?

Log in

No account? Create an account

Previous Entry Share Next Entry
Пресуппозиции (6) Трансформирующие пресуппозиции оценки путём счёта/ шкалирования
Red Tailed Hawk
metanymous wrote in metapractice

http://metapractice.livejournal.com/509787.html

http://realpeoplepress.com/blog/on-a-scale-of-0-10-how-useful-is-scaling?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+SteveAndreasNlpBlog+%28Steve+Andreas%27+NLP+Blog%29

on-a-scale-of-0-10-how-useful-is-scaling?
04 Mar Posted by: Steve Andreas in: Articles
Recently I watched a workshop presentation of our forgiveness pattern. Overall it was an excellent presentation, and one thing caught my notice: the presenter used scaling on the problem state, resentment. “On a scale of 0-10, with 10 being the most intense resentment you have ever felt, how resentful are you now?” Initially I thought, “Oh that’s interesting, I never thought of doing that.” But over the next few weeks I had a nagging feeling that maybe it wasn’t actually such a good idea. This led me to think in much more depth about how scaling works, and when it’s useful and when it isn’t.

Some therapeutic approaches make regular use of “scaling” as a way to monitor changes in the intensity of a client’s feeling response, in order to track the usefulness of interventions. This is particularly true in Solution Focused Therapy, and in EMDR where the scale is known as a SUDS scale, an acronym for “subjective units of distress.” Scaling is most often used for unpleasant responses, but it can also be used for feedback about progress toward a positive outcome. “On a scale of 0-10, where 10 is the happiest you have ever been, how would you rate the way you feel right now?”

What’s not widely recognized is that scaling isn’t just a way to get feedback about interventions. It is actually a substantial intervention in itself, because scaling elicits a number of specific predictable changes in the client’s experience.

Many clients start out focusing exclusively on their present feelings without reference to other times and places, creating a kind of “tunnel vision,” in which their problem state occupies all their attention. This narrow focus often leads them to think of their problems in absolute digital terms, as something they are in—a “depression,” a “trap,” a “stuck state,” etc. that they would like to be out of.

When an experience is thought of as being a digital either/or, that implies that it would be very difficult to make the huge change to the opposite polarity, for instance from depression to happiness. When the problem experience is located on an analog scale, it is easier to think about making smaller changes along that scale, say from a 10 to a 9.

A conversational way to reply to a client who is thinking about their situation in a digital way is to say sincerely, “OK, how depressed (or trapped or stuck, etc.) are you right now?” The word “how” changes the absolute either/or into a comparison with other similar experiences, creating an analog continuum that presupposes different degrees of depression (or being trapped or stuck). The same thing happens when a client is asked to locate their present feeling somewhere on a scale of 0-10. Even if they rate it as a 10 at the end of the scale, that places it in relation to other experiences on the analog scale, creating a more balanced perspective.

A scale also requires the client to make simultaneous comparisons between different experiences. “Well this one was bad, but this other one was worse, and this other one wasn’t quite as bad.” While it is possible to make a simultaneous comparison in the auditory or kinesthetic modalities, it is much easier to do this with visual images. So even when the scale is not explicitly described visually as a horizontal scale or a vertical ladder, there is a strong likelihood that a client will spontaneously represent their kinesthetic feeling state as a visual image. When a kinesthetic feeling is represented as a visual image, that reduces the felt emotional response, making it less overwhelming, and easier to change.

When you visualize two (or more) experiences on a scale simultaneously, you become an observer of both, making it even harder to be immersed in either one. This creates some distance between the client and the problem state, sometimes called “self-distancing,” “externalization,” or “becoming more objective.” (NLP has traditionally called this “dissociation” but that term has many troublesome connotations in psychiatry, so I have turned to other more descriptive words.)

Seeing two images at the same time also usually reduces the size of the mental image of the present state, because generally the two images have to fit into the same space as a single image. This smaller size further reduces the emotional response, and this makes the problem appear easier to resolve.

Scaling can also be used as a basis for adjusting the location of a problem on the scale. “If you were to be at a 5, rather than a 6, how would your experience be different?” “What would it take for you to change from a 10 to a 9?” Scaling is particularly useful in something like pain control, or physical tension, in which the goal is simply to reduce a troublesome sensation.

So to summarize, what seems like a simple question for gathering information is actually a substantial intervention that changes a client’s experience in a number of ways, and sets the stage for further interventions.

This morning was chilly, with a beautiful fresh snowfall. My wife said, “It’s 7:45,” using a time scale. But she could as easily have said, “It’s 66” if she was commenting on the temperature, or “4” to indicate the depth of the snow in inches. Each of these responses can be useful, depending on the context. The time might be most important if we have a morning appointment, the temperature if I need to build a fire, the depth of snow if we’re concerned about driving somewhere. Whenever we quantify one aspect of an experience, that reduces it to a number on a single continuum, a huge oversimplification that ignores all the other aspects. Numbers are great for allocating people to airplane seats, but that inevitably ignores all their individual differences, and this can create problems.

In therapy, focusing on a “scale of 0 to 10” for a given feeling directs attention to its intensity, and away from qualitative aspects that may be more important. For instance the forgiveness pattern does result in resentment being reduced. However that’s not all it does. Much more significant is that it replaces resentment with a completely different feeling response, forgiveness. Using scaling for resentment continues to focus the client’s attention on the resentment, diverting attention from the possibility of having a qualitatively different response. While this may not prevent a client from benefitting from the forgiveness process, it certainly doesn’t support the change. Ideally every aspect of our interventions support each other in reaching an outcome.

Conclusion

If your goal is to simply elicit an analog change in the intensity of a response, as with pain, stress or tension, then it’s useful and appropriate to use scaling, which presupposes that a change in intensity is what matters.

But if your goal is to elicit a digital change in response—such as from anger to forgiveness, anxiety to confidence, grief/loss to a sense of presence, etc.—then scaling is not appropriate, and could even interfere with the process you are using.

If you’re not sure whether a quantitative or qualitative change is appropriate for a particular problem or outcome, you can combine these two approaches, which is what Connirae and I did many years ago when we were developing the Eye Movement Integration process. We asked clients to report any difference in the intensity of a feeling, and also asked them to report any qualitative changes in the content of the image, the submodality process elements (color, brightness, distance, etc.) or any changes in the kind of feeling.

7 Responses


  1. Nick Kemp

    05|Mar|2016 1

    I use scaling a lot when working with clients who have anxiety issues, along with a lot of fractionation. My strategy is to show the client how they can create and maintain their own personal control over their own states. All sessions are recorded so everything “is on the record” for the client to listen back to from a 3rd position. This has proved to be exceptionally effective and a recent international athlete was able to achieve her lifetime best track time after a client session using this approach!


  2. Bob Janes

    05|Mar|2016 2

    A few random thoughts on scaling after reading this.

    + I don’t like setting the ‘most resentful’ at the ten end. “Let’s put this on a scale, if we put your most resentful down here at zero, what goes up here at 10?”

    + Going off the scale can be useful: “OK so if 10 is the happiest you’ve ever been, I’m curious, what would 11 or 12 be like? What would you have to do for that to happen?”

    + ‘Physical’ scaling works too. I have clients work with ‘projects’ on a time-line facing into the future: “Hey, that looks a bit big, just to make it easier here, how about we shrink it down so that you can clearly see all of it?” accompanied with a downward movement of both hands to allow the client to look down at the project in front of them.


  3. Bruce Teall

    06|Mar|2016 3

    Steve — This is a wonderful example of you taking something that is often taken for granted and then analyzing the heck out of it! I totally agree that scaling questions can be very useful, and also that it is important to be mindful of the way in which they are used and to what purpose.
    As you mentioned, Solution-Focused Therapies use scaling questions, and I think often as an intervention. They can be very useful in breaking up all-or-nothing thinking. As an example, this can be done by asking “On a scale of 1-10 where 10 is having completely achieved your goal, how much progress have you made so far?” In this way you accomplish a few of things. First, by asking a scaled question instead a yes/no question you are offering a range of evaluations instead of “yes I’ve achieved my goal” or “no I haven’t achieved my goal.” Second, the way the scale is set up you are leading the client to be aware of their progress, no matter how small, instead of how much they haven’t achieved. Third, once they answer you are set up to help them explore realistic next steps in the process by asking, “So you are currently 4/10, what would let you know you were at 5/10?”
    Thanks for a thought-provoking article.


  4. Nick Kemp

    06|Mar|2016 4

    PS I would regularly ask clients “So what makes this a 5 as opposed to a 6?” The paying attention to the analogue differences in my experiences allows the client a better opportunity to identify and have better insight into these distinctions. Also it’s at the heart of The Provocative Change Works model whose purpose is to empower the client into affirming what is useful!


  5. Nick Kemp

    07|Mar|2016 5

    I do very simple relaxations with clients relaxing from 5 – 0. It then occurred to me also I could suggest a minus scale. This works surprisingly well as clients don’t expect it. I also like to add in the suggestion of “counting on and counting in whatever number is appropriate in future times”

    Regards

    Nick


  6. Mike

    07|Mar|2016 6

    Steve, it is such a pleasure to read your analysis of anything. I fondly remember joining you for breakfast before your 3-day seminar about Scope and Category in Austin. Now when I read your words, there is a deeply compassionate voice to go with them. Your posts always leave me at an 11 (on a scale of one to ten).

    Mike Brown


  7. Kris Hallbom

    08|Mar|2016 7

    Great article Steve. Tim and I couldn’t agree with you more. I use scaling for pain and stress when working with clients. However, I have never used it for anger, forgiveness, grief and so on. It never even occurred to me to use scaling for those type of issues, it doesn’t make sense for all the reasons you listed. Thank you for writing such a thought provoking and well written article.




http://w1tp.com/imquack.htm


  • 1
Additional Details
I want to respond to a number of points that have been raised in the comments to date.

Several people proposed using a scale of 1-10 rather than 0-10. A 1-10 scale implies that the lowest point on the scale is 10% of the highest point on the scale, making it difficult to scale a zero response. When I asked one woman why she used 1-10, she replied that the physicians who refer to her insisted on her using that scale in reporting progress, and that their reason was that, “There was no possibility of a complete absence of an issue” (precluding any possibility of a digital shift).

I responded that I thought it would be fairly easy to think of counterexamples to that particular limiting belief, such as asking the physician, “Do you ever seriously think about wearing women’s clothes to your office, or taking up wing suit flying?”—or some other similar unlikely possibility. And then ask him if he would scale that “issue” as a 1 or a 0, with 10 indicating, “Yes, I’m planning to do that tomorrow!” However, in her position I thought it would probably be best to just use 0-10 in her work with clients, and translate a 0 into a 1 when reporting to a physician.

Since we usually assume that a higher number indicates more of something, Bob’s suggestion to assign a 1 to the “most resentful” seemed counterintuitive to me. When I try doing that, I get a little confused, so I asked myself, “OK, When might it be useful to introduce a little confusion or uncertainty?” Many clients suffer from an excess of certainty, so it would be interesting to try that with a few of them, and find out if it is useful in loosening up the present state. Bob and I are corresponding about this, but haven’t yet reached a resolution to share.

Bob’s third comment was, “ ‘Physical’ scaling works too. I have clients work with ‘projects’ on a time-line facing into the future: ‘Hey, that looks a bit big, just to make it easier here, how about we shrink it down so that you can clearly see all of it?’ accompanied with a downward movement of both hands to allow the client to look down at the project in front of them.” That kind of intervention can be very useful, but it is somewhat different from asking an overt scaling question, so I won’t comment further on now.

I like both Bob and Nick’s suggestion of going off the scale that has been established. “What would an 11 (or a -1) be like?” This ought to be especially useful for a client whose experience is mired in the mid-range of what is possible for them, and who could usefully expand that range—something that is probably true for all of us.

Finally, Rob Voyle’s excellent post clarifies a very important additional situation. A client’s problem, described with a very general word like “distress,” “resentment,” or “bad feeling” may appear to be analog, but may actually be a combination of two (or more) distinct digital components. When one of these components is resolved, the overall intensity of distress is reduced, so it may appear to be an analog change, but full resolution requires a digital change in the one(s) remaining. This will often be true in PTSD, because the client’s bad feeling may be a mix of guilt, shame, grief, resentment, etc. in addition to the core phobic experience. Resolution of one of these digital components may actually be successful, but appear to have failed because of the remaining components.

The original question about when scaling is appropriate led first to the distinction between analog and digital change, and then to quite a number of additional understandings, which has certainly refined how I think of change. Again thanks to all who participated in this exploration.

  • 1