question cube: A model for developing question repertoire in training couple and family therapists, The
Brown, Jacob Edward
This paper presents a three-dimensional model for teaching questioning to those wishing to develop skills in couple and family therapy. The model breaks questions into their component parts of format (the style of the question: open, closed forced choice, rating, or ranking); orientation (the person who is being inquired about: self or other), and subject (the content of the question: behavior, feelings, beliefs, meaning, or relationship). The model is presented in the context of our post-Milan version of couple and family therapy training. The model is use**ul in that it allows students gradually to increase their repertoire of questions in a way that offers step-wise learning and integrates with their existing skills.
The field of couple and family therapy has expanded in a multitude of directions as therapists have worked with and developed ideas that have emerged over the past 30 years. Many models of therapy have contributed to the evolution and further refinement of the therapeutic process. Initially, therapists developed and described ways of working that were connected to a particular theoretical background. Their theories and strategies were illustrated with descriptions of therapy and often with verbatim transcripts from sessions (e.g., de Shazer, 1982; Fisch, Weakland, & Segal, 1982; Haley, 1989; Madanes, 1981; Minuchin, 1974; Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1978; White, 1988). Although the descriptions and transcripts of therapy were helpful, new therapists were often unable to emulate them, making the particular model of therapy an unattainable goal. However, as the ideas of social constructionism began to influence couple and family therapy, deconstruction of the process of therapy became part of the debate. Reflections on therapy included consideration of the use of particular questions and classifications of these questions. The Milan Associates were among the first to focus on the importance of questioning as a therapeutic tool with their emphasis on circular questioning (Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1980). Subsequently, a number of therapists have devoted considerable effort to the task of delineating ways of using questioning as a part of the process of conducting couple and family therapy (e.g., Fleuridas, Nelson, & Rosenthal, 1986; Penn, 1982; Tomm, 1987). Although these models have been extremely helpful in developing a wider range of questions for experienced therapists, many student therapists learning to interview couples and families have often felt overwhelmed and unsure where to begin. This paper examines a three-dimensional model of questioning that breaks down questions into component parts and is thus helpful in teaching students to attend to their own questioning repertoire and to incorporate new dimensions in the development of their style of questioning.
THE QUESTION CUBE Although the creation of difference through questioning is an important concept for students to grasp, it is insufficient for the methodical teaching of questioning. In working with students over the past 6 years at our training program, I have developed a three-dimensional model that breaks questions down into component parts: format (the basic structure of the question), orientation (the object of the respondent’s answers to questions: self or other), and subject (the content of the question). A graphic representation of the cube is presented in Figure 1. The dimensions are described below, together with a number of examples. While predominantly demonstrating the highlighted dimension, all questions contain the components listed above and, as such, each example demonstrates all three of these dimensions. To place the examples in the context of the model, the three dimensions that the question demonstrates are written in parentheses following each question. For example, the first sample question is “How would you describe your relationship with your partner?” (open/self/relationship). This question is an open question. However, it is also a self-oriented question. Finally, the subject of the question is an exploration of the relationship, justifying the classification, (open/self/relationship).
Format Format refers to the degree of openness in the question asked or the amount of structuring provided by the interviewer for the client response. As more structure is provided by the therapist, less information is required from the client. It represents the way in which the question is structured by the therapist. There are five question types that represent different formats in the model: open, closed, forced choice, ranking, and rating.
Open questions. These questions are the least structured, allowing a client to respond freely. Open questions are often used to increase the amount of information obtained from a client. These questions do not offer preconceived notions in terms of an answer and allow clients to respond or to structure their response in any way desired. Clients are encouraged to qualify their answer, providing them with maximum control over how they present themselves to the therapist. When clients tend to respond with one-word answers, open questions may help them to provide greater elaboration. Examples are as follows:
* How would you describe your relationship with your partner? (open/self/relationship)
* What behavior concerns you most? (open/self/behavior)
* How do you think your parents made sense of you having done well last year at school and poorly this year? (open/other/meaning) Tell me what ideas your family had about a career for you. (open/other/beliefs) Describe the feelings that you had when you found out that your child was not doing well at school. (open/self/feelings)
* What beliefs or ideas did you get from your parents that have been helpful in your ability to parent? (open/self/beliefs)
Closed questions. These questions are the most highly structured, requiring the briefest response from a client. Closed questions are often discouraged in therapy because they limit the response from a client to a simple yes or no. However, if the correct question is asked at an appropriate time, even such a brief response may be very significant. These questions are useful with clients who talk excessively with little progression in the information presented as a way of moving the conversation beyond the circle in which the client seems to be entrenched. They are useful when the therapist wishes to contain the client or to obtain a quick, relevant answer from a client who normally provides extensive qualifications of answers without really answering the question posed by the therapist. They are also helpful with clients who respond to questions only with silence. A yes or no may be significant when there has been no response at all. At other times, a client who does not feel comfortable with the content may be helped by the therapist posing a question requiring only a oneword response. For example, questions that may embarrass a client around areas such as sexual activity, previous abuse, or thoughts that are often seen as socially unacceptable may be introduced by the therapist through closed questions. Thus, there are a number of occasions when closed questions may achieve the desired effect. Examtles are as follows:
* Do you get on well with your partner? (following a long set of qualifications by a client that do not answer the question) (closed/self/relationship) * Does your problem have something to do with sex? (closed/self/behavior) * Did your daughter feel upset when you found out that she was not doing well at school? (closed/other/feeling)
* Do you think that your partner found your parents’ ideas around parenting helpful to you in your ability to parent? (closed/other/beliefs) * Did you ever wish that your parents would die when you were a child? (closed/ self/behavior)
* Do you think that your son ever feels that life is not worth living? (closed/ other/meaning)
Forced choice questions. These questions are also highly structured, but they require a client to respond with one of the choices presented rather than a simple yes or no. They are a type of closed question and are often used to introduce information to the client in a way that presents equally socially acceptable or unacceptable response options. When a client cannot or chooses not to respond to an open question, a forced choice question provides two or more alternatives, making a response easier. Often a therapist may find it useful to suggest motives or emotions behind behavior in a forced choice question as a way Or introducing information that the client may not have previously entertained. Sometimes the forced choice needs an explanation that allows each response to appear socially desirable, making either option acceptable. The following question is an example: “Do you think your relationship was better before having your daughter because you talked more to each other or because you both had interesting paid employment?” This question may provide information that allows clients a new way of thinking about their relationship. A therapist might never obtain a response similar to one of the options presented if he or she waited for it to emerge from a client through an open question, These questions often provide a quicker and sometimes the only way for a therapist to elicit underlying motives, beliefs, or emotions about a situation directly from a client. These questions may be seen as statements from the therapist put in the form of questions. Examples are as follows:
* Are you getting on better with your partner because you are spending less time together with the new job or because you communicate better in the smaller amount of time that you have together? (forced choice/self/relationship) * Does your sex life make you feel anxious because of experiences you’ve had in the past or because of something that’s currently happening between you and your partner? (forced choice/self/feelings)
Would you like to stop coming for therapy because you feel that things are going better for you or because you feel that this is not the right time for you to be in therapy? (forced choice/self/behavior)
* Does your family think that you should come to therapy as a way of helping you put up with a difficult situation or as a way to help you change the situation? (forced choice/other/behavior)
* When you heard that your child was having problems at school, did you feel more angry or sad? (forced choice/self/feelings)
Whose ideas on parenting did your partner rely more heavily upon, her mother’s or her father’s? (forced choice/other/beliefs) Ranking questions. These questions require a client to rank people, usually family members, on various qualities. This is a type of forced choice question in which information is created by the rankings provided by the client. The qualities could be on specific behaviors, feelings, and beliefs or on their understanding of particular events or relationships. Thus, ranking may take place on all of the subject categories discussed below. The question is a way of communicating to families that a particular characteristic occurs not just in one person in the family but is distributed across all family members to different degrees. For example, if a family member is described as angry, the following ranking question may be a subtle way of showing that all family members may have some anger: “Who is angriest?
Who is next most angry? Then who? Who is the least angry in the family?” This question format may also be used around meaning questions to see how committed family members are to their particular understanding of the problems in the family: “Who most thinks that the problem is caused by father being away at work too much of the time? Who next most thinks that? Then who? Who least thinks that the problem is caused by father being away at work too much of the time?” At the relationship level, the questions would be “Who is closest to dad? Who is next closest? Then who? Who is least close to dad?” Ranking questions draw connections among various family members around a particular behavior, belief, or attitude. These questions are the first step in going beyond a dominant view of blaming one family member for the problem. In families which think that the problem is caused by one member, a space is created to find out what alternate views exist through follow-up questions asked of the individual who least agrees with the dominant view. These questions also help to integrate the person seen as a scapegoat in the family by revealing that most or all family members share a characteristic (e.g., anger) to some degree. The question also helps achieve a greater sense of balance as the therapist asks further questions that go beyond a particularly vocal or dominant view so that all family members are heard. Examples are as follows:
* Who in the family is most satisfied with the relationship between the two of you? Who next? (ranking/self/relationship)
* Who most wants to stop coming for therapy? Who next? (ranking/self/behavior)
* Who is the most upset by your child’s problems at school? Who next? (ranking/self/feelings)
* If you were answering for your partner, who in the family would he say is most concerned about the problem of managing your children’s behavior? Who next? (ranking/other/feelings)
* Who in the family most believes that childhood should be a time of fun with very few responsibilities? Who next? (ranking/self/belief) * Who would be the most distressed if you decided to take your life? Who next? (ranking/self/feelings)
Rating questions. Rating questions are designed to provide a more absolute estimate of particular behaviors, beliefs, and attitudes by asking clients to rate them on a scale of 1 to 10. This category corresponds to the scaling questions that Berg and de Shazer (1993) have discussed. The rating could be on a behavior, a feeling, a particular belief, explanations or understandings of family situations or relationships. Family members are not considered in relation to each other, but each person is rated on his or her own scale. However, if ratings are taken on more than one person, comparisons across family members are possible. Rating questions provide some idea of the extent or seriousness of a particular complaint since the perceived degree is provided through the rating. They may also be a way of checking the similarity of family members’ views. For example, a therapist may ask, “How would you rate your commitment to the relationship on a scale of 1 to 10?” A ranking question would reveal which partner is more committed to a relationship. However, a rating question might suggest that neither partner has a great commitment if both provide a low rating on the commitment scale question. A question of this type could provide useful information about the direction of therapy. For example, if there is little commitment to the relationship, the therapist may more seriously consider issues of separation. Thus, rating questions can be a refinement of ranking questions when a more absolute view is required. Examples are as follows:
* Rate your satisfaction with your relationship on a scale of 1 (very dissatisfied) to 10 (extremely satisfied). (rating/self/relationship) * How would you rate your concern regarding your sexual problem on a scale of 1 (no concern whatsoever) to 10 (extremely concerned)? (rating/self/feeling) * How do you think your son would rate his wish to take his own life on a scale of 1 (he has no desire to take his life) to 10 (he has a very strong desire to take his life)? (rating/other/behavior) * How do you think your mother would rate her anger with your inability to solve your problems on a scale of 1 (not angry at all) to 10 (extremely angry)? (rating/ other/feelings)
* Rate your beliefs that your child’s problems at school are due to a poor teacher on a scale of 1 (not due to the teacher at all) to 10 (totally due to the teacher). (rating/ self/belief)
* How do you think your son would rate your ability to manage your children’s behavior on a scale of 1 (not able to manage the behavior at all) to 10 (totally able to manage the behavior)? (rating/other/behavior)
Orientation Orientation refers to who is inquired about in the question asked. The question may be asked of a person about him or her self or about another person. This is a difficult distinction for students to make because they are used to asking people about themselves in the therapy room. The two types of orientation questions are self-oriented and other oriented.
Self-oriented questions. These questions. These questions are used to obtain the client’s self-perceptions of his or her own behavior, thoughts, feelings, and motives. This is probably the most common question format, used extensively in all types of interviewing. It is drawn out as a type of question to distinguish it from the next category of other-oriented questions. These questions are particularly useful questions in establishing empathy with a client or in allowing a client to feel valued by the therapist. When a client is feeling unheard in a session, self-oriented questions may be useful in re-engaging with the client. Examples are as follows: * What did you do when your partner told you she was leaving? (open/self/behavior) Did you feel more angry or sad when your partner told you she was leaving? (forced choice/self/feeling)
What are your ideas about marriage and couples staying together until death? (open/ self/beliefs)
What were you trying to say when you got upset when your partner told you she was leaving? (open/self/feelings)
How would you rate your relationship on a scale of 1 (totally unsatisfactory) to 10 (completely satisfied with it)? (rating/self/relationship) Whose feelings most overwhelm them in the family? Whose feelings next most overwhelm? Whose feelings least overwhelm them? (ranking/self/feelings)
Other-oriented questions. These questions are used to obtain perceptions on the behavior, feelings, motives, and beliefs of another person. They are observer status questions and thus likely to be influenced by the subjectivity of the respondent rather than the person about whom the response is made. They promote the message that there is more than one view about any situation. They also provide feedback when one person describes her/his partner’s behavior and what s/he thinks it means. People tend to respond to others on the basis of their own interpretation of the other’s behavior. Other-oriented questions provide a reason for the respondent’s behavior toward the other. For example, a husband might withdraw when his wife comes home late. In therapy, if the therapist asks him why he thinks his wife has come home late and he says that he thinks she is seeing another man, then his wife may have a new understanding of his withdrawal. These questions may elicit answers different from those the person him or herself would provide. They are normally asked before a self-oriented question as the answer is less likely to be influenced by responses directly from the person involved. Other-oriented questions may be dyadic, in that one person comments about the other, or triadic, in that one person comments about the relationship between two other people. These questions create considerable interest as clients listen to responses about themselves from others and may generate useful feedback or information that may stimulate change. Examples are as follows:
* What did your son do when his father told him you were leaving? (triadic) (open/ other/behavior)
* Do you think your partner was more angry or sad when you told him you were leaving him? (dyadic) (forced choice/other/feelings) * What do you think are your partner’s beliefs about marriage and couples staying together until death? (dyadic) (open/other/beliefs) * What do you think your partner was trying to say by getting upset when you told him you were leaving? (dyadic) (open/other/meaning) * How do you think that your parents would describe their relationship? (triadic) (open/other/relationship)
* How do you think your partner would rate his ability to deal with feelings that overwhelm him on a scale of 1 (unable to cope) to 10 (able to cope extremely well)? (dyadic) (open/other/feelings)
Subject The subject refers to the general content of the questions asked. Questions asked can usefully be classified in terms of content or context. Questioning normally begins at the content level and then proceeds to the context level. The question categories allow for a wide range of questions within the particular category to be asked. Thus, within the behavioral category, many different questions about behavior could be asked, such as who engages in the behavior, how often, and what exactly they do. If using other question formats, behavior could be rated or ranked. Thus, the category subject of behavior can lead to a long sequence of questions that are all behavioral.
Content level. Questions at this level are used to obtain basic information. about the client situation. Although not exhaustive, these questions can usefully be thought of as falling into the three areas of behavior, feelings, and beliefs. Although other question categories could be used, these seem to be useful categories to stimulate students in developing questions within the Milan methodology.
Questions about behavior are the first questions asked because they are the most obvious data influencing communication and thus influencing relationships between clients. They are also the easiest questions for clients to answer since clients are usually more familiar with behavior than they are with feelings or beliefs. Behavior is the basic unit providing data for interpretations by others that often go far beyond those intended by the actor, often creating complex problems. Behavioral questions can be strung together to obtain sequences of behavior that show how the behavior of one person is influenced by the behavior of others. Once the actual sequence of events is sorted out, it is often possible to see how current perceptions that help maintain the problem began. Examples are as follows:
* What did your partner do when s/he found out that s/he had lost his/her job? (open/ other/behavior)
* How could you tell that your partner was upset? What did s/he do? (open/self/ behavior)
* From your partner’s point of view, who do you think s/he would say was the most upset between the two of you? How did s/he show it? (forced choice/other/behavior) * How would somebody know that you have a strong belief that fathering is important? What would they see you do? (open/self/behavior)
* How would a bystander rate the importance of your relationship to each of you on a scale of 1 (not important at all) to 10 (very important)? On what basis would the rating be made? What would s/he see you do? (rating/other/behavior) * What does your partner do that tells you that she loves you? (open/other/’behavior) Questions about feelings are asked as a way of creating a more vivid picture of the motivation for behavior and its impact on others. Feelings help interpret behavior and thus play a central role in understanding client perceptions and meanings. These questions are also a way of increasing empathy among family members as they come to understand the different feelings that certain behaviors evoke. They may invite a client to identify with the feelings of another and to draw the connection between behavior and evoked feelings in self and others. Examples are as follows:
* How did you feel when you found out that you had lost your job? (open/self/ feelings)
* When your partner is upset, is s/he more likely to speak in an angry manner to you because sAle thinks that you are the cause of the problem or because s/he thinks that s/he is incapable of controlling his/her own anger under the circumstances? (forced choice/other/feelings)
* When your sister says she doesn’t care any more, what do you think she :is feeling? (open/other/feelings)
* When your mother says that you are a bad boy/girl, what sort of feelings do you have? (open/self/feelings)
* Who do you think has the greatest feelings of love right now for your father? Who next? (ranking/self/feelings)
* Does you brother feel more love or hate for your father right now? (forced choice/ other/feelings)
Questions about beliefs are asked to help understand the nature and origin of often unquestioned ways of behaving, feeling, or thinking. These questions are particularly useful in exploring issues surrounding the family of origin, culture, religion, social class, gender, sexual preference, and commonly held societal views. The process of questioning may challenge the rigidity and appropriateness of the belief. Questions about beliefs may also promote understanding in the individual and others, providing a new level of acceptance or rejection of a particular belief. Examples are as follows: Where do you think your husband got the idea that men should be breadwinners? (open/other/beliefs)
* Do you think that it’s better for women to feel angry or sad? (forced choice/self/ beliefs)
* What beliefs about remaining with your partner through thick and thin did you bring with you from your family of origin? (open/self/beliefs) * In your family, who most believes that parents should be perfect? Who next? (ranking/self/beliefs)
* How would you rate your partner’s belief in the importance of being in love in order to remain with him/her on a scale of 1 (not at all important) to 10 (extremely important)? (rating/other/beliefs)
* Do you think that it is ever all right to feel angry with your parents? (closed/self/ beliefs) Context level. Questions at this level are used to reflect on information obtained at the content level. They are meta questions and relate to the general meaning taken by clients about the content or more specifically about the meaning for the relationship that emerges from the content.
Meaning questions are asked to help clients understand how their behavior is interpreted by others and also to help them understand the responses that their behavior evokes. Thus, these questions often explain why the current client situation exists. The answer to these questions may help one family member understand the behavior of another in a new way that may provide the impetus to change the behavior so that more appropriate messages can be conveyed. Examples are as follows: * When you stayed out all night the evening you lost your job, what message were you trying to convey to your partner? (open/self/meaning) * When your father is upset and stays out, what sense do you make of it? (open/self/ meaning)
* If I asked your brother to tell me why he is sad, what do you think he would say? (open/other/meaning) * When he takes his son and not his daughter out for the day, do you think that he does not care about his daughter or that he is trying to establish a good father-son relationship? (forced choice/other/meaning)
* Who do you think most strongly thinks that not celebrating your wedding anniversary last week was because you see it as a pagan ritual? (ranking/self, meaning) * How would you rate your children’s acceptance of your explanation that you are not living with your husband because he is on holidays on a scale of 1 (they do not believe the explanation at all) to 10 (they totally accept the explanation)? (rating/ self/meaning)
Relationship questions are used to show how behavior is related to the nature of the relationship more explicit. They draw connections in a circular way between the level of closeness and the existing behaviors, feelings, and beliefs. Relationship questions personalize the meaning of the content level by focusing on the intimate relationship level of interaction between clients. Answers allow clients to reflect on the impact of behavior, feelings, and beliefs on their relationship. Examples are as follows: * When your sister runs away from home, do you think that she brings the family closer together because everybody is more concerned about her or pushes it farther apart because everybody argues about why she ran away from home? (forced choice/self/relationship)
* When he is upset and stays out, do you think it brings you closer together since making up is a sweet process or pushes you further apart since you tend to argue more about the staying out? (forced choice/self/relationship) * When he is sad and his mother comforts him, does that bring them closer together because they understand each other better or because they are afraid that the sadness will create an even greater rift? (forced choice/self/relationship) * How would you rate your commitment to the relationship on a scale of 1 (no commitment) to 10 (total commitment)? (rating/self/relationship) * Who is most committed to seeing this family stay together? Who next? Who is least committed to this? (ranking/self/relationship) * If I asked your partner, how do you think she would say it affects your relationship when she tells you that she loves you and then stays out all night? (open/other/ relationship)
USING THE MODEL WITH STUDENT THERAPISTS Before beginning to teach the model, I introduce the concept of difference as the underlying principle that guides the entire process of questioning. We then practice creating difference in the questions asked. In this process, client responses which appear to show no difference or have little information value are used as stimuli to develop questions that create difference. Once students have a basic understanding of creating difference through questioning, we move on to the question cube. Because students think and learn differently, making an order for learning the dimensions of the model is difficult. However, while being aware of student differences, I have found that there is considerable congruence between the order in which I normally teach the dimensions and categories within the dimensions.
At first glance, the model may look more confusing than others that currently exist. However, when it becomes apparent to students that they already have many of the skills required, they then simply need to know which of the three components to concentrate upon as their next learning goal in developing their interviewing style. This is easily discernible following the analysis of their current style of interviewing, which is accomplished through supervision of live sessions. The model does not replace their questioning style but rather adds many question types to it. Teaching questioning style may be viewed as simply teaching students to ask an endless range of questions of varying relevance. However, it should be pointed out that questions may be analyzed in the manner presented in this paper, but they are always asked in the context of an interview that has previously been planned. It is important for students to have a range of questions at their disposal in order to use them when appropriate. If they have not been practiced, these questions are unlikely to be in their repertoire, regardless of the model of therapy being followed. Of the three component parts of format, orientation, and subject, I find it most useful to begin with format.
Format With the format dimension, students are encouraged to think about the effect that they wish to achieve with a particular question. Students often begin training using mainly closed questions. With some practice, they are able to begin to ask more open questions. Ranking questions and rating questions are integrated quite easily once students have consolidated the strategy of maximizing difference in the interview to create inforrnation. In my experience, the most difficult form of questioning to master is forced choice questions. Sometimes students are able to ask forced choice questions but need practice including qualifications to the alternatives to increase the social acceptability of each of the options.
This appears to be the most difficult skill to achieve since students are often unable to come up with motives or justifications on the spur of the moment. Once students have a good facility with all of the formats, it is possible to teach them common sequences of formats. For example, an open question that is not answered to the satisfaction of the therapist may be followed with a forced choice question. If an open question is well-answered in the sense that it provides useful information, the therapist may choose to use a ranking question to provide further clarification. If a client is unable or unwilling to answer an open question, the therapist may then ask a closed question as a way of drawing the client out. Students usually move through the formats in the following order: closed, open, ranking, rating, forced choice. This order guides students in the learning of new formats. Once students are able to master all of the question formats, I move on to the subject dimension, although it is possible to proceed simultaneously with format and subject, depending on the students’ ability to respond to more complex tasks.
Subject When considering the subject component of questions, I vary the focus, depending upon the background of the student. I initially encourage students to focus on the content level. If they have had a strong behavioral background, then behavior questions should already be part of their repertoire and the focus will be on feelings and then on beliefs. If, however, they have had a strong client-centered background, then they usually have a good sense of feeling questions but not of behavior questions and hence the focus would be on behavior followed by beliefs. When learning to ask behavior questions, students often need to learn not to accept generalizations that clients make. Thus, if a client says that his son was in a bad mood, the student is encouraged to explore what a bad mood means in behavioral terms. Feeling questions are often ignored as we often emphasize the meaning behind behavior as one of the most important aspects of interviewing and thus quickly focus on meaning questions. However, meaning is often facilitated by an exploration of feelings. Questions around beliefs are some of the most difficult for students to incorporate into their repertoire. Belief questions often relate to the wider systems of society and need to be encouraged in an understanding of the context of client problems.
Once students have a good understanding of the content level, I move to the context level of meaning and relationship. Students often move easily into meaning questions once they have a good grasp of behavior and feeling questions. Questions about the relationship are usually the last to emerge in the acquisition of the model. They are very confrontational questions in that they are deeply personal, accounting for some of the difficulty in their use by students. Thus, although there are individual differences, students often learn subject questions in the following order: behavior, feeling, meaning, belief, relationship. By keeping this order in mind or by noting those categories that are absent from the students’ repertoire, trainers can easily direct students to the next question category for skill acquisition. Finally, I move on to the orientation of questions.
Orientation Orientation is usually the last dimension of questioning to be taught since students need a good grasp of the dimensions of subject and format first. As the usual way of asking questions is self-oriented, students have little difficulty with this form of questioning. Thus, I allow them to use this orientation for questioning except when I phone in a question to be asked of the client during live supervision. Gradually, students learn to ask other-oriented questions as they become competent in the other dimensions and are able to concentrate on the orientation dimension. Once this has been mastered, students often feel that this is the only type of question that should be asked. They then need to be taught how to decide when to ask other-oriented and when to ask self-oriented questions. This is somewhat difficult to teach as it relates to a complex assessment of the engagement of the therapist with clients and the maintenance of that connection, as well as the perceived information value of asking a particular other-oriented question. Students must also decide when to folLow up an other-oriented question with a similar self-oriented question. If this sequence is always employed, the sessions may become tedious. Other-oriented questions are best used when there are likely to be differing views among family members or when the therapist is curious about this possibility. Students are taught to watch their clients carefully to help determine which orientation to pursue.
Once students have mastered the types of questions in all three component dimensions, they are then in a position to consider how the dimensions relate to each other. All the while they will have been practicing putting all three dimensions together while predominantly concentrating on the dimension they are trying to master. Thus, if there are some obvious types of question that are missing, I encourage them to develop the particular combination. For example, the ranking and rating format is often useful with behavior, feeling, and relationship questions. Other-oriented questions are often useful with behavior, feeling, meaning, and relationship questions. Beliefs are often best explored through open-ended questions. The forced choice question format is often good for exploring feelings and meanings. While there are no definite correct combinations to be taught, trainers will no doubt have their favorite combinations that they will teach to their students. The advantage of the model is its focus on component parts of the question as a way of facilitating competency in the development of interviewing skills. Once these basic questions have been mastered, the therapist is more easily able to go on to other more complex question types (e.g., Penn, 1982; Tomm, 1987). Through live supervision, questioning is developed in the context of the interview. Thus, as students are adding to their repertoire of questions, they are learning about the circular nature of the interview since their questions are constructed in response to previous answers of clients. Having a wider range of question types at their disposal provides students with more options when reacting to clients’ answers. If students are learning circular questioning in the process of learning the Milan model, then of course the questions are linked more directly to the theory. We do this at our training program through seminars that we conduct at the same time as we engage in the process of live supervision. However, students may wish simply to learn more about questioning to apply in other contexts and thus integrate this style of questioning into their repertoire of other skills.
CONCLUSION The model described in this paper is useful for training student therapists because (a) it caters to therapists who are currently practicing in a wide range of models and who wish to incorporate other forms of questioning into their current practice without learning a completely new model of therapy; (b) it increases therapist control over the therapeutic session; and (c) it has the potential for breaking questions into incremental steps to facilitate learning, allowing students to concentrate on only one aspect of a question in the learning process. Once the model is mastered, it provides a solid reservoir of questions for students, allowing them the flexibility of including these questions in their own style of therapy. The model also suffers from some of the problems afflicting most classification systems due to the inevitable difficulties of overlap between categories and the omission of some types of questions. First, the model is not comprehensive; it would be difficult to devise a model that anticipates every possible question. For example, some would argue that subject categories of values and thoughts should be incorporated in a model of questioning for couple and family therapy. However, it could be argued that belief and meaning questions would cover these additional categories. Thus, there is some ambiguity about the subject categories. Second, it may be difficult to categorize some questions according to subject. For example, when a therapist asks a question about the feelings associated with a particular behavior, it could be argued that the question has a subject of both feeling and behavior. However, for practical purposes, most questions can be categorized by subject and in the final analysis, the categorization of the question is not as important as the stimulus value of a subject that triggers therapists to ask questions around a particular content area. Finally, some categories of the 50 available questions may not be as meaningful or relevant as others. For example, it could be argued that the (rating/meaning/self) question “How would you rate your understanding of your husband staying out all night on a scale of 1 (you think there is no basis to your understanding) to 10 (you think that your understanding is completely correct)?” may have less use than the (open/meaning/self) question “How do you understand your husband staying out all night?” The second question is much more validating for the client than the first question. Thus, a simple application of the model may not always be possible because the user must consider the sensibility of the questions being asked as well as the particular category of question. The model often acts as a trigger to stimulate other questions within one of the three categories and thus does not provide specific questions. It could be claimed that this adds to its flexibility, which no doubt it does. Consequently, therapists still need to use their other therapeutic skills in designing questions that have been prompted by the model and that supply the information they wish to have released into the system. The model has been effectively used for the past 4 years in our postgraduate university and in our institute courses with approximately 100 students. Comments by students confirm its utility. The model also has potential in empirical research since questions may be categorized by reviewing tapes of therapy sessions as a way of more clearly defining therapy. The model has already proved helpful to students in establishing a more positive learning environment and to trainers in guiding students to the next step in mastering interviewing; it may prove useful for researchers as well.
Berg, I. K., & de Shazer, S. (1993). Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new language of change (pp. 5-24). New York: Guilford. de Shazer, S. (1982). Patterns of brief family therapy. New York: Guilford. Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San
Fleuridas, C., Nelson, T. X., & Rosenthal, D. M. (1986). The evolution of circular questions: Training family therapists. Journal of Marital and Family Therapy, 12, 113-127.
Haley, J. (1989). Problem solving therapy. San Francisco: Jossey Bass. Madanes, C. (1981). Strategic family therapy. San Francisco: Jossey-Bass. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Pallazzoli-Selvini, M., Boscolo, L., Cecchin, G., & Prata, G. (1980). Hypothesizing – circularity
neutrality: Three guidelines for the conductor of the session. Family Process, 19, 3-12. Penn, P (1982). Circular questioning. Family Process, 21, 267-280.
Selvini-Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G. (1978). Paradox and counterparadox. A new model in the therapy of the family in schizophrenic transaction. New York: Jason Aronson. Tomm, K. (1987). Interventive interviewing: Part II. Reflexive questioning as a means to enable
self-healing. Family Process, 26, 167-183.
White, M. ( 1988). The process of questioning: A therapy of literary merit. Dulwich Centre Publications, 8-14.
Jacob Edward Brown
Australian Institute for Relationship Studies
The author wishes to thank Kerrie James, Director of Clinical Services at Relationships Australia (NSW), and the reviewers of a previous version of this paper for their helpful comments. Jacob Edward Brown, PhD, is Director of the Australian Institute for Relationship Studies, which is affiliated with Relationships Australia (NSW), 135 New South Head Road, Edgecliff, NSW 2027, Australia.
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