Lora Silver

Counseling Paper #3
3/14/2016

Prepared Questions
o

What has changed since we last saw each other?

Lets review the specific goals you set out to accomplish last time: how many

days of that following week did you eat fruit? How many pieces/servings a day?
Compare to goal: twice/day for 5 of 7 days; How many days did you track
hunger/satisfaction at pre and post eating in your food journal? Compare to goal: all
meals and snacks on 5 of 7 days.
o

What else have you noticed about your eating lately?

How are those insights/reflections important to you? How can you use them to

make positive changes or set and reach goals for yourself?

o

What are you proud of or excited to share with me from these last couple weeks?

What was challenging about the goals we developed last time?

What information about food and nutrition feels like it is missing for you?

What do you feel most comfortable committing to at this point?

How could you break this down into a few steps, starting with what you might set

out to do this next week?

o

How can you see yourself getting stopped on the way to this goal?

What kinds of motivations could you brainstorm right now with me that are way

bigger and more important to you than the potential obstacles you just listed?
o

What kind of support would make the biggest difference to your success in this

area?
o

What do you want to know in order to feel more confident about this next step?

What is different after having these three sessions together? What remains the

same?
Brief re-introduction of client
My client John Doe is a 48-year-old Caucasian male who lives with his wife and
two children. He is 64 and weighs 266 lbs, and his current wellness goals include
eating healthy and engaging in more physical activity in order to lose extra weight,
improve energy throughout the day, and develop active lifestyle habits for his long-

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Counseling Paper #3
3/14/2016

term health. He came to session 1 very driven and focused, and I rated him in the
action stage of change, since he already lost 12 pounds since November 2015 by
adding activity and changing his food choices. He is very self-aware, and his ability to
comfortably and confidently continue his favorite activities, river fishing and cycling,
as well as to set a healthy example for his children, motivated him to pursue his
current goals. JOHN DOE has described an opportunistic and super-sized
portions approach to his food in the past, and he described having a comfortable
budget for food, his biggest obstacle being time to plan and prepare healthy meals.
1. Personal Progress
I set out to practice and gain comfort with reflections and paraphrasing during
this class, and my clients naturally strong tendency toward introspection made him
an ideal client for this practice. I gradually became more confident and consistent in
my reflections in proportion with the open-ended questions I was asking: I have
really appreciated having the general guideline of a 2:1 ratio, meaning 2 reflections
for each open-ended question I ask!
I also gained much experience this quarter in the motivational interviewing
approach, and by the third session, I felt much more familiar with the process of
guiding my client to consider pros and cons. The more comfortable I was moving in
and out of guiding and following, the more smoothly the conversation flowed, and
the more clearly my client was able to draw a conclusion or see his statements more
clearly for himself. When I was struggling through it during parts of session 1, and
earlier in session 2, however, I was overly concerned with the structure of the
conversation, and I think that interrupted the flow and the value of the client hearing
himself say certain things and seeing his own ambivalence more clearly.
I still have much room to improve in the ways that I clearly communicate the
agenda of the session and honor the boundaries and plans I set for the agenda,
length of session, and accountabilities. My default behaviors are to follow the client,
occasionally guide with gentle nudges, and listen very deeply, while I am less
comfortable with directing and taking charge. But this does not always get us out on

Lora Silver
Counseling Paper #3
3/14/2016

time or help us accomplish our agenda! My clients completed feedback form
reinforces this, too, so that is good for me to see. It would have been a service to my
client if I more assertively set the agenda for each session and practiced respectful
interruption to keep my client on track and complete all items on my agenda at each
session.
In my self-observation, I see a successful counseling relationship was formed in
that my clients feedback consistently said he was very comfortable opening up to
me and felt very heard and respected. I know he made reference on multiple
occasions to the fact that our conversations felt collaborative to him, and I think he
felt a strong alliance with me as someone who genuinely cares and supports his
positive changes. I think this kind of relationship is possible even if I kept more strict
boundaries and accountability with him, although I am aware of my concern that my
increased ability to enforce boundaries will lead to a clients discomfort and lack of
collaboration. I simply need to practice boundary-setting more and more in my
counseling practice sessions to demonstrate to myself that this is not the case!
2. Impression & attitudes toward client
In many ways, my client and I were well-matched. He highly values selfawareness and introspection, and all strategies to reveal hidden drivers of his eating
and lifestyle habits seemed to fascinate him. Meanwhile, my approach naturally
leans toward intuitive eating, gentle step-wise changes, and introspection and selfreflection that guides the behavior changes. We are both Caucasian, speak English
as a first language, and grew up on the West Coast, and I think we had an easy time
understanding each other with much of the same vocabulary. The main obstacles he
discussed included time and prioritization in his life surrounding his responsibilities to
his family and his white-collar, professional job, and these are also among the top
obstacles I face in setting and reaching my own wellness goals, rather than extreme
financial barriers or lack of physical safety/security or lack of access to a clean
kitchen or fresh fruits and vegetables. I have counseled clients in the past with some
of these barriers present, but I know it requires more of my objective skills and

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Counseling Paper #3
3/14/2016

empathy practice to understand barriers such as these that I myself do not
experience on a daily basis.
On the other hand, though, it is easy for me to assume I understand my clients
experience of familiar obstacles before I even ask him for more details, and
sometimes I noticed myself jumping to assumptions or conclusions in this way.
3. SMART Goal-setting
My client did achieve his goal from session 2 to add in two servings/day fresh
fruit and to implement a plan that adds convenience and easy access to healthy food
choices in his typical environments of his work office and home office. He also
successfully added hunger/satiety tracking to his food journal for two weeks and
concluded that this kind of tracking was really beneficial and surprising to him. In our
work together, I wanted to help him create more structure to maintain the Action
stage of change that he was already operating in as of session 1, yet the goals I
encouraged him to set in session 2 do not feel aligned with action and maintenance
to me now upon reflection. Now his goals feel more experimental and tentative, as if
he is trying healthy eating for the first time, which he is not! I know he was very
happy to set and reach these goals, and he learned a lot about environmental cues
and setting up his environment for success by doing this fruit experiment, however I
think I could have challenged him even more to create SMART goals to support his
maintenance over a longer period of time.
4. Session length
Session 1 was close to two hours (!), so I requested we set aside 90 minutes for
session 2. In session 3, mostly due to scheduling limitations, we kept it to 60
minutes, and I felt like it was a more productive session as a result. The data
collection in session 1 would have felt too rushed for me to complete thoroughly in
60 minutes, although I think sessions 2 and 3 are suitable for 60 minutes. Having a
firm stop at 60 minutes in session 3 forced me to be more assertive with our agenda
and keep to our scheduled time, and I think I was more comfortable making some

Lora Silver
Counseling Paper #3
3/14/2016

interruptions and enforcing the boundaries of our agenda because I knew we
needed to feel the closure of this being our last session, rather than stopping the
session at mid-conversation. My client talks at great length very easily, and shares
his self-observations with little hesitation, so it was my responsibility to politely
interrupt and return his focus to a specific question or next step during our sessions.
Given my high comfort with asking open-ended questions and active listening, I err
on the side of longer sessions, and my growing edge is to keep to boundaries to end
on time and finish the agreed-upon agenda.
5. Continuation vs Termination
I ended the counseling relationship with this client because I choose to not carry
forward a client responsibility while I have a demanding workload right now. I had set
the expectation of a 3-session program at the beginning with my client, and I
reminded my client of this when scheduling session 3 and at the start of the session
3. Despite the clear expectations on all sides, I felt very uncomfortable ending the
relationship! Perhaps I felt pressure to continue the relationship and make myself
much more available for help and support since my client is a friend of a friend.
Perhaps I felt pressure to continue because my client had mentioned other interests
in session 1 that I knew we did not have time to fully address and handle in session
2 or 3, so I felt like I owed it to him to continue this service. These three months felt
very short to me, and I felt as if I did not have enough to say when I summarized my
clients progress from the beginning to the end of these three sessions. However, I
was committed to my decision to end the formal counseling relationship with session
3, and I arrived at session 3 prepared with a BCNH referral as well as a follow-up
mindful eating worksheet (see #8 below) so that I would feel better about leaving him
with additional resources and support. My client appeared very comfortable ending
the relationship here, mentioning that he will incorporate his wellness goals into the
work he does with a professional accountability coach to maintain the momentum of
our sessions. Upon hearing this plan of his, I realized that I neglected to ask him
what social supports and other structures he could establish to help him maintain the

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Counseling Paper #3
3/14/2016

momentum of our sessions! This plan of his was a valuable example and reminder
to me to add this to my final session agenda.
6. Video Recording Self-Reflection
I think my eye contact and mirroring of body language are consistent and
appropriate throughout the session. I saw myself making gestures in the recording in
ways that enhanced the meaning but did not distract from what I was saying. To my
surprise, I did not appear to fidget or fuss with my nails or pencil as much as I
thought I was doing during the session! I think my session was a good example of
tracking the clients responses and meaning by nodding and mirroring the clients
emotions in validating ways.
As I watched the recording, I was distracted by my lack of eye contact only
during the moments when I am speaking, and I have an evident habit of looking
away from my client when formulating a question or thoughtfully putting together a
reflection following an open-ended question. I was cringing as I watched myself do
this because, in the moments where I noticed myself doing this in the recording, my
lack of eye contact seems to cause my client to break eye contact as well. In these
moments, then, my clients eyes are off wandering out the window or on the floor,
and I have a feeling that he is less engaged in the conversation when that is
happening. I cannot know for sure without directly asking him for feedback on this
habit of mine, but I have a hunch that my distraction while watching the recording is
indicative of distraction that was felt during the session itself.
I also noticed my comfort with silence and pauses during the session: I am aware
of this in myself, but I was very pleased to see that my client seemed to take the
opportunity of these pauses to genuinely search for the answers. He may have
responded with a shrug or smirk at first to a question he found more challenging or
confronting, but after sitting with only my silence in return for several seconds, I saw
his facial expression gradually change and become more meditative and I think
this was a more honest version of his answer after some time to pause. I can be

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Counseling Paper #3
3/14/2016

self-conscious of how long I pause for in a session like this, but it was interesting to
see how this strategy was very effective for this particular client.
The video recording demonstrate to me that I tend to be harder and more
exacting on myself than I need to be. There were certain moments of the session
where I was convinced the recording would reveal that my client was uncomfortable
or not engaged or not finding the session to be effective. However in those
moments, my clients non-verbal behaviors were nothing unusual, and what I saw as
major flaws did not appear to impact his perception of me as an effective counselor
in those moments. This matters to me because I want to improve and grow as a
counselor in ways that will actually improve my effectiveness as a counselor, not
simply strive for perfection for the sake of perfection.
7. Other Self-Reflective Thoughts
The improvisational skills required by the counselor are most challenging to me. I
can prepare several questions, familiarize myself with theoretical approaches, and
practice counseling strategies in mock sessions, yet a real session with a client that
counts on me for valuable input and goal-setting support really challenges me to
move flexibly between directing, guiding and informing as a counselor. As I
mentioned earlier, the more I saw myself moving fluidly between these three
communication styles, the more effective the conversation appeared to be for my
client. The less familiar I was with improvising in these styles back and forth, the
more distracted and less present I was as a counselor. My client was very forgiving
though, and setting clear expectations from the start that I am a counselor in training
looking for a client with whom to practice and receive honest feedback was key!
The most rewarding aspect of my counseling engagement with my client was the
relationship we developed over the three sessions. I became genuinely fond of my
client, and I wanted him to know how much I sincerely supported his goals. I think
that natural affinity and alignment with my client is something I will enjoy more and
more, especially when I have opportunity to work with clients across multiple
sessions for several weeks or months. I also really enjoyed satisfying my natural

Lora Silver
Counseling Paper #3
3/14/2016

curiosities about human nature and the multi-layered meanings of food in my role as
a counselor. I get to indulge my curiosities and hear peoples stories as a counselor
when I partner with them to consider what will make gradual but lasting lifestyle
change work for them and their unique circumstances.
I felt the most pressure to self-disclose when my client offered positive feedback
during or after a session. He would often start this portion of the session by saying
how embarrassed he was to be learning this nutrition stuff so late in his life, or how
abnormal or unusual he felt for getting so much value out of the relatively simple
goals and ideas we discussed in our sessions. On the contrary, I would insist to him,
he is not so unusual for feeling this way. These were the moments when I felt most
inspired to briefly share with him that his dissociation from physical cues of hunger,
his sometimes-troubling relationship to sugary foods, and his lack of awareness of
some basic nutrition principles were all true for me only a few years ago as well. I
shared with him that my enthusiasm for my graduate studies was fueled by these
recent experiences, and I revealed to him some of the personal health benefits I
experienced following my pursuit of healthy lifestyle changes those years ago. I
shared a bit more with him than I think I otherwise would because I knew I would see
him socially in the future as a friend of a friend, however I feel really comfortable with
the way I self-disclosed to him. The information I shared was brief and above all
validating and important to advance the conversation, and I know the client
experienced some relief and benefit hearing this from me. As Molly Kellogg would
encourage us to do, my self-disclosure was important to my ability to validate and
normalize the cilents experience, and I think my comfort with self-disclosure
increased my clients comfort level in each of our sessions.
8. Educational Materials
My client was very eager to receive additional resources, and after session 2, I
provided several upon his request, including the BCNH Sample Menus for his
appropriate daily calorie level, the BCNH Healthy Plate handout, BCNH Whole
Foods nutrition education handout, and a blank Food Journal along with the

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Counseling Paper #3
3/14/2016

Hunger/Satiety Scale guide. At session 3, he mentioned that he is still making his
way through the session 2 resources, so I did not want to overwhelm him with many
more. However, I provided a short worksheet adapated from a mindful eating
workbook by Susan Albers because we spent some time in session 3 discussing the
various environmental and social cues that prompt him to eat. Awareness of these
cues really surprised him during his recent food journaling, so it was a very
appropriate resource. I noticed my tendency is to provide a client with many
resources, perhaps because I enjoy sifting through such things and learning that
way. While this client did not complain or show any signs of overwhelm, I am still
afraid that I provided too much, and next time I would prefer to provide few
resources with higher engagement/personalization of each. This way he would feel
like the information is uniquely tailored to his situation and needs, and he might have
more natural interest to read and use it right away in his daily life.
Completed Client Feedback Form
1. What one thing stood out for you from this session? What might you remember and take
home with you? The one thing that stood out for me on this session was that I've
never had a committed listener in the area of health and wellness. My interactions
with my gen prac doctor are so mind-numbingly fast that I would never be able to
bring up and discuss things the way I have on these. The times I can discuss
things in depth, I am with my friends (whose opinions on such matters I would not
trust!!) This discussion was a real singularity.
2. Did the counselor listen to you? Did you feel heard? Rate this on a 7-point scale with 7
representing that you felt very much listened to and 1 that you were not heard: Yes: 6,
I felt that your listening was very focused and intentional. Follow up questions,
clarifying interrupts, and references made it clear that there was powerful
listening. I've given this feedback before, and I'll say it again, your demeanor and
listening is one of your strengths and it makes it easy to speak openly.
3. What did you find most helpful? What did the counselor do that was right? Please be
specific. For example, not You did great, but rather, When I talked about _______, you
listened to me very carefully. Most helpful for me was creating structure. In my
exploration I came to realize that the overwhelming factor in my relationship to
food is not what nutrients my body is asking for. It is "where am I" or "what time is
it" or "what is my emotional state" or any other number of non-physiological
queries. So, the natural place to approach is behavioral and you provided direct
assistance in translating my observations to that.

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Counseling Paper #3
3/14/2016

4. Overall, rate the quality of this session in terms of its helpfulness on a 7-point scale with
"7" representing that this session was very helpful to you and "1" that this session was
not at all helpful to you: The quality of this session is a 6.
Any other comments or suggestions you want to share:
I don't have any other comments - but I really enjoyed the discussions and I learned a
LOT. You are a naturally talented listener/observer/contributor. Thank you!