Page 178 - Nutrition Counseling and Education Skills: A Guide for Professionals

Do I benefit from thinking this way? What would happen if I change my thinking?
What can I say about myself in self-defense?
Am I exaggerating a negative situation? Is there an alternative explanation?
Is it as bad as it seems? What is more realistic?

Box 8-3 ■ Questions to Ask Oneself

The client learns to interrupt the automatic nature of negative self-talk and appraise and challenge the
situation. The negative cognitions or thoughts are viewed not as facts, but as hypotheses worthy of testing.
The client can be encouraged to ask the questions in Box 8-3.

In addition to client records of food, exercise, and thoughts, the counselor can discuss with clients the range
of eating situations, past and present, during which they have had false thoughts, such as hopeless thoughts
about previous attempts to lose weight or follow specific dietary changes.

Using the Socratic method and a collaborative approach, the counselor asks open-ended questions so that
clients verbalize their thoughts and feelings concerning food, eating, and the dietary goal or change. One may
ask: “How do you feel about . . .?” and “What do you think about . . .?” to determine what individuals are
thinking to themselves about the eating behavior to be changed, about their ability and desire to change it,
and at follow-up appointments, about their progress.

EXAMPLE “How do you feel about eating more fruits and vegetables instead of cookies?”
“How do you feel about cutting down on the amount of fried foods you eat?”
“What do you think about your ability to make these changes starting tomorrow?”
“On a scale of 1 to 10 with 10 being the highest, how important is this to you?”
In group counseling, cognitions can be discussed such as the negative self-talk of obese people. Clients
need to realize the self-defeating and self-fulfilling aspects of their thoughts.

Making Changes
In the third phase, actual change takes place. The counselor helps clients modify their internal self-talk to
produce new, more adaptive thoughts and behaviors. Clients are encouraged to control negative, self-
destructive thoughts, to talk back with positive self-statements as a coping strategy, and to reinforce
themselves for having coped. The goal is for clients to start noticing and interrupting negative thoughts as
they occur.

An obese woman who is eating differently, for example, can tell herself how well she is doing and to keep it
up. The “power of positive thinking” greatly enhances motivation and results. As clients learn to respond in
new ways and eat differently, the counselor can note the results of the intervention and document it.

For a future desired behavior, cognitive rehearsal with visual imagery permits attention to the important
details. A client may rehearse, for example, his or her food order at a restaurant or the amount of food and
beverages to consume at a party. If individuals think about or imagine themselves overcoming barriers and
performing adequately, actual performance is likely to improve.

One’s motivation is partly influenced by cognitions or thoughts. People form beliefs about what they can or
cannot do, set goals for themselves, and plan actions to achieve results they value. The ability to represent

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