Jennifer Hubbard
Nutrition Counseling
9/28/2011
Critical Evaluation and Role Play of Nutrition Counseling
In session one of role play, I played the part of the Nutrition Counselor. The
client’s issues included an increased BMI, and decreased physical activity, which led to a
concern to prevent future health problems. Throughout the session the client suggested
other apprehensions. These including lack of support from husband at home, who felt
change was not necessary, and feeling challenged with making the best food choices for
weight loss in the grocery store and in restaurants. Specifically, she was concerned with
what to look for on the food label or nutrition information report, low calories or low
sodium.
As the counselor, I feel the strongest part of the session included the use of open
ended questions. This led to a more narrow approach in client thinking, and allowed the
client to devise her own plan of action to resolve her concerns. In this process, she was
able to put aside the secondary issues that could be addressed later, and set small
achievable goals. I feel that in the long run, the client is more inclined to stick to a path
they have laid out for themselves verses one someone else suggests.
Secondly, paraphrasing and summarizing what the client was communicating was
a strong part of this session. I was able to use active listening skills successfully, and
repeat back to the client, in my own words, what she was communicating to me. By
reflecting meaning, I was able to check for my own understanding, as well as highlight
the situation for the client from a different perspective.
After reviewing the process of this session I feel the most challenging part, and
therefore the weakest area, was reflecting feelings. It was difficult without simply asking
“how does that make you feel” to ask the correct leading questions that would allow the
client, and myself, to uncover root feelings about certain issues. The challenge was
mainly staying on track to resolve her original concern of decreasing BMI. Feelings
themselves are not a significant part of choosing low calorie or low sodium foods for
weight loss and decreasing BMI, but the outer lying areas, such as guilt about exercising
at night while her husband is at home alone, opens the door for a multitude of feelings. In
my opinion, follow up sessions would be more appropriate for reflecting feelings when
deeper concerns may be addressed, and therefore reflecting feelings could be done more
effectively.
Another weak area, was the lack of confidence on my part, about where to include
any nutrition information that the client was lacking, and in need of, to achieve her goal. I
focused my attention on maintaining a dialogue. For fear of leaving the client centered
session that we had established, I never actually answered her question of whether she
should lower her calorie or sodium intake in order to lose weight.
The effectiveness of the counseling session overall, was strong. The client and
myself established a relationship of equality and respect. With direction from my
leading questions, the client, who was ready to make a change, was able to put the
concerns of her husband aside for now and focus on her own health for the future benefit
of her family.
Throughout the conversation, I was able to suggest switching from two percent
milk to one percent milk. I advised the use of lower calorie substitutions in family
recipes.
She committed to making better food choices, and to thirty minutes of physical activity
per day.
The lesson in this role play is to remember that it is acceptable to include some
nutrition education. Practice in using the correct questions that open the door to this is
recommended. Possibly asking questions such as “what do you know about a BMI of
35...”and affirming or correcting that knowledge. Also, asking the client what she feels is
the best approach to decreasing her BMI and again affirming, correcting and/or adding to
her thoughts on the matter.
Taking this approach, will answer the questions the client is asking, but will make
her feel included in the overall decision to change. She is more likely to achieve goals
and change behaviors if she takes ownership in the path set to get there.
The roles were then reversed and I became the client and my partner became the
counselor. As the client, my challenge was high cholesterol. I currently had a normal
BMI of 24 and had successfully decreased my fat intake during the day. My husband was
not interested in joining me, making dinner a challenge. He also enjoyed eating out often
which made it even more difficult for me to decrease my fat intake in the evening.
The counselor used many open ended questions during the session. This assisted
in continuing dialogue and helping me to look at the situation from different angles. For
example, upon entering the session, I as the client, was looking at the problem as
unsolvable. I felt I had done all that was possible to improve my cholesterol and placed
all the focus on my husband and his lack of desire to support me. With her questions, the
counselor helped me to isolate the problem as a “meal” and not a person. I began to
understand that I can do something to control the meal and have no control over the
thoughts and opinions of another person.
A second strength of the session was the way the counselor seemed to convey
great concern to help me solve my problem and reach my goal. Her use of encourages
and paraphrases helped impart understanding, and belief in the authenticity of her
concern. In some situations she was successfully able to reflect meaning, again allowing
me to look at the situation in a different light. This made my “unsolvable” problem
become solvable.
In assessing weaknesses of the session, the relationship established was not
necessarily that of equality. The counselor had many workable ideas on how to decrease
my fat intake at dinner, in light of my husbands opinion. She used phrases like, “could
you do“… or “what about it you“…While her ideas were well founded, and ultimately
correct, the dialogue we had working was interrupted. By the end of the session, closed
ended questions began to capture the conversation. It was difficult for myself and the
counselor to pick it up again.
As she gave advice on alternatives, I found myself agreeing with her out loud but
in my mind thinking, “I already told you I can’t do that,” and “my husband will never go
for it.” I began just answering “yes, I guess I could do that,” to her suggestions, but not
really believing that I would do it. This is where the conversation would stop, and she
would then ask another good open ended question to direct us somewhere else.
Lastly, it seemed difficult, as I think is for all of us currently, for the counselor to
reflect feelings. Her approach was centered mostly around solving my issues which
prevented us from touching on the feelings surrounding the situation. I would say
something along the lines of …”that made me feel..” and she would repeat it to me, but
there was no time spent on reflection.
Overall the session was effective. I left the session with a clear picture of the
problem, which was increased cholesterol and the dinner meal itself, and not solely my
husbands attitude. The counselor gave me lots of suggestions to help to decrease my
cholesterol, such as increasing my physical activity instead of just focusing on
decreasing the fat in my dinner meal alone.
The lesson learned here is to pay close attention to the what kind of relationship
you are fostering with your client. I feel it is ok to include some suggestions that help
solve the client’s problem, however it can not become the center of the entire session.
At the end of our time, I did have many solutions, however no direction in where to start
to implement any of the them. My recommendation is to continue practice in active
listening that includes reflecting feelings. This will help perpetuate the conversation and
establish a more parallel relationship between client and counselor. This will also aid in
diminishing the need for including an over abundance of nutrition education, which may
leave the client feeling overwhelmed in the end.