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Reflecting on the MITI Highway

Monday, July 02, 2018
By:  Ali Hall

Reflection of the word CHANGE

When we know what we are doing well, we can build on that to stretch to the next level in Motivational Interviewing skillfulness. 


Reflecting only challenges not the change     


I could hear that I was expressing Partnership and Empathy and that I was really hearing the patient’s deeper self-exploration. But I was reflecting their expressed challenges--those very things that were standing in the way--rather than reflecting where that individual wanted to go.


Hidden underneath obstacles             


From a foundation of listening, I could then choose to reflect the importance patients were expressing about change that was hidden underneath their obstacles. When the patient says “I’m so discouraged, I’ve tried so hard to cut back on smoking and nothing seems to work,” rather than reflect “you really sound discouraged” I could reflect “this has been so important to you that you keep trying, you haven’t given up on this and are looking for something that will help.”       


When we reflect around the obstacle, we’re helping patients begin to hear their yearnings for change more strongly, and they begin to strengthen that for themselves.           


The MITI can give us important data about how well we are listening and how well we are specifically responding to patient language that favors movement toward changes they consider important.