The three phases of therapy are diagnosis, therapy and follow-up. In the first phase, diagnosis, the therapist asks lots of questions and identifies the problem.
Gathering information helps to formulate a plan of what to do. The down side is that the same questions that give the therapist a better picture of the problem actually adds to the client’s despair and depression.
The reason for this is that the client has been thinking obsessively about the problem for a long time. Clients often hyperreflect, that is, they pay exaggerated attention to the details and obsess over their problem in a way that is getting them nowhere.
One word from the therapist can be interpreted in a way that further feeds their already existing doubt and anxiety. For example, a counselor may ask a man with marriage problems how he met his wife, her good and bad qualities, his expectations and how far he is prepared to meet her wishes. As a result of these questions the man will continue to analyze and reflect more. The counselor will pay attention to everything that is abnormal. The client then gets the impression that he cannot change, and he becomes even more discouraged. This is called iatrogenic neurosis, or neurosis that develops as a result of something the therapist said or did. It’s important to be aware of the effect your words have on the client.
On one hand, probing produces much-needed information. On the other hand, it comes at the expense of intensifying the problem. To resolve this, Elizabeth Lukas created a technique called the alternating diagnosis. Instead of getting all the information at the beginning, the therapist alternates between asking questions about the symptoms and asking questions about healthy, positive areas of life.
For example, Lukas told a young woman with low self-confidence that she was a pleasant exception to the prevalence of excessively self-centered people and that she wanted to help strengthen her assertiveness only to protect her in this egotistical world and not to change her personality. She told an elderly man who was anxious about his depressive phases that while no one can know with certainty whether a depression will come back, we do know that he has come out of his ‘downs’ with long periods of ‘ups’. She said ‘You have so many healthy ups ahead of you that you had better start thinking soon about what you are going to do with all this healthy time.’
Lukas advises the therapist to be careful to ‘stick cautiously to the truth but present it within the framework of what is meaningful in each case, stressing positive aspects.’ (Meaning in Suffering, p. 24) In the above mentioned cases, there is a truth that is debilitating and a truth that is redeeming. As Lukas says, ‘In the human dimension, truth is always more than truth.’ (p. 25)