John Suler's Teaching Clinical Psychology

Reflection as a Psychotherapy Technique

Unsophisticated Reflections: When talking about the technique of reflection in psychotherapy, I enact the following dialogue between an imaginary subject and the doctor. I play both roles, which adds some extra humor to the role play:

reflection in psychotherapy
S: "I'm very depressed today, Doctor."
D: "You're very depressed, Mr. Smith."
S: "Yes. I haven't been this depressed in a long time."
D: "You haven't been this depressed in a long time."
S: "I'm so depressed that I'm thinking about killing myself."
D: "You're thinking about killing yourself."
S: "I'd like to kill myself right now."
D: "You'd like to kill yourself right now."
S: "Yes, I'm so desperate that I think I'll open this window and jump out."
D: "You're thinking of jumping out that window."
S: "I'm gonna do it. See? I'm opening the window.... and I'm gonna jump."
D: "You're going to jump out the window."
S: "Bye, doc. Here I go........ aaaaaaaaaaaaaaaaaaaaah" (splat)
D: "Aaaaaaaaaaaaaaaaaaaaaah, splat."

Sophisticated reflections: I do this humorous role play to illustrate how the basic technique of reflection, by itself, is not sufficient for effective psychotherapy. Then I go on to emphasize how reflection is deceptively simple. While it may be used in a clumsy, superficial manner, it can also be applied as a versatile and powerful lens for helping a client uncover and clarify extremely important intrapsychic issues - as in Rogerian therapy.

To demonstrate this, I set up a chair in front of the room, sit down, and role play a client for three or four minutes. The class just listens while I talk about my "problem." I may role play some real person that I know (but whom the students don't), or I just improvise an imaginary client. When I finish, I ask the students to write down in their notebook what they would reflect back to the client. It's important that they write down EXACTLY what they would say, word for word, for their "reflection."

We then go around the room and have each student read what they wrote. It quickly becomes apparent that even only three or four minutes of a client talking produces an amazing amount of material. The variety of reflections posed by the students reveal that there are many different themes that could be reflected - and many important subtleties in how to word those reflections. What each student chooses to reflect might also reveal something important about the student.

The bottom line: reflection is an art.

Andy Erkis:

I am a 2nd year doctoral candidate in Counseling Psychology at Penn State. I have been a TA for an introduction to counseling course (which looks a lot like your intro to clinical course). I will be teaching the course this fall and was excited to find your ideas because I am always looking for creative ways to make the material "come alive."

I have not done this yet but I am thinking about spending the one lecture leading a discussion about Rogers --- Rogers style --- I envision myself taking a seat in the middle of the classroom after (possibly) explaining what I am doing. I am hesitant to do this but I think it would be a powerful, learning experience (and it would make Rogers proud!)

Dr. Hayes, my advisor, developed what I think is an ingenious way to illustrate different types of reflection. He has a student volunteer to come to the front of the class and talk about his or her weekend (nothing too personal...) Dr. Hayes, myself, and another 2nd year doctoral student each take the responsibility for a certain type of reflection: content (the other 2nd year student), feelings (me), and process (Dr. Hayes). We stop the volunteer with a hand signal and each reflect our respective parts. Then we had volunteers try to do our parts (we have had a few brave soles do it and they did fine we had them reflect content of course content was easiest)

Another addition to your reflection exercise. Ask students what they think about the utility of reflection. Invariably you will hear the criticism that "parroting will not be helpful..." - take this opportunity to reflect back to them and see how long you can pull it off.

  • student : "it just seems like repeating things back to clients would not feel 'real'
  • me : it wouldn't feel genuine (reflect)
  • student : yeah, the client will be like why do you keep repeating everything I say?
  • me : the client will be thinking 'what is this counselor doing... he is just repeating what I say to him' (reflect)
This summer I went for about 1 minute with a student before he caught on to what I was doing. It was fun and a powerful way to reinforce the message that reflection can communicate "I am hearing you" (I also had a good sense that the student would not experience my "trick" as shaming because I knew him pretty well.)

I also encourage students to try reflections with their friends and talk about it the following class.

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