Client-centred nutrition counselling: Do we know ...

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Title Client-centred nutrition counselling: Do we know what this means?
Author(s) Debbie L. MacLellan, Shawna Berenbaum
Date 2003
Volume 64
Issue 1
Start page 12
Abstract Over the past decade, the health-care system in Canada has changed in response to rising costs, changing demographics, and consumers' increased interest in directing their own medical care. Many health professions have begun to promote a practice approach that includes the client as an important partner in health-care delivery (11). Although a variety of different terms are used to describe this approach (client-centred, person-centred, client-driven, patient-centred, patient-focused), in each case the emphasis appears to be on including the client/patient in the health-care decision-making process (11). What is less clear is how the various health professions are defining client-centred counselling, or how individual members of these professions are implementing this approach in their practices. In the dietetics profession, we have adopted a definition developed by the occupational therapy profession, a definition that has its roots in Rogers's client-centred counselling theory. As Law and Mills (11) point out, however, '[t] he difficulty with the term client-centred is that it has been used by institutions and writers to describe approaches that may not be conceptually consistent with Rogers' original ideas.' The first time that the term 'client-centred' care is mentioned is in an abstract by Hawirko et al. in 1994 (30). These authors discuss the expansion of the nutrition focus of the Healthiest Babies Possible (HBP) program in British Columbia. The purpose of the expansion was to provide more 'holistic client-centred services.' They note that ....putting the client first often means changing departmental policies.' Educational strategies designed to '...balance clients' priorities with our HBP agenda of preventing low birthweight' were being used. Again, in this description we see pieces of what Carl Rogers would have referred to as a client-centred approach. Certainly Rogers would have considered the idea of putting the client first important; however, the idea pf putting the client first important; however, the idea of balancing priorities rather then allowing the client to set his of her own priorities is contradictory. The struggle to use a client-centered approach within the healthcare system is also evident here. The importance of changing the way we think about the nutrition counselling process has been recognized in the past few years. In 1998, Kiy outlined what she referred to as an 'emerging speciality within the field of dietetics' - nutrition therapy (34). According to Kiy, 'nutrition therapy is clientcentred and combines the philosophy and practice of dietetics, mental health counselling and education.' She states that the relationship that develops between the client and the clinician is therapeutic in and of itself, and is more important than any nutrition intervention needed by the client and provided by the nutrition therapist. This view is certainly very similar to what Rogers calls a 'growth promoting climate' (7). Kiy also discusses the client's role in the learning process, and states that clients learn best when they are able to build on their interests, concerns, and experiences rather than told what to do by the therapist. Kiy concludes that the philosophy outlined in her article will '...assist dietitians in making the switch from a focus on teaching and the subject to a focus on learning and the client.' However, she fails to make any concrete suggestions as to how dietitians might incorporate these ideas into their everyday practice.

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