Unconditional Positive Regard

Why? How? and What are the Challenges for

Dietitians?

 
Issue 6
May 2014


Welcome everyone to Issue 6, especially new subscribers ! Hello!

Practice Pavestones had some BIG news this month! Check out the side bar

It is so exciting for me to hear about how Practice Pavestones is resonating with practising professionals. I received this feed back from a new subscriber:

'...........there are great ways in which we as Dietitians can positively impact our clients through a greater awareness of how we are perceived. This is based upon, fundamentally I feel, our ability to effectively empathise and equalise the relationship whilst maintaining, as you suggest, a 'solid definition of ourselves'.'
Stephen Davis APD | Nutrition Counsellor / Dietitian at Inwards Outwards: Psychology & Dietetic Services

In this Issue of Practice Pavestones we are visiting the last core attribute in our client centered hub: Unconditional Positive Regard. Contraversial at times, I hope this exploration will get you thinking.

If you would like to revise the 'hub and spoke' analogy for Client Centered Dietetics you can have a quick look here at Issue 3 .

........................... be sure to send me feedback and questions. I always encouraged by your ideas and experiences.
 
Remember! If you are short on time - scroll down to the Pavestone for this issue

Practice Pavestones Listed on DINER

Practice Pavestones has been accepted as a listed resource for Dietitians on DINER.







For my non-APD subscribers DINER is a professional resource library on the Dietitians Association of Australia (DAA) website. Acceptance criteria for DINER listing includes high level production, content, resource development and evidence base.

I am looking forward to Practice Pavestones receiving more exposure through the professional listing on DINER - I am so keen to spread the word about the value of a client centered approach in our profession! If you are enjoying the newsletter PLEASE pass it on and encourage your colleagues to subscribe!


 


 

 

Ever wondered about undertaking Supervision ?
 
One of the most effective ways to enhance your learning and adoption of new skills is to receive mentoring/supervision for your work. If you would like to learn more about this you are welcome to have a look at my service. If you'd like to make an enquiry please feel free to email me. You could consider booking a session with a colleague and practice together between sessions.
 
 


 

HAES Workshop for Dietitians in Sydney!


Fiona Willer APD and Fiona Sutherland APD will be running their one-day HAES workshop intensive in Sydney July 19. Workshop content features theory and practical counselling skills. Here is what they say:

'The non-diet approach is the most helpful, least harmful method for dietitians to assist people with weight concern. It should be a part of every dietitian’s skillset.'

To find out more Click Here



Shout Out Of the Month!

Goes to Dietitians who work with people recovering from Eating Disorders!

Check out a truly amazing collection of testimonials here on the website for International Federation of Eating Disorder Dietitians. Entitled 'A Dietitian Changed My Life' you can read first hand what clients report really helps in Dietetic care. It is inspiring and so educational.

 


Befriending The Body - A Buddhist Experiential Retreat for Women

24th - 29th October Pymble Sydney. 

Click Here for More Details

 



CBT Training
1 Day Introductory Training in Sydney September 3, 2014.
Click Here for details.Subheader

 


 

A Bit of Fun with a Talking Cookie

This bit of fun comes courtesy of Lucy Aphramor UK Dietitian and HAES Champion.

Listen to your body and MAGIC HAPPENS! 
Check it out here on Lucy's website

 

 

'Who wants to talk to someone who disapproves of you?'
Ellen Glovsky RD


'People also nurture our growth by being accepting—
by offering us what Rogers called unconditional positive regard.
This is an attitude of grace, an attitude that values us even knowing our failings.
It is a profound relief to drop our pretenses, confess our worst feelings, and discover that we are still accepted............we are free to be spontaneous without fearing the loss of others' esteem
.'
David G. Myers
 

 

'Clients are more likely to blossom and change if prized for their human potential rather than rejected for their human failings'
Richard Nelson-Jones
 




Let's start with a recent comment from a client, to get the ball rolling. This client had spent the best part of her first session sharing her long history of yo-yo-ing diets and weight rebounds.

Client: 'I am so relieved by our session today'

Dietitian: 'Relieved?'

Client: Yes!. It is such a relief to get this all off my chest and have my reality accepted.

Alongside of her reality being accepted this client was also experiencing having her self accepted. This was a very meaningful outcome from a session that she had anticipated would end with another diet sheet. She left feeling that whilst her behaviours were causing significant consequence she was not judged by them. The climate for change was being cast.

It is interesting to me that this is not the first vignette I have shared in Practice Pavestones featuring the experience of 'relief' in a Dietetic session being valued and debriefed by a client.  So many of our client centered skills and attributes contribute to this and again and again clients share how important it is. (This says something I think about burden of expectation experienced by clients when consulting with a Dietitian but I'll save that for another newsletter!)

So how does unconditional positive regard contribute to relief, acceptance and other experiences that our clients really value?

Firstly.......


What is Unconditional Positive Regard UPR?

UPR is a disposition or attitude towards our client whereby:
 
'the client is viewed with dignity and seen as a worthwhile human being'  Phillip Burnard.
 
This attitude accepts that our clients have a right to their subjective reality and is offered without conditions.

When a client experiences UPR they often report feeling:

genuinely cared for by their health professional
praised spontaneously and authentically
valued
respected
supported without strings attached
affirmed
warmly accepted














Why Does UPR Help?

UPR is a core attribute in our client centered hub. Carl Rogers, the originator of client centered counselling (Introduced in Issue 1), hypothesised that our positive feelings towards our client and the communications of these feelings (verbal/non-verbal, implicit and explicit) were an essential contributor to the success of the helping relationship.

The current evidence base for UPR demonstrates that 'the provision of positive regard is strongly indicated in practice' Norcross p183.  Norcross asserts that the breadth of this data has clear implications for the conduct of all professionals engaged in helping relationships.

Let's consider..........

Our clients come to us for help with behaviours that are too hard to change on their own. They have usually learned this through attempting change themselves or with another practitioner. They have probably discovered that the change they seek is overwhelming, too confusing or they just can't make the change stick. It is an understandable consequence of this that our client may feel they have failed or perhaps learned to see themselves as damaged or incapable. As a foundation for change any human being needs to feel worthwhile, resourced and connected to their self-efficacy. This is why the Dietitians attribute of UPR is so vital.

I'd like to suggest two important outcomes of the Dietitians expression of UPR:
  1. Feeling the respect and acceptance of the Dietitian enables clients to risk difficult disclosures about eating and fully experience their feelings, thoughts and embodied information. They can truly be themselves - faking it ain't gonna make it!
  2. In experiencing the positive focused affirmation of the Dietitian, a client can establish a connection to their inherent capacities for moving forward. Affirming is a key component of Motivational Interviewing, enabling a client to progress into action phase of change. UPR generates hope that when harnessed well, can lead to action.


How does the Dietitian 'Do' UPR?
 
At face value UPR feels like a tall order. We might wonder  'but how do I like everyone, all the time, no matter what?'.......and you'd be right! That is a tall order!

UPR shouldn't be confused with 'liking' our client and it is easy to make this mistake at first.

It's also not about 'doing a PollyAnna' on our clients.















OOOOOh scary-way-too-positive-weirdy-girl.

Being able to adopt the attitude of UPR requires an alignment with the theory behind it. This theory states that people are innately oriented towards constructive behaviour and given the right conditions (respect and  space for self determination) they will actualise positive changes.

So, when we are expressing UPR in our client relationships, we are congruent with our client's capacity to move in a 'life-forward' direction and we trust that capacity. We also hold compassion for the struggles in this process.

I really like how this balance is expressed by Richard Nelson Jones (p34):

'.....helpers respect and value the deeper core of clients and identify with their potential rather than with their current behaviours. UPR involves compassion for human frailty and an understanding of universal conditions that lead individuals to become less effective persons than desirable' 

When aligned with this theory the 'doing' naturally follows through our attributes of empathy (Issue 4) and genuineness (Issue 5) and our skills. There will be more on this in the skills newsletters coming up. For here, I'd like to acknowledge three aspects of the Dietitians 'person' that in my own experience are key to facilitating expression of UPR:
  1. Self awareness - an outward expression of UPR starts with an inward experience of patience with self, self care and self-compassion. Engaging in our own process of self acceptance is an essential precursor to the expression of UPR.
  2. Confidence, positivity and warmth toward our own abilities and skills in the health care relationship. Keep practicing, keep learning and use your supervision!
  3. A genuine appreciation that we can never truly know another's reality - no matter how closely it may resemble our own story or that of another client, family member or friend. Consider for a moment the similarities but stark differences between our two fishy friends in the jar below:

















 
So, in a nutshell, as Dietitians we can practice the attitude of UPR by:
  • appreciating our client's reality,
  • being compassionate about their struggles,
  • looking for our client's strengths,
  • seeking out what they are doing 'right',
  • listening out for their forward movements and ...................
  • saying something affirming about it all. 

What Might UPR Sound like?

A few quick sound bites:

'Great! I like that you took that risk!'

'Good thinking .....that's real progress from where you were a few weeks back'

'Keep going.........I'm following, you're making sense'

'Its tough going but you're not giving in!'


Some more complex ideas:

'I want to thank you for taking the courage to share all that with me today. This stuff is hard to talk about. I wonder if I am beginning to understand that you are stronger than you realise'

'Yes, as you say, there is a sense of fear about this change but also a part of you that wants it deeply. I'm looking forward to getting to know better the part of you that can see the value in taking the next step'.

'It sounds like so many experiences of failure have invited you to feel like a failure. My hunch is that it was the method you adopted to change your eating, not your 'will power'  that let you down. It is abundantly clear to me that you genuinely want to look after yourself and that is what really counts for finding a way forward'


Challenges for Dietitians

As for all helping professionals there are many potential challenges to maintaining UPR for our clients. Let's consider the difficulties of remaining unconditionally regarding when...........

............. we have been 'tasked' with changing a client by a referring colleague

..............differing ideas about change between you and your client create a climate of discord (a.k.a. the 'resistant client')

..............the climate of weight stigma pushes our buttons. I'd like to lean in on this one a bit more...........

Weight stigma is being recognised as a real and present impediment to delivering positive, respectful health care amongst health professionals. If you would like to learn more about this have a look here online at the BEDA Weight Stigma Awareness Week resources page. A great introductory article written by Judith Matz can be accessed here (also mentioned in Issue 4).

Dietitians are not immune to the cultural normalising of weight bias. In my opinion it is essential for us to be aware of the current societal constructs about fatness. For example, perhaps take a moment to reflect on what beliefs deem it necessary to depict in the media, humans beings of certain size without a head? How do these beliefs influence our own views and work?  How do these beliefs impact our regard for our clients....... no matter what their size? 



















Becoming familiar with current weight science and the data on permanent weight change (great starter article here) can be a tremendous support for helping our clients move in valued directions, step out of repeated failings and provide their reality scientifically validated context. 

I will leave you to ponder the beautiful poignancy of this statement when considering the power of unconditional positive regard:

'.....every act of knowing brings forth a world.'
H. Maturana & F. Varela
 
 


Get out your fluro top, big earings ,tutu and doc martins! The soundtrack for today just HAD to be 'True Colours' by Cindi Lauper. Have fun waving your lighter in the air! Here it is!.

 



 



Issue 6 Pavestone: Unconditional Positive Regard

 

Nutrition is a science. Eating is a behaviour.

Behaviour change is difficult.

Unconditional Positive Regard (UPR) is an evidence based, key component of the therapeutic relationship and human change process

UPR is our experience and expression of our belief in the dignity, capability and worth of our client. It is the expression of a valuing attitude toward our client

The client experiences UPR as being cared for and respected by their health care professional, without strings attached.

UPR is aligned with the theory that all humans have the capacity for constructive change and given the right conditions people will naturally move towards this change.

UPR can assist our clients talk about difficult behaviours and connect with their own resources for change

Dietitians may be challenged to remain positively regarding of their clients when they have been tasked with 'changing the client'

Weight stigma is a serious threat to UPR in all areas of health care provision


Suggestions for Reflection:

What is my personal belief about the inherent capacities of my clients and how does this support or challenge my expression of UPR?

How often do I communicate with my clients my belief in their ability? What is the effect on the client when I do this.

What are my innate qualities that facilitate my ability to express UPR?


What do I find challenging about the practice of UPR and who could I discuss this further with?
 

Enjoy experimenting!
Keep reflecting!




Tara


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

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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