Page 128 - Nutrition Counseling and Education Skills: A Guide for Professionals

CASE ANALYSIS 3

How would you discuss with Robin her pros and cons of making a change versus continuing her current
choices?

In the early stages of the interview, open-ended questions allow individuals to explore the problems and
help to establish an atmosphere of trust and acceptance. The counselor may say, for example: “In the time we
have together, I want to get an understanding of any issues you have with your choices of foods. I’ll be
listening so that I can understand your concerns.” Or: “I’ll also need to get some specific information from
you. What do you see as the issues?” Or: “What would you like to discuss first? What concerns you about your
food intake?” When responding to change talk by the client, one asks for elaboration to know more about
details or examples.

Affirming
Many clients have tried to make changes in the past and ultimately have failed. As a result, it may be necessary
to instill hope through affirmations, something positive about the person such as an action, strength, effort, or
intention.7 Examples are statements of appreciation of the personal strengths and internal resources that the
client brings. They may include words of understanding of specific positive behaviors, support, or competence
in specific situations.11

One focuses on the client’s strengths and positive attributes. For example, “You must have a lot of strength
or resolve to try to lose weight again.” Or “You did a really good job keeping food records this week.” Center
on the word “You.” Comment positively on an example of affirming what the person has said. The counselor
should not argue for change which may result in the client arguing why it won’t work for her. The “Yes, but . .
.” response may result.

Reflecting
Reflective listening is a foundational MI skill that counselors use to communicate acceptance, interest,
understanding, and empathy, rather than asking questions.10 It may also be used to strengthen client change
talk and ultimately build trust.7,11,12 Responses should be kept close to what the client said or a similar word to
move conversation forward. One may also use it to verbally discuss a thought, encourage more information, or
shift away from negativity.7

Reflective listening allows the counselor to test a hypothesis of what one has heard and make statements
that test understanding of the client’s meaning. The purpose is to have the client continue to explore the
problem.7 Simple reflections keep the conversation going. As the conversation progresses, reflections may
become more complex.

How the counselor responds to what the client says is an important element of reflective listening.
Reflective listening may be one of several types. The counselor may repeat part of what the person said or may
rephrase slightly using different words, serving as a mirror to the client.

Paraphrasing is a more major restatement in which the counselor tries to determine the meaning in the
statement and reflects back in new words adding to or extending the meaning. Finally, the deepest form of

128