Should Therapists Give Advice?

It’s Friday, so we have, looking us straight in the eye, another piece of therapy culture nonsense from Lori Gottlieb. New York Magazine’s resident therapist becomes starkly defensive when asked why therapists refuse to give advice. Gottlieb offers up a mountain of post-Freudian silliness, to the effect that she cannot offer objective advice and that even if she gave it her patients would ignore it. 

As normally happens, Gottlieb confuses giving advice with telling people what to do. When you give advice the other person is free to take it leave it. When you tell someone what to do, the person is not. The distinction is crucial. Most therapists miss it. Such is life.

The shadow hanging over this is Freud. And the other shadow hanging over this is Socrates. Yes, that Socrates. Why? Because Socrates said that he knew nothing, except his desire. Freud said as much. Since these great minds did not know anything they could not transmit any knowledge, certainly not any objective, fact-based or experience-based knowledge. Their goal was to help you to discover your truth within yourself, to find out what you really, really want. 

One recalls incipient Tiger Mom Lenore Chu who took her three-year old to school in Shanghai and discovered authoritarian teaching. She discovered that the technique was effective and that children who respected the authority of a knowledgeable teacher learned math better than did those who were induced to try to dream up mathematics by introspecting and discovering their desire.

To fashion her own version of this theory Gottlieb and begins with the notion that she, a therapist, possesses no objective knowledge about how to conduct one’s life. She even pretends that everything she thinks is so starkly colored by her own personal bias that she cannot see another person’s problems objectively. 

But then, what good all that professional training ? And one might add that overcoming personal bias and offering an objective professional opinion is the sign of being a professional. If you lawyer told you that he could not offer an objective piece of advice because he was so narcissistic and so solipsistic that he referred everything to his own personal experience, you would fire him. Gottlieb has inadvertently exposed the shortcomings of her own profession. Can you think of one other professional who would dare offer such a cop-out?

Allow Gottlieb a say, just in case you think I am exaggerating:

For one, despite my good intentions, whatever I suggest will be mediated by my own biases and life experiences. So while I took your living situation into account, it’s also true that I advised you to buy a place partly because I bought my first home in my 30s and in hindsight I wish I’d bought earlier. In other words, my advice was clouded by my personal beliefs about real estate appreciation. Likewise, I suggested that you go on the date because if it were me — if I were almost 30 and really liked a guy and wasn’t close to a woman who briefly dated him over a year ago — I’d go on the date. But you might have different ideas, values, and tolerance for any potential fall-out. What might be a good idea for me might be a disaster for you. And by giving you advice, I might be projecting my own values and beliefs about the world onto you, rather than helping you to gain a stronger sense of your own.

If a therapist cannot tell the difference between herself and her patient, what is she doing? Perhaps she should get over her own self-absorption.

As for the problems presented, the therapist should probably not tell the woman whether or not to buy the house. The therapist is not an expert in the real estate market. She might recommend that the patient consult with someone who had some expertise in the field. And she might help her to figure out how to make the decision. Knowing whether you want a house is only a small part of the elements of a complex decision-making process.

As for whether the patient should go on a date with someone an acquaintance dated a while back when she knows that doing so would hurt the acquaintance, the answer is: No, she should not. Unless she is willing to suffer the consequences of hurting the acquaintance, and is willing to risk compromising her reputation among the friends of the acquaintance, she should pass. You see, that was easy. It was a moral issue, and is not of the same order as deciding whether or not to buy a house.

And, of course, therapists do well, in most circumstances, not to advise people to divorce. The decision is too consequential for a therapist to get involved. And yet, when a couple is in a brutally abusive relationship or marriage, a therapist should not hide under a mask of neutrality. When people are getting hurt or are in danger, one should offer advice. Perhaps not always about whether to stay or to go, but certainly an assessment of the situation.

Gottlieb engages in typical therapist doublespeak:

A therapist might see a couple and think they should divorce, but some people prefer to be in a highly-conflictual marriage than to be alone, no matter how much the therapist might personally champion being alone for a time over a highly-conflictual marriage where one partner refuses to change. Our patients’ lives are theirs to live, not ours.

Of course, if your patients are adults they do not expect that you will have the definitive answer to their real estate problems. A therapist is being paid for knowing something and should impart it when appropriate. If he does not know the answer he can perhaps help the person to make a better decision:

I’m asked all the time questions like which job a person should take, whether they should have another kid or freeze their eggs or confront their friend, and whether they should go to their chaotic family’s house for the holidays or do something more pleasant instead. And when I don’t meet that desire, it can feel like I’m sadistically withholding “the answer” that, in their view, I can easily provide and that will solve their pressing problem.

As I said, Gottlieb is trapped in the post-Freudian thought. She wants people to discover what they really, really want… as though that will tell you whether to buy a house or to rent an apartment. Somehow she confuses giving advice with making life choices for other people.

In the first place, giving advice and guidance is not the same as making life choices. And most patients who receive advice weigh it along with other advice they give. If a therapist like Gottlieb imagines that her patients will jump at everything she recommends perhaps she has not taught them how to deal with advice, when given:

As a therapist, I’m trained to understand people and help them sort out what they want to do, but I can’t make their life choices for them. I’m not a real-estate specialist, career counselor or, most importantly, soothsayer. Part of what people want from my advice is relief from uncertainty — if my therapist says X, I don’t have to sit with my anxiety around ambiguity. But one thing that’s certain about life is its uncertainty, and the inability to tolerate the uncertainty of what will happen if they decide X or Y or Z leaves people trapped in indecision. Learning to slow down and reflect on their choices and anticipate the potential consequences of their actions helps to decrease their anxiety in the long-term. Taking a therapist’s advice alleviates anxiety in the moment, but it won’t last.

Gottlieb is right, however, when she says that people should learn how to anticipate the potential consequences of a decision. It’s called policy analysis. And yet, how are they supposed to do this if their therapist does not offer up some advice, and does not teach them decision making skills. If Gottlieb thinks that when a patient discovers what she really, really wants she will automatically know what to do—regardless of reality—she is suffering the same foolish illusion that doomed psychoanalysis. 

One suspects that if Gottlieb’s patients resent her advice, they must find it especially lame. I have not had the same problem, so I assume that she is not offering good or sensible advice. As for whether children want to have agency in their lives and want to make all of their own decisions without referring to anyone who might know more than they do, I again refer to the experience of Lenore Chu in Shanghai. Gottlieb’s position is simply wrong. You do not need to jump into an empty swimming pool to know that you should not do so:

Yes, they may ask — repeatedly, relentlessly — but after you actually tell them, their initial relief is often replaced by resentment. This happens even if things go swimmingly, because ultimately humans want to have agency over their lives, which is why children spend their childhoods begging to make their own decisions rather than have them made for them.

As I said above, if a therapist is offering advice the patient is perfectly free not to follow it. If said patient turns it all into a massive psychodrama, this only shows what she has learned from therapy. No patient has to defend not taking advice. As for the value of advice, the value always lies in whether or not it works.

Apparently, that is not the way it happens in Gottlieb’s office:

Despite getting exactly what you asked for, you might not do it. You might procrastinate, coming up with all sorts of reasons why you haven’t gotten around to it yet. And then you’ll feel bad for not doing it. And you’ll start to think, I feel bad because my therapist made me feel bad by trying to tell me what to do. How dare her! I’m not doing this, dammit, just because she told me so. Who is she to boss me around? And you’ll sit on her couch every Friday at 5, not telling her that you didn’t do the thing she suggested, because you resent her for intruding on your voice, for making you feel like your own opinion doesn’t matter; and on top of that you’ll be consumed by the shame you feel for displeasing her by not doing the thing she wants — which is what this whole interaction will have gotten twisted into in your mind, even though the ostensible point of her giving the advice was to please you, not her. In the end, nobody’s happy.