Topic 3: Responsive Communication
“You can’t fake listening. It shows”
- Raquel Welch
Contents:
Nevada WIC C.A.R.E.S.
 Key messages for Champions ………………………………………….
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 Activities for staff ……………………………………………………………
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 Ideas for facilitated conversations with staff …………………..
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 Sample script ………………………………………………………………….
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 Observation guide …………………………………………………………..
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 Self observation guide ……………………………………………………..
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 Handouts …………………………………………………………………………
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 References/Resources ……………………………………………………… 21
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Key Messages for Champions
Participants who express and talk openly about their motivations to adopt healthy behaviors for
themselves and their families are more likely to actually make those changes. One conversational
tool to help participants to talk more throughout the WIC appointment is reflective listening.
Reflective listening helps participants to feel heard and understood and helps them continue to
discuss and explore possible healthy changes for their family. This section will begin to explore how to
use reflective listening to enhance WIC conversations. Below are key messages to help staff start to
understand the benefits of reflective listening including when and how to use the tool successfully.
What is reflective listening?
A reflection is a brief response that lets the speaker know you’ve been listening and helps you check
your understanding of what is being said or the emotion behind it. When we reflect, we make a
guess about the meaning and say it as a statement in our own words. This process helps participants
know that you are truly listening and trying to understand, helping them to trust and continue to talk
more throughout the session.
Characteristics of reflective listening
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It is a statement, not a question. Unlike with a question, your voice will not turn up at the end.
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Involves active listening. While the participant is talking, think to yourself:
o What does this person mean?
o What are they really trying to say?
o How do they feel about this?
o What is important to them?
o What are they not saying?
o What is their tone or body language saying and is it different than their words?
Why use reflective listening?
Reflective listening serves many purposes and can be used throughout the WIC appointment. Some
common uses for reflective listening during the appointment include:
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Helping participants talk more and explore their emotions and ideas
Letting the participant know you are listening
Allowing you to check the accurateness of the information you heard
Helping to build participant’s trust and openness to share more
Helping to uncover the participants reasons for making healthy changes in their lives
Allowing you to collect more information
Helping the participant to think and talk about change and strategies for change
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Reflecting change talk
Change talk is any participant talk that signals a movement toward change. What motivates each
person to make positive health and nutrition related changes is different so it is important to help
participants explore their own inner motivations for change. Reflective listening helps us explore the
participants own motivations, emotions and ideas for adopting healthy behaviors. Module 2
explored using open questions to bring out change talk. When the participant expresses any talk that
expresses their desire, ability, reasons or need to make a change, reflecting that change talk back to
them will help them hear their own reasons for change and help them to continue to explore it.
When to use reflective listening
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After an open-ended question: this helps the participant to continue to share and helps to
collect more information.
When you hear change talk: by reflecting change talk, the participant will hear their thoughts
two times, when they say it and when you reflect it. The more they continue to explore the
change, the more likely they are to follow through with the change.
When you hear or sense resistance: often rolling with resistance by simply reflecting it will
help participants be less defensive, reducing the resistance.
When you hear ambivalence: often participants will feel two ways about a topic. Reflecting
the ambivalence will help participants explore both sides of their feelings around change.
When you hear strong feeling: stopping to explore strong feelings around feeding and
nutrition issues will help participants explore the source of the feelings.
Making a guess
Sometimes the counselor does not reflect what is actually said but takes a guess about what the
person actually means or how they feel. Additionally reflective listening may involve taking a guess at
what the participant may say next. You are anticipating what they will say and continuing the
paragraph.
When being wrong is ‘right’
A participant’s statement can have many different meanings. Using reflective listening to essentially
make a guess about the meaning of a participant’s statement. Reflections allow you to make sure
you understand what the participant is trying to express. In most cases, there is no penalty for
reflecting incorrectly. Both correct and incorrect reflections can encourage participants to continue
to talk. Either the participant agrees with your reflection and most often will continue to share more,
or the participant will disagree with your reflection and offer an explanation of their true meaning.
Often just hearing their thoughts being reflected out loud will cause a participant to change how they
are thinking about an issue.
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Types of reflective listening
There are different types of reflections. Some reflections are simply paraphrasing what the participant has
said and others go deeper, moving beyond what the person has directly said. Simpler reflections are often
used at the beginning of the assessment and more complex reflections are used as the trust builds. A complex
reflection moves beyond what the participant says and to uncover deeper meaning or to reframe the
information in a way that the participants may not have considered before.
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Simple reflection : Slight rewording of what client said
Complex refection: Moving beyond what was said
 Meaning
 Emotion / Feeling
 What is not said
 Finishing the thought
 Ambivalence –feeling 2 ways about the topic - double-sided reflection
Reflection with a reframe: Choosing words to reframe how the participant is thinking about the topic.
Summary reflection: Putting together a summary of all the key points
Understating emotions
When reflecting emotion, it is often best to understate the emotion rather than overstate the
emotion. Overstating the emotion may cause participants to back away from the topic. If you
understate the emotion the client is more likely to continue to elaborate and share more.
Instead of:
“You were very angry with your mother for giving him treats instead of
the healthy snacks you left for him.”
Try:
“You’re upset that your mother gives him treats instead of the healthy
snacks you had packed.”
Helping words
Some people find it helpful to have some words to get them started in making a reflective statement.
Some examples are listed below. A common element in the helping words below is the word “you.”
Be careful not to overuse the stems.
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You are…
So you…
You don’t think…
You feel…
So you are saying that…
You’re wondering if…
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You think…
It’s as though…
You’re frustrated…
You want to…
Kind of like…
It sounds like…
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The difference between reflecting and responding
When a participant makes a statement, sometimes our natural tendency is to respond instead of
reflecting, which doesn’t necessarily show we are listening.
Participant:
Responding:
Reflecting:
“I think my child’s weight is fine.”
“The growth chart shows he weighs more than the majority of kids his
age.”
“You are not concerned about his weight.”
Reflecting resistance
When participants are voicing resistance to change, often simply reflecting the resistance is more
effective than arguing against it, or trying to convince participants to feel a different way about the
topic. Reflecting resistance helps the participant realize that it is their decision to make (or not make)
the change and helps them not feel judged.
Examples:
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“You haven’t found a way to get your child to eat vegetables that works for you.”
 “Although you have heard some positive things about breastfeeding you have some real
concerns about how it will fit into your lifestyle.”
 “That idea won’t work for you.”
 “You don’t agree with the doctor’s assessment of her weight.”
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Activity 1: Forming reflections
Introduction:
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Explain to staff that this exercise is about forming reflections.
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Ask staff to share what they have learned about reflections and why they are important.
Share content as appropriate from the Key Messages section.
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Ask: when are some times during the appointment when reflections are useful?
Activity – Forming reflections
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Have staff work in small groups to complete the exercise and then share responses. After
reading each statement on the page below, each group should write down 2 or 3 possible
reflections for each statement. To get the group warmed up, you may offer an example and
have the group brainstorm possible reflections before working in groups.
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Example:
I did want to breastfeed with my last baby but she ended up drinking less and less breast milk and
more and more formula.
Possible reflections:
“You had some issues with your milk supply.”
“You want to breastfeed but you’re worried about making enough.”
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Remind participants that reflections are not questions but statements and that there are
many possible reflections for each statement. After the groups are done, read each
statement and have the groups share one or two of their reflections for each. Encourage
many reflections for each statement.
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For each statement listed below, offer 2 or 3 possible reflections. Try reflecting the meaning or
feeling of the statement. You can reflect any ambivalence (participant feel 2 ways) or change talk.
1. I am expecting my second baby. I never paid much attention to what I ate before. I know it was a
lot of fast food. I ended up gaining about 40 pounds and it was hard to take off.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
2. I have tried a bunch of things and nothing has worked. I know it’s not good for her teeth but she
will not fall asleep without the bottle. It is like a safety blanket for her.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3. The WIC checks for fruits and vegetables help but they are still expensive. I would rather spend my
money on something I know they will eat.
_______________________________________________________________________________
_______________________________________________________________________________
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4. I know everyone says breastfeeding is healthy but I am not sure I want to go through it. I tried with
my first baby and it was really painful.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Activity 2: Finding and reflecting the change talk
Introduction:
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Explain to staff that this exercise is about finding and reflecting participants’ thoughts about
change.
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Ask staff to explain what change talk means to them.
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Explain that often people thoughts about change are mixed with reasons not to change. By
identifying and reflecting the change talk, you can keep people exploring and talking about
change which makes it more likely that they will change.
Activity – Part 1: Finding the change talk
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Read each of the paragraphs on the sheet below. Ask staff to underline parts of the statement
where they hear change talk.
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Ask for volunteers to identify the change talk in each statement.
Activity – Part 2: Reflecting the change talk
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After identifying the change talk, have staff work in small groups and write down 1 or 2
possible reflections for each statement that reflect the change talk.
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After staff members have shared ideas, discuss the activity:
o How will reflecting the change talk help participants talk more about it?
o How will isolating the change talk from the reasons not to change help participants to
change?
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For each participant statement below, underline the change talk and suggest one or two reflective
listening statements that will highlight that change talk.
1. Maybe I should get more creative with the fruits and vegetables and how I serve them. As it is, I
put them on the plate, but they don’t even take a bite – even to try them. It makes me wonder why I
bother.
_____________________________________________________________________________
_____________________________________________________________________________
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2. I don’t know where I would find the time to exercise. I think walking or taking a group class would
help me feel healthier but my days are full already. You can’t create time.
_____________________________________________________________________________
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_____________________________________________________________________________
3. I’ve just never been a milk drinker. I know I need the calcium but milk doesn’t taste good to me. I
don’t mind yogurt, especially when I mix in some cereal, but straight milk is not going to work.
_____________________________________________________________________________
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4. She loves the juice. She could drink it all day long. I worry a little that it is filling her up and that is
why she is so picky but at least she is getting the vitamins from the juice.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Activity 3: Continuing the thought
Introduction:
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Explain to staff that this exercise is about taking a guess at what the participant will say next
and reflecting that.
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Explain that this is a form of reflecting and helps the participant open up and talk more.
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Share that there may be several interpretations of what the participant means and this is a
way of testing a guess at the meaning. Most of the time, participants will either agree or
continue to share or correct the information, and continue to share.
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Ask: what are some of the reasons why this form of reflective listening would be valuable?
o Possible answers could include: participants may not offer the entire story until they
can trust you; this helps them think through the next step; this may help a participant
look at the situation differently.
Activity – Continuing the thought
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Have staff work in small groups to complete the exercise and then share responses. After
reading each statement on the page below, each group should write down 2 or 3 possible
continuations to the sentence.
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To get the group warmed up, you may offer a couple of examples and have the larger group
brainstorm possible reflections together before working in small groups.
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Examples:
o
My child wants the same thing night after night.
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Continuing responses could include….
“and that is making you worried”
“ and you’re concerned about his health”
“ and you’d like him to eat a wider range of foods”
o
Everyone is giving me different stories about breastfeeding.
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Continuing responses could include…
“it is up to you to sort through it all and find out what is right for you”
“and they are making you doubt your choice”
“it has you confused about the best choice to make”
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For each participant statement below, brainstorm possible reflections that would continue the
thought of the participant. For most statements, you may have to take a guess about how the
participant feels about the issue.
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I did try to breastfeed with my first baby but it really hurt. I guess I could try to breastfeed again.
_____________________________________________________________________________
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I know that bribing him with dessert is not the best thing to do.
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I have been eating all the time. I am so hungry; I just can’t seem to stop.
_____________________________________________________________________________
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She is with her grandmother during the days while I am at work. Her grandmother gives her all
kinds of goodies and candy.
_____________________________________________________________________________
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Ideas for a facilitated conversation with staff:
Reflective Listening
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Let staff know that this discussion will be about using reflective listening with participants.
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Ask staff to start by thinking about a mirror. Mirrors reflect what we see. What are all the
reasons to use a mirror?
o Possible answers: (encourage fun responses) to make sure my clothes look ok; to see how
other people will see me; to check my hair.
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Share: Reflective listening is a little like holding a mirror up for participants.
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Ask: What is reflective listening. (Use some information from Key Messages section if necessary)
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Ask: What are some of the reasons to use reflective listening in conversations?
o Possible answers: to keep participants talking; to show interest; to check your
understanding; to help them dig deeper.
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Ask: Tell me about your experiences with using/forming reflections.
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Ask: What are some challenges to using reflective listening?
o Write down the challenges mentioned. (Responses may include: it may sound like I am just
parroting what the participant has said; it is like we are putting words in their mouth)
o Ask staff to brainstorm solutions or changes you could make to address those issues.
Examples may include:
 Ask: How can you use reflective listening without sounding like you are simply
repeating what the participant is saying?
 Ask: How do people feel about guessing at what people mean – in essence “putting
words in their mouth?”
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Share: As long as the guess is not extremely far off, participants will
respond and clarify their answer, so you will end up with a more
accurate picture and more information.
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Ask: What are some reflections that you have found to be effective?
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Ask staff to look at the handout Examples of Reflective Listening.
o Have staff take a couple of minutes to read through the examples and circle 2 that they
think would keep the participant talking or direct the conversation in a positive way.
o Ask staff to share which they chose and why?
o Optional - ask staff to share ideas with a partner.
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Share: reflective listening is not something that we all naturally do in conversations. When we
listen to participants, our natural tendency is to ask another question or start to educate. Because
of this, it takes time and practice to use reflective listening effectively.
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Ask: Can anyone think of some ways to practice reflective listening?
o Possible answers (share some ideas if they were not brought up): try reflections with your
friends and family; record your sessions and listen for reflections; tape a TV talk show (like
Oprah or Dr. Phil) or a radio talk show and listen for reflections and write them down.)
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Summarize the discussion.
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Sample Script
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The following sample of a WIC appointment is adapted from the Oregon WIC Listens resources.
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Ask staff to play the parts of the CPA and the mom. Give them the script ahead of time to read
through to prepare.
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Explain to the staff that we will be role-playing the first part of a WIC appointment to
demonstrate effective uses of reflective listening.
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Ask staff to jot down any reflections they hear.
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After the role play, have staff share their feedback about the interaction:
o What were some things the CPA did well in this scenario?
o What were some of the reflections the CPA used?
o How did they help the interaction with the participant?
o What were the main issues for this participant?
o How would you proceed from here?
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Prenatal Certification – Sample Script
Scenario: Pregnant woman is at WIC for her enrollment appointment. She has already been checked in at
the front desk and is waiting in the waiting room.
CPA: __(client name)____? Hi ______, it’s nice to meet you (build rapport). My name is ________ and I’m one
of the CPAs with WIC. I understand that you are interested in enrolling in WIC today (set agenda). Is that
correct? (check for understanding)
Mom: Yes.
CPA: That’s great! We’ll spend about 30 minutes together today to complete the enrollment process and I’ll be
gathering some information from you during that time (set agenda). How does that sound? (ask permission)
Mom: Fine.
CPA: Good! Then let’s go back to my office and we can get started. Have you ever been on WIC before or had a
friend or family member on WIC? (check what client already knows)
Mom: No, I’ve never been to WIC before, but I heard about it from a friend who was on WIC in California
when she had her baby.
CPA: So this is your first time here. (simple reflection) Well welcome, we’re glad to have you here today.
(affirm, build rapport).
CPA: If it’s all right with you (ask permission) I’d like to begin by getting your height and weight and taking one
drop of blood from your finger to check your iron count (set agenda). Will that work for you? (asks permission)
Mom: Ok, sounds good, except for the finger part.
CPA: You’re not a big fan of having your blood taken? (reflection with a guess at feeling). A lot of people feel
that same way (affirm). So maybe we can do the height and weight first? (ask permission)
Mom: Alright.
CPA: In order to get accurate measurements, I’ll need to ask you to take off your coat and shoes. (Client gets
coat, shoes off to do height and weight) So, how many pregnancies have you had?
Mom: This is my first pregnancy.
CPA: You sound excited. (reflection) Congratulations! (build rapport)
Mom: Yes, excited and nervous.
CPA: Both are certainly normal reactions! (affirm) Now, if you’ll please stand with your heels and back against
the wall I’ll check your height. (Client stands against measure board). Thank you. Next, if you will step up on
the scale, I’ll get your weight. (Client stands on scale). Thanks. You’re welcome to have a seat here and put
your shoes back on. After we check your iron count, we can go back to my office and talk about your health
and what you’ve been eating. (review agenda) Are you ready for the iron test? (ask permission)
Mom: We might as well get it over with…
CPA: This process makes you a little nervous (reflection) so I’ll be as quick as possible. I’ll wash your finger
then there will be a prick (does finger stick) and that’s it! Are you OK? (build rapport)
Mom: Yeah, that wasn’t too bad.
CPA: I’m glad to hear it! While we wait for the results, what are some questions you have that you’d like us to
be sure to cover today?
Mom: I’m not really sure, I haven’t thought about it much.
CPA: That’s fine; just let me know if you have any questions or concerns as we go along. (build rapport) I see
that your iron level today is 10.1; a level of 11.0 is typical. (neutral feedback)
Mom: Is that bad?
CPA: Well it is a little lower than we might hope for, so we can talk about this before the end of the visit. Let’s
go back to my office now.
(Mom and CPA move to counseling room)
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CPA: While we are talking, I’ll be taking some notes and putting some information into the computer. To begin
with, I’ll enter your height and weight. So today I have you as 5’6” with a weight of 150 lbs. (provides feedback
in a neutral way). How does that compare to what you used to weigh before you were pregnant?
Mom: I don’t know, I think I was about 140 before, but I don’t weigh myself very often.
CPA: So you’ve gained about 10 lbs so far. How does that match with what you’ve heard about the amount of
weight gain recommended during pregnancy? (checks what Mom knows, prepares for exchange of
information)
Mom: I haven’t really heard anything about what’s recommended. I just know that a couple of my friends got
totally huge during their pregnancies. I think they gained like 70 lbs or something! I hope that doesn’t happen
to me!
CPA: You’re pretty concerned about the whole weight gain issue. (reflection)
Mom: Yeah, I’m really worried that this pregnancy might change my weight in the long run. I mean I know
getting pregnant means gaining weight, but like I said I don’t want to end up like my friends.
CPA: I can see that. If you’re interested, I could share with you what the general recommendations are for
weight gain during pregnancy. I think you might find it a relief. (asking permission, gauging interest). What has
your doctor told you about weight gain? (assess for prenatal care)
Mom: Oh, I haven’t been able to see anyone yet. I’m not sure where to go until I get my insurance figured out.
CPA: So right now you’re without a doctor for prenatal care (simple reflection). Is that something that you
might like us to work on before you leave today? (asks Mom’s permission, gauges her readiness to address
issue).
Mom: Yeah, that’d be great. I’m really worried about not having seen anyone yet.
CPA: Great! Before we talk more about weight gain or prenatal care, there are a couple of other questions
from your questionnaire that I would like to ask if it is OK with you? (ask permission)
Mom: Sure.
CPA: Tell me about your health so far during this pregnancy? (open ended question)
Mom: Pretty good. I’ve been a little nauseous but other than that I’ve been healthy.
CPA: You have had a bit of nausea (simple reflection). How has that nausea that you’ve experienced affected
your appetite?
Mom: Not much. I just don’t eat much in the morning.
CPA: So tell me, what have you heard about eating well during pregnancy? (open ended question, check what
the Mom already knows)
Mom: Well, everyone says that you’re eating for two now, so I know I should probably be eating more, but
really I’m not that big of an eater. And I know that you should try to eat lots of healthy foods and not a lot of
junk or anything.
CPA: You haven’t really altered the way you have been eating. (reflection)
Mom: Well a lot of times I skip breakfast because I’m just not that much of a morning person. But sometimes
I’ll have toast or a bagel or something. Lunch and dinner, it’s sort of whatever’s around the house. And I like a
snack before bed.
CPA: So, what you eat depends on the time you have and what’s around. Does that seem like a fair thing to
say? (simple reflection, checks for understanding)
Mom: Yeah, I guess that’s true.
CPA: What foods do you especially enjoy eating? (open ended question) (diet assessment)
Mom: I like fruit and ice cream and pasta dishes like macaroni and cheese.
CPA: Those are some tasty choices. (affirm) What, if any, foods do you avoid eating? (open ended question)
(diet assessment)
Mom: Well, I really don’t eat meat very much. And since I’ve been pregnant the smell of it cooking makes me
want to throw up, so I’ve been avoiding it.
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CPA: That’s not uncommon to feel that way. It’s also not uncommon for pregnant women to crave some pretty
weird things. What types of things, if any, have you found yourself craving that people wouldn’t typically think
of as a food? (open ended question) (diet assessment)
Mom: Nothing I can think of at this time. I hope if I get cravings it will be something fun like chocolate.
CPA: Chocolate cravings would be good! (simple reflection) In addition to the foods you’re eating, tell me
about any vitamins or other supplements that you might be taking? (open ended question) (diet assessment)
Mom: I’m just started taking a prenatal vitamin last week when I found out for sure I was pregnant.
CPA: Great. That’s very important for helping you get all the nutrients you need and might help with your iron
levels too (affirm). Keep it up!
CPA: Thanks for answering those questions for me. It’s great that you’re making such healthy choices for you
and your baby! (affirm) Now thinking about your baby, what have you thought about how you are going to
feed your baby once it arrives? (open ended question, checks what Mom already knows)
Mom: I don’t know. I’m just dealing with finding out I’m pregnant. I’ve heard that breastfeeding is really good,
but I really haven’t thought about it much.
CPA: You have a lot to think about. (simple reflection) What are a few of those really good things you’ve heard
about breastfeeding? (open ended question, checks what Mom knows, sets up for Mom to state her own
reasons, which are more powerful reciting the ‘benefits’ speech).
Mom: Well I’ve heard that it will help your baby be healthier and it might help you lose weight faster.
CPA: And both of those are very important to you. (reflection)
Mom: Yes, I want a healthy baby and I wouldn’t mind getting my figure back.
CPA: You want a healthy baby and you already know that breastfeeding can be an important part of that.
(reflection)
During our conversation I jotted down several topics that came up that seemed to be of interest to you
prenatal care, weight gain during pregnancy, and breastfeeding. As your WIC counselor I would like to add the
low iron we found on your blood test. Is there any other subject that I didn’t mention that you would like to
talk about today? (summarize, transition to education)
Stop here and ask the discussion questions above.
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Observation Guide: Reflective Listening
Option 1: Observe staff. Note any reflections used and areas where reflective listening may have
been helpful.
Option 2: Have staff observe each other and use this form to note any reflective listening
statements. Have them share specific feedback with each other about strengths they saw.
Encourage sharing strategies.
Comments and examples
When reflections were used
Reflecting after an open-ended question
Reflecting change talk
Reflecting ambivalence
(double-side reflection)
Reflecting tone or body language
Reflecting strong emotion
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Self Observation Guide: Reflective Listening

Each time you use a reflective listening statement successfully to encourage conversation with
participants, note the reflection you used. Writing down the reflections you use will help you
become more aware of them and help you to use more reflections during your appointments.

Save this sheet to remind you of successful reflections and share them with your co-workers.
Successful reflection –
give yourself a star!
Write down successful reflective listening statements that led to a
positive interaction with the participant

When I asked the participant how she felt about her weight, she said
she would like to lose 10 pounds because it is getting difficult to pick
up the baby.” I reflected, “For you, losing some weight would allow
you to do all the things you want with the baby and have the energy
to do it.” She shared more about her desire to lose more weight and
we brainstormed some food and activity strategies to get her
started.
Ideas from my co-workers:
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OA
RS: Reflecting
(Listening and Responding)
Reflections have the effect of encouraging the other person to elaborate, amplify,
confirm, or correct.
 Ways to open:
So you feel….
It sounds like you….
You’re wondering if….
It seems to you that….
You’re feeling….
So you…
 Tone of voice turns down at the end
 Metaphors and similes
Kind of like…
It’s as though…
 Levels of reflection
1.
2.
3.
4.
Repeating (repeats an element of what the speaker said).
Rephrasing (uses new words).
Paraphrasing (makes a guess to unspoken meaning).
Reflections of feeling (deepest form; a paraphrase that emphasizes the emotional
dimension through feeling statements).
In general, simpler (1 & 2) reflections are used at first, when meaning is less clear. Deeper reflections
are tried when we understand and know our clients better. Jumping too far beyond what was said,
however, can turn into a roadblock. It is better to understate a feeling than overstate it (overstating can
stop dialogue, understating continues it).
 Continuing the Paragraph
Reflections ideally move forward rather than simply repeating what the client has said. In essence, the
counselor is making a guess as to what the client’s next sentence will be, instead of merely echoing the
last one.
 Understate versus Overstate
Larson Sturtevant Consulting, LLC
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Nevada WIC C.A.R.E.S.
Reflective Listening …Some Examples
Simple reflection: Slight rewording of what client said
Participant: “She is growing but she cries a lot and I think she needs to be drinking more formula.”
Reflection: “You are wondering if she is getting enough to eat.”
Reflecting Meaning: Going deeper to take a guess about what the participant means
Participant: “I grew up hating vegetables too. My mother never served them. When she did, I wouldn’t
eat them. I am trying to do things differently with my daughter. I am even trying to eat more veggies.”
Reflection: Being a role model of healthy eating for your daughter is important to you.
Emotion / Feeling: Emphasizing and reflecting the feeling of the statement
Participant: “She wants to breastfeed constantly. I can’t keep up. I am exhausted. I think I will start with
some formula so it will hold her a little longer.”
Reflection: “You’re tired and need a break. You feel that formula may give you that break.”
What is not said: Taking a guess at what the wants but has not yet said
Participant: “He stays at my sisters some times and plays with her son who is about the same age. I am
lucky to have her but I think she is feeding him lots of junk.
Reflection: “You’d like to talk about the junk food with her but you unsure about bringing it up because
she is doing you a favor.”
Double-sided reflection: Reflecting both sides of the participants thoughts
Participant: “I don’t want to spoil him. But it makes me happy to see him happy and if a cookie does that
than that is what I am going to give him.
Reflection: “On the one hand you want to feed him things that are healthy and on the other you want to
feed him things that he likes and will make him happy.”
Reflection with a reframe: Choosing words to reframe how the participant is thinking about the topic.
Participant: “I should be walking more, but there is no time. I am busy most of the day with the kids.”
Reflection: “You like walking but haven’t found the best way to fit it into your day yet.”
Summary reflection: Putting together a summary of all the key points
Participant: “After work when I pick them up from daycare is the hardest time. They are hungry, cranky
and tired and so am I. Going to the drive through at McDonalds is so easy. I know it isn’t the best food
but it is quick. It helps me get them home. Today I had some snacks in the car, so they had those and that
quieted them a bit. The worst is when they see the McDonalds sign. It is so hard to drive past.
Reflection: “So it is important to you to give them healthy options and it is tough when they are hungry
and tired. One thing you have found that may work for you is having some healthy snacks in the car to
give them on the way home.”
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Nevada WIC C.A.R.E.S.
References / Resources
Books

Kellogg, M. (2006). Counseling Tips for Nutrition Therapists, Volume I & II. Philadelphia, Kg
Press.

Rollnick, S. Miller, W. Butler, C. Motivational Interviewing in Health Care. New York, the
Guilford Press.

Rosengren, D. (2009). Building Motivational Interviewing Skills: A practitioner workbook. New
York, the Guilford Press.
Websites

Oregon WIC Listens
www.oregon.gov/DHS/ph/wic/docs/orwl/

Touching Hearts, Touching Minds Website, Pam McCarthy and Associates
www.touchingheartstouchingminds.com

California WIC Program
http://www.cdph.ca.gov/programs/wicworks/Pages/WIC-LocalAgencyResources.aspx

WIC Works Resource System
http://wicworks.nal.usda.gov
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