What Do I Say?

The Therapist's Guide to Answering Client Questions

Linda N. Edelstein, Charles A. Waehler

• Publisher: Wiley
• Year: 2011
• ISBN:
  9781118061480
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The must-have guide to honestly and sensitively answering your clients' questions

Written to help therapists view their clients' questions as collaborative elements of clinical work, What Do I Say? explores the questions—some direct, others unspoken—that all therapists, at one time or another, will encounter from clients. Authors and practicing therapists Linda Edelstein and Charles Waehler take a thought-provoking look at how answers to clients' questions shape a therapeutic climate of expression that encourages personal discovery and growth.

Strategically arranged in a question-and-answer format for ease of use, this hands-on guide is conversational in tone and filled with personal examples from experienced therapists on twenty-three hot-button topics, including religion, sex, money, and boundaries. What Do I Say? tackles actual client questions, such as:

• Can you help me? (Chapter 1, The Early Sessions)
  
  

• Sorry I am late. Can we have extra time? (Chapter 9, Boundaries)
  
  

• I don't believe in all this therapy crap. What do you think about that? (Chapter 3, Therapeutic Process)
  
  

• Why is change so hard? (Chapter 4, Expectations About Change)
  
  

• Will you attend my graduation/wedding/musical performance/speech/business grand opening? (Chapter 20, Out of the Office)
  
  

• Where are you going on vacation? (Chapter 10, Personal Questions)
  
  

• I gave your name to a friend... Will you see her? (Chapter 9, Boundaries)
  
  

• Should I pray about my problems? (Chapter 12, Religion and Spirituality)
  
  

• Are you like all those other liberals who believe gay people have equal rights? (Chapter 13, Prejudice)
  
  

The power of therapy lies in the freedom it offers clients to discuss anything and everything. It's not surprising then, that clients will surprise therapists with their experiences and sometimes with the questions they ask. What Do I Say? reveals how these questions—no matter how difficult or uncomfortable—can be used to support the therapeutic process rather than derail the therapist–client relationship.

PART 1

Client Questions in a Broad Context

INTRODUCTION TO PART 1

Eileen dropped heavily into the chair and opened her second session with questions. “When will I stop feeling so guilty? Will I ever get over this? How do I forgive myself?”

Zac, her therapist, was stumped. These direct questions prompted a flood of racing thoughts that filled his mind. Which approach would be best? Should he answer the question, pose questions himself, or explore, but how could he make the transition into meaningful exploration? Or would it be better to use reflections like “You’ve had another rough week,” or take the question at face value and provide information? And if he did try to answer the question, what was the correct answer? He didn’t want to sound glib or provide false reassurances; at the same time, she was asking for a reason to hope. He knew what some theories said about processes of guilt and forgiveness, but Eileen was her own unique individual. Their therapeutic alliance was new and untested. How could he prompt further examination without making her feel dismissed or put down? How could he use this moment to gain credibility and trust as an empathic listener?

Eileen might be 30 or 70 years old. She might be in prison for murdering her child or feel guilty because she has fallen in love with her co-worker. She may be reacting to a transgression that occurred 2 weeks ago or 20 years ago. Zac might be analytic, eclectic, cognitive-behavioral, or feminist. What remains a constant is that clients ask questions, and clinicians often find themselves wanting to know more about how to reply in ways that are thoughtful and intentional. This isn’t an unusual example. Zac knew that Eileen’s questions revealed some of her most intimate struggles and intense emotions. He was also filled with his own thoughts and feelings. He wanted, as most clinicians do, to engage Eileen, to respond in ways that deepen their dialogue, and to provide clarity and hope to his client.

As caring, social beings, people who have chosen to become mental health practitioners are usually pretty comfortable conversing with others. We all practice active listening skills such as empathic paraphrasing, open-ended questions, and nonjudgmental reflective statements to encourage therapeutic conversations. We have learned various intervention techniques so that we can help guide clients to be more effective in their lives. At times we stumble through these skills. Everyone does. But for the most part, we feel confident knowing what to say and what to ask in order to interact therapeutically with our clients. And then a client asks a direct question.

Direct questions, even when they are innocent and innocuous, often catch us off guard. When the question feels challenging or intrusive, self-protection is often the natural first reaction, and we want to shut the conversation down. Our sense of control has been upset; it feels like the tables have been turned. After all, aren’t we the ones who get to ask the questions?

We have each been in practice for more than 25 years, but it isn’t hard to recall our jumbled reactions from the client questions of earlier days. In answering their questions, we wanted to be brief, but not simple; to engage our client’s curiosity, but not parrot back the question; to avoid giving direct advice, but not sidestep a request for assistance. We wanted to sound wise but knew that how we sounded was less important than promoting our client’s therapeutic goals. Good manners said that we ought to be polite and forthcoming, but this is therapy, and the goal is additional exploration of our client’s own ideas. We wanted to examine the overt and covert meanings of the question, but not become interrogating detectives; and we wanted to express ourselves without making the conversation about us.

In short, we wanted to practice our craft well and that made us anxious, particularly when we were faced with difficult questions. So, for better or worse, we responded and moved on, but we were sometimes left believing that we could have been more effective. We knew that there would be other questions from other clients, and we wondered what a more experienced therapist might have been able to do. We realize now that we had the skills; we just hadn’t focused them on responding effectively to questions. With all our training and reading and clinical placements, no one had ever addressed answering questions as a significant aspect of everyday therapy. We hope to change that.

WHY DO CLIENTS’ QUESTIONS CAUSE APPREHENSION?

Answering clients’ direct questions can be perplexing for several reasons. Consider your own practice, and see if any of these seven reasons apply to you:

1. Client questions represent a shift away from the normal therapeutic pattern in which the therapist asks the questions. When this activity is reversed, you may feel like your role has been usurped, leaving you perplexed, unprepared, and feeling like you have lost control of the process and content.

2. Client questions reflect different motives. They can be variously intended as inquisitive or invasive, engaging or deflecting, polite or intrusive, clarifying or complicating, solicitous or dismissive, congenial or offensive, curious or aggressive, innocuous or challenging, helpful or obstructive. And this list is not exhaustive. Many questions represent a combination of several of these motivations and a variety of complicated communications—no wonder they can be disconcerting.

3. Questions can make you feel very responsible, and although you want to be helpful, you are rightfully reluctant to take on the influential role inherent in providing a specific answer. If you believe that you help your clients when you promote autonomy, critical thinking, and self-examination, then providing simple answers to questions is nearly impossible.

4. You will not always have the answers. Optimal answers to client questions are always going to be highly personalized and idiosyncratic to what is going on with this client at this time in his life. It is daunting to think about having to answer and address all these unique meanings.

5. You may have recognized that many answers take the focus and energy of the session off the client and put it on you. This isn’t the attention you want.

6. Because your answers reveal much about you, they also highlight the nonclient, nontherapist relationship. You may not want to head in that direction.

7. As you probably know from answering questions tossed out by family and friends, there is a serious possibility to disrupt the relationship with the wrong answer. Potential misunderstandings abound.

Your ability to respond effectively is enhanced by increased awareness, knowledge, consideration, and experience. Clients’ questions and your responses can be used constructively when you are prepared. The many questions and potential responses we offer in the 23 topic chapters provide ways for you to think about the attitudes and strategies that work best for you as you receive client questions, clarify them, and respond successfully, turning the interchange into effective psychotherapy.

Charlie

Toward the end of every intake interview I conduct, after I have spent most of our time asking questions and exploring the client’s answers, I say “I have asked a lot of questions here. I wonder if you have any questions for me?” Usually after brief reflection, most clients respond “No, none that I can think of now.” Sometimes I get a general, appropriate question along the lines of “So what do you think is going on?” or “Is there any hope for me?” or “What do we do now?” Sometimes I get a question like “Why did you ask me about …?” or “What is your training to do this work?” or “Have you ever seen anyone like me?” I believe that client questions yield additional information with which to formulate beginning diagnostic impressions. As important as this information can be, when I invite questions my main goal is to communicate my desire to have the client be a fully involved, valued participant in the therapeutic process and to authorize him to ask questions and be curious in our work together.

Clients want to know that they are understood. You can show understanding in many ways other than directly responding to questions. When a client asks plaintively, “Do you know how painful relationships can be?” he does not want his therapist to say, “Yeah, I’ve been married 15 years and at times it’s really hell. In fact, recently we have been going through a tough patch involving …” as a response. He also doesn’t want to be met with silence. He wants empathy and understanding. He also wants a smart, sympathetic ear that will help him explore and clarify his struggle. We hope that you will neither dismiss questions nor answer them reflexively without exploration. Appropriate statements in this example involve words like “I can see that you are struggling now. Tell me about your relationship.” or “What has become painful for you at this time?” or “Relationships can certainly be painful; what’s going on for you?”

WHAT DO THE DIFFERENT THEORIES ADVISE?

Various theories have good reasons for proposing seemingly contradictory advice about answering client questions—they work with different models that believe in distinctly different strategies for change. With the exception of psychodynamic and psychoanalytic theorists, almost nothing has been written directly about responses to client questions. Because this book focuses exclusively on that topic, we have little guidance, but we also have no shackles. It is an opportunity to examine the basic principles of different theories and extrapolate reasonable ideas about their attitudes toward answering client questions.

You probably have opinions about the major theories—the ones you like and those that leave you cold; the ones whose principles make intuitive sense and others that require intellectual stretching. You may even consider yourself a firm disciple of one theory. As you read about the theoretical approaches to answering questions, you may find, as we have, that your philosophical leanings don’t match exactly to your practice when it comes to answering questions. Don’t worry; as you get further into the topic chapters, you will be increasingly able to discern what questions you want to answer, how you want to answer them, and why you are making that particular choice.

We begin with traditional psychoanalytic perspectives, because they are clearly stated. This view says that therapists should resist answering direct questions and instead promote their client’s fantasy. The less the client knows about the therapist, the more the client is able to generate fantasies regarding the therapist. Clients are told this information at the beginning of treatment so they are not dismayed by a lack of response coming from their analysts. Both parties agree that these fantasies become valuable therapeutic material. The alliance between the analyst and client is based on many factors, but therapist verbosity is not one of them. The technique reflects the underlying theory. Freud encouraged therapists to be neutral with their patients, so as to reflect nothing but what was shown to them (Freud, 1912/1959). Orthodox analytic perspectives about client questions have traditionally tended to see them as resistance, defensiveness, or avoidance. If that is your view, you might interpret a question with “You would find it easier to have me talk than you.” or “You would rather have me explore this topic than you doing it.” or “You are avoiding talking about your life.”

Greenson (1967) suggested that, from the analytic point of view, the first time a client asks a personal question, you encourage him to explore his reasons for asking. After listening to the client’s associations, Greenson would explain to the client that by processing the question’s meaning instead of answering, he and the client could gain a greater understanding of the significance of the question. Furthermore, he informed clients that most of their questions would not be answered so he did not appear unnecessarily cold and unresponsive. The second time a client asked a question, he remained silent. So, if you are strongly analytic, you have a model that provides clear reasons and guidelines for responses.

Other psychodynamic clinicians take a softer approach. Langs (1973) cautioned that unnecessarily frustrating responses to realistic and appropriate questions may serve the therapist’s defensive and hostile needs, rather than the positive work of the client and the therapy. Langs maintained that realistic and reasonable questions may have deeper implications, but he urged clinicians to maintain a reasonable and human balance between a direct answer and the need, when indicated, to analyze rather than respond...

Table of contents

• Cover
• Half Title page
• Title page
• Copyright page
• Dedication
• Preface
• Acknowledgments
• Part 1: Client Questions in a Broad Context
• Part 2: Client Questions and Responses by Topic
• Concluding Thoughts
• References
• Index
• About the Authors