This post is a continuation of my focus on kindness, positive psychology, and becoming the best possible versions of ourselves. Lyrics from Katharine Lee Bates’s America the Beautiful are part of my underlying inspiration. Buried in the 3rd verse, she wrote, “Till all success be nobleness.” We all should be seeking to be our best and noblest selves, but there are forces in the world pulling in less noble directions. Be forewarned that this post can be interpreted politically or through an historic religious lens. That’s not my intent. The point is simply that we should resist darker impulses and join together to elevate virtuous well-being for as many of us as we can muster. (Here’s Keb Mo singing my favorite version of “America the Beautiful” https://www.youtube.com/watch?v=zcUx3I0k_Fw):
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In 2015, at a family dinner, I told my sister that if then-candidate Donald Trump were caught in a strong headwind, his hair would fly up, revealing the number 666 (the mark of the Beast) on his forehead. My sister said, “John, you’re being overly dramatic.” She was right.
And so was I.
So many scenes and statements over the past month have been nauseating and shameful. When Trump, along with his #1 sycophant, JD Vance, berated Ukrainian President Volodymyr Zelenskyy (the only courageous person in the room), it was like a bad episode of an already failing reality television show. Trump likes to use the word disgrace to describe his adversaries. Trump was, is, and always will be a disgrace. As with most of his insults, “disgrace” is a projection that he pulls out of his own psyche and pastes onto others.
Musk and Trump are firing civil servants and dismantling government services. They have no concern for the lives of people they are destroying. One of their first targets was USAID. Why? Because USAID does kind, generous, and nice things for people across the globe who are in need and suffering. USAID does not promote crypto or cater to the well-heeled. For Musk and Trump, the suffering of others is sometimes collateral damage; other times being cruel is their point.
My new measure for politicians and other humans is kindness. USAID was doing more kind, generous, and compassionate things in one day, than Musk and Trump have done in their combined lifetimes. Marco Rubio recently announced that over 80% of USAID programming is cut. This is not a noble path.
If you don’t believe me, that’s fine. Do the research. Check it out. But don’t believe them. Mega-wealthy people who tell you they’re looking out for your best interests are nearly always lying. Trump and Musk didn’t get rich off their compassion; they got rich using, abusing, and scamming others.
My list of republican sycophants is long and boring. I’m thinking of Lindsey Graham and Rubio, but there are so many others. Most republicans don’t have Zelenskyy’s courage, so they insult him, or imply that he didn’t read the room. Seriously? He read the room with precision. His first option was to get screwed by Trump and Vance while acting like their lap dog. His second option was to stand strong in the face of their theatrical insults to fight for his country and his people. He chose the latter. There never was an option that was in Ukraine’s best interests. The situation was a set up; Zelenskyy took the only respectable option.
Many republicans recognize our democracy is at stake, but they cave to Trumpian bullying anyway. Spineless, led by their fear, they capitulate, even when they know that unpredictable tariffs are reaping chaos on the economy. They capitulate even when they know that pardoning January 6 rioters who attacked the police is wrong. They remain quiet and demur while a legal protester and recent graduate from Columbia University is arrested.
I’m in a fevered state. I may regret putting my thoughts into words, but what I’m saying is coming directly from the burning in my heart for noble causes. I love America. I love the goals and hard work of organizations like USAID. I love civil servants. I stand with them, with Zelenskyy, with peaceful protesters, with the Department of Education, to push back against the big gangsters in their big, imaginary thrones.
If Evil had a plan, it might be this: Make the tired, hungry, and poor the enemy. Sow fear and distrust; grow it into jealousy and hate. Once the hate sprouts, attack the poor and disenfranchised. Cut federal education because of its great value to the poor and uselessness to the rich. Eliminate environmental protections for marginalized communities; let them breathe monoxide and drink brown water because their voices are easy to ignore or dismiss. Destroy USAID, because what wealthy person ever benefited from aid to the hungry or medicines for the sick? Convince the gullible to distrust medicine and question life-saving vaccines; only the affluent deserve to live long and healthy lives.
If Evil had a plan, it might be happening—even as you read these words. And the plan is profoundly Un-American.
But Evil is not a thing or a person. Evil, and all things we call Evil, are conceptual. The great Evil makes us all fall from grace. Evil plays the news cycle, promotes hate, stokes division, and makes us all less good, less happy, angrier, and less compassionate. I was wrong in 2015. If you look closely at Donald Trump’s forehead, you won’t see the numbers 666. He’s no concrete embodiment of Evil. Instead, if you look and listen closely, you’ll see and hear a large vacuous ego that seeks to fill itself with power, and by inspiring everyone to hate more and be less humane, because, quite frankly, that’s how “Evil” works.
Now is the time to put Evil in the rear-view mirror. We will need all our combined strength to make this happen. We need to reach out in kindness and compassion. We need to push back against messages of hate and division and policies that further decimate the poor and disenfranchised. We need to listen to the small, still voice in the night, the voice that knows our name, the voice beckoning us to embrace our better selves and noble natures.
Author Note: As simple and naïve as this may sound, my new subversive social message and political metric is kindness. The social message is intentional kindness. Kindness everywhere; kindness as often as we can muster. The political metric is, “Who is acting with kindness?” Let kindness be our judge.
Occasionally in my life, I’ve seen the future. This moderately delusional belief is related to my love of prediction. Right now, I see tomorrow’s opportunities unfolding. I’m sharing my vision here as a strategy for nudging these opportunities forward. The future I’m seeing is all about, “A Declaration of Independence.”
You might view this post as political. I’m sure it is. That said, my intent is humanitarian. I want people to be treated with respect and compassion. Again, think of kindness.
Donald Trump has begun his presidency at a manic pace. This is a planned mania. He needs mania now, because his days are numbered; his days are numbered due to his age and the forthcoming midterm elections—when he could and should lose substantial power. He and his team can feel the clock ticking.
His mania is a confession of vulnerability. Approximately half the republican party lie in wait for their moment of emancipation . . . the moment to make their declaration of independence from Donald Trump.
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Dear Moderate Republicans,
This is your moment.
Now is the time to seize the day.
You have an unprecedented opportunity for heroism.
I know you can feel and sense this opportunity. You’re too smart and savvy to be ignorant of political opportunity. You must know that now is the time for you to stand up and do what’s right and good for the country and for the world.
Heroism requires self-sacrifice; it involves risk. You cannot achieve hero status without engaging in risky, humanitarian, and possibly sacrificial acts.
But you have a rare heroic opportunity to benefit OTHERS while simultaneously benefiting YOURSELF. Yes, there is still risk.
The risk involves standing up to Donald Trump. And, while that is a risk, most of the country and most of the world are waiting and hoping for someone to emerge who represents wise leadership. You know it’s not Elon Musk or J.D. Vance. It could be you.
Risk is frightening. Risk is also invigorating. Incredibly invigorating.
But why take a risk when you can—in poker terminology—stand pat, take no risk, and continue to experience a modest gain from remaining a status quo supporter of Donald Trump.
Here’s why.
You know in your heart how good it will feel to honor what you know to be true. To live your life with a clear conscience; to look yourself in the mirror and say, “I did something amazing.”
If following your heart and conscience needs a nudge, here are a few actions you’ve been asked to lie about—to yourself and to the American people:
Allowing a vaccine-denier to serve as Secretary of Health and Human Services, a Fox News analyst as Secretary of Defense, a potential Russian asset as Secretary of Intelligence, and a professional wrestling executive for Secretary of Education. You know America deserves better.
Replacing traditional federal oversight mechanisms (like Inspectors General) with Musk and his DOGE crew to cruelly eliminate what they judge to be waste in the federal system. You know the depth and breadth of Musk’s conflicts of interest. You know that giving him more power will not satiate his voracious hunger for even more power.
Ignoring the dangers of reaching out to Putin and turning our backs on Ukraine.
Pretending that creating a Gazan coastal resort to further the Trump/Musk empire is a just and viable road to peace in the Middle East.
Giving the go-ahead to illegal and unregulated mass deportations and the repopulating of an unaccountable Guantanamo Bay.
Acting as if the U.S. can unilaterally annex Canada, grab Greenland, and steal the Panama Canal.
Trusting that global tariff wars will improve relationships with our allies or reduce the cost of eggs.
And finally, you cannot give up your critically important constitutional responsibilities to rein in a power-hungry executive branch. The founding fathers created a system with separation of powers for times like these. Don’t let them down.
Now is the time to pick one or more of the preceding issues and stand firm in the face of the Donald Trump-Musk bloviating firestorm. You risk threats, name-calling, and manipulation; but, the majority of Americans (and global citizens) are waiting, hoping, and longing for YOU to step up and stand strong.
People will shower you with praise, affection, and much more power and attention than you’ll ever get by playing it safe as a quiet member of the Trumpian order.
By standing up for truth, you will be revered.
Honor your conscience. Be honest with yourself. Make Americans proud.
This post is for my Chinese friends, or my friends who speak Mandarin . . . or anyone who wants to read about the process of self-evaluation, the pain of self-reflection, and personal/professional growth.
Last year I was asked to participate as a psychotherapist for the One-Way Mirror Project. The project was inspired by the old and now classic “Three Approaches to Psychotherapy” videos. Not surprisingly, I was honored to be asked to participate, and said yes despite a number of challenging factors, including doing therapy late at night with a Chinese woman via Zoom. I share this because this post is about transparency and so I’m transparently beginning by making excuses for not being the best therapist I imagine myself to be.
Here’s the scenario: One session. Minimal pre-meeting information. Post-session viewing (by me) and commentary on my performance. One other therapist also met with the same client. I get to watch his session; he gets to watch mine. We then have a Zoom meeting to debrief and share our thoughts about our respective sessions (mine was in English; his was in Mandarin).
This was a super-interesting process.
Below, I’m sharing my written self-reflection comments. There’s also a video version . . . which is similar to, but not verbatim from, these notes. The comments are numbered sequentially.
I hope you enjoy this self-reflection/analysis. Thanks for reading.
John S-F – Commentary on His Session with Evelyn
My first reaction to watching this video of myself was embarrassment. I’m sharing this reaction because it’s true. I don’t want to pretend that I think this is a particularly good session.
That said, I also don’t think it was a particularly bad session. I did some things well, and some things less well. In this commentary I will try to describe: (a) what I’m doing (or trying to do), especially from different theoretical perspectives, (b) how Evelyn is responding, (c) what I’m doing well and what I’m doing that’s much less good.
In critiquing my own work, I’m also hoping to connect with all of you. Whether you’re a beginning student or an experienced professional psychotherapist, watching ourselves and hearing ourselves can be humbling and embarrassing. It’s natural for all of us to make mistakes and be imperfect . . . and in this session I do an excellent job of being imperfect😊. . . so much so that while watching the video, during several points I kept shouting at myself to “shut up!” So, that’s a glimpse into one thing I would change about MY behavior in this session. Although I’m okay with being imperfect, I’m not very comfortable with being as imperfect as I was in this session.
How I Work – 0:10 – This explanation has three main goals. First, I’m showing transparency, which is consistent with person-centered and feminist therapies. Second, I’m explaining the process of our session, which is a role induction designed to help clarify expectations. Third, I’m including an invitation for collaboration.
SFBT Opening Question – 1:30 – “If we have a useful meeting, what will we accomplish?” This is a goal-oriented question to help me be more aware of Evelyn’s vision of a successful session.
Evelyn’s Goal – 1:50 – Evelyn says she wants a “different perspective” of what she’s worried about.
JSF’s Goal – In a single session treatment, and maybe most therapy sessions, it’s best to begin with what the client wants. Evelyn’s goal is a “cognitive goal.” In this moment, I decide to go with George Kelly’s “Credulous approach to assessment,” which essentially means “believe the client.” That could be a variation of Carl Rogers’s assertion that we should “Trust the client, because the client knows what hurts and where to go.” JSF – Your goal is my goal, as long as it’s legal and healthy.”
What I Know – 2:25 – This is another effort to be like Carl Rogers and show transparency.
Feelings and Thoughts Around That – 3:00 – Here, I’m trying to prompt her to explore feelings and/or thoughts. She says, “So many worries overwhelming” and talks about not knowing what is overwhelming and then references social media, and four main issues/worries: (a) Fitness/body image/comparison, (b) feelings of unfairness related to gender issues, (c) she loves her partner, but “he is a man” (with sarcasm, implying he therefore cannot understand), (d) humiliation linked to breasts filling with milk involuntarily.
A Broad Summary/Paraphrase – I respond with an accurate summary of her four “feelings and thoughts”
“You can choose; I cannot” – 7:10 – Evelyn focuses on the inherent sex/gender unfairness as related to having a baby. In response, we discuss the burden of social responsibility and how she has internalized societal expectations around being a woman.
May I Share an Observation? – 8:30 – At this point, I try to be a mirror that reflects back to Evelyn what I’m experiencing as one of her positive attributes or strengths. When working across cultures, it’s especially important to be affirming of client strengths. I end this reflection using first-person pronouns—which is a language skill that Rogers used and called “Walking within” – 9:10
Evelyn Continues – 10:45 – to talk about feeling powerless and influenced by her age, generation, societal expectations, and then notes that she wants to “make peace with what she wants to be and what she can be.” The thought of having a baby is a particular trigger for her anxious thoughts and fears. – 11:15
An Intellectual Grasp – 12:15 – I observe that Evelyn has a good intellectual grasp of feminism and of her internalized expectations about how women should be.
A Reflection and SFBT Question – 12:35–13:29 – Using too many words, I finally get out a “Unique outcomes” question: “How have you dealt with internalized fears and conflicts before?”
I Love That Question – 13:35 – Evelyn reflects on a story from age 24 and provides examples of how she felt time running out, dated like crazy, was very brave, and fought back toward her goal of a loving relationship even after having her heart broken.
How did you manage? – 15:03 – I continue to pursue Evelyn’s pre-existing strengths and insights around, with a bit of a focus on what motivated her to “fight back.”
As a Good Therapist – 15:35 – Evelyn expresses motivation to be a good therapist and that requires expansive live experiences.
Anything Else Pull You – 16:54 – Evelyn shares an early fear of death, noting, after an anecdote, that her class presentation on death left her feeling “more lonely (or different) than ever.” – 17:54. [not psychoanalytic]
I Reflect – 18:30 – Being a better therapist and fear of death motivate her to live a life full of experiences.
Imagine self at end of life – 19:00 – Found someone I love and would like to have a child. I want to try it. That would complete my experience. – 19:30
Values vs. Anxieties – 19:55 – Still feel anxieties. “I have to carry a child” etc. . . walking within. Amplifying expectations so she can hear them.
That’s my barrier –
Fought those off those expectations before – 20:45 – And yet . . . you have fought off expectations before. What makes you think you will be a victim to those expectations in the future? Here, I’m trying to identify what CBT people might consider an “irrational” or “maladaptive” thought/belief that doesn’t have much evidence to support it. Also, exception. . .
Focus on the Physical/Somatic – 22:25 – Evelyn notes this task is “harder” and supports that with physical changes she’s experiencing with aging. . . and I interpret that as “Anticipatory grief” regarding her physical decline [this is likely death anxiety too]
Self-Disclosure – 23:40 – May I share something? “I have a 35-y/o daughter with similar issues.” [Too many words! Should have stopped when Evelyn laughed and put her hand to her face and then explored her initial reaction]. I finally get to “What’s your reaction?” [Late, but I got there]. She says . . . and this is potentially central to “one” therapy goal: “I feel, like, less lonely.” [Again, I should just stop there or repeat it back. . . or “What’s it like inside to feel less lonely?”].
Curious about what I could learn from her – 25:35 – I turn this around. Why? Because I want her to value herself as a source of wisdom.
When I share with my partner – 26:25 – She notes “he can relate” and that “men are limited.” [This could have been good transference exploration or Adlerian basic mistake]
Session shift to “so much feeling” – 27:16 – Evelyn is talking about her emotionality, I’m reflecting ok. More on unfairness, but notes BF is pretty accepting. I do a strength-based reflection, “Openness, strength, do not run from feelings!” This is a little CBT as I want her to “perceive” herself with more strengths to cope with her future challenges.
Thoughts about yourself? – 31:00 – I’ve been working on some CBT stuff and now am shifting back to the important self-evaluation process. Her response is constructive as she describes lots of planning she has already done for this coming year.
I want to hear out my fears – 32:10 – This is a great insight on her part. It prompts me to have her listen to her fears in the here and now. Evelyn responds [33:10] that she likes that question and explores, perhaps with a tiny bit of surprise, that her fears are not harsh, but more of a gentle reminder to not have regrets. [Here, I could and probably should have had her get deeper into here and now processing. “Let’s have you hear the gentle voice of your fear right now. What’s it saying to you? Say it as if you are the fear. Also, could have used repetition.]
Reflections and WW – I stay with the themes and use WW to keep bringing them back. Why? In part, desensitization. Hearing her anxiety-producing words in a potentially trusting/comforting setting can take some edge or power out of them [MCJ – 1924]. She says, somewhat conclusively, “Sounds like fear just wants me to get prepared and not critique.” [One thought, I could have been her child and asked her to tell me what she has learned.]
Evelyn asks JSF Q – 36:28 – This is one place where I fall off the rails. She asked me a question and my obnoxious, intellectual, professor-self emerges. . . for far too long. [I could have said, “I have some thoughts about that, but I’d like to hear yours first.”] Instead, JSF blah, blah, blah, and to compound the error, I do not check in on her reaction.
Evelyn continues exploring – 40:52 – She notes Yuval Harrare and feminism as a new way to resolve conflicts without war. I do manage to shift back to listening with a pretty good paraphrase: “Communication with your partner may be your best way to grow and develop and maintain your feminist identity through childbirth and your relationship.”
Evelyn recognizes perfect equality not possible – 42:35 – JSF “Love what you said. What do you think? How does it feel?” [2 Qs, boo, but my focus on her self-evaluation is still pretty solid.] I continue with “What’s your assessment of yourself and your communication skills?” I’m hoping she can express trust in her communication skills.
Non-violent communication as restraint – 46:00 – This is an interesting side road where E says, “Sometimes I just want to be violent and like a child” and notes that she prefers “emotionally charged communication.” She finds emotions and aggressive communication to be helpful. [Note: at this point I’m beginning to feel time pressure. No time to go deeper. If more sessions, I’d earmark this and close. Instead, I ask, “Is it ok to have both” (nonviolent and emotional communication) as a quick prompt toward integration.
Moving toward closing – 49:00 – I’ve lost track of time because of early tech problems. I’d like to think that’s my excuse for ending poorly. First, I begin a summary. This isn’t good. It’s MY summary . . . and I should be asking for HER summary before offering mine. I’m far too verbal. The content isn’t terrible.
Thank-you so much – 52:45 – She’s tracking time, and this should be it. I’m not. And do another disclosure and ask for her summary.
Whatever the influences, while in grad school, I got slightly obsessed with predicting human behavior. My four roommates were an inspiration. They were wonderful, and, they provided entertaining signs of four different DSM personality disorders. Although not officially “diagnosable,” they each had distinctive “features” of compulsive, histrionic, narcissistic, and dependent personality disorders.
I was convinced I could predict the behavior of my roommates based on their personalities. As one example, during a group therapy session involving nickname-sharing, my so-called “narcissistic” friend shared that his nickname was “Lord.” As another, my “dependent” friend took to following me around and calling me his “hero.” I could go on, but this blogpost is about the future and not the past.
But first, four more historical reflections: (1) I developed my own totally bizarre personality test (the Sommers-Circles), (2) I did my thesis and dissertation on personality and prediction, (3) I discovered, as it turns out, personality is a rather poor predictor of human behavior, and (4) I also discovered that nothing is a very good behavioral predictor, and humans are more unpredictable than not.
Now, with my thesis 40 years behind me, and despite scientific evidence against anything being predictable, I still believe—as the famous/infamous social psychologist Daryl Bem wrote in 1974 (paraphrasing here), “That my predictions are right and the research is wrong.”
In honor of my lifelong prediction obsession, here are my Predictions for 2025.
On January 8, I, along with the Montana Happiness Project, will announce big, luscious, and wonderful news.
In early 2025, we will rediscover once again that, in fact, the body does NOT keep the score, but that the brain and body keep the score together, just as nature and nurture work together, despite annoying efforts by the misinformed to keep them apart.
To rebalance our collective worldwide preoccupation during the first half of the 2020s with TRAUMA as being at the root of everything and everything being TRAUMA, the second half of the 2020s will be about growth and resilience in the face of stress and oppression.
After January 20, Trump will continue to be Trump. What will that mean, specifically? First, he won’t suddenly become “presidential” (although the media will continue to expect him to). Second, he will lie about nearly everything, nearly all the time. Third, he will take credit for positive local and world events, and avoid or deflect responsibility for anything negative. Fourth, he will be cruel toward anyone he views as (a) beneath him or (b) unloyal. The corollary to this is that he will not be cruel toward Elon Musk or Vladimir Putin, but people like Laura Loomer will be left out to dry like laundry in the wind. Fifth, cracks will form within his circle of influence, which liberals will gleefully interpret as signs of his imminent fall, but he will carry on halfheartedly with his public agendas, and full-heartedly with his private agenda of making as much money as possible, while stomping on the poor, needy, and vulnerable.
Other than a few rogue reporters here and there, the press will continue to snuggle up to Trump in ways that make many of us feel sad about journalism.
Similar to #3, other than a few rogue republicans, when it comes to Trump, the GOP will continue to be unable to find their voices, souls, and morals. . . in ways that make many of us discouraged about the future of the country. This charade of cooperation with emperor trump will begin deteriorating in the run-up to the midterm elections, unless the so-called emperor coalesces power in ways that allow him to destroy the constitution and democracy.
The Buffalo Bills will defeat the Detroit Lions 36-30 in Super Bowl LIX.
Around the time of the Super Bowl, Trump will fire someone from his cabinet. Although Ramaswamy would be likely, his position will only ever be pretend, and so his squeaky voice will only fade into the background.
Auburn will defeat Duke, 80 to 76, for the NCAA basketball championship.
The price of groceries will NOT come down. If anyone in the media has the courage to mention high grocery prices, Trump will blame it on Biden, Harris, Obama, “Crooked” Hillary, fake news, or whomever is most convenient.
Global and local temperatures will continue to rise. Politicians and businesses with corporate interests in fossil fuels will continue to question climate science . . . just as they have since the 1950s, when Edward Teller and others began warning the world about carbon.
The New York Mets will defeat the Los Angeles Dodgers in the World Series, in six games, partly due to Dodger’s manager Dave Roberts continued affinity with his “gut” over analytics.
Suicide rates in the U.S. will remain stable, at or near modern highs.
Taylor Swift will marry her boyfriend.
The rate of worldwide species extinction will continue at unprecedented rates, matched only by the collective denial of politicians and corporations (which, as it turns out, are not people).
Jennifer Lopez will marry Michael B. Jordan, resulting in J-Lo-Jo.
At some point, someone will make the obvious point that even though the media loves rich people, most (not all) rich people have gotten rich through selfishness and greed, and consequently, putting rich people in charge of the country will not work out well for anyone other than the rich people.
Like other predictions by famous pundits, no one will remember this blog, and consequently, I’ll be free to boldly, irresponsibly, and confidently make predictions for 2026, despite having no successful track record or credibility for making predictions.
But one thing is certain: January 8th will be big news day here. . . on this blog, and elsewhere. . . so stay tuned.
Happy New Year,
John
P.S.: Here’s a copy of the 1974 (Bem and Allen) article that inspired me to pursue the science of prediction.
Every day, I keep getting older. I can’t seem to stop myself. And every day, I keep running into dialectics. They’re everywhere. My aging experiences of ubiquitous dialectics seems consistent with the fact that yesterday, Merriam-Webster declared “polarization” their word of the year (https://www.merriam-webster.com/wordplay/word-of-the-year).
Boo, Merriam-Webster! I would have chosen dialectics. Here’s one of the definitions for dialectic listed in the online M-W dictionary: “the Hegelian process of change in which a concept or its realization passes over into and is preserved and fulfilled by its opposite.” TBH, I have very little understanding of what the heck Hegel was talking about, but I’m pretty sure it’s happening ALL. THE. TIME.
This morning I find myself plagued by the idea that although most mental health professionals advocate mindfulness, many mental health professionals (including myself, sometimes), aren’t very mindful when using basic counseling skills in practice. Today’s topic is questions. I’m polarized inside a dialectical and thinking, “We should all be more mindful and intentional in our use of questions in counseling and psychotherapy.” At the same time, I’m sure, “we should all relax and be more of ourselves.”
With these confusing caveats in mind, today, tomorrow, and maybe the next day, I’m posting about the very basic use of questions in counseling and psychotherapy. This content is excerpted from our Clinical Interviewing textbook.
Here’s our opening section on questions, which is conveniently found in Chapter 5 of Clinical Interviewing, which I’m continually surprised that not everyone has read (but really not at all surprised).
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Questions
Imagine digging a hole without a shovel or building a house without a hammer. For many clinicians, conducting an interview without using questions constitutes an analogous problem: How can you complete the interviewing task without using your most basic tool?
Despite the central role of questions in clinical interviewing, we’ve avoided discussing them until now. Similarly, when teaching clinical interviewing skills, we usually prohibit question asking for a significant portion of the course (J. Sommers-Flanagan & Means, 1987). Our rationale includes several factors: Questions are easy and often misused. Also, because questioning isn’t the same thing as listening, our goal is for students to develop alternative information-gathering strategies. Asking questions can get in the way of gathering important information from clients. The Little Prince expresses a fundamental problem with excessive questioning.
Grown-ups love figures. When you tell them that you have made a new friend, they never ask you any questions about essential matters. They never say to you, “What does his voice sound like? What games does he love best? Does he collect butterflies?” Instead, they demand: “How old is he? How many brothers has he? How much does he weigh? How much money does his father make?” Only from these figures do they think they have learned anything about him. (de Saint-Exupéry, 1943/1971, p. 17)
The questions you ask may be of no value to the person being asked. Ideally, your questions should focus on what seems most important to clients.
Despite our reservations about excessive questioning, questions are a diverse and flexible interviewing tool; they can be used to
Stimulate client talk
Inhibit client talk
Facilitate rapport
Show interest in clients
Show disinterest in clients
Gather information
Confront clients
Focus on solutions
Ignore the client’s viewpoint
Stimulate insight
There are many forms or types of questions. Differentiating among them is important, because different question types produce different client responses. In this section, we describe open, closed, swing, indirect, and projective questions. Chapter 6 covers therapeutic questions. Although we distinguish between general question types and therapeutic questions, all questioning can be used for assessment or therapeutic purposes.
Open Questions
Open questions are used to facilitate talk; they pull for more than a single-word response. Open questions ordinarily begin with either How or What. Sometimes questions that begin with Where, When, Why, and/or Who are classified as open, but such questions are only partially open because they don’t facilitate talk as well as How and What questions (Cormier, Nurius, & Osborn, 2017). The following hypothetical dialogue illustrates how using open questions may or may not stimulate client talk:
Therapist: When did you first begin having panic attacks?
Client: In 1996.
Therapist: Where were you when you had your first panic attack?
Client: I was just getting on the subway in New York City.
Therapist: Why haven’t you tried to ride the subway again?
Client: Because I’m afraid I’ll have another panic attack.
Therapist: How are you handling the fact that your fear of panic attacks is so restrictive?
Client: Not so good. I’ve been getting more and more scared to go out. I’m afraid that soon I’ll be too scared to leave my house.
As you can see from this example, open questions vary in their openness. They don’t uniformly facilitate depth and breadth of talk. Although questions beginning with What or How usually elicit the most elaborate responses from clients, that’s not always the case. More often, what’s important is the way a particular What or How question is phrased. For example, “What time did you get home?” and “How are you feeling?” can be answered very succinctly. The openness of a particular question should be judged primarily by the response it usually elicits.
Questions beginning with Why are unique in that they commonly elicit defensive explanations. Meier and Davis (2020) wrote, “Questions, particularly ‘why’ questions, put clients on the defensive and ask them to explain their behavior” (p. 23). Why questions frequently produce one of two responses. First, as in the preceding example, clients may respond with a form of “Because!” and then explain, sometimes through detailed and intellectual responses, why they’re thinking or acting or feeling in a particular manner. Second, some clients defend themselves with a “Why not?” response. Or, because they feel attacked, they respond confrontationally with “Is there anything wrong with that?” Therapists minimize Why questions because they exacerbate defensiveness and intellectualization and diminish rapport. In contrast, if rapport is good and you want your client to move away from emotions and speculate or intellectualize about something, then a Why question may be appropriate and useful.
Closed Questions
Closed questions usually begin with words such as Do, Does, Did, Is, Was, or Are and can be answered with a yes or no response. They’re useful if you want to solicit specific information. Traditionally, closed questions are used later in the interview, when rapport is established, time is short, and efficient questions and short responses are needed (Morrison, 2007). Questions that begin with Who, Where, or When also tend to direct clients toward talking about specific information; therefore, they should be considered closed questions (see Practice and Reflection 5.1).
Closed questions restrict verbalization and lead clients toward details. They can reduce or control how much clients talk. Restricting verbal output is useful when working with clients who talk excessively. Closed questions are used to clarify behaviors and symptoms and consequently used when conducting diagnostic interviews. (For example, in the preceding example about a panic attack on the New York subway, a diagnostic interviewer might ask, “Did you feel lightheaded or dizzy?” This question would help confirm or disconfirm one symptom possibly linked to panic disorder.). As compared to open questions, closed questions usually feel different to clients.
Sometimes, therapists inadvertently or intentionally transform open questions into closed questions with what’s called a tag query. For example, you might start with, “What was it like for you to confront your father after all these years,” and then tag “was it gratifying?” onto the end.
Transforming open questions into closed questions is fine if you want to limit client elaboration. When asked closed question, clients will likely focus solely on the answer (e.g., whether they felt gratification when confronting their father, as in the preceding example). Clients may or may not elaborate on feelings of fear, relief, resentment, or other thoughts, emotions, and sensations.
If you begin an interview using a nondirective approach, but later change styles to obtain more specific information through closed questions, it’s wise to use role induction to inform your client of your forthcoming shift. You might say,
We have about 15 minutes left, and I have a few things I want to make sure I’ve covered, so I’m going to start asking you more specific questions.
Beginning therapists are usually advised to avoid closed questions because closed questions are frequently interpreted as veiled suggestions. For example:
Client: Ever since my husband came back from active duty, he’s been moody, irritable, and withdrawn. This makes me miss him terribly, even though he’s home. I just want my old husband back.
Therapist: Have you tried telling him how you’re feeling?
We usually boldly tell our students to never ask, “Have you tried. . .” We believe have you questions are advice-giving in disguise. We’re not against advice; we’re just against asking questions that imply clients should have already tried what you’re recommending. In the preceding interaction, the client might think the therapist is suggesting she should open up to her husband about her feelings. Although this may be a reasonable idea, therapists and clients are better served with an open question: “What have you tried to help get your old husband back?” Our advice—which is not disguised in the least—is that when you feel an impulse to ask a “have you” question (and you will), simply stop yourself, and add the word “What” to the beginning to make it an open question. Closed questions are a helpful interviewing tool—as long as they’re used intentionally and in ways consistent with their purpose.
Swing Questions
Swing questions can function as either closed or open questions; they can be answered with yes or no, but they also invite more elaborate discussion of feelings, thoughts, or issues (Shea, 1998). Swing questions usually begin with Could, Would, Can, or Will. For example:
Could you talk about how it was when you first discovered you were pregnant?
Would you describe how you think your parents might react to finding out you’re leaving?
Can you tell me more about that?
Will you tell me what happened in the argument between you and your daughter last night?
Ivey and colleagues (2023) believe swing questions are the most open of all questions. They note that clients are empowered to decline answering a swing question by saying something like, “No. I’d rather not talk about that.”
For swing questions to work, you should observe two basic rules. First, avoid using swing questions unless rapport has been established. Without rapport, swing questions may backfire and function as a closed question (i.e., the client responds with a shy or resistant yes or no). Second, avoid using swing questions with children and adolescents, especially early in the relationship. This is because children and adolescents often interpret swing questions concretely and respond accordingly (J. Sommers-Flanagan & Sommers-Flanagan, 2007b). For example:
Counselor 1: Would you tell me more about the fights you’ve been having with your classmates?
Young Client 1: No.
Counselor 2: Could you tell me about how you felt when your dad left?
Young Client 2: No.
Counselor 3: Would you like to come back to my office?
Young Client 3: No.
Swing questions with young clients (especially if you don’t have positive rapport) can produce awkward and unhelpful interactions.
Indirect or Implied Questions
Indirect or implied questions usually begin with I wonder or You must or It must (Benjamin, 1987). They’re used when therapists don’t want to directly ask or pressure clients to respond. The following are examples of indirect or implied questions:
I wonder how you’re feeling about your upcoming wedding.
I’m wondering about your plans after graduation.
I’m curious if you’ve given any thought to searching for a job.
You must have some thoughts or feelings about discovering your child is transgender.
It must be hard for you to cope with your wife being shipped out to serve overseas.
You can use other indirect sentence stems to gently imply a question or prompt clients to speak about a topic. Common examples include “I’d like to hear about…” and “Tell me about…”
Indirect or implied questions can be useful early in interviews or when approaching delicate topics. Like immediacy, they can contain a supportive self-disclosure of interest. They’re noncoercive, so they may be especially useful as an alternative to direct questions with clients who seem reticent (C. Luke, personal communication, August 7, 2012). When overused, indirect questions can seem sneaky or manipulative; after repeated “I wonder…” and “You must…” probes, clients may start thinking, “And I’m wondering why you don’t just ask me whatever it is you want know!”
Projective or Presuppositional Questions
Projective questions are used to ask clients to imagine particular scenarios and help them identify, explore, and clarify unconscious or unarticulated conflicts, values, thoughts, and feelings (see Case Example 5.5). Solution-focused therapists refer to projective questions as presuppositional questions (Murphy, 2023). These questions typically begin with some form of What if and invite client speculation. Projective questions can trigger mental imagery and prompt clients to explore thoughts, feelings, and behaviors they might have if they were in a particular situation. For example:
What would you do if you were given one million dollars?
If you had three wishes, what would you wish for?
If you needed help or were really frightened, or even if you were just totally out of money and needed some, who would you turn to right now? (J. Sommers-Flanagan & Sommers-Flanagan, 1998, p. 193)
What if you could go back and change how you acted during that argument (or other significant life event): What would you do differently?
Projective questions are also used to evaluate client values, decision making, and judgment. For example, a therapist can analyze a response to the question “What would you do with one million dollars?” to glimpse client values and self-control. Projective questions are sometimes included as a part of mental status examinations (see Chapter 9 and the Appendix).
CASE EXAMPLE 5.5: PROJECTIVE QUESTIONING TO ELICIT VALUES
Your use of projective questions is limited only by your creativity. John likes to use projective questions to explore relationship dynamics and values. For example, with a 15-year-old male client who had an estranged relationship with his father and was struggling in school, John asked, “If you did really well on a test, who’s the first person you would tell?” The client responded, “My dad.” After hearing this response, John used the fact that the boy continued to value his father’s approval to encourage the boy and his father to meet together for counseling to improve their communication and relationship.
[End of Case Example 5.5]
And . . . here’s a pdf of the Chapter 5 Table describing the different question types.
Tomorrow is a celebrated holiday involving gratitude. Given the American history of mistreatment, oppression, and abuse of indigenous peoples, I have trouble saying the holiday name. You may think I’m being over-sensitive or politically correct, or you may find yourself seeking some other label to describe me. No worries, I’m here to help. My current labels (which switch with considerable frequency) are grumpy and discouraged.
I know better than to dwell too long on my grumpy and discouraged thoughts, feelings, and somatic complaints. Those of you who know me well know that it makes me grumpy to even use the word somatic, and so the discouragement is deep. While I’m drilling down into my negativity, I’ll add that it also makes me grumpy to hear the words “fight-or-flight” and “brain shut-down” and “amygdala hijack” and “PHQ-9 or GAD-7” and “mental illness” and the mispronunciation of “Likert” and everything else our culture is using to push us into negative mental and emotional states—and keep us there.
I also know that some of the preceding linguistic pet peeves may seem cryptic. That’s okay. I like being mysterious. I’ll just say that I would prefer “amygdala hijinks” over “hijack,” and leave the mystery unsolved.
Not surprisingly, the bigger laments are what give the smaller laments most of their negative power. My bigger laments are probably obvious, but here are a few: How did we develop into a culture where the voices and opinions of people like Andrew Tate and Joe Rogan shape the psychology, emotions, and behavior of so many young men? How did we become a nation that could elect a convicted felon, rapist, racist, sexist, reality television star as the next president? When did Christianity take a turn and become a narcissistic, nationalist, anti-immigrant movement? How did our mainstream media become an entity that gives voice to social media posts from the president elect? And, because the president elect is a well-known serial and pathological liar, how did the media decide they should center their reporting around his likely dissembling bloviations as potentially truthful statements?
I do have to admit that it makes me a little bit happy to use the word bloviations. That was fun.
Now that I have you (my six faithful readers) grumpy and discouraged along with me, maybe I should pause to take stock of the many things and people toward whom I feel gratitude. If, by chance, you’ve also been feeling your share of doom and gloom, I hope you’ll consider joining me in a gratitude activity.
First in line is Rita. Only minutes ago, while planning a few Turkey Day dishes, I offered up one simple suggestion that may have required only one or two brain cells and could easily have been brought forth during a so-called fight-or-flight brain shut-down. Her response of, “That’s a REALLY good idea!” made me laugh out loud (even amidst my gloomy mood). This small interaction reminded me of the many ways that I am lucky to be supported and inspired by Rita every day.
Our children (and son-in-law) are basically overachieving geniuses who work every day to make the world a better place. I won’t go into details here, but this is more good fortune on a rather magnificent scale.
This past weekend I hung out with my sisters, attending a Bat Mitzvah with my Jewish cousins who welcomed us into their celebration with open arms and hearts. We mercilessly teased each other, laughed together, played games, and did what family does. My sisters and I often marvel at our mutual family experiences . . . as given to us by our amazing parents. More big gratitude.
First thing this morning, I got to lightly supervise a few interns who are facilitating a group for dads, prepping to present to classrooms of 8th graders, and being coached by Dylan Wright, who just might be the most dynamic presentation coach of all time. These young people are smart, capable, and committed to being therapeutic forces in the world. . . and I get to work with them.
Tomorrow Rita and I will have dinner with a long-time friend who, having already made substantial contributions to the mental health of a multitude of Montanans, invited us over to help her eat up a frozen turkey that she surprisingly found in her freezer. We have gratitude to her for the past, present, and future.
Just in case you’re wondering, the empirical research on gratitude is pretty fantastic. Focused and intentional gratitude will not immediately transform your life, but in general, gratitude practice is linked to improved mood, increased positive communications with others, hope, and improvements in physical exercise. That last one is as cryptic as my linguistic pet peeves. How could gratitude make you exercise more? Nobody knows. All I can say is this: How about you practice gratitude tonight, tomorrow, and into the future and then see if it helps you exercise more? As B.F. Skinner might say, we should all experiment with our experiences.
Given all the world-wide and local reasons to be grumpy and discouraged, my plan is to counter those feelings by spending more time being grateful. I know it won’t fix the world . . . but I know it will create nicer feelings . . . and that, I suppose, is plenty good for now.
Someone in one of my classes recently mentioned Hand, Foot, and Mouth Disease. This reminded me of my blog post on the topic, which made me realize that I’ve blogged about nearly everything!
Earlier this week, I had an amazing Montana educator tell me, among other things, about how the election results ignited fears for the future of public education. In response, I wrote the following piece. I know it’s a little intellectual, but that’s what you get from a college professor. I’m sharing this with you mostly because I think you’re all amazing Montana educators and want to support you in whatever way I can.
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In this moment, I’m aware that while some are celebrating this morning’s election outcome, others are experiencing despair, sadness, anger, betrayal, and fear. After an election like this one, it’s easy to have our thoughts and emotions race toward various crisis scenarios. If that’s what’s happening to you, no doubt, you are not alone.
We all have unique responses to emotional distress. If you feel threatened by the election outcome, you may have impulses toward action that come with your emotions. In stress situations, we often hear about the fight or flight (or freeze) response, but because we’re all complex human beings, fight or flight or freeze is an oversimplification. Although feeling like running, hiding, freezing, or feeling surges of anger are natural and normal, most of the fight or flight research was conducted on rats—male rats in particular. For better and worse, our emotional and behavioral responses to the election outcomes are so much more complex than fight or flight.
As humans we respond to threat in more sophisticated ways. One pattern (derived from studies with female rats) is called tend and befriend. Although these are also simplistic rhyming words, I translate them to mean that if you’re feeling stressed, threatened and fearful, it’s generally good to reach out to others for support and commiseration, to support others, and to gather with safe people in pairs or families or groups.
If you work in a school, I encourage you to be there for each other, regardless of your political views. For now, it will probably feel best to stay close to those with whom you have common beliefs. Eventually, I hope that even those of you with different beliefs can recognize and respect the humanity within each other. The most destructive responses to stress and threat are usually characterized by hate and division. The more we can connect with others who feel safe, the better we can deal with our own rising feelings—feelings that may be destructive or hateful.
Another complex thing about humans is that we can have a therapeutic response to focusing on our pain, grief, anger, and other disturbing emotions. There’s clear evidence that letting ourselves feel those feelings, and talking and writing about them, is important and therapeutic. But, in an odd juxtaposition, it’s also therapeutic to intentionally focus on the positive, to imagine and write about the best possible outcomes in whatever situations we face, and in looking—every day—for that which is inspiring (rather than over-focusing on that which is depressing or annoying). To the extent that you’re feeling distressed, I encourage you, when you can, to take time going down both those roads. That means taking time to experience your difficult and painful feelings, as well as taking time to focus on what you’re doing that’s meaningful in the moment, and whatever positive parts of life you can weave into your life today, tomorrow, and in the future.
My main point is that you are not alone. Many people, right alongside you, are in deep emotional pain over the outcome of the election. As you go through these bumpy times, times that include fears for the future of children, families, education, and communities I hope we can do this together. Because in these moments of despair and pain, we are better together.
Or, as Christopher Peterson said, “Other people matter. And, we are all other people to everyone else.”
You matter and your reactions to this immense life event matters. Please take good care of yourself and your colleagues, friends, and family.
During my supervision this week, I noticed that the concepts and process of Motivational Interviewing came up several times. When students or professionals don’t know the basics of Motivational Interviewing (MI), I feel compelled to speak up. MI is a method, strategy, or philosophy that’s complex, nuanced, and essential. We should all know about and have MI skills. To feel the centrality of MI to counseling and psychotherapy, it helps to start with MI’s most fundamental organizing principle.
“It is the client who should be voicing the arguments for change” (Miller & Rollnick, 2002, p. 22).
If you contemplate this principle (and you should), then you’ll need to examine your own role in the change process. That’s because, if look at (or listen to) yourself, and YOU’RE the one voicing the arguments for change, you must stop.
If you don’t stop, then you may be contributing to your clients’ resistance to change.
MI ideas are challenging to our natural impulses. We want to tell clients how to be healthier, but our job is not to voice the argument for positive and healthy change; our job is to nurture their argument for positive and healthy change. This is where the nuance comes in. How can we, as interviewers (aka counselors or psychotherapists) create an interaction wherein the client is more likely to take the lead in voicing the arguments for positive and healthy change?
The answer to that question is complex, as it should be. In part, my answer today is to include an excerpt from Chapter 12 (Challenging Client Behaviors and Demanding Situations) of our Clinical Interviewing text. This excerpt starts with the topic of “Challenging Client Behaviors” or behaviors that clients engage in that counselors and psychotherapists often find challenging. The content includes a discussion of the concept of “resistance,” MI strategies, as well other ideas of our own and from the literature.
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Challenging Client Behaviors
As the client and therapist talk more and more about the solution they want to construct together, they come to believe in the truth or reality of what they are talking about. This is the way language works, naturally.
—Insoo Kim Berg and Steven de Shazer, Making numbers talk, 1993, p. 6
Not all clients are equally cooperative. Here are a few opening lines we’ve heard over the years:
Do I have to be here?
No disrespect, but I hate counselors.
I’ll never talk to you about anything important, and you can’t make me.
This is a shitty little office; you must be a shitty little therapist.
How long will this take?
How old are you? How are you supposed to help me if you’re still in middle school?
In our work with adolescents and young adults, we’ve directly experienced the pleasure (or pain) of being in interviews with people who want little to do with therapy, and nothing to do with us. We’ve had clients refuse to be alone in the room with us, others who refused to speak, a few who insisted on standing, and many who told us with great disdain (and punctuated with profanity) that they don’t believe in counseling.
The first part of this chapter is about interviewing clients who oppose the helping process. It’s also about the deep satisfaction of working with clients who slowly or suddenly shift their attitudes and become cooperative. When these clients eventually enter the room, begin speaking, stop swearing, agree to sit, and begin believing in counseling (and counselors!), it can be a profoundly rewarding experience.
Defining and Exploring Resistance
Freud viewed resistance as inevitable and ubiquitous. Following Freud’s lead, psychotherapists for many years considered virtually anything clients did or said as potential signs of resistance, such as
Talking too much, or talking too little
Arriving late, or arriving early
Being unprepared or overprepared for psychotherapy
The Death (or Reframing) of Resistance
Many theorists and practitioners question the nature and helpfulness of resistance as a concept. In 1984, writing from a solution-focused perspective, Steven de Shazer announced the “death of resistance.” He subsequently held a ceremony and buried it in his backyard. Other theorists and researchers—particularly from culturally diverse perspectives—have followed his lead in viewing resistance differently (Adames et al., 2022; Chimpén-López, C., 2021). They view resistance as an unhelpful linguistic creation that developed because sometimes clients don’t want to (or shouldn’t) do what their “bossy” or oppressive therapist wants them to do (Ratts et al., 2016). In other words, resistance isn’t a problem centered in the client; it’s a problem created by therapists and the power dynamic this presents.
Around the time de Shazer was burying resistance in his backyard, William R. Miller was discovering that reflective listening, empathy, and encouragement with clients who had substance problems, outperformed confrontation and behavioral interventions (W. Miller, 1978, 1983). This discovery led to the development of motivational interviewing (W. Miller & Rollnick, 1991; Miller & Moyers, 2021). Motivational interviewing (MI) is now widely acknowledged as an effective treatment for health, substance, and mental health problems (McKay, 2021; Romano & Peters, 2015).
Resistance is Multidetermined
Unlike the early psychoanalytic position, resistance is neither inevitable or ubiquitous. But it’s probably not dead either. Instead, resistance (aka ambivalence or reluctance) originates from three main sources:
Resistance from the client. Sometimes resistance is real, palpable, and originates from clients’ beliefs, attitudes, ambivalence, or internalized view of therapy as an oppressive situation (Adames et al., 2022). When resistance emanates from clients (regardless of therapist behavior), clients are usually in the precontemplation (not interested in changing) or contemplation (occasional transient thoughts of changing) stages of change (see Chapter 6 for an overview of the transtheoretical stages of change model; Prochaska & DiClemente, 2005).
Resistance that therapists stimulate. Sometimes therapists behave in ways that create resistance rather than cooperation. Overuse of confrontation or interpretation can stimulate client resistance (Romano & Peters, 2015). Therapists who don’t examine and manage their countertransference biases toward particular client populations (e.g., teenage clients, reluctant clients, mandated clients, or clients from diverse cultures), or who perpetuate marginalization of diverse populations, are especially prone to creating client resistance (Ratts, 2017; Tishby & Wiseman, 2020).
Resistance as a function of the situation. Resistance may be a product of a difficult and uncomfortable situation, a situation or expected coercive interpersonal interactions that naturally trigger reactance (i.e., negative expectations and defensiveness; Beutler et al., 2011). Reactance is a well-established psychological phenomenon (Brehm, 1966; Place & Meloy, 2018): When people feel coerced or pushed, they tend to push back, resisting the perceived source of coercion (e.g., therapist). For most mandated clients and for many ambivalent clients, resistance to therapy is a natural, situationally triggered behavior (J. Sommers-Flanagan et al., 2011). Also, for clients with diverse ethnicities or societally-marginalized identities, therapy can naturally feel like the repetition of power-imbalanced colonization experiences (Gone, 2021; Singh et al., 2020).
We realize that framing resistance as multidetermined and natural (or burying it) doesn’t automatically make it easier to handle (J. Sommers-Flanagan & Bequette, 2013). To therapists, resistance can still feel aggressive, provocative, oppositional, and threatening.
It’s unrealistic to expect all clients—especially adolescents or mandated adults in precontemplation or contemplation stages of change—to immediately speak openly and work productively with an unfamiliar authority figure. It’s also unrealistic to expect clients for whom therapy is a new and uncomfortable experience to immediately begin sharing their innermost thoughts. If you use the word resistance, it’s helpful to add the word “natural.” Doing so offers empathy for the client’s entry into an uncomfortable situation and acknowledges the need for strategies and techniques for dealing with client behaviors that are too easily labeled resistant (Hara et al., 2018; Miller & Moyers, 2021). The central question then becomes: What clinician behaviors reduce natural client resistance and defensiveness?
Motivational Interviewing and Other Strategies
In their groundbreaking text, Motivational Interviewing, W. Miller and Rollnick (1991, 2002, 2013) described a practical approach to recognizing and working with client resistance. They emphasized that most humans are ambivalent about personal change because of competing motivations. For example, a client may simultaneously have two competing motivations about smoking cigarettes:
I should quit because smoking is expensive and unhealthy.
I should keep smoking because it’s pleasurable and gives me a feeling of emotional control.
Imagine yourself in an interview situation. You recognize your client is engaging in a self-destructive behavior (e.g., smoking, cutting, punching walls). In response, you educate your client and make a case for giving up the self-destructive behavior. W. Miller and Rollnick (2002) described this classic scenario:
[The therapist] then proceeds to advise, teach, persuade, counsel or argue for this particular resolution to [the client’s] ambivalence. One does not need a doctorate in psychology to anticipate what [the client’s] response is likely to be in this situation. By virtue of ambivalence, [the client] is apt to argue the opposite, or at least point out problems and shortcomings of the proposed solution. It is natural for [the client] to do so, because [he or she] feels at least two ways about this or almost any prescribed solution. It is the very nature of ambivalence. (pp. 20–21)
In MI, resistance is framed as natural ambivalence about change. Consider this from a physical perspective. If you hold out an open hand and ask someone else to do the same and then push against their hand, the other person usually pushes back, matching your force. During a clinical interview, this process happens verbally. The more you push for healthy change, the more clients push back for staying less healthy (Apodaca et al., 2015).
This leads to the central MI hypothesis for resolving client ambivalence and activating motivation:
This points toward a fundamental dynamic in the resolution of ambivalence: It is the client who should be voicing the arguments for change. (W. Miller & Rollnick, 2002, p. 22, italics added)
But how can clinicians help clients make arguments for change?
MI practitioners refer to clients voicing their own arguments for change as change talk. When clients voice their arguments against change, it’s called sustain talk,because clients are arguing to continue or sustain their unhealthy behaviors. The central hypothesis of MI is that the more clients engage in change talk, positive change is more likely to occur.
MI has relational and technical components. The relational component involves embracing a spirit of collaboration, acceptance, and empathy. Embracing the relational component is crucial, if only because clients who report greater secure attachment to their therapists, also report less resistance (Yotsidi et al., 2019). The technical components include intentional evocation and reinforcement of client change talk (W. Miller & Rose, 2009). In practice, it’s difficult to separate the relational and technical components, and it’s likely more efficacious when they’re delivered together anyway. As you work with reluctant, ambivalent, or so-called resistant clients, you’ll need to make sure your Rogerian person-centered hat is firmly in place, while simultaneously using good behavioral skills to evoke and reinforce change talk.
Using Open Questions, Opening Questions, Evocation, and Goal-Setting Strategies
Open questions are fundamental to MI. However, W. Miller and Rollnick (2013) cautioned asking too many questions, including open questions:
A simple rhythm in MI is to ask an open question and then to reflect what the person says, perhaps two reflections per question, like a waltz. Even with open questions, though, avoid asking several in a row, or you may set up the question-answer trap. (p. 63)
Miller and Rollnick (2013) recommended loosely following their two-to-one waltz metaphor; the point is to do more reflecting than questioning. They offer a stronger warning against repeated closed questions, noting, “Chaining together a series of closed questions can be deadly for engagement” (p. 63).
When opening sessions with clients who may be unenthused to see you, you should use positive, strength-focused, empathic, and non-blaming opening questions:
What brings you here today and how do you hope we might help? (Miller & Moyers, 2021, p. 95)
What would make this a helpful visit?
If we have a great meeting today, what will happen?
What needs to happen in here for our time to be productive?
Open questions and opening questions are especially good tools for evoking clients’ strengths, hope, and solutions (McKay, 2021). Not surprisingly, reluctant clients tend to be more responsive when therapists pursue strengths, rather than pathology. Evocation is a technique used to help clients speak to their resources and strengths. Miller and Moyer (2021) view evocation as inherently containing the message: “You have what you need, and together we’re going to find it (p. 93”). If you’re using open questions to bypass natural resistance, you should aim toward evoking client change talk.
Consider the following example of using a variety of questions to facilitate change talk in an emergency room setting (M. Cheng, 2007, p. 163, parenthetical comments added):
Clinician: What would make today’s … visit helpful? (Clinician asks for goals.)
Patient: I want to kill myself, just let me die… (Patient states unhealthy goal/task.)
Clinician: I’m sure you must have your reasons for feeling that way … What makes you want to hurt yourself? (Clinician searches for underlying healthy goal.)
Patient: I just can’t stand the depression anymore and all the fighting at home. I just can’t take it. (The underlying healthy goals include coping with depression and fighting.)
Clinician: … so we need to find a way to help you cope with the depression and the fighting. You told me yourself that there used to be less fighting at home. What would it be like if we found a way to reduce the fighting, have people getting along more? (Clinician uses past hope to focus on future goal)
Patient: A lot better, I guess. But it’s probably not going to happen. (Client expresses little hope)
Clinician: Okay, I can see why you’re frustrated and I do understand that probably the depression makes it hard to see hope. But I believe that there is a part of you that is stronger and more hopeful, because otherwise you wouldn’t be here talking with me. (Clinician externalizes unhealthy thoughts or behaviors as being part of the depression and tries to help the patient rally against the depression.) That hopeful part of you said that your mood used to be happy. What would it be like if we could get your mood happy again?
Patient: A lot better I guess.
Clinician: Just to help me make sure I’m getting this right then, what would you like to see different with your mood? (The clinician reinforces the client’s goals by having the client articulate them.)
Patient: I want to be happy again.
Clinician: And at home, what would you like to see with how people get along?
Patient: I want us to get along better.
Clinician: Let’s agree then that we will work together on finding a way to help people get along, as well as help your mood get better. How does that sound? (Clinician paraphrases patient’s healthy goals.)
Patient: Sounds good… (Patient agrees with goals.)
In this example, Cheng (2007) illustrated how to help patients articulate goals and potential benefits of positive change (change talk). Although the process began with a negatively worded question—“What makes you want to hurt yourself?”—Cheng listened for positive, health-oriented goals. This is an important principle: Even when exploring emotional pain, you can listen for and resonate with unfulfilled positive goals contributing to that pain.
Using Reflection, Amplified Reflection, and Undershooting
Throughout this text, we’ve emphasized nondirective interviewing skills: paraphrasing, reflection of feeling, and summarizing. Research on MI supports this emphasis, showing that these reflective techniques are powerful tools for working with resistance (McKay, 2021). W. Miller and Rollnick (2002, pp. 100–101) provided examples of simple reflections that reduce resistance:
Client 1: I’m trying! If my probation officer would just get off my back, I could focus on getting my life in order.
Therapist 1: You’re working hard on the changes you need to make. Or,
Therapist 1: It’s frustrating to have a probation officer looking over your shoulder.
Client 2: Who are you to be giving me advice? What do you know about drugs? You’ve probably never even smoked a joint!
Therapist 2: It’s hard to imagine how I could possibly understand.
Client 3: I couldn’t keep the weight off even if I lost it.
Therapist 3: You can’t see any way that would work for you. Or,
Therapist 3: You’re rather discouraged about trying again.
When therapists accurately reflect client efforts, frustration, hostility, and discouragement, the need for clients to defend their positions is reduced.
Reflections also stimulate talk about the constructive side of ambivalence. While supervising graduate students in counseling and psychology as they conducted hundreds of brief interviews with client-volunteers, we noticed that when student therapists made an inaccurate reflection, the volunteer-clients felt compelled to clarify their feelings and beliefs in ways that rebalanced their ambivalence. For example:
Client: I’m pissed at my roommate. She won’t pick up her clothes or do the dishes or anything.
Therapist: You’d like to fire her as a roommate.
Client: No. Not that. There are lots of things I like about her, but her messiness really annoys me.
This exchange shows the interviewer inadvertently overstating the client’s negative view of the roommate. In response, the client immediately clarifies: “There are lots of things I like about her.”
As it turns out, the interviewer accidentally used an MI technique called amplified reflection (W. Miller & Rollnick, 2013). Amplified reflection involves intentionally overstating the client’s main message. W. Miller and Rollnick wrote: “As a general principle, if you overstate the intensity of an expressed emotion, the person will tend to deny and minimize it, backing off from the original statement” (p. 59).
When used intentionally, amplified reflection can feel manipulative. This is why amplified reflection is used along with genuine empathy and never includes sarcasm. Instead of being a manipulative response, it’s the therapist’s effort to deeply empathize with client frustration, anger, and discouragement. The following are amplified reflections. Scenario 1 involves a mother of a child with a disability and her ambivalence over whether she can take any time for self-care:
Client 1: My child has a serious disability, so I have to be home for him.
Therapist 1: You need to be home 24/7 and turn off any needs you might have to get out and take a break.
Client 1: Actually, that’s not totally true. Sometimes, I think I need to take some breaks so I can do a better job when I’m home.
Scenario 2 involves a college student with ambivalence over giving herself the time and space to grieve her grandmother’s death.
Client 2: When my grandmother died last semester, I had to miss classes and it was a total hassle.
Therapist 2: You don’t have much of an emotional response to your grandmother’s death—other than it’s really inconveniencing you.
Client 2: Well, it’s not like I don’t miss her, too.
Amplified reflection is an empathic effort to fully resonate with one side of the client’s ambivalence; it naturally nudges clients the opposite direction.
It’s also possible to use reflection to understate what clients are saying. W. Miller and Rollnick (2013) refer to this as undershooting. They advocate using it to encourage clients to continue exploring their thoughts and feelings:
Client: I can’t stand it when my mom criticizes my friends right in front of me.
Therapist: You find that a little annoying.
Client: It’s way more than annoying. It pisses me off.
Therapist: What exactly pisses you off about your mom criticizing your friends?
Client: It’s because she doesn’t trust me and my judgment.
In this example, the therapist uses an understatement and then an open question to continue exploring what hurts about the mother’s criticism.
Coming Alongside (Using Paradox)
Intentionally undershooting or using amplified reflections are subtle ways to move client talk in particular directions. A less subtle form of this is paradox. Paradox has traditionally involved prescribing the symptom (Frankl, 1967). For example, with a client who is using alcohol excessively, a traditional paradoxical intervention would involve something like, “Maybe you’re not drinking enough.”
Paradox is a high-risk and provocative intervention. We don’t advocate using traditional paradox. Interestingly, Viktor Frankl, who wrote about paradox in the early 1900s, viewed paradox as operating based on humor. It’s as if clients unconsciously or consciously understand the silliness of behaving in a destructive extreme and consequently pull back in the other direction. Frankl’s formulation might be viewed as working with ambivalence in a manner similar to MI.
W. Miller and Rollnick (2013) discuss using paradox to address resistance, but refer to it as coming alongside. Similar to amplified reflection, coming alongside is used with empathy and respect. The difference between amplified reflection and coming alongside is that in the latter the therapist makes a statement instead of a reflection. Here are two examples:
Client 1: I don’t think this is going to work for me, either. I feel pretty hopeless.
Therapist 1: It’s certainly possible that after giving it another try, you still won’t be any better off, so it might be better not to try at all. What’s your inclination?
Client 2: That’s about it, really. I probably drink too much sometimes, and I don’t like the hangovers, but I don’t think it’s that much of a concern, really.
Therapist 2: It may just be worth it to you to keep on drinking as you have, even though it causes some problems. It’s worth the cost.
Using coming alongside requires authentic empathy for the less healthy side of the ambivalence.
W. Miller and Rollnick (2002) commented on the difference between using coming alongside as compared to traditional paradox:
We confess some serious discomfort with the ways in which therapeutic paradox has sometimes been described. There is often the sense of paradox being a clever way of duping people into doing things for their own good. In some writings on paradox, one senses almost a glee in finding innovative ways to trick people without their realizing what is happening. Such cleverness lacks the respectful and collaborative tone that we understand to be fundamental to the dialectical process of motivational interviewing. (p. 107)
Paradoxical techniques should be delivered along with basic person-centered core attitudes of congruence, unconditional positive regard, and empathic understanding. Paradox shouldn’t be used as a clever means to outwit or trick clients, but to explore the alternative outcome out loud with the client and allow them to respond.
Using Emotional Validation, Radical Acceptance, Reframing, and Genuine Feedback
Clients sometimes begin interviews with hostility, anger, or resentment. If clinicians handle these provocations well, clients may open up and cooperate. The key is to keep an accepting attitude and restrain from lecturing, scolding, or retaliating if clients express hostility.
Empathy, emotional validation, acceptance, and concession can elicit cooperation. We often coach graduate students to use concession when power struggles emerge, especially when working with adolescent clients (J. Sommers-Flanagan & Sommers-Flanagan, 2007b). If a young client opens a session with “I’m not talking and you can’t make me,” conceding power and control can shift the dynamic: “You’re absolutely right. I can’t make you talk, and I definitely can’t make you talk about anything you don’t want to talk about.” This statement validates the client’s perspective and concedes an initial victory in what the client might view as a struggle for power. MI therapists refer to this as affirming the client.
Empathic, emotionally validating statements are also important. If clients express anger about you or therapy, a reflection of feeling and/or feeling validation response communicates that you hear their emotional message. In some cases, you can go beyond empathy and emotional validation and join clients with parallel emotional responses:
I don’t blame you for feeling pissed about having to see me.
I hear you saying you don’t trust me, which is totally normal. You don’t know me, and you shouldn’t trust me until you do.
It sucks to have a judge require you to meet with me.
I know we’re being forced to meet, but we’re not being forced to have a bad time together.
Radical acceptance (RA) is a principle and technique based on person-centered theory and dialectical behavior therapy (Görg et al., 2019). RA involves consciously accepting and actively welcoming all client comments—even odd, disturbing, or blatantly provocative comments (J. Sommers-Flanagan & Sommers-Flanagan, 2007a). Here’s a case where a client began a session with angry statements about counseling:
Opening client volley: I don’t need no stupid-ass counseling. I’m only here because my wife is forcing me. This counseling shit is worthless. It’s for pansy-ass wimps like you who need to sit around and talk rather than doing any real work.
RA return: Wow. Thanks for being so honest about what you’re thinking. Lots of people really hate counseling but just sit here and pretend to cooperate. I really appreciate your telling me exactly where you’re coming from.
RA can be combined with reframing to communicate a deeper understanding about why clients have come for therapy. One version of this is the love reframe (J. Sommers-Flanagan & Barr, 2005).
Client: This is total bullshit. I don’t need counseling. The judge required this. Otherwise, I can’t see my daughter for unsupervised visitation. Let’s just get this over with.
Therapist: You must really love your daughter to come to a meeting you think is bullshit.
Client: (softening) Yeah. I do love my daughter.
The magic of the love reframe is that clients nearly always agree with the positive observation about loving someone. The love reframe shifts the interview to a more pleasant and cooperative focus.
Often, when working with angry or hostile clients, there’s no better approach than reflecting and validating feelings … pausing … and then following with honest feedback and a solution-focused question.
I hear you saying you hate the idea of talking with me. I don’t blame you for that. I’d hate to be forced to talk to a stranger about my personal life too. But can I be honest with you for a minute? [Client nods in assent.] You’re in legal trouble. I want to be helpful—even just a little. We’re stuck meeting together. We can either sit and stare at each other and have a miserable hour, or we can talk about how you might dig yourself out of this legal hole. I can go either way. What do you think … if we have a good meeting today, what would we accomplish?
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The chapter goes on and on from here, including content on dealing with clients who may be delusional, as well as substance abuse interviewing.
Also, if you want more info, here’s a nice article, albeit dated, where Miller and Rollnick write about 10 things that MI is NOT.
This past week I spent four days at West Creek Ranch, where I was forced to eat gourmet food, do sunrise yoga, experience a ropes course (briefly becoming a “flying squirrel”), watch a reflective horse session, dance away one night, hike in the beautiful Paradise Valley, and hang out, converse, and learn from about 25 very smart/cool/fancy people. Yes, it was a painful and grueling experience—which I did not deserve—but of which I happily partook.
On the first morning, I provided a brief presentation to the group on the concept of belonging, from the perspective of the Montana Happiness Project. Despite having shamefully forgotten to take off my socks during the sunrise morning yoga session, and having anxiety about whether or not I belonged with this incredible group of people, they let me belong. They also laughed at all the right moments during my initial mini-comedy routine, and then engaged completely in a serious reflective activity involving them sharing their eudaimonic belongingness sweet-spots with each other.
If you don’t know what YOUR eudaimonic belongingness sweet-spot is, you’re not alone (because hardly anyone knows what I mean by that particular jumble of words). That’s because, as a university professor, I took the liberty of making that phrase up, while at the same time, noting that it’s derived from some old Aristotelean writings. Yes, that’s what university professors do. Here’s the definition that I half stole and half made up.
That place where the flowering of your greatest (and unique) virtues, gifts, skills, talents, and resources intersect (over time) with the needs of the world [or your community or family].
I hope you take a moment to reflect on that definition and how it is manifest in who you are, and how you are in your relationships with others. If you’re reading this blog post, I suspect that you’re a conscious and sentient entity who makes a positive difference in the lives of others in ways that are uniquely you. Because we can’t and don’t always see ourselves as others see us, in our University of Montana Happiness course, we have an assignment called the Natural Talent Interview designed to help you gain perspective on your own distinct and distinctive positive qualities. You can find info on the Natural Talent Interview here: https://johnsommersflanagan.com/2023/12/26/what-do-you-think-of-me/
And my West Creek presentation powerpoint slides (all nine of them) are here:
You may have missed the main point of this blog post—which would be easy because I’m writing like a semi-sarcastic and erudite runaway loose association train that’s so busy whistling that it can’t make a point. My main point is GRATITUDE. Big, vast, and immense gratitude. Gratitude for the Arthur M. Blank Family Foundation (AMBFF) and our massively helpful program officers. Gratitude for our retreat facilitators. Gratitude for the staff at West Creek Ranch. Gratitude for the presence of everyone at the gathering. And gratitude for the therapeutic feelings of belonging I had the luxury of ruminating on all week. My experience was so good that I’m still savoring it like whatever you think might be worth savoring and then end up savoring even more than you expected.
Thank you AMBFF and Arthur Blank for your unrelenting generosity and laser-focus on how we can come together as community and make the world a better place.
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*Note: At the Montana Happiness Project, we do not support toxic positivity. What I mean by that is: (a) no one should ever tell anyone else to cheer up (that’s just offensive and emotionally dismissive), and (b) although we reap benefits from shifting our thinking and emotions in positive directions, we also reap similar benefits from writing and talking about trauma, life challenges, and social injustice. As humans, we are walking dialectics, meaning we grow from exploring the negative as well as the positive in life. We are multitudes, simultaneously learning and growing in many directions.
The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.
John Sommers-Flanagan 