Simple vs complex reflections: MI examples

A simple reflection says back what the person said, staying close to their words. A complex reflection adds meaning: it names a feeling, links two ideas or guesses at what they haven't said yet. Both are statements, not questions. In motivational interviewing you use simple reflections to show you heard and complex ones to move the conversation forward.

What a reflection is

A reflection is your best guess at what the other person means, offered as a statement. Miller and Rollnick describe it as a hypothesis: you're checking whether you understood.

Reflections differ from questions in one important way. A question asks the person to answer you. A reflection hands their meaning back so they can hear it, correct it and keep going. That's why reflections often get you more information than another question would.

Two delivery rules matter more than any wording:

• Make it a statement. "You're worried about the side effects," with your voice going down at the end. "You're worried about the side effects?" sounds like you doubt them.
• Skip the preamble. "So what I hear you saying is..." gets old fast. Start with "You" or with the content itself.

Simple reflections

A simple reflection repeats or rephrases what the person said. It adds little, and that's its job: it shows you're listening and lets them lead.

I'm running forty minutes behind by noon most days. Of course people are complaining. I would too.

You're way behind by midday, and you get why patients are frustrated.

Use simple reflections when:

• The person is upset and needs to feel heard before anything else.
• You aren't sure what they mean yet.
• The conversation is moving well and you don't want to steer.

Their weakness is that they can stall the conversation. If you only use simple reflections, the person may repeat themselves, and the conversation goes in circles.

Complex reflections

A complex reflection goes past the words. It might name an emotion, pull out a value, join two things the person said, or guess at the next thing they'd say.

I keep picking up extra shifts because nobody else will. I don't mind, really. It's just that my kids are starting to notice.

You keep picking up the extra shifts.

You care about the unit, and you're starting to feel what it's costing your family.

The simple version is accurate. The complex version names the tension under the words: loyalty to the team pulling against family. That gives the nurse something to respond to.

Levels of reflection

A useful way to think about depth is a ladder from the surface to deeper meaning. Here's one statement, from a patient with type 2 diabetes, reflected at each level.

I know I'm supposed to be walking every day. But by the time I get home from my shift, I can barely stand.

1. Repeating. Using their words. "You can barely stand by the time you get home."
2. Rephrasing. Swapping in your own words for the same idea. "You're worn out after work."
3. Paraphrasing. Inferring meaning. "Your job takes everything you've got, and there's nothing left for walking."
4. Reflecting feeling. Naming the emotion. "It's frustrating to know what would help and not have the energy for it."

The first two are simple reflections. The last two are complex. As you go deeper, you take more of a risk of being wrong, and you also give the person more to work with.

Kinds of complex reflection

Continuing the paragraph

Here you say the sentence the person might say next. It works when you can hear where their thinking is heading.

I haven't asked anyone for help because everyone's slammed.

And you'd rather fall behind than become one more thing on someone's list.

If you're right, the person often says "Exactly" and keeps going. If you're a little off, they'll correct you, and you learn something.

Double-sided reflections

When someone holds two views, reflect both. Join them with "and," not "but," because "but" erases whatever came before it. Put the side leaning toward change last so it's what they hear most recently.

Bedside report wakes patients up and drags on. But I guess families do like being included.

It can feel disruptive at the bedside, and you also see what it means to families to be part of it.

Double-sided reflections are one of the most useful moves when someone is ambivalent. They show you've heard the reasons not to change without arguing, and they leave the person's reason for change in the air. More on this in how to respond to sustain talk.

Amplified reflections

You reflect the person's position a little more strongly than they stated it. Often they'll back off the extreme and offer the other side.

Nobody reads those reports until the tenth anyway.

The deadline doesn't make any difference to anyone.

Well, finance needs the numbers. It's more that the third feels arbitrary.

Say it plainly, with no sarcasm. If it comes out with an edge, it lands as mockery and you'll create the very argument you were trying to avoid.

Reflecting values

You name what seems to matter to the person. This often works as both a reflection and an affirmation.

I double-checked everything and I still almost missed that interaction.

Getting it right for your patients matters a lot to you.

How deep to go

Two errors pull in opposite directions.

• Overshooting. Reflecting more than the person said or felt. "You're furious" when they said "It's a little annoying." Most people will correct you, and some will feel misread.
• Undershooting. Reflecting less. "You're a bit bothered" when they're crying. This can feel dismissive.

When you aren't sure about intensity, aim slightly under. If you say "You're frustrated" and the person says "I'm more than frustrated," they've told you more and the conversation deepened.

Choosing what to reflect

People rarely say one thing at a time. Your choice of what to reflect steers the conversation, so it's the most MI-specific part of the skill.

It's not like I'm ignoring them. I get buried. Although, yeah, Mr. Patel waiting two weeks for a callback wasn't okay.

You could reflect "You're buried," which invites more about the workload. Or you could reflect the change talk:

Letting a patient wait that long doesn't sit right with you.

Both are accurate. The second invites the coordinator to keep talking about why follow-ups matter. Learn to hear those moments in change talk vs sustain talk.

After the reflection, wait

New learners often follow a good reflection with a question right away. "You're worried about the side effects. What are you most worried about?" The question cancels the reflection, because the person answers the question instead of responding to what you reflected.

Say the reflection and stop. Count to three in your head if you need to. The silence tells the person it's their turn, and what they say next is often more important than anything you could have asked.

You're worried this one will make you as tired as the last one did.

Yeah. I couldn't work for a week. I can't afford that again.

The patient added a reason the pharmacist didn't know about: money and work are on the line. A question would probably have gotten a narrower answer.

Common reflection mistakes

• The upward inflection. "You're worried?" is a question. Drop your voice at the end.
• Starting with "I understand." It claims understanding without showing it. A reflection shows it.
• Parroting. Repeating every word sounds robotic. Rephrase most of the time.
• Adding a "but." "You're frustrated, but the policy is the policy" cancels the reflection.
• Sneaking in advice. "You're tired, so maybe a break would help" is a suggestion. Stop after the reflection.
• Reflecting only content. If someone tells you about the nine tickets they've submitted, the feeling ("You've done what you were asked and it feels like nobody's listening") often matters more than the facts.

Building the skill

Complex reflections are the clearest marker of MI skill, and they're the hardest to produce in real time. A good exercise: take one statement and write four reflections at different levels, then a double-sided one. Do this with a few statements a day and it gets faster. If you coach others, our trainer page shows how to assign reflection drills between sessions. The OARS guide shows how reflections fit with the other core skills.