Step By Step: A Program for Dietetic Interns
to learn counseling skills

This program is designed to complement Dietetic Internship outpatient rotations. The focus here is on the basic skills that are the foundation of quality nutrition counseling. This is a practical program that easily fits into the inevitable down time of rotations.  It is all on-line and available immediately upon purchase. It is appropriate for interns who will be shadowing only as well as those who will be counseling actual patients.

This program works best when preceptors follow along.   Preceptors may apply for 4 CPE credits at no additional cost. If they choose to demonstrate practice of the skills they can apply for 8 credits ($15 processing fee.)

The Program includes: Nine topics, each with a podcast (or video webinar,) notes and a practical article. Suggested discussion topics are provided for each section. Four units have either a session video or audio included. In response to Intern requests there are now brief “success stories” provided by practicing dietitians in many of the units.


  • Engaging the Client (11-minute podcast & 5-minute case dialog video)

The Basics: OARS

  • Open-ended questioning (6-minute podcast & 3-minute cse dialog audio)
  • Affirming (15-minute podcast)
  • Reflecting (11-minute podcast & 3-minute case dialog audio)
  • Summarizing (10-minute podcast)

The Change process:

  • Behavior change and resistance to change (17-minute podcast & 5-minute case dialog video)

Attending to the client:

  • What is important to the client? (8-minute podcast)
  • Listening for change talk (13-minute podcast)

When it’s time to provide advice:

  • Providing advice effectively (9-minute podcast)

Putting it all together:

  • Using Evidence-based Strategies in Nutrition Counseling, Joanne Spahn, MS, RD, FADA & Molly Kellogg, RD, LCSW. Ninety-minute recording of presentation given live at the 2009 Food & Nutrition Conference & Expo in Denver, CO. Includes slides handout.

Supplemental Materials:

  • Counseling Session Feedback Form
  • Pair Exercises:
    • Open questioning
    • Reflecting
    • Providing advice

Buy Now  $254. Purchase allows all interns and preceptors in one DI program to access the materials for a year. If you purchase now you will have access to the program through August, 2019.

I encourage Internship Directors and Preceptors to attend further counseling training for themselves. Step by Step purchasers get a $50 discount on registration for the Counseling Intensive workshop. For cities and dates, click here. E-mail me at to register.


This program is designed to fit the Accreditation Council for Education in Nutrition and Dietetics (ACEND): Core Competencies.

It will fulfill:

  • CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.

And contribute to these competencies:

  • CRDN 1.6 Incorporate critical-thinking skills in overall practice.
  • CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff.
  • CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings.
  • CRDN 3.7 Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management.
  •  CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends.

Some of the feedback from interns:

  • Listening to the podcast and then practicing right away really worked well.
  • Hearing about resistance to change helped me understand the patients better.
  • I like that my preceptor listened to the podcasts too. She showed me how she was using the skills.
  • I liked discussing the skills with the other interns.

Preceptors have also benefited from joining in with the interns. Many took advantage of the credits available. Here is some of their feedback:

  • I wish I had learned these skills early on in my career.
  • Not only did it provide education on theories and skills, but it also allowed for role playing and critiquing to teach and enforce the skills.
  • This  helped the interns establish rapport with patients.
  • Listening  made me want to start putting the practical advice to use right away in my own practice. Then I can better assist the interns when they join me.

Feedback from an Internship Director:

“We have used the Step by Step program for several years, and the interns are much better (and comfortable) with counseling, and the preceptors always appreciate the hours. I love the program. Everyone should try it!”

Tiffany Hull, MS, RDN, LD, FAND
University of Central Oklahoma