The Mystery of Happiness

How to live a soulful and spiritual life

by T. Byram Karasu, M.D.

Successful Failure

The healer is authentic and imperfect

Published on September 19, 2012 by T. Byram Karasu, M.D. in The Mystery of Happiness

The issue of mistakes seems of more concern to therapists than to patients. Therapists have to grow to recognize that the world of their profession is not based on eternal verities. They must learn that they are not always right, nor need to be, about their understanding of the patient’s world. As D.G. Edwards advises, one should not even aim to always be right. Having a predetermined fixed response or role ― imposing a strict standard or rigid rule for a presumably perfect therapeutic word or deed ― is neither possible, nor advisable. Thus in the matter of mistakes in psychotherapy, it is not even preferable to be too correct. A grain of wrong actually belongs to good taste, says Nietzsche.

The process of psychotherapy involves oscillations in small increments between “getting worse” and “getting better,” between failures and mini-successes. No treatment is ever a total failure, as it is joked; it can always be used as a bad example. More seriously, if every gesture were thoroughly rehearsed against making mistakes, it might give an impression of spontaneity, but it would not really be. Furthermore, it would be exhausting and ultimately ineffective.

Ironically, some of the negative repercussions of psychotherapy come from its effectiveness, insofar as collective reviews of research have typically shown greater variability of outcomes in treated than untreated groups. They have even shown that a proportion of treated patients get worse. H.H. Strupp and colleagues were more specific in their findings that personality characteristics of the clinician impacted upon therapy effectiveness. Qualities such as coldness, hostility, seduction, pessimism, and narcissism of the therapist contributed to negative outcomes, as well as having an inappropriate goal or goals for the patient, fostering overdependence, and breaching confidentiality.

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Specifics aside, in some fundamental sense the therapy has to fail in order for the patient to succeed. Here is how it goes: Patients first must become more vulnerable within treatment, if they are to become less vulnerable outside. For example, the patient must regress and repeat the traumas of his or her past in order to deal with adult desires and disappointments. Here psychotherapy can come closest to a delayed mourning process, as the yearning patient may grieve over earlier real or fantasied events, unmet wishes, and unresolved conflicts. He or she may relive the memories of those who failed him, for example, an absent or unavailable mother, an abusive father. At bottom, he may grieve the loss of his or her own former self.

So, too, the therapist must, in fact, first fail the patient ― as did others in his or her life. Only then can both patient and clinician simultaneously examine and understand that process of frustration and failure as it takes place in treatment. Psychotherapy thus necessitates, first, a process of failure on the part of both parties, which acts as a new version of an old scenario, and helps to understand the current one by experiencing it in vivo. [As A. Camus said, when you understand one thing through and through, you understand everything.]

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T. Byram Karasu, M.D. is the author of The Psychotherapist as Healer