Most of my patients come to me seeking advice. Since I was taught that advice inhibited the analytic process and was not helpful to the patient, it has only been after two decades of work as an analyst that I have found this strict orthodoxy did not always reflect what is best for the patients in my care.
According to Webster’s, advice is “an opinion or recommendation offered as a guide to action, conduct, etc.” To advise is defined as “to give counsel to; offer an opinion or suggestion as worth following.” While it’s unlikely that I would ever proffer an opinion to a patient, I might, on the other hand, find myself giving counsel or recommendation. Clearly there is a distinction between giving counsel or recommendation and advancing an opinion.
While some might say I’m unorthodox, at times I find that giving advice is the exactly appropriate course of action. Working in the trenches has taught me the need for flexibility when applying the precepts of psychotherapy to the needs of a patient.
Several years ago, I treated a man who had difficulty maintaining an erection when having sex with his girlfriend. While Viagra was helpful with sustaining an erection, the medication inhibited an orgasm. This problem had been ongoing since the beginning of their relationship. At one point I asked him if and how his partner’s orgasms might play a role in their sexual dysfunction. Nonplussed, he said he had no idea and had never thought to ask. My thinking was that if the focus of their sexual difficulties was only on him, satisfying her may open up their sex life in new ways. I recommended that he approach the topic with her and do his best to break the sexual stalemate. By advising him, I allowed him to talk about the difficulties he had expressing sexual thoughts.
Another patient who was in a long-term relationship became infatuated with a co-worker and was having an affair. She felt very guilty about the affair and put an end to it while she contemplated what to do next. But because she saw her co-worker every day at work, she found herself being pulled into continuing spending time with her. This was confusing and only exacerbated her guilt. I thought it would be helpful to establish boundaries with her co-worker. I helped her set ground rules governing how much time she spent with the other woman. By working with her and advising her around boundries, I helped her clarify her needs and feelings.
As therapists, we must remain open to what may be best for those patients in our care. While there are many theories and modalities on how to best treat patients, it’s essential to remain flexible. I find that being open and eclectic, even at times giving advice, serves the people I treat and best yields improvements to their mental health.
