Date of Award

Spring 2023

Project Type


Program or Major


Degree Name

Doctor of Philosophy

First Advisor

Paula M Salvio

Second Advisor

Andrew D Coppens

Third Advisor

Joseph J Onosko


Empathy is considered critical to client-centered care within the broader nutrition profession. Through empathy, practitioners are said to recognize the individual experience better, support client/patient autonomy, and encourage collaboration in decision-making regarding treatment. However, the literature on empathy is fraught with conceptual disagreement and methodological misalignment, which has resulted in a limited understanding of the role and presence of empathy within a nutrition counseling session. Additionally, research conducted on nutrition undergraduate students using self-reported questionnaires may offer insight into students’ perceived/believed tendencies related to empathy but fail to provide evidence of empathy during a patient/client interaction. Given the current landscape, this dissertation set out with two overarching aims. First, to make a case for empathy as an interactional process framed by the theory of constructed emotion. Secondly, to explore empathy within the context of an initial nutrition counseling session between a senior-level nutrition student-practitioner (n=7) enrolled in a practicum course and their volunteer client (n=7) from the local community. This study utilized video-cued narrative reflection, which included recording the initial nutrition counseling session between a student-practitioner and their client and a two-part debriefing process (Immediate Recall Interview and Video Review Meeting) to allow each participant individually, the opportunity to identify the most meaningful aspects of the initial session. Comments made by each participant during the Video Review Meetings were incorporated into the transcript of the initial session in perpetuity to create a layered transcript. Data from the layered transcripts were used to identify opportunities presented by the client in which student-practitioners participated in the interactional process of empathy. Findings from this dissertation help to highlight that a client’s perspectives, experiences, and emotional landscape are not something fixed in which to be understood but are evolving sensations undergoing degrees of construction influenced by taking part in nutrition counseling. While differences existed in degrees of participation, greater participation, despite resulting in a co-constructed understanding of the client’s experience, may come at a cost and is sometimes clinically counter-productive. Clients who resisted the role of ‘client’ extended opportunities differently than clients who felt comfortable assuming the client role. Student-practitioners who had a difficult time seeing themselves as the practitioner due to feelings of nervousness or lack of confidence or perceived themselves as intrusive or burdensome limited their participation in the interactional process of empathy and were more likely to use ’declarations of understanding’ or ‘statements of knowing’ to transition the conversation away from the demands of further participation. Clients who place great trust in a practitioner’s ‘declarations of understanding’ or ‘statements of knowing’ may offer limited nuanced insight into the subtitles of their experience, potentially impacting the quality of personalized care they receive. Educators who wish to encourage or prepare students to participate in the interactional process of empathy more readily or with greater awareness of the complexities of such a task ought to create pedagogical approaches that affirm the uniqueness of the human/client experience and support students’ abilities in identifying opportunities to participate in the interactional process of empathy.