You begin the session with a check-in, set the agenda, and then decide on the agenda item you want to start with. What happens next? You want to identify a specific situation that is problematic for your client and that you can work on in therapy.
Frequently, your client will describe his trigger situation in vague terms, and you don’t really under- stand what happened. You need to help your client become more specific and concrete. A specific and concrete description includes what happened, with whom, and the specific time and place it occurred.
For example, a vague description of a situation would be “My partner doesn’t respect my work”; a more concrete and specific description would be “My partner told me that she thought her work was more important than mine.” Below are some additional examples of situations that are described vaguely, along with more specific and concrete descriptions of the same situations.
Examples of Vague and Specific Situations
Vague Description Same Situation Described in a Specific and Concrete Manner
My child was rude to her stepmother. My daughter swore at her stepmother and left the room when her stepmother asked her to help with the dishes after dinner.
I have to walk on eggshells around my father; he
gets angry at the smallest thing. I asked my father if I could have the car on Saturday night, and he yelled at me that I should know he wanted it to go out with his friends.
I had a few too many drinks over the weekend. I was at a bar with my friends and probably drank over eight beers and at least four shots.
The more specific and concrete your client’s description of the situation, the more your client will be emotionally engaged with the situation, and the more he will have access to his feelings and thoughts.
Consider your own experience: Think of someone you are a little annoyed with. Now, think of a spe- cific situation when you were annoyed with this person. Try to remember the situation in detail.
Chances are that as you thought about a specific situation, you became more annoyed and your feelings and thoughts became more immediate. The same thing will happen when your clients talk about spe- cific situations.
Sometimes your client’s situation is a long, complicated story. In this case, listen to the whole story and then ask what was the worst or most difficult part for your client. It is helpful to identify a situation that lasts from a few seconds to thirty minutes (Greenberger & Padesky, 2016)—any longer and your client will probably have a large variety of feelings and thoughts, and it will be hard to focus on the main ones.
Questions to help identify a specific situation. I know I have a clear understanding of the situation if I can form a picture in my mind. If not, I ask my client the W questions: What happened? Who was involved? Where did it happen? and When did it happen? I am looking for the facts of the situation.
In some ways it is similar to being a detective or a newspaper reporter on a fact-finding mission, except rather than being a solo operator, you are a fact-finding team with your client. I usually start with being sure I understand What happened.
Let’s look at an example. One of my clients was upset with her boyfriend. I asked for an example.
She responded, “My boyfriend was really mean to me last night.” Let’s see if we have the answers to the W questions. Do we know What happened? No, we don’t. Do we know Who was involved? Yes, the boyfriend, but we don’t know if anyone else was involved. Do we know Where it happened? No, we don’t. Do we know When it happened? Yes, it happened last night. Before we can start to explore my client’s feelings, physical reactions, behaviors, and thoughts, we need a clearer idea of what occurred.
Here is another example. If you remember from chapter 4, Suzanne’s main agenda item was about being invited to a barbecue at the principal’s house. She doesn’t feel like going and thinks she will just
say no. Her therapist wants to get a better understanding of the situation. Let’s look at what happens when her therapist uses the four W questions.
Suzanne: I was invited to a barbecue event at the principal’s house.
Therapist: I want to make sure that I understand. (Notice her therapist explains what she will do.) What is the event?
Suzanne: The principal invited all the new teachers to her home for a barbecue.
Her therapist doesn’t want to fire a volley of questions at Suzanne, but she also wants more information.
You can ask more than one of the W questions at the same time.
Therapist: Can you give me a better sense of what’s involved with the barbecue, for example, who was invited, where is it happening, and when?
Suzanne’s therapist learns that Suzanne was invited to a barbecue at her principal’s house along with the three other new teachers. It is taking place after school in two weeks. Once you are clear on the situation, you and your client can start to figure out why she is upset by using the four-factor model.
Your Turn!
Help Neale Identify a Specific Situation
Neale, a thirty-six-year-old man, starts a session by saying he wants to focus on his relationship with his mother. Try to help him specify a situation that he wants to work on.
Therapist: You said you wanted to focus on your relationship with your mother today.
Neale: Everything is going wrong; my relationship with my mother is worse than ever.
Look at the three possible responses below and pick the one that will help you get a better under- standing of the situation that is troubling Neale.
1. Can you tell me more about your relationship with your mother?
2. I can see that your relationship with your mother is really upsetting you; it feels as if everything is going wrong.
3. Could you give me an example of what is going wrong between your mother and you?
Response #3 is the most likely to help the client identify a specific situation. Response #1 is too vague.
If this was the first time you were hearing about Neale’s difficulties with his mother, it could be a good question, but it does not help you focus on a specific difficult situation. Response #2 is supportive, but it also does not help identify a difficult situation.
Therapist: Could you give me an example of what is going wrong between your mother and you?
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.