The Complicated Answer to Whether Therapists Should Give Advice

People don’t need others to reason for them; but, often, they need someone to reason with them.

Individualism permeates psychotherapy as much as any other financial and interpersonal endeavor in the US.

The raging debate about the field, one of many but a major one, is about whether or not to provide patients (clients?) with advice. On the one hand, we don’t want to infantilize our clients and continue to guide them so that they, in turn, continue to line our pockets. On the other, we don’t want to completely abandon them to their own reasoning, as many of their parents did years before. The individualists tell us that our choices are solely our responsibility. But how true is that? Instead of only pointing our fingers at individual smokers, do we not also hold Big Tobacco accountable? Do we not ask our doctors to be just as responsible for the health of their patients as the patients themselves? So, why should therapy be any different?

I used to cringe when my patients asked me for advice, reminding them that my job wasn’t to tell them what to do; it was, merely, to provide them with tools, to help them problem solve and better manage their emotions. But, I realized at some later point, my stance was a complete cop out. After all, these people were paying for my expertise. Technically, they could have easily learned those same tools on their own. They needed someone, an expert of sorts, or an outsider, to shoulder some of the burden of their difficult choices. They needed support; again, what their parents were, at some points, supposed to offer them. At bottom, they needed someone with skin in the game, rather than an aloof observer repeatedly telling them that everything happens in due time or that no one can absolve them of the need to choose.

Existentially, our choices are ours. But, when paying for therapy, I’m of the opinion that most of my patients want to know that I deeply believe in what I’m teaching them, that the tools are as useful to me as they would be to them. This means that when we use the tools in session, they want to know that I agree with their judgments, that I would make the same choice if I were in their shoes. And, frankly, that isn’t much of an ask. Advice is telling someone else what you believe is best; agreement is the solidification of sustainable pride and equanimity. As therapy progresses, one’s clients will inevitably move away from inquiring about her views; that’s part of the point. But, for some time, the therapist’s views will and should matter in an exceptional way.

Some will argue that even if you approve of or agree with a choice, you still aren’t the one facing the consequences; but, you actually are, just in a less significant manner. If my clients realize that I’m consistently wrong, they’ll stop seeing me and stop referring me to others. Yes, I’m no seer, but I’m also not just a friend. When I’m at a loss and assess the risk at 50/50 odds, I say it. And when I believe the odds of success to be higher, then I say so as well. Therapy appears, at times, to be divorced from reality and real needs people have. Treatment can isolate as much as it can connect. And therapists, like their clients, fear taking responsibility for their own misjudgments.

Psychoanalyst Nancy McWilliams writes, “The Western myth of human independence exists despite the fact that all people throughout life in practical and emotional terms need each other. Psychotherapy does not make dependent people independent; on the contrary, it makes them able to more effectively use their natural dependence in their personal interests… Many adults who come to therapy feel like children trapped in destructive relationships, and decide on this basis that their need for others carries a certain threat. Ideally, in the process of therapy, they understand that the problem lies not in the plane of their basic needs, but in how they treat them.”

In that respect, taking partial responsibility, at least in some instances and for some time, for the patient’s choices allows them to re-establish, or establish, trust between themselves and others. Or, better yet, to establish trust with trustworthy others. Approaching therapy, as Nancy alluded to, people tend to blame their needs rather than the responses of their significant others. And therapy can just as easily reinforce that belief by implicitly or explicitly teaching the client that she’s on her own and needs to stop seeking counsel, to trust herself, etc… Therapy and life, in contrast, teach us that needs and relationships aren’t that neat and that, ultimately, to some extent, we are responsible for one other.