Ask “How Come?” Instead of “Why?”

It is natural to feel blamed or accused when under stress. Patients who are faced with illness, fatigue, and uncertainty may be prone to misperception of even essential interview questions. Asking “How come?” instead of “Why?” can smooth the patient’s perception of important questions asked to ascertain motivations and health beliefs around sensitive topic areas. Although a helpful technique, this strategy cannot entirely obscure the pitfalls of the clinician’s negative countertransference.