The psychologist who stopped treating food as background noise

Food is already in the counselling room

Tanvi Shah sees clients four days a week from a small consulting room in Ahmedabad, and has done for seven years. On an ordinary Wednesday she might see a nineteen-year-old with examination anxiety who has not eaten before noon since February, a woman in her thirties whose gynaecologist has told her that her polycystic ovary syndrome will improve if she loses weight and has told her nothing else at all, a man who is fine until about nine at night and then eats standing at the fridge until he feels unwell, and a client six months into a new medication whose appetite has changed in a way nobody warned her about.

None of those people came to talk about food. All of them talked about it. It arrives sideways, as a detail inside something else: the skipped breakfast mentioned while describing the morning panic, the two in the afternoon crash described as proof of being useless, the biscuit packet that is the only thing in the flat, the fasting the client keeps for religious reasons and the guilt attached to breaking it, the diet a cousin sent that lasted nine days and ended in a binge that is now the thing being discussed.

A psychologist notices all of this and is trained to do exactly one thing with it, which is to treat it as material. The eating is a signal about mood, control, family or self-worth, and the eating itself is left alone. That is sound as far as it goes. It stops going far enough at the point where the client asks a direct question and the room falls silent.

The question that ends the silence

What Tanvi kept meeting was a specific moment. A client says, in effect, all right, so what should I actually eat. Not as a challenge; as a person who has been given a psychological explanation and would now like the practical half. The honest options available to her at that point were to say it was outside her scope and refer, which is correct and frequently goes nowhere because the client does not follow it up, or to say something general enough to be safe and useless.

Meanwhile the client was not going without an answer. She was getting one from a search, a reel, a relative or a supplement shop, and bringing it back into the room as a plan she had already started. Tanvi found herself in the strange position of doing therapeutic work on the distress caused by advice she had no standing to evaluate.

Where a psychology training runs out

Indian postgraduate psychology curricula are crowded and nutrition is not one of the things they are crowded with. It appears, if it appears, inside a health psychology paper, as a paragraph confirming that diet is a health behaviour and that behaviour change models apply to it. What that gives you is a framework for change and nothing to change towards.

The gap shows most sharply in three places. The first is fatigue, which a counselling psychologist hears described daily and is trained to read as depression, burnout or sleep debt. Those are frequently right and they are not the only possibilities, and the ones outside psychology are common enough in Indian women that not considering them is a real omission. The second is anything involving a hormonal condition, where the client arrives having been given a weight instruction and no method, and the psychological work gets built on top of a practical problem nobody has addressed. The third is the group of clients whose eating has become disordered, where a psychologist without nutrition literacy may not recognise how far it has gone, and a psychologist with a little nutrition literacy may be tempted into exactly the wrong kind of help.

What the training changes in a practice

1. Diet becomes part of the intake rather than an aside

The first change was to the assessment. A short, structured account of a client's usual day of eating now sits in the intake alongside sleep, substance use and routine: what time the first food is, what it is, how long the gaps run, what the evening looks like, who cooks, whether meals are skipped deliberately or simply lost to the day. It takes about six minutes and it reorganises what follows.

It also changes how a client hears the work. Asking about food carefully, without alarm and without a lecture, tells a client that this is a subject the room can hold. A surprising number of people have never been asked the question by anybody who was not also about to tell them to lose weight.

2. Fatigue gets a second set of questions and a proper referral

Tanvi learned to recognise the picture that should prompt a medical question rather than a psychological formulation: long-standing tiredness that predates the low mood, breathlessness on stairs that used to be nothing, heavy periods described as normal because they have always been that way. She does not diagnose any of it. She raises it, asks whether the client has had blood work done recently, and refers to a physician for testing.

That sounds like a small procedural change and it is the one clients notice. Being told that the exhaustion might not be entirely psychological, by the psychologist, tends to be received as being taken seriously rather than being passed on.

3. The hormonal health client gets the other half

For clients with polycystic ovary syndrome the practical and psychological halves are not separable in any useful way. The weight instruction produces shame, the shame produces restriction, the restriction produces a binge, and the binge is brought back to therapy as evidence of failing at something. Understanding what actually helps, and what portion of it is within the client's control this month, lets the therapeutic work proceed on accurate ground instead of on a myth the client has been carrying.

4. The eating disorder boundary gets sharper, not blurrier

This is the section Tanvi would put first if the page allowed it. A nutrition qualification makes a psychologist better at noticing disordered eating, and it must not make her the person who treats the food half of it.

Anorexia nervosa, bulimia nervosa, binge eating disorder and the presentations that sit between them are managed by a specialist team: a psychiatrist, a physician monitoring the physical risk, and a dietitian with eating disorder training, working together with the therapist. Refeeding carries medical risk. Weight targets, meal prescriptions and exposure work around food are set inside that team, with monitoring, and not by a counsellor with a nutrition certificate acting alone. The qualification is a skill certificate and not a degree in clinical dietetics, which is exactly why the referral rule is written into the way she works rather than left to judgement on the day.

In practice her rule is simple. If the eating pattern is the disorder rather than a feature of something else, she screens, she raises it, and she refers into a team; she may keep the therapeutic work when the team wants her in it, and she does not take the nutrition side of the case at all. The uncomfortable truth about adding nutrition training to a counselling practice is that it increases the temptation to help in the one situation where helping alone does harm.

What the week looks like afterwards

Private practice has an awkward timetable for study: clients cluster in the evenings and at weekends, which is when most courses run. Tanvi took the Post Graduation Diploma in Nutrition, Dietetics & Public Health with NNWA, attending live where the diary allowed and working through recordings on the two mornings she keeps free for notes and supervision. The recordings are the part that made it possible, because a client in crisis does not reschedule for a class.

She added Nutrition for Mental Health & Mood and Women's Health & PCOS Nutrition afterwards, the two short courses that map most directly onto who walks into a counselling room in a city like Ahmedabad. Clinical Nutrition & Dietetics came third, less because she intended to work clinically and more because she wanted to understand the vocabulary of the dietitians she now refers to.

The consultation itself did not change shape. She did not start selling diet plans as a separate service, which would have blurred the relationship she has with clients. What changed is that a session can now contain fifteen honest minutes about food when food is what is in the way.

The limits she keeps

She does not prescribe therapeutic diets. She does not advise on supplements, and she is careful with clients who arrive already taking four of them, because the correct move there is a conversation with the prescribing doctor rather than an opinion from her. She does not comment on how a psychiatric medication interacts with anything, which belongs to the psychiatrist. She does not set weight goals because a client asks her to, and she treats a client's request for a diet plan as material worth examining rather than an order to fill.

There is one more limit that is professional rather than clinical. Nutrition counselling and psychotherapy are different contracts with a client, and mixing them without saying so is how a practice loses its boundaries. Tanvi names which one is happening, in the room, when it changes.

Is it worth it for a counselling psychologist?

It is worth it if food is already showing up in your sessions and you have been leaving it on the floor. It is worth it if you work with women's health, adolescents, or anyone whose presentation has a body attached to it, which is most people. It is worth it if you want your referrals to be better targeted rather than defensive.

It is not worth it if you are hoping to treat eating disorders single-handed, because the qualification argues in the opposite direction. It is not worth it if you expect it to shorten therapy; it tends to make the first few sessions more thorough rather than fewer. And it is not worth it if you cannot commit real study hours, because a half-understood subject is more dangerous in a consulting room than no subject at all.