Just Tell Me What to Do
A 58-year-old delivery driver with COPD, 35 pack-years, two exacerbations in the past 12 months, was referred by his pulmonologist. In session three he leans forward and says, "I know you're not supposed to tell me what to do, but I'm paying for this. Just tell me to quit and I'll do it." He has used nicotine patches twice, and once quit for 11 days. He describes his wife as nagging and says he "shuts down" when she brings it up. Most of his smoking happens in the cab with his brother-in-law after a 10-hour route. He adds, "And don't make me talk about my feelings - just give me the plan."
1. You have about thirty seconds to respond. What do you actually say, and what is your reasoning for not simply granting his request?
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What I say (roughly): "You're right that I'm not going to hand you orders - but I don't think that's really what you're asking me for. Sounds like you're tired of being told and tired of it not sticking. What would it mean if I did just tell you to quit?"
Reasoning:
- Granting the request is the righting reflex in a costume. He is inviting me to take ownership of his behavior. If I do, the next lapse becomes a failure of my instruction, and he is off the hook.
- The request is diagnostic information, not an obstacle. It tells me (a) he expects experts to be directive, (b) he has low confidence in his own agency after two failed patch attempts, and (c) he is testing whether I will behave like everyone else in his life.
- Naming it without interpreting him. "Tired of being told and tired of it not sticking" offers a reflection he can confirm or correct. It keeps me curious rather than clever.
- Preserve autonomy explicitly. Saying I won't give orders, then immediately asking a question that steers him, is the same trap. The question has to be genuinely open, and I have to be willing to hear "nothing."
2. Use the material he has given you to move the work forward. What do you explore, and in what order?
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Order matters - go where there is energy and specificity.
- The 11 days. It is the only success in the story and he will not have framed it as one. "Eleven days is not nothing. What was different about those eleven days?" This surfaces functional information about what already works - the scaffolding for the plan he says he wants.
- The cab. It is the single highest-yield detail: a predictable, repeated context with a social component. "Walk me through the last twenty minutes of a route." Concrete behavioral description beats abstraction; it also surfaces a lever (the brother-in-law) that he may want to use or may refuse.
- The wife. Reframe "nagging" as a person who is frightened, and ask what he wishes she would do instead. This is a relationship question he can tolerate better than a feelings question.
- Importance and confidence, kept separate. "How important is quitting, 0–10? How confident are you that you could go a week without the cab cigarette, 0–10?" High importance with low confidence is a very different conversation than low importance, and the second number tells me whether to build a plan or keep exploring.
- Ask permission before anything resembling a plan. "You said you want a plan. Can I ask what you'd want in it?"
Throughout: reflect and summarize more than I question. He shuts down under pressure, so a short summary - "so it's not that you don't care, it's that being told makes you want to stop listening" - is doing more work than three more questions.
3. Two sessions later he says, "I'm not doing the feelings thing. Just the plan." How do you honor that request while still doing relational work?
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Honor it literally, not grudgingly. A client's stated limits on emotional disclosure are a boundary to respect, not resistance to be worn down. I can do substantive work inside his constraint.
- Shift the register to behavioral and structural. Triggers, timing, contexts, scripts, what he will say to his brother-in-law, what he wants his wife to stop doing. This is legitimate coaching content, not a consolation prize.
- Keep affect in the room without demanding it. Brief reflections that name what I notice, offered lightly: "That's the second time the cab has come up." He can pick it up or leave it. I am not requiring him to elaborate.
- Use third-person and hypothetical frames. "What do guys on your route do about that?" and "If your brother-in-law quit, what would change?" carry emotional content with less exposure.
- Watch for the threshold I must cross anyway. If he discloses worsening dyspnea, hopelessness, or heavy drinking, I have to address it directly regardless of his preference - safety obligations outrank pacing preferences, and I would say so plainly rather than sneak up on it.
- Name the arrangement once, briefly, so it is a collaboration rather than a workaround: "I'll stick to the plan side. If something comes up that I think matters, I'll tell you and you can decide whether to go there."
Judgment point: refusing to talk about feelings is not the same as being unable to. Treating it as a fixed trait is a common coaching error; treating it as a preference to be respected while periodically renegotiated is the accurate read.