Discover the power of seeking exceptions to a problem
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Issue 25 February 2016

A Warm Welcome to Issue 25


February Wrap Up - what a month for training with Practice Pavestones!

We welcomed over 70 attendees to three sold out events from diverse backgrounds including Psychology, Medicine and of course Dietetics this month. It was a real honour to support my colleague Sue Zbornik MS APD present the unique work from her book Find Your Happetite in her interactive day workshop 'Skills and Wisdom for Working With Appetite'. Here she is 'doin' her thang' at Abbotsford Convent in Melbourne presenting the Eating Continuum™. We turned many people away from Sue's workshops and will be looking to run again in 2017.

There are some great repeat events scheduled over the coming months. Please check out the training news in the next box for early bird dates. If you would like to see Pavestones come to you in Tassie in June, please act on the call out for Hobart registration deposits. Deposits are due in just a few days; March 3. We also have made an exciting announcement for New Zealand subscribers. Read on.......


Don't forget Dietitian Day coming up on March 11th in Sydney. I'll be seeing you there!  Come and say 'Hi' at my Market Stall at morning tea and watch out on the day for some great training give aways.

Dietitian Day was a fabulous event in 2015. A real pot stirrer and a refreshing change from typical Dietetic conferences. I came away last year thinking 'Now THAT was a great PD event'. I felt invigorated and supported in my profession. Maree Ferguson PhD APD is turning around the culture of PD in Australian Dietetics with Dietitian Connection and Dietitian Day is certainly the jewel in the DC crown. This year Maree is featuring my colleagues Fiona Sutherland APD and Fiona Willer APD who will be presenting some vital ideas for progressive thinking Dietitians to consider. You can check out the program and register here


In This Issue

We will be exploring some more about explorative & directive questions. I'll be inviting you to get curious about questions that explore exceptions to a problem behaviour or pattern. Why do that? How to do that? on for more

As always if you are short on time scroll down to the
Purple Pavestone Box at the end..........happy reading!


Motivational Interviewing Core Skills and Spirit

Feedback from Workshop Melbourne Feb 20th 2016:

I think we've all hit a patch where we feel unfulfilled in our job; we give too much and risk burning out. This workshop re-iterated there IS another way, and provided another option for consultations. It was a really fun, interactive day, time flew by and I left feeling invigorated about my job and more confident in my ability to guide and assist my clients
L.G. APD Feb 2016

This workshop provides a wonderful way to reflect on your own practice and experiment (in a safe space) with a different way of 'being' with clients that is more empowering for both of you.
APD Feb 2016

Read more feedback and learn about the workshop HERE



**Sydney May 6 2016**

Early Bird Ends March 11th in 12 days


**Hobart June 3 2016**


This event is running on a deposit system to
confirm interest before the event.
Please put your deposit in before March 3 if you would like the workshop to come to Hobart.

**Wellington New Zealand**

August 31st 2016



The Essential Counselling Skills
Workshop for Dietitians

'This training well and truly surpassed my expectations! I strongly believe each Dietetics course in Australia needs to incorporate Tara's training into student training if, as a profession, we are going to work in a client centered manner. Tara's training needs to be a core competency, forming the foundation skills for all Dietitians'
JS APD June 2015

Read more about the workshop HERE

Brisbane June 23rd - 24th 2016

Early Bird Closes April 21st




We apologise for any inconvenience

Why & How to ask Exceptional Questions

Hope says: 'try one more time' when the world says 'give up'.
Fredrike Bannink

There are always occasions in a person's life upon which they
have escaped a problem's influence.
Problems never successfully claim 100% of people's lives or 
Alice Morgan

Questions can be like the lever you use to pry open a stuck lid on a paint can
Fran Peavey

So let's see, in Issue 24 we spent some time thinking about directive questions that pull out the client's preferred future by eliciting resources, strengths and visions of change. Broadly called 'Solution Focused' questions these types of questions are a powerful tool in the kit bag of behaviour change therapists.

Travelling along a similar vein in this issue, I am inviting exploration of questions that look for exceptions to the problem. These types of questions may offer a much more subtle and client focused alternative to imposing a new thought about change. 'Exception Questions' may do this by inviting the client to sift through their own experiences with a lens that captures times when the problem has been less of an influence.

When considering the benefit of this approach, Solution Focused Brief Therapy (SFBT) offers this idea to ponder:
'Analysis of the problem isn't useful in finding solutions,
whereas analysis of exceptions to the problem is'
p 20 Bannink

I'm going to jump right in and say (in my opinion) problem analysis has many different uses in effective therapy which are integral to the helping process. Establishing rapport, developing empathy and creating a safe space for a coherent story are probably the big hitters that come to mind up front. However it is an interesting question that Bannink asks us to consider. If our focus is on the problem, are we missing the hidden treasures of resource that lie in analysis of exceptions to the problem? Do we risk entrenching the problem by keeping the exploration stuck there?

In looking at theoretical origins of this approach it's important to acknowledge not just SFBT but also the huge contribution Narrative Therapy has made to this angle of therapeutic thinking.

A "Tinsy Toe Dip" into Narrative Therapy

Narrative Therapy works with the notion that 'problem' experiences can coalesce to form stories for people that encourage them to reach unhelpful or 'thin'** conclusions about themselves or their lives. These conclusions typically invite the person to see themselves as less resourced, in some important way, than they actually are. This can result in a nasty catch-22 where beliefs engendered by the problem entrap the person in the problem story.

Questions that get the client talking about when the problem behaviour has had less, little, or no influence over them can start to break the saturation of the problem in the story. The narrative opened up by these sorts of questions may start to re-author a richer story for the person that honours ideas, beliefs, goals and resources that are not betrayed or dominated by the problem behaviour. Options for change may start to feel broader, truer; possibilities may start to open up from within the client's experience.

**Thin in this context is a narrative term used to
describe conclusions or views that are
limited or narrowed by a problem perspective


If you'd like to read more about Narrative Therapy there is an easy intro here. You can click through to The Dulwich Centre website here - the home of Narrative Therapy (yes it's Australian!)

What do these Exceptional Questions sound like?

Let's get some practical demos going here. I've plucked these examples out of thousands of conversations with clients and there would be an infinite variety of demonstrations we could use.

I'd like to use an example of a client who has been struggling with yo-yo dieting and overeating episodes for many, many years. For this client it feels like 'forever' that she has failed to control her eating. Her statement in session is heavy with problem and feels immovable:

'I've been like this forever. There is no hope for me to eat differently I am an utter failure at eating properly'

As the practitioner in this scenario, you'd be excused for thinking you've got a fancy road to nowhere. Or worse:


But there is an alternative route.

After skillfully using our reflective listening abilities to demonstrate connection and empathy and open into that safe working space, we have the option to experiment with some exception questions.

Firstly enquire about any time that the problem wasn't as dominant:

Practitioner: Have there been any times when you can recall feeling satisfied by a meal and stopping when you had had enough? A time when it wasn't so out of control?
You can encourage the client to take her time and think hard; search the internal data base 

Client: Hmmmmm. No....Well yes.....I gave myself a night off with the girls last week. We went to my favourite gourmet burger restaurant. I ordered the house special. It was so delicious. You know normally I'd swing past the BP on the way home for ice cream but I didn't for some reason. I'd just had enough'

Practitioner: It surprises you to notice on that night you did stop. You just knew you didn't want anymore food.

Follow up by exploring how the exception to the problem came about:

Practitioner: I'm curious. What was different about that night that helped you to eat and enjoy your food, without over doing it?

Client: Oh that's easy! It was my choice that night and I love Archie's burgers. It was exactly what I felt like. Totally hit the spot.

Practitioner: So it seems when you eat in a way that really satisfies your unique appetite at the time, you are able to find the stop button no problem.

In this scenario the practitioner can then go in a few different helpful directions. One would be asking permission to give a little information about the theory of Intuitive Eating to help the client understand and legitimise the important internal resource she encountered that night.

Another would be:

Invite the client to 'do more' of the exception to the problem:

Practitioner: I wonder what it would be like for you to consider doing more eating like that, where you really think about what it is you want and allow yourself to have that food with complete permission?

How would you start?

Is this where you would like some guidance from me?

Next issue we will explore in more detail a beautiful application of the exception approach created and championed by Sue Zbornik. Those of you who attended Sue's workshop recently would have had the pleasure of observing a demonstration and real play experiential of this.

Some Exception Questions to 'Pop Up Your Sleeve'

I really appreciate this list of suggested 'back up' questions provided by Alice Morgan in her book: 'What is Narrative Therapy?'

You may like to spend a moment reflecting on contexts in which you would find these useful to play with asking your clients:
  • How have you managed to stop your blood sugars [or insert 'problem'] from getting worse?
  • Are there times when your bingeing [or insert 'problem'] is not as bad as usual? Are there times when the binge urge is not as dominating and bossy?
  • Can you think of a time when worrying about your size [or insert 'problem'] could have stopped you or got in the way but didn't? What happened?
  • Is there a story you could tell me about a time when you resisted the Anorexia [or insert 'problem'] and looked after yourself despite its demands? 

Would you like to learn more about Narrative Therapy? 

I highly recommend workshops conducted by Adrian van den Bok a Narrative Therapist based in Sydney. Adrian has a two day workshop coming up in May in Melbourne. You can read more here. Adrian is not just a highly skilled and experienced therapist but an engaging and warm presenter. 

Watch out for an exciting Pavestones Event in the wings for September 2016 in Sydney featuring a specialist workshop on Narrative Therapy and Eating Disorders.
I stumbled upon this recording 'Halftime' from Amy Winehouse while fossicking around for a soundtrack match for this issue. It is a pearl of a song and I suspect something of a hidden gem. I had never heard it before and it has no video. Amy's velvety gravel voice breathes such life into this beautifully soulful production. It's right under my skin now. Shut the door on the world for three minutes, click on Amy below, sit back and sink into it.


Halftime, time to think it through
Consider the change
Seek it from a different view
Halftime, time to think it through
Consider the change

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.
Issue 21

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.
Open question word stems include 'What', 'How', 'Why', 'When'  and 'Where' . The safest and most effective to start with are 'How' and 'What'
Issue 22

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

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
Issue 24

Solution Focused questions are concerned with solution-building rather than problem-fixing
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 

Suggestions for Reflection

You are invited to think about a time in your own life where you have experienced an exception to a patterned problem behaviour. What did you need to believe about yourself to enable this exception? What resources were you able to connect with as a result of this different belief or thought?

Ponder the encouragements in this issue. What do you feel ready to experiment with in your client sessions this week? Perhaps choose a sample of one question and see where you might be able to use it. You are encouraged to journal your experience in your reflective practice journal.

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

Enjoy experimenting!
Keep reflecting!

Tara MacGregor

Counselling Skills Training for Health Care Agencies & Hospital Departments

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PLAN NOW for 2016

If you are interested in organising training for your department come on over to the new webpage to learn more, read great feedback and email Tara as the 2016 schedule is being planned now and is filling fast. 

'Thanks again for such a fantastic training day last week. Implementing counselling skills has been the hot topic around the office all week, and I have received lots of positive feedback on the day. We found it both rewarding and challenging (in a good way), and already we can identify so many patients who would benefit from our new skill kit. Hopefully we can have you back in the Central West sometime soon! R.B APD

Supervision and Mentoring
A Great Way to Affirm Your Skills

To learn more about Supervision and Mentoring come on over to Tara's Supervision page HERE 

This Issues Great Reads

A must read for the perpetual dilemma in non-diet work:
When clients come to us with the desire to lose weight.

Another great article for some 'seriously profound logic bombs' that have some meaningful resonance with this Issue's content:
The Science of Happiness

Looking for Past Issues of Practice Pavestones?

It's so easy to access past issues now through Tara's blog on the new website. Click here and do let Tara know if you have troubles finding what you are looking for

Affirm Your Knowledge!
Online CPD Quiz for APDs

You can turn your dedicated reading of Practice Pavestones into assessed CPD hours with on-line convenience using the 2014 & 2015 Quiz.

Learn all about the quiz options available on the dedicated webpage HERE


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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