Stop wasting time in session. Yes, some stories from clients matter—even long stories can be important—but many are long-winded and unhelpful. The advice here is not about how to cut stories off or when to be invalidating; instead, I focused on how to deepen therapeutic conversations, access profound discussions, and move therapy forward. Ideally, we’d get to this point in each session as soon as is reasonable and stay there as long as is useful.

Providing thoughtful structure and guidance to sessions is not only useful but also ethical. Therapy should be a collaboration: clients are experts on their own worldview, and we are (hopefully) experts in therapy itself. Ideally, this convergence leads to a trusting alliance and engaging, vulnerable conversation. The particular information you focus on with clients can be modulated by what approach you are using in that moment.

While there is significant value in hearing a client’s story and being validating, particularly during initial sessions, you've likely experienced clients telling you unimportant stories with far too much ‘content’. 

What is Content versus Process in therapy?

• Content: stories about what happened; shared at length and with extraneous details

• Process: accessing the client’s internal experience and working through parts of it

To a large degree we can modulate the efficiency of conversation based on what questions we ask our clients. Think of it as a funnel. At the top there is a lot of ‘water’—the unnecessary detail in a longer story. Toward the narrow base there is much less ‘water’—minimal extraneous detail and more internal experiences. However, we need to hear enough of a client’s story to have context for our questions, as well as to build trust and rapport. The more effectively we do this, the further ‘down the funnel’ we can move and remain during sessions.

Due to how time-restricted and information-dense therapeutic conversations are, therapists must limit what they ask about. Each question we choose to ask will be based on one perspective of one thing the client said. Thus, we end up ‘ignoring’ much of what the client mentioned and all the other ways to ask about it. In a perfect world we would only ignore the ‘right’ things. 

How to ask Process Questions in Therapy

When a client is discussing something important to them, let them tell the initial story and listen until your client invites you to help them. Otherwise, and after initial sessions* you should mostly ask ‘process’ questions that:

• Focus on the client themselves and their internal experience

• Help the client ‘slow down’ and reflect on ideas or feelings that seem significant

• Use immediacy to ask about emotions you’re noticing in a moment

• Focus on themes, patterns, and affect

• Align with the client’s current stage of change

  (*Obviously risk assessing is an exception to these suggestions)

  
  

  Examples of good process questions for therapy:

• “What’s it like for you when he responds in a defensive way like that?”

• “I might be off here, but were you feeling rejected again in that moment?”

• When you notice heightened emotion (during a meaningful disclosure a client gets quiet, has a sad look, etc), you can ask, “What’s coming up for you right now?”, “How’re you feeling, talking to me about this?”, or “What’s it like, telling me about this?”

• “What do you wish other people knew about what you are experiencing?”

• “Is there anything you keep hoping I’ll ask you about?”

• “Today or in our previous sessions, have you found yourself thinking ‘I wish they’d ask me about blank”? (Ask every question on this list in a sincere way, but especially ones like this)

• “What question do you need someone to ask you, that no one has?”

• “How did that make you feel about yourself?” (Shifting focus onto self-concept and self-efficacy, which you can connect with themes and feelings)

• “What you just mentioned about X seems important, at least to me. Could we slow down and stay with this idea/feeling for a moment?” (i.e., Deepen and talk more about this important theme, which also helps us stay away from more story.)
  
  

How to Ask Bad Questions in Therapy

Again, this can be different in first sessions and/or when risk assessing, but in general, unhelpful questions are content-based and:

• Focus on other people and their actions, versus focusing on your client

• Are about the ‘story’ and unhelpful details

• Ignore themes and affect

  
  

  Examples of unhelpful questions in session:

• “What did she say after that?”

• “What did your father-in-law do after he finished dessert?”

• “How did she respond? Maybe just hand me your phone so I can read the texts” 

• “Hang on, did this mini-put course have nine or eighteen holes? Was it glow-in-the-dark?”

  (Obviously in some cases these answers matter, but most of the time you’d be encouraging more detail. I regularly see therapists accidentally perpetuate storytelling and it’s painful. It’s also highly context-dependent so good “bad examples” are hard to come up with.)
  
  

That’s the basic point of process vs content in therapy, with examples. It may seem a little abstract, but in my experience, once a counsellor wraps their head around it, their sessions start to hit harder and look quite different. 

A warning, though: clients will repeat themselves until they feel understood. So, don’t jump ahead of their initial story to get to process. Listen until your client invites you to help them. Well-timed process questions help people feel more understood and witnessed, and poorly timed ones can make people feel cut off. Process discussions require trust.

As for clients repeating a story, you should pay particular attention in that moment. Be certain to validate and show understanding. Often, I’ll even say, “I’ve noticed you’ve mentioned X to me a few times now. It seems really important to you, and I may have missed it earlier. Sorry. Can you tell me more about it?”

Below, I discuss the related concepts of how to start sessions to get into useful discussions more quickly, as well as some ways of dealing with overly talkative clients.

Start Sessions More Effectively

We need to let clients share their initial story in session one, and we often get a small update at the start of each session with some clients. How you begin those subsequent sessions has a significant impact on their progression. I try to be friendly and get small talk out of the way during the walk from my waiting room to my office (though, we can’t do this in online therapy). I do this so we can get to work as soon as we sit down. It also models good boundaries and ethics by not discussing confidential information outside the office. My most-used initial questions once we sit down are: 

• “What would be most important or helpful for us to focus on with our time today?”

• “What do you need to leave here with today?”

• “How did the homework go?”

• Review themes and/or a brief version of the treatment plan and see where they want to pick things up. 

• Consider creating a structure you use to begin all sessions, such as: 

  • “What stood out to you from our last session?”

  • “What have you done since our last session that helped?”

  • “What do we need to focus on today?”

    Some clients appreciate this framing, and these are useful questions for clients to reflect on, knowing their therapist will ask them as each session begins. It’s a little too formal for me, but it works well for some therapists. A caution though: the second question can lead to content-based answers. In essence, it’s a great solution-focused question, but if this question leads to unhelpful content, structure the line of inquiry more firmly in an SFT approach, experiment with how to ask it differently (perhaps in combination with outcome measures), or see what the difference is if you don’t use this second question.

Suggestions Regarding Talkative Clients:

• Start the next session by immediately addressing it so things don’t run away from you again, by discussing guidelines about how the time would be best spent: 

  • “You spent quite a bit of time last session telling me about X, and that’s okay, but I want to check in first and make sure you’re getting what you need out of our time together—or if we need to do anything differently today.”

  • “Should our conversations be back and forth?” 

  • “Am I allowed to interrupt you or re-direct? Under what circumstances?”

• Consult with a supervisor or experienced colleague so you have a clear idea of how to structure the next session. The details of every case are different, and advice from people who aren’t familiar with those details needs to be analyzed and adapted.

• It might become a bit of a contract; the client gets to vent for X minutes at the beginning of each session.

• A classic approach: I validate that their sharing demonstrates their legitimate need for connection and to feel understood, and we come up with relevant homework about where else they could get those needs met, both independently and with supports (in addition to sharing in therapy with me; be careful here not to reject them.)

• Some common phrases: 

  • “I’m just thinking about the time and I wanted to make sure I asked you about…”

  • “Let’s hit pause on this for a moment—I wanted to check in on something you said a minute ago.”

• Sometimes, it’s as rudimentary as waiting for them to pause or take a breath then asking, “What are you hoping to get out of telling me this?”

• I know people who will drop something on purpose to create a pause, then take advantage of that pause to redirect the conversation (though my style is to be direct).

• Teach and then do a regulation skill in session before continuing, if relevant.

Considering Yalom’s Content vs Process

It would be shortsighted of me to ignore Irvin Yalom’s contributions to this area of counselling. He has a slightly different perspective:

• Content: the words spoken and the issues addressed in the therapy hour

• Process: “the interpersonal relationship between the patient and therapist…what do the words (and the nonverbal behavior as well) tell us about the nature of the relationship between the parties engaged in the interaction?” ~Yalom, The Gift of Therapy
  
  

Yalom highlights the differences between client stories and client relationship dynamics (particularly the client-therapist relationship). Yalom’s approach to situating process directly in the therapeutic alliance is fascinating and bold, though it requires therapists to be creative, mature, courageous, and have strong alliances. 

Yalom is incredibly well-read and is able to incorporate large philosophical ideas into session in a fluid manner. Yet, he sometimes described feeling bored with lengthy client stories and uncertainty about how to ‘interrupt’ clients and help them talk about more vulnerable and useful subjects, and that his clients would rebuff his attempts to do so at times. I don’t imagine I’m skilled or experienced enough to criticize Irv’s work, though I’ll say that augmenting the content vs process discussion as I explored above has given me a reliable way to resolve this ‘redirection’ concern. Yalom’s descriptions of his process work (e.g., in Love’s Executioner) are incredible and worth reading. 

Above, I described applying the same process principle to a slightly different aspect of therapy than what Yalom goes over. 

We owe it to our clients to ask questions that will have a better chance at improving the quality of our limited session time. Navigating the differences between content and process is one useful way. There is no substitute for experience, so get back out there.

I'll only contact you if I have an excellent/relevant idea (maybe once a year); we're all tired of being advertised to.

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