Question: I’ve been having a few sessions with a client who consistently directs their attention towards discussing other people in their life rather than focusing on their own experiences. It seems that they are more comfortable delving into the details of their relationships, family dynamics, and friends’ issues, but when it comes to exploring their own thoughts and emotions, they tend to evade the topic. This has been making it difficult for me to effectively address their personal concerns and goals for therapy. How can I shift the focus of our sessions towards their own self-reflection and inner experiences without causing discomfort? Any suggestions on how to navigate this situation would be incredibly helpful for me in guiding the therapeutic process.
Response from Dr. Chua: It’s common that people feel more comfortable focusing on the external than on the internal. The internal world may be uncomfortable, strange, overwhelming, and painful. So, I’m not sure you can shift the focus of sessions towards self-reflection and inner experiences without any discomfort. An agreement with your client to shift the focus inward would be useful. But even then, of course, the experience will likely be somewhat uncomfortable.
How does your client feel sessions are going? Do they feel they’re productive and useful and heading in the right direction? Are there objective signs of improvement? If yes, then maybe sessions are going better than you think.
In any case, I’ll assume the sessions haven’t been productive because of the external focus. I’m curious how your client responds when you try to bring the focus inward. You can make some gentle process observations about your client’s response to your response. In many humanistic approaches like Emotion Focused Therapy and Interpersonal Psychotherapy, process observations are regularly made.
Just be mindful that your client probably has difficulty focusing inward and they might keep shifting to the external. Here’s an imagined conversation with a client using Cognitive Behavioural Therapy…
T: You wanted to talk about the argument with your mother. [Bringing up an agenda item]
C: Yeah, she’s always nagging me about how much I’m eating and yet she guilt trips me when I don’t finish my food.
T: Mmhmm. That’s a pretty difficult thing to experience. What would be most helpful for you as a result of our discussion today? [setting a session goal]
C: I want to know what to do when she nags me.
T: Alright. Let’s jump straight into this then. When did this argument happen? [Trying to focus the conversation on a specific event]
C: All the time! She does this so often.
T: That sounds rough. [Acknowledging client’s difficult experiences] Did it happen again this week? Was there a specific one that we could focus on so we can figure out what happened? [Trying again to focus on a specific event]
C: Well, it happened yesterday again. She made my favourite meal, chicken rice, and so of course I went for seconds. Last time when I didn’t eat so much, she was offended. So this time, I just went for more. Then she said, “Wah, eating so much again!” What the heck?! Everything I do is wrong. She’s never satisfied with me.
T: What did you say in response? [Focusing on collecting information on the event – behaviour response]
C: I didn’t say anything at all. Whatever, I just kept eating.
T: Ah, OK. So, she said that comment, and you stayed silent and kept eating? [Brief clarification]
C: Yeah. What else could I do?
T: Sounds like you felt you couldn’t do much.
C: [Nods] It’s always like that.
T: How did you feel when your mom said “Wah, eating so much again”? [Collecting information on emotion]
C: She’s always like that. I don’t know why I even bother.
T: So like…frustrated? Hurt? [Gently suggesting some emotion labels]
C: I just don’t know why it’s so hard to please her.
…..
[Let’s skip ahead and imagine that you continue trying to collect information on her feelings but to no avail.]
T: I was just wondering what it is like to talk about feelings? I noticed that when I turn the conversation towards your inner world especially your feelings, that you rather focus on what the other person is doing. [Process observation]
C: It’s fine. But, of course, I focus on the other person because the other person is doing something wrong.
T: I get that you see the other person as doing something wrong. What we’re here to explore is the impact of what the other person is doing on you and what you can do about it. [Provide explanation] Does that make sense? [Elicit feedback]
C: Not really.
T: OK, let me try again. [Acknowledge feedback] You wanted to figure how to manage your mom when she nags, right?
C: Yes.
T: And so far you’ve managed it by keeping silent and not saying anything back to her. But I am guessing that’s not satisfying to you, and so you want to try something different?
C: Yes. How do I get her to stop criticising me?
T: Exactly. And that’s an important goal to have. [Acknowledge client’s goal] Because as we discussed the last time, her criticism also makes you feel bad about yourself. So we have to figure out what works for you – what you want to say and how you want to say it. In other words, we need some information about her, but a lot more information about you. When we focus the discussion more on you, it’ll help us figure out better ways to help you. [Provide rationale] Does that make sense? [Elicit feedback]
C: Hm..
T: OK, maybe not? It’s still pretty abstract. [acknowledging feedback] Why don’t we try an example and we can discuss after whether it’s more or less helpful when we focus the discussion on you instead of others. [Elicit collaboration] Is that alright? [Elicit feedback]
C: OK.
In this conversation, the therapist first tried to suggest feelings to help client focus. As that didn’t work, the therapist made an observation about the client’s external focus and explained why focusing internally might be more helpful. The client wasn’t quite convinced, so the therapist acknowledged the client’s feedback and asked if they could try it out as an experiment and discuss the experience after.
Even in humanistic therapies, it’s helpful to provide a rationale/explanation for what you’re asking the client to do. Remember, autonomy supportive therapists have better outcomes. We can guide the client, but we don’t force them to follow us.
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