Appreciative Inquiry in the Clinic and the Classroom and…

 I spend a lot of time studying anatomy and refining my understanding of the techniques I use with patients and teaching students. I also work hard to understand integrated theories and practices in body-mind healing such Interpersonal Neurobiology, Polyvagal concepts and Attachment theories. All of these inform me in working with patients and students and in my work with myself – and really just being human.

There is another concept that we work with at Moving Mountain Institutethat guides us at all levels form establishing big picture strategies to how I focus in the classroom with each student and in the clinic with each patient.

It’s called Appreciative Inquiry.[1] My interpretation of the philosophical premise is two-fold. 

First, people have an innate draw to feel more integrated, this is a way to explain healing. Carl Jung termed it individuating. The fields of Interpersonal Neurobiology (IPNB) and Attachment Theory have brought to the forefront that one of the crucial ways we do this integrating (healing) is within the context of our meaningful relationships. If we can co-regulate our nervous systems with people who matter to us our system can begin to integrate those places where in the past we have possibly been hurt or learned to strongly protect ourselves. This is happening for all of us all the time and is just a bit more potent in our more meaningful relationships.

Second, and this is much simpler, people are motivated by feeling valued and/or appreciated for who they are. AI makes an explicit practice of being curious about strengths and possibilities and highlights things that are working well and then wonders how that can happen more in arenas where there are challenges? 

The AI Commons website offers this as an introduction and I just love it! It is a great mantra practice before walking into treatment or the classroom or just anything… J

Ap-pre’ci-ate,v. 1. valuing; the act of recognizing the best in people or the world around us; affirming past and present strengths, successes, and potentials; to perceive those things that give life (health, vitality, excellence) to living systems 2. to increase in value, e.g. the economy has appreciated in value. Synonyms: VALUING, PRIZING, ESTEEMING, and HONORING.

In-quire’ (kwir), v.,1. the act of exploration and discovery. 2. To ask questions; to be open to seeing new potentials and possibilities. Synonyms: DISCOVERY, SEARCH, and SYSTEMATIC EXPLORATION, STUDY.

What a fabulous practice for work with a patient or in the classroom! 

With patients this begins, with being as attentive as I can with my language and looking for frames that are positive or oriented around possibility. It is likely that even behaviors that a patient identifies as causing them some dissatisfaction were at some time serving an essential need for them – most likely helping them maintain connection with a caregiver or somebody important to their survival. These behaviors should be validated and honored. They should be seen as successful in helping that person get to where they are. This is a concrete way to practice nervous system co-regulation. It is likely, if we do this with good intent and at least a little skill, our patient will feel us as an ally, and will begin to explore how safe they can feel in treatment

If our dialogue with our patients is oriented around appreciating their strengths and highlighting their specific potentials for change they embody and we embrace an open and curious stance patients will naturally feel drawn towards that inquiry and that potentiality. 

I actually get teased by a lot of patients for telling them that they are doing a good. I do this a lot during a session. It is on purpose. When I am working in an area and I feel tissue change I say “nice” or “good work.” This is an example of me using an AI based approach. I believe that people naturally pay more attention when they are told they are doing something well. If we take that natural curiosity and direct it towards their felt sense their interoception grows. They become more aware of themselves. It is also an example of establishing nervous system resonance with a patient throughout the session. 

I believe people learn best when they feel safe and are having fun. I explicitly look for students skills, what are they doing well, what are their natural strengths or inclinations and then draw those towards the skills or content we are working studying. Teaching cranialsacral therapy is a great opportunity for putting AI principles in practice. People often have beliefs about cranial work that it is hard to do or feel – it can be. I had a very hard time feeling anything when I first started doing cranial work 20 years ago. Students can and do learn the technique by emphasizing in every lab what they are naturally able to feel and do – over the course of a weekend that just builds – it’s teaching in “the direction of ease.”

There are 5 actionable principles within the AI approach. I think they are beautiful and highly adaptable. I think they are things a lot of us are naturally doing to some degree and if we make the practice more conscious we can do more of this in more areas more skillfully! Here are the 5 Principles of AI adapted from the AI Commons and The Thin Book of Appreciative Inquiry:

•  Constructionist Principle:Words create worlds. The language we use creates a world we inhabit – and can be an invitation to cocreate with others if we speak inclusively and honestly. 

• Simultaneity:Inquiry creates change. In medicine, there are strong assumptions embedded within the questions we ask – often oriented towards illness and coming from the mainstream medical system which is rooted in a mechanical metaphor for the body. We can be aware of the type of questions we include in our dialogue with patients that are inclusive of a holistic and inclusive nature.

• Poetic Principle: We can choose what we emphasize – the nature of our attention is creative! Our relationships with our patients are potent vehicles for change in their own right. If we emphasize establishing right-brain to right-brain connection with patinets they feel or presence. That feeling becomes a potential for neural co-regualtion. 

• Anticipatory Principle:Images create action. Our imagination is crucial to our work. We use it when we imagine techniques as we are learning or refining them, images are central to our touch and often to our clinical insights. The images we hold of the body, the metaphors implicit within those images become determinant of our beliefs – it is such a good exercise to reflect on our language and see if we are using images that are consistent with what we feel and believe.

  Positive Principle:Positive questions lead to positive change! This takes us back to the first principle – language matters. Framing our questions as containing positive change potential and including within them the assumption of capacity is helpful for people. 

The cool thing about AI is that it is highly adaptable to nearly any context. The AI Commons has a lot of resources for learning more. And, I think all of us bringing these ideas more explicitly into all areas of our practices, through the amazing unique prisms each of us are, has the potential for generating more good.

Contributed by Michael McMahon

 [1]AI was developed by David Cooperrider and Suresh Srivasta at Case Western Reserve University, it was an outcome of Cooperrider’s doctoral work in Organizational Behavior and Suresh Srivasta was Cooperrider’s advisior and mentor.