As clinical mental health professionals, we are accustomed to asking questions. Our questions are in the service of the patients goals for treatment and of the therapeutic relationship. What happens, however, when those questions are met with, I dont know?
Perhaps the most frequent outcome after an I dont know is that the line of questioning ends and the therapeutic conversation takes a slightly different direction. At times, this can be a form of resistance in therapy, but I have found that this is not always the case (Newman, 1994).
It is also possible that the question is reframed or rephrased in a way that elicits a different response.
Another alternative outcome is to explore the I dont know. What function does it serve at that point in time? How can knowing this information aid in the course of therapy or enhance the therapeutic relationship?
While only three words, I dont know powerfully communicates necessary information about a patients cognitive, affective and interpersonal experiences. It is essential to understand which phrase you are encountering.
I have found that this can often be done by simply asking, Which flavor of I dont know do you mean? If further clarification is necessary, which it often is (as we do not generally differentiate the intent of these three words), psychoeducation explaining various intentions and motivations is helpful.
Types of “I Don’t Know”
“I don’t know” meaning “I really don’t know. I will need to give that some thought.”
In this instance, patients generally have not consciously thought about their answer to the question. Their intention is to communicate that they will give thought to the topic and perhaps return to it at a later date. Is this a topic they have thought about before? Do they think it is important/unimportant? Will they spend some time in thought?
I dont know meaning I dont know because Im ambivalent and/or indecisive.
Being ambivalent and/or indecisive has several important implications in therapy. Is indecisiveness an ongoing pattern? What is underlying the ambivalence? Perhaps the patient will benefit from motivational interviewing and resolution of ambivalence. How is not making a decision serving the person?
I dont know meaning I have given it thought, but I havent figured it out just yet.
This style of response may indicate that the person would benefit from a problem-solving based approach in which empowerment is key. When, if important, is a decision needed? What do they believe is getting in the way of making a decision? Can taking certain steps or talking to someone in their life resolve this situation? How can the therapist help them arrive at both short- and long-term steps in figuring it out?
I dont know meaning I dont want to talk about it right now.
The motivation behind this statement is to set a boundary for discussions. Especially in times of building trust, it is important to respect that patients do not want to talk about certain topics. What is their understanding about why they dont want to talk about it? Is it too painful? Do they feel exhausted and/or overwhelmed?
Any patient response to this question provides important information about their experiences and direction for the rest of the session. Is there something else they would prefer to discuss? Do they believe the therapist has gotten off-track?
I dont know meaning I dont want to tell you.
Similar to the I dont want to talk about it right now, this statement implies a boundary. Is there something specific about the person of the therapist or the therapeutic relationship to this point that prevents disclosure? What is getting in the way? Is this information they have talked about with other people in their life? What might need to happen within the therapeutic relationship for the patient to feel comfortable and how might the dyad foster necessary safety?
I dont know meaning Im embarrassed/ashamed/afraid to tell you.
Frequently as therapists, we inadvertently shame patients shame. That is, if a patient says, Im ashamed, we are often drawn to comfort the experience of feeling ashamed. In doing so, we indirectly communicate, no, you shouldnt feel ashamed about that, and thus perpetuate the shame.
Finn (2013) discussed several ways for working with shame to validate it and redirect it in a way that is productive. Is the patient worried about what you are thinking or will think of them? How have people responded to them in the past about this situation/topic?
I have found it effective to ask the client to ask you a yes-or-no question about what they fear is effective (i.e., Are you going to think less of me?” Will you think Im a disgusting person?).
Create a Safe Space
As the therapist, you can then provide reassurance and create a safe space for them to disclose whatever they had felt embarrassed or ashamed to tell you (i.e., No, I will not think less of you, no, I will not think you are a disgusting person, Given how people have responded to you in the past about this, I understand why you might fear that I would, but the answer is no.)
Working through this form of I dont know can be extremely healing of past psychological injuries around various topics and promotes a form of unconditional acceptance for a persons holistic experience. In sum, exploring the meaning of I dont know provides rich opportunities for patient growth and relationship enhancement. It gently communicates safety and boundaries within discussions that are driven by the patients cognitive, emotional and interpersonal experiences.
As a mental health professional, challenge yourself personally to explore your own forms of I dont know and in which situations you employ various forms of it. Ask patients about their motivations and intentions surrounding I dont know and new therapeutic avenues will openones that might have been previously foreclosed with those three powerful little words.
References
Finn, S. Understanding and working with shame in psychological assessment. Workshop presented at the Annual Conference of the Society for Personality Assessment, San Diego, CA. March 20013
Newman, C. F. Understanding client resistance: Methods for enhancing motivation to change. Cognitive and Behavioral Practice, 1, 47-69. 1994.
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