"How do you know what questions to ask?"

When doing talk therapy, how do you know what questions you ask? How do you conduct talk therapy and what runs in your mind when doing it?

Great question - something I probably couldn't tell you as concretely in my formative years as a clinician. Which is scary. For both of us, I guess.

I'll answer your first question first: how do I know what questions to ask - or maybe more specifically, how do I know the right questions to ask?

I don't. Well, I don't and I do. What I do know is what I need to know - your symptoms, the severity of them, your safety plan, your family history, environmental factors - things that you might find on one of the assessments I've asked you to fill out. This is the easy part - and even the hard questions get easy to ask, the more you ask them.

What's harder is coming to know the things that you don't even know. Or don't want to know, so you've hid them from yourself. And they've stayed hidden for so long you've forgotten where you put them. And it's been forgotten for so long you've been living your life like it no longer exists. But now you're in pain, and you don't know why. And what I've found to be true is, it doesn't matter how deep your mind digs the ditch it dumps its skeletons into, the body never forgets.

So you come to me counterintuitively - to help you unearth the bodies you worked very hard to make disappear. (Excuse the morbid analogy, I've been watching Sopranos, lately). 

And you make it hard for me to help. If it were easy, I’d ask something straight forward like, what do you need me to say to help you feel better about your issue? And sometimes I do, and sometimes it works just fine because you’re ready to hear it. 

But others, not so much. And that’s what’s running through my head as I’m speaking with you. Where are you in your stages of motivation to change? What is the tone of the narrative you’ve been playing to yourself? What are you asking of me in this moment? To validate? To reflect? To challenge?  And so this thing of ours goes, until we’ve addressed the reasons you decided to come to me in the first place. And in the meantime I do everything I can to help you feel comfortable and safe to explore and share.