How can we tune our ears to be better facilitators of change? Grab last seats for workshops in March & April
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Issue 36 February 2017

Welcome to Issue 36



 
Hi Everyone! Hope your month has been a fun and productive one and that you have survived the heat (for my neighbors along the Australian east coast).

February introduced Pavestones to another 88 Health Professionals in Melbourne and Canberra looking to improve their client counselling skills for behaviour change. Dietitians, Diabetes Educators, Maternal & Child Health Nurses and Exercise Physiologists jumped in boots and all to the four MI classes run this month. It is wonderful to work with such breadth and depth of experience in a class and I would like to extend a huge thanks to Pip Golley at ACT Health for organising the Canberra classes so seamlessly.

The more I train this material, the more I come to appreciate the commonality of our struggles in helping people to look after themselves in the context of busy, complex lives. Ours included! At the completion of MI 2, attendees are asked what they would thank Motivational Interviewing for if they met MI in the street like an old friend. The themes are powerful, here are some particularly resonant responses:
 
'Thank you for reminding me that it's about the client. I am grateful you've shown me a joyful way to create partnerships to work with people that enables them to discover they already hold what they need for change.'

'Thank you MI for giving me the space to notice, reflect and discover my strength and have kindness for my continued learning.'

I am looking forward to returning to my old stomping ground at RNSH this week for MI 1. Training with friends in the room is a lovely way to spend a day at work. Motivational Interviewing 1 & 2 will be running again in April in Sydney and there are four places left. Registrations close on March 9th . If you are thinking of coming along it would be great to meet you. You can still access early bird discount if you have attended a Pavestone event in the past.
 


Training with 'Friends of Pavestones'


'Last rounds' are being called for Eve Reed's and Terrill Bruere's workshops coming up in March. If you work with women with PCOS or would like to know more about the Satter Feeding Dynamics Model for working with children the Training Box up next has all the details.

There are great workshops in non-diet approach coming up around Australia with my colleagues Fiona Willer and Fiona Sutherland at www.healthnotdiets.com. Body Positive Australia will also be hosting their retreat for ED Professional again this year in June in Victoria. Check out the classifieds boxes for more details after the editorial or click through here.
 


In This Issue


In January's Issue 35 we explored the Righting Reflex - the part of us that wants 'good things' for our client and the paradoxical impact this desire has on promoting unhelpful behaviours in session.
We can manage our Righting Reflex by many skillful means. One such means is being able to attend to the 'change language' of our client. In this issue we are going to take a toe dip into what we mean by change language to equip you with some starting points if you are practising implementing MI into your counselling skill repertoire. Read on for more. To skip straight to the editorial click here 

As always if you are short on time, you can fast track down to the summary in the Purple Pavestone Box at the end of the editorial by clicking here...happy reading!

 

Working Effectively with Common Childhood Feeding Challenges: An Introduction to the Satter Feeding Dynamics Model


Facilitated by:

Eve Reed APD in SYDNEY March 24th 2017

Registrations have formally closed. There are 2 places remaining 


Email Tara to access a late ticket

Click
HERE for all the workshop details



Working with Women with PCOS:
Navigating the Real-Life Challenges


Facilitated by:
Terrill Bruere APD in MELBOURNE March 30th 2017.


Registrations close In two days on March 2


Only 4 places left 

Don't forget if you have attended a Pavestone event in the past you can still access Early Bird rates until regos close


To learn more about this workshop Click HERE



Motivational Interviewing 1 & 2 

SYDNEY April 6th & 7th 2017


Registrations Close March 9th

 

Great Discounts available for attending BOTH events

Only 4 places left

 

Click HERE for MI 1


Click HERE for MI 2




Fresh Feeback from MI 1 delivered to ACT Health Feb 2017

I really liked the practical nature of this workshop and Tara's ability to take very difficult situations and turn them into a learning session without glossing over it. The workshop really builds confidence in exploring client issues [with behaviour change] and using their experience to resolve these issues.
S.F. Dietitian

This was an excellent workshop. Great ideas for practical, usable interactions with clients of all sorts. I am looking forward to trying out my new skills and hoping to have the opportunity to learn more. MI is a great, practical model which is client focused, affirming and helps practitioners to provide positive input.
L.K. MACH Nurse


'Save The Date' for BRISBANE MI 1 & 2

August 17th & 18th 2017


Regos OPEN SOON

Listening Out For Change


Subtitle: as an alternative to making change happen
(and good luck with that!)

 
What most people need is a good listening to
Mary Lou Casey

Ambivalence is a wonderful tune to dance to. It has a rhythm all its own.
Erica Jong

She has but doesn't possess,
acts but doesn't expect.
When her work is done, she forgets it.
That is why it lasts forever

Stephen Mitchell [translation of Tao Te Ching]
 

When practising Motivational Interviewing as a practitioner we are deeply interested in our client.
In spirit, we apply ourselves to attending to our client with compassion, suspending judgment and partnering with them to discover together what they want for their lives should they engage in the difficult task of change.
In skill we are listening with undivided attention, tuning in to and working intentionally with their language. We refrain from imposing ideas or advice.

Whilst the spirit of MI may be foundational to many client centred communication paradigms and therapies, the skill of working with our clients' language of change is uniquely MI. This skill lies at the core of Evoking: the third process of Motivational Interviewing.
 

What is this 'Language of Change'?


A little warning - this next piece gets complicated quickly.
If you are new to MI, hang in there, I will be simplifying
the 'data' into TWO very usable language
concepts to help get your practice up and running

In the course of any client session concerned with exploring behaviours, our clients will say many different things about change. Motivational Interviewing has looked closely at these statements and assembled them into categories represented in the acronym DARN CATS.  

To bring DARN CATS to life, consider scenarios where you may hear a client say something about:
  • their desire to change or maintain the status quo: 'I wish things could be better'
  • their belief in their ability to change or not: 'I am able to cook more at home'
  • their reasons to change or keep things the way they are: 'I'd have much less stress if I stopped this work routine'
  • their need for things to be different or for holding steady: 'I need to get on top of this to stay out of rehab'
If our client is expressing high levels of motivation we may also hear them share:
  • a clear commitment to change: 'I will start my medications today'
  • suggestions they are actively preparing for change: 'I have filled the script the psychiatrist gave me'
  • reports they are already taking steps and describe new behaviors they are actually already doing: 'I started the anti-depressants last week after our session'
There is a LOT of data there. Can't say I didn't warn you! Let's keep this simple for now (and for as long as you need).
 


Rather than become too preoccupied with different categories of language featuring change, you are encouraged to experiment with listening out for two simple groups of change language.

Firstly: Change Talk

Secondly: Sustain Talk

Much easier.

What is Change Talk?


Change Talk is simply the client’s own statements that are in favour of change.

Some examples include (on top of those given above):
  • I’d like to feel more in control of my blood sugars
  • I’d save so much money if I gave up smoking
  • Well I could walk the dog more I guess. Hey! my wife would get off my back
  • I need to get on top of this, the price I'm paying is too high

What is Sustain Talk?


Sustain Talk is simply the client’s own arguments for not changing or for maintaining the status quo.

Some examples include (in direct contrast to what we hear above):
  • I’m not that worried about my blood sugars to be honest
  • A cigarette is the only thing that gets me through the day
  • My feet hurt if I walk too far, it’s my arthritis see
  • I'm not gonna leave him, he loves me deep down


Getting Practical: Why are these concepts important? 


When we can identify Change Talk and Sustain Talk, we can skillfully respond to clients in ways that are demonstrated to make change MORE LIKELY.

A quick recap of last issue:
  • When a client is ambivalent about change they will present both sides of the argument (for and against change) in their language. We will hear both change talk and sustain talk blended together. An example I can exquisitely relate to:
  • When we are motivated to help by directing our client to change (engaging our Righting Reflex) we essentially vocalise their change talk: 'Its time to take a break, you need to practice better self care' 
  • This leaves the client with vocalising their sustain talk. 'But then I'll just end up MORE behind'
  • The more we pick up the argument FOR change the more the client is left emphasising their reasons to NOT change.
  • This leads to poor outcomes as the client essentially talks themselves into staying the same.
We can give our Righting Reflex a bone to chew on by channeling its energy into listening out for our client's own change talk. When we can identify our client's change talk we can do something (actually many things) that are much more effective than persuasion, advice or direction. By strengthening the change talk we hear we increase the likelihood of change.

The first step is simply identifying your client's change talk.
 
 


After Identifying Change Talk, What Comes Next?


When you are ready, you can practice two simple strategies to start with.

Firstly reflect the change talk you hear, then ask for elaboration.


What might this sound like? 
 

In the examples below I have underlined the change talk in the clients' opening statement. You will also hear sustain talk. For now we are just leaving that be. There will be plenty more sustain talk skill debriefs in future issues.
 
 
*****
 
Client: 'I'd like to get my blood sugars under better control but I hate exercise'

Practitioner: 'Getting your sugars down matters to you. [reflect] Can you say a little more about how it would help you to have better sugar levels?' [elaborate]
*****

Client: 'I'd like to drop a dress size you know but I am just so sick of counting calories. Dieting is actually driving me crazy'
 
Practitioner: 'Dieting is costing you more than its worth. [reflect] What might life be like if you could eat without anxiety again?' [elaborate]
 
*****

Client: 'I’d save so much money if I gave up smoking but a cigarette is the only thing that gets me through the day'

Practitioner: 'You're thinking about the extra cash if you quit. [reflect] I wonder for you, what other upsides there might be to giving up the cigs?' [elaborate]

*****

Next issue we will be exploring more about Change Talk and how to invite our client to offer more of it. 
 
Ambivalence is a tricky state to work with and it is not uncommon to find ourselves feeling as stuck as our clients. Listening out for our clients' change talk offers opportunities to access some traction and open up new avenues of conversation. Our ears are tuned in to hope, it's a good thing.
For this month's soundtrack I have a cautionary tale from Steelers Wheel about getting 'Stuck in the Middle' . It don't sound so good!
 
 


Well, I don't know why I came here tonight
I got the feeling that something ain't right
I'm so scared in case I fall off my chair,
And I'm wondering how I'll get down those stairs


Clowns to the left of me, jokers to the right,
Here I am, stuck in the middle with you


Yes, I'm stuck in the middle with you,
And I'm wondering what it is I should do
It's so hard to keep this smile from my face,
Losing control, and I'm all over the place

 

Issue 36 Pavestone
Listening Out For Change 

 

Nutrition is a science. Eating is a Behaviour. 
Behaviour change is difficult.


 
Using Reflections, Affirmations, Open Questions and Summarisations are core skills in Client Centred work fundamental to building trust, engagement and communicating respect The Four Processes of Motivational Interviewing is a framework for using our core client centred skills intentionally to guide our client's conversation about behaviour change in a meaningful, goal focused direction

The Four Processes include Engaging, Focusing, Evoking and Planning
 
Engagement is a dynamic process of building a helpful connection with the client 

Engagement creates an environment which respects the client and invites them to fully participate in the conversation about change

Engagement relies on the skills of Active Listening, Affirming, Reflecting and Open Questions and invokes the tone of empathic, warm curiosity
 
Engagement can be limited by specific practitioner behaviours including being 'the expert', conducting a lengthy premature assessment and describing a client in language they disagree with or do not identity with.

In Motivational Interviewing these dis-engaging behaviours are referred to as 'traps' as they can catch the practitioner unawares and restrict movement in the engagement phase of work
 

Moving from Engagement to the next process in MI called Focusing needs to be well timed to avoid the 'Premature Focus Trap'

Focusing is the process by which the practitioner develops and maintains a specific direction or focus in the conversation about change, with the client

When you can  confidently communicate back to the client a summary of why they have come to see you and what the issue is from their perspective, you can shift into the process of Focusing
 

We may encounter many challenges to finding a focus with our client. This is particularly so when the client may state they are doing 'everything they can' when perhaps that isn't the case.

Client centered, open questions and reflective listening are core skills to assist with focusing challenges.
 


Issue 33
Skillful means may be adopted by the MI practitioner to assist the client choose a useful focus for their conversation about change.

The practitioner can add to the focus for session by simply asking permission to do so.
 

Issue 35
The Righting Reflex can be defined as:
The desire to fix what seems wrong with people and to set them promptly on a better course, relying particularly on directing

Directing and advising ambivalent clients can be counter productive as this typically provokes the client to rehearse out aloud all of their reasons for NOT changing.
 

This Issue 36
Clients' statements about change can be loosely grouped into: 
Change Talk: any client statement that is pro-change &
 Sustain Talk: client statements that are about maintaining the status quo

Identifying Change Talk and responding skillfully is a key step to reinforcing our clients' own motivations for change and is directly correlated to better change outcomes. Working with Change Talk is the core work of the third process in MI: Evoking

 


 Suggestions for Reflection  


You are invited to take a few minutes with your reflective practice journal and jot down 5 typical change talk statements you might hear your clients say to you in your sessions.

How would you reflect those statements back to your client? - practice your ideas on paper

What could you ask your client that would invite them to say more about their pro-change statement?

If you were to do this in your sessions with clients how would this be of benefit to your work?
I'd love to hear your thoughts, curiosities, insights. Please email me to let me know.

Enjoy experimenting!
Keep reflecting!


Tara MacGregor
www.taramacgregor.com.au
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Counselling Skills Training for Health Care Agencies & Hospital Departments


PLAN NOW for 2017


If you are interested in organising training for your staff come on over to the new webpage to learn more and read great feedback. Please email Tara to express your interest for 2017 as inquiries are coming in and the schedule is now booked until June
 

Affirm Your Knowledge
Online CPD Quiz for APDs


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

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


You still have time to use the 2016 Quiz for your upcoming APD Renewal.


Click HERE to access the 2016 Quiz Issue 

'Health Not Diets' Training

 

For all upcoming dates for 2017
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


Looking for On-Line Convenience?


NEW ON-LINE TRAINING


The Non-Diet Approach for Dietitians online course suits dietitians and nutrition professionals.  It is a self-paced interactive course hosted by Open Learning which uses video, written materials and activities to develop your understanding of the clinical application of the weight-neutral Health at Every Size paradigm.  Participants have 12 months to complete the course, and passing the assessment means you'll get a lovely certificate for your efforts but more importantly fabulous skills for helping your clients. 
More details and the enrollment link can be found here

Eating Disorder Professionals Retreat 


June 30th-July 4th 2017


Suitable for any health professional working with people who feel concerned about their body, food and eating. Dietitians who work in Eating Disorders will find this retreat particularly suitable.

Hosted by  Body Positive Australia (including Fiona from The Mindful Dietitian)

Featuring creative and innovating workshops from some of Australia's most experienced practitioners, as well as yoga, amazing food, great networking opportunities and so much more!

For all information about workshops, rooms, rates etc please click through here 
Please contact Fiona directly fiona@bodypositiveaustralia.com.au with any queries.

 

This Issue's Great Read


...........is actually a great WATCH.

A timely new webinar produced by the ASDAH Education Committee features HAES dietitians Kori Kostka, Julie Duffy Dillon, Marsha Hudnall, and Aaron Flores who skilfully describe how they respond to clients who express a desire to lose weight. 

For the video click HERE

As a HAES® practitioner, you want to support your clients in healing their relationship with food and overcoming body hate, using a weight-inclusive approach. Your client hopes, prays, and pleads that weight loss will be an outcome of this healing process. How do you validate their concerns while also communicating the futility of trying to control the number on the scale? Four registered dietitians provide answers to this question with practical tips and strategies.  
 

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 

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

Follow Practice Pavestones on Instagram


@practicepavestones


 

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
www.taramacgregor.com.au
www.taramacgregor.com.au
tara@taramacgregor.com.au
tara@taramacgregor.com.au
Copyright © 2017 Tara MacGregor, All rights reserved.


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