The session ends, the client leaves and you feel sick to your stomach. You messed up. Your goal was to help but now look. You tell yourself that you’re a lousy therapist. You replay the mistake in your mind over and over. You wonder how the client is doing. Are they okay? You feel awful and ashamed.
Every therapist has been through this experience. But what can we do about it?
In this article, we will look at
- The hidden positives
- The Mae West Principle
- Making it better
By the end of this post, you will know your next steps for you and your client. You will see this as an opportunity rather than a calamity.
The hidden positives
The first thing to acknowledge is that all therapists make errors from time to time. Think of a therapist you most admire. It may be a colleague or someone you have read or been taught by. Guess what. They’ve made these kinds of errors too.
Think of how many transactions are exchanged between you and your client in a given session. Calculate how many take place just in one week. It’s inevitable that some of those will be imperfect and some will be slap bang mistakes.
The fact that this mistake stands out at all shows that you’ve got a great strike rate.
But there is a deeper hidden positive at play here. You noticed the error. This shows a level of self-awareness that marks you out as an excellent therapist. Who would you rather be? The therapist who sees it for the error that it is, or the one who is oblivious and thinks they did a stellar job?
The other hidden positive is that you care. The fact that you made a mistake in the session clearly matters to you. This is huge. For all of our models and knowledge, who wants a therapist who doesn’t sincerely care?
I recall a client who had a good outcome with me despite it seeming a complicated case. My clinical supervisor, in pursuit of my own learning, asked me how I had helped to make that happen. I could have spoken about this technique or that model. But I gave what felt a more fitting answer. I said, “Giving a shit goes a long, long way.”
You clearly do. And it really does go a long, long way.
So let’s check the evidence. Your error rate is tiny compared to the number of interactions you have. You are self-aware and, crucially, you give a shit.
If any of us were to define what makes for an excellent therapist, those sentences would surely be in there. You’re ticking those boxes big time.
Given that you’re an excellent therapist who cares about your errors, you will learn from this. Go gently on yourself and reflect on your learning and you will become an even more effective therapist as a result.
The Mae West Principle
Mae West was a movie star in the early 20th century. She famously said: “When I’m good I’m very good. But when I’m bad, I’m better.”
Research shows that this is a good way to describe what happens in the therapeutic relationship. When we drop the ball and fix the breach in the relationship, outcomes are better than if we hadn’t dropped the ball at all.
Mistakes in themselves are not necessarily a bad thing. Even breaches in the relationship are, in themselves, not a problem.
Instead, if handled well, they are an opportunity for growth and improved outcomes.
When we make an error that weakens the therapeutic relationship with our client, what can we do about it to make the most of that opportunity?
Making it better
I remember a client who I worked with. I made a choice that resulted in a full-blown panic attack. The autonomic response had such an impact that their mood sunk for about two weeks.
Thankfully, this is very much the exception. Yet naturally, I was really upset with myself. I beat myself up and told myself that I was an idiot for the choice I made. I kick myself for it even now.
Yet this client had a great outcome. So why did this client stick with me? How were they able to get all of the changes they wanted from therapy despite my monumental blunder?
I owned my mistake completely. I invited the client to share their feelings about it. I gave them permission to be pissed off with me and invited them to express it. “After all”, I said, “I’m pretty pissed off with myself.”
We talked through what had happened. I apologised. I heard about their feelings and needs. I treated their feelings as valid. I responded to their needs by reassuring them that I wouldn’t make that choice again.
We can underestimate how therapeutic this kind of response to an error can be. Many of our clients have been mistreated horribly in their lives. Yet their pain has never been adequately validated or acknowledged by those who had some responsibility for it.
When we acknowledge our mistakes and make it clear that their upset and feelings matter, this can be a meaningful experience. To explore their needs and take a sincere account of them has therapeutic value.
As therapists, our hope is that clients get lasting relief from the pain of their past traumas. The only brain mechanism that results in permanent change is memory reconsolidation. It is triggered by experiences that create an anomaly.
For instance, many of our clients have been taught through experience that they don’t matter, that they are worthless and nobody cares about them. They often hold the expectation that their feelings will be dismissed and their experience of pain brushed away.
To respond to your mistake so attentively acts to contradict these beliefs and expectations. It is in these anomalous contradictions that deeper change can be triggered. Memory reconsolidation itself depends upon such disconfirming experiences.
None of us wants to make mistakes with our clients. We are driven to be the best therapist we can be for them. We want them to have a positive experience that produces lasting positive change.
Yet, we are each human. So from time to time, unfortunately, we mess up. How we attend to it is what matters.
As well as producing an opportunity for therapeutic growth, it also role models how ruptured relationships can be repaired and made stronger. Again, some of our clients will believe that the only way to deal with ruptures is to end the relationship. The way we respond to our mistake gives the opportunity to model a different path.
Our clients are fallibly human too. So, like us, they will also make mistakes and will talk about them in session. Your mistake may be useful to refer back to. A client berating themself for a slip may find it helpful to be reminded that their therapist makes errors too.
You want to serve your clients well. When you make mistakes it feels awful. Yet even the greatest therapists make errors. It is inevitable given the number of interactions you exchange each week. That also means your error rate is minuscule in proportion.
What separates a good therapist from an ordinary therapists is that you spot the error, you care, and you learn.
The Mae West Principle reminds us that breaches, handled well, actually improve outcomes. So these errors are not the end of the world, but a genuine opportunity for something even better.
Handling it well involves owning the error, showing that it matters to you, and hearing the clients feelings and needs around it. It means validating those feelings and responding to what they need by ensuring things are different going forward.
Memory reconsolidation shows that all lasting change happens as a result of anomalous experiences. Your response to the mistake experientially challenges a client’s view that they are not worthy of care. Likewise, it contradicts the expectation that their pain gets brushed off and that they don’t matter.
Beyond that, it models relationship repair and normalises the fallible humanity of mistake making. This is especially helpful for clients who struggle with the burden of perfectionism.
Your mistake is an opportunity for personal learning and for an even better outcome for your client. Making these errors are hard to live with. So go easy on yourself and move forward with the self-compassion you encourage in your clients.
As Brene Brown says: “When I see someone fall down, get back up, and say, ‘Damn. That really hurt, but this is important to me and I’m going in again’—my gut reaction is, ‘What a badass.’”
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