Clients who have a lot to tell us can challenge reflective listening. Read more about some strategies to help
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Issue 15
March 2015

How Do We Reflect When Clients
Have A Lot to Say?
Responding Part 3
 

                                
                   
Welcome to Edition 15 folks! It is a spectacular autumn in Sydney so far but it's like 'spring has sprung' for Practice Pavestones! So much happening!

It is a pleasure to welcome 50 new subscribers on board who came and said G'day at my exhibit table at Dietitian Day 2015 in Brisbane. I'm sure those of you who attended the event would agree it was a fabulous day and wholehearted congratulations are extended to Maree Ferguson of Dietitian Connection for being such an innovator and trail blazer for our profession. The counselling skills workshop WILL be coming to Brisbane after such a warm welcome from locals! 2016 dates will be announced soon.

Since the last edition of Pavestones TWO public training dates for The Essential Counselling Skills Workshop have been announced. Read on for more details. A big thank you to those of you who responded with expressions of interest for Perth in May. Due to your enthusiasm the dates are confirmed and venue booked. Practice Pavestones will also be consulting to Hunter New England Local Health District to run the workshop for staff and colleagues in November. Exciting developments!

As always - check out he classified box for great training and resources from others to keep your skills fresh and your practice alive and dynamic.

 
In this Issue
Continuing on our exploration of reflective responding, in this issue we will be looking at tweaking our reflective listening for clients who have a lot to say in session. Talkative clients can present a very specific challenge to our active listening skill. To revise the more broad challenges to reflective responding debriefed in last issue you can have a look HERE. 

If you are having some format problems with this issue please use the browser  link at the top to view in your browser. 
As always if you are short on time scroll down to the Purple Pavestone Box at the end..........happy reading!
  
                                     

The Essential Counselling Skills for Dietitians Workshop

PERTH WA May 18-19th Click HERE

MELBOURNE June 4-5th Click HERE 

                   
 

'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 Attendee Feb 2015 
 

'Do your little bits of good where you are;
it's those little bits of good put together that overwhelm the world'

Desmond Tutu

'After nourishment, shelter and companionship, stories are the thing we need most in the world'
Phillip Pullman

'The more you leave out, the more you highlight what you leave in'
Henry Green
 
Variations are normal occurrences in nature. We could consider verbosity in clients as one such variation. Bell Curves are handy diagrams to conceptualise variation in all its forms.

                  

In this issue we are going to be exploring a little about clients who talk probably more than others and definitely more than others and the challenges this may place on our practice of reflective listening.

We are all familiar with the scenario. We invite our client to speak and within a short period of time we are getting that uneasy feeling.........'whoa...where is this going?' . We may start to panic, there is time to keep, the next client will be here in 15 minutes, we need to 'get to the point' but we know the value of reflecting and attending. It can all get us a bit overwhelmed.....

                 
                                    

It can be very hard to know what to attend to and what to reflect when the client has done the metaphoric, story-telling equivalent of turning their handbag upside down and letting gravity work its magic.

                            


Or man-bag.  It would be dangerous to assume that it is only our female clients who can be the talkative ones.

               
                         


(Hmmmm It seems that in an effort to be inclusive I have made things worse. I'll move on from my sexual stereotyping.....quickly !)

 


A Strategy to Consider


There are many reasons why some clients talk a lot. One is anxiety. Meeting with a Dietitian or talking about stressful behaviours can be extremely anxiety provoking. Long and complex stories are often a symptom of a hyper-aroused state and can be (unconsciously) functional in providing a great distraction.

Anxiety in our client is important to acknowledge as it points to some ways we can be helpful in this situation. Here's a handy acronym to get a handle on things: 


SES
(Aussie subscribers can think: 'State Emergency Service')

 

Stay calm and connected
Empathise to remain alongside your client
Sharpen the focus with your client


S

Staying calm is essential to all good client centered practice and this will be a topic of a whole future edition (and then some). Briefly: staying in your body, watching your breath and feeling your feet are great grounding strategies to counteract a racing mind. 'Lots of story' can be a powerful invitation to disconnect from yourself and your client - watch for this and remain alert and attentive.


E* 

Empathising to remain alongside your client keeps the working alliance going in a context that easily can put you and your client on different pages. As suggested by Egan (p98) in The Skilled Helper, asking this question (or similar) of yourself can help keep your empathic response brief. We don't want to repeat or amplify the overwhelm in a lengthy reflection.


'What is the core of what the person is saying to me?'


we can then reflect that core message back to the client.


S

Sharpen the focus with your client. This is well within our capacity as skilled communicators and we can remind ourselves this as a self affirming strategy when feeling stuck.  You can experiment with using this question to bring your client in to work with you on this challenge :

'What is the most important part of what you have shared for us to pay attention to?'

we can then reflect the response back to the client

* for more on the power of empathy in client centered work see Issue 4 HERE


What does this strategy sound like?


Let's consider the following client statement and how we may effectively respond reflectively using some of the ideas above:

Dietitian:  'How have things gone this week with your eating and the goal we set at our last session?'  

Client: 'The week didn't go well. I couldn't find that product we talked about at the supermarket for starters. Did you know that the Coles up the road has changed their aisle lay out? I can't believe it. That's the second time this year. What are they trying to do to us? I guess we are just the customer after all! We are shareholders you know - no wonder the dividends are going nowhere. That's 'Mum and Dad' investing for you I guess. Anyways I'm rambling I do that although my son is worse, I got called up to school this week to talk to the teacher about it. Hes a good boy though. Unlike his father - didn't make a show this week. So anyways, I couldn't find that product and then I sort of lost focus. Its a problem when I get frustrated like that. I kind of give up. Around and around I go'.

Dietitian:
S: (Steady breathing, remaining alert. Thinks: What is the core of what the client is trying to say to me? - it's been a challenging week for her and she couldn't follow through). '
E: 'Hmmmm Its been a really hard week - lots going on that got you knocked off course'.
S: 'What would be the most important aspect of this week for us to focus on in terms of your eating?'

Client: Yeah, absolutely hard week. Well in terms of what to talk about, and yeah, sorry I dumped all that on you, I do that, we'll get used to it, I guess I'm lost and I don't know where to pick up from. Arggggh I'm a lost cause! Heavens! (Sigh)... OK. I know I wanted that new product but seriously, what a fuss, maybe we should rethink that. Do something simpler'

Dietitian; 'So looking back on the week, keeping things simpler feels like a starting place'

Client:  'Yep, Uhu'

Dietitian: 'Great work, clear thinking! Is this where you would like some ideas from me?'

For more on 'Giving Advice and Staying Client Centered' see Issue 2 HERE

 

 


 

Managing your Feelings


Clients may 'push our buttons'  for many reasons. It happens. It's natural and being conscious of our buttons is good practice.

Here is a reaction that may (ever so slightly!) suggest a client's verbosity is a button pusher for us:

                              

You may like to take a minute to reflect on the impact of this hypothetical reactivity (also called countertransference) on the expression of empathy and positive regard for our client. These are our core client centered attributes for alliance building, without them we are not effective professionals.

Whilst countertransference is natural we must take responsibility for recognising it and managing it. This is where journalling in a practice journal and regular quality peer review or supervision is absolutely vital.
 
 

It's Soundtrack Time!


I've picked a comedic video clip from Ellen DeGeneres for this issue - just for a bit of a laugh. Now it comes with a warning - if you don't like silly sexual stereotyping (which Ellen acknowledges) press skip! If you'd like some fun insights on the feeling of being stuck in conversations and how to use ketchup creatively to get out of it - go for it! Click on Ellen's image below.
                          
                            
             

 

Issue 15 Pavestone 
Reflecting Effectively when a Client Talks a lot

 

 

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

A very talkative client can directly challenge our reflective listening practice. We can find ourselves anxious and managing challenging feelings towards our client.

It may be helpful to consider the strategy of S: Staying calm. E: Empathising with our client. S: Sharpening the focus of discussion

We can use these questions experimentally to help us in this process:
To Ourselves: What is the core of what the client is trying to say?
To Client: What is the most important part of what you have shared for us to pay attention to?
 

Suggestions for Reflection

  
What have been my experiences of talkative clients?

What would I consider my biggest impediment to reflective responding in this client group?

What stands out as important strategies for experimentation for enhancing my reflective practice when my client has a lot to say?

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

Enjoy experimenting!
Keep reflecting!




Tara

 
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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

 
 

On-Line CPD Quiz for Editions 1-11


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

You can access the quiz Here for a fee of $9.95

The CPD Quiz features 11 multiple choice questions with multiple correct answers based on the content of editions 1-11. Points are awarded for each correct answer. You can print your results for your records with all marked questions recorded. Price includes multiple attempts of the quiz if you wish to learn as you repeat. You can also break during testing if needed and access your incomplete quiz on-line at a later date.

If you would like to access issues 1-11 for revision the best way to do this is via Edition 12 which has a synopsis of each issue and a link for handy access to the complete editorial for each issue. It's available HERE
 

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?
 

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 http://tinyurl.com/SattAus.  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!

 
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
 
www.taramacgregor.com.au
www.taramacgregor.com.au
tara@taramacgregor.com.au
tara@taramacgregor.com.au
Copyright © 2015 Tara MacGregor, All rights reserved.


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