Paul Burke Training Group
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Beyond training: Looking at learning MI in a whole new light!
Thoughts on Improved Practice
(TIP) #2315
This amazing building is located in Sopot, Poland. It’s bent. (To say the least). It was designed that way. Why?
Well – it seems that sometimes we pay more attention to things that have a bit of a bend to them!
(Left, is the same building in a daytime view.)
Wild! And – what’s equally amazing is the effect that “bending” your reflective statements can have on your clients – if you can learn to bend them in useful ways. Of course, you can’t bend them too far – or they break! Still, learning not to give everything back to your client “straight” can really help both of you to clarify exactly how you see things.
Bending Your Reflections!
Statement #1: “Let me see if I got this straight”, the helper says to her client. “You’re saying that you
aren’t satisfied with the way things are going right now” [a “simple” or “straight” reflection].
“That’s right”, confirms the client. “It sucks”.
Statement #2: “Yes, I can hear that”, replies the helper. “And what you’re saying is that the time has come to do something about it. You’re thinking that you’d like to make a change in this situation now, before it gets too difficult to change it at all” [a bent, or complex reflection].
Can you see how the second reflective statement, above, moves the conversation forward a little. It took the “straight truth” of what the client had said and “bent” it – just a little. It didn’t bend it so far that the integrity of what the client was saying, originally, got lost (that would break the reflection – not just bend it). Bending what a client has said (usually called “complex reflecting” in MI) is an important skill to learn – and to get comfortable with. Without that skill, you can be accurate ‘til the cows come home in terms
of letting your clients know that you are hearing what they say. But – if you use too much simple reflection – you just might find that your conversations go around and around in circles – more than they move forward – in the direction of the intended target.
Made you look!
Bent reflections help the client to pay more attention to what you’re saying about what they’re saying!
When you “bend” what a client has said a little, it makes them listen a little harder to the content of your reflection. As you reflect in this more complex fashion, your client will be asking herself “is this really what I meant – or is this person just distorting my words?” They give more attention to what you’re saying and to the meaning that you ascribe to the words the client uses.
Clients get used to straight (simple) reflections. They’re easy to hear – but bent reflections make people look! They make people look into what you are saying – more deeply – to check for the accuracy of the content – and of the meaning – and to be sure that you are listening to them “deeply” – and not just to the words that they use.
Bending something far enough – but not so much that the content loses its structural integrity – is an art. It takes practice.
When you learn to bend what the client is saying a little, it will also help you to test your level of empathy with their point of view. A colleague of mine, Allan Zukoff, explains empathy as having the ability to say more than the speaker said, but not more than the speaker meant. That’s a useful way of thinking about empathy. Allan also adds an important note of caution. He says that while empathy involves saying more than the client is saying – it also means avoiding saying more than the client means! All in all, learning to bend your reflections enough to help your client hear what she says, and also what she means, and also to hear the implications of what she is saying – is what moves the conversation forward.
The important thing is to get practice with learning how to bend – and at the same time to “nail it”! E.g. to nail the meaning, the implications, the emotions, the hopes, the goals, the wishes, and the “next steps” that are inherent in what your client is saying – so that you can move them on to that topic in the conversation while avoiding as much sustain talk as possible.
“You were saying that you’re really worried about the effect that your smoking is having on your heart”, the helper says. “And it sounds like you’re hoping that I can help you find a logical and do-able first step in starting the stopping!”
“Yep. Pretty much. I’d say you nailed it right on the head”, the client replies.
OK – So Now It’s Your Turn! Give it a Try!
In the boxes below, a few client statements are offered. In the box to the right of each statement, write out what you think might be a good “bent” reflection that adds in the implication of what the client is saying, or meaning. Be careful to avoid adding in an interpretation however. Interpretations reflect what you think about what the client is saying – not what the client is meaning! (And example of an interpretative statement is given below)
1. Client: I’m 54 now, but ever since I turned 50, I’ve been having trouble sleeping. It’s weird. I used to sleep like a baby. My husband has no sympathy for me either! He sleeps like a rock.
1. Interpretation: “As you age, you’re starting to notice the effects of the changes in your body a lot. Menopause is really causing you some problems with your sleep – and your husband is not really very aware of the changes that a woman’s body goes through at this time in her life”
1. Complex – Bend: You’re concerned that something has changed in terms of your sleep pattern in the last few years and you’re not sure what accounts for that. You’d like to look into that a little and find out what might get you back into sleeping more like your husband does.
2. Client: My P.O. is always on my case about monitoring my feelings. That makes me so mad. He is so hung up on feelings. It’s stupid. Sometimes I just wish I could scream! But – the weird thing is – I don’t really ever say anything when I’m mad. I’ve always been like that. I just keep it all bottled up.
2. “Your P.O.’s focus on your feelings has got you feeling a lot of feelings! You’ve noticed a pattern though, and that is that you tend not to express feelings when you’re mad. You’re starting to wonder if it might be helpful to … (finish the reflection):
3. Client: Well, I worry about it sometimes, you know. I mean, my Aunt had her left foot amputated because of diabetes, and she was only 44. I’m 49 and she says her blood sugars were never as bad as mine are now. Still, I haven’t had any circulating problems in my feet at all – knock on wood!
3. “You’re feeling kind of safe, for now, because:…
you’re also thinking: ….
4. Client (to a CBT Therapist): My daughter just called to say that she’s going to the hospital in two weeks in San Diego. That’s a 6-day drive for me – at the very least – and I’m not good at driving alone or long distances. I can’t drive after dark either because of my eyes. I need to get there though, because she needs help with babysitting the twins at home. She wants me to fly. She said she’d pay for the ticket – but I’m terrified of planes. I can’t see myself going there by plane – but I can’t let Julie down either! I’m really stuck as to what to do.
4. “There’s just no way that you’re going to be getting on a plane here. You’re hoping that maybe I could …
5. Client (to marriage counsellor): My marriage is on the rocks. I can feel it. There’s no point in trying to talk to my wife about seeing a counsellor at this point. She hates counsellors. Besides – she says that I’m the one with the problem. She says that if I want to pray for miracles, I don’t have to pay somebody $120 an hour to “wish upon a star”. That makes me feel like it’s pointless to ask her to come with me. Still, if I don’t ask her – I know for sure it’s pointless.
5. “You’re in one of those awkward “damned if you do – and damned if you don’t” positions. It has you pretty bummed out, and yet …
Key Point for the Week:
Remember that “bending” what the client is saying just a little helps them see things differently. It causes them to look! To pay attention!
So – help them to hear what they are saying. But – learn to help them to hear what they mean too – just beneath what they are saying. Beyond the content of their words however, help them to hear the implication of what they are saying – if things don’t change – and also to hear what they’re hoping, or wishing, or needing, or even what they might be suggesting they could do … See you next week!
