Question #1: “What do you want to work on today?”
Everyone walks in with the same goal: to feel better. When you're miserable and overwhelmed, it can be disconcerting to be asked where you want to start. Therapists are the ones with a degree - shouldn't we know what comes next?
It’s your therapy. You’re the one who knows what you can handle and what’s most important. Too often, we therapists will wear ourselves out on an issue, then learn our too-quiet client didn't want to talk about it at all. By putting you in charge of what to work on, we give you practice in taking charge of your life.
By the time we ask this question, you should have already have completed a treatment plan and learned how your problems can be treated. Pick from any of the goals you agreed to. A good therapist will follow you where you're willing to go.
This should be obvious, right? If you've just explained your mother needs chemotherapy, you could be tempted to say, “How do you think it makes me feel?” When others ask how we feel, we usually respond with an evaluation like, “Fine,” “Great,” or, “I'm hanging in there." Therapists ask for the specific emotion, and that's personal.
Why we ask:
1. Identifying emotions is healthy. It’s information that helps you understand what is happening and why. When you let emotions up, that means they're on their way out, and that's what helps you feel better.
2. Feelings are what you've asked for help with. A mechanic can’t fix your car without a look under the hood. Since most of us aren't practiced in naming feelings, good therapists will have a list of emotion words handy for your referral.
3. We don’t know. We know how we would feel if was us, but it's not. Our psychology degrees taught us about people in general, and you are you. Maybe there's a numb feeling that's taken you by surprise. Maybe your cancer-stricken mother made childhood miserable and you’re enjoying the schadenfreude. We ask, because it's arrogant to assume. (Have you watched movies or TV shows where therapists see through clients in seconds? They're a load of bunk.)
Question #3: “Are you thinking about killing yourself or anyone else?”
This one is a little insulting, isn’t it? Especially if you’ve told your therapist you’d never do such a thing. Didn't you say so just last week?
We know what you said last week. We want to know about this week.
Anyone who's ever worked in a mental hospital can tell you about a patient who looked fine, said they felt great, and killed themselves a day or two after they left. People often commit suicide when they’ve been depressed for a long time. You could look the same as you have all along, and be on the edge of finally ending it all.
Under the law, it's our job to know when a client might hurt somebody, and to prevent it if possible. When a client commits suicide, we're on the hook, legally and emotionally. Even when there's no legal action or licensure-board investigation, we’ll spend months or years wondering how we might have kept them alive. The regrets and second-guessing are worse than any lawsuit. That's why this question is never an accusation; it's a way to settle our nerves by doing our job.
Are there other therapist questions that leave you wondering? E-mail me and I'll address them in an upcoming post.
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