The Psychotherapist and Asking the Right Question

Years ago I was working in a large inpatient setting which at times had some very psychotic patients. I was new to the job and “shadowing” someone while taking in this unfamiliar psychiatric setting. While in this role, I observed an interaction between a very disturbed patient (who had a history of violent behavior) and several clinical staff members who were doing their best to coax this patient out of the shower where he was in essence, holding the shower hostage. He took his stand in a narrow entry way leading into a single shower stall that was shared by many other patients one at a time. Because of his positioning, he was throwing the entire day’s routine off schedule, and in a setting such as this one, the situation had the potential of upsetting other patients and staff.

I’ve never forgotten the lesson that I learned about the power in the right question while I was observing this interaction. The scene unfolded like below.

The large, muscular, psychotic man was standing in the narrow passageway, and wouldn’t budge. Staff members, including a senior clinician, were doing all that they could to attempt to get this man to exit the shower area. The senior staff member asked Mr. X if he would come out so that other patients could use the shower. “Mr. X,” he said over and over, “would you please come out of the shower?”

After maybe an hour of this line of questioning and efforts to coax the patient to come out, things were beginning to get more serious. There was now discussion of getting a team together to forcefully get this patient out of the shower area. Of course in a psychiatric setting like this, when things get to this point, it gets more worrisome because people (patients and/or staff) can potentially get hurt.

Just minutes before the team was going to begin the forceful extraction, another clinical staff member entered the area. And that was all that it took. A new perspective entered the scene. After quickly assessing the situation, this woman expertly asked the patient one simple question that had yet to make the rounds of questioning. She said, “Mr. X, is there a staff member here that you would care to speak with?”

Upon hearing this question, the wild eyes and posture of Mr. X seemed to soften. He looked toward this young woman and said, “Yes, I want to talk to Ms. Y.” As if on a dime, both the tone and intense feelings related to the entire scene changed.

Soon the team that had been preparing for the extraction disassembled. Other staff went to get Ms. Y, who the patient had requested to speak with. I left the scene shortly after this, but heard later that the patient came out of the shower area as soon as Ms. Y arrived, and he did not need any further more intrusive interventions such as physical restraints or involuntary medication.

As psychotherapists, we sometimes forget about the psychotherapeutic power that lays hidden in the right question. I also believe that the overall model embraced by a large portion of the mental health system throughout much of North America, also forgets about the power inherent in both the right questions and the more general mode of “talk” therapy.

The “right” questions from the psychotherapist can save a patient from more intrusive interventions that can become harmful, such as in the above example, in both inpatient settings, and in the outpatient consulting room.

In today’s climate of managed health care, quick fixes, and a greater reluctance of insurance companies to adequately cover outpatient psychotherapy, psychotherapists and the current mental health system in general, sometimes forget the life-saving power in the right psychotherapeutic questions. As psychotherapists, we invest great time and energy in schooling and study that prepares us for the privilege of being able to call ourselves a psychotherapist (fill in your credential here—LCSW, MFT, Psychoanalyst, Psychologist, Psychiatrist).

The different training modalities of preparing the psychotherapist all have their rightful place in a world where so many individuals are suffering with emotional and thought disturbances and/or a life without meaning. But all of us who call ourselves “psychotherapist” share some very important qualities. We are all granted license to use the right questions that can make or break a unique situation and also make a significant difference in a client or patient’s life.

Sometimes, the right question will remain with a client for many years, perhaps even a lifetime. At other times, the right question will help to initiate a client on a path of less suffering or more meaning. As psychotherapists, it is essential that we not forget the psychotherapeutic power in the right question no matter the climate that we are practicing in now. Sometimes the right question can even save a life.

 

© 2012, Dr. Jeff Howlin. All rights reserved.

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6 Responses to The Psychotherapist and Asking the Right Question

  1. Thank you again Jeff for another fascinating post. I can imagine how that man felt — he needed something, but didn’t know how to express it — maybe he didn’t even know what it was until the wise Ms. Y came in and demonstrated the power of seeing past the dramatics of the situation and into his humanity. Beautiful.

  2. Dr. Howlin says:

    Hi Sarah,

    Thanks for commenting on my latest blog post. You put it right about Ms. Y seeing past the drama. The more I thought about this scenario as I was writing about this topic, the more I realized how indeed just one simple question can have such a powerful impact. I really appreciate your comments and support Sarah. Thank you!

    Jeff

  3. Nancy W says:

    Hi Jeff,

    In my training, which I’m currently participating in, to become a psychotherapist I have the opportunity this semester to learn in a practicum experience for the first time. I saw my first client just last week. Prior to my experience I asked my sister, who is a medical social worker, what advice she had and it mirrors yours, “It isn’t always about asking questions, it is asking the right question?” As your post demonstrates the right question isn’t always apparent – exploration and time assist in rooting it out.

    Thank you for your post – it was particularly meaningful for me, as today I will see a new client for the first time later today. It is a reminder that patience and compassion can lead to the right question.

    Best,
    Nancy

  4. Dr. Howlin says:

    Hi Nancy,

    I’m glad that you stopped by my site, and I’m also glad that the reading material on this post fit with your work this week. Seeing new clients as you begin practicum work is an exciting time. I certainly remember it as that way. Yes, like your sister said, I believe that the “right” questions really can make a difference. Much of the time, I feel that our intuition, coupled with clinical acumen, can help us with this. Good luck Nancy as you move foward with your training, and thanks for the comment!

    Jeff

  5. Yes, asking the right questions is vital. Often we fail to ask questions as we look for ways to insert our wisdom in the form of answers to questions not asked. We are an answer focused culture and are troubled by questions, especially those questions for which we don’t have answers.

  6. Dr. Howlin says:

    Hi Robert,

    I agree completely with what you said about our culture being an answer focused culture. As psychotherapists, having answers to questions not asked are not even close to as helpful as having the right question at the right time. Thanks so much for your input.

    By the way, I enjoyed your latest post on celebrating Canadian Thanksgiving in America. Though I live in America, I have friends and family in Canada and have always had very close ties there, so I sometimes get to celebrate Thanksgiving twice!

    Jeff

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