Reflective Listening

Listening, really listening to a patient is the cornerstone of Motivational Interviewing (MI). Reflective listening is something that requires practice and patience. With practice providers can become skillful at listening and reflection becomes natural.

Listening Roadblocks

Miller and Rollnick (2013) recommend that part of the process of developing strong reflective listening skills is to recognize what constitutes good and poor listening habits. Gordon (1970) described 12 responses that are roadblocks to reflective listening (as cited by Miller & Rollnick, 2013). According to Rosengren (2009), these responses/interventions  are roadblocks because they interfere with a patient’s movement in a conversation. Therefore, these responses/interventions stall a patients progress towards change. Roadblocks are provider centered instead of patient centered as well as imply a unbalanced relationship between the patient and the provider (Miller & Rollnick, 2013).

According to Gordon (1970) these roadblocks include (as cited by Rosengren, 2009, p. 32):

  1. Ordering, directing, commanding 
  2. Warning, cautioning, threatening 
  3. Giving advice, making suggestions, providing solutions 
  4. Persuading with logic, lecturing, arguing, providing solutions 
  5. Moralizing, preaching, telling patients their duty 
  6. Judging, criticizing, disagreeing, blaming 
  7. Agreeing, approving, praising 
  8. Shaming, ridiculing, name calling
  9. Interrupting, analyzing 
  10. Reassuring, sympathizing, consoling 
  11. Questioning, probing 
  12. Withdrawing, distracting, humoring, changing the subject 

Listening with the Whole Body

Listening is also a non-verbal skill. Miller and Rollick (2013) state it is important to give patients undivided attention when talking with them. This can be hard to achieve in busy settings and with the large amount of technology we interact with. As providers we are used to completing several tasks at once. However, when engaged in MI with patients it is essential to focus on only listening to the patient.

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