Questions from the client in psychotherapy usually always create some degree of anxiety in the therapist. If nothing else it puts the therapist momentarily on the spot while they think about their response. On another level it breaks one of the rules of therapy i.e. that client’s are there to talk about themselves.
This is an aspect of practice that is rarely written about in any of the psychology or psychotherapy journals or books for that matter. The only significant paper I have found on this is by Tamara Feldman in the Journal of Contemporary Psychotherapy. Fortunately Feldman’s paper is superb and probably obviates the need for further papers on the matter. For those of you that have the time, (access appears free) I highly recommend this paper. Much of this post is a summary of her ideas. While Feldman is clearly a psychodynamic therapist her article is relevant for any type of therapy. Ralph Greenson is his book The Technique and Practice of Psychoanalysis also has some discussion of client questions in his chapter on Technique of Analysing Transference.
Because a patient asking questions creates anxiety in the therapist we often attempt to minimise this by formulating blanket rules about patient posed questions. It is not uncommon to hear a therapist say, “always answer a question with a question”.
Two men are walking down a corridor together
The first turns to other and says, “…and what do you do for a living?”
The second replies, “What makes you ask?”
"Ah I see you are a psychologist", responds the first.
The other common rule is to try and answer the question factually unless it transgresses the therapist’s boundaries. Both these rules fail to accommodate the fact that questions can be asked by a client for a number of reasons. Responding to questions becomes all the more difficult when we may have only met the client for one or two sessions and have no clear formulation or intuition as to what may be driving the question. Does the client feel safe enough to explore the needs or fears underlying the question? Not knowing the client’s style may inhibit our sense of humour and make our response somewhat more formal. Will setting boundaries on the questions asked, hinder or enhance the therapeutic alliance. At these early stages we have to rely more on the art than the science of our practice and often the best we can do is guess and take a punt.
So why do clients ask questions?
- Client may simply want information.
- Client may want to focus away from themselves. The question serves as a defence against affect or anxiety.
- The client is attempting to meet a need through the question.
- The client may be wanting to strengthen the relationship by engaging more with the therapist.
- The client may be wanting to equalise or change the nature of the relationship with the therapist.
Feldman notes that question asked early on in the early sessions:
When questions are asked at the beginning of a session, especially the initial one, this may be an expression of the patient’s anxiety about beginning treatment. Therefore, one way to respond to questions asked early on in the session is to point out that the patient may have some anxiety about seeking help. The clinician can also ask an open-ended question, such as, “What is it like for you to be here?” or, somewhat less threatening, “What was it like/ how did you feel when you set up the initial appointment?” Anxieties about coming to treatment can manifest in multiple ways, and the clinician’s ability to be attuned to these anxieties is crucial for the treatment’s viability.
Whereas question asked as the end of session may be an attempt to prolong the session.
Questions posed at the end of sessions may have a different meaning. Questions asked toward the end of the session, particularly after the clinician has ended the session, a way for the patient to prolong the session. These questions suggest that the patient has difficulty leaving and may point to broader difficulties with separation. If the clinician suspects that one of the patient’s core issues is around separation, and the patient asks a question at the end of the session, this can serve to bolster the clinician’s hypothesis. Questions posed at the end of the session may also be the patient’s way of transitioning from the therapy room to the “outside” world. The verbal and emotional freedom the patient is afforded in treatment does not extend to his life beyond the treatment setting (at least not completely). This adjustment may be particularly difficult for some patients—they may ask questions as a way of “buying” a few moments to prepare themselves for the transition as the clinician responds. If this is the case, the clinician can use this as an opportunity to understand the patient’s difficulties shifting from the therapy room to his life outside this setting.
See also: Responding to Client Questions II