I have worked with the reflecting process for nearly 30 years. I value the collaborative, open conversational approach in which my clients, as well as trainees, can select what is useful for each. As I describe my work with the reflecting process, I hope to underscore that it is a therapeutic stance that I hold in all of my work even when a team is not present; it is not a technique. Both in clinical work and training, I emphasize the importance of the talking or speaking position and listening position for all members of the conversation. Tom Andersen, who initiated reflecting dialogues, looked at the relationship between the outer talk and the inner talk or thinking, and suggested that the inner talk can change or transform as a person (whether client, therapist or team member) listens to another speak.
At the Salem Center for Therapy, Training and Research, we have included interns in our clinical work for the past 20 years. When an intern first joins me, I offer them some small guidelines for our work with the reflecting process before we meet with clients. I underscore the importance of the separate talking and listening positions for all members of a therapeutic conversation. I also share my preference for them to avoid eye contact with family members when they are in a listening position. For their reflections, I suggest speaking about what they heard from the clients in speculative language, with an avoidance of pathological language or direct statements.
An intern or trainee begins their work in a listening position and will offer her/his ideas at one or more times during a clinical meeting. If I am meeting with one intern, we will have a conversation while the client(s) listens. If multiple interns are present, they will have a conversation while the family and I listen. After each reflection, the family is asked to comment on what they have heard. Since we are in a room together, I can offer guidance to the intern if needed.
I have wondered if our training model, in which an intern begins her work in a listening position, might limit her/his experience. I questioned if it might be better to give them more responsibility at the outset. However, my experience is that the shifting listening and reflecting positions allow competence to develop. This question led me to do some qualitative research with previous interns about their experience of the training model. The responses from the research interviews strongly support this observation that a listening and reflecting position allows clinical skill to develop quickly in a supportive setting. One former intern commented in the research interview, “At the Salem Center, I think I was asked to serve as interviewer in my second or third meeting with a family. And I did not feel that those in the room where observing and evaluating me. I felt that we were all rolling up our sleeves and going about the work. I noticed in the therapy meetings that the “clients” were de-centered, not the object of the therapeutic gaze. They rolled up their sleeves, too.”
Marjorie Roberts, PhD, is the Director of the Reflecting Dialogues Endeavor at the Salem Center for Therapy, Training, and Research, an organization she co-founded.