To Confront or Not to Confront ... Is That the Question?
I lead several clinical consultation groups for therapists and one issue that comes up frequently is ambivalence around confronting our clients. Similar to confronting, is confusion around giving advice or opinions. I mean really, many of our clients come to therapy seeing us as experts and hoping for advice. Although there is a time and place for confronting our clients and even giving advice, we often feel ambivalent about it. I think that's because many of us haven't learned specific skills to use when we are ambivalent about confronting or giving advice.
Strategies for Confronting When Ambivalent
1) Share Your Ambivalence
Recently a member in one of my consultation groups was talking about having reactions to severe self-deprecating remarks that her client was making. She was ambivalent about confronting this because he usually laughed it off as humor. We talked about her sharing her ambivalence with him like this:
I'm ambivalent because when you just said that, I had a reaction to it and thought about confronting you about it but, on the other hand, I know you were just kidding. I'm torn about whether we should talk more about it.
By talking about her own ambivalence, the therapist is able to gently bring up the matter while also enabling the client to consider their willingness to explore this. I find that when we as therapists are ambivalent, it can be a relief to realize that we don't have to know which direction is right. I teach my consultees (as well as my clients) that most of the time when we are ambivalent, it's because there is some wisdom on each side. Therefore, coming up with a way to honor both sides is often more effective than taking a side or waiting. In this example, there is no pressure for the client to make the right answer. Either way, the feedback was given and the proverbial seed is planted. Even if the client laughs it off and moves on, the therapist can refer to it again the next time it happens. I'm having that reaction to your comment again...
2) Access the Client's Own Problem-Solving Ability (pre-frontal lobe functioning)
Another client was criticizing herself for not revising her resume yet as part of her desire to get a new job. Since the goal from the last session was to just start the document and the client hadn't even done that, the therapist was unsure what to do next without confronting the client on not following through. In these situations, therapists can deal with their own ambivalence by accessing the client's own problem-solving ability like this:
So part of you is upset that you didn't start your resume but another part of you just can't get started yet. What can happen?
In a therapy session, I am usually trying to help the client move back and forth between activation of their emotional and instinctual parts of their brains to activation of their prefrontal lobes. In the above example, if I took the side of getting started on the resume (which seems like the reasonable thing to do), the client may hear it as a should and just feel even more shame or engage in "yes-butting". "Yes-butting" often is evidence that they are not thinking from their pre-frontal lobes but reacting to you. Asking the question "what can happen" often will activate prefrontal lobe functioning in the form of curiosity and problem-solving so that the client's own wisdom can emerge. Motivation is strongest when it comes from within.
Many of our clients don't know how to intentionally access their prefrontal lobes, so helping them do this in the session is great practice and generates wisdom for developing goals rather than shoulds. To summarize, when ambivalent about confronting, rather than take a side (even when it seems to be the obvious choice), point out their ambivalence and ask "what can happen."
Strategies to Use to Avoid Giving Advice
So we have all been taught that we shouldn't give advice in psychotherapy. This is for several reasons such as the need to access a client's own wisdom, a concern for projecting our own values, eliciting a defensive reaction from our client, and providing advice prematurely which can lead to increased shame in clients who are already prone to feeling shame. But we all do it! There are also many reasons that we do it including the need to be helpful or seen as an expert and then there are those times when our clients specifically ask for it. The following are some strategies to use when asked or tempted to give advice.
1) What do you think I should do?
I'll help you come up with things to do but first let's talk about what it's like for you when people tell you what to do.
This response allows you to circumvent the knee jerk reaction some people have when being told what to do even when they've asked for advice. These opposing reactions to asking for help are common due to the multiplicity of human personality and the common dialect in all psychotherapy. Dialectics refers to the tension between two contradictory viewpoints, where a greater truth emerges from their interplay. Whenever people are trying to change something, there is likely to be one part of them that wants change and one part that is afraid of it. This becomes a problem, and can be very confusing, when we are only talking to one part of the client's needs at a time.
2) You're the therapist, tell me what to do?
I'm happy to tell you what I think you should do but I may not fully understand why it might be hard for you to do it. So of course, I'd say start your resume Monday but that's what we discussed last week. Maybe we could talk about what makes it hard for you to do that.
This response honors the client's wish for advice and the therapist's urge to give advice but minimizes the actual advice-giving part of the conversation. Additionally, this strategy might help the client to shift to a state of curiousity which then enables them to consider what advice to give themselves.
I've written another blog on why it's hard for us to resist giving advice that you can read here and one on helping clients access their own wisdom here.
If you'd like to learn more, I have written a book called A Clinician's Guide to Pathological Ambivalence: How to be on Your Client's Side without Taking a Side and a companion workbook for the client called Understanding and Resolving Ambivalence. I'd love to hear from you. If you found this helpful please click on the heart below or leave a comment.