Why Understanding Context is the Key for Effective Therapy
Will Bratt
Do you ever have the feeling that something isn’t right in your life, but you can’t quite put your finger on what it is? Or maybe you know very well how things aren’t working, but you struggle to see why?
When people first sit down to with us to talk about the challenges they’re facing, it’s not uncommon for them to say, “I feel this way for no reason”, or “I don’t know why I feel this way…I just do”. When you feel stuck and are struggling to make sense of why that is, talking with a counsellor who can help you see the bigger picture can make a world of difference.
Why Context is Crucial
Reasons are important. For better or for worse, how we make sense of the problems we face directly informs how we deal with them.
Examples of this are clear throughout human history. Just look how far we’ve come in the field of medicine! For instance, have you ever heard of bloodletting (apologies to our squeamish readers)? This was a practice used over several thousand years to treat illnesses, which were thought to be caused by people having too much blood in their bodies. When people got sick, medical professionals would remove blood in attempts to restore equilibrium and good health.
If you’re alive in 2017 and have ever seen a doctor, you know that bloodletting is not considered a standard (or even remotely appropriate) practice. Instead, we treat illnesses with things like antibiotics, probiotics, vitamins, immune boosters, and specially developed interventions that directly target the problems our bodies face. Because we know more about the context surrounding particular ailments than we did 3000 years ago, we can address them more effectively in context-specific ways.
Why the Big Picture Can Be Hard to See
That’s all fine and good when it comes to issues around our physical health, but what about the kinds of problems people bring to counsellors like us? These are often issues that have more to do with emotions and experiences than the nuts and bolts mechanics of our bodies.
As social beings, the popular ideas of our societies and cultures inevitably make their way into our thought processes and lead us to think certain things about how we respond to our experiences. Here’s an example of how we see that in our work as Victoria BC counsellors:
After her health declined significantly over the course of several months, Sam’s mother was diagnosed with both cancer and an auto-immune disease. Sam found this profoundly upsetting, and put forth all the effort he could muster to support and care for his mom, as well as his father and sister who were also struggling with these developments. The weight of the situation was tremendous for Sam, and he experienced a decline in his appetite, more frequent moments of irritability with his partner, and wakefulness at night when he was trying to sleep. In counselling, he lamented that although this was the most difficult period he and his family have ever faced, these feelings were out of character for him, as he’s usually a happy and carefree person who rarely feels upset when the going gets tough. Coming in to counselling, Sam had the idea that his despair was unacceptable and invalid, which added another layer of distress to his situation.
Because no one lives outside the influence of culture, we have to consider how ideas about “appropriate” experiences and expressions of emotion inform someone like Sam’s understanding of their responses to what they’re dealing with.
Ideas that suggest “being strong” means not feeling profoundly upset when hardship strikes (or not showing that we’re upset when we are), or that we should just be able to “carry on like normal” can lead us to believe that there’s something wrong with how we’re feeling.
This places the emphasis on “fixing” our emotions rather than exploring what we need within the situation we’re dealing with. By doing this, the context surrounding our distress is made illegitimate and we’re left scratching our heads as to why we’re experiencing things this way.
The Cost of Easy Answers and Quick Fixes
Simple, individualistic explanations for why we struggle can be both appealing and troublesome. It can be easy to think about the issues people bring to counsellors, like feeling unhappy or experiencing a lot of worry, as problems of the mind. Period. Just like with Sam’s situation above, this leads us to see our responses to the adversity we face (like our emotions) as the parts that need fixing. We believe there’s more to it than that.
There’s a sea of information on the internet about how to address so-called problems of the mind, and more often than not that’s where people begin their journey of trying to make things better. “Strategies to not feel anxious” or “ways of not feeling depressed” can be really helpful in some practical ways, but they may not address the reasons behind the feelings you’re experiencing. In short, they look at the small picture – the emotion or behaviour – but not the bigger web of relationships between the emotion or behaviour and other important contextual factors.
Focusing on the small picture, and the small picture alone, can lead you to feeling more upset, frustrated, and discouraged that things aren’t improving despite your best efforts.
Focusing on Context Makes for More Effective Therapy
The field of psychotherapy has a long history of trying to get to the bottom of things as simply as possible. Over the decades, this has involved reducing the reasons for the problems we experience to singular origins. For example, someone might say they struggle with confidence because their parents never encouraged them enough, or they feel unhappy because their self-talk is negative. Period.
While it’s nice to have simple and straightforward answers to things, perspectives like these leave out more aspects of your experience than they actually take into consideration. They may be relevant pieces of the puzzle, but they probably don't account for the whole picture.
When people come to us, we find it really helpful to not just focus on their feelings, behaviours, or pain, but to expand the scope and explore their place in the tangible world they live in. We invite people to get out of their heads and into the broader realm of their experiences. One way we do this is by asking questions that go beyond your thought processes and feelings. You can read more about that here.
This is a good time to revisit Sam. If we were using a more traditional, less contextually-focused approach to our work, such as Cognitive Behavioural Therapy, we might guide him toward monitoring his thoughts and practicing private interventions when he notices himself feeling low or anxious. That would, in all likelihood, be helpful to some degree, but may also fall short at addressing other important aspects of Sam's situation.
A more contextually-focused approach, like Response-Based Practice, allows us to help in even more tangible ways. Here’s an example of what that might look like with Sam:
Asking Sam questions about how he’s managing the complex situation he and his family are facing:
“What do you worry about the most throughout the day: your mom’s health or your own responses to the situation?”
“What’s more stressful: not knowing whether your mom will be ok or trying to ‘hold it together’ for her, your dad, and your sister?”
“Who would you worry about the most if they were to know that this has been so hard for you to deal with?”
“Who do you imagine would worry most about you if they knew how much you were struggling?”
-Questions like these can shed light on Sam’s awareness of the social dynamics between himself and the others involved, and how he’s navigating those factors.
Asking Sam questions about the meaning behind his emotional responses:
“If your despair could speak for itself, what would it say about what your mom, dad, and sister mean to you?"
“What do your worries and fears say about the care you have for each person in your family?”
“Who in your life would be most concerned if you weren’t feeling much of anything about the situation at hand? Why would that be cause for concern?"
-Questions like these can clarify Sam’s values and show how the feelings he’s concerned about are expressions of love or care.
Offering questions that help identify Sam’s needs or longings behind his responses:
“If you could absolutely trust that someone in your life would be ok if they knew how hard things were for you right now, who would you want that to be?”
“How much pressure would be released if you knew you didn’t have to hide the extent to which you’re struggling on top of the worry about your mom?”
“What do you like most about being a support to the people you care about? Who in your life do you think would be most grateful for the opportunity to support you at this time? How would you let them know you value that support?”
-Questions like these can help reveal practical solutions that can actually make a tangible difference for Sam’s wellbeing.
Our hunch is that a conversation like this would help Sam go out on a limb and recruit more support for himself, thereby reducing the strain he feels from having to “be strong” in such an understandably difficult time.
Using Questions to Better Understand the Context Around Your Own Problems
We hope this gives you an idea of how response-based, context-focused questions can help draw your attention to pieces of the big picture that are totally relevant in understanding your struggle, but which are also often left unexplored.
You can use questions like these on your own to shed light on the big picture of struggles you face:
When did you first notice that things took/were taking a downward turn? What was different between this time and before things got bad?
Who noticed that things took a turn for you in this way? What was their response like? Did their response help or did things get worse for you after?
Is there anyone you’ve been careful to keep out of the loop regarding how you’re doing? Why is that? What difference does self-censorship around certain people make for how you’re doing?
Who is most worried about you and how do they let you know? What difference does their concern make in terms of how you’re doing?
If you could imagine removing or adding certain “key ingredients” (contextual factors) to make things better, what would those be? What difference do you imagine that making?
Are there any particular ways that you use to see the bigger picture of what you or others are dealing with?
If you think it could be helpful having these kinds of conversations, feel free to drop us a line.