From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

When We Fail: No, I Mean Really Blow It

How we react to our mistakes and change our responses

Failure. Screw-up. Blunder. Gaffe. Collapse. Flunk. Crash.

Those are just a few of the synonyms that came to my mind when I recently made an enormous mistake at work at the beginning of this week. My work is divided into two parts; clinical where I see patients and administrative which consists of reviewing charts for various reasons such as appropriateness for admission, following up on discharges, determining risk level and others. I also do the online reporting to the city agency that monitors substance abuse patients who meet certain criteria.

This last area is where I screwed up. The reporting has to be done on a schedule and I was sometimes late. There was also a certain section that I completely omitted from when I worked on the site.

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I learned about this on Monday when the director of the chemical dependency program came to my office with a letter from this city agency. She handed it to me to read. Phrases such as “significantly out of compliance” and “will no longer make new referrals to this site” jumped out at me.

“Oh my God,” I gasped. I didn’t know what to say. To say that I was sorry seemed inadequate. She and I went on the site and she opened up a few sections that I had never seen.

“Not to lay blame on anyone Susan,* but I was never trained on those sections. I’ve never seen these before.”

“Weren’t you curious about them?” she inquired sharply.

She showed me how to set up the first segment and following that, I did the rest so from now on I would know how to manage them. Then we continued our discussion.

“I have to take a lot of the blame for not getting the reports in on time and for sending out the requests late, but you also know that some of the therapists didn’t get back to me within a reasonable time frame. Look,” I waved a late report in her face. “I put this request in Isabelle’s* mailbox on 9/11 and she gave it back to me on 9/25.”

I was close to tears but for the sake of my professional image, I managed with great effort to hold  back.

“Gerri,” Susan looked at me intently. “It’s over. We all make mistakes.” We don’t get that many patients from them anyway. If it was ten a week, it would be one thing, but it’s not. And it’s only for three months. I don’t want use the word blame — that’s not useful. One of us should have caught it before it got to this point. Just do the good job with the reporting that you do with everything else from now on and we’ll be fine.”

As soon as Susan closed my door I put my head in my hands and burst into tears, wailing softly in my small office. I grabbed tissue after tissue, sobbing at my own incompetence. My mother never would have screwed up like this. I’m going to end up like my father flashed through my mind.

I lapsed into a funk. My bad mood affected my sleeping, my eating and my migraines intensified. My psychiatrist Dr. Adena* was in Europe for the Jewish holidays so she was unreachable. I did something that was new for me. I reached out to friends and family and they all gave me helpful and supportive feedback.

“You’re allowed to make a mistake.”

“How else do you learn?”

“Knowing you, you won’t let it happen again.”

I went back to my office and set up an elaborate checks and balances system on my calendar for the remainder of the year. When to send out the weekly report, the monthly report, and the quarterly report on each patient to their therapist. Room on the calendar to record when I get the report back. Reminder memos. Update memos. When to enter the report onto the site.  All marked in different colored highlighters.  It looked like a drawing a three year-old would have done.  But it made perfect sense to me.

I had to admit that my friends were right. It’s just that after recently taking a week off for my relapse of the anorexia, I had been feeling as if my perfectionist antennae had to be extra-tuned. But over the rest of the week, once I got myself organized and at least semi-confident that I could handle the job from now on, I began to feel a little better.

              ~                                              ~                                           ~

My patients complain that they too err in various aspects of their lives. Both men and women have lost significant amounts of weight and gained it back and more. Some admit that they have taken on responsibilities like school or a job, and not shown up for their classes and flunked out, or been late for work enough times and have been let go.

Some realize they have difficulty controlling their temper and been fired from a job for that reason or asked to leave a public place and not return. Some have committed crimes either in the past or in the present; the majority have been arrested and served time, but a few have not yet been caught and are plagued by thoughts that at any time the law might catch up with them.

I have and will continue to convey comments to my patients along the same lines that my friends and supporters delivered to me. These remarks are common because they have proved to be true over the years.

“We learn from our mistakes and hopefully don’t repeat them.”

“We make our mistakes and move on from there.”

“You’re allowed to make a mistake every now and then. Nobody’s perfect.”

I try to get a sense of how they feel about their error and what I have said to them. Maybe they don’t feel they have made a mistake and don’t care for my platitudes.

Following that, this being a therapeutic relationship, I take it to the next level and try to explore with my patients what prompted them to err, if it was a lapse in judgment or self-sabotage or a hidden fear of success. We may return to their childhood and their relationship with their parents; how their parents treated them, what their parents expected of them. Their relationship with their siblings is also relevant — did they get along or did they fight? Obviously, this exploration can go in many different directions and can go on indefinitely. I prefer to make it a topic to put on the treatment plan — with the patient’s permission — so we can check on its progress at intervals along the way. And this prevents the issue from disappearing or floating out of consciousness, because surely it will continue to be an important concept in the patient's life.

I am going to make this topic the priority for my first session when Dr. Adena returns from vacation. I believe that for myself the issue is not so much that I made an error, but how harshly I treated myself and that I allowed it to affect other aspects of my life — especially my eating, so soon after my relapse. Knowing I have a tendency toward perfectionism just exacerbates the negative effects of a major error. And due to the tremendous success of my mother and the extreme breakdown of my father’s life — this live black and white snapshot exaggerates my belief that grey doesn't exist.

Things at work will settle down. I’ll settle down.

And eventually one of the things that I’ll learn is that black and white makes grey.

 

* Names have been changed

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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