Interventive interviewing and the IPscope

1. Introduction

Version followed: Karl Tomm's interventive interviewing trilogy in Family Process (Part I 1987, strategizing; Part II 1987, reflexive questioning; Part III 1988, the four question types), plus the IPscope as Tomm presented it in Geneva in 2017 and as set out in the 2014 Routledge book he edited with St. George, Wulff and Strong. For the later question families and internalized-other interviewing I followed Tomm's University of Calgary slide notes on couples. Parts II and III were read in full. For Part I only the abstract and introduction could be opened, and the 2014 book only through its publisher page.

This is not a manualised therapy with set sessions. It has two parts. Interventive interviewing is a way of running any family, couple or individual interview, built on Milan systemic practice. The IPscope is a systemic assessment tool for seeing and naming recurrent interpersonal patterns (IPs). Tomm developed both at the Calgary Family Therapy Centre at the University of Calgary, Canada. [source: Tomm 1987a; Tomm 2017; Routledge 2014 book page]

How change happens:

Everything the interviewer says and does, including silence, is treated as an intervention. Questions are the main tool. [source: Tomm 1987a]
Reflexive questions trigger reflexivity between levels of meaning in the family's own belief system. Family members then produce new thinking and behaviour themselves ("self-healing"), rather than taking on the therapist's insight or instructions. [source: Tomm 1987b]
In IPscope terms, families get stuck in pathologizing interpersonal patterns (PIPs). These are mutually coupled invitations that repeat because each person's move sets off the other's. Therapy aims to displace PIPs with healing (HIPs) and wellness (WIPs) patterns, using transforming patterns (TIPs) between therapist and family. [source: Tomm 2017; Routledge 2014 book page]

2. Framework

The sources set out no fixed phases, session count or manual. The structure below has two parts. The first is the in-session arc Tomm describes in Part III. The second is the order of IPscope work he describes in 2017. Linking them into a course of therapy is my synthesis. [source: Tomm 1988; Tomm 2017] [synthesis]

Format: conjoint family or couple sessions, individual sessions (with absent others brought in through questions or internalized-other interviewing) and supervision. The Milan-derived end-of-session intervention is optional. Tomm treats it as one part of treatment, not the main agent of change. [source: Tomm 1987b; Tomm couples slides] The sources give no session count or session length [uncertain].

Stage A: Engage and orient (opening of each interview and of therapy)

Goal: give the meeting a focus and join the family's own view of the problem.
Main tools: some lineal questions (problem definition, problem explanation), then circular questions. [source: Tomm 1988]
Move on when you have a working, partial systemic hypothesis and the family feels heard rather than judged [synthesis].

Stage B: Explore and map (early to middle phase)

Goal: understand "patterns that connect" and build the PIP.
Main tools:
- circular questions: difference, behavioural-effect and triadic questions [source: Tomm 1988; Tomm 1987b]
- IPscope PIP construction: intuit the strongest emotions, find the behaviours that trigger reactivity, couple them, describe the loop in gerunds, draw it [source: Tomm 2017]
Move on when an "opening" appears, meaning the family is curious, a spontaneous positive move shows up, or members begin to see their own loop. [source: Tomm 1988 ("opening"); Tomm 2017 (spontaneous moves)]

Stage C: Influence (middle phase)

Goal: open space for alternative meanings and co-construct HIPs that contradict a component of the PIP.
Main tools:
- reflexive questions (eight Part II types and later families)
- TIPs: deconstructive, co-constructive and utilization
- occasional strategic questions
- statements where information is missing [source: Tomm 1988; Tomm 1987b; Tomm 2017]
Move back to orienting questions whenever the family feels judged or manipulated, or the session "freezes". [source: Tomm 1988]

Stage D: Consolidate and protect (later phase)

Goal: extend HIPs into WIPs, and help the family recognise deteriorating patterns (DIPs) that could slide back into the PIP. Also attend to socio-cultural patterns (SCIPs) that hold the problem in place. [source: Tomm 2017]
Ending criteria: the family spends more time in WIPs than PIPs, can name its own DIPs, and the presenting problem no longer has its interactional support. This is inferred from Tomm's statement that clinical families get stuck in PIPs while healthy families spend more time in WIPs. [synthesis]

Tomm's "IPscopic Reflectogram" maps the whole process of systemic therapy across these pattern types. Its detailed layout is not given [uncertain]. [source: Tomm 2017]

Training and licensing: No certification, licensing or fidelity system is described. Tomm teaches through the University of Calgary Family Therapy Program, the Calgary Family Therapy Centre, workshops and the 2014 book. Chapter 3 of the book covers teaching and chapter 9 covers supervision. [source: Routledge 2014 book page; Tomm 2017] [uncertain]

3. Guiding principles

The whole interview is the intervention. Every question, comment, nonverbal act or silence affirms or challenges a pattern, so choose each one on purpose. For example, asking "what problems shall we discuss?" after a good stretch can bring the problem back. [source: Tomm 1987a]
Hypothesizing (as a conceptual posture). Always hold a working, revisable systemic hypothesis. A partial hypothesis is acceptable, and it can be offered as a question. [source: Tomm 1987a; 1987b]
Circularity (as a posture). Look for recurrent, interactional loops rather than causes inside one person. [source: Tomm 1987a; 1988]
Neutrality (as a posture). Stay accepting of every member and position. After any suggestion, return to neutrality quickly so the suggestion does not harden into pressure. [source: Tomm 1987b]
Strategizing (the fourth guideline). Decide moment to moment what to ask, and anticipate each question's probable, possible and improbable effects before you ask it. [source: Tomm 1987a; 1988]
Classify by intent, not wording. The same sentence can be lineal, circular, strategic or reflexive depending on your aim and tone. Check your intent before you ask. [source: Tomm 1987b; 1988]
Orienting versus influencing. Know whether a question is meant to change your own understanding (orienting) or the family's (influencing). Most questions fall somewhere between the two. [source: Tomm 1988]
Lineal and circular assumptions are complementary. Use lineal questions where facts and sequences matter, without letting them drive the formulation. [source: Tomm 1988]
Clients are autonomous and cannot be instructed directly. Prefer facilitative, invitational questions to corrective, impositional ones. [source: Tomm 1988; Tomm couples slides]
Intent does not guarantee effect, and the client decides the effect. Watch the response and accept that some effects show up only later, or never visibly. [source: Tomm 1988; Strong et al. 2008]
The question prefigures the response. Every question limits the legitimate answers, so own the power built into how you frame and deliver questions. [source: Tomm 1988; Tomm couples slides]
Questions bring forth the client's views; statements set forth yours. Use statements on purpose: to give missing information, an "if-then" observation or an ironic remark. [source: Tomm 1988; Tomm couples slides]
Name patterns, not people. Put the problem in the coupling between people, in gerunds such as "criticizing/defending", so that nobody's identity becomes the problem. [source: Tomm 2017; Strong et al. 2008]
IPs are serviceable fictions. Treat a pattern description as a useful construction that is always changing, not a fact. You are responsible for the distinctions you draw, because the same distinction can pathologize or heal (second-order view). [source: Tomm 2017]
Look for what the family is seeing and not seeing. Aim questions at the edges of their current view. [source: Tomm 1987b]
Collaborate on descriptions. If a pattern description does not land, work out a more mutually fitting one. Notice weak agreement and keep adjusting your wording until it fits. [source: Strong et al. 2008]
Attend to power and discourse. Circular descriptions can hide unequal power. Look for socio-cultural patterns (for example male dominance) and redress injustice rather than treating influence as equal. [source: Tomm 2017]
Avoid cookbook use and the "Law of the Instrument". Build the unique pattern of this family. Do not let the IPscope crowd out other descriptions, emotion or biology. [source: Tomm 2017]

4. Intervention inventory

The inventory has four parts:

A. The four question types (Part III, 1988)
B. The eight reflexive question types (Part II, 1987)
C. Strategizing, sequencing and statements
D. Later questioning practices, then the IPscope procedures

Tomm's own example questions are quoted only when they are short. All other example language is my illustrative wording.

A. The four question types: the map

Tomm crosses two dimensions:

Intent: orienting (changing your own understanding) versus influencing (changing the family's).
Assumptions: lineal versus circular.

This gives four types: lineal (investigative), circular (exploratory), strategic (corrective) and reflexive (facilitative). He links each type to a therapist role:

lineal: investigator or detective
circular: explorer or researcher
strategic: teacher, instructor or judge
reflexive: guide or coach

[source: Tomm 1988]

A1. Lineal questions (problem definition, problem explanation)

Purpose: establish focus and the facts of who, what, where, when and why. They also join the family's own account of the problem. Use them mainly at the start of an interview and of therapy. [source: Tomm 1988]
Steps:
1. Ask each member what the problem is and what they want help with.
2. Ask for the sequence: when it started and what happens.
3. Ask for their explanation.
4. Keep this short, then shift to circular questions.
5. Notice where you are starting to blame someone. [source: Tomm 1988] [steps: synthesis]
Example language (illustrative): "What brings you in? When did you first notice this? What do you think is causing it?"
Watch for:
- Lineal questions are reductionistic and tend to carry a judgmental attitude. They can bring up shame, guilt or defensiveness.
- Their effect on the family is conservative: they entrench the existing view.
- They can make you, the interviewer, more judgmental.
- Working well looks like the family feeling understood and a clear focus emerging. [source: Tomm 1988; Tomm couples slides]

A2. Circular questions (difference, behavioural-effect, triadic)

Purpose: explore how members are connected and what loops keep the problem going. Use them across the early and middle phases, and whenever you need to rebuild neutrality. [source: Tomm 1988]
Steps:
1. Difference questions: ask about category differences (who is most or least affected, who agrees most) and temporal differences (before or after an event, better or worse now).
2. Behavioural-effect questions: ask what A does when B does X, and how B then responds.
3. Triadic questions: ask a third person to describe the relationship between two others. Tomm uses triadic and circular questioning throughout Part II.
4. Follow each answer with a question built on the information it gave.
5. Build a loop hypothesis as you go. [source: Tomm 1988; Tomm 1987b] [step ordering: synthesis]
Example language (illustrative):
- "Who in the family worries most when Sam stays out late? Who next?"
- "When your mum raises her voice, what does your dad do? And then what does she do?"
- "Is it more or less like this since Grandma moved in?"
Watch for:
- The effect on the family is liberating. Listeners start to see their own circular patterns, and your neutrality and acceptance grow.
- Risks: drifting into irrelevant areas, and stylised, repetitive questioning that irritates the family.
- Working well looks like members adding new information and describing interaction rather than character. [source: Tomm 1988]

A3. Strategic questions (leading, confrontation)

Purpose: correction. A strategic question indirectly tells the family what is "right". Use them occasionally: to challenge a stuck or complacent pattern, or to lead to a solution that is obvious. [source: Tomm 1988]
Steps:
1. Check that you are making a deliberate choice, not acting out frustration.
2. Put the challenge as one leading or confronting question.
3. Watch the reaction.
4. Return quickly to neutral circular or reflexive questions. [source: Tomm 1988; Tomm 1987b] [steps: synthesis]
Example language (illustrative): "Don't you think he is old enough to manage his own homework?" (leading). "How can you say you want closeness when you leave every time she starts talking?" (confrontation)
Watch for:
- The effect is constraining and sometimes coercive or guilt-inducing. Tomm likens it to cross-examination.
- It pulls you into an oppositional stance, and overuse harms the alliance and works against therapy.
- Signs of trouble: defensiveness, silence, or the session "freezing".
- Tomm notes that embedded suggestions turn strategic when you push too hard, sliding into "quasi-lecturing". [source: Tomm 1988; Tomm 1987b]

A4. Reflexive questions (overview)

Purpose: facilitation. A reflexive question invites members to reflect on their own meanings and options, so they generate new cognition and behaviour themselves. Its effect is generative for the client and creative for the clinician. [source: Tomm 1987b; Tomm 1988; Tomm couples slides]
Steps:
1. Pick the type from the eight below to fit your hypothesis and what the family is not yet seeing.
2. Use a soft, tentative tone.
3. Give the family room not to answer.
4. Questions left unanswered in session may still be worked on at home. [source: Tomm 1987b]
Watch for:
- Possible disorienting confusion. This can be therapeutic when it loosens rigid "knowing", but it needs enough direction.
- Signs it is working: pauses, new descriptions, members wondering aloud, and changes reported at later sessions. [source: Tomm 1988]

B1. Future-oriented questions

Purpose: bring forth alternative futures, goals and anticipated consequences. Tomm's Part II subtypes include questions about goals, anticipated outcomes, hypothetical scenarios and catastrophic fears [uncertain: subtype list; the summary confirms the type and its general purpose]. [source: Tomm 1987b]
Steps:
1. Ask about plans and hopes.
2. Ask about the likely consequences of the current pattern continuing or changing.
3. Ask hypotheticals such as "if X happened, what would…". Tomm's opening example of a reflexive question is a hypothetical about a parent's prolonged hospitalisation.
4. Let answers stand without evaluating them. [source: Tomm 1987b]
Example language: Tomm asks a young person, "What plans do you have for a career?" [source: Tomm 1987b]. Illustrative: "If things keep going this way for another year, where do you think the two of you will be? If they got better, what would be the first sign?"
Watch for: Hope and planning language appearing. The risk is fostering unrealistic hopes; Tomm flags this in his hope sequence. [source: Tomm couples slides]

B2. Observer-perspective questions

Purpose: increase awareness of self, others and interaction patterns by inviting a member to observe from outside, including from another person's position. [source: Tomm 1987b]
Steps:
1. Ask the person to describe their own behaviour as an observer would.
2. Ask them to imagine the other's inner experience.
3. Ask a third party to describe the loop. [source: Tomm 1987b]
Example language: Tomm: "What do you imagine he experiences when he gets into a situation like that?" [source: Tomm 1987b]. Illustrative: "If a camera were recording the two of you on Sunday night, what would it show each of you doing?"
Watch for: Empathic statements, a member describing their own contribution, and a softer tone. [synthesis]

B3. Unexpected context-change questions

Purpose: bring out the opposite, masked side of a problem or relationship. The question shifts the context the family expects, for example from conflict to enjoyment. [source: Tomm 1987b]
Steps:
1. In the middle of problem talk, ask about the opposite: good times, exceptions, or the positive face of the symptom.
2. Follow up with circular questions about who noticed it.
Example language: Tomm: "When was the last occasion that the two of you had a good time together?" [source: Tomm 1987b]
Watch for:
- Surprise, laughter or a pause suggest a useful shift.
- If the question feels dismissive of their distress, go back to acknowledging the problem first. [synthesis]

B4. Embedded-suggestion questions

Purpose: carry a specific reframe or possible action inside a question. Examples include an alternative response, an apology or forgiveness. [source: Tomm 1987b]
Steps:
1. Describe the alternative action in the hypothetical ("if, instead of X, you did Y…").
2. Ask what effect it would have on each person.
3. Return quickly to neutrality. [source: Tomm 1987b]
Example language: Tomm's form starts "If, instead of withdrawing or leaving when she got upset, you simply sat with her…" and asks what would follow [source: Tomm 1987b]. Illustrative: "Suppose you told him you were sorry for that comment. How do you think he might respond?"
Watch for: If you push too hard, the question becomes strategic, a form of quasi-lecturing. Signs: the client defends, or agrees only to please you. [source: Tomm 1987b]

B5. Normative-comparison questions

Purpose: connect the family to social, developmental or cultural norms. They can also stress similarity to other families to reduce isolation and shame. [source: Tomm 1987b]
Steps:
1. Frame the difficulty as common, or ask how it compares with other families or with this life stage.
2. Then ask when they first noticed it in themselves. Tomm's example normalises difficulty with anger before asking when they first realised they shared it. [source: Tomm 1987b]
Example language (illustrative): "Many parents of teenagers find this stage harder than they expected. How does your experience compare with your friends'?"
Watch for: Relief and less shame. The risk is imposing a dominant cultural norm; check which norms are theirs. [synthesis]

B6. Distinction-clarifying questions

Purpose:
- clarify causal attributions, categories, sequences or dilemmas
- separate fused ideas, such as a child's behaviour from the child's identity
- invite uncertainty about rigid beliefs [source: Tomm 1987b]
Steps:
1. Ask each member how they define the key term (in Tomm's case example, "stealing").
2. Ask how one category differs from another, and which came first.
3. Keep a strictly neutral tone. [source: Tomm 1987b]
Example language (illustrative): "Is that something he is, or something he does? When did taking things without asking become 'stealing' for you?"
Watch for: Asked in a non-neutral tone, these become strategic confrontation. Signs that they work: the family uses finer distinctions and less global labels. [source: Tomm 1987b]

B7. Questions introducing hypotheses

Purpose: offer your hypothesis tentatively as a question. It might be about a recursive loop, a defence, an unmet need or a danger in change. A partial hypothesis is acceptable. [source: Tomm 1987b]
Steps:
1. Put the hypothesis into a question that describes the loop.
2. Include the effect on third parties.
3. Let the family accept, modify or reject it. [source: Tomm 1987b]
Example language: Tomm describes the loop in both directions (anger, then withdrawal, then anger), then asks what the children do [source: Tomm 1987b]. Illustrative: "I wonder whether getting better might mean something difficult for the family. What might be the risks if she stopped being worried about?"
Watch for: Engagement with the idea, including disagreement, means it was useful. If the family takes your hypothesis as fact, step back to orienting questions. [synthesis]

B8. Process-interruption questions

Purpose: comment on what is happening in the interview or in the therapeutic relationship. This lets the family see, and stop, a problematic pattern as it happens in session. [source: Tomm 1987b]
Steps:
1. When the pattern happens in the room (for example escalating argument), interrupt with a question about the process.
2. Ask whether it is typical.
3. Ask about its effects. [source: Tomm 1987b]
Example language: Tomm: "When your parents are at home, do they argue as much as they do here?" [source: Tomm 1987b]. Illustrative: "What just happened between us when I asked about school? Was that helpful or did it feel like I was taking sides?"
Watch for: Disclosures in session can expose members to reprisal at home. Before ending, assess and address that risk. [source: Tomm 1987b]

C1. Strategizing in session (choosing and sequencing questions)

Purpose: this is the fourth guideline, the decision-making posture that governs everything else. [source: Tomm 1987a; 1988]
Steps:
1. Before each question, name your intent to yourself: orienting or influencing, lineal or circular.
2. Anticipate its probable, possible and improbable effects.
3. Start the interview with some lineal questions for focus.
4. Stay mainly with orienting questions in the early and middle part.
5. When an opening appears, shift to influencing questions. Choose reflexive ones by preference and strategic ones rarely.
6. Monitor reactions continuously. If members feel judged or manipulated, or the session freezes, switch to neutral circular questions, make a statement or pause questioning. If the family is complacent, consider a few strategic questions.
7. Remember your influence over the direction of talk, because every question prefigures its answer. [source: Tomm 1988]
Example language (illustrative, self-talk): "I'm about to ask a leading question. Do I want to correct them, or to open space? What could this question do if it goes wrong?"
Watch for: Tomm's own warning example. He opened a follow-up session that had started with good news by asking what problems the couple wanted to discuss, and a bitter argument followed. Ask about the improvement instead. [source: Tomm 1987a]

C2. Using statements alongside questions

Purpose: questions bring forth the client's views, while statements set forth the therapist's. Use statements when clients lack information, or to give an "if-then" statement or ironic remark that prompts discovery. [source: Tomm 1988; Tomm couples slides]
Steps:
1. Notice when a question would only be a disguised statement.
2. If information is truly missing, say it plainly and briefly.
3. Follow with a reflexive question about what the information means to them. [synthesis]
Example language (illustrative): "Many children react to a parent's illness by acting up at school. If that were partly happening here, what would you want him to know?"
Watch for: Lecturing. Keep statements short and return to questions. [synthesis]

C3. Optional end-of-session intervention

Purpose: Part II treats a final intervention (in the Milan tradition) as one component of treatment, not the main agent of change. In this approach, the questions in the interview do most of the work. [source: Tomm 1987b]
Steps: if you use one, keep it consistent with the hypotheses developed in the interview, and with neutrality [synthesis]. The sources give no specific format [uncertain].
Watch for: Relying on a clever ending rather than on the interview itself. [synthesis]

D1. Later reflexive question families (named in Tomm's couples slides)

What the source gives: beyond the eight Part II types, Tomm's Calgary slides list these families: grounding, externalizing, internalizing, agency, re-construction, audience, interpersonal pattern, motivating, responsibility, re-emotioning, de-construction, endurance and self-reflexive questions. [source: Tomm couples slides]
The slides give names only, with no definitions or examples. Their exact meaning in Tomm's teaching is [uncertain]. Externalizing questions very likely draw on White and Epston's narrative practice, and agency, responsibility and audience questions likely belong to the same narrative-informed phase of Tomm's work [uncertain: inference from the names].
Practical use [synthesis]: treat these as prompts for which aspect of the client's meaning system to aim a reflexive question at. Examples: separating the problem from the person (externalizing); noticing their own capacity to act (agency); who would notice a change (audience); how they have kept going (endurance). Do not present them as Tomm's defined techniques.

D2. Bifurcation questioning

Purpose: in the slides this branches the conversation across past choices, present options and future possibilities. It makes visible the choice points where a person could have gone, or could now go, one way or another. [source: Tomm couples slides]
Steps [synthesis; no procedure found]:
1. Identify a choice point.
2. Ask what led them down one branch rather than the other.
3. Ask what the other branch would have meant.
4. Bring it to the present: which branch they are choosing now.
5. Bring it to the future: what each branch could lead to.
Example language (illustrative): "At that moment you could have walked out or stayed. What helped you stay? Which way are you leaning now, and where might each path take you?"
Watch for: Pressure towards the "right" branch makes it strategic. Keep both options legitimate. [synthesis]

D3. Internalized-other interviewing

Purpose: the person speaks from their inner experience of another person. The idea is that the self contains an "internalized community" of others, and any of them can be interviewed. It aims to deepen empathy and understanding and to widen therapeutic options. The real other can be present and "meet themselves" as they exist within the client. Examples: a husband interviewed as his wife while she listens, or a parent as their adolescent (and the reverse). [source: ASC 2026; Tomm couples slides] Brosh (2007) credits the method to Tomm (1996), and it is often traced to David Epston [uncertain: Epston origin not confirmed].
Steps: the sources give the frame but no step list. The steps below are [synthesis] built on that frame:
1. Explain the exercise and get consent from both partners. The person being represented agrees to listen without interrupting.
2. Ask the client to answer as the other, in the first person and in the other's voice.
3. Address the client by the other's name throughout.
4. Ask questions about the other's experience: the relationship, what they feel when the pattern happens, what they wish their partner understood, what they appreciate.
5. Close by addressing the client by their own name again, to step them out of the role.
6. Invite the listening person to reflect on what fit, what surprised them and what was missed.
7. Ask the speaker what it was like to stand in the other's shoes.
Example language (illustrative): "I'd like to talk with the Maria you carry inside you. Maria, what is it like for you when Tom goes quiet after work?" Later: "Tom, coming back to yourself, what did you notice?"
Watch for:
- Signs it is working: the listener feels understood, and the speaker shows surprise or new empathy.
- Do not use it where one partner is coercive or abusive, or where the listener may be punished afterwards. Do not let the listener "correct" the speaker harshly. [synthesis]
- A controlled dissertation found positive immediate effects that did not differ overall from standard couple interviewing. [source: Brosh 2007]

D4. Named question sequences

What the source gives: the couples slides list several sequences:
- co-constructing hope (hope defined as "Living a preferred future in the present"), with a caution against fostering unrealistic hopes
- co-constructing responsibility
- a child accepting a stepparent
- deconstructing shame and guilt
- opening space for apology, forgiveness and reconciliation [source: Tomm couples slides]
The slides give the sequences' aims, not their question-by-question content [uncertain].
Practical use [synthesis]: build each sequence from the Part II question types:
- hope: future-oriented and embedded-suggestion questions
- shame and guilt: distinction-clarifying (act versus person) and normative-comparison questions
- apology, forgiveness and reconciliation: embedded-suggestion questions about apologizing and forgiving, then observer-perspective questions about the effect on the other. This pairing is also an IPscope HIP. [source for apology/forgive pairing: Tomm 2017]

E. IPscope procedures

The IPscope is a "cognitive instrument" for seeing interpersonal patterns, by analogy with a microscope or telescope. Patterns are coupled invitations, described in gerunds. There are six types:

WIPs (wellness patterns): build generativity, competence or effectiveness, or sustain health in the relationship.
PIPs (pathologizing patterns): increase negativity, pain or suffering, or lead to relationship deterioration.
HIPs (healing patterns): a kind of WIP that specifically contradicts one component of a PIP.
TIPs (transforming patterns): a kind of WIP, usually between therapist and client, that moves away from a PIP or towards a HIP or WIP.
DIPs (deteriorating patterns): a kind of PIP that sets up a likely slip from a TIP, HIP or WIP back into a PIP.
SCIPs (socio-cultural patterns): members take up and enact a social discourse, value or belief, and so reinforce it.

[source: Tomm 2017; Routledge 2014 book page]

E1. Constructing a PIP

Purpose: turn the presenting problem into a circular, interpersonal description that nobody owns alone. Use it once Stage B has given you enough interactional detail. [source: Tomm 2017]
Steps (Tomm's sequence, paraphrased):
1. Intuit the strongest negative emotion in each main participant.
2. Identify the observable behaviours that express those emotions.
3. Find the specific behaviour in each person that triggers the most reactivity in the other.
4. Select one core behaviour per person that reinforces the other's negative behaviour.
5. Highlight the coupling as a recurrent loop, named in gerunds where possible.
6. Visualise or draw it in the interpersonal space between them. [source: Tomm 2017]
Conceptual skills to apply [source: Tomm 2017]:
- Collapsing time so the circularity becomes visible.
- Locating the complementary coupling between persons.
- Recognising habit: internalised sequences get re-enacted even without awareness.
- Using gerunds to stay behavioural and limit speculation.
Example: Tomm couples "complaining" (sadness: frowning, hunched) with "criticizing" (anger: scowling, crossed arms). Common PIPs: criticizing/defending, judging/protesting, condemning/evading, frustrated pursuing/distancing, domination/submission. [source: Tomm 2017]
Example language (illustrative): "Can I check something? It sounds like the more you criticize, the more he defends, and the more he defends, the more you feel you have to criticize. Does that fit? What would you call it?"
Watch for:
- Agreement in the family's own words, and relief that nobody is "the problem".
- If the description lands weakly, revise it together. [source: Strong et al. 2008]
- Drawing the pattern can drift towards false objectivity. Present it as a working picture. [source: Tomm 2017]

E2. Generating a HIP to displace the PIP

Purpose: co-construct a specific antidote pattern that contradicts one component of the PIP. [source: Tomm 2017]
Steps (paraphrased):
1. Imagine, or look for, constructive behaviours that contradict components of the PIP.
2. Notice spontaneous positive moves in the session, affirm them and draw them out.
3. Select behaviours that could reinforce each other, and couple them.
4. Refine the wording into doable behaviours, in gerunds.
5. Visualise or draw the preferred pattern.
6. Ask specific questions that bring out each complementary half of the HIP. [source: Tomm 2017]
Example pairs:
- for criticizing/defending: selectively noticing competence / performing more competence (also in Strong et al. 2008)
- apologizing / forgiving
- for depression with blaming or diminishing: affirming / crediting
- for adolescent control struggles: giving more options, relinquishing undue control
- for lying: accepting inner struggles, selectively honouring honest admissions
- for sibling rivalry: treating each child as unique
- for professional labelling: naming the pattern as external to the person [source: Tomm 2017]
Example language (illustrative): "Just now, when he admitted he'd forgotten, you didn't criticize. You said 'thanks for telling me'. What did that make possible? What would it take to do more noticing of what he gets right?"
Watch for: Both halves need to appear. One person changing while the other keeps the old move tends to collapse back into the PIP [synthesis].

E3. Using TIPs (therapist-family transforming patterns)

Purpose: use the therapist's own interaction with the family to move it from PIP towards HIP or WIP. [source: Tomm 2017]
Three types [source: Tomm 2017]:
- Deconstructive: enquire into the systemic nature and origins of the problem, and disclose its relational nature.
- Co-constructive: distinguish possibilities, consider new initiatives and ask reflexive questions.
- Utilization: ask about helpful variations within the PIP, and identify useful aspects of it.
Steps [synthesis]:
1. Start deconstructive: "where did this pattern come from?"
2. Move co-constructive: reflexive questions towards the HIP.
3. Use utilization when the family cannot give up the pattern. Find its useful parts and its milder variants.
Example language (illustrative): "When the arguing happens but doesn't get as bad, what's different about those times?" (utilization). "Where do you think you each learned to handle disagreement like this?" (deconstructive)
Watch for:
- The therapist can enter a PIP with the family, for example diagnosing/labelling, or pressuring/resisting.
- Treat the therapy relationship as a pattern to be IPscoped too. [source: Tomm 2017 (professionally induced stigma; pressuring/resisting DIP)]
- Gaete, Sametband and Sutherland's chapter covers TIPs in practice; It is not drawn on [uncertain].

E4. Identifying and pre-empting DIPs

Purpose: spot the patterns that make slipping back likely, before they grow into a PIP. Whether a DIP becomes a PIP depends on its intensity. Examples: scrutinizing/performance, seeking attention/ignoring, pressuring/resisting. [source: Tomm 2017]
Steps [synthesis]:
1. Once a HIP is established, ask what could tip things back.
2. Name candidate DIPs in gerunds.
3. Agree an early-warning signal and a HIP move for each.
Example language (illustrative): "Now that things are better, what small things could start pulling you back into the old loop? How would you each notice it first?"
Watch for: Over-scrutinizing improvement is itself a DIP (scrutinizing/performance), so keep the check light. [source: Tomm 2017 (pattern); application synthesis]

E5. Working with SCIPs

Purpose: make visible how members enact wider social discourses, which can help or harm. Examples: a sexist SCIP of male dominance versus an egalitarian SCIP. This addresses the feminist critique that circular descriptions hide unequal power. [source: Tomm 2017]
Steps [synthesis]:
1. Ask where the beliefs inside a PIP come from: family, culture, gender, religion, migration.
2. Ask who benefits and who pays.
3. Invite a preferred SCIP. For domination/submission, Tomm's antidote is acknowledging privilege and redressing injustice. [source: Tomm 2017]
4. For gendered and intercultural patterns, see book chapters 6 to 8 [uncertain].
Example language (illustrative): "Where do you think the idea comes from that the man should have the final say? How does living by that idea affect each of you?"
Watch for: Preaching. Keep questions reflexive. Where power is abusive, safety outweighs neutrality (see section 5). [synthesis]

E6. Consolidating WIPs and using the IPscope in supervision

Purpose: extend healing patterns into ongoing wellness patterns. The IPscope also helps you look at your own patterns with families, and at supervisor-supervisee patterns ("IPs-supervision", book chapter 9). [source: Tomm 2017; Routledge 2014 book page]
Steps [synthesis]:
1. Ask the family to name their WIPs.
2. Ask how they will keep them going.
3. In supervision, map the therapist-family pattern as a PIP or TIP, and generate a therapist HIP.
Example language (illustrative): "What are the two of you doing now that keeps things good? Who would be first to notice if it faded?"
Watch for: The family taking over the pattern language on its own is a good sign of readiness to end. [synthesis]

5. Handling problems

Each item says what the sources give and what is my own synthesis.

Session freezes; the family feels judged, cross-examined or manipulated

What Tomm says: this usually follows lineal or strategic questioning. Switch to neutral circular questions, make a plain statement, or stop questioning for a while. [source: Tomm 1988]
Practical response [synthesis]: name it with a process-interruption question ("I think my last few questions may have felt like an interrogation. Did they?"). Then go back to difference questions that do not assign blame.

Stuck or complacent family; nothing moves

What Tomm says: a few strategic questions may help, used sparingly. Also look for spontaneous positive moves to affirm, and ask utilization questions about milder or helpful variations of the PIP. [source: Tomm 1988; Tomm 2017]
Practical response [synthesis]: check whether you have joined the PIP yourself, for example pressuring/resisting. If so, relax your own pressure first. That is a therapist HIP.

"Resistance" or disagreement with your pattern description

What the sources say: treat it as a fit problem, not opposition. Work out a more mutually fitting description, and keep repairing your wording when agreement is weak. [source: Strong et al. 2008]
Practical response [synthesis]: ask the family to name the pattern themselves.
The trap to avoid: Tomm's framing of strategic questioning as producing an oppositional stance suggests that pressing harder will deepen the impasse. [source: Tomm 1988]

Confusion or overwhelm from reflexive questions

What Tomm says: disorienting confusion can be useful when it loosens rigid certainty, but it needs enough direction. [source: Tomm 1988]
Practical response [synthesis]:
- Slow down and ask one question at a time.
- Summarise what you have heard.
- Give a short orienting statement about where the conversation is going.
- If a member shows acute distress, stop pattern work. Ground them, and attend to that person's safety before going on.

Questions go unanswered; "non-adherence"

What Tomm says: there is no homework in the usual sense. Families may not answer in session, but you should still ask, because they may carry on the questions at home. [source: Tomm 1987b]
Practical response [synthesis]: at the next session, ask what came up afterwards about last time's questions. If you add between-session tasks, frame them as invitations to notice the HIP rather than as instructions.

Circular questioning feels repetitive or irrelevant

What Tomm says: stylised, repetitive circular questioning irritates families and drifts into irrelevant areas. [source: Tomm 1988]
Practical response [synthesis]: tie each question to the current hypothesis and to the family's stated concern. Vary the form, and every so often ask whether this line of conversation is useful to them.

Rupture through over-pushing an embedded suggestion

What Tomm says: an embedded suggestion pushed too hard becomes strategic and quasi-lecturing. Return to neutrality quickly. [source: Tomm 1987b]
Practical response [synthesis]: acknowledge it openly ("I think I got ahead of you there"), then ask an observer-perspective question about how the suggestion landed.

Disclosures in session lead to reprisal at home

What Tomm says: process-interruption and other questions can expose members to retaliation after the session, and the therapist should address this. [source: Tomm 1987b]
Practical response [synthesis]:
- Before closing, ask who might be upset by what was said and what might happen at home.
- Plan for that.
- Where there is any sign of violence, see members separately and follow local safeguarding procedures.

Violence, coercive control and abuse; limits of neutrality and circularity

What Tomm says: he acknowledges the feminist critique that circular descriptions imply equal influence and hide real power differences. He names domination/submission as a pervasive PIP whose antidote is acknowledging privilege and redressing injustice. [source: Tomm 2017]
Practical response [synthesis]:
- Do not describe abuse as a mutual "loop".
- Hold the person using violence responsible, and do safety and risk assessment before any conjoint work.
- Do not do conjoint sessions, internalized-other interviews with the victim listening, or apology/forgiveness sequences while there is risk.
- Use the SCIP lens to name dominance discourses.

Hope turns into unrealistic expectation

What Tomm says: he flags unrealistic hope as a risk of the hope sequence. [source: Tomm couples slides]
Practical response [synthesis]: pair future-oriented questions with questions about small, present-day steps ("living a preferred future in the present"). Also ask about likely setbacks, which brings in DIP awareness.

Relapse after improvement

What Tomm says: this is the DIP concept: deteriorating patterns create conditions for slipping back into the PIP. [source: Tomm 2017]
Practical response [synthesis]:
- Treat relapse as information about a DIP. Map it, and revive the HIP.
- Avoid scrutinizing progress too intensely, because scrutinizing/performance is itself a DIP.
- Watch your own opening questions after a good week. [source: Tomm 1987a (example)]

Pattern language felt as blaming, or as dismissing biology or emotion

What Tomm says: some users find the IPscope too behavioural or too abstract. It assumes fairly normal biological functioning, and it can eclipse other useful descriptions. [source: Tomm 2017]
Practical response [synthesis]:
- Keep the emotions you intuited in step 1 visible.
- State plainly that naming a pattern does not deny illness, trauma or neurodevelopmental difference.
- Combine pattern work with appropriate medical or psychiatric care.

Cookbook use, or the therapist over-identifying with the tool

What Tomm says: he warns against formulaic, cookbook use and against the "Law of the Instrument". [source: Tomm 2017]
Practical response [synthesis]: build each PIP from this family's own words and behaviours. Use the sample pattern pairs in E1 and E2 only as prompts to check against.

Diagnosis or labelling creates a professional PIP

What Tomm says: diagnosing/labelling can work as a professionally induced pattern that adds stigma. The HIP is naming the pattern as external to the person. [source: Tomm 2017]
Practical response [synthesis]: when a diagnosis is needed, discuss it alongside the interactional description so it does not become the person's identity.

Problems specific to internalized-other interviewing [synthesis throughout]

The speaker caricatures the other: slow down and ask for the other's feelings rather than their behaviour.
The listener corrects angrily: hold the reflection until the end and frame it as "what fit and what you'd add".
The speaker cannot stay in role: use fewer, simpler questions and keep addressing them by the other's name.
Distress after stepping out of role: allow time to de-role and debrief.
Grief work with a dead or absent other: go gently and check consent at each step.
No published cautions from Tomm on these points are given [uncertain].

Cultural mismatch, or intercultural PIPs

What the sources give: chapter 8 of the 2014 book covers intercultural PIPs. It is not drawn on [uncertain]. [source: Routledge 2014 book page]
Practical response [synthesis]:
- Ask normative-comparison questions about their own reference groups rather than your norms.
- Check whether the pattern words fit their language and values.
- Watch for questioning styles, such as triadic questions about elders, that may breach cultural norms of respect.

Sources

Sources: