Why Therapy is Simply Glorified Advice

As a professional I’ve been erroneously labeled many things: Charlatan, Quack, Psychobabblist, Witch Doctor, Asshole, Inner Child Molester and Psycho Lover, just to name a few. I think that last one came from the mental health equivalent of a homophobe. It seems that no matter how many research studies you cite, independent of the number of positive outcomes you can produce in your office, some people will hold onto an unyielding ignorance about the benefits of either therapy or psychiatric medications. I suppose that’s just their loss.

Recently however, a fellow bar patron – a guy who is pretty open-minded about mental health – asked me if I considered myself an Advice Dispenser. “You know, like Pez. Only words.” After a moment of thought I gave a resounding “yes!” to that one. Without a doubt, unequivocally and decidedly, therapy is advice. Any shrink who says otherwise is either lying or suffers from delusions of grandeur. Giving advice is what we do.

That being said, advice deserves a broader definition than “You should do _______.” It lives and breathes in degrees and levels. And very often the advice from shrinks is quite subtle *.

Let’s take a look at an example with three different therapeutic styles. Consider this statement from a patient, a woman who is expressing frustration about her romantic situation:


“I don’t understand why I can’t make this relationship work. I tell him what I need, I ask him what his needs are, but I can’t get him to communicate, to open up. I just, just…I don’t know, maybe it’s my own fault.”

Now, each therapist will handle this in a different way, but all are communicating a form of advice:
Therapist 1, a Freudian who is likely to focus on unconscious needs and conflicts to help clients gain insight into their difficulties:

“I wonder if you can stop and notice how you are talking right now. You are speaking freely about your frustration toward your partner, and then you seem to stop and turn the problem back on yourself. What do you make of that?”

What is the “advice” in the therapist’s questioning? Stop for a second and think about why you’re afraid to fully express your anger, to let it run its natural course. Is there something about the way you were raised? Are you afraid that you’re anger will lead you to do something you won’t like? In other words, stop and look, really examine your own psychology at this moment. This will help you.

This is advice. It may not be the same as a friend of yours who says “Just dump the douche and be done with it,” but this therapist is telling you that if you do what he or she suggests, you will be on the path toward feeling better.

Now consider therapist # 2, one who was trained by Carl Rogers. Rogers was a famous Psychologist known for what he termed “unconditional positive regard” for his clients. Although not a popular form of therapy today, his thinking was that complete and absolute empathy would help clients to deepen their understanding of their own emotional experience, ultimately leading to a resolution of conflict:

“I hear you saying you’re frustrated with him, yes? You give so much, try so hard, and yet don’t get the results you crave, that you yearn for, maybe even deserve? Is that right?”

Again, what is the advice? Stay with this feeling. It will tell you something about what you need to do to feel better. In fact, consider that feeling at a deeper level. Think about what you believe you deserve, because I think I’m hearing that issue emerge. If you do this, you’ll likely start to feel better.

Finally, therapist # 3, a behavioral therapist, whose focus is almost solely on changing behaviors – as opposed to working directly with emotions or feelings- has yet another approach:

“How about we consider some other ways to communicate with and act around your partner? Perhaps you are phrasing your needs to him in a way that is putting him on the defensive, or stating your position in a way that make it difficult for him to open up.”

The advice? You’re likely going about this the wrong way. You are possibly lacking the skills in this situation to help you get what you want. Let me teach some things that might bring you a better outcome.

None of these approaches are necessarily better than the others and the efficacy of each statement is bound by a ridiculous large number of factors (e.g., quality of the therapeutic relationship, mood of the client at the moment she hears the advice, the nature of her relationship with her partner, etc.) that go beyond the scope of this post. The point is that what shrinks do can vary by approach, disorder, and/or goals for treatment. But what the therapist says proves to be a direct communication that, if followed, can potentially lead to a change in thinking, feeling and/or behavior. Call that a prescription, an intervention, a suggestion or a directive, but when boiled down to the bare elements, it is advice, pure and simple.

* This is not to imply that shrinks will sometimes give opinions on topics completely unrelated to psychology. I once told a client that anyone who thinks Clubber Lang could beat up Ivan Drago is a fool, but I prefaced it with the fact that I’m a shrink, not a boxing analyst.

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12 Responses to “Why Therapy is Simply Glorified Advice”

  1. I disagree that we give advice. I see my role as providing a place for reflecting, processing, and (hopefully) helping them gain greater insight. I think some people enter therapy thinking we will give them the answers, which really isn’t our role. I actually go out of my way to avoid advice giving, because frankly it doesn’t matter what I think, as I am not living their life. Advice giving also brings you down the, “but you told me to….xyz” road.

  2. mm says:

    My take on it is that therapy is ‘advice giving’ but not advice as one conventionally thinks about it. Therapists export their mind – that is the service that is provided. It is not about giving patients/clients advice on a final decision, it is about using everything you know to provide them with advice on how to go about making that decision or thinking matters through to resolve their dilemma. To pick from the post, that is probably the biggest different between what a therapist may say and what friends/associates say – in that friends and associates tend to fast forward to a course of action eg. dump him.

  3. Angela says:

    Slightly OT, but this post reaffirms why I wanted Therapist #3. The first two would have had me twitching in an attempt not to start railing against impracticality and narcissistic “speshul snowflake” bullcrap.
    I appreciate your honesty in how you would label what you do. This is a reflection of the honesty you have with your clients, I think.

  4. Jacob says:

    It seems that there may be some words that should not exist. Some of them directly relating to Mr rob here.
    http://homelesstales.com/2009/08/10-words-for-the-trash-bin/

  5. Clindos says:

    Awesome post Dr. Rob. I believe that is the reason people go to therapy. Talking to some one who is apply to lead you down paths you otherwise wouldn’t know about, it what therapy is all about (IMO). Hey, Therapeutic Ramblings, did you even read the article? Why don’t you get off your high horse, and stop stroking yourself. Or is it that you don’t understand the word subtly. I sure don’t understand how you can talk to a patient and not give advice. How do you ask them to re-examin something they just said, “providing a place for reflecting, processing, and (hopefully) helping them gain greater insight.” Really how are you reflecting is you don;t point stuff out to them, aka giving them very subtle advice saying Hey you need to take a closer look at this. Dr. Rob if your ever in Houston, send me an email. I’ll treat you to a glass or two of wine, spot on man.

  6. Wayland says:

    Nice.

  7. Jessica says:

    Agreed. There are lots of therapists who will refuse to call what they do advice-giving, I think for the same reasons that Therapeutic Ramblings gave. Calling what you do “giving advice” may cause people to think you’re going to give them all the answers. That would be overt, direct advice. Like Dr. Rob said, therapeutic advice is subtle. I think the advice in therapy is clear — the therapist clearly chooses which thoughts need to be re-examined and which do not. Yes, therapy is about reflecting and processing, but the therapist’s role is clearly the guide through this reflection, and without a doubt, the therapist’s views will influence the path that it takes, and the conclusions that are reached.

  8. Anon says:

    I’m in cognitive-behavioral therapy, and my shrink absolutely gives advice. He might call it “brainstorming coping strategies”, but really it’s him listing solutions and me saying,”yeah, i’ll try that.” or “nah, i don’t think that would work.” He’s a total fix-it guy and has an answer for almost everything. Most of the time I love it, but as a woman, frankly sometimes I just want to vent. I don’t need him offering a solution to my coffee-withdrawl headache (“Maybe try weaning off slowly to decaf..?”) or how to host a better birthday party next year. It’s sweet that he tries so hard, though.

  9. “Really how are you reflecting if you don’t point stuff out to them, aka giving them very subtle advice saying Hey you need to take a closer look at this.”
    Reflection is not about giving them advice (subtle or otherwise). Reflection is about helping them examine how they view the world, how this impacts them, etc. Advice implies being partial to a particular view, and reflection doesn’t take a side.

  10. Dorothy says:

    I hear what you’re saying Dr Rob, but with all due respect, I ‘m not sure I agree. I think people who come to therapy often want advice and do wish for someone else to give them an answer, but I don’t believe that’s our role as therapists. I think coaches give advice. Therapists provide openings and options based on their experience.

    Definition of advice :
    an opinion which someone offers you about what you should do or how you should act in a particular situation.

    What you’re describing in these 3 case scenarios isn’t advice. It’s offering possibilities and options. The nuance may be small, but I do think there is one.

    Now if someone asks specifically for an opinion, I guess that’s a whole other thing. I’d be curious actually to see the response of these 3 approaches to the question:
    “doc, what do you think I should do ? ”

    Just my 2 cents. 🙂

  11. Ren says:

    Inner Child Molester, now if someone called me that I think I would buy him/her a drink… My personal reaction being: “you have no idea.” It does bring up a question though… Does the victimizer need a bath as much as the victim does, in this case, or more?

    Have you ever thought of changing your name to DR Pez?

  12. UnSavioury says:

    As a patient, I wouldn’t call therapy so much “advice” as it is “guidance”…there is a subtle, but important, difference. Sure, some people want to sit down with a therapist with the “fix me” and “what should I do” attitude. But the therapist wants the patient to come to conclusions on his/her own. Once the patient starts talking, the therapist catches clues where they should examine deeper, or think about more. They also question and magnify certain behaviors that the patient otherwise overlooks. In essence, the patient ends up answering their own questions and “fixing” themselves, with the therapist merely acting as a very good guide. I know there are things about me that I thought were very insignificant, but with guidance and exploration, they opened up huge avenues for making things better.