Enhancing Patient Engagement: The Power of Complex Reflections in Physiotherapy

Complex reflections are a crucial component of Motivational Interviewing (MI), a counselling approach developed by William R. Miller and Stephen Rollnick. This technique is designed to support and strengthen a person's own motivation and commitment to change.

A complex reflection is a statement made by the clinician that goes beyond simply mirroring what the client has said. Instead, it delves deeper into the meaning or emotion behind the client's words, often making inferences about the unspoken content or feelings, or suggesting what the client might say next.

For physiotherapists or any health care clinician, complex reflections can be a powerful tool to enhance patient engagement and promote behaviour change that can lead to improved health outcomes. Here are a few clinical examples where complex reflections could be effectively used by physiotherapists:

• A patient struggling with adherence to an exercise regimen:

Patient: "I know I should be doing my exercises, but I just find it so hard to stay motivated.”

Physiotherapist (label + complex reflection): "It sounds like you recognise

the importance of the exercises, but it feels overwhelming to maintain the routine without some form of encouragement or support.”

• A patient expressing ambivalence about recovery after an injury:

Patient: "Some days I feel optimistic about getting better, but other days I wonder if it's worth the effort.”

Physiotherapist (complex reflection): "You're torn between hope for recovery and the frustration of the slow progress, which can sometimes make you question whether the hard work will pay off."

• A patient who is apprehensive about pain during treatment:

Patient: "I'm worried that doing these exercises will just make my pain worse.”

Physiotherapist (complex reflection): "You're concerned that the exercises might lead to more discomfort, and that fear is holding you back from fully engaging in your treatment plan.”

• A patient who has made significant progress but doesn't acknowledge it:

Patient: "I've been working hard, but I still feel like I'm not where I should be.”

Physiotherapist (label + complex reflection): "It seems like you're being hard on yourself because you have high expectations for your recovery, despite the considerable improvements you've made.”

• A patient who is consistently late or misses appointments:

Patient: "I know I missed a couple of sessions, but I've been really busy with work.”

Physiotherapist (label + complex reflection): "It sounds like you're juggling a lot right now, and finding a balance between work and your rehabilitation is challenging.”

• A patient who expresses a sudden disinterest in continuing therapy:

Patient: "Maybe I'm just not cut out for this, I don't see the point anymore.”

Physiotherapist (label + complex reflection): "It seems like you're feeling discouraged, as if the effort you're putting into therapy isn't leading to the results you were hoping for.”

These examples aim to illustrate the utility of complex reflections in addressing various patient concerns and emotions, thereby facilitating a deeper understanding and fostering a therapeutic alliance.

To practice the skill of making complex reflections, physiotherapists can follow these steps:

• Listen actively and empathetically: Pay close attention to the patient's words, tone of voice, body language, and emotions to fully understand the context of their statements.
• Reflect on the underlying meaning: Before responding, consider what the patient might be feeling or thinking beyond what they have explicitly stated.
• Articulate the reflection: Make a statement that captures the essence of what the patient has communicated, adding depth or a new perspective that can lead to further discussion and insight.
• Check for accuracy: After making a complex reflection, check with the patient to see if your interpretation resonates with them. This can be done by asking for their feedback or observing their response.

Practice regularly: Incorporate complex reflections into your daily patient interactions. Seek feedback from colleagues or mentors, and consider role-playing exercises to refine your skills.

By mastering complex reflections, physiotherapists can create a more collaborative relationship with their patients, fostering an environment that is conducive to change and supporting patients' autonomy and self-efficacy in their recovery journey.

Contact me to find out when I’m coming to your state for communication skills workshops: [email protected]

CS4CS Communication Skills 4 Client Success Level 1 Workshop Perth 1st and 2nd November