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Issue 30 July 2016

Welcome to Issue 30




 

It was a pleasure to host my colleague Eve Reed APD on Friday in Sydney delivering her workshop 'Working Effectively with Childhood Eating Challenges'. Contributing to the day was a dynamic group of attendees from public health and private practice bringing enthusiasm, questions and curiosities. Here is some of their feedback hot off the press:
 
'This workshop is a must for anyone who works with babies and children. The Division of Responsibility is a great way to help families have happy meal times.' K.L. APD

'This workshop gives great strategies for working with families to improve the confidence of parents and reduce meal time stress. It filled the gap in my current practice to help parents to teach their children to become intuitive eaters' J.L. APD

 
In the pic featured you can see Eve demonstrating her skills with Meg McClintock from Choose Nutrition role playing an anxious parent. Meg did a fabulous job (clearly a very experienced practitioner!). Eve will be running her workshop again in Melbourne in two weeks. Both events in Sydney and Melbourne sold out with wait lists - Eve and I will be discussing dates for 2017 soon.

 

Registrations are now open for Motivational Interviewing 1 & 2 Oct 2016 in Sydney


All the details you need to know are in the Training News box up next. This will be the last time 'MI 1 Core Skills and Spirit' will be running this year. If you have completed MI1 and are wanting to take your MI skills further why not think about coming along to MI2? 
 

In This Issue

 
Have you ever considered that your 'job' may get in the way of you doing good work? In this issue we are looking at how some of our workplace requirements and role expectations can really limit our effectiveness  in facilitating behaviour change by blocking client engagement. While taking a look at these challenges I will be exploring some alternative ideas and options to consider. 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 Purple Pavestone Box at the end of the editorial by clicking here...happy reading!

Motivational Interviewing 1:
Core Skills and Spirit

Sydney October 27th 2016



 
This workshop has sold out FOUR times this year.
If you are keen to come you are encouraged to book in early.
M.I.1 will not run again in 2016
You can attend this workshop as a stand alone event or combine it with M.I.2 the next day and access a discount registration for M.I.2. 

You can read more about the workshop and read reviews from past attendees on the dedicated webpage here



Motivational Interviewing 2:
The Power of Process and Change Talk

Sydney October 28th 2016

 

 
This workshop is designed to take your Motivational Interviewing practice to the next level by affirming and extending on your developing MI skill base. Attendees will be guided through the Four Processes of MI which scaffold the behavior change counselling process into specific stages with unique tasks and tools.

If you work with clients who struggle with change and you have completed preliminary experiential MI training (including M.I.1 above) this workshop is pitched to be of great benefit to your practice.

Expect to have some fun along the way!
Registration includes a workbook, delicious catering and a kazoo.

Yep a kazoo. Can't promise it will be a sparkly as this one
 

 

Motivational Interviewing 1:
Core Skills and Spirit


WELLINGTON NZ AUGUST 31ST 2016



 To put your name on the waiting list please click through to the booking portal HERE

 
 
 

Narrative Therapy and Eating Disorder Recovery
Hope Through Empowering Conversations

 

Presented by: Janet Conti PhD

 

SYDNEY November 11th 2016

 
To read more about this full day workshop and how it could benefit your work:




'I would highly recommend this workshop to anyone interested in learning more about how Narrative Therapy can be a powerful tool when working with people with eating disorders. Janet’s extensive knowledge, skill, warmth and approachability made this workshop
a highly valuable experience for me
.' 
J.Thomson Registered Psychologist
 

 

Using Expressive Arts Therapy & 
Health at Every Size ® to
Address Eating Disorders and Body Image Dissatisfaction


Presented by: Dr Deah Schwartz

 

SYDNEY December 7th 2016



 

MELBOURNE December 12th 2016

 

 
Download a flyer to follow links to samples of Dr Deah's work.


Do not miss this rare opportunity to experience
Dr Deah's work in Australia.


‘Deah is a masterful presenter; clear, engaging, informative and extremely responsive to her audience.  Consider yourself lucky to attend one of her presentations’ 
Ellyn Herb, Ph.D. Licensed Psychologist

The first three Pavestones subscribers to book in to Deah's workshops will receive a copy of her book: Dr Deah's Calmanac: Your Interactive Monthly Guide to Creating a Positive Body Image.

 


The Classic 'Dis-Enagagers' We Do All The Time

Wisdom is the reward you get from a lifetime of listening
when you would have rather talked

Mark Twain

An open ear is the only believable sign of an open heart
David Augsberger

When you sit across from someone who is troubled, are you focused
on connecting with them or correcting them?

Dana Sturtevant
 
For those of you that are just joining the conversation, we are currently exploring the first process in the Four Processes of MI introduced back in Issue 28. This important starting point for MI is referred to as Engagement and we completed an introduction to what this really means and what helps it to happen last issue. Engagement is much much more than a friendly warm greeting.

For today, I'm going to pick up from where Carol Beer (Britain's rudest Medical Receptionist) left us in the soundtrack last issue and consider how we may de-rail engagement with our clients. 

I'm going to kick straight off with a piece from THE book on effective behaviour change which I probably drag out every issue by Miller and Rollnick Motivational Interviewing Helping People to Change 3rd Ed.  Here's what they say that I'm keen on for our exploration today: 

'Perhaps the largest threat to active engaging ...is the communication of non-mutuality. Professional messages that imply 'I'm in charge here; I'll determine what we talk about and decide what you should do'. p 40

(see Ms Beer's performance above!)
I guess what the authors are describing in words is what this picture shouts in spadefuls:
 

Miller and Rollnick refer to challenges in the engagement phase (and throughout the Four Processes) as 'traps'. I really like the analogy of the trap to define this class of practitioner behaviours. Take a minute to consider what trap means to you. I think of a device that can catch us unawares and hold us captive or restrict us in some important way. Ultimately the outcome is painful.

Let's take a deeper look at three common traps that predict a poor outcome for the client by limiting engagement.
 
 

The Expert Trap


Picking up from Dr Finger-Wag above, MI refers to this is kind of practitioner trap as the 'Expert Trap'. Perfectly fitting if you need antibiotics for an ingrown toenail or an MRI for a persistent headache but unlikely to be helpful for facilitating personal behaviour change that is sustainable and meaningful.

In our behaviour change sessions the Expert Trap may sound like:
  • Giving advice up front when we haven't asked if the client wants it or needs it. "What you need to do is........ ' or 'It's important that you understand..............'
  • Not asking the client what would be important to them to discuss in session and ploughing on with our own agenda (even though that agenda may be 'indicated'). "What we need to talk to about today is.........' or ' What I need next from you is........'
Typically, what is driving the expert trap is our desire to help (also known as our 'righting reflex'- more on this another time). The important thing to acknowledge is that this desire is not a bad thing and it certainly doesn't make us 'bad practitioners' - it is often why we are in our job in the first place - it's just not such a good informant for effective and useful counselling skills.

The call here is for the eager, knowledgeable practitioner to put in some speed humps. The sample 'engager questions' from last issue are great humps to experiment with. 
 


The Assessment Trap


This trap comes up again and again and again as a challenge for practitioners attending the MI training Pavestones has conducted so far. You are in good company if your head is nodding as you read about this trap.

I was taught at Uni that it is necessary to know a hell-ova-lotta data before I should attempt to help my client. In fact I was taught I would NOT be able to help my client unless I knew all their data. I remember even asking clients things like what brand of margarine they ate 'Flora or Meadow Lea?'. Yes I'm cringing as I write. Knowing the details of course may have it's time and place, we just need a very good rationale and well honed skills for keeping our client alongside us as we ask. 

There are so many issues with lengthy, premature assessments. A big hitter for the client is that it puts them in such a passive role (cue a fertile climate for the expert trap). Also they are spending the bulk of their session talking about what they already know. BORING...and pointless for motivating change.

And speaking of boring. I can still sense that pesky 'o lordy I'm losing the will to live'  feeling when I stumble across assessment pro-forma's applicable to my practice area. Please, no, anything but death by closed questions. Surely there must be a better way? Like my favourite-politician-to-make-fun-of Christopher Pyne commented recently: 
 
"Sometimes I feel a bit like Elizabeth Taylor's eighth husband,
I know what needs to be done,
I've just got to try and keep it interesting."
 

Well THAT is certainly interesting!

We don't have to dress like a Strip-a-Gram for the benefit of engaging our clients (please email me if you have tried this). Thankfully, there are alternatives. Two strategies you could play with include:

1. Quarantining Engagement Time

Stephen Rollnick suggests do nothing BUT engage for the first 20% ** of any session. For a 45 minute first session that is 9 minutes. You can hear your client say a lot in 9 minutes and more importantly they can hear themselves say a lot in that time. Here is a question that may help you scaffold this quarantining with the client:

'There are a number of questions that I will need to ask you after a while but first I would just like to know what brings you here today and how you hope we may be able to help you' p 151 Miller and Rollnick

** A note of caution, the more ambivalent your client the more this percentage increases. In my area of work I may spend months shifting back and forth into engagement. 

2. Audit Your Assessment Questions

You are invited to take a good look at your assessment questions. Have a think about what you really must know in that first session. Be prepared to audit 'on the hop' after you have done a super 9 minute engagement and discovered you know enough already to be useful to the client. Debrief this flexibility with your line manager if your agency or employer requires a tick-a-box approach to assessment. The impact of engagement on client outcomes is evidence based. 

With the permission of one of my supervisees I'd like to share a recent in-session conversation that brings this to life:

Supervisee: 'Last issue of the newsletter really got me thinking. I get caught up in assessment with my clients and this involves mostly just asking closed questions......it doesn't promote conversation.  I...I need to find a better balance of collecting the information but getting their story too.'

Supervisor: 'That issue did get you thinking. You're wondering how your assessment could be simplified or shortened. What would you compromise on?'

Supervisee: 'Ummm well I'd definitely drop some of the questions I think. Let go of everything needing to be done in the first session' 

Great Work!

The Labelling Trap
 


Clients can quickly disengage when the terminology we use feels like a label. This can be particularly so if the client isn't sure they agree with the diagnosis. The more ambivalence or shame associated with a particular diagnosis the more reticence there may be on the client's part to engage with it. Understandable.

You may consider someone being referred to as 'An Anorexic' or 'An Alcoholic' or even 'A Diabetic' or 'Obese'.

If there is a sense this may be an issue that matters to a particular client they can be invited to offer how they would like to refer to 'the matter'. This can be a powerful engagement maker when the client's right to maintaining an autonomous identity is respected.
In the Soundtrack for this issue, Dr Deah Schwartz brings the Label Bible to life in song with her clever ditty "Ode To The DSM-V'. Talk about the Label Trap! Very witty Deah! Don't forget you have a chance to see Dr Deah and learn from her wonderful skill set in December when she will be visiting Oz! Click on Deah below.
 

Issue 30 Pavestone
Classic Dis-Engagers we do all the time

 

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
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

Effective engagement will invite the client to feel in the driver's seat of their change process 
 Issue 29


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
 

 Suggestions for Reflection  


You are invited to take a moment and think about: 

Which 'trap' could you most relate to?
What would matter to you about working on minimising this trap?
How would you go about addressing this trap in your workplace?

 

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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Affirm Your Knowledge!
Online CPD Quiz for APDs


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

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

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 as the 2016 schedule is at capacity. Express your interest for 2017 in advance. 
 

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 

'Health Not Diets' Training


For all upcoming dates for 2016
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

The Mindful Dietitian


Events and Resources


Providing innovative opportunities for Dietitians & Nutritionists to connect, share & develop skills in client-centred practice, mindfulness & mindful eating. Click on events to explore this great service for health professionals founded by Fiona Sutherland APD

Want to Contribute your Ideas on Improving FBT ? 


Are you experienced and trained in Family Based Treatment for Anorexia Nervosa? Interested in participating in some qualitative research consisting of a 60-90 minute interview? Janet Conti PhD is conducting research at University of Western Sydney asking: How Can We Improve Maudsley Family Therapy for Adolescent Anorexia? Great question. Please participate if you can. To learn more please click here.

Janet and her research partner Diana Sales are also looking for families who have experience of FBT to participate. If you can help out please get in touch.

This Issue's Great Read


Are you stumped knowing what to charge for public speaking gigs? Read great advice from Glenn Cardwell APD here. Republished with permission. Ta Glenn!

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

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@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 © 2016 Tara MacGregor, All rights reserved.


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