125Additional “gold standard” types of questions to consider used throughout the
session are as follows: “Please tell me more.” “Please give me an example.” “What
are you thinking about right now?” and “What are you feeling right now?” These
questions may be particularly helpful for quiet patients and/or patients who are
speaking in generalities.
Questions to Avoid Asking
As we mentioned earlier, one type of question you generally should avoid is “Why?”
questions. “Why” questions ask for a rational explanation of a person’s behaviors,
thoughts, or feelings. As such, they imply the person is reacting rationally. In reality,
a great deal of human behavior is based on irrational, unplanned, and unconscious
forces or is due to habit or ritual; your patient will probably make up a reason, when
there isn’t a rational one (Krueger and Casey 2014 ). Furthermore, why questions
imply judgment (e.g., “Why didn’t you talk to your doctor about having the test?”),
and the patient may become defensive, feel guilty, or be offended (Geldard and
Anderson 1989 ; Hill 2014 ). Any response to this type of question will be a rational-
ization or excuse (e.g., “Well, I didn’t have the time to call and schedule an appoint-
ment with her”) (Geldard and Anderson 1989 ). Asking your patient, “‘Why do you
feel that way?’ can’t be answered, doesn’t go anywhere, and may well make your
patient defend himself...If a why question is necessary, we find that the client feels
better if you tell him why you are asking him why...” (Fine and Glasser 1996 , p. 69)
(e.g., I’m asking you why you didn’t have prenatal testing done because it might
relate to your decision about this pregnancy). You can try to rephrase why questions,
for example, “Could you tell me about your decision not to talk to your doctor about
having the test?” Be aware, however, that rephrased questions may still sound
judgmental.
5.2 Other Considerations
Goodenberger et al. ( 2015 ) present several hypothetical scenarios illustrating the
importance of psychosocial counseling skills, including questions, used by genetic
counselors working in diagnostic laboratories. For example, when speaking with
physicians, genetic counselors would use “open and closed-ended questions...to
gather information. The counselor initiates the information gathering part of the
interaction by stating her reason for calling. This statement sets the expectation for
the call and provides the physician (her client) with something to react and respond
to... [An open question] allows the counselor to not only gain an understanding of
why the test was ordered but also to assess whether the physician is aware that the
test could be uninformative. Subsequently, by asking closed-ended questions about
the patient’s symptoms, age, and father’s diagnosis, the genetic counselor relieves
the physician of the responsibility of interpreting what information is relevant to the
counselor” (p. 8). Similarly, when counseling patients about how to obtain
5.2 Other Considerations