Neale: We had a big family dinner on Sunday afternoon and it was just awful. My mother and I just don’t get along.
Before looking at the therapist’s response, ask yourself what the therapist could ask to help Neale be more specific about what happened.
Therapist: You were saying that the family dinner was just awful last Sunday. Can you tell me what happened?
Neale: I am so upset because my mother was so critical of me.
Ask yourself the W questions: Do you know What happened? Who was involved? Where it happened?
When it happened? You don’t know what happened; you know Neale’s mother was involved and that the situation occurred at a family dinner last Sunday. We need more information.
Look at the three possible responses below and pick the one that will help you get a better under- standing of the situation.
1. When you say your mother was critical of you, can you help me understand what your mother did?
2. Can you tell me more about your mother being critical?
3. When your mother was critical, what did you think?
Response #1 is most likely to help Neale become more specific about the situation. Response #2 is a good start, but it is too vague. Neale could react by talking about his feelings or thoughts, or about the situation. In response #3 you don’t know what the client means by critical, so it is too early to ask about his thoughts.
Exercise 5.1: Raoul’s Boss Is Difficult
Practice identifying a specific situation.
THE FACTS ABOUT A SITUATION ARE DIFFERENT FROM THE
girlfriend asked me home to meet her parents. She’s moving too fast; I don’t want to get serious.” In this example, the facts of the situation are the girlfriend invited the client home to meet her parents; the thoughts or what the situation meant to the client are, “She is moving too fast; I don’t want to get serious.”
Often a client will use an adjective to describe the other person in the situation; the adjective is usually the client’s thought about the other person. For example, a client says, “My child was very inconsiderate toward the teacher.” “Inconsiderate” is an adjective. You know that the client thought the child was inconsiderate, but you don’t know what the child did. If you want to understand the facts of the situation, it is helpful to ask, “What did your child do that made you think he was inconsiderate?”
Sometimes a client will include his feelings as part of the situation; for example, when describing a situation he will say, “I was so angry at my mother when she was late.” The fact is that his mother was late; the feeling is anger. A client can also include his behavior in the description of the situation, for example, “When my boss yelled at another coworker, I just sat there and did nothing.” The boss yelling at another coworker is the fact in the situation; the client doing nothing is the client’s behavior.
Your Turn!
Separate the Facts about the Situation from the Thoughts about the Situation
Below are examples of situations where clients mixed up the facts about the situation and their thoughts about the situation. In the examples below, separate the facts about the situation from the client’s thoughts. Complete the worksheet below before looking at my answers in the appendix.
Examples of Situations Facts about the Situation Client’s Thoughts about the Situation
Instead of doing homework, I was lazy and went out with friends.
My boss told me I did a good job, but he didn’t really mean it.
My child is not normal; he is not crawling at age five months.
The huge mess my husband left in the kitchen
Exercise 5.2: Find the Facts
Practice distinguishing the facts about a situation from the thoughts and feelings about the situation.
Video 5.1: Identify a Trigger and Explain the Understand Your Reaction Worksheet
Agenda Item #3 : Understand Your Clients’ Reactions
Identifying trigger situations is an important first step. The next step is using the four-factor model to understand your client’s reaction. It is important to explain what you will be doing, both so that your client understands the process and so that he learns a tool to use outside of therapy. I use the Understand Your Reaction worksheet that we looked at in the beginning of the chapter as a structure. I show the worksheet to my client and explain each column. I usually say:
I think you did a really good job identifying the situation. What I would like to do now is to see if we can understand your reaction by identifying your feelings, physical reactions, behav- iors, and thoughts—and then see how they all go together. I call this using the four-factor model.
I want to complete this worksheet. (I get out the worksheet or draw one on a sheet of paper.) You see there are five columns. This first column says “Situation,” and we are going to write down the situation we just identified. (I write it down or the client writes it down.) We are then going to see if we can identify your feelings, physical reactions, behaviors, and thoughts and write them down in the next columns.
When clients see the five columns, they automatically become more organized, and some of the jumble and distress starts to diminish. My own attitude is one of engaged curiosity, as this models a helpful attitude my client can take toward his own problems. Notice how I start by saying, “I think you did a really good job identifying the situation.” Providing positive feedback for learning a specific skill reinforces the skill and helps the therapy relationship. Many of our clients rarely receive any positive feedback; to hear that they did something well is important.
YOUR TURN!
Practice in Your Imagination: Explain the Understand Your Reaction Worksheet
Choose a client who you think would benefit from identifying his or her feelings, physical reactions, behaviors, and thoughts. Before you start, rate from 1 to 10 how comfortable you feel introducing and using the Understand Your Reaction worksheet. At the end of the exercise, rate your level of comfort again to see if it changed. Now, let’s try this exercise.
Imagine you want to introduce the Understand Your Reaction worksheet to your client. Try to get a picture of him or her in your mind. Imagine yourself in your office with your client. See your office;
notice the sounds and smells in the room. Read over how I suggest introducing the worksheet while imagining yourself saying the words. You can also use your own phrases. Really hear and feel yourself taking out the worksheet and explaining it to your client. Now, imagine explaining the worksheet two more times with the same client. Each time, imagine that your client responds positively.
Agenda Item #4: Help Your Clients Identify Their Feelings
In this book, we are going to start with identifying feelings, then physical reactions and behavior, and lastly thoughts. This is because most clients are more aware of their feelings than their thoughts and tend to come in talking about feelings. However, in practice, you could start with any of the four factors. I often start with the factor that my client brings up first.
The ability to label feelings is a part of affect regulation, or managing one’s feelings in a healthy way.
When you ask your client, “What were you feeling?” you are asking him to pause and reflect, which automatically interrupts his negative path. Labeling feelings helps both client and therapist understand the client’s reactions. Asking your client to label his feelings gives the message that you are interested in his experience. Clients’ feelings can also guide therapy. You may want to try different interventions depending on your client’s dominant feelings. For example, if your client tells you he feels “bad,” it is hard to know where to start, but if he tells you he feels “anxious,” you can start to explore his fears.