Do Therapists Give advice?

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I started off as a peer counselor in an outpatient substance abuse treatment program– I had stopped using mind altering substances in an addictive way for over a year and gave lots of advice to people who were trying to quit. One of the reasons I “turned pro” was that my way didn’t work for everyone & I could see the limitations of advice giving as a way of helping others.

So I went back to school to become trained in psychotherapy & psychotherapeutic techniques. One of the things that the coursework emphasized was that I shouldn’t give advice– that’s not therapy. Being as I was already working as a paid counselor, this created a period of adjustment– people who were used to getting advice suddenly found that I wouldn’t give advice, and that made some of them angry. They thought I was holding out on them, even felt abandoned. Whoops!

Of course I learned over the years that there are a lot of things they tell you to do in therapist school that people fail to do, and things they tell you not to do that people do all the time. One glaring example: if you’re counseling couples, all the training in couple counseling directs that the family therapist not tell the couple whether or not they should break up or divorce. This always seemed like a no–brainer to me, but I’ve heard many stories of licensed people who violated that principle.  I’ve not specialized in couple counseling, which Consumer Reports once determined to be the form of counseling with the lowest customer satisfaction rating.  I have seen couples who stayed together when it was a mystery to me why, but I’ve never had trouble refraining from telling them what to do.

The most salient exception to this is in cases of severe domestic violence, but even then it’s a very dicey thing. At one time in San Francisco the police studied murders of women trying to leave abusive relationships and found that it was a major risk factor in their deaths.  Even in those cases it’s about being able to safely leave the relationship. But I digress.

Trying to rebalance my own practice when I transitioned from advice-giving peer counselor to non-advice-giving professional therapist, I found that there are times when people ask for advice and holding out on saying  something will damage the relationship. I also leavened the practice with a decent amount of common sense. What we all know from everyday life is hey– you give people advice, then they do what they want. There’s a difference in how people take it coming from a helping professional, however.

So let’s be realistic for a minute. One of the most widely practiced forms of talk therapy these days is CBT– Cognitive/Behavioral Therapy. If you look at David Burns’s book The Feeling Good Handbook it’s full of advice– identify ways your thinking is making you unhappy, change your thinking, change things you do, and so on. I’ve frequently suggested it to people and they’ve gotten good results from doing the worksheets and other exercises. That’s a form of advice, in my perspective, and it’s helpful. What it isn’t, however, is the kind of advice that tells you whether or not to quit your job, change your diet, get married, divorced, etc., etc.

So the clear answer to the question “Should a therapist give advice?” is a classic therapist-style answer: yes and no. To come back to my own in-session response to questions seeking advice, I mostly have come up with a specific approach: I will tell the client that I will offer advice, but first I want them to explore the various choices under consideration, do all the pro’s and cons, including the classic DBT pro’s and cons on paper (there are many links to this, not just the one I’m including) a lot of the time, before giving any input from my point of view. One of the traps of advice giving from the therapist’s point of view is that sometimes clients simply want someone other than themselves to blame when it all goes bad.  (And this is considering that I’ve never had a politician for a client!) The other thing that I do is point out the common sense perspective I mentioned above– hey, you’re going to do what you do regardless of what anyone, including a professional helper, says.  I frequently will go a step further– you already know what you want to do. This is especially the case if I’ve just gone through pro’s and cons with the person in session.

Let’s look at another side of this–we frequently ask for advice when what we really want is support. Should I get out of this bad relationship? How do I make this change in my life? That’s where, as the therapist, I have an unvarying approach to people’s requests for advice: I will be here for you and we can debrief how that turns out. After all, isn’t that one of the bedrock aspects of therapy?

I’m reminded, however, of a line from somewhere in Tolkien’s Lord of the Rings. One of the hobbits has asked an elf for advice. The elves, having lived for many lifetimes compared to everyone else, are supposed to be very wise, and the elf says something like, “Advice is a dangerous gift, even from the wise to the wise, and all courses may run ill.” Sometimes none of the choices open to us include anything we want to do. But that’s another topic.

 

image from:  http://curioustendency.blogspot.com/2012/05/psychoanalysis-part-i-transference-and.html

 

About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, change, choices, cognitive therapy, dealing with change, Dialectical Behavior Therapy, mental health, Therapy processes and tagged , . Bookmark the permalink.

2 Responses to Do Therapists Give advice?

  1. Swiss Scall-Hart says:

    Hi there, Jamie.
    Great post as always.
    You are missed.
    Sincerely,
    Swiss

  2. jamesmatter says:

    Take care of yourself!

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