Reflective Practice

Reflective practice is one of the most important skills a psychologist can have, according to our professional bodies.  We are encouraged to reflect on the work that we do and in turn encourage others to participate in reflective practice and to reflect on their own work.

Reflective practice has been shown in the literature to improve staff working relationships with patients and to reduce staff burnout.  It is also an evidenced based method of teaching and learning from experience.

For the Stage 2, the emphasis is on reflection rather than on evidencing practice, although this also has to happen.  Trainees are expected to reflect on everything that they have done but, importantly, also to discuss what they would do in the future based on the literature.  It is not enough to be aware of your emotional feelings and to reflect on your responses, you must understand your responses and others' responses by using psychological theory and psychological literature.  You must then discuss what you have learnt and how you move forward using best practice guidelines and the literature.  To not finish this step or to  not adequately use theory and research is to be seen by the assessors to not be reflecting adequately.

Reflective practice is a way of studying your own experiences to improve the way you work. The act of reflection is a great way to increase confidence and improve your interactions with colleagues, clients and patients.  Reflective practice such as writing can be a cathartic process after an interaction to help you to understand how and why something happened and discover appropriate ways to act in the future.  This means that feelings about this interaction can then be contained within the reflective process rather than directed towards the client or patient through counter-transference and in this way unconditional positive regard can be maintained (Bolton 2010).  This suggests that reflective practice has an ethical impetus, as it offers a balance between emotional release and respect for the patient as well as between learning from literature reading and learning from experiences. 

There have been a number of theories of reflective practice such as Rogers’ consciousness raising (Rogers 1969).  He stated that education should “pose problems about our lives in the here and now”.  Similarly to his client-centred therapy, he proposed that learning should be learner-centred whereby a person cannot be taught by another but that learning can be facilitated by others.  This included using reflection as a means of learning through experiences whereby the self and preconceptions are challenged by gently encouraging open mindedness.  More recently, Action Research has emerged as a model of reflective practice and has structured the model as a cycle of planning, acting, observing and reflecting (Bolton 2010).  Action research has been widely used in the psychotherapy community however research into its effectiveness as a teaching and learning tool has not been conducted. 

Different models of reflective practice do not go into the same emotional depth as the models above but do still encourage people to examine alternative reasons for an incident occurring or the outcome of an interaction.  Gibbs’ (1988) Reflective Cycle is one such model where it offers a process of six steps.

The steps are presented as a cycle because the action one takes in the final stage will feed back into the first stage.  This cycle is fairly straightforward and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what you would do if the situation arose again.  It is possible to use this model for individual reflection. 

In contrast, Johns’ (2000) model for structured reflection supports the need for the learner to work with a supervisor throughout their learning experience. He refers to this as “guided reflection”, and recommends that students use a structured diary such as a practice diary.  Johns inferred that sharing reflections on learning experiences encourages greater understanding of those experiences than what could be achieved by reflection as a lone exercise.  John’s Model for Structured Reflection:

1. Commitment - accept responsibility and be open to change
2. Contradiction - note tension between actual and desired practice
3. Conflict - harness this energy to take appropriate action
4. Challenge - confront your own typical actions, beliefs and attitudes in a non-threatening way
5. Catharsis - work through negative feelings
6. Creation - move beyond old self to novel alternatives
7. Connection - connect new insights in the world of practice
8. Caring  - realise desirable practice
9. Congruence - reflection as a mirror for caring
10. Constructing - building personal knowledge in practice

Rolfe (2001) however, criticises this as it only responds to a situation which has been resolved and does not make provision for the question of how one can take forward learning to the next interaction or incident.  Rolfe’s framework uses three questions to reflect on a situation.

1. What ...is the problem? ...was my role? ...happened? ...were the consequences?
2. So what ...was going through my mind? ...should I have done? ...do I know about what happened now?
3. Now what ...do I need to do? ...broader issues have been raised? ...might happen now?

The questions “What? So what? And now what?” can stimulate reflection from all levels of training and experience.  Firstly the practitioner reflects on the situation in order to describe it. The second phase encourages the practitioner to construct personal theory and knowledge about the situation in order to learn from it. At the third level the practitioner reflects on action and considers ways of improving the situation and reflects on the consequences of his/her actions.

Although this review is by no means an exhaustive list of the models of reflective practice, I have examined a range of models from different psychological approaches.  I have chosen to demonstrate Gibb’s and Rolfe’s models in the training.  This is because they have a simple and concrete structure for those beginning their learning in reflective practice.  The staff who will be taking part are not psychotherapists and although they should be able to understand the concepts within action research and Rogers’ consciousness raising, these are not necessarily the most practical or relevant to their daily tasks and interactions.  Within these models there are methods of reflective practice such as the Through the Mirror technique, practice diaries, Personal Development Plans and Portfolios, Problem Based Learning, (Leitch & Day 2006) that could be useful for the individual.  However the time constraints of the service means that simpler models that can also be used in groups would be more beneficial.  

Group reflective practice has same set up as group interventions but also has the benefit of shared experience and learning such as Rowland’s (2000 in Bolton 2010) 'shared context'.  Both Gibbs and Rolfe’s model allow for easy facilitation in groups as well as individual reflective practice sessions.

As a trainee, you will need to choose an appropriate model of reflection and base all your writing: practice diaries, exemplar reports, reflective reports in this way and have these supported by evidence.

What you cannot guarantee is whether you will reflect on something that the assessors feel needs reflecting on. For example, the assessor may feel that you described an incident that required more reflection than you gave or that you made a decision but did not base how you got to your decision in best practice and the literature.