• Fresh Views

    Doing things differently: Using solution focused questions to build a therapeutic alliance

    Tami’s photos from the Chihuly glass sculptures exhibit at the Biltmore Estate in Asheville, NC. She did things differently by not only viewing the exhibit in the daylight, but also after dark, and got an entirely different perspective.

    Doing things differently leads to something exceptional. – Anonymous

    We’re just returning home from the fantastic #AADE19 Annual Meeting and look forward to sharing some new information next week. Today enjoy an encore post from this past march where we discussed the concept of a Therapeutic Alliance!

    The strength in a therapeutic alliance

    As you may know, we strongly believe in the concept of a “therapeutic alliance” (which you may also know as the “helping alliance” or the “working alliance”). This alliance refers to the relationship between a healthcare professional and the person with diabetes by which they engage with each other to bring about beneficial change for that person with diabetes. This relationship is a most important component.

    The power of language

    It’s near to impossible to create those connections and build that alliance without focusing on language. Language and word choice is one of the most powerful choices we have. Words can demonstrate respect, empowerment and support or words can shame and blame. Respecting the expertise and experience of the person living with diabetes is essential to develop a strong therapeutic alliance.

    Focusing on solutions, not problems

    You also probably know that we are using solutions focused brief therapy (SFBT) and coaching in our work. SFBT is a questioning approach with conversation focusing on the client’s vision and how he/she identifies potential solutions. The questions asked during the interaction focus on a desired future state, and on what is already working well for that individual in the present. We acknowledge that the client has all the skills necessary to achieve their goals. As we mentioned last week, our goal, through incorporating principles of SFBT and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.

    10 questions practitioners can use to build a therapeutic alliance

    If you are a healthcare practitioner, we want to share 10 questions that you might find useful when engaging in discussions with patients or clients to acknowledge and build the therapeutic alliance. These questions reinforce the human side of both parties. They demonstrate that you care about the person sitting with you and that the relationship between you is important. Moreso, the word choices and body language during the interaction can go a long way towards creating a relationship of mutual respect.

    1. Thank you for coming in. Tell me what’s been going on. What can I help you with today?
    2. What do you wish to achieve or learn by the end of this session so that you can say you’re glad that you were here?
    3. What is the best way for me to work with you? (For example, do you prefer talking on the phone or text messages?)
    4. So that I can learn more about you, what do you consider your assets and strengths?
    5. Is there anything else you’d like to share that I should know?
    6. When you are at your best, what does that look like? How is that different from the way things are now?
    7. How can you do more of what is making things go well?
    8. If we created a plan, what would you consider a start to your being on the right track? And what else?
    9. What can you take from this session that can help you in the coming weeks?
    10. What will you be doing differently after the visit?

    Here are 3 additional questions that can be used to glean insight and feedback on the interaction:

    1. What feedback would you like to give me about today’s session?
    2. On a scale of 0-10, to what extent did you feel heard, understood, and respected during this session? 0 being you did not feel heard, understood or respected at all.
    3. On a scale of 0-10, to what extent did we talk about and work on the things that are important to you during this session? 0 being not at all.

    If you try incorporating some of these questions, we’d love to hear from you about your experiences and if you felt differently during your client visits. We leave you with 3 things to consider:  

    • Do you feel more present and “conscious” during the visit?
    • Do you feel like a “human” first and a practitioner second?
    • Do you notice that your clients are achieving their goals, and most importantly, are they feeling more confident in their ability to live well while managing diabetes?

    Subscribe to our blog and we’ll email you when a new post is published!

    Follow us on Twitter and Instagram @AFreshPOVforYou.

    Disclaimer: A Fresh POV for You is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.

  • Fresh Views

    November 27, 1996, 7:10 AM

    While our A Fresh POV for You blog only began in November of 2018, Deb has been blogging about travel adventures and experiences for some time. She wanted to share a story, along with some special travel blog posts from the past, today, on this special day for their family.

    Adoption Day, June 19, 1997 Yangzhou, Jiangsu, China

    Today, June 19th, is the adoption day of Deb’s amazing and talented daughter, Diana. Diana was adopted when she was 6 months old from Yangzhou, Jiangsu, China and for the first 21 years, they celebrated adoption day with a small gift, one from today along with a cherished gift they bought in China.  They brought home 21 gifts, one for each year. Some were simple, like a stuffed panda, and some were more meaningful, including pearls for her 16th birthday (matching pears like the ones Deb is wearing in the photo above). Now that Diana is 22 and there are no more gifts from China, Deb remembered the biggest gift of all, and wanted to share the story today on this very special day.

    Here’s a little bit of Deb’s story and links to 2 previous travel blog posts.

    As with many children adopted from China we don’t have any information about Diana’s life before she entered the orphanage, and simple things we all take for granted, like knowing the time and date of your birth are not always known.  We knew the date of Diana’s birthday, but were never certain it was accurate, but it really didn’t matter, it was her birthday. (And interestingly the same birthday as my dad and step mother, but my dad passed away before we adopted Diana).

    When Diana was in grade school she had a project that required her to enter the time of the day she was born.  It was hard to tell her that I didn’t know. So we looked at the clock (We lived in Chicago on Central time) and it was 9:10 am, so I said, “Let’s just say you were born at 9:10 in the morning. No one else needs to know anything different.”  So, life went on. We moved to California (now Pacific time, so two hours earlier) and we were fortunate to take a special trip back to the orphanage in China in 2009 with a group of moms and daughters that we originally traveled with to adopt Diana in 1997.  

    Four of the mom’s and daughters, from our original 1997 trip, who returned to Yangzhou as part of a larger group trip.

    If you are interested in the whole, amazing, incredible trip you can read all of the blogging I did that week here.  I titled this particular blog, on Wednesday March 18, 2009, November 27, 1996, 7:10 am  because we found a miracle and a most amazing gift. You can read all of the details of that special day if you are interested, but the short story is this.  We found a “red note” while looking through Diana’s medical records. A mythical and elusive thing we heard other families talking about, often written by birth families, and attached to babies before being taken to the orphanage, since the Chinese Zodiac is an important concept in China and birth information is needed.

    We never knew Diana had a note. We were not told it came with her.  I immediately started crying, unsure of what it said and secretly hoping that November 27th was her real birthday.  And when they read to us that it indeed said November 27, 1996 AND 7:10 AM we were stunned, amazed and now really crying.  On that day in Chicago, when we looked at the clock it was 9:10 am BUT it was 7:10 am in California, where we live now. Surreal!

    Discovering the “Red Note” and learning Diana was born at 7:10 AM

    Unfortunately they would not let us take the note home. We were crushed, …..we cried, …..we begged, …..we pleaded and I think to get us to stop talking, they told us she could come back when she was 18 and get it.  So when she turned 18 I emailed and asked if she could have the note and they said no. When she turned 19, I asked again, and they said no. And Finally when she was 20 I asked again, and I told them how happy she was and how she was living her dreams at UCLA and marching in the band and loving life, and the only gift she really wanted was to have that one small piece of her past that connected her to her birth family in China and I didn’t understand why she couldn’t have it.  Finally, they relented, and said, “Okay, you can come and get it!” That was one of the happiest emails of my life. We were already planning a holiday trip to Asia that December, so Mark, Diana and I left a few days earlier and went back to her orphanage to meet everyone there, and most importantly to get the note. You can read about our whole trip here.

    We also decided to retrace our trip that we made 20 years ago, remaking photos and having so much fun sharing that special time with Diana.

    All of our photo remakes. My favorite is Mark carrying Diana up the steps of Dr. Sun Yat Sen’s Mausoleum in Nanjing.

    How do I tie any of this to using solution focused methods?  Well we had a vision for the future that would not let us stop working towards our goal (getting that red note). We kept trying and used all the strengths we had and told a story, full of possibilities and opportunities, that finally moved someone enough to make things happen.  Sometimes life is messy and sometimes it’s hard and then, one day it happens to be really, really beautiful.

    The red note, still in the medical record
    Diana, Deb and Mark touring Yangzhou

    On this very special day, a day that changed our family’s life forever, I want to tell our daughter how much we love her and how proud we are of her and most importantly that our lives would be so less without her in it. Happy Adoption Day, Diana!

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  • Fresh Views

    Finding joy: In life and through diabetes education services



    Tami and Deb “finding joy” in Glencoe, Scotland a couple of years ago

    Joy is strength. – Mother Teresa

    Today is the 1st day of spring! The sun, warmer weather, and flowers in bloom definitely sparks joy for us. On the topic of “sparking joy”, @AFreshPOVforYOU had the opportunity to moderate the #DSMA Twitter Chat last Wednesday 3/13/19. We had a great discussion that delved into finding joy in life, as well as in diabetes education. (We’d like to hear your thoughts too! If you’re willing to share, click the link to a survey here or at the end of this blog).

    This topic of sparking or finding joy, was inspired by @MarieKondo and her Netflix show about her KonMari method. Are you familiar with her and her wildly popular method of organizing, the KonMari method? Basically, it consists of gathering together one’s belongings, one category at a time, and then keeping only those things that “spark joy”. If they don’t spark joy, then you thank them, and let go of them. (The KonMari method also inspired us to get an early start on spring cleaning!)  Maybe you’re not into organizing, that’s okay. But this concept of what sparks joy…it got us thinking about how we could apply it to diabetes and explore how diabetes education may spark joy.

    During the chat, conversation began with what sparks joy for people in their own life, and then turned to when engaging with the diabetes online community (DOC). We asked participants to summarize in one word their experience with the DOC. Here are some of the words people shared: unifying, heartening,  inspiring, awesome, knowledge, enlightening, meaningful, village and yes, joyful!  

    So how can those same words be used to describe engaging diabetes education services?

    We discussed the concept of co-design and wanted to learn if people with diabetes designed a diabetes education program or service, what would they include and how would they design it?  And ideally, what would spark joy for them when participating in a service or program? We heard some really interesting ideas that resonated with the solutions focused approach we are incorporating in our services.  

    Here are some of the thoughts and suggestions:

    • Diabetes is more about the person, than the numbers and gadgets!
    • Experienced people with diabetes (PWD)  teaching newbies
    • Personalized, person centered, there is no “right way” or “one way” to do anything.  Let people choose from a variety of options.
    • Several mentioned meeting people where they are, focusing on strengths, and not worrying about getting “straight A’s”, but realizing everyone is unique
    • Use of technology
    • Self-advocacy
    • Focus on emotional health and goal setting
    • PWD telling their stories
    • Stronger connection to others with diabetes, Interacting with others who have diabetes
    • Be community-based
    • Incorporate personality questions
    • We were really inspired by the amazing @KellyRawlings who thought that “joy” should be one of the AADE7 self-care behaviors for managing diabetes!

    We observed an overwhelming commonality of people wanting or needing to connect more with other PWD as they are learning about living with diabetes. As we closed out the chat, we challenged participants to do something every day that sparks joy in life!  So today, that is our challenge to you too. Do something for yourself, or for others that sparks joy! And if it helps you, track your experiences and feelings in a gratitude journal.

    Thank you to @DiabetesSocMed and Cherise for allowing us to moderate the chat and engage in a fast and fun chat, it really sparked joy for us!

    Would you like to help us learn more about what would make an ideal diabetes education experience?

    At A Fresh POV for you, our goal is to co-design innovative diabetes education services. If you or someone you know has type 2 diabetes or prediabetes and would be interested in participating in a focus group about co-designing education, please complete this survey which will take less than 5 minutes.

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  • Fresh Views

    Going off the beaten path


    From our off the beaten path adventure to  Ireland’s rugged West Coast

    Life throws challenges and every challenge comes with rainbows and lights to conquer it. –  Amit Ray

    With St. Patrick’s Day a few days away, memories of a trip we took to Ireland 4 years ago come flooding back into our minds. We and our husbands, along with two other couples, each of us from a different part of the US, convened for what became a trip of a lifetime.

    While the trip began in Dublin, the real adventure started when we got off the beaten path. When we got away from touristy spots, outside our comfort zone, and took a cross country road trip to the Western rugged coast of Ireland. The picture you see above with the rainbow was taken from the back yard as we were “imprinting” and savoring our last view at the end of the trip. This trip truly turned out to be our proverbial pot of gold at the end of the rainbow.  On this journey not only did we see magnificent castles, abbeys, history galore, sheep galore, glorious green like we’ve never seen, and breathtaking views, we laughed A LOT. We strengthened friendships, we made new lifelong friends in Ireland, but most importantly we learned that when you go off the beaten path (so to speak), good things can happen. You get a different view. You gain a different perspective. You get a different experience. (And yes these experiences are in our gratitude journals and brought us great joy! If you’ve been reading our blogs you’ll know how we embrace expressing gratitude and finding joy in life).

    The majesty of the Cliffs of Moher, County Clare, Ireland

    Reflecting and bringing these experiences back to our practices leads us to ask: What if you went off the beaten path so to speak, and rather than focusing on the things in life when managing diabetes that are NOT going the way you want, instead, focus on the things that ARE going well? In our experience, so often we see that healthcare professionals and those living with diabetes alike, fixate on things that are not as desired – whether its an out of range blood glucose, a high A1C, or frequent hypoglycemia. That can leave you burnt out, and frankly beat down. What if instead you get a whole different experience by taking the road less traveled? Focusing on what you are doing well and how you can achieve or do that more.

    This next week we challenge you (whether you live with diabetes or not) to identify at least 1 thing that’s gone well. Is it possible to repeat what you did to lead to more “positive” experiences and days?

    In closing, returning to the our Irish adventure. The four couples deeply bonded on this trip. We valued the time spent together. It  made us realize we wanted to spend more time together over similar shared experiences. So, we are in fact planning another “off the beaten path” adventure across the South of France this summer. Adventuring through life experiences worked for us. It brings us joy. So we are going to do it again. We are sure to have some new perspectives, new learnings and beautiful views to share with you!

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  • Fresh Views

    Doing things differently: Using solution focused questions to build a therapeutic alliance


    Tami’s photos from the Chihuly glass sculptures exhibit at the Biltmore Estate in Asheville, NC. She did things differently by not only viewing the exhibit in the daylight, but also after dark, and got an entirely different perspective.

    Doing things differently leads to something exceptional. – Anonymous

    Our blog last week focused on being a human first.  There was so much information in that one blog post that we decided to highlight and reinforce a few concepts today. So here we go!

    The strength in a therapeutic alliance

    As you may know, we strongly believe in the concept of a “therapeutic alliance” (which you may also know as the “helping alliance” or the “working alliance”). This alliance refers to the relationship between a healthcare professional and the person with diabetes by which they engage with each other to bring about beneficial change for that person with diabetes. This relationship is a most important component.

    The power of language

    It’s near to impossible to create those connections and build that alliance without focusing on language. Language and word choice is one of the most powerful choices we have. Words can demonstrate respect, empowerment and support or words can shame and blame. Respecting the expertise and experience of the person living with diabetes is essential to develop a strong therapeutic alliance.

    Focusing on solutions, not problems

    You also probably know that we are using solutions focused brief therapy (SFBT) and coaching in our work. SFBT is a questioning approach with conversation focusing on the client’s vision and how he/she identifies potential solutions. The questions asked during the interaction focus on a desired future state, and on what is already working well for that individual in the present. We acknowledge that the client has all the skills necessary to achieve their goals. As we mentioned last week, our goal, through incorporating principles of SFBT and coaching in diabetes care and education, is to change the conversation, the interaction and the experience of the diabetes community to improve health.

    10 questions practitioners can use to build a therapeutic alliance

    If you are a healthcare practitioner, we want to share 10 questions that you might find useful when engaging in discussions with patients or clients to acknowledge and build the therapeutic alliance. These questions reinforce the human side of both parties. They demonstrate that you care about the person sitting with you and that the relationship between you is important. Moreso, the word choices and body language during the interaction can go a long way towards creating a relationship of mutual respect.

    1. Thank you for coming in. Tell me what’s been going on. What can I help you with today?
    2. What do you wish to achieve or learn by the end of this session so that you can say you’re glad that you were here?
    3. What is the best way for me to work with you? (For example, do you prefer talking on the phone or text messages?)
    4. So that I can learn more about you, what do you consider your assets and strengths?
    5. Is there anything else you’d like to share that I should know?
    6. When you are at your best, what does that look like? How is that different from the way things are now?
    7. How can you do more of what is making things go well?
    8. If we created a plan, what would you consider a start to your being on the right track? And what else?
    9. What can you take from this session that can help you in the coming weeks?
    10. What will you be doing differently after this visit?

    Here are 3 additional questions that can be used to glean insight and feedback on the interaction:

    1. What feedback would you like to give me about today’s session?
    2. On a scale of 0-10, to what extent did you feel heard, understood, and respected during this session? 0 being you did not feel heard, understood or respected at all.
    3. On a scale of 0-10, to what extent did we talk about and work on the things that are important to you during this session? 0 being not at all.

    If you try incorporating some of these questions, we’d love to hear from you about your experiences and if you felt differently during your client visits. We leave you with 3 things to consider:  

    • Do you feel more present and “conscious” during the visit?
    • Do you feel like a “human” first and a practitioner second?
    • Do you notice that your clients are achieving their goals, and most importantly, are they feeling more confident in their ability to live well while managing their diabetes?

    Subscribe to our blog and we’ll email you when a new post is published!

    Follow us on Twitter and Instagram @AFreshPOVforYou.