This is the second edition of what could be described as a tool-kit for counselling skills. The first edition came out ten years ago and this second edition, also published by Blackwell Publishing, reflects the fact that in the world of dietetics there have been some changes although, of course, many things have remained the same. While Judy Gable's book appears to be large and perhaps a bit daunting, what I discovered was a very concisely written and cleverly arranged book which I enjoyed reading. However, this book is more than simply reading and absorbing information; it requires that the reader do quite a bit of self-reflection.
The book's title indicates that its target audience is dietitians, but it could be broadened out to include anyone who has dietary behaviour change as their focus. Behaviour change is the key and essential ingredient in what dietitians and many other health professionals do. Behaviour change components to health behaviour changes are being endorsed as a key factor within multicomponent interventions. While helping people change their behaviour is an essential aspect of most health-related professions, it is a difficult job to ‘tell’ the experienced dietitian or health practitioner how to change or adapt their clinical practice and how they deal with patients. Attempts to do this in practice often find many people defensive about their existing skills. Gable manages this skilfully and eloquently without sounding patronising. Her side notes assume that the reader already has a certain amount of awareness, for example body language. Yet these side notes provide tactful reminders and work extremely skilfully to get the reader to think about their current practice and also their experiences as a patient.
I particularly liked how the book concentrated on the dietitian needing to focus and reflect on their ‘personal philosophy’. As I mentioned before, the book takes the reader on a journey of reflection of their own skills and reflection of their practice. The self-awareness encouraged in the book is a great skill not just for health practitioners but for everyone!
The book is divided into four parts. Theses are preceded by an Introduction, that explains which sections need to be read according to the reader's existing skills base. Each of the four parts includes several chapters and each part begins with a brief summary of what it contains. Each chapter commences with a box describing what will be discussed and ends with an elegant summary that also highlights what will come. There is a post script which summarises each of the four parts to the book. Additionally, there are recommendations for further reading. To give a flavour of the layout and content: Part 1 (four chapters) covers ‘A counselling approach’ describing the patient–health professional relationship and issues relating to empathy. Part 2 (three chapters) provides the reader with ‘The skills’ they will require including active listening, non-verbal communication and reflective responding. Part 3 (six chapters) focuses on ‘The patient interview’, providing a framework that includes important factors such as where the desk and seats are positioned, insights into first impressions and closing an interview. Chapters 9–12 in this part focus on specific issues, including bereavement, parents and children, transcultural communication and working with difficulties in physical and mental health. Part 4 (three chapters) covers ‘Areas for personal development’.
There were some new concepts to me, such as ‘echoes within’ (p. 63) which is the name given to those thoughts you have when listening to someone else. I also discovered a new acronym: SOLER (p. 61), which is a checklist for non-verbal communication. The book has been written and advice given while acknowledging the real-life situation of a busy dietitian trying to obtain a diet history, maintain eye contact, make their client feel comfortable and keep the clinic running on time!
Throughout the book there are examples of conversations between the dietitian and the patient. What I found extremely useful were that these conversations include notes in brackets which indicate when the dietitian has used one of the skills mentioned. The chapters frequently ask the reader to reflect individually or with a ‘partner’ on the topics covered in the book.
While I have read and found other publications on changing behaviour useful, I found this text with its specific focus on nutrition really useful. My one regret is not reading the first edition when I was a dietetic student!