ASSIGNMENT – Observation of a Nutrition

Counselor

Assignment Objectives:
After completing this assignment, you should be able to
demonstrate the following competencies:

 Describe components of a nutrition counseling interview

 Analyze theoretical approaches used in a nutrition
counseling interview
 Identify techniques you would or would not like to use in
nutrition counseling

Assignment:
Observe a nutrition counselor counseling a patient in an
inpatient, outpatient clinic, or private office setting for 1 hour.
Your report should be typed. GROUP COUNSELING SESSIONS
ARE NOT ACCEPTABLE. Use complete sentences to address the
items and answer the questions in the attached table. Number
each of your answers. USE THE ANSWER TABLE AS THE FIRST
PAGE OF YOUR REPORT.

Grading:
Grading is done on a point system. There are 100 points given
for this assignment. See the attached table for point breakdown.
 Item Possible Earned
Points Points
 1. Identify the name of the setting, address, starting and ending
time of the observation, date and counselor you observed. Provide
contact information for counselor (email and phone) 5
 2. Describe the physical setting where the nutrition counseling 5
sessions took place.
 3. Describe the counselor’s attire and the appropriateness of 5
his/her manner of dress.
 4. Select a client you observed and give the following information
to the best of your ability. Identify each answer with the
designated letter.

a. Gender, Age, Cultural/ Ethnic Orientation

b. Was a helping relationship established? If not, why not? If yes,
what did the counselor specifically do and/or say to encourage an
effective relationship?
c. Explain the nature of the client’s problem.
d. Was there evidence of collaboration between the counselor and the 33
client to define dietary objectives? Explain. (3 pts each)
e. Were short or long-term goals established? If yes, what were they?
f. Describe any teaching or visual aids.
g. Was there evidence of tailoring dietary objectives to address the
client’s lifestyle issues? Explain.
h. Give your impression of the client’s educational level and needs.
i. Give your impression of the client’s health belief and self-efficacy
regarding their dietary objectives.
j. What were the client’s barriers to meeting their dietary objectives?
k. Was there evidence of social support for the client to meet the
dietary objectives?
 5. Complete a counseling observation checklist (page 42 of text) 7
 6. Review the theoretical approaches to counseling covered in this
chapter (Client-Centered Counseling, Solution Focused Therapy,
Cognitive-Behavioral Therapy, and Motivational Interviewing. 25
List EACH ONE and indicate if there were any components of the
approaches demonstrated in your observations. If yes, explain. If
no, how could they be incorporated?
 7. Describe your general impressions of the counseling session. 15
What did you learn from this experience?
 9. Question checklist included as first page of report. 5

TOTAL _____________
NAME __________________________________________________

1. RD Danielle Geiger
Business Title: Nutritionally Balanced, 872 Middle Country Road, Saint James, NY
11780
11 AM-12 PM, November 22, 2019
dgeigerrd@live.com, (631) 940-7777

2. The physical setting that this nutrition counseling session took place was Danielle’s
office. She works in a building where there are other offices. For example, she shares an
office unit with a person who specializes in aromatherapy and a chiropractor. Danielle
owns her own business for nutrition counseling, however, her business does have one or
two other RDs also providing counseling. Her actual office that she counsels the clients
in is small but spacious enough to fit a small family on the one side of her desk (about
three people). She also has a fair number of amenities such as a Keurig in the lobby, an
essential oil diffuser, tissues, water, and very comfortable chairs that are similar to dining
room chairs.

3. Danielle dressed in professional attire, which was a nice blouse, dress pants, and nice
flats. This outfit was appropriate because it presented a professional demeanor to the
client and was a clean image.

4.

a. Female, about 60 years old, Predominantly German (Caucasian)

b. A helping relationship was established in the client’s previous sessions with
Danielle (she has been with her for about four months, meeting once a month) as
well as during this specific session. Some of the things Danielle did that
encouraged this effective relationship was making sure she was comfortable,
provided with water, tissues, and other amenities. In terms of the relationship
with regards to her dietary plan, Danielle made sure that the majority of the
session was asking what the client liked the most and what she didn’t feel a need
to eat. This helped to keep the client in control and not simply eat what Danielle
said. Additionally, since this session was done a week before Thanksgiving, she
provided the client with a double sided sheet of paper that had a couple of tips for
staying in balance with their blood sugar, as well as a short answer section where
the client was instructed to outline what they believed would be of easy access to
them on Thanksgiving day, not only what she planned on cooking, but also what
she thought her family members would be bringing to ensure she was fully
equipped with a knowledge of what she could eat and stay within her
“constraints.” Another important part of the counseling session was when
 Danielle continued to ask about how the client’s family was doing, as she had the
knowledge that the client’s husband and mother had recently been to the hospital.
This allowed for an atmosphere that the client felt most comfortable in and a safe
space to share whatever kinds of stresses had been weighing on her.
c. The client’s “problem,” as far as I know, was a diagnosis of Type II Diabetes
Mellitus about five months prior to this specific session. Her doctor encouraged
her to see a Registered Dietitian to help guide her to a healthier lifestyle. Other
than that, she did not have any other health conditions.
d. As stated above, there was evidence of collaboration between the nutrition
counselor and the client through something as simple as the worksheets Danielle
provided the client with. The worksheet on Thanksgiving not only gave tips from
Danielle on how to keep one’s blood sugar at a stable rate, but it also gave spaces
for the client to write in their food choices and then modify them to fit Danielle’s
“meal plan” (just in regard to how many carbohydrates she can have in one
sitting). Danielle also continued with this strategy by asking the client what she
thinks will happen as well as asking what ways she plans to follow her own
personal guidelines on that day. Through this, both Danielle and the client were
able to go through her specific foods that she thinks will be offered/available on
Thanksgiving Day and the amounts that fit in Danielle’s “plan.” Overall, the
worksheets created for a very collaborative nature since the client was able to fill
them out with what she thought while also getting Danielle’s input on what she
had written, with then following up with a conversation/discussion.
e. This session was mainly about short-term goals, however, there were some long-
term goals outlined. The short-term goals focused on Thanksgiving decisions, for
instance, one discussed how most people see Thanksgiving as a holiday to “go
overboard,” however, Danielle was able to break it up in her worksheets and tell
the client a sufficient amount of carbohydrates to consume on that day as well as
base it off of what she had planned to eat anyways. The long-term goal that was
focused on in this session was more in regard to the aftermath of Thanksgiving
and Christmas “month,” since it isn’t just one day that more foods are at your
disposal that may not help your dietary objectives. For example, Danielle spoke
about how the main goal during the month of December (especially concerning
diabetes clients) is to keep your blood sugar in a good range and not allowing it
to go to the extremes for an extended amount of time. She then explained how if
 her clients do go out of the normal range, it can be difficult for the entire month
of January to get back to their weight they were before December.
f. As stated, the main visuals/teaching aids Danielle used were the worksheets for
handling Thanksgiving and December (I have attached copies of them to the back
of this report). Another major visual aid she used was measuring cups. This
helped the client to visualize more of what amount they could eat on
Thanksgiving without feeling uncomfortable or unsatisfied.
g. The worksheets Danielle used allowed for the client to state what foods they
expect to be offered on Thanksgiving, therefore, allowing for changes or
enhancements to what her diet was already. Since the client had told Danielle
about her past month since they had seen her, Danielle complimented her on how
she had been doing. The client expressed that both her husband and mother were
admitted to the hospital for separate reasons in the past month. Danielle’s tips for
diabetic clients are to ensure they are eating every 4 hours or so. The client then
expressed that she had packed snacks of almonds, trail mix, and cheese cubes for
those days. Danielle saw on her chart of what she had recorded for her weight
that she had consistently maintained her numbers throughout those weeks and
even lost a couple of pounds here and there. Hence, the client had used the
dietary tips Danielle had given despite outside compounding factors. They then
discussed more about how this was an excellent tactic to maintain her weight and
blood sugar range.
h. The client was close to retirement however, it seemed that they had been a nurse
the majority of their life, or a similar occupation in the healthcare/medical field.
Therefore, she already had a fair understanding of lab values and blood sugar’s
impact on the body. The main thing that it seemed she needed to learn from
Danielle was how to actually maintain a good blood sugar level and what foods
would help and hinder that in what amounts.
i. After the client discussed their complications in the past month, it was evident
that she was confident in her abilities to enhance her diet and create a healthy
lifestyle for herself. In terms of health beliefs, she seemed to be much more
equipped at maintaining a healthy lifestyle and diet after seeing Danielle.
j. The client’s main barriers were the events that happened in the past month, social
gatherings, and her dietary choices in the past. Since it seemed like she had
enough income to afford any type of food she would want, food insecurity and
 unattainable healthy options were not barriers. She had overcome any struggles
that could have come with the events that had occurred in the past month. Social
gatherings and not overeating seemed to be her main concerns.
k. After discussing her new dietary choices, it seemed like she had a fair amount of
social support. The only thing she mentioned that may have hindered the social
support she had was when she was visiting her mother in the hospital and waiting
in the lobby for about five hours. She pulled out two snacks during this time
period, and her sisters were surprised to see that she was eating during a stressful
time such as this. She responded that she wanted to keep her blood sugar in a
normal range. However, after she explained this, they understood where she was
coming from and no longer sounded judgmental. She did explain afterwards to
Danielle that normally, they are very willing to provide her with measuring cups
or scales when eating together so she can eat the proper amount of food she had
planned for.

5. Counseling Observation Checklist

Almost always

Always
Rarely

Occasionally

Often
Undecided
Counselor name: Danielle Geiger
Date of session: 11-22-19
Length of observation: One hour
Estimated percentage of time counselor talked: 35%

Did nutrition counselor appear to be comfortable with ✓

the client and with the subject areas discussed?
Did counselor avoid imposing values on client? ✓
Did counselor remain objective? ✓
Did counselor focus on client, not just procedure of ✓
providing diet instruction?
Were the counselor’s skills spontaneous? ✓
How would you describe the likelihood that the client ✓
would return to this nutrition counselor again? (very
high)
Comments: Danielle does an excellent job at
incorporating the client’s ideas and thoughts into
the conversation and incorporating her own prior
knowledge in.
6. Client-Centered Counseling incorporates the client into the conversations. They “actively
participate in clarifying needs and exploring potential solutions,” (Bauer, Liou, 2016).
Danielle did an excellent job at enhancing this technique during the session since she
asked the client what they planned to eat during Thanksgiving and what they thought and
felt about the amount that would be there, as well as what they would actually be eating.

Solution Focused Therapy is “concentrating on solutions that have worked for them in
the past and identify strengths to be expanded upon and used as resources,” (Bauer, Liou,
2016). Danielle incorporated this theory by working off of what the client had told her
about the past month with all of the potential hardships/stresses she faced. The client
succeeded in a very difficult situation for any individual so Danielle made sure to applaud
her for this as well as reassure her that she could do this again in the future and succeed
again!

Cognitive-Behavioral Therapy is described as “incorporating both cognitive therapies and

behavior therapy and includes a wide range of treatment approaches,” as well as, “by
altering the environment or internal factors, new behavior patterns develop,” (Bauer,
Liou, 2016). In this nutrition counseling session, Danielle incorporated this concept
through analyzing what the client did while in the hospital for her mother and husband.
Her behavior to plan ahead with healthy snacks in her bag helped with her cognitive
performance later on while she was in the hospital. Rather than her initial instinct to be
going down to the cafeteria to get unhealthy items, her cognitive decision of reaching into
her bag and eating those snacks showed a healthy behavior pattern that she is more likely
to perform again, since she realized her success with it in these past experiences.

Motivational Interviewing “entails a focus on strategies to help motivate clients to build

commitment to make a behavior change,” (Bauer, Liou, 2016). Once again, based on her
prior experience of packing snacks for a time when she knew she couldn’t get healthy
items, Danielle was able to applaud the client and remind her that if she has accomplished
this success once before, she will be able to do it again. In addition, by reminding the
client that Thanksgiving has a lot of healthy options, they were able to choose some of
her favorite food options for the day and encourage the client to be excited to spend that
time with her family.

7. Overall, I found that Danielle’s method of counseling is very adaptable between her
different clients and optimistic. I have shadowed a lot of her counseling sessions before
and even gave a presentation to four of her clients this past summer so I already had a
good idea of what to expect. Some of the major things I’ve learned from her counseling
methods are the skills necessary to change someone’s mindset to a more positive outlook,
and the importance and struggles that surround the ability to live a well-balanced life. In
connection with what I have learned from this class, I have been able to understand more
about the different levels of readiness of the clients to enhance/change their dietary
choices and lifestyle. In addition, it is important to validate the client’s feelings regarding
keeping a healthy and balanced lifestyle. The most effective nutrition counselors are the
ones that work with the client to identify any barriers they may have that prevent them
from enhancing their lives, and working together to figure out ways to eliminate them.

8. (Question checklist first page of report).