The Multiple Choice Question in Couple Therapy

As the years go by, I find myself making increasing use of three types of questions in my effort to help partners find their voice and come up with the missing conversation. These three are the multiple-choice; how much, how much; and sentence-completion questions. This blog is devoted to the multiple-choice question, which expands an earlier blog entry. I’ll deal with the “how much, how much” and sentence-completion questions in subsequent blogs.

In the effort to slow an angry exchange or energize a muted one, couple therapists typically ask some version of, “How do you feel about…?”  Partners sometimes answer, “I don’t know”—a response that can suck the energy out of the room.

In an effort to restore the energy, I might reply, “What’s your best guess?” or “This is a trick question but, if you were to know what you feel, what would it be?” Most of the time, however, I take advantage of the “I don’t know” to suggest possibilities.

Dan (to Jerry): I’ll make it a multiple-choice question. Do you feel (a) upset with Alexa for bringing this up, (b) grateful to her for doing so (c) embarrassed by what she brought up, (d) relieved that it’s now out in the open, or (e) something else entirely?

My unspoken message is, “Jerry, you say you don’t know what you feel? Don’t worry. We can figure it out. In fact, there’s a wealth of possibilities here. I’ll mention a few to get you started.” Since Jerry is having trouble putting words to his feelings, I ask him simply to pick out the feeling from a list I put in front of him. If nothing on the list strikes him, that’s okay because I’m priming the pump of his own thinking about the matter.

Jerry (to Dan): It isn’t quite any of those. It’s more that ….

The multiple-choice question allows me to raise possibilities that Sam didn’t think of, didn’t feel entitled to say, or didn’t realize would be useful and relieving to say. My task is to broaden his repertoire to include such thinking and talking. The goal is to help people struggling in lonely battle with difficult feelings get the comfort that can come out of finding words for their experience.

Dan: Okay Anton, as you said, when Elise didn’t show up when she said she would, your mind went blank and you got into this kind of numbed-out state where you didn’t know what you felt. Let me make up some stuff and see what you think. Did you feel “I can’t count on her just as I could never count on anyone when I was a kid” or “What’s wrong with her? Why does she treat me this way?” or “That’s just the way she is; what can you do?” Or is it none of these and something else entirely?”

I could have also included, “That’s just how it is; I’m all alone in this world,” “I must have done something wrong but I don’t know what?” or “I’m upset with myself for getting upset.” I base my speculations on what I’ve learned about Anton in previous sessions. By presenting alternatives—and not emphasizing one over another—I hope to increase the probability that he will base his response on his own sense of things and not on what he thinks I want him to say. I want to protect him from the weight of my authority and his own possible suggestibility.

When I ask partners about their feelings, I take into account, as Bernard Apfelbaum would put it, their relationship with themselves about these feelings—their feelings about their feelings. In some situations, Nate feels okay about his anger. He sees it as an understandable feeling a person can have. In other situations, he experiences it as a sign of weakness and immaturity. In other words, at some moments he feels okay about his anger and at some moments he doesn’t.

If I were to say, “I guess you’re angry,” and Nathan were in the feeling-okay-about-his anger state of mind, he’d answer something like, “You bet I am. I’m glad someone noticed.” If he were in the feeling-not-okay-about-his-anger state of mind, he’s likely to hear my comment as, “You’re angry and you shouldn’t be.”

To avoid Nate’s taking my “I guess you’re angry” as an accusation, I:

• Use a less charged term: “Are you feeling frustrated (or upset, exasperated, irritated, annoyed, or agitated)?”
• Or normalize his anger: “Do you feel angry? I think I might if I were in your situation.”
• Or list anger as an item in a multiple-choice question.

Dan: Nate, do you feel hurt, puzzled, disappointed, frustrated, angry, or something else entirely?

My unspoken message is, “There are a number of understandable reactions a person might have in your situation. Anger is one.” I’m trying to protect Nate from his shame-based way of viewing his anger so he’ll be able to think about it and so we’ll be able to talk about it. I’m trying to entitle him to his experience in the process of suggesting what it might be.

A multiple-choice question doesn’t have to have a lot of items. In many cases, two are enough, are all I can think of, or cover the logical possibilities.

• How much is that something you believe deep down and how much is it a speculation—something you’re not sure of at all?
• How much does that resonate and how much does that not resonate?

The multiple-choice allows me to recover from the sag in energy caused by partners’ “I don’t know;” prime the pump of their own thinking about the matter; introduce new ways of talking and thinking; and protect partners from their internalized culturally-based judgments, the weight of my authority, and their shame-based frame of mind. The multiple-choice question serves both as a revitalizing force and as a vehicle for making interpretations.