Being Warm and Real with Our Clients
 
Issue 5
April 2014
Welcome everyone to Issue 5. I hope you all had a restorative holiday period 

I'd like to share some feedback I received from Issue 4: The Power of Empathy which beautifully affirms the importance of empathy in Dietetic work:

'This is wonderful. The fundamental rule I remember  is that acceptance by another always precedes self acceptance  And self acceptance always precedes change. You can't change someone by telling them what's wrong with them or what they are doing wrong.'
Lesley APD Mental Health & Palliative Care

In this Issue of Practice Pavestones I am going to be discussing the next core attribute in our 'hub': Genuineness and Warmth. A subtle and sophisticated attribute, I hope you enjoy pondering the benefits of being warm and real with our clients. 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

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.
 


 

 



 If Not Dieting Workshops

Dr Rick Kausman has announced his next round of training intensives for health professionals. Rick's work is without peer in Australia. If you are unfamiliar with his book 'If Not Dieting Then What?' you can buy it here.

Training dates are 13-14th June in Gippsland Victoria. You can access Rick's website Here.


 

DBT Video on line


Available here are two short videos out lining the use of DBT Dialectical Behaviour Therapy in assisting clients with Eating Disorders. Sponsored by ANZAED, the brief videos feature a very useful introduction to key concepts by Shelly Hindle, Clinical Psychologist




Shout Out Of the Month!

In Perth WA there is a very special Dietitian Laura Kiely. An accomplished clinician who is not just an APD but also a Gestalt Therapist.  It is very fitting that she is featuring in this issue on warmth and genuineness. Laura is one of a kind and the 'GO TO' APD for expertise in bariatrics and disordered eating. Her website is here.

Laura's mad humour and kindness saved my sanity when I was 'living West' a few years back! Thank you Laura - you're a gorgeous woman and very dear.

 

A Bit of Fun with DSM V
 

A fun little ditty recorded by Dr Deah Schwartz at the recent BEDA Conference. I love Deah's work as regular readers will know - she's a hoot!.

Check it out here

'Be Yourself, everyone else is already taken'
Oscar Wilde

'If you want to be trusted, be honest
If you want to be honest, be true
If you want to be true, be yourself'

Unknown Source

Knowing yourself is the beginning of all wisdom
Aristotle



'



I'd like to start by considering this dilemma, I am sure familiar to many of you:

Your client comes in to session - all smiles and energetic. You are welcoming and reflect her positive state in your body and voice. You begin to explore together the reason for her coming to see you and she shares her enthusiasm for getting your help to lose weight.

You start by inviting some story telling.
You might say...     'Have you tried to lose weight before? Can you tell me a little about those experiences?'

What follows is a long tale of repeated failures, weight cycling, suffering and self blame......and yet the client seems completely unmoved - ready to go again, smiling ....

Something in you says 'This doesn't match!' You are reflecting her positivity but hearing her desperation. You might be aware of a weird kind of strain or a sense of confusion in you. You know in yourself the client is incongruent. What she is saying and what she is feeling don't line up.
















Source
At this point, as the Dietitian, we have a choice:

We can ignore what we feel and continue to fall into the client's slip stream of blind faith. Result: two people pretending in the room!

OR

We can recognise the opportunity to be genuine. We can lean into our sense that something isn't right and be transparent with our client about what we are sensing. 
















Source

A huge influence on our effectiveness as practitioners is the trust that we can build with our clients. Recently, a client shared with me:

'You have always answered my questions really honestly, I really appreciate that!  I trust you and that is so important to me..........and I know what you are saying to me right now is right'. 

The benefit of our openness will vary from client to client. For this particular client my transparency was absolutely vital to our engagement. In my experience, the more anxious the client and the more 'failures' they have experienced in their change process, the more important it is to communicate with immediacy and authenticity. This client had asked some very direct and challenging questions. She respected that I had worked to meet her questions 'head on', without defence or deflection. It wasn't easy and I fumbled around a bit but in my 'realness' I was able to gain her trust. This is where our qualities of warmth and genuineness play such an important role.


What do we mean by 'Warmth and Genuineness'?

The attribute of warmth is well described by Philip Burnard (p33) in this excerpt:

'Warmth in the health care relationship refers to an ability to be approachable and open to the client. ...Warmth is as much a frame of mind as a skill and perhaps one developed through being honest with yourself....' (my emphasis)

The attribute of genuineness can also be described as :
congruence
transparency
realness
immediacy
authenticity
honesty
openness

You may be able to get a sense from these definitions how warmth and genuineness compliment and co-exist. The key underpinning quality in the practitioner is self awareness. Honesty with ourselves is the prerequisite to honesty with our clients. When we have a solid map of our own inner territory we can be more open, more responsive, calmer and more welcoming. In this way genuineness aligns very strongly with our empathic ability.


 Why is it important to 'Be Real'?

It has been argued that warmth and genuineness are the most important core attributes in client centered practice. Aside from enabling trust already described, let's consider two key reasons why:

1. Firstly, if our client does not experience us as real and honest they may experience any expression of empathy or positive regard as fake or professionally manufactured. Unhelpful!

2. Secondly, self awareness takes courage. Real, immediate expression of self awareness takes courage. If we can do this in the presence of our clients - we invite them to do it in our presence and more importantly, we invite them to be real with themselves. From this place we facilitate our client's insight, new discoveries and ultimately their change.

By being real with our client we lead the way.


How do we do it?

Genuineness and congruence takes time, personal growth and practice. It relies on three key abilities:

1. The practitioner is able to sense their own experience, in the moment, in the context of  a client interaction
2. The practitioner is able to self regulate around their experience
3. The practitioner can communicate their experience to their client, judiciously, in order to benefit the client.

Being transparent is a delicate balance. We are striving to maintain a professional boundary whilst not hiding behind a professional veneer. We are striving to show enough of our human selves to validate and encourage our client without making the session 'about us'. (There will be more on this on a future issue on boundaries!)


What does it sound like?

Relational authenticity can present as affirming and also challenging depending on what content is shared. I really like Norcross' (p199) summary:

Congruent responding may well involve considered self-disclosure of personal information and life experiences. It could also entail articulation of thoughts and feelings, opinion, pointed questions and feedback regarding patient behaviour. Congruent responses are honest.










Source

Here are some really quick sound bites demonstrating genuineness that is affirming in different contexts:

'As you share that with me I get a real sense of the heaviness of it all. It sits in my chest.... here (hand on sternum)'

'Your energy is contagious! I'm all tingles (waves fingers up and down) listening to these amazing shifts in your eating this week!'


'Change is anxiety provoking for all human beings! What you are saying reminds me strongly of my own experience of anxiety. I really get how it can be so derailing'



I'd like to also consider a more complex example that perhaps offers more challenge to the client:

Frank presents as extremely anxious at the commencement of session and launches into a series of fast rolling questions about food choices which are growing in urgency and complexity. Let's pick up from here:

Frank: (rushed voice) So what am I going to do? I am completely lost and I don't know  anymore. I was going so well and now it is all falling apart and I really need you to tell me what to eat . What would you eat? I've already tried everything and now I am back to square one and (something about protein).......... and..(something about sugar).........

Dietitian: (interrupting, firm) Frank, Let's press pause! I know I interrupted you there and I don't like to do that ......... So I'm just gonna take a deep breath. (pause and breathe). I'm aware of something going on for me now as we have been talking. I'd like to share it is that OK?

Frank: Yeah ..Sure........... Sorry about all that!

Dietitian: That all sounded pretty unpleasant for you but I actually think this is really important........... what is happening here right now...... As I was listening I was feeling myself getting pretty worked up and uptight. I had to remind myself where my feet were and I noticed that I was finding it really hard to think straight and find a helpful thing to say. That isn't normal for me, so it was a big clue that this is probably how you are feeling too. Overwhelmed and off balance. Is that kinda right?

Frank:  Yes absolutely!......... Actually I have been fighting off a binge all morning.  Oh Yeah. This is what it's like just before I binge. I get frantic and the binge is like - a release or something. .....Wow! it is amazing you felt it too.

Dietitian : How is it for you Frank that I shared my experience of feeling it?

Frank: Perfect! Really. This is good. Thank you.

Dietitian: OK Frank great. It feels good to me too. How would you like to use our understanding of what just happened here?

 

No soundtrack for this month folks, just some words of wisdom on the lighter side of genuineness endorsed by my 15 year old son. Enjoy!















Source

 



Issue 5 Pavestone: Being Warm and Real with our Clients

 

Nutrition is a science. Eating is a behaviour.

Behaviour change is difficult.

Warmth and Genuineness is an evidence based, key component of the therapeutic relationship and human change process

Warmth is our ability to be approachable and open.

Genuineness can also be referred to as transparency, authenticity and immediacy.

Effective relational authenticity relies on the skills of self awareness, self regulation and reflective communication.

For transparency to be safe and therapeutically valuable it is important for the clinician to maintain good professional boundaries and be mindful of their client's response to openness.

Remember: we want our client to leave session with less of us and more of themselves

Suggestions for Reflection:

How does my professional persona act as a support to being real with my clients and how does it impair my transparency?

What are my own embodied messages that signal incongruence in my communications to my clients or my client's communications to me?

What are my innate qualities that facilitate my ability to be genuine?

What skills would I define as important to practice to continue to develop my ability to be transparent?

 

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