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The 10 Most Frequent Mistakes Therapists Make

Failures of empathy cause many therapeutic errors.

The relationship between a therapist and a client is like no other relationship. In the best possible scenario, an individual seeks help from a credentialed therapist with the hope that s/he can lead a less tormented/stressful/sad existence, and the therapist enters this journey mindfully and with similar hope and lots of positive energy and intention.

When the therapeutic journey begins, the client begins to spill secrets, describe ineffective life patterns, and expresses all kinds of emotions. The hope is that the therapist will be present in the moment, attuned to the client's needs, moods, and readiness level and conduct the therapy sessions in a graceful and responsive manner.

When we enter the journey with a client, we should be honored that the individual has allowed us into their lives. Hence, the therapeutic journey begins.

Over time, I have had the privilege of working with hundreds of individuals at various ages and stages of their lives. I have listened to stories of what went right and wrong in previous therapeutic relationships to reduce the possibility that I will reproduce the same errors.

Then, I proceed carefully and remain aware of what is resonating with the person facing me and what is not. And yes, sometimes I make therapeutic errors and try to recover and repair the moment as skillfully as possible.

The client needs to be aware of the moments that go wrong in therapy. These therapeutic errors, or empathic failures, fall into a number of categories. I would like therapists and clients alike to be aware of these moments and to talk about them in the moment or after some recognition that an asynchronous moment has taken place.

Of course, sometimes a therapist is a client and a client is a therapist. Therapists, of course, should seek therapy for their own issues for their own well-being so they are less likely to bring their own baggage into the consultation room. (Therapists, too, struggle with the human condition and are not flawless.)

Therapeutic errors, or failures of empathy, fall into a number of categories but I will start the conversation with the following:

  1. Forgetting the important players in the client's life. It is crucial for therapists to take careful notes following sessions which include recording the names of significant others in the client's life story. Confusing the name of the client's ex-husband and current partner in the midst of the therapeutic journey is not acceptable. The therapist should be immersed in the story.
  2. Not being attuned to the client's feelings and mislabeling them. Suggesting, for example, that the client is angry when they are sad is an empathic failure. It is crucial to listen very carefully prior to labeling a feeling. The therapist's role is to join the client and utilize the client's input to then label the feeling. A rush to label is a problem. Time, patience and being in the moment must be part of a good therapist's repertoire.
  3. Checking out. I have heard this one frequently and am very saddened by it. I have heard several clients describe therapists who appeared to be checked out and have even fallen asleep during a session. Yikes. Imagine describing your life and then facing a therapist lost in a dream of his/her own. Or sometimes a client will pause and the therapist responds awkwardly, clearly having tuned out. Therapists must and should get enough rest and only see the number of clients that they can be present for. These hopeful individuals who enter our consultation rooms have certainly already had a number of checked out individuals in their lives. A good therapist is tuned in.
  4. Projecting their own issues onto their client's lives. "You must have mother issues," says the therapist who has clearly faced such issues of his/her own. Or, the therapist may identify motivations and intentions based on his/her life experiences rather than on those of the misunderstood client.
  5. Talking about themselves too much. The complaint and frustration that therapists talk too much about themselves is way too frequent. The session is not about the therapist. Yes, sometimes it is appropriate to share a bit of information to be supportive of your client but these moments must be the exception rather than the rule.
  6. Answering the phone during the session. This is also not infrequent. The time allotted to the session belongs to the client, not to a new person who wants to schedule or even to a personal friend who wants to check on a time to meet after work.
  7. Assuming the wrong tone. What I hear about most is clients' feeling that their therapists become irritable and even a bit snarky. This is not okay. The goal of therapy is for the client to have a new and corrective experience in the consultation room. I am quite sure that they have already experienced lots of negativity in their lives. If they haven't it is unlikely that they would have entered into the therapeutic relationship.
  8. Asking the client "How does that make you feel?" way too often. After a while, this question loses its power. It starts off as a powerful question, but should not be repetitive. Therapy should be an interesting and creative process. Repetition leads to boredom, right?
  9. Getting offended when asked for their credentials. Clients have the right to know about the credentials of their therapists. Yet, many therapists get irked by this question and assume that they are being doubted. We all need to calm down here and let the client know who they may be and are working with. It is their right.
  10. Misdiagnosis. Of course, therapists sometimes miss the extent of the client's suffering because of a misleading self-report or presentation. We must assess the client's level of depression and safety frequently and carefully. This is our ultimate responsibility as licensed mental health professionals.

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