Egyptisch paneel — Egyptian Panel in Hermitage Museum, St Petersburg. Photo Eva de Hullu

The Method of Levels: helping clients without getting in their way

This is a translation of the text “Welke vraag zal ik stellen?” by Ger Schurink, originally posted 17/01/2020 under a creative commons CC BY NC licence on Methodoflevels.nl, when that site was maintained by Eva de Hullu. This is a translation with slight adaptations (replaced “I” by “Ger Schurink”) by Eva de Hullu, shared here for the purpose of international training in MOL.

Preface

Which question to ask without getting in the way? is a part of the Introduction to the Method of Levels that Ger Schurink wrote between 2016 and 2018 for his Dutch MOL courses.

This manual is part of that compilation and gives many examples of the type of questions you can ask in an MOL conversation. Just mixing good ingredients doesn’t make a good chef or a nutritious and healthy dish. It takes a lot more than that: above all, you need to understand exactly what it’s all about and always keep an eye on whether you’re still doing the right thing. To start with, you need knowledge of the MOL and the Perceptual Control Theory. Explaining this is beyond the scope of this text. but see for example Carey, T. A., Mansell, W., Tai, S., Mansell, W., & Tai, S. (2015). Principles-Based Counselling and Psychotherapy: A Method of Levels approach.

The practice: the start of an MOL session

The Method of Levels (MOL) is a transdiagnostic therapy that states that psychological problems are solved by clients becoming aware of how and why feelings, thoughts and behaviour conflict with important views or goals. The therapist has only two important tasks: to help the client stay focused on the subject and by asking questions in case of disruptions in the conversation.

The aim of the therapist is not to understand what is going on or to empathically support, advise or explain. The therapist constantly asks curious questions in response to what he hears the client say or do at that moment and focuses on what is going on in the client. He goes into detail with questions about a particular word that is used or relating to body language. The therapist assumes that he does not know exactly what his client means and asks ‘naive’ and sometimes strange questions. His goal is to use his questions and his involvement to help the client to get a clear view for himself. The therapist constantly says with his questions: think about this; look at this; what does it evoke; let that get through to you. Attention is constantly focused on an aspect of the emotional problem in the here and now.

An example:

Therapist: What would you like to discuss with me today?

Client: I’m getting cold feet about my the threat of dismissal.

Possible MOL questions are:

Dismissal?
Threat?
Very upset?
Threat of dismissal?
What makes you upset?
Do you feel very upset right now?
How big is the threat?
Can you tell me a little more about the threat of dismissal?
Do you mind being fired?
How do you feel about the threat right now?
Do you feel it especially in your feet?
How cold are your feet right now?
Do you feel the threat in other places?
What does it do to you now that you’re saying it out loud?
Can you get your feet warm again?

The questions listed above are questions that can help you on your way. You’re not supposed to ask these questions in this order or any other order. The other examples below are also given for inspiration so that you can get a sense of how the Method of Levels works in practice.

After receiving an answer, you ask new questions, sometimes preceded by a short summary or explanation. You pay special attention to disruptions and evaluative remarks. A disruption can be: a pause, looking away, smiling, crying, shaking your head, speaking with more volume, talking faster, or just softer and slower. An evaluative comment is commenting on oneself or something they say like: it’s ridiculous, I don’t remember, it’s stupid of me, and so on.

Just before you start: thoughts to hold

People themselves have the knowledge to solve their psychological distress
I help them to focus their attention so that they get to the pain and see and feel everything clearer.
I offer them space so they can express themselves safely and freely and I don’t get in their way with my own concerns.
If everything is allowed to be there and gets enough attention a recovery process will start.
My client decides what he/she wants to talk about.
I ask questions and only give advice, an opinion or explanation if someone really can’t come up with it themselves.
I am alert to myself and do nothing out of personal motives, my ‘I’ is not decisive here.
In case of non-verbal disruptions and in case of evaluative remarks I ask questions.
I help the client to stay with the direct experience at this moment.
I help my client to stay focused on the subject.
During and at the end of the conversation I ask for feedback.

Questions at the start of an MOL conversation

What do you want to talk to me about?
What do you want to talk to me about today?
What are we going to do today?
What’s our topic for today?
Which topics are important to discuss now?
What’s on your mind at the moment?
Which topic should we focus on?
What would you like help with?
How can I help you?

If there is stagnation at the start

The client doesn’t know and says, for example, “I have no idea!”

What makes you having no idea?
Was there an idea first and now there isn’t?
What’s it like not having an idea now?
Where have the ideas gone?

If there are many problems/subjects: “I don’t know where to start.”

How does it feel not knowing where to start?
What goes through your mind right now when you think about this?
What starting points are there?
How many problems are there right now?
What do you see in front of you right now?

If the client asks for advice on the choice of a theme: “Which topic should I choose?”

Do you already know what you would like to do with an advice?
What makes this question come to mind?
What kind of advice would help you right now?
If you see your choices now in front of you, what does that do to you?

Questioning nonverbal disruptions

Disruptions are often visible when important thoughts in the background briefly enter awareness. Nonverbal disruptions are the changes you see and hear in your clients, in their voice, facial expression, attitude and behaviour. The speed and ease with which they talk can change, as well as the volume. There are hesitations, silences, hiccups. Someone wobbles with a foot or fidgets with their fingers, frown, looks away, shakes their head, smiles, stiffens, sighs or gets a colour. These are the (non)verbal additions to the flow of words. They are ripples, the small and larger waves in the course of the conversation because of something that is stirring just at or under the surface.

Questions in case of nonverbal disruptions

What occurred to you when you stopped talking just now?
Why are you shaking your head?
What makes you laugh?
You tell me this and start frowning.
I can tell you’re talking louder when you talk about this.
You take a pause?
What’s going on inside you right now?
Why do you stop talking for a second?
What happens now?
Can you tell me about the silence that just fell?
Did something go through your mind when you were sitting there so still?
What makes you hesitate?
You’re hesitating… what’s coming up?
What makes you smile for a moment?
You talk cautiously; why…?
You have tears in your eyes; what makes you sad?
What’s going on in your head/inside of you?
What do you realize right now?
I have the impression that you’re getting more and more tense…why?
What thoughts are there with this silence / smile / hesitation?
Tell me…where does that sigh come from?

If you have asked such a question, ask two or three more follow-up questions about it, which will keep your client’s attention focused on this area for longer than would otherwise be the case.

If it’s a dead end, you say, okay, let’s pick up the trail. Where are we? Or: This was just a side-track, where do we pick up the thread again?

Ask questions in case of verbal disruptions

Disruptions are not only visible in the changes you see and hear in your clients, in their voice, facial expression and posture. Evaluative comments and special words can also be a sign of important background thoughts on which you can focus the light of attention. People often comment on or value their own behaviour. These are comments with which they assess their own situation from a distance, as it were. For example:

I need to stop complaining / whining / worrying .
You must think he is crazy!
What I am saying now is not quite accurate.
Stupid. I’m 47 years old now and I’m still dealing with this.
I’ll never learn!
It’s my own stupid fault!
I don’t want to think about this at all!
I don’t want to think about losing him!
I’ve made a mess of it.

Questions about verbal disruptions

What makes you say or think that?
What do you think about that… (fill in the comment)?
How does it feel to say this right now?
What do you realize right now?
How stupid is your guilt?
What does “making a mess of it” look like?
What happens when you hear yourself saying this?
What does it do to you that you blame yourself?
What do you want to think about right now?
What do you think when you think about losing him?
How do you feel when you think about losing him?
How do you feel right now, now that you’re telling me this?
Is this what you’re thinking about all the time or is something else happening in your life?

Asking questions when very little seems to be happening

Smalltalk, a superficial conversation about this and that is useful as relaxation, to get used to each other or to keep the conversation light. It can also be a way to keep painful things at a distance and that’s not the intention in MOL conversations.

You can intervene if the conversation has been somewhat flat for a while and there are few or no disruptions. You can then ask a question about the here and now such as:

What’s it like to tell it all this way?
What is your opinion of the events you have been going through?
What else comes to mind when you think about this?
What is the connection between what you’re telling me now and the problems you’re facing?
What do you notice when you talk about these things to me?
What do you think about the very experiences you have just described?
How do the things you say resonate in your own ears?
You tell a lot about xyz, why is that?

Painful things to avoid?

Sometimes you get the impression that somebody is beating about the bush. Asking about it can help.

Do you doubt if you want to talk about anything?
What happens when you do talk about it?
Is there something you don’t want to talk about?
Are you hesitating to discuss something with me?
Are you holding something back?
May I suggest something to you? Is it possible you’d like to keep the conversation a little light-hearted?

I don’t know!

Suppose someone sits across from you and says: I just don’t know where to start. Then you could say:

You don’t know?
Is there anything that prevents you from starting?
Do you have several things in your head but you don’t know which one to choose?
Is there too much to choose from, or is there nothing at all?
What’s going on in your head right now?
Tell me about not knowing where to start.
What’s the feeling of “I don’t know where to start”?
How do you know when you can start?

It also happens that at the start of the conversation someone has no topics to discuss with the counsellor. The appointment was already there and the client showed up obligatorily.

There is no point in looking for a subject to fill in the time. Then you can end the conversation in agreement with the option for a new appointment if that is appropriate.

Sometimes in the course of a conversation the energy is running out or it has cost your client so much that the concentration suffers severely. Again: discuss this and if necessary pick a new date.

Ask questions when it’s cool and distant

It is of course confronting to think intensively about problems: it hurts. Moreover, people often think they have to talk about the past because their problems arose in the past. Or if they anticipate something, that they should talk about something in the future. They also expect to tell the small details so that the story is complete and a solution can be found. Counsellors and psychotherapists are also partly themselves to blame for chatting because they generally start therapy sessions with informing about how things have been over the previous period. Too broad questions or compassionate reactions can also cause clients to lose their way.

As soon as the conversation is about something other than feelings and thoughts in this moment or if it is a ‘cold’ conversation, it is important to bring the attention back to the ‘pain’ in the here-and-now and make it ‘warm’. You can’t make an omelet without breaking a few eggs.

Questions when it is cool and intellectual:

What do you experience in this moment talking about it?
What is it like to see the future in front of you like this?
What happens to you now you have these memories?
How do you feel right now?
And what do you find especially annoying about it now?
What does this trigger in you right now?
What happens to you when you hear yourself tell this?
How do you feel when you talk about xyz like that?
What thoughts do you have about these events?
What else comes to the surface when you think about this?
What is the connection between what you are telling now and the problems you are facing?
What is going on in the back of your mind when you talk to me about these things?
What do you personally think about the experiences you have just described?
How do the things you say resonate in your own ears?
You tell a lot about xyz, what does this evoke?

It is an essential part of effective therapy to let clients talk about the things they would rather not talk about and to let them focus on suffering in the present moment. Holding on to this task can be as uncomfortable and unusual for the counsellor as it is for the person who needs help. Sticking to the basic principle that it is about feelings and thoughts in the present moment can help.

In a nutshell; if you want to make your conversations with clients as effective as possible, you can do the next:

For starters, do not ask questions that are an invitation to tell (long) stories.
As soon as the conversation is about the past or the future, return the focus on the experiences in this moment.
Is it distant and cool? Then make it more personal and warm.
Pay attention to (non-)verbal behaviour that reveals that feelings are stirring in the background. Bring these to the front by focusing attention on them: I can see that you’re hesitating / looking away / being stressed; what happens now?
Do you have the impression that someone is avoiding a painful subject? Asking about it might help: Do you have any doubts about something you want to talk about?.Is there something that takes a lot of effort to discuss? Or are you trying to hold something back?

Ask for feedback on the conversation

In MOL conversations , you can ask for feedback during and after a session, especially during the first session(s). This is also desirable if you have the impression that the conversation is not proceeding as well as it should. This gives the client the opportunity to help you make some adjustments.

In an MOL conversation, ask one or more times how your client is experiencing the conversation.

Some examples of questions for feedback during a session:

How do you feel that the conversation is going?
How do you feel about talking about your problems in this way?
How are you doing right now?
Do you have any suggestions for me, so I can help you as best I can?
Are there any things you think I should do differently?
What are the most important things I’ve said or done that helped you?
What was particularly important for you in this conversation?

Don’t accept meaningless socially desirable answers such as: fine. Then continue asking. Example. T: What did you like? C: That I could talk openly. T: What’s the good about being able to talk freely? Or: What is the good of being able to say out loud what you can’t say normally? You could also ask: Are there any other issues you would like to talk freely about? Or: What else can I do or do to help you talk as openly as can be?

Ask for feedback from your client at the end of an MOL session

Examples of questions at the end of each session:

What in particular helped you in this conversation?
Is there anything you would like to do differently next time?
Did something happen during this session that was not that good?
Maybe there are things that I need to do differently, that I need to do more or not that much?
Do you have any helpful advice for the chef, like you can have after dinner in a restaurant?

It is sometimes better not to inquire at the end of a session and let it take its natural course. Occasionally the pace of a conversation is too fast or too slow, or the client feels that the subject he would like to talk about hasn’t really been addressed.The feedback about this helps to determine the approach for the rest of the session or the next session.

A follow-up appointment?

Do you want a new appointment? With “no” you can inform your client that they can contact you again as soon as they would like to. With “yes” you can ask when he/she would like a new appointment. You can also state that your client can cancel this appointment again or move to a later moment. This will give your clients as much control as possible. Occasionally you have to mention your options and the available options within the organisation.