Working with Non-Verbal Messages

Tuning Into our Clients Pt 2
 
 
Issue 8
July 2014
Practice Pavestones has had a very exciting month. Subscriptions have now passed the 600 mark with lots of APDs & other health professionals looking to develop and strengthen their counselling skills, coming on board.  Welcome!

I have had numerous requests for archives of previous newsletter issues from new subscribers. Please see the side bar for full archive access.

The Essential Counselling Skills for Dietitians Workshop has been officially announced. For more details and registration see the top billing on the side bar.

This issue of Practice Pavestones will be extending on the theme of 'Attending' introduced in Issue 7. What do we attend to in our client when we are actively listening? Lots to talk about here so the next 4 issues will be devoted to answering this question in some bite size chunks.

Don't be a stranger ! please send me your feedback - I am always encouraged by your ideas and experiences.
 
Remember! If you are short on time - scroll down to the Pavestone for this issue










The Essential Counselling Skills Workshop for APDs

The workshop will be held in Sydney on October 9 & 10 in Sydney.

For REGISTRATION and more info please click HERE

Numbers will be limited to ensure a quality, highly experiential learning format. The workshop will offer attendees unique experiences in reflective enquiry and practical skill development. It will also be lots of fun!

There will be opportunities to join small group supervision as a follow on from the workshop to receive ongoing support for the integration of your learning and skills.

There has been a lot of interest from subscribers in Melbourne and I will be planning a visit for the workshop in the first quarter of 2015. Please get in touch if you are in Melbourne (or any other location) and would be interested in coming along or would like me to visit your city.  Email me here.
 
 

 

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.



 

 










ARCHIVES of Previous Newsletters


Thanks for all of your requests for copies of previous newsletters.

You can access the full archived collection by clicking HERE


 


 


HEAR DR SUSIE ORBACH IN SYDNEY

Endangered Bodies first annual seminar

Don't miss this amazing opportunity to hear Dr Susie Orbach and Dr Rick Kausman speak. Also presenting are Melinda Tankard Reist and Sarah McMahon.

August 10th 2-6pm Footbridge Theatre Sydney


For more details and registration Click Here
 



Clinical Management of Severe and Enduring Anorexia Nervosa (SE-AN) Workshop

November 21, 2014 Melbourne 
Prof Stephen Touyz and Prof Phillipa Hay

I was fortunate enough to attend this workshop in Sydney this year and found it extremely valuable. I highly recommend it for APDs and other health professionals who work with clients struggling with SE-AN.


Register and more info HERE
 
 

Dr Rick Kausman on Channel 9

Many of you know Dr Rick Kausman - Australian Champion of the Non-Diet message.

Dr Rick appeared on the Channel 9 Today show recently discussing Intuitive Eating.

Great cut through Dr Rick!

You can have a look at the TV clip here


 


 



Shout out of the month

Goes to Jane O'Shea APD  who recently announced: 

'I am very proud to advise that I am now a licensed facilitator for the "Am I Hungry?"®Mindful Eating Program.  My first two courses start shortly (6th and 9th August) and I will offer online courses in 2015.'

It is great to be supporting APDs upskilling in important areas of eating behaviour work.

Jane is based in Warrawong NSW and can be contacted through her website here



 



 
A Bit of Fun from South Coast NSW


A sign spotted on holidays at Bulli:





The sign reads: 'UNBELIEVABLE BACON. $3.99 A PACK'

Fabulous with improbable eggs on dubious toast. 

For the ultimate breakfast sceptic


EATFED Conference in Sydney


Contemporary Research & Cutting Edge Treatment for Eating Disorders
Sydney August 15th & 16th

Hear Dr Anita Johnston Clinical Psychologist and Eating Disorder Specialist present her wonderful ideas on the importance of metaphor and narrative in eating disorder work and recovery. Dr Johnston is Author of Eating by The Light of the Moon.

For more details of conference click here

 

A trembling in the bones may carry more convincing testimony than the
dry documented deductions of the brain.

Llewelyn Powers

The body never lies
Martha Graham

My body is a bulletin board, transmitting my condition
Terri Guillemets



In Issue 7 the skill of attending to our clients as a core piece of the Active Listening process was introduced and included for illustration was this beautiful graphic of the Chinese character for listening. It summarises succinctly the details of WHAT we attend TO when we actively listen:
 




 Source
 
 

Looking more closely, we use:
 
  Ears
  for attending to
  The verbal messages of our client
  Eyes
  for attending to
  The non-verbal messages of our client
  Heart
  for attending to 
  Resonances in our clients message
  Mind
  for attending to
  Our interpretations, interruptions and overall
  perspective taking








When we think about the data we collect when we listen, usually the first thing that comes to mind is the words that we hear. While this is of course essential, we are all familiar with the expression 'Actions speak louder than words'. In the process of fully understanding the communications of another human being, it is well established that we privilege non-verbal messages over verbal. So, for this first issue on attending, it made sense to start with a discussion about attending to our clients' non-verbal messages.


What are Non-Verbal Messages?

Often referred to broadly as 'Body Language', non-verbal messages may be considered in discernible parts.

Egan in 'The Skilled Helper' defines these parts as:
  • Bodily Behaviour - posture, movement and gestures
  • Facial Expressions - self explanatory!
  • Vocal Behaviour - tone of voice, speed of speaking, pausing, volume of speech
  • Physiological Responses - often autonomic such as flushing, sweating or quickening of breath
  • Physical Characteristics - including appearance and body size (need to be used cautiously!)

How are non-verbal messages useful in Eating Behaviour Counselling?

1. Developing empathy
'Empathy is the ability to accurately perceive the lived experience of another; emotionally, cognitively and bodily and reflect that understanding back to the other' (Issue 4). Attending to our client's body language is essential to the development of empathy as it contributes vital information about our client's present moment experience.

2. Providing important information for our 'assessment' process
Remember, behaviour change is difficult. Our client's body language can give us all sorts of information about how they are experiencing that difficulty.  Non-verbal messages in our client's communication can be useful for both confirming a verbal message and also conflicting with a verbal message. They can also be useful to give us data about preparedness for change, anxiety states and self awareness in our client. 

3. Inviting our clients to have a body connection
When we attend to our client's body language we model acceptance of our client's body's messages. The power in the congruence of this action in eating behaviour counselling cannot be underestimated. 


What does working with non-verbal messages sound like?

Just as there are infinite examples of what a client may say verbally in session to their Nutrition Counsellor, there are infinite possibilities of what a client may say non-verbally in session too. To grease the wheels of thinking about the usefulness of non-verbal messages in our client sessions, I will work with Egan's definitions (above) to demonstrate a couple of examples within these infinite possibilities:

Bodily Behaviour
Example 1.















Our client here may be experiencing overwhelm, shame or frustration with herself. Talking over the top of this is unlikely to be helpful as the client is certainly NOT saying to us 'I am receptive to you'. More likely what is being communicated is a need to hide.

We might appreciate this by going slower with our inquiry, softening our tone or empathising directly:

Dietitian: 'I get a sense your eating yesterday is really hard to talk about, I can really see what a struggle it is to be revisiting all this just now'

Client: ' Yes I've never told anyone about my bingeing before. I hate it'

Dietitian: 'It takes courage to do this work............let's go a little slower....perhaps take a deep breath, invite yourself to relax a little'


Example 2.

(you might notice that Google Images doesn't offer a great line in 'subtle!')
















Our client here is unlikely to be indicating she is 'ready for action'. Whilst we might be triggered to find a solution to her malaise or exhaustion, launching into a goal setting session or a well meaning 'pep talk' is unlikely to be effective at meeting her where she is at! Trusting that validation is key to our alliance with the client we might consider saying:

Dietitian: 'This week of change has been huge for you, I can see it has asked of you just about all you have'

Client: ' I'm done with it all. I'm not sure I can keep going'

Dietitian: 'You're ready to chuck in the towel'

Client: 'Yes.............(hesitates, tired) but no too.......I guess this means too much to give it all away'

Dietitian: 'I wonder what we could learn just now about what it is you might need to do to look after yourself during this process of change?'

Client: '...(Sigh) ......As usual I over did it! I need to learn pace'


Facial Expressions

Let's consider some examples here that are congruent and conflictual.

Example 1 Congruent facial expression













We could say that our client here is exhibiting a genuine, relaxed smile. This might be an opportunity to hear more about 'the good' and strengthen her resources in the moment. Expanding on 'the good' is a great tool for building your client's authentic confidence from within their own experience.

Dietitian: 'I can hear some great progess and I can see how pleased you are about it too!'

Client: ' Yes, this feels pretty good just now'

Dietitian: 'Wonderful! Can you tell me some more about this feeling good?'

Client: 'I did what I set out to do. It was hard but this time I cracked it.

Dietitian: 'Yes you did! I wonder, looking back over this week, what it was you did differently to help the change get over the line? What resources or knowledge did you draw on?


Example 2.  Conflicting facial expressions.













Our client here is likely to be experiencing some trouble or internal conflict with what he is saying.  The smile is forced and there is a mismatch with his eyes. If this client was telling us that he wasn't worried at all about his eating or his health we would be unlikely to believe him.  Challenging this discrepancy is vital to keeping the conversation real and our assessment accurate.

Dietitian: 'Thanks Bob for sharing that. It's strange ......and correct me if I am wrong but......., I am hearing one thing as you talk  and I am sensing another. ...mmmmmm.....my hunch is perhaps all is not as good for you as you say. Am I on the right track?

In Issue 5 on being real with our clients, I give another important example of this scenario very common in working with clients transitioning to the non-diet approach. Click here for a quick revision to compliment this exploration of conflicting communication signals



Vocal Behaviour

Example 1

A client launches into a fast rolling recall of their week's eating experiences. The data pours out, one event after the other hardly drawing breath and very hard to follow. You notice the tone becomes a little more shrill and volume a little louder - your client's vocal behaviour may be indicating a degree of anxiety and overwhelm. The invitation to the Nutrition Counsellor is to work with this anxiety to manage the session better

Dietitian: 'Wow Anish, there is a lot going on in all that. I can hear in your voice it must have been pretty messy for you this week.'

Anish: 'Yes, Messy is a good word for it!' (Takes a deep breath and his body settles, shoulders and eyes soften)

Dietitian: 'Hmmm  a deep breath - looks like you needed that' (encouraging smile, reassuring tone).' I wonder Anish, to keep the messiness from taking over your session here - what would be the most important thing to focus on together slowly?'


Physiological Response

Example 1.

A client, Susie, recovering from an eating disorder as agreed to check her weight in session with you. She has indicated she is fine with this and proceeds to stand on the scales. On returning to her seat you notice that her neck and upper chest has become quite flushed in large red patches. Her mouth is smiling, but a bit like Bob above, her eyes indicate something that pulls against the sense of ease she would like to portray. Physiologically her body is experiencing anxious arousal. Her body cannot betray her true experience. If you have a good engagement with Susie the conversation may proceed like this:

Dietitian: 'Susie, I know you have reassured me that you are comfortable with checking your weight with me but I am noticing some signs in your body that tell me this is pretty tough for you'

Susie: 'No I'm really fine with it. I don't feel anything, really' (slight strain in vocal tone)

Dietitian:  'May I ask Susie is this something that happens in other situations for you.........it is hard to get in touch with how you are feeling in the moment?'

Susie: (little laugh) 'Yes it is actually. My psychologist is always talking to me about it.'

Dietitian: 'Would it have use to you, do you think, to mention this experience to her as well?'

Susie: 'Yes OK, good idea'

Dietitian: 'Susie I think for now how I'd like to work with this is to remind myself that I need be mindful of how we do things that might be stressful for you. How does that sound to you?'

Susie: 'Good Yep. Thanks for that'


Physical Characteristics

Example 1

A female client presents every session immaculately clothed with flawless make-up. In supervision you reflect on your sense of your client as being like a 'perfect china doll'. This further informs your understanding of your client's strive to be perfect at all times in all aspects of her life including her eating behaviours and food choices. You decide to debrief with Susie in her next session if she would be interested in trialling some spontaneous eating experiments and how she would consider this to be of benefit to her.



Some Caution with using Non-verbal Messaging

In a nutshell.....hold interpretations loosely and always check your impressions with your client or  work with tentative suggestions. I also appreciate what Egan says here: 'The trick of course is to spot the messages in these behaviours without making too much or too little of them'.
 
The body is sensitive. It registers every thought and feeling. Be tender with it.
Brendan O'Regan
 
 
No Soundtrack this issue. Instead I'd like to pay homage to a hero of my adolescence - Rik Mayall, who sadly passed away on June 9th 2014. Rik played 'Rick' the arrogant, self-absorbed, self-proclaimed 'people's poet' and anarchist in The Young Ones comedy series in the 1980s. He was the master of the 'I don't give a toss, you're stupid and everyone knows it'  face. So perfect for this month's issue. Thanks Rik for all the laughs and making the puerile and grotesque so 'everyday'.

 



Issue 8 Pavestone: Using Non-Verbal Messages

 

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 only possible when we truly attend to our clients. Attending may be thought of as our 'whole-hearted' attention

When we attend to our clients we pay attention to both their verbal and non-verbal messages, our own embodied resonances and our thinking processes.

Non-verbal messages are more powerful than verbal messages and include bodily behaviour, vocal behaviour, facial expressions, physiological responses and physical characteristics.

Attending to  our client's non-verbal messages can assist greatly in developing empathy, gathering information, challenging discrepancies and modelling body acceptance and attunement


Suggestions for Reflection:

Think of someone who I consider to be a 'good listener'. What is it that they 'do' when they listen? How does this effect what I am able to talk about?

How do I use my clients' non-verbal messages in my listening process? Is this something I am comfortable with or are their unique challenges for me?

What else would I need to know about using non-verbal messages to develop my competence in this area of my nutrition counselling skill set?

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