It takes lots of training and a long time to become a competent therapist (Orlinsky & Ronnestad, 2005). Why is psychotherapy so difficult to learn? One reason is that the therapeutic relationship is private. Students have experienced many teachers and professors; thus, plenty of good models exist for students who aspire to jobs in academia. However, few students have experienced more than one or two therapists in their lives, and The Sopranos and old reruns of The Bob Newhart Show at 2:00 a.m. don’t really count.
Another reason psychotherapy is difficult to learn is that it is unique. Students begin therapy training with ideas about relationships based largely on their interactions with family members, friends, physicians, and others—ideally, not including parole officers. But these relationships, although similar in superficial ways, are not at all like psychotherapy in several very important ways. Thus, many students need to correct some misconceptions about therapy. As Grater (1985) put it, "To a significant extent the trainee learns to replace social patterns of interacting with therapeutic responses” (p. 606).
Give Up Giving Advice
The first misconception: Psychotherapy involves clients who relate problems and therapists who tell clients how to solve those problems. This is what I call the financial planning model of helping: "I know the best investments for you, and I don’t really need to know much about you to offer advice.” Physicians and attorneys use a similar model. These relationships involve high levels of expert knowledge—about diseases, finances, law—and a lot of specific advice.
Students are often surprised that psychotherapy does not involve the same kind of advice, because therapists actually know very little about how clients should live their lives. Think about it: In an hour a week, you will never have enough information about your clients to make decisions or offer specific advice about their lives. The expertise of psychotherapy is about the properties of a growth-producing (therapeutic) relationship and about methods to help clients use therapy to make their own decisions.
It might be useful to distinguish between process and substantive advice. "Process advice consists of suggestions for how to go about solving problems, or how to make the most of therapy,” whereas "substantive advice consists of suggestions for specific solutions to the problems, or for how to live” (Anderson & Handelsman, 2010, p. 102). Process advice is great; too much substantive advice may indicate that therapists are taking too much responsibility for clients’ lives.
Some advice sounds substantive, but is actually so general that it can be given to anybody: For example, "I think you two, as partners, should learn to communicate better.” Beyond these generalities, how do we know what’s best for a particular individual?
Personal Experiences Don’t Count as Much as You’d Think
Many beginning (and veteran!) therapists believe that having endured and solved some life problem gives them a built-in advantage with clients who have similar problems. I disagree. Such experience may give therapists a way to empathize. However, expertise in therapy comes from the integration of theory, researchbased skills, and personality—not simply from personal experience. Thus, therapists may be less effective with clients who have similar issues because therapists may: (a) miss important client information because they assume clients are just like them, (b) be too quick to give only advice they found useful, and (c) rely too heavily on their experience—which may be atypical—and not enough on what the research says. As a professional, the only person you are qualified to help based only on your own experience is … you!
The bottom line: Too much advice and too much self-disclosure by therapists may constitute, or lead to, unethical behavior. These behaviors are examples of "boundary issues” (Gutheil & Gabbard, 1993), which I shall discuss in future columns.
Anderson, S. K., & Handelsman, M. M. (2010). Ethics for psychotherapists and counselors: A proactive approach. Malden, MA: Wiley-Blackwell.
Grater, H. A. (1985). Stages in psychotherapy supervision: From therapy skills to skilled therapist. Professional Psychology: Research and Practice, 16, 605–610.
Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and riskmanagement dimensions. American Journal of Psychiatry, 150, 188-196.
Orlinsky, D. E., & Ronnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington, DC: American Psychological Association.