Narrative of Session 1

For this nutritional counseling assignment, I had the pleasure of meeting Zainab Bannout.

Our first session took place at Franklin Township Library as it was a midpoint for the both of us

to meet and we believed that the first session would be best in person in order to break the ice.

We met in a conference room in the library and I started off by introducing myself by saying

how I am a senior Dietetics student at Montclair State University and told her a bit of what I do

and who I am and then thanked her for volunteering for my project. After my introduction, she

introduced herself and then I explained the details of my nutrition counseling project.

After our introductions and explanation of the project, I asked her some questions and

learned that she is a 20 year old Capella University student majoring in criminal justice and

aspires to be a police officer. She currently works part time as a front desk associate at a gym

called Jersey Strong. She talked about her interest in weight/strength and cardio training. Over

the past year, she cleaned up her diet and started weight training hard which caused her to gain

about 15 pounds. Over the past 3 months she feels that she may have plateaued as she is either

maintaining her weight or losing it over the weeks. Currently, she is weight training 6 days a

week, jump roping 4 days a week, and has 1 rest day. Furthermore, she suffers from mild IBS

and bloating, eats a Halal/Kosher diet and tries to avoid food containing gluten/wheat.

Zainab’s goals are to gain weight consisting mainly of muscle, have guidance on healthy

eating habits, and meal planning for her desire of gaining muscle mass. She wishes to be told

exactly what to eat in strict details. Her discipline works best when she is told what to eat rather

than figuring it out herself based on calorie counting. At the end of the session, she stated she has

no concerns and is willing to do anything it takes to better her nutritional and active lifestyle.
 Session One: SOAP

Subjective:

 Client wants to gain muscle mass and increase overall strength. In addition, client wants

to be in a caloric surplus to eliminate weight loss while consuming healthy meals.

 Client wants to learn to properly and strictly meal plan by weighing every food item and

recording it into a food diary such as, “MyFitnessPal.”

 She uses supplements such as, whey protein, protein bars, and multi-vitamins.

Objective:

 Client is very active and weight trains 6 days a week and jump ropes 4 days a week.

 Client gained about 15 pounds over the past year and plateaued in the past 3 months.

 Client currently weighs 137 pounds at 5’8” with a BMI of 20.8 (normal weight) with a

goal of gaining weight.

Assessment:

 Calorie needs (EER) with physical activity are 2879 kcals.

 Excessive intake of protein (shakes and bars) and high stress can be a cause of her

IBS/bloating symptoms.

 Client has a high desire for change and has shown considerable motivation.

Plan:

 Teach client how to meal plan with nutrients from each food group and how to properly

portion control the weights of foods.

 Incorporate more grains, dairy, and oils in her diet while decreasing her excessive protein

intake. Build a meal plan according to her likings and healthy food choices.
 Session One: ADIME

Assessment:

 Client is a 20 year old female, weighing 137 pounds, and standing at 5’8” with a BMI of

20.8. She has a calculated calorie need of 2879 kcals a day.

 24 hour recall included intake of a 3 protein shakes, mozzarella cheese, 3 eggs, salad with

chicken, 2 protein bars, chicken with rice, cashews and raisins, green grapes, salmon, and

rice krispies with whole milk. This recall concluded a diet excessive in protein and fruits,

adequate in veggies, and low in dairy, oils, and grains.

Diagnosis:

 Problem: Assumed high intake protein from supplements based on client’s food recall.

 Etiology: Client’s diet consists of many protein supplements which are highly processed.

 Sign and symptoms: Client describes IBS symptoms and bloating.

Intervention:

 Focus on a well portioned plate per meal with variety of foods from the food groups.

Have foods listed into MyFitnessPal to keep track of her meals, macros, and calories.

 Dedicate about 2 days per week focusing on meal prepping including cooking, weighing

and tracking, and packaging them into containers so they are ready to eat.

 Include more dairy and grains into her diet. Slightly cut back on some protein

supplements and focus more on whole foods. Increase fiber intake and decrease artificial

protein sources to help with IBS symptoms and bloating.

Monitoring/Evaluation:

 Review and assess client’s anthropometric measurements along with changes in physical

appearance and weight. Track, record, and review her eating habits on MyFitnessPal

while keeping her training the same routine.

 Will have the client fill out a 3 day food log order to get a better understanding of her

eating habits and consistency. This will help me understand what foods she likes to

consistently eat so it can be included in her meal plan.

 Narrative of Session 2

Session 2 took place online on Zoom on 11/12/2022. After processing and understanding

our conversation during the first session, Zainab was much more confident and motivated to start

taking things seriously. Since the first session till now, she cleaned up her diet and started to

weigh food items and track them on MyFitnessPal. She tried her best to hit her EER goal of 2880

kcals per day but tended to go over by 100 on a couple of days. During this second session we

started taking things more seriously and talked about food monitoring tools and provided

nutrition education on the topic indicated in the questionnaire. In addition, I provided my client

with a 3 Day Food Log to fill out and return to our next session to better understand her eating

habits in detail.

After explaining the 3 Day Food Log, we then talked about certain food monitoring tools.

I explained the tool; “MyPlate” and Zainab did great on understanding it. However, she did

express her concerns on using MyPlate or DASH. She stated that even though these tools offer

great information, it will not be suitable for her as she can only follow a plan or change her

habits if she’s told strictly what to do and what to eat. The client was not capable of following a

food group plan and expressed a need for structure. As a result, we came to a mutual conclusion

on using a “Detailed Meal Plan” and “Meal Replacements” as our food monitoring tool. In

addition, the client wanted to log her food onto MyFitnessPal to make sure she does not skip a

meal.

Lastly, since the client was not just goal setting and wanted a serious plan to get things

started a SMART goal plan was not needed. Instead, I made a well detailed meal plan for her

which included meal replacements shakes in limit and increased fiber. The meal plan included

her favorite food items fitted to hit her EER and macronutrient goal of 50% carbs, 30% protein,
and 20% fats. The meats included in this diet were halal/kosher meats. Towards the end of our

session, I provided her nutrition education on topic indicated on her food frequency

questionnaire. I had stated the servings required for each food group and explained how she was

low in some while excessive in others.

 Food Monitoring Tool (Detailed Meal Plan” and “Meal Replacements)

Meal 1:
 1 bottle of Fair life protein shake
 40g of oatmeal
 3 whole eggs

Meal 2:
 1 bottle of Fair life protein shake
 8oz of whole milk
 70g of rice krispies cereal

Meal 3:
 6oz of grilled chicken breast
 140g white rice
 1.5 cups of green salad mix
 30g cashews
 0.25 cups of raisins

Meal 4:
 4oz of salmon
 140g white rice
 1.5 cups of green salad mix

Meal 5:
 1 quest protein bar
 1 banana
 1 cup green grapes

Snack (30 minutes before weight training)

 2 Rice Krispies treats

Intra shake (Drink while working out)

 50g Gatorade powder in water
 Nutrition Facts from MyFitnessPal

Total Calories: 2875

Total Carbs: 373g (50% of calories)
Total Protein: 200g (28% of calories)
Total Fat: 75g (22% of calories)

Meal Calories Fat (g) Saturate Polyunsaturated Monounsaturated Trans Fat (g)
d Fat (g) Fat (g) Fat (g)

Meal 1 510 20.5 6.5 1 1 0

Meal 2 603.3 10.5 6.5 0 0 0

Meal 3 636.1 16 3.7 2.4 8.2 0

Meal 4 382.5 14.3 3.1 0 0 0

Meal 5 367 9.7 3.2 0.2 0.1 0

Meal 6 375.7 4 1 0 0 0

Meal Cholesterol Sodium Potassium Carbohydrate Fiber Sugar Protein (g)

(mg) s (g) (g)
(mg) (mg) (g)

Meal 1 565 430 760 33 4 3 53

Meal 2 45 788.3 880 82.7 2.3 23.3 42.7

Meal 3 97.5 137.7 467.1 76.9 4.9 29.6 49.9

Meal 4 54.5 206.4 0 35.4 2.2 2 29.7

Meal 5 5 203 748 63.8 17.9 29.9 22.9

Meal 6 0 536.1 97.8 81.8 0 61.7 2

Meal Vitami Vitamin Calcium Iron

nA C

Meal 1 18 0 81 22
Meal 2 64.3 58.3 98 116.7

Meal 3 25 12.5 8.8 22

Meal 4 39.5 8 2 3.5

Meal 5 3 23 1 2

Meal 6 0 0 0 4

Session Two: ADIME

Assessment:

 Client is a 20 year old female, weighing 137 pounds, and standing at 5’8” with a BMI of

20.8. She has a calculated calorie need of 2879 kcals a day.

 Client has cleaned up her diet and ate 2800 to 3000 calories per day. Client is feeling

much more dedicated and motivated to get things rolling.

Diagnosis:

 Problem: Assumed high intake protein from supplements based on client’s food recall.

 Etiology: Client’s diet consists of many protein supplements which are highly processed.

 Sign and symptoms: Client describes IBS symptoms and bloating.

Intervention:
  Focus on the given meal plan and experiment with it to see how it suits her. Have foods

listed into MyFitnessPal to keep track of her meals, macros, and calories.

 Use the diet given in the food monitoring tool as a guide to help her meet her calorie and

macro goals. Positively reinforcing the clients eating habits with given diet with

encouraging text messages.

Monitoring/Evaluation:

 Track, record, and review her eating habits on MyFitnessPal while keeping her training

the same routine.

 Give the client a 3 day food log to record her progress and see what she eats with the

given diet.

Narrative of Session 3

Session 3 took place online on Zoom on 11/19/2022. The conversation started by Zainab

thanking me for everything that I’ve done for her and all the education and knowledge I’ve

provided to her. After just 2 sessions of meeting with my client, she learned a lot about nutrition

and continued to go out her way and teach herself more about nutrition and bodybuilding. Zainab

then stated that she followed the detailed meal plan every day and didn’t cheat once. She

weighed all her food to the nearest gram and enjoyed every meal. The client loved the meal plan

and didn’t want to change anything on it. She used zero calories sauces and spices to help bring

out flavor and savor every meal.

The client then started to talk about how she feels much stronger when weight training

and had high amounts of energy throughout the day due to the high carbohydrates in the diet.

The extra added fiber in the diet also helped her feel less bloated and her IBS symptoms started
to go down. Overall, the client’s week was a success both physically and mentally. She started to

feel more confident in herself and also stated that her weight went up about 0.5 pounds from

session 2 to now. The 3 day food log shows she ate the same meals for the 3 days.

After congratulating her on her high dedication and discipline, I emailed her the Physical

Activity Medical Readiness Form and the Physical Activity Feedback Form to fill out. For the

Physical Activity Medical Readiness Form she marked off “No” for all the questions and for the

Physical Activity Feedback Form all her standards were met and was at a level 4 (action) for

motivation. Since, she follows her own weight training and cardio plan; I did not change her

workouts. In addition, her physical activity is very active so no further action was needed for her

physical activity. I ended the session by giving her the Stress Awareness Journal to fill out for

next session.

Session Three: ADIME

Assessment:

 Client has cleaned stayed on track with the diet for a full 7 days. She has not cheated on

her diet once and ate everything according to plan.

 Client has gained 0.5 pounds in only a week and feels stronger in the gym.

 Client’s symptoms of bloating and IBS have significantly decreased.

Diagnosis:

 Problem: Assumed high intake protein from supplements based on client’s food recall.

 Etiology: Client’s diet consists of many protein supplements which are highly processed.

 Sign and symptoms: Client describes IBS symptoms and bloating.

Intervention:
  Focus on following the same diet again till the next session. Allowing the client to eat

anything of the plan on the following Saturday as a reward meal.

 Positively reinforcing the clients eating habits with given diet with encouraging text

messages.

Monitoring/Evaluation:

 Track, record, and review her eating habits on MyFitnessPal while keeping her training

the same routine.

 Follow up with text messages and emails.

Narrative of Session 4

Session 4 took place on 11/28/22 at Franklin Township Library. The conversation started

by the client stating that she still stayed loyal to the meal plan. On her free meal on Saturday

night she had a burger, fries, and milkshake to reward herself. Other than that she stayed strict

and kept eating the same meals that was listed on the plan. She stated that her body felt healthy

and strong. In addition, she did not have any symptoms from IBS or bloating from the

continuation of this diet plan.

The client said that she gained another 0.5 pounds this week and her physical appearance

has started to look more muscular and toned. She also started to lift heavier weights in the gym

and is noticing a lot more progress now than when she was not following a meal plan. Zainab has

started to get considerable amounts of compliments from family and friends. The client was
really happy with herself and for my help. In a matter of 2 sessions she stated that her symptoms

of IBS/bloating is nearly gone and she is fulfilling her goal of gaining weight.

After discussing her accomplishments and progress, I started to look over her stress

awareness journal that I have her last session to fill out and complete. According to the client and

the stress awareness journal, the client’s level of stress is almost to none. The journal states that

she felt stressed on 11/21/22 at 8am with symptoms of a headache due to a morning jog and her

way of fixing it was getting hydrated. In addition, she felt stressed on 11/23 at 8:30pm with

symptoms of anxiety due to homework so she took a break. Other than that, she does not have

high levels of stress.

We concluded this session by thanking each other for the month long journey we had.

Zainab will continue to reach out to me if she has any questions or just wants more education.

She was really sad that the sessions had come to an end as she was having fun and enjoying this

process with me. Overall, this journey was a success as I was able to help the client reach her

goals regarding nutrition and alleviate her IBS/bloating symptoms. She was an amazing client

and with her discipline and open mindedness she will be very successful.
 Session Four: ADIME

Assessment:

 Client has gained 0.5 pounds in only a week and feels stronger in the gym.

 Client followed the same diet for another week and is noticing much better weight gain

progress.

Diagnosis:

 High intake of protein from supplements and low dietary fiber intake related to frequent

consumption of highly processed protein supplements as evidenced by symptoms of IBS

and bloating.

Intervention:

 Client will continue to follow the same diet plan throughout the weeks.
  Client will still be contacting me if anything is needed or to answer her questions.

Monitoring/Evaluation:

 Keep her in contact and message her 2 times a month if needed to see how she is doing.

 Follow up with her to see if she is still gaining weight 2 times a month.

Case Study

1) Name: Zainab Bannout

Age: 20

Sex: Female

Marital Status: Single

Number of children: 0

Height: 5’8”

Weight: 137 lbs.

2) Occupation: Front Desk Assistant

Major: Criminal Justice

3) Clinical Diagnosis: IBS

4) No family history of any problems/diseases.

5) No further medical history other than IBS symptoms.

6) No pertinent lab values as the client has not gone for bloodwork for over a year.

7) The client does not use any medications. However, she does use supplements such as

protein bars and protein shakes. These supplements were limitedly included in her meal

plan to help reach her protein intake goal.

8) Nutrition and Eating Behavior:

 The clients overall nutrition seemed to be decent. Her previous diet was really low

in fiber and unnecessarily filled with highly processed protein supplements. Other

than that her nutritional intake of vitamins and minerals were decent according to

MyFitnessPal. The clients eating behavior was pretty controlled. She would

consistently eat 3-5 meals in a timely manner. The only problem was her small

portions per meal as she thought it seemed like a lot of food until she weighed and

tracked it all.

9) Social History:

 The client has a great positive social life. She is always surrounded by friends and

family that motivate her and encourage all her decisions. However, the only

psychological factor that the client has is that once she starts something she will

give her 100% and make many sacrifices to get it. For example, during this 4

week weight gain journey she stopped going out as much and canceled plans with

friends just so she could cook and eat her meals as well as train hard in the gym.

Although it was not such a big issue, talking to the client and explaining that it is
 still okay to go out and socialize helped her open up and enjoy both socializing

and dieting/training.

10) During session 1, our goal initially was to give her the proper calories (EER) and the

right macronutrients needed to eat in a day. Using that she could have just tracked her

foods on MyFitnessPal and eating more freely. However, this goal had to be changed

throughout session 1 to session 2. As she was a person in need for structure, I had to

make her a strict meal plan that would hit her EER target and her macronutrient goal.

Ultimately, this new technique gave us the best success on reaching her goal.

Audio Tape Evaluation

1) Before meeting with my client, I had taken the time to review the RDA’s for people

above the age of 19. As I learned about my clients IBS and bloating symptoms, I had

taken the time to research more in depth about nutritional related symptoms related to

IBS and bloating. I reviewed the recommended food group servings as well as MyPlate

and the calculations required for BMI, Calorie Needs, etc. In addition, I printed out

diagrams from MyPlate and the RDA’s to educate my client during session 1.

2) Verbal facilitation that I used during our sessions included active listening, managing

time, and setting guidelines. During our sessions, using active listening and setting

guidelines worked the most effectively. The client had a lot to say and in order for me to

properly understand and help her I listened to her every thought. In addition, setting
 guidelines such as a meal plan and eating timely meals helped reached her goal. The main

relationship building responses that worked effectively with the client was weekly

encouraging text messages. Not only did this make out relationship stronger, but it helped

push her to stay on track.

3) Behavior change techniques used were getting rid of junk food from the house and

tracking her meals on a daily. These methods were considerably effective according to

the client. Removal of junk food from the house eliminated any temptations of snacking

that could have aroused. In addition, tracking her meals assisted her on hitting her EER

goal as well as not forgetting to eat a meal.

4) After listening to the zoom recordings there were no messages or cues missed. We both

took our time and communicated and processed each other effectively. I did not move on

to the next topic until we both understood what we said to each other.

5) After these 4 sessions, I can confidently say that I focused on the main lifestyle issue that

concerned my client. The client was in a plateau with gaining weight for 3 months before

we started our sessions. After just 2 sessions she was gaining about 0.5 pounds a week. In

addition, her symptoms of IBS and bloating were starting to go away.

6) I did keep the focus of the session on my client’s main issue. In order to keep my client

on track, I sent her weekly encouraging and motivating messages and continued to check

up on her progress every 3-4 days. Furthermore, I created a flexible diet for her to follow

to hit her daily EER and macronutrient goal.

7) I was considerably impressed by the emotions expressed by my client after listening to

the recording. Each and every session showed excitement, motivation, and happiness

from my client. Every week her attitude became more positive as her results were coming
 in fast. These impressions were not different than what I understood at the time of the

counseling session. Her excitement was really easy to pick up on as she spoke with great

enthusiasm and kept smiling when talking about her success.

8) Before and during session 1, I was extremely nervous when it came down to counseling

my first client. After about 30 minutes into session 1, I was becoming more relaxed and

comfortable as we started to get to know each other and open up. My emotions at that

time did impact the session fairly. If I wasn’t so nervous at first then I could’ve asked her

more questions and talk to her more about nutrition in the hour we had together.

9) My overall impression on how my client responded was shocking. During each session,

the client was more and more excited. Even during session 1 the client did not show any

signs of nervousness. Her positive and comforting responses caused me to feel more

comfortable with the sessions.

10) If I could redo this session, I would try to meet the client in person during every session.

Even though the meetings on zoom got the job done, the environment was very different

as an in person meeting can be more professional. In addition, I would take the time to

prepare my thoughts and questions more before the meetings.

11) The audiotape experience had taught me a lot. Because of the recordings I was able to

pinpoint my weaknesses during my speeches. For example, during session 2 I noticed my

mind was starting to blank when I introduced the topic of the food monitoring tool. My

mind causing to blank could have been caused from nervousness or not preparing enough

before the meeting.

 Reflection of Sessions

1) Overall, all counseling sessions gave me a great experience. The best counseling session

was session 3. Session 3 showed that my client proved to be committed and motivated to

stay on track and to keep things going. For example, during session 2, I gave the client a

meal plan to follow. To a normal person it might have looked strict, but to my client it

was extremely easy as she works well with structure and strict plans. After concluding

session 2 and explaining the diet we waited to follow our third session. When session 3

started, I was mixed with positive emotions to hear that my client stayed on track with

her diet and fitness progress. Everything was a success and the client continued to thank

me for the help. The commitment to this diet and my clients positive emotions on her

progress made me feel happy which proves that session 3 was the best counseling

experience.
2) The main counseling strategies that I used were positively reinforcing the clients eating

habits with the given diet by sending encouraging text messages to keep pushing and not

giving up and by being available at any time needed throughout the days to answer any

questions or concerns she may have. For example, after giving her the meal plan during

session 2, I texted her encouraging and motivating messages every 2-3 days to remind her

to stay on track and why we started this journey. At the end, the client stated that these

messages helped her tremendously as somedays she felt like giving up but didn’t due to

my motivating messages. This reminded her to never give up. In addition, any time the

client had to macro match a food item due to the original foods being unavailable, she

would text or call me and I would respond to her immediately and allowing her to have

access to me at any given time.

3) There were not really any difficulties as the client and I became comfortable with the

process and she listened to everything that I said. During each session, I made sure to

answer every question and educate her to the best of her knowledge. One possible

difficulty that could have aroused was her letting go of her social life in order to stay on

track with fitness and training. After session 3, she stated that in order to get all her meals

in and have time for the gym, she needed to sacrifice her social life. She also stated that it

made her feel lonelier. After discussing her difficulty, we did reach to an immediate

solution. I restated that it is okay to still be on track while having fun. As a result, we

came to a conclusion that she will still be able to go out with friends but would simply

pack and bring her meals with her. And if she wanted to have a drink or two, then there

was no harm in doing so. After comforting her and positively reinforcing this behavior,

she became comfortable and still made her progress while bringing back her social life.
4) This experience had to be one of the best experiences I ever had! It was so much fun and

not only did I have my very own first client but I made a friend that I will continue to

help if needed in the future. This experience helped me step out of my comfort zone and

engage in face to face counseling. I always wondered how it would be to work in a

counseling session and now I have obtained the experience to answer my questions. The

4 weeks flew fast and I really wish it was longer or even had more clients to do this with.

Acquiring this experience will help me become a much better dietician/counselor in the

future. This project helped me ease my anxiety and prepared me for future counseling.