COUNSELING SKILLS TRAINING:Improving Client Outcomes

DietitianInstitute.com

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PRINT OUT SLIDES

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TODAY, WE ARE GOING TO TALK ABOUT…

➤ The psychology of behavior change ➤ The challenge of maintaining habits ➤ Beyond the SMART goal ➤ Approaches you need in your toolbox to help clients ➤ How to keep clients coming back (excited and

motivated)

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THE PSYCHOLOGY OF BEHAVIOR CHANGE

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Shift your perspective

on client attitudes

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STAGES OF CHANGE

➤ Pre-Contemplation ➤ Contemplation ➤ Preparation ➤ Action ➤ Maintenance

Behavior Change l Motivational Interviewing

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ADDRESS WHERE YOU CLIENT IS ON THE STAGE

OF CHANGE SCALE

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BEHAVIORS ARE COMPLEX

➤ Almost all behaviors are complex and have multiple working parts

➤ Break down the behavior ➤ Tackle each part successively

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“ What are we truly asking of our patients?

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“We are asking our patients to change the ritual without teaching them how

to do it.

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THE CHALLENGE OF MAINTAINING HABITS

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PSYCH OF RESTRICTION

➤ The longer foods are forbidden the more seductive they become

➤ Dieting mindset overwhelmingly leads to feelings of rebellion, guilt, shame and deprivation

➤ Frequently, post-diet bingeing and rebound weight gain occur

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AFFINITY FOR SHORT TERM FIXES

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21 DAYS TO CHANGE A HABIT?

➤ Based on Psycho-Cybernetics by plastic surgeon Dr. Maltz ➤ OBSERVED phenomena that tended to show that it

requires a minimum of about 21 days for an old mental image to dissolve and a new one to jell.

➤ Psycho-Cybernetics was published in 1960

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“ 66 day average to change a habit. *Range 18-254 days

-European Journal of Social Psychology (2009)

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STUDY: COOKIES & RADISHES

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COOKIES & RADISHES

➤ 1996, Case Western; 67 participants ➤ Examined whether “willpower” was a finite resource ➤ Freshly baked cookies smell + seeing an assortment of

chocolate treats

➤ Participants being tested were told to only eat radishes ➤ Test: Puzzle that could’t be solved

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“ Those who ate radishes made far fewer attempts and devoted less than

half the time solving the puzzle compared to the chocolate-eating

participants. 

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CONCLUSION: SELF CONTROL IS EXHAUSTIBLE AND CAN BE EXHAUSTING

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APPROACHES YOU NEED IN YOUR TOOLBOX TO HELP

CLIENTS

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“What is the clients biggest obstacle(s)?

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HOW DO YOU HELP CLIENTS WHO …➤ Seemingly resistant to change? ➤ Constant and negative self talk? ➤ Feel “too busy” to take care of themselves? ➤ Out of touch with their bodies signals?

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MOTIVATIONAL INTERVIEWING

MINDFUL EATING

NARRATIVE COACHING

INTUITIVE EATING

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MOTIVATIONAL INTERVIEWING

➤ Helps resolve ambivalence ➤ Ambivalence: the state of having mixed feelings or

contradictory ideas ➤ Internal motivation needed for behavior change ➤ Practitioner holds the map, but patient is driving

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BEST: WHEN PATIENT IS REQUIRED TO FOLLOW A

SPECIFIC DIET FOR DISEASE MGMT

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NARRATIVE COACHING

➤ Helping client create a new inner monologue ➤ Challenging negative self talk ➤ Provides positive, but realistic mantras ➤ Used in conjunction with other approaches

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BEST: CLIENTS WHO ARE SEEMINGLY NEGATIVE OR

RESISTANT TO ANY ADVICE YOU GIVE THEM

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MINDFUL EATING➤ Effective in conjunction with any approach (even diet

based approaches) ➤ Art of being aware and present in the moment ➤ Modern life has made mindfulness and mindful eating

more difficult

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MINDFUL EATING

➤ Eating slowly and without distraction ➤ Listening to physical hunger cues and eating only until

full ➤ Distinguishing between actual hunger and non-hunger

triggers ➤ Engaging your senses by noticing colors, smells,

sounds, textures and tastes ➤ Noticing the effects food has on how you feel

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BEST: MOST CLIENTS CAN BENEFIT FROM MINDFUL

EATING

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INTUITIVE EATING➤ Encourages client to build a healthy relationship with

food ➤ Based on idea that restrictive eating patterns lead to

diet failure ➤ “No one can be the expert of you.”

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PRINCIPLES OF IE1. Reject the diet mentality

2. Honor your hunger

3. Challenge the food police

4. Make peace with food

5. Respect your fullness 6. Discover the Satisfaction Factor

7. Honor your feelings without using food

8. Respect your body

9. Exercise (feel the difference)

10. Honor your Health

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BEST: CLIENTS WHO HAVE STRUGGLED WITH

RESTRICTIVE EATING PATTERNS OR EMOTIONAL

EATING

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BEYOND THE SMART GOAL

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“ I want to lose 20# over the next 6 months by walking 2 miles 4 times

per week and reducing my overall calorie intake to 1600 calories. I will track my walking and calories on my

FitBit.

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CLIENT GOAL➤ 35 year old female ➤ 190#, 5’4 ➤ No known health issues ➤ Meds: MVI ➤ Works as Physician’s assistant ➤ Current Activity Level: Sedentary, but played sports in

college (~6 years ago) ➤ Stage of change: Preparation; Motivation: High

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PROS OF SMART GOALS

➤ Offer specificity for client goals ➤ Encourages clients to be realistic ➤ Supports monitoring and tracking of progress

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CONS OF SMART GOALS

➤ Can still be too broad ➤ Discourages goals that focus on “how you feel?” ➤ Don’t naturally encourage us to break down the end

goal or the steps ➤ Lack a “why?”

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BEYOND THE SMART GOAL➤ “Why” do you want to lose 20#? ➤ What can you measure besides weight or calories? ➤ What happens when you have a stressful day at work? ➤ What are the big picture goals? ➤ In what tracking time increments will the client be the

most successful?

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HOW TO KEEP CLIENTS COMING BACK

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HOW TO KEEP CLIENTS COMING BACK

➤ Personalize the approach ➤ Whole body approach ➤ Don’t do a “knowledge” dump ➤ Measure and track ➤ Maintain accountability ➤ Create smart packages

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HOW TO KEEP CLIENTS MOTIVATED AND EXCITED➤ Build rapport ➤ Structure sessions to maintain motivation, excitement ➤ Work in groups ➤ Between session support

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DietitianInstitute.com

Motivational Interviewing & Intuitive Eating Trainings

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THANK YOU!

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