Page 107 - Nutrition Counseling and Education Skills: A Guide for Professionals

It is important to identify the client’s SOC.

In sum, the client’s effective health behavior change depends on doing the right things (processes) at the
right time (stages). The best strategies at one stage may be ineffective at another. After identifying the
person’s health, dietary problems, and need for change, integrating the stage levels with the processes of
change provides intervention suggestions for the counselor.3 Keep in mind that the client may be at an early
stage for one type of change, such as increasing fruit and vegetable intake, but at another stage for a different
behavior, such as increasing exercise or decreasing portion sizes.

The counselor needs to be collaborative, empathic, and supportive in encouraging the client to develop
insight into the health problem. By the action stage, the counselor is more like a coach and consultant
available to provide expert advice and support.3

Decisional Balance

Decisional balance is a process of weighing the client’s pros or advantages of changing with the cons or
barriers to changing. The counselor may ask the client to make a written list of the pros and the cons. Clients
who are unwilling to discuss the cons need to be encouraged to do so because they must be recognized and
addressed. The balance between pros and cons varies by stage, with the cons outweighing the pros in the
earlier stages. By the contemplation stage, the pros need to start outweighing the cons. See Table 5-3 for an
example of a cost–benefit of change.

Whether dealing with weight control, reducing dietary fat or sodium, or increasing exercise, daily
temptations and urges to eat unhealthy foods may arise when one is emotionally upset, in social situations
with others, or craving a favorite food.4 One may or may not be able to cope in high-risk situations when
decisions are made about what to eat.

Across the stages, changes in pros need to occur more frequently than changes in cons. The pros may
change more easily because the benefits are more immediate, such as feeling better about oneself for losing
weight. Some of the cons may be beyond the individual’s control, such as the cost and availability of healthful
foods, yet others may be strongly held preexisting beliefs. It may be easier to increase the pros of the client by
promoting awareness of the benefits of change, some of which may be unrecognized by the client.

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