What do you think?

You would be forgiven for thinking this is the most natural question someone coming to counselling would ask of their treating practitioner. If you have not been to see a psychologist, you would think this an unremarkable expectation.  If you have, you may be like many who have said to me that this question is most often turned a full 180 degrees by the therapist thus: ‘What do you think’? ‘What ideas do you have’? ‘What have you tried already’?

In my psychology training, and throughout the counselling and therapy field, there is an understandable injunction about not telling people what they ‘ought’ to do in their lives.  For one, it is presumptuous and perhaps condescending. It is also impractical since we know that people are much more likely to make substantial progress with the goals and commitments that they themselves have articulated.

It is presumptuous because psychologists struggle with life as much as anyone! We don’t have the answers to life’s conundrums and when we honestly look at our own vicissitudes, we can be as lost as anyone with respect to what to do.

It is impractical because every therapist I know has watched as clients agree that their (brilliant!) suggestions are great and then proceed to ignore them or at least not commit to them.  You can tell people what to do, but it rarely is helpful.

This can create interesting tensions in the therapeutic situation, for example, where often people come with the expectation that the psychologist will have informed views on, not only what ails them, but what they should do about it.  I’ve heard many laments from clients about therapists engaging in value-neutral approaches characterised exclusively by reflective listening. They refuse to say what they really think the person ought to do.  Typical complaints are: ‘If I knew what to do, I wouldn’t be here’; or ‘I thought you were the expert in these matters’!

Now, for a few caveats: In every case these frustrations and laments were not bitter nor derogatory. There was frequently positive regard for the practitioner (they were very nice; very empathetic; great listeners etc).  But there was also a sense of frustration at how long the process took, often for only modest gains.

The intentions of these therapists are of course unimpeachable.  They are committed to the wellbeing of their clients.  They are appropriately aware of power relations and their positions of authority – especially when clients are not in their best shape cognitively and emotionally and are thus more likely to uncritically clutch at advice.

The general solution in the field has been to teach clients techniques wherein they can solve their own problems (Cognitive Behavioural Therapy providing the most common techniques).  In folk parlance the logic is:

Give someone a fish, and you feed them for a day. Teach them to fish, and you feed them for a lifetime.

After all, our job as practitioners is to engineer our own redundancy.  I’m certainly not a fan of years of analysis dissecting the past and becoming experts at inducing emotional catharsis – the benefits of which are highly dubious.  Nor is the answer what I call ‘handholding’ therapy.  We have to provide more than ‘total positive regard’ for our clients.

Given all this, what is to be recommended as a better approach?  Meta-analyses (studies across all the studies) consistently suggest therapist-client relationship is the most important variable for positive therapeutic outcomes. Being experienced as a compassionate and empathetic fellow traveller in people’s travails counts for a lot. But not for everything. 

The practitioner’s primary function is not to give advice or opinions. In fact, this is often strongly contraindicated.  You most definitely do want people to take responsibility for their own lives and to think through deeply their own commitments and life strategies.  Some come to counselling to avoid this kind of responsibility and it is a mistake to collude with such avoidance. In short, there are intertwined complexities here which I’ll try to unravel.

But, in most therapeutic relationships there comes a time for a more collaborative approach that moves beyond active listening and compassion.  That is, at the right time, the practitioner is also to offer an informed opinion.  Clients want us to share what we honestly think.  At critical junctures, with sensitive timing, this can be decisive.  These opinions can be of two types:

  1. Those based on empirical research that indicate preferred approaches and actions
  2. Those based on judgement and intuition

1. is common sense: wellbeing can only occur if the person is solidly grounded in what is real. In short, if science can help us uncover facts about better adaptation to reality, we ought to share those insights with our clients. This is what evidence-based practice is all about. In this way, all opinions are not equal. This is not a game of competing subjectivities located in a relativist discourse.  

There are good reasons to be wary of ‘counsellors’ who have had minimal training.  In most countries, the bar is set quite high to enter psychology, the training is rigorous, and it is long (typically 6 years).  There are ongoing continuing professional development requirements to maintain registration, entailing supervision and providing stringent ethical guidelines to be adhered to. By contrast, anyone can call themselves a ‘counsellor’.  Buyer beware! Crucially, the profession of psychology is based on science and evidence.  This rightly lends it some authority and credence.

2. is wisdom: for the experienced practitioner (both in life and practice) there is often great value in one’s judgements and intuitions as to the best course of action. If we are to ever trust intuition, it should be the intuition of experts – as such intuition is the ‘thin slicing’ of deep experience in domains of high complexity.  Such opinions are still to be offered lightly, as a feeling of what is best: not as fact.  No doubt they are informed by scientifically based knowledge and experience.  In making complex decisions under conditions of uncertainty (most substantive issues in therapy are like this) this is a useful contribution for the client.

Offering such opinions is to treat the client as an equal capable of collaborative exploration.  Often such a relationship takes a while to develop and thus there is a natural ‘timeline’ that much therapy follows: in the early stages we mostly listen and elicit, well before we come to any opinion.  As George Kelly put it: we form tentative hypotheses that we share with our clients and are ready to abandon them given more evidence.  In this we model the scientific method as a method for navigating life’s challenges as well.   

All of this has implications in training others in therapy and coaching.  Without doubt, the greatest (and most difficult) skill to master is listening, including reflective listening.  Young therapists are wise to begin according to the dictum ’first do no harm’.  Early in one’s career it is appropriate to largely confine oneself to reflective listening and teaching evidence-based strategies, such as cognitive behavioural therapy.

But this is not for the entirety of the therapeutic relationship, nor the only thing to learn as a practitioner.  As a practitioner grows more experienced, older, and hopefully wiser, she can venture her opinions and intuitions more often, in addition to sharing research findings and empirically supported approaches.  All practitioners are not equal, and it is the master practitioner who has also developed the art of intuition-based judgement, tendered carefully and with humility.