Counseling Flashcards
Define counseling
A time-limited relationship in which counselors help clients increase their ability to deal with the demands of life
What are the 3 variables of counseling?
1) The need and wants of the client
2) The mandate of the counseling setting
3) The expertise and competence of the counselor
What are the 5 steps of the counseling process?
1) Establishing a relationship
2) Assessment
3) Setting goals
4) Interventions
5) Termination and follow-up
What is nutrition counseling?
- Client centered
- Individualized
- Collaborative
- A process
- Listening to the client, understanding the problem from the clients point of view, and enabling the client to take action to resolve their own problem
What is the immediate goal of counseling?
To provide assistance o that clients can gain control over their problems
What is the long term goal of counseling?
Restore or develop clients ability to cope with the changing demands of their lives (empowerment)
List 5 common counseling errors
1) Rigidity and use of a “one size fits all approach”
2) Insufficient attention to the counselor-client relationship
3) Advice giving
4) Absence of core conditions (empathy, attending, genuineness)
5) Loss of objectivity and judgemental responses
What are the four skill clusters for counseling?
1) Relationship building skills (empathy, active listening)
2) Exploring and probing skills (active listening, attending)
3) Empowering skills (identifying resources, defining problems as opportunities)
4) Challenging skills (confronting, setting limits)
What are the 5/10 basic counseling responses?
1) Attending (active listening)
2) Reflection (emphasizing)
3) Affirmation
4) Mirroring
5) Paraphrasing
What are the 10/10 basic counseling responses?
6) Clarifying (probing)
7) Noting a discrepancy (confrontation)
8) Directing (instructions)
9) Advice
10) disclosing
What is attending?
Attending is active listening. Where there is an ambiance created to facilitate meaningful communication, and involved giving individual attention to the client.-
–> Many attending behaviours are non-verbal
How can we be attending?
- Reorganize surroundings
- Sit down, face client squarely
- Adopt an open posture
- Lean towards client slightly, and make good eye contact
What are barriers to attending?
- Time constraints
- Temperature
- Noise
When we are talking, how many word per min?
100-200 words
When we are thinking, how many words per min?
600-800 words
What should be doing when thinking about what the client says during attending?
- Thinking about what the speaker says
- Summarizing key points
- Listening for feeling, and not only for content
- Looking for consistency and inconsistencies
What are some strategies for effective attending skills?
- Minimize distractions,, including environmental, from the client and WITHIN
- Delay judgement
- Listen to non-verbal
- Loo for incongruence between verbal and on-verbal
- practice empathetic listening
What kinds of helpers should we avoid being?
- Frenetic
- Self-centered
- Self-absorbed
What is reflective listening?
- Used by helpers to stimulate deeper exploration of the facts, feelings and meanings
- Forges empathetic bond
- Content, and emotional side are equally important
How are reflections phrased?
- Makes a guess about what the speaker means
- Good reflection is NOY phrased as a questions, but as a statement
Why should reflective listening NOT be phrased as a question?
- A question places a demand on the person for an answer
- Results in subtle pressure/micro-integration
- When we offer statements, the speaker keeps right on talking
What should be rephrased in reflecting?
- The affective (feelings)
- However, the feeling component of the message is often hidden because disclosure of feelings is bound by cultural and family rules
What are the four steps in reflecting meaning?
- Correctly identify the feeling being expressed
- Reflect the feeling you have identified to the client
- Match the intensity of your response to the level of feeling expressed by the client
- Respond to the feeling of your client, not the feeling of others
What is the reflecting meaning?
- A technique which helps users restate the personal impact and significance of the even that the client is describing
- Meaning is even deeper below our awareness than feelings
What are the two things that we can reflect?
- Feeling
- Meaning
What is the formula for reflecting feeling?
You felt ______ when ______ happened
Example of reflecting feeling?
You felt frustrated when you wouldn’t seem to make him understand
What is the formula for reflecting meaning?
You felt _____ because (meaning)
Example of reflecting meaning?
You felt angry with yourself because this was the way you were going to prove to your parents that you were a success
What is affirming?
- A type of reflection, but NOT a pep talk
- A positive statement regarding one’s character of values that acknowledges some strength and efforts
When may affirming statements be beneficial?
- Encourages a client who lacks initiative/self-confidence
- Positive thoughts, words and actions is a way to support positive change
- A good affirmation requires first that you notice it
What can affirming involve?
- Can recognize and comment on someone’s strengths, efforts or steps in the right direction
- It does NOT need to be something large or grand, and should not be exaggerated
- It helps clients recognize their strengths and abilities
What can affirming statements do?
- Empower the client
- Permit client to being internalizing positive attributes
- Boost clients overall self-confidence
- Encourage persistence
- Support forward momentum towards change
Examples of affirmations?
“You are the type of person who works hard for what you have”
“You stuck to your goals even when it was challenging to do so”
“You know yourself well, and where you would like to focus your attention”
What is mirroring? (Parroting, echoing)
- Repeating what you have head with a few words changed
- Allows the counselor to let the client know that you are listening and encourage the person to keep talking and explore
Client says “my diet is a disaster” RD mirroring statement?
“A disaster”
What is paraphrasing (summarizing)
- Reflective skill on content and thoughts
- Rephrasing on the contents of what the client said and meant
- NOT a word for reiteration
- Can state thoughts from a different angle
When may paraphrasing be beneficial?
- To interrupt excessive rambling
- Restating key messaged to the client
- Confirms understanding and checks assumptions
- Gives the client the opportunity to correct inaccuraciess
Examples of sentence stems to introduce paraphrase responses?
“It seems like”
“It appears as though”
“The picture I get is”
What are the two key steps in paraphrasing?
1) Listen carefully to the client’s story, feeding back to the client in a condensed, non- judgmental version of the facts and thoughts
2) Find the important information in a large volume of client material and repeat it in a succinct summary
What are three cautions with paraphrasing?
- Avoid accusatory or moral tone (What you really mean is ..)
- Think of paraphrasing as a tentative inquiry (Do you mean ….)
- Don’t paraphrase too early, wait until you have a firm grasp of the important details and thoughts
When can paraphrasing be used?
- Can be used to transition into a new topic
- Can provide closure at the end of a session
What should paraphrasing/summarizing include?
- Review what has occurred during the session
- Include a summary of the issues
- Identify strengths and efforts you have heard
- Restate the goals
- Plan for next counseling encounter
What is clarifying (probing) used for?
- To encourage more elaboration from the client
- To check out accuracy and what you head the client say
- To clear up vague and confusing messages
- Permit the counselor to be clear about the clients feelings and experiences
How can we clarify?
- Often use a question
- Often use “why” after ambiguous message
- -> “Can you explain that in a different way?”
When may clarifying be used to note a dicrepancy? (confrontation)
-Useful in addressing inconsistencies, discrepancies that come with resistance to making lifestyle changes
When may directing (instructions) be used?
-When telling a client exactly what needs to be done
When is advice used?
-Providing possible solutions for problems when there is a clear understanding of the problem
How should advice be given?
- Should be non-judgemental
- Should identify the problem
- Should explain the need to change
When is interrupting useful?
An interactive element that varies greatly among cultures and individuals
When should we NOT interrupt?
- When client is exploring reasons to make change
- When client is expressing strong feelings
When should we interrupt?
- When the client is wandering off topic
- When you have heard some change talk and you want to summarize
How can interrupting be done?
- With respect
- Could start with the clients name
- With an apology
- With an offer “I have a thought or an idea”
When should allowing silence be used?
- Counselors need to balance their verbal agility with an equally strong capacity for silence
- Allows a person to gather thoughts, no more than 30-60 secs
- Could be intimidating, some people are not comfortable with silence
Which clients or situation may benefit from silence?
- When the client needs space for internal reflection and self-analysis
- Used after an emotional outburst
- After a complex reflection that gets the clients attention
- After complex instructions have been provided where client needs to process information
- After a client has realized something important or has insight
When can silence be negative? (3)
- When tension os high
- When the client is confused or anxious
- -When no empathy is experienced
When can silence be positive?
- When the counselor attends to the silence (eye contact, focusing on the client)
- Understanding/acceptance is apparent
Examples of acknowledging silence?
“You’ve become very quite, i’m wondering what that means”
“Perhaps you are hesitant to tell me or you just need some time to think?”
What are two strategies to break the silence if nothing else is said?
- Repeat the last phrase or sentence said with questioning tone or ask what the client was thinking about
- Ask client what his/her thoughts are, or what their response was
What is self-disclosure?
Sharing information about self during a session
–> Revealing current feelings, concerns, idea are more useful than revealing past history
What is important to note about self-disclosure?
- Should not shift the focus from client to counselor
- Too much disclosure can be as inappropriate as too little
- Important to maintain professional boundaries
What can self-disclosure be used for?
- To build trust and increase openness
- Not useful until rapport has been established with client
- Avoid using frequently as it may appear that the counselor is becoming “chatty”, self-absorbed, or lacking discretion
Give 5 examples as why nutrition therapy differs from nutrition education
- More time
- Fosters choice among options
- Dietitian and client develop a relationship
- Gives motivation and praise
- Explores personal issues
Discus the importance of time boundaries
- Sets appropriate professional boundaries
- Some clients don’t understand time limits wells
- Most clients are comfortable if they know what the expect
Who will benefit most from time boundaries?
Clients who push your time limits are the ones who will benefit the most from the firm application of time limits
What should be considered when planning time limits?
- Adequately scheduling clients
- Planning billing/payments and fees
- Positioning a clock visible to client and to you
- If client is late, state how long is left
- Stand up when over
Key phrase if client comes in late?
“i’m afraid I have a client scheduled right after so I can’t offer to give you the full session time”
Key phrase for clients who push time limits?
“We have 10 mins left, are we addressing what you need today?”
Key phrase for clients who respond well to empathy?
“I know it’s hard to stop. This is all so important to you, remember that real change happens slowly”
What are the advantages of home visits in counseling?
- Opportunity to look at the environment in which the client does much of his/her eating
- Permits you to better assess the clients economic resources (more evident in their home)
- Can do label reading with items that they already have, discuss portion sizes with their measuring cups
Disadvantages of home visits?
- May be interrupted
- Can be harder to adhere to time limits
- Don’t have access to all your resources
- Take up more time at the beginning
- Safety
How can home visits facilitate the helping relationship?
- Can feel more social and less professional
- Client is now the role of the host
- More difficult to maintain control of session
- Must be planned well ahead of time to understand client and counselors role
What are the 4 phases in the counseling and interviewing process?
1) Involving phase
2) Exploration phase
3) Resolving phase
4) Closing phase
Discuss the involving phase
- Greetings and intro
- Identify clients long-term behaviour change objectives
- Explain rationale for recommended diet
Discuss the exploration phase
- Assess food behaviour, activity patterns and past behaviour attempts
- Explore problem, skills and resources
- Assess readiness to change
Discuss the resolving phase
-Tailor the intervention to the client’s motivational level
Discuss the closing phase
- Support SE
- Review issues and strength
- Re-state goals, express appreciation and arrange follow-ups
