# 105 November 2008

"Streams and waves never stop moving, and yet they are at rest, and restful to hear, because they are in no hurry to reach any destination. Indeed, they are not going anywhere at all. . . ."

Alan Watts
from Cloud Hidden, Whereabouts Unknown

(continues below)

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# 105 November 2008

Gentle Ways of Approaching a Difficult Topic: Tips for Uncovering Incest

TISA Description of the Problem: Arguably one of the most difficult topics to raise with a patient or client - whether one is a physician or nurse in a busy family practice office or a therapist in a hectic community mental health center - is the topic of incest. To raise the topic in a sensitive fashion is of the utmost importance, for to not do so is to risk the sense of safety that can only come from trust. Without trust, the healing process will find it hard to get a foothold. The following perceptive clinical interviewing tips were provided by a participant in one of my recent workshops, Carla Roth. All three of them illustrate gentle ways of approaching the topic of incest. See what you think.

Tip: I find that there are many different ways to raise the topic of incest with clients. Often it can be of use to begin with indirect questioning as these techniques show (which can always be followed by more direct inquiry if necessary):

Question #1: "Has anything ever happened to you that just made you feel 'yucky' inside?" (the word 'yucky' almost always seems to resonate).

Question #2: "Looking back over your life, what circumstances or events stand out in your mind as being especially upsetting or traumatic to you?"

Question #3: "Has anything ever occurred that caused you to feel violated by another person?"

TISA Follow-up: I really like all of these techniques suggested by Carla. They remind me of another question that can be of use and that I like to share when teaching clinical interviewing, "When you were growing up did anyone in your family or someone outside your family, touch you sexually in a way that you felt uncomfortable or wish that they hadn't?" Even a brief pause by the client after such a question, may provide a graceful lead-in to the uncovering of an abuse history as with, "It looks like that question struck a cord with you, what are you thinking about?" I sometimes add, "It can be difficult to talk about such things. Just share what you feel comfortable sharing, it might really help me to help you."

I have a particular interest in creating a list of such practical questions, for it allows clinicians to flexibly pick-and-choose which type of question may work best with a specific client. If you know of some other useful tips about raising the topic of incest or family violence, please e-mail them to us. Together we are creating a valuable teaching collection on a topic where trainees often do not hear about different approaches.

Tip provided by:

Carla Roth

TISA is a site dedicated to advancing the science and art of preventing suicide and teaching clinical interviewing