I recently read a book on spiritual direction (by Kenneth Leech) called Soul Friend. I do recommend it highly. He is man of great breadth and wisdom. And though the first 30 pages or so were hard to engage with for me, in the end I found his ideas gracious and expansive.
Perhaps the most helpful issue that he clarified for me was both the connection between and the difference between the sacramental and the therapeutic. He is well read and knowledgeable about the role of a spiritual director in accompanying someone on their spiritual path, reflecting them back to themselves in unconditional regard, and how this can be of immense benefit to both of the participants in this most honest and authentic of conversations.
But the distinction he made between this very therapeutic element of the sacred conversation and the sacramental role of a priest was fascinating for me. In essence, if I understood him well, he was saying that there comes a point when a threshold must be crossed, and this becomes a sacramental moment, a moment where someone must assume a priestly role and be some kind of gatekeeper, some kind of guide across a threshold, perhaps a spiritual midwife. In his experience as a Christian minister, this might be a moment where a deep confession might emerge, where the 'client' might need to undergo a moment of forgiveness, accountability and catharsis, and depending on the circumstances, be assured of the truth and holiness of the new moment they are moving into.
At such a point some simple ritual might be absolutely the right and the only thing to do, and at this point the sacramental nature of the conversation becomes clearer. One leads, guides, holds and acts with authority, becomes a priest; the other is held, follows, submits. It is perhaps only for a moment, and the collegiate relationship continues beyond it. There will almost certainly be therapeutic results, and these may be quickly apparent or may take a little time to emerge. But the sacramental moment should not be avoided out of a sense of fear that telling another soul what to do next is by definition a misuse of authority. Of course, any authority can be misused, but unuse can also be misuse. Midwives tell mothers when to push and when not, and spiritual midwives should not be scared of either.