The Power of Being Direct
On the Blog
Lessons From a Heart Surgeon
Last week, my dad underwent a heart procedure for blocked arteries, and the experience left me reflecting deeply—not just about his health but about how we, as therapists, interact with our clients. The surgeon who treated my dad was young, skilled, and incredibly direct. He didn’t sugarcoat the seriousness of my dad’s condition. He told him, without hesitation, that if he didn’t make significant lifestyle changes, the risks to his life were very real. But what struck me most wasn’t just his bluntness—it was the care behind his words.
At the end of the consultation, the surgeon leaned in, put his hand on my dad’s shoulder, and said, “I care for my patients as if they are family, and I want the best for you and your family. You deserve it.” In that moment, I could feel his honesty, integrity, humility, and generosity. His words weren’t just technical advice; they were delivered with genuine concern for my dad’s future. As I thought about the years of medical school, residency, and fellowship he must have endured to get to this point, I was moved by the sense of pride he had—not just in saving lives, but in making a real difference.
On my drive to work that day, I couldn’t help but wonder: Why is it that mental health professionals sometimes struggle with this kind of directness? What is it about our work that makes us hesitate, soften, or avoid tough conversations with our clients, even when they are necessary for growth? I realized that this surgeon's directness wasn’t just about his medical expertise—it was about his deep care for my dad’s well-being. And I think that’s what we, as therapists, can learn from.
What Gets in the Way of Being Direct as Therapists?
There are many reasons why therapists might struggle with being direct, and it’s worth exploring some of the common barriers:
The Rescuer Mentality:
Many of us, myself included, enter this field because we want to help others. Sometimes, this can turn into wanting to rescue our clients from their pain. Instead of empowering them to do the hard work, we might unconsciously soften our feedback to avoid discomfort, unintentionally enabling behaviors that keep them stuck.Family Dynamics and Old Patterns:
Therapists often come from families where they were the problem solvers or caretakers. This can lead to a tendency to take on responsibility for the client’s progress, doing the emotional heavy lifting instead of encouraging clients to take ownership of their journey.Societal Shame Around Mental Health:
Mental health still carries a lot of stigma and shame. Many of us, both therapists and clients, have internalized messages about what it means to struggle with mental health. We might avoid being direct because we fear reinforcing that shame, or because we ourselves carry embarrassment about our own emotional struggles.Fear of Losing the Therapeutic Relationship:
Being direct with clients can feel risky. What if they react poorly? What if they decide to leave therapy? This fear of rupture can sometimes prevent us from offering the candid feedback that’s necessary for true growth.
How Can We Do Better?
I keep coming back to the image of that young surgeon, and the balance he struck between directness and care. He didn’t just deliver hard truths; he did it with a genuine belief in my dad’s ability to make the necessary changes. And that’s what we need more of in therapy—direct feedback that is grounded in compassion, trust, and belief in our clients’ capacity for growth.
So, how can we, as therapists, lean into the work in more effective ways?
Embrace Discomfort:
Growth doesn’t happen in comfort zones, for us or for our clients. We need to be willing to sit with discomfort—both our own and our clients’. Being direct isn’t about being harsh; it’s about being honest in a way that invites the client to step up and take responsibility for their own healing.Normalize Vulnerability:
As a society, we need to shift the narrative around mental health. Receiving feedback—whether in therapy or in life—isn’t a sign of weakness, but an opportunity for growth. We can help our clients (and ourselves) by modeling vulnerability and showing that it’s okay to receive, process, and act on difficult feedback.Encourage Client Ownership:
Therapy is not something we do to our clients—it’s a collaborative process. We need to empower clients to own their therapeutic journey, to ask for what they need, and to be active participants in their healing. Sometimes that means being lovingly direct and saying, “This is what I’m seeing, and I believe you’re capable of more.”
How Can Clients Demand More?
Clients, too, have a role in this dynamic. They can—and should—demand more from therapy. Therapy isn’t just about showing up; it’s about doing the work. We can encourage clients to:
Be open to receiving honest feedback.
Reflect on their own role in the therapeutic process.
Lean into vulnerability and recognize that growth often comes from challenging moments.
The Bigger Picture
At the end of the day, whether we’re surgeons or therapists, we’re all in the business of changing lives. But change doesn’t happen without honesty. As mental health professionals, we need to trust that our clients can handle the truth, and we need to deliver it in ways that honor their humanity and potential.
Let’s be direct, but let’s also be compassionate. Let’s offer feedback that challenges and empowers. And let’s remind ourselves, just like that young surgeon did, that we do this work because we care—deeply and genuinely—about the people we serve.
We’re here to change lives. So let’s do it in ways that really work.
With love,
Hasti Raveau, PhD, LP
Founder & Director
