The development of Empowered Conversations

The Six Degrees team have been working on the Empowered Conversation approach and course for a number of years, the following working paper provides a brief history of this evolution.

Empowered Conversations came out of a local Low Intensity IAPT (Improving Access to Psychological Therapies) provider and has its roots in a model called Empathic Curiosity.

Empathic Curiosity started with the idea of therapeutic alliance: the idea that therapy works because of the relationship but what creates the relationship?  In 2013a, McEvoy et al. proposed the mechanism was through full bodied listening and being actively curious about the other person.  The theory is based on Perceptual Control Theory (PCT) which proposes we choose behaviour (both consciously and unconsciously) that helps us achieve our goals (which again may be conscious or unconscious). PCT also suggests that mental ill health can occur when we have two high level goals that are in conflict.  Maybe we want to have an image of ourselves as a highly skilled cook but we also want to be seen as competent by our family (so we don’t practise our cooking skills in case it goes wrong and our family laugh at us).  Our mental health suffers if we are too inflexible to allowing some give and take with these goals.

In McEvoy et al. (2013b), the authors move their attention from high level theory to practical examples of how to use the skills of empathic curiosity with a person with dementia.  They note the focus of many other communication models is on the past and reminiscence.  The authors propose that empathic curiosity can work with a person with dementia in the present.  The paper suggests using empathic listening and curious attitude with some pragmatic strategies for communication with someone with impaired memory, attention or language abilities.  The paper also introduces the idea of needing to keep the self in mind whilst communicating (which will later develop into the full theory of mentalizing).  The practitioner is encouraged to explore metaphors.  People living with dementia sometimes have problems with word finding and may use a word or phrase that represents what they mean, using creativity and curiosity to explore the meaning demonstrates a willingness to engage with a person with dementia where they are and an assumption that a person with dementia is saying something that is worth understanding

In the next paper (McEvoy and Plant, 2014), empathic curiosity is proposed as a way maintaining or developing relationships with a person with dementia.  It is the first paper to explicitly mention mentalizing.  Mentalizing is where we realise that another person is responsible for their own mental state and they may or may not be reacting to us and our action.  Much like when a baby realises it is a separate being from its mother (or primary care giver).  In Empowered Conversations, we call this “keeping the mind in mind”.  The approach, in this paper, is still in concept phase as the paper references being in the first stage of the MRC guidance on developing an evaluation of a complex interventions (Craig et al., 2008).  The paper also notes that whilst empathic curiosity is simple, it is far from easy in practice.

In McEvoy et al., 2016, we return to a theoretical perspective as the paper explores the Perceptual Control Theory as an exploration of behaviour of a person with dementia.  This understanding may support a carer by considering the reaction of a person with dementia as reasonable rather than random but mostly by giving the carer a lens through which to interpret behaviour.  The paper also addresses how an empathic curiosity approach can take an interaction from confrontation to collaboration.  Again the paper concludes that this approach can be difficult in practice.

The final paper in this review (McEvoy and Bellas, 2017) is the first to introduce the training with its new name “Empowered Conversations” and focuses on the benefit of the self-reflection for carers that features throughout the training.  It notes that structured way the course gets people to acknowledge their unconscious thoughts around particular interactions with a person with dementia.  It also uses the group as a resource to process the reflection and turn it into learning.

Phil is passionate about getting academic papers written and published, the following provides a list of the papers we have written and contributed to:

Luxmoore, B and McEvoy, P 2016 Mentalization in Dementia Care – An auto-ethnographic account of a project workers experience, Published – Working with Older People

Bellass, McEvoy, Williamson 2016 Communication skills: Empowered Conversations.  Journal of Dementia Care Vol 24 No 4 Page 16

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. and Petticrew, M., 2008. Developing and evaluating complex interventions: the new Medical Research Council guidance. Bmj337, p.a1655.

McEvoy, P., Baker, D., Plant, R., Hylton, K. and Mansell, W., 2013a. Empathic curiosity: resolving goal conflicts that generate emotional distress. Journal of psychiatric and mental health nursing20(3), pp.273-278.

McEvoy, P., Eden, J. and Plant, R., 2013b. Dementia communication using empathic curiosity. Nursing Times110(24), pp.12-15.

McEvoy, P. and Plant, R., 2014. Dementia care: using empathic curiosity to establish the common ground that is necessary for meaningful communication. Journal of psychiatric and mental health nursing21(6), pp.477-482.

McEvoy, P., Eden, J., Morris, L. and Mansell, W., 2016. Dementia: Towards a Perceptual Control Theory Perspective. 2044-1827.

McEvoy, P. and Bellass, S., 2017. Using drawings as a reflective tool to enhance communication in dementia care. Nursing Standard31(19), pp.46-52.

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Six Degrees has received funding from the Big Lottery to run free courses for family carers of people with dementia across Greater Manchester. Want to find out more or book on a course near to you?