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MI: Skillful listening

Reflective listening is the most central of the OARS skills, and can also be the most challenging to learn and practise effectively. Many counsellors assume they already know and practise reflective listening; yet when their interviews are recorded and reviewed, it becomes clear that they default to some combination of questioning, advising and affirming.

There are two types of reflective responses: (1) simple reflections essentially repeat back to a client the explicit content of something he or she has said; (2) complex reflections include the client's unspoken (implicit) meaning, feelings, intentions or experiences. In general, complex reflections are more effective at continuing and deepening the conversation.

One way to understand the difference between these two types of reflection is to imagine an iceberg . The tip of the iceberg (above the water) represents the content (or the words the client speaks); a simple reflection focuses on the tip of the iceberg. The huge mass of the iceberg below the water represents all the thoughts, feelings and meanings that lie behind the client's words; a complex reflection focuses below the waterline (Miller & Rollnick, 2013).

Done well, reflective listening on its own can help open up new ground with clients and convey understanding and empathy. Table 5-3 provides examples of simple and complex reflections in response to different statements.

Client statement Simple reflection Complex reflection
I don't think I have a problem with drugs. Using drugs is not a problem for you. Your drug use is not something to be concerned about, so you aren't sure that coming here is going to be helpful for you.
I can see that I need to stop using crack, but smoking a joint now and then is no big deal. You don't see a problem with the cannabis. You're feeling like people don't understand that it's not the cannabis that's causing you all these problems, it's the crack use.