Advice in Therapy

Scrolling through Twitter, I saw another therapist share the image featured here and found myself thinking about the role of advice in counselling and psychotherapy.

There can be a lot of confusion around the role of the therapist, what exactly they are there do to, the scope of their guidance and how directive they can, or should, or shouldn’t be. In the Venn diagram of mental health professional and social media influencer the shared space seems to be all about advice, “here’s 5 things you can try…” “you’ve been thinking like this, try thinking like this instead…” And of course, there is something very attractive about this, who doesn’t want the answer or solution that will take the pain away. This prospect can be particularly potent when it is paired with feelings like low self-esteem, anxiety, shame. An inherent feeling of being the problem makes it all the more plausible that there is an external expert who sees our failings clearly and can simply tell us what to do instead.

This leads quite naturally then to the expectation that the therapist is presumably the perfect person to tell us how to fix ourselves, how to be better, get better, do better. In turn the desire to help, which is also why so many enter the field, can slip readily into advice giving and indeed there will be practitioners who see this as their role.

However, I think the excerpt featured offers an excellent illustration of some of the flaws in this approach. Firstly, in my experience, people aren’t short of advice, indeed often it has been the opposite. Maybe the advice has been (what would seem to be) good and maybe it hasn’t been, either way, if it were that simple we probably wouldn’t be sitting here.

And secondly, ‘better’ is ultimately subjective. In the example pictured below the therapist, if they pursued their initial reaction, would be telling this client how to live better by correcting them. It is not necessarily advice in the most obvious sense but it is a steer on how to be in the world and is in this way particularly useful in demonstrating how covert advice can enter the therapy room. Whether it is nudging a client towards a course of action, asking self-serving questions (for example if a client talks about a desire to cheat and the therapist’s own moral compass means they keep asking about the impact on their partner rather than exploring the fantasy) or directly responding to questions like “what should I do?” the practice of advising prioritises getting things right over curiosity and exploration and for me, misrepresents the nature of the expertise of the therapist.

The therapist does not know how you should live your life or what you should do. They are not an expert in this. Instead, hopefully the expertise is in how to be facilitative, how to be professionally curious in a way the client can make use of. The example of the three questions in the excerpt are I think good examples of this:

• Did you help the client move from an external to an internal frame of reference?

• Did you help him come closer to himself, to explore and express what he found there rather than enmesh himself in platitudes and the evaluative labels others had been all to ready to bestow upon him?

• Did you enable him to tell you how he genuinely feels, how things truly look to him?

I should say there will be exceptions to this. Moments of advice might come up and may be entirely appropriate, like suggesting going to the doctors for a physical ailment and not solely working on the basis that it’s related to mental health: maybe the knot in your stomach is stress, but let’s also rule out any physical causes. And sometimes there might be another driver for it, which will always be worth exploring and that process itself may be useful. This post isn’t about those times, but rather when it becomes part of the practice or is the practice.

To longing for advice is, as mentioned at the beginning, entirely understandable, and mentoring and coaching can be hugely valuable, but they are distinct, separate practices. In therapy, let’s stick with asking questions rather than giving answers. Let’s stay curious.

The image features a photo of an excerpt from the book The Helping Interview, by Alfred Benjamin and reads as follows:

"When Charles, a black youth from Harlem told you he hated Jews and would gladly strangle them all if he could, there was much you wanted to say. It was all on the tip of your tongue when you recalled that you were here to help if you could. How could he realise you wanted to help him if you wouldn’t even listen to him. If this was how he felt, you decided, it was better to listen and try to understand what it meant for him. And so you did not scold, you did not criticise, you did not tell him not to talk or feel that way. You did not moralise about Judeo-Christian vales. Instead, you opened his perceptual field even wider by saying “Right now you hate the Jews desperately.” He poured out deep feelings of rejection, bitterness and hopelessness. Gradually you began to see, to understand. You did not agree, you did not condone but you began to feel what he had gone through and was still going through. You saw how full of hate and resentment he was against the Jews he knew and how totally unaware he was that you were Jewish.

Question: Did you help the client move from an external to an internal frame of reference? Did you help him come closer to himself, to explore and express what he found there rather than enmesh himself in platitudes and the evaluative labels others had been all to ready to bestow upon him? Did you enable him to tell you how he genuinely feels, how things truly look to him?"