In traditional talk therapy, the skill of questioning is one of the most important. When exploring somatic expression, the therapist needs to ask good questions to decipher what the body is physically communicating. We teach two types of questions in our basic skills class: open-ended and closed questions. Open-ended questions invite the client to talk more, and closed questions can usually be answered with one word. Since this phase of creative play therapy is more directive and talk based, you will likely use both, but the best therapists use this kind of questioning strategically.
Skill: Open-Ended Questions
When you want to facilitate the client's free, uncensored thoughts, ask open-ended questions. These usually begin with what and how, such as, "What sensations did you notice?" or, "How does that feeling in your stomach physically feel?"
Open-ended questions are broad, and do not solicit specific types of information. They are helpful for gaining an overview and lots of pieces of information. Clients can answer these in multiple ways, and they generally talk in paragraphs when answering. Sometimes they require the client to think more deeply. Usually, we encourage students learning to become helpers to mostly ask open-ended questions, but there are times when closed questions are more strategic.
Helpful Open-Ended Questions to Understand Somatic Expression
- • Help me understand that better. What is it like for you?
- • How would you describe that feeling?
- • If you were describing this as a symptom to a medical doctor, how you explain it?
- • What does it physically feel like?
- • When else have you felt this sensation?
- • What does [a descriptive phrase the client used] mean to you?
- • If this sensation had words, what would it be saying to you?
Skill: Closed Questions
When you want more specifics or a quick clarification, use closed questions. Closed questions require only a one or two-word response, such as a yes/no question or an either/or question. Closed questions are often used during intake interviews when you need specific information quickly without too many details. Closed questions also help provide clarification without expounding on a tangent.
In questioning about somatic symptoms, closed questions can be used to help clarify exactly what type of sensation the client is describing with a yes/no question such as, “Is it a painful feeling?” or an either/or question, such as, “Is it a sharp pain or a dull pain?” Sometimes, it is helpful to ask about the color or temperature of the sensation, which is not usually something the client would think to describe. That, too, is a strategic closed question that can be answered with a brief response.
You want to ask enough questions about the sensation to be able to nearly feel it yourself. If a client feels nauseous, is it a roiling feeling in the gastrointestinal area, a clenching of the stomach or an expanded gaseous feeling in the tummy? All may be described as nauseous, but it helps you to understand what the body is communicating. It is significant whether it is expanding (feeling bigger) or contracting (feeling smaller), as one may seem to demand to be noticed and one may seem to try to stay hidden and contained.
Of course, sometimes clients will provide more than one word to answer a closed question. They may provide more details or have an insight, and that is fine. The purpose is not to limit their answers in this phase, but to expedite the process.
Helpful Closed Questions to Understand Somatic Expression
- • On a scale from 1 to 10, with 1 being low and 10 high, how would you rate the intensity of this feeling?
- • On a scale from 1 to 10, how would you rate the discomfort of this feeling?
- • Is it hot or cold?
- • What color is it?
- • Is it soft or hard?
- • Does it have a sound?
- • Does it have a smell?
- • Is there movement with this sensation?
- • Do you feel it on both sides of your body or just one side?
Physical Feelings and Metaphors
Some clients will naturally use a metaphor to explain somatic sensations. A metaphor (Metaphor, 2019) is a figure of speech where figurative language symbolically represents another thing, such as being so mad that you are a volcano about to explode. While not every client will use this literary device, when clients do, you can expand the metaphor by using related vocabulary, client phrasing and visual images to enhance understanding for both you and your client. Below is an example. Notice the open and closed questions as you read.
Therapist: Help me understand that better. What does the ache in your
head feel like?
Client: I don’t know exactly. It hurts.
Therapist: It hurts. What does that mean to you?
Client: It feels kind of like an oil well pumping and drilling down into
Therapist: So, it’s like an oil well. Rhythmic, up and down, but not
Client: Exactly. It’s a constant up and down feeling.
Therapist: What does the up part feel like?
Client: It feels like anxiety. I know the drilling down is coming, but
there is a slight pause first.
Therapist: The up part feels like anxious anticipation. What about the
Client: That’s when it drills down into my head telling me that I’m
not good enough, that I deserve all this.
Therapist: So the down part has a voice.
Client: Yeah, and it’s relentless.
Therapist: A relentless voice. What does that relentless voice sound like?
Client: It sounds like my Dad’s voice.
Therapist: Your Dad’s voice drills down in your head telling you that
you aren’t good enough, that you deserve this. Sometimes, there is a pause, but even in the pause, you get anxious, knowing that it’s just a matter of time until it starts drilling down again and again.
Skill: Empathic Listening without Judgment
Empathic listening is important throughout Creative Play Therapy, but the somatic expression phase may feel the riskiest for the client. If a client tends to have somatic symptoms, the body's way of physically communicating, it is likely that at some point he or she has been told that "It is all in your head," or "Just ignore it" or other insensitive and unhelpful messages, especially if the client has been to a medical professional and test results indicated that nothing was physically wrong. There may be a history with shame and embarrassment. For some clients, the physical sensations may be very disconnected from core needs and past trauma that the somatic symptoms are communicating about and thus seem to be unrelated to why they came to see you. If the client is skeptical, acknowledge the skepticism. If a client is hesitant, be willing to go slowly. If a client has strong physical reactions, look for ways to include physical movement in the healing process.