Mirror thinking in health care
The mirror-thinking effect in health care
The mirror-thinking effect is the tendency to assume that the other person thinks like yourself. In mental health care, this can lead to major pitfalls.
Pitfall: projection of thinking style
- Health care provider highly contextual → thinks that patient/client is also highly contextual.
When this is not the case, divergent or literal thinking is sometimes misinterpreted as a result of trauma. - Health care provider lowly contextual → expects linear and literal thinking from the patient/client.
When the patient/client thinks highly contextual, their nuance or indirect communication can be misunderstood.
Low-contextual ≠ trauma
A specific pitfall is that low-contextual thinking is often confused with trauma.
- A patient/client who communicates very literally and is detail-oriented can be seen by a highly contextual health care provider as someone who thinks "abnormally" due to a traumatic experience.
- In reality, this can arise from a structural difference in context sensitivity, and therefore have nothing to do with trauma suffered.
Pseudo-narcissism
Another misinterpretation is pseudo-narcissism. This can arise when a high-contextual patient/client is assessed by a low-contextual health care provider.
- The patient/client speaks with nuance, uses implicit signals, and makes many connections. Or he/she uses humor/sarcasm that the health care provider does not understand at all.
- The health care provider expects concrete and direct language.
The result: the patient/client appears circuitous or self-absorbed, which can be incorrectly interpreted as narcissism. In reality, this is a difference in thinking style, not a personality disorder.
Examples
Case
A patient/client says very concretely: "I hear a sound at night and wake up." The highly contextual health care provider expects nuance and thinks: "This must be a trauma, he associates sounds with bad experiences." But in reality, the patient/client is just literally describing what is happening. The wrong interpretation can lead to an unnecessary trauma diagnosis.
Case
A man forgets to close the bedroom door late at night when he goes to get water. He estimated it would only be for a short time (the bathroom is right next to the bedroom, everyone is asleep in the house).
For his girlfriend (low-contextual), this is unacceptable: the door was open = proof that he is disrespectful and does not truly love her. She reacts with extreme statements ("you're a creep", "I hate you"), without considering the context or his intention.
The man (high-contextual) remains calm, apologizes, and explains that it was a mistake that says nothing about his love or care. He tries to put the situation into perspective, but his nuance does not reach her.
Suppose this couple enters therapy with a low-contextual therapist: they may find the girlfriend's explanation convincing ("the door was open, so he is wrong"). This confirms the girlfriend's rigidity, and the man feels even more misunderstood.
This example shows how differences in context sensitivity can lead to serious misunderstandings, and how the mirror-thinking effect can also be a pitfall for therapists.
Case
A patient/client has social phobia and does not dare to go outside.
Health care provider A automatically assumes this stems from a traumatic experience in childhood, as the mother showed severe borderline traits. Health care provider B, on the other hand, sees a possible hereditary connection between borderline and low-contextuality, and suspects that the patient/client is low-contextual themselves.
This second health care provider refers the patient/client to a multidisciplinary center for diagnosis. There she is diagnosed with autism.
This shows how the same complaints can be interpreted from different perspectives: trauma versus contextual thinking. The mirror-thinking effect can lead to one healthcare provider projecting their own assumptions, while the other takes into account differences in thinking style.
Related phenomena in health care providers
The mirror-thinking effect is a concept specific to Context Thinking. Yet it connects with phenomena that are well-researched in health care:
- Emotional contagion — feelings spread between people. Recently reviewed by Herrando and Constantinides (2021).2
- Personal distress versus warm concern — Singer and Klimecki (2014) show that being drawn into another's pain is different from a warm, caring attitude. The former increases the risk of exhaustion.1
- Secondary traumatic stress and compassion fatigue — well-known risks for those who work intensively with suffering.
That such transmission genuinely occurs is demonstrated, among other things, by research among partners of people with post-traumatic stress (Powling and colleagues, 2024).3 For the health care provider, this means: it is important to maintain the distinction between sensing what the patient experiences and taking it on.
Conclusion
The mirror-thinking effect is a structural pitfall in mental health care. By being aware of differences in context sensitivity, health care providers can avoid normal varying thinking styles being wrongly seen as pathological or trauma-related.
References
- Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875–R878. doi:10.1016/j.cub.2014.06.054
- Herrando, C., & Constantinides, E. (2021). Emotional Contagion: A Brief Overview and Future Directions. Frontiers in Psychology, 12, 712606. doi:10.3389/fpsyg.2021.712606
- Powling, R., Brown, D., Tekin, S., & Billings, J. (2024). Partners' experiences of their loved ones' trauma and PTSD: an ongoing journey of loss and gain. PLOS ONE, 19(2), e0292315. doi:10.1371/journal.pone.0292315 — PubMed 38354114