Boundary Crossing Scenario Formula Recommendation

You work as a dietitian at a community health centre. After careful consideration, a client who has just given birth tells you that she has made an informed decision and she will not be breastfeeding. She asks for your recommendation for the best formula on the market for her baby. What do you do?

Dietitians, like most health practitioners, often choose their career to “help” people. They try to establish a therapeutic relationship of trust and openness on the part of the client. It is only human for a dietitian to try to reciprocate by being open as well, without realizing that this may not always be appropriate.

It is also important to keep in mind that a client can initiate a boundary crossing in good faith, without understanding the boundary or the reason why it exists. It’s up to the dietitian, as the in the relationship, to maintain professional boundaries. In the professional relationship, the dietitian has the power that comes from knowledge and expertise. Unfortunately, because dietitians are often “helpful”, they may find it hard to say no.

The request for a formula recommendation is relatively benign. It appeals to your sense of expertise and includes you in the family relationship. However, if the client is trying to include you in a personal decision, it is really hers to make. Limiting comments to relative nutritional qualities of the formulas on the market, in order for the mother to make an informed decision regarding how to feed her baby, would leave you with no legitimate role in the decision. A greater concern would be if you were asked to become increasingly involved in the childcare decisions respecting the baby, moving from dietetic issues to where the baby should sleep.

Be mindful of self-deception. Typically, boundary problems present themselves in a dietitian’s area of weakness or vulnerability. A dietitian with a tendency towards rescue fantasies will be able to handle a sexually precocious young client by identifying the need to keep the boundary clear, but may get into trouble with an isolated and depressed teenager, becoming a “friend” in order to help “save” this client. It is always the responsibility of the dietitian to see and maintain the boundary.