Blog: Perspectives on mental health services

Becoming a more informed client and consumer

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Myth: Therapy is just expensive advice

It’s easy to assume that therapy is essentially advice.  After all, when we try to help out friends or family members, we usually tell them what we think they should do.  Dr. Phil and other “TV” or “radio psychologists” also reinforce this view: they give a lot of advice, and leave the distinct impression that that’s how therapy works.  In reality, though, conceptualizing therapy as advice leads to some worrisome questions.  For one thing, if you can get advice from anyone, why should you pay a therapist for it?  After all, there’s no guarantee that your therapist’s advice will be any better than anyone else’s.  In fact, friends and family have the advantage of knowing your life circumstances firsthand; your therapist only knows your side of the story.  It seems to me that, if therapy is going to be of real value, it must offer something more than and different from advice.

Still, it would be silly to argue that advice is bad, or that therapy never includes advice.  Advice is, in fact, much more limited than we commonly acknowledge, but that doesn’t mean it never helps.  Also, therapists do give advice, though we often deny it.  The fact is, our clients sometimes need explicit guidance.  Recommending a psychiatric consult is a kind of advice.  We also might recommend leaving an abusive partner or stopping drug use.  Sometimes clients are having significant coping difficulties, or need immediate guidance to help them through a difficult time.  Another problem with categorically denying that therapy includes advice is that advice can be subtle, particularly in relationships where one party is purportedly the expert.  Arguably, even the apparently innocuous comment “See you next week” is tacit advice, because from a therapist it communicates, “I think there are still things we need work on, so you should come in for another session to talk about them.”

Therapists also do many things that look like advice, even though we don’t think of them as such.  For example, a therapist may recommend writing down your thoughts or practicing a certain skill.  We don’t consider these recommendations advice because they’re not about telling you what we think you should do.  Rather, such techniques introduce new ways of managing troubling thoughts and feelings, or provide different options for how you can behave.  Nevertheless, from the client’s point of view, these recommendations feel a lot like advice.

Even making allowances for some advice within therapy, the truth remains that traditional advice is quite limited and often fails to help as much as we might hope.  Think back to times when you’ve given advice.  How often has it actually helped?  Even if your advice was dead on, how often did the person actually follow it?  More likely, they acknowledged you were right, but nevertheless didn’t follow through.  There are many reasons for this, one being that sometimes people already know what they “should” do before you recommend it, but still can’t bring themselves to do it.  Indeed, when our friends and family ask for advice, they’re often looking for us to either confirm what they know but don’t want to hear, or give them a pass on what they already think they should do, but ultimately don’t want to do.  No wonder our advice goes nowhere.

Advice is even more limited when someone is struggling with significant psychological issues.  If you know anyone who battles clinical depression, for example, then you’re probably familiar with the futility of advice in such circumstances.  It’s not that being more positive wouldn’t help.  Going for a walk in the park—or just getting out more—probably would be beneficial.  Trying medication or therapy might be a good idea.  It’s not that your suggestions aren’t valid.  But conditions such as depression have the nasty wrinkle that, by definition, they are problems that get in the way of their own solution.  For example, those suffering from depression might feel helpless to change their circumstances, hopeless that anything will help, or they may lack the energy and motivation to even go for a walk.  That’s what depression is; hence your well-meaning advice never even has a chance to get off the ground.  In a sense, acting on your advice is predicated on not being depressed, which is precisely what your loved one cannot do.  And so it goes for social anxiety, anger issues, OCD and so forth.

From a therapeutic point of view, there are other problems with advice, and therapists are wise to use it prudently.  For instance, we might be experts in human nature, but that doesn’t make us experts in your personal life.  Can we really tell you what job to take, whether or not to move, or if you should get a divorce?  In such cases, don’t we only know part of the story?  But even when our advice really helps—you follow it and it actually solves the problem—this raises other concerns.  Therapy is about helping you make your own choices, not making them for you.  We want to help you live your own life, not tell you how to live it.  We want to promote your autonomy, not make you dependent on us for guidance.  So, even if our advice helps, is this really the kind of help we should be striving for?

Therapy has to be something more than and different from advice to be of real and unique value.  Therapists strive to give you a different view of the problem and of yourself.  We help depressed clients see their hopelessness, helplessness and lack of energy for what they are.  We help them see how their own actions and point of view perpetuate these difficulties.  For example, depressed people often feel helpless about things they cannot in fact change, but then come to see everything in this light, so they fail to recognize the things they actually could change.  Thus, they experience futility and defeat when they try to change the things they cannot, but cheat themselves of the experience of success and agency by failing to act when it would make a difference.  Recognizing these dynamics can open the door for new options and new ways to behave.  Unlike advice, though, this isn’t about your therapist telling you what to do, but about helping you recognize the options already in front of you so you can choose your own course of action.