Tell Me What To Do
Photo by Phillip Glickman
“Tell me what to do,” is a request many patients make in therapy. In fact, some of them may even quit therapy if the therapist fails to oblige. From their perspective, therapists should not hesitate to advise on issues, big or small; in fact, it should be a key part of their job. These patients may say, sure, there is merit in therapeutic discourse, but must therapists turn things upside down and inside out, every single time? Can’t they just give a quick yes-or-no, please?
I get it. Who does not wish to be taken care of, at least sometimes? The idea that a trusted therapist might share the burden of decision-making can be comforting, especially in light of the therapist’s familiarity with our inner workings. But, while many people do not hesitate to ask their therapists for direction, few are certain to follow through with concrete suggestions. In fact, whenever I get a request like this from a patient, my reply is typically, “So you will do exactly as I say?” Upon hearing my response, most people chuckle and realize their own ambivalence.
There is nothing wrong with seeking feedback or support, in therapy or in life. However, in therapy, a statement that suggests the patient is actively relinquishing control deserves further examination, and the therapist will invariably want to explore what is behind the request. The topics may include the nature and timing of the request, the circumstances, as well as a host of other factors. So, for the therapist to hold off from dispensing quick advice is actually not a cop out; it is a sensible and therapeutic approach.
Of course, there are occasions where the therapist can be swift to render an opinion. For example, if an adult patient reports abuse, the therapist may insist on a safety plan or even an exit strategy. In such a case, the intricate interpersonal dynamic will continue to be explored in therapy, but the pragmatic issues are likely to take precedence. (Of course, if the patient is a minor, the therapist, as a mandated reporter, is legally required to alert the authorities immediately.)
As human beings, we are complex and nuanced. We are not robots; we are more than the sum of our parts. If the therapist seems reticent when asked, it is probably because the quandary requires thorough deliberation. The reality is, after teasing out feelings of anxiety and insecurity, most of us ultimately want the competencies and skills to figure things out for ourselves, therapy or not.