I love commercials that make an interesting philosophical point. One that aired recently in the United States highlights the value of asking questions instead of making statements. The commercial gives examples of how replacing a period with a question mark makes a difference in the way you think. For example, “Phones are only for making phone calls,” becomes “Phones are only for making phone calls?”
That commercial reminded me of the power of asking questions when working in therapy with individuals who have a maladaptive over-controlled personality style. Asking questions and having an open mind about ideas and beliefs is a therapeutic tool in Radically Open DBT.
We all have beliefs about ourselves and the world that come from the culture we live in, the family we grew up in and the beliefs of the era we live in. Some of what we believe to be true about ourselves may in fact be unexplored. If you examine certain beliefs you may find those beliefs are not facts but a view of the world based on your biology and history. If someone’s beliefs and perceptions are controlling their behavior and keeping them in pathological patterns, then questioning those perceptions becomes a critical part of treatment. The idea isn’t that there is cognitive error to be found, but to explore the belief to see what can be learned. But how do you help someone who tends to have a closed mind to question their view of the world?
“We do not see things as they are. We see things as we are.” Anais Anin
James is an individual who suffers with maladaptive over controlled personality style. He comes to therapy because of pressure from his boss and his wife. It’s clear that he has difficulty accepting feedback that would help him make effective changes. His wife, his boss and others have told him that he looks angry most of the time and the number of rules he has is annoying. James discounts that feedback. After all, there are right ways and wrong ways to do things and people need to go by the rules. He works hard, is reliable, and outperforms most others in the office. He’s a good provider. James says he isn’t angry, at least not more than most people, and has no idea what they are talking about. He resents these comments and has thoughts about being unappreciated. James might be viewed by some as a help-rejecting complainer, a client that is known to be difficult to treat.
In treating individuals with over-controlled personality styles, one of the goals is to increase receptiveness to new ideas and disconfirming feedback. Asking strategic, authentic questions is part of the process of increasing receptivity in RO DBT. Instead of giving solutions or defining the problem for the client, the therapist explores and gathers data together with the client through skillfully asking relevant questions and also assist the client in looking at different possibilities for moving toward psychological health.
Learning how and when to accept feedback is a skill that is important for growth and relationships. RO DBT ADOPTS is the acronym for learning this skill. Included in ADOPTS are 12 questions for clients to use in considering whether or not to accept feedback that is offered.
When James uses this skill to consider the feedback he’s been given, he realizes that the person giving him the feedback is someone who has more experience than he does, that accepting the feedback would improve his relationship with the person giving the feedback, that he is capable of making the changes suggested, that the person giving the feedback did so in an easy manner, that the feedback is relevant to his current situation, that he has heard the feedback from others and that he is set on being right, no matter what – thus accepting the feedback is the indicated response.
In terms of James’ stating that he isn’t angry, questions help clarify the truth. The therapist might ask, “If I were a fly on the wall, what would I notice about your facial expression when you are with other people? Can you show me?” When James demonstrates a blank face, then she can demonstrate this expression to him and ask, “What does my blank face signal to you?” Blank faces are most often viewed as hostile. Experiencing this fact is more powerful and more likely to bring about change than being told the information or just talking about it.
James also experiences painful emotions at times when interacting with others. For example, recently someone suggested that he would like to travel as much as James does. James felt upset. He defended himself, stating that he doesn’t travel that much and that recently his trips have been mostly for work. His degree of upset didn’t match the comment. In RO DBT, this is not a time for soothing and regulating, but is a time to be curious about the emotion. To be curious about the emotion, James considers different questions to ask himself, such as “What is it I need to learn about others expressing envy of me?” and “What is it about admiration that makes me so uncomfortable?” The idea is to come up with the question that increases his energy or discomfort and think about that question for brief periods over a few days to learn more about himself. This process is called self-inquiry, one of the mindfulness techniques in RO DBT.
Questions in RO DBT are part of both the acceptance and change techniques. Questions, asked with true curiosity and mindfulness, help create safety and openness and help facilitate change in accordance with the client’s values.
About the Author: Karyn Hall, Ph.D.
Karyn Hall, Ph.D. is the Director of the DBT Center in Houston, Texas. She is the author of four books and has been a speaker both nationally and internationally. She is intensively trained in RO-DBT.