Skills in Health Motivation | Continued Professional Development

Raising the issue

Posted on June 4 2019 by Garrath Ford

I am often struck by practitioners voicing their lack of skills and confidence in supporting clients to change their health behaviours. The greatest concern is often given to how to ‘raise the issue’, for example, weight management.

This is one area where Solution Focused Health Improvement is radically different!

Any talk of ‘raising the issue’ reveals a problem-focused approach. Such traditional methods are still interested in forwarding the agenda of health services. What is important to health professionals is imposed on individuals and gets talked about or ‘raised’.

To those professionals not yet familiar with Solution Focused Health Improvement, it may come as a surprise that in over 10 years of clinical practice, I have never found the need to ‘raise’ the problem issue with anyone.

Recently, I was working with someone who’s best hopes were ‘to get my internal drive and optimism back’. As we explored his preferred future various desired changes in his health behaviours were expressed, including: eating a healthy breakfast, taking breaks from work, exercising, refraining from risky sexual behaviour and reducing alcohol consumption.

When we ask about what clients’ want, raising the issue simply becomes redundant.

Try it and you will see that individuals’ themselves raise all their own issues (and solutions)!

Twist and shout

Posted on May 28 2019 by Garrath Ford

One of my weaknesses is being overly eager to shout about what is unique about solution-focused work and failing to acknowledge what there is in common with other approaches.

I know when I am doing this when I have course participants ask me -is it still okay to talk about problems? People are often surprised to hear in my answer that I spend most of my time in solution-focused work talking with clients about problems!

You will have probably recognised yourself that when clients are attempting to describe their best hopes and preferred future, they often make reference to their problems.

We can have one foot in the problem but we want our hips going in the other direction!

We acknowledge problems but as always add in a solution-focused twist. This acknowledgement is especially important when discussing emotions. We are careful to give clients permission to experience their emotions and view them as a resource. For example:

How will you know when you are being angry in the right ways? or
How will you notice when you are arguing with your husband in the right ways?

Solution-focused health improvement encourages us not to chase problems but to maximise our input towards solutions. We can rest assured that the problems will find us and when they do we can simply utilise them for firming up the preferred future.

How will you notice when you are responding to problems with a twist? And don’t forget your hips!

Ready, Steady … Bananas!

Posted on May 21 2019 by Garrath Ford

The concept of ‘readiness to change’ is central to traditional health behaviour change. It has long been suggested that individuals need to be ready to change.

So how come in Solution Focused work we do not choose to work with this theory?

I would suggest that readiness to change only becomes relevant when the professional is imposing a lifestyle change on to an individual e.g. weight management.

But what if we approached every individual with the idea that they want something from choosing to see us?

The banana skin in our work is getting in the individual’s way with what we want to talk about (and of course what we are really saying is ‘we know better than you!’).

Falling on our bottom is when patients don’t change and we explain away our failings by labelling them as ‘not ready to change’!

Let’s make it easier for clients and ask them what they would like to achieve from working with us?

What else?

Posted on May 14 2019 by Garrath Ford

Solution-focused health professionals are interested in details. More specifically, we are interested in the details we can only find out from our patients- their local knowledge/ wisdom.

It may be the fine details of their preferred futures or what they are already doing to help themselves.

One question which can help to elicit more and more information is ‘What else?’. I have found this simple little question immensely fruitful, especially when I get stuck and can’t think of anything else to say!

However, one lesson for caution struck me in the early years of my practice. In my enthusiasm and rush to be helpful, I noticed that asking ‘What else?’ could sometimes imply that I was dismissing a patient’s last answer.

Of course, this could be true of any question that doesn’t do a good enough job of pausing and validating patients’ responses. Over time, as we become more familiar with Solution Focused work, we are able to draw more and more on patients’ own language.

For example,

Professional: What’s better?

Patient: I have been feeling brighter these last few days.

Professional: How could you tell you were feeling brighter?

Patient: I don’t know, I just noticed I was feeling more myself.

Professional: What were you doing when you notice you were feeling more yourself?

Patient: I decided to take my wife a cup of tea in bed.

Professional: What made you decide to do that?

Patient: Well I want to start doing more again.

Professional: I see?.. and what else have you noticed that tells you, you are feeling brighter?

Like many of our questions, over time we use each of them less and less. We gradually increase our repertoire of Solution Focused questions and become braver to think up our own.

But if you’re starting off, asking ‘What else?’ is useful for getting the client and you into the flow.

You Matter

Posted on May 7 2019 by Garrath Ford

I once had a client who, as he was saying a final goodbye, mentioned he was going to buy himself a special lunch as a reward for all his progress. He then asked what I was going to do for myself for my involvement? I hadn’t even thought about it and was stuck for words!

The term self-care is often used in relation to patients’ activities towards protecting and improving their health. With good reasons, our managers, colleagues and we focus on improving services and patient care.

It’s what we do. But are we taking care of ourselves?

Our work is demanding and many of us are being asked to do more with less.

When everything is going right, nothing beats our work. But if for whatever reason we are not at our best or when challenges arise, working days can be hard and take their toll. Our resilience can become lowered and our motivation drained.

You are human too. Your health is important too.

Let’s look out for clues that we need to prioritise ourselves.

Let’s notice how we are being kind to ourselves and give ourselves credit for our efforts. Is your hope to start saying no, check in with friends more often or simply make a commitment to stop and eat lunch?

You know what it is. Start doing it or do more of it.

If a client asked you, would you have something to say?

Team Health Check

Posted on April 30 2019 by Garrath Ford

Many of my training course participants have the same complaint!

They ask: “Why don’t we have conversations like this in our workplace?”.

This is because within the first 10 minutes of my training they notice the radical difference between their usual way of talking and Solution Focused health promotion.

Try these Solution Focused questions at your next team meeting. They work great in pairs with one person asking the questions and the other answering. Swap over after a couple of minutes and move on to the next question.

How do our colleagues support you?

What does our team notice that you do well?

Why is our team right for you at this time?

How does being a part of our team help you contribute to others?

What would you be pleased to tell us about what you did well last week?

What is our team really good at?

What do you do well that your team haven’t noticed yet?

How do you show our manager that you appreciate them?

Remember to ask for feedback at the end but be ready for the complaints!

Solution-focused groups

Posted on April 23 2019 by Garrath Ford

The biggest lesson in my practice development came when visiting a solution-focused support group.

Individuals with long-term health conditions had come together to learn how to self manage and support each other. I had the privilege of seeing a physiotherapist deliver education and facilitate the group in a solution-focused way.

The session began by participants getting into pairs and interviewing each other on “what’s better since the last session?” I discovered that the members were not only improving their condition management but that they were well on their way to becoming highly skilled solution-focused practitioners!

My jaw dropped as I began listening to group members lead solution-focused conversations with one another. I remember thinking that these individuals were more skilled than myself ……and I was two years into my training!

I was in awe.

The group explained to me that ‘their’ group was a world apart from their past experiences of health services. The members were eager to tell me all about the solution-focused model and how it helps them inside and outside of the group.

My visit was extra special – they had shown me how to slow down, convey empathy and take a real and genuine interest in others!

Taking the lead

Posted on April 16 2019 by Garrath Ford

As people and professionals, we tend to do what we have always done. We get shown what to do and we focus on becoming good at it. We fit in.

This is okay- as long as we are satisfied with our outcomes and we are feeling like we are doing our best work.

A few people want to challenge the status quo and make things better. These special people see opportunities and are willing to experiment we new concepts and ways of working.

But there can be difficulties when we change and others don’t. This is when we are required to be leaders (of ourselves and ultimately others).

Being a leader is tough.

Who is supporting you? Who is on your team? Who is reminding you why you are leading?

Don’t be a drug dealer

Posted on March 19 2019 by Garrath Ford

We either trust our clients or we don’t. Simple.

Which one we choose says and means everything.

One communicates ‘you need my help’, ‘try this’, ‘I have the answer for you’, ‘I know what is best for you’, ‘my way is better than yours’, ‘you can’t do this without me’, ‘what you need is….’ etc

The other says ‘you have already got what it takes’.

Expert professionals don’t trust. They snatch responsibility away. Individuals are slowly rendered passive. Dependency is created and clients come back again and again for another hit.

We can still be professionals with expert knowledge but added to that we can trust that people are trying their best, do things for good reasons and know the way forward. Instead of pushing advice, we can ask questions.

In a world of drug dealers, clients will wonder why they are thriving in your presence.

Let’s promote independence.

Numbers talk!

Posted on March 12 2019 by Garrath Ford

Way back in the 1970’s it was first noted that clients spontaneously used numbers from 0-10 to convey their progress. Today, scales are a central feature to Solution Focused Health Improvement.

Numbers give ‘handles’ to our conversations. Abstract concepts- clients’ best hopes and perceptions can be tapped into and discussed in detail.

It can be helpful to spend approximately 80% of the time asking about which aspects of clients’ preferred futures are already in place?

“Why are you a 4 and not lower?”

“What is it that is telling you you’re at 4?”

“What do you know about the past, the present or the future that is telling you that you are at 4?”

“What else are you pleased to know, that is saying you are at 4?”

Then we can spend the rest of the time asking:

“Where would like to get to on the scale through our talking together?”

“Where will be good enough?”

“How will you know when you have moved up one point?”.

Through scales, clients discover what they are already doing to help themselves and how they will recognize more progress.

Numbers talk, they say: things can get better.