Following in the footsteps of the first anniversary edition this issue collates a synopsis of the year’s issues with handy links to each issue’s full editorial. Due to the popularity of the 2014 CPD Quiz a 2015 CPD Quiz has been included in the Purple Pavestone box at the end of the issue summaries. You can buy the quiz to test your knowledge and convert your dedicated reading of Practice Pavestones into assessed CPD hours for your APD renewal…..just around the corner. Please support Pavestones by sending on to APD colleagues who may be looking for great value assessed self-study in this vital area of practice.

Read Issue 23

As mentioned in the wrap up of last issue, this editorial will be exploring in more detail the formulation of open questions and we’ll get some practice in converting closed to open questions using handy word stems.

‘Word Stems’ for Open Questions

Typical choices for getting your questions off to an open start include:

What
Why
How
Where
When
Which
This is in contrast to these typical closed question openers:

‘Do you……’
‘Did you…..’
‘Can you….’
Read the rest of the issue to consider some examples of using these word stems in effective open question formulation

Read Issue 22

For a stunning ‘Captain Obvious’ I’ll start with this definition of a question from The Oxford Dictionary:

a sentence worded or expressed so as to elicit information.

Pretty straight forward. But do we stop to think what kind of information is most beneficial to our client to elicit?

Most health professionals receive lengthy training in assessment and are well rehearsed in asking questions. But what about asking questions with purpose beyond our intake form? If a primary focus of client centered work is to explore our client’s ideas and experience, how can we be aware of the type of questions that can open up exploration and those that can close it down?

To answer this, it can be helpful to consider questions in two basic classes: Closed and Open. Let’s take a quick tour of the difference and pros and cons of each. Download this issue to find out more

Read Issue 21

A central tenet of client centered work is that the client’s understanding of themselves and their lives is privileged over what the counselling professional may think or believe they ‘know’ about the client. The client is considered the expert in their lives.

This core idea can guide all aspects of our communications with our client. This includes the skill of affirming. When we focus on our client’s ideas and knowledge of their strengths and positive qualities we are potentially opening up a powerful new aspect to this very helpful micro-skill. We are inviting co-creation and autonomy in affirming.

You may be able to hear the invitation for autonomy and co-creation in affirming in this quote from Motivational Interviewing 3rd ed :

‘The spirit of MI starts from a [….] strengths-focused premise, that people already have within them much of what is needed, and your task is to evoke it, to call it forth. The implicit message is ‘You have what you need, and together we will find it’ p21
Miller and Rollnick

So, in this issue we are exploring merging these two principal MI ideas:
Calling forth the client’s knowledge and emphasising their autonomy (this reduces resistance and enhances empowerment in the change process)
Affirming our client’s strengths (this increases hope and confidence to change)

Read on to discover more about this powerful skill mash up!

Read Issue 20

#affirming #autonomy

For those of you who are seasoned practitioners, you will be familiar with the very bumpy road that is characteristic of our clients’ behaviour change process. If you are new to facilitating change in others I am sure that a minute of self reflection will confirm that even (or particularly!) for ourselves, ‘being’ different and ‘doing’ different is hard work requiring energy, focus and commitment.

It is not uncommon for our clients to share ‘problem saturated stories’ of repeated experiences of failure, lack of hope or even reluctance to be visiting our office to meet with us. It can be a genuine challenge to our skill of affirming to seek out our clients’ strengths to reflect back to them when there’s seemingly nothing ‘going right’. The paradox is of course, that this can be a powerful time to do it. Demonstrating our willingness to notice capacity and capability in our client when they cannot see it for themselves can be a strong alliance builder.

So where to start?

Read Issue 19

#about affirming clients #affirming

I recently had a series of very humbling experiences…..listening to recordings of myself at work with clients. I was required to record several client sessions to analyse my skills for a training application that was due this month. In this process of listening and self analysis (and with mentoring from my Skills Coaches), I discovered that my affirming needed some work.

One thing I was surprised to learn is that when I engage in affirming I can sometimes inadvertently ask a question by ending the affirmation with an upward voice inflection. Easily done (especially if you are an Aussie). Not necessarily harmful but also not particularly helpful.

These recent experiences of mine got me thinking about this next issue. Now that I have lead the way, I thought we might explore ways that we accidentally stuff our affirmations up.

Quick Menu of Affirmation ‘Stuff Ups’

Here’s a wee check list of three easy ways we might go off track when trying to practise the skill of affirming:

Make it about us
Engage ‘Cheer Leading Mode’ (also known as positivity overload)
Inadvertently ask a question (see my ‘Exhibit A’ above!
Download this issue to read some examples of what these ‘stuff ups’ may sound like and some strategies for correcting them…

Read Issue 18

#about affirming clients #affirming

In Issue 16: Working With Our Clients’ Strengths, I finished up with the following suggestion for reflection:

If you are new to affirming you may like to practice by:

reflecting on the strengths of each of your current clients
writing two or three strengths in each of your clients files
experiment with affirming your client in their next session….just once
Following on from a group discussion in the last training workshop, I thought it may be valuable to list some examples of strengths and attributes we may encounter in our clients.

Below is a list you may like to consider and reflect on. It is largely inspired by ‘The Library of Strengths’ in Stephanie Dowrick’s book Choosing Happiness (Penguin 2007). Download to contemplate more…..

Read Issue 17

#about affirming clients #affirming #non-diet approach

For most people struggling with change, being really heard is a very encouraging and positive experience. Past issues of Practice Pavestones have featured lots of discussion about the power of reflective listening in assisting our clients this way. Affirming takes the skill of reflective listening one step further to amplify the positive effects of being heard and understood.

In the course of a session, clients can say an awful lot to us. What we select from our clients’ statements to reflect back to them can have a real influence on our client and the direction of the conversation in session. As we become more skilled at active listening we can become more deliberate in what we highlight to our client in our reflective responding.

Affirming is the intentional act of reflecting back to our client something about:

their strengths
what they want (motivations for change)
what matters to them
the effort they are putting into their change process
Here’s a great definition from David Rosengren:

‘Affirmations are statements of appreciation for the client and his or her strengths. ….The statements are strategically designed to anchor clients to their strengths and resources as they address their problem behaviour’ p 62

When we affirm, we sift through our clients dialogue and actions and creatively highlight aspects of forward movement. To read more on what this may sound like and the practitioner attributes involved go for the download!

Read Issue 16

#about affirming clients #affirming #reflecting #unconditional positive regard

In this issue we are going to be exploring a little about clients who talk 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.

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:

Read on to find out more

Read Issue 15

#reflecting clients #reflections

Responding reflectively to our clients can be a challenging skill to develop when we are trained in advisory and solution focused models. In the counselling skills training group this week we brainstormed together all of the possible road blocks to reflecting with our clients.

Here is a summary of what was collated:

Trying to make ‘it’ OK for our client
Meeting requirements of our workplace assessment form
Focusing on an outcome
The Almighty Urge to ASK QUESTIONS
Lack of practice
Worry about getting the reflection ‘wrong’
To bring these road blocks to life, let’s consider how these challenges may appear in response to the following client statement:

‘My last diet resulted in me gaining 5 kg more than I started with. It was a disaster.’

Read on to learn more………

Read Issue 14

#reflecting clients #reflections