Counseling

Why reflect

- Increases self disclosure - Leads to deeper exploration of facts, feelings and meanings - Creates a client-helper bond

What is counseling?

A time limited relationship in which counselors help clients increase their ability to deal with the demands of life

Closing phase objectives

Provide support and provide closure

What is advice?

Provides possible solutions

Using technology: types and issues

Recording, but can become obsessed Reminders, but can become acclimated --> ignore Resources

How to break the silence

Repeat last phrase Ask what the client was thinking What are your thoughts about that?

What is paraphrasing?

Rephrasing Reflects content and thoughts Restates key messages Non judgmental

What is reflecting?

Rephrasing the feeling of a message

Other counseling responses

Respect Personal support Partnership Giving feedback Questioning

What is self disclosure

Sharing information about yourself during a session Revealing current feelings, concern, ideas

Why paraphrase?

Shows you're listening Encourages the client to keep talking To interrupt excessive rambling To confirm understanding, the client can correct inaccuracies

Closing phase

Support self-efficacy Review issues and strengths Restate goals Express appreciation Arrange F/U

Resolving phase

Tailoring the intervention to the client's motivation level

What is directing?

Telling a client exactly what needs to be done

When not to allow silence

Tension is high Client is confused/anxious No empathy

When to interrupt

The client is wandering off topic To summarize change talk

Involving phase: objectives

To establish rapport, trust, communicate ability to help

Why summarize?

To transition to a new topic To provide closure at the end of a session/ a plan for the next session

What is nonverbal?

Voice volume, speed, pitch Gestures, eye contact, hand movements

When/how should advice be given

When there is a clear understanding of the problem - Non-judgmental - Identifies the problem - Explain the need to change

Why use self disclosure?

Builds trust, increases openness Helps increase self disclosure

What is attending?

- Active listening, giving attention to the client

Conversation about handouts

- Ask what types of materials and processes work best - Ask about each handout before giving it, pay attention to bobverbal - Suggest that the client take notes - Link materials to specific things the client asked about - At the end of the session, ask if more is needed

Advantages of handouts

- Compliment and support what is communicated - Can help with food intake monitoring, triggers, appetite - Help client's memory -Helps fill in the gaps

Why clarify?

- Encourages elaboration - Checks accuracy - Clears up vague/confusing messages - Makes feelings and experiences more clear

How to attend

- Sit down - Face client - Open posture - Lean in slightly - Eye contact - Be relaxed - Focus on the client

How to interrupt

- With respect - Can use client's name, with an apology, an offer - Wait for permission

TOP 10 MOST COMMON COUNSELING ERRORS

1. "ONE SIZE FITS ALL" APPROACH 2. INSUFFICIENT ATTENTION TO THE COUNSELOR-CLIENT RELATIONSHIP 3. ADVICE GIVING 4. ABSENCE OF CORE CONDITIONS (EMPATHY, ATTENDING 5. NOT PAYING ATTENTION TO THE NON-VERBAL CHANNEL 6. LOSS OF OBJECTIVITY AND JUDGMENTAL RESPONSES 7. PACING PROBLEMS (TOO FAST, TOO SLOW, INAPPROPRIATE TIMING OF RESPONSES) 8. INAPPROPRIATE USE OF SELF-DISCLOSURE (TOO MUCH, TOO LITTLE, POORLY TIMED) 9. RESCUING, FALSE REASSURANCE, MINIMIZING PROBLEMS 10. CULTURAL INSENSITIVITY

Name 8 aspects of nutrition couselling

1. Client centered 2. Individualized 3. Collaborative 4. A process 5. Develops a helping relationshing 6. Listening to the client 7. Understanding the problem from the client's point of view 8. Enables the client to take action to resolve their own problem

Attending, pointers

1. Minimize distractions - environmental, from the client and within (reactions to individuals, defensiveness) 2. Delay judgment 3. Be quiet and listen 4. Pay attention to nonverbal 5. Incongruence between verbal/nonverbal? 6. Empathetic listening 7. Be focused, client centred and emotionally available for the client

What are the 5 steps of the counselling process

1. Relationship building 2. Problem assessment 3. Goal setting 4. Counseling intervention 5. Evaluation, termination or referral

4 Skills clusters for counseling

1. Relationship building skills (empathy, active Listening, questioning, sustaining the Relationship) 2. Exploring & probing skills (active listening, Attending) 3. Empowering skills (identifying resources, Defining problems as opportunities) 4. Challenging skills (confronting, setting Limits)

What are the 3 variables of counseling?

1. The needs/wants of the client 2. The mandate of the counseling setting 3. The expertise and competence of the counselor

Allowing silence: how long, issues?

30-60 seconds Could be intimidating

What is legitimation?

Affirming, a type of reflection - Affirms strength and effort by the client

When to allow silence?

After an open ended question After an emotional outburst After a complex reflection After giving complex instructions: allows processing time After an insight

Why allow silence?

Allows a person to gather thoughts

Exploration phase

Assess: - Food behaviour - Activity patterns - Past behaviour change attempts Explore: problems, skills, resources Give non-judgmental feedback Elicit client response Assess readiness to change

Reflecting meaning

Beyond reflecting feelings; need to KNOW your client - Restates the personal impact/significance

Why attend?

Creates an ambiance to facilitate communication Engages the client Builds a relationship with the client

What does the research say about self-monitoring with technology?

Does not hinder weight loss

When not to interrupt

During change talk When the client expresses strong feelings

Long-term goal of counseling

Empower clients to cope with the changing demands of their lives

Why affirm?

Encourages a client who lacks initiative/ self confidence

Why mirror?

Encourages the person to keep talking/exploring But dont overdo it

Resolving phase: objectives

Help client make decision about behaviour change Indicate that the client is the best judge of what will work

Lateness

If late, state how long is left

When not to use self disclosure

If rapport hasnt been established Dont use too often Not all clients like this If beliefs differ significantly

How far away in social interactions?

Intimate distance = 2 feet Personal distance = 2-4 feet Social distance = 4-12 feet Public distance 12 + feet

4 phases of the counselling process

Involving Exploration Resolving Closing

What legitimation is not?

Not about you, so dont use I statements Not a pep talk

6 aspects that nutrition counseling is not:

Not giving advice Not rescuing Not minimizing problems Not one size fits all Not prescriptive, not telling people what to do Not judgmental

What is confrontation?

Noting a discrepancy Addresses inconsistencies that come with resistance to making lifestyle changes

Disadvantages of Handouts

One size fits all Gives impression that the job is finished

What is summarizing?

Paraphrasing an extended interaction Identifies strengths/efforts Restates goals

What is mirroring?

Parroting, echoing Repeating, a few words changed

What is clarifying

Probing Can you clarify what you said? Anything else? Let me understand what you have said?

Immediate goal of counseling

Provide assistance so that clients can gain control over their problems

Exploration phase objectives

Provide information Show acceptance Learn Nature of problems Learn Strengths Promote self-exploration Help client evaluate the situation

Handout pointers

fit the language, education level and culture Websites, classes, support groups, videos Match their learning style/ readiness

Involving phase

greetings, introductions Identify long-term behaviour change objectives Explain rationale for recommended diet Explain counselling process Set agenda