by Marc G. Schramm, Psy.D., C.G.P.
One function of this column is to offer advice, so it only seems appropriate that I dedicate at least one number to advice-giving by the group therapist. If you cringe at the thought of a therapist giving direct advice, you are not alone. Over 2000 years ago Publius Syrus observed that though "Many receive advice, few profit by it." Most therapists have tended to agree, although group members tend to favor advice over other therapeutic factors (Lieberman et. al. 1973). There is, however, some evidence that advice can be a valuable therapeutic tool, depending on how it's given.
In his examination of this issue, Flowers (1979) recognized that there are different ways of giving advice. He found simple, unelaborated advice was not all that helpful. But two forms of advice did stand out as quite effective. One is to offer at least two alternative ways of handling a situation. The second is to offer one option, but to provide a step-by-step approach to carry it out.
Flowers feels that unless therapists are trained to avoid advice-giving, they will frequently resort to it. The paraprofessional clinicians in his study judged simple advice-giving as more therapeutic than instructions or alternatives--though subjects gave the opposite ratings, and outcome measures backed them up. Flowers objects to attempting to train therapists against advice-giving altogether, noting that "eliminating advice, besides being difficult and only partially successful, removes a therapeutic tool which is effective if used properly."
How should one decide when to offer non-simple advice? The nature of the group is of course a factor. Advice-giving is a typical feature of psychoeducational groups. Therapists working with populations less capable of insight work also use advice more often than reflection.
With more insight oriented groups, the meaning of a request for advice should be considered by the therapist. A request for advice may be just that, but may also reflect (for instance) larger dependency issues. The content of the request for advice may in some cases be irrelevant itself, merely providing a medium for a larger process. One sign to look for is how the client reacts to the therapist's response. If, after a reflection-seeking response, the request for advice is not brought back up, this would tend to indicate that process issues were much more important than the particular content. If instructive or alternative-providing advice leads to "yes, but..." reactions, this also suggests the primacy of process over content.
In understanding the process issues involved, it is crucial to keep the group context in mind. Frequent advice-seeking in group may represent a competitive bid for the therapist's attention. Group dynamics may pull the therapist to give advice where he/she might avoid doing so in an individual setting. Some advice may please one sub-group while antagonizing another.
Even if advice-seeking is generated by broader issues, advice-giving is not necessarily a therapeutic error. Two general questions can help to evaluate this risk. First, would responding with advice represent a departure from what the therapist might normally do in similar situations? If so, it is wise to figure out what is pulling for a differential response before deciding whether or not to make it.
Second, would giving advice seriously impede exploration of other possible issues inherent in the process of advice-seeking? If reflection and exploration remain possible, or can be done prior to advice-giving, options for therapeutic work are not closed off, and even negative fall-out can often be worked through productively. It should be noted that one peril of giving advice is that it may prove to be wrong. A therapist should always keep this in mind when giving advice, and be prepared to deal with such an eventuality.
There is one more piece of advice I'd like to offer about patients who seek advice. Because I believe that the group is the main therapeutic agent in group psychotherapy, I usually defer requests for advice to the group itself. In doing so, I look for the group to provide more than one alternative, and to offer instructive advice. I am most likely to consider offering advice when the questions involve issues on which I have professional expertise. More often than not, group members are at least as qualified as I am to deal with the issues fellow members bring up.
Marc G. Schramm, Psy.D., is a Founding Certificant of the National Registry of Certified Group Psychotherapists, a clinical member of the American Group Psychotherapy Association, and President of the Tri-State Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222
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