In this issue I am extending on the beautiful Parker Palmer poem shared in Issue 48. If you missed it or would like a refresh you can take a peep in the blog listing below. In this 'poem' Palmer encourages us to work with presence rather than intervention, to be truly helpful when someone is stuck or struggling. This encouragement is deeply resonant with the spirit of MI and in this issue I thought it may be useful to bring this encouragement to life and offer a sample of what this may actually sound like in session with a client. This sample dialogue feature a practitioner working within the HAES ® approach to health. Read on for more.......
As health professionals, we are trained to use our minds in the listening process to listen evaluatively. Listening evaluatively enables us to perform two very important functions within the medical model of patient care:
1. Assess our client's nutritional health
2. Formulate an appropriate intervention, education or prescription.
Our skill as evaluative listeners is a hand in glove match for performing the role of helper in the medical model. However, when we start to segue into the client centered model, evaluative listening can often prove to be something of a hindrance. Let's explore why.
Through our training, we are often oriented towards spending valuable listening energy formulating responses and advice whilst our client is talking. Our busy and eager 'helping mind' can really get in the way of effectively attending to our clients' messages. This can cost us valuable engagement and can also set us up to work much harder than our client.
Let's consider too that when our clients are struggling it can be so tempting to step out of listening and engage in some quick 'installation therapy' i.e. telling the client what we know to make them 'better'. And we often know a lot of really useful stuff! But as many of us have learned the hard way, installation therapy rarely works..........
.......our client may simply not be ready to hear what we know
......what we know may be irrelevant (ouch)
...........or our client may have a much better idea of what they need to do!
So when we need to be listening, what are we to do with our expert knowledge and urge to help? Neither are wrong, it's just how we harness them that keeps them useful. As a place to start, it can be helpful to remember the power of keeping our client front and center and our ideas second place. Read on for some tips on this challenging process...
.....Hmmmm a challenging issue to write this one.
The first challenge: how to define the function of 'heart' in the listening process.
The second challenge: keeping this exploration relevant to our work as Dietitians or any other health professional immersed in the objective medical model.
Defining 'Heart' in the Process of Active Listening
What do we mean when we refer to 'heart' in the listening process? This is open to many interpretations - all with merit.
In this sense we may consider that listening with heart could be defined as Empathic Listening - sensing into the emotional content of our client's communication.
I'd like to also suggest that an extension to the definition of 'heart' in the listening process could include 'body'. In this way we might use the word 'heart' as a proxy for the data within our Body's Felt Sensing that we experience when we attend to our clients.
For some, the concept of Right Brain comes closer to defining 'heart' in tuning into our clients. In this sense Right Brain may be appreciated as offering the more fluid, creative, intuitive aspects of our connecting with our clients and the meaning making process. In Issue 9 I touched on this a little when considering our clients' verbal messages and pondered the idea of 'whole-brained' attention. If this fascinating aspect of communication interests you...and to read more about what it may sound like in your sessions with clients ...read on.
When we think of 'tuning into our clients', our most obvious attention point is our clients' verbal messages i.e. - what they are actually saying to us in words. Particularly for our objective data collection as health professionals, understanding our clients' verbal messages is essential.
When we are listening to our clients talk, it can be useful to consider these three areas of experience that our clients may be verbally describing:
What they are thinking
How they are feeling
What they are doing
As Dietitians, our training tends to focus on recording and analysing very specific aspects of data within the frame of what the client is doing. For example - when do you eat?, what do you eat?, what is your body doing? (symptoms, bloods etc) what medication do you take?...doing doing doing doing.........
This data is often very important, particularly when we are new to the work. Typically we need this data to assess aspects of nutritional quality, nutrients, metabolic response and how the human body seeking our assistance is operating.
So what's the problem with honing in like this on the 'doing data' ? Well, when it comes to working with eating behaviors it often misses the point..read on to find out more
When we think about the data we collect when we listen, usually the first thing that comes to mind is the words that we hear. While this is of course essential, we are all familiar with the expression 'Actions speak louder than words'. In the process of fully understanding the communications of another human being, it is well established that we privilege non-verbal messages over verbal. So, for this first issue on attending, it made sense to start with a discussion about attending to our clients' non-verbal messages.
What are Non-Verbal Messages?
Often referred to broadly as 'Body Language', non-verbal messages may be considered in discernible parts. Egan in 'The Skilled Helper' defines these parts as:
Bodily Behaviour - posture, movement and gestures
Facial Expressions - self explanatory!
Vocal Behaviour - tone of voice, speed of speaking, pausing, volume of speech
Physiological Responses - often autonomic such as flushing, sweating or quickening of breath
Physical Characteristics - including appearance and body size (need to be used cautiously!)
To find out more about the usefulness of non-verbal messages in eating behaviour counselling and what working with these messages may sound like - read on!
Listening in a therapeutic or helping relationship is a much more active process than the behaviours we might get away with in our day to day interactions. No surprise then that this core skill is referred to as Active Listening. I often think of Active Listening as Listening on Purpose
Active Listening is central to the effective functioning of a helping relationship. Being truly listened to is key to the experience of being valued, understood and 'allowed'.
Even when our role necessitates a strong education focus, Active Listening performs a vital function. As they say: 'If you can identify, you can rectify!'. Listening properly to our clients helps us to provide the 'right' education for their needs.
Judy Gamble writes a great definition of Active Listening in her book 'Counselling Skills for Dietitians': 'Active Listening .......is a dynamic process which involves the skill of attending, i.e. giving someone our whole-hearted attention.' p60
Let's pick up with this notion of 'Attending'....read on!