Counselling Skills for Dietitians, 2nd Edition

Judy Gable

Blackwell Publishing, 2007, 257 pp. Cost: £27.99. ISBN 978 1405147279

This book opens an interesting debate: is dieteticadvice counselling or communication? A helpingrelationship is based on the three core conditionsof empathy (the ability to enter into and movearound the patient’s world), acceptance (of whereand who the patient is in the here and now) andgenuineness (being and being seen to be anautonomous, consistent person). As Judy Gableso eloquently points out in Counselling Skills forDietitians, traditionally, dietitians have seen theirrole as that of teacher, advisor or guide, whereasnowadays, perhaps the most appropriate focus ismore towards facilitating change or dietary coun-selling, a patient-centred approach. Jane Thomas,Senior Lecturer in Nutrition and Dietetics atKing’s College, London, in her forward to thistext acknowledges the change and makes theobservation ‘that advice tailored to the lifestyle ofan individual based on constructive negotiation ismore likely to result in positive outcomes’.

The focus therefore of this book comes at anopportune moment to enlighten today’s students,and in addition, enables more experienced prac-titioners to reflect on their skills and competences.Ms Gable draws on her own personal engage-ments as a dietitian and counsellor to offer soundadvice and real-life examples that enable thereader to visualize the situation and responsesmost clearly. The advantage of this particular textis that the inclusion of material is based on theneeds and interest shown by dietitians who par-ticipated in training courses run by the author.The information therefore is very much groundedand designed to stimulate self awareness, encour-aging the reader to adopt a reflective self-directedapproach to learning.

Judy Gable is a state-registered dietitian whereher interest in the psychological aspects of weightmanagement led her to training as a counsellor. Inthe past, she has taught counselling skills to dieti-

tians and students, and currently works as a coun-sellor in general medical practice. It comes as nosurprise therefore that this book is easy to readand packed with useful, up-to-date informationpresented in a very accessible way. An introduc-tion is presented for each section which sets outclearly the topics to be covered enabling thestudent to determine relevance. References andfurther reading are found at the end of eachchapter, allowing readers to expand their knowl-edge if so required.

In this second edition, the basic structure of thebook is unchanged and is divided into four parts.Part one explains the counselling approach asdistinguished from a dietitian as teacher oradvisor. It explores the role of the dietitian includ-ing a personal philosophy and focuses on what isinvolved in the helping process, addressing quali-ties of empathy, acceptance and genuineness.Patient expectations are highlighted, and explor-ing the ambivalence that underlies an inability tochange is the basis for the section on motivationalinterviewing. Developing a counselling approachis to develop self-awareness and, as such, thereare some excellent well-positioned self-reflectionexercises throughout the chapters. Establishing atime boundary and rules of confidentiality is atthe core of any ethical framework, and this isdealt with most sympathetically.

Part two centres on the fundamental skills oflistening and responding, and shows how the atti-tudes and awareness explored in part one under-pin the communication skills of attending andreflective response. Verbal and non-verbal com-munication are described with comment on eyecontact, facial expression, appearance, posture,gestures, managing silences, mirroring and touch-ing. Ways are examined in which skills togetherwith skilful questioning can be used to makehelpful interventions. Part three emphasises how

Book review

© 2007, The Author

Journal compilation © 2007, Blackwell Publishing Journal of Foodservice, 18, pp. 130–131

130

the skills described previously can be used indietetic practice with the dietetic interview help-fully broken into three sections (beginning,middle and end). The beginning section plays asignificant part in creating an environment inwhich the dietitian and patient can work comfort-ably together. The middle section of the interviewincludes assessing motivation to change, forminga working agreement, taking a diet history andgiving dietary advice. Using a person-centredapproach, a relationship of trust, respect and indi-vidual responsibility should develop. Lastly, theprocess of closing the interview is explored andthe dietitian encouraged to reflect in a structuredway. In addition, this section engages the readerwith particular issues of working with differentgroups of people, e.g. those who are bereaved,children, those with physical or mental healthconditions and most importantly, in this age ofthe multicultural society, those whose culturalbackgrounds different from that of the dietitian.Most interestingly, we are introduced to theaggressive, absent or overprotective parent andstrategies for coping.

Lastly, part four focuses on personal develop-ment and has been revised and expanded in thisedition in response to requests by dietitians.Issues addressed include developing assertivebehaviour and handling aggressive behaviour,not only with patients but also with colleaguesin the workplace. Finally, personal support iscovered, which includes managing stress, build-ing self-esteem and the notion of mutual colle-gial support, describing how this can beestablished. I actually found the exercise onincreasing understanding of our own stress mostilluminating, and the analysis certainly added tomy own personal understanding.

The sequence of the text is orderly, giving thereader a clear sense of direction through thecomplexity of dietetic competences. Within eachchapter, there are exercises and scenarios thatmake readers reflect on their own practice andskills, an invaluable addition in any learning situ-ation. The dialogue given demonstrates the prac-tical aspects of counselling skills and clarifiesprocess between patient and dietitian. My onlycriticism would be that Ms Gable seems to feelthe necessity to delineate gender (it is agreedthat dietetics is a female-dominated profession;however, there are some very competent maleexamples); this sits at odds with her apparentsensitivity, demonstrated throughout the book.

Ms Gable states that she hopes, with this book,to show how counselling skills can be integratedinto dietetic practice so that the limited time pos-sible with patients can be utilized effectively andmeaningfully for both dietitian and patient. Inthis aim, the author has met if not exceeded herexpectations and has produced a most useful andreadable resource. The main thrust of this text issurely acknowledging life skills as well as profes-sional skills and, as such, yes, will be of use todietetic students but also to anyone with an inter-est in interpersonal communication.

Dr Heather HartwellSenior Lecturer in Food Studies

School of Services Management BournemouthUniversity Talbot Campous Poole, Dorset

BH12 5BBUK

131Book review

© 2007, The Author

Journal compilation © 2007, Blackwell Publishing Journal of Foodservice, 18, pp. 130–131