Archive

Clinical Education

lovebot

 

Find your light

 

I’ve been collaborating with a colleague who teaches performing arts in putting together a “stage presence” workshop for educators and presenters. Our joint approach was sparked by a hallway conversation a few months ago about how stage and theatre performers have much in common with teachers: both need to foster an immediate, emotional connection with the audience/class, and both need to create and sustain an atmosphere of excitement, engagement and inspiration. In addition, all performers, teachers and presenters occasionally experience equipment malfunctions, bad venues, challenging audiences, and unexpected events. What separates the veterans from the beginners is in how we respond, improvise and model ‘grace under pressure’.

A common axiom among theatre performers is to “find your light”. That is, step out onto the stage and find the spotlight. Lately I’ve been thinking about the implications of metaphorically finding your light. In a classroom or lecture hall there aren’t usually spotlights and curtain calls, and the best educators are more occupied with facilitating students’ learning as opposed to occupying centre stage. So, what does finding your light mean in the context of presentation and teaching skills?

I think that in teaching and presenting, our “light” is our truest, most authentic self. If we can model authenticity in a group, with all of the attendant risk and vulnerability that entails, we encourage others to do the same. It is something of a paradox – approaching a presentation as a conversation versus a performance is the essence of great performance! Theatre ‘works’ when it’s a conversation with the audience (either explicitly in experimental theatre, or implicitly in traditional “never break the fourth wall” approaches). And while acting, by definition, involves assuming a character, great actors fully inhabit their character. All that we teachers/presenters have to do is fully inhabit ourselves.

There is something about stepping up to the front of the room that makes people freeze up. It’s a shame when that happens, because we are most engaged when we encounter others as their real selves. Finding your light is about shining your light – for all to see.

 

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. 

street art basketball

 

 

Nothing is possible without engagement

In any interpersonal interaction, nothing is possible unless there is engagement. This is true whether it’s a one-to-one counselling session, a classroom full of students, or a company team meeting. Engagement is the foundation of relationship, collaboration and change.

Enter Motivational Interviewing: A collaborative conversation for exploring and resolving ambivalence about change.

It seems like no matter how many years I have spent as a Motivational Interviewing trainer and practitioner, I still find nuances and insights in this model of practice decribed as ‘simple, but not easy‘. Lately I have been thinking about engagement as the essential underlying process in Motivational Interviewing, and mulling over how we can translate the clinical skills of establishing engagement with clients to our everyday skills in educational and work place settings to foster student and employee engagement.

 

Engagement is less about skill than it is about the spirit in which we practice – as clinicians, educators and leaders

What would our conversations, classrooms and meetings look, sound and feel like if we were able to deeply and consistently enact the four components of MI Spirit?
  1. We come to the relationship from a stance of respectful partnership, where all individuals bring valued and equal expertise
  2. We unconditionally accept others’ autonomy, worth and capacity – even when their intentions or actions don’t align with what we think best
  3. We are deeply committed to the highest interests of the other, rather than advancing our own agenda: compassion
  4. We are as eager to hear others’ stories, perspectives, beliefs, wisdom and values as we are to share our own: evocation as opposed to installation or education.

First and foremost, the spirit of Motivational Interviewing is more important than the skills.

Simple but not easy

When we like what we see, hear and feel, it’s relatively straightforward to respect what others bring to the table (partnership), to affirm their absolute autonomy (acceptance), to act with their best interests at heart (compassion), and to create a space in which their voice is heard and affirmed (evocation). The going gets tough when we don’t like what we’re seeing, hearing or feeling. That’s where our real work begins, and where we are most tested as clinicans, educators and leaders.

Authority is the enemy of engagement

Engagement isn’t the whole story, but it’s the essential beginning. Nothing substantive happens without it.
And when we have it, all things become possible.
compassion motivational interviewing quote

 

bike flowers

 

How do you want to travel?

 

Presentations and workshops are particular journeys for all participants – the facilitator included. From an overall accountability perspective, responsibility for the session sits squarely on the shoulders of the presenter, and rightly so. The content, pacing, climate and structure need to be clearly communicated and consistently enacted. Course evaluations assess how effectively presenters perform across these domains, and offer immediate feedback for improvement. But what about the audience?

Lately I’ve been thinking about individual audience members’ accountability, and the delicacy in creating a climate where each person in the room feels as invested in the value and success of the event as the presenter. This goes beyond learning outcomes and focuses on process (how we engage) as well as content (what we learn).

Most workshops and presentations typically start with some or all of:

  • Learning outcomes
  • Session overview or outline
  • Participants’ learning goals
  • Pre-session learning assessments.

However, few workshops explicitly build in a chance for participants to identify how they will contribute. In other words, reflecting on how we learn and participate, what might hold us back, and what would make it safe to take risks and participate in ways that might feel downright uncomfortable. I think these questions are crucial precursors to the usual content-focused questions or assessments, because a conversation about process sets the stage for joint responsibility for engagement.

It comes down to a conversation about how we (both presenter and group) collectively want to make the journey together. From a presenter’s perspective, this means starting out by asking questions such as:

  1. Are you coming to this session as a spectator or as a participant?
  2. What are some possible ways into the content that would resonate for you, and how could you amplify these entry points?
  3. What would it take to make you want to step outside your comfort zone?
  4. If you decided to take some risks in the interest of your own ‘deep learning’, how can the group support you?
  5. How will you translate and adapt ideas or applications to make them 100% relevant for you?

You don’t have to ask all five questions, and there are a wealth of other questions you could pose. The key is our intentionality in creating time for all participants to reflect on their roles, and on the nature of the voyage they are going to take with you and one-another.

And the next time I attend a presentation or workshop (or a class, meeting, performance, celebration or other opportunity to actively engage), I will be asking myself: “How do I want to travel?”

 

 

 

little green flying insect

It’s the practice itself that really matters

I found this on Twitter the other day, and it got me thinking about the art of listening…

While someone else is speaking, how often am I busy framing a reply? And if I’m focused on thinking about what I’m going to say next, that’s not actually listening. And then, I started thinking about how many conversations occur where both parties are more engaged in their own internal dialogues rather than a real, authentic, “I’m listening to you” dialogue.

Through this lens, silence isn’t just not speaking while someone else has the floor. Silence is a way of being, an inner stillness. In addition to silencing my “outside voice” (i.e., not interrupting), listening includes silencing my “inside voice” (see above) … and paying complete attention: with ears, eyes, undivided attention and heart.

I’ve been delivering training on Motivational Interviewing for about the last 15 years, and have spent much of that time focusing on the skill of reflective listening in clinical practice. In fairness, I also endeavor to “walk the walk” in everyday life. But something about that tweet caught my attention and made me pay attention.

Every conversation is an opportunity to simply practice listening. And like any discipline, it’s the practice itself that really matters.

DSC_0008

 

The Future of (Online) Learning

 

I’ve been teaching a fully online graduate course for the past 13 years. It’s been interesting seeing the cutting-edge become mainstream (with some caveats). MOOCS have made their mark on the learning landscape, and the democratization of education is blossoming. Are exemplars like Khan Academy, TEDEd, YouTubeEDU and iTunesU the disruptive innovation for higher education?

These are not easy times for bricks-and-mortar institutions, grappling with a challenging funding climate and a competitive enrollment landscape, alongside student-as-consumer expectations of outstanding service (and sometimes grades). If that’s not enough, a massive cohort of faculty and administration who grew up in “traditional” classrooms come with a decidedly instructivist slant despite our constructivist intentions (I include myself in this). Maybe that’s why most classrooms are still oriented to a podium at the front, even in new builds. What happens when the hyper-connected, online-all-the-time iGen takes over?

Predicting the future is perilous, and I’m no fortune-teller. But my read on the state of higher education leads me to posit the following, “VUCA“-informed, present-vs-future, higher learning trends for 2015 and beyond:

 

Then and Now Up-and-Coming
Instructor-generated content (Instructivism, Constructivism) User-generated content (Paragogy, Heutagogy)
Lesson Plans Gamification
Episodic assessment (occurs throughout a course) Embedded assessment (assessment is “in the water”)
eLearning mLearning, PLNs, Virtual World
Multimedia Immersive multimedia
Siloed Content APIs
Same content delivered to all learners Prescriptive (customized) content
Opaque Transparent
Learning feels like work Learning feels like play

 

 

%d bloggers like this: