Relationship Questions
Step 4: Identifying Solutions
After the client describes in detail a future without the problem(s), the crisis worker uses exception questions, coping questions, and questions about past successes to assist the client to identify solutions that are conducive to realiz- ing the envisioned future. At the same time, the crisis worker uses scaling questions to help the client quantify and evaluate his or her situation and progress.
Scaling Questions
Scaling questions allow for quantifying the client’s problem and goal, which can be helpful not only in evaluating the client’s situation and progress but also is an intervention itself (Greene, 1989). Scaling questions ask the client to rank the problem and goal on a scale of 1 to 10, with 1 as the worst the problem could possibly be and 10 as the most desirable outcome. The clini- cian usually begins each meeting by asking the client where he or she is on the 1 to 10 scale of the problem/goal continuum. When clients rank them- selves higher on the scale in subsequent meetings, even slightly, the clinician asks what she or he has been doing to make this happen (Berg, 1994). This is a way to help the client notice what has been helpful, which may otherwise go unnoticed. The following case illustrates the use of scaling questions.
Grief and Loss
A woman called saying she needed to talk. Her father died yesterday. The client is upset but goes on to say that her main problem is the fact that her divorce will be final any day. She was married for 3 years and has two chil- dren under the age of 3. Her husband left her with the children and has moved in with another woman. The client says she does not know how she will make it.
Worker: I’m amazed that you’ve kept yourself going for the past 6 months.
Client: Yeah, me too. I guess things have been worse. Worker: They’ve been worse than even now?
Client: Yeah, when he first left I was at an all-time low.
Worker: If I were to ask you to rate the way you’re handling this situa- tion on a scale of 1 to 10, with 1 being 6 months ago and 10 be-
ing where you want to get to, where would you say you’re at to- day?
Client: I’d say I’m at a 3 or 4.
Worker: Wow, that’s pretty impressive given what you’ve been through. How have you gotten yourself from a 1 to a 4?
Client: Well, I decided I’ve got to keep myself going for the kids. I’ve been taking classes to get my GED, even though I’m not very good at math.
Worker: Your kids give you energy to move on and to start planning for your future.
Client: Yes, I think so.
Worker: What would need to happen in order for you to move from a 4 to a 5? (Using the scaling question to help the client identify solu- tions)
Client: Well, I haven’t thought about that. . . . Maybe if I get support from my own family . . . like if they baby-sit my babies when I am preparing for the exam.
Worker: Who in your family can possibly baby-sit your children? (Be spe- cific)
Client: Maybe my sisters.
Worker: How will they know that you need their help?
Client: Well, maybe I need to talk to them. . . . We have pretty good rela- tionships with each other.
Exception Questions
When clients first see a crisis clinician, they usually start talking about their crisis situation and their corresponding feelings (the presenting problem). In keeping with solution-focused therapy’s assumption that there are fluctua- tions in how the client experiences the problem, the clinician asks questions to learn when the problem does not exist or at least is less frequent or in- tense. In regard to this Kral and Kowalski (1989) state: “The therapist’s job is not to initiate change, but to punctuate the differences between the com- plaint pattern and the pattern of the exceptions (change) thereby making explicit the ‘naturally’ occurring variations which are in the direction of the desired solution” (p. 73). The assumption is that during these times the client is usually doing something to make things better, and the clinician asks fur- ther questions to discover what the client is doing. After “doing more of what works” comes “do more of the same,” making the exception the rule (Kral & Kowalski, 1989). The next case provides an illustration of identify- ing exceptions.
Maintaining Sobriety
Jane is extremely disappointed by and ashamed of her recent fall from sobri- ety. She has been sober for 19 months but yesterday got into a big argument with her ex-husband and spent the evening in a bar getting drunk.
Worker: You were able to stay sober for 19 months?
Client: Yeah, but what good is it? I wasn’t sober last night!
Worker: It sounds like you felt drinking would be a way for you to deal with the stress of your ex-husband?
Client: Yeah, that’s usually when I always got my drunkest, when he and I would get into one of those fights.
Worker: How many times during the last 19 months did you argue with your ex-husband and not drink?
Client: Well, there have been a few times.
Worker: How did you manage to not drink during those times? Client: Well, one thing that kept me from drinking is going to my AA
meetings. I really count on those people for support.
Worker: How did you know to go to an AA meeting when you had these arguments with your ex and you did not drink?
Client: I just told myself if I don’t go to a meeting and talk to someone I’m going to drink. And I got myself away from him.
Worker: That’s very smart thinking on your part. Is this something you’re willing to do again in the future?
Client: Well, I think I can, especially with the help of the program.
Past Successes
Sometimes clients initially have difficulty identifying exceptions to their pres- enting problem in their current lives or their recent past. When this situation occurs, the clinician can ask about times in the past when the client success- fully handled the same or similar situations and how she or he was able to do so (Berg & Gallagher, 1991). In regard to the presenting problem, the clinician can even ask the client about exceptions that occurred years earlier. If the client cannot come up with any exceptions, the clinician can ask about an exception to similar problems in the past. The idea is to find out what solutions have worked in the past and to apply them to the current crisis situation. The following case illustrates the use of identifying past successes.
A Suicidal Client
The anonymous client was a 58-year-old woman who reported feeling de- pressed and suicidal. She began having these feelings at Christmas, when an
argument developed between her sister and mother. The client stated that she had spent several years and much effort trying to mend these relationships, and she now fears it has all been for nothing. The argument also brought up the many issues of her childhood, and now she finds it necessary to deal with these issues again. The client says she is so depressed that she is contemplating suicide.
Worker: Have you ever felt suicidal in the past? Client: Yes, about 25 years ago.
Worker: Did you make a suicide attempt then? Client: No, somehow I got out of it.
Worker: How did you do that?
Client: A doctor put me on antidepressants for a while. I also keep busy walking and exercising. Talking to friends also was very helpful. Worker: How did you keep from thinking about those family problems?
Client: I just kept occupied.
Worker: Are you doing any of those things now that you did then? Client: No, but I guess I could.
Worker: What is one small thing you could start with?
Coping Questions
Oftentimes clients in crisis will state that nothing is going right, that they can find nothing positive in their lives, and that they are unable to identify any exceptions, either present or past. Such clients can feel hopeless about themselves and their future (Berg & Miller, 1992b). The crisis worker needs to recognize such negativity as a sign of great desperation and a signal for empathetic help. In such a situation, the client could perceive the clinician’s focus on the positive as being artificial and imposing. The coping question can be quite effective with these clients in crisis who see little possibility for positive changes (Berg & Miller, 1992b). Coping questions can be an impe- tus for clients feeling a sense of empowerment because they start to become aware of resources they did not know they had or had forgotten (Berg, 1994). The following example illustrates the use of coping questions.
The Desperate Single Mom
Loraine was a 26-year-old unemployed single mother with a 7-year-old, “im- possible” boy, Teddy. According to Loraine, she had never been able to han- dle Teddy, who never listened and destroyed almost everything. Recently, Teddy set fire at the apartment and inappropriately touched a 5-year-old girl. Loraine claimed that she had a very bad relationship with Teddy, had not talked to him for a long time, and was on the verge of giving up. Loraine was
very depressed and became agitated when the worker tried to get her to think about positive changes in the mother-child relationship, which seemed to be impossible to Loraine. The worker used the coping questions instead. Worker: If I ask you to rank your relationship with Teddy on a scale of 1
to 10, with 1 as the worst scenario both of you can get to and 10 as the best possible relationship that both of you can have, how would you rank your relationship with Teddy now? Client: I have to say it would be in the minus range.
Worker: Sounds like the situation is really bad. I just wonder what have you been doing to keep it from getting worse? You know, the sit- uation can be much worse; how do you keep it from getting any worse?
Client: I do pay attention to him sometimes. I don’t ignore him totally, even though sometimes I feel so depressed and overwhelmed it’s all I can do to pay attention to what’s going on with me. Worker: So how are you able to do that—to take care of Teddy some of
the time even though you are feeling so bad you don’t feel like it?
Client: I just do it. I am his mother, and I do have responsibility for him. I really don’t know how I do it. I let things go for a while, but eventually I just tell myself I’ve got to take care of Teddy, since no one else can. I know I should be doing a better job of being a mother, but right now I feel like I can barely take care of myself.
Worker: That’s really something that you are able at times to get yourself to do what you have to do for Teddy even though you don’t feel like it. Using the same 1 to 10 scale, with 1 meaning you don’t want to take care of him at all and 10 meaning that you would do whatever you have to in order to take care of Teddy and keep him from getting into trouble, how would you rank your- self?
Client: I would say around 7.
Worker: That’s pretty high. When was the last time you were able to take care of Teddy and keep him from getting into trouble? (Excep- tion questions)
Compliments
Many clients seeing a clinician for the first time expect to be judged and criticized, and they may be prepared to defend themselves (Wall, Kleckner, Amendt, & duRee Bryant, 1989). Complimenting clients is a way to enhance their cooperation rather than elicit defensiveness and resistance. Compli- ments do not have to be directly related to the presenting problem but can
be related to whatever the client is doing that is good for him or her, that he or she is good at or aspires to (Berg & Gallagher, 1991, p. 101). Such compliments, therefore, are feedback to clients about strengths, successes, or exceptions. Clients are usually surprised, relieved, and pleased when they receive praise from the clinician. A consequence of therapeutic compliments is that clients are usually more willing to search for, identify, and amplify solution patterns. The following provides an example of using compliments.
Relationship Issues
Betty was hysterical when she called and asked for advice. She is a single mother of four children. Betty must work full-time to support her children and often feels guilty about the time she spends away from them. Betty’s guilty feelings intensified today when she came home from work to find her 7-year-old daughter and 9-year-old son involved in “sexual play.” She is feel- ing very inadequate as a parent.
Worker: Wow, this must feel terribly overwhelming for you. I want to commend you on your strength and courage in calling here to- day.
Client: Well, I don’t know how strong I am. Look what a mess my kids are in. And it’s all my fault. If I didn’t have to work so much, this probably wouldn’t be happening.
Worker: What have you said to your children about your working? Client: They know I work to feed ’em, clothe ’em, and keep this shack
over their heads.
Worker: That is a lot of responsibility: working, raising four children as a single parent, keeping food on the table, clothing on the children, and a home together. It takes a lot of energy, skill, and motivation to do that. I really admire you for being able to do all that.
Complimenting clients is helpful at any time during the interview but espe- cially toward the end of a session as a preface to giving clients homework assignments or tasks. However, clients in crisis often are overwhelmed by their problematic situations and tend to be pessimistic. The crisis worker has to be careful not to overcompliment, which the client may perceive as super- ficial and insincere. Compliments should be based on what clients have actu- ally done or mentioned in the interview.