It’s said that there’s no such thing as a stupid question. But for therapists who want to communicate well with the families they serve, there are certainly some ways to ask the questions that are smarter than others. How can therapists ask the questions they need to get crucial information from families, and how can families ask their pressing questions in ways that help them become fully informed, empowered members of the therapy team? There’s no such thing as a dumb question, but if we think more carefully about how we are asking, not just what we are asking, the lines of communication may become clearer.
One of the biggest mistakes that therapists make is asking yes/no questions, or questions that lend themselves to single-word replies. If you start the session by asking, “How did things go this week?” I can almost guarantee you that the family will say, “Good,” regardless of how the child did at home. That leaves you pretty much still at square one. What information does that really give you about the child’s performance? Instead, try, “Last session, we talked about [Goal X]. What is he doing for that at home?” This serves multiple purposes: you remind the parent that therapy has to carry over throughout the week and that goals don’t just get worked on in therapy and then forgotten, and you are asking a specific question: what is happening at home related to this goal?
Sometimes, a parent will comment to you about something their child is doing — either something positive (using a goal you’ve targeted in the past at home), or something in need of remediation (e.g. “He’s making his /s/ sound funny”). As the therapist, you need more information. I like to ask, “What does it look like when this happens at home?” to encourage the parent to give me specific examples. In the first scenario, where a parent is telling me that the child has accomplished a goal, this helps me to “calibrate” my expectations with the parents’ so that we’re both looking for the same thing as evidence of having achieved the goal at home. In the second scenario, where the parent is describing a problem or roadblock they’re encountering, it helps me gain a more specific understanding about what exactly is wrong.
Another awful thing to do to parents is to ask questions that box them into a corner. If the therapist asks, “Does he wear his hearing aids all waking hours of the day?” what most parents hear is, “I [the therapist] want to hear that he is. And if you tell me he’s not, I’m going to think you’re a bad parent.” And yes, the truth is, I 100% want the children on my caseload to be wearing their devices from the minute their little eyes open to the final second before they shut at night… but asking questions that make parents feel the need to lie to me doesn’t get us any closer to that goal. What about asking, “What does a typical day look like for [Child]?” This is my not-so-secret sneaky way of getting way more information than about just hearing aid use. For example, if the parent outlines the whole day to me without specifying when (if ever) the hearing aids go in the child’s ears — aha! That’s information I can use! If the parent describes the whole day but it’s full of very low-stimulation, low-interaction, low-talk activities — aha! I need to know that, too, so I can best coach this family to create habits that will help their child thrive. These types of questions yield much, much more information because they’re open-ended and non-judgmental. I’m just asking the family to tell me about their day.
Wrapping up a session is a major opportunity for asking the right kind of questions… but we often miss it by saying things like, “Do you have any questions?” or “Does everything make sense?” At this point, 99.9% of parents will probably say that no, they don’t have any questions, and sure, everything makes perfect sense. Then they’re out the door and on their way and who knows what goes on during the week. Part of this confusion can be eliminated by having the parent participate as an equal partner throughout the therapy session, giving him or her a chance to try out activities with the therapist there to guide and coach and redirect if the parent is not quite understanding an activity or target. That’s step one. Step two is asking the right kinds of questions at the end of the session. Instead of launching into the “do you understand it” type of questions, I find it helpful to go over each activity we did again, what the goal was, and how the child did. Then I start to collaboratively brainstorm with the parent ways the family can practice it at home. Usually I’ll volunteer an idea and then ask, “How else do you think we could get [Child] to do this at home during the week?” Sometimes, the parent is able to come up with suggestions of their own easily. Other times, I may have to offer a hint — maybe the parent has already told me about the child’s toy du jour that week, or a new book they’ve just checked out from the library, or an upcoming family event. Usually that’s all that is needed to jog the parent’s memory and get them thinking about ways to incorporate goals into those toys, books, or situations. Whether the parent needs no help or lots of help from me to come up with ways to work on goals at home during the week, by making the process into a discussion rather than a yes/no question, they’re much more likely to remember the targets and follow through.
Professionals also need to learn to listen for the question behind the question. When parents say things like, “Will he always have to wear ‘that thing’?” or “How long will we have to be in therapy?” or “Do you think he’ll ever go to the prom?” we have to ask ourselves, “What is the family really asking here?” Sometimes it helps to answer those questions that go unasked or those that are waiting underneath the surface.
One last tip for helping parents ask the right questions and get the answers they need is to be available. I always tell parents, “If something we talk about today seems to click now, but when you’re reading your child’s session report it seems totally foreign, or if something comes up later that you don’t quite understand, or if she does something during the week that’s totally off the wall and you want some help processing it… email me!” Questions don’t always happen on Monday from 10-11AM or whenever your session is. We’ve all had the experience of going to a doctor’s appointment and remembering some crucial question just as we pull out of the parking lot. Give parents a way to get the just-in-time information they need, whenever the questions occur.
Elizabeth A. Rosenzweig 