Ever since I became interested in things psychological, I have heard of open and closed questions. Whether in English-language psychology or Polish psychology, open or open-ended questions are the yardstick of good psychological practice. For a linguist, I’m sorry to say, it’s complete nonsense. Why? Well, in a nutshell, because it doesn’t matter. It’s a fetish.
I was reminded of open-ended questions again in a tweet by Andy Fugard who retweeted the Samaritans’ listening tips:
— Andy Fugard (@inductivestep) July 7, 2016
They include this:
Use open questions: ones that need more than a yes/no answer, & follow up e.g. ‘Tell me more’
And at face value, it’s difficult to disagree with this. Of course, one needs more to say than yes or no. The problem is that people do not just answer polar questions (Yes/No questions, which I always knew as general questions) with a mere yes or no. In fact, such answers in many contexts will be considered curt, impolite, evasive at so on, and so forth. Do we really expect a simple yes/no answer when we ask a question such as:
Do you love me, my love?
I think, if ‘my love’ answered with a mere ‘Yes’, I would be a tad concerned. On the other hand, if a doctor is palpating my abdomen and asks “Does this hurt?’, a simple yes/no is fully justified. But what if a psychotherapist asks a question like that Does it hurt?’, which apparently is anathema. Am I, the client, going to answer by simply yes/no? After all, I do realise that the psychotherapist wants me to talk, wants me to tell them more. So, I might say, something like:
Yes. You have no idea how much. I never thought it would, I always thought I would cope. But I don’t…..
It’s a sensible answer, isn’t it? So what’s wrong with this closed question? But even if I do respond with a mere yes, doesn’t it tell you, the therapist, quite a lot? And if you keep your gob shut, you might actually get me speak on. Or, perhaps, you could say:
Tell me more.
Or is it really too much for your royal highness?
You could also introduce here the notion of a narrative contract (Barthes), that is an understanding between the narrator and the narratee in which the former is expected to ‘tell a story’ – whatever that story might be – and the other is expected to listen. The narrative contract supersedes any question type.
You might wonder, of course, to what extent the patient/client understands that they are expected to tell a story, but that’s a completely different issue and has nothing to do with the type of the question. If a patient (after seeing a psychiatrist) says something like
You know I do make the cardinal mistake and with tenacity. Namely, I do try to say the most, in order to make a diagnosis easier for the doctor. And then I think that I talk too unnecessarily, too much and off the topic. Or that the doctor looks at me with a distance, like at a hysterical broad who is so self-centred and is completely unable to control herself and tells what needs to be told and particularly what doesn’t. Without thinking. And has become verbose, and that it is unnecessary.
as I quoted in a recent post. What the patient says suggests that the narrative contract is absent. At issue are the doctor’s expectations of what the patient is supposed to say (and how they perceive it), and how those expectations are managed and negotiated. The kind of questions that the clinician asks doesn’t even arise as a problem here!
Many years ago, Ulrike Meinhof and I got an ESRC grant on border identities. We were interested in how people living in cities through which a border came were constructing their identities. We decided not to ask questions (I’ll come back to it) and show photographs as trigger material. And it was really going well, until I came to an interview with a woman who really didn’t want to talk, despite having agreed earlier. Even tough the photographs were the most open-ended ‘questions’ as possible, they simply didn’t work. The interview ended after about 5 minutes. The informant responded with monosyllables.
Psychology’s insistence on open questions ignores the fact that conversations are acts of cooperation (Grice) and they are not released like spring traps just because a psychologist (or anyone else for that matter) asks a question of a particular kind. Moreover, just like any open-ended question can be ignored and met with silence, any closed question can be met with a narrative.
In the Twitter exchange that ensued after Fugard’s tweet, it was suggested that the insistence on open question might result from the power imbalance between the clinician and the client and attempts to redress it. It’s a very interesting explanation and I would probably agree with it. After all, an open-ended question suggests giving up the power to focus on particulars and open space for the client’s story. Yet, in fact, positioning open questions as mere triggers that I cannot but respond to, suggests that psychological questions are conisdered so wondrous and compelling that I will simply jump to a narrative mode and tell you all how it is. And that, incidentally, constructs psychology as magic! I’m afraid it doesn’t work like that, open questions or not.
Now, let me come back to the border study. Why didn’t we ask questions? Well, we simply didn’t know how to ask a question. Consider. We are in a town which was German before the war, now is half Polish and half German, the border goes right through the middle. And so, how do you ask a question whether Poles in the town go to…Exactly, where do they go? The other side? Germany, across the river, Goerlitz? Every choice we make closes the possibility of our informants telling us how they construct it. Indeed, had we asked our questions we would not have heard something like:
I quickly popped down to Germany for some hair colour.
You just can’t say this! You cannot ‘pop down’ to Germany. Except you could in that particular town, and we got this, because we didn’t ask questions at all. For every question carries with it the questioner’s ‘interest’ (Kress and van Leeuwen’s term), a particular way in which they focus and construct reality. It’s the difference between, for example, going ‘to Germany’ and ‘across the river’, which, admittedly, is significant. Understanding what questions do, we allowed our informants to say what they wanted.
Now, in clinical communication you cannot, of course, show pictures. But this is precisely why you should understand what your questions do. Instead of wondering about open and closed questions, it’s much better to understand that saying:
What are your symptoms?
carries with it a host of assumptions which might not be mine. It’s not so much about medicalisation of my experience, but imposing your frame of reference on me. I have to answer either adopting it or challenging it. But that starts a counter useful power game between us. Every language choice carries such assumptions, understanding them is crucial.
How then about understanding that a question like:
Do you feel like running away?
does not really ask for a yes/no answer, even though it is closed. It actually can be used to open spaces for the narrative, and, in fact, it does. Moreover, it might lead to insights precisely because you asked a yes/no question! And if psychology regularly transcribed its clinical communication, it would know that closed questions not only can, but, in fact, do open communication space. Just like a question such as
Can you tell me more?
which is a closed question. Wait a second, is it? So is it open? Oh, who cares, for pity’s sake!?
And so, as psychology resists to have a hard look at its communication practices, we actually know precious little about what happens between the psychologist and their client (in fact, we know much more about psychiatrists!). Such research is necessary also to reinforce understanding that clinical communication is not about question types. They are irrelevant. It is about opening space for a cooperation between the clinician and their client/patient. Opening such space might actually be done by a closed question. That’s indeed why it is so difficult to communicate with your patient. Yet, you might start by not worrying about question types.