<p>One therapeutic issue with being <strong>confrontational</strong> – a problem that does not arise unless one is <strong>direct in a bad way</strong> – is <a href="http://en.wikipedia.org/wiki/Reactance_%28psychology%29" rel="nofollow noreferrer"><strong>reactance</strong></a>. I've described this issue in a separate answer to a question you commented on five days ago, "<a href="https://cogsci.stackexchange.com/q/5796/4086">How to change someone&#39;s beliefs?</a>" Telling someone who doesn't believe he or she has a problem that s/he does have a problem implies that s/he should change. If the person is inclined to deny the premise of this implied suggestion, the person may also resent the suggestion itself. Thus resistance and defensiveness may arise in reaction to the suggestion that s/he is not free to simply continue behaving "normally" without further consequence.</p>

<p>Another potential problem with <strong>directness in a bad way</strong>  may arise by carelessly assigning diagnoses. Diagnosis of psychopathology is a very difficult process; despite my PhD, I am not qualified to perform it. Even those who are qualified (officially, at least) do not perform it with satisfactory accuracy by my (high) standards. Part of the problem is directness <strong>in the context of careless inattention or inexperience</strong> (see also <a href="http://en.wikipedia.org/wiki/Schema_%28psychology%29#Modification" rel="nofollow noreferrer">schema modification</a>). I.e., directness is not the real problem here, but it provides a channel for these problems to cause other problems via communication of <strong>misinformation</strong>, especially in the context of professional authority. Non- psychologists tend to <a href="http://en.wikipedia.org/wiki/Social_influence#Obedience" rel="nofollow noreferrer">defer to the authority</a> of psychologists even on topics beyond the expertise of both parties. This makes restraint on the part of the more authoritative party very important. Failure to withhold first impressions and unexamined opinions about possible diagnoses can result in psychologically harmful <strong><a href="http://en.wikipedia.org/wiki/Labeling_theory" rel="nofollow noreferrer">labeling</a></strong>. This can impose anxiety-exacerbating pathological characteristics on the identity of the person so labeled, especially if s/he does not possess the wherewithal to question these labels or is predisposed toward anxiety or self-loathing, as often apply to psychotherapy patients.</p>

<p>In the opposite contexts of psychotherapy that is not pejorative or otherwise invalidating (e.g., <a href="http://en.wikipedia.org/wiki/Rogerian_psychotherapy" rel="nofollow noreferrer">Rogerian</a> and other <a href="http://en.wikipedia.org/wiki/Humanistic_psychology" rel="nofollow noreferrer">humanistic</a> modalities) practiced by therapists with appropriate restraint and excellent breadth of experience, directness is probably desirable and helpful. Methods such as <a href="http://en.wikipedia.org/wiki/Motivational_interviewing" rel="nofollow noreferrer">motivational interviewing</a> benefit from their direct focus on clients' own ambivalence toward positive changes, which is often the root problem, especially with <a href="http://en.wikipedia.org/wiki/Egosyntonic_and_egodystonic" rel="nofollow noreferrer">ego-syntonic</a> disorders. Conversely, ego-dystonic disorders may benefit from treatment via methods such as <a href="http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy" rel="nofollow noreferrer">cognitive behavioral therapy</a> that directly address problematic, derogatory aspects of clients' identities, such as the inflexible conviction: "Something is wrong with me." Thus directness itself is not the problem, but more a moderator of the consequentiality of a therapist's choice of approach to the problem a client presents. If the approach chosen is bad, harm may be reduced by self-restraint. If the approach is good, benefit may be enhanced by directness.</p>

CC BY-SA 3.0
2014-02-27T20:13:54.987Z
2014-02-27T20:30:05.443Z
2017-04-13T12:56:16.417Z
Nick Stauner
<p>While it is possible to  tell someone that they are affected by OCD or they are narcissistic, I think that trying to help people simply by giving them direct advice doesn't work. I also think that citing authoritative sources, which show that they are positive to some disorder diagnostic test, usually doesn't work.</p>

<p>Dale Carnegie explains that people don't take into consideration what is right or the truth, but what doesn't hurt their self-esteem.</p>

<ul>
<li>Can you explain me better why psychotherapy is not directly telling patients what their diagnosis is? </li>
<li>Why is it more effective to avoid being direct in trying to correct people's personality traits?</li>
<li>Is this phenomenon bound to <a href="http://en.wikipedia.org/wiki/Confirmation_bias" rel="nofollow">confirmation bias</a>?</li>
</ul>

CC BY-SA 3.0
2014-02-27T19:44:00.943Z
FWIW, I disagree with the first two sentences, and am skeptical of your third sentence and the premise of your first question. I.e., I would not presume to know what would happen, especially without other information about the person; giving direct advice seems a good way to give advice, the quality of which seems a more important factor; I could see the third being true because you've at least stated this probabilistically, but would bet against it without evidence to support it; and I doubt that those qualified to assign diagnoses do not share them with their patients. Evidence would help!
Nick Stauner
CC BY-SA 3.0
2014-02-28T01:35:48.103Z
changed the wording a little bit to make clear that the views are the OP's opinions.
Jeromy Anglim
<clinical-psychology>
Why isn't psychotherapy more direct with patients?
Revious
# Why isn't psychotherapy more direct with patients?

(Asked by: username_0 on 2014-02-27)

While it is possible to tell someone that they are affected by OCD or they are narcissistic, I think that trying to help people simply by giving them direct advice doesn't work. I also think that citing authoritative sources, which show that they are positive to some disorder diagnostic test, usually doesn't work.

Dale Carnegie explains that people don't take into consideration what is right or the truth, but what doesn't hurt their self-esteem.

* Can you explain me better why psychotherapy is not directly telling patients what their diagnosis is?
* Why is it more effective to avoid being direct in trying to correct people's personality traits?
* Is this phenomenon bound to [confirmation bias](http://en.wikipedia.org/wiki/Confirmation_bias)?

**Tags:** clinical-psychology

> **Comments:**
> **username_1**: FWIW, I disagree with the first two sentences, and am skeptical of your third sentence and the premise of your first question. I.e., I would not presume to know what would happen, especially without other information about the person; giving direct advice seems a good way to give advice, the quality of which seems a more important factor; I could see the third being true because you've at least stated this probabilistically, but would bet against it without evidence to support it; and I doubt that those qualified to assign diagnoses do not share them with their patients. Evidence would help!  
> **username_2**: changed the wording a little bit to make clear that the views are the OP's opinions.  

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## 1 answers

### Answer by username_1 on 2014-02-27. Score: 6 | Accepted answer

One therapeutic issue with being **confrontational** – a problem that does not arise unless one is **direct in a bad way** – is [**reactance**](http://en.wikipedia.org/wiki/Reactance_%28psychology%29). I've described this issue in a separate answer to a question you commented on five days ago, "[How to change someone's beliefs?](https://cogsci.stackexchange.com/q/5796/4086)" Telling someone who doesn't believe he or she has a problem that s/he does have a problem implies that s/he should change. If the person is inclined to deny the premise of this implied suggestion, the person may also resent the suggestion itself. Thus resistance and defensiveness may arise in reaction to the suggestion that s/he is not free to simply continue behaving "normally" without further consequence.

Another potential problem with **directness in a bad way** may arise by carelessly assigning diagnoses. Diagnosis of psychopathology is a very difficult process; despite my PhD, I am not qualified to perform it. Even those who are qualified (officially, at least) do not perform it with satisfactory accuracy by my (high) standards. Part of the problem is directness **in the context of careless inattention or inexperience** (see also [schema modification](http://en.wikipedia.org/wiki/Schema_%28psychology%29#Modification)). I.e., directness is not the real problem here, but it provides a channel for these problems to cause other problems via communication of **misinformation**, especially in the context of professional authority. Non- psychologists tend to [defer to the authority](http://en.wikipedia.org/wiki/Social_influence#Obedience) of psychologists even on topics beyond the expertise of both parties. This makes restraint on the part of the more authoritative party very important. Failure to withhold first impressions and unexamined opinions about possible diagnoses can result in psychologically harmful **[labeling](http://en.wikipedia.org/wiki/Labeling_theory)**. This can impose anxiety-exacerbating pathological characteristics on the identity of the person so labeled, especially if s/he does not possess the wherewithal to question these labels or is predisposed toward anxiety or self-loathing, as often apply to psychotherapy patients.

In the opposite contexts of psychotherapy that is not pejorative or otherwise invalidating (e.g., [Rogerian](http://en.wikipedia.org/wiki/Rogerian_psychotherapy) and other [humanistic](http://en.wikipedia.org/wiki/Humanistic_psychology) modalities) practiced by therapists with appropriate restraint and excellent breadth of experience, directness is probably desirable and helpful. Methods such as [motivational interviewing](http://en.wikipedia.org/wiki/Motivational_interviewing) benefit from their direct focus on clients' own ambivalence toward positive changes, which is often the root problem, especially with [ego-syntonic](http://en.wikipedia.org/wiki/Egosyntonic_and_egodystonic) disorders. Conversely, ego-dystonic disorders may benefit from treatment via methods such as [cognitive behavioral therapy](http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy) that directly address problematic, derogatory aspects of clients' identities, such as the inflexible conviction: "Something is wrong with me." Thus directness itself is not the problem, but more a moderator of the consequentiality of a therapist's choice of approach to the problem a client presents. If the approach chosen is bad, harm may be reduced by self-restraint. If the approach is good, benefit may be enhanced by directness.


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