Reflective listening

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Reflective listening is a key component of showing empathy and a core skill of person-centred therapy. It involves listening to what the client is saying, forming an understanding of what they are talking about and then giving voice (reflecting) to that understanding. Reflecting shows respect and acceptance to clients, establishes trust and helps with the exploration of perceptions and values, enables the building of a collaborative and non-judgemental relationship, and allows the AOD worker to show their support without necessarily agreeing with the client’s ideas or statements [758].

Good reflective listening keeps the client talking, exploring, and considering. It is also specific in the sense that the AOD worker selects specific information on which to reflect. Reflecting can range from simple (i.e., repeating or rephrasing the client’s words) to complex (i.e., reflecting the underlying meaning or feelings with the use of different words). The depth of reflection increases with the level of the AOD worker’s experience and expertise. Importantly, reflective listening is not making assumptions about the underlying meaning of clients’ statements, but rather forming hypotheses about the meaning or feeling and listening carefully to the client’s response after the hypothesis is tested. Simple reflections are useful for client engagement and obtaining their perspective but can sometimes lead to slower progress if the AOD worker is not able to add complexity and depth by interpreting the spoken and unspoken content, anticipating what may come next. More complex reflections can expand a client’s self-exploration [758, 1847]. Some examples of simple and complex reflections are provided in Table 65.

Table 65: Examples of reflective listening responses

Type Client statement AOD worker response Purpose Considerations
Repeat My girlfriend is hassling me about how much I smoke. Your girlfriend is hassling you about how much you smoke.

Shows empathy.

Builds rapport.

Avoid mimicking.
Rephrase My girlfriend is hassling me about how much I smoke. Your girlfriend is pestering you about how much you smoke.

Shows empathy.

Emphasises selected meaning or feeling.

Moves the conversation along but slower than with complex reflections.
Feeling I’d like to give up smoking pot so I don’t make my girlfriend’s asthma worse. You’re afraid that your girlfriend’s asthma will get worse if you keep smoking pot.

Emphasises selected feeling.

Emphasises discrepancy between values and behaviour.

Reinforce change talk, avoid reinforcing sustain talk.
Meaning I’d like to stop smoking pot because my girlfriend has asthma and I heard that second-hand smoke can make asthma worse, and I don’t want that to happen to her. You want to protect your girlfriend from the possibility that her asthma will get worse if you continue to smoke pot.

Emphasises selected meaning.

Emphasises discrepancy between values and behaviour.

Reinforce change talk, avoid reinforcing sustain talk.
Double-sided I know I should quit smoking pot but it’s the only time I have for myself. Giving up smoking pot would be hard and you recognise that it’s time to stop.

Resolves ambivalence.

Acknowledges sustain talk and emphasises change talk.

Use ‘and’ to join reflections. Start with sustain talk reflection and end with change talk reflection.
Amplified I think my pot smoking is just not a problem for me. There are absolutely no negative consequences of smoking pot. Amplifies sustain talk to evoke change talk. Use sparingly. Avoid being caught in sustain talk.

Adapted from SAMHSA [1847].

Among clients experiencing symptoms of co-occurring mental health conditions, these statements should be simple, concise, and frequent. Avoid repeated reflecting of the client’s negative statements and allow them time to consider these reflections [1919].

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