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