Find out what can challenge reflective responding in our work and daily listening parctice
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Issue 14
Feb 2015

What Can 'Get In The Way' of Reflective Listening?
Responding Part 2

I am delighted to report back on the February Counselling Skills Workshop which went ahead this week in Sydney. For me as a trainer it was fabulous to work with a group of APDs who brought such great insights, experience and energy to our two days of learning. A real growth experience for all in the room. Here is a snippet of some of the feedback:
'This course takes our science knowledge, our 'what to do' and transforms it into 'how to do'. The skills developed or enhanced by this course are essential to working in the tricky world of nutrition counselling. Adding these skills to our toolbox will result in so much greater job satisfaction and significantly reduce burnout. I really enjoyed this training, it could have easily gone on longer!' 
Susan Williams APD

Counselling Skills Workshop Comes to Melbourne
The next workshop will be running in Melbourne June 4-5th. Registrations will open soon so watch your inbox for a special Pavestones announcement.

Counselling Skills
Training for your Hospital Department
Pavestones has recently received enquiries from hospitals in NSW looking for counselling skills training for their Dietetics Departments. This is such an exciting development! Practice Pavestones does travel and the counselling workshop is being remodeled to fit an 'in-service friendly' one day format. If this sounds interesting for your workplace please feel free to get in touch. Email me HERE

Great Training from Others!
There are some wonderful opportunities for eating behaviour skill development coming up. Two stand outs are Rick Kausman and Ellyn Satter both running their world class courses this year. Scroll down to the classifieds boxes to learn more. The Dietitians Retreat in April run by Body Positive Australia has SOLD OUT! and by popular demand has been rescheduled for an additional retreat to run in June this year. Opportunities are also opening up for non-diet training for colleagues in New Zealand. See the classifieds!

In this Issue
Our last issue of Pavestones opened an exploration of the importance of responding reflectively to our clients when actively listening. Click HERE for a revision. This issue will be looking at the question: What can sometimes make this vital aspect of the active listening process difficult?
As always if you are short on time scroll down to the Purple Pavestone Box at the end..........happy reading!
''I can resist everything except temptation'
Oscar Wilde

'Never say "oops" say 'Ahhhh Interesting"'
Unknown source

It was when I found out I could make mistakes that I knew I was on to something
Ornette Coleman

Responding reflectively to our clients can be a challenging skill to develop when we are trained in advisory and solution focused models. In the counselling skills training group this week we brainstormed together all of the possible road blocks to reflecting with our clients.

Here is a summary of what was collated:
  • Trying to make 'it' OK for our client
  • Meeting requirements of our workplace assessment form
  • Focusing on an outcome
  • The Almighty Urge to ASK QUESTIONS
  • Lack of practice
  • Worry about getting the reflection 'wrong'

To bring these road blocks to life, let's consider how these challenges may appear in response to the following client statement:
'My last diet resulted in me gaining 5 kg more than I started with. It was a disaster.'



Trying to Make 'it' OK for the Client

Some client statements can really ring the bell of the 'fixer-uper-er' in us. Stories of diet failure are not only ubiquitous but also a sure fire bell ringer.

Consider the sense in you, if you were to respond to the statement above with:

'Oh, don't worry  I'm sure I can find a way to make things work for you this time'


You may like to reflect on where the balance of the work sits as a result of this response? As the image suggests - on us and that load 'ain't goin' nowhere! Jumping in to 'make things OK' can quickly scratch an itch for us but often blocks exploration and can covertly teach the client that they NEED to be told what to do. 

You're invited to consider where the balance of work lies in this alternative reflective response:

'Hmmm,  your last experience did not yield the results you worked for'

Offered sensitively with a pause, your client is likely to follow through from this reflection with more of their experience to start to build a story and a working alliance.



Meeting the Requirements of our Workplace Assessment Form

The pressures of a 'tick-a-box' intake form can really jam the lines of reflective engagement as we move through the procedural requirements of our workplace.

Consider this response to the red sample statement above and the 'box it ticks':

What did you weigh when you first started dieting?


We do need to collect data and technically there is no problem with this question but what about its timing? What opportunity may have been missed in terms of engagement, by skipping this reflection first:

'Hmmm a tough time, that last diet'

 Asking a question has its uses but it is not listening



Focusing on An Outcome

The client centered paradigm assumes outcomes are a result of a productive therapeutic alliance. This alliance is a working relationship that is based on respect, collaborative understanding and authentic communication.

In advisory professional paradigms, outcomes are often assumed to be a result of our intervention. In this case we might be tempted to respond to our sample statement with:

'A meal replacement product will produce better results for you this time'

Can you feel the expert trap?


Giving advice may be helpful at times but it is not listening. Judy Gamble author of 'Counselling Skills for Dietitians' refers to advice giving in her list of 'high risk' responses.  She goes on to say:

'....this means of communication has a high risk of creating a barrier between those concerned. The person who received the communication may seem acquiescent at first but more than likely will feel confused and annoyed..............later' p73



The ALMIGHTY URGE to Ask A Question

Curiosity is an asset to sound client centered work. The challenge is to keep our curiosity in balance with our capacity to stay alongside our client's experience.  

Asking this in response to the sample statement in red above: 

Was that a calorie controlled diet? How many calories was it?

..............may produce some interesting data but at what cost? Would we blame our troubled client for feeling a bit......


...................miffed. Probing is not listening.

Our curiosity may be better received by our client after being offered this acknowledgement first:

'Yes hmm I hear - that did not work well for you at all'



Lack of Practice

I really appreciate this one.

Reflective responses don't fit naturally in the medical model. We can feel very tongue tied and clumsy when we start to experiment with this new skill.

Early on in my skill development I remember my teacher encouraging me to 'just play'. Playing with reflections and practicing in social relationships can devleop familiarity and also enhance confidence to just give it a go. Your friends/family might find it a breath of fresh air! Most people find it a very pleasant surprise to experience being heard.




Worry about Getting the Reflection 'Wrong'

Fear of reflecting our client's intended meaning inaccurately can be a huge impediment to introducing reflective listening into our skill base. The wonderful news is, if you do reflect 'wrong' it probably doesn't matter! In fact it can be a real engagement maker.

In my experience, the encouragement that Miller and Rollnick provide on this matter has tremendous credibility:

'Everytime you offer reflection you get immediate feedback as to how accurate it was. There is no penalty for 'missing' because when you guess wrong, the person simply tells you more about what she actually meant' p59

Let's consider this sample response to the client statement we are considering above:

Dietitian: 'Uhuh, so you were OK until you gained weight on the diet'  
Client: 'Well, no not really, I've been battling my weight for years and this was about the 5th diet I tried. This has been going on for a long time. Sad really.'

Dietitian: 'Ahh I see, that's helpful to know. These experiences have been repeating a while for you. It gets you down'.

Getting it wrong opens doors to more engagement, it enhances collaboration and gets us out of the expert trap. Bonus!



It's soundtrack time!

I've got The Preatures' CD 'Blue Planet Eyes' on high rotation at the moment. Great Sydney band. Click on their pic below for their song 'Somebody's Talking'. Turn it up!


'And if I listen to this song
It’s out on the waves, breaking in sets
bringing me back into your shore

To your shore'
The Preatures. 'Somebody's Talking'

Reflections bring us back to our client.

Issue 14 Pavestone 
What gets in the way of Reflective Listening?

Nutrition is a science. Eating is a behaviour.

Behaviour change is difficult.

Active Listening is a fundamental skill, core to the process of understanding our client's experience, inviting their trust and building the helping alliance

Active listening is as much about how we respond to our clients' communications as it is about how we attend to our clients' communications.

Helpful responses can include minimal encouragers (both verbal and non-verbal), reflections and summarisations

Reflections involve reflecting back to the client something they have just said. In their words or paraphrased, reflections can focus on content, meaning or feelings or more than one of these elements

Blocks to reflecting can include: trying to fix our client, completing intake forms, focusing on outcomes, the irresistible urge to ask a question and lack of practice.

Reflecting incorrectly to our client can be paradoxically an engagement maker not breaker. Take a risk and experiment with letting your client know you are listening.

Suggestions for Reflection

When my client speaks what is my habitual response? 

What would I consider my biggest impediment to reflective responding?

What else might I need to know about reflective responses to experience less barriers to practising this new skill?

I'd love to hear your thoughts, curiosities, insights. Please email me to let me know.

Enjoy experimenting!
Keep reflecting!



Ellyn Satter Coming to Australia!
Aug - Sept 2015

Ellyn Satter, MS, RD, MSSW, who pioneered the Division of Responsibility in Feeding and Eating Competence, will do an Ellyn Satter Institute sponsored Australian speaking tour from August 11 through September 12, 2015. She will be in Sydney, Perth, Adelaide, Brisbane, and Melbourne.  For the dates and presentations, click here (ESI website). To register for the ESI Australian Tour mailing list, click here  Please share these links with others!   Don't miss this amazing opportunity to hear Ellyn in Australia

If Not Dieting Then What? Training 2015

May Melbourne
September Brisbane


Dr Rick Kausman is a medical doctor who is recognised as the Australian Pioneer of the person-centered non-diet approach to well being. The 'If Not Dieting' (R) Health Professional Training program assists health professionals to effectively support their patients to be the healthiest they can be and as a result of that, achieve a healthy weight for them. This is an exciting program drawing from the most current world research and also Dr Rick's 25 plus years of practical and unique experience. If you are new to Rick's work, if you work in weight management this training is essential.

 CLICK HERE for Training Flyer

New Dietitians Retreat Announced - Yoga, Workshops & more!


Hosted by Body Positive Australia (Fiona Sutherland, APD & Sarah Harry, Psychotherapist & Yoga Teacher), July 2015

If you missed out on the first one in Byron Bay in April, no need to worry because Body Positive Australia is running another unique retreat just for Dietitians, this time in the gorgeous "spa & foodie" area of Hepburn Springs, just a little over an hour away from Melbourne. They'll be offering a fabulous program with everything your body loves (Yoga, delicious food, opportunities for massages, walks) & the stuff your mind loves such as workshops with expert APDs, socialising and networking with colleagues. More information can be found here.



Expressions of Interest - New Zealand Dietitians

Fiona Sutherland writes: 

Fiona Willer (APD, Nutrition Sense) and I, Fiona Sutherland (APD, Body Positive Australia) have joined forces over the past year, running sold-out 1-day workshops around Australia on The Non-Diet Approach for Dietitians. If you're a Kiwi Dietitian, we would LOVE you to get in touch with us if you'd be interested in having us come over and present a day-long workshop in your city? Information about the workshops can be found here and please contact Fiona Willer via that webpage if you're interested -We look forward to hearing from you!


Looking to Enhance your Skill Development?

Ever thought about Supervision? ..........or up-skilling with some counselling skills training?
One of the most effective ways to enhance your learning and adoption of new skills is to receive supervision/mentoring for your work. If you would like to learn more about this you are welcome to have a look at my my service. Why not consider sharing supervision with a colleague and practice together between sessions?

Did you miss the BUMPER 1st Anniversary Edition of Practice Pavestones? 

Issue 12 has links to the full collection of issues 1-11 

PLUS an online CPD Quiz to convert your dedicated reading into self-assessed CPD hours for your renewal just around the corner. Why not use Pavestones to plan your 2015 CPD? 

It's available HERE
About Tara MacGregor
Tara MacGregor is a dual qualified Accredited Practising Dietitian and Counsellor & Psychotherapist in private practice. Graduating from Sydney University in 1991 she has worked in a broad spectrum of clinical areas in public and private hospitals until specialising in disordered eating in 2004. Tara works exclusively in the non-diet paradigm and is passionate about teaching and promoting the Health At Every Size (R) philosophy. Tara provides skills training and mentoring in the form of clinical supervision for Dietitians and enjoys tremendously the exciting opportunities, insights and growth this offers both herself and supervisees.

Make an enquiry about supervision and mentoring with Tara

Make an enquiry about supervision and mentoring with Tara

Tara MacGregor PACFA Reg. 21520 BSc MSc H.Nut & Diet. G.Dip Couns

Counsellor & Psychotherapist Accredited Practising Dietitian

Suite 3, 780a Pacific Highway Gordon NSW 2072
M 0459 991 788
Copyright © 2015 Tara MacGregor, All rights reserved.

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