Olivia Wooliver NUTR 422 10/30/2013 Critical Evaluation of Role Play

2 The area of Nutrition counseling and education is a staple in Dietetics. As professionals, we must be able to communicate effectively with clients from all settings in terms of background, attitude, and nutrition knowledge; we must know how to properly assess and evaluate the clients needs in promoting behavioral change. During the role-play activity, each group member was given the role of counselor, client, or evaluator; roles were switched until each member had participated in each role. This exercise was very beneficial in that it gave us hands-on practice with the material we have learned thus far in terms of communication skills, professionalism, behavior modification, motivational interviewing, and the client-centered approach. Additionally, it made us realize that counseling sessions are not always black and white; two separate sessions will not move in the same direction or proceed through the same series of stages. It is up to the counselor to pinpoint the specific stage and move forward from there. My group mates were Dana Omari and Louise Peery.

My Role as Counselor In the first session, Louise was my client, and Dana was the evaluator. Louise came to me as a middle-aged, normal-weight woman with high cholesterol. From the getgo, I picked up on two signs of her motivation to change. First, she knew the implications and expressed fear of the potential health consequences associated with her condition. Second, she made it clear that she sought a Nutritionists help on her own, without a doctors order. At this point, I reflected back and summarized her statements to ensure that what I was hearing was correct; I then determined that lowering cholesterol was her chief concern and that her motivation to change was fairly high. After asking what she

3 thought could be done, she expressed feelings of confusion on how to go about lowering her cholesterol, specifically about what to cook and how to appease her family with healthier meals. I began asking her what she had tried in the past in addressing the problem; I gathered that her daily schedule was very busy, including transporting kids to and from school and various other functions on top of a 9-5 job. Essentially, she was too tired by the end of the day to cook something healthy, and the few times she did try, the family was not happy with the meal. I then tried to pinpoint details of her meals, i.e. what she normally cooked, what the family did not like, etc. She really had no idea where to start in terms of making her meals healthier, so I proceeded to offer some education on simple ways to cut out cholesterol in meals as well as resources for healthy options that would be acceptable by her family. I also recommended attending cooking classes, eating out less, educating her husband on healthy habits, and I finally ended my education spill with the recommendation of increasing physical activity. I did not realize at the time, but this was obviously information overload for Louise. She gave me permission to offer education, but offering so many options left her overwhelmed, and I failed to pinpoint an area to focus on or ask her which option she would rather focus on. The session ended with a known motivation to change, a known stage of change (Preparation/Action), and a summary of goals to work towards. I feel that my ability to reflect back and summarize the clients comments and concerns was a strong point throughout the session, as well as the fact that I was empathetic with her fears and expressed my true intent to figure out ways to reverse the problem. I made it a point to leave decisions up to Louise, i.e. chief areas of concern and ways to go about change. Given the fact that Louise came to me with only one problem,

4 i.e. high cholesterol, the initial chief concern was not hard to pinpoint. Things got messier when I began giving the client nutrition education and recommendations; I threw a lot at her at one time, and I failed to address areas that the client felt were most attainable, which left her overwhelmed and confused on where to start. Overall, as the counselor, I should have been more specific in the area of implementing change and the clients thoughts on which change to tackle first. I should have ended the session with a more detailed plan and a more simple, specific goal for Louise to work on.

My role as Client In the second mock session, I was Danas client. I sought Danas nutrition expertise because I had hypertension, high cholesterol, and was obese, which I voiced to her initially. She proceeded to ask about my feelings pertaining to my conditions. I explained that I was extremely fearful about the potential health consequences and the chance that I would not live to see my grandchildren; I made it pretty evident that my motivation to change was decently high. The counselor proceeded nicely to the next step of asking what I believed needed to be done and if I had implemented strategies for change previously. At that point, I basically read the rest of my client issue slip; I explained that I sit at my desk all day at work and rarely exercise; I skip breakfast and lunch, so by the time I get home from work I am really hungry and eat, mostly snack foods, consistently from then until I go to bed. I made it evident, via a tone of distress in my voice, that I knew my daily lifestyle was unhealthy and that I needed to change. At this point, Dana tried to figure out why I engaged in such unhealthy activities; I explained

5 that because there were so many ailments in my lifestyle and diet, I was overwhelmed about where to start. I figured there were so many things to keep track of in a day that messing up one of them was reason enough to revert back to old habits and that most of my previous attempts had failed because of that. At this point, Dana offered to provide education on the potential long-term outcomes of my habits, which I accepted. However, because I already knew that my activities were unhealthy, this education did not mean much. I was then asked what short-term goals I thought were achievable; I proceeded to go down the list in terms of trying to get more exercise, making it a point to eat breakfast and pack my lunch every day, and replace snacks with nutrient-dense foods. Finally, Dana summarized the session and the goals I formulated. As the client, I felt the session had no real direction or strategy. Dana did a good job with asking open-ended questions, supporting my autonomy, and allowing me to voice my concerns, but that is as far as it went; I feel I was being asked a new question without addressing the previous one. Additionally, as I know the client should be talking for the majority of the session, I felt as if I were not only talking excessively but also leading the session; either I was trying too hard in terms of my client role, or the counselor was not doing her job in steering the session in the right direction. The aspect of collaboration was lacking; I believe the cause of this was that after mentioning some short-term goals, I was never asked how I felt about them or which ones I felt were most attainable. This, in turn, left no room for evocation. Overall, Danas strengths were evident initially, but as the session proceeded, no concrete plan developed.

6 My Role as Observer In the third session, Dana was the client, and Louise was the counselor. Dana took on the same role as Louise in the first session: a middle-aged, normal-weight woman with high cholesterol. As Louise initially identified high cholesterol as the chief concern, she still was unsure of Danas attitude, knowledge, and motivation to change, so she proceeded to decipher these areas. After asking Dana her thoughts, feelings, and how to possibly reverse her high cholesterol, Louise determined that Dana had become rather unenthusiastic about changing. She said she had formerly tried sticking to low-fat diets, but after seeing no results in terms of lowering her cholesterol, she returned to old ways. At this point, Louise interpreted a low motivation to change. Still unaware of the root of the problem, Louise asked Dana why she thought her attempts to eat healthier were not working. Dana mentioned that her husband made it very hard for her on account of his constant demand for good, i.e. unhealthy, foods, as well as the fact that they enjoyed eating out together regularly. Dana made it clear that her husband came first and that eating out less was not an option. At this point, Louise did a good job of resisting the urge to persuade and educate on the effects of eating out regularly; she maintained the clients autonomy and moved on to other areas in which the client would be more willing to make changes. However, moving on to other areas proved to be difficult for the counselor; the client did not seem to want to give very detailed information, such as what exactly she ate on dinner outings or how she might change dinner choices for the healthier. I think Louise struggled to pinpoint a specific area that the client would be willing to change, or if the client was willing to change period. At the same time, I think Dana as the client was trying to keep her story straight and not giving Louise much more to go from. However, I

7 think Louise did a good job of moving the session forward without coming off as too autonomous and allowing Dana the opportunity to voice potential concerns, despite the scarce nature of her responses. As the client was obviously in the Precontemplation/Contemplation stage of change, Louise eventually asked permission to offer education on the potential consequences of high cholesterol. The client accepted but gave little evidence as to whether or not she took Louises education to heart. A selfmonitoring plan was suggested to the client, and the counselor ended with a summary of the session. As counselor, Louise was very detail-oriented, which I feel steered the session in the right direction and kept the client focused on initial, easily achievable goals; this was a definite strength. I also think Louise did a good job at keeping her cool, for lack of better words, in times of awkwardness and confusion throughout the session. She kept herself from taking on the role of food police and made sure to steer clear of education overload. The fact that she maintained the clients autonomy and left decisions up to her, despite the clients seemingly unwillingness to address details, was a major strength. Additionally, I think it was a good call on Louises part to recommend the 3-day selfmonitoring strategy; she was not making much ground in terms of sparking motivation in the client, and I feel that seeing the actual amount of fat she consumes daily may do so. Overall, I think Louise did a good job in active listening, attempting to pinpoint key areas of concern, assessing the clients knowledge and prior attempts at change, and attempting to identify areas in which the client was more willing to change. The session as a whole conveyed the fact that clients are not always going to be as responsive as we

8 would like, but it is the counselors job to work around these obstacles and use his or her skills to identify the most affective way of getting through to the client. On the whole, this activity was very beneficial in practicing the techniques we have learned in class and strengthening our skills in terms of nutrition counseling. Several obstacles arose, i.e. confusion on what stage of change the client was in, the clients key areas of concern, what questions to ask, when to provide education and what kind of education to provide, and others. However, finding solutions to these problems was an important exercise in itself in that, as Registered Dietitians, we will be faced with similar obstacles daily.