Page 106 - Nutrition Counseling and Education Skills: A Guide for Professionals

The 10 processes are more effective during certain of the six SOC. Each stage has its own challenges. As a
result, the counselor needs to match the processes with the person’s identified SOC. In earlier stages, such as
precontemplation, focusing on the benefits of making a change and how that change can improve the
individual’s life or health is suggested. The goal is for the client to think about the health problem. Clients
may, however, doubt their ability to change and have decreased self-efficacy.

During precontemplation, clients are not thinking about making a change, are resistant, and have no plans
to change. Consciousness raising methods can help clients become more aware of the negative consequences of
their behaviors and possible changes that could help. The disease or death of a friend with the same or similar
medical problem may raise consciousness also.3

In precontemplation, consciousness raising by providing nutrition information (oral, written, web addresses)
about the benefits of healthy food choices, about the individual’s risk of chronic disease based on dietary
habits, and about the advantages of change is suggested. Self-reevaluation of thoughts, feelings, values,
problems, self, and the environment is appropriate. The client needs to weigh the pros and cons of change,
with the pros (“I’ll see my grandchildren grow up.”) outweighing the cons (“I can’t eat whatever I want
anymore.”). Cons outweigh the pros at this stage.

Consciousness raising continues in the contemplation stage as clients note the nature of their health problems
and reevaluate themselves. The self-reevaluation of the client’s values and environmental reevaluation will
consider the effects of the behaviors on the people they care about. Changes are required in how people think
and feel about their health problems and lifestyle.3 Cognitive and affective self-reevaluation, in addition to
raising awareness, is suggested in the contemplation stage.

The preparation stage shows a readiness to change and may include learning from past attempts to make
changes. Setting specific goals, priorities, and developing an action plan with a commitment to follow it is
helpful. Because some small changes have been made, clients are already involved in self-regulation of their
health behaviors.3 They are taking small steps, may use stimulus control and reinforcement control, and need to
believe that they can change.

Self-liberation, a belief that one can change, the actual making of a commitment to it, and using behavioral
techniques are important in the preparation stage. Self-liberation is partly based on self-efficacy or the belief
that one can succeed.3 In the client’s assessment, the benefits or pros of making changes must outweigh the
cons.

The action stage requires stimulus control, counterconditioning, and reinforcement management to cope with
conditions that may lead to lapsing. In the action and maintenance stages, behavioral techniques, such as
those discussed in Chapter 7, namely, stimulus control, reinforcement management, self-monitoring, as well as
recipe modification, and learning coping responses during conditions when relapse is likely, are helpful.
Developing a social support system of significant others is useful.3 Skills for controlling lapses and relapse are
discussed in Chapter 8.

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