Reflections are an important aspect of reflective listening. Reflecting in motivational Interviewing (MI) involves listening to the patient and then making statements not asking the patient questions (Rosengren, 2009). Reflections are defined as statements of understanding (Miller & Rollnick, 2103). Utilizing reflections and reflective listening involves the practitioner listening to the patient’s statements and the provider then making a statement that is a reasonable guess at the meaning of what the client has said (Miller & Rollnick, 2013: Rosengren, 2009). At first many feel uncomfortable with the idea of guessing at the meaning of client statements because they are afraid of being wrong. However, reflections, even if incorrect, can lead to more patient conversation and an opportunity to gain a better understanding of the patient perspective. Usually patients do not get upset, they typically clarify what they really mean and continue the conversation. Reflections also go beyond parroting what the patient has said and try to get to deeper meaning. When reflections are well crafted they allow a natural flow to patient conversation.
Why Reflect When You Could Ask the Patient Questions?
Questioning patients can and does occur in motivational interviewing sessions. However, I have found that questions are used limitedly and reflections are essential in conversing with patients. Miller and Rollnick (2013) state that asking questions of patients that necessitate them having to explain themselves and/or their meaning actually distances them from what they are experiencing. Also questions are more likely to cause the patient to become defensive. Using reflections are more likely to continue exploration.
Depth of Reflection
Reflections can be simple or complex. According to Miller and Rollnick (2013) simple reflections rephrase what the patient said and they add little to what was said. Complex reflections are used to inject some meaning or emphasis on what the patient has said. Simple reflections tend to get at the surface while complex reflections dig deeper. It takes time, practice, and training to become skillful at using reflections well during MI sessions. Rosengren (2009) points out that providers should vary the depth of reflections when working with patients.
Types of Reflection
There are many different types of reflections. Often these reflections are used to respond to sustain talk. According to Rosengren (2009) as well as Miller and Rollnick (2013) these reflections include:
- Straight Reflection – This includes a simple or complex reflection of what the patient states. This can assist in eliciting change talk.
- Amplified Reflection – This occurs when a provider makes a reflection that overstates what the patient has said. This can help a patient see through ambivalence and arrive at change talk
- Double Sided Reflections – This type of reflection is used by providers to demonstrate ambivalence. These statements often recognize a patients sustain talk and combines it with change statements that the patient has said previously. It is recommended to form these statements using the word “and” instead of “but” because but implies that the second half of the statement contains the important information. It is also recommended that you reflect the sustain talk before the conjunction and finish the statement with the change talk.
- A example of a double sided reflection would be: “You know that it will be a challenge to quit smoking and you also know it would be important to help manage your asthma.”
- Metaphor – Metaphors tend to be very complex reflections. Use of metaphors can be tricky in practice but can assist patients to see their situation in a new way while giving organization for adding to the converation. Metaphors provide patients with a new way to understand and hopefully, respond to a situation.
Motivational Interviewing for Smoking Cessation 