One simple realization I had years ago changed my view of my role as a clinician treating patients with psychiatric and related problems. This realization occurred when I looked up the etymology of the word ‘question’ on the internet. I don’t remember what triggered me to do this except that I’ve always been interested in word etymologies because learning the origins of words allows me to uncover the more concrete, physical object or activity that many words originally referred to before they became more abstract and disconnected from their non-metaphorical origins. I feel I gain a deeper understanding of not only the individual words I look up but also of language and thought more generally, and even beyond that to catch a glimpse into sentient experience unmediated by language.
In any case, back to the etymology of ‘question.’ Its root is the Latin word ‘quarere,’ meaning to seek, search for, hunt, or ask. Quarere is the root for the English words quest, question, request, enquire, inquiry, inquest, acquire, and several others.
Until that moment I never realized that the words ‘question’ and ‘quest’ had the same root and shared meaning – yes, a bolt of the obvious. To ask a question of someone is to engage in a search, a quest. But a search for what?
When I ask my patients questions, I am indeed seeking information about them to help me establish a diagnosis and develop a treatment plan based on my diagnostic impressions. If that were all there was to being on a quest, it would not have advanced my understanding of my role as a psychiatrist. Of course, I ask questions to gather diagnostic and treatment-related information. I knew this all along.
But then another thought entered my mind: that there is an additional aspect to this questioning quest. I realized that the patient and I are on a quest to move the patient from their current lived experience to a different lived experience, a better one. My goal expanded from being the resolution and recovery from whatever psychiatric disorder the patient suffered from to include a search for a life worth living – a phrase used often by Marsha Linehan. The second goal differs from the first and is often broader. A life worth living often includes recovery from a psychiatric disorder, but sometimes a life can be changed from one not worth living to one worth living by changing other aspects of a person’s life unrelated to psychiatric symptoms. These other aspects can be part of the quest.
I further realized that asking questions was not only about me engaging in a clinical quest to gain information about the patient, but also meant engaging in a mutual clinician-patient quest to help the patient find their way to their best life available to them. This fundamentally changed my attitude towards my role generally and even to each question I posed. I was only a part of the equation, more a facilitator of self-healing than a ‘fixer’ of a broken person. By asking questions, I wasn’t only extracting information, I was also helping the patient realize that they are on a quest to get to a less distressed, more functional and happier life. Such a quest is complex and many patients have been on it for years and failed to achieve recovery and a better life. Asking many questions, some of which will yield deeper understanding, is only the first step toward a better life, but it is an important first step that for many people must occur before the next steps can kick in. The next steps are, of course, taking actions towards that better life, but the actions that are chosen, because they are deemed relevant, are based on the understanding gained through asking and pondering questions.
My question-asking modeled to the patient the importance of asking questions, and that questions can be asked by another person but can also be asked of oneself. One sign I was on the right track was when a patient would come in and say something to the effect of, “Last week I faced a challenging situation and I was going to fall right back into my ineffective or dysfunctional way of dealing with it. Then I heard your voice in my head asking me the kinds of questions you ask me, and I realized I could do that for myself. And it led me to realize I could react differently to the situation I was in, that every situation has more than one way to deal with it.”
By now you probably want some concrete examples. Sure.
One of the changes I made to my formal intake interviews and ongoing conversations with patients was to focus much more on the patient’s preferred outcomes. I did ask questions to establish which psychiatric disorders the patient suffered from – I wasn’t willing to give up on my role as a psychiatric diagnostician – but I focused much more on the patient’s goals and what it would take to reach them. My approach became much more consistent with motivational interviewing and with solution-focused brief therapy. These are the kinds of questions that became more prominent in my conversations with patients:
- If your depression would miraculously disappear so that you woke up tomorrow morning feeling completely free of it, what would your life be like? What would you be doing? Who would you be with? What would you be having for breakfast? For dinner? What would you be doing for fun? What time would you go to bed? What would you do around the house?
- You’ve painted me a beautiful word picture of your preferred life. Where is a good place to start to make it happen? There are probably many changes you need to make to make that life happen, and it’s easy to get bogged down and overwhelmed. But remember that you don’t have to do everything at once. It’s important to start somewhere. I suggest you pick something that will make your life better right off the bat and something that isn’t super hard to achieve. What’s a good option?
- Now that you’ve picked that one change you want to make, what do you need to make it happen? Please give me more details. What else could help you achieve that? How about writing down a daily schedule? Or putting up reminder notes in your bathroom or kitchen? Would it help you if right now I recorded a message on your voice notes app on your phone? Let’s write the script for this voice message together. What would be helpful for you to hear from me as you played my message anytime you wanted to?
- Now, let’s talk about the things that could get in the way of you succeeding in this initial goal. You know that life is complicated, that we often run out of time or energy, that we get distracted, that we lose motivation, that someone or something can make us angry or afraid; all of these challenges will arise at one time or another. Let’s talk about them. What do you think are your most likely challenges? How can you prepare for them? And if that, let’s call it plan A, doesn’t work, what else can you try to stay or get back on track? And if plan B also doesn’t work either, what then? And what can you do for plan C?
- What do you think we should talk about next time we meet?
- My request for both of us is that next time we meet you tell me what worked and what didn’t, what was easy and what was hard, where you succeeded and where you failed. Then you and I can talk about what we can learn from that and adjust going forward. Is that ok?
- What do you think I can do to be most helpful to you? What should I do more of? What should I do less of or stop doing altogether?
- Who else in your life can be a support or resource for you? In what way? Have you talked to them about this yet? How do you think they would respond if you did? Would it help you if you invited them to join us during one of our sessions? Is there anything in particular you would want me to say to them or tell them about you? Is there anything I should not mention about you to them? You know, some things can be kept private. You choose what to share about yourself.
- Thank you. I feel good being on this journey with you.
Until next time,
“Every solution to every problem is simple. It’s the distance between the two where the mystery lies.” ― Derek Landy
“Possible is more a matter of attitude,
A matter of decision, to choose
Among the impossible possibilities,
When one sound opportunity
Becomes a possible solution.”
― Dejan Stojanovic
“There is no worse thing that can be done to some people than to show them a solution to the problems they complain about.” ― Luigina Sgarro
“Empty complaints are the sources of everyday failure, but not the problem being complained about. Problems are solvable; but not with complaints. A complainer is just an explainer of problems!” ― Israelmore Ayivor
“Tantrum begets tantrum, action begets solution.” ― Abhijit Naskar
“A problem can’t be solved by the same kind of thinking that has created them.” ― Albert Einstein