One moment, many approaches

Notice the prediction and what avoidance prevents the person from learning.

You might say: “What do you predict will happen, and what small step could help us learn more?”

Grounding: Cognitive Behavior Therapy: Basics and Beyond, 3rd ed. (opens in a new tab); The Case Formulation Approach to Cognitive-Behavior Therapy (opens in a new tab)

Wonder what feeling becomes difficult when the conversation comes close.

You might say: “When you imagine saying it, what feeling appears, and what helps you move away from it?”

Grounding: That Was Then, This Is Now: Psychoanalytic Psychotherapy for the Rest of Us (opens in a new tab); Long-Term Psychodynamic Psychotherapy: A Basic Text, 3rd ed. (opens in a new tab); Deliberate Practice in Psychodynamic Psychotherapy (opens in a new tab)

Explore a chosen direction alongside the discomfort.

You might say: “If the anxiety could come with you, what would you want your next step to stand for?”

Grounding: Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. (opens in a new tab)

Listen for reasons on both sides without taking the choice away.

You might say: “You want to protect the relationship, and you also want something to change. What feels most important?”

Grounding: Motivational Interviewing: Helping People Change and Grow, 4th ed. (opens in a new tab)

Separate a particular event from a global conclusion.

You might say: “What happened this time, and what supports or complicates the conclusion about all of you?”

Grounding: Cognitive Behavior Therapy: Basics and Beyond, 3rd ed. (opens in a new tab); The Case Formulation Approach to Cognitive-Behavior Therapy (opens in a new tab)

Explore the demand for perfection and the global judgment.

You might say: “Could doing something badly mean it went badly, without deciding your worth as a person?”

Grounding: New Directions in Rational Emotive Behaviour Therapy (opens in a new tab); Deliberate Practice in Rational Emotive Behavior Therapy (opens in a new tab)

Notice the harsh critical state and its effect.

You might say: “What happens inside when that critical voice takes over?”

Grounding: Schema Therapy: A Practitioner’s Guide (opens in a new tab); Cambridge Guide to Schema Therapy (opens in a new tab)

Stay with how painful the experience is to this person.

You might say: “It sounds as though one mistake leaves you feeling that all of you is unacceptable. Have I understood?”

Grounding: Person-Centered Psychotherapies, 2nd ed. (opens in a new tab); The necessary and sufficient conditions of therapeutic personality change. (opens in a new tab)

Understand both the immediate benefit and the wish for change.

You might say: “It helps you get through, and part of you wants something different. Tell me about both.”

Grounding: Motivational Interviewing: Helping People Change and Grow, 4th ed. (opens in a new tab)

Ask about short-term relief and the longer direction of life.

You might say: “What does this help you avoid, and how does it fit with the life you want?”

Grounding: Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. (opens in a new tab)

Validate the difficulty and examine the sequence before problem solving.

You might say: “Let us understand what happens before the evening gets difficult and what follows.”

Grounding: DBT Skills Training Manual, Revised Edition (opens in a new tab); Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis (opens in a new tab)

Explore what becomes more bearable through the protective response.

You might say: “What feeling is hardest to be with at that time, if any?”

Grounding: That Was Then, This Is Now: Psychoanalytic Psychotherapy for the Rest of Us (opens in a new tab); Long-Term Psychodynamic Psychotherapy: A Basic Text, 3rd ed. (opens in a new tab); Deliberate Practice in Psychodynamic Psychotherapy (opens in a new tab)

Track an escalating cycle and the vulnerable concerns underneath.

You might say: “As one of you pulls away and the other pushes harder, what does each of you fear is happening?”

Grounding: The Practice of Emotionally Focused Couple Therapy: Creating Connection, 3rd ed. (opens in a new tab); Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families (opens in a new tab)

Follow reciprocal responses without choosing a culprit.

You might say: “What happens just before the pulling away, and how does each next response affect the other?”

Grounding: Handbook of Family Therapy: The Science and Practice of Working With Families and Couples (opens in a new tab); Becoming an Effective Family Therapist: Research, Practice, and Case Stories (opens in a new tab)

Reconstruct a specific exchange and explore communication options.

You might say: “Could we go through the last conversation, using the words each of you actually said?”

Grounding: The Guide to Interpersonal Psychotherapy: Updated and Expanded Edition (opens in a new tab)

Include circumstances, expectations, and power in the account.

You might say: “Are there expectations or pressures around this relationship that we have not understood?”

Grounding: Cultural Humility: Engaging Diverse Identities in Therapy, 2nd ed. (opens in a new tab); Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality (opens in a new tab)

Acknowledge the real lapse before exploring an expectation or pattern.

You might say: “I did start late, and that mattered. What was it like to tell me you were hurt?”

Grounding: That Was Then, This Is Now: Psychoanalytic Psychotherapy for the Rest of Us (opens in a new tab); Long-Term Psychodynamic Psychotherapy: A Basic Text, 3rd ed. (opens in a new tab); Deliberate Practice in Psychodynamic Psychotherapy (opens in a new tab)

Hear the experience without explaining it away.

You might say: “You were hurt, and saying so here took something. I want to understand.”

Grounding: Person-Centered Psychotherapies, 2nd ed. (opens in a new tab); The necessary and sufficient conditions of therapeutic personality change. (opens in a new tab)

Treat the relationship strain as important feedback about the work.

You might say: “Thank you for telling me. What did the delay mean to you, and what should we change?”

Grounding: Cognitive Behavior Therapy: Basics and Beyond, 3rd ed. (opens in a new tab); The Case Formulation Approach to Cognitive-Behavior Therapy (opens in a new tab)

Stay in contact with the feeling and its meaning.

You might say: “As you say you were hurt, what part of that experience feels most important now?”

Grounding: Learning Emotion-Focused Therapy: A Comprehensive Guide, 2nd ed. (opens in a new tab); Deliberate Practice in Emotion-Focused Therapy (opens in a new tab)

Help make a preferred change visible in everyday detail.

You might say: “What is one small thing you might notice tomorrow if things were a little better?”

Grounding: Solution Focused Therapy Treatment Manual for Working with Individuals, 3rd ed. (opens in a new tab); Solution Focused Brief Therapy: 100 Key Points and Techniques (opens in a new tab)

Explore a direction that matters rather than a perfect outcome.

You might say: “What would you want your actions to express, even on a difficult day?”

Grounding: Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. (opens in a new tab)

Negotiate a specific, manageable goal.

You might say: “Which part of your week would be most useful to work on first?”

Grounding: Cognitive Behavior Therapy: Basics and Beyond, 3rd ed. (opens in a new tab); The Case Formulation Approach to Cognitive-Behavior Therapy (opens in a new tab)

Ask about a relationship change and the support it could bring.

You might say: “Is there a relationship in which a small change might make the week easier?”

Grounding: The Guide to Interpersonal Psychotherapy: Updated and Expanded Edition (opens in a new tab)

Understand the behavior sequence and the parent’s emotional experience.

You might say: “What usually happens before the refusal, and what happens for you just before shouting?”

Grounding: Handbook of Behavioral Parent Training (opens in a new tab); Deliberate Practice in Behavioral Parent Training (opens in a new tab)

Explore the interaction around the event and how others respond.

You might say: “Who does what next, and how does that change the situation?”

Grounding: Handbook of Family Therapy: The Science and Practice of Working With Families and Couples (opens in a new tab); Becoming an Effective Family Therapist: Research, Practice, and Case Stories (opens in a new tab)

Keep the young person’s developmental perspective in view.

You might say: “What might your child be trying to tell you or manage in that moment?”

Grounding: Deliberate Practice in Child and Adolescent Psychotherapy (opens in a new tab); Evidence-Based Psychotherapies for Children and Adolescents, 3rd ed. (opens in a new tab)

Include strain, resources, and expectations rather than locating every difficulty within a parent.

You might say: “What pressures and supports shape these evenings for your family?”

Grounding: Cultural Humility: Engaging Diverse Identities in Therapy, 2nd ed. (opens in a new tab); Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality (opens in a new tab)

Track the change and attend to anxiety before deepening.

You might say: “Something changed just then. Shall we slow down and notice what feels manageable?”

Grounding: Undoing Aloneness and the Transformation of Suffering Into Flourishing: AEDP 2.0 (opens in a new tab)

Wonder about a protective move without deciding what it means.

You might say: “Going blank may be doing something protective. What was happening just before it?”

Grounding: That Was Then, This Is Now: Psychoanalytic Psychotherapy for the Rest of Us (opens in a new tab); Long-Term Psychodynamic Psychotherapy: A Basic Text, 3rd ed. (opens in a new tab); Deliberate Practice in Psychodynamic Psychotherapy (opens in a new tab)

Invite awareness of present experience without imposing an interpretation.

You might say: “As you notice going blank now, what else do you notice, if anything?”

Grounding: Skills in Gestalt Counselling & Psychotherapy, 5th ed. (opens in a new tab); The Relational Attitude in Gestalt Therapy Theory and Practice (opens in a new tab); The Paradoxical Theory of Change (opens in a new tab)

Stay connected while respecting the person’s capacity to remain present.

You might say: “We do not need to push through this. What would help us stay with it gently, or pause?”

Grounding: Learning Emotion-Focused Therapy: A Comprehensive Guide, 2nd ed. (opens in a new tab); Deliberate Practice in Emotion-Focused Therapy (opens in a new tab)