Counselling Skills for Dietitians

Judy Gable, Tamara Herrmann

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118943786
• Edition: 3
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

The third edition Counselling Skills for Dieticians has been fully revised and updated to reflect the recent developments, research and interests in the field. It explores the skills required for dietetic counselling, and includes frequent examples of dialogue from patient consultations, as well as exercises and activities so that the reader can undergo experiential learning relevant to their practice.

• Includes examples from daily practice to illustrate the difficulties encountered by dietitians and demonstrate the application of counselling skills
• Clearly explains theoretical models of accepted counselling practice underpinning the skills described
• Has been updated to include additional information on topics such as assertiveness skills and eating distress
• Addresses practical and psychological issues faced by dietitians and patients
• Includes the latest research evidence for counselling skills in dietetic practice
• Draws upon research evidence, theory and experience from the fields of psychotherapy and counselling
• Now provides access to a range of supportive online material including videos of consultations, case studies and resources for trainers

PART 1
Using a counselling approach in patient-centred practice

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1. Chapter 1 The dietitian
2. Chapter 2 The patient
3. Chapter 3 The relationship between dietitian and patient
4. Chapter 4 Aspects of the helping process
5. Chapter 5 Conducting a structured interview

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CHAPTER 1
The dietitian

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

World Health Organization, 1948

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In this chapter, we discuss:

• The role of the dietitian
• Using a prescriptive approach
• Changing approaches to providing health care
• Developing a patient-centred approach
• Introducing counselling skills
• Developing a counselling approach
• Qualities for a dietitian to develop
• Personal and professional development
• Different approaches to counselling and psychotherapy
• Overview of the evidence concerning the use of communication skills in dietetic practice.

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The role of the dietitian

Whether working in a hospital, the community, private practice, the media or academia, a large amount of a dietitian’s time is spent interacting with other people, such as patients, students, colleagues and professionals from other disciplines and walks of life. The role is therefore varied and challenging. Dietitians need to provide tailored, practical nutritional advice based on the latest scientific research, while at the same time considering carefully how best to communicate with a diverse range of people in many different contexts.

The manner in which dietitians communicate their knowledge is gaining increasing attention. The Curriculum Framework for the Pre-Registration Education and Training of Dietitians, launched in 2013, includes communication as a key subject (British Dietetic Association 2013 ). The ability of dietitians to communicate effectively on nutrition matters and dietary management with a broad range of people in a variety of settings is now seen as crucial (Health and Care Professions Council 2013 ). The change in the National Health Service (NHS) from a prescriptive approach towards a more patient-centred one has emphasised this. Nowadays, many dietitians describe their role as one of facilitating behavioural change or of nutrition counselling (Cant & Aroni 2008b ), and they see themselves as guiding others to make appropriate and healthy choices with regard to diet. In order to facilitate this process, a number of dietitians have undertaken various introductory courses in counselling skills, and some have undertaken advanced training.

Effective communication lies at the heart of counselling skills. However, an understanding and appreciation of the value of these skills and competence in using them only develops with practice. Therefore, to become competent and confident in their role as patient-centred practitioners, dietitians need to consciously apply these skills in their daily work.

Using a prescriptive approach

Traditionally, the communication skills used by dietitians have centred around advising, teaching, informing and instructing in order to pass on knowledge to others. This approach fits well with a medical model of health care, in which patients are expected to comply with dietary advice given by a dietitian, in order to improve their condition. When using the prescriptive approach, the relationship between patient and health professional is based on the authority and expertise of the latter. Dietitians using this approach are therefore in a position where they have most control over what takes place. They may not always find this satisfying, however; especially when a patient does not respond to the prescribed therapy.

When faced with an authoritative figure, patients may be anxious, outwardly acquiescent and in awe of the health professional. On the other hand, they may be openly or covertly rebellious. Recent research into dietetic practice shows that most patients prefer an individualised and empathic approach (Hancock et al. 2012 ). Nevertheless, while considering possible problems with a prescriptive approach, we also acknowledge that there are some patients who state that they prefer a practitioner-led consultation, where information-giving and an educational approach is sufficient (Hancock et al. 2012 ; Endevelt & Gesser-Edelsburg 2014 ). It therefore seems crucial that the dietitian possesses the flexibility to adjust to the patient’s preferred style (Hancock et al. 2012 ), as addressed later in this chapter.

Control, compliance and responsibility

The prescriptive approach, as already explained, and as applied in Scene 1 of the video accompanying this book (www.wiley.com/go/gable), raises issues to do with compliance and responsibility. This approach allows and encourages patients to relinquish responsibility for their actions. Patients may comply in order to please the dietitian. If they do not comply, then they are in a position to blame the dietitian for the apparent failure of the treatment plan. Dietitians can then find themselves accepting this as their responsibility, or, alternatively, blaming the patient for their non-compliance. In effect, they assume a parental role, while the patient assumes the role of a child. The psychology of this is best explained with the model of ego states used in transactional analysis (TA) (see Transactional Analysis, p.).

When faced with a problem, many helpers, as the experts with authority, feel a responsibility to come up with a solution for the person they are helping, and see it as their job to use persuasion as a means get their solution adopted. Dietitians who think they should be the ones to provide the solution to a problem are also likely to associate compliance on the part of the patient with their own effectiveness. It is then tempting for the dietitian to resort to a variety of strategic communications in an attempt to feel better. If the patient does not follow their advice, dietitians are likely to use methods which allow themselves to be in control, such as lecturing the patient on the importance of modifying their diet. They are also more likely to resort to m...