Strengths-based conversations: Skills for effective communication

[Introduction]

The Research in Practice for Adults Podcast, supporting evidence-informed practice with adults and families.

Kate: Hello and welcome to the first in a series of four podcasts where we will look at strengths-based conversations. In this first podcast, Tish Elliott, a registered social worker and practice educator will talk us through the theory and art of having strength-based conversations. We'll also hear a summary from Lyn Romeo.

[The rationale for strengths-based approaches]

Tish: I mean, the first thing to say about strengths-based working is that it's not new and it's certainly not new to social work. It's been central to practice for quite a few decades. Dennis Saleebey wrote his first edition of Strengths-based Perspectives in 1992 that was published, and his fifth edition is out, it just came out in 2009. I think there's since been a sixth edition that is a US (United States) version. And the strengths perspective offers a really useful alternative to the more traditional deficit and problem-oriented approaches that have been criticised for leaving people feeling like that I am the problem rather than I have a problem. It can be seen to pathologise people in that way, if all that we're doing is talking to people about their needs and what their issues are and what the problem is for them, rather than their capabilities and strengths and how people are surviving some difficult challenges. So that's the backdrop to strengths-based perspective.

Kate: So, why is it we're considering reintroducing or revisiting strength-based perspectives currently?

Tish: Well, certainly the Care Act (2014) recognises the importance of keeping people's wellbeing at the heart of the way that we work in adult social care. And it requires us, it requires local authorities to… and their partners, of course, to consider people's own strengths and capabilities. So what support might be available from the individual and their family and friends and their wider support network. So, only then thinking about what else other than the provision of care or support might help that person to achieve the outcomes that they want to achieve? And I think another useful context for it is the Social Institute for Excellence piece of work about identifying strengths. It says that we're aiming to discover what the person believes would constitute a good life for them and their family and how people can work together to achieve this, by looking at the individual's strengths, hobbies, abilities, abilities, wishes, their support network, their friends, family, neighbour and the needs and the challenges and the risks. And then that part of the conversation, the strengths-based conversation and the idea is that you focus on strengths, it doesn't mean that you're ignoring the risks but you're looking at how can you maximised the strengths and the assets or resources that people have around them to overcome the challenges and the risks.

[The art of having strengths-based conversations]

Kate: Fantastic, it sounds very good. And, so you've mentioned the theory and, kind of, where we are right now, what about the art of having strengths-based conversations?

Tish: Absolutely, and I think, in any social care approach, it's really important to focus then on how does that work in the reality of people's lives. And that's the art, it's about not being prescriptive and having conversations by rote or asking a series of questions one by one by one and ticking them off. It's very much about building relationships with the person that you are having the conversation with and finding a way that feels into when and how to ask the strengths-based conversations. So, Saleebey, Dennis Saleebey identifies seven strengths-based questions that can be helpful to use. But it's not about launching in to them asking these questions one by one, it's spending a lot of time really listening to the person and building that relationship. And as you're listening, you're listening out for anything, no matter how small, that might be one of the things that has helped that person to survive so far. And the person might be a carer of someone with care and support needs or it might be the person who has a care and support need. But what you're doing is having a conversation with someone where you're storing away in your mind anything that you hear that stands out to you as one of their core capabilities or strengths that's helped them to survive so far. So, I think one way of putting it that is helpful is someone called Graybeal wrote about the CPR approach, if you think about it in terms of health services, in CPR, you're helping someone to breathe until they are given medical treatment, which means that they can breathe again for themselves.

What Graybeal says is that the strengths, in the strengths perspective, we're giving people CPR in the sense that what you're doing is believing in someone until they can believe in themselves. And so, by exploring the strengths of the individual group or community, the C stands for you're exploring people's capacity, their courage, their character and their competencies. The P is for having a conversation about what their purpose and potential is. What sort of positive expectations do they have? Do they have a picture in their mind of how things would be if they were working at their very best? And the R stands for people's resilience, their resolve, their resources and their relationships. So you can keep that acronym in mind, is that what you're doing when you're having a strengths-based conversation is you're building a relationship with someone, you're actively listening to what their story is, what their life feels like to them and you're think all the time about when might you ask a strengths-based question that would help explore something that they have told you in the course of telling the story that would help you to explore their capabilities, their potential, their resilience, further taking that CPR approach.

Kate: In fact, Lyn Romeo, the chief social worker for England, in her round table report, summarises her view of what integrated strengths-based working looks like, which we feel brings together the theory and arts just discussed by Tish.

Lyn: So much of what we do in our profession is about enabling people to have the best possible lives. We are there to help them build on their strengths and focus on the things that work, to overcome the barriers preventing them reaching their full potential. Even in the most challenging and difficult of times, there are things we can do to give people strength and hope that things will get better. One of the ways we do that is by focusing on what matters to people, their talents, resources and their own unique perspective on life. People are experts in their own lives and, usually, the best solutions come from their own experiences with support from others. It's a deliberately empowering approach, supporting individuals and their families to be in control of life decisions, bolstered with the tools and support networks to succeed.

[Outro]

Kate: So, having set the scene for strengths-based social work practice with adults, join us next time when we'll be looking at how to find out more about an individual's strengths and their assets.

Voiceover: You've been listening to the Research in Practice for Adults Podcast and we hope you've enjoyed it. Why not share with your colleagues and share your thoughts on Twitter? Tweet us, @ripfa [please note @ripfa is not in use, please contact us @researchIP], thanks for listening.

[Introduction]

The Research and Practice for Adults podcast. Supporting evidence-informed practice with adults and families.

[Exploring strengths and assets]

Kate: Hello and welcome to the second in a series of podcasts on strength based working. Again, we're going to be joined by Tish Elliott, a registered Social Work and Practice Educator, and today we're going consider how to find out more about an individual's strengths and community assets. So, how do you find out more about strengths and assets?

Tish: That's a good question and it really depends on the person you're having a conversation with, is where I would start, is that you are working to find a way of asking that person what matters to them. What's important to them, rather than what their difficulties are or what services they need. So you're moving from that service led approach to having a conversation with someone about their lives and what's important to them, and talking in that way helps to move from focusing on whether or not somebody is eligible for services, to really listening to the detail of their lives. And whilst you're listening, you're listening out for anything at all that you think might be something that could be built on. So, that might be a personal strength of theirs. An example of things that are working for them and it could be things within their family, their local network of friends and contacts, or from their community, and in having that conversation you're tuning into that person's own language. So, everyday language. You're not using the, sort of, jargon phrases of, 'What are your assets?' and 'What are your strengths?' You're adapting the way you communicate to the way that that person communicates and so you're using phrases and questions that work from their way of speaking, as much as you can, but the whole point of the conversation is to find out what works for them. Who or what is important to them. And from that you're building this picture of what, to use the three conversations model language, you're trying to find out what does a good life look like to them. So, as you're having the conversation, you're making a mental note of anything at all, no matter how small, that they tell you that is something that is working for them, and you reflect back what they've told you and then you would ask a strengths-based question to help explore that some more. If people are telling you a lot about what isn't working, then you're trying to find a way of asking a question that would phrase it as, 'What do you have available to you that might help you to overcome or to live with that difficulty?'

[Communicating effectively when discussing strengths]

Kate: That's fantastic. But how might it feel for people or carers who are accessing services to be asked about their strengths?

Tish: People who are feeling that there is very little hope or that their situation is restricting them can feel very upset or angry at being asked, 'What does a good life look like?' in that their response can be, 'Well, what's the point of thinking about that because I won't be able to have that anymore, now that I have a diagnosis of early onset dementia?' So, for some people, the last thing that they want to be asked is, 'What does a good life look like?'

Kate: So is that saying there are times then it might not be appropriate to take a strengths-based approach?

Tish: I think it's about learning how to phrase questions using that person's own language and really tuning in to their own perspective on what's going on for them. So, I have heard some people say how wonderful it felt to be asked about their strengths and what worked. That it made a real change and was much more hopeful, than continually being asked about what the problem is and what their issues are, and what do they need. So, for some people, it's positive and exciting to be asked strength based questions, and for other people it's the thing that they feel is now beyond their grasp, and therefore it's exasperating or, at worst, upsetting to be asked about it. So, the art of having a strengths-based conversation is to really tune in to that person's perspective, that person's own language and way of talking about their lives, and from that to build up to having the three conversations in a way that comes naturally, and isn't by rote. And what's underpinning that is exploring with the person, what I would say is, 'What does a better life look like?' and certainly that's the feedback that I've had from carers is it feels easier to be asked, 'What does a better life look like?' than, 'What does a good life look like?' because if a good life feels impossible, then that's not what you want to be asked, because a good life is, 'I haven't got early onset dementia.' or, 'I haven't got a mother who has Alzheimer's.' or, 'I haven't got a child with autism.' So, for carers, framing it as, 'What does a better life look like?' feels more possible. So, this is when it's especially important for the practitioner to really draw on their emotional intelligence about when and how to ask resilience questions or questions about the person's assets and strengths. So, if what you're picking up is today is a really bad day or that the person that you've just met is feeling very low, is it more helpful to ask questions about what does a good day look like, than to ask them more resilience based questions in terms of, 'What helps when you're feeling like that?' So, the art of strengths based working is to build a whole tool bag of strengths based questions to be thinking about these quite hard as you're having the conversation, and actively listening on an emotional level to how the person is, and choosing the sort of question that might be most appropriate right now. When we were talking in the first podcast, we were referring to Dennis Saleebey's seven strengths-based questions and in a later podcast, we can talk a bit about solution focused communication and all of these tools are going to help to build the repertoire of strengths based working.

Kate: One of the other challenges practitioners have raised is the use of language, especially the word, 'connect' in strength based approaches within the three conversations model.

Practitioner: Will someone please tell me how this works with very elderly people? Say, 80 to 90, who really don't want to go out. They just want someone to help them dress and eat. Most people I see would think I was talking a foreign language, if I went out and said, 'How can I connect you?' Can someone please just let me know what I am supposed to be asking people without all the, 'connect' jargon.

Tish: Okay. So that's a really good question, because it highlights the difference between our knowledge base around strengths-based working. So the theory, the different models. That includes the three conversations model and our communication skills that convert that theory into having an everyday conversation with the people that we work with. So, in this instance, then the practitioner will be trying to find an alternative word for the word, 'connect', have some knowledge around asset based working and ideally have an open idea about what sorts of assets might be available in the local community. So, having had a conversation about what a good life looks like for that person or what a better life looks like for that person, in other words what, in social care language, we might say their desired outcomes, instead of their eligibility outcomes. The practitioner has a much clearer idea of what, if things are working well, living with dementia at its best could look like for that person. So, the next part of the conversation is, 'What can I link you to that may support your picture of what a good life looks like?'

[Asset based community development]

Kate: And here is Mick Ward, Chief Officer of Transformation and Innovation at Leeds City Council describing asset based community development, how it complements strength based working and his experience of this in practice in Leeds.

Mick: At the heart of asset based community development, it's really about finding out what people living in a particular community really care about and care enough about to work together to change it, to develop things to sustain stuff. That's important for us, because quite often you will find that what they want to change and support, are things that support people's health and wellbeing, and that fits really well in regard to a, sort of, shift towards strength based social care. And I think that's important for two reasons. One of which is having a focus on strength based social care and supporting people to, for example, access things within their communities, within their neighbourhoods, if there's not things going on. So, what ABCD (asset based community development) is actually it creates space for that to really happen. I think the really important thing, as well, is that at the heart of it is ABCD is community led. So, it's about that community themselves identifying what needs to happen, but crucially, identify and develop the assets to meet that, and that fits just so well in a community. Feeling more positive about itself, linking really close with strength base, which is about individual's strengths and how they can be utilised more.

[Outro]

Kate: Thank you for listening and please join us in the third of our podcasts on strength based working, where we consider appreciative enquiry and solution focused communication. Thank you.

Voiceover: You've been listening to the Research and Practice for Adults podcast and we hope you enjoyed it. Why not share with your colleagues and share your thoughts on Twitter. Tweet us @ripfa [please note @ripfa is not in use, please contact us @researchIP]. Thanks for listening.

[Introduction]

The Research in Practice for Adults Podcast, supporting evidence-informed practice with adults and families.

[Appreciative Inquiry]

Kate: Hello, and welcome back to the third podcast in our series around strengths-based working. Once again, we're joined by Tish Elliott, and this time, we're going to consider two different models of methods for strengths-based working and, first of all, we're going to have a look at Appreciative Inquiry. So, maybe, Tish, you could start by explaining what is Appreciative Inquiry?

Tish: It's an approach that focuses on what works and in that sense it could be described as shining a spotlight on success and, historically, I'd describe it as a research methodology, in that it is a way of finding out what works, by having conversations with all the people that are involved in a particular area of practice. That might include the people that have care and support needs, those who care for people with care and support needs, those who work in a professional role with people with care and support needs, and their wider network. So, in that sense, it's a way of finding out what works, by involving everybody in the process, and it builds on success, and I would describe it as a way of finding out that is relational rather than procedural. So, it moves away from a linear approach, if you like, to finding out something, to a more relationship-based approach, and in that sense, what is found out is continually changing and growing trough a collaborative process. So, I think, from that description, we can make links with strengths-based working in that, instead of focusing on a problem, it focuses on what is working and what is working well, and in that sense, it then builds on what works well. So, I'd describe it as a research methodology, but also, a social work intervention. If you think about evidenced-informed practice, the three elements of that are the wishes and feelings of people with care and support needs and those who care for them, so the service user perspective. In addition to that, you're drawing from practitioners' wisdom, the knowledge and the skills that people working with people with care and support needs develop, and in addition to that, you've got the research element. So, there are those three things that contribute to our growing understanding of social care, and Appreciative Inquiry is a way of looking at success, which is congruent with strengths-based working.

The assumptions that underpin Appreciative Inquiry or the principles, if you like, as I say, are congruent with strength-based perspectives, and it works on the belief, and this comes from some work by Sue Hammond, back in the late '90s, around Appreciative Inquiry, that it's based on the belief that in every society or organisation or group, something works. No matter how small, there will be some things that work. If we focus on those things, then that becomes our reality, and that reality is created in the moment, but there are also multiple realities. So, we're talking there about the complexity of the work that we do, and that there's no one right answer, there are often many ways of building on what works, and that the art of asking questions of the organisation or the group or the individual will influence that person and that group and that organisation. So, if we focus on what works, then we're going to enable that to grow. If we only focus on what's going wrong and the issues and problems, then we're, in some ways, working in a deficit way. That if you believe that what you focus on becomes more, then if you only focus on what isn't working, then we're keeping the reality based on what doesn't work. One of the other underlying principles is that, if people have more confidence and feel more comfortable to journey to the future, the unknown, they carry forward the parts of the past that are known. So, if you're focusing on what works, then those are the things that will carry on into the future, and within the whole process, differences are valued and essential. So, that brings us back to the importance of working with the feedback from people that use services and their wisdom as experts via experience is as equally as important as practice wisdom, and the formal research that gives us the evidence-base overall. So, finally, I would say that it's similar to strengths-based working in that we're thinking about the language that we use and how that influences the direction in which we're going.

[The 4D Model of Appreciative Inquiry]

Kate: So, how do we do it?

Tish: The model that I've used a lot in practice comes from the work of David Cooperrider and it's called the 4D Model of Appreciative Inquiry. The four Ds standing for Discovery, Dreaming, Design, and Destiny. So, the first phase of finding out what works is the discovery phase, so that's the first D, and in those conversations, you're finding out what people's view of what best means to them, what success means to them, and having a 'what works?' conversation. So, things like, 'What has been helpful? What should we do more of? What does success look like to you?' and in that way, we're discovering what, from that person's perspective and in their world, success looks like. The dreaming phase helps us to identify what the person's desired outcomes are, and in these two stages, the discovery and the dreaming stages, it's about having conversations with the person, about what their life would look like if it was working the best that it can. People are very realistic. In my experience, people don't have desired outcomes that are impossible, that they are very grounded in reality, and working to people's own expertise of living with, for example, dementia or bringing up somebody with a learning disability. What would it look like if things were working the best that they can? So, the skills needed throughout the 4D model, and I'll talk about the third and fourth phase, in a moment, the skills that are required are active listening, really, really tuning into the detail of what people are telling you about what works for them and what they aspire to achieve for the future, and having that outcomes-focused conversation with people, where you're gathering the detail of what those aspirations are. So, the next stage is the design stage.

That's where, having together got a much clearer picture of where that person is trying to get to, and what is already working well, then from that, together you're looking at what will help us to get there. What are the step-by-step goals? What is around to enable that to happen? From that, you're deigning a pathway, if you like, that helps towards the final phase, which is the destiny phase, where it's the (TC 00:10:00) process of creating what will be and how things are going to move from the design stage into achieving those desired outcomes.

[Skills]

Kate: So, you mentioned some of the skills, like active listening and outcome-focused conversations required in appreciative inquiry. Do you think there are any other skills that people can use that can be helpful?

Tish: Yes, definitely. This takes us back to what we were talking about in the first two podcasts, which is strengths-based questioning and drawing from the seven strengths-based questioning skills described by Dennis Saleebey, but also, taking us to a particular approach that is congruent with Appreciative Inquiry, and that's solution-focused communication. Solution-focused therapy or solution-focused brief therapy is an approach that was developed in the States in the 1980s and that comes from the work of de Shazer and Berg, and it focuses on what people want to achieve, rather than on the problems that have led to the person seeking help. So, it does acknowledge problems and past issues, but the main focus is on the person's strengths and future hopes, and then, helping them to look forward and use their own strengths to achieve their goals. There are a number of principles and core ideas, in that it keeps the focus on there are always opportunities available to us, if we can identify what those are. So, rather than looking at the problem, it focuses on opportunities. There are no failures, only learnings. So, something presents itself as an obstacle, it's seen as an opportunity for that learning, and there's not just one solution, there are many, and that often relates to the complex situations that we're working with, in that there's never one right answer or one solution. There are many different actions and ideas that, together, could enable people to move to a position where they're better able to live the life that they are aspiring to have. So, the principles are what can I do differently to create more solutions for myself and my network, in the future?

So, effective questioning is going to be key in exploring what's already working and how the person would like their life to be and exploring the person's own previous solution, what have they done before that has worked well? Reminding the person that the objective is to support them to do more of what's working and access support and resources that are available in their own familiar community, that is going to help them build on what has worked. The questioning skills, we've thought about the seven strengths-based questions of Dennis Saleebey. The ones that a solution-focused approach particularly build on re the miracle questions, the exception questions, and the scaling questions. So, the miracle questions link to the second phase of appreciative inquiry, that's the dreaming phase, and a miracle question, I think it's really important to think about, is a miracle question going to be helpful? Is the person going to look at me as if I've lost the plot if I ask a three wishes question, or if one night, a miracle happened and everything looked better in the morning, how would you know, and what would be different? So, the art, again, of having conversations of this sort is about knowing when and how to explore those details, in terms of if what you aspire to happens, what would be different? Unless you know what the detail is, then it's hard to work out a structured, step-by-step plan. So, the miracle question then gives us the goal in the person's own words, and it gives a very rich description of what, in solution-focus terms, would be called the solution state, as that person, the cared for person or the carer, sees it. It's really focusing in on, if things were working the best that it possibly could be, then what would you doing differently? So, you might be asking that question, 'If it was the best it could be, what would be happening? What weld you be doing?' and then, you allow some time for that person to think about that and you listen carefully to the answer, drawing out what those goals are.

Then, you might ask, 'What else?' and, 'What else?' and, 'What else?' So, that in that sense, you're gathering a very detailed picture. The other types of questioning from solution-focused ideas are the exception questions. So, these are the ones where your questioning is helping to explore what works for the person, to really gather the detail of their success stories, and exploring when things were less bad, that's the exception. If things are awful now, can you ask, in a way that helps to gain a picture of when things were less bad, what was going on? What was different then? How was the problem less bad then than it is now? So, you're asking for explanations of those exceptions, which in solution-focused language might be called positive blame. So, is there anything that you or somebody else did that helped, that that person can be blamed for making it better, if you like. How is it possible that that happened, that you were able to do that? Finally, the solution-focused questions that are often referred to in the literature are those called the scaling questions, and these are the ones that help to think about where is the person now and what are the steps to them moving on a scale to progress into where they would like things to be? So, the scaling questions ask, 'On a scale of one to ten, where do you think you are now?' If the cared for person or the carer says, 'Ooh, around about three or four,' where one is the best and five is the worst, then your next question is, what needs to happen for you to move to a five or a six?' and so on, reviewing progress towards the desired outcome that's been established through the course of the solution-focused conversation, and the strengths-based conversation.

So, on a scale from one to ten, you would be asking, 'Where do you think that you are now, if one is the worst and ten is the best?' and if the answer is, 'Three or four,' then you're asking, 'What would help you to move from three or four to five or six? What would it look like if you had achieved that?' In this way, you're supporting people to move from where it is now, to a nine or a ten.

Kate: So, are there any challenges in working in this way?

Tish: Yes, there are always challenges and there's never one easy answer to any of the complex situations that we're working with. There's always more than one right answer, in fact, there are many, if we can have support and good supervision to help us to explore those, and we'll be looking at that next time. In answer to your question there, I think it takes us back to the first two podcasts in that it's very much about the art of using these ideas in practice. It's definitely not about applying things by rote, thinking that you must always ask a miracle question or a scaling question. It's about having all of these ideas in your practice tool-bag and thinking about, 'What would be helpful to explore at this point in time and what is this person's perspective and how can I work from that perspective?' So, in that way, thinking about what would be the most useful thing to explore right now and, 'How can I bring that into the conversation in a way that may be useful to the person today?'

[Outro]

You've been listening to The Research in Practice for Adults Podcast and we hope you enjoyed it. Why not share with your colleagues and share your thoughts on Twitter? Tweet us @ripfa [please note @ripfa is not in use, please contact us @researchIP]. Thanks for listening.