I received a question the other day about the use of directives in psychotherapy due to my having written other posts about applying absurdity and paradox as effective therapeutic directives. The question I received is “How do you do directives in an ethical manner”? This question caused me to pause as I usually do not think about how I do directives as being unethical at all. Upon further reflection I think the question came about because of the power distribution within the session in which directives arise. In order to give directives, the therapist has to become the “director” of the session and cannot be merely a passive onlooker. This can create concern for those who are uncomfortable with having a larger amount of power and control in their therapy sessions. I completely understand this concern.
To address this concern, first, I must state that if you are a therapist it is crucial that you adhere to the ethical guidelines set forth by the organizations who are involved in your licensing (APA, ACA, NASW, etc.). Thoroughly knowing what is appropriate and what is not in the ethical codes is an important part of being a professional therapist. If there is uncertainty on one’s part about a course of action, I recommend consulting with a colleague or supervisor to bounce ideas off of so that one can have a better perspective on a directive. The allure of power can be seductive so it is imperative that we in the healing profession proceed with caution. At the same time, we need to not be so uptight and worried about what we are doing that we lose our spontaneity and creativity.
Secondly, I think the best way to use directives is to simply ask yourself, “Would I be willing to do what I am asking my clients to do?” If the answer is “yes”, then implement the directives. If the answer is “no”, then do not implement the directive. If we are unwilling to do what we are asking of our clients, then not only are we not congruent with the therapeutic offering, but we are also putting unnecessary burdens and expectations on the people we are trying to help. By approaching directives with this mindset, it creates an opportunity for us to expand our own comfort zones. If we ask our client to do an odd action to change his or her patterns of interaction, then why not implement that same pattern in our own lives? It may help us become less regimented and more creative in how we approach our own problems. I have a rule that I never ask any of my clients to do anything that I would not be willing to do. This helps keep me mindful of the issue of power in the therapeutic relationship and also reminds me that there are areas that I need to work on and expand in myself.
A recent example of this occurred when I had a client who was very anxious about having things in order. She specifically was bothered by the idea of germs in her home. I was able to get her to agree to not wash one of the pans she used in cooking for two days (it was no small feat to get that agreement!). This allowed her mind to observe that not having everything perfectly clean would not automatically lead to excessive germs and sickness. As I gave this directive, I noted that I can be a bit of a neat freak in my own home. I make my bed and wash my dishes daily and do not like things out of order. As a result of giving her the directive to not wash a pan for two days, I decided to implement a similar directive for myself. I did not wash a pan for two days nor make my bed. This may seem like it is not a big deal to some of my readers, but for me it was an annoyance to alter my usual routine. It did pay off as I reminded myself that routines are sometimes made to be broken and it also gave me a level of congruence with my client.
If you direct your client to stand up more for himself in situations where he would previously back down, then make sure you are willing to stand up for yourself in a situation where you usually back down. If you want your client to expand her comfort zone by try something new, then make sure you are willing to try something new outside your comfort zone. By being willing to do what we ask of people we can defend against potential ethical issues.