We have all been in one of these situations: Noticing that sessions have the same pattern/topic of conversation. Wondering what would be a good thing to say after a shocking statement. Trying to decide if silence would be enough to help the client reflect. Maybe even the dreaded question asked by a client, “Do you have a question for me?”
Silence can be a powerful tool if you can master it, but some moments call for a shocking question to spark change.
I thought I would write down some questions that might help you go beneath the surface for different types of clients. It is key that you create a safe environment first and validate when needed. When that is established, these questions may be a spark that helps the client think deeper and produce a change for any client.
1. How do you wish I had reacted to what you just said?
This can be an eye-opening or healing question. I once had a client say something so shocking, but I did not react except to ask this question. In this case (and changing some details for privacy), the client said shocking things to make people fearful so the client could not get hurt again by others. In another case, the client hoped I would remind them of their strengths, something they never got as a child.
2. What is this thought/behavior protecting you from and is it working?
This question gets into defense mechanisms. It may help the client think about their defenses and whether it is actually working. After all, if it could work, it likely would have already. Self-Criticism is often meant to help us feel better prepared to handle the criticism of others, but most often it just keeps wounds from healing. Similarly, avoidance can help us feel less vulnerable, but not usually safer.
3. How do you fear others will react to what you’ve said? Can you look at me and tell me if I’m reacting in the way you fear?
Ever had the client who looks down every time they feel ashamed for what they are feeling? It keeps them from healing from that unconditional positive regard that we give. Be careful though not to push too hard. Sometimes all you need is a gentle “can you look at me even for just a moment? I want you to see that I have no judgment of you.”
4. When was the last time you could (blank) without (blank)
This is pretty much the root of solution-focused therapy. What has worked before and can we recreate it? For example, I used to have a hard time getting up in the mornings, but when I was younger, I would jump out of bed if my dad offered me my favorite breakfast. So, when I had this problem again, I put a snack next to my bed for me to eat in the morning.
5. How do you wish (blank) had gone?
So a situation happened and we know how it made the client feel and think. We validated what is valid. What now? This question may lead to a guided imagery intervention to help a client heal through experiencing that moment in their mind. It may also lead to a conversation about how the client can fill their own underlying need. Maybe it leads to you simply providing the validation they longed for.
6. What gets you up every day?
What is important to the client? What are their goals? What are their values? Are their actions aligned with these things? How can skills, habits, or other techniques help use get the client more aligned with their goals and values?
7. Who first gave you this thought?
The people around us as children often influence our inner voices as adults. Alternatively, thoughts and statements that arise during a traumatic event can often be hard to shake. Have clients reflect on these things.
8. What is this feeling trying to tell you?
Feelings are not bad. They have a purpose. Have the client reflect on the feelings from the movie Inside Out and what the characters’ jobs were. Have the client look at the Anger Iceberg. Have them talk to their feeling. If all else fails, maybe role play as the feelings.
9. What would you say to a friend with these same thoughts?
Classic CBT. Challenge those intrusive thoughts, people! Often, the client already knows how to change these thoughts; they would do it for a friend.
10. Can you walk me through everything that led to this moment? From the amount of sleep that you got to how much food you ate?
Often we do not go from 0-100 in a second. Clients are often already running at a 60 and they just are not aware. You may find the client is anxious for “no reason” when they had a venti coffee and little to no food. A sugary cereal, for example, would often not be enough to neutralize the anxious feelings caffeine on an empty stomach can cause. You may also find that your client snapped at a friend in a class because they were already feeling annoyed simply by being in their dreaded math class.
This is not a comprehensive list, and I want to encourage you all to talk to your supervisors for specialized consultation. We often save supervision to consult about clients who are really struggling, but it is also important to consult about clients who are plateauing. Hopefully, these questions get you thinking and produce meaningful conversations. Good luck!
Thank you for reading and I hope something was helpful!
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