Pic 32: The title “Complex Reflections” appear with the same icon of two speech bubbles. This time, the second speech bubble has a plus sign within it.
DANIELLE: A complex reflection, on the other hand, adds meaning to what the patient has said, may emphasize or draw out the feelings behind their words, or makes an educated guess about the reasoning behind them.
Pic 33: Two people icons appear with quotes:
PATIENT: “I tried to follow a strict diet, but it didn’t work.”
DOCTOR: “If you were confident that you could lose weight, you’d have an easier time staying away from junk food.”
Pic 34: Then the quotations update with the following:
PATIENT: “I know exercise is important, but I usually spend my free time watching TV.”
DOCTOR: “You’re realizing that TV watching keeps you from being more active.”
Pic 35: Danielle reappears on screen. To the left, the title “Reflections” appears. Three concentric circles appear on top, with the outermost circle labeled “Understand”, the middle labeled “Listen”, and the innermost circle containing a person icon.
DANIELLE: Reflections show patients you’re listening and trying to understand, encourage them to keep sharing, and create a judgment free space where they feel free to explore their pro change attitudes.
Pic 36: Two headers “Reflections” and “Open ended questions” appear. Underneath “Reflections”, five icons of circular arrows appear to represent reflections. Underneath “Open ended questions”, five icons of a question mark expanding outwards appear, with three of them exed out.
While you should be careful not to ask too many open ended questions in a row, reflections can be used frequently to show you’re supportive and engaged.
Pic 37: The “Reflections title updates with a “2x” in front of it. Two reflection icons and one open ended question icon now appear.
Ideally, you should use twice as many reflections as questions.
Pic 38: Screen returns to the “OARS” acronym, now with “Summaries” highlighted. Then the title changes to “Summaries” on the top, and icon of a speech bubble with a list and a pencil appears. This icon shifts to the left and Danielle reappears on screen.
Summaries combine different points made by the patient and are your opportunity to reflect back all the change talk you’ve heard.
They check your understanding of what the person has said and are useful transitions between various points of the conversation.
Pic 39: The screen goes to a dark gray background with the title “Summaries”. Underneath, three quotation examples appear one by one, with the Change Talk meter appearing again at the bottom. Every time a line appears, this meter fills in another speech bubble icon to represent an increase in change talk:
“So you smoke to relieve stress, and at the same time you’re worried about how much money you spend on cigarettes.
You’re concerned about what it’s doing to your health.
And you also don’t like how you wake up in the morning and start coughing.”
Pic 40: Screen changes to the title “Elicit Provide Elicit”. The icon of three speech bubbles, the first with an arrow pointing left, the second having an arrow pointing right, and the third having an arrow pointing left again, appears. The caption “A collaborative way of sharing information in MI” is displayed underneath.
DANIELLE: Elicit Provide Elicit is a three step process.
First, ask what patients already know about a subject.
Pic 41: Screen returns to a dark gray background and the first word of “Elicit Provide Elicit” is highlighted. The following quotation with a doctor icon appears:
DOCTOR: “What is your understanding of what your cholesterol value means for your health?”
DANIELLE: Then, ask permission before sharing a small chunk of information. This reduces defensiveness.
Pic 42: The title updates so that the second word of “Elicit Provide Elicit” is highlighted. The following quotes are revealed:
DOCTOR: “May I share some information about why controlling your cholesterol is important?”
PATIENT: “Sure.
DOCTOR: “High cholesterol can cause blood clots, heart attacks, or strokes.”
DANIELLE: Finally, follow up with an open ended question like “what do you make of that?” to elicit the patient’s response.
Pic 43: The title updates so that the last word of “Elicit Provide Elicit” is highlighted. The following quotes are shown:
DOCTOR: “What do you make of that?”
PATIENT: “I guess it’s more serious than I thought.”
Pic 44: The header “Give them time” appears on the top with an icon of a head and a puzzle piece inside it.
Pic 45: Screen returns to Danielle on an abstract background. The words “Simple Reflections” and “Complex Reflections” return with their associated icons.
DANIELLE: Of these tactics, reflections are the most nuanced and are a great tool for responding to change talk. That’s because they convey respect and interest while encouraging the patient to continue with more change talk. Let’s try it!
Which of these best reflects the change talk in this statement?
Pic 46: A questionnaire screen appears with the title “Identify Simple Reflections” on the top. Each prompt has a few response selections.
Select the simple reflection that best emphasizes the patient’s interest in change.
Prompt 1: “I want to be healthy, but I don’t want to change my whole diet.”
“You don’t want to change what you eat.”
Feedback if chosen: This reflects the patient’s interest in an unhealthy behavior. It would be better to reflect the patient’s interest in being healthy with a statement like “You’re interested in eating healthier in a way that works for you.”
“You’d like to eat healthier?”
Feedback if chosen: You did note the patient’s interest in change. However, this is phrased as a question. Sometimes that can stop the person’s train of thought and prompt them to verify what they just said, or even imply a judgment of what they said. A statement like “You’d like to be eating healthier in a way that works for you.” would emphasize the patient’s interest in change without interrupting or implying judgment.
“You’d like to eat healthier in a way that works for you.”
Feedback if chosen: Yes! This reflection emphasizes the patient’s interest in change, specifically, an interest in eating healthier.