It’s like clockwork – open questions come back regularly. This time closed questions are juxtaposed with the intellectual programme of the Open Dialogue, which, presumably, should be based on open questions. And, I am sorry to say, it’s nonsense.
The ‘open question’ question is one of those things I have tried to explain for some time. In a nutshell, for the most time, it doesn’t matter if you ask closed questions, it doesn’t matter if you ask open questions. The so called ‘closed questions’ in fact close nothing. If I want, and you will listen, I can continue talking about my ‘yes’ or ‘no’. Just like a I do just about every day. What you should be asking is what kind of question is conducive to furthering your communication and relationship with your patient at any given time. The answer might be that it is a ‘closed question’.
Some time ago, I wrote a post about it and there is no need to repeat the arguments I made there. But it might be time to accept that no matter what I say, no matter if the whole of linguistics says that the issue of open/closed questions is a psychological/psychiatric fetish, psych students will be taught that open questions are cool and closed question are evil. But I started wondering why this is so. Why insist on such an obviously simplistic solution to what is obviously a very complex question? Below I attempt an answer, but I might be going the scenic route route.
Let me start with an obvious point. Communication is about negotiation, sharing of meanings, cooperation. What it is certainly not about is triggering a response with a well placed question (it becomes interrogation then). And here is my problem. This primarily psychological insistence on asking a particular kind of question shows clinical communication as depending on, yes, I will say it, a particular trick.
So, time and again, people are told off for asking ‘closed questions’, as they are not conducive to dialogue. And then they are offered a solution – ask open questions! Hey, presto, you ask them, dialogue will be happening like a dream! The simplicity of such ideas is, to be honest, breath-taking. As open questions are the easy way to achieve the wonders of (open) dialogue, patients are constructed as dolls who have a button which needs to be pressed. Yes, you guessed it, the button says: open questions. As you ask an open question, the button is pressed and the doll starts talking. Gosh, it just talks, and talks, and talks.
Just like the question “What matters to you?” does not begin to persuade me to tell you anything, your open questions are as doomed, if I don’t feel I can tell you anything, if I don’t trust you or simply if I don’t like you. And above all, I will not tell you anything, if I do not think you will listen. Yes, listen. I don’t care what kind of questions you ask me, if you just listen to me! So stop treating me as if I were an automaton which is activated by your open questions. Stop positioning yourself as the suave James Bond of a psychologist who has just found the passkey to my soul.
Too much? I don’t think so. It really irritates me that someone might think this banal strategy of asking a question which cannot be answered by yes/no is the way to unlock my pain, my hurt, my trauma. All that comes with what I want to spit out when I come to see you about the dark hole I am in. For goodness sake, get a grip and ask yourself: “Really? That’s it? I just need to remember that yes/no questions are no-no?”
I mean, really?
There is more though. When I think about this mind-boggling simplicity of the solution of achieving ‘open dialogue’, I just wonder…. Is it more because it’s conducive to teaching a clear set of instructions which, really, do not need to be reflected on? Isn’t ‘open’ good and ‘closed’ bad, anyway? Or is it perhaps about not even trying to understand the complexity of communication? You know, that communication with me, your patient, is also about how I perceive you, whether I trust you. Whether I like you. It might also be about the quality of your voice, tilt of your body. And above all, I think, again, that you listen! No, it’s not about my talking. It is about your listening!
Open questions circumvent all these things and even though, linguistically, it makes no sense to insist on them, you will do, because it is so much easier than consider the rest that goes in your communication with me, your patient. To be honest, I actually understand. Communication is difficult. The fetish of the open/closed question, however, offers an easy way out.