Module 8: MI Microskills - Reflective Listening & Summaries

Question 1

Define reflective listening and why it is the core skill in motivational interviewing.

Answer 1

• Rephrasing what the client has told you
• It makes them feel heard and understood.
• Helps ensure that you are understanding them correctly.
• Can be used to guide the conversation.

Question 2

Discuss when to use reflection listening.

Answer 2

• When you hear change talk
• When the client expresses ambivalence
• When you hear sustain talk

Question 3

Discuss how to use reflection listening.

Answer 3

• Reflect change talk  rephrase in a way that emphasizes the ability or the reason they are able to make the change being discussed
• Ambivalence – double-sided reflection  rephrase their statement including their reason not to change and to change
• Reflect sustain talk  rephrase in a way where they can hear their own hesitation, they may argue with you and say they still want to change (used sparingly)

Question 4

List the different types of reflective statements.

Answer 4

• Simple
• Metaphors
• Reframing
• Continuing the paragraph
• Double-sided use
• Undershooting
• Amplified

Question 5

Simple reflective statements

Answer 5

Rephrase or summarize their statement without adding anything

Question 6

Metaphors reflective statements

Answer 6

• Using a metaphor in your reflection to show you understand and relate to client
• Ex: “Dieting can feel like a rollercoaster ride, before you know it you are upside-down”

Question 7

Reframing reflective statements

Answer 7

• Reflection that highlights a different perspective, you’re still rephrasing what they said but in a way that helps them move toward change-talk
• Ex: “My doctor made me come” Practitioner: “You trust your doctor and you’re wondering how I might be able to help”

Question 8

Continuing the paragraph reflective statements

Answer 8

• Add what is implied in the conversation
• Ex: client: “I’d like to go on walks with my sister. She is the perfect exercise buddy because she goes my pace. Her life is really busy though” Practitioner: “And you’re concerned she may not be reliable”

Question 9

Double-sided use reflective statements

Answer 9

• Use with ambivalence
• Rephrase in a way that shows the positive and negative of what they are saying.
• End with the positive to move the conversation in that direction.

Question 10

Undershooting reflective statements

Answer 10

• Used for further explanation, depreciates the emotion expressed to clarify what the client meant
• Ex: Client: “I hate that my husband eats whatever he wants around me when he knows I’m trying to watch what I eat” Practitioner: “You’re not crazy about your husband’s eating habits” Client: “More than that, it makes me crazy and a little resentful”

Question 11

Amplified reflective statements

Answer 11

• Reflects back on their statement in an exaggerated way
• Ex: client: “I’m just so busy it’s hard to find time to work out and I’m so tired by the time I finish work” Practitioner: “There is just no space in the day to exercise” Client: “Well, I don’t know. Maybe I can exercise on my lunch break at work”

Question 12

Define summarizing statements.

Answer 12

A combination of reflections that emphasize ambivalence and change talk that give clients a bird’s eye view of their thoughts and feelings about a behavior.

Question 13

Describe how to use summarizing statements.

Answer 13

• Summarize points in the conversation where you discussed specific feelings, ambivalence, or guesses about their feelings based on verbal and nonverbal communication
• Use it for “big picture” things

Question 14

Describe when to use summarizing statements.

Answer 14

• Communicate interest and understanding
• To highlight ambivalence
• To reinforce change talk
• To transition to a new topic or phase of the appointment
• To wrap up a session