Why It's Unethical and Irresponsible For Psychotherapists to Give Clinical Advice in Informal Settings

Most psychotherapists have had the experience of being in an informal setting, like at a party or at the gym, where people ask for clinical advice about a problem they're dealing with at the time.

It's Unethical and Irresponsible to Give Clinical Advice in Informal Settings

In these situations, the person usually provides a snippet of information to the therapist and hopes to get an answer to their problem.  

Most of the time, the people who are seeking clinical advice in this way see it as being innocuous. But there are important ethical and clinical implications involved if a psychotherapist gives advice under these circumstances.

So, for instance, if someone at the gym finds out that another gym member is a psychotherapist or a psychiatrist, he might say something like, "Say, I hear you're a mental health professional.  Can you tell me what I should do about my teenage son who is doing poorly in school?"  

Aside from the fact that the gym member seeking help is giving very little information and the therapist hasn't met the teen who is having the problem, if the therapist gives clinical advice, like, "Your son might be anxious" and the gym member relies on this information, things could go terribly wrong if the teen is actually depressed or misusing alcohol or drugs, and the therapist can be held responsible.

In order for a therapist to diagnose a problem, there needs to be a thorough biopsychosocial assessment and it usually takes at least several sessions to get a complete picture in a clinical setting.

So when someone briefly mentions a problem to a therapist outside of a clinical setting, it's obvious there isn't going to be a thorough assessment and there can be many possibilities as to what the problem might be.  

Here's another example: A gym member approaches another member, who happens to be a psychotherapist, and says they're having headaches. They ask the therapist if the problem might be related to stress.  The appropriate response from the therapist would be to seek help from their medical doctor first to rule out any medical problems.  

An inappropriate response would be, "It sounds like stress to me. Have you tried meditation?"

Imagine if the gym member who has headaches follows this therapist's advice, but later on finds out that the headaches were actually the result of a brain tumor.  It's clear in this case that the therapist was ethically and clinically irresponsible to have made assumptions about the problem and to have given what turned out to be inappropriate advice.

Not only could there be disastrous results for the person with the headaches, but the psychotherapist could be placing their license in jeopardy.

Most lay people understand this, especially if the therapist explains why they can't speculate on the problem or give advice.  But, at times, there are some people who don't understand.  They misunderstand and think the therapist is being evasive or withholding information.  

So, if you ever ask a psychotherapist for informal advice and the therapist's response is for you to seek help from a licensed mental health professional in a clinical setting, the therapist is not trying to get rid of you.  They're being responsible and giving you the best advice under the circumstances, which is to have your problem thoroughly evaluated by a mental health professional who is licensed and who has the skills and expertise relevant to your problem.

Getting Help in Therapy

Often, the most challenging part of seeking help in therapy is taking the first step by contacting a licensed psychotherapist.

In New York City there are many ways to seek help from a licensed mental health professional.  

If you have health insurance, you can contact your insurance carrier for a list of names of licensed professionals in your area.  

If you don't have health insurance, you can seek help from one of the many postgraduate mental health training institutes in New York City that offer the possibility of low-fee therapy depending upon your income.

There are also psychotherapy directories, like PsychologyToday.com, which have therapists listed by name, licensure, location and expertise.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also, see my article: Why Your Psychotherapist Can't Be Your Friend.

Friendships: Losing a Friend After Giving Advice

One of the wonderful things about close friendships is the mutual support you provide to each other. Recently, a personal acquaintance told me how she lost her best friend after giving her advice, and she gave me permission to use her story, if I change her name, because she felt it might benefit others. Over the years, I've heard many versions of this story, and I've come to realize how common it is.

Yvonne (not her real name):
Yvonne and Sally were best friends since high school. They grew up in the same town, got married to their high school sweethearts with a couple of months of each other, and they continued to live close by even after they got married. They saw each other frequently, spending time with each other together as well as with their husbands. Over the years, they shared their secrets, hopes and dreams with each other. They thought of each other as sisters.

Sally and Yvonne Were Best Friends

It was not unusual for Yvonne and Sally to ask each other for advice. So, Yvonne thought nothing of it when Sally came over for coffee one day and told her that she needed Yvonne's advice. Sally told Yvonne that she suspected that her husband might be having an affair with his secretary.

At first, Yvonne thought Sally was joking. Everyone thought that Sally and Bob were the happiest couple in town. But when Yvonne realized that Sally was serious, she got over her initial shock and listened attentively to what Sally had to say.

Sally told Yvonne about all the telltale signs of Bob's infidelity: staying out late after work, sexually the provocative text messages on Bob's phone that Sally found when she became suspicious and searched his cell phone, and the sudden lack of sexual interest that Bob was showing for her.

They had been planning a vacation to Hawaii for months and now, suddenly, Bob wasn't sure if he wanted to go. As Sally told Yvonne all of this, she lowered her head and began to cry. She asked Yvonne, "I've been thinking about confronting Bob about this. What do you think should do?"

Yvonne told me that, at this point, her mouth had gone dry, and she hardly knew what to say. She had never seen Sally so upset in all the years they'd been friends. Her heart went out to Sally, and she wanted to help her. So, after a few moments of silence in which she composed herself, she told Sally she thought she should confront Bob. When Yvonne told me this part of the story, she said, "I would do anything now to take back those words."

A few days later, Sally came to see Yvonne. Sally looked like she hadn't slept in days. Her eyes were red and puffy with dark circles and she looked exhausted. Yvonne was shocked to see Sally in such a state.

After they sat down with cups of coffee, Sally told her that she confronted Bob. At first, he denied it. Then, after arguing about it for a few days, he admitted everything: He and his secretary were having an affair and he had no intention of giving it up. He felt ashamed, but he was also relieved because he hated lying to Sally.

At first, he thought his affair was only a passing thing. But after Sally confronted him about the affair, he had time to think about it. Before she confronted him, he said, he was going to break it off. But his arguments with Sally forced him to think about it more, and he realized that he was really in love with his secretary and he wanted to marry her. He apologized profusely to Sally, and then he asked her for a divorce.

As Yvonne sat there in stunned silence, Sally told her she couldn't help feeling that if she had not taken Yvonne's advice, Bob might have broken off his affair and all of this would have blown over. Maybe they would've had a chance to save their marriage.

But now she felt everything was lost. Bob moved out the day before to live with his new girlfriend, and he told her they should sell their house. Then, taking no responsibility for her own decision to confront Bob, Sally told Yvonne that she felt Yvonne's advice ruined her marriage and she wanted nothing to do with her ever again. And, with that, Sally walked out, leaving Yvonne in tears.


By the time Yvonne told me this story, five years had passed. True to her word, Sally wanted nothing to do with Yvonne. She ignored Yvonne's phone calls and email, and she refused to open the door when Yvonne tried to see her. In a few months after their last conversation, Sally sold her home and moved out of state. Yvonne never heard from her again.

Hindsight is 20/20
Hindsight is 20/20, and Yvonne had important insights over time. She came to see that, even though they were in their 30s, her friendship with Sally was somewhat adolescent and enmeshed. At the time, when Sally asked Yvonne for advice, Yvonne didn't have enough distance, due to their enmeshment, to stop and think about it before she gave advice.

She said that, if she could do it all over again, she would've told Sally that she couldn't advise her what to do and Sally should seek the help of someone impartial, like a mental health professional. She realized that, under most circumstances, no one can tell a friend what to do about his or her marriage.

Although time had passed and Yvonne was over the initial stage of hurt and anger for Sally blaming her and ending the friendship, she said she will never forget the important, painful lesson she learned. As I mentioned earlier, I've heard variations of this story many times. It can be a very painful lesson to learn that, even when a close friend asks for this type of advice, giving them advice about their marriage or relationship can backfire.

More importantly, we can never know what's right for another person's relationship. Even most experienced therapists don't give advice--they help clients to come to conclusions that are right for the individual clients.

So, the next time a friend seeks personal advice about serious problems in his or her relationship, unless you fear for your friend's physical safety, rather than risking the friendship, provide a comforting ear and a sounding board, but resist telling your friend what to do. Suggest that your friend seek professional help fro a licensed psychotherapist so your friend can figure out what's best for him or herself.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Exp I work with individuals and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 or email me.

Friendship: When to Give Advice and When to Just Listen

As adults, we've all been in the position, at one time or another, when we hear from a friend who is upset about a personal situation or a situation at work. It is sometimes difficult to know when our friends just need a sounding board, when we should give advice and when we should refrain from giving advice.

Friendship: When to Give Advice and When to Just Listen

Our Natural Inclination is that We Want to Help Friends
For most of us, our natural inclination is to try to help our friends, if we can. When a friend is upset, it's especially tempting to rush in with advice because we want to relieve the friend's suffering or offer comfort. 

But, without realizing it, we might be stepping into a very tricky situation, especially if the friend is calling about problems in his or her relationship. Although there are no hard and fast rules about this, there are some steps that we can take to ensure that, in the long run, we don't end up causing resentment later on or even ruining the friendship.

Ask Your Friend What She Needs
The first step that we can follow, after we have listened empathically to our friend's problems, is to ask what he or she is looking for from us. This might sound so simple, but in a situation where someone close to us is upset, it's easy to forget and lose sight of this. 

Now, you might say that if your friend is calling you and he or she is upset, of course, your friend is looking for advice. But this isn't always the case, and if you rush in, you might discover that you've misunderstood and you're not at all on your friend's wavelength.

By asking, we're letting our friend know that we want to be helpful in a way that is meaningful to him or her. We're not making any assumptions about what our friend needs or wants--no matter how long we've been friends or how well we think we know the friend. In a moment of upset, our friend might not be able to say what he or she needs, but this question can help him or her to clarify and organize his or her thoughts to be able to reflect on what's needed at that point.

Does Your Friend Want Advice or a Sounding Board?
If what's needed is for you to be a sounding board and nothing else, then your friend is letting you know that he or she just wants to vent and advice is not being sought. 

If your friend is looking for advice, if you choose to give advice, which can be tricky, there are tactful ways to approach this. Most important of all, we can never assume that we know exactly what might be right for our friends.

Does Your Friend Want Advice or a Sounding Board?

So, it's usually better to frame whatever you say by first saying that this is what you would do if you were in this situation (assuming that you have an opinion about it), and this may or may not be what is best for your friend. 

By saying this, you're letting your friend know that you're not assuming that you know what's right for him or her. You're also putting the responsibility for the decision back with your friend, where it belongs. But even this can be tricky. When a friend is calling about relationship problems, it can be especially tricky.

The following fictionalized account illustrates a common scenario where a friend calls for advice:

Susan and Pat:
Susan and Pat were close friends for several years. Pat was in a rocky relationship with Jim for the last two years. Usually, Susan avoided getting caught up in giving Pat advice because she knew that Pat wasn't ready to leave her relationship with Jim, no matter how much Pat complained about it. 

But on this particular day, without realizing it, Susan got caught up in Pat's emotions. Pat was calling for the third time in two weeks to say that Jim was verbally abusive and he wouldn't listen to her when she tried to discuss this with him. Usually, he would walk out and not call her for several days. Then, they would get back together as if nothing had happened.

As Susan listened to Pat crying on the phone, she felt exasperated. It really bothered her to see Pat in so much emotional pain. Before she realized what she was doing, Susan began telling Pat, "You've got to get out of this relationship! He's making you so unhappy. This keeps happening over and over again. He's not going to change." Pat responded by saying that Susan was probably right and, soon after that, she ended the conversation.

After that call, Susan didn't hear from Pat in several days, which was unusual. She left Pat a few messages, but she didn't hear back from her, and Susan began getting concerned. When she finally reached Pat, Pat was terse and aloof with her. At first, Susan couldn't understand what was going on with her friend. When Pat tried to get off the phone quickly, Susan asked Pat if she was angry with her.

Pat was silent for a moment, and then she said that she didn't think they could continue to be friends any more because she felt that Susan didn't like Jim. Susan was stunned and speechless for a moment, still not understanding what was going on. 

Then, Pat reminded Susan about the advice that she had given Pat about leaving Jim. Pat said, "I just couldn't believe that you would say that to me, knowing how much Jim and I love each other. I thought you were my friend, but I feel like you betrayed me. When I told Jim what you said, he got really mad and he said he didn't think you were much of a friend to me. And, you know, Susan, I have to agree with him." And with that, Pat hung up, leaving Susan feeling shocked and hurt.

Use Good Judgment
The scenario above is a common occurrence. In the heat of the moment, a friend calls in distress and complains about a boyfriend. Afterwards, especially if this friend is caught in a dysfunctional pattern, she reverts back to her habitual way of being in her relationship. She might even feel guilty for complaining about her boyfriend. 

Then, she thinks about the conversation where her friend tells her to leave the relationship, and she feels angry with her friend. Let's say, she's no longer in her upset state. She has already reconciled with her boyfriend. At that point, it's easy to blame her friend and feel betrayed rather than reflecting on the dysfunctional cycle that she keeps getting caught in with her boyfriend. I've seen this happen so many times.

Does Your Friend Need Professional Help?
In situations like this, you could understand how someone like Susan might feel exasperated, especially after listening to her friend complain over and over again. 

But, rather than react, it's better to step back after listening and ask your friend how you can be supportive. And if your friend is caught in a dysfunctional cycle and you know that by allowing her to vent to you, she just lets off steam and gets right back into the same cycle, the best thing that you might do is to let her or him know that you're not a professional, and it might be better for your friend to seek professional help with a licensed psychotherapist. 

Not only might this stop the cycle of her complaining to you and then just going right back into the same dysfunctional situation, but by getting professional

It's not always easy to know what to do when friends call on us for help, but by taking a moment to reflect on the situation and asking a friend what he or she needs from us, we can avoid crossing boundaries with our friends that could ruin a friendship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR therapist, and Somatic Experiencing therapist.

I work with individuals and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.