The Art + Science of Therapy, Part 3: How to Get and Stay Focused In Your Sessions

Topics covered:  asking questions with purpose and intention, use of language and metaphor in therapy, three ways to goof up, managing content and change. Length: 45:08



About Dr. AnnaLynn Schooley

Dr. Schooley returns for part three of her series on the art and science of therapy as craft.  She has been the guest expert for Part 1: Foundational Skills, and Part 2: Crafting Questions.

Dr. Schooley is a professor of marriage and family therapy for Capella University, as well as a licensed mental health counselor, licensed marriage and family therapist, and qualified supervisor in the state of Florida.  Additionally, she is an AAMFT-approved supervisor and supervisor for supervisors (Whoo!  That's a lot.  Needless to say, she is VERY knowledgeable and experienced). 


Class Notes


KEY TAKEAWAYS

1 |  We get focused by not only getting a picture of the problem, but also getting a picture of the goal

Asking the question

  • Check in with the client on what is it we’re working on, early in the session, or throughout the session.  
  • We tend to be good at getting the session started, but we can get so enthralled in the problem story, that we don’t check in with what it is clients are looking for (their goal/intention for the session).
  • Very often clients don’t know what they’re looking for, until we ask them

Example:  So, at the end of today, what is it you’re hoping you’ll have?

  • In order to stay focused so that all of our work is much more efficient, and all of the questions we craft go to the place where the clients want to go, then we have to ask.

Managing content

  • Sometimes the answer is very concrete, and sometimes it’s vague.
  • For example, when completing a formal assessment--what we ask could give the impression that something is important, because I (the therapist) asked it.
  • When you have a list of things to work on, you don’t work on everything, you start with one thing, because everything is connected.
  • MRI (Mental Research Institute therapeutic approach): Ask the client where to start.  “So which of these things, if you got a handle on it, would really seem like things were moving forward?”

The client's focus

  • We’re working on things that are salient, congruent, meaningful to the clients.
  • When in doubt, ask. Then you’re questions all go to the focus.
  • We as therapists don’t have to decide, but we do have to remember to ask the clients.

The tent pole metaphor: All of your questions are focused on the center tent pole.  When you get more content, or extra stories, remain focused by asking, “So, help me understand how that relates to this thing you want to work on.”

Language

  • Consider the word “goal” as a word used in therapy
  • Examples:  At the end of the session, ask
    • “So, what stood out as having been useful?”
    • "You said you wanted this today, how close to it did we get?"

Tip:  If I ask it at the beginning, then at the end, I can check in on it. And then I can transfer it from session to session.  

“So, we left last session with you saying you wanted to work on this, is that--are we still there, or have things changed? Or are there more things you want to work on?

  • How do we work on happy--be mindful of goals--can you partner with the clients on their goal (the way it's phrased)?

Three ways to goof up

1 |  Work on the wrong problem

It is our responsibility to clarify that we’re going where they want to go.  

Assume nothing, like a qualitative researcher, even if it appears obvious.

"So, you’re telling me this story… is this what you want to work on?"

2 |  Working with the wrong people

Who are the people who can make this happen, and are they in the room, on the phone, or am I accounting for them with relational or circular questions (see part 2 in this series for more information about circular questions)?

Who has the power to make that happen?  Who has the authority? What’s getting in the way?  

If there is an absent party, and I don’t account for that, then we’ll get nowhere. Preferably, allow them to be present in the therapy room.

  • I’ve gotta get the right people in the room

3 |  Getting invested in an outcome

  • I have to be willing to either not have any interest in any outcomes, or in reflecting team style, have a variety of outcomes.  Stay un-invested in their choices.  Ask questions and stay curious about their goal, in order to generate all these different ideas.
  • I have to not get invested in any possibility, but to explore all of them as well as their pros and cons.

Example from couples therapy:  neutrality (being on the side of the relationship) vs. multi-directional partiality, from Contextual Therapy (being on each partner's side).

On constant change

  • If we hang on to “change is the constant in the universe,” why wouldn’t their goal change over time? 

“You never step in the same family twice.” --Jay Haley, Strategic Family Therapy

  • You want the family to be changing from week to week. Their goal could change, or something could happen--a crisis or emergency.
  • We have to be available for whatever that catastrophic event is, but any big change. Or, it doesn’t have to be a catastrophic change for clients to shift focus. Perhaps the original focus has become less important.
  • Quote: That’s why I suggest that we ask every session, “So, are we still working on this?”
  • Solution-Focused therapists would say, “So, what’s been different in the last week?”, or “What’s been better with xyz?”--And you invite that conversation of “Are we still working on this?”
  • You were barking up the right tree last week, but it could be the wrong tree this week.

 

Question: How do you stay focused given the fact that change is constant?  

Answer: This is a new family/client this week.

 

The meaning of therapy + the role of the therapist

  • This all comes back to, What does therapy mean? What is my role as a therapist?  Taking these ideas in order to re-define these, so that what it means is simply holding the questions together (with clients).
  • This is a process (therapy) in a widget-making culture.  The outcome is only important to the family.
  • What matters is, can they manage stuff? Do they manage the one thing after another in a way that is more function for them, in a way that they define it.

Are they able to do life in a way that works for them?  --yes, and only they can answer that.


  • Therapy is about how clients define success.

Language, continued.

Metaphor

  • Book, Metaphors We Live By.  A “dry” book, but really useful for recognizing the metaphors that are already “swirling around.”
  • The better handle you have on language, the better and more purposeful you’re going to be in your questions.
  • For example, “up” is always good.  The solution focused scaling question is always the most of something desired. We’re scaling up toward something we want, rather than down toward something we don’t want.  Because, metaphorically, up is always good.
  • People understand metaphor at a subliminal level. Get into the metaphors that are meaningful to the clients.
  • I have this great metaphor, but let me ask the family about that metaphor, in the context of what matters to them.
  • For instance, using the client’s(s) profession and its terms as metaphors for relational dynamics.  Examples:  Lawyers, business owners, football
  • Be curious about clients' interests, then bring the metaphors into goal or other therapeutic conversations, so that it’s relevant to them.
  • By asking about their interests, I am communicating that their world is important to me, and that I care about their world.
  • A really great metaphor can be your tent pole.

Aphorisms

  • Aphorisms are sayings; we can gather them from clients who have native languages other than English.
  • Use the aphorism to bring depth to the story.
  • The beauty of metaphors and aphorisms is that we’re not talking about the problem, we’re talking next to the problem. It’s somehow safer for clients. 
  • Using metaphoric language is particularly useful for people reluctant to be in therapy.
  • I don’t want to use any language that sets them up for failure--and sets me up for failure.

"We want to co-construct a problem that we can actually do something about."


Our responsibilities

  • Don’t rely on the client to check you.
  • Sharpen your hearing, so when they give you metaphor, you can “jump on it.”
  • Transcribe your sessions and find the metaphors.
    • If you pause and  “spin out” the metaphor, what are 4 or 5 questions you could have asked?
    • How would I generate more questions around the metaphor to get a bigger picture, and how does it relate to the tent pole (goal/focus).

Resources

Books:

Metaphors We Live By, Lakoff & Johnson

Problem Solving Therapy, Jay Haley


>> Download the class notes, and the Questions for Staying Focused Cheat Sheet, or find them in Library-->Resources