Good Clinical Questions Receive Quality Answers

May 6th, 2010 | Posted by Michael Taleff in Addiction | Alcohol Addiction

Many people in our field will try to convince you that you need the most modern research data, more experience, or the latest greatest treatment to help your clients. While they certainly help, all have limits.


Yes, for example, research as it is most often conducted gives you good information on groups. The results will often present conclusions on the stage of change for a sample of clients, the average AA attendance rate for a sample of clients, or the average depression index for another sample. Sometimes authors try to extrapolate such findings into clinical suggestions on what to do with sampled information. The problem is such research does not give you clear information on what to do with the client sitting in your office. Essentially, general research lays claim for what works well for groups of clients that may not work for your specific guy. Most all evidence based research around today usually has that problem.

As to experience, it certainly carries array of skills and knowledge, but it also carries years of short-sided heuristics and overconfidence bias, among other short-comings. It needs to be said. Experience contains both positives and negatives, and it should not be the final trump card on any clinical decision.

Finally, no addiction treatment today has ever demonstrated that it is head and shoulders above any other in terms of effectiveness. Period.

So, what happens when you hit these limits? Well, most of us just plug away with the limitations. We generally stick with what we know and bang away with a treatment even in the face of repeated failure. Sometime in frustration we grab onto something just because it is “evidence based” or some authority says it works.

Yet, what is the dedicated addiction counselor to do?

A suggestion – ask questions, especially clinical questions. Like:
• What is the best treatment for this client?
• I’m providing what the research says works, but why
isn’t it working?
• What am I not seeing that is important in this case?
• What question am I not asking that may help me?

Many in the addiction field don’t often ask such questions. They just want answers. Yes, you need answers, but the way to get them is to ask high quality questions. Such queries push at you to find the answers you really need, and won’t relent until you find the good ones. Questions make you think, answers don’t.

Consider the question and the variety of answers they provide as clues along a clinical trail that leads you to what really works. This question-answer combination might get to you see clinical options not available from research, experience, or standard treatments.

While some people just want answers, questions keep your eyes open to possibilities, and that’s what you want to give your client.

Bear that in mind for the next stubborn, hard-headed, “resistant” client in treatment whom you run into. Slow down a bit on your formulations and theories, particularly the quick, snap-judgment ones. They stifle possibilities.

When it comes to our clients we want new ideas, and asking endless, beautiful questions will give them to you.

And for what it’s worth, asking endless questions might be the germ of workshop idea. The addiction field, it could be argued, does not have question mind set. Teaching addiction professionals how to ask important questions may well enhance our practice and advance our field.

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