Therapists' use of reflection of feeling with trauma survivors

Reflection of feeling (ROF), a component of empathy, has been widely theorized as a technique that can benefit clients and enhance the therapeutic relationship, but scant research has been conducted on it. The current study aimed to fill a gap in the literature by being the first to examine how often novice therapists utilized reflections of feeling in actual psychotherapy sessions with clients who experienced trauma. A deductive and inductive qualitative content analysis was employed to investigate the use of ROF by four therapist-client pairs in 12 psychotherapy sessions at a university’s community counseling clinics. For each therapist-client pair, three recorded sessions representing the beginning, middle, and end of treatment were selected, transcribed and analyzed. Results indicated that the ROF technique was used infrequently (11.6%). When ROF was used, simple reflections were more prevalent than complex reflections, and were the most frequently coded reflection type (18 out of 31 ROF codes) in both trauma and non-trauma discussions. Inductive analyses revealed that the most common codes observed throughout psychotherapy sessions included acknowledgements (e.g., “mm hmm;” “yeah”; 50.56%) and follow-up questions (25.1%). Future research regarding ROF in a naturalistic setting appears needed to study whether clients find this technique useful or not, how it impacts the therapeutic relationship, what training conditions enhance its use, and whether it differentially affects different populations (e.g., trauma and nontrauma survivors). Researchers who aim to study ROF could replicate and enhance the coding scheme developed in the present study