To advise or not advise: that is the ethical question

Sam Gerrard throws new light on the case for directive or non-directive counselling.

Ethically responsible counsellors should never give clients advice or guidance. For those who have trained in, for instance, the Freudian or Rogerian schools of counselling, these forbidding words will no doubt be familiar, as this core principle of counselling is commonly taught to new students and stressed throughout their training. This was certainly the experience I had last year, when I completed a course in psychodynamic counselling: my fellow students and I were told that it was an unethical, anti-therapeutic and disempowering practice to give clients any sort of advice or guidance.

Despite my sincere desire to become an ethically responsible counsellor, I felt uncomfortable accepting this principle, which appeared far too rigid and explicit to be applied to every single case and circumstance.

What if, for instance, a client told me that they had made plans to commit suicide – could I not advise them to postpone whilst I tried to help them through their difficulties? Or what if I could see that a client was causing their own anxiety and depression by misusing their imagination – could I not advise them on how they could change their negative thought patterns and teach them some relaxation techniques to help reduce their stress levels? And what if a shy and lonely person told me that they had difficulty forming friendships and relationships – could I not advise them on how they could improve their social skills and help them to plan new ways to meet people? Surely, I thought, there must be a more balanced and realistic perspective to be found on advice-giving.

It was later that same year that I began my training as a human givens psychotherapist and, to my relief, discovered that such an alternative perspective did exist; I found that the healing and generative potential of advice-giving, under certain circumstances, was clearly demonstrable, and valued, by this more contemporary school of psychotherapy. I have spoken with many experienced counsellors who say that they have successfully used advice-giving as part of their interventions – allowing them to guide their clients through some extremely difficult circumstances, quickly and ethically. In some cases, I was left with little doubt that, without advice and guidance being included as part of the intervention, clients’ suffering was destined to be prolonged or, in some cases, become chronic. Published examples of this are also legion, both in this journal, over the years, and in books on the human givens approach. For instance, I was struck by this powerful case study, which was first published in Human Givens in 2004¹. It described the case of Nina, a career-driven 26-year-old woman who, recognising that she had become unhealthily obsessive and perfectionist, had gone to a counsellor for help. Unfortunately for Nina, the counselling did not seem to be effective and her mental health deteriorated to the point where she became almost incapable of normal functioning; she was put on a heavy dose of antidepressants, became suicidal and ended up in a psychiatric hospital. Subsequently, Nina saw Mike Beard, a human givens therapist.

Analysing the intervention delivered by the human givens therapist makes it clear how instrumental and effective advice-giving can be in triggering positive change. Firstly, Nina was advised (given information) about the cyclical nature of depression², and how to break that cycle. By doing so the therapist was handing back autonomy and control to the patient – ‘planting a seed’ of expectancy and hope to focus her attention outward and optimistically on the changes that she could make for herself. This, of course, is the opposite of how most people diagnosed with depression think; they tend to introspect about their difficulties, lack a sense of autonomy, and feel enveloped by ‘their’ depression – all of which result in disturbed sleep and a deepening of their depressed state.

Next, the therapist showed Nina how to lower her levels of emotional arousal with a simple relaxation technique to practise daily and taught her strategies to prevent negative thoughts, introspection and worrying. For example, she was encouraged to talk with her partner each day about their future goals and aspirations and, when she was struggling to make important decisions, to write lists of pros and cons to help her to see things from a more rational perspective. Finally, the therapist advised Nina to add more structure and routine to her day, by finding an enjoyable part-time local job that would bring her into contact with people (while she kept applying for posts within her field), walking with her partner, socialising, and undertaking a fitness programme to boost her serotonin levels. Nina had just three sessions with the human givens therapist. After the final one she said that she felt “full of life, love, energy and curiosity. … I really think I have learned how to handle my unhealthy perfectionism and my inability to handle failure.”

Human givens therapist Frances Masters, who trained first as a person-centred counsellor, has described working, in her capacity as a bereavement counsellor, for nearly a year with one severely depressed widow. “As Christmas loomed, she told me she felt suicidal. At this point, as I had gradually become more confident of human givens ideas and methods, I decided I had to shift my approach.” Masters explained how depression caused black-and-white thinking and gave the woman two notebooks, one with a white cover and one with a black one, the first in which to note down positive thoughts and the second, negative ones. Together they looked at needs that weren’t being met and she nudged the client towards focusing on how she could make some positive changes. “She left that session no longer suicidal and dreading Christmas but looking forward to the New Year, full of hopes and plans. After a year of listening intently and doing nothing but, unwittingly, embedding her depression more deeply, I discovered that she had done all she needed to do to bring about positive change, after just one human givens session.”³

In the previous issue of this journal, occupational health psychologist and human givens therapist Sarah Worsley-Harris described advising her clients, highly conscientious mental health workers absent long term from work through stress or burnout, to imagine a bully on their shoulders to represent the old habit of negative self-talk and replace it with the image of a supportive friend instead. One former client of hers now uses this image routinely with the team he manages, as he had found it such a useful way to learn compassion for himself.⁴ In such cases, it seems clear that the clients would not have had the necessary knowledge to move forward without the simple advice and guidance offered by the therapists.

Ethical or unethical?

Might it be reasonable to suggest, therefore, that to deny the provision of advice-giving on ethical grounds could, paradoxically, be unethical?

Many counselling practitioners would dispute this – for instance those whose therapeutic approach originates from Carl Rogers’ non-directive therapy (which later become known as person-centred therapy). One of the core principles of this approach is that clients have the ability to ‘self-actualise’ – ie to navigate themselves and know how to resolve their own difficulties. Because this process of self-actualisation is ongoing, many counsellors believe that there is no answer, solution, insight or final result to achieve during counselling⁵ – they would therefore be cautious of advising the client on how, from their perspective, they thought the client could help themselves through their difficulties.

I also know from my own experience of training in a psychodynamic (Freudian) approach that many such practitioners would be uncomfortable about giving advice to clients as they are taught that the client might feel that the counsellor is imposing their beliefs on them – therefore, that they are losing their autonomy, becoming disempowered and may grow dependent on the counsellor to solve their problems (creating an imbalance of power within the relationship). Such ideas no doubt originated with Sigmund Freud, who also taught his students not to give advice.⁶

Contested meaning of "counselling"

It is largely because of these influential figures that the ‘anti-advice’ position held by some of the largest models of psychotherapy within the UK has been so long-lasting and widespread. However, it is by no means an open and shut case and there are widely differing views about what the word ‘counselling’ actually means. In the Compact Oxford English Dictionary, for instance, the word ‘counselling’ is defined as: 1 Give advice. 2 Give professional help and advice to (someone) to resolve personal or psychological problems. 3 Recommend (a course of action). And the word ‘advice’ is defined as: “guidance or recommendations offered with regard to future action”.⁷

These definitions denote a strong relationship between counselling and advice-giving. However, as Tim Bond, the author of Standards and Ethics for Counselling in Action, suggests, there is no one definition that is accepted within all approaches to counselling⁸ – although it is now becoming more common for leaders of counselling associations to acknowledge and legitimise the use of advice-giving in some contexts. For example, the late Hans Hoxter, founder of the International Association of Counselling (which exists to “promote the wellbeing of peoples worldwide by advancing relevant counselling practice, research and policy”) opined that, “Whereas the counselling is primarily non-directive and non-advisory, some situations require positive guidance by means of information and advice”.⁹

A further significant milestone in the legitimisation of advice-giving has been the re-evaluation and modification of the British Association for Counselling and Psychotherapy (BACP)’s position. After a decade of stipulating to its members that “Counsellors do not normally give advice”, this clause was retracted from its guidelines and does not appear in its Ethical Framework for Good Practice in Counselling and Psychotherapy, published in September 2001.¹⁰ Tim Bond (the principal author of the framework) has said that there were a number of reasons for the BACP adopting the change at the time, including the following: “Brief therapy and cognitive-behavioural therapy were becoming more open to giving advice, directly and indirectly; empirical research using discourse analysis suggested that even non-directive counsellors were using covert ways of influencing clients and we therefore decided that this earlier guidance was starting to lack integrity and sense of reality; it was felt that it was better to limit advice to overt communications that serve therapeutic purposes and to be accountable for any advice given. The value attached to overt advising could then be determined by the applicable school of counselling/model.”¹¹

Advice as a "performance"

This comment seems to demonstrate a self-evident truth – that advice and guidance are deeply rooted in our everyday communications with one another and it is very hard to remove it. It is, therefore, natural in a counselling environment for both client and therapist to guide each other throughout their conversation, learning from each other, sharing and testing ideas and gaining new perspectives. Rather than viewing this evidence as a negligent error made by the ‘non-directive’ counsellor, it may be more realistic to accept that, to some degree, most counsellors propose or pursue certain directions within counselling (for instance, by showing through positive body language or verbal responses that they think a comment or concern raised by the client warrants further exploration) and that every interaction they have with a client is interventive, and potentially directive. This is a concept which has been explored in depth by psychologists/family therapists Shari Couture and Olga Sutherland, who have proposed the concept that advice is a dialogical ‘performance’, to which both counsellors and clients contribute.¹²

Like a dog[ma] with a bone

Despite the BACP’s changed stance on advice-giving nearly a decade ago, and two of the other largest UK professional associations – ENTO Professional Development and the United Kingdom Council for Psychotherapy – not directly making any references to ‘anti-advice’ positions in their ethical frameworks,^13,14 it is curious how far the ‘anti-advice’ position still prevails. There is little documented evidence to suggest why, but I feel it is likely to be influenced by the following factors:

• Counsellors working from Freudian and Rogerian models still view the efficacy and validity of advice-giving from the position determined by their particular school of therapy. Trainers may fail to inform their students of the diverse perspectives on advice-giving outside of their own model. This could lead students to deride any counselling practice that endorses advice provision.
• Counsellors may be reluctant to let go of the beliefs they adopted during initial training, even if they are later given cause to question them. This was evident during some conversations that I had with fellow students on my psychodynamic counselling course, when they were clearly not willing to contemplate, or engage in discussions about, the appropriateness of advice-giving in certain cases, despite the information I put before them.
• Outdated educational resources still appear to be in circulation. For instance, the BACP’s official definition of counselling still states “[Counselling] does not involve giving advice or directing a client to take a particular course of action …”¹⁵ If an authority such as the BACP has still not updated its own material and references since it changed its position on advice-giving nearly a decade ago, then it seems reasonable to postulate that many other books, websites, magazines and journals will still be in circulation with outdated content.

Working from human nature

Maybe the debate has to move on from whether advice-giving is acceptable to what kind of advice-giving is acceptable. It is interesting to note that the word ethics comes from the Greek word ethikos, which means ‘dealing with human nature’.¹⁶ In the human givens approach it is understood that we have innate human needs which, when met, allow us to flourish and which, when unmet, give rise to mental and physical problems. With an understanding of the human givens, making decisions on advice-giving becomes less complicated, as the aim is to do whatever needs to be done to help people get their legitimate needs met, in a balanced and responsible way. (This might well include directing them towards help with housing, financial or other such problems, which are not usually deemed to be within the remit of counselling.)

Clearly there are times when giving a client advice could be unethical and anti-therapeutic – for example, if a counsellor dictates to a client or imposes a personal view onto someone who is too passive or vulnerable to discriminate for themselves what is useful for them. But if counsellors are conscientious and work to deepen their understanding of human nature, ethical considerations should begin to become internally generated, so that a core sense of propriety monitors their behaviour and becomes a stable reference point.¹⁷

However, as a counsellor who is not yet hugely experienced, I have found certain basic principles useful to abide by.

• Encourage clients to be self-determining and autonomous when they have the knowledge and resources to do so.
• Ensure that any advice offered to the client is focused on the therapeutic goal – ie helping them to get their needs met and become self-governing.
• Always explore the consequences of the advice given – remaining vigilant to potential implications for both the client and others.
• Never offer advice that is beyond one’s experience and training.
• Respect clients’ decisions and their right to accept or decline any advice offered to them.
• Ensure advice is free from self-interest and delivered with clean intentions.

This article first appeared in "Human Givens Journal" Volume 17 - No. 4: 2010.

1. Beard, M (2004). On the receiving end. Human Givens, 11, 2, 20–3.
2. Griffin, J and Tyrrell, I (2004). Human Givens: a new approach to emotional health and clear thinking. HG Publishing, East Sussex.
3. Masters, F (2008). A cloud lifted… Human Givens, 15, 3, 34–8.
4. Worsley-Harris, S (2010). Images for recovery. Human Givens, 17, 3, 34–8.
5. McLeod, J and Wheeler, S (1995). Person-centred and psychodynamic counselling: a dialogue. Journal of the British Association for Counselling, 6, 4, 283–7.
6. Strean, H S (1985). Resolving Resistances in Psychotherapy. Wiley, New York. Cited in Couture, S J and Sutherland, O (2006). Giving advice on advice-giving: a conversation analysis of Karl Tomm’s practice. Journal of Marital and Family Therapy [online].
7. Soanes, C (ed) (2008). Compact Oxford English Dictionary of Current English, 3rd ed. Oxford University Press, Oxford.
8. Bond, T (2010). Standards and Ethics for Counselling in Action, 3rd ed. Sage Publications Ltd, London.
9. Hoxter, H (1998). Counselling as a profession: status, organisation and human rights. Conference programme. International Association for Counselling, London. Cited in Bond, T (2010). Standard and Ethics for Counselling in Action, 3rd ed. Sage Publications Ltd, London.
10. British Association for Counselling and Psychotherapy (BACP) (September 2001). Ethical Framework for Good Practice in Counselling and Psychotherapy. BACP.
11. Bond, T (2010). Email message to S Gerrard, 4 May.
12. Couture, S J and Sutherland, O (2006). Giving advice on advice-giving: a conversation analysis of Karl Tomm’s practice. Journal of Marital and Family Therapy [May 2010]. Available here. 
13. ENTO (September 2007). National Occupational Standards for Counselling. ENTO.
14. UK Council for Psychotherapy (UKCP) (September 2007). Ethical Principles and Code of Professional Conduct. UKCP.
15. British Association for Counselling and Psychotherapy (BACP). BACP Education &Training – What is counselling? [online]. BACP.
16. Human Givens Institute (2009). Ethics and professional conduct policy. Human Givens Institute, East Sussex.
17. Tyrrell, I and Griffin, J (2010). Human Givens Diploma Manual. Human Givens College.