Reflection as a Clinical Practice (p.2)
Reflection is STILL your best friend. Let me explain some more. (PS part 1 is here)
One of the best tools you’ll have in your clinical work is developing the ability to regularly reflect on your work. As you develop this tool, do so with self-compassionate, non-judgmental mindfulness. You’ll get better results and clearer information as a result (and bonus: you’ll feel much better).
An assumption (an unproven belief) I use to make regularly is that someone with psychosis would only respond minimally to therapeutic interventions, and was best served by pharmacotherapy. I thought if I tried to do counseling with them, they wouldn’t understand me, or I wouldn’t understand them. We wouldn’t be able to connect on a deeper, emotional level. Change wouldn’t happen. Normal therapeutic tools (empathy, reflective listening) wouldn’t help them. Luckily, I’ve had opportunities to test this one out a lot, and have been very surprised by the number of individuals with whom I’ve had very real, Carl-Rogers-would-be-proud conversations, and seen that they in fact did respond quite positively to a therapeutic conversation, and it shaped the outcome of their treatment in a positive, recovery-oriented way. By reflecting back on these several sessions, I could see what I did that they responded either negatively or positively to.
Our respective codes of ethics support and encourage us in doing our best to be as cognizant as possible of our functioning assumptions and beliefs in any given moment. If you find yourself feeling ‘stuck’ in your work, see if you can trace it back to an underlying belief; do the same if you are feeling content in a certain area of work. I promise, there’s valuable information in both of those scenarios! See which choices your assumptions lead you to. When you have a positive outcome in your work (e.g. someone gets housing, gets sober, gets into treatment, has an improved mood, etc.), try and walk back and see the intervention you used, and the assumption you held.
It’s as simple as:
I thought _________________________,
so I did _______________,
and the client did ________________________.
For example, I thought people experiencing psychosis did not respond well to therapeutic interventions, so I relied more heavily on them getting well from psychiatric medications, and the client generally stayed the same. When I reflected on that, and found it wasn’t working, I tried a new intervention. Here’s what my reflection for that looked like: I thought people experiencing psychosis might respond well to empathy, so I tried empathetic reflections when talking with them in conversation, and they were able to share more about their personal experience and tell me what matters to them in life, what’s missing, and what they’d like to create; together we found more resources to help them reach their goals.
If you want to read more on this topic, check out this study on clinical psychologists in Singapore using reflective practice to inform their work. You can also read about implementing reflection and reflective practice at a system level here.
You’re doing great work out there. Reach out for support as needed. I’m here to help.