Grace Kim

Counseling Critique Assignment

Part I: The Initial Interview

Subjective Data
Patient background/history:
Weight remains fairly consistent
On a scale of 1-10 (1 being very hungry and 10 very full): eats at a 2-4 and stops eating
around 8
Occupation: graduate student (heavy credit load this semester)
Cultural background: Chinese-American

Diet recall notable for:

Variation in a typical day diet and meal times because dines out/eats sporadically
around class and work schedule
Can cook and cooks Korean food occasionally (stews, rice-based meals)
Dines out between classes/weekends (on average 3-4x per week)
Eats relatively smaller breakfasts or skips altogether
Drinks herbal teas. No coffee or sodas. Fruit juices occasionally.
Has a big sweet tooth. Eats sugary snacks between meals.
Inadequate vegetable intake
Could increase fruit intake
Eats fast between classes, will go long stretches without eating when busy or at work and
becomes very hungry

Physical activity:
Sedentary lifestyle both as student and job at library
Walks between class and work and between 10-minute walk between subway and home.
Rarely goes to the gym (no free gym at her university) or exercises.

Typical day diet:

Breakfast: 2 hard-boiled eggs w/ wheat toast or half a bagel w/ cream cheese
Lunch: Sandwich and/or soup from fast-casual restaurants (Pret, Chipotle, delis).
Leftovers from dinner if at home.
Dinner: Pizza, Thai food, sushi etc. when dining out. Stir-fry, pasta, Korean dishes when
cooking at home.
Snacks: granola bars, baked goods (pastries, cookies), fruit (bananas, apples, grapes).

Willingness to try SMART goals: 8/10

Objective Data
Name: YH
Age: 24

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Gender: Female
Height: 54 Weight: 125 lb BMI: 21.5
Estimated healthy weight: 110-140 lb (BMI 19-24)
Rec kcal/day: 2000 kcal
Relevant Meds: None Allergies: None
24-hour recall:
Breakfast: Trader Joes Honey Crunch n Oats cereal (about 1 cup) with almond milk (1
cup)
Lunch: Sandwich with turkey, swiss cheese, lettuce, tomato, mayo on pumpernickel
bread (5 inches). Chocolate-chip cookie (3 inches)
Snacks: Banana w/ tablespoon of peanut butter. Hot chocolate (1 cup)
Dinner: Salmon and avocado rolls (8 pieces) w/ soy sauce. Miso soup (1/2 cup). Green
tea ice cream (1 scoop shared with a friend)

Assessment
Although patient YH does not have immediate medical concerns or health problems, she
acknowledges that her diet could improve, especially through inclusion of more (fibrous and
nutrient dense) fruits and vegetables. Her snacks and meals usually have added sugar in them, as
she is a self-proclaimed sweets lover. Because she is a busy student, her priorities may lie in
cheap, filling, and convenient food over healthy food. She was not an athlete, and her school
does not have a gym, so getting into the habit of exercise may prove difficult for her. However,
she is curious about nutritional health and open to making changes to her lifestyle.

PES Statement
24-year-old female student with suboptimal nutrition and sedentary lifestyle related to a
busy schedule as evidenced by diet and physical activity recall.

Plan
While YH does have favorable variation in her diet due to frequent dining out, there is
room for long-term improvement in both her diet and physical activity. In the long term, she
could decrease the number of meals dined out by increasing the number of meals she cooks at
home. She can use her partiality towards and ability to cook Korean food to her advantage by
cooking one or two large, vegetable-heavy Korean stews once a week and packing her leftovers
for lunch. By increasing her vegetable intake and eating more whole grains, she could increase
nutrient and fiber intake. For education, YH can also learn about the long-term effects of
excessive sugar on the mind, body, appetite, and stress levels. Learning the benefits of steady
blood sugar could motivate her to limit her intake. Becoming aware of her sedentary lifestyle
will help her incorporate more walking or exercise into her schedule in the long term. Another
long-term goal would be finding a physical activity she enjoys.
The first SMART goal was: become aware of sources of added sugar in her diet by
reading nutrition labels (throughout the week) and substitute her sugary snacks with fruit on the
days she is in school and work the entire day (Monday, Tuesday, and Thursday).
The second SMART goal was: jog for 30 minutes at least twice in the following week
alongside Franklin D. Roosevelt East River Drive, which is located near her home in East Village
(Wednesday, Friday, and weekend mornings work well with her schedule).

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 Part II: Follow-Up

In the initial counseling session, I gathered YHs detailed information about her diet
recall, level of physical activity, and relevant background on her and her lifestyle. I noted that
she is a working college student who dines out 3-4 times a week, snacks on sweet, processed
foods, and could increase vegetable intake. On a scale of 1-10, she said she was at an 8 on
readiness to incorporate changes into her life. Together, we made two specific goals that she
believed were achievable for the following week.
In the follow-up session, YH and I discussed how the past week went. She went to the
grocery store and stocked up on portable fruit (oranges, bananas, apples), which helped her
achieve her first SMART goal. She said that having plenty of fruit stopped her from grabbing a
snack from the vending machine or deli while she was out. In terms of her second SMART goal,
she only went jogging once because she had to study for a test later in the week. However, we
discussed the benefit of going across that first hurdle, as she now knows how achievable it is to
walk to East River and jog for 30 minutes. Our first session made her more aware of how much
of her time she spends sitting in a desk or subway seat.
She was inquisitive about how much sugar she is allowed to eat in a day and how
added sugar is detrimental to ones health, so we briefly discussed the relationship between sugar
and ones body. I recommended documentaries she might be interested in, such as Fed Up. She
did not mind the jogging and was willing to work exercise into her schedule when she has
time. I advised that she slowly incorporate more exercise into her weekly routine, including
simply walking more or bicycling to destinations. Because she will not be able to jog in the
winter, she can work on finding physical activities she enjoys in her neighborhood, such as a
kick-boxing or yoga class. Eventually, finding vegetables and whole grains she enjoys and
cooking larger batches at home would not only provide more vitamins, minerals, and fiber for
fewer calories, but also save her money. It will also increase her awareness of what goes into her
meals and add to her nutritional literacy.

Part III: Objective Self-Evaluation

On October 21, I sat down with YH, a friend of my roommate, for our first nutritional
counseling session. During this meeting, I guided our discussion through the three phases of an
interviewopening, exploration, and closing. We discussed her background, current lifestyle,
and diet, and I made sure to gather all the necessary information to build a subjective and
objective framework of YH. Our follow-up session took place a week later, during which we
discussed her attempt at achieving the goals we had set. Through this exercise, I was able to
gauge my strengths and weaknesses in my first nutritional counseling setting.
Before the interview, I prepared by reviewing the phases of an interview. On a piece of
paper, I made questions and spaces for SOAP data I would need to receive from YH in the
general format of each interview phase. For the interview, I used a voice-recording app and had a
pen and paper with my questions. I occasionally used the pen and paper to jot down any notable
assessments during the interviews exploration phase and for recording our SMART goals, but
for the most part, I relied on the voice recording.

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 Before I formally started the interview, we talked asked her how she was doing with
school and work and about the dinner plans we made for that evening. Building rapport was
easier than starting a relationship anew with a stranger because I had met her a couple of times
this year. In the opening/involving phase, I introduced myself as a nutrition student who would
be interviewing her about her diet and background, then counseling her on a couple of areas for
improvement. In comparison to the Motivational Interviewing algorithm, I did not invite input
from her in this initial phase. Our introductory phase was the shortest in duration, therefore I
could have asked her if she had any questions for me at that point or, Before we begin, are there
any topics you would like to cover today?
In the exploration phase, I initially spent a couple of minutes gathering quick, objective
data such as her weight and relevant health history. Then I moved onto general, open-ended
questions (Can you describe your diet history?). Because she mentioned that there was a lot of
variation in her diet, I asked for both a typical day and the past-24-hour recall. YH mostly talked
in this phase about her food behavior and activity patterns. Similarly to the MI algorithm, the
education phase was not clearly delineated from the exploration phase, but rather diffused
through it. For example, when we were discussing her level of physical activity, I tried giving
neutral feedback by saying, It sounds like you are pretty aware of your sedentary lifestyle. I
think the USDA recommends about 30 minutes of moderate activity per day. Would you say this
something youre interested in trying? I asked follow up questions when relevant to gather more
details, such as portion sizes and How representative would you say your 24-hour recall is of
your everyday diet? Then, we went onto creating the two SMART goals based on both my
assessment (I recommended lowering sugar intake) and her interests (she wanted to try
exercising more). Her willingness to try the SMART goals and make changes to her lifestyle was
an 8 out of 10. Although we discussed her busy schedule while creating these goals, I could have
asked outright why it wasnt a 9 or 10.
There are other smaller details I would have tweaked or added throughout the interview.
For example, I asked her willingness to try the goals on a scale of 1-10 but not how important
change is to her or how successful she thinks she was going to be in her goals. Although I did ask
about her beverage intake (she does not drink coffee or sodas), I forgot to ask how much water
and tea she does drink throughout the day and about her alcohol intake. Also, one phrase I
mistakenly used was inquiring about her breakfast, lunch, and dinner rather than first, second,
third meals of the day.
In the closing phase, I remembered to be encouraging in terms of her goals (If you
incorporate exercise slowly and keep track of your progress, its really motivating); next time, I
would try to support self-efficacy through empowerment in my encouragement. Then, I asked
her to paraphrase her SMART goals and asked if she had any questions for me. We arranged to
meet again in a week for a follow-up session. All in all, our relationship grew through this
interview. I believe our body language (eye contact, laughing, speaking with our hands) reflected
that we were fully present in the conversation and took away much from it.

Part IV: Subjective Self-Evaluation

In most ways, I felt prepared for the interview. The list of questions I had clearly
allocated into different phases of an interview helped immensely in moving the interview along.
The outline was a good foundation from which we were able to cover our bases and further

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explore relevant details. It was easier than I expected to gather all the information I needed, as
many follow-up questions came up naturally.
I still feel that I am learning to strike a good balance between asking all the questions I
have prepared and knowing how far I should take follow-up questions to my patients answers. I
was surprised by how much time can be used by exploration of tangents. I am still practicing
open-ended questions, especially in terms of questions phrased in a variety of different ways. In
the diet recall portion of the interview, my repeated word choice sometimes felt stagnant, and I
found a helpful list of open-ended questions in the textbook that I could use for future counseling
interviews. Upon reviewing the recording, I realized how casual the atmosphere and banter was,
which actually worked for this interviewee, yet may not be up to par to the level of
professionalism I would like to strike in a clinical setting.
Upon completion of the self-evaluation checklist (see Appendix A), I realized that there
were techniques I did incorporate sometimes but could have spent more time preparing to use. I
felt that my attention was more on going through the correct steps of the counseling session than
on reflective listening. I did use some affirmations and reflective statements (It sounds like you
dont like exercise; would you say so?) in the natural flow of the conversation, but do not feel
that I prepared enough to use them more consciously.

Part V: Building Rapport & Increasing Client Self-Efficacy

Building rapport is something we do in our everyday lives in new relationships, and it is

also an integral part of nutritional counseling. The relationship you build with your client
especially in the initial sessionscan help or hinder your counseling abilities as well as the
receptiveness of your client towards your advice. Building rapport extends far beyond the
involving phase, and I must remember to be aware that relationship building continues through
all the stages of the interview and in follow-up sessions.
Building rapport was easier in this case because the client was a friend of my roommate,
and this was not our first meeting. I asked how her midterms went, and we made small talk
before the interview. Furthermore, the client was close to my age and also a fellow Korean-
American college student. I imagine it would be a more difficult process of developing rapport
with someone much older than I am or is of a different gender, socioeconomic status, or cultural
background. I find that remembering and recalling details from previous encounters helps build
connections. Body language, such as looking present, receptive, and smiling, is also essential to
an engaging conversation. In a more professional, clinical setting, I hope to keep in mind that
concentrating solely on improving a clients diet can be negated by a tepid relationship; rapport
and simply knowing more about the clients life can only help me be a better counselor.

Part VI: Conclusion

Through this counseling session, I learned the dissonance between theory and practice.
There were some aspects of counseling that were easier to work into the conversational flow than
I had expected. For example, in class we discussed how gauging readiness to change on a scale
of 1-10 seemed awkward and forced. However, in the nutritional counseling setting, YH did not
seem to think the tool was strange at all, and the question came off as a motivational tool rather

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than a condescending one. What I thought would have been easier, such as encouragement and
reflective statements, felt new to me. I definitely want to work on having a good relationship
with my clients, which in turn can motivate them to stick to their eating and physical activity
goals. Learning which motivational tactics help empower which client is a skill that I would like
to hone. I found it helpful to feel out role of the counselor for the first time and then hear my
mannerisms and the flow of the conversation from the recording. I definitely learned the
essential nuances of how a counseling session both is and isnt an everyday connection.

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 Appendix A: Self-Evaluation Form

CASE STUDY EVALUATION OF AN INTERVIEW

Student: Grace Kim Date: October 21, 2015

Interview Component Satisfactory Fair & Unsatisfactory Comments

Improvement
Needed
1. Introduced self appropriately
2. Established rapport
appropriately using open-
ended questions mixed with
closed-ended questions
3. Created agenda with client
4. Verified medical or health
issues as related to food,
nutrition and lifestyle
5. Used culturally-sensitive,
open-ended questions
appropriately
6. Used reflective listening in
response to clients
responses
7. Assessed interest,
willingness and confidence
8. Clarified/followed up on
answers appropriately
9. Established how the client
wished to proceed
10. Established follow-up
activities and appointments
 Appendix A: Self-Evaluation Form (Part II)

Summary Comments/Evaluation:

List two interviewing strengths for the counselor (version 1).

1. Preparedness: had questions and comments ready for each phase of interview.

2. Non-judgmental and thorough listening. Did not tell clients how to feel/finish their sentences/rush client.

List two interviewing techniques that the counselor (version 1) needs to improve.

1. More reflective listening statements

2. Asking for input on what the client wants to gain from the counseling session

List two constructive suggestions you could offer to the counselor (version 1).

1. Use phrases such as I understand, It sounds like you, and Lets

explore that. Do more paraphrasing of what the clients say.

2. Explore more variations of open-ended questions such as Will you tell me a little about yourself? and What
foods do you like to eat?