The Mystery of Happiness

How to live a soulful and spiritual life

The Therapist Cannot Help But Err

But don’t let failure go to your head.

“The analysand can do no wrong because he can do no right,” R. Schafer said. It seems to be the reverse for therapists. They are highly loyal to their mistakes and not very motivated to report them.

After all these years of clinical work, there have been only a few occasions that I did not regret either having said something in a session, or not having said something and thereby missing an opportunity. As soon as a patient walks in, I feel a kind of anxious anticipation, not knowing what will present itself thereafter. This attitude of expectancy is natural, even good, as the clinician comes prepared for a mutual adventure, similar to chess master Savielly G. Tartakower’s remark on the game’s opening position: “Mistakes are all there to be made.” [The incorrectness of the bullfight is what makes it appealing.]

Common mistakes can occur across a very broad spectrum ― from devastating to the patient to embarrassing to the therapist. For example, the therapist can create a chaotic situation by not getting patients’ negative feelings out of their hiding places, by too early interpretation, by interpreting the meaning of what the patient says before addressing his or her resistance, or by interpreting the resistance before it is fully developed. Less chaotic, but more embarrassing, mistakes are related to not gathering all of the relevant information before offering recommendations. A recently divorced friend of mine told me that a consultant therapist had spent the entire first session on his immediate reasons for treatment. After an initial consultation that was largely devoted to descriptive details of the patient’s clinical symptoms of anxiety and depression, including periods of inactivity and boredom, the therapist recommended that he take up some hobbies ― “like playing a musical instrument.” The only problem with this otherwise reasonable advice was that my friend was already a professional pianist!

L. Friedman takes a quite original posture on the subject. For him, to talk about mistakes in psychotherapy itself is a mistake. To speak about “errors” in psychotherapy, he says, is misleading because due to contradictory duties that are required, the therapist cannot help but err. The therapist is even squarely in a false position. He has to balance perception with influence, objective dispassion with expressed concern, and he has to shuffle several roles in order to maintain a therapeutic posture while at the same time to be “real,” to be both a man of mystery and a seeker of truth.

Friedman feels that the clinician has only two choices: how much trouble to invite and from what direction. If he really cannot avoid mistakes, he should learn precisely what undesired consequences may be caused by his erroneous actions. M. F. Basch says that erring therapist need not worry. Whenever he went wide of the therapeutic mark, the patient indicated in some way that he had not registered the meaning of what was said ― that is, he disavowed the therapist’s comment or interpretation and went on to use the therapist in a way that made sense to him. It may be further consolation to therapists to hear Karl Jaspers say that learning results not merely from experiencing anew, but rather in the experience of error.

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

 

T. Byram Karasu, M.D., is Silverman Professor of Psychiatry at Albert Einstein. He is the author of many books including The Art of Serenity.

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