As a therapist, I often find that questions are a more powerful tool than statements because questions allow us to discover what we don’t yet know. So, questions help clients learn more than me telling them things. In this blog entry I’m going to present and briefly describe some of the most common and powerful questions that I use when working with clients.
Clinical Questions
What do you have control over and what don’t you have control over?
My post on Relationship Boundaries touched on this topic but here I want to make the question bigger than just, “What do you have control over in relationships?” I am asking, “What do you have control over in life?”
Focusing on what you have control over and acknowledging what you don’t have control over is an anxiety reducing process. Of course, sometimes, I have seen clients get nervous when they face these realities (especially if they have been living under the illusion that they have more control than they really do). However, I find that once a client acclimates to the reality (usually this only takes a couple of minutes) then the person suddenly relaxes. Once you face what you don’t have control over, you don’t have to attempt to control them anymore, and you can let go of self-blame when those efforts fall short (which was inevitable in the first place). After discerning what you do have control over, you get to begin asking more important questions like the Path questions described below.
What is the sense behind your symptoms?
Many clients come into my office with a presenting symptom like depression, panic, or compulsive sexual behavior and they want the therapy to eliminate that symptom as quickly as possible. I’m usually on board with that intention but I almost always start with asking why the symptom exists in the first place. Without the symptom what would happen to you?
The symptoms are usually there to protect you from something. Depression often masks a fear of hurting other people (low self-esteem) or prevents you from doing something that you have already learned won’t be effective (learned helplessness). Anxiety is often a signal that you think you should be able to do something but you can’t, fear that you can’t, or don’t know how. If the stakes of failure seem high enough, then panic protects you from trying and failing. Compulsive behaviors often arise when other emotions become intolerable, the repetition and the rewards provide a way to change the intolerable feelings, at least for a little while.
I find that one of the best ways to change symptoms is to understand why they exist, trusting that there is something good about them. Then we provide you with another way to meet that needs that the symptoms fulfill. We don’t eliminate depression, we find another way for you to respond to the things that trigger depression. We don’t eliminate panic, we help you realize that failure isn’t that scary so that you don’t need to panic. We don’t fight against compulsive behaviors, we help you learn to respond to your overwhelming emotions.
Goal questions
The next three questions share a quality of directing attention toward an aspiration. Find the right way to direct your motivation for change is very important. Once the destination is set, it suggests which steps follow. I find that a lot of paralysis and indecision in my clients come from not being sure about where they want to go and so these questions often help set that direction.
To you, what makes a good life?
For example, is a good life characterized by a lot of memorable experiences, by a secure routine, by fulfilling relationships? Different people will have very different answers to these questions. I have seen that many times clients know what they want but they judge their personal desires against a cultural standard and evaluate their own vision of a good life against that cultural norm. They decide they should want something different. This can easily create a situation where the client is “successful” and has “everything” yet the things they have are not the things that provide them with a good life. So, they experience malaise, depression, or self-sabotaging behaviors. Figuring out and embracing what actually makes a good life for you, and choosing not to compare that to anyone else’s vision is an important life task.
What kind of person do you want to be?
This question often comes up at a critical juncture in the therapy. After all of the stories have been told and after I have empathized with the client, the question shifts to, “Now what?” This question puts the onus for change back on the client and it can sometimes feel unfair or painful. Overly simplified, the question sound like, “Yes, your parents mistreated you, and now what kind of person do you want to be?” or “Yes, your spouse criticizes you and this is inappropriate and unkind. Yes, your pain currently leads you to lash back out and them. And, is that the kind of person do you want to be?” This question brings the therapeutic conversation to one of the most fundamental aspects of our human nature, that we can choose to do something other than what we are inclined to, and in practicing that behavior we can make it the new inclination.
What are you connected to that is bigger than you are? What do you believe in that is worthy of your effort and attention?
I will talk more about why I don’t ask a question about what makes you happy in a subsequent section. Here, I simply want to point out that this question is the antidote to a question about happiness. Fulfillment and a meaningful life can come from dedicating ourselves to something of value. Sometimes that effort will also make us happy but sometimes not. For example, imagine that you find charity work fighting poverty to be fulfilling and meaningful. You will likely encounter poor people and their suffering. This may not make you happy. It may do the opposite, you may come to share in that suffering. But if it is meaningful and brings value to your life, you will be enlivened by it (as long as you balance it with appropriate self-care). If you direct your attention to those things that are bigger than you, you may find that more sustainable than pursuing something for yourself that makes you happy.
Path questions
If you have read this far in this post, you may be wondering about the practical application of these concepts in therapy. So far, I have identified clinical questions and goal questions. These are all fine but without action they are inert. The following questions prompt the creation of an agenda to help the client get from the vision about where they want to go, to what they can begin doing about it today.
What is the first next step in helping you move toward the life and the behavior that you want?
One of my common habits in therapy is to recommend that the client take action on a goal during session. For example, I might suggest that a socially phobic client ask a friend out for dinner during session with me present. This immediate action step taken during the session often cuts through anxiety, philosophizing, and abstractions and helps to reduce the power of those hurdles in the future. If you know the next small step that will help you move towards the goal and you can cut through the paralysis of the moment to initiate that change, you get immediate positive feedback from me as the therapist, from yourself in terms of a change in your self-assessment, and from reality in that the friend may say yes or no, but either way, you moved past one imagined internal obstacle and now are facing real external obstacles.
Are your behaviors actively creating the kind of life you want?
This is a challenging question but it is the action oriented correlate of the goal oriented question above, “What kind of person do you want to be?” Sometimes when I ask this question of a client, the client will respond with some version of, “No, I can’t because [person] is [doing something I don’t like] which makes me [do things that aren’t creating the kind of life I want].” I strive to be compassionate as I challenge this thought process in a therapy session. The pain in response to the other person’s behavior is real and I try to never minimize that pain. And I also bring to the client’s awareness that their behavior in response (barring a physically abusive relationship where safety is at risk) is their choice.
To actively create the kind of life you want, you need to begin becoming aware of the discrepancy between your behaviors and your goals. That is, you need to move from saying, “No” to this question toward being able to identify and attempt the next steps asked about above.
Which relationships support you in becoming who you want to be?
While our behavior and our choices are our responsibility, we are also influenced by others around us. Their choices influence us. Want to go to the gym more? One way to support yourself is to spend more time (maybe even at the gym) with your friend who already has a good gym habit. Trying to make a change in your behavior but need some accountability? Then having a friend that you can tell about your goals is a good way to make sure that you are maintaining that intention.
Sometimes, clients will say in response to this question, “But isn’t that what therapy is for?” Yes, and no. While I as the therapist am there to help clients make changes, I also want their capacity to make changes to be self-sustaining. If you need to come in for therapy for every life event, then I will have created a therapeutic dependency, not helped you create self-sustaining habits that can support you outside of therapy. For this reason, after I help clients make initial changes, I often help them evaluate what worked to make the changes happen and identify who supported them. If you don’t have supportive relationships outside of the therapy, I encourage you to get them. In that way, you will be able to continue your journey of development without requiring therapy at every turn. (And I welcome returning clients too)
Questions not to ask
Why did it happen?
Though a certain degree of reflection on the past about how a negative pattern developed is important both for ending that pattern and for preventing relapse into that pattern, I find that there is a limit to the productivity of the search for a cause. We are too nuanced and there are too many potential influencing factors, from biology to environment to personal biography, to ever pinpoint exact causes. The search for causes is always speculative. So, I find that staying focused on, “What now?” questions is more productive than, “Why did it happen?” questions.
Whose fault is this?
Similarly, search for blame, in self or others is a distraction. Whether you caused your presenting issue entirely, or whether someone else did, in the therapy room one thing is perfectly clear, the only people who can work together during that hour to fix it are you and me. We’re the only ones in the room! So, I find that focusing on personal ability to respond is more valuable.
What makes you happy?
As I mentioned above, I am dubious about the search for happiness. Happiness tends to be a transitory condition. Whatever thing, event, or process brings you happiness is likely to change over time. If instead of identifying happiness, you can affirm that this is the life you chose, and the happiness and challenges that come with that life are meaningful and fulfilling to you, then you will find an equanimity that is different than happiness but which may also coexist with it.
Conclusion
This post has focused on questions that I’ve found helpful to ask my clients. I’ve described Clinical, Goal, and Path oriented questions that are useful as well as questions that I’ve found less helpful. I want to end with a reflection about the process of asking these questions in therapy. I don’t know the answers. I don’t know the answers even after I know you well. When I’m asking these questions, we may both be surprised by how you answer them. Sometimes your answers will change over time. My answers to these questions for myself certainly have. I consider that a characteristic of the unfolding and ever changing mystery of being human.
What are the most important question you ask yourself?
