HOW TO TURN BAD THERAPY INTO GOOD THERAPY

Paula is off at the Couple’s Conference this week (see our earlier blog if you don’t know what that is) so I thought it was a good time for me (Nic) to confess.  Sometimes I  do bad therapy  – I make mistakes and do things that are not good for the client.   Yet I am frequently encouraging my clients to be tolerant of their own mistakes, to learn how to turn “crap into compost”.

So while I don’t like getting it wrong, over the years I have got more compassionate with myself about it.   I have realised that it’s OK to be human as a therapist. We all make mistakes. We:

  • Miss important cues
  • Follow the wrong lead
  • Misunderstand what clients say
  • Over-estimate a client’s reslience
  • Over-estimate a client’s fragility
  • Allow a client to dominate OR avoid
  • React out of our own issues (project)
  • Let our fear of being seen as a bad therapist run our responses etc etc

When I do these sorts of things, as well as taking them to supervision and trying to improve my practice, I try to focus on how to turn it into a useful experience for my clients. Situations such as this, can, in the long run, prove to be good therapy for them. Handled right, dealing with a mistake can model for clients that

  • ruptures in the relationship can be healed
  • people can take responsibility for their errors without justifying, minimising or blaming
  • it’s possible to make a mistake and still be credible, strong, useful
  • they can be angry and stay in relationship
  • their opinion, thoughts and feelings matter

In writing this blog I have tried to organise my thinking into some guidelines for dealing with mistakes. This is a first attempt at this so I would be interested to hear what you think about them and if you have other suggestions. Much of it is the sort of thing I try and teach clients about apologising and taking responsibility with in their intimate relationships

  1. Admit the mistake as soon as possible – in the session at the time if you can. If you aren’t aware of it till after the session (e.g. when writing your notes) then, if you think it’s serious, contact the client by phone or email to apologise. Otherwise acknowledge it at the beginning of the next session.
  2. If you aren’t aware of it until your client points it out – stay focused on the therapeutic relationship. At some point you will have to make a decision about whether the client’s concern is accurate (i.e. you made a mistake) or inaccurate (i.e. they are deflecting, projecting etc…), but that is secondary to listening to them and treating their experience as valid. Acknowledge (reflect) how they feel and what it means to them. This is not the same as agreeing you made a mistake. (Depending on the sophistication of the client and where we are up to in therapy I may make the direct comparision with the Inquirer role)
  3. If you don’t immediately agree it was a mistake, ask for time to reflect – put it on the agenda for the beginning of the next session (again – I may point out that they can also do this in their relationship when their partner raises a problem or complaint). Stress that this is because you consider it an important issue and don’t want to give an unconsidered response.
  4. At what ever point you realise you have made a mistake – apologise without qualifying or explaining. Thank them for taking the risk of pointing it out to you and/or being willing to hang in there with you
  5. Make it really clear that they have done the right thing, something that is helpful to you and them
  6. Encourage them to keep giving you feedback (you can use Scott Millar’s ORS and SRS – if you are not familiar with them you can read about them here https://www.psychotherapy.net/article/therapy-effectiveness )
  7. Check in with them in the next session how you are going in the area where you had problems – normalise talking about it

What do you do when you’ve made a mistake?? We’d love to hear

We are planning a one day workshop for later in the year on dealing with mistakes and challenges – watch this space!

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