Therapists don't give advice

I love advice columns. I always have; even as a kid, they were my favorite part of any magazine. My Google tiles are mostly suggestions for Dear Amy and Dear Abby and Dear Prudence. I have a subscription to the Savage Love newsletter. I am addicted. I love that the problems are concise and (mostly) straight forward and that the answers are the same: here’s what to do!

But as a therapist, I don’t get to give advice. Don’t get me wrong, it’s sometimes tempting to just tell someone what to do. As your therapist, I have the benefit of objectivity; you may not know why you’re having such a hard time but it’s usually rather clear to me. I’m able to clarify and reflect back what you’ve told me so that you can decide how you want to move forward. It’s not advice but a different perspective.

This difference can be a tough distinction for clients to make. Often at the end of a session, my client asks, “so do you have any advice for me?” Of course the short answer is yes! I have very strong opinions about many things! As I said, the temptation to tell my clients what to do is sometimes very powerful. But advice is often best for the person giving it, not the one who receives it. Tempting as it may be, as right as I think I am, therapy is not like an advice column. The goal of therapy is to help my clients come to their own conclusions and make their own path.

You may not get advice in therapy but I think what you end up with is even better: trust in yourself to figure out how to change or move forward or let go. You know the answer; you just need someone to help you see it. Even Dear Abby agrees.

Now what? moving on when things change

Most often, I’ve written about grief as it relates to the death of a loved one. But grief isn’t only related to death and dying. In fact, it’s one of the most pervasive and universal experiences we share as human beings. It’s a part of the life cycle: relationships and jobs and the stages of childhood all come to an end. Life is full of changes that feel like losses and those losses have to be grieved.

As I’ve said before, I’m a real hit at cocktail parties when I tell people that I specialize in grief and loss. For most people, my work sounds deeply sad. And it can be! As I’m fond of saying, hard feelings are hard. But looked at another way—I live to reframe things, it’s the only part of CBT that I’m truly confident in—it’s a gift to honor our grief when something ends. We can experience our grief without wallowing; we can honor endings without big rituals. We can choose to acknowledge that endings are hard without staying stuck in the hard part.

So how do we do that? There are tons of sort of pop psychology buzz words people throw around, memes on social media meant to inspire, about “closure” and “closing the chapter” and “rising from the ashes.” Those are all lovely sentiments and I don’t disagree with them. But I think we lose the nuance of the grieving process when we put it into that kind of phraseology. Closure, for instance, isn’t a thing. Our lives are not actually laid out in neat chapters that resolve after X number of pages. We never leave behind the people we were, even if we make dramatic changes or dramatic changes happen to us. Instead, we add layers and learn lessons and yes, move forward. In short, like any kind of grief, the only way out is through.

Relearning the work

I keep a postcard at my desk at work that I got at a conference when I was in graduate school. I've had it for years but I haven't had an office in so long, it's most recently been hanging out in our guest room (to inspire my guests, I suppose). It says: "I cannot learn other people's lessons for them. They must do the work themselves, and they will do it when they are ready." I have read it a million times but I don't always retain it. Do you know what I mean? It's similar to that social work joke (yeah, I'm telling it): how many social workers does it take to change a lightbulb? Just one but the lightbulb has to want to change. Groan away but the point stands. And whether it's a bad joke or my little postcard, I know this lesson to be true. I know it from personal and professional experience. So why do I sometimes forget it?

Here's a good example. When I was a medical case manager I had a lot of clients who were constantly in crisis, usually financially. Every month we would talk about where their money went and how to budget and I would help them fill out forms to get services. Every month I would say, "you should have enough money if you do x, y, and z." And they would agree. Then we would do it all again the following month.

The thing is, I was doing it wrong. I didn't allow my clients to come up with their own goals; I told them what the goal should be. I'm reading about motivational interviewing right now, which is a strategy that can be really useful in changing behavior. One of the tenets about MI that really speaks to me was that no one wants to fail. No one wants to set an unachievable goal but often that's what we're asking patients to do: we've decided what their goal should be so we've also come up with the solution to acheiving it. It's a theme I sometimes saw in hospice too: for months or years, patients had been told to "fight" their disease. Then suddenly, we told them to accept their death. We didn't give them a choice to change their goal so much as tell them the goal had changed while they were doing something different.

I think most helping professionals like to consider themselves good listeners; I know I pride myself on it. But I'm not sure we always hear what our clients are saying. We walk in with a goal already in mind and that leads our visit. Motivational interviewing encourages the practitioner to help the client name their own goal. It's difficult to want to achieve something you have no stake in. Helping clients name their own goals and helping them see what changes they can make to accomplish those goals makes them stake-holders, not just people who get lectured and then feel guilty when their problems don't go away. 

Now, in this new role, I keep looking at my postcard. Not only can I not do someone else's work for them, I can't tell them what the work should be. I became a social worker because I wanted to help people. It's been a long journey of reminding myself that I can only help people who want to be helped. And even then, I can only do so much.