REVIEW OF: Hill CE et al, Psychotherapy (Chic) 2023;60(3):295-305

STUDY TYPE: Literature Review

Learning Objective

After reading this article, you should be able to...

1. Formulate evidence-based techniques to offer advice, suggestions, and recommendations (ASR) in psychotherapy.

Therapists working in different streams of psychotherapy have different engagement styles and general guidelines about whether and when to offer advice, suggestions, and recommendations (ASR). Beyond personal style, reasoning, and ideology, research on the dynamics of ASR in the sphere of psychotherapy has been scant. Do ASR help or hinder your work with your client? Psychologist and educator Clara E. Hill, PhD, and colleagues examined this question and formulated evidence-based guidance on the matter.

The research team performed a literature search in the PsycINFO database to identify articles pertaining to the evaluation of ASR. They looked specifically for data on ASR in relation to immediate in-session outcomes (immediate client response to ASR), immediate delayed outcomes (response later into the session), and intermediate outcomes (response at the start of a subsequent session). A total of 45 studies were identified. Seven studies met all inclusion criteria and represented 327 clients and 131 therapists. The studies were assessed, and outcomes were coded as positive, neutral/no effect, or negative. 

The research team found that clients’ level of collaboration tends to decrease immediately after a therapist gives advice. However, the client may benefit from requests to remember and revisit the ASR at subsequent sessions. Importantly and not surprisingly, the study found that the more well-established a clinician-client relationship is, the more amenable to ASR the client may be. 

While conceding that their study had many limitations—including a lack of data on disparities and cultural dynamics—the authors had the following recommendations for practitioners:

• Consider client’s reactance level (ie, clients with low reactance levels are better candidates for ASR than those with high reactance levels).
• Reflect on the motive for giving advice and consider whether guiding a client toward their own solution may be a better course of action.
• Be clear but not too directive when offering ASR.
• After providing ASR, be observant of its impact on the therapeutic relationship.

Carlat Take

The study found that providing clients advice can be quite helpful, especially if you’ve developed a strong alliance. Just be careful not to inadvertently discourage your client’s own efforts at coming up with their own solutions to their problems. 

APA citation:

Hill, C. E., Knox, S., & Duan, C. (2023). Psychotherapist advice, suggestions, recommendations: A research review. Psychotherapy (Chicago, Ill.), 60(3), 295–305. https://doi.org/10.1037/pst0000476.