Page 158 - Nutrition Counseling and Education Skills: A Guide for Professionals

the person to apply, and applied immediately for the greatest effect. Never reinforcing a behavior leads to its
extinction.2,5,11

In some cases, contracts may be desirable. Contracts are clear statements of target behaviors of the
individual; they specify the type of reinforcers to be used, the person who will deliver the reinforcers, and the
frequency of reinforcement. They are signed and dated by the counselor and the client. Contracts ensure that
all parties agree on the goals and procedures and provide a measurement of how close the client is to reaching
the goals. The signatures help to ensure that the contract will be followed, since signing is a commitment and
may provide added motivation to change.4 Figure 7-1 is an example of a contract.

Figure 7-1 ■ Example of a behavioral contract for change.

An alternative to a formal contract is encouraging the client to write out a list of behaviors to change and a
few strategies to implement the change. Also, a simple list of pros and cons of modifying food choices can
become a key eye-opener to some.

CASE ANALYSIS 4

What would be some eating changes or goals that might be created with Martha’s input? Identify one or
two reinforcers that may help change Martha’s eating habits.
Completion of behavioral assessment, including a consideration of the Stage of Change, is needed before
counseling begins. Examination of the ABC framework antecedents, behaviors, and consequences by the
nutrition counselor and the client assists both parties in understanding current eating behaviors and allows
discussion of what can be changed. Maintaining new behaviors when under pressure or stress is especially
difficult. The counselor may consider assessing client self-confidence and the ability to cope with stress or
anxiety. This evaluation may help identify clients who will need additional support at particularly stressful

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