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For those of you who may be familiar with my work, it will come as no surprise that I look at clients and their issues through a strengths-based lens. This means staying curious about, pursuing, and identifying what is “right” with the client, rather than looking for what is “wrong” with them. Unfortunately, the process of assessment and the pressure to find a DSM diagnosis to justify treatment and increase the likelihood of insurance reimbursement often steers clinicians down a more pathologizing path. We have already looked at the potential hazards of asking intimate and emotionally loaded questions too quickly. In Part 4 of this series, I emphasize the importance of including questions that will help the therapist, as well as the client, identify areas and characteristics of strength.
When a client’s strengths are openly acknowledged and honored, new resources for coping can be accessed and reinforced. In addition, a focus on strengths brings hope back into the process. By the time a client lands in a therapist’s office their hope is significantly diminished and they typically view themselves through a negative lens. I have actually had clients attempt to give me a long list of their perceived deficits and “weaknesses” during the assessment phase. They assume it’s “important” for me to know about their shortcomings or former diagnoses, but it doesn't occur to them that it’s even more critical for me to know about their strengths. The following are some potential prompts that therapists can use to help open the door to an exploration of a client’s internal and external resources and positive attributes. Finding opportunities to weave these questions into the earliest stages of assessment gives the client the message that they’re more than their trauma and shows them that treatment can unfold from a more positive perspective.
- Where do you find the courage to manage your challenges?
- How do you remain so resilient?
- What creative coping strategies did you use to survive in the past?
- How did you not give up?
- Can you give me three positive adjectives to describe yourself?
- What are three positive adjectives that someone else who cares about you would use to describe you?
- Tell me one thing you feel proud of about yourself.
- Can you tell me about a time when you were faced with something difficult and you overcame it?
- How have you managed stress in healthy ways?
If the client is not able to easily respond to these questions, reassure them that they don't need to come up with the answers right away. By asking the questions and offering the prompts, you are “planting seeds.” As the process of therapy nurtures those seeds they often take root. It’s a good idea to revisit those same questions at a later stage of treatment. As the client begins to formulate answers, it becomes tangible evidence of their growth and progress in therapy. If the client does feel compelled to reveal what they perceive to be a “deficit” let them know it “makes sense” given where they’ve come from and what they’ve endured. This helps them make a connection between past trauma and current struggles-moving them away from the idea that they’re “defective” or inherently “bad.” You can also suggest the possibility that what they think of as a weakness or flaw was in actuality a life-saving and necessary coping strategy that speaks to their creativity, determination, and cleverness. That also allows for an exploration of whether or not that strategy is still needed in the present.
As I have alluded to before, whenever possible, therapists should hold off on the more emotionally loaded assessment questions until there has been ample opportunity to establish some rapport and trust in the relationship. Think about starting with less threatening questions that don’t demand graphic content. In the next installment I’ll offer some specific questions that provide information about family of origin dynamics in a more “backdoor” fashion. These are questions that can set the scene for deeper emotional and cognitive processing down the road.
Missed previous installments of this series? Click on the link to read:
Part 1, Part 2, Part 3, and Part 5
What are the assessment questions you ask your clients that allow for a more strengths-based focus?
