Learn about responses that complement good listening skills and encourage exploration
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Issue 13
Jan 2015

'What do I say next?'
The 'Other Side' of Active Listening

 Welcome to the first issue of Practice Pavestones for 2015! I hope that you all enjoyed a restful holiday period and have that re-charged feeling for the start of another round.

2015 looks like a great year for Practice Pavestones - more training in the wings and another CPD quiz planned for mid year. 103 subscribers took advantage of the free CPD Quiz in December and the feedback was super. The quiz will return!
The Essential Counselling Skills Workshop will be COMING TO MELBOURNE June 4th & 5th 2015. More details will follow in February.  
Are you in Canberra or surrounds?
Canberra is being considered for the Counselling Skills Workshop in September. Please send an EOI HERE if you would be interested in attending training in Canberra.

Don't miss the link in the 'classifieds' at the end of the issue for a very special PD event for Dietitians. The first of its kind - a residential retreat in Byron Bay in April - run by Body Positive Australia. There are only a couple of places left so if you are interested, don't delay.

Also in the classifieds section is the announcement of the winner of the First Anniversary Competition! A huge thanks to all entrants for their thoughtful submissions. There is some really solid, client centered work being practised by subscribers. Fabulous to see.

In this Issue
I will be exploring the aspect of responding in the Active Listening process. After we have attended to our client's communications...what do we do next to effectively build alliance and enhance probability of change for our clients?

As always if you are short on time scroll down to the Purple Pavestone Box at the end..........happy reading!


The Essential Counselling Skills Workshop
Feb 23rd & 24th 2015 
in Sydney 

Early Bird Registration Closes January 24! 



.....about what you'll learn, what attendees said about their experience of the workshop last year and why you should come!

Behind the discipline of good listening is a trust that
it is useful for clients to explore their
own experience and perceptions

Miller and Rollnick

It takes two to speak the truth -
one to speak and the other to hear

Henry D Thoreau

Today you are you! That is truer than true!
There is no one alive who is you-er than you!

Dr Seuss


So far we have explored Active Listening through the skills of attending (Issues 7 - 11). Whilst attending is always our first step in engaging in Active Listening, the process would be rather futile if sitting in silence was all we did, no matter how perceptive we were.

Active Listening is as much about how we respond to our clients' communications as it is about how we attend to our clients' communications... this may be in part why this form of listening is called Active not Passive Listening. 



Helpful Responses in  the Active Listening Process

We can engage in both helpful and unhelpful responses when we listen to our clients. Our responses to our clients' disclosures have the capacity to keep the talk about the client and their experiences or start to make it about us (what we know, what we what them to do and all that jazz). Our responses have the capacity to close the exploratory conversation down or open the exploring up. Our responses can enhance safety and acceptance or invite a subtle tone of expectation or even judgement.

No prizes for guessing which of those options is more helpful!

I will save exploring unhelpful responses for another issue (but here's a sneak preview):


For this issue I'd like to briefly explore helpful responses in three rough categories:

1. Minimal Encouragers 

These are simple communications that let the speaker know you are with them and encourages them to keep talking, exploring and revealing. Simple yet powerful. 

'Uh-huh', 'good', 'yes', 'Hmm-mmm' and a head nod are all examples of minimal encouragers when combined with good eye contact and relaxed, alert posture (see Issue 7 ).  There are probably an infinite variety of verbals and non-verbals to play with as minimal encouragers. 


2. Reflections

Reflections essentially involve saying back to the client something of what they have just said to you. Reflections can be -

Simple: a single sentence, couple of words, slight rewording or repetition of what the client has said.


Complex: perhaps a longer sentence or a couple of sentences, paraphrasing meaning and possibly extending on what the client has said.

Reflections can include your guess at the client's intended meaning, specific content or a feeling. With skill and practice you can become more selective about what you choose to reflect to influence the direction of the conversation. If you are new to responding I'd encourage you to not over think it, just give it a shot. As Miller and Rollnick muse: 'You don't need to be clever and complex, just interested and curious'

Here are a couple of examples:

Client's Statement

'I'm not sure I'm ready to make that change'


'I cant believe my weight hasn't changed! I have tried so hard'


'The doctor says its time to take this seriously. Like I'm not! I felt so angry about being told that. How dare she assume I don't try! I'd like to see she how she went coping with my problems!'


Dietitian's Reflective Response 

'You feel unsure about this'
'You need more time before making this change' 
Hmmm not ready yet'


'This really gets you down'
'After all your efforts, it seems impossible you haven't got results' 

'Hmmm a real blow'


'It gets you really angry being dismissed like that' 

'Your health really does matter to you' 

'You are trying. It's frustrating to have your efforts overlooked especially when its tough to cope with everything on your plate. That's not the support you are looking for'



3. Summarisations

A form of complex reflection, summaries pull together several strands of what the client has been discussing with you to create a 'whole picture' for the client to consider.  

Simple reflections can be a bit like line fishing - attending to one statement at a time, summarisations can be like casting a broad net over several of the clients 'statements in session and reeling in the catch for them.


Here is an example of a summarisation response to all three of the client's statements above. This summary also manages to express the client's ambivalence about change, finishing on her reason for change - an important reflective technique we will review in future issues.

Dietitian: ' You have been working hard, your health really matters to you and it's frustrating for you to not see results and to also be dismissed by your Dr. You don't feel quite ready to take the next step and you also want to restore your weight and energy levels.'



 What's missing in these examples of helpful responses?


You might notice that this brief sketch of helpful responses in Active Listening does not include questions or advice, persuasions or cautions, agreeing, analysing or reassuring!

That's not to say some of these options aren't helpful in the right place, they just aren't at the core of Active Listening Responding. But more on that another time.....


Given we do need to ask questions and give advice from time to time how do we know when to offer this sort of responding? (for more on giving advice client centered style, you can have a look at Issue 2)

Here's a handy guide: Motivational Interviewing encourages practitioners to offer two or three reflections for each question asked of the client. The practitioner's responses are ideally reflections 50% of the time. 



What is the Impact of a Reflective Response in Active Listening?

Reflective responses punch way above their weight in terms of the impact they can have on working with a client effectively. They are such an integral part of Active Listening the term Reflective Listening is often used interchangeably.

You may also come across the term Empathic Listening when reading more about this. This reflects the power reflective responses have in generating empathy between speaker and listener.

Experimenting with reflective responses can at first feel a little awkward, perhaps a bit fake or contrived. It may be helpful to consider why it is worth persevering with this vital skill development.

Judy Gamble in her book 'Counselling Skills for Dietitians' puts it very well when she says:

Reflective responding is an effective way of demonstrating understanding and acceptance and of creating an environment in which change can take place. When the listener reflects back to the speaker what has been said, she is acknowledging that she has heard, accepted and understood. The speaker on hearing the reflection feels validated.' p 70 

Observing the examples above you may be able to get a sense of the collaboration taking place between this client and her Dietitian as they create a confirmed narrative of the client's meaning and experience. A collaborative relationship is at the core of the therapeutic alliance in the client centered model. This can be compared with a more instructive relationship at the core of the medical model. This collaboration offers opportunities for uncertainties to be clarified not just between client and practitioner but also within the client herself. The client becomes known to herself through the reflective collaboration.

Richard Nelson-Jones touches on this when he discusses: 

'..clients' experiences may seem more real to them if they verbalise rather than just think about them, and even more real when they hear these experiences verbalised again by you. Such verbalisations may put clients more in touch with their own thoughts, feelings and experiences' p 56

For me professionally in my work and personally, in my own experience of being heard, this is one of the most powerful functions of the reflective process. In hearing our words said back to us - we may understand our own experience for the first time. We may make important tweaks to our understanding that open up that 'ah-hah' feeling. Ultimately we are given the space and opportunity to see ourselves without judgment.

'As I hear myself talk I learn what I believe'
D. Brem

In some PD I undertook last year, the trainer (Dr Stan Steindl) referred to reflections as 'the engine room of Motivational Interviewing'. It's a great analogy I think. Reflective processes drive insight, validation, self acceptance and empathic relating - all key to the process of behavioural change.

For a revision of the importance and evidence base for
and Acceptance in behaviour change
you can click on the highlights for previous issues.


It's soundtrack time!

Like shooting fish in a barrel for this issue. Click on the 'Tell Me More!" below. The video is a hoot.
Shoo bop-bop, Shoo bop-bop, Shoo bop-bop yeah!



Issue 13 Pavestone 
Responding: The 'Other Side' of Active Listening

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

Summarisations involve reflecting several statements back to the client to give the client the opportunity to weave together the 'big picture' of their communicated experience.

Reflections are powerful tools for developing the therapeutic alliance and enabling self driven change

We can aim to offer a couple of reflections for each question we ask our client

Suggestions for Reflection

When my client speaks what is my habitual response? To reflect or to ask the next question?

What would I consider to be the benefit of using more reflections with my clients?

How could I go about practising reflective responding? Using my reflective practice journal? A colleague in role play?

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

Enjoy experimenting!
Keep reflecting!



Congratulate Kia Roberts APD

It is with great pleasure that Practice Pavestones announces the winner of the First Anniversary Competition, Kia Roberts APD.

Kia's entry was selected by the judging panel out of 6 great entries. It was a tough choice but Kia's attention to the gradual integration of skills was what clinched it for her in the end. Well done Kia and to all of the entrants! Keep up the great work.

To learn more about the competition you can have a look here

Transforming Dietetic Practice: Innovative Conversations about Mindfulness, Eating Behaviour and Body Image

Professional Retreat for Dietitians- Byron Bay 18-22nd April 2015
Hosted by Fiona Sutherland (APD) and Sarah Harry from Body Positive Australia, this first-of-it’s kind retreat aims to bring together all the best aspects of a conference PLUS opportunities for you to unwind, relax and rejuvenate in one of Australia’s most stunning locations. We’ll be offering 5 days of innovative and experiential workshops (including fabulous APD guest presenters), daily yoga, meditation and amazing food (what kind of Dietitian doesn’t love food!). Spaces are strictly limited & early bird offers are available until Feb 15th.
For more details, see DIETITIANS RETREAT

Did you miss the BUMPER 1st Anniversary Edition of Practice Pavestones? 

Issue 12 has links to the full collection of issues 1-11 

PLUS an online CPD Quiz to convert your dedicated reading into self-assessed CPD hours for your renewal just around the corner. Why not use Pavestones to plan your 2015 CPD? 

It's available HERE

Feeling a bit Overwhelmed? Stuck? Confused?

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?
Don't forget to consider my training - registrations close September 9 for this round.
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
Copyright © 2015 Tara MacGregor, All rights reserved.

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