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Issue 26 March 2016


A Time for Reflection and Renewal

A very warm welcome to this issue and particularly all of our new subscribers joining the Pavestone community from The Journey seminar for new grads and Dietitian Day 2016! Wonderful to have you on board.

Congratulations to The Winner!

Samantha Thomas APD was the very lucky winner of the Dietitian Day Practice Pavestones Market Stall Competition and received a $695 training voucher to spend over the next 12 months at a Pavestone event/s of her choice. Samantha was delighted to receive her voucher and explained she'll be using her prize for:

'learning the most effective ways to help individuals achieve their goals, on their terms. I want to get a fresh perspective on how to engage individuals in the change process and achieve success. I'm motivated to keep my knowledge up to date and expand my skill set because as an industry-based Dietitian I don’t often get the chance to use my skills in this area'

Great Samantha! Pavestones works hard to deliver exactly the support you are looking for. 

Training Updates

Watch your inbox for a very exciting special announcement: Paediatric Workshop in Sydney July 29th
You'll find plenty of reminders follow in the Training News box up next. Rego's close on April 8th for the next Sydney event with only 3 tickets remaining so if you are planning to come along you might want to giddy up! 

In This Issue

As an offering of contemplation for this holiday season this issue has a beautiful illustration from Sue Zbornik of how our conversations with clients can invite reflection and renewal.
As always if you are short on time, scroll down to the Purple Pavestone Box at the end of the editorial...happy reading!


HOBART JUNE 3rd 2016

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Motivational Interviewing Core Skills and Spirit







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How the Past May Hold a Key for the Future
Applications of 'Exceptions to the Problem'

'With intention, we can work in a way that reconnects
our client to their own competence'

Susan Zbornik

Curiosity is a more exciting way to live in the world.
It is the secret to living a bigger life

Brian Grazer

The wise man doesn't give the right answers; he poses the right questions'
Claude Levi-Strauss
Last issue we spent time exploring how questions can be used to seek exceptions to a problem behaviour. Uncovering these exception experiences can reveal overlooked or dismissed resources. Reconnecting our clients to these resources is a powerful intervention that can reinforce our client's competence and autonomy in the change process. If you'd like to have a quick revision you can click for the full issue here.

Sue Zbornik APD demonstrated a beautiful application of the exception idea at her Appetite Workshops in February. I invited Sue to contribute to this issue and talk a little about this special form of conversation she has with her clients

'When I last ate to my appetite...........'

By Sue Zbornik

Clients with food and eating issues are frequently caught up in their current difficulties and overwhelmed with the shame of their behaviours. However many are easily able to remember a time when they didn’t have any concerns; a time when they naturally ate according to their appetite with little thought devoted to food, eating or weight.  Those of you familiar with the evidence base for intuitive eating to promote healthful behaviours will appreciate the importance of establishing connection to these memories of capability.

Accessing information about previous exceptions to current behaviour can be an invaluable tool during behaviour change counselling.  The information gleaned can serve as an informative aid for the practitioner and a reminder to the client.  A reminder that they do have experiences of not worrying about their eating and could, at some time, naturally make food choices that satisfied their hunger.  For clients with eating disorders or repeated experiences of failed dieting this process can help guide them away from the feelings of shame and give them hope for change from within themselves. So we are talking here about enhancing confidence via connection with intrinsic motivations; the holy grail of behaviour change counselling.

If you work in this client group, you could consider experimenting with ‘exceptional questions’ early on in your assessment process.  I’d recommend in the first session or two if the immediate concerns aren’t medically driven. And a helpful reminder....get permission from your client to do so before you proceed.  

What might this sound like?

Here's a sample:
  • “If it is okay with you, it may be quite helpful to recall a time when you didn’t have these current problems with eating.  Would it be okay to do that now?’
If the answer is ‘No’, take care of their current concern and come back to the ‘exceptional questions’ about the time they didn’t have any concerns about their eating or weight later on in the assessment process. Keep your client in the driver's seat. Their objections will there for a good reason and therefore will be important to address in the moment.

Should your client be willing to proceed...Here are some starter questions to guide your exploration:
  • When was the last time you didn’t have any food, eating or weight concerns?
  • How old were you when you last ate according to your appetite?
You could consider the following questions to set the scene of this time in the client's life to really 'colour-in' the context and bring the memory to life. Remember to grease the wheels of your questions with plenty of reflections to accompany your client as they travel. (If you need a recap, Pavestones has the following issues devoted to the skill of reflecting Issue 13,  Issue 14Issue 15)
  • Who ate with you?
  • Where did you eat breakfast? 
  • What foods did you eat for breakfast back then? 
  • How did you decide what to eat?
  • How much did you eat?
  • How did you decide how much to eat?
  • What were you favorite foods back then?  What did you like about those foods?
  • Where there any foods you didn’t eat? What did you not like about those foods?
  • Did you have any foods you didn’t like?
  • What did you drink?
As you explore the clients responses listen out for the client's appreciation of taste, texture, fragrance, hunger, satiety, permission to eat and permission to not eat, eating for pleasure and eating for necessity. Look out for modelling around the client in these memories - what were significant care-givers doing that made this form of eating more or less possible?


What my clients have taught me about the power of this conversation

Nearly everyone feels reassured having this conversation and there is often a much lighter tone to the session during this discussion.  Sometimes there is even laughter as clients remember how they used to eat.  Invariably I discover their REAL dislikes and natural meal pattern.  My client's have taught me that spending time on this conversation helps with everything that follows.  The information gathered becomes a touchstone for us to revisit again and again during the various stages of their change process.  To say a little more on this we can consider these specific forms of support:
  • When establishing a meal plan it helps us to set up a pattern that reflects their previous eating competence.
  • When resistance about challenging food fears is high, it reminds them what is possible.
  • When transitioning from the structure of a meal plan to appetite-driven eating it gives them permission to experiment with flexibility.  
  • When body trust is low, it can remind them of a time when they did trust their body.  
  • It also always makes the client feel instantly more competent and a capable member of the team.  
Most importantly, this conversation about exceptions to the problem can restore hope.

What happens when a client can't recall when they ate last to appetite?

Great Question!
There are occasional clients who can’t remember a time when they didn’t have any concerns about their eating or weight.   Be ready with extra support for these clients.  

A supportive statement might simply reflect what the client tells you or it could sound something like this:  

‘It is understandable, given your history, how baffling it must be for you to watch how naturally others eat and make food choices. Maybe it is even scary for you.  It would be like asking someone who has always taken breath with the help of a machine to breathe without the machine.  I want you to know that it isn’t you or your appetite that is at fault and you aren't alone.  It is our job to work together to discover what is preventing you from feeling competent at eating and disconnecting you from being able to listen to and trust your appetite.'

About This Issue's Guest Writer

Sue Zbornik is an Accredited Practicing Dietitian with a Masters Degree in Educational Counselling from the University of Wisconsin. For more than 20 years Sue has specialised in helping clients to manage the symptoms of their eating problems and to trust their bodies – and appetites - again. Ms Zbornik works in private practice in Bondi Junction, NSW and is the author of Find Your Happetite, a book providing practical tools to help clients reconnect with their natural appetite
Sue was hoping this soundtrack choice wouldn't 'show her age!'. Wisdom is timeless girlfriend! Delighted to share this toe-tapping, irresistibly feel-good oldie for this issue: Van Morrison's 'Bright Side of The Road'

Won't you help me share my load
From the dark end of the street
To the bright side of the road 

Issue 25 Pavestone
Asking 'Exception' Questions


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
Issue 7

Active listening is as much about how we respond to our clients' communications as it is about how we attend to our clients' communications.
Issue 13

The questions we ask our clients can open up opportunities to actively listen or close them down.

A closed question is typically a question which can be answered by a specific short answer, single word or a 'Yes' or a No'.

An open question is harder to answer and invites the client to think in order to respond. An open question is explorative and invites the client's expertise not the practitioner's.
Issue 21

 Open question word stems include 'What', 'How', 'Why', 'When'  and 'Where' . The safest and most effective to start with are 'How' and 'What'

Caution needs to be exercised with the use of 'Why' as this can be experienced as intrusive and impact on our client engagement.
Issue 22

Open questions can be directive by guiding a client to talk about their hopes, ideas, solutions and strengths. Such questions are called Solution Focused questions

Solution Focused questions are concerned with solution-building rather than problem-fixing
Issue 24
Open Questions can guide the client to look for and describe exceptions to the problem behaviour. This creates opportunity to reconnect with overlooked resources and practice the exception experience 
Issue 25

An application of the technique of using questions to look for exceptions to a problem behaviour can start by asking the client..'When did you last eat to your appetite....?'


Suggestions for Reflection

This issue opens the opportunity for you to reflect on your own experiences of eating to appetite as a child. What can you recall from that time using Sue's prompters above? How do these experiences continue to inform your eating now? What has fallen away? What would you want to reconnect with? What is better left in the past?

How would these decisions to reconnect (or respect as history) be a resource for your own health, wellbeing and ongoing joy of eating?
I'd love to hear your thoughts, curiosities, insights. Please email me to let me know.

Enjoy experimenting!
Keep reflecting!

Tara MacGregor

'Health Not Diets' Training


For all upcoming dates for 2016
follow the link HERE to the Health Not Diets website

Find out about:
  • The Health at Every Size (HAES) ® movement
  • The five core components of the non-diet approach
  • Strategies and worksheets to use with your clients
  • Evidence base, current research and practice based research potential
  • How to integrate the non-diet approach into the Nutrition Care Process, including nutrition diagnosis and PESS statement development

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Supervision and Mentoring
A Great Way to Affirm Your Skills

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This Issue's Great Read

Body Respect Disrupts Business as Usual to Advance Nutritional Well-Being for All

Access this great blog post from Lucy Aphramor RD last year Here

Looking for Past Issues of Practice Pavestones?

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Tara MacGregor PACFA Reg. 21520

 BSc MSc H.Nut & Diet. G.Dip Couns

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 a committed teacher and promoter of the Health At Every Size (R) philosophy. Tara is a PACFA Accredited Supervisor, Member of the Motivational Interviewing Network of Trainers (MINT) and author of The Essential Counselling Skills for Dietitians Workshop. Tara provides skills training and mentoring in the form of clinical supervision for Health Professionals and enjoys tremendously the exciting opportunities, insights and growth this offers both herself and supervisees. 

Make an enquiry about supervision and mentoring with Tara.

Suite 3, 780a Pacific Highway Gordon NSW 2072
M 0459 991 788
Copyright © 2016 Tara MacGregor, All rights reserved.

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