Telling people what they need to hear: Are psychotherapists being "nice"?

Welcome to the August 2025 edition of the Your Listener Counselling newsletter! This month, we are exploring the nature of psychotherapists' empathy toward their clients, and the ethics of telling clients what they need to hear when they may not want to hear it. To begin, let us explore the importance of empathy.

"Empathy" means understanding another person's experience in concept. It is practiced by attending to all forms of communication they use (including their words, voice, non-verbal cues, and possible implied meanings), and demonstrated to them with a variety of approaches. These range from simple empathic reflections whereby we repeat the literal meaning with similar words, to more complex understandings whereby we connect multiple ideas which the person has communicated at different times and suggest (albeit tentatively and objectively) what these ideas may mean. This type of communication is referred to by a number of terms, including "empathic listening" and "active listening". In quality psychotherapy, the therapist does this while practicing "unconditional positive regard". Made prominent by the pioneering Dr. Carl Rogers, it means treating the client with respect and care regardless of how the therapist may feel about them.

While compassion and respect are essential in psychotherapy, empathy does not simply mean being pleasant to the client for its own sake. Rather, it helps facilitate the mentality for problem-solving. When the client receives empathy, a neurological phenomenon occurs whereby they are better able to regulate intense emotions (which may arise when discussing uncomfortable issues), perceive all the aspects of a situation (whereas in a negative emotional state, they are more likely to perceive only the negative aspects), and think in more flexible, complex ways. Likewise, when the therapist actively listens, they detect more of the client's communications. Furthermore, a person seeking therapy may have experienced judgement or negative treatment already; perhaps they have been a victim, or been admonished for victimising others via their behaviour. The therapist must make reasonable efforts to alleviate the mental strain of this as the client is less likely to engage if they feel judged. If, for example, a criminal is receiving psychotherapy following conviction, the therapist's empathy does not mean approving of their behaviours, nor having positive feelings about the interaction or the client themselves. Having these opinions is not the therapist's job. Rather, the empathic psychological environment is more likely to facilitate the goal of helping the client to change for the better. If the resulting change reduces the likelihood of the client re-offending, then regardless of what anyone believes the client deserves, the therapist has ultimately prevented further harm to the client and others.

Simultaneously, another necessity is for the therapist to be able to tell the client what they need to hear when they may not want to hear it. This is a complex matter. Without shaming people, it is often the case that we contribute to our problems in ways of which we are not aware. This is due to the complexity of our minds and how our experiences affect us, combined with the fact that we are not often taught to understand this and practice introspection — largely a societal failing. However, if the therapist improperly delivers these explanations, it is easy for the client to interpret them as victim-blaming. A salient explanatory example involves victims of traumatic abuse, with whom I often work (as well as having survived trauma myself). A common experience is for them to unknowingly perpetuate the symptoms that ail them by repeating the mental and behavioural habits that they developed from their abusive experiences. However, especially since they are often blamed by either their abusers or others for the abuse, they may be understandably hyper-sensitised to criticism and may interpret such guidance as blame for what happened to them. Furthermore, I and countless others have either experienced or heard tales of "tough love": being abused physically or emotionally and being told that this is "for their own good, because the world is not easy and this will prepare them for it". Some even eventually praise their abuser, thanking them for "raising them with the right values". It is no wonder, then, that plenty of well-intentioned people, including therapists, struggle to explain to others that they must take responsibility for the change process. What good person wants to become another abuser? How do we discern between abuse and telling people what they need to hear?

A competent therapist acknowledges that they are human and that even the best of us can make mistakes with devastating consequences without any malice. Hence, they proactively self-reflect on their rationale for educating and guiding as they do, to ensure that they are acting objectively in their clients' best interests. Teaching clients how to take personal responsibility is not inevitably blaming them. In objective reality, we can not change the past, force another person to compensate us (except in legal cases, however this is another matter), make life easy, or otherwise control others' actions. But we can choose many of our own actions, and while life will never be perfect, the best life available to us becomes possible only when we consciously make appropriate choices. A client may have valid reasons to complain, but complaining will only self-perpetuate and not solve a problem. Whether it is comfortable or not, therapists are obliged to help their clients realise what will result in the best possible outcome for them. It takes some time to build their trust and introduce these ideas. And, of course, none of these facts should be an excuse for us to not collectively take responsibility for making the world a less harmful place.

This raises another question: whether or not therapists should give advice as opposed to helping an individual to form their own advice. It is arguable that the acceptance of the latter approach derives from the idea of the "client-as-expert", a common ethos in psychotherapy. It is easy to misinterpret this idea as meaning that the client already has all the information they need to change, and simply needs a "compassionate ear" to hear it all and give perspective. The reality, however, is that it is necessary for a client to learn about how their mind works in order to have the best possible chance of the outcome they desire, and usually they do not have this information — which again, is not their fault, but the fault of our society not prioritising teaching it. Tellingly, I have witnessed complaints about therapists who are too passive and do not actively assist their clients to develop new behaviours, and I suspect that they were taking the client-as-expert philosophy too literally. The actual utility of it is that while we must provide a client with all the relevant information that they should use to make a decision, we must then allow the client to decide on their goals and make the final decisions, to respect their autonomy.

As an example, a known phenomenon is for victims of relational trauma to remain in abusive relationships because they have some sense of comfort or regularity (this is due to a complex system of beliefs developed from their experiences). Notwithstanding any duty to report abuse which the therapist may have, it would be unethical for them to insist that the client end such a relationship, as such actions have been known to have worse consequences for the victim, who in a vulnerable state may be more suggestible to advice without evaluating the risks and benefits. However, we can establish certain truths: the abuse is not the victim's fault, they do not owe their abuser an explanation, and the abuse is unlikely to stop on its own and may well escalate. Hence, we could educate them on what may motivate any victim to stay in such a relationship, the unlikelihood of an abuser suddenly changing, the risks and benefits of the decisions they could make, and other services which could support them. From this, they could extrapolate the realisation that they need to act, but they have undergone the decision-making process for themselves. Simultaneously, there are ambiguous situations in which the emphasis on a particular decision would not necessarily be objectively in the client's best interests. As a client, I once expressed concern to my therapist about deciding whether to leave a friendship characterised by what I suspected was an imbalance of psychological power against me. They were quick to emphasise that I should simply keep quiet and stay because they believed I was in need of the benefits of that friendship. Needless to say, that was not the only questionable deed by that therapist, and I eventually discontinued therapy with them. As I always conclude: competence in life is born of sound nuanced judgement rather than being beholden to rigid rules.

Among life's injustices, compassion is a virtue. When we suffer, it is all too easy to seek comfort in surrendering because the pain of persisting with life often brings with it greater mental anguish. It is not easy for a compassionate person to suggest to someone in the depths of suffering to persist despite the pain, but often it is the only option readily available and likely to help. Compassionate delivery of this type of assistance is the difference between helping and harming a client in psychotherapy. It will never be easy, but we should not be choosing this profession for its ease.

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Thought of the month

Ideologies are often a form of moral licensing. They provide self‑assurance that we are righteous without having to reflect on the actual consequences of our behaviours. Consider the person who sponsors starving children in poor countries and votes for political candidates with policies that "protect the children", only to drive too quickly while using their mobile telephone near schools.