Where does it hurt? That’s the key diagnostic question whether you’re a presenter or a clinician
A common clinical dilemma in counselling practice is when the practitioner is more invested in change than the client. This is manifested in clinicians working harder than their clients and caring more than they do about change. How and why does this happen?
I think this disproportionate effort stems from two things:
- Practitioners are trained to identify issues of concern and have a heightened awareness of the long-term implications and consequences of negative health behaviours.
- Because of their training and awareness, practitioners often feel that they know what is best for their clients.
The first point is helpful; the second…not so much.
It’s like the quotation:
“Advice is what we ask for when we already know the answer but wish we didn’t.” In other words, people are the experts in their own lives.
So what does all this have to do with presentation secrets?
In a teaching context, the instructor – just like the clinician – is expert in his or her specific knowledge domain and strategies for internalizing and enacting knowledge and skills. It’s when we take the stance of “I know best” that we run into trouble in the classroom. All people (whether patients or students) are in charge of their own lives and actions; learning is volitional and learners will always be self-determining in what and how much is learned.
Here’s the secret:
Always start with the problem that the learner identifies as relevant and pressing. Affirm autonomy. Offer solutions in the spirit of collaborative problem-solving. Tailor the content to the real-world needs of the individuals with whom you are engaged.
How do you know if you’re doing it right? Hearing “Yes, but…” is the clue that you’ve gone off track. Figure out the pain point and offer ways to make it better. Then leave it up to the real experts: the people you are entrusted to serve.
A small investment that can add big value to your training or workshop
People attend courses and workshops for a variety of reasons: some are there to learn, some are forced to attend, and others are curious-but-skeptical. Yet whatever the reason, how can we add value in the form of creating a compelling and memorable experience? An experience that effectively reaches beyond the workshop into the “real world” inhabited by our learners?
An obvious way to help bridge the learning-practice gap is to offer a package of professional, relevant and well-designed handouts. We trainers reassure ourselves that this invaluable resource will serve as an oft-consulted reference for learners post-session. Yet, how many of these things have you unearthed and pitched out in an office-purge years later? It’s a natural tendency to “file it and forget about it”. So…What else is needed?
I have attended two recent faculty development sessions where the speakers employed an ingenious and appealing strategy. So brilliant, so obvious, why have I never done this before? I am decided that I will now incorporate this into every single workshop:
Give each and every participant a small, meaningful token – a symbol – of the underlying meaning or “spirit” of your session.
Don’t tell them ahead of time. Do it near the end of your workshop or talk. Involve them in an activity demonstrating how they might use it.
In the Motivational Interviewing workshops that I facilitate, we talk about the skill of affirming as one of four foundation skills in this counselling approach. Last week at a session I gave for Queen’s University Health, Counselling and Disability Services clinicians, I handed out “saphires” (plastic, from a discount store) to each participant, and asked them to consider an affirmation that they could offer to a challenging student they are working with. Long after the workshop, that “jewel” on a practioner’s desk is a tangible reminder of mindful practice, and more evocative (and concise) than the 40 page handout I provided! (Or even the one page ” MI Tips ” for that matter).
Learners give their time, attention and wisdom to us when we co-construct learning communities. In the spirit of reciprocity, I have decided that going forward, a symbolic token to take away represents a significant value-add for learners and a reminder of what we have collectively shared.
Do one thing this year that scares the hell out of you
When I think about learning and all it implies, my mind automatically goes to unicorns and rainbows. Phrases like “transformative learning”, “learning community”, “lifelong learning”, “learner-centred”, etc. conjure up an idyll of intrinsically motivated and enriching experiences and endeavors. Don’t get me wrong – this is legitimate and genuine and real. But it doesn’t tell the whole story.
Yesterday I attended a talk focused on institutional commitments in a learning-centred organization. The speaker ended with a powerful call to action: her own. She committed to identifying and doing “one thing this year that scares the hell out of me”. And then she invited everyone in the audience to do the same. This got me thinking: deep learning happens when the going gets tough. Doing something that scares you is a 100% guarantee that you will learn something new.
In his book The Talent Code, Daniel Coyle talks about the phenomenon of deep learning. In this mode, peoples’ acquisition of a new skill resembles a herd of deer on an icy, slippery slope: tenuous, tentative, struggling, messy. In other words, deep learning is hard and it’s scary, but it may be the most effective route towards mastery.
A few years ago I gave my undergraduate university class a critical analysis assignment, consisting of three parts: (a) Read a challenging scientific research article (selected by me); (b) Submit a critique of the article, no more than three pages in length; (c) Locate two related research articles from an academic database. I loved this assignment because it so effectively assessed essential professional skills of understanding and critiquing research literature in the field, as well as navigating academic databases and locating relevant research. Practicing professionals need to be able to do this.
My students, on the other hand, hated the assignment. They were up in arms! Some said they had to read the article six or more times before they even understood it. Others struggled with how to even begin to critically analyze a scientific article published in a peer-reviewed journal. And still others had successfully avoided exposing themselves to Scholars Portal, and wanted to keep it that way.
Faced with an onslaught of indignation and outrage from approximately 60 people, I went into reflective listening mode: “So, what you’re saying is, this assignment was incredibly challenging. You hated reading a boring article ten times before it even began to make sense. Scientists aren’t too good at making the products of research accessible. Life would have been so much better if the assignment I gave you involved no more than a couple of hours work the night before.” Nods of agreement and reluctant smiles.
But here was my pivotal question to the group:
“If I had given you that easy assignment (welcome as that may have been), tell me this, would you have learned anything?”
“And what about this terrible assignment…did you learn anything useful?”
An unequivocal Yes! … even though it was pretty aversive.
And then the conversation shifted – big time.
We talked as a group about why they had come to university in the first place. We talked about the experience of learning. About how, when things are hard, that is exactly when learning happens. Instead of a mutiny on my hands, the experience was an epiphany for all of us.
I have to keep reminding myself of that lesson. The challenge to commit to one really tough thing this year and follow through is the challenge to commit to the slippery slope of deep learning.
And maybe among the herd of deer on that icy slope, there will be a couple of unicorns.
“What I don’t know I don’t know” – That’s the most essential learning
In nearly every course or workshop I teach on Motivational Interviewing (MI), there are nearly always practitioners who express some variation of “I already do MI naturally”. In other words, why spend time “learning” about something that I already know how to do? A reasonable response, if accurate.
I say ‘if accurate’ because research on MI practice suggests a disconnect between what practitioners say they do versus the MI skills they can actually demonstrate. We’re talking video recordings of actual client sessions, coded by skilled clinicians trained in the use of a standardized instrument. So while there may be a small proportion of therapists who really are “MI naturals”, it’s likely that most practitioners, whether they know it or not, can not or do not demonstrate the skills of MI without training, coaching, practice, coaching, and practice.
Motivational interviewing is essentially a way of being with a client (Dr. William Miller, the originator of MI, calls this “MI Spirit”), comprised of partnership, acceptance, compassion and evocation. It seems intuitive, but the “Righting Reflex” is hard to resist. Additionally the processes of MI – engaging, focusing, evoking and planning – are accompanied by a range of skills and strategies. Integrating both spirit and skills demands artful practice, and integrating MI with other approaches (for example Cognitive Behavioural Therapy, CBT) involves even greater therapeutic sophistication.
No practitioner ever reaches the apex of clinical perfection – it doesn’t exist! Just like the clients we serve, practitioners are engaged in an ongoing process of development. And it’s the basics (reflective listening is a good example) that can be the most challenging.
People come to a learning environment with four general categories capturing both pre-exisiting knowledge and knowledge deficits:
- What I know that I know: Everyone comes in with something of value
- What I know that I don’t know: Everyone has areas they can identify as avenues for further learning
- What I don’t know that I know: Everyone has knowledge and skills of which they aren’t aware
- What I don’t know that I don’t know: We all have a blind spot when it comes to what we still need to learn. When we can shine a light on it, that’s the “aha” moment!
Patient safety includes patients’ subjective feelings of safety
I have participated in and taught about interprofessional collaboration (IPC) for many years, but last week I experienced it firsthand from a new perspective… as a patient.
Here’s a quick replay:
It is 6:15 AM. No coffee. Emerging from the changing room in a hospital gown and disposable slippers I re-enter the Admitting waiting area with others similarly attired, accompanied by our respective escorts. The only exuberance is among a group of three teenage girls, whose noisy laughter and nonchalance exudes the indestructibility of youth.
From Admitting, on to the Pre-Op waiting area. One by one patients are called, and then it’s my turn. Past the swinging double doors, down a wide corridor, more people in surgical scrubs, into the Operating Room. It’s kind of freaky being the one with the IV: “Just hop up here onto the operating table.” A narrow bed in the centre of that big room, with really bright lights just like on TV. Ummm…sure. Too late to back out now.
Have you noticed how right away you can feel a room’s atmosphere (positive or negative)? Well in that moment of total vulnerability, I sensed the camaraderie of a super-high-functioning team. I felt respect, cooperation, kindness and compassion. Not just toward me but to each other. More than anything anyone actually said or did, the underlying atmosphere was like a warm blanket of reassurance and comfort.
Health and counselling practitioners universally affirm the importance of positive regard, mutual respect, trust and acceptance in relation to our patients or clients. Last week was a good lesson about how profoundly our interprofessional relationships – those same elements of positive regard, mutual respect, trust and acceptance – are visible, impactful and meaningful. Just like kids know when their parents are fighting (even in the absence of verbal cues), patients know when there is discord in the team.
As I discovered firsthand, IPC is not just about patient safety, it’s also about patients’ subjective feelings of safety. A skillful surgeon is key. An outstanding team takes it to the next level.
P.S. The biopsy was negative.
It’s all about creativity, reflexivity and connectivity
Teaching as informing is a short-term solution to a long-term problem. Today, providing information is secondary to engaging peoples’ interest and motivation so much that they will want to seek out more and more, beyond the boundaries of the boardroom, lecture hall or online discussion forum. It’s about meta-teaching…teaching others to become their own teachers.
Daniel Pink, in A Whole New Mind, describes how the information age has undergone a seismic shift to the conceptual age. Meaning that the left brain skills of information management/analysis have been surpassed by the right brain skills of creativity, reflexivity and connectivity.
We’ve progressed from a society of farmers [the agricultural revolution] to a society of factory workers [the industrial age] to a society of knowledge workers [the information age]. And now we’re progressing yet again – to a society of creators and empathizers, pattern recognizers, and meaning makers [the conceptual age].
In the conceptual age, educators and presenters need to go way beyond informing because:
a. The information that the presenter deems essential may not align with the relevance and priorities of the audience; so that means little incentive for long-term retention.
b. People generally don’t remember much of what they hear. Or if they do, the half-life of information is pretty short, so there isn’t much impact to be realized if our focus is on the content of a presentation.
c. Even if the information is relevant and memorable, our knowledge landscape is a moving target – information changes so rapidly that what is current today quickly becomes out of date.
And that is where transformative learning comes in…
Introduced by Jack Mezirow in 1997, transformative learning is about engaging peoples’ underlying assumptions and facilitating change in frames of reference. Think of it as that “aha!” moment, when a whole new concept seems to snap into place and suddenly we see things from a new and broader perspective. Signal moments in learning are accompanied by affect – delight, surprise, disappointment, satisfaction, excitement – extending beyond solely cognitive-based insight or understanding.
A defining condition of being human is that we have to understand the meaning of our experience. For some, any uncritically assimilated explanation by an authority figure will suffice. But in contemporary societies we must learn to make our own interpretations rather than act on the purposes, beliefs, judgments, and feelings of others. Facilitating such understanding is the cardinal goal of adult education. Transformative learning develops autonomous thinking.
How can we as educators make this magic happen in our day-to-day work? Well, transformative learning presupposes transformative teaching (if teaching is the right word in this context) (a.k.a. transformative faculty development?). And in turn, transformative teaching implies…teaching about teaching. Meta teaching.
Both the words and the music. Play that funky music.