing it, everything got easier.
And also, it's good for us to model that for our clients, in whatever setting it is.
From day one, I've always been very transparent with clients. So, they see me when I'm grumpy in the morning and I haven't had coffee. That my face is scowly, I'm grunting at people, they see that. And while on one hand, they're kind of terrified and worried, on the other hand, once I'm in a better place to talk about it, I'll talk about it with them! I'll say "yeah, I was grumpy this morning! How was that? You got to see me be real and be human." Or sometimes the stuff they say, just makes you cry, and you go with that and be real with them and show them a true human experience.
Yeah, I remember when I first started working at Center For Discovery, I was so nervous and felt like I would ruin everything by saying the wrong thing, but it's been eye opening to see that recovery is not that fragile.
Yeah, they're normal people. They've already survived the worst thing life can throw at them. They also really idolize their treatment team. Because they have this ideal image of us, I want to show them that I wear dresses and don't shave my legs! Or that I come to work without make up on. I get grumpy and frustrated, and I talk about it. I don't punch walls or go and not eat or tell people "I'm fine." It's a lot more than just the nutrition work. It's also the whole person modeling life experience.
Do you have any advice you would share for those of us that are still students? Anything you wish you'd known?
What prepared me the best, and what I think really created a strong foundation, was attending any and all CEU events. In whatever field or aspect of nutrition you're really interested in, attacking the CEU events. Because you'll get an incredible breadth of knowledge that you won't get in school. School tends to be very basic. You'll also get to network and make really great relationships with people who can help guide you and mold you. Also, do something other than nutrition. Be a well rounded person. Get involved in other causes, other interests, especially if the internship is something that you want. At least what my preceptors told me made me stand out was that I wasn't just nose to the books, doing school, only nutrition. I had involvement in suicide awareness, I had involvement in AIDS awareness and general student activities and the honor society and other things. Rock climbing, this and that, all things that made for a more three dimensional experience. A lot of students, especially with the pressure of the internship, basically feel that they can only eat, sleep and breathe nutrition and that's actually going to be detriment. Keep the big picture in mind - it's about what you learn and how you grow. My preceptors knew me really well, and they saw that I had Bs on my transcript and they used to tease me about it and say "Courtney, what's this?" and I would say "Yeah, I got a B and my world didn't end and I didn't take the class over like I wanted to." That was a moment to share a growth experience and a learning experience and a chance to share a strength and a weakness that I'm working on.
I think we've all talked in school about being perfectionists and wanting to be a certain way, and since you brought that up, do you find that to be true in the "real world" as well?
I noticed it in undergrad. I noticed it at Bastyr. It's a strength and it's a weakness. Being high achieving and wanting more for yourself and wanting so much to do good in the world and having that attention to detail are amazing things. But when they become critical or perfectionistic, rigid, that's more problematic. Embrace those qualities in yourself and develop that mental flexibility because that's going to be extraordinarily important. And what I've noticed in the field is that the people that succeed are the people that can harness the positives of those qualities and be flexible and have a really strong basis in critical thinking. So not just knowing what you know, but knowing how to apply it and apply it in novel situations.
Going back to that last question, what I wish I'd been told: to deeply and closely examine your own philosophies on health, nutrition, well-being, all of that. Identify any biases you have, any red flags going on. A lot of nutrition students have quite a few red flags for EDs themselves, whether it's because they are to find a cure for their distress or whatever it is. Really doing that internal work to understand "what's my approach to food?" and taking it to the next step of "am I recommending this to others because it fits for them, or because I think I'm right and this is right for everyone?" I wish it would have been an assignment in school, to write about my food beliefs, where they come from. That first nutrition professor did that. We had critical thinking questions at the end of every class, including ones on eating disorders where you could notice the red flags.
I feel like that's so important, especially so you can know it and get the support that you need whether it's other people in the profession, or other help, whatever it is.One last question - do you feel like it's important for students to get experiences outside of the Bastyr food philosophy?
So many students are attracted to Bastyr for its whole foods approach and the focus on sustainability and farm to table and stuff, but part of being a well rounded person is getting out of that. Go volunteer at WIC and see how you can make a whole foods approach work. A dollar doesn't stretch very far. Think about how busy someone is and how much time they're going to spend on food prep. I feel like it helps, too, to get a job while you're in school. Get out of Seattle - go north, go south, into less affluent communities. Go into minority communities. Familiarize yourself with their practices, their food beliefs, their real life experiences.
Courtney Fasano, MS, RD, LMHCA is a graduate of the Basyr MSN/CHP program. As shown in the interview below, she has focused on eating disorder treatment throughout her career. Today she shares with us how she approaches eating disorder treatment, and advice on how she approaches self care in a stressful career.
Interview with Courtney Fasano, MS, RD, LMHCA