In my time, I have been a student-counsellor assessor & mentor in a local counselling-training organisation. Two things that first-year student-counsellors have taught me:
- Firstly, they can struggle with asking open questions (eg a question that invites a client to talk (more) about a subject, and one that often contains one of the words: “who”, “how”, “what”, “where” or “why”);
- Secondly, having mastered “how” they can get stuck with over using intervention “… how do you feel about that?”
“How do you feel about that … ?” Let’s ponder on the purpose of this question.
Before a counsellor-in-training gets the hang of the thinking-process: “what is the purpose of what I’m about to ask?”, emulating questions heard during personal therapy can be a common learning practice for student counsellors. The thinking behind it: if my counsellor asks this question then it must be a good one (even through I don’t yet know why, yet).
But, focussing on that “how do you feel about that?” intervention, what are we really hoping to achieve? There’s a big assumption here: that all people will be able to answer a question about feelings. What about people who do not “feel”? How do they manage with counsellors who insist on asking this “feeling” question without thinking?
Let’s discuss other approaches to “feeling…
Not Everyone “Feels”.
People process material in different ways. Some can recognise their feelings, and some cannot.
…if we ask questions about what a person is thinking we are asking implicitly about the other areas of a person (emotions, behaviour and physiology).
At an extreme end of the scale, asking someone who is alexithymic (the inability to express feelings with words) how do they feel about something will be met with a client unable to answer the question.
And if alexithymia is someone who cannot express feelings with words, we might be mindful of someone who has experienced horrific trauma leaving him in a position where he must not express feelings with words for fear or reliving the event.
On a more common, although perhaps stereotypically scale, we might also be mindful of men who tend to “think” and women tend to “feel” – what are we hoping to achieve asking a man who has never needed to recognise his feelings “how do you feel about this?”
Some therapists may take the position in some cases that helping a client to recognise his feelings, or even to teach a client about feelings, is an appropriate course of treatment. If the client agrees with this then why not?
But, what approach can we take to ask a client what’s going on for them without focussing 100% on feelings?
Borrowing from an Cognitive Behavioural Therapy (CBT) Approach.
CBT Cognition, Emotion, Behaviour, Physiology diagram
I’m referring you to a Five Areas Approach which, whilst heaving used in CBT, can be helpful in non-CBT approaches when a therapist is faced with forming questions that are (a) not necessarily focussing on feelings and (b) might be more understandable by a client.
On the right hand side is a common diagram of Five Areas.
It shows four areas:
- Cognition: about thoughts and thinking process.
- Emotion: about feelings and emotional processes.
- Behaviour: about actions and what we find our body doing.
- Physiology: about somatising and how our body makes expresses.
… and a fifth area (not shown) that encompass all the areas, which we might call environment.
This diagram suggests that the whole is an expression of various portions of each area … and that each area is connected to each other area. With such connections, what we think effects how we feel, and how we feel might effect our behaviour, and how we behave might effect our body and so on.
Hypothetically, if we ask questions about what a person is thinking we are asking implicitly about the other areas of a person (emotions, behaviour and physiology).
“How do you feel about that” can now exist with other variations.
Cognition-based Variation.
“What do you think about that?”
“What might be your thoughts around this?”
“What thoughts were going through your mind at that time?”
Emotion-based Variation.
“How do/did you feel about that?”
“How did that make you feel” (although some would suggest that feelings are a choice, so can one be made to feel?)
“Have you recognised this feeling in situations before?”
Behaviour-based Variation.
Example: a client notices herself driving past a graveyard on the way home, without intending to.
“What did you notice you were doing at that time?”
“How often do you find yourself doing this?”
Physiology-based Variation.
“What happens around your body?”
“What did you notice about your bodily sensations at the time?”
… and a general encapsulate-all variation for all:
“Tell me about [what you were thinking / what you were feeling / what you were doing / how your body was responding] when…”
So, as therapists, using the CBT “doughnut” Five Areas model can give us opportunities of re-phrasing an intervention in a way that may be more understood by our client.
ALSO: If you have some examples of more-adept variations on the above four areas of intervention, please add them to the comments section below.
Marple Cross 'Cognitive behavioural therapy (CBT)' Therapists…
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Therapists who work with: Cognitive behavioural therapy (CBT).
Tags: Cognitive behavioural therapy (CBT), Emotions, Physiology, Training
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