“People do not grow in sterile containers with perfect analysts; they grow in messy human relationships with analysts who try their best to do right by their patients but whose best must frequently consist of reparative efforts vis-á-vis the difficulties they have created.”
Therapists make mistakes. I make mistakes. How do we recover from the mistakes that we make? We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for more than 40 years and I still make mistakes — different ones, but mistakes nonetheless.
We must start with accepting the patient’s feelings of hurt or anger or other feelings affected by our error. Which means at least initially not trying to get the patient to understand or accept an explanation of our good intentions— we have to avoid yielding to the very human effort to defend and explain. When we do that — try to explain — it is really for the therapist, an attempt to soothe ourselves and to see ourself again in a positive light.
Initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully.
Sometimes the therapist’s mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.
A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists — one who fell asleep in a session with him and another he found unsympathetic. So I knew I started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now I knew I had left no indicator of who I was or why I was calling, but it didn’t matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. And these days with the ubiquity of mobile phones, the chances that a message I might leave will be heard by someone other than the intended recipient is pretty small.
Sometimes with the best intentions, like Humpty Dumpty, all the king’s horses and all the king’s men cannot put the therapy back again.
It is hard to let go but what I want for a patient may not be what is best for her in her eyes — and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way — and sometimes patients do come back– but at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most.