Resource for Trainers

Learning objectives

This page provides some important learning objectives for students to aim for while studying each chapter of Counselling Skills for Dietitians.

Part 1: Using a counselling approach in patient-centred practice

Chapter 1: The dietitian

After reading and studying this chapter, students will be able to:

• • describe the traditional role of the dietitian as an instructor, teacher, adviser and guide;
• • explain why a patient-centred approach is now used;
• • discuss the issue of control between dietitian and patient;
• • describe the philosophy and qualities of the dietitian who uses counselling skills;
• • list the benefits of reflective practice;
• • name and describe at least two other approaches/models in counselling and psychotherapy;
• • summarise the evidence about the use of communication skills in dietetic practice.

Chapter 2: The patient

After reading and studying this chapter, students will be able to:

• • describe a patient’s likely concerns about (i) their appointment with the dietitian and (ii) living with a chronic condition;
• • describe the nature of change and typical reactions to change;
• • discuss the evidence relating to patient satisfaction and the implications for dietitians;
• • list the likely feelings and hopeful expectations of patients.

Chapter 3: The relationship between dietitian and patient

After reading and studying this chapter, students will be able to:

• • describe each of the core conditions of empathy, genuineness and acceptance, and explain their importance in developing a helping relationship;
• • explain how the issues of power, dependency, transference and counter-transference may arise and affect the relationship between dietitian and patient;
• • describe three elements of the working alliance and their possible implications for dietetic practice.

Chapter 4: Aspects of the helping process

After reading and studying this chapter, students will be able to:

• • discuss the importance of maintaining boundaries concerning time, confidentiality and professional role;
• • explain the stages in the helping process according to Egan’s model;
• • describe the process of change;
• • suggest ways in which a dietitian could help a patient resolve their ambivalence;
• • give an example of how a dietitian might apply a systemic approach in a patient interview;
• • describe how a dietitian could ensure a satisfactory ending to a relationship with a patient;
• • give an example of a situation in which a dietitian might discuss a referral to a counsellor with a patient, stating the words that they might use.

Chapter 5: Conducting a structured interview

After reading and studying this chapter, students will be able to:

• • explain the practical and personal aspects to consider when preparing for a patient interview;
• • list non-verbal ways in which a dietitian can create a good first impression;
• • describe how first impressions are formed and how they can affect the way a dietitian communicates with a patient;
• • describe how to begin an interview, giving examples of questions which a dietitian might ask a patient;
• • give an example of how to set an agenda for an interview with a patient;
• • describe, with examples, some counselling skills to be used when discussing motivation with a patient;
• • name and explain some of the pitfalls to avoid when giving dietary advice;
• • describe some ways in which a dietitian could make the process of taking a diet history more patient-led;
• • explain how a dietitian could (i) track the helping process and (ii) monitor the relationship with the patient;
• • list the components that make for a satisfactory ending to a patient interview;
• • give examples of reflective questions that dietitians could ask themselves after a patient interview in order to learn from the experience.

Part 2: The skills

Chapter 6: Active listening

After reading and studying this chapter, students will be able to:

• • define the process of active listening;
• • describe the non-verbal skill of attending;
• • describe briefly at least two potential barriers to listening;
• • list six aspects of a patient’s non-verbal communication of which a dietitian needs to be aware;
• • explain the value of attending to non-verbal communication and how to interpret discrepancies;
• • explain the benefit of maintaining a silence in a dietetic interview;
• • describe mirroring: what it is and its purpose;
• • list the advantages and disadvantages of touch as a way of communicating with a patient.

Chapter 7: Ways of responding

After reading and studying this chapter, students will be able to:

• • explain why some responses may entail a higher risk than others of creating a barrier between patient and dietitian;
• • name six categories of verbal responses: three high-risk and three lower-risk;
• • give one verbal example of each;
• • give an example showing how a low-risk response can become high-risk and vice versa, and explain how this can happen;
• • give an example of words which are empowering for the patient and which offer possibilities, and words which convey the opposite;
• • describe the effect of reflective responding and explain when this is useful;
• • name four specific ways to reflectively respond;
• • name the four levels of reflection;
• • give one or two examples in which a dietitian observes how a patient is feeling and state how the dietitian could helpfully respond;
• • name three words which indicate the use of (i) visual, (ii) auditory and (iii) kinaesthetic language and give examples of replies which mirror each category;
• • explain a situation in which reflective responding would not be appropriate;
• • explain the risks of self-disclosure.

Chapter 8: Making helpful interventions

After reading and studying this chapter, students will be able to:

• • define the purpose behind a helpful intervention;
• • list four categories of helpful intervention and give one example of each;
• • describe how a dietitian’s attitude to a patient might affect the way they intervene;
• • explain why the timing of an intervention is important and give an example to illustrate this;
• • give an example of how a dietitian can gently confront a patient using reflective responding;
• • list the pros and cons of using questions when taking a diet history;
• • list the advantages and disadvantages of asking closed and open question and describe the effect each is likely to have;
• • give an example of a reflective response focusing on (i) feelings, (ii) thinking and (iii) behaviour;
• • describe how a dietitian might respond to a patient who contradicts themselves;
• • briefly explain the concept of cognitive behavioural therapy (CBT);
• • give an example of a patient’s negative thought and the assumption which underlies it, as well as an example of a more helpful thought that could replace it;
• • list two ways in which a dietitian might help someone to challenge a negative thought.

Chapter 9: Conveying a clear message: assertiveness in action

After reading and studying this chapter, students will be able to:

• • define what is meant by assertive communication;
• • explain briefly the link between assertiveness, self-awareness, self-esteem and counselling skills;
• • explain the difference between assertive, aggressive, passive and manipulative behaviour;
• • describe the advantages and disadvantages of assertive behaviour, giving examples of each;
• • describe how to prepare to deliver an assertive message;
• • describe assertive body language;
• • explain the acronym FEW;
• • describe some ways to respond assertively when the recipient of a previous assertive message discounts what has been said;
• • give an example of a dietitian making an assertive communication (i) with a patient and (ii) with a colleague;
• • write a fictitious short dialogue in which a dietitian confronts a patient about their lack of motivation;
• • list a useful sequence of steps to follow when responding to a criticism in an assertive manner;
• • state how to (i) give positive feedback and praise in a way that diminishes the risk of sounding patronising and (ii) receive positive feedback and praise in a way that reduces the risk of the other person feeling discounted;
• • state two methods/ways in which to defuse aggressive behaviour;
• • describe briefly how to look after oneself after an aggressive encounter.

Part 3: Putting skills into practice: further considerations

Each chapter in Part 3 focuses on particular points for dietitians to be aware of in situations commonly encountered in dietetic practice.

After reading and studying the chapters in Part 3, students will be able to:

• • be aware of how a patient may react in each situation;
• • be aware of the various points the dietitian needs to pay attention to;
• • consider ways in which a dietitian could apply counselling skills in each situation.

Part 4: Areas for personal and professional development

Chapter 15: Developing self-awareness

After reading and studying this chapter, students will be able to:

• • explain why self-awareness is important when communicating with another;
• • briefly describe mindfulness;
• • list six ways of increasing self-esteem;
• • explain why it is important for dietitians to recognize stress (i) in themselves and (ii) in others;
• • give two examples which illustrate how one might deal with stress (i) in the short term and (ii) in the long term;
• • give an example of managing a stressful situation using CBT;
• • briefly describe how a reflective diary might be useful for self-support.

Chapter 16: Giving and receiving support

After reading and studying this chapter, students will be able to:

• • describe two instances in which a dietitian might feel challenged beyond their limits;
• • list five ways in which a dietitian could support themselves;
• • list (i) six useful tips for asking for support from a colleague and (ii) six tips for providing effective support to a colleague;
• • explain the purpose of casework supervision;
• • briefly describe how personal counselling might help someone.