When we think about what is the most effective way for us, as practitioners, to respond to a client as they attempt to explore making a change, many initial thoughts and ideas may emerge. What we do know is that before a person speaks, they have a particular message or meaning they would like to communicate. And our goal is to make sure that we understand that meaning, although it is often imperfect. Therefore, reflective listening gives us a way to see if we are understanding their meaning correctly and we do it in the form of a statement. The reason we do this in the form of a statement is because a good reflection is less likely than a question to produce any defensiveness and is more likely to continue the conversation.
If we were to break down the dynamics of communication, a question requires a response where a statement encourages continued conversation and exploration. For example, if we look at the responses below from a practitioner, notice the different way this could be heard from the client. Again, whether it is a question where your voice tone typically goes up at the end versus a reflection where the voice tone usually goes down at the end.
鈥淵ou don鈥檛 think this is a big problem?鈥� // 鈥淵ou don鈥檛 think this is a big problem.鈥�
鈥淵ou鈥檙e considering an abortion?鈥� // 鈥淵ou鈥檙e considering an abortion.鈥�
鈥淵ou鈥檙e feeling sad?鈥� // 鈥淵ou鈥檙e feeling sad.鈥�
And you may ask why we would not just ask people what they mean. The reason is because continuing to ask people to explain themselves can oftentimes create distance from their experience and from you as the practitioner.
In reflective listening, we are actually making a guess about the meaning being expressed by the client and not assuming that we already understand. Below, please find an example offered by Miller and Rollnick from a counseling session with a man who had open heart surgery. Each reflective statement makes a guess about what the client is attempting to communicate as well as moves the conversation forward by not just repeating what the client has said but also being curious about where the client may go next in the conversation.
Practitioner: How have you been feeling lately, since your surgery?
Client: It was quite an ordeal, I can tell you. I鈥檓 lucky to be here.
Practitioner: You could have easily died.
Client: They said there was 90% blockage, and at my age that kind of surgery is major, but I made it through.
Practitioner: And you鈥檙e glad.
Client: Yes, I have plenty to live for.
Practitioner: I know your family is important to you.
Client: I love seeing the grandkids-two boys and two girls, you know, right here in town. I like doing things with them.
Practitioner: You really love them.
Client: I do. And I enjoy singing with the community chorus. They count on me; they鈥檙e short of tenors. I have a lot of friends there.
Practitioner: You have a lot of reasons to stay healthy.
Client: At least I鈥檓 trying. I鈥檓 not sure how much to do.
Practitioner: How much activity.
Client: I don鈥檛 want to overdo it. I played golf last week and I got this pain in my shoulder. The doctor said it was just muscle pain, but it scared me.
Practitioner: You don鈥檛 want to have another heart attack.
Client: No. one is enough
Practitioner: And sometimes you wonder how much exercise is good for you.
Client: Well, I know I need to stay active. 鈥淯se it or lose it,鈥� they say. I want to get my strength back, and they say regular exercise is good for your brain, too.
Practitioner: So that鈥檚 the puzzle for you-how to be active enough to get your strength back and be healthy, but not so much that would put you in danger of another heart attack.
Again, reflective listening trusts that clients are experts about themselves and their own experiences and that they can come up with their own plans and solutions.
A few reminders about reflective listening:
- Reflective statements usually follow open ended questions
- There are usually 2 or 3 reflective statements per open ended question
- If the practitioner guesses wrong with a reflective statement, the client typically clarifies their meaning and continues to move forward
- The reflective statement should not be longer than the statement it follows by the client
Lastly, it is almost always possible to turn a question into a reflective statement and remove unnecessary words at the beginning of a reflection. The way to do this is by removing the question and words that are not needed at the beginning and starting with the word 鈥測ou.鈥�
For example, removing the words in parenthesis and starting the reflective statement with the word 鈥測ou鈥�:
鈥�(What I hear you say is that) you are feeling sad.鈥�
鈥�(Do you mean that) you want to move forward with this decision.鈥�
鈥�(It sounds like) you are confident in your abilities to make this change.鈥�
Reflective listening can seem quite challenging at first, but with practice, like with most new skills we are attempting to learn, it gets easier. Again, thanks for the great questions related to listening and I look forward to continued explorations into all aspects of Motivational Interviewing!
People cannot benefit from a treatment to which they are not exposed.
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For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.