Step 5. Practicing Preference Invitations
We cannot safely assume that other people’s minds work on the same principles as our own. All too often, others with whom we come in contact do not reason as we reason, or do not value the things we value, or are not interested in what interests us. - Isabel Briggs Myers
The assessment of preferences is an invitation to dialogue - to dance, if you will - about what specifically will work for the other. It constitutes, in our view, an advanced form of empathy.
Without at least a modicum of that empathy, the assessment itself will probably deteriorate into a sterile process of collecting more, irrelevant information. If it does, we implore you not to bother with preference work at all.
In this relational dance, we believe active listeners should “reach out” to their service users rather than assuming they will simply step forward with their wants. Inevitably, a power dynamic exists between client and practitioner, and research shows the tendencies of clients to defer to their clinician.
Consequently, clients may feel uncomfortable or inhibited from sharing treatment preferences. For instance, they may think, “Surely it is not my place to voice my opinion here,”; “If I ask for something that the therapist doesn’t like, she may make me leave therapy,”; or, “I don’t want to embarrass my therapist by making them think they’re doing something wrong.” Of course, these reactions may be furthest from our minds and lips, but clients—particularly those used to critical or defensive responses from others—may predict such responses and much worse.
Hence, it is rarely enough to respond empathically and acceptingly if clients do voice preferences. Rather, clients should be actively invited to say what they have strong likes and dislikes for - to be introduced to the idea that the psychotherapeutic process is one that they can shape and offer feedback on.
Here are a few openers by which clients can be invited to voice their preferences:
♦ Based on your previous experiences of therapy, what do you think will be useful here?
♦ What would you like in our work together? Do you have any sense of what might be helpful or unhelpful to you?
♦ We have learned the importance of tailoring or personalizing psychotherapy specifically to you. May I ask a few questions to identify your strong likes and dislikes for psychotherapy?
♦ Try this brief exercise. Close your eyes, breathe deeply a few times, and imagine in your mind’s eye what you would strongly like to happen in here. What would I ideally do? What would I not do?
♦ Let’s think together about how to reach your therapy goal. Which treatment method? What type of therapy relationship? What type of out-of-office activities—self-help, exercise, apps, and so on?
Actively inviting clients to share their preferences may be particularly vital in identifying what they would strongly dislike in treatment - and, even more so, what they are strongly disliking now. For a client to say to a psychotherapist, for instance, “I don’t find it helpful when you ask me to do homework” or “I wish you would say more in our sessions” may feel excruciatingly awkward. Many clients will need to be reassured, perhaps several times, that such “critical” feedback is welcomed - indeed, that the clinician welcomes it as part of their own learning and development.
Although clients expect to be asked about their treatment goals, they are typically surprised when the clinician enquires into their psychotherapy preferences. Hundreds of our psychotherapy clients (and supervisees) have spontaneously exclaimed, “I was not expecting that!” or “Did not see that coming” or “I was not prepared for that question.” You can transform this novelty into a learning or therapeutic moment.
When clients respond with surprise or incredulity to the invitation, we take a number of tacks depending upon their reaction and clinical context. But we squarely put the emphasis on (a) normalizing their reaction then (b) leveraging it to distinguish psychotherapy from most health care.
Normalizing responses do just that; for instance, “It is rare to be asked what you want,”; “Your surprise is understandable and frequent; that’s not how it’s usually done,”; and “Not expecting that one, huh? Doctors don’t often ask what the client wants.”
We segue immediately into a brief explanation and, we hope, a corrective experience into how 7 Cups differs from most health care. That can be communicated in words and deeds. You might say for instance, say something along the lines of:
Much of medical care remains rooted in the passive client receiving treatment from an authority. But here, we expect and cultivate an active client working together to create the best treatment. I am an expert on behavior change, but you are the expert on you and your preferences. We will collaborate and work as a team to personalize or individualize care to you.
If the client is a health care professional or familiar with the terminology, then you might add, “Similar to precision or personalized medicine,” and finish with, “How does that sound to you?” or, “How would that work for you?”
Watch the following video for some pointers on assessing client preferences:
During your upcoming listener conversations, practice asking the 2 questions:
- What do you strongly dislike or despise in treatment (listener conversations)?
- What do you strongly like or desire?
Use the box below to share any reflections.