Are you Spoiling your Reflections?
Your employer signs you up for a Motivational Interviewing (MI) training or you just attend since you are intrigued by what you have heard about this language and its efficacy with behavior change. You learn one of the key skills of MI – complex reflections – which adds meaning to a client’s words.
You may hear a quote from Bill Miller, one of the co-authors of MI, “your clients will teach you MI. If you hear change talk (direction towards change), you know you are doing it and if you hear sustain talk (status quo language) you probably are not.
In your next session you intentionally dip your toe into the water and make what you think is a beautiful complex reflection, and nothing happens – no change talk. What went wrong?
Here are a few possibilities:
1. You made a complex reflection and followed it right up with a question. This is a common thing that happens when learning MI. Trust your reflection – make it and then be silent. Let it “percolate” so the client can take it in and respond. You might want to make a second reflection after they respond or then if appropriate ask your evoking question. Like a tasty dish you must build the flavors and let them simmer.
2. Your voice went up at the end of your reflection. We call this a “spoiled” reflection. An uptick in your voice at the end makes it a question, which is very common with those learning MI. My fellow MINTie (Motivational Interviewing Network of Trainers) Margo Bristow says have your voice “go to the basement.” Make sure the tone of your voice goes down at the end, so you are truly making a reflection. Making sure your tone is flat or goes down can take some practice and intention.
3. You reflected the struggle. Another fellow MINTie who is also a comedian Mallori DeSalle asks, “are you hanging out in pain town?” Denise Ernst, author of the MITI coding system asks “are you cuddling the problem?” If you reflect the struggle you are going to hear sustain talk or more of the problem. Although you may be trying to be empathetic you could be moving your client further away from change. Reminding the client of the struggle is not as impactful as you might imagine.
The skill of learning complex reflections is not an easy one. Listen to the words of your client and ask yourself “what is UNDERNEATH their words?” What is the desired hope and change? If someone talks about how depressed they are a possible complex reflection might be “so although you are blue, you came in today since you want to feel better – you have hope for yourself.” This statement is both empathetic and reflects hope for change.
Listen to your client words – where can you reflect hope and open the door a little more towards change? If you listen closely enough, you will find it. It will leave your client with more thoughts of change and be personally satisfying realizing you made a difference in someone’s life.
April 25, 2022 @ 9:17 pm
Thank you for the helpful article. In my work at Loma Linda VA Healthcare System, I continue to apply what you taught me. I can attest that the methods of MI are effective.
I hope to repeat your courses in the future.
April 26, 2022 @ 10:39 am
Thank you Russell – really appreciate your kind words and glad things are going well!
April 27, 2022 @ 10:52 am
Great article and it’s a good reminder. I tend to get MI “drift” as the months go by, your articles are timely and help to recenter my efforts!
April 27, 2022 @ 1:17 pm
Thanks Aaren – always nice to hear from you!