Presentation at Therapeutic Conversations #10 by Karl Tomm MD 12 May 2012

1. Expanding the Interventive Interviewing Framework with Contextual Questions, Meta-questions, and Enhanced Awareness Presentation at Therapeutic Conversations #10 by Karl Tomm MD 12 May 2012

2. The original model of Interventive Interviewing (Karl Tomm 1987 & 1988) Linear assumptions Lineal questions Strategic questions Influencing intent Orienting intent Circular questions Reflexive questions Circular assumptions

3. Interventive Interviewing in transition (Carsten Hornstrup et al 2005)Considerations for introducing some changes: • Despite the usefulness of the original framework, when applied in organizational coaching, the differences from therapy justified some adjustments • Strategic questions were re-labeled “action clarifying questions” to render them more acceptable and useful in organizational practice • Both past and future oriented (lineal) questions could be regarded as clarifying the client’s understanding of the present situation • The juxtaposition of contrasting theoretical paradigms that was inherent in the original framework gradually became apparent (objectivity vs constructionism) • If the whole framework was placed within a constructionist perspective, all four quadrants could yield useful systemic questions (the lineal vs circular dimension was no longer necessary when interviewers were embedded in constructionist thinking) • Contextual and meta questions, inspired by Bateson’s theory of mind, were increasingly included (in an ad hoc manner)

4. Two theoretical paradigms were inherent in the Original Model Linear assumptions Traditional Objectivist Paradigm Influencing intent Orienting intent Social Constructionist Paradigm Circular assumptions

5. The transitional model abandoned the objectivist component and expanded the constructionist portion of the original model Lineal Objectivist Paradigm Constructionist Paradigm Influencing intent Orienting intent Constructionist Paradigm Circular The transitional model The original model

6. The initial shift into a transitional model (Hornstrup et.al. 2005) Linear assumptions Orienting intent Orienting intent Influencing intent Past Present Future Influencing intent Circular assumptions

7. Name changes in the initial shift (Hornstrup et.al. 2005) Linear assumptions Orienting intent Action clarifying questions Case clarifying questions Lineal questions Strategic questions Orienting intent Influencing intent Present Future Past Influencing intent Circular assumptions

8. Hornstrup’s transitional model of Interventive Interviewing (Hornstrup et.al. 2005) Orienting intent Action clarifying questions Case clarifying questions Present Future Past Circular questions Reflexive questions Influencing intent

9. Expanded Interventive Interviewing (Hornstrup & Tomm 2009)Further considerations for elaborating a new model: • Our collaboration in drawing upon experiences from two different fields (therapy and organizations) seemed mutually enriching • Both axes could be redefined further to clarify the model and propose an overall sequence for the questions • If the (past) and (future) were placed in parentheses, it could become clearer that past and future questions were contributing to an understanding of the here and now systemic process in the present • All four quadrants of questions could be re-named to fit more closely with their actual use in practice (instead of using names that reflected theory) • Contextual questions could be elaborated in all four quadrants and seemed to warrant a whole second layer of questions • Meta questions could also be identified in all four quadrants to raise systemic awareness and be added as a third layer of questions

10. A second shift (Hornstrup and Tomm 2009) Systemic (circular) co-clarifying intent Orienting intent (Future) (Past) Future Past Present Present Influencing intent Invitational (circular) co-constructing intent

11. 3A Re-naming the dimensions Co-clarifying intent (Past) Present (Future) Co-constructing intent

12. 3A Re-naming the 4 basic categories of questions Co-clarifying intent Initiative clarifying questions Situation clarifying questions (Past) Present (Future) Generating possibilities questions Other perspectives questions Co-constructing intent

13. A summary of the re-naming process from the original model • From lineal vs circular assumptions, to co-clarifying vs co-constructing intent • From orienting vs influencing intent, to (past) and (future) in the present • From linear or case clarifying questions, to situation clarifying questions • From circular questions, to other perspectives questions • From reflexive questions, to generating possibilities questions • From strategic or action clarifying questions, to initiative clarifying questions

14. 3C Adding 2 layers: contextual and meta questions situating questions contextual questions meta questions

15. Three layers of questions: • The core layer - Situation focused questions are intended to clarify and explore the clients’ current understandings of their situation, and to generate new insights and possibilities. • The second layer - Contextual questions are intended to enhance an awareness of the ‘bigger picture’ and how the situation is always embedded in, and influenced by, a larger context. • The third layer - Meta questions are intended to encourage mindfulness of the process of the interview itself and to reflect on the effects of the questions, other possible questions, and what conditions, assumptions, and intentions guide the attention of both interviewer and interviewee.

16. 3C The current expanded framework of Interventive Interviewing (Hornstrup and Tomm 2010) Co-clarifying intent Meta situation Meta Initiative Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Past) (Future) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Meta perspectives Meta possibilities Co-constructing intent

17. 3A Examples of questions from the core of the revised model Co-clarifying intent Initiative clarifying questions Situation clarifying questions (Past) Present (Future) Generating possibilities questions Other perspectives questions Co-constructing intent

18. Sample Core Questions • Situation Clarifying Questions • What is your main concern at the moment? What is your understanding about how things came to this? • Other Perspectives Questions • How would your colleagues describe your situation? What about your best friend’s view? • Generating Possibilities Questions • What is the outcome that you would prefer? What are some even better outcomes that you could imagine? • Initiative Clarifying Questions • How could you move towards those outcomes? On the basis of what we talked about so far, what steps would you consider taking now?

19. 3B Examples of questions from the contextual layer Co-clarifying intent Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Future) (Past) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual generative Co-constructing intent

20. Sample Contextual Questions • Contextual Situation Questions • What is the historical context out of which this situation arose? What does the institutional, community, or cultural context say? • Contextual Perspective Questions • If your situation were placed in a different context, how would it be seen differently? What other context could shed a different light on the situation? • Contextual Generative Questions • What kind of institutional or community changes can you imagine that could enable you to move forward? • Contextual Initiative Questions • What new precedents might be established in your community if you acted on your new hopes/plans?

21. 3C Examples of questions from the meta layer Co-clarifying intent Meta situation Meta Initiative Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Past) (Future) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Meta perspectives Meta possibilities Co-constructing intent

22. Sample Meta Questions • Situation meta questions • How do you feel about the questions I have asked so far? What further questions could I ask to help understand your situation? • Other perspective meta question • Who else could I ask you about, who might hold a significantly different view of your situation? • Generating possibilities meta question • What else could I ask you about, that might help you stretch yourself, to think outside the box? • Initiative clarifying meta question • What else should I be exploring with you to clarify the potential effects of the actions you are considering?

23. 3B Differentiating questions within the contextual layer Co-clarifying intent Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Future) (Past) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Co-constructing intent

24. Contextual Questions • Physical level – re: food, shelter, space in home, office, environment, ecology, genetics, etc • Relationship level – re: families of origin, friends, neighbors, mentors, social networks, etc. • Socio-cultural level – re: race, ethnicity, cultural discourses, social injustices, financial, legal, ethical, spiritual, etc.

25. Contextual Situation Questions • Physical level • What physical circumstances/limitations could be constraining your current situation? • Relationship level • What personal/professional/community relationships might be contributing to your current stuckness? • Socio-cultural level • What ideas/beliefs/assumptions/injunctions from the culture could be oppressive or limiting your movement?

26. Contextual Perspective Questions • Physical level • What other physical circumstances could have influenced your current situation differently? • Relationship level • What other possible personal or professional relationships could have influenced your current situation? • Socio-cultural level • What other ideas/beliefs/assumptions/injunctions from the culture could influence your current situation differently (e.g. pro-justice)?

27. Contextual Generative Questions • Physical level • What new physical circumstances might enable constructive changes in your current situation? • Relationship level • What new personal or professional relationships could you imagine that would enable future possibilities? • Socio-cultural level • What new ideas/beliefs/assumptions/injunctions could you adopt that might liberate you and/or propel you forward into some future possibilities?

28. Contextual Initiative Questions • Physical level • What specific changes in the physical circumstances need to be implemented to move forward? • Relationship level • Which personal or professional relationships will you enter into to keep your momentum going? • Socio-cultural level • Which ideas/beliefs/assumptions/injunctions will you privilege and/or adopt to formulate and implement the policies you need to keep moving forward?

29. 3C Differentiating questions in the meta layer Co-clarifying intent Meta situation Meta Initiative Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Past) (Future) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Meta perspectives Meta possibilities Co-constructing intent

30. 2 general types of meta questions • To oneself • What questions should I be asking this client? • Why am I asking this particular question? • To the client • Are these questions meaningful or relevant to you and your situation? • What else should I be asking you about?

31. Meta Situation Questions • To oneself • What else could I ask that could help us understand what is keeping this person stuck in this situation? • What else could I ask to disclose further contextual factors/issues that may be oppressing and/or restraining my client(s)? • Should I be asking additional clarifying questions here or is it time to move on? • To the client • What else could I be asking you about that would help me understand your situation more fully? • How do you feel about the questions I have been asking so far? • Would some questions about unfairness/injustice be helpful? • Is it OK if I move on now to other kinds of questions?

32. Meta Perspective Questions • To oneself • Who else in this situation could I ask about that might have a different perspective to offer? • What additional contextual factors/issues could I ask about to shed new light on this situation? • Should I be asking more alternative perspective questions here or should I move on? • Possibly to the client • Who else could I ask you about who would have a very different point of view? • Whose perspective could I be asking you about that would help you see another angle on your situation? • Could some questions from a social justice perspective add some new insights?

33. Meta Possibilities Questions • To oneself • What questions could I ask to open space for this person to see things altogether differently and to generate new possibilities? • What could I ask to open space for my client to potentially move forward? • Should I be asking more possibilities questions here or should I move on? • Possibly to the client • What else could I be enquiring about that would help you create new understandings and possibilities?

34. Meta Initiative Questions • To oneself • What could I ask this person to help clarify the next steps to be taken? • Should I be asking about very small steps he/she could take or a major jump forward? • What should I ask to draw attention to some potential consequences for such action? • Possibly to the client • What other questions could I ask you to explore further initiatives and/or consequences of your proposed next steps?

35. 3A Co-clarifying intent A basic proposed sequence through the four quadrants Initiative clarifying questions Situation clarifying questions Other perspectives questions Generating possibilities questions Other perspectives questions Situation clarifying questions Generating possibilities questions Co-constructing intent Initiative clarifying questions

36. 3C A second proposed sequence: moving from the inside out Co-clarifying intent Meta situation Meta Initiative Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Past) (Future) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Meta perspectives Meta possibilities Co-constructing intent

37. 3C Using the full expanded framework in a stepwise progression Co-clarifying intent Meta situation Meta Initiative Contextual situation Contextual initiative Initiative clarifying questions Situation clarifying questions Present (Past) (Future) Generating possibilities questions Other perspectives questions Contextual perspectives Contextual possibilities Meta perspectives Meta possibilities Co-constructing intent

38. A structured demonstration interview • A volunteer interviewee is required for the demo. • The volunteer will experience the direct effects of the different questions (observers will be limited to vicarious effects). • The interviewee decides on the content issue for the demonstration: it could be a personal life situation, a work situation, or simply one’s current interest in this workshop. • The pass rule applies, i.e. the interviewee is entitled to “pass” on any question to maintain his/her privacy (no explanation required). • The interviewer will ask questions from each category in a systematic sequence. • There may be brief interruptions to mark a move from one category to the next, leaving the interview somewhat stilted.

39. In summary, we encourage practitioners to use the Original Model to guide them towards privileging constructionist questions Linear assumptions Traditional Paradigm Influencing intent Orienting intent Constructionist Paradigm Circular assumptions

40. When practitioners are able to hold a constructionist stance in the original model, they are encouraged to expand into the new model Co-clarifying intent Lineal Objectivist Paradigm Constructionist Paradigm Influencing intent Orienting intent (Past) (Future) Constructionist Paradigm Co-constructing intent Circular

41. Yet, remain mindful of possible slips into an objectivist paradigm Lineal Co-clarifying intent Traditional Paradigm Influencing intent Orienting intent Constructionist Paradigm (Past) (Future) Constructionist Paradigm Co-constructing intent Discovering intent Circular Traditional Objectivist Paradigm Actual Future Actual Past Advising intent

42. 3A Could a third dimension strengthen one’s groundedness in co-constructive/constructionist/systemic interviewing? Obscurity Clarifying intent Present (Future) (Past) Co-constructing intent Transparency

43. Possible steps along a third dimension from ‘Obscurity to Transparency’ Obscurity - Unaware of one’s own experience/perceptions/thinking - Distinguishing one’s experience - Questions to oneself - Questions to oneself about one’s questions - Questions to the other person - Questions to the other about situations and contexts - Questions to the other about others - Interpersonal perception questions - Internalized other questions - Questions to the internalized other of an internalized other Visibility/audibility

44. Calgary Family Therapy CentreDepartment of PsychiatryUniversity of Calgary www.familytherapy.org ktomm@ucalgary.ca