I’ve been thinking recently about the perils of answering questions as a cognitive behavioral therapist. Not personal questions, necessarily – I think we all know that answering those sorts of questions from our clients can backfire in any number of ways. I’m referring more to the bigger, broader questions clients may wish to have answered, the kind of questions that bring someone into therapy in the first place.
What is wrong with me?
Why is this happening to me?
How can I become someone different/better/not so afraid?
Cognitive Behavioral Therapy (CBT) as created and practiced by Beck suggests that therapists assume the role of a curious guide, helping the client to uncover evidence for and against their beliefs, relentless in the search for truth. This approach inherently assumes that truth really exists, that there is a right answer which can be uncovered through careful sleuthing.
And while the search for truth is often useful in therapy, there are times when it falls short. There are times when questions simply cannot be answered.
Assuming that every question has an answer sets the client and the therapist up for failure.
It means that the client will search and search for some objective fact that will explain their pain away. It means that the therapist is expected to provide an answer should the client find themselves unable to reason it out.
But we all know that not all questions have objective answers that can be discovered through careful reasoning. And we all know that sometimes even careful reasoning will not eradicate a deep, abiding belief. In these moments, it is not helpful to pretend that facts (intellectualized, rational facts) will hold up against the fire of emotion that burns beneath a question like “What is wrong with me?”
So what is the alternative? How do we as behavioral and cognitive therapists let go of our role as calm, rational expert? And when does it make sense to do so? I would argue that the therapeutic stance encouraged by Acceptance and Commitment Therapy (ACT) provides a helpful means of addressing unanswerable questions in a way that is helpful to both client and therapist. ACT views the therapist as an equal to the client, just another human being trying to get through his or her life. Which means that when a client asks a question to which we don’t know the answer, it’s actually helpful from an ACT stance to acknowledge our ignorance.
In doing this, we’re actually validating the client’s perspective more than if we tried (and failed) to give a factual answer or led the client through a series of Socratic questions to help them uncover an answer themselves. Rather than setting ourselves up for failure and setting our clients up for disappointment, an unanswerable question can become an opportunity to connect around the pain of human existence, the frustration of not always knowing why things happen to us or how our lives turned out a certain way.
What is important about this is that we don’t retreat to the unanswerable question defense in response to every challenging query. That is doing our clients a disservice in the same way that pretending to be an all-knowing expert is doing them a disservice when they (and we) come up against our human fallibility. We need to help our clients answer the questions that can be answered. But we also need to be wise about when a question is simply beyond the capability of anyone to truly understand. Why do certain people get schizophrenia? What makes someone feel completely incapable of managing their own emotions? We can provide facts and figures, but ultimately these questions are bigger than that. These questions are essentially asking what we all ask ourselves from time to time – why am I different than other people? Why do I feel this pain? Why does life hold such a mix of joy and sorrow? And why are there times when I seem to feel that sorrow more acutely that other people?
There are no answers to the why me question, other than to understand that asking it is part of our experience of being human. It is important as therapists to recognize that we are in that experience just as much as our clients and to recognize when our desire to appear intelligent, professional, or “above it all” can hinder our work. We can use unanswerable questions as a moment to connect, to share the sadness, the confusion, the pain of being human, rather than as another example of why we’ve earned the fancy degrees hanging on our walls.
Of course, facts and skills are still useful. If someone wonders why they have such a hard time controlling their emotions or why they are experiencing distressing symptoms of a mental health condition, we can provide psychoeducation and teach behavioral and cognitive skills to help deal with these concerns. However, validating the emotion that is central to broad, unanswerable questions, and using that emotion as a chance to truly connect with our clients, is central.
Unanswerable questions, though they can sometimes feel like a challenge or a panic-inducing test, are actually a gift. And if we take a deep breath and admit the truth – that there may not be an answer, that life is hard and we all (even therapists) wonder why and how things turn out the way they do – we can use the moment as a chance for both client and therapist to grow. With this approach, the unanswerable question becomes a way to help our client be heard and understood.
Example Transcript: Unanswerable Questions
Client: I just don’t get it. What is wrong with me? Why am I like this? I try so hard, but everyone else seems to get how to manage all of this and be normal, and I just can’t.
Therapist [nodding, leaning toward client]: Yes, you have worked so hard, and yet you still carry all of this pain around with you.
Client: Yeah, but I’m seriously asking – why am I like this? You tell me because I have tried and tried, and I can’t figure out why I can’t just be normal.
Therapist: Honestly, I wish that I could tell you why things are like this. I wish I could explain why any of us as human beings struggle with being in pain, with feeling confused, with feeling separate from other people. But I think you and I both know that there isn’t a factual answer I can give.
Client: It’s so frustrating though. Like why do some people seem to struggle so much more than others? It’s not fair.
Therapist: No. It’s not fair at all. And it hurts. There’s a lot of frustration and sadness there.
[You should allow space for silence throughout this entire exchange, but certainly when you get to a place where both you and the client are feeling the pain of what the client is alluding to – the pain of human existence that cannot be escaped. It’s important not to rush to provide an answer, or facts, or throw skills at the client in a moment like this. It’s important not to try to fix, but just to experience this emotion with the client.]
Client [after a minute or two of silence]: I just don’t know what to do.
[Now the client has turned from the pain itself to looking for a response to the pain, a real shift. You have a choice in this moment. If it feels like this is an avoidance move, then it’s usually most helpful to redirect to the emotion with a statement like “Notice how your mind is trying to search for a solution right now, how it’s trying to pull you out of the pain. But I think that pain is telling us something important about what this is like for you.” This will help let the client know that you’re going to be hanging out with the pain a bit longer, not to be punishing but to help the client really experience what is there, to process it. However, if it feels like the client has truly had some time to experience the pain and that he or she is ready to progress to the more tangible questions that do have answers (“how do I approach my life in a way that is meaningful to me, even with this pain?”) then you can progress to psychoeducation or teaching skills. If you like, you can do both: acknowledge the pain once more, and then pivot to talking about practical interventions.]
Therapist: And this might not be something that you can fully “do” something with, feeling abnormal or different from others might be a part of your experience, a part of being human, something that we all struggle with. And I think there are some ways we can work on skills to help with managing difficult emotions that might help you connect a bit more with the people you want to be close to.