The Rule of 9

Clinical Skills

The Rule of 9

In previous articles and during SWEET seminars, we often talk about the problem-solving process. We often describe how part of the process is to first formulate the problem and agree upon its definition.  We also explain that the next step then is to seek to understand what is causing the problem in the first place.  At this point we are not talking about the immediate cause, rather we are talking about the root cause, and for that, we need to go through the process of a root cause analysis.

A root cause analysis is essentially the analysis of the root cause or initial cause, or primary cause, or the real cause of a problem. This is worth emphasizing because often enough what may seem to be the cause of a problem may simply be an effect – the result of the actual cause, the real cause, the latter known as the root cause. Hearing all this may come across as a daunting task.  While it may be, there are different devices that can help with that. For example, we can adopt the “Rule of 9” to help simplify the process.  

The principle of the “Rule of 9” is related to the neurocognitive concept that is explained as the fact that we often need to hear something multiple times before we finally really hear it.  This, in turn, can be adopted to mean that we need to ask, “why,” multiple times, in order to get to the root of any issue, whenever we are conducting a root cause analysis.  In practice, when applied well, the “Rule of 9” often leads to an “ah-ha!” moment.

To illustrate the “Rule of 9,” let us use the below scenario. It is a scenario based on a clinician that is seeking to fully understand the root cause of her client’s maladaptive behaviors, using the “Rule of 9.” 

Scenario: “I see you don’t have a ring, and you are very well dressed. Sometimes I wonder if you are as well dressed on the days I don’t come here to see you,” Ken asked Maria, on several occasions. He then added, “You are the type of woman I want and deserve, and I know you want me desperately.”

The “Rule of 9” Applied (with possible answers):

Maria’s supervisor, Karen, is going to use the Rule of 9 to lead Maria to the root of Ken’s current behavior.

Karen: Tell me why you think Ken is acting this way towards you?

Maria: There seems to be several contributing factors, including his family subculture, his religious beliefs, and his upbringing.

Karen: Why is all this, that you have mentioned, contributing to his current inappropriate behavior?

Maria: His family subculture, religious beliefs, and upbringing seem to have taken precedence over considerably socially appropriate behaviors.

Karen:  Why did that precedence take place?

Maria: There has been a lack of social modeling of adaptive behaviors in this current context.

Karen: Why did a lack of social modeling lead to this?

Maria: He may not have learned how to adjust his behaviors to different social contexts.

Karen:  Why may he have not learned how to adjust his behaviors to different social contexts?

Maria: The people whom he looks up to may not have told or taught him otherwise, or may not have told him enough times. Furthermore, he may not have been exposed enough to different social contexts to learn the importance of adjusting his behaviors.

Karen:  Why have those people around him not told him before?

Maria: People around him may have chosen to act out, or ignore him, or not tell him in the most effective way possible how to adjust his behaviors to different social contexts.

Karen: Why have they been responding to him like this?

Maria: Those in his subculture may not necessarily perceive such a behavior as being problematic in a different social context; While those outside of his subculture may not know how to effectively deal with his behavior, and/or how to respond to it effectively.

Karen: Why would they not know how to effectively deal with this behavior?

Maria: Dealing with such inappropriate behaviors requires a specific set of skills, and most individuals may not have learned such skills.

Karen: Why is it that he has not taken responsibility and learned on his own how to adapt to new social contexts despite people around him having not been able to effectively deal with his behavior?

Maria: He doesn’t need to since people have not been describing it as a problem to him, and it is still meeting a need for him.

As you have seen, the answers to the first questions are all related to what was lacking externally for Ken as the reason behind his behavior. However, as we continued to explore the Why, the conversation shifted to some internal factors related to Ken himself. In other words, the Rule of 9 allows us to explore as many of the factors as possible, including the ones that might be easily overlooked otherwise.