Final Exam Flashcards
Differentiate intellectual quotient (IQ) from emotional intelligence (EI)
IQ
o High erudition
o All learning gained from books
o Can quote any law or formula in any situation
o The “walking, talking encyclopedia” type
EI o Instinctive and intuitive o Less nerdish, more street smart o Learning from interaction o Ability to manage any situation
Define professional helping
- Involves responding to feelings, thoughts, action and social system of clients
- Is characterized by confidentiality and privacy
- Focuses on the needs and disclosure of the client rather than the counselor
Describe the steps in the counseling process
- Relationship building
- Problem Assessment
- Goal setting (when at appropriate stage of change)
- Counselling intervention
- Evaluation, termination or referral
Name and describe the 2 phases of the helping relationship
Phase 1: Building a relationship
• Requires good rapport with client
• Ability to show empathy
• Formation of a trusting relationship so the client can disclose information to you
Phase 2: Facilitating positive actions
• Help client identify specific behaviour to alter
• Design realistic behaviour change strategies to facilitate positive action
Describe the listening process
Hearing and remembering verbal and non-verbal information –> Selecting and sorting information, ideas and feelings –> Understanding meaning and emotions –> responding
What 3 verbal responses can communicate to clients that you are listening to them?
Paraphrase
Reflection
Summarization
Describe active listening
- Is a cluster of skills used to increase accuracy of meaning
- Builds rapport
- Does not threaten people with an over attempt to change them
- Includes skills in: attending, being silent, summarizing, paraphrasing, questioning and empathizing
- Involves earing what is said and what is left unsaid
- Involves paying careful attention to cues:
o Word choice
o Tone of voice
o Posture
o Verbal hesitations
Define empathy. What does it imply?
The ability to understand the client’s experience and feel with or emotionally resonate to the clients experience as if it were your own but without losing the “as if”
Empathy involves being sensitive and needs to feel genuine.
It is NOT:
- merely supporting or agreeing with the client
- pretending to understand
- taking on your client’s problems
- a one-time behaviour (crucial that it is present throughout the counselling process)
How does empathy contribute to the counseling relationship?
- Encourages expression of emotions
- Normalizes and validates feelings
- Reduces isolation of client
- Increases awareness of emotions, including ambivalent feelings
- Stimulates further exploration of client’s subjective experiences
- Helps client recognize the impact of emotions on themselves and others
- Assists clients to understand how emotions influence decision making of how they impede action
- Provides a starting point for managing and expressing emotions in constructive ways
Name 7 ways in which empathy can be demonstrated.
Eye contact Muscle of facial expression Posture Affect Tone of voice Hearing the whole patient Your response
Differentiate empathy from sympathy.
Empathy: Just listen
Sympathy: Give unasked advice
Empathy is the ability to experience the feelings of another person. It goes beyond sympathy, which is caring and understanding for the suffering of others
Empathy is not interpreting: the counselor should respond to the client’s feelings and should not distort the content and what the client is telling the counselor
What is empathetic listening?
Centers on the kind of attending, observing, and listening needed to develop an understanding of clients and their worlds.
Name the 6 relationship building responses
- Attending
- Reflection
- Affirmation
- Respect
- Partnership
- Personal support
What is Interviewing?
A special type of interpersonal communication which is purposeful and serious, usually involving questions and answers, with the goal of sharing information or facilitating therapeutic outcomes.
Part of an assessment process that helps the counselor be a more effective helper as it permits to confirm that you are in the right direction and addressing the right issues.
- Important to acquire and organize relevant information through timely listening and responding
- Indispensable for effective counseling – counseling and interviewing are always together. To be a good counsellor, you need to be a good interviewer
Explain the 4 parts of an interview.
- Preplanning
- Interview guide, reading chart
- Physical environment (Distance/proximity (personal space), Privacy)
- Patient context
- Psychological privacy - Opening (involving)
- Greeting and introductions (safe talk) “Is it your first time seeing a P.Dt? What brings you here today?”
- Statement of purpose
- Explain counseling process
- Set agenda (summarize what you will go through during the time you have with them, what the time limits are)
- Development of rapport - Body of an Interview
- Sequence of topics
(Assessment –> Explore problems, skills and resources –> Assess readiness to change –> Non-judgemental response
- Maintenance of rapport - Closing/ending of interview
What is the role of questioning in the interviewing process?
- Questions assume and encourage an active role for the client in the process of changing the behaviour
- Questions are important interviewing tool for gathering information, providing focus to the interview, promoting client’s insight.
- Good questioning might lead the client through problem solving and can help the client to examine areas they might have overlooked.
- Involve using words such as which, when, why, who, where, how, what?
Describe open questions, and their pros and cons.
- Begin an interview
- Encourages client to express more information
- Permit disclosure, depth
- Require more time and interpretation by the counselor
- Request a story from the client not just an answer
- Begins with: “what, how, who, where, when, why”
- Increase client’s sense of control: gives client control
- Require more effort in relating response to the information that you need
- Helps build rapport
- Encourages self-exploration, elaboration
- Can be a barrier to communication if not asked with a useful purpose of checking understanding or assessing knowledge
Describe closed questions, and their pros and cons.
- Major tool to obtain information during the assessment phase
- Limit client responses (yes or no, a number, short answer)
- Begins with: “have you, did you, do you”
- Give quick answers/valuable information
- Lessen client’s sense of control: keeps client more passive
- To confirm or disconfirm a hypothesis
- Useful when the helper knows what he/she is looking for
- Narrowing the area of discussion by asking client for a specific response
- To gather specific information
- Could be used to interrupt an overly talkative client who “rambles”
- May discourage discussion if used excessively
- Useful and more frequently used for clients with limited mental ability and children
- Can effectively bring closure/ending to an interview
- Can slow the pace of a very “chatty” client
- Avoid using too many when the client tends to be very succinct
What is the proper ratio of open-ended to closed-ended questions?
around 50:50 to 70:30
How do we close/end an interview?
• Review what has occurred during session, a concluding kind of review or ask the client to summarize
• Avoid asking open-ended question not to re-open issues
• Express appreciation
• Restate goals
• Explain/arrange future contacts
• Nonverbal signals
“time is coming to an end”
“We will need to stop in a few minutes”
“It looks as if our time is up for today”
The closing is the responsibility of the counselor!
What are the 4 models and theories of behaviour change?
- Health belief model
- Social cognitive theory
- Reasoned action, planned behaviour theory
- Stages of change model
What are common features of the 4 models and theories of behaviour change?
Protection motivation
o “I am motivated to become physically active so I can protect myself from a heart attack”
Self-Efficacy
o The confidence to perform a given set of behaviours under specific circumstances
Reasoned action
o “I believe that as I follow a lower-fat diet, I’ll lose weight, look better, and reduce my chances of a heart attack”
Decisional balance
o Weighing the pros and cons of behaviour change
Define self-efficacy
The confidence to perform a specific behavior (Albert Bandura)
People’s beliefs about their capabilities, abilities to accomplish something, to produce designated levels of performance that influence events that affect their lives.
Self-efficacy beliefs determine how people feel, think, motivate themselves, and behave.
Very important in attempting to perform a given behavior under specific circumstances
What is self-efficacy mainly built on?
life experiences
What are the 4 main factors influencing self-efficacy?
- Performance accomplishment (for similar tasks)
- Vicarious experiences (Someone similar to themselves)
- Verbal persuasion (depends on the credibility of the person encouraging)
- Physiological states: Emotional arousal a learner experiences, and how they interpret it (butterflies in stomach = stress? anxiety? or rather excitement?)
How is self-efficacy measured?
S-E is rated on the General Self-Efficacy Scale (GSE)
Score from 10 to 40
Higher score = higher self-efficacy
What can a counselor do to promote self-efficacy in a client?
- Help clients identify their past successes
- Encourage clients to make an inventory of their strengths and resources
- Look for opportunities to affirm their client’s efforts, strengths and successes
Explain the health belief model. Why was it first developed?
One of the first models developed exclusively for health-related behaviours
Currently among the most popular models
–> Developed in 1950s to understand why many individuals failed to participate in programs to prevent/detect disease.
• A goal setting theory based on level of aspiration, in which the individual sets the target of future performance based on past performance.
• Framework for understanding individual’s psychological readiness or intention to take a given health action.
• States that people’s beliefs influence their health-related actions or behaviors
• Perception of the health problem and appraisal of benefits and barriers of adopting health behavior are central to a decision to change
What are the 5 aspects that are the basis of the decision to change in the health belief model?
Decision to change (or not) depends on how the client perceives:
- Severity of potential condition or disease (perceived threat)
- Susceptibility to that condition or disease (perceived threat)
- Benefits of taking representative action (outcome expectation)
- Perceived barriers to taking that action (most powerful) (outcome expectation)
- Ability to make the required changes (self-efficacy)
- Cues to action
Readiness to action is based on the following beliefs or convictions in the health belief model:
- The threat to my health is serious
- I perceive that the benefits of the recommended action outweigh the barriers or costs
- I am confident that I can carry out the action successfully
- Cues to action are present to remind me to take action
Name an example of a project using the health belief model.
Low fat eating for Americans project (LEAN)
What is the social cognitive theory?
A relationship exists between…
• Behavior
• Cognitions and personal factors
• External environment
Change is affected by a combination of these
Theory goes well beyond individual factors to include environmental and social factors
• Proposes that behavior is the result of personal, behavioral and environment factors that influence each other
o Personal factors: people thoughts and feelings
o Behavioral factors: food, nutrition and health related knowledge and skills
o Environmental factors: factors external to the individual such as physical activity and social environments
Name examples for each of the 3 categories of factors influencing behaviour according to the social cognitive theory
Personal/cognitive factors: Knowledge, expectations, attitudes
Behavioural factors: Skills, practice, S-E
Environmental factors: Social norms, access in the community, influence on others and environment
e.g.
- Social networks
- Media
- Social support, social structure of the family (approval of spouse? Peers? Etc.)
- Cultural practices
- Worksite
- Food production and marketing
- Healthy food accessibility
- Means to be physically active
Explain the reasoned action and planned behaviour theory
- People’s behavior is determined by their intentions which in turn are influenced by attitudes, social norms and perception of control over the behavior
- This theory assumes that people make decisions in a reasonable manner
- People are more likely to engage in a behavior if they intend to do so
Explain the three factors that influence the intention to act/change in the reasoned action and planned behaviour theory
Social-psychological approach to understanding and predicting determinants of health behavior.
Behavior is determined by the intention to act/change, which is determined by three major factors:
1. Attitude towards the behaviour
- Beliefs about outcomes
- Beliefs about the value of the outcome
2. Influence of social environment
- What other people think
- Motivation to comply with opinions of others
3. Perceived behavioral control over
- Opportunities , resources, skills
- I believe that taking this action will lead to outcomes I desire (attitude)
- I perceive that the positive outcomes of taking this action outweigh the negative outcomes (attitude)
- I have positive feelings about taking this action, and taking action will make me feel good about myself (attitude)
- People important to me think that I should take this action and their opinions are important to me (social environment)
- I am confident that I can carry out the action, despite difficulties (self-efficacy)
Explain the transtheoretical model
Stages of change (Prochaska)
• From a large comparison of behavior modification theories, showing that change is realized through a series of stages.
• An on-going process, not an event, is cyclical
• Is a model of behavior change, not a model predicting behavior
• Based on the assumption that individuals have varying levels of motivation or readiness to change.
• The idea behind this is that behavior change does not happen in one step
Why is the transtheoretical model used in counseling?
Serves 2 purposes for us, as counselors:
o Helps understand to process of behaviour change
o Helps to develop and select effective intervention strategies
Based on the transtheoretical model, what are the 2 mediators to change?
Decisional balance (pros and cons) Self-efficacy
Based on the transtheoretical model, what are the 4 barriers to behaviour change?
- Lack of motivation
- Lack of support
- Past failures
- Unrealistic goals
Explain the pre-contemplation stage of change.
- Ignoring the problem exists
- Consciously intending not to change
- Do not see a problem: denies having a problem
- Stage of resistance, reluctance
- Makes excuses (“yes but” syndrome)
- Blames other people for the problem
- Feeling hopeless after attempting to change (past failures)
- May be resigned
- Also included in this category are those who have tried and failed and no longer want to think about it
Cons > Pros
What should be done by the counselors in the precontemplation stage?
- Empathic and sensitive listening encouraging clients to examine their situation and its consequences can be very helpful
- confrontation is NOT the remedy for denial
Counselors can:
• Provide information
• Offer feedback
• Encourage reflection
What are the counseling goals for the people in the pre-contemplation stage of change?
- Increase awareness of the need for change
- Personalize information on risks and benefits
- Help patient develop a reason for changing (make them reflect on it)
- Validate the patient’s experience
- Encourage further self-exploration
- Leave the door open for future conversations
Explain the contemplation stage of change.
- “Sitting on the fence”
- Considering a change but not right away (change expected in the next 6 months but not in the next month)
- Knows behavior is a problem: not ready yet
- The most common stage for clients to come to a P.Dt. for assistance in changing
- Ambivalence re: consequences of behavior change (not as resistant as pre-contemplation, but still ambivalent)
- Considering change but rejecting it
Perception that long-term health benefits do not compensate for short-term real or perceived costs
• A lot of perceived barriers (unacceptable tastes, economic constraints, inconvenience)
Cons > Pros, but more aware of pros
What should be done by the counselors in the contemplation stage?
- As counselors, assist them in thinking through the risks of the behavior and potential benefits of change and to instill hope that change is possible
- Clients at this stage need motivational activities rather than action-oriented, behavior change strategies
- Clients may be burned out from previous unsuccessful attempts at change
- Clients lack self-esteem and believe that they do not have the skills, capacity or energy to change
- Clients may be open to new information as they self- assess their problems and advantages/disadvantages of change
What are the counseling goals for the people in the contemplation stage of change?
- Remove ambivalence to engage in the change process
- Validate the patient’s experience
- Clarify the patient’s perceptions of the pros and cons of attempted weight loss
- Encourage further self-exploration
- Leave the door open for moving to preparation
Explain the preparation stage of change.
- “Testing the waters” New year’s resolutions is a good example!
- Some ambivalence still present…
- “I’m going to do it in the next weeks”
- Getting ready to make a change soon
- Stage with window of opportunity
- Feeling that taking action is important
- Might have started a few changes already (e.g. took an appt with you, bought a gym membership…)
- Might have taken a few steps to prepare for change such as making an apt with a dietitian, inquiring about a walking club)
- When advantages outweigh disadvantages
Pros > Cons
What should be done by the counselors in the preparation stage?
- Counselors need to sustain the energy for change throughout support, encouragement and empathic caring.
- Client in this stage might be willing to try a new recipe or to taste some new foods
- Assist them to develop concrete goals and action plan strategies
- -> Goal setting starts in preparation
What are the counseling goals for the people in the preparation stage of change?
- Develop concrete strategies for action
- Praise the decision to change behavior
- Prioritize behavior change opportunities
- Identify and assist in problem solving re: obstacles
- Encourage small initial steps
- Encourage identification of social supports
Explain the action stage of change.
- “Go for it”
- Has taken steps (< 6 months) towards making a change
- Change is initiated
- Only 15% of clients initially seen will be in that phase (most are in contemplation phase!)
- Clients may miss their old lifestyle and have conflicting feelings about the change
What should be done by the counselors in the action stage?
- Counselors can remind clients when encountering obstacles of previously developed contingency plans
- Action-oriented strategies are very helpful
- Clients are actively involved in the change process
- Clients are working on the goals and implementing the plans developed in the preparation stage
What are the counseling goals for the people in the action stage of change?
- Implement change and sustain momentum (important to check with the client if he has discovered parts of the change plan that needs revision)
- Increase self-efficacy for dealing with obstacles
- Combat feelings of loss and reiterate long-term benefits
Explain the maintenance stage of change.
- “Steady as she goes”
- “I’ve done it. I need to keep doing it”
- Continued commitment to sustain new behavior (> 6 months)
- Has made a change and has been successfully working on it for past 6 months to 5 years
- Clients might still be insecure and nervous about being able to maintain changes
What should be done by the counselors in the maintenance stage?
- Client need to work actively on modifying the environment to maintain the changed behavior and prevent relapse (remove triggers for relapse)
What are the counseling goals for the people in the maintenance stage of change?
• Sustain change and accept relapses (develop new strategies for dealing with stress points and triggers)
What is a relapse? When does it usually occur?
- The most common time to occur is in the first 3 to 6 months
- Has returned to old behavior
- Accompanied by feelings of failure & self-doubt
- Client succumbs to the pressure to resume their old ways of behaving
- It’s important to discuss lapses and relapses early with our clients
What are the counseling goals for the people in the relapse stage?
- Counselors can help clients accept
- Counselors can help clients identify the decision or action which got them into the high-risk situation (unexpected temptations, personal stress, triggers, letting down one’s guards, sabotage by others….)
- Recovery requires re-learning skills from earlier stages and learning new skills to “get back on the horse”
Explain the termination stage of change.
Individual has no temptation to return to his previous unhealthy behavior, no longer succumb to any temptation and feel total self-efficacy.
Summarize the 6 stages of change.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse/Termination
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?
- The needs and wants of the client
- The mandate of the counseling setting
- The expertise and competence of the counselor
Differentiate the immediate from the long-term goal of counseling
Immediate goal: To provide assistance so that clients can gain control over their problems
Long-term goals: Restore or develop client’s ability to cope with the changing demands of their lives
–> EMPOWERMENT
Name the 10 most common counseling errors
- Rigidity and use of a “one size fits all” approach
- Insufficient attention to the counselor-client relationship
- Advice giving
- Absence of core conditions (empathy, attending, genuineness…)
- Missing the opportunities offered by paying attention to the non-verbal channel
- Loss of objectivity and judgmental responses
- Pacing problems (too fast, too slow, inappropriate timing of responses)
- Inappropriate use of self-disclosure (too much, too little, poorly timed)
- Rescuing, false reassurance, minimizing problems
- Cultural insensitivity
What are the 4 main skills for counseling?
- Relationship building skills (empathy, active listening, questioning, sustaining the relationship)
- Exploring & probing skills (active listening, attending)
- Empowering skills (identifying resources, support systems, past successes and failures, defining problems as opportunities)
- Challenging skills (confronting, setting limits)
Name 3 ways in which technology can be used in counseling
- Recording
- Reminders
- Sharing resources
Does technology-based programs hinder weight loss?
One of the consistent findings was that adding a technology-based program did not hinder weight loss.
Name as many basic counseling responses as possible.
- Attending (active listening)
- Reflection (empathizing)
- Legitimation (affirmation
- Respect
- Personal support
- Partnership
- Mirroring
- Paraphrasing (summarizing)
- Giving feedback
- Questioning
- Clarifying (probing)
- Noting a discrepancy (confrontation)
- Directing (instructions)
- Advice
- Allowing silence
- Self-disclosing
What is attending as a counseling response?
- Is active listening
- Create an ambiance to facilitate meaningful communication
- Involves giving individual attention to the client
- Many attending behaviors are non-verbal
- Engage, build a relationship with the client
What can be done to increase the attending response from the counselor?
Reorganize surroundings - Try not to have a desk between you and the client Sit down to enable eye contact Face client squarely Adopt an open posture Lean toward client slightly Maintain good eye contact Try to be relaxed Focus on client not self Pay attention to a client’s vocal style (speech, rate, volume, tone…) should indicate concern Gestures Barriers (Time constraints, Temperature, Noise)
What is the…
- Intimate distance zone?
- Personal distance zone?
- Social distance zone?
- Public distance zone?
- Intimate distance zone (private exchange, intimate thoughts and feelings)
o 0.5 meter or 2 feet - Personal distance zone (less intense exchange with friends and family)
o 0.5 – 1.0 meter or 2 – 4 feet - Social distance (impersonal meetings and social contacts)
o 1.0-3.5 meters or 4 – 12 feet - Public distance (giving speech or lecture, casual exchanges)
o 3.5 meters or 12 feet
How many words does one think in a minute? What should you be thinking about during counseling?
Thinking: 600-800 words/min
- Thinking about what the speaker says
- Summarizing key points
- Listening for feelings, not only content
- Looking for consistency/inconsistency
*Talking: 100-200 words/min
What is reflecting as a counseling response? Why is it used for?
- Rephrasing the affective (feelings) part of a message
- Brings the client to deeper and deeper levels of self-disclosure
- One of the most challenging skill to develop
- The feeling component of a message is often hidden because disclosure of feelings is bound by cultural and family rules
- Used by helpers to stimulate deeper exploration of the facts, feelings and meanings (includes emotions) in the client’s presentations of the problem
- Forges empathetic bond between the client and the helper (client senses that someone has taken time to understand)
- Effective listening uses statements rather than questions
- When reflecting your client’s feeling, understate what he or she said.
What are the 4 steps in reflecting?
- Correctly identify the feeling being expressed (anger, fear, conflict, sadness, happiness) –> not too early
- 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 are the formulas to reflect a feeling and a meaning?
Formula to reflect a feeling:
You felt ____ (emotion) when ____ (event or thought)
Formula to reflect a meaning:
You felt ____ (emotion) because ____ (meaning)
OR “it sounds like…/seems like…”
What is legitimation (affirming) as a counseling response? Why is it used for?
- It’s a type of reflection
- A statement that affirm some strength and efforts shown by the client
- Points out a job well done
- Avoid using the “I” word and highlight non-problem areas
- Encourages a client who lacks initiative/self-confidence
- Positive thoughts, words and actions as a way to support positive change
What are common difficulties in reflecting feelings/meaning?
- Having trouble separating their own feelings from the experience of the client
- Deciding on which of several feelings the client is experiencing to reflect
- Stating the client’s feelings too definitely (e.g. you are obviously angry)
- Feeling uncomfortable when the client expresses intense feelings (ex: when clients cry, helpers may want to take away their sadness and pain rather than accepting the feeling and being with the client in a difficult moment)
What is mirroring as a counseling response? Why is it used for?
(Parroting, echoing)
• Repeating what you have heard with a few words changed
• Do not overdo this response
• Allows counselor to let client know that you are listening and encourages the person to keep talking and exploring
• Could choose to echo back key words or a key word
My diet is a disaster” –> “a disaster.” Or “what do you mean by a disaster?”
What is paraphrasing as a counseling response?
- Reflective skill on content and thoughts
- Rephrasing on the content of what the client said and meant
- Not a word for word reiteration
- Done non-judgmentally
- Stating thoughts from a different angle
- Can summarize prior statements or several statements of a conversation
Why is paraphrasing used?
- Lets the client know that you are listening
- Encourages client to continue talking
- To interrupt excessive rambling
- Restating key messages to the client
- Confirms understanding and checks assumptions
- You won’t find yourself arguing, when you basically agree.
- The other person will realize you are trying to understand their side and will be more willing to listen to you.
- Gives client the opportunity to correct inaccuracies
Name a few phrase or sentence stems to introduce paraphrase responses
- It seems like
- It appears as though
- From my perspective
- As I see it
- It looks like
- As I hear it
- Put a different way
- The picture I get is
- What you’re saying is
- I hear you saying
- You’re telling me that
- From my standpoint
What are the 2 steps in paraphrasing?
- Listen carefully to the client’s story feeding back to the client in a condensed non-judgmental version of the facts and thoughts
- Find the important information in a large volume of client material and repeat it in a succinct summary
Differentiate paraphrasing from summarizing
Paraphrasing an extended interaction is referred to as summarizing
What is included in summarizing?
- Review what has occurred during the session
- Include a summary of the issues
- Identify strengths & efforts you have heard
- Restate the goals
- Could use a partnership statement
- Plan for next counseling encounter
What is clarifying (probing) as a counseling response?
- To encourage more elaboration from the client
- To check out accuracy and what you heard the client say
- To clear up vague and confusing messages
- Permits the counselor to be clear about the client’s feelings and experiences
- Often use a question
- Often use “why” after an ambiguous message
What is directing (instructions) as a counseling response?
• Telling a client exactly what needs to be done, instructions
E.f. fluid intake in kidney disease, carb counting in diabetes, etc.
When and how should advice be given in counseling?
- Do it scarcely
- Providing possible solutions for problems when there is a clear understanding of the problem
- Should be non-judgemental
- Should identify the problem
- Should explain the need to change
- Don’t use too much, however, none might leave the client confused
When should a counselor NOT interrupt their client?
- When the client is exploring reasons to make changes (change talk – Client from contemplation –> preparation phase –> action phase)
- When a client is expressing strong feelings
When should a counselor interrupt their client?
- When the client is wondering off topic
- When you have heard some change talk and you want to summarize
How should the counselor interrupt a client if needs be?
- With respect
- Could start with the client’s name, single words
- With an apology
- With an offer: “I have a thought or an idea”
- Wait for permission to provide idea or advice
When should a silence be used in counseling?
o Client need space for internal reflection and self-analysis
o May be after an open-ended question
o Used after an emotional outburst (disclose of feelings, crying)
o After a complex reflection that gets the clients attention
o Used after complex instructions have been provided when client needs to process information
• After a client has realized something important or has insight
When can silence be negative in counseling?
- Tension is high
- Your client is confused or anxious
- When no empathy is experienced
How should a counselor break the silence if nothing else is said?
o Repeat last phrase or sentence said with a questioning tone or ask
o What the client was thinking about during the silence
o Ask client was his/her thoughts are or what his/her response is to that?
Differentiate the old counseling method “nutrition education” from “Nutrition therapy” (new)
- Time constraints vs. more time
- Gives dos and donts vs fosters choice among options
- no relationship vs relationship
- Limited f/u vs. open-ended with time
- Strictly diet-oriented vs. explores personal issues
- Less opportunity for measuring adherence vs. evaluate adherence and make adjustments
- client is dependant vs. independance promoted
- Less interdisciplinary op vs team approach emphasized
Name advantages of home counseling
o The most obvious is that home bound patients can’t come in to your office
o Some starting dietitians do so as it permits them to avoid the overhead costs of maintaining an office
o Gives you the opportunity to look at the environment in which the client does much of his food storage, preparation and eating (look into fridge, pantry, is there a table for family meals, cooking utensils…)
o permits you to better assess the client’s economic resources (more evident in their home)
o you can do label reading with items they already have, discuss portion sizes using their won measuring cups, plates, glasses, bowls…
Name disadvantages of home counseling
o In someone’s home, you can never be certain that you will have an uninterrupted session (phones, tv, family members…)
o It can be harder to adhere to time limits
o You don’t have access to all of your resources (handouts, Food models….)
o Take up more of your time (travel time, finding parking, small talk at the beginning, being offered coffee…)
o Safety: you don’t know what you are walking into
What does home counseling do to the helping relationship?
o There is a tendency for the visit to feel a bit more social and less professional
o The client is in the role of a host
o More difficult to maintain control of the session when you are in the client’s space
o Some dietitians like to use a clock to time their visit to adhere to time limits
o You need to discuss ahead of time with your client your role, what
you expect to accomplish, what you will need from him, the time of the visit, who will be there…
What are the 4 phases of the counseling/interview process?
- Involving phase
- Exploration phase
- Resolving phase
- Closing phase
Explain the involving phase of counseling
- Greetings and introductions
- Identify client’s long-term behaviour change objectives
- Explain rationale for recommended diet
- Explain counseling process
- Set agenda
- Objectives are to establish rapport, trust to communicate an ability to help
Explain the exploration phase of counseling
- Assess food behaviour, activity patterns and past behavior change attempts
- Explore problems, skills and resources
- Give non-judgmental feedback
- Elicit client response
- Assess readiness to change
- Objectives are to provide information, show acceptance, learn nature of problems and strengths, promote self-exploration by the client and help the client to evaluate the situation
Explain the resolving phase of counseling
- Tailor the intervention to the client’s motivational level
- Objectives are to help the client make decisions about behavior change, indicate that the client is the best judge of what will work
Explain the closing phase of counseling
- Support self-efficacy
- Review issues and strengths
- Restate goals
- Express appreciation
- Arrange follow-up
- The objectives are to provide support and provide closure
What is the definition of life skills?
There is no universally accepted definition of life skills.
Different organizations attach different meanings to the term.
According to the International Bureau of Education (IBE) what are the 4 pillars of learning? and what defines life skills?
- Learning to know
- Learning to do
- Learning to be
- Learning to live together
and defines life skills as personal management and social skills which are necessary for adequate functioning on an independent basis.
What are the 4 H quadrants of the life skill model?
Head, Hearth, Hands, Health
What are the 2 categories included in the HEAD quadrant?
Managing & thinking
What are the 2 categories included in the HEART quadrant?
Relating & caring
What are the 2 categories included in the HANDS quadrant?
Giving & working
What are the 2 categories included in the HEALTH quadrant?
Living & being
Explain the aspects included in the “managing” category of the life skills model
o Resiliency
- Being accepting, stop asking questions or looking for answers
o Keeping records
- Keep things up to date
o Wide use of resources
o Planning/organizing
o Goal settingExplain the aspects included in the “thinking” category of the life skills model
o Service learning
- Give back to profession
o Critical thinking
o Problem solving
o Decision making
o Learning to learnExplain the aspects included in the “relating” category of the life skills model
o Communication
o Cooperation
o Social skills
o Conflict resolution
o Accepting differences
- Culturally competent
