How to use scaling in therapy

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Utilising the magic of numbers with your clients
- by Mark Tyrrell

Pain, whether physical or emotional, tends to make us see our situation in 'all or nothing' terms:

I am in agony! If only I was free of this pain!

or:

I am so miserable! Why can't I be happy?

Using scaling in therapy with our clients and helping them to break down their perception of their situation into 'grades' accomplishes three things:

• we 'put a fence' around the experience so that it no longer feels limitless and uncontrollable, and becomes more manageable and therefore more hopeful
• we help them step 'outside' their experience by observing it and engaging the non-emotional part of the brain to scale (or 'grade') their pain, anxiety, misery, motivational level or whatever it may be
• we break down expectations and therapy strategy into discrete steps, rendering them more realistic and achievable.

How do we go about this?

1) "On a scale of one to ten... "

When working with a client who is experiencing severe prolonged pain I might say:

Okay, so if '10' is the most unbearable agony possible, and '1' is the most blissful comfort, what number would you put yourself on right now?

Notice how we have instantly reframed 'pain' as 'numbers'. (There is no need to labour this point.)

Of course, they might straightaway say "10!" Or perhaps they'll think about it for a bit and judge that, well, actually, they have felt worse pain than this, so they'll grade their current experience with, for example, an '8'.

So now they have gone from being 'in agony' to being at '8' on a scale of one to ten.

I might then ask how they are going to know when the discomfort level has decreased to a '7'...

This approach will work equally well with other states than pain. You can set your scale up in either direction, depending on where you want to lay the emphasis, or whether you want to increase or decrease the perceived response.

If '1' is the most depressed you've ever felt, and '10' is the happiest, where are you on the scale now, would you say?

Okay, if '10' is the most anxious and '1' is the most relaxed, where do you feel you are on that scale right now...?

'Grading' or 'scaling' is effective for anxiety because it demands the engagement of the 'thinking brain', which itself loosens the grip of the 'emotional brain'. Using scaling in therapy gets the conversation switched from being 'about' emotions, to being 'about' numbers - and this in itself can help people feel calmer.

2) Ask questions that precipitate change

Once we have started to break down the 'all or nothing' perception by using numbers, we can ask questions that presuppose (and possibly even precipitate) positive change.

I recall asking a man in chronic pain to tell me how he would know when his pain had gone down from a '7' to a '6', what difference would he notice?

He described the exact difference to me in great detail, and actually found himself "slipping down to a '5'!" as he was speaking.

It's not enough just to get the numbers. We need to use the numbers.

So if someone tells me that on Tuesday they felt that they were at '4' on a depression scale (where '10' was the happiest they could be), I might ask something like:

Think really carefully now. What prevented you from being a '3'?

This kind of careful targeting of our questions helps us find out what they are already doing that helps them cope better and then encourage those behaviours. Similarly, we can ask what will it be like when they are at a '5', and so forth.

Again, if someone tells me their motivation to quit smoking is at '8', when '10' indicates that they are fully motivated and committed to stop, I would need to discover what is keeping them from that '10', and what would need to be in place for them to get up to '10'.

3) You don't have to stick to numbers

Some people are just not that number minded, and a more visual approach might work better. You can, of course, write out numbers on a piece of paper to create a visual scale, but you can also leave numbers behind altogether.

I keep a large picture of a staircase that I can use at a moment's notice. I might show my client the picture and say:

If the bottom of the staircase is 'no motivation whatever' and the top of the stairs is 'unstoppable motivation', can you point to the step you're on right now?

If I don't have pictures to hand, I'll use hypnosis to get the person to visualize a path or a staircase and simply tell me where they are on that path. I can then hypnotically encourage them to explore the progressively positive steps along that path.

Scaling in therapy is a simple yet formidable tool that gives your clients a sense of control over and a new perspective on their difficulties, empowering them to make changes they may never previously have believed possible.

You can learn How to Stop Anyone Smoking with Mark Tyrrell on our Smoking Cessation Training Course (online).

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