Relationship Health

Are you in a committed relationship wanting to enhance the health of your relationship?

Denice has recently become a certified PREPARE/ENRICH facilitator. PREPARE/ENRICH is an evidence-based program focused on creating and sustaining healthy relationships. It utilizes a personal assessment providing feedback on a number of aspects that influence relationship health.

The PREPARE program focuses on helping engaged couples build a strong foundation for marriage by providing insight on personality, relationship dynamics, and planning for various life cycle stages committed couples generally navigate together. The ENRICH program is a type of relationship “check up” geared toward strengthening commitment and communication. Both PREPARE and ENRICH focus on relationship strengths and areas of growth.

The PREPARE/ENRICH program may be conducted in a workshop format with follow-up couple counseling sessions, or if a workshop is not available, or there is a scheduling conflict, couples may opt to engage in personalized counseling sessions from the start.

For more information or to schedule your first couples session call 404-895-1525 or email Denice@walkandtalkatlanta.com

 

Exercising gratitude

Its that time of year where we in the US start focusing on being thankful in preparation for Thanksgiving. I see many people post their daily November updates on something for which they are grateful and as a walk-and-talk therapist here in Georgia I am thankful for the cooler temperatures and the colors of the changing leaves. Claiming something daily for which we are thankful during the month of November is a wonderful practice; however, gratitude is something on which we should not just save focus for a single month a year.

Why, you ask? Because exercising gratitude has multiple health benefits! Yes! According to Harvard Health it can help improve mood including improving overall happiness and reducing depression. It can also help individuals overcome adversity, as well as helping improve physical health.

One recommendation I frequently give my clients is creating a gratitude journal where they record items from their daily lives for which they are grateful, or at the very least start and end each day being mindful of a few things for which they are thankful. Sometimes, in the midst of their current circumstances this can be difficult. And sometimes it requires some creativity to reframe their circumstances to find some positive. This is one of the beauties of exercising gratitude. It helps us create new neural pathways to notice the positive rather than settle on our automatic negative bias.

So in this season of thanks keep on documenting the things for which you’re thankful…and maybe try to carry that forward into the New Year!!!

Two steps forward or three steps back? Sometimes both!

Therapy can be messy. Although it is designed to help people feel better, think more clearly, and act with more purpose, sometimes through the process of therapy, especially in the early stages things can get worse before they get better…especially when there is more than one person involved. And there is ALWAYS more than one person involved. How so?

Clients, even individual clients, bring all of their systems into therapy. They bring their family, their friends, their social support network, their work relationships, and even their enemies into therapy with them. The events of their lives and their interactions with others over the course of a lifetime, combined with their unique personality serve to shape the lens through which they view their circumstances both good and bad. The same can be said about all those with whom they interact. We all have our personal lens. We all have our personal morals, truths, and sense of right versus wrong. For some these are very black and white. For others everything hangs in an atmosphere of various shades of gray. And inevitably the intersection of our very different lenses can be a potential source of stress/distress.

Therapy serves as a safe place to examine this stress and these systems…a place to make sense of the past, the present, and to help shape a plan for the future with the understanding that nothing is certain.

And although for some a single therapy session can serve as a “quick fix” for most that is not the case. In addition, clients often experience a period, or periods, of things being worse before they get better. Why?

On reason why is that what most people believe to be the overall issue is merely just the tip of the iceberg. Therapy helps people see beneath the surface, or to peel back layers to see what else may be going on underneath. The presenting issue may merely be a symptom of something that goes much deeper.

Another reason why is all those other people/systems I mentioned earlier. When someone enters therapy and begins to change himself or herself inevitably they also begin to change aspects of each of their systems. For example, when someone starts learning to speak up for themselves their interactions change. This is uncomfortable for others who are used to relating in a specific way. Change in one person necessarily incites the need for change in another. Yet systems seek to maintain homeostasis. What does this mean? This means the rest of the system puts pressure on the part that is trying to change to stop and stay the same, to go back to the original way of relating.

When a person in therapy begins to unearth patterns of living, working, doing, feeling, thinking, and behaving that no longer serve them well and starts implementing new patterns it has the potential to disrupt all his/her systems. This is where things can get messy and can be a critical point of therapy: people often decide its too painful to continue and stop therapy, or this is where they experience a breakthrough.

Unlike other professions where a trained expert comes in and repairs something and makes it “good as new” therapy is a collaborative effort that requires teamwork between therapist and client. The client has to be willing to roll up his/her sleeves and do some work themselves. This may mean greater personal discomfort at least for a while, and probably some discomfort for others. It can mean taking three steps backwards before being able to make any progress forwards. It can feel like trudging through mud. But, any movement is better than being stuck. Even temporary backward movement is progress.

Good therapists/counselors will let their clients know that although they seek to incorporate the latest, evidence-based theories and practices therapy is imperfect; they are not able to make guarantees. However, the person willing to engage in therapy is much more likely to experience a change than those unwilling to do so. At the very least, anyone willing to engage will gain a greater understanding of why their systems function they way they do. At that point they have the choice of accepting things the way they are or moving forward with their own change.

Rx: More exercise

Physicians should be prescribing exercise but they don’t (click here to read more). Many of them also do not know how to have conversations surrounding those behaviors that their patients should or should not be doing that “accounts for 50 percent of our overall health.”

This is MY specialty! I am trained to have these conversations and we can have the conversation over a walk in the park! Give me a call and we can take the first step toward overall health and well-being sooner rather than later! 404-895-1525 or email me at Denice@WalkAndTalkAtlanta.com.

 

What is your motivation?

All this talk about change: stages of change, processes of change, change talk…

How does a person step into and make lasting change? By tapping into what motivates them.

Remember I asked about the thing you had considered changing but had not yet done so. How long have you thought about it? Where are you in terms of stage of change? What kind of language do you use when you think and talk about this change? Are you still ambivalent, preparing, or have you moved into mobilization?

motivation

When I have conversations about behavior change with my clients, particularly related to health behaviors, there are lots of questions I ask them to help them think more about what their motivations to change are such as, “What would be the most important reason to make this change?”

Oftentimes other people asking us to make a change impose their agenda upon us. For example, a physician might tell us to eat healthier and get more exercise so we can lower our cholesterol and control our blood sugar. Those are legitimate reasons to do so and yet so many people do not follow through. Why? Because the doctor’s reasons for making the change do not align with our reasons. A discussion about changing behaviors related to health that might have more impact would be to get the person talking about their goals, values, and dreams related to life and health. My mom wants to live to be at least 100. I hope to one day have grandchildren and I want to be active and healthy so I can run around and play with them. Someone else may want to travel and see the world. Different people have different reasons for making the same change. Some examples of questions that might uncover these reasons are as follows:

• What things are you struggling to do currently but wishes you could do because you have not made the change?
• How would life be better five years down the road if you make this change?
• What will life look like in five years if you don’t make this change?
• What are the three best reasons to do this?

Another approach is to have the individual talk about past successes in making change and how to overcome any barriers to making the change right now.

• How have you made other changes in your life in the past?
• What things have you done in the past toward making this change and how were you successful?
• What things stand in the way of doing this and how might you overcome them?

In keeping in mind the stages of change, it is often necessary to consider preparation. Remember change is a process and some changes require much more preparation and take longer to make. I don’t just decide today that I want to lose 20 pounds and wake up tomorrow morning 20 pounds lighter! Lots of preparation takes place in the form of changes in diet, increases in physical activity, and even then progress is slow.

I learned a while back that even skilled hikers whom have prepared extensively to climb Mt. Everest still have quite the journey ahead of them once they arrive in Nepal at the foot of the mountain. They don’t arrive and immediately climb straight to the top. They spend weeks on the mountain often taking daily jaunts going back and forth but not really making any progress up. Why? To acclimate themselves to the altitude and harsh environment. Progress requires preparation and that may take many shapes and forms. Someone seeking to become healthier may need some time to acclimate to the changes. They may need a support system to guide them along the way.

• What kind of support system do you need in place to make this change? How can you make that happen?
• What would have to happen in order for you to do this?

Something else to consider is what one person is willing and able to do may be very different than what others are willing and able to do. I used to work for a primary care medical residency. Our medical residents, fresh out of medical school were eager to impart their knowledge to their patients and they were more than ready to let all their patients know about the importance of eating healthier and getting more exercise. Makes perfect sense! However, upon arrival to their new training assignment our residents were taken on a community “ride along” and what they discovered was that there were some very real challenges to this poor community regarding diet and exercise. The area was what was known as a food desert. There were limited grocery stores with fresh fruits and vegetables and these were not centrally located. Many of the community members did not have reliable transportation if they had transportation at all. They often relied on public transportation and that makes grocery shopping difficult. On the other hand, convenience stores, fast food, and liquor stores lined every corner and were within walking distance making unhealthy eating very convenient. As for exercise, much of the area lacked sidewalks for safe walking or bike riding, and many people feared walking in their neighborhoods because of crime. While there were some parks, even these were not always safe, nor were they located close to some of our patients’ neighborhoods. If these individuals were going to eat healthy and exercise it was going to require a lot of preparation and some creativity on their part to make it happen. Our residents learned it wasn’t enough to tell their patients, “You need to…” They came to understand there were some very real barriers to engaging in healthy habits.

Finally, when someone agrees it is time to make a change and they have expressed willingness to do so, rather than jump to outlining sour own plan for them one of the very best questions to ask is , “So what, then, is your first step?” Remember, whose idea is the best idea? The person making the change! So if they’re going to make the change, ask them how they plan to do it! You might be surprised. It might not be how you would approach it, but if it works for them, let them run with it. And they will find out soon enough whether it’s going to work. And if not, it’s not failure, it’s just a lesson learned about what not to do!

These questions are just scratching the surface of how a change conversation might occur with me in a client session. In fact, we would explore some of these questions in much greater depth over time depending on how serious the issue is. Sometimes, particularly depending on the stage of change the individual is in, the conversation might be short and sweet. The person may have just needed to speak the decision out loud and have someone hold him/her accountable. And sometimes people need to uncover the underlying issues that prevent them from moving forward and these can be varied and complex.

The goal of change conversations is to uncover the discrepancy between where someone wants to be versus where they are now and highlight that discrepancy. Back to my running example: On the one hand, I say I want to run faster, run stronger, and fit back into my size six skirts, yet on the other hand I don’t run as often as I should. Why do I not do what I say I want to do? I know what has worked for me in the past and that is a good support system, running partners, and/or some type of competition or accountability. I am currently lacking those things. In order for me to step into that change I would need to figure out how to incorporate those things where I am now in life.

So before being critical of yourself or others for not moving forward in a change, take a moment to step back and consider that different people have different reasons for making changes, even similar changes. Also, different people have different motivations, different goals, dreams, and values. Real change has to tap into what is most important to the individual and aligns with what that person feels he/she is willing and able to do.

Are you thinking about a change you would like to make? Would you like for me to facilitate that conversation? Schedule your walk-and-talk session with me today. You can reach me at 404-895-1525 or Denice@WalkAndTalkAtlanta.com. I also have office appointments or online sessions (for Georgia residents).

Whose time? Mine or yours?

time for change

What is one sure fire way to predict behavior change (besides evidence of the change actually taking place)?

If we regularly engage with people regarding behavior change, how do we recognize whether others are ready for change?

By listening to what they are telling us.

Yesterday morning my husband was kissing me goodbye as he headed off to work. He knew I was going to visit with a colleague/friend whom I had not seen in a while later in the day. As he kissed me goodbye he said, “Give (him) my best,” but in my half-asleep/half-awake state I heard, “Give (him) a lead vest!” WHAT???? Clearly I wasn’t listening!

What specifically are we listening for with regard to behavior change?

Miller and Rollnick (2013) tell us we should be listening for change talk!

But what is change talk?

Change talk is exactly what it sounds like. It is talk about making a change; however, there are two types of change talk and one is more predictive of actual change than the other.

First there is preparatory change talk followed by mobilizing change talk. Let’s examine the differences:

Preparatory change talk occurs when people are starting to think about change while they are in the earlier phases of the stages of change we discussed earlier. Basically, preparatory change talk occurs during the ambivalence period up until real change actually takes place.

And I promised yesterday to talk about DARN-CATs. Let’s start with DARN!

D is for DESIRE: I want to make a change. I wish I could make a change. Life would be better if I made this change.

A is for ABILITY: I know I can make this change. I can do this. I have made similar changes in the past.

R is for REASON: I would feel better if I made this change. I would be better off.

N is for NEED: I need to do something different or I’m going to be in real trouble.

Anytime someone expressed desire, ability, reason, or need they are expressing preparatory change talk. There is understanding and a willingness to make the necessary change but the actual change has not taken place yet. This type of change talk often occurs in the precontemplative and sometimes the preparatory stages of change.

Mobilizing change talk is recognized by the acronym CATs:

Commitment: I am going to do this! I am going to make this change.

Activation: I am ready and preparing to make this change.

Taking steps: I followed through and did the following things this week toward my change goals.

These three types of change talk occur when people have fully moved onto the preparatory and into the action and maintenance stages of change and are most predictive of actual change occurring.

So back to my running example. These are some statements I might make about running according to each type of change talk:

Desire: I want to run more. I wish I had time to run more. I wish I ran faster. I wish I felt like running more. I wish it wasn’t so hot outside. I want to be able to wear those size six skirts in my closet. I don’t want to have to get rid of those size six skirts!

Ability: I have run many more miles per week in the past. I used to be a faster runner. I have run two marathons, including the Walt Disney World Dopey Challenge in the past. I have scheduled my runs better in the past.

Reason: I feel better when I run regularly. I sleep better at night on days I go for a run. My stress level is lower when I run. I don’t snap at my family members nearly as much when I regularly exercise.

Need: I need to get a handle on my weight because diabetes runs in my family. I need to lose some weight.

Commitment: I am going to start running more regularly.

Activation: I have scheduled my runs in my calendar. I have laid out my running clothes for a run tomorrow morning.

Taking steps: I laced up my shoes and went for a run this morning.

See how these statements fit into each category?

So think back to the change I asked you about earlier, then think forward to the stages of change. What types of statements do you find yourself making about that behavior change? Where do you find yourself? Are you still in ambivalence/preparatory mode or have you moved to mobilization?

Later we’ll talk about listening—for change talk, and listening in general.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.