Have you ever noticed that when one of your clients is in pain, they can tend to see their world in ‘all or nothing’ terms? For instance, you may hear them say something like:
I am in complete agony! If only I was free of this pain!
I am so miserable! Why can I never be happy?
And this feeling that pain, whether physical or emotional, is all-encompassing and never-ending can lead to hopelessness and helplessness.
But as therapists and counsellors, we are (usually) lucky enough not to be in the same state of agony. So we’re able to understand that little in life is black and white.
From outside of our clients’ situations, we can see that no one is completely in pain or completely pain-free all the time. And that even the most depressed person we’ve ever met had days or moments when they felt better than other times.
So, sometimes we need to help our clients find the shades of grey so they can benefit from and build on the more subtle improvements in their situation.
Fortunately, we have a simple but powerful solution-focused therapy technique at our disposal to do just that.
It’s called ‘scaling’.
The power of scaling
Using scaling in therapy or counselling is a way to help your client break down their perception of their situation into ‘grades’.
Doing this accomplishes three things:
- We ‘put a fence’ around the experience so it no longer feels limitless and uncontrollable. The client can begin to see it as more manageable and therefore more hopeful.
- We engage the observing self and help the client step ‘outside’ their experience. Scaling engages the ‘thinking brain’ and loosens the grip of the ’emotional brain’.
- We break down expectations and therapy strategy into discrete steps, rendering them more realistic and achievable.
Scaling (sometimes called grading) is effective in therapy because it switches the conversation from being ‘about’ emotions to being ‘about’ numbers – and this in itself can help people feel calmer.
This is an excerpt of a video demonstration from Uncommon Practitioners’ TV.
Here are 3 solution focused questions which use scaling to help your clients find hope in their situation.
1) “So on a scale of 1 to 10…?”
So, when working with a client who is experiencing severe prolonged pain, I might say:
Okay, so if 10 is the most unbearable agony possible and 1 is the most blissful comfort, what number would you put yourself on right now?
You might notice here how we’ve instantly reframed ‘pain’ as ‘numbers’. (I’ve personally found there’s usually no need to belabour this point – people instinctively understand how to rate their pain and feelings.)
Of course, they might straightaway say, “10!” Or perhaps they’ll think about it for a bit and judge that, well, they have actually felt worse pain than this, so they’ll grade their current experience with, for example, an 8.
So now they have gone from being ‘in complete agony’ to being at 8 on a scale of 1 to 10.
I might then ask how they are going to know when the discomfort level has decreased to a 7…
This approach can work equally well with problem states other than physical pain. And you can set your scale up in either direction, depending on where you want to lay the emphasis or whether you want to increase or decrease the perceived response:
If 1 is the most depressed you’ve ever felt and 10 is the happiest…?
Okay, if 10 is the most anxious and 1 is the most relaxed…?
2) Ask questions that precipitate change
Now, it’s not enough just to get these numbers. We can use these numbers to really help our clients start to think more flexibly and feel hope in the immediate future.
Once we have started to break down the ‘all or nothing’ perception by using numbers, we can ask questions that presuppose (and possibly even precipitate) positive change.
I recall asking a man in chronic pain to tell me how he would know when his pain had gone down from a 7 to a 6. What difference would he notice?
He described the exact difference to me in great detail and actually found himself “slipping down to a 5!” as he was speaking.
If someone tells me that on Tuesday they felt they were at 4 on a depression scale (where 10 was the happiest they could be), I might ask something like:
Think really carefully now. What prevented you from being a 3?
Or if someone tells me their motivation to quit smoking is at 8 when 10 indicates that they are fully motivated and committed to stop, I might ask something like:
And what would you need to be different so you’re able to get up to that 10?
Careful targeting of such questions helps us find out what they’re already doing that helps them cope better or what they need to do differently. We can then encourage those behaviours. Similarly, we can ask what will it be like when they are at a 5 and so forth.
3) Don’t just ask questions about numbers
We can also keep in mind that scaling doesn’t have to be limited to numbers. For some people, a more visual approach might work better.
You could write out numbers on a piece of paper to create a visual scale, but you can also leave numbers behind altogether.
For instance, I keep a large picture of a staircase that I can use at a moment’s notice. I might show my client the picture and say:
If the bottom of the staircase is ‘no motivation whatsoever’ and the top of the stairs is ‘unstoppable motivation’, can you point to the step you’re on right now?
Or if I don’t have pictures to hand, I might use hypnosis to get the person to visualize a path or staircase and simply tell me where they are on it. I can then encourage them to hypnotically explore the progressively positive steps forward.
I hope this helps you to see that scaling can be a simple yet formidable tool in therapy for giving your clients a new perspective on their difficulties. With this tool in hand, clients often feel a new sense of control and empowered to make changes they may never have believed possible.
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