On Giving Advice

Tuesday, October 4th, 2011, Written by jackrosenberger

“Teachers who offer you the ultimate answers do not possess the ultimate answers, for if they did, they would know that the ultimate answers cannot be given, they can only be received.”
-Tom Robbins

A common misconception about psychotherapy is that the role of the therapist is to give direct advice to his patient. I would like to examine why this situation often arises, and explain why a good therapist should rarely give a patient direct advice.

What might be happening when a patient begs his therapist to, “Just tell me what to do”? Well, it is possible that this is an expression of frustration or exasperation. The attuned psychotherapist will cue in to this feeling and should encourage the patient to further explore this emotional state. Can they express how they are feeling? When have they felt this way in the past? Are they frustrated with the therapist? What are their expectations of the therapist? Who else might trigger these feelings in the patient? This is the real work of psychotherapy, and these sorts of exploratory questions will help a patient to gain new insights into their previously automatic emotional responses. Simply indulging the patient’s frustration and giving them direct advice robs the patient of the opportunity to explore these more salient underlying issues.

Whatever the current dilemma that the patient may be wrestling with, for example should they take a new job or end a current romantic relationship, is certainly important, but it is also usually superficial. In the long run, the underlying personality characteristics of the patient will not be impacted by the decisions they make about their day-to-day life circumstances, and good psychodynamic psychotherapy usually concerns itself with the long run. Patients have friends, family members, co-workers, and romantic partners that they can bounce ideas off of and solicit advice from. The psychotherapeutic relationship is most effective when it is unique, and a therapist who reduces the distinctiveness of this relationship by relating to their patient as they would a friend is doing a grave disservice to their patient.

Furthermore, while a therapist might have opinions about what a patient should do, these are more likely to be reflections of what the therapist would do in a similar situation, and it is unfair for a therapist to impose his values and beliefs onto the patient. Therapists are not models for how to live a virtuous life, and those who believe they possess “The Answer” need to re-examine their motivations for engaging in this type of work. They also need to get back in their own course of therapy and explore their hang-ups with issues of power and control. At the same time, a patient who is so willing to give up his sense of agency also likely has issues with power and control. It is likely that he feels weak, ineffectual, or helpless to alter the unsatisfactory conditions in which he finds himself. A therapist who attempts to rescue this patient by solving his problems for him only serves to reinforce these feelings of helplessness.

Another reason that a therapist should not tell a patient what to do is because of the issue of accountability. There are a number of therapeutic conditions that are intended to reinforce the idea that the patient is accountable for his own treatment. Some of these include the patient’s responsibility to pay the fee, his responsibility to be on time, and his responsibility to pay for missed sessions that he does not cancel in advance. A therapist who tells a patient what to do makes himself accountable for the outcome of these decisions. What if the situation doesn’t work out? Then it is the therapist’s fault. Worse yet, what if they situation does work out in the patient’s favor? Then the therapist gets the credit for being wise. Either way, the patient loses out on an opportunity to learn and to grow.

Of course, there are certain situations where a therapist in fact has a responsibility to be directive with a patient, and these include situations where risk of harm is involved. If a patient says, “I’m feeling like hurting myself, and I don’t feel safe being alone, what should I do,” the appropriate response is usually, “Call 911 or go to your nearest emergency room.” I want to emphasize that what I’m discussing here relates more to the daily dilemmas that we all face.

To conclude, it is my belief that a therapist should always assume that the patient knows more about himself than the therapist does. Think for a moment how utterly disrespectful and infantilizing it would be for someone who is essentially a complete stranger to claim that they know what is best for you. Now, over the course of time it is likely that the therapist will become aware of recurring interpersonal dynamics and patterns of behavior observed in the patient that remain unconscious to the patient, but that is a different situation. There are people, such as life coaches and executive coaches, who specialize in taking a more active and direct role in shaping an individual’s daily life circumstances, and that type of intervention might be appropriate for some people. However, life coaching is not the same as psychotherapy, and they should not be considered interchangeable.

Psychotherapy provides the opportunity for an individual to develop new insights into their previously automatic emotional and interpersonal responses, and it provides the opportunity for an individual to develop real and lasting change. Psychotherapy also provides the opportunity for an individual to discover his or her own Truth, and I firmly believe that is something that can only come from within.

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