Friendship versus Therapy

A friend called me today to ask for advice about a conflict in his relationship with a mutual friend. After listening for five minutes, I told him exactly how I thought he should handle it. He was grateful and I was pleased; I joked that I wish that I could do the same thing with my clients--that is, tell them what to do and make everyone happy. After we hung up, I started thinking about the difference between friendship and therapy. In both cases, I provide support, give advice, and, to varying degrees, facilitate insight and personal growth. So what's the difference?

One of the biggest differences is that, for two reasons, I rarely flat out tell a client what I think he or she should do. Why not?

1) It's risky. I know my clients in a very limited context. I've never been to their home or to their workplace and I haven't met their partners, children, friends, or colleagues. If I tell a client how she should, for example, discipline her daughter, handle her overbearing boss, or respond to learning that her partner reads her personal emails, it could easily backfire, causing significant distress for which I would be partly responsible. Further, my client and I may have very different values, and a solution that seems perfectly appropriate to me may be completely out of the question for her. I know most of my friends much better than I know my clients and we share a lot of the same values, making it less likely that I would give bad advice (and if I did, there would be no question of professional liability). 

And the more important reason:

2) It's kind of like "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime." The goal of therapy is to render the therapist obsolete; I want clients to gain enough insight into their behaviour and develop enough new skills for problem-solving and for managing stress and distress that they no longer need a therapist. Telling clients what to do does not facilitate learning, and so a client who asks for straight-up advice will often get the answer-a-question-with-a-question technique. For example, if a client asks "Do you think I should take antidepressants?" I'll ask "What are some things that helped last time you were depressed?" If a client asks "Should I leave my partner?" I'll say "What are some of your options?" 

It can be challenging to not tell clients what I think they should do--especially if it seems obvious--but it's much more powerful if they figure it out on their own. And when clients surprise me by demonstrating that they learned exactly what I was hoping they'd learn (e.g., "None of my avoidance habits really work. I guess it's time to try something different," or "I notice that when I force myself to be active, even if I don't feel like it, my mood lifts"), it's therapy gold. 
 
NB: There are two situations in which I would tell a client exactly what to do. The first is if I have a tip the client can use to solve a practical problem (e.g., If you're suffering from insomnia, don't get into bed until you're tired; if you keep falling asleep during your relaxation exercises, try doing them before instead of after lunch). The second is a suicidal or other serious crisis (e.g., "When we hang up the phone, call your husband; if he doesn't answer, go to the ER").

What Went Well

Researchers in positive psychology study well-being, positive emotion, and quality of life. Investigating happy and unhappy people, they found that one thing that can make us unhappy is spending a lot of time thinking about what's going wrong in our lives, and very little time thinking about what's going right. Analyzing negative events is adaptive because we learn from our mistakes and avoid repeating them, but an exclusive focus on problems isn't helpful and can lead to rumination and depression.

What should we do instead? Positive psychology researchers have developed short exercises sometimes referred to as "positive activity interventions;" one exercise that's been consistently demonstrated to improve mood involves learning to notice when things go well, and to think about and savour the experience. Here's what to do:

1. Before you go to sleep each night, write down three things that went well that day.
2. Don't just think about them, but actually write them down; that way you'll have a physical record.
3. The events can be important (e.g., "I got a raise at work"), but don't have to be (e.g., "The bus pulled up just as I arrived at the bus stop this morning").
4. For each item, answer the question, “Why did this happen?”  For example, if you got a raise, you might write “I worked hard this year and my boss noticed." If you were perfectly on time for the bus, you might write "I checked the schedule and made sure to leave the house on time."

Research has demonstrated that people who stick with this exercise feel happier and less depressed after six months. I believe in positive psychology, so decided to try it for one month. It worked! I noticed that:

• I remembered and reflected upon positive experiences that I wouldn't otherwise have remembered or counted as positive, e.g., I re-potted my plant, I made a good dinner, I received the book I ordered online, I was invited to a dinner party.
• I started doing positive things on purpose so that I could put them on my list, e.g., going to the gym even if I didn't feel like it, taking care of an irritating but important errand, calling my mom to say hi, picking up a treat for dessert.
• I started noticing positive things in real time, including lots of things that I wouldn't have noticed before or wouldn't have counted as positive, e.g., I got a seat on the metro during rush hour, I was able to switch the date on my plane ticket without paying a penalty, there was no line at the drugstore when I went to pick up my prescription.
• I didn't always have an answer for "Why did this happen?" (e.g, why did I get a seat on the metro during rush hour?), but when I did (e.g., I was invited to a dinner party because my friends like my company, or I was able to change my plane ticket without paying the fee because I was patient and assertive with the customer service agent), it felt good. 

This exercise gave me a boost of positive emotion every night before I went to sleep. If you try it, let me know how it goes!