perfect daisy

 

What’s the ideal proportion of time spent doing the stuff you have to do, versus time spent doing whatever you want to do?

 

It was supposed to be a glorious day off until I had to schedule an urgent dental appointment. The only available opening was 4:15 pm, allowing ample time to anticipate the procedure and all its attendant aversive qualities. Did I mention that I loathe needles? An act of supreme courage carried me over the threshold and kept me in the chair.

The next morning, sore of mouth and jaw, I forced myself out of bed for an early meeting. Pelting rain. Juggling briefcase, handbag, umbrella, keys and coffee, I lost my footing on the slick wood surface of the back deck en route to the garage, my hot coffee making a graceful arc through the air and onto my just-dry-cleaned cream-coloured dress. Not a good look. Back into the house for a frantic wardrobe re-boot.

As I drove to work, I asked myself: in the ideal world, what proportion of my life would optimally be comprised of doing things that are enjoyable, versus the percentage of time spent in doing the myriad, often unpleasant or less pleasant, things I have to do. Including the things that are good for us. My initial calculation was approximately 70-30 (in favour of the more pleasant and enjoyable aspects of life). But then, I started thinking about values, learning, growth and expansiveness. After all, it’s the hard stuff that shapes us.

A couple of days later I’m still not sure what the perfect balance would be. Perhaps the proportion is supposed to vary, depending on timing and circumstance. For example, during a fabulous holiday it would be close to 90% in favour of doing whatever we want. In more challenging times, the times that really test what we’re made of, it can feel closer to 5%. I asked a friend what she thought. Her take was that there is no wanting or not wanting to do, there is only to be fully present in each moment (as in Buddhist non-attachment and mindfulness). Which I agreed sounded extremely wise, a lifelong learning journey in itself, and easier said than done.

The thing is, nothing beats the feeling of making it through tough times. The deep satisfaction of accomplishment, and the deeper happiness that comes from having made a meaningful difference.

After all of the rain, last night’s full moon took my breath away.

 

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rain drenched peony

 

I woke up early this morning to a magnificent summer storm.

 

The incomparable sound of rolling thunder and rain; finally quenching the thirsty garden and filling puddles for small wild things.

cute baby raccoon

water droplets on leaves

Step outside and smell the very essence of summer.

 

 

Vector illustration of 3d rings. Background design for banner, poster, flyer. Hand drawn watercolor paint splash.

 

The most important time we can spend is in developing the capacity of others

 

At a recent leadership institute where I co-facilitated, there was considerable discussion about the challenges of balancing operational or administrative responsibilities together with the inspirational, transformative and exciting work that is deeply satisfying and of the greatest organizational value. Participants shared that they often feel so bogged down in the day-to-day, it’s hard to find time to pursue strategic and innovative projects – let alone vision them!

I think this feels true for most administrators – in higher education or elsewhere. In a way, the conversation that the group had juxtaposes the polar opposites of a continuum: from managing through to leading. And in response to this dilemma, it was natural to get caught up in the “righting reflex“: collectively problem-solving around things like time management, setting priorities, finding efficiencies and performance management. However, upon reflection, these solutions were really management focused ideas. None of them got to the heart of the problem.

So…what would a leadership-focused approach look like? The shift in the room happened in response to a question that I’ve asked myself:

If every member of your team was working to their fullest capacity, expending their collective discretionary energy, and was truly excited by their work and contributions, how would that impact your own time and capacity?

This question opened up a whole new conversation, now centred squarely on leadership. The beauty of the question is that it highlights how supporting and developing our teams is the most essential role we have as administrators (that is, as leaders). The only way we can realize relentless innovation and thrive in conditions of rapid change is to open up a space for individuals to step into their own leadership potential.

Of course, this is easier said than done. Day-to-day operations will always need care and feeding, and engaging teams in distributed leadership is as much (or more) art as it is science. Plus, there may be very real resource inadequacies and/or employee performance concerns. However, on the whole, feeling overwhelmed by details is a symptom to pay attention to. It’s a cue to ask the above question and fearlessly look in the mirror.

And to ask a follow-up question: Where am I focusing, and what more can I be doing to unleash the potential of my team?

We all want meaningful work, to be inspired, to make a difference and have an impact. To be happy. Leadership isn’t just about increasing organizational productivity or freeing up more time for ourselves – when we invest in the capacity of others, that might just be the most deeply satisfying work we can do.

 

 

Plastic Toy Blocks for Child and Adults

Planning for Positive Change

In each of three previous posts, we looked at Motivational Interviewing (MI) as having four key processes and reviewed practice exercises targeting the first three processes:  engagingfocusing and evoking. In this article we examine the fourth MI process: planning.

Commitment language is predictive of behaviour change, and is distinct from preparatory change talk in that it embodies implementation intentions. Consider the following example:

commitment language continuum

Reference: Miller and Rollnick, 2012: 290

 

What’s the hurry?

Practitioners often rush toward action planning prematurely, resulting in clients’ reactance and disengagement. Learning to recognize – and strengthen – commitment language signals to us when it is appropriate to move toward the planning process in MI. Also, remember that the four processes are recursive. In other words, even when we hear strong commitment language, clients may still experience ambivalence (evoking process)  and decide to re-examine their goals (focusing process).  And, as always, we need to continuously engage and re-engage with the other person (engaging process).

 

Strategies to Strengthen Commitment

Here are some strategies to strengthen clients’ commitment for change:

  • Engaging in a supportive and collaborative working relationship
  • Focusing on clear goal(s) for change
  • Linking the person’s values with their goals
  • Evoking the person’s own motivations for change
  • Developing a specific change plan
  • Determining what step(s) the person is ready, willing and able to take.

 

MI commitment language

 

 

We can’t force a plant to grow, but plants are likely to thrive under the right conditions. What about human growth and realizing our potential? Motivational Interviewing provides the “right conditions” in which people can become ready, willing and able to make positive change.

 

Reflective Practice Questions

Consider a challenging client – one who does not seem to be making progress. Based on your understanding of the four processes of MI (engaging, focusing, evoking, planning), where do you think you need to be with this client? Are there avenues for small, incremental change that you could focus on to evoke commitment language? What might these be?

Come up with a reflection or a question that would evoke commitment language.

 

Garden tools and watering can with grass

Evoke change talk to enhance motivation for change

 

Previously, we looked at Motivational Interviewing (MI) as having four key processes and reviewed practice exercises targeting the first two processes:  engaging and focusing. This week’s intentional practice centers on evoking, specifically on evoking change talk.

Once we have engaged with our client and have collaboratively identified a goal (focusing), ambivalence about change is still common. Increased client change talk is associated with increased likelihood for change. Evoking change talk is key. When ambivalence is present, it is normal for change talk to occur within the context of sustain talk. This activity will help you practice selectively reflecting the change talk content contained within ambivalence.

 

Instructions: Review the client statements below, containing both change talk and sustain talk, and develop reflective statements that are focused on the change talk.  

Here’s a pre-test to get you started:

Client statement:

“I am 78 years old, and this medication is ruining what life and pleasure I have left. I know the doctor said there is a good chance it will help things, but I just don’t think these side effects are worth it.”

Sample therapist responses: Which reflective response focuses on the change talk in the above statement?

a. You really don’t want to continue with this medication.

b. It’s pretty clear that the doctor wants you to continue.

c. You’re not sure whether it’s worthwhile to continue the medication.

(check out the end of this article for the correct answer)

 

Note: The point of this exercise is not to do a double-sided reflection, but rather to listen for and select the change talk, and make that your focus in your reflective statement.

Client Statement: Start out by underlining the change talk in the statements below

 

Reflection: Now write down a reflection that selectively responds only to the client change talk contained in the statement
1.      The material the clinic gave me for my high blood pressure said I should avoid processed food, or else read the labels. I’m so busy I barely have time to eat, let alone shop, analyze my groceries, and spend half the night in the kitchen. These people do not live in the real world.

 

 
2.      Is it such a crime that I want to enjoy life while I’m still young? Once I’m tied into work, paying the bills, kids and all that I can scale things back.

 

 
3.      It is so frustrating that the minute you get pregnant everyone expects you to be perfect! I am so stressed out, it can’t be good for the baby. I am only having a few cigarettes a day, and my partner is totally on my case about it.

 

 

Reflective practice questions:

  1. How easy or difficult was it for you to identify the change talk in each of the client statements?
  2. How easy or difficult was it for you to frame a complex reflection that would further evoke change talk?
  3. What are the implications of this for your own continued growth and practice as a Motivational Interviewing practitioner?

(Correct answer: b. It’s pretty clear that the doctor wants you to continue.)

Adapted from: MINT TNT Manual (2014), various authors. 

camera lens

 

Focusing means strategic centering with a collaborative goal

 

In a previous article, we looked at Motivational Interviewing (MI) as having four key processes: Engaging, Focusing, Evoking and Planning.

Motivational Interviewing is directional – not directive. There is a horizon, something that we and the client are committed to working toward. However, finding and collaboratively agreeing on goals can be a challenge! This week’s intentional practice looks at the process of working with your client to jointly identify an agreed-upon goal. Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for a follow-up session with a client with the intention of setting an agenda for change. The skills for intentional practice in this activity are to:

Practice a focusing conversation using the skills of MI – with special attention to those noted above. How can you practice these skills to guide the client toward focusing on a meaningful and collaborative goal? Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

 

Case Example 1:

You are meeting with your client, Akilesh, for a follow-up appointment. In your initial session, you learned that he has been under a great deal of stress due to impending lay-offs at his work place. To make matters worse, his wife is in her first month of maternity leave with a reduced income. His mother’s health is failing, and his older son has been acting out at school: hitting and spitting at other children in his class, and on one occasion, his teacher. Finally, at the end of your first session, Akilesh “came clean” with you and acknowledged that he smokes 10-15 cigarettes per day.

 

Case Example 2:

You are meeting with your client, Elina, for a follow-up appointment. At the end of your initial session, Elina reluctantly agreed to come back and see you again. You suspect that in addition to appeasing her cardiologist by attending the referral appointment with you last time, she is now coming back for this second appointment because she wants to appease you. In the previous session, Elina acknowledged that she would probably be healthier if she quit smoking, but stated that smoking is a profound pleasure for her. She shared that she has already made so many changes, she just can’t see herself giving up her cigarettes.

 

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?

 

1 engaging

 

Engaging is the Relational Foundation

 

In their 2012 edition of the Motivational Interviewing “textbook”, Miller and Rollnick outline four recursive processes of MI. My colleague Wayne Skinner and I summarized these in a recent book chapter on MI:

Engaging: Client engagement is essential to the helping relationship. Without engagement, it is not possible to proceed, as the client makes a decision about whether to join with the practitioner and actively participate in treatment. The skills of engagement must also continue throughout all stages in the helping relationship.

Focusing: This “strategic centering” process hones in, with the client as equal partner, on the possible target(s) or direction(s) for change. At all times, client autonomy is respected – it is for the client to determine what he or she would like to address or work towards in treatment. Periodic “re-focusing” may be needed as goals evolve or change over time.

Evoking: Once the client is engaged in treatment, and client and practitioner have agreed on areas of focus, it is the practitioner’s task to evoke from the client his or her ambivalence about changing, reasons for change and strategies for change. In this stage the skills of MI become strategic in guiding the person in the direction of change by paying special attention to evoking change talk.

Planning: The process of planning can occur when (and only when) the client is ready to make a commitment to change. The skills of evoking commitment language, as well as the client’s strategies and ideas for change are key in this process.

Note that these processes follow a logical sequence, as each builds on the one before. However, practitioners may circle back to previous processes throughout the helping relationship.

 

Advancing Practice

Advancing our clinical practice takes practice. People often ask how they can access further training in Motivational Interviewing (MI), and there are lots of options available, but the most effective way is to just practice the skills! Peer practice is a good approach especially for those new to MI. I like case-based simulation as a teaching tool in MI to support integrated practice.

 

Case-based Learning

This exercise challenges you to intentionally practice the spirit and skills of Motivational Interviewing as they relate to engaging with our clients. The first few minutes of the very first session are powerful: this time communicates a wealth of information to your client about who you are as a person and a practitioner, as well as how you regard them. As you practice, consider how you can optimize the spirit and skills of MI as a powerful and impactful entry into engagement.

Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for the first five minutes of your consultation. Remember that your purpose in this activity is to:

  • Intentionally embody the spirit of MI: partnership, acceptance, compassion and evocation
  • Beware the “righting reflex” – your task is to engage, not to fix it!
  • Practice reflective listening – incorporate at least three reflective responses in your practice.

Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

Case Example 1:

Akilesh has been referred to your clinic because he has just been diagnosed with Type 2 diabetes. He is not overly concerned, as he was told that his condition at this time is not severe and can be controlled with diet. He is hoping for some clear guidelines and advice about foods to stay away from, and how to adapt his eating patterns. His chart states that he does not drink alcohol and that he is an “occasional smoker”. When he comes into your office, you notice that he smells strongly of tobacco smoke.

Case Example 2:

Elina is attending her appointment to appease her cardiologist, who is very concerned because of her continuing heavy tobacco use following her heart attack nine months ago. Elena is polite but clear that she does not intend to quit smoking. She has started an exercise program and is now eating a healthier diet, and feels that there is a limit to what changes she is willing to make in order to maintain her “quality of life”.

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?

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