By Richard Kahn, Ph.D., MS, RD
Specializing in Infants, Children, and Families | Facebook page is RichardKahnNutrition

Solution-Focused brief therapists use lists. We make lists every time we keep track of positive exceptions or explore the details of exceptions, e.g., “is there anything or anyone else?” Lists are especially useful when applying SFBT in the nutrition context. Shopping lists or menus transform into insight with an SFBT approach to nutrition.

Lists have incantatory power. Lists poems take advantage of this rhetorical power. Poetry teacher, Betsy Franco, says list poems are easy to write, repetitive, conventional all in the context of personal interests and passions. SFBT lists tap into the personal and passionate by detailing routines as they lead clinicians to ask more questions and open up windows into strengths. Co-creating the list can effect catharsis which is the purpose of poetry.

The Bible contains an early example of a list poem in the story of creation which counts the days of the week. This story progresses from chaos to the sublime order of rest and sufficiency. At the end of the first seven days, God has created a “yes set” by declaring the work “good.” Looking closer, God compliments Himself often by repeating the word “good” and does not use the word “perfect.”

Lists in Nutrition

Food lists are utilized by nutritionists under the terms diet histories, food frequencies and “food recalls”. These lists become long once we include ingredients, ethnic, health or religious concerns. Detail is paramount with some health concerns.

Nutritionists trained in SFBT view their patients’ food lists through a second lens, searching for the strengths, VIPs, positive exceptions and surprise comments. What SFBT recalls lose in detail, they gain in creating insight. Rather than focusing on every detail of food consumption, SF nutritionists co-create food recall lists with their patients within individual emotional and social frames.

Because food is intimately linked to daily experience and deep emotions co-created SFBT food recall lists intentionally jog pleasant and stressful food memories. The resulting co-created food “poems” often lead to inspiration, helping the patient to identify and experience ‘good’ things regardless of whether the list is perfect. In the Pragmatics of Hope, Yvonne Dolan suggests that such lists let clients see their own wishes and abilities.

SFBT “diet recalls” balance the need for technical information and behavior change. After patients present their seeming incoherent lists, dietitians can group the foods to demonstrate that a given diet, even a diet circumscribed by health condition, economics, and custom, may correspond at least to some degree, to nutritional norms.

As a dietitian, parents often tell me that their child eats few foods or vegetables. Usually, however, a list eventually gets long enough to satisfy the parents. However long they take to make, lists typically shake up the patient’s’ original views. Making a list can shift a parent’s limbically charged view of their child’s food habits into a calmer and more logical “frontal lobe” perspective. The pursuit of minutiae, according to Dolan, helps people remind themselves about existing successes. In my experience, her view is useful even when developmental delays cloud abilities or challenge normative views of children’s diets. Achieving a “good enough” diet can be a cathartic experience for parents simultaneously relieving worries and satisfying the need to be good, not perfect, nurturers.

For example, here is what happened in a workshop for parents of special needs children, aged 3-5 years, with most of the children on the autism spectrum. Children on the autism spectrum frequently have extremely limited diets. Limited diets lead to additional parental stress. The parents may see no “good” in their creation’s diet. The child may not even eat a tempting treat making mealtime socializing one more challenge.

The workshop proceeded with questions and answers about feeding and nutrition framed within the standard developmental guidance that usually helps parents at the table. One couple from this group volunteered to tell me what foods their child ate. At first, the list was maybe ten foods. As more parents began to participate, the volunteer parents kept chiming in with more foods their child routinely ate. By the end, the child had a less limited diet than first expressed and demonstrably ate at least a few foods from all food groups. The class triggered a sparkling moment. Another parent stood up with tears in her eyes, affirming how she had not realized until now that she was, in fact, doing a good job of nurturing her delayed child. Her listing had created the insight.

It may take skill, time and digressions for memory jolts and as if by chance to create a list of foods for a person with a limited diet. Stressed parents, especially, become chronically preoccupied with the chaos of frustrations instead of the facts of rest. Sticking with the ‘what else,’ ‘with whos,’ and positive exceptions can prove worthwhile, providing the time to create meaningful contexts to reveal what is clinically important for the patient.