Client Care Counseling Critique Assignment Osteoporosis 1. Describe the counselling approach or aspects of different approaches used by the counsellor. Would a different approach have been more appropriate given the counselling situation? Why or why not? During this particular counselling session, the counsellor uses Motivational Interviewing and Cognitive Behavior Therapy when working with Mrs. Johnson, her client. In the case of Mrs. Johnson, the counsellor uses a very friendly approach that is both encouraging and positive. Considering that Mrs. Johnson is making considerable efforts to change her diet and lifestyle behaviors in order to help control her osteoporosis, this seems like the right approach to use. If the client was less interested in improving her diet and less determined to do so, then it might make sense for the counsellor to use a slightly more forceful approach. However, since Mrs. Johnson is evidently ready to change on her own, the best approach is to give friendly encouragement, which is what the counsellor does. Thus, in this particular instance, the Motivational Interviewing approach to counseling seems to be the best option for the counsellor. Motivational Interviewing is a form of counselling that gives the client a chance to target ambivalence. Here, the motivation to change one s behavior must come from the client. When Mrs. Johnson states that she has low levels of calcium, the counsellor asks her if she likes soy milk; she tells the counsellor that she does not. Consequently, the counsellor suggests that Mrs. Johnson try various brands of soy milk, because the taste could differ between the brands. Here, the counsellor tries to reduce her client s resistance to beneficial, high-in-calcium foods like soy. Cognitive Behavior Therapy is an approach to counselling where the patient addresses and unlearns self-defeating patterns of thinking. In this case, the counselor challenges addictive patterns of thinking in her client. She encourages Mrs. Johnson to cut down on her caffeine intake. She also emphasizes that caffeine leads to a loss of calcium in the body, thus encouraging Mrs. Johnson to reevaluate her negative habit. The counsellor also acknowledges her client s initiative to create positive changes in her life, such as weightlifting and going outside, in order to absorb some vitamin D into her body. It seems that a combination of approaches works best in this case because it allows for the counsellor to respond her client s changing needs. Furthermore, a combination of approaches also works well here because it helps the counsellor to target Mrs. Johnson s negative patterns of thinking. This type of approach is particularly useful with behaviors that are difficult to change, or clients that may be not very responsive to the counsellor s suggestions; as was the case with the suggestions made by the counsellor with respect to Mrs. Johnson s caffeine intake. 2. Identify, name and analyze 5 instances of basic counselling responses utilized for facilitation and relationship building. 1. Questioning: The counselor uses open-ended questions to explore how Mrs. Johnson has been doing since their last session.
2. Clarifying: The counselor uses different sized glasses to use as models to help the client describe how large of a glass of orange juice she drank yesterday. 3.Attending: The counselor asks, Have I lost you? at one point which is important as it helps the counselor know if the patient is understanding what is being said or not. 4.Empathizing: The counselor empathizes with the client concerning her dislike of root vegetables and provides a personal story about how she did not previously enjoy olives but after consuming them for a while she now likes them very much, and perhaps if the client continues to try eating root vegetables she will come to enjoy them as well. 5. Respect, praising: The counselor empowers Mrs. Johnson at the end of the session by expressing how she is doing a great job of changing her diet and lifestyle habits (affirming statements), expressing a belief in the client s ability to change and supporting her self-efficacy. However, she does this by stating I can tell whereas it would have been better if she had not used I and spoken instead in a more objective manner. 3. Identify, name and analyze 5 negative or ineffective responses exhibited by the counsellor in interacting with the client (i.e. roadblocks, counselling responses used inappropriately). 1. Distraction: The counselor answers the phone during the session, twice. While the conversations are short, this still interrupts the flow of the session and is unprofessional. 2. Shaming, ridiculing: The counselor judges people who smoke, asking how can anyone smoke today? Don t they know it is bad for them? This judgmental attitude then appears to make the client uncomfortable as she admits that her husband smokes. This causes the counselor some embarrassment. She would not have been embarrassed if she had not been judgmental. 3. Changing the subject: after the counselor brings up smoking and speaks of it in a judgmental manner, as Mrs. Johnson is noting that her husband is unsuccessfully trying to quit, the counselor quickly changes the subject (out of embarrassment), which is quite rude as well. 4. Not prepared: The counselor ran out of copies of the list of low-sodium foods. She tells Mrs. Johnson that she will mail her a copy, but this is not repeated later in the session, so it is possible she may forget to do so. When she was on her last copy of the list of low-sodium foods, she should have made more copies, so she would have them to offer future clients such as Mrs. Johnson. 5. Persuading with logic: When Mrs. Johnson expresses an interest in taking supplements to increase her calcium instead of making the necessary dietary changes, the counselor disagrees and roadblocks this discussion by encouraging the client to try to receive enough calcium through her diet. While getting the adequate calcium intake through her diet is a good idea for the client, the counselor could have discussed the benefits and drawbacks of taking supplements rather than basically ignoring the client s idea and disagreeing with her. 4. Comment on the non-verbal behavior exhibited by the counsellor and the client. The counselor begins the session by smiling a lot, which is a great way to express friendliness, but as the session continues she looks more serious and does not smile. It would have been better if she had smiled more often throughout the session. The counselor also uses hand gestures in an appropriate manner to emphasize her words, and nods her head to show that
she understands what Mrs. Johnson is saying. The counselor also sat at an arm s length from the client, which is a good distance, and made lots of eye contact. Writing down the client s dietary intake shows that the counselor is taking this aspect of the session seriously and does not want to miss anything. However, the counselor does ask open-ended questions very quickly and seems, in general, like she is busy or even rushing this becomes more obvious towards the end when the counselor looks at her watch and says that they do not have time to discuss how to read nutrition labels during this session. However, the next session is then scheduled for one month later, so Mrs. Johnson will not know how to read food labels for a whole other month. The client displays non-verbal behavior mainly by crossing her arm when something is mentioned that she is unsure of, such as the counselor s idea that the client add soy milk instead of water to her soups, to help increase her calcium intake. The client also makes a facial expression that shows discomfort when the counselor judges people who smoke, as the client s husband smokes. Otherwise, the client appears to be fairly comfortable, according to her nonverbal behavior. 5-What goals (if any) did the counselor (possibly with input from the client) identify during the session? Were the goal(s) identified appropriate? If yes, why? If not, how could they be improved upon? By using 24 hours recall the counselor goals during session was to increase calcium intake in client diet and gave her suggestion, alternatives and some strategies for healthy eating as well as reduce caffeine intake. The goals statement are S, M, A, R, T. 6-Comment on the phases of the session that you identified (involving, explorationeducation, resolving and closing). What are your recommendations for improvement? During the involving phase for this session, it is obvious that the counselor built a strong relationship with the client during the first session and there is a level of trust and comfort in their relationship. This second session begins well with a friendly greeting and some small talk about hair, including the counselor s compliment on the client s hair. The involving phase concludes with the counselor learning about the client s concerns regarding having an inadequate calcium intake. The exploration-education phase then begins with the counselor asking the client about her previous days dietary intake. The counselor analyzes the dietary intake in terms of its calcium content and then makes very good suggestions for how the client s calcium intake could be improved, both by reducing caffeine intake and eating more high-calcium foods. They also explore the issue of sodium intake and the counselor provides some information about how to reduce sodium intake, although she does not have the list of low-sodium foods to give the client. The resolving phase involved the counselor encouraging the client to eat high-calcium foods even though she may not like them; the counselor hopes she will learn to like them, as occurred with the counselor and olives. During the resolving phase, the counselor also asks the client about how well she has been doing at meeting previously set goals of becoming more physically active an getting outdoors for some sun three times per week. The closing phase was handled well by the counselor in some ways, as the counselor was very encouraging, stating that the client is doing a great job of making an effort to change her diet and lifestyle, and the counselor
also arranges their next appointment. However, the counselor does not summarize the session or remind the client about the goals that were set during this session. 7. Based upon your study thus far in the course, identify any additional strengths or weaknesses of the counselling session and provide suggestions for improvement. Be sure to include your rationale. In addition to what has already been stated, it is worth adding that the counselor s focus is a major strength. The client expressed concern about her calcium intake, and that is mainly what the counselor focused on during the session even the comments regarding caffeine were in relation to calcium. This focus demonstrates that the counselor is really listening to the client and responding to what concerns the client the most. However, while the counselor is friendly and focused, she also makes assumptions and is judgmental at a couple of points during the session. At one point, the counselor states, I assume that you check nutrition fact labels on food products However, the client does not do this and does not know how to. By assuming that the client does this, she makes it seem wrong when the client admits that she does not, and the client may even feel stupid for not knowing how to do something that the counselor assumed she does. This assumption makes the client uncomfortable and is unproductive, in a manner similar to how the counselor s judgment of smokers made the client feel. 8. Create a chart note for this interaction based upon the information provided in this video and accompanying preamble. Identify the charting format you have chosen. SOAP Note: Subjective: The client returns for her second nutrition counseling session. She has been trying to include more calcium-rich foods in her diet, such as yogurt, cheese and soy milk, but she is struggling and feels that she is still not consuming an adequate amount of calcium. Objective: The patient has osteoporosis so recommendations have been made to help her increase her calcium intake as a treatment. According to her recollection of her previous day s dietary intake, her calcium intake is low, while her caffeine intake is quite high. Assessment: 1. Osteoporosis 2. Low calcium intake Plan: 1. Client has agreed to try to cut back on her caffeine intake by switching to decaffeinated beverages for some of the drinks she has during each day. 2. Client will continue to try to achieve her goal of consuming more calcium-rich foods. 9. Identify your significant learnings from completing this assignment. One thing I learned from this video is how being friendly can set your client at ease and make them feel comfortable. Meanwhile, making assumptions about them and judging behaviours (such as smoking) that they or their family members may engage in can make them
feel very uncomfortable. This is an important point: just because the client does not smoke, or eat fast food, or play video games for hours, that does not mean it is okay to judge these behaviors or speak ill of them, as the client may have friends or family who engage in these behaviors. Even if they do not, it is still not a good idea to judge people for their behaviors. We all have our weaknesses. Also, I learned to always keep extra copies of useful documents ready, such as lists of foods to eat for certain reasons (including reducing sodium). Finally, I would like to remember, if I am a counselor some day, to continue smiling throughout a counseling session, not just at the beginning. Smiling is a great way of expressing friendliness with little effort it is important to remember to keep smiling (but not in a fake way, in a genuine way).