Reflections are the most effective of all the strategies in conversations about change. Here, we explore how to make reflections more powerful by making them more complex.
What does this do?
- Supports the client to feel more deeply heard. Think of a time you were talking over a difficult decision with someone. Notice the difference here: If your friend said, “You can’t decide” (simple reflection), or instead, “You are stuck between a rock and a hard place.” Or “You’ve got a dilemma to work through here” (complex reflection). Which of these makes you feel more like the person gets it?
- Encourages a client to step back and see the bigger picture. People get lost in the specifics of their lives. When we offer a different perspective, this may allow something to shift.
- Can help focus the session or move the session along toward planning. Especially when the client seems to wander around topics, complex reflections can focus the session.
To be blind is bad,
but worse it is to have eyes and not to see.
Helen Keller
I would not give a fig for the simplicity this side of complexity,
but I would give my life for the simplicity
on the other side of complexity.
Oliver Wendell Holmes
Examples:
- Feeling reflections: “You’re puzzled.” Or “You are worried about how this will affect your health” Or “You are annoyed your doctor made you come to see me.” This last one is an example of rolling with resistance. It may allow the client to feel heard enough to then become engaged in the session.
- Implied larger goals or possible plans: Sometimes, we sense a goal or intention in the client’s words, though it is not spoken directly. We can reflect the goal or plan more clearly. It’s OK to go out on a limb a bit. “You want to be that person who takes care of her health” or “You are considering talking with a counselor about these moments of emotional eating.”
- A process you see happening: Often, clients do not notice patterns of thought and/or behavior that are contributing either to change or to being stuck. These patterns may be obvious to you. Part of your role is to offer this perspective. The more matter-of-fact your reflection, the more likely it will be accepted. Here are some reflections of positive patterns: “Entering your food in your phone keeps you mindful.” Or “The routines you have during the week support you to eat consistent meals.” Reflections of processes that are not supporting change: “You notice that when you yell at yourself for eating a cookie, the ‘what-the-heck’ thought comes next, and you tend to eat more of them” or “Food shopping when you are hungry leads to bringing home more sweets.” This last one can be reworded in a positive way. “You’ve noticed that when you go food shopping with some food in you, you are pleased with what you bring home.”
- Adding a positive spin on a stuck place by reframing: When you are not hearing much change talk (Tip #69), it is tempting to reflect some of the sustain talk (Tip #101) that you are hearing so much of. Simply repeating the reasons to not change will allow the client to feel heard. However, it may contribute to his staying stuck. You can offer a reframe at the same time you are hearing some of the sustain talk. “If you are to move toward your goal of getting off these medications, we will need to find a way to work with your busy schedule.” Or “You haven’t yet found a way to be a bit more active.” Or “You are considering various options for your next step.” This last one assumes that all the talk is moving toward forming a specific plan and, therefore, encourages that movement. Often, our clients get stuck in the concrete specifics of their lives. This may sound to you like a long, detailed story that does not seem to be leading anywhere. Take a deep breath, and briefly shift your focus on the client to a softer, more distant perspective. This will help you see a bigger picture to offer to the client.
- Reflecting both sides: Here, you are reflecting the ambivalence you hear. Don’t assume that the client has a clear picture of the parts of them that don’t want to change and the parts that do. It is most effective to place the non-change side first and end with the change side. “You don’t enjoy cooking, and you know that eating at home more would be healthier” or “You find your evening drinks relaxing, and you would like to decrease your calories so you can lose weight.”
Health professionals often voice common worries about using complex reflections:
- “What if I’m wrong when I go out on a limb?” This is a risk. We make associations in our head based on our life experiences and on what we have heard from other clients. Sometimes, we either have misheard the client or have made an association that does not fit for this client. This is rare, and when it happens, the client will correct you. “That isn’t what I meant.” You can accept the correction and move on. “Oh, thank you.” If that does not seem to be enough, and you have triggered significant discord in the relationship, you will need to work to regain engagement (Tip #130). This fear of being wrong often holds us back. The power of complex reflections is worth this small risk.
- “These reflections seem to deepen the conversation quickly. What if I get in over my head and find myself out of my scope of practice?” Indeed, valuable conversations about making health changes can quickly get into deep territory. As long as the client is talking about specific diet and health changes, you are within your scope. (More on nutrition therapy vs. psychotherapy in Tip #31.) Whenever you believe your client would benefit from working with another, or additional, professional, you can make a referral (Tip #98 ).