To underscore the importance of the therapeutic relationship in quality Dietetic work I would like to share with you a message I received from Joanne Ikeda:
'I very much appreciate Issue 3 of your newsletter. For over 20 years, I taught nutrition education and counseling to dietetics majors at the University of California, Berkeley. The very first thing I taught my students was the importance of establishing an effective helping relationship with clients. I am glad to see this reinforced in your newsletter.'
Joanne Ikeda, MA, RD, Nutritionist Emeritus, University of California, Berkeley
In this Issue of Practice Pavestones I am going to be focusing in on one of the core attributes underpinning the formation of this effective helping relationship - Empathy. How does empathy play a role in practicing effective Dietetic counselling? Let's to start this exploration by considering a recent real life scenario:
Dietitian: 'Mary, I'm wondering as we near the end of your session today how it was for you to share with me the story of your ups and downs with eating so far?'
Mary: 'It was good -...'
Dietitian: ..(gently) ......'Good?'
Mary: 'Yeah you really understood where I was coming from. I think you can help me'
What Mary is really saying here is that the experience of being understood left her feeling that she could be helped.
This is the power of empathy in a nutshell. It enables a connection which sits in direct contrast to the sense of isolation that comes with a difficult problem. It is this isolation that often drives despair, shame and entrenchment of behaviours. With empathy, it is in our power to give our clients a new experience of relating to their problems. Can you hear the subtle motivational edge in Mary's observation above? If this idea interests you, you are welcome to download the full issue....
There are so many counselling modalities offered to Allied Health Practitioners to assist in helping their clients: ACT, CBT-E, MI...to name a few. Recently I was asked by a colleague which counselling modality was the 'best one to start with' for Dietitians. My short answer to this question is Motivational Interviewing (MI)- a great starting place for health professionals working in behaviour change. For a more comprehensive response there are some really important issues to consider beyond choosing a 'best fit' modality. Knowing where to start can be confusing and a tad overwhelming!
With the risk of actually adding to the confusion I am going to be quite challenging and say – take great care with how you begin with any of the modalities above! Let me share more…….
Thanks for all of your great feedback from Issue 1 of Practice Pavestones. Following on from this issue I had a number of readers ask a very similar question regarding how to remain client centered whilst also providing advice. This is such a great question I thought I would feature this in Issue 2.
To start, let's imagine this (real life) scenario.
A client Mary, is nearing the end of her session with her Dietitian. The Dietitian enquires as they are winding up:
‘Mary, I’m wondering what stood out for you today in our discussion? What felt helpful to you?’
Mary reflects, takes a minute and responds
'You listened to me and you didn't’ tell me what to do, it is such a relief!’
The client goes on to describe a couple of ideas she has taken from session she would like to work on or pay attention to.
How was this achieved without leaving the client feeling advised? Given the Dietitian is traditionally there to give advice and probably did during various stages of the session - how are we to understand this comment? What is going on!?
Giving advice can be a vital part of being helpful but depending on HOW we do it we can run the risk of disempowering our client or rupturing our working alliance. If you are called upon to advise in your work with clients ………you are encouraged to read on!
I was listening to a webinar by Dr Ellen Glovsky RD recently and I had to laugh out loud when she said:
‘After 20 years of practice…I began to notice that almost NO ONE who I had asked to make changes to their diet over the 20 years I had been working had actually made those changes that I had recommended!’
I laughed heartily, not at Ellen but at the stark bold truth in what she was saying. It was spot on. Ellen goes on to comment on how discouraging it is to be well intentioned, highly educated and hard working and not be able to make a lasting difference to people’s well being. I’m with you Ellen!
As APD’s (and many other health professionals) we are diligently trained in the medical model. Of course this has great merit in imparting the importance of scientific rigour and knowledgeable expertise. For those of us working in the area of nutritional science, the medical model is an important paradigm.
For those of us working in helping people with eating behaviours (most of us out there) the medical model gives us a square peg for a round hole! It can be a profound impediment to helping people.
In this issue I will be exploring some of the core ideas that discriminate the client centered model from the medical model in which most of us work and were trained. How does the client centered model offer us leverage to be effective and also help us enjoy our job more? Download to read more...