Double-sided reflection      Show More

    Reflecting ambivalence is used for developing discrepancy in the sufferer’s values and future goals, for example, on the one hand … yet on the other hand … The sufferer may recognize the need to change and they may be at a loss as to how they can instigate change.

    Therapist: In our last session you wanted to try and think of new ways of opening up communication with mum and dad. How did you get on with that? (simple reflection/open question)

    Sufferer: Not very well really, em I was trying to, trying to talk more openly about all this stuff … I think I’ve been struggling a bit as well … it’s not easy. For example, I’m hoping to go to university, that’s what we’re all kind of aiming for but we were talking and I said ‘oh my whole life is always going to be a mess’ … like just kind of shouted at them.

    Therapist: So on the one level, you feel you’re experiencing difficulties in initiating opportunities for communication yet on another level, whilst you were talking, you were responding with pretty powerful messages with regards to how you’re feeling. (reflection using developing discrepancy)

    Sometimes the carer will have to change the subject in order to keep his/her daughter/son on track.

    Sufferer: I just feel so frustrated – you want to know EVERYTHING about my life – what I eat, where I’m going when I go out, when I’ll be home, where I exercise, how much I exercise…. it’s hellish – I have no choices. I have no other place to live. I have no other choices. All you seem to concentrate on is food, food and more food.

    Carer: This certainly sounds upsetting. I’m not surprised you feel angry and frustrated. You’re probably feeling pretty sad as well as it hasn’t always been like this. Let’s come back to those feelings later and for now move ahead and talk about some of the ways you can perhaps nudge your life forward in a more positive direction. Let’s talk about those choices. (affirmation/empathy/complex reflection/shifting focus/open question)

    This involves taking the negative side of the argument or even amplifying it. Acknowledge the truth…it may be too difficult. Be careful not to say it with sarcasm. If there’s sarcasm or aggression, it will have the opposite effect:

    Sufferer: I hate these winter mornings… it’s blowing a gale out there and it’s harder running against the wind.

    Carer: This daily exercise routine sounds very important to you. How would you feel skipping it on days like this when the weather is bad? (complex reflection/open question)

    Sufferer: I don’t know. Guilty I guess…guilty and bad about myself, lazy….no self control.

    Carer: Hmm… that’s too bad. It’s not gonna work at this particular moment in time. Sounds like it’s just going to cause too much anxiety for you . (empathy/reflection, citing with the negative)

    Sufferer: Mmmm…(pause) … yep you’re right. It just freaks me out when I don’t exercise. I could use working on that and finding something else to help me calm…maybe yoga? Wish I wasn’t so harsh on myself at times. Maybe I could skip the really cold mornings and see how I go with it. I might need your support with this….

    This is when parents encourage their loved ones to see something in a different way, taking something their son/daughter is unhappy with and reframing it as a strength.

    Carer: So sounds like this sense of self-control is a big deal to you but at the same time it also weighs heavy on your shoulders making you do things that you don’t particularly feel like (complex reflection using developing discrepancy)

    Sufferer: At times it feels that way

    Carer: This part of your personality has been positive in many areas of your life – you play the piano beautifully and you certainly needed to be focused to have achieved this. Your music also alleviates some of your anxiety. (affirmation/complex reflection)

    Sufferer: That’s true

    Carer: So on the one hand, it can be your friend but there again, it can also act as your enemy (complex reflection using reframing)

    Agreement with a twist

    This is a reflection or an acknowledgement followed by a reframe.

    Carer: So you feel your own anxiety levels are lowered when you shop at several supermarkets on your way home from work in an effort to try and ensure dinner is less stressful for you. It sounds as if it may be worth the effort for you. (Complex reflection + reframe)

    Sufferer: On some levels, yes, but a lot of the time, no … some days I feel tired and quite embittered that I have to go through all this rigmarole when other normal people don’t. Most nights it doesn’t even work. Emphasizing personal choice In their training DVDs, Bill Miller and Steve Rollnick (2) attribute particular significance to this aspect. When working with people with eating disorders, its significance lies in reminding the sufferer that we all have choices.

    Carer: As your mum, I realize that you are at the helm in your own recovery path and that I can merely support you in your fight against it. You have choices – you talk of your longing to be like your other friends, you’ve also spoken about your desire never to have to go back into the inpatient unit again. You sound understandably frightened and distressed at the anorexia taking a stronger and stronger hold of you. What steps can you take to feel a bit more empowered? (summary/open question … emphasizing personal choice)

    Sufferer: Well guess I can try and challenge some of these awful thoughts. There’s no reason why I shouldn’t and every reason why I should.