You know your therapist is tired when...

they give you advice.

I am a little bit joking and a little bit not. Psychotherapy is the broadest definition for the multiple training streams that comprise our discipline. These include counselling, psychology, psychiatry, social work and theology to name a few. A commonly shared principle across the streams once you arrive in your actual training in the practice of therapy, is the complexity and danger of giving advice.

Advice betrays an element of the relationship’s structure that is thought to be fine in a personal relationship but problematic in a therapeutic one. I am a highly independent person by nature and I don't ask many people for advice. The very few people I ask for advice are held so dear to my heart that I would trust them with my life. But more importantly, I trust them with my nature. Those people don't advise what they imagine to be best. They advise what they imagine to be best for me. Advice and guidance in an integrated, authentic, mutual and loving relationship can sound absolutely nutso. Because it is an act of connection and celebration of the unique self and we are all a little bit weird. "Yes, you should quit your job. Yes, you should pull your child out of school. Yes, you should throw all the clothes away in your closet. No, you should not run that marathon. Yes, you should stand on your head." None of those statements make sense unless the unique meaning, significance and impact of the act(s) are known.

I never used to advise my clients in any way. Committed to deeply held beliefs about each person’s potential for a distinct human experience, I never wanted to interrupt or persuade or toxify their moments in therapy. Tripping over yourself in that room week after week is such a slog sometimes that you can desperately want your therapist to pull you along. And I am so committed to the individuality of each of us, that I never rescued people much. Most well-seasoned therapists will tell you that advice can lead to blame, shame, failure, unpredictable negative consequences, inauthentic growth, maladaptive dependency and in the very least a client's disengagement from their own inner world. All true if you take liberties you shouldn’t and certainly if you make it about you and not them.

But I had a moment with a couple early in my training where I broke the "rule". I did it out of fatigue and by complete accident and immediately regretted it. Having started in my placement after my master’s and just having had a baby, I was headed back to the workforce with a nursing child at home every night. Going on to my sixth session in the day at a very intense training placement, I was set to see a couple that I had worked with for months with "no improvement". (That was a box we had to tick in our note-taking software UGH). I quite liked these folks and was so sad for their circumstances. Nothing seemed to be working for them either in their own internal worlds or in the universe that surrounded them. But they adored each other for the most part and kept at the slog. For the millionth time they said, "just tell us what to do". So exhausted from lack of sleep, I grasped at a straw and said, "walk together silently for 30 minutes every day this week and then come back and tell me what you've learned about your relationship".
 

I was so embarrassed by the exchange that I didn't dare add it to my notes.

They didn't attend our next session and I assumed all my wildest dreams had come true. They were never coming back, they thought I was a quack, they figured their time was better spent in self-help books and they had moved along to someone more qualified. Two weeks later, they returned apologizing profusely for missing their appointment and laughing about the fact that they had forgotten it because they were out on their walk together. Like it was a thing they did now.

They said that silent walk had saved their relationship and they had continued to invest in that time with each other day in/day out over the two weeks (and beyond). I was laughing at the absurdity and shared with them what I have just written above...all of the beautiful theories as to why that was the wrong thing for me to do. Their response was simple: "We are desperate and can't get through the day. We trust you and need to do something different."

Since then, I have realized that advice in the therapeutic room is similar to that in real life. It exists where

have a party together.

If I am promising to help carry you in the worst times, I am going to use advice as an element of that despair/trust/change trifecta to your advantage. It isn't that the advice itself is so brilliant (I wouldn't recommend a silent walk for everyone). Advice that emerges from therapeutic rapport can unlock your conviction to change. That couple had tried so many of their own ideas that had backfired, but they tried that walk differently.

In my current practice, I look for this moment where the stars have aligned so that a person, a couple, or a family is in this state of readiness. And then we try something. It is generally small but sometimes it is big. It is never more of the same, it is always different than what has come before and it is always about being as much as it is about doing. I often know this moment has come when I am attuned to my own need to give the advice. When I am starting to feel the level of fatigue and despair that you are feeling about your own issue, it tells me we have arrived in that moment. And as I look back at the session when I learned this lesson, I realize that my own fatigue that day was for that couple on their behalf not on my own.

Therapists are intense humans. We are attenuated to clients in deep and profound ways and it gets honed as we mature. This is the whole point of why you come to therapy...to leverage our empathy and insight for your benefit.

So now I know…if I am tired…you are ready.

Britta Regan West
 MA, RCC, TITC/CT-CFST
 Clinical Counsellor, Clinical Traumatologist, Compassion Fatigue Specialist