There seem to be a number of questions that therapist’s get asked with some regularity.
Questions about shared experience
Questions about shared experience are common and include questions about the therapist’s personal life such as age, marriage, sexual orientation, race and children but also shared problems such as depression of anxiety. These questions often relfect concern that the therapist will not really understand or really empathise with the patient.
Are you concerned that because I don’t have children I may not understand what it is really like for you?
Questions about qualifications and experience
These questions often arise out of concern as to whether the client can be helped. At the base of these are often schemas around being defective, unlovable or too crazy. The difficulty is that questions about qualifications and experience often tap into the therapist’s incompetence schema and create anxiety in the therapist or a feeling of being attacked. Responding directly to the question may allay the therapist’s anxiety but does nothing about the client’s anxiety.
Part of you worries that I may not have enough experience to help you. Tell me more about that.
Questions about treatment
Most of us are likely to give some indication to the client about the probable length of treatment. However the degree that this is useful for the client is unclear.
…..describing the therapeutic process to a patient is similar to describing how something unusual tastes. It is difficult to capture the essence of the experience in words. Furthermore, many clinicians feel that the duration of treatment cannot be predicted ahead of time; much of it depends on the nature and extent of the patient’s difficulties, the degree to which the patient wishes to work on these difficulties, and external and internal obstacles that may arise along the way.
If treatment was to take a long time how would feel about that?
If treatment were to take a shorter time how would you feel about that?
Feldman suggests the following general responses for any questions that occur.
- Can you help me understand why that information is important for you to know?
- Can you help me understand how that information will help you?
- I have found that people ask questions that are really important to them. Perhaps you could help me understand why that question is important to you.
- I have found that the questions people ask are related to some of their difficulties. It might be helpful if you could tell me a bit more about your question.
- I am concerned that if I simply answer your question I would be robbing us of the opportunity to understand what might lie behind the question.
Many of these questions the client has a right to know and I find it is usually useful to have a moment in the first couple of sessions where I take the initiative to answer some of these questions before they are asked. Having covered the answers to these questions early I then feel safer to focus on the underlying content of the question when they reoccur.
…..since question asking is often borne out of some anxiety, offering a direct response to a question is an attempt to swiftly dispel this anxiety. This may undermine the treatment, since one goal of therapy is to help the patient better tolerate his feelings, especially negative and uncomfortable ones. By taking time to examine the patient’s question, the clinician can begin to model that anxiety can be tolerated, and that one way of doing so is to understand it. This approach also demonstrates to the patient that the clinician is able to tolerate and contain the patient’s anxiety, which will be useful in fostering a trusting relationship. An immediate “yes” or “no” to a patient’s questions may only serve to demonstrate that the clinician also has difficulty managing anxiety.
Is it better to respond with another question highlighting underlying content or is it better to make an interpretation? This will probably depend on your orientation.
Is it better to respond to questions initially with direct responses until a number of them have occurred?The question for the therapist is at what time do you respond to the underlying content of the question? Do you respond on the first occasion or is it better to wait to have a number of examples before responding to the content? Not responding to the underlying content the first time a question is posed may be perceived as unempathic by the client. However waiting until there is a clear pattern of repeating the question and then exploring it provides more compelling evidence to the client that there are deeper issues to explore. This is particularly true when questions are used as a way of deflecting or defending against anxiety or affect.
I am aware every time we begin to talk about this issue you start to talk about it but as soon as the emotion starts to come up you starts to ask me questions about my life. What do you think this pattern is about?
Care should be taken not to make the questions slightly punitive because the client has put you on the spot. Using interpretations at times can be our way of punishing the client and putting them back in their place. It is sometimes a reflection of feelings of shame or guilt on the therapist’s part who feels their incompetence may be exposed.
The therapist needs to make a decision in responding to a question what you will highlight in your responding question
Do you highlight the underlying needs or motivations?
How will knowing more about my qualifications help you in your decision to engage in therapy
What need does knowing my qualifications meet for you?
Do you highlight the anxiety, conflict or fear?
I have a sense that part of you hopes I will be able to help you but part of you fears I may not be qualified enough to help you. Tell me more about this conflict.
Do you highlight the cognitions?
I am interested in the thoughts that went though your mind that led to you asking this question.
Questions occur with most clients at some time in therapy. Having a set of flexible responses to client questions not only heightens our empathic response to the client but helps minimise our own countertransference reactions.
See also: Responding to Client Questions