Pic 13: The screen transitions to one which has the “Complex Reflection” text and symbol.

A complex reflection, by contrast, adds meaning to what the client has said, making an educated guess about the reasoning or emotions behind it.

Pic 14: The image disappears and is replaced with the figure of the health coach, and there are three word bubbles coming from the figure, which read “So,” “Sounds like,” and “What I’m hearing is.”

These “sentence starters” can help you form complex reflections: 

Let’s see how complex reflections work. 

Pic 15: The screen changes to one titled “Examples of Complex Reflections” with two example conversations between a client and a health coach told through word bubbles.

Client: I tried to follow a strict diet but it didn’t work.

Health Coach: Sounds like losing weight is important to you. 

Parent: When I ask my son to play outside, he just wants to watch TV.

Health Coach: What I’m hearing is that you’re worried about how much TV he’s watching.

With complex reflections, it’s less important that you guess correctly, and more important that you show empathy and move the discussion toward change. 

Now try identifying some complex reflections.

Pic 16: The screen changes to a slide titled “Identify Complex Reflections.” It includes an example statement and multiple response options with feedback. The example statement reads “I played football all through high school and college, and now I can’t even do a pullup.”

• Sounds like you miss being in shape.
  • This response is really effective! It made an educated guess about this client’s reasons for change based on what the health coach heard. Remember, it’s no big deal if you don’t guess exactly right.
• Sounds like you kind of dropped the ball.
  • The client did imply that, but dwelling on his failures won’t help build motivation for change. Instead, think about what his reasons for change might be and try to reflect those with a statement.
• Sounds like you should get back into shape.
  • That isn’t a reflection of what the client said, it’s a recommendation. This could provoke a defensive response or derail the client’s consideration of change.

Pic 17:  The screen transitions to the next example statement and responses, with the example statement being “Snacks keep him going during the day, but then he won’t eat anything healthy at mealtime.”

• Snacks have become part of his routine.
  • This is a good guess about what the parent means, but it reflects an argument against change, when a health coach should be trying to amplify the parent’s arguments for change with a statement like “You’re worried his snacks may not be good for him.”
• When he snacks, he doesn’t eat at mealtimes.
  • This is a simple reflection, restating what the parent just said. A complex reflection adds meaning or emotion.
• What I’m hearing is you’re worried his snacks may not be good for him.
  • Right! This is a reasonable guess about what the parent might be thinking or feeling, and it emphasizes a reason for change.

Pic 18: The screen transitions to the next example statement and responses, with the example statement being “I started smoking to look cool for my friends. Are cigarettes really as bad as people say?”

• What I’m hearing is you’re a bit worried that, if you keep smoking, you might have health problems.
  • This is a good response. It made an educated guess about the unspoken desires for change this client might have, based on what they said.
• Are you worried you might have health problems in the future?
  • This is a question instead of a statement, which interrupts the client’s train of thought and can make them feel interrogated.
• What I’m hearing is that you want to quit smoking
  • This is quite a leap from the client’s question about smoking, and they might feel like it’s pressuring them to quit. It would be better to reflect the client’s feelings and let them say if they’re ready to quit.

Pic 19: The screen transitions to the next example statement and responses. This example statement reads “It’s touch because Kally’s friends aren’t very active, so she only gets activity when we schedule it for her.”

• You wish her friends were more active.
  • This is an educated guess about what the parent meant. But it focuses on something that is probably beyond their control, the daughter’s friends. It would be better to focus on something the parent does control.
• It’s hard to constantly schedule activity for her.
  • This is an educated guess about what the parent meant. But it reflects an argument against change, when you should be trying to amplify the parent’s arguments 
• So you wish she could get more activity throughout the week.
  • This is correct! This is a reasonable guess about this parent’s unspoken desire for change. It’s no big deal if it isn’t accurate, as the parent will correct you, and you’ll learn more in the process. 

Pic 20: The screen changes to a new background where the text and image for “Action Reflection” appear.

Lastly, an action reflection turns a barrier or a statement of how, when, or where into a possible action step.

Here’s what action reflections might look like: 

Pic 21: The screen changes to one titled “Examples of Action Reflections” which includes two example conversations between client and health coach told through word bubbles.

Client: I tried to follow a strict diet, but it didn’t work.

Health coach: You’re looking for a plan that’s easier to stick to.

Client: When I ask my son to play outside he just wants to watch TV.

Health coach: Sounds like you’d like to find an activity that would interest him.

Action reflections are only appropriate once you and the client agree on the solutions you’re looking for, which may not occur in every visit. 

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