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WEEK 11 PRACTICAL SESSION: QUESTIONS AND REFLECTIONS WEEK 11: LEARNING OUTCOMES Practice the appropriate and effective use of questions and reflections within a naturopathic consultation WEEK 11- BREAK IT DOWN: Practice the appropriate and effective use of questions and reflections within a naturopa...

WEEK 11 PRACTICAL SESSION: QUESTIONS AND REFLECTIONS WEEK 11: LEARNING OUTCOMES Practice the appropriate and effective use of questions and reflections within a naturopathic consultation WEEK 11- BREAK IT DOWN: Practice the appropriate and effective use of questions and reflections within a naturopathic consultation Use different types questions to gather information and understand the individual Use reflections: reflecting content, feeling, and meaning Use active listening skills and OARS to support appropriate conversational use of questions, reflections, clarifications, affirmative responses, and intentional silences. PRACTICAL SESSION Agenda: Grounding Check-in: body based awareness in the present moment Demo: with a group member as the speaker and a focus on their current experience of stress, we will demonstrate how to use questions, reflections, attunement, empathy, and active listening in a first conversation Discussion: a space for debriefing, questions, what-ifs, and do-overs Close DIFFERENT TYPES OF QUESTIONS Questions will help us get to know our patients and are important in understanding their concerns. They are also essential part of any diagnostic process. Questions can help to open up new areas for discussion. They can help to pinpoint an issue and they can help to clarify information. Questions that invite patients to reflect or recall can support them in their journey of self-exploration and help empower them to be active agents in their own wellbeing. Open ended vs closed ended questions Exploratory vs directive questions Leading questions Loaded questions OPEN ENDED QUESTIONS OEQ are great for opening a conversation, inviting discussion, and encouraging selfreflective awareness. Encourage the client to speak + invites elaboration + opens the conversation Invite the speaker to pause, think, and reflect Offer an opportunity to gather information about the client and their concerns Can help the speaker to explore their own process May begin with how, what or who (NOT why) Require an answer other than yes/no or some other one-word answer May be used to gain information (“what happened when….?”) May be used to explore thoughts, feelings, attitudes and opinions (“how were you feeling when…”) Can be both directive and exploratory As “door openers,” OEQ questions can help to initiate conversation. They also invite the speaker to elaborate and share more of their experience. When used respectfully, OEQ help build a trusting relationship where the speaker feels safe to explore what is going on for them. For example: - “What brings you here today?” - “What’s on your mind?” - “Can you tell me more?” - “Can you say more about that?” - “What positive changes would you like to see happen in your life?” - “What do you see as being the biggest problem?” - “How does that make you feel?” → Notice where we could turn some of these “why” questions into better “what” questions For example“why do you believe…” → what makes you believe that…” “why do you feel…” → “what makes you feel…” → How does changing the word “why” to “what” land for you? EXPLORATORY AND DIRECTIVE QUESTIONS Exploratory questioning: non-directive; follows the patient and invites examination of thoughts, feelings, and behaviors (these will always be OEQ). With exploratory questions, you don't know where the patient is going to go with their answer, or what kind of content they may choose to share. Ex: You said that you’re the most stressed out that you ever have been in your life. What going on for you? Directive questioning: use an OEQ to invite expansion on a specific topic. Ex: Can you tell me more about your problems with sleep? CLOSED QUESTIONS These are specific questions that can be answered with a single word or phrase, which does not invite the speaker to elaborate or open other content areas. They are generally directive, in that they are identifying and asking about specific details/information. They have a place in the interview– to focus on very specific information, to get specific details, and to clarify Often begin with: is, are or do Many LODRFICARA questions are often closed-ended and are used to gather information on specific aspects of a health concern For example: Is this your first time to se an ND? Are you able to walk without your cane? Do you enjoy your job? On a scale of 1-10, how strong is your pain? How many days has it been since you last had a bowel movement? While closed questions can be used to draw out and clarify relevant information, there is a risk of over-using closed questions and/or using them in a way that can have a negative impact on the session For example: Repeated use of closed questions may lead to the speaker saying less and less + the interviewer feeling more pressure/anxiety to ask more questions and keep the interview going Repeated use of closed questions can also lead to a sense of being interrogated, rather than listened to CAN YOU IDENTIFY THESE QUESTION TYPES? What kinds of questions are these? “You mentioned that you get headaches more frequently when you’re under pressure at work. Can you tell me more about how you feel when you’re under pressure in general?” -- this is a reflective comment (content) + an exploratory and open ended question “I’d like to get some more information on your dietary habits. Can you describe what you might eat on a typical day? …What did you eat yesterday? …How often do you skip breakfast? …Do you usually have coffee and donuts at work? …What other kinds of snacks do you like?” -- this is a series of directive questions with a focus on CEQ AVOID LEADING QUESTIONS Leading questions: encourage a particular response by the way that the question is phrased Ex: doctor to patient on a return visit: 1) I assume you’re still doing well with the treatment plan, right? 2) How have you been doing with the treatment plan since our last visit? or 1) How much have your headaches improved since we started the acupuncture treatments? 2) What do you notice about your headaches since we started the acupuncture treatments? or 1) You must be really angry about that 2) How are you feeling about that? LOADED QUESTIONS Loaded questions: could potentially come with emotional charge and/or have the potential to be unexpected or embarrassing to the client. A Naturopathic intake may be quite different from the conversations patients are used to having with their MDs. → It may be important to tell the patient what kind of information you are asking for and why you are asking these questions Be aware of questions that have the potential to embarrass the patient (sexual behavior, bowel habits, etc) and ask about these areas clearly and with confidence (assertive communication is important here). It may also be useful to introduce the topic and say a few words about why it is important, especially if it is not directly linked to the patient’s identified concerns. When asking a question that has a potential for emotional charge and when a patient experiences a question as loaded, be sure to acknowledge it and respond with empathy. Use reflections and invite the patient to share their experience. For example: “I see that this brings up emotional energy for you…. Is it ok if we just take a moment to be with that together? Would you like to share a bit about what’s coming up for you? …How is it to just be with this for a moment?...” USING QUESTIONS EFFECTIVELY Ask open-ended questions Ask questions based on what the speaker is saying Follow questions up with a reflection or empathic highlight instead of another question Ask a limited number of questions​: someone who is skilled in the “art of listening” will use open questions sparingly, to help clarify what the client has said so that they can reflect and paraphrase it more accurately Be sensitive to loaded questions and respond with empathy when they arise INAPPROPRIATE USE OF QUESTIONS Asking too many questions in general Asking more than one question at a time Irrelevant questions Misuse/overuse of “why” questions Avoid leading questions Do not engage patients in question-and-answer visits (over-use of closed questions) FOCUS ON THE “OARS” Open-ended questions: allow the patient to express their experience in their own words Affirmative statements: allows you to validate patient’s experience + acknowledge health-affirming actions, available resources, character strengths, etc Reflective comments: clarify content, recognize emotion, offer interpretive understanding (meaning) Summaries and Silence and Smiles 3 KINDS OF REFLECTIVE COMMENTS CONTENT: reflect content: this is not the same thing as parroting. It is paraphrasing, offering your own creative summary of what you have heard. It also identifies important details and allows you to be clear on information you may need from an assessment perspective. FEELING: reflect feeling: let the speaker know that you have heard the emotional content of what they have said or nonverbally expressed. Whether feelings become a focus of conversation or not, acknowledging them is an implicit invitation for discussion and lets the patient know that you are able to hold a safe space and attend to them on this level. MEANING: reflect meaning: the combination of feelings, facts, and interpretations result in meaning. As you listen attentively, you may begin to sense links between feelings and facts, or make intuitive associations within their narrative. You may want to offer these tentative interpretations as feedback in an accepting, non-judgmental way. This type of communication helps you both gain understanding and insight. This is a form of mentalizing and acknowledging perceptual patterns. SUMMARIES – SMILES – SILENCE The “S” of OARS can help keep us connected: Summaries: use summaries when you’re not sure what you’ve heard (invite clarification) when important information has been shared and you want to make sure you’ve got it right when you’re not sure what to say/where to go next (it buys you time to see your next step or sets it up to ask the client where they would like to focus) Smiles: This reminds us to pause, to check in with ourselves, and to come back into secure connection with our own experience and that of the patient. Are we attuned, present, and engaged? How is rapport being shared? Are we conveying openness, warmth, and receptivity? Can we use a smile? Silence is golden Take a breath or two before you speak. Allow space between your questions. Practice being comfortable with short periods of silence; use body language appropriately in silent spaces. If something is difficult to say, we tend to hesitate before saying it. Give the patient time to cross this threshold That said, silence can also be awkward or hostile– in those cases, it is be best to break the silence and try and re-engage the patient THE FLOW OF THE CONVERSATION The general goal in an unstructured interview is to keep the conversation moving forward with ease. Although it should flow in a way that feels natural to the patient, you are also monitoring the level of information gained and what information you still need to obtain. You can be mindful of the structure behind the interview while still speaking in a fluid and conversational way. To achieve this, use a mix of open-ended questions (best for evolving conversation, inviting elaboration, exploratory phase; there should be more open-ended questions in general) and closed ended questions (best for clarification or eliciting specific details; keep them to a minimum). Ask for clarification: asking questions when something is unclear allows you to get more information and demonstrates your interest and concern. Notice where you make assumptions about what you think the patient means and learn to pause there, asking for clarification. You will also want to REFLECT what you think you have heard at the level of CONTENT, FEELING, and MEANING, inviting CLARIFICATION and ELABORATION while maintaining presence and the sense of “being with” the patient. ACTIVE LISTENING What is it? Interested and participatory listening, where we: - Listen to verbal messages (content and feelings) - Observe non-verbal messages (posture, expressions, tone of voice) - Look for what is not being said - Reflect your understanding of the content and feelings that the person has shown you - Stay tuned in to yourself as you listen ACTIVE LISTENING Why is it important? Active listening is a loving process that allows change and helps the person to: - Feel safe, supported, heard, and understood - Get in touch with and express thought and feelings - More clearly see their issues - Make new choices in their life ACTIVE LISTENING How do we do it? - Establish rapport - Match body posture/gestures - Eye contact - Match language/ tone/ speed - Listen to verbal / non-verbal messages and what is not said - Reflect content and feelings - Remain in touch with yourself wnd with the effect on you as you listen – make space TURNING CLOSED Q INTO OPEN Q One of the most common stumbling blocks in an interview is getting stuck in a series of closed ended questions. Not only does this prevent the speaker from opening up the interview and offering their own associative links, but it also tends to generate anxiety in the interviewer, as they must try to anticipate the speaker’s experience and then create a question that confirms or denies their assumption. The interviewer begins to focus more on their next question and listen less, all adding to their anxiety and working against engagement. Consider this example: A patient seeks treatment for stomach pain and indigestion. The doctor has already collected the LODRFICARA information on the pain. The doctor suspects it could be food related. Dr: So you’ve been having stomach pains. Do you think the pain is related to anything that you eat? Pt: No, I haven’t noticed any associations. Dr: Spicy foods? Pt: Usually I'm ok with them. Sometimes I get the pain though. Dr: Dairy? Pt: Seems ok. I have dairy most days and the pain is on and off. Dr: What about wheat and gluten? Pt: I eat bread, I try to get the whole grain kind. Haven’t noticed anything. Dr: What about caffeine? Do you drink coffee? Pt: Yes, 1 or 2 cups most days. But doesn't bother my stomach. Dr: Do you have any food allergies or sensitivities? Pt: Not that I know of. Dr: Ok. What about stress? Do you think your stomach pains are triggered by your stress at work? Pt: No. Dr: (internally anxious—what else can I ask about? They’re looking at me…. Doctor scrambles and begins asking more closed ended questions… Interview shuts down.) Consider this difference: Dr: So you’ve been having stomach pains. Do you think the pain is related to anything that you eat? Pt: No, I haven’t noticed any associations. Dr: Are there any foods that seem to affect your digestion at all? Pt: I’m pretty good with most things. The stomach pain comes and goes, it doesn't seem to be triggered by anything specifically. Sometimes greasy foods make my stomach feel upset though. Dr: OK, how does your body react to greasy food? Pt: Well, usually I get this pain in my stomach and sometimes I need to go to the washroom right away. Dr: (choicepoint → ask more about bowel movements and stool or continue dietrelated questioning) TURNING CLOSED Q INTO OPEN Q A great skill to practice is that of turning a closed ended question into an open ended one. To do this, ask yourself: what information you are trying to discover about the patient. Then share that with the patient in a simple and open-ended format. In general, open-ended questions are easily constructed when you are transparent about your thought processes. Let the transparency work to your advantage: What am I curious about? → “So I am curious to hear more about what you said a moment ago, when you were speaking about (reflect content + feeling or meaning)” What am I wondering? → “So knowing what you said about (reflect content + feeling or meaning), I’m wondering now about…..” What am I not sure I understand? → “I’m not sure I understood exactly what you meant, can you say more about…” What would I like to know more about? → “Can you say a little more about….?” You aren’t sure which direction to go in at a choice point → “So there are a few different ways we can go from here…. This is what I’ve heard you say (reflect content + feeling) and I’m wondering about how that might relate to (direction 1) or (direction 2) or even (direction 3). What do you think is most important for us to talk about?” “a meaningful and trusting relationship can provide lasting positive change in a person’s life” WEEK 12 PATTERN RECOGNITION AND A CONVERSATION WITH A PURPOSE WEEK 12 Learn to conduct a naturopathic interview + obtain information relevant to the assessment of cognitive/emotional/relational patterns WEEK 12- BREAK IT DOWN: Learn to conduct a naturopathic interview Presence, safety, and regulation What do we talk about? Learn to obtain relevant information Use OARS to support a meaningful conversation Learn to recognize significant patterns Perception CNS/polyvagal status Emotions Relationship dynamics LEARN TO CONDUCT A NATUROPATHIC INTERVIEW An engaged conversation, with a purpose 1. Essential components: presence, safety, and regulation 2. What do we talk about? Complaint oriented inquiry + the non-complaint oriented aspects of care Understanding the individual Biopsychosocial determinants of health; risk and resiliency factors; specific content regions that will build your understanding of the patient over the first series of appointments 1. PRESENCE, SAFETY, AND REGULATION These are 3 ESSENTIAL components to care. What does it mean to be “present?” What takes me out of presence? How do I develop my ability to tune in and be present? Why is attunement important? What do we mean by safety? Why is safety important? How do we create safety? What does regulation mean? How do I know if I am regulated or not? Why is social engagement so important? SAFETY VS STRESS AS AN AUTONOMIC SETPOINT If our patients are in a chronic state of stress, healing becomes that much more of a challenge. In the broadest sense, our focal point of care should be to support patents in moving out of survival mode and recalibrating into a state of safety. When safety and ventral vagal availability is our default, we have resources for healing, growth, and vibrant expression. What produces stress? Many things--- and one of the primary influencers is perception. Please refer to video #2 (Bruce Lipton, PhD) Epigenetics and The Power of Perception See additional notes: Perception as a Foundation for Health 2. WHAT DO WE TALK ABOUT? GENERAL CONTENT REGIONS: Personal medical history Family medical history Biological determinants of health Psychological determinants of health Social determinants of health SPECIFIC POINTS OF REFERENCE Will vary in terms of relevance for each individual; helps you to collect data and better understand the patient’s experience (*see file “Taking the Case” for more detail) WHAT DO WE TALK ABOUT? 5 areas to include in every conversation: SLEEP, ENERGY, DIGESTION/ELIMINATION, MOOD, STRESS and COPING You will get lots of practice in other courses with complaint-oriented questioning. Unique to this course is our focus on the NON-COMPLAINT oriented part of the conversation. These are areas that you would gather information about, regardless of what brings the patient in. You will learn a lot about a patient by exploring these areas in a flowing, conversational way Remember: A Naturopathic intake may be quite different from the conversations patients are used to having with their MDs. → It may be important to tell the patient what kind of information you are asking for and why you are asking these questions The anxiety of being ill (or just meeting a new doctor) can interfere with the patient’s ability to communicate effectively You want to stay present and pay attention → reinforce the patient’s efforts to be a responsible and accurate source of information Be aware of questions that have the potential to embarrass the patient (sexual behavior, bowel habits, etc) and ask about these areas clearly and with confidence (assertive communication is important here). It may also be useful to introduce the topic and say a few words about why it is important, especially if it is not directly linked to the patient’s identified concerns. 3. OBTAIN RELEVANT INFORMATION Active + participatory listening OARS: Asking quality questions: inviting elaboration with open endedquestions and exploratory questions; using directive questions to get specific details Using affirmations to acknowledge client strengths/resilience Using reflections to clarify and confirm (reflecting content, emotion, meaning) Using summaries and silence The flow of the interview: The general goal in an unstructured interview is to keep the conversation moving forward with ease. Although it should flow in a way that feels natural to the patient, you are also monitoring the level of information gained and what information you still need to obtain. You can be mindful of the structure behind the interview while still speaking in a fluid and conversational way. To achieve this, you can use a mix of open-ended (best for evolving conversation) and closed ended questions (best for clarification or eliciting specific details). You will also want to REFLECT what you think you have heard at the level of CONTENT, FEELING, and MEANING, inviting CLARIFICATION and ELABORATION. Remember your “OARS” Open-ended questions: allow the patient to express their experience in their own words. Be curious. Affirmative statements: allows you to note health-affirming actions, available resources, character strengths, etc Reflective comments: clarify content, recognize emotion, offer interpretive understanding Summaries and Silence and Smiles (*see file The Naturopathic Interview and OARS for more detail) 4. RECOGNIZE SIGNIFICANT PATTERNS: Perception: cognitive filters (beliefs, assumptions, expectations) organize our experience of reality and translate into physiology + emotion Emotions: suppression/healthy expression/overwhelming experience our emotional habits are attempts at adaptation CNS: Polyvagal theory fight-flight-freeze-appease vs ventral vagal Relationship dynamics: Attachment styles: secure vs insecure Communication styles: passiveassertive-aggressive RECOGNIZE SIGNIFICANT PATTERNS: *We will move into a more in-depth discussion on patterns of perception, emotion, CNS/polyvagal, and relational dynamics in term 2. For now, please familiarize yourself with the basics of these areas as presented and discussed here. * MIND AND BODY ARE DYNAMICALLY ENGAGED AT ALL TIMES We are in a constant process of adaptation to our perceived environment Note the bidirectional, reciprocal relationships and physiologic interactions: Between CNS state, perception, emotion, and physiology Neuroception Implicit memory Amygdala and limbic system HPA axis State and trait Short term states (adaptations/coping attempts) can become long-term traits (chronic disruptors) NEUROCEPTION Neuroceptive state is based in unconscious perceptions of threat vs safety. It is responsive to/determined by our set (internal cues) and setting (external cues). Our neuroceptive state determines our conscious interpretations and narratives. “How neural circuits distinguish whether situations or people are safe, dangerous, or life threatening... Neuroception takes place in primitive parts of the brain, without our conscious awareness.” Dr. Steven Porges NEUROCEPTION Neuroception: a subconscious monitoring system, unique to us, which constantly scans for danger and safety, based on: Facial expression Noise Tone Movement Familiarity/newness And many other aspects of our environment. Neuroception is influenced by our experiences. In each of our relationships, the autonomic nervous system is “learning” about the world and being toned toward habits of connection or protection. Week 13 Practical session: The helping professional and the therapeutic relationship WEEK 13: PRACTICAL SESSION Demonstrate the role of the professional helper in the context of a naturopathic counselling relationship Demonstrate presence and effective communication in support of the therapeutic alliance WEEK 13: BREAK IT DOWN Focus Questions: What does it mean to be a helping professional? What qualities are important for this role? What interrupts our ability to support others? Practice skills: presence, safety, regulation, and therapeutic alliance THE ROLE OF THE HELPING PROFESSIONAL INCLUDES…. Building healthy, meaningful, and trustful relationships with others (“therapeutic alliance”) Being mindful of what we bring to the relationship. Supporting people by helping them to express and explore their experience: clarify issues, identify influences, explore options, develop strategies, and increase selfawareness. Creating a safe and non-judgemental space where others are invited to be themselves: presence, connection, understanding, respect + an invitation to speak freely about deeply personal thoughts and emotions. Acknowledging the experience of the other. Respecting behaviour as an attempt at coping. Attending to body language, emotional expression, words, and the relational space between you. THE ROLE OF THE HELPING PROFESSINAL INCLUDES.. Creating a safe and non-judgemental space where others are invited to be themselves: presence, connection, understanding, respect + an invitation to speak freely about deeply personal thoughts and emotions. Acknowledging the experience of the other. Respecting behaviour as an attempt at coping. Attending to body language, emotional expression, words, and the relational space between you. THE THERAPEUTIC ALLIANCE The ability to develop a healthy therapeutic relationship (“alliance”) is an essential professional skill. It refers to the clinician’s ability to create a secure relational container, offering the client support for achieving positive change in their lives. As noted by Carl Rogers (founder of humanist, person-centered therapy), therapy’s actual capacity to produce beneficial results was directly connected to the quality of relationship that a therapist was able to cultivate. Better therapeutic relationship → better outcomes THE THERAPEUTIC ALLIANCE According to Rogers, there are 3 main components a good therapeutic alliance: empathy, congruence (or genuineness), and unconditional positive regard (truly believes in their clients and meets them with compassion). In other words: Is the therapist supportive and understanding? Is the therapist genuine? (have they worked through their own egodriven needs, adaptive traits, and sub-personalities?) Are they compassionate? Do they see your value as a person? RESEARCH SIDE NOTES: As described in this 2021 paper, “The “person-centered” approach to care delivery has been valued as a core part of service design and is necessary to provide a nurturing environment that is respectful, compassionate, and responsive to the needs of the individuals. Understanding the situation of or lived experience of health services by each client has increasingly been recognized as a key element of quality healthcare to improve safety and patient outcomes. For example, patient satisfaction with service or effectiveness of interventions promotes treatment compliance and supports recovery in mental health settings (Katsakou et al., 2010; Urben et al., 2015).” Seow LSE, Sambasivam R, Chang S, Subramaniam M, Lu HS, Assudani HA, Tan CG, Vaingankar JA. A Qualitative Approach to Understanding the Holistic Experience of Psychotherapy Among Clients. Front Psychol. 2021 Aug 6;12:667303. doi: 10.3389/fpsyg.2021.667303. PMID: 34421720; PMCID: PMC8377233. RESEARCH SIDE NOTES A review of studies on therapeutic alliance over a span of more than 60 years, confirms that “the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome, independent of the variety of psychotherapy approaches and outcome measures.” They also noted that the client’s perception of the alliance was more significant than the clinician’s Ardito, Rita B, and Daniela Rabellino. “Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research.” Frontiers in psychology vol. 2 270. 18 Oct. 2011, doi:10.3389/fpsyg.2011.00270 WHAT QUALITIES ARE IMPORTANT? Presence Skillful listening and responsive conversation Non-judgement Empathy Compassion Authenticity (genuineness, congruence) Curiosity Humility The ability to hold a secure relational container Secure sense of self Self-reflective awareness and accountability The ability to meet your own needs /self care THE THERAPEUTIC ALLIANCE Psychotherapy has been described as a dance, “a synchronicity of the mind and body that occurs between therapist and client” (Schore, 2014, p. 388). Psychotherapy and counseling in general are arenas for authentic, intimate, and unique interactions between a client and a therapist. With over 200 different approaches to counseling, there are a few key points that all the methods share (Rivera, 1992). Every form of therapy requires an interpersonal relationship, with the goal of helping a client heal or relieve distress. Therefore, understanding this sacred relationship is something that anyone in a helping position should seek to do. Therapeutic Relationships in Counseling: 4 Phases Explained. 20 Mar 2021 by Melissa Madeson, Ph.D. https://positivepsychology.com/therapeutic-relationship-phases/ AN “EXPERT COMPANION” “...An expert companion serves as a facilitator of growth rather than a creator of growth; and yet an expert companion does not necessarily need to be a trained professional. While professional expertise is crucial for the treatment of clients seeking help in challenging times, without companionship, such expertise can be hollow. Indeed, untrained individuals can play a significant role as expert companions and are routinely able to serve in this role when they possess good listening skills, patience, acceptance, and humility: many of the same qualities used to describe effective therapeutic relating (Calhoun & Tedeschi, 2013). AN EXPERT COMPANION (2) “An expert companion first and foremost assumes the role of a non-judgemental listener who does not feel compelled to give advice, rather they support the idiosyncratic ways people cope with negative life experiences. Simply put, expert companionship is a type of social support from a trusted individual who is adept at providing compassion and understanding, and open to hearing about experiences that need to be shared (Tedeschi & Moore, 2016). In doing so, the expert companion supports the development of a new narrative which validates experiences and reconnects individuals with their strengths and previously held values (Butera-Prinzi et al., 2014).” AN EXPERT COMPANION (3) “Although there may be times when an expert companion is more active in providing assistance, they are proficient in allowing the individual to just be, accepting a mostly passive role and offering ideas from a different perspective without judgement or expectations regarding pace or progress, and without attempting to solve all the client’s problems (Tedeschi & Moore, 2016). At its simplest, a non-professional expert companion can support the development of new narratives and, in doing so, nurture the process of healing and growth in the aftermath of negative life events”. Houston, Elaine. Identifying our expert companions. Positive Psychology Toolkit, 2021. WHAT INTERRUPTS OUR ABILITY TO SUPPORT OTHERS? Mistaking sympathy for empathy Trying to fix-solve-change-heal- improve others (and lets notice the parts of ourselves that seek to gain esteem by doing so) The need to prove one’s worth (or intelligence, or value, or ability to be a “good” doctor) Judgement, bias, and a limited ability to shift perspective Unresolved emotional energy / triggers Lack of awareness of what we bring to the relationship (*See videos for week 13: Brene Brown on Empathy and Blame) “FOR SOME PEOPLE, JUST THE PROCESS OF TELLING THEIR STORY AND BEING LISTENED TO IS HELPFUL.” ADDITIONAL RESOURCE: GO TO THE LINK FOR WEEK 13: THERAPEUTIC ALLIANCE *Please read this article before you come to the practical session* This Article Contains: What Is the Therapeutic Alliance in Psychology? Therapeutic Relationship Model: 3 Components Explained 4 Phases & Stages of the Alliance 4 Real-Life Examples A Look at Healthy Boundaries in Therapy Therapeutic Relationships vs Social Relationships PositivePsychology.com’s Relevant Resources A Take-Home Message References PRACTICAL WEEK 13 Today’s Agenda: Meet with your TA group 30 min: Grounding Check-in 50 min: Demo / experiential process/ debrief and discussion WEEK 14 PRACTICAL SESSION: DEMONSTRATE A PRACTICE OF SELF REFLECTIVE AWARENESS THAT CAN HELP IDENTIFY AREAS OF PERSONAL STRENGTH AND DIFFICULTY, WITH THE GOAL OF PERSONAL AND PROFESSIONAL DEVELOPMENT WEEK 14: PRACTICAL SESSION Demonstrate a process of self-reflective awareness within the therapeutic context Identify areas of personal strength and areas for growth; support personal/professional development Practice skills: presence, safety, regulation, and therapeutic reationship WEEK 14 – BREAK IT DOWN Self-reflective awareness within the therapeutic context Areas of personal strength Areas for growth Personal-professional development Building skills: presence, safety, regulation, and the therapeutic relationship PRACTICAL ASSESSMENT The WLO are embedded within the final assessment for this course. We invite you to reflect on your personal-professional development over these weeks, with an emphasis on presence, safety, curiosity about your present moment experience, and learning how to come more easily into a regulated, ventral-vagal state. EXPLORING VULNERABILITY AND CONNECTION Dr. Brene Brown speaks about the connection between vulnerability, intimacy, and shame. She also speaks to her research, which clarifies the difference between people who experience themselves as worthy of love and belonging and those who do not— it is a BELIEF SYSTEM. This belief system can isolate us. We may feel lonely, yet we crave connection. However, our defenses activate in a way that actually blocks real connection an intimacy. For many reasons, we believe that we would be rejected / unworthy / unloveable if others were to know our real, inner experience. In an attempt at self-protection, we perpetuate adaptive responses that hide our authentic experience in an attempt to create connection. However, the attachment is insecure and so drives a further belief “they would reject me (or some variant of that) if they knew the real me.” ATTACHMENT VS AUTHENTICITY What we need to know: If we are going to build real, authentic, and positive relationships, we have to allow others to see the “real” us. This means coming into an inclusive relationship with ourselves, including all of our perceived faults, flaws, and shortcomings. This means making peace with our “shadow” self– all of the things we we tend to hide out of fear of being judged and perceived as ”not good enough,” “weak,” “incapable,” “undeserving” and all the other conditions that were placed around our worth. We were all told that it was good to be certain ways and bad to be others; for many of us, our experience of love, belonging, and acceptance was directly linked to conforming to these conditions Everyone has repressed certain parts of themselves, out of fear of not being accepted. Our shadow side holds failure, doubt, regret, and insecurity and the shadow is part of every person’s life. Yet we tend to present a “social mask” self to the world and hide whatever we fear may not be accepted. We pretend like it doesn’t exist, and fear the discovery that it does. This is an adaptive reaction to the authenticity vs attachment dilemma that most of us have experienced in childhood, and we continue to perpetuate it as our ego/personality “protects” us through our adult encounters. As we practice the skills that allow us to hold space with others, we will practice bringing awareness to our own patterns of vulnerability and communication. In the role of ND, we are asking patients to step into a vulnerable position and to share their stories and experiences with us. Done well and with a safe, regulated relational container, this enhances authentic connection. Done poorly will drive all of the negative belief systems about self and other. In our class time together, we will continue to work with our own vulnerability and our personal experience of being in connection. INVITING AWARENESS AROUND DISCLOSURE Carl Rogers [1, 2] suggested that loneliness can be alleviated when one feels understood, accepted, and cared about. This is the same foundation we want to create with our patients- one of acceptance, care, and understanding. However, to experience this sort of intimate connection, one must be willing to expose one’s true feelings, insecurities, and needs. How can another person understand us if we refrain from sharing what we truly feel? How can we feel fully accepted if we pretend we make no mistakes? How can others take care of us if we are too afraid to share our needs? This sort of disclosure can bring up old emotions and patterns of protection. We need to be able to acknowledge this when it arises and met it with compassionate attention. Disclosure involves sharing information about ourselves with others. The information you might choose to share includes your innermost experience: thoughts, emotions, stories about yourself or your life, dreams, goals, failures, successes, and fears. Disclosure is not about telling everyone every little thing about yourself. It is about choosing what you want to share and then sharing appropriate information with the right people. You can be open to others through self-disclosure and still keep a sense of privacy. In fact, this is can be an important boundary. Some people find disclosure more difficult than others. Sharing personal information can make us feel exposed and vulnerable. However, vulnerability is not necessarily a bad thing, nor is it a sign of weakness. It takes a lot of strength and courage to share something about yourself. Vulnerability is a powerful way to create new connections and build more meaningful relationships. Allowing yourself to be vulnerable creates a sense of closeness with others, helps build intimate and trustful relationships, and encourages others to be open and honest in return. Safely held, an expression of vulnerability leads to a more authentic experience of self and a more meaningful connection with others. FYI: RESEARCH NOTES Evidence for the link between vulnerability and positive relationships comes from the research on selfdisclosure. Self-disclosure is linked to increased intimacy , where self-disclosure of emotion is a better predictor of intimacy compared to self-disclosure of fact. People who are more willing to express negative emotions tend to have more friends and form more relationships compared to those who are less willing to share these feelings. Self-disclosure of personal vulnerabilities has also been associated with support. Shimano revealed that when spouses examined messages from their mates, messages that included disclosures of vulnerabilities prompted more supportive responses compared to messages lacking this content (see also ). Further support for the link between vulnerability and support comes from research by Graham, Huang, Clark, and Helgeson. In the first of a series of studies, participants were asked to read a series of vignettes in which another person was anxious and either chose to share this information or not. Participants reported they would provide more help when the person chose to express this feeling. In Study 2, participants who believed a confederate was in an anxiety-provoking situation helped her more when she expressed that she was nervous. In sum, these findings support the view that the courage to be vulnerable is an important ingredient in the formation of positive relationships. References Clark, M.S., Ouellette, R., Powell, M.C., & Milberg, S. (1987). Recipient’s mood, relationship type, and helping. Journal of Personality and Social Psychology, 53, 94-103. Collins, N. L., & Miller, L. C. (1994). Self-disclosure and liking: A meta-analytic review. Psychological Bulletin, 116, 457-475. Graham, S. M., Huang, J., Clark, M. S., & Helgeson, V. (2008). The positives of negative emotion: Willingness to express negative emotions promotes relationships. Personality and Social Psychology Bulletn, 34, 394-406. Laurenceau, J.-P., Barre , L. F., & Pietromonaco, P. R. (1998). Intimacy as an interpersonal process: The importance of self-disclosure, partner disclosure, and perceived partner responsiveness in interpersonal exchanges. Journal of Personality and Social Psychology, 74, 1238-1251. Rogers, C. (1951). Client-centered therapy: Its current practice, implications, and theory. Constable. Rogers, C. R. (1961). On Becoming a person: A psychotherapist’s view of psychotherapy. Houghton Mi in. Shimano , S. B. (1987). Types of emotonal disclosures and request compliance between spouses. Communication Monographs, 54, 85-100. (Adapted from: Connecting with Others by Self-Disclosure, by Dr. Hugo Alberts and Elaine Houston. 2021 by Positive Psychology. Authors give permission for free use within educational settings.) PRACTICAL WEEK 14 Today’s Agenda: Meet with your TA group 30 min: Grounding Check-in 30 min: Demo/ experiential process/ debrief and discussion 20 min: Closing the space Self reflection and closure THANK YOU FOR YOUR PRESENCE IN OUR TIME TOGETHER. BE WELL. “Isn't this the purpose of education, to learn the nature of your own gifts and how to use them for good in the world?”