I found myself talking about ‘tone-matching’ a few months ago whilst I was describing a piece of clinical work that has stayed with me from many years ago. I was working with a youngish person in their twenties who had been referred to me by a Home Treatment Service. My client had gone through a very tough time, had lost their job, had lost their home, and had been actively considering and planning suicide as a result of which my client had been hospitalised. On discharge from hospital my client had been referred to the Home Treatment Service who, whilst delivering on-going support was also in a position to monitor safety, and who decided to refer to BRIEF.
My first meeting with the client was not unusual, best hopes, preferred future and best-hopes-progress scale. At the end of the session, as is typical of my practice, I ‘warned’ my client that the very first question that I would ask at the beginning of the second session would be ‘so what’s been better’ adding that if my client were to watch out for better that this might make the next session easier but of course that what my client did between sessions was for my client alone to decide. And off my client went. When my client returned I started with ‘well I did warn you – so what’s been better?’ And my client responded by saying ‘well I suppose that I have been getting up earlier’. Now getting up earlier had been central to the client’s description of a preferred future. Having lost their job my client had taken to getting up in the late afternoon and staying up all night, and drinking to excess, going to bed at a time that previously had been a late getting up and going to work time. Life truly was up-side-down and did not fit with getting back to work, which was my client’s initial response to the best hopes question. So ‘getting up earlier’ was potentially significant. However very fortunately I resisted the urge to ‘wow’ (as it were and if there is such a verb). Instead I chose to centralise the client’s view.
‘So were you pleased to find yourself getting up earlier?’
‘Yes I suppose so.’ (The tone was slightly reluctant – perhaps ecven doubtful.)
‘So might I ask how pleased?’
‘Well – you know – if I could even have imagined myself a year ago sitting here with someone like you (and I have to say that it did not feel flattering as my client pointed at me) saying that getting up earlier was an achievement, was something to be pleased about, I would have thought how pathetic, what has my life come to.’
‘Sure – I imagine that a year ago getting up early was something that you did not even have to think about.’
‘That’s right.’
‘But compared with the way that things have been just recently it is a little bit different. Would that be right?’
‘Yes.’
‘So would it be OK if I just asked you a few questions about that.’ (My tone was slightly apologietic.)
‘Yes I suppose so.’
And away I went asking how my client had been getting up earlier and inviting my client to consider the difference that getting up earlier had been making to life more generally, who had noticed, what they had made of this change and so on.
Crucial to this conversation however had been my decision, as I came to refer to it recently, to ‘tone-match’. So rather than attempting to construct a conversation emanating from my evaluation of the change ‘wow that’s great – so you’ve been getting yourself up earlier - how have you been doing that?’ I stopped and checked and centralised my client’s evaluation. So doing made it more than clear to me that if I had responded in an overly enthusiastic manner my client would have felt insulted and patronised. Getting up early was not a big deal for my client, it was not a huge achievement, it was just a little bit different from how things had been recently. Recognising this and ‘flattening my tone’ through this process of ‘tone-matching’ meant that I was cooperating with my client, and my client was able to come with me in the conversation rather than feeling patronised, feeling that the worker was bigging up something that to the client did not feel like a big deal.
On this occasion I asked the client ‘so might I ask how pleased?’ but not infrequently we can pick up the client’s calibration of the degree of success and pleasure involved in their tone. ‘Tone-matching’ in this way enables the client to hear our question and to go with us rather than feeling jarred by the question; it removes potential road-bumps in the therapeutic conversation smoothing the process, such that the client can just listen to their own voice rather than being irritated by ours.
Evan George
From Bahceli/Kalograia on the island of Cyprus
02 June 2024
