Page 132 - Nutrition Counseling and Education Skills: A Guide for Professionals

important this is, and how confident the person is that she could do this if desired. On a scale of 1 to 10 with
10 the highest, how important is this to you?

CASE ANALYSIS 7

If you have other suggestions for Robin, how would you approach her about them?

Counselor Approaches

Traditional nutrition counseling may focus on the assumption that the client has a deficit of information or
knowledge which results in the giving of advice and information. Nutrition professionals may talk about the
benefits of change and risks of continuing a current behavior in providing information on changes to make.

Instead, the MI counselor asks the client to choose a topic to discuss from several options. One starts with
the client’s priority while other problems may be examined later. The counselor guides the client to express
the reasons for and against change and how current behaviors affect the person’s ability to achieve his or her
life goals.7 The guiding style is best suited to counseling about change. The assumption is that a change in
behavior is more likely to result from motivation than from giving advice and information. Problem eaters, for
example, often already know that they are eating too much or the wrong foods.

One image of the counselor is that of a helper or guide accompanying a person on a journey. The guide
“needs the qualities of a companion and the skills of someone who knows the route,” but acknowledges the
client’s freedom of choice and personal responsibility for change.6 Counselors who conduct MI successfully
focus on reflection, including reinforcing positive statements about change, rather than responding with
questions and advice. Another factor of importance is the empathic understanding of the counselor in creating
an atmosphere of positive regard, acceptance, and safety in which clients feel comfortable discussing the
positive and negative aspects of a behavior and exploring the change. A nondirective guiding style uses
strategies to elicit the client’s own motivation for change.16

Communication Skills

Finding and drawing out the client’s thoughts involves three communication skills: (1) “asking,” (2)
“listening,” and (3) “informing.”7,17 A guideline is to ask questions that the client can answer with “change
talk.” Examples are: “What do you want to do differently?” “What small changes could you make?” “What
would be some benefits?”8

The counselor “asks” open-ended questions for the client to explore the how and why of change in
developing an understanding of the problem. For example: “Tell me about how you would go about losing
weight and the reasons you want to do it.” This is a way to assess the client’s choices in considering changes.
The counselor may ask the client’s thoughts about the options, and how they could affect behavior. For
example: “Of the three ways you mentioned, which ones do you think would work best?” (See Box 6-2).

The counselor “listens” to understand the client’s frame of reference and experience. The counselor then
responds with a brief summary of understanding. The counselor “informs” by first asking permission to
provide options and information. One may ask the client’s thoughts about the information provided, and how
it could affect behavior. For example: “May I have your permission to share some information with you that

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