Reflections: It’s Complex

Blue Consultation-1When you’re trying to learn Motivational Interviewing, where do you begin? We know we can’t learn Spanish or French in a day so what’ the best skill to focus on in learning the language of MI?

The skill of complex reflections: complex to learn but can make most impact.

The first step in moving away from your comfort zone is backing away from questions.

Well-formed complex reflections thicken and color what the client is saying by adding more texture than what they said but not more than they meant.

This serves your session is several ways. First it slows your client down and gives them more of a sense of their world which is in itself attention getting. Second, it buys you some time to explore and strategize about how to navigate.   And you will catch things in the net of reflections even if you unsure of where exactly conversation is going.

Complex reflections have the potential of calming defensiveness so that your client can think in new ways about old topics. They will feel affirmed by your interest and your attempts to clarify their situation.

The challenging part about these types of reflection is reflecting things that are emotionally charged and difficult to articulate since they may clash with your beliefs, hopes and values for your client.

For example, your client might say: “I wanted to drink and almost did, and I would have if I had money.”  A complex reflection might be: “so you aren’t sure that your recovery is worth it anymore?”

Complex reflections require maintaining neutrality.

Try adopting a “man from mars” stance as you make reflections that broaden the client and your perspective. This may require you changing your clinical speak and talking in kitchen table language.

The client might say, “I can’t sleep at all, I just lay there and then after a while I get up and then I am up all night.” Instead of responding “so you are having insomnia and restlessness at bedtime that does not resolve so you get up and your body is over stimulated,” you might try “you get in bed tired but the your body acts like it doesn’t know it.”

In reflective listening less is more.

Specific word choice as well as what to highlight and minimize can also make reflections more interesting and engaging to the patient.

You can highlight autonomy by emphasizing personal choice and control.

“You want some choices that might help you avoid these long nights without sleep.”

When first learning Motivational Interviewing, your only goal might be to make reflections. Think of it as working a muscle and think, speak and organize with reflective listening so that your patient doesn’t even notice.

Once you have a good responsive reflex for complex clients statements you will begin to see the millions of options that good reflective listening offers. This is truly when the fun begins!

Guest Blog written by Annie Fahy, RN, LCSW