Transcript Document

Unit 3 - Counseling
Theories
Amy Bridges MS, RD, LDN
Kaplan University Instructor
Unit Outcomes
• Identify the basic parameters of a clinical
nutrition assessment
• Discuss appropriate counseling skills in a
variety of situations
• List barriers of effective nutrition
counseling
• Recognize behavioral, cognitive, and
psychoeducational treatment strategies in
given scenarios
Chapter 7 - Physical
and Psychosocial
Assessment
Assessment
• A dynamic, comprehensive and organized
system of gathering information relevant
to the nutritional care of your client
• The type of assessments you choose to
perform will depend upon the task at hand
• Assessment should be part of each and
every counseling session
The Assessment Process
• The process is broken down into sections
including:
• Medical history, biochemical parameters, and
clinical examination
• Anthropometrics and fitness evaluation
• Food intake, preferences, allergies and needs
• Psychosocial factors, family influences,
development skills, motivation, and readiness
• Lifestyle and health risk appraisal
• Personal and preferred learning style
Screening
Nutrition screening is the process
of identifying characteristics known
to be associated with nutrition
problems
Characteristics of the
Screening Process
• May be completed in any setting
• Facilitates completion of early intervention
goals
• Includes the collection of the relevant data on
risk factors
• Includes the interpretation of data for
intervention and treatment
• Determines the need for an in-depth nutrition
assessment
• Cost-effective
Medical-BiochemicalClinical
• Medical History
• Health Status
• Medication Usage
• Biochemical Parameters
• Clinical Examination
Anthropometrics
• Weight
• Circumference Measurements and
Skin-fold Thickness
• Fitness Evaluation
Dietary Intake and
Nutritional Needs
• Determining Current Intake
• 24-hour Recall, Food Records, Food Frequency
• Evaluation of Current Intake
• Estimating Nutritional Needs
• Energy, Protein, Vitamins and Minerals, Fluid
• Psychosocial Factors Affecting Food Intake
• Social Influences, Food Availability Issues, Cultural and
Religious Background, Stress and Emotions,
Developmental Skills, Motivation and Readiness
Chapter 8 - Counseling
Skills for Behavior
Change
Rationale for Learning and
Using Counseling Skills
• Reasons for making the effort to learn and
use counseling skills are to:
• Facilitate change
• Empower clients to make their own decisions
• Empower dietitians to be change agents not
just educators
• Increasing Effectiveness/Produce results
Core Counseling Skills
• Counseling is a two-part process
• During the first phase the goal is the
development of a strong trusting
relationship
• The second phase involves the generation
of behavior change strategies
• Success in counseling is based on the
counselor’s level of skill in both phases of
counseling
Phase 1 - Developing a
Helping Relationship
• Nonverbal Active Listening Skills
•
•
•
•
Eye contact
Tone of voice
Body language
Practice activity
Verbal Active Listening
Skills
• Active listening is one of the keys to
developing rapport and empathy
• Active listening creates an accepting
environment
• Reflective responses summarize what
the client said or target the feelings
expressed
Verbal Leading Skills
Leading skills advice, question, influence
or educate as well as coach and facilitate
Types of Questions
• Open Questions allow the client to explore an
issue instead of simply answering “yes” or “no”
• Closed Questions can usually be answered with
“yes” or “no” or in one or two words. They do not
encourage exploration
• “Why” Questions can put clients on the defensive
because they seem to require an excuse
Self-Referent Skills
• Use provides nutrition counselors vehicles
for talking about themselves and their
feelings during a counseling session
• Negative effects of using these skills too
early or too often
• Counselors may spend more time talking about
themselves than listening to the client
• Counselors may unintentionally offend the client
• Counselors may turn the counseling into chatting
visits rather than helping sessions
Self-Involving Responses
• These responses actively put the counselor
into the session
• May be used to gently confront or to provide
feedback to the client about how you feel
• Follows the format: I (the counselor) feel
(this way) about what you (the client) said
or did
Self-Disclosure
• Often used without thinking about
the consequences
• With this response, a dietitian talks
about himself or herself
Phase 2 - Developing Behavior
Change Strategies
•
•
To empower clients is to enable them to
achieve and to take control of their lives
Setting goals involves three steps:
1. Help clients identify the goal
2. Assess its importance
3. Analyze the roadblocks that hinder goal
attainment
Step 1 Goal Identification
• In order to identify a goal, you must
have a very clear picture of the
problem
• Achievable goals are positive, specific,
and under the goal setter’s control
Step 2 - Goal Importance
Assessment
• Goal importance assessment defines
the motivation
• Always check to see if clients feel
they should reach the goal or if they
want to reach it
Step 3 - Goal Roadblock
Analysis
•
Four obstacles that impede goal
achievement are:
1.
2.
3.
4.
Lack of knowledge
Lack of skills
Inability to take a risk
Lack of support
Chapter 9 - CognitiveBehavioral
Therapy
Ethical Considerations
• A number of ethical issues arise as
one considers using counseling
methods in dietetic practice
• Please review your text for
guidelines and examples
A Triarchic Eating Typology
• New Eating Problems
• Old Eating Problems
• Loss of Control Eating Problems
• Fit the Technique to the Client
Behavioral Programs
• Two forms of learning are discussed
at great length by behaviorists:
• Classical Conditioning
• Operant Conditioning
Classical Conditioning
• A type of learning that influences involuntary
processes
• Example: Pavlov’s Experiment
•
•
•
•
Unconditional Stimulus (US) - the meat
Unconditional Response (UR) - salivation
Conditioned Stimulus (CS) - the sound of a bell
Conditioned Response (CR) - salivating at the
sound of a bell and the presence of meat
Operant Conditioning
• Refers to voluntary processes and is based
on the premise that behavior is controlled
mainly by consequences in the
environment
• Positive Reinforcers - increase a desired
behavior
• Negative Reinforcers - work by increasing a
certain behavior to avoid a negative outcome
• Punishment - serves to decrease the frequency
of a particular behavior
Stimulus Control
• Once identified, problematic stimuli
can be better managed so that desired
outcomes can be achieved
• The focus of stimulus control should
be on managing or coping, rather than
controlling perfectly
Imagery
• Imagery techniques may help the
clients to recall or to visualize, in the
moment, a problematic eating
situation, to conceive of possible
solutions, and to identify which
solution seems most feasible in a given
circumstance
• This technique provides the client a
forum to practice various healthy
coping behaviors
Role-Playing
• A treatment technique used to in the
presence of the counselor
• Role-playing provides the client a
forum to practice new behaviors in a
safe environment
Real-Life PerformanceBased Techniques
Similar to role playing, however in
addition they allow the client to
practice new behaviors in vivo
Self-Reinforcement
Positive reinforcements (operant
conditioning) are the methods by
which new behaviors are rewarded
Modeling
•
•
A form of imitation and occurs in a
four step process
This process includes:
1.
2.
3.
4.
Observing
Remembering
Reproducing
Reinforcing
Systemic Desensitization
• Technique used to relieve a person of
phobic anxiety
• May not be appropriate for use by a
dietitian
Treatment
• Decatastrophizing
• Challenging the “Shoulds”,”Oughts”,
and “Musts”
• Reattribution
• Decentering
Psychoeducational
Treatment Strategies
• Psycho - mind or mental processing
• Educational - suggests knowledge
that may be acquired through a
process of teaching and learning
• Psychoeducational - a process of
learning about oneself and learning
to regulate one’s behavior
Three Sample Treatments
• Distraction - changed the client’s attention
away from unwanted thoughts or behaviors
• Delay - used by itself or in combination with
parroting, may prevent an automatic response to
follow an urge to do something
• Parroting - technique in which a client repeats
certain phrases to himself or herself in an
attempt to dissipate and extinguish eating urges
Have an
excellent
week
everyone!!