As counselors, we strive for accurate empathy. We listen carefully and reflect back what we hear that seems important. In order for us to conduct the most effective conversation about change, we can at times stretch our reflections a bit. There are several situations where this “going out on a limb” is particularly useful.
Don’t be afraid to go out on a limb.
It’s where all the fruit is.
In an exploration section of a session, the process is moved along when you make a guess and offer a continuation of what you believe the person is saying. This is easier to do when you know the client well. This can be called “continuing the paragraph” or “lending change talk.” You reflect what you hear that hasn’t quite been said but might have been. Either the client will accept your interpretation and add more of the same type of change talk (Tip #69), thereby moving in the direction of change, or the client will correct you and you may apologize and then more closely reflect what you heard.
In this example, the counselor continues the client’s thoughts in a positive direction:
Counselor: How have you been doing with your diet this week?
Client: I don’t know. This is all so hard.
Counselor: You’ve been focusing hard on eating well.
Client: Yes, and a few days I had great meals.
Counselor: You’re pleased with what you are able to do.
Client: I’ve gotten into a habit of bringing my lunch. It’s the nighttime when things fall apart.
Counselor: You want your evenings to contribute to your health, too.
Client: Yes, I suspect that is where the higher blood sugars come from.
Counselor: That’s the next thing you’d like to work on.
Here the counselor reflects stronger change talk than what the client said:
Client: I know I should get more exercise. (Need statement)
Counselor: You know that fitting in more activity would improve your health. (Reason statement)
Client: “Well, I suppose I could start walking with the group at lunch.” (Ability statement)
Counselor: “So your plan is to join the lunchtime walking group at work.” (Commitment statement)
Powerful affirmations are often a bit of a stretch. For example:
Client: It’s been a few months since I binged and purged.
Counselor: You’re someone who can make the changes that matter to you.
Client: I know exercise is important, but I don’t have time. I’m so busy at work that when I’m going up or down only two flights, I take the stairs. Our elevators take so long.
Counselor: You’re creative in finding ways to fit activity in your busy day.
Reflections of client sustain talk can be tricky. We hear many excuses and reasons to not change. Reflecting a bit of this can allow the client to feel heard. However, reflecting more than a little bit will evoke more sustain talk and the client will stay stuck. Search for whatever change talk you can manage to find and reflect it. If you are not hearing much or any change talk to reflect, you can try more complex or amplified reflections to shift the tone of the session. Here are some examples.
Client: I don’t think I need to exercise more. (Sustain talk)
Counselor: You wouldn’t get any benefit from moving more. (Complex reflection)
Client: Well, I guess I would have more energy. (Change talk – Reason)
Client: I think my lunches at work are just fine. (Sustain talk)
Counselor: There is no room for improvement there. (Complex reflection)
Client: Well, I guess they aren’t perfect, but they’re good enough. (Ambiguous talk)
Counselor: There is no way they could be any healthier at all. (Amplified reflection)
Client: Yes, they’re fine, expect for the dessert part. (Change talk – Vague need)
Counselor: You’re thinking about making a change in that part of your lunches. (Suggested focus)
Client: That is probably where a lot of the calories are. (Change talk – Reason)
Take care with your tone of voice when amplifying. It may be tempting to add a bit of sarcasm to an amplified reflection. This is more apt to be rejected and does not fit the spirit of motivational interviewing. Stick with simple curiosity and maintain compassion for the client.
When reflecting strong emotions, going out on a limb can be counterproductive and cause discord. For example, a client says he gets annoyed when his wife nags him about his diet. If you reflect it this way, “You are angry at your wife for bossing you around,” he will likely argue with you because you took his stated emotion and exaggerated it. Instead you could simply say, “That annoys you.” Or to perhaps open a way of looking at it differently, you could say, “That doesn’t provide the support you need.” This allows him to be heard and may lead to some ideas about how to handle the situation.
It’s tempting when going out on a limb to add a questioning tone to a reflection. Here is an example:
Client: Well, I like you and I know that I do better when I’m in a group with other people, but it is a pretty long drive to do every week.
Counselor: (Say each of these out loud to notice the difference)
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