Taking off the Stems

IMG_4755You’ve just bought a beautiful bouquet of flowers and are heading home. What’s the first thing you do before putting them into a vase to enjoy? You take off the wrapping, pull out your scissors and cut off the stems so they have the best chance of survival for the week. Then you put the little flower preservation packet in the water before putting the vase on display.

Classically therapists were trained to use conversational stems such as: “it sounds like,” “I’m hearing,” and “I understand that.”

In MI we say “stems” dilute the meaning of a reflection and can actually be manipulative.

Suppose you are speaking to a client who is feeling particularly stressed about their week. Consider how these two reflections “land” on a client.

Say out loud:

“It sounds like you had a really challenging week” versus “you had a really challenging week.”

Which reflection is likely to have more impact? Which one shows more empathetic listening and will lead to forward moving conversation from the client?

In MI our goal is to generate “change talk” when the client is arguing for change versus the clinician.

If you have the spirit of MI (collaboration, partnership, avoiding the expert role and evoking change from the client) you can start your reflections with “you.”

  • “You really want to make a change in your life.”
  • “You want to be valued in your work.”
  • “You want a partner to love and cherish.”

If you are wrong with your reflection, your client will correct you and tell you their truth, so putting out a “you” statement is okay either way.

Part of our work as clinicians is helping move conversations with our clients towards change and seeing the beauty that results in their lives. Taking off the stems may be the best chance for having an impact and create that imaginary lovely vase of flowers we all want to see in those we are privileged to help.

Our goal is understanding and preserving the integrity of our client’s conversations by reflecting the beauty they desire, and that does not come in a little packet but a reflective conversation…without stems.