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vi Contents
Cultural Influence on Communication 49 Chapter 4

Guidelines for Enhancing Counseling Meeting Your Client:
Communication Effectiveness 52
the Counseling Interview 77
Use Focuses and Intents When
Formulating Responses 52 Introduction 78
Use Effective Nonverbal Behavior 54 Nutrition Counseling Models 78
Harmonize Verbal and Nonverbal Nutrition Counseling Motivational
Behaviors 55 Algorithm 79
Analyze Nonverbal Behavior Assessing Readiness to Change 80
of Your Client 55 Nutrition Counseling Protocols:
Communication Roadblocks 56 Analysis and Flow of a Counseling
Interview and Counseling Session 82
Empathy 56
Involving Phase 82
Basic Counseling Responses 58
Greeting 82
Attending (Active Listening) 59
Establish Comfort 83
Reflection (Empathizing) 60
Small Talk 83
Steps in Reflecting 60
Opening—First Session 84
Legitimation (Affirmation, Normalization) 63
Opening—Subsequent Sessions 84
Respect 63
Identifying Client’s Long-Term Behavior
Personal Support 64
Change Objectives (General Goals) 84
Partnership 64
Explain Program and Counseling
Mirroring (Parroting, Echoing) 64 Process—First Session 84
Paraphrasing (Summarizing) 64 Discuss Weight Monitoring,
Giving Feedback (Immediacy) 65 If Appropriate—First Session 85
Questioning 65 Setting the Agenda—First Session 85
Useful Questions 65 Setting the Agenda—Subsequent
Problematic Questions 66 Sessions 85
Clarifying (Probing, Prompting) 67 Transitioning to the Next Phase 86
Noting a Discrepancy (Confrontation, Exploration–Education Phase 86
Challenging) 67 Educational Activities 86
Directing (Instructions) 68 Assessment—First Session 86
Advice 68 Assessments–Subsequent Sessions 87
Allowing Silence 69 Giving Nonjudgmental Feedback 88
Self-Referent (Self-Disclosing and Determining What’s Next 88
Self-Involving) 70 Assessing Readiness to Make a Change 88
case study: Communication Analysis Resolving Phase 89
of John’s Interactions 71
Level 1: Not Ready to Change
Review Questions 74 (Precontemplative) 89
Exercise 3.4 Answers 74 Raise Awareness of the Health
Exercise 3.10 Answers 74 Problem and Diet Options 89
Assignment—Observation and Personalize Benefits 90
Analysis of a Television Interview 74 Ask Key Open-Ended Questions to
Suggested Readings, Materials, Explore Importance of Change
and Internet Resources 75 and Promote Change Talk 90
Books 75 Summarize 91
Website 75 Offer Professional Advice, If Appropriate 91
References 75 Express Support 91
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents vii
Level 2: Unsure, Low Confidence 92 Dietary Assessment 107

Raise Awareness of the Benefits Step 1: Food Intake Data Collection 108
of Changing and Diet Options 92 Step 2: Data Analysis 115
Ask Key Open-Ended Questions to Explore Step 3: Interpretation of Analysis 116
Confidence and Promote Change Talk 92
Energy Determinations 117
Explore Ambivalence by Examining
Step 1: Determine Resting Energy
the Pros and Cons 92
Expenditure (REE) 117
Imagine the Future 93
Step 2: Select a Physical Activity (PA) Factor 118
Explore Past Successes and Provide Feedback
Step 3: Determine TEE 118
about Positive Behaviors and Abilities 94
Step 4: Adjust for Weight Loss 118
Encourage Support Networks 94
Physical Assessments and Healthy
Summarize Ambivalence 94
Weight Standards 118
Choose a Goal, If Appropriate 94
Weight-for-Height Tables 119
Level 3—Motivated, Confident, Ready 94
Body Mass Index 119
Praise Positive Behaviors 94
Waist Circumference 120
Closing Phase 94
Documentation and Charting 121
Framework for Brief Interventions 95
Soap Format 122
Considerations for Acute Care 95
case study: Nancy: Documentation
case study: Nancy: Intervention at Three Levels of Motivation 124
at Three Levels of Motivation 96
ADIME Format 125
Review Questions 99
Nutrition Care Process 125
Assignment—Case Study Analysis 99
Standardized Language 126
Suggested Readings, Materials,
Step 1: Nutrition Assessment 127
and Internet Resources 99
Step 2: Nutrition Diagnosis 128
References 99
case study: Nancy: ADIME
Chapter 5 Documentation–Assessment 128
Developing a Nutrition Care Self-Evaluation of PES Statements 131
plan: putting It all together 101 Step 3: Intervention 131
Planning the Nutrition Intervention 131
Introduction 102
Implementation of the Intervention 131
Goal Setting 102
Explain Goal Setting Basics 103 case study: Nancy: ADIME Documentation–
Diagnosis with PES Statement 131
Explore Change Options 103
Step 4: Monitoring and Evaluation (M & E) 133
Identify a Specific Goal from
a Broadly Stated Goal 104 case study: Nancy: ADIME
Documentation–Intervention 133
Define Goals 105
NCP Documentation and Charting 134
Design a Plan of Action 105
case study: Nancy: ADIME
Investigate the Physical Environment 106
Documentation–Monitoring
Examine Social Support 106 and Evaluation 134
Review the Cognitive Environment 106 Review Questions 135
Explain Positive Coping Talk, Assignment—Nutritional Assessment 135
If Necessary 106
PART I–Nutritional Assessment
Modify Goal, If Necessary 106 of a Volunteer 135
Select a Tracking Technique 107 Involving Phase 136
Verbalize the Goal 107 Provide Feedback 137
Write Down the Goal 107 Part II–Report 137
viii Contents
Suggested Readings, Materials, Assignment—Food Management

and Internet Resources 137 Tool Usage 165
Indirect Calorimetry Resources 138 Method 1 165
References 138 Method 2 166
Method 3 167
Chapter 6 Method 4 167
promoting Change to Write an Evaluation 167
Facilitate Self-Management 140 Suggested Readings, Materials,
Introduction 141
Weight Loss Program 167
Strategies To Promote Change 141
Meal Plans and Recipes 167
Food Management Tools 141
Food Guides 167
Meal Replacements 141
Self-Help Resource 168
Detailed Menus and Meal Plans 142
References 168
Exchange List for Weight Management 143
MyPlate or Dash Food Plan 143
Chapter 7
Goal Setting 144
Tracking 144
Making Behavior Change Last 170
Journaling 144 Introduction 171
Journaling Alternatives 145 Social Network 171
Behavior Change Strategies 145 Social Support 171
Behavior Chain 146 Social Disclosure 173
Cue Management (Stimulus Control) 147 Social Pressures 173
Countering 147 Stress Management 175
Reinforcement: Rewards 149 Stress Management Counseling 178
Contracting 150 Relapse Prevention 178
Encouragement 151 Immediate Determinants 179
Goal Setting 151 Covert Antecedents 180
Modeling 151 Relapse Prevention Counseling 180
Problem Solving 152 Mindful Eating 182
Cognitive Restructuring 153 Ending the Counseling Relationship 183
Education During Counseling 157 Preparation for a Conclusion 183
Effective Education Strategies 157 Final Session 184
Effective Education Language 160 Handling Abrupt Endings 185
Positive or Negative Approach 160 Counseling Evaluation 185
Supporting Self-Management 161 Evaluation of Client Progress 185
Terminology 161 Goal Attainment Scale 185
Individualization of Therapy 162 Final Client Evaluation 186
Length and Frequency Evaluation of Counseling Effectiveness
of Counseling Sessions 162 and Skills 186
Perception of Quality of Care 162 Client Evaluation of Counselor 186
Nonadherence Counselor Issues 163 Assessing Client’s Nonverbal Behavior 186
case study: Mary: Busy Overweight Checking 186
College Student and Mother 164 Counseling Checklists (Interview Guides) 186
Review Questions 164 Charting 187
Contents ix
Video, Audiotape, or Observation Walking Basics 210

Evaluations 187 case study: Officer Bill 211
case study: Amanda: The Busy Sales Review Questions 211
Representative 187
Assignment—Physical Activity
Review Questions 188 Assessment and Counseling 212
Assignment—Identifying Stress 188 Suggested Readings, Materials,
Suggested Readings, Materials, And Internet Resources 214
and Internet Resources 188 Guiding Clients in Designing
Mindful Eating 188 a Fitness Program 214
Stress Management Resources 188 Walking and Fitness 214
Creative Arts Resources for Stress Reduction 189 Selected Internet Resources 214
Relapse Prevention 189 References 214
Investigating Assessment Forms 189
References 189 Chapter 9
Communication with Diverse
Chapter 8
population Groups 217
physical activity 191
Introduction 218
Introduction 192
Gaining Cultural Competence 218
Physical Activity Initiatives 192
Reasons to Focus on Cultural Competence 218
Role of Nutrition Counselor in
Cultural Competence Models 219
Physical Activity Guidance 193
Cultural Competence Continuum 220
Physical Activity And Fitness 193
The LEARN Model 220
Benefits of Regular Physical Activity 194
The ETHNIC Model 220
Injury Risks Associated with Exercise 196
Campinha-Bacote Cultural Competence
Exercise Myths 196
Model for Healthcare Professionals 220
Physical Activity Goals 196 Cross-Cultural Nutrition
Moderate Physical Activity 197 Counseling Algorithm 226
Vigorous Physical Activity 197 Working with Interpreters 226
Methods to Determine Level of Exertion 198 Life Span Communication
Muscular Strength 199 and Intervention Essentials 228
Flexibility 199 Preschool-Aged Children (2 to 5 Years) 228
Barriers to Becoming Physically Active 200 Intervention Strategies 229
Physical Activity Counseling Protocols 200 Middle Childhood (6 to 11 Years) 230
Assessments of Physical Activity 200 Intervention Strategies 230
Physical Activity Status 200 Adolescence (12 to 19 Years) 231
Medical Assessment 201 Intervention Strategies 232
Motivational Level 202 Older Adults 232
Assessment Feedback 202 Intervention Strategies 234
Resolving Phase Protocols 203 Eating Disorders 237
Level 1—Not Ready to Change 203 Weight Bias 237
Level 2—Unsure About Changing 206 Intervention Essentials 238
Level 3—Ready to Change 207 Individuals with Disabilities 239
Level 4—Physically Active 208 Mobility Impairment 243
Issues Pertinent to Physical Activity Goal Visual Impairment 243
Setting and Action Plan Development 210 Deaf or Hard of Hearing 243
x Contents
Speech Disabilities 243 Chapter 11

case study: Counseling in a Keys to Successful Nutrition
WIC Program 244
education Interventions 277
case study: Activities 244
Introduction 278
Invisible Disabilities 245
Nutrition Education Settings 278
Review Questions 245
Keys to Nutrition Education 279
Case Study Answers 245
Keys to Success 1—Know Your
Assignment—Conducting an Interview Audience, Conduct A Thorough
Across Cultures 246 Needs Assessment 279
Suggested Readings, Materials, Needs Assessment Categories 279
Data Collection Methods 281
References 249
case study: Nutrition Education
Intervention for a Congregate
Chapter 10 Meal Program 282
Group Facilitation and case study: Keys to Success 1—Know
Your Audience, Conduct a Thorough
Counseling 254 Needs Assessment 283
Introduction 255 Keys to Success 2—Determine Your
Communication Styles 255 Educational Approach 283
Using Questions in a Group 255 case study: Keys to Success 2—Determine
Types of Questions 256 Your Educational Approach 285
Facilitating Groups 257 Keys to Success 3—Design Theory-Based
Preparation 257 Interventions 285
Consensus 259 case study: Keys to Success 3—Design
Theory-Based Interventions 287
Group Management 259
Community Level and Planning
Group Counseling 262
Models: Social Marketing 287
Advantages of Group Counseling 262
Definition of Social Marketing 287
Disadvantages of Group Counseling 262
Basic Principles of Social Marketing 287
Group Process 262
Application of Social Marketing 289
Ending 268
Keys to Success 4—Establish Goals and
Practical Considerations for Objectives 290
Successful Groups 270
Goals 290
Evaluation of Group Interactions 271
Objectives 290
case study: Group Facilitation at a
Verbs 291
Diabetes Camp for Adolescent Girls 272
Types of Objectives 291
Cognitive Domain 291
Assignment—Practice Group
Counseling 273 Affective Domain 293
First Session 273 Psychomotor Domain 293
Subsequent Sessions 274 Generalizations 294
Written Report of the Group Instructional Plan 296
Counseling Experience 275 case study: Keys to Success 4—Establish
Answers to Exercise 10.4 275 Goals and Objectives 296
Suggested Readings, Materials, Review Questions 300
and Internet Resources 275 Assignment 300
References 275 Answers to Chapter Exercises 300
Contents xi
Suggested Readings, Materials, Books 325

and Internet Resources 300 Educational Strategies Websites 326
References 301 Media Technique Websites 326
Evaluation Website 326
Chapter 12 References 326
educational Strategies,
Mass Media, and evaluation 303 Chapter 13
Introduction 304
professionalism and
Keys to Success 5—Provide Instruction
Final Issues 328
Planning and Incorporate Learning Introduction 329
Strategies 304 Professionalism 329
Presentation 305 Practice Standards 329
Discussion 309 Practice Management and Advancement 329
Demonstration 309 Practice Resources 329
Visual Aids 309 Ethics 330
Action-Oriented Techniques 311 Client Rights 335
Technology-Based Techniques 312 Confidentiality 335
Learning Domains and Strategies 313 Procedures and Goals of Counseling 335
Keys to Success 6—Develop Appealing Qualifications and Practices
and Informative Mass Media Materials 314 of the Counselor 336
Developing Audio and Audiovisual Boundary Between Nutrition Counseling
Messages 315 and Psychotherapy 336
Developing Print Materials 315 Referrals 336
Stage 1: ASOAP Analysis 317 Proper Dress Attire 338
Stage 2: Outline and Collect Resources 318 Starting a Private Practice 338
Stage 3: Write the First Draft 318 Define a Focus 338
Stage 4: Polish Your Paper 318
Professional Credentials
Application of Emotion-Based Approach 319 and Achievements 340
Keys to Success 7—Conduct Evaluations 322 Learn and Connect 340
Planning for an Evaluation 322 Create a Business Roadmap 340
Formative Evaluations 323 Professional Support Systems 340
Summative Evaluations 323 Business Basics 341
case study: Presentation to Marketing Basics 341
Working Adults 323 Marketing Plan 342
Review Questions 324 Web-Based Marketing 342
Assignment—Develop a TV Public Social Media Marketing 342
Service Announcement 324
case study: Interactive Personal
STEP 1: Define the Issue 324
Case Study 344
STEP 2: Develop Initial Message Concepts 324
STEP 3: Assess Message Concepts 324
Assignment—Evaluate Your
STEP 4: Fine Tune Your Message 324 Counseling Effectiveness 345
STEP 5: Validate Message 325 Additional Considerations of Videotape
STEP 6: Write a Report 325 Observations 346
Suggested Readings, Materials, Suggested Readings, Materials,
and Internet Resources 325 and Internet Resources 346
xii Contents
Websites 346 The Four Counseling Sessions 351

Books 346 Preparation for Session 1 351
References 346 Session 1 352
Session 2 353
Chapter 14 Session 3 353
Guided Counseling experience 349 Session 4 354
Introduction 350 Appendix A DASH Food Plan 374

Developing a Counseling Style 350 Appendix B Body Mass Index 377
Finding Volunteer Clients 350 Appendix C Exchange Lists for
Goals of the Guided Counseling Experience 350 Weight Management 378
Skill Goals 351 Appendix D Lifestyle Management Forms 400
Attitude Goals 351 Index 437
preface
WeLCoMe to the thIrD eDItIoN DIStINGUIShING FeatUreS oF

oF NUtrItIoN CoUNSeLING the thIrD eDItIoN oF NUtrItIoN
aND eDUCatIoN SKILL CoUNSeLING aND eDUCatIoN
DeVeLopMeNt SKILL DeVeLopMeNt
The third edition of this book continues to pro- ● Practical examples: Recognizing that nutri-
vide a step-by-step approach guiding entry-level
tion education and counseling takes place
practitioners through the basic components
in a variety of settings, concrete examples,
of changing food behavior and improving nu-
case studies, and first-person accounts are
tritional status. Behavior change is a complex
presented representing a variety of wellness,
process, and there is an array of strategies to in-
private practice, and institutional settings.
fluence client knowledge, skills, and attitudes. ● Action based: Exercises are integrated into
In order to be effective change agents, nutrition
the text to give students ample opportunity
professionals need a solid foundation of coun-
and encouragement to interact with the
seling and education principles, opportunities
concepts covered in each chapter. Instruc-
to practice new skills, and knowledge of evalua-
tors can choose to assign the activities to be
tion methodologies. This book meets all of these
implemented individually at home or used as
needs in an organized, accessible, and engaging
classroom activities. Students are encouraged
approach.
to journal their responses to the exercises as a
basis for classroom discussions, distance learn-
ing, or for documenting their own reflections.
Instructors can assign journal entries and col-
INteNDeD aUDIeNCe lect them for evaluation. Reading journal en-
This book was developed to meet the needs of tries allows instructors to gain understanding
health professionals who have little or no previous of how students are grasping concepts. Each
counseling or education experience, but do have a chapter has a culminating assignment and a
solid knowledge of the disciplines of food and nu- case study that integrates all or most of the
trition. Although the book addresses the require- major topics covered throughout the chapter.
ments of nutrition professionals seeking to become ● Evidence-based: Science-based approaches,
registered dietitians, the approach focuses on skill grounded in behavior change models and
development useful to all professionals who need theories, found to be effective for educational
to develop nutrition counseling and education and counseling interventions, are analyzed and
skills. The goal of the book is to enable entry level integrated into skill development exercises.
practitioners to learn and use fundamental skills ● Putting it all together–a four-week guided nutrition
universal to counseling and education as a spring- counseling program: The text includes a step-
board on which to build and modify individual by-step guide for students working with vol-
styles. unteer adult clients during four sessions. The
xiii
xiv Preface
objective of this section is to demonstrate how Chapter 13 Professionalism and Final Issues.
the theoretical discussions, practice activities, ● Core Academy of Nutrition and Dietetics Prac-
and nutrition tools can be integrated for an ef-
tice Standards including Code of Ethics, Scope
fective intervention.
of Practice, and Standards of Practice were
updated.
NeW eDItIoN hIGhLIGhtS ● The review of social media sites was updated.
All chapters of the new edition have been updated
to incorporate the latest professional standards, aCKNoWLeDGeMeNtS
government guidelines, and research findings. In
particular, resources and references were updated Thank you to all the reviewers and the individuals
throughout the entire book. who shared their expertise and assisted in the
development of the manuscript. Your insights and
Selected Chapter-by-Chapter Updates comments were invaluable to the third edition. We
The sequential flow of the chapters follows the needs greatly appreciate the staff at Cengage Learning for
of students to develop knowledge and skills during their encouragement and tireless work shepherding
each step of the counseling and education process. us through the process. A special thanks to Casey
Lozier, Associate Content Developer for Life
Chapter 1 Preparing to Meet Your Clients and Earth Sciences, and Peggy Williams, Senior
Acquisitions Editor of Life Sciences and Nutrition.
● Recent studies regarding factors affecting
In addition, we want to acknowledge the valuable
food behavior were integrated throughout the
research and editing assistance of Kelsey Gatto,
chapter.
Melissa Vecchione and Megan Trusdell, Montclair
Chapter 2 Frameworks for Understanding and State University Graduate Assistants. We would
Attaining Behavior Change also like to thank the following reviewers for their
valuable comments as we revised this edition:
● Visual diagrams of the Health Belief Model,
Theory of Planned Behavior, and Social Reviewers
Cognitive Theory were added. Jennifer Markusic,
Owens Community College
Chapter 5 Developing a Nutrition Care Plan— Erin Burch,
Putting It All Together Trocaire College
● The most recent Nutrition Care Process guide- Lisa Herzig,
lines were incorporated into this chapter. CSU Fresno
Chapter 6 Promoting Change to Facilitate Self- Aimee Mattiolo,

Management Suffolk Community College
● A review of the U.S. Department of Agriculture Carol Erwin,
ChooseMyPlate.gov guidelines was added. Wayne State University
● Supporting self-management topics were SeAnne Safaii,
added to this chapter. University of Idaho
● The Food Management Tool Assignment was
updated to include MyPlate. Gina Pazzaglia,
West Chester University of Pennsylvania
Chapter 7 Making Behavior Change Last Susan Swadener,
● An exercise was added: Practice Eliciting the California Polytechnic State University, San Luis
Relaxation Response. Obispo
Preface xv
Kelly Eichmann, Cindy Swann,

SCCCD Point Loma Nazarene University
Stephanie Pratap,
Allied American University aBoUt the aUthorS
Martha Smallwood, Kathleen D. Bauer, Ph.D., R.D., is the founder
Abilene Christian University and has been the director of the Nutrition Coun-
seling Clinic at Montclair State University for
Jau-Jiin Chen, over 15 years. She teaches both undergraduate
Lamar University and graduate nutrition counseling courses. Pub-
Ellyn Herb, lications include book chapters and articles on
San Jose State cultural diversity and evaluation of nutrition
counseling education methods. Her applied indi-
Joan A. Marn,
vidual and group nutrition counseling experiences
Florida International University
extend to faith-based and wellness programs, fit-
Tracey Boncher, ness centers, hospitals, nursing homes, and pri-
Ferris State College of Pharmacy vate practice.
Doreen Liou, Ed.D., R.D., has been the direc-
Tay Kennedy,
Oklahoma State University tor of the Didactic Program in Dietetics at Mont-
clair State University for the past 10 years. She
Virginia Uhley, teaches both undergraduate and graduate
University of Michigan-Flint courses in nutrition education and social mar-
Romy Nelson, keting. Her research interests encompass quali-
Central Arizona College tative and quantitative methods in addressing
chronic disease risk and the applications of social
Jodie Shield, psychological theories in minority population
Benedictine University groups. Her nutrition education experiences ex-
Patricia Davidson, tend to a variety of academic, community, and
West Chester University clinical settings.
Chapter
1
Preparing to Meet Your Clients
Getty Images/Comstock/Jupiterimages
Not only is there an art in knowing something but also a certain art in teaching it.
—CiCero
Behavioral Objectives Key Terms
● Define nutrition counseling and nutrition ● Cultural Groups: nonexclusive groups that
education. have a set of values in common; an individual
● Identify and explain factors influencing food may be part of several cultural groups at the
choices. same time.
● Describe characteristics of an effective ● Culture: learned patterns of thinking, feeling,
counselor. and behaving that are shared by a group of
● Identify factors affecting clients in a counseling people.
relationship. ● Cultural Values: principles or standards of a
● Evaluate oneself for strengths and weaknesses cultural group.
in building a counseling relationship. ● Models: generalized descriptions used to
● Identify novice counselor issues. analyze or explain something.
● Nutrition Counseling: a supportive process
guiding a client toward nutritional well-being.
● Nutrition Education: learning experiences
aimed to promote voluntary adoption of
health-promoting dietary behaviors.
● Worldview: perception of the world that is
biased by culture and personal experience.
2 Chapter 1 Preparing to Meet Your Clients
InTrOducTIOn counseling can be defined as an interaction in which the

counselor focuses on client experience, client feeling, client
Nutrition counselors and educators provide guid- thought, and client behavior with intentional responses to
ance for helping individuals develop food prac- acknowledge, to explore, or to challenge. (p. 5)
tices consistent with the nutritional needs of their
bodies. For clients, this may mean altering com-
fortable food patterns and long-standing beliefs EXERCISE 1.1 DOVE Activity: Broadening Our
and attitudes about food. Nutrition professionals Perspective (Awareness)
work to increase knowledge, influence motiva- d—defer judgment
tions, and guide development of skills required for O—offbeat
dietary behavior change. This can be a challeng- V—vast
ing task. In order to be an effective change agent, E—expand on other ideas
nutrition counselors and educators need a solid Divide into groups of three. Your instructor will select an
understanding of the multitude of factors affect- object, such as a cup, and give you one minute to record
ing food behaviors. We will begin this chapter by all of the possible uses of the object. Draw a line under
addressing these factors in order to enhance un- your list. Take about three minutes to share each other’s
derstanding of the forces influencing our clients. ideas, and write the new ideas below the line. Discuss
Then, we will explore the helping relationship other possibilities for using the object with your group and
and examine counselor and client concerns. Part record these in your journal. Use the DOVE technique to
of this examination will include cultural compo- guide your thinking and behavior during this activity. Do
not pass judgment on thoughts that cross your mind or
nents. Nutrition professionals always need to be
on the suggestions of others. Allow your mind to think of
sensitive to the cultural context of their interven-
a vast number of possibilities that may even be offbeat.
tions from both their own cultural perspectives
How many more ideas occurred with sharing? Did you see
as well as their clients. Some of the activities in
possibilities from another perspective? One of the goals
this chapter will provide opportunities for you to of counseling is to help clients see things using different
explore the cultural lenses that influence your lenses. What does this mean? How does this activity
view of the world. relate to a counseling experience? Write your thoughts in
your journal and share them with your colleagues.
FOundATIOn OF nuTrITIOn Source: Dairy, Food, and Nutrition Council, Facilitating Food
cOunSELInG And EducATIOn Choices: Leaders Manual (Cedar Knolls, NJ: 1984).
Nutrition education has been defined as the fol-

lowing: “Nutrition education is any combination
FundAmEnTALS OF
of educational strategies, accompanied by envi-
ronmental supports, designed to facilitate volun-
FOOd BEhAVIOr
tary adoption of food choices and other food- and The heart of nutrition education and counseling
nutrition-related behaviors conducive to health is providing support and guidance for individuals
and well-being.”1 The needs of a target community to make appropriate food choices for their needs.
are the focus of the nutrition education process. Therefore, understanding the myriad influences af-
Nutrition counselors have similar goals, but inter- fecting food choices is fundamental to designing
ventions are guided by the needs of individual cli- an intervention. Influencing factors are often in-
ents. In particular, nutrition counseling has been tertwined and may compete with each other, leav-
defined as the process of guiding a client toward ing individuals feeling frustrated and overwhelmed
a healthy nutritional lifestyle by meeting nutri- when change is needed. Before we journey through
tional needs and solving problems that are barriers methodologies for making change feel achievable,
to change.2 Haney and Leibsohn3 designed a model we will explore aspects of environmental, psycho-
of counseling to enable guidance to be effective, logical, social, and physical factors affecting food
indicating that choices, as depicted in Figure 1.1.
Fundamentals of Food Behavior 3
healthfulness of the types of foods and drinks

Children
Cost they consume.10 Consumers are more likely to
respond to healthful food messages if the advice
Convenience Taste stresses the good taste of wholesome foods and
Food Physiology/ convenient ways to include them in the diet.4
choice metabolism Health status of an individual, such as having
Self-
Variety loss of teeth or digestive disorders, can also affect
expression
the amount of food consumed and food choice.8
Health
Well-being outcomes ● Nutrition Knowledge: Traditionally, educators
Adults
and nutrition counselors perceived their roles as
Figure 1.1 The Consumer Food Choice Model disseminating information. After research indi-
Source: Adapted from A. Drewnowski, Taste, Genetics, and cated that many clients were not responsive to
Food Choice. In Food Selection: From Genes to Culture, H. simple didactic approaches, their roles expanded
Anderson, J. Blundell, and M. Chiva, Eds. (Levallois–Perret, to include a variety of behavior change strate-
France: Danone Institute), 30. Copyright 2002. gies. However, the value of increasing knowledge
should not be devalued. Those who have higher
● Taste and Food Preference: Taste is generally levels of knowledge are more likely to have
accepted as the most important determinant of better quality diets and to lose more weight in
food choices.4 Biological taste preferences evolve weight loss programs.11,12
from childhood based on availability and so- ● Convenience and Time: For many individuals
cietal norms, but research shows that prefer- striving to make food choice changes, stress-
ences can be altered by experiences and age.5 ing convenient ways to prepare
Generally, young children favor A young man in his early twenties commenting desired foods is imperative.4 Our
sweeter and saltier tastes than about his food habits stated, “My friends do fast-food culture has created a
adults, and relocating to a new not say ‘let’s eat a salad together.’ If you are
demand for easy-to-prepare and
a guy, it is a woozy thing to do. It is kind of
environment will often change tasty food.13 In a research survey,
looked down upon if you are a guy—weak. Eat
eating patterns and even favor- the steak, eat the greasy stuff, be a man.”* 5
about half of women surveyed
ite foods.6 Without consumers expressed that they spend less
realizing it, a number of food companies have than five minutes for breakfast and lunch prepa-
been improving the nutritional quality of their ration and less than twenty minutes for dinner
foods by slowly changing recipes, such as lower- preparation.14 Take out, value-added (precut,
ing sodium or sugar content or increasing fiber. prewashed), and ready-made foods have become
For example, Ragu Old World Style Pasta Sauces a cultural standard.
stealthily reduced sodium by 25 percent from ● Culture and Religion: Food is an integral part
2004 to 2007 with no loss of market share.7 of societal rituals influencing group identity.15
The fact that taste preferences can be modified Ritual meals solidify group membership and re-
should be reassuring for those who want to affirm our relationships to others. For example,
make dietary changes. Illness may also modify all-day eating at weekly family gatherings on
food preference. Individuals going through Sundays or daily coffee breaks with sweet rolls
chemotherapy may find some of their favorite are rituals that do much more than satisfy the
foods do not taste the same, and they lose the appetite. If clients need to change participation
desire to eat them.8 in these rituals because of dietary restrictions, it
● Health Concerns: Research has shown that is likely to create stress for clients, friends, and
health can be a driving force for food choice as relatives. Culture also defines what is acceptable
illustrated by public campaigns to increase in-
take of fruits, vegetables, and whole grains. 9 In
*Numerous first-person accounts from dietetic students or nu-
a national survey, 56 percent of the participants trition counselors working in the field are included throughout
indicated they give a lot of consideration to the this book.
for consumption such as sweet red ants, scorpi- unhealthy food and large portion sizes. Almost
ons, silk worms, or a glass of cow’s milk. Culture anywhere you go—drug stores, gas stations,
also defines food patterns, and in the United hardware stores, schools, for example—there
States, snacking is common.16 In addition, reli- are opportunities to purchase unhealthy food.
gions advocate food rituals and may also define Even laboratory animals put in this type of
food taboos such as restrictions against pork for environment are likely to overeat the calorie-
Muslims, beef for Hindus, and shellfish for Or- dense food and gain excessive weight.22
thodox Jews. Due to increasing diversity, minor- ● Economics: An individual’s residence and so-
ities make up one-third of the people living in cioeconomic status can influence a myriad of
the United States. As a result, an array of ethnic factors, including accessibility to transporta-
foods are available in restaurants and grocery tion, cooking facilities, refrigeration, grocery
stores and have influenced the national palate.13 store options, and availability of healthful
For example, in the past, ketchup was consid- food choices.23 For those who are economically
ered a household staple; however, recent na- disadvantaged, meeting nutritional guide-
tional sales of salsa now compete with ketchup lines is a challenge.24 Low-income households
and at times have surpassed ketchup sales. spend significantly less money on fruits and
● Social Influences: Food is often an integral vegetables than high-income households, with
part of social experiences. Sharing a meal with 19 percent buying none in any given week.25
friends after a football game or going out for ● Availability and Variety: Individuals with
ice cream to celebrate an academic achieve- increased numbers of food encounters, portion
ment helps make special experiences festive. size, and variety of available choices tend to
However, foods associated with sociability are increase food intake.26–28 Variety of food intake
often not the most nutritious. Social eating fre- is important in meeting nutritional needs,
quently encourages increased consumption of but when the assortment is excessive, such as
less-nutritious foods and overconsumption. 17,18
making food selections from a buffet, overcon-
Eating with friends and family increases energy sumption is probable.
intake by 18 percent. However, even though
19 ● Psychological: Research has shown that indi-
regular family meals have been shown to be viduals vary in their food response to stress.
correlated with positive health outcomes for Some people increase consumption, whereas
adolescents, an analysis of soci- others claim they are feeling too
etal trends indicates that fam- A female college student stated: “The whole stressed to eat. Certain foods have
society does not emphasize eating healthy.
ily meal frequency at home has been associated with depression
When you are eating, you have to think hard
remained the same from 1999 about what are the healthy foods to eat.” and mood alteration. Severely
to 2010 and has declined for depressed individuals have been
middle school students, Asians, and adolescents found to consume more chocolate (up to
from families with low socioeconomic status.20 55 percent) per month than others.29
● Media and Physical Environment: North
An understanding of how all these factors in-
Americans are surrounded by media messages,
fluence our food behaviors is essential for nutrition
and most of them are encouraging consump-
tion of high-calorie foods that are nutritionally
challenged. In 2004, food manufacturers spent EXERCISE 1.2 Explore Influences of Food Behavior
9 billion dollars on advertising to persuade Interview three people and ask them to recall the last
consumers. Commercials can have powerful meal they consumed. Inquire about the factors that
influences on the quantity and quality of food influenced them to make their selections. Record your
consumed.21 Not only do we encounter food findings in your journal. Compare your findings to this
messages repeatedly throughout the day, but section on influences of food choice.
we also have access to a continuous supply of
Understanding an Effective Counseling Relationship 5
educators and counselors. Since we are advocating

lifestyle change of comfortable food patterns, we EXERCISE 1.3 Helper Assessment
need to understand the discomfort that our clients Think of a time someone helped you, such as a friend,
are likely to feel as they anticipate and attempt the family member, teacher, or counselor. In your journal,
alterations. Our role is to acknowledge the chal- write down the behaviors or characteristics the person
lenge for our clients and to find and establish new possessed that made the interaction so effective. After
patterns that provide a healthier lifestyle. reading over the characteristics of effective counselors,
compare their qualities to those identified by the
leading authorities. Do they differ? Share your thoughts
undErSTAndInG An EFFEcTIVE with your colleagues.
cOunSELInG rELATIOnShIp
No matter what theory or behavior change model
affecting the behaviors, attitudes, and feelings of
is providing the greatest influence, the relation-
clients: knowledge, self-awareness, ethical integrity,
ship between counselor and client is the guiding
congruence, honesty, ability to communicate, and
force for change. The effect of this relationship is
gender and culture awareness. The following list
most often cited as the reason for success or failure
describes these characteristics as well as those thought
of a counseling interaction.2 Helm and Klawitter30
to be effective by nutrition counseling authorities:
report that successful clients identify their per-
sonal interaction with their therapist as the sin- ● Effective nutrition counselors are self-aware.
gle most important part of treatment. To set the They are aware of their own beliefs, respond
stage for understanding the basics of an effective from an internal set of values, and as a result
counseling relationship, you will investigate the have a clear sense of priorities. However, they are
characteristics of effective nutrition counselors, not afraid to reexamine their values and goals.33
explore your own personality and culture, exam- This awareness aids counselors with being hon-
ine the special needs and issues of a person seek- est with themselves as to why they want to be a
ing nutrition counseling, and review two phases counselor and helps them avoid using the help-
of a helping relationship in the following sections. ing relationship to fulfill their own needs.34
● They have a solid foundation of knowledge.
characteristics of Effective Nutrition counselors need to be knowledgeable
nutrition counselors in a vast array of subjects in the biological and
“Ideal helpers” have been described as possessing social sciences as well as have an ability to apply
the following qualities: principles in the culinary arts. Because the sci-
ence and art of nutrition is a dynamic field, the
They respect their clients and express that respect by be-
ing available to them, working with them, not judging foundation of knowledge requires continuous
them, trusting the constructive forces found in them, updating. Clients particularly appreciate nutri-
and ultimately placing the expectation on them to do tion counselors who are experienced with the
whatever is necessary to handle their problems in living problems they face.
more effectively. They genuinely care for those who have ● They have ethical integrity. Effective counsel-
come for help. They are non-defensive, spontaneous, ors value the dignity and worth of all people.
and always willing to say what they think and feel, pro- Such clinicians work toward eliminating ways
vided it is in the best interest of their clients. Good help- of thinking, speaking, and acting that reflect
ers are concrete in their expressions, dealing with actual racism, sexism, ableism, ageism, homophobia,
feelings and actual behavior rather than vague formula-
religious discrimination, and other negative
tions, obscure psychodynamics, or generalities.31 (p. 29)
ideologies.35 Ethical integrity entails many facets
After thoroughly reviewing the literature in that are addressed in the Academy of Nutrition
counseling, Okun32 identified seven qualities of and Dietetics’ Code of Ethics (a discussion of
counselors considered to be the most influential in this topic can be found in Chapter 13).36
● They have congruence. This means the coun- and a sincere regard for their clients. Effective
selor is unified. There are no contradictions nutrition counselors are able to make sensitive
between who the counselor is and what the comments and communicate an understanding
counselor says, and there is consistency in about fears concerning food and weight.29
verbal and nonverbal behaviors as well. (For ● They have a sense of gender and cultural
example, if a client shared about some unusual awareness. This requires that counselors be
behavior, such as eating a whole cake covered aware of how their own gender and culture
with French dressing, the counselor’s behav- influence them. Effective counselors have a
ior would not be congruent if the nonverbal respect for a diversity of values that arise from
behavior indicated surprise but the verbal re- their clients’ cultural orientations.
sponse did not.) ● They have a sense of humor. Helping clients
● They can communicate clearly. Clinicians must see the irony of their situation and laugh
be able to communicate factual information about their problems enriches counseling
EXERCISE 1.4 People Skills Inventory

● Do you expect the best from people? Do you assume that others will be conscientious, trustworthy, friendly, and
easy to work with until they prove you wrong?
● Are you appreciative of other people’s physical, mental, and emotional attributes—and do you point them out frequently?
● Are you approachable? Do you make an effort to be outgoing? Do you usually wear a pleasant expression on your face?
● Do you make the effort to remember people’s names?
● Are you interested in other people—all kinds of people? Do you spend far less time talking about yourself than
encouraging others to talk about themselves?
● Do you readily communicate to others your interest in their life stories?
● When someone is talking, do you give him or her 100 percent of your attention—without daydreaming, interrupt-
ing, or planning what you are going to say next?
● Are you accepting and nonjudgmental of others’ choices, decisions, and behavior?
● Do you wholeheartedly rejoice in other people’s good fortune as easily as you sympathize with their troubles?
● Do you refuse to become childish, temperamental, moody, inconsistent, hostile, condescending, or aggressive in
your dealings with other people—even if they do?
● Are you humble? Not to be confused with false modesty, being humble is the opposite of being arrogant and
egotistical.
● Do you make it a rule never to resort to put-downs, sexist or ethnic jokes, sexual innuendoes, or ridicule for the
sake of a laugh?
● Are you dependable? If you make commitments, do you keep them—no matter what? If you are entrusted with a
secret, do you keep it confidential—no matter what?
● Are you open-minded? Are you willing to listen to opposing points of view without becoming angry, impatient, or
defensive?
● Are you able to hold onto the people and things in your life that cause you joy and let go of the people and things in
your life that cause you sadness, anger, and resentment?
● Can you handle a reasonable amount of pressure and stress without losing control or falling apart?
● Are you reflective? Are you able to analyze your own feelings? If you make a mistake, are you willing to acknowledge
and correct it without excuses or blaming others?
● Do you like and approve of yourself most of the time?
Affirmative answers indicate skills you possess that enhance your ability to relate to others.
Source: Adapted from Scott N, “Success Often Lies in Relating to Other People,” Dallas Morning News, April 20, 1995, p. 14C.
relationships. In addition, humor helps pre-

vent clients from taking themselves and their EXERCISE 1.5 How Do You Rate?
problems too seriously.33 Ask a close friend or family member who you supported
● They are honest and genuine. Such counsel- at one time to describe what it was about your behavior
ors appear authentic and sincere. They act that was helpful. Write these reactions down in your
human and do not live by pretenses, hiding journal. Review the desirable characteristics for an
behind phony masks, defenses, and sterile effective counselor described in the previous section.
roles.33 Such counselors are honest and show Complete the personality inventory in Exercise 1.4,
spontaneity, congruence, openness, and will- and then identify what characteristics you possess
that will make you a good helper. What behaviors need
ingness to disclose information about them-
improvement?
selves when appropriate. Honest counselors
Write in your journal specific ways that you need to
are able to give effective feedback to their
change to improve your helping skills.
clients.
● They are flexible. This means not being a per-
fectionist. Such counselors do not have unreal-
istic expectations and are willing to work at a Intertwined with a personality evaluation is a
pace their clients can handle. self-examination of why you want to be a counselor.
● They are optimistic and hopeful. Clients want What you expect out of a counseling relationship,
to believe that lifestyle changes are possible, the way you view yourself, and the personal atti-
and they appreciate reassurance that solutions tudes and values you possess can affect the direction
will be found. of the counseling process. You should be aware that
● They respect, value, care, and trust others. as a helper, your self-image is strengthened from the
This enables counselors to show warmth and awareness that “I must be OK if I can help others in
caring authentically through nonjudgmental need.” Also, because you are put into the perceptual
verbal and nonverbal behavior, listening at- world of others, you remove yourself from your own
tentively, and behaving responsibly, such as issues, diminishing concern for your own problems.34
returning phone calls and showing up on Sometimes counselors seek to fulfill their own
time. This behavior conveys the message that needs through the counseling relationship. Practi-
clients are valued and respected. tioners who have a need to express power and in-
● They can accurately understand what people fluence over others tend to be dictatorial and are
feel from their frame of reference (empathy). less likely to be open to listening to their clients.
It is important for counselors to be aware of This type of counselor expects clients to obey sug-
their own struggles and pain to have a frame gestions without questions. A counselor who is
of reference for identifying with others.33 particularly needy for approval and acceptance will
fear rejection. Belkin36 warns that sometimes coun-
It is one of the most beautiful compensa- selors try too hard to communicate the message “I
tions of this life that no man can sincerely want you to like me,” rather than a more effective
try to help another without helping himself. “I am here to help you.” As a result, such counsel-
—ralph Waldo Emerson ors may be anxious to please their clients by try-
ing to do everything for them, perhaps even doing
understanding Yourself—personality favors. The tendency will be to gloss over and hide
and culture difficult issues because the focus is on eliciting only
positive feelings from their clients. Consequently,
According to Brammer,34 our personalities are one
clients will not learn new management skills, and
of the principal tools of the helping process. By
dietary changes will not take place.
taking an inventory of your personality character-
Another important component to under-
istics, you can have a better understanding of the
standing yourself so as to become a culturally
ones you wish to modify.
Your worldview is determined by your culture

EXERCISE 1.6 Why Do You Want to Be a Helper? and life experiences. Culture is shared history, con-
Describe in your journal what it means to be a helper sisting of “the thoughts, communication, actions,
and why you want to be a helper. How does it feel customs, beliefs, values, and institutions of racial,
when you help someone? Is it possible that you have ethnic, religious or societal groups.”38 Possible soci-
issues related to dominance or neediness that could etal groups include gender, age, sexual orientation,
overshadow interactions with your clients? physical or mental ability, health, occupation, and
socioeconomic status. Any individual will belong to
several societal groups and acquire cultural character-
competent nutrition counselor and educator is to istics and beliefs from each based on education and
know what constitutes your worldview (cultural experiences within those groups. Because the experi-
outlook). Each culture has a unique outlook on ences are unique, no two people acquire exactly the
life, what people believe and value within their same cultural attributes. In addition, we are likely to
group. Our worldview provides basic assump- migrate to and away from various cultures through-
tions about the nature of reality out our lives. For example, we may
and has both conscious and un- My aunt died of high blood pressure. Her
change jobs, religions, residence, or
religious belief was that her illness was
conscious influences. An under- health status, and as a result, cul-
God’s will and should not be interfered with
standing of this concept becomes by taking medicine or changing her diet. tural attributes will also alter. How-
clearer when we explore assump- ever, there are attributes that prevail
tions regarding supernatural forces, individual and will affect the way we perceive ourselves and
and nature, science and technology, and materi- others.
alism. (See Table 1.1.) Kittler and Sucher 37 relate We share a commonality with those who are
this unique outlook to its special meaning in the most like us. For example, many North Ameri-
health community: cans appreciate a friendly, open health care pro-
fessional. People from other cultures, however,
. . . expectations about personal and public conduct, as-
sumptions regarding social interaction, and assessments may feel uncomfortable interacting with a profes-
of individual behavior are determined by this cultural sional on such terms and may even view this be-
outlook, or worldview. This perspective influences per- havior as a sign of incompetence. Your food habits
ceptions about health and illness as well as the role of can also be an important component of your cul-
each within the structure of society. (p. 37) ture. For example, Hindus find eating beef to be
Table 1.1 Worldview Assumptions
category Assumption
Supernatural Assumptions Supernatural assumptions include beliefs regarding God, malevolent spirits, ancestors, fate,
or luck being the cause of illness. The concept of soul loss causing depression or listlessness
is prevalent in many societies. In order to alleviate supernatural problems, societies have
devised ceremonies or rituals.
Individual and Nature Not all societies make a clear distinction between human life and nature as in the United States.
Some societies believe that we are subjugated by nature and need to show respect for natural
forces and attempt to live in harmony with nature. The dominant culture in the United States
sees human beings as having higher value than nature with a need to exploit or protect it.
Technology The citizens of the United States put great fate in technology and the scientific method.
Diseases are viewed as correctable mechanistic errors that can be fixed by manipulation.
Americans tend to think science can help humanity—a view not as highly held in Europe.39
Materialism Many people around the world believe that materialism dominates the worldview of
Americans, that is, the need to acquire the latest and best possessions. This may have
contributed to the popularity of “supersize food portions.”
Source: Jandt F. An Introduction to Intercultural Communication: Identities in a Global Community. 6th ed. Thousand Oaks, CA: Sage Publications,
Inc.; 2009.
abhorrent—much the way many Westerners feel Table 1.2 Functions of Cultural Values
about Asians consuming dog meat. ● Provide a set of rules by which to govern lives.
Understanding the role of cultural values in
● Serve as a basis for attitudes, beliefs, and behaviors.
your life as well as in lives of clients from cultures
other than your own provides a foundation for de- ● Guide actions and decisions.
veloping cultural sensitivity. Our cultural values are ● Give direction to lives and help solve common problems.
the “principles or standards that members of a cul-
● Influence how to perceive and react to others.
tural group share in common.”40 For example, in
the United States, great value is placed on money, ● Help determine basic attitudes regarding personal,
freedom, individualism, independence, privacy, bio- social, and philosophical issues.
medical medicine, and physical appearance. Cul- ● Reflect a person’s identity and provide a basis for self-
tural values are the grounding forces that provide evaluation.
meaning, structure, and organization in our lives. Source: Adapted from Joan Luckmann, Transcultural Communication in
(See Table 1.2.) Individuals may hold onto to their Nursing. Belmont, CA: Delmar Cengage Learning, 1999.
values despite numerous obstacles or severe conse-

quences. For example, Jung Chang describes in her official in the party. His devotion to the party never
family portrait, Wild Swans: Three Daughters of China, wavered, even during the Cultural Revolution when
how her father actively supported Mao’s Commu- he was denounced, publicly humiliated with a
nist takeover of China and rose to be a prominent dunce hat, and sent to a rehabilitation camp.41
EXERCISE 1.7 What Is Your Worldview?

Indicate on the continuum the degree to which you share the following white North American cultural values; 1 indicates
not at all, and 5 represents very much.
not Very
at All much
1 2 3 4 5 Personal responsibility and self-help for preventing illness.
1 2 3 4 5 Promptness, schedules, and rapid response-time dominates.
1 2 3 4 5 Future-oriented—willing to make sacrifices to obtain future goals.
1 2 3 4 5 Task-oriented—desire direct participation in your own health care.
1 2 3 4 5 Direct, honest, open dialogue is essential to effective communication.
1 2 3 4 5 Informal communication is a sign of friendliness.
1 2 3 4 5 Technology is of foremost importance in conquering illness.

1 2 3 4 5 Body and soul are separate entities.
1 2 3 4 5 Client confidentiality is of utmost importance; health care is for individuals, not families.
1 2 3 4 5 All patients deserve equal access to health care.
1 2 3 4 5 Desire to be youthful, thin, and fit.
1 2 3 4 5 Competition and independence.
1 2 3 4 5 Materialism.
Can you think of a time when your values and beliefs were in conflict with a person you were trying to associate with?
What were the circumstances and results of that conflict? Write your response in your journal, and share your stories
with your colleagues.
Source: Adapted from Kittler P and Sucher K, Food and Culture in America, 2d ed. (Belmont, CA: West/Wadsworth; 1998); and Keenan, Debra P.
In the face of diversity: Modifying nutrition education delivery to meet the needs of an increasingly multicultural consumer base, J Nutr Ed.
1996;28:86–91.
orientations, health care problems, and issues related

EXERCISE 1.8 What Are Your Food Habits? to the counseling process. Each person’s individual
Record answers to the following questions in your personality should be recognized and appreciated.
journal; share them with your colleagues. Clients have their own set of needs, expectations,
● Who purchases and prepares most of the food concerns, and prejudices that will have an impact
consumed in your household? on the counseling relationship. In the rushed at-
● What is your ethnic background and religious mosphere of some institutional settings, health care
affiliation? workers can lose sight of the need to show respect,
● Are there foods you avoid eating for religious especially if a client has lost some of his or her physi-
reasons? ological or mental functions due to illness.
● List two foods you believe are high-status items. From a cultural perspective, clients are diverse
● What major holidays do you celebrate with your in many ways, belong to a number of societal
family?
groups, and have a set of unique life experiences
● List two rules you follow when eating a meal (for
contributing to a distinctive view of the world. Get-
example, “Don’t sing at the table”).
ting a fresh perspective from a counselor is one of
● Are there food habits that you find morally or ethi-
cally repugnant?
the advantages of counseling. However, the farther
● Are you aware of any of your own food habits that away counselors are from their clients’ cultural ori-
others would consider repugnant? entation, the more difficult it is to understand their
worldview. If this is the case, then you will need to
Source: Adapted from Kittler P and Sucher K, Food and Culture,
explore your clients’ culture through books; news-
4th ed. (Belmont, CA: Wadsworth/Thomson; 2004), pp. 24–25.
papers; magazines; workshops; movies; and cul-
tural encounters in markets, fairs, and restaurants.
As nutrition counselors and educators advo- Learning your clients’ beliefs about illness and the
cate for change, there needs to be an appreciation various functions and meanings of food are partic-
of the high degree of importance placed on cer- ularly important. While exploring cultural groups,
tain beliefs, values, and cultural practices. You can you should remember that the characteristics of a
then empathize with individuals from nonwest- group are simply generalities. You want to avoid
ern cultures who are experiencing confusion and stereotyping. Do not fall into the trap of believing
problems as they try to participate in the North that each characteristic applies to all people who
American health care system. Also, awareness can appear to represent a particular group. Remember
help prevent your personal biases, values, or prob- that the thoughts and behaviors of each individual
lems from interfering with your ability to work develop over a lifetime and are shaped by mem-
with clients who are culturally different from you. bership in several cultural groups. For example,
Conscious and unconscious prejudices unre- a homosexual male who grew up with a learning
lated to cultural issues that a counselor may possess disability in Alabama with first generation parents
could also interfere with emotional objectivity in from Italy and lives in Chicago as an adult would
a counseling situation. Individuals could have ex- have a number of social groups and life experi-
aggerated dislikes of personal characteristics such ences influencing his communication style, view
as being obese, bald, aggressive, or poorly dressed. of the world, and expectations. People totally, par-
Awareness of these prejudices can help build toler- tially, or not at all embrace the standards of a cul-
ances and a commitment not to let them interfere ture they appear to represent.
with the counseling process through facial expres- The circumstances that bring clients to coun-
sions and other nonverbal behavior. seling can have a major impact on their readiness
for nutrition counseling. Those who have been
understanding Your client recently diagnosed with a serious illness may be
Just like counselors, clients come into nutrition experiencing shock or a great deal of physical dis-
counseling with unique personalities, cultural comfort to deal effectively with complex dietary
guidelines—or any guidelines at all. They may dis- a perilous mountain pass or a rushing torrent, whatever
play a tendency toward rebelliousness, a denial of in my terror I may imagine.47 (pp. 165–166)
the existence of the problems, anxiety, anger, or To help alleviate the negative impact of such
depression.2,42 When counseling an individual with issues on the counseling process, the motive
a life-threatening illness, nutrition counselors need for help and the nature of the helping task as
to take into account a client’s position on the con- perceived by the counselor should be made clear to
tinuum of treatment and recovery.43 the receiver.33
An attitudinal investigation of young and well-
educated patients with diabetes suggests a desire
for a collaborative relationship with their health relationship Between helper and client
care providers helping them to explore options The helping relationship is often divided into two
rather than simply being told what to do.44 On the phases: building a relationship and facilitating posi-
other hand, this same study identified a signifi- tive action.34 Building a relationship requires the de-
cant number of the elderly with diabetes who did velopment of rapport, an ability to show empathy,
not desire an independent self-care role. Promot- and the formation of a trusting relationship.48 The
ing self-sufficiency is often stated goals of this phase are to learn
My client, a robust man in his youth, was a about the nature of the prob-
as a goal of nutrition counseling ; 45
World War II veteran who took part in the
however, for some clients, that invasion of Normandy. But at age seventy-
lems from the client’s viewpoint,
goal may need to be modified. This five, he suffered a stroke and went into a explore strengths, and promote
issue has also been addressed by veterans’ hospital for treatment. During self-exploration.
his hospital stay, he asked a health care
the expert panel for the National The focus of the second
worker to help him get into bed because he
Institutes of Health report, Identi- wanted to go to sleep. The worker told him phase of the counseling process
fication, Evaluation, and Treatment he would be able to go to sleep after he is to help clients identify specific
of Overweight and Obesity,46 which finished his lunch. My client became very behaviors to alter and to design
angry and threw his lunch tray at the health
states that a weight maintenance realistic behavior change strate-
care worker.
program consisting of diet therapy, gies to facilitate positive action.45
behavior therapy, and physical activity may need This means clients need to be open and honest
to be continued indefinitely for some individuals. about what they are willing and not willing to do.
Some clients may regard the counseling pro- Lorenz et al.48 state that in the successful Diabetes
cess itself as an issue. The act of seeking and re- Control and Complications Trial, clients could bet-
ceiving help can create feelings of vulnerability ter communicate their capabilities when health
and incompetence.33 During counseling there is professionals articulated what problems could
a presumed goal of doing something for the cli- develop in attempting to improve blood glucose
ents or changing them in some way. This implica- control. They found honesty more likely to occur
tion of superiority can raise hostile feelings in the in an environment in which clients do not feel
helpee because the act presumes that the helper is they will be criticized when difficulties occur, but
wiser, more competent, and more powerful than rather believe the caregivers will show understand-
the helpee. This is illustrated in Helen Keller’s ac- ing and work toward preparing for similar future
count of her dreams about her teacher and lifelong circumstances. Nonjudgmental feedback was also
friend, Annie Sullivan, who provided constant an important component of the successful DASH
help for almost all aspects of Helen’s existence: (Dietary Approaches to Stop Hypertension) dietary
trial for reducing hypertension.50 Counselors must
[T]here are some unaccountable contradictions in my
dreams. For instance, although I have the strongest, deep-
communicate their willingness to discover their
est affection for my teacher, yet when she appears to me clients’ concerns and help them prioritize in a
in my sleep, we quarrel and fling the wildest reproaches realistic manner.
at each other. She seizes me by the hand and drags me by In summary, it would be futile to start design-
main force towards I can never decide what—an abyss, ing behavior change strategies when an effective
Attending to the second part of the counseling process

EXERCISE 1.9 Exploring Food Habits of Others without the strong foundation afforded by the first part
Interview someone from a culture different than your results in dealing with the problem as being separate
own. Ask that person the questions in Exercise 1.8, and from the client, or worse yet, providing solutions to the
record his or her answers in your journal. What did you wrong problems. Behavior-change strategies designed un-
learn from this activity? How can you personally avoid der these circumstances are not likely to succeed. (p. 352)
ethnocentric judgments regarding food habits? The scenario in Exercise 1.10 illustrates a com-
mon mistake helpers make—indicating that
everything will be fine. Because it has no basis for
reality, the comment belittles the client’s feelings. If
EXERCISE 1.10 Starting a Relationship
the client actually feels reassured by the comment,
Lilly is forty-two years old, has three children, and is the benefit is temporary because no solution to the
about twenty pounds overweight. She sought the help problem has been sought. Patronizing a client is self-
of a fitness and nutrition counselor, Joe, because she defeating. It indicates superiority and can automati-
wants to increase her energy level and endurance. She cally create negative feelings. Effective counselors
tires quickly and feels that exercise will help her stamina.
provide reassurance through clarifying their roles
Joe Hello, Lilly. It’s great you came a little early. in the counseling process, identifying possible solu-
Let’s get you right on the scale. OK, tions, and explaining the counseling program.
at 163 pounds, it looks to me as if you
need to shed about 20 pounds. You have novice counselor Issues
a ways to go but worry not—we will get New counselors typically have concerns about their
it off you. Everything will be fine.
competency. A counselor who feels inadequate
Lilly I really…
may be reluctant to handle controversial nutri-
Joe I am not kidding, Lilly—don’t worry. We
tion issues, sometimes giving only partial answers
will start slowly. What you want to do is
and ignoring critical questions. Confidence in your
get your BMI down, your muscle tissue
up, as well as get rid of the fat. If you ability will increase with experience.
follow me, I’ll introduce you to everyone, Client: Are high-protein diets a good way to lose weight?
sign you up for an aerobics class, and
start you on your routine. Counselor: Some people say they lose weight using
Lilly Well, you see I only want… them.
Joe Hey, Rick, this is Lilly. She is a newcomer. In this example, the counselor is talking like a
rick Welcome, Lilly. Don’t forget to take home
politician—not taking a stand, trying not to offend
some of our power bars—they are great
anyone. If you are not clear about an issue, you may
for beginners who may not know how to
want to tell your client that it is a topic you have
eat right.
not thoroughly investigated and that you will re-
Joe Yeah, and be sure to bring a sports drink
in with you; you will get mighty thirsty. view the matter. If after investigating the issue, you
No pain, no gain! still do not have a clear answer, you should provide
your client with what you have found out regard-
In groups of three, brainstorm the concerns in this
scenario. Why is this helping relationship off to a bad ing the positives and negatives of the topic. The
start? What questions or comments could Joe have Academy of Nutrition and Dietetics Code of Ethics35
made that may have been more helpful? states, “The dietetics practitioner presents reliable
and substantiated information and interprets con-
troversial information without personal bias, recog-
relationship has not developed and you do not nizing that legitimate differences of opinion exist.”
yet have a clear understanding of your clients’ Another issue for novice nutrition counsel-
problems or an appreciation of their strengths. Ac- ors is assuming the role of expert or empathizer.33
cording to Laquatra and Danish:48 Combining the two roles can contribute to an
References 13
effective intervention, but a single approach is influenced them. This activity may help in the
likely to hamper progress. An authority figure is process of understanding the factors that have
impressive and appears to have all the answers. framed your values, views, and thinking patterns.
Clients blindly accept the direction of the “guru,” Culture is defined as “the thoughts, commu-
but little work is done to determine how to make nication, actions, customs, beliefs, values, and
the lifestyle changes work for them. As a result, institutions of racial, ethnic, religious or societal
clients revert to old eating patterns. On the other groups.” 38 You are a member of several cultural
hand, the empathizer puts so much effort into fo- groups. Select pictures from print media or use
cusing on client problems that the client receives your own photographs that represent cultural
little direction or information. With experience forces that have influenced your worldview. Attach
and determination, the two roles can be effec- them to a poster board. Be prepared to discuss your
tively combined. collage with your colleagues.
rEVIEW QuESTIOnS rEFErEncES

1. Define nutrition counseling and nutrition 1
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2. What is generally considered the most impor-

2
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3. Name and explain the seven qualities of coun-
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selors considered to be the most influential by 4
Glanz K, Basil M, Maibach E, et al. Why Americans
leading authorities as identified by Okun.
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5. Identify and explain how seeking to fulfill two Drenowski A. Taste preferences and food intake.
5
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Sass C. Yummy! Yucky! Ick! Tasty! Know what your
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6. Why is it important for counselors to under-

7
Spittler L. Under the radar: Stealth nutrition in the food
industry. ADA Times. March–April 2007.
stand their worldviews to achieve cultural
sensitivity?
8
Hopkinson JB, Wright DNM, McDonald JW, Corner
JL. The prevalence of concern about weight loss and
7. Name and explain the two phases of the helping change in eating habits in people with advanced cancer.
relationship. J Pain Symp Mngmt. 2002; 32:322–331.
8. Why is indicating to a client that everything 9
American Dietetic Association. Nutrition and You:
will be fine unlikely to be productive? What is Trends 2011. 2011. Available at: http://www.eatright
a more useful approach? .org/nutritiontrends/#.UuQLLSj0Cb8. Accessed
9. Identify three issues for novice counselors. January 24, 2014.
10
International Food Information Council. 2013 Food
& Health Survey: Consumer Attitudes toward Food Safety,
ASSIGnmEnT—BuILd A cOLLAGE Nutrition & Health. 2013. Available at: http://www
.foodinsight.org/LinkClick.aspx?fileticket=spavtJtVkzM
The purpose of this assignment is to reflect upon %3d&tabid=1482. Accessed January 19, 2014.
the aspects of your culture that have had the great- 11
Klohe DM, Freeland-Graves JH, Anderson ER, et al.
est impact on you. Part of becoming a culturally Nutrition knowledge is associated with greater weight
competent nutrition counselor is to understand loss in obese and overweight low-income mothers.
your own beliefs, attitudes, and the forces that J Am Diet Assoc. 2006; 106:65–75.
Variyam JN, Blaylock J, Smallwood D, Basiotis PP.

12 25
Blisard N, Stewart H, Jolliffe D. Low-income
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Washington, DC: US Department of Agriculture: 1998. Agricultural Economic Report No. 833. US Department
Technical Bulletin No. 1866. of Agriculture Economic Research Service Web site.
13
Jarratt J, Mahaffie JB. The profession of dietetics at a Available at http://www.ers.usda.gov/publications
critical juncture: A report on the 2006 environmental /aer833/aer833.pdf. Accessed January 19, 2014.
scan for the American Dietetic Association. J Am Diet 26
Duffey KJ, Popkin BM. Causes of increased energy
Assoc. 2007; 107:S39–S57. intake among children in the U.S., 1977–2010. Am J Prev
Chu YL, Addo OY, Perry CD, Sudo N, Reicks M. Time
14 Med. 2013; 44:e1–e8.
spent in home meal preparation affects energy and food 27
Epstein LH, Fletcher KD, O’Neill J, Roemmich JN,
group intakes among midlife women. Appetite. 2012; Raynor H, Bouton ME. Food characteristics, long-term
58:438-443. habituation and energy intake. Laboratory and field
Mintz SW, Bu Bois, CM. The anthropology of food and
15 studies. Appetite. 2013; 60:40–50.
eating. Ann R Anthropo. 2002; 31:91–119. Levitsky DA, Iyer S, Pacanowski CR. Number of foods
28
Piernas C, Poplin BM. Snacking increased among

16
available at a meal determines the amount consumed.
U.S. adults between 1977 and 2006. J of Nutr. 2010; Eat Behav, 2012; 13:183–187.
140:325–332. 29
Rose N, Koperski S, Golomb BA. Chocolate and
Liou D, Bauer K. Obesity perceptions among Chinese
17
depressive symptoms in a cross-sectional analysis. Arch
Americans: The interface of traditional Chinese and Intern Med. 2010; 170(8):699–703.
American values. Fd Culture Soc. 2010; 13:351–369.
Helm KK, Klawitter B. Nutrition Therapy: Advanced
30
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Salvy SJ, Howard M, Read M, Mele E. The presence of Counseling Skills. Lake Dallas, TX: Helm Seminars; 1995.
friends increases food intake in youth. Am J Clin Nutr.
Egan G. The Skilled Helper. 9th ed. Pacific Grove, CA:
31
2009; 90:282–287.
Brooks/Cole; 2009.
Hetherington, MM, Anderson AS, Norton BNM, et al.
19
Okun B, Kantrowitz RE. Effective Helping: Interviewing
32
Situational effects on meal intake: A comparison of
and Counseling Techniques. Pacific Grove, CA: Brooks/
eating alone and eating with others. Physiol Behav. 2006;
Cole; 2007.
88:498–505.
Corey G. Theory and Practice of Counseling and
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Neumark-Sztainer D, Wall M, Fulkerson JA, Larson
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Psychotherapy. 8th ed. Pacific Grove, CA: Brooks/Cole; 2008.
N. Changes in the frequency of family meals from
1999 to 2010 in the homes of adolescents: Trends by Brammer LM. The Helping Relationship Process and
34
sociodemographic characteristics. J Adolesc Health. 2013; Skills. 8th ed. Englewood Cliffs, NJ: Prentice Hall; 2002.
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Harris JL, Bargh JA, Brownell KD. Priming effects of and Practice. Pacific Grove, CA: Brooks/Cole; 1998.
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Psychology. 2009; 28:404–413. Association/Commission on Dietetic Registration Code

Tordoff MG. Obesity by choice: The powerful influence
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Regul Integr Comp Physiol. 2002; 282(5): RI536–RI539. 109:1461–1467.
23
Baker EA, Schootman M, Barnidge E, Kelly C. The role of Kittler PG, Sucher KP. Food and Culture in America.
37
race and poverty in access to foods that enable individuals 5th ed. Belmont, CA: Thomson/Wadsworth; 2008.
to adhere to dietary guidelines. Prev Chronic Dis (serial 38
U.S. Department of Health and Human Services,
online). Centers for Disease Control and Prevention OPHS Office of Minority Health. National Standards for
website. July 2006. Available at: http://www.cdc.gov/pcd Culturally and Linguistically Appropriate Services in Health
/-issues/2006/jul/05_0217.htm. Accessed May 28, 2010. Care Final Report (Washington, D.C.: U.S. Government
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JH. Compliance with dietary guidelines and relationship 39
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Chapter
2
Frameworks for Understanding and
Attaining Behavior Change
© iStock.com/majaiva
Change and growth take place when a person has risked himself and dares
to become involved with experimenting with his own life.
—Herbert OttO
Behavioral Objectives Key Terms
● Explain the importance of behavior change ● Behavior Change: conducting oneself
models and theories for a nutrition practitioner. differently in some particular manner.
● Describe and apply major concepts of selected ● Behavior Change Models: a conceptual
behavior change theories and models. framework for analyzing and explaining
● Describe major components of selected behavior change.
theoretical approaches to counseling. ● Theories: constructs to provide an explanation
● Differentiate counseling approaches for various based on observation and reasoning of why
durations of brief interventions. phenomenon occurs.
● Concepts: the building blocks or major
components of a theory.
● Constructs: concepts developed for use in a
particular theory.
● Models: generalized descriptions used to
analyze or explain a phenomenon.
● Motivation: a state of readiness to change.
● Self-Efficacy: an individual’s confidence to
perform a specific behavior.
● Self-Motivational Statements: arguments for
making a behavior change made by the client.
16
Self-Efficacy 17
InTrOducTIOn into some counseling approaches. Next, we will look

at three theories that primarily focus on individual
Historically, nutrition counselors and educators
factors, such as knowledge, attitudes, beliefs, and
overlooked many fundamental factors affect-
prior experience. These include the Health Belief
ing food behavior and attempted to change food
Model (HBM), the Transtheoretical Model (TTM),
choices by simply dispensing facts and diets. The re-
and the Theory of Planned Behavior (TPB). The last
sults were often disappointing. Eventually, nutrition
theory to be addressed is the Social Cognitive The-
professionals recognized a need for a new procedure
ory (SCT), which does not look solely at individual
and turned to established psychotherapy counsel-
traits for understanding behavior but incorporates
ing approaches and theoretical models stemming
a person’s relationship with social groups and the
from food-related research and social psychology to
environment. We will then turn our attention to
guide nutrition interventions.1 During the 1980s,
counseling approaches frequently used to assist cli-
the focus was on behavior modification, giving
ents with making health behavior changes. Because
way to goal setting and client-centered counseling
Client-Centered Counseling provides guidance for
in the 1990s. More recently, the Transtheoretical
establishing an effective counseling relationship,
Model and Motivational Interviewing have pro-
many practitioners utilize basic aspects of this ap-
vided guides for instituting behavior change in the
proach. Then we will explore Solution-Focused Ther-
health arena. An array of counseling philosophies,
apy. This widely used counseling approach has not
theories, behavior change models, and counsel-
received much attention for changing dietary behav-
ing approaches are currently available to deal with
ior, but it offers some intriguing useful strategies in
the complex process of changing health behaviors.
nutrition counseling. Next, we will review Cogni-
Table 2.1 summarizes the usefulness of using theo-
tive Behavioral Therapy (CBT), which has repeatedly
ries and models for formulating an intervention.
been shown to be effective for changing health be-
The following discussion summarizes the
haviors, and finally Motivational Interviewing (MI),
approaches most often identified as useful for
which is becoming widely used, especially with cli-
designing interventions and guiding and appraising
ents who are in the early stages of behavior change.
changes in dietary behavior. Note that some of the
You will observe a great deal of interplay among the
concepts overlap among the behavior change theo-
theories, models, and counseling approaches.
ries, therapies, models, and approaches. We will start
by discussing self-efficacy, which is a construct of
several behavior change theories and is incorporated Self-effIcacy
The concept of self-efficacy as a basic component
Table 2.1 Benefits of Theoretical Behavior Change of behavior change was developed by Albert Ban-
Theories and Models dura.2 Although sometimes considered a separate
● Present a road map for understanding health behaviors model, self-efficacy has been widely accepted and
incorporated into numerous behavior change mod-
● Highlight variables (for example, knowledge, skills) to
target in an intervention els. Bandura3 defines self-efficacy as “the confidence
to perform a specific behavior,” such as a belief
● Supply rationale for designing nutrition interventions
in ability to change food patterns. Attainment of
that will influence knowledge, attitudes, and behavior
health behavior changes has been found to cor-
● Guide process for eliciting behavior change relate solidly with a strong self-efficacy,4 probably
● Provide tools and strategies to facilitate behavior because self-perception of efficacy affects individual
change choices, the amount of effort put into a task, views
● Provide outcome measures to assess effectiveness of of barriers, and willingness to pursue goals when
interventions faced with obstacles. As a result, a person’s confi-
Source: Adapted from Academy of Nutrition and Dietetics. Nutrition Coun-
dence in his or her ability to accomplish a behavior
seling Evidence Analysis Project. http://andevidencelibrary.com/default.cfm. change may be more important than actual skill.2
Another random document with
no related content on Scribd:
DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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eTextbook 978-1305252486 Nutrition

Counseling and Education Skill

Cultural Influence on Communication 49 Chapter 4

Level 2: Unsure, Low Confidence 92 Dietary Assessment 107

Suggested Readings, Materials, Assignment—Food Management

Video, Audiotape, or Observation Walking Basics 210

Speech Disabilities 243 Chapter 11

Suggested Readings, Materials, Books 325

Websites 346 The Four Counseling Sessions 351

Introduction 350 Appendix A DASH Food Plan 374

WeLCoMe to the thIrD eDItIoN DIStINGUIShING FeatUreS oF

Chapter 6 Promoting Change to Facilitate Self- Aimee Mattiolo,

Kelly Eichmann, Cindy Swann,

InTrOducTIOn counseling can be defined as an interaction in which the

Nutrition education has been defined as the fol-

healthfulness of the types of foods and drinks

educators and counselors. Since we are advocating

EXERCISE 1.4 People Skills Inventory

relationships. In addition, humor helps pre-

Your worldview is determined by your culture

Table 1.1 Worldview Assumptions

values despite numerous obstacles or severe conse-

EXERCISE 1.7 What Is Your Worldview?

1 2 3 4 5 Technology is of foremost importance in conquering illness.

orientations, health care problems, and issues related

Attending to the second part of the counseling process

rEVIEW QuESTIOnS rEFErEncES

2. What is generally considered the most impor-

6. Why is it important for counselors to under-

Variyam JN, Blaylock J, Smallwood D, Basiotis PP.

Piernas C, Poplin BM. Snacking increased among

Psychology. 2009; 28:404–413. Association/Commission on Dietetic Registration Code

Munoz C, Luckmann J. Transcultural Communication in

Individualizing nutrition counseling for patients with

National Institutes of Health (NIH) Obesity Health

InTrOducTIOn into some counseling approaches. Next, we will look

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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