Psychotherapist advice, suggestions, recommendations: A research review

Psychotherapists provide at least some advice, suggestions, and recommendations (ASR) in most treatment approaches. We define ASR, offer clinical examples, and review the research evidence for the immediate in-session, immediate delayed, and intermediate effects of ASR, as well as for the moderators of these effects in individual psychotherapy. In seven studies with 327 clients and 131 therapists, we found evidence of neutral immediate in-session outcomes (e.g., client experiencing levels), neutral immediate delayed outcomes (e.g., client-rated helpfulness during postsession videotape reviews), and positive intermediate outcomes (e.g., implementation of recommendations as rated in subsequent sessions) for ASR. These differences may be related to methodological variations in studies in addition to the different timing of the outcome measurement. In terms of moderators, there is some evidence that the working alliance, client collaboration prior to the ASR, content of the ASR, and therapist and client attachment styles moderate the effects of immediate in-session outcomes, and that type, difficulty, and therapist influence moderate the effects of intermediate outcomes of ASR. We conclude with research limitations, training implications, and therapeutic practices related to ASR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).