What Is a Nudge in Counseling?

The Ethics of Nudging

I attended a recent presentation by artificial intelligence (AI) ethicist John Sullins. During the Q&A, Sullins was asked where he stood on a question posed by Pew Research, asking participants if AI was exciting, terrifying, or a combination of both. In his response, Sullins remarked that one of the potential risks of our rapidly improving AI that concerned him was the possibility of nudging people without their awareness. He stated that the ability to do so was already here.

Sunstein and Thayer anticipate the “dark side” of nudges by proposing a nudging bill of rights. They argue that nudges should be transparent to the target, not hidden, as Sullins fears. Nudges should maintain human dignity by being in the interests of the people being nudged and consistent with their values. Sullins spoke of the need for “guardrails” for AI, which can also be true for nudges. Nudges should be consistent with constitutional law, and people should be able to reject them.

These guardrails sound like a good idea, but they are not in place nor even more than a blip in contemporary conversations. We would like to believe that people would not take advantage of the power of nudging, but it’s probably a good idea to work on those guardrails as soon as possible. Nudging has also been widely criticized as paternalistic—someone else is deciding what is in our best interests for us.

Nudging in Counseling

Can nudges be useful in counseling? While reading through the previous description, many counselors could likely see the advantages of the nudging strategy and think of examples where it might be particularly useful.

Most of us know that telling another person to engage in behavioral change is rarely effective. The person has to want to make that change for it to work. What if we could use nudges to help make that happen? Remember that our efforts along these lines must be transparent, and the client’s dignity must be top of mind. 

The importance of personal relevance of information cannot be overstated. I recall reading that interventions designed to discourage teen tobacco use usually fell flat. The interventions often focused on the 15 years or so of lost life expectancy associated with tobacco use. Unfortunately, dying at 65 instead of 80 has little personal relevance to many teens. When the message was changed to emphasize the negative effects of tobacco on personal attractiveness (yellowed teeth, bad breath, premature aging of skin), the teens sat up and took notice.

Changing default choices can help clients overcome inertia. Instead of asking a client to make a new appointment after each visit, appointments could be scheduled automatically unless the client opted out. Be creative about reducing physical and financial effort on the part of the client. Perhaps offering a telehealth session when a client is experiencing difficulty commuting to an office will be just what is needed. A financial equivalent to auto-shipping might be helpful. If you automatically enroll in a regular schedule of visits, with payment information saved, you get a discount.

In all likelihood, the most salient of the barriers addressed by nudges to counseling is the boost to self-regulation. So many problems presented to psychotherapists revolve around the need for more self-regulation, whether talking about substance use, anger management, or depressed mood. Although counselors have many items in their toolkits to address self-management, we can all learn new things. 

The idea of regular reminders, especially using technologies like cell phones, already forms the basis of apps that present Marcia Linehan’s dialectical behavior therapy directly to clients. Throughout the day, clients are asked about their current state of mind, and suggestions for coping are offered. In my personal quest to maintain a sizeable weight loss for the last 16 years, I know that stepping on the scale every morning without fail is the most important part of my strategy. The numbers allow me to adjust my eating patterns that day or not, and I usually opt for adjusting.

There is something compelling about publicly committing to a plan of action for our social species. One has to wonder if this isn’t one of the driving forces behind successful self-help groups, such as AA or Weight Watchers. It’s one thing to make a commitment to yourself in the form of a New Year’s resolution, but it’s entirely different to let others know that’s what you’re trying to accomplish. We don’t want to let them down. 

This aspect of human behavior can certainly be leveraged gently by counselors, who help clients make reasonable goals. Even if the goals are known only to the client and therapist, they’re still there.