“How are you?” This is a really versatile question. We can ask it of the stranger in the elevator to make polite conversation. We can ask it of a dear friend we haven’t spoken to in a while. And just as versatile as the question itself is the range of responses. Most people can answer it without too much thought.
“Good, thanks.” “Fine.” “Busy.”
But if you really drilled down and asked again, “No wait, how are you, really?” then it might prompt that person to pause and think. Some might think about their past week and answer accordingly. Some might mentally scan their body and notice stress or fatigue. Many people, on the other hand, might come up with no response. They draw a blank. They can’t identify what they’re feeling; they either don’t have words for it, or they don’t even know how to unwind their tangled mess of emotions.
I notice this in therapy with my adult clients. It’s not uncommon to begin a session with this question, and if I’m not intentional, we could talk for an entire hour without ever getting into the deeper part of their response.
If my inquiry was met with an “I don’t know,” I used to doubt that being a true response. I would assume they weren’t ready to talk or were trying to guard their feelings. Surely, you know how you’re feeling, right? But the longer I’ve been doing this work, the more I’ve learned that this can be quite an authentic response.
This is especially true with children. If you’ve ever asked a child this question, you’ve surely been met with silence or a simple answer like, “Good.” And while they may offer an answer because they’ve learned it’s what’s expected, they’re not truly engaging with the question itself. They’re not digging deep or noticing that they’re tired or considering their past week. This isn’t the way a child speaks or connects—yet.
The art of talk therapy, then, is learning how to speak like the other person.
This can feel intimidating for my trainees who are considering working with children. I remind them that they already have this capability—they were a child for many years of their life. They just need to practice that language again.
This week our family experienced a nightmare scenario with our two-year-old daughter. She had had a cold virus for several days, and she started to have significant problems breathing. This led to a four-day PICU stay, marked by high-flow oxygen, IV fluids, BiPap machine, pokes, prods, and wires all over her body.
When we got the good news that she’d finally recovered enough to go home, I decided I wanted to buy her a doctor playset. I didn’t think too deeply about it at the time, but intuitively I knew she had some processing to do. (And let’s be real—this is par for the course when you’re a psychologist and a mother.)
When she opened up the doctor set, she promptly put on the stethoscope. She picked up the otoscope and examined her ears. I knew to just observe, narrate her play, but not lead or direct it by saying things like, “Put this here,” or “It doesn’t go on like that.”
After she’d explored the various plastic medical tools, she made me her patient—placing the chestpiece of the stethoscope on my heart, then walking to my back to take a listen as well. She examined my ears. She fumbled with the blood pressure cuff. She bonked my forehead a little too hard when trying to read my temperature. And she placed a bandage—or rather, in her mind, the O2 sensor—on my toe and put my sock back on, mimicking how it was placed on her toe in the hospital. Intermittently, she would smile at me and say, “Good job, mama.”
I knew I was witnessing magic—or truly, I was witnessing healing.
She was in control now. She’d spent four days in the PICU, where she’d been completely out of control. When the medical team put on her life-saving BiPap machine, I distinctly remember her crying, screaming, “All done, all done!” Thrashing so hard that she almost pulled out her IV port and reminded the staff that a 2-year-old girl has some strong kicks.
So, her reversing this—being the doctor and so sweetly offering comfort to her patient—was powerful. Moment by moment in her play, she was regaining her sense of autonomy.
And the healing didn’t stop there. Later in her play, she became the patient again, directing me to listen to her lungs, put on the blood pressure cuff, change her diaper—all the things that she bristled at in the hospital.
I didn’t need to ask her how she was doing—by speaking her language, or rather, listening for it, she showed me.
This doesn’t have to be a one-time conversation. I might figuratively ask her again. The next time she discovers that doctor set, she might return to it in a different way. Maybe this time she’s easily frustrated. Maybe her patient doesn’t understand that she’s trying to measure your O2 because she’s using a pair of tweezers. But expressing negative feelings in play is processing too—because just like adults, children’s feelings are complex and come in waves.
Asking someone, “How are you, really?” is a deeply meaningful way to express care and make space to listen. It’s important. It’s a way to begin healing.
Our role, then, is to make sure we’re speaking and listening for their response in their own language—and maybe returning to that question again and again.
