Being a Reflective Therapist We have come to realize that failure is not only an inevitable component

of therapeutic practice but a potentially useful one in the learning and growth can stimulate.

Since it is the drive for perfection and the denial of fallibility that create the most problems for
therapists and their clients, any strategy for dealing with negative results—both within sessions and
with in the clinician’s mind —will have to consider one’s attitude.

Hoffman, Kohener, and Shapira (1987), for example, describe a creative technique that The
Imperfect Therapist emerged from work with therapeutic impasses.

To reverse failure by getting at the client’s overdependence, rejection, anger, and ambivalence, the
authors experimented with two therapists treating a single, chronically resistive client.

They found that even with schizophrenics, passive dependent cases, and other difficult clients who
had previously been inscrutable, dual therapist teams could be effective in a relatively short period.

The strategic or behavioral therapist who focuses on symptoms will, nevertheless, work on building
a client-centered relationship or exploring underlying psychodynamics.

This convergence of universal principles is even more pronounced today and allows therapists to
acknowledge failures and withstand them through a more flexible style of practice.

The philosophy of pragmatism, as it was formulated by Being a Reflective Therapist Charles Peirce
and William James at the turn of the century, the professional turned from contemplation,
abstraction, imprecision, and rigid principles in favor of calculated action, flexible thinking, effective
intervention, and desired results.

The eclectic therapist thus counteracts negative results by constantly experimenting with alternative
strategies.

The goal is “to use the com m on factors in psychotherapy as effectively as possible with all patients,
while applying specific techniques to individual patients selectively, depending on the needs of the
patient, the most appropriate techniques available, and the personality of the therapist” (Rubin,
1986, p. 385).

Since skillful practice involves knowing more than The Imperfect Therapist can ever say or do, the
reflective practitioner relies on a certain reflecting-in-action: Actions and judgments are carried out
spontaneously, and the therapist is quite unaware of how these things were ever learned in the first
place.

Schon goes on to develop his ideas of reflecting-in-action by noting how jazz musicians or baseball
pitchers or urban planners or therapists can improvise their performance, adjust to changing
circumstances, and repeat those “pitches” that have proved successful and avoid those that do not
seem to be working.

Through reflection, he can surface and criticize the tacit understandings that have grown up around
the repetitive experiences of specialized practice and can make a new sense of the situations of
uncertainty or uniqueness which he may allow himself to experience” (Schon, 1983, p. 61).

Less concerned with mulling over endlessly, remorsefully, what exactly went wrong and analyzing
the far-reaching implications of negative outcomes, such practitioners help themselves cope with
failure by focusing on the practical considerations that will lead to future success and more accurate
predictions.

Since failure can occur only in a static situation in which rules and definitions of success remain
constant, Jenkins, Hildebrand, and Lask (1982) suggest a strategy for overcoming failure that involves
a constant reformulation of the problem based on new information gleaned from the previous dead-
end.

The Being a Reflective Therapist 153 the first step requires the therapist to identify all those cues
that indicate failure is indeed occurring.

The second step considers the reasons why therapy is not proceeding in the desired direction: •
What secondary gains is the client celebrating as a result of the failure?

If the therapist engages in constant reflection, unsuccessful therapeutic strategies can yield useful
information leading to more effective predictions and interventions in the future.

He believes the use of “ thought experiments” would be a useful tool for examining specific
empirical situations, encouraging greater flexibility in thinking and acting on the part of the
practitioner: “ What I am suggesting as one possibility, then, is that when a clinician poses a
theoretical question or asks for the exact specifications of a concept, or proposes a research task,
these questions or proposals should be accompanied by a serious effort to demonstrate the clinical
relevance of the request.
To conduct these thought experiments, the therapist would operate with the maximum flexibility-
letting go of ideas that do not fit or no longer work, creating alternative constructs that might work
better.

Therefore, failures in therapy can best be prevented or at least processed with the client when there
is a mutually caring and trusting relationship.

As long as there is trust between client and therapist, there is the time, the incentive, and the
opportunity to work out any disagreement, rectify any error, and overcome any setback.

It is when the therapy is viewed only as a business pact or contractual arrangement (which it partly
is), rather than an authentic encounter between two people working toward the well-being of one of
them, that the client is likely to seek redress or revenge if things do not work out.

As a result of this single brush with a patient’s feelings of betrayal and subsequent revenge, Powles’s
practice became “tinged with a touch of paranoia.” He continues: “Thus far, this experience has
taught me how o m n IP o tenthly I have practiced, and how I have clung to the belief that ‘good’
physicians can practice without making errors when they’re careful enough.

“The definition of goals for therapy then becomes a shared project and, in fact,” he remarks, “often
constitutes the therapy for protracted periods.” In this way, therapists can acknowledge, from the
start, both the benefits and the pitfalls of therapy thereby affording them and their clients a realistic
view of what to expect.

Being a Reflective Therapist 157 Many painful experiences—divorce, unemployment, rejection,

The key point, for our clients or ourselves, is that whether the situation is viewed as a failure or
success depends very much on the interpretations, we choose.

Furthermore, there are many cases in which startling progress occurred months or even years after
therapy terminated unsatisfactorily for the therapist, the client, or both.

Since mistakes are an inevitable part of any job, and success often depends on many random factors
out of our control, shrugging off failures is a necessary skill.
Among the prominent therapists whose experiences with failure were described earlier, the ability
to shrug off disappointment seems to be a common denominator.

One of the things Ellis (personal communication, 1988) has pointed out is that by subscribing to
irrational beliefs such as those, we noted in Chapter One (“ a failure with my client meant my failure
as a therapist” [D.B.]

or “with every client, I must put myself on the line” [J.K.]), Being a Reflective Therapist 159 sary
anxiety regarding our performance.

In an article admonishing clinicians to be more forgiving of their fallibility, Ellis suggests that using
self-talk to overcome irrational beliefs would be as valuable to us as it is to our clients: “When you
ferret out the absolutistic philosophies and perfectionistic demands that seem to underlie y o u r
difficulties, ask yourself— yes, strongly ask yourself—these trenchant questions: (1) Why do I have
to be an indubitably great and unconditionally loved therapist?

Common examples of irrational beliefs that contribute to a therapy its’s stress and feelings of failure
are supplied by Deutsch (1984, p. 839): I should be able to help every client.

Since Fisch specifically defines success or failure as the resolution of a client’s presenting problem,
his treatment outcomes become quite clear.

He does not like to fail but seems to mobilize his energy and motivation to work even 160 The
Imperfect Therapist harder for his clients.

Gerald Corey distinguishes between making a mistake and learning from it (a largely beneficial
experience) and failure (an experience that has a highly negative connotation).

Corey and Corey (1988) urge the therapist to get in touch with intense feelings toward the client,
biases, attitudes, fears, and present life conflicts that are getting in the way.

At this juncture, the therapist often views resistance as normal, necessary, and even helpful, both to
the client installing for time and to the therapist in signaling that they are exploring the right
territory.
When failure is treated as a special case of managing resistance in general, then one proceeds just as
one would with any impass getting a supervisor’s insights, increasing self-awareness of blind spots,
and working on unfinished business that gets in the way.

Freudenberger and Robbins (1979), writing about the general hazards of being a therapist,
recommended that we take Being a Reflective Therapist 161 several steps to metabolize the stresses
and frustrations of our work.

As in all instances of burnout, recovering from the specialized symptoms of failure is best handled by
asking yourself certain questions: Are you free enough to let a client go when you are not interested
in working with him?