FAMOUS THERAPIST ERRORS - Continuing Psychology Education

FAMOUS THERAPIST ERRORSINTRODUCTIONUnderstanding therapeutic errors may lead to improvedfuture performance through refinement of our strategies andthe necessary implementation. Therapists grow bydemonstrating what works and by identifying what does notwork. Lapses in judgment, mistakes in timing and pace, andmis-use of techniques and interventions are instructivebecause they are fundamental errors suggesting the need toutilize basic therapeutic strategies.A good indication of therapy failure is “when both partiesagree there has been no apparent change” (Kottler & Blau,1989, p. 13). Uncertainty of therapy effectiveness may stilloccur though given clients not disclosing truthfully abouttheir satisfaction level. Further, Kottler (2001) reminds usthat we may receive completely different feedback from theclient’s significant others compared to the client him/herself.Keith and Whitaker (1985) indicate that therapy may appearworthless in the short-term but can result in long-termbenefits. Defining bad therapy is difficult, in fact, Bugental(1988) believes that every session includes elements that areboth good and bad.Hill, Nutt-Williams, Heaton, Thompson, and Rhodes(1996) examined factors that lead to impasses in therapy byinterviewing twelve experienced therapists who wereworking with relatively severe cases in long-term treatment.Variables most associated with impasses included clientcharacteristics (severity of pathology, history of interpersonalconflict), therapist characteristics (therapist mistakes,counter-transference), and problems with the therapeuticcontract yielding disagreement about treatment goals. Stiles,Gordon, and Lani (2002) reviewed empirical studiesdifferentiating good from bad therapy and found thefollowing two most significant factors: the depth or power ofthe therapy, and how smoothly things proceed. Theseresearchers note that often therapists and clients do not agreeabout how smoothly or deeply the therapy is proceedingwhich may result from different treatment expectations.Hollon (1995) suggests that insight regarding therapyimpasses may be attained not only from a supervisor but alsofrom the client. Whether accurate or not, Hollon believesthat client feedback is the perception most influencing theresult.The following section examines the self-admittedtherapeutic errors of prominent practitioners. The goal is forall of us to learn from their mistakes and to confront our own.THE ERRORS OF PROMINENTPRACTITIONERSKottler and Blau (1989) and Kottler and Carlson (2003)interviewed noteworthy practitioners and asked them todescribe an experience with therapy failure due to their ownerror, what they learned from the experience and how it hasimpacted their life. Albert Ellis, William Glasser, ArnoldLazarus, Gerald Corey, and others shared some of theirimperfections allowing us to learn from their mistakes and tobe more disclosing of our own.ALBERT ELLISEllis is known for developing Rational Emotive Therapy(RET), an action-oriented therapy designed to makeemotional and behavioral change through challenging selfdefeatingthoughts. He died on July 24, 2007, at age 93. TheAmerican Psychological Association, in 2003, named Dr.Ellis the second-most influential psychologist of the 20 thcentury, second to Carl Rogers. In 2005, his 78 th book, TheMyth of Self-Esteem, was published.He remembered working with Jeff, a young man who wasvery depressed. Client had responded well to active-directivetherapy with Ellis in the past but after a number of years hereturned to therapy with severe depression. Therapistdisputed client irrational beliefs and used a variety ofbehavioral imagery and RET interventions.Client depression occasionally improved but as businessslowed down he regressed into severe despair and selfdowning.After 23 RET sessions client’s wife insisted thatsomething other than his desire to succeed was troubling him;she became upset with therapist for not helping her husbandand coerced him to attend psychoanalysis. Eight monthslater he attempted suicide and was hospitalized for severalweeks. Since that time he has maintained a marginalexistence. Client would like to return to RET but wifeprevents this and she encourages him to take antidepressants,which help moderately.Ellis concludes that he made at least the following threeerrors: 1) He diagnosed Jeff as a severe depressive but he didnot rule out endogenous depression. He knew client’s fatherexperienced depression but he did not investigate other closerelatives. “I now think that endogenous depression probablyruns in the family.” 2) During the second round of therapy,Ellis did not urge client strongly enough to try antidepressantmedication concomitant with the therapy. “I misled myselfby remembering the good results we had obtained withoutmedication. I now believe that Jeff could have profited mostfrom psychotherapy and pharmacotherapy combined.”3) He did not urge client to bring his wife fully into thetherapy, in fact, she attended only one session. “Instead, Iprobably should have arranged continuing sessions with herand with both of them.”Ellis concluded by stating, “As a result of my failing withJeff and with several similar cases of severe depression, Inow take greater care to look for evidence of endogenousdepression, to enlist other family members in the therapeuticprocess, and to ferret out and actively dispute – and teach myclients to dispute – their dogmatic shoulds, oughts, andmusts.”2 Continuing Psychology Education Inc.Copyright © 2011 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSWILLIAM GLASSERGlasser is the creator of reality therapy and has writtennumerous books, including the classics, Reality Therapy,Choice Theory, and Reality Therapy in Action.He described a case regarding a woman in therapy whoeventually decided to leave her husband. The husband, awealthy man used to getting his way, convincingly threatenedto kill himself if she left him unless his wife agreed to livewith him for two months a year. Glasser noted, “I just didn’tknow what to do, or whom to call. I mean the man was notinsane. In those days, there was no chance whatsoever ofgetting someone committed who was reasonably sane. Ithought of calling the police. I didn’t even know what to sayto him.”Therapist confronted the man, tried to negotiate a suicidecontract and attempted to convince him to check into ahospital – but unsuccessfully. He then asked the wife towrite a letter stating that she was aware of the situation butchose to leave her husband.One day the husband did not show for a scheduled session,out of concern, therapist drove about ten miles to his home.Glasser knew the man was inside but he did not respond sotherapist called the police who broke in and found him dead.Glasser still wondered if he had done something wrong.“What I could have done – I did this with a few other people– is sat with him for a long period of time. Maybe I couldhave shown him how much I cared. In all my years ofpractice, this was the most disturbing thing I faced.”After some deliberation, Glasser confided of another casein which he saw a wealthy woman from Beverly Hills whowas the mother of several daughters he was seeing in therapyfor some time. He could not remember her reason for seeinghim but he recollected that she was highly obnoxious. As thesession was about to end, therapist told the mother how hefelt about her. “I told her that I felt uncomfortable talking toher. I didn’t like the way she presented herself. I feltantagonistic toward her. Then I said to her, ‘I can’t wait untilyou leave.’”Upon reflection, Glasser realized that this may have beenbad therapy because he did not help the mother or daughtersby this action. He let her get under his skin but he learnedfrom the experience and expressed “… I can’t recall a timewhen I ever lost my cool like that again.”Glasser believes that bad therapy occurs “when you tellpeople that they need help, and that only I can fix you.You’ve got something wrong that you can’t figure out andyou need me to do it for you.” Additionally, he admits thathaving his therapeutic theory already in mind guides him but“Sometimes I think I’ve gone a little bit too far with this andtoo fast. Sometimes I’m not careful enough to build arelationship with the client before pointing out that he or shemay have made some bad choices.”In assessing his career, Glasser realized that it was not histheoretical contributions or therapeutic techniques that cameto mind but instead his relationships with people – thecommitment he felt toward the people he helped. Whenasked about his weaknesses, he revealed that sometimes hisimpatience led to pushing someone faster than expected,fortunately, he learned from his mistakes, was quick toapologize once awareness set in and then he moved at anappropriate pace.ARNOLD LAZARUSLazarus, a Rutgers University faculty member, coined theterm “behavior therapy” then combined cognitive therapyand other interventions with his behavioral approach tobecome the founder of multimodal therapy. He has writtennumerous books, including The Practice of MultimodalTherapy, Brief but Comprehensive Psychotherapy: TheMultimodal Way, I Can If I Want to, and The 60 SecondShrink: 101 Strategies for Staying Sane in a Crazy World.He has won many honors, including the DistinguishedService Award of the American Board of ProfessionalPsychology in 1982 and the Distinguished PsychologistAward of the Division of Psychotherapy of the AmericanPsychological Association in 1992.When asked what constitutes bad therapy, Lazarus offereda list of errors such as the therapist who lacks empathy andcompassion. He admitted that it is possible to be lessengaged or concerned than what is required, for example,“…when we have seen 8, 9, or even 10 clients in a day, it iseven more difficult to concentrate on remaining caring; undersuch circumstances we have sometimes found ourselvesfunctioning on autopilot.” Ineffective therapy also occurswhen therapists: do not hear their client, constantly answerquestions with other questions, engage in labeling, misreadthe client, utilize malignant interpretations, ridicule, insult, oroffer destructive criticism, and do not employ empiricallysupported techniques when relevant.Lazarus described one of his bad therapy sessions whichinvolved a man in his 40’s who had lost three jobs in eightmonths and agreed to therapy per his wife’s request. Clientpresented as skeptical, hostile and attacking which began toirritate Lazarus. During one session client verbally attackedtherapist and then his own wife which led to therapist losingself-control and telling client that he was “a reallyreprehensibly guy” and stating to client’s wife, “I don’t knowwhy you put up with this guy. I mean he is the most royalpain in the neck.” Therapist never saw client or his wifeagain.Lazarus admitted that this was not a therapeuticintervention, rather, “I stopped being a therapist at that pointand I came across purely as a crazy fellow going for thisguy’s jugular.” After deliberation through the years, Lazarusconcluded that client’s putdowns, criticism and the way hetreated his wife bothered him. Referring client to anothertherapist was an option in therapist’s mind, “But I couldn’tthink of anyone I hated enough to refer this guy to.”When asked why he was so affected by this client, Lazarusresponded, “Perhaps there are just times, for whatever reason,that our own life problems place us in a vulnerable state.” Healso admitted that client reminded him of a bully who beat3 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORShim up in high school – a good example of countertransference.Another insight gained from past mistakes led Lazarus tostate, “One of the tendencies that I used to have was to movein too quickly without getting the full picture.” He learnedthat the therapist must validate what client is truly indicatingbefore moving forward toward a perceived target. “Manytimes I’ve seen some of these people jump to conclusionsafter less than a minute, and they almost always miss thepoint. They hadn’t heard their clients. They hadn’t asked therelevant questions. They didn’t even realize they were wayoff base.”In reflection, Lazarus observed that he has become lesspatient over the years; moreover, he believes that therapistsoften try to cover up and deny their mistakes whichdiminishes learning opportunity.GERALD COREYCorey is a premier textbook writer specializing in thetraining of therapists. His numerous books include theclassic, Theory and Practice of Counseling andPsychotherapy.The error that Corey disclosed occurred when he was coleadinga training group. A former student and trainee in thegroup asked Corey how he viewed her. The other co-leaderintervened and asked the student to verbalize why thisinformation was important to her and she responded that sherespected Corey but she feels insignificant in his eyes. Coreydid not respond to her. When asked by the co-leader duringthe break why he had not responded Corey stated that he feltuncomfortable, put on the spot and he did not know what tosay. The co-leader suggested he could have stated these truefeelings along with the observation that the student did notassert herself by requiring a response.This issue was raised in a subsequent group sessionwhereby some thought Corey’s non-response was a techniquewhile others thought it was insensitive. Corey admitted, “…I felt put on the spot and was somewhat at a loss for words. Ilet the group know that I do struggle at times with giving myimmediate here-and-now reactions when I am confronted,and that I become evasive or sometimes say nothing at all. Iacknowledged that I made a mistake. She did deserve aresponse from me, and I regretted holding back myperceptions.”Corey and the co-leader were intrigued how groupmembers often discount their inner reactions, relinquish theirpower and seek justification for a group leader’s mistake.Corey realized that “ … it isn’t easy to do what one knowsis appropriate, and that under pressure we sometimes revertto old patterns of behavior. In my eyes, although I did makea mistake, the situation did not turn into a failure because Iwas willing to explore what happened with my co-leader andthe group members. In this particular case, all of us learnedsomething from my mistake.”SUSAN JOHNSONIntegrating components of humanistic and systemicconstructs, Johnson is one of the originators of EmotionallyFocused Therapy (EFT) which assists couples to emotionallyexpress themselves constructively. She has been a professorof Clinical Psychology at The University of Ottawa and amember of the editorial board of the Journal of Marital andFamily Therapy, Journal of Couple and RelationshipTherapy, and Journal of Family Psychology. Her books offerpractitioners a guide to dealing effectively with conflictedcouples, evidenced by Emotionally Focused Therapy forCouples; The Practice of Emotionally Focused Therapy:Creating Connection; and The Heart of the Matter:Perspectives on Emotion in Psychotherapy. Her approach ispremised upon the idea that expression of significantattachment-related emotions can elicit new, healthy responsesin partners and facilitate improved bonding. Johnsonreceived the Outstanding Contribution to the Field ofMarriage and Family Therapy Award given by the AmericanAssociation of Marriage and Family Therapy in 2000.Administering therapy is an ongoing learning process toJohnson, who reasons that therapists are mentors who havegone through their own learning which gives otherspermission to learn from us and permission for therapiststhemselves to continue learning. She notes, “I feel like oneof the reasons I do couples therapy is because I learn fromevery couple.”When considering a personal case of bad therapy, Johnsonrecalled an intimidating and difficult woman who wouldinterrupt and even yell at her coupled with therapist feelingtired and depleted. Client divulged a personal experience oftesting whether she could count on her husband (whom shefelt was callous and incompetent) by pretending to hangherself in the basement of their home, making all thepersuasive noises to convince the husband and waiting to seehis reaction. Ten minutes elapsed before husband went to thebasement which convinced client that her husband wasuseless. Therapist disapproved of this extreme test and begansaying blaming remarks to client such as “You really felt likeyou needed to go to this extreme measure” and “You weretrying to prove him wrong.” Johnson knew her responseswere not helpful and later felt uneasy because she lostperspective and the capacity to put herself in client’s shoes.While spontaneously processing the session that evening,Johnson suddenly could hear client’s voice in an objectivemanner without therapist becoming reactive or negative andshe sensed how their alliance was damaged but how shecould restore the connection. Counselor told client the nextsession, “What I didn’t understand until I put myself in yourshoes was what incredible courage it must have taken to testout your worst fears. You were so afraid and you weresaying to your husband, ‘I can’t count on you in the mostbasic ways. I believe that you would abandon me if I wasdying.’ That is a huge thing to say… I can’t imagine howmuch pain you must have been in and also how muchcourage it must have taken to really test it. The conclusion4 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSyou came up with is that he really couldn’t be there for you.If indeed that is true, then the relationship really isn’t safe foryou.”Once Johnson stopped judging the woman and began tounderstand and validate her then the therapy flourished. Thewoman became logical and coherent with her struggle thatshe married a man who could not be her spouse. Sheadmitted that he did not want a partner and that she capturedhim. Therapist was amazed by client’s transformation due toan empathic approach and shared, “I still keep that in myhead as a lesson.”Counselor acknowledged that trouble with her clients couldensue if she labeled, blamed, or judged them. “Bad therapyfor me involves times when I get caught in a reactive cyclewith clients and start to pathologize them and not give themthe benefit of the doubt. If I had then started to do some sortof superficial coaching, trying to teach her not to be soaggressive, I think it would have been even worse.”In another case, Johnson recollected a couple in which thehusband was highly verbally abusive to his wife. Counselortried to contain the man’s negative emotion, place it in thecontext of his attachment, needs, fears and their interactionalcycles, increase his self-responsibility and transcend theanger. It wasn’t working, instead, he would blame his wifeand justify his behavior; he even began to become hostilewith therapist when confronted. The man began to storm outof the session leaving Johnson worried about the wifebecause it looked like she would not leave him. Therapistasked wife if she could talk to her individual therapist but thewife politely refused and wept. Johnson concluded that thiswas not a case for couples therapy, alternatively, he neededto examine his rage in a safe environment. Though therapistfelt nothing more could have been done, she still pondered ifthere were other ways to have reached him. She felt thecouple’s helplessness but could not join successfully withthem to implement change in their interactions. “The bottomline is that I couldn’t make an alliance with him and thetherapy never got off the ground.”In reflection, Johnson wished she could have helped thehusband realize he had a problem because that would havebeen a first step. Given clients refusing to make a change,Johnson’s method is to step back to where they are, stay withthem, recognize their being stuck and their need to selfprotectand validate them until they are ready to take a firststep. She has experienced a client stating “I can’t move atall” which fosters therapeutic movement in itself – in thiscase, she would have liked the man to have looked at his wifeand said, ‘I can’t let you in. I don’t think I can ever let youin. Perhaps, I’m never going to let anyone in.’Unfortunately, this case did not move as such.The lesson for Susan Johnson is that “bad therapy takesplace not only when your model doesn’t work, but when youdon’t have another model that you can reach for. You see thatclients need something other than what you are offeringthem, but you can’t figure out what that might be. Youremain stuck with what you already know how to do.”JON CARLSONCarlson has authored 40 books and 150 journal articles andhas been professor of psychology and counseling atGovernors State University in Illinois. He receivedDistinguished Services awards from the AmericanPsychological Association, American CounselingAssociation, International Association of Marriage andFamily Counselors and the North American Society ofAdlerian Psychology. Dr. Carlson was named one of five“Living Legends in Counseling” in 2004 by the AmericanCounseling Association.Carlson described a client who was hired by his officemanager to assist with their office work during the time theclient was in therapy with Carlson. The office manager feltthis situation would not become a dual relationship problembecause the client was not working for Carlson. Client’sissue was determining whether to leave a bad marriage.Ultimately, the client’s husband suspected his wife of havingan affair with Carlson. Therapist asked client what mighthave led to this absurd suspicion and she disclosed that shewas having an affair – with the minister of the church whohad recommended client to Carlson.Therapist received a phone call from the attorney of theclient’s husband, after client filed for divorce, becausehusband was threatening a lawsuit and registering acomplaint with the Licensing Board for unethical conductbased on therapist having sex with his wife. Resolutionoccurred when husband sought his own therapist andCarlson’s client arranged for Carlson to attend one ofhusband’s sessions; she gave him permission to reveal herextra-marital affair to the husband’s therapist but not tohusband. Carlson recollects, “The other therapist did somegood mediation and was able to calm the husband down andtry to get him to look at why their relationship didn’t work. Iwasn’t defrocked of my license and I wasn’t accused ofimproprieties, but I still have to take responsibility ofcreating a big part of this mess.”A second case was disclosed by Carlson which involved aman in his early 30s seeking help with relationship issues andwho also acknowledged being in recovery from drug andalcohol abuse. Client stated that he would be in recovery forthe rest of his life but in therapist’s view this way of thinkingis a liability, consequently, therapist mentioned someevidence that people can train themselves to be socialdrinkers. Client’s immediate response was to nod his headand not respond verbally but several days later client wrotetherapist a letter terminating therapy stating that therapist wasunprofessional, did not understand that alcoholism was forlife and such people cannot be taught to drink socially.Carlson sought closure by sending client a termination letteralong with literature supporting feasibility of social drinkingand wrote the information was controversial and client wouldhave to reach his own conclusion.Several years later, client called and wrote to therapistrevealing he began drinking a glass of wine at dinner for thepast year without losing self-control and he no longer viewed5 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORShimself as an alcoholic. Soon thereafter, Carlson received aphone call and visit from a police officer informing him of athreat against his life and that the police would patrol hisstreet on a regular basis. The past client had begun drinkingheavily leading to the loss of his job and control over his life.Ultimately, client was arrested for being out-of-control andhe threatened Carlson’s life while in detox. Client’s wifewrote therapist declaring him to be a terrible counselor andthat he ruined their lives.Carlson immediately reflected on the experience seekingresolution, he admitted, “It was really upsetting to me thatsuch a spontaneous passing remark could have such a hugenegative impact. Again I was right: research supported whatI had said but it was totally inappropriate for this individual.I learned after that to be very careful about the things I say topeople. At the very least, I might say to him now, “Wouldyou be interested in knowing …?” Or maybe I wouldn’tbring it up at all.” Therapist learned that he should havegiven the information in a different way, with greater respectto where the man was coming from. He felt sad that he nevertalked to client after this experience and that closure wasnever obtained.Carlson noted, “I have a lot of regret and sadness about theblessedly few failures I have encountered. They are storieswithout endings, and I have to live with that.” His currentbelief is that therapists do make mistakes but it’s important tonot continue making the same mistakes.PEGGY PAPPThis therapist is known for her innovative work exploringgender differences in the practice of family therapy. In heracclaimed book, The Process of Change and FamilyTherapy: Full Length Case Studies, she was one of the firstto trace family belief systems that affect core values ofindividual members. Other noteworthy books include, TheInvisible Web: Gender Patterns in Family Relationships, andCouples on the Fault Line: New Directions for Therapists.She has been a supervising faculty member of the AckermanInstitute for the Family and founder/director of Ackerman’sDepression and Gender project. Papp received the AmericanAssociation for Marriage and Family Therapy’s LifetimeAchievement Award, and she was honored by the AmericanFamily Therapy Academy for her ground-breaking work onThe Women’s Project for Family Therapy. She has been inprivate practice in New York while supervising therapists atNorth General Hospital.In recollecting a past therapy failure, Papp describedworking with a couple utilizing the technique of sculpting infront of a large crowd for demonstration purposes. Eachmember is asked to have a fantasy about their relationshipand then act out the fantasy together; the fantasies offer ametaphorical view of the way each member experiences therelationship and the metaphors are then used as a guide forbettering the relationship. Therapist recalled how the wifecould not derive a fantasy and the husband’s fantasy wasabout a rock which was difficult to sculpt. To make mattersworse, therapist intentionally did not have backgroundinformation on this couple – her therapeutic style is to formher own opinion rather than be potentially biased by areferring therapist – and this lack of information militatedagainst this demonstration as well. Ultimately, therapistcould only muster a “flimsy kind of message” back to thecouple and she felt it was the worst session she ever did.Papp felt that she ignored her intuition and continued towork within a structure that was not working. She learnedthat it is “unrealistic and inappropriate to decide ahead oftime on a treatment method before even meeting the familyand hearing their story. Such a structure was eventuallybound to fail.” Certainly, it is important to not remainfocused on a specific treatment or plan when the flow ofinformation suggests a different approach.Upon reflection, Papp concluded, “… no matter how longyou practice therapy, even in the most stressful ofcircumstances, you can never really get to the point whereyou can handle everything deftly that comes your way.There are therapists who think they can, but that is onlybecause they are oblivious to the different ways they couldhave proceeded.” She believes that human behavior ismysterious and unpredictable thus rendering therapists to behumble about their work, otherwise, we can be insensitive tothe dilemmas of our clients. Papp contends that “It takeswisdom sometimes, not techniques and approaches to behelpful to people. It takes a kind of real understanding abouthuman suffering.” Finally, she stresses the need fortherapists to work within the particular cultural context ofeach client and to respect those beliefs.VIOLET OAKLANDERThis pioneer of child and adolescent therapy has attainedinternational recognition and has received several awards forcontributions to the mental health field. Her books, Windowsto Our Children: A Gestalt Therapy Approach to Childrenand Adolescents, and Hidden Treasure: A Map to the Child’sInner Self reveal her unique Gestalt and Expressive Therapytechniques.In sharing an example of her bad therapy, Oaklanderdescribed a 16 year-old boy who was reluctantly attendingtherapy at his father’s request and whose mother was analcoholic. The youth disclosed many physical complaints,including chronic stomach aches which eventually led toulcers. He was passive, quiet, restricted in self-expression,and admitted to skipping a lot of school. Client becameemotional several times upon admitting he could not invitefriends to the house because his mother was drunk. Therapistfelt progress was occurring and that client would perhapsexperience a catharsis soon, however, after six sessions clientrefused to continue attending therapy because, in his words,“I feel things. And I don’t like it. I don’t want to feel what Iam feeling.” Further probing revealed that he recently criedin the classroom when criticized by his teacher and he yelledat an acquaintance who made him mad. He said, “I don’t6 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSwant to do that, I don’t like this stuff. I like the way it wasbefore when I didn’t feel anything.”Therapist told client that releasing feelings hurts at first butlater if feels better and that his physical problems werecaused by keeping his feelings inside. Nonetheless, clientdiscontinued therapy which left therapist with anuncomfortable feeling. Oaklander assessed the case andconcluded that she hurried the pace of therapy, “I had gonemuch too fast with him and I just hadn’t paced the sessions. Ihad just pushed him – it didn’t feel like I pushed him – butthat’s really what I did. I just kept going further and furtherand pushing him and all these things would come out. It waslike he lost control over himself and I certainly didn’t helphim feel any control over anything. I thought a lot about this.I learned a lot about pacing sessions and being careful,particularly with a child with his background.” Therapistresolved that children cannot manage a lot of expression offeelings all at one time as adults can due to a lack of egostrength. She stated, “Often children will take care ofthemselves by breaking contact. They say they don’t want todo it anymore. With a child with his background, I needed tobe more alert about not pushing him too hard. Ever since thatcase, I have handled this differently.”Another unsettling concern for Oaklander is that she neverlearned what happened to client which left her with a feelingof uncertainty as expressed by, “I try to comfort myself thatwhatever we did together might have been helpful to him, butI am really not sure about that.”In a second case, Oaklander described a 13 year-old boywho was often truant from school and was failingacademically. His mother brought him in and she was angrywith his behavior.Therapist observed that client was not emotionallyexpressive and would not be motivated for projective workbut he did show enthusiasm toward fishing which was hisfavorite activity during his school truancy time. Therapistadvised the mother to notify the school of her intention toallow her son periodic mental health days to go fishing whichmight heighten desire to attend school. Therapist alsorecommended to mother to seek professional help for somelearning disabilities that she observed in client and suchimprovement could make a big difference. The mother saidshe could not possibly do that then she got angry withtherapist and immediately terminated her son’s therapy.Sadly, the mother called therapist about a month later andsaid that her son had hanged himself and she wished she hadlistened to therapist. Oaklander recounted, “Since then, I’vealways wondered about what I could have done or said sothat she would have listened to me. I don’t know if it wouldhave helped him or not, but I always wondered about what Ihad missed.”Upon reflection, Oaklander realized that she may havegiven ample attention to client but not enough to mother. “Iknow sometimes I will be so much the child’s advocate that Imight forget to listen to the parent, to honor the parent.” Inhindsight, therapist would have been more empathetic withmother’s feelings and frustration, in her words, “It is nothelpful to the child if we antagonize the parents, or if wecriticize them. Some parents are not ready to hear things thatwe tell them. And I think where I went wrong is that hismother felt criticized by me.”Each of Oaklander’s cases illustrates that failure may occurdespite good rapport with child or adolescent if parent isignored or not valued; contrarily, she admits, “Parents taketheir kids out of therapy when it’s not time, or it’s too soon”resulting in a sense of futility over lack of control of parentalaction.RICHARD SCHWARTZDr. Schwartz pioneered the Internal Family Systems modelof psychotherapy which combines family therapy with intrapsychicfactors. Clients learn to separate their extremebeliefs and emotions thus liberating a wise andcompassionate Self-state capable of creating harmony withself and others. His accomplishments include being associateprofessor at the University of Illinois at Chicago andNorthwestern University and Fellow of the AmericanAssociation for Marriage and Family Therapy. He authoredthe book, Internal Family Systems Therapy and co-authoredFamily Therapy: Concepts and Methods, a widely-readfamily therapy textbook; additionally, he has been on theeditorial board of four professional journals and he developedthe Center for Self Leadership in Oak Park, Illinois, designedto address issues of violence, racism, abuse and oppression.Schwartz notes that some therapists pathologize theirclients by using the DSM (Diagnostic and Statistical Manual)as a Bible, hence, only perceiving the individuals throughthat scope of vision. This view can lead to therapy becomingmere self-fulfilling expectations and the therapist’s selfprotectivenesscan trigger unhealthy aspects within client.Schwartz pleasantly admits, “I don’t have these strugglesbecause I don’t make those presumptions about people whenthey come in.” His therapeutic method avoids traditionaldiagnostic labels and focuses instead on labeling importantparts of the self. People, including therapists, have manydifferent parts along with a “core” self; the concern is thatone part, for example, having extreme reactions to people,may take charge of the therapy session and lead to nonproductivity.This therapist discloses, “My goal when I amworking is to try to maintain what I call “self-leadership”most of the time. I have my parts around, but I won’t havethem taking over… It’s a different take oncountertransference. The parts of me that have gotten me introuble would include parts that can be very impatient andthink that therapy is taking too long.” The “impatient self,”Schwartz admitted, may encourage him to rush clients intodoing things before they are ready and the part within himdesiring to be entertained can attempt to rush the pace oftherapy to the detriment of the client.A dislike of clients who are highly dependent, yetdemanding is another part of self that Schwartz must be7 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORScognizant of. His cold side could take over when confrontedby a client being needy or entering into a childlike state asillustrated in his words, “I might say all the right words butthere would just not be any heart in them at all. That againwould make my clients’ needy parts just that much moreneedy. They might feel abandoned by me and panic evenmore.” Schwartz is aware that many of our clients exhibit apresenting style of feeling helpless and lost and seekdirection from the therapist so we must balance thisawareness with the urge to simply state “do something andstop complaining.”In recounting a past therapy failure, Schwartz described afemale survivor of abuse who displayed neediness thustriggering coldness in therapist leading to rageful anddemanding client behavior. Client rage elicited a critical partof therapist skewing his perception that client wasmanipulative and tapping into a part of him that was afraid ofher. Client sensed therapist negative feelings and criticaljudgment resulting in her feeling more worthless. Thingsescalated such that therapist secretly wished client woulddiscontinue the therapy; this desire came to fruition whenclient was ultimately hospitalized and another therapist tookover.After deliberation, Schwartz concluded that this caserepresented bad therapy because he did not seek consultation.He noted that “When parts of you take over, as was true forme, you don’t even know that you are out of line.” Thistherapist admitted that practitioners sometimes look to justifytheir own actions rather than exploring alternative therapeuticmethods when clients act in unexpected ways, in his ownwords, “As I got more experience I realized my own role inthings, I felt righteous until I saw how much differently Icould have handled things. It does still haunt me.”Schwartz learned from this case that he needed to continueevolving an awareness of the parts within him that preventedhis best work, to control those parts so they do not preventclient from full emotion-expression, and “to trust in me moreand let myself keep my heart open even in the face of therage, dependency, the neediness, or whatever parts of myclients that are coming at me.”In offering advice to therapists, Schwartz encouragesawareness of countertransference and self-protective thoughtsand behaviors that get triggered by our clients. He believesthat we may not notice when we lose focus of client’s needsin the context of becoming oblivious to our own issuessurfacing. Essential for good therapy, according to Schwartz,includes: 1) being more aware of our inner thoughts, feelings,and various parts, 2) monitoring the variables that appear tobe slowing the therapy process, and 3) avoiding placing allthe blame on client when the process is not going well orclients display resistance.Schwartz feels that managed care and brief therapymodalities can generate pressure on therapist to producequick results yielding insecurity and anxiety in both therapistand client. He also has observed that beginning therapistsmay feel insecure about their performance which can lead toclient becoming resistant thus scaring therapist even more.For beginning therapists, “I try to help them with those veryanxious parts that make them either push too hard or becometotally passive and let clients do whatever they want;” heencourages self-patience for beginners as well as the abilityto apologize to client if the process is not unfolding perfectlyor not going smoothly. Regarding apologizing to client, thistherapist shared, “My experience is that clients reallyappreciate it. They feel like their perceptions are finallyvalidated. Here is somebody who is not going to try andpretend they are right and the client is wrong, which is whattheir family usually did.”In managing client resistance, Schwartz recommendstherapists to respect these protective parts that disallowaccess to momentarily weak areas and that ensure client thattherapist is competent enough to maneuver within them. Heurges therapists to listen to client fears rather than pushingpast them and then resistance will lessen.In his therapy model, Schwartz believes in being himselfand assuming much responsibility for successful andunsuccessful outcomes instead of blaming client’sunresponsiveness or resistance or the therapy model. He hasadopted the tendency to look at himself when things did notend well. He admits that “The kind of therapy that I aminviting is a riskier kind of therapy for your ego because youget more involved. It does take more of an investment on thepart of the therapist and you do kind of eliminate all thosedifferent protective barriers – not all of them but the commonprotective barriers we have for keeping a kind of distance.”Schwartz reiterated that if he can maintain a self-leadershipplace then therapy failures will be rare, specifically, hereveals, “When I have been able to make a self-to-selfconnection with someone and have been able to respectfullyhandle their protective parts and get to some of their verywounded parts, we generally don’t fail.”STEPHEN LANKTONThis therapist’s accomplishments include being director ofthe Phoenix Institute of Ericksonian Therapy, facultyassociate at Arizona State University and editor of theAmerican Journal of Clinical Hypnosis. Lankton studiedwith Milton Erickson for five years then combined this workwith neurolinguistic programming into a practical,relationship-oriented approach. He is a recipient of theLifetime Achievement Award for outstanding contribution tothe field of psychotherapy and the Irving Secter Award foradvancement in clinical hypnosis. His books includePractical Magic, The Answer Within, Enchantment andIntervention, and Tales of Enchantment.Lankton believes that bad therapy occurs when therapistdoes not engage with client and that creative therapeutictechniques will not work given the failure to have developeda solid relationship with client. In sharing a personal therapyfailure central to this theme, Lankton described a manattending therapy for back pain referred by a psychiatrist.Therapist saw client in the parking lot leaving his car with the8 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSaid of his wife helping him walk every step of the way.Client appeared to not meet his wife’s assistance half-way, infact, his body language was perceived as uncooperative andresistant. Upon therapy beginning, client often responded ina condescending manner with the phrase, “Let me tell yousomething, Sonny” despite client being of the same age astherapist. Lankton asked client if he had ever tried selfhypnosisfor his back pain, which was the purpose of thepsychiatrist referral, and client replied, “Let me tell yousomething, Sonny. I never tried hypnosis and I’m nevergonna try hypnosis.” Therapist changed tact with an indirectapproach of reporting past successes he had by using selfhypnosison chronic pain but client retorted, “Let me tell yousomething, Sonny. I don’t think it happens like that.”Therapist felt client was calling him a liar and answered,“Okay, then I’d like to just call it a day. If you ever get tothinking about this in a way that would make you want togive it a shot, then you call back.” Therapist walked thecouple to the door and as they reached the waiting roomclient turned back and offered Lankton his hand. Therapistresponded by saying, “Tell you what, I’ll shake your handnext time I see you.”As the man slowly hobbled out the door, therapistimmediately reflected on his own strong negative reaction tothe event. He heard Milton Erickson’s voice in his mindsaying, “You know how you could have engaged that client,Steve?” After reflection, Lankton concluded that he couldhave engaged this man by speaking his language rather thandemanding client mirror his speaking-style and he feltfrustrated that he was not willing to “invest the hard workinvolved in meeting the man on his terms.”A second failed case disclosed by Lankton illustrated morethan just a waste of time, instead, a negative outcome. Clientwas a young woman with self-doubt, social anxiety, she keptmany problems to herself, and she was the victim of sexualabuse in a satanic cult. Client refused to discuss the sexualabuse, only reporting that she addressed the issues inprevious therapy; her goal was only to overcome socialanxiety. Therapist resolved not to confront her past but tofocus on alleviating her social avoidance, as she requested,since the past may not have been relevant to the presentingconcern. Client made progress over the next eight weeks andeach person felt the therapy was successful, but the story didnot end here.Lankton decided to continue the therapy; in a later sessionclient revealed becoming more social but her fears of sexualcontact were surfacing. She asserted her inability to haveorgasm and her embarrassment to bring this up to her dates.Therapist felt comfortable to transition from social anxiety tothis issue and he stated to her, “I can help you learn to havean orgasm.” Client showed horror and shock but counselorclarified his awkward statement and true intention byexplaining his previous success with sensate focus and howshe would perform such exercises in the privacy of her ownbedroom. He educated her on the success rate for thisdifficulty and how his only interest was to help her,unfortunately, his attempts to convince her only led toincreased agitation – there was an apparent irreversiblebreach of trust.Counselor revealed, “What I had felt was that myrelationship with her had built such trust that I could speak toher with an ease that I should not have felt. I was trulysaddened by her reactions. I even had tears in my eyes as Iexplained to her that I would never do anything to hurt her. Iwas so sorry that this had taken away from her othersuccess.” Lankton asked her to think things through beforereaching a conclusion, that she return when feeling morecomfortable and to come back with a third party if necessary.The young woman chose to report to the referring agent thattherapist was inappropriate and unethical leading to aninterview to clarify the complaint. Though no evidence ofmisconduct was found, rather, just a misunderstanding,Lankton felt bad about the outcome.Lankton gave the following explanation: “This caseillustrates one of those principles that Milton Erickson drilledinto my head and that I never should have forgotten for amoment. The most important thing is to speak the client’sexperience and language. The fact that you build goodrapport with the person doesn’t mean that you can forget thatbasic principle. It doesn’t mean that you can now speak fromyour own experience and language and expect them tofollow. Rapport doesn’t open the doors as wide as you cometo think it does.”Therapist relied upon his intuition and empathy but thesesenses failed him in this particular case, as he admitted, “Mycore understanding of the world was shaken. My intuitionwas slapped.” Lankton learned that “we must always keepone foot in the client’s world.”RAYMOND CORSINIThe Biographical Dictionary of Psychology lists Corsini asone of the most important psychologists of the past 150years. He is known to scholars and students in counselingand psychotherapy as first editor of the classic text, CurrentPsychotherapies, which was the major introduction to theoryin the profession and currently, in its sixth edition, is stillwidely popular and has sold more copies than any other inthe field. His scholarly production in the fields of prison,industrial/organizational, educational psychology, andpsychotherapy is significant. His 4-volume Encyclopedia ofPsychology is widely acclaimed as one of the best in its genreand along with his The Dictionary of Psychology, Corsinideveloped comprehensive resources for practitioners.Corsini studied with Carl Rogers and Rudolf Dreikers,demonstrating his diverse training; this interest insynthesizing different viewpoints is manifested in his books,Case Studies in Psychotherapy, Six Therapists and OneClient, and Handbook of Innovative Therapy.When encountering therapeutic difficulties, Corsinirecommends flexibility in thought and action. He recalled acase when client-centered therapy led to stagnation but achange to hypnosis brought success, similarly, another caseutilizing Adlerian methods led to resistance until9 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSpsychodrama was integrated into treatment. This adaptiveapproach is reflected in his own words, “The ideal therapistknows everything, knows every technique and every methodavailable. You shouldn’t be stuck with any particularmethod.” Employing medicine as an example, heacknowledged that it is impossible for a physician to knoweverything in the profession, but more mastery of knowledgeleads to more treatment options. “In therapy, we are free tobe ourselves and we are not stuck with anything, whether it’spsychoanalysis or Adlerian or cognitive behavior and so on.The ideal therapist, I think, is a person who has a workingknowledge of many systems.” Upon reflection of pastclients, Corsini was proud of his willingness to try so manydifferent methods because when feeling stuck, he simplyreached out for a different approach until the rightcombination of modalities worked.Corsini reflected on a case occurring when he was ChiefPsychologist at San Quentin Prison in California. The inmatewanted to know why he had acted as a criminal in the pastdespite his not feeling or thinking as a criminal. Therapistused Rogerian therapy over a course of three months butwithout resolution, however, ninety minutes of hypnosisculminated in client realizing a childhood experience was asignificant contributor to his present situation. Corsinireferred to this example of flexibility that helped throughouthis career; he admitted that he did not think in terms ofsuccess and failure, rather, sometimes it merely took him awhile to uncover the right treatment. He was confident that iftherapy would “go bad” it was mandatory to use that data tomake adjustments and switch gears. Contrarily, Corsini feltbad for therapists (and their clients) who are stuck operatingwith only one model because they have fewer options whenthings do not go well.Corsini’s views are summarized in the following message:“As I think I have already mentioned, the more you knowabout psychotherapy the more likely you are to be good at it.Learn all these systems, all of them, and try to learn as manyas possible because all have something to offer.”FRANK PITTMANDr. Pittman, psychiatrist, author, faculty member ofGeorgia State University, and bimonthly writer of columns inPsychology Today and Psychotherapy Networker has been afamily therapist with specialization in couples in crisis. He isa widely quoted author with books including, Turning Points:Treating Families in Transition and Crisis; Man Enough:Fathers, Sons, and the Search for Masculinity; Grow Up:How Taking Responsibility Can Make You a Happy Adult;and Private Lies: Infidelity and the Betrayal of Intimacy.Both of his daughters are psychologists.This therapist recalled a case of bad therapy involving atherapy demonstration before an audience with a young man,apparently depressed, his grandmother, mother, aunt, andsisters who he was living with and who were always pityinghim. Pittman recounted that client would cry and reportfeeling bad but he did not specify any reasons. Counselorassessed the situation as an individual being irresponsible andrefusing to display independence, choosing instead to blameothers for his misfortune. The more intense the sessionbecame then the more nurturing and protective the womenbecame but therapist wanted them to back off and informclient that he could take care of himself, get a job, and beindependent. As client began to cry, therapist asked familymembers of the best way to respond to client when he actedso pitiful and when he tried to get control of them in thisunhealthy way. As usual, they tried to rescue client ratherthan encouraging him to work things out on his own. Theyoung man then complained that everyone was so mean tohim, to which Pittman responded with, “If I were you and Iwas unappreciated this much, I think I would leave home andgo find people who would not complain so much abouttaking care of me while I sit around and don’t do crap. Showthem you don’t need them.”Unexpectedly, the young man stood up, walked off thestage and left the building. The audience became uneasy andthe family members began to leave when Pittman urged themto stay and proclaimed, “I suggested to the family that theynot follow him. I told them that this was an indication ofwhat good therapy we were doing. I said that what we hadbeen tying to get him to do was to stop collapsingdependently upon them and to get up and go do something. Itried my damnedest to get them to see this, and get theaudience to see this. I told them that this was a verytherapeutic move, one that I had fully anticipated. This wasexactly what I was tying to bring about and that is was a greatstep toward health.” The six women looked at Pittman likehe was crazy and he then became concerned for his safetylest the audience might riot in indignation.Upon assessment, Pittman concluded that therapists riskpeople getting mad at them whenever they do somethingtherapeutic: “You are shaking them from their usual patternand you are making them aware of the fact that they havemore power than they thought they had. You are telling themthat they can do things that they had not been doing before.Empowerment can be terrifying. Naturally, when you scarepeople this much, you have to expect a certain amount ofanger toward you for this.”In this case, Pittman resolved that he made a mistake and itsurfaced in other cases as well – he thought clients really didwant to change. “You have to avoid making the assumptionthat these people have already figured out that what they aredoing doesn’t work and they are asking you to correct theerror of their ways.”To Pittman, bad therapy increases people’s emotionalexpression and intensity without increasing their sense ofpower and good therapy does not necessarily inform client ofa right answer or a recommended course of action. Headvises therapists to be caring toward client but not to thepoint of instilling dependency upon counselor as expressed inthe following, “A good therapeutic relationship creates morebad therapy than anything else a therapists can do. It getspeople dependent upon the therapist. It gets people thinking10 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSof themselves as lacking some sort of power that the therapisthas.”In the above case, Pittman admitted that his mistake wasplaying for the audience instead of responding to the family’sneeds. In such settings, there can be a conflict of interest inthe needs of therapist and client, specifically, “If you aredoing therapy right, it’s not very showy. It’s very warm, it isvery comforting, yet at the same time it is quite confrontive.You put new information into the system but it does notmake a spectacular show and it doesn’t wow a crowd. Whenyou try to make it a great show, you run the risk of alienatingthe people you are trying to help.” On a positive note,Pittman deduced that client left the session knowing whatwas expected of him and that there was at least one otherperson who believed he had the ability to do it. Therapistadmitted to not knowing client’s outcome because manyvariables are involved that are out of therapist’s control;Pittman addressed this issue by saying, “I try my hardest notto take responsibility for things over which I have no control– that would really paralyze me as a therapist.”Counselors may work with people in pain and anguish, butPittman cautions practitioners to remain objective, otherwise,we could feel as bad and become as paralyzed as they maybe. “We have to be there in the midst of that pain whilekeeping ourselves sufficiently out of it. We have to maintainour ability to have hope, our ability to do reality testing. It’svery hard work.”Relieving client pain is one goal for therapists, but Pittmanbelieves that within this honorable intention therapy errorsmay be concealed, in turn, he suggests vigilance and alsocognizance that sometimes we must inflict pain byenlightening clients that they are doing something wrong andthat they can do things differently. Despite his vigilance,Pittman disclosed that “In every interview I am hittingsomething too hard or not hard enough. I’m hitting thewrong thing or my reality testing is faulty, but even then mycaring comes through, and more importantly, my optimismfor change.”When asked how he would like others to perceive him,Pittman modestly said, “I’ve been around about as long asanyone in family therapy. Because I have been doing privatepractice most of that time, and because I am rather a terminalworkaholic, I’ve done a lot of family therapy. I figuredrecently I had logged more than 75,000 hours. And I’m stillnot doing it right.”SAM GLADDINGGladding has written some of the major texts in thecounseling field, including Community and AgencyCounseling; The Counseling Dictionary; Counseling: AComprehensive Profession; Family Therapy: History Theory,and Practice; Group Work: A Counseling Specialty; Ethical,Legal, Professional Issues in the Practice of Marriage andFamily Therapy; and Becoming a Counselor: The Light, theBright, and the Serious. In 1999, he was cited as being in thetop 1% of authors in the counseling field. He has been acounseling professor at Wake Forest University, and he hasbeen President of the American Counseling Association andthe Association for Counselor Education and Supervision.Ineffective therapy, to Gladding, is when therapist or clientexhibits less than desirable behavior culminating in a badsituation, or therapist says or does something that does notsucceed.This counselor described a personal therapy failureconcerning a middle-aged woman presenting with the issueof being nervous all the time. Therapist tried to help herrelax allowing exploration into the issue but she actuallybecame more agitated and ultimately ran out of the office.He tried systematic desensitization, deep breathing,attempted to work through her irrational thinking, and askedclient to try meditation but the situation simply worsened.In evaluating his performance, Gladding assessed that hedid not prepare client well enough for the treatmentmodalities, went too fast instead of letting her talk and thenbeing reflective, and he tried to fix her rather than allowingher to ventilate feelings. Counselor reflected, “Maybe Ishould have been more self-disclosing and personal with her,especially about my own nervousness. I certainly shouldhave reflected her feelings more often and stayed with herexperience. Maybe that would have been more appropriateinstead of going with a ‘Let’s see if I can help you relax’ kindof response.”Gladding felt bad because client walked out on himresulting in no closure so he never learned what happened toher. He learned to sense when to go slowly with a client asindicated by his evaluation, “I thought here is a situation thatis maybe teaching me that there is much more to human lifethan what I thought I knew. Instead of addressing matters asquickly as I had before, I’ve been more cautious and morehumble in working with people.”This case reminded Gladding that one must be prepared forthe unexpected even when presenting issues appear simpleand predictable. A potential hazard for veteran counselors isto treat new cases as if they are familiar because ourassumptions can distort the unfolding of actual events.Gladding believes that therapists must be lifelong learners, infact, “It’s being somebody who’s constantly trying tounderstand the human condition. It is about realizing thatpeople sometimes don’t fit our theories.”When asked why counselors are reluctant to divulge theirtherapy failures, Gladding mentioned two factors: therapistsare trained to uphold confidentiality so we do not disclose allevents occurring during a session, and admitting mistakes cancause us to lose some status. Further, there may be evenmore to lose for well-known practitioners who have attaineda certain status in the field – these individuals may havesuperhuman expectations leading to belief in their ownmyths.Gladding admitted that he had experienced other badtherapy cases but the one he shared simply haunted him morethan the others. A concluding analysis by Gladding led himto say, “I think that bad experiences in therapy are like grainsof sand in oysters. At first, they are really irritating. They11 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORScan even kill us. But over time, if we live long enough, theycan become pearls of wisdom.”LEARNING FROM THERAPY FAILURELiterature on the subject of therapy failure suggests thatrarely does one specific reason to which we attributeunsuccessful therapy explain the entire truth. Deducingcauses of failure is difficult because clients may not knowwhy they felt dissatisfied or given such awareness they oftenkeep reticent over the reason for leaving treatment. Further,therapists may lower their own cognitive dissonance overlosing a client by clouding the issue in order to appearcompetent, denying mistakes, and avoiding selfresponsibilityfor negative outcomes. Finally, the manycomplexities of the therapeutic encounter itself imply that anumber of variables are involved rather than just one factor.The most pervasive variables in therapy failure, whetheralone or in combination, are categorized into factorsattributed to client, therapist behavior, interactive effectsbetween therapist and client, and sabotaging influencesoutside of therapy.CLIENT FACTORSMost often, clients terminate therapy because of therapistactions or inactions, but in some cases, regardless ofcounselor competency, clients may be determined to avoidimprovement. They may unconsciously be driven tosabotage progress or to defy efforts of the most skilledcounselor, hence, some people may never succeed in therapy.Certain personality and mood disorders, various defensemechanisms, and people with impaired judgment or insightare concerns limiting treatment potential – progress in thesesituations may be measured in decades rather than weeks.Greenspan & Kulish (1985) found that clients whosuddenly end their therapy before work has been completedhave a tendency to be young adults, a minority groupmember, have insurance coverage with maximum benefits,have been referred by another professional in a clinic facility,and have situational, acute, or adjustment reactions that theyblame on external factors beyond their control. Colson,Lewis, and Horwitz (1985) determined that individuals inpsychoanalytic treatment with higher chronicity of symptomsand degree of disturbance revealed poor prognosis predictors.Clients who display any of these traits are less likely toimprove in therapy: poor impulse-control, lack social supportsystems, are older, lack sense of humor, are impatient, haveborderline personality disorder, tend to externalize and lackpsychological sophistication (Stone, 1985). It is advised thatcounselors not be pessimistic when dealing with issues ofpoor prognosis in the literature because that would contributeto a self-fulfilling prophecy, rather, to remain optimisticwhile being realistic regarding that which is within our powerto change. Therapists need not avoid or fear high-risk casesbecause often treatment success correlates with client’smotivation, personality, and attitude, in turn, client’s failure12 Continuing Psychology Education Inc.is not automatically the therapist’s failure. Despite thisinformation suggesting that there are some people thatnobody can help, the preponderance of therapy failure is dueto other causes.Research indicates that clients present with a broad rangeof combinations of goals, instead of single or isolated goals,of which symptom relief represents only a small percentageof all possible goals (Connolly & Strupp, 1996; Grosse-Holtforth & Grawe, 2002; Grosse-Holtforth et al., 2004;Hasler et al., 2004; Uebelacker et al., 2005). These studiesalso reveal that treatment goals are only partly associatedwith client diagnosis, hence, therapists cannot assume theyknow client’s treatment goals solely based on diagnosis.Symptom relief appears to be the most important clientreported goal across clinical settings but it is not the mostfrequently indicated goal. Other commonly reported clientgoals include interpersonal problems, personal growth, andexistential issues (Hasler et al., 2004; Holtforth et al., 2004).Hasler et al. (2004), for example, found that clients withpersonality disorders and adjustment disorders did notinclude symptom relief as their most important desiredchange, and Uebelacker et al. (2005) determined thatdepressed clients indicated psychosocial functioning wasequally important a goal as symptom relief. Further, certainclient variables, such as employment status, affect preferredclient goals. Hasler et al. (2004) discovered that unemployedclients reported more social support goals than employedclients. These studies infer that various client characteristicsinfluence their treatment goal preferences.Gross-Holtforth & Grawe (2002, p. 79) define treatmentgoals as “intended changes of behavior and experience thatpatient and therapist agree on at the beginning ofpsychotherapy and on which successful psychotherapyshould be instrumental.” Establishing realistic and beneficialtreatment goals is deemed clinically important because theydirect patient participation and therapist interventions (Long,2001; Tryon & Winograd, 2002). Eliciting active clientparticipation in the development of treatment goals has beenfound to increase commitment to goals and the probability ofgoal-attainment (Locke & Latham, 2002).THERAPIST FACTORSAnalysis of treatment failures in family therapy ledColeman (1985) to observe the following most commontherapist causal factors:1) Failure to comprehend the true nature of the presentingproblem and the circumstances surrounding the referral.2) Insufficient bond with family members or a weaktherapeutic relationship with client.3) Theoretical omissions or inconsistent interventions.4) Waning energy.Coleman concluded that failures were not caused byconscious or unconscious errors as much as therapists beingsurprised by “unforeseen entanglements.”Within a psychodynamic treatment process, H. S. Streanconcludes that failures generally occur when therapist is not

FAMOUS THERAPIST ERRORSmotivated due to negative feelings toward the client (Streanand Freeman, 1988). Interestingly, he cites one of his owncases as an example involving a philosophy professor, namedAlbert, who after two years of therapy became moreimpaired. Strean recalled, “Usually after a first interview, Ifeel an eager and interested anticipation of the next session,much like the feeling of getting ready to go on a journey.This time, however, I found myself obsessing about Albertafter he left. I knew from my analytic training that obsessingis a sign of mixed feelings. After my first interview withAlbert, and after a number of succeeding sessions, I engagedin fantasied arguments in which I was trying to ward off abully who made me feel weak and vulnerable. Obviously,Albert threatened me, and it was difficult for me toacknowledge this truth, so I argued with him in fantasy. Inhindsight, I have to admit my work with him was a failure inthat I could not give him the help he was entitled to receiveand was, I believe, capable of using” (pp. 186-187).With amazing candor, Strean assessed his work with thisclient and resolved that he made many significant errorsresulting from his negative attitude toward client. A caseanalysis illustrated the following therapist mistakes yieldingimportant learning material:1. Therapist lost objectivity, thus, he fell prey to client’smanipulative ways.2. Due to feeling threat, jealously, and competition,therapist maintained a continual power struggle.3. He made “correct” interpretations and used “right”words, but with a hostile and non-empathic tone ofvoice.4. He spent excessive time trying to prove to client that heknew what he was doing.5. Despite his awareness that countertransference feelingswere negatively impacting therapy, therapist could notmonitor or confront them and did not receive supervisionor therapy to resolve them.6. He hid behind a mask of cold, objective analyst andwas punitive instead of being empathic and supportive.Strean evaluated this case: “Actually my work with himshould not really be called psychoanalytic treatment. It wasmore of an interpersonal struggle between two men who feltuncomfortable with each other, each one trying to prove hispotency to the other and to himself” (p. 191).Misdiagnosis caused by not identifying a hiddenpsychopathology or organic dysfunction will often result inpremature therapy termination. Straightforward anxiety, forexample, can be a sign of hyperthyroidism or a variety ofcardiovascular or neurological disorders. Even with anaccurate assessment, the ensuing fundamental helping skillscan go awry; the following is a list of the most commonmistakes and interventions that end therapy prematurely:1. Confronting client in a style received as overly aggressive.2. Making an interpretation viewed as too threatening forclient at that particular time.3. Establishing unrealistic goals or that are inconsistentwith client values.4. Acting too passively or failing to respond adequately.5. Showing a lack of care, respect, and acceptance towardclient.6. Not creating a strong alliance with client.7. Over-stepping a boundary that violates client’sprivacy or security.8. Enacting paradoxical strategies, psychodramaticmethods, or other techniques that fail.9. Inquiring by using a series of close-ended questionsthat are felt as interrogative.10. Acting evasively or mysteriously leaving client tofeel manipulated.11. Offering poor empathic responses that resembleparroting.12. Mismanaging silence by allowing it to continue beyondreason.Therapist-induced failures can be minimized if issues aredetected early given counselor honest and objective selfanalysis;if necessary, consultation may be sought.Additionally, since clients often present with an array oftreatment goals rather than a single theme evolving aroundsymptom relief, therapists are encouraged to develop a widerange of clinical skills affording the opportunity tocompetently work with a greater number of clients (SanMartin, 2007). Given that clients often express acombination of goals only partially elucidated by theirdiagnosis, Grosse-Holtforth & Grawe (2002) suggest thatspecializing in only one thematic area increases the risk ofdisregarding client’s various issues and they recommendclinicians to engage in broad training covering areas beyondsymptomatic change.THERAPIST-CLIENT INTERACTIVE EFFECTSThe most common causes of therapist-client therapyprocess failure are unresolved transference experiences ordependency issues (Herron & Rouslin, 1984). Specifically,separation conflicts are mismanaged or prematurelyterminated due to therapist’s emotional attachment to a clientrepresenting a form of symbiotic interdependence. Thecounselor’s personal and unresolved issues ofseparation/individuation and parent/child bonding becomeinterwoven with client’s ambivalence between the desire forcontinued intimacy versus freedom. Therapists mayterminate therapy prematurely if they feel threatened by thesedynamics, contrarily, they may unnecessarily extend therapyif wishing to avoid the sense of loss that results fromseparation. Premature therapy termination can cause client tofeel abandoned leading to regression, isolation, rejection,bitterness, and debilitating anxiety. Lack of confidence andexperience together with a desire to punish the “heartlessparent/therapist,” can cause recurrence of client symptomsand exacerbate them given the new feelings of anger andbetrayal. Prolonged therapy can induce client dependencyupon therapist and lower probability of personal autonomy.Many therapy failures occur because therapists are not awareof their own dependence or that of their client, therefore, thissymbiotic intimacy is not confronted and resolved.13 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSTransference is a potential cause of unrealistic perceptionin relationships and may be defined as “the client’sexperience of the therapist that is shaped by the client’s ownpsychological structures and past and involves displacementonto the therapist of feelings, attitudes, and behaviorsbelonging rightfully in earlier relationships” (Gelso & Hayes,1998, p. 51). Being aware of transference in therapy isrelevant because it is believed that the therapeuticrelationship evolves into a replication of other relationshipsin the client’s life (Teyber, 2000).The therapist’s own unresolved issues and characterdefenses can create countertransference suggesting that theremay be a pattern in each of us regarding the typical errors wemake, situations we misperceive, and the failed therapy caseswe encounter. Our own feelings of anger, fear, or love maysabotage progress with certain clients or may compel us towork overtime with other clients. Fortunately, therapistresistance, countertransference, and blockages aremanageable through self-awareness, self-monitoring,supervision, and if needed, personal counseling – often, it isundiagnosed concerns and disguised feelings that perpetuateour therapy failures. Many therapist issues are recognizablebut many are still beyond our awareness at any given time,thus highlighting the need to know how to avoid failure aswell as the need to learn from it.Mohr (1995) indicates that therapist lack of empathy,under-estimation of the severity of client’s problems, andnegative countertransference are related to negative therapyoutcome; additionally, disagreement with client regarding theprocess and content of therapy may yield poor results. Mohrprofesses, “Certainly, it cannot be too much to ask that we dowhat we ask of our patients – to examine our failings with anopen mind and with a view toward change.” Unfortunately,this researcher believes that the field of psychotherapy haschosen to avoid looking at negative outcomes and seldomreports them. He contends, “To the extent that the fieldavoids examining when psychotherapy fails, the fieldsucceeds only in limiting its own potential” (p. 24).Case studies and surveys on sexual involvement withtherapists and other therapeutic errors have been correlatedwith client deterioration. Pope and Tabachnick (1994)surveyed psychologists who were in therapy and found that22% felt the therapy was harmful due to the followingreasons: sexual acts or attempted sexual acts, therapistincompetence, therapist emotional abuse, therapist failure tounderstand them, and boundary violations.Another common therapist-client interactive variableleading to failure is counselor’s attitude of “I’ve seen it allbefore.” Experienced practitioners can become jaded intothinking that most new clients present with only a fewscenarios that are routinely repeated. For example, clientanger toward counselor may be automatically deemed“transference reaction” or shyness always means “poor selfesteemand fear of rejection.” These assumptions based onpast experience can be faulty as each individual is unique andpresents with a different history, personality, and perceptionof the world, regardless of symptoms appearing similar. Wemay then see a culmination of past events rather than what isreally there. Beginning therapists may fail with a particularclient due to lack of experience, whereas, if not cautious,veterans may do so through neglect and a waning energylevel.Excessive therapist self-disclosure can cause the client tofeel bored, ignored, and minimized and lead to clientterminating therapy. Effective usage of self-disclosure mayproduce bonding, modeling, empathic understanding,sincerity, authenticity, and can assist in moving throughclient resistance, denial, and aloofness. Concern arises whentherapist offers long and tedious self-revelations that maynegate client’s worth by implying who is really the importantone in the process, in fact, self-disclosure is one of the mostabused interventions. Therapists can also lose their value asa neutral transference figure through talking too much aboutthemselves because client may conclude “this therapist is justlike me” and they may then question the value of attendingtherapy. Revealing too much of one’s life story, trying toconvince clients of their next step and to view things the waywe do can overwhelm them into thinking that they mustconform to only one option which might stifle their personalgrowth and self-exploration.Failed therapy often occurs when clinician underestimatesthe psychopathology, which slows progress, and whenexcessive patience and tolerance is granted toward client whoviolates basics of the treatment contract such as lateness, noshows,noncompliance, late payments, and continued druguse. Additionally, Lambert and Bergin (1994) determinedthat severely disturbed clients treated with techniques thatrely upon breaking down defenses and challenging typicalpatterns of behavior or coping strategies are more likely toexperience negative outcomes. They also suggest thatintense groups with coercive group norms that promote brutalhonesty and quick fixes have been related to clientdeterioration.Contrarily, research has proposed that goal agreementbetween therapist and client can significantly assist indeveloping a positive working alliance and is associated withpositive treatment outcome, treatment engagement andtreatment compliance (Horvath & Symonds, 1991; Krupnick,1996; Martin et al., 2000; Tryon & Winograd, 2002).Definition and agreement on treatment goals is alsoassociated with client satisfaction, which, in turn, correlateswith greater treatment gains (Eisenthal et al., 1983; Holcombet al., 1998). The working alliance between therapist andclient as related to positive therapeutic outcome has receivedsignificant empirical support (Martin, Garske, & Davis,2000), whereas, disagreement on therapeutic aims betweencounselor and client can significantly hinder client progress(Tryon & Winograd, 2002). These studies collectivelyemphasize the importance of defining and negotiatingtreatment goals with clients at the beginning of therapy; thisprocess may assist therapists to articulate the relevance ofvarious treatments and to tailor treatments as needed(Uebelacker et al., 2005).14 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSSan Martin (2007) notes that clients present with numerousgoals that are only partially associated with their diagnosis,therefore, the potential for failure exists among manytreatments not designed to resolve issues beyond those ofpresenting symptoms. She recommends that clinicians assessclient treatment goals early in therapy and then activelydiscuss with client any treatment limitations that couldimpede progress. This open discussion might “strengthen theworking alliance, increase satisfaction, and reduce earlydrop-outs.”CONFRONTING THERAPY FAILUREThough therapy failures are generally viewed with disgust,they simultaneously present creative opportunities forpersonal and professional development given an open mindset.An accepting and probing attitude toward ourtherapeutic failures can foster:• Enlightening reflection• Positive change• Beneficial information• Useful feedback on the effect of taking action• Broadened flexibility• Learning to be humble• Heightened motivation• Enhanced frustration-tolerance• Improved creativity and experimentationKottler and Blau (1989) suggest five stages that therapistsexperience upon therapy-failure awareness: illusion, selfconfrontation,the search, resolution, and application. Thepractitioner’s experience level and how a negative outcome isdefined are two variables affecting movement through thesestages. During illusion, therapists live in denial and seeksomething or someone to blame other than themselves. Theemotions of fear, anxiety, and guilt that an unexpectedlynegative outcome is occurring fuel the search. The egopursues protection through distorting reality such as claiming“I’m not at fault, it’s the client.” Next, self-confrontationinvolves self-anger/blame/doubt while therapist takes selfresponsibilityfor the error and stops blaming others. Thethird stage, the search, is driven by a desire to determine whattruly happened, leading to information-seeking and a carefulstudy of the event and its causes. Similar to the datacollection phase during scientific research, therapists exploreand analyze various possibilities though self-study andutilization of all resources. This research facilitatesunderstanding the multi-dimensionality of the experienceculminating in a broader and healthier perspective increasinglikelihood of resolution. The next stage, resolution, focuseson attaining new insights and direction allowing therapists toprocess causes of the negative event within a manageableperspective. Although therapists may never know preciselywhat went awry, they understand and accept their role in theprocess. The last stage is application of new learning infuture work. Therapist feels more determined to workcompetently and more interested in ongoing learning.Confronting failure breeds confidence, professional growth,and an appreciation of our vulnerability, which is often thecompelling force for change and growth.Kottler and Blau (1989) recommend practitioners to askthemselves the following questions in honestly assessingtheir work:− What are my expectations of the client? Of myself?− What does the client expect of me? Of him-or herself?− Are my expectations congruent with the client’sexpectations?− What is my investment in this case? What do I need fromthe client?− How aware am I of the timing necessary for the process tounfold?− What reaction is triggered in me by this client?− What am I doing that is helpful?− What am I doing that is not helpful?− How may I be getting in the client’s way?− What changes can I make?− What outside resources can I tap? Colleagues? Experts?Literature?Examining our clinical work by asking such questions canengender greater receptiveness to new information anddiscovery.Veteran practitioners accept shortcomings andimperfections of others and themselves. Through self-study,they learn of their limitations, mistakes, and misjudgmentsand they work diligently to not repeat them. Certainly, byexamining our mistakes and forgiving ourselves we cantransform therapy failures into opportunities for enhancedpersonal and professional efficacy.CONCLUSIONThese practitioners agree that therapists are human andthereby susceptible to error of many types, includingmisperceiving client response, using inappropriatetechniques, not responding to client frame of reference, andhaving neurotic lapses themselves. Such mistakes often yielddiscomfort but also, hopefully, a desire to examine the flawedsituation, take self-responsibility, gain insight and move on.Lazarus echoes these thoughts by suggesting therapistsbenefit by maintaining a balanced view of therapy withrealistic expectations allowing them to take failure in stride.Consensus abounds among these prominent therapistsregarding how refinements in technique and theory resultfrom their successes and failures. They respect their failuresand personally reflect upon these negative outcomes withimprovement as the goal. Other strategies for dealing withfailure include Lazarus’s belief in working with modestexpectations (seeking a first down rather than a touchdown),and Ellis’s objective and systematic analysis of his errors forlearning purposes. Corey’s approach is to remain open togrowth after a mistake; he understands occasional errors areinevitable and he cannot control a client’s behavior but he15 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORScan control the decision to examine his behavior facilitatingimproved performance. The characteristics of self-honestyand a clear perception of reality are deemed vital forunderstanding one’s therapeutic strengths and weaknesses.Admitting and learning from our therapy errors can assistus in numerous ways:Promotes reflective thought – Processing mistakes leads tohealthy reflective action that can foster growth toward beingthe best we can be in this role. Desire to improve suggeststhe need to identify our weaknesses and build on ourstrengths.Imparts valuable information – Therapy errors can be viewedas simply feedback en route to a successful outcome ratherthan the end in itself. Generally, given trust, clients will bepatient as therapist seeks a combination of methods thatwork.Enhances flexibility – Awareness that a specific therapeuticapproach is not working with a given client ideally will leadto utilization of a different strategy. Often, greater flexibilitycan decrease the likelihood of bad therapy.Increases patience – If therapist and client are patient withone another while maintaining realistic goals andexpectations, and forgive one another’s miscalculations thensuccessful outcomes are more likely.Reinforces humility – Listening carefully and responding toclient’s needs is vital whereas therapist need to be right, towin power struggles, and to prove his or her way is the rightway can lead to ineffective therapy. Confronting our errorsand failures teaches us to accept and ultimately turnweaknesses into strengths.The therapy process may be a process in itself of failureand correction such that even the “prominent figures” in thefield are susceptible to making errors in judgment. Thequestion then becomes whether we have the courage to speakmore openly about our failures and subsequently make theappropriate modifications.REFERENCESBugental, J.F.T. (1988). What is failure in psychotherapy? Psychotherapy,25, 532-535.Coleman, S. (ed.). (1985). Failures in Family Therapy. New York:Guilford.Colson, D., Lewis, L., and Horwitz, L. Negative Outcome in Psychotherapyand Psychoanalysis. In D. T. Mays and C. M. Franks (eds.),Negative Outcome in Psychotherapy and What to Do About It. NewYork: Springer, 1985.Connolly, M. B., & Strupp, H. H. (1996). A cluster analysis of clientreported psychotherapy outcomes. Psychotherapy Research, (6), 30-42.Eisenthal, S., Koopman, C., & Lazare, A. (1983). Process analysis of twodimensions of the negotiated approach in relation to satisfaction in theinitial interview. The Journal of Nervous and Mental Disease, 171,49-54.Gelso, C. J. & Hayes, J. A. (1998). The psychotherapy relationship:Theory, research, and practice. New York: Wiley.Greenspan, M., & Kulish, N. M. (1985). Factors in premature terminationin long-term psychotherapy. Psychotherapy: Theory, Research, andPractice, 1985, 22 (1), 75-82.Grosse-Holtforth, M., & Grawe, M. (2002). Bern inventory of treatmentgoals: Part 1. Development and first application of a taxonomy oftreatment goal themes. Psychotherapy Research, 12, 79-99.Grosse-Holtforth, M., Ruebi, I., Ruckstuhl, L., Berking, M., & Grawe, K.(2004). The value of treatment-goal themes for treatment planning andoutcome evaluation of psychiatric inpatients. International Journal ofSocial Psychiatry, 50, 80-91.Hasler, G., Moergeli, H., Schnyder, U. (2004). Outcome of psychiatrictreatments: What is relevant for our patients? Comprehensive Psychiatry,45, 199-205.Herron, W. G., and Rouslin, S. (1984). Issues in Psychotherapy.Washington, D.C.: Oryn Publications.Hill, C.E., Nutt,-Williams, E., Heaton, K.J., Thompson, B.J., & Rhodes,R.H. (1996). Therapist retrospective recall of impasses in long-termpsychotherapy: A qualitative analysis. Journal of Counseling Psychology,43, 207-217.Holcomb, W. R., Parker, J. C., Leong, G. B., Thiele, J., & Higdon, J.(1998). Customer satisfaction and self-reported treatment outcomesamong psychiatric inpatients. Psychiatric Services, 49, 929-934.Hollon, S.D. (1995). Failure in psychotherapy. Journal of PsychotherapyIntegration, 5(2), 171-175.Holtforth, M. G., Reubi, I., Ruckstuhl, L., Berking, M., & Grawe, K.(2004). The value of treatment-goal themes for treatment planning andoutcome evaluation of psychiatric inpatients. International Journal ofSocial Psychiatry, vol. 50 (1), 80-91.Horvath, A. O., & Symonds, B. D. (1991). Relation between workingalliance and outcome in psychotherapy: A meta-analysis. Journal ofCounseling Psychology, 38, 139-149.Keith, D.V., & Whitaker, C.A. (1985). Failure; Our bold companion.In S.B. Coleman (Ed.), Failures in family therapy (pp.8-23). New York:Guilford.Kottler, J.A. (2001). Making changes last. New York: Brunner/Routledge.Kottler, J.A., & Blau, D.S. (1989). The imperfect therapist: Learning fromfailure in therapeutic practice. San Francisco: Jossey-Bass.Kottler, J.A. & Carlson, J. Bad therapy: Master therapists share their worstfailures. New York: Brunner-Routledge, 2003.Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins,J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance inpsychotherapy pharmacotherapy outcome: Findings in the NationalInstitute of Mental Health treatment of depression collaborative researchprogram. Journal of Consulting and Clinical psychology, 64, 532-539.Lambert, M. J., & Bergin, A. E. (1994). The effectiveness of psychotherapy.In A. E. Bergin & S. L. Garfield (Eds.), Handbook ofpsychotherapy and behavior change (pp. 143-189). New York: Wiley.Locke, E. A., & Latham, G. P. (2002). Building a practically useful theoryof goal setting and task motivation: A 35-year odyssey. AmericanPsychologist, 57, 705-717.Long, J. R. (2001). Goal agreement and early therapeutic change.Psychotherapy, 38, 219-232.16 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSMartin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of thetherapeutic alliance with outcome and other variables: A meta-analyticreview. Journal of Consulting and Clinical Psychology, 68, 438-450.Mohr, D C. (1995). Negative outcome in psychotherapy: A critical review.Clinical Psychology, 2, 1-27.Pope, K. S., & Tabachnik, B. G. (1994). Therapists as patients: A nationalsurvey of psychologists’ experiences, problems and beliefs. ProfessionalPsychology: Research and Practice, 25, 247-258.San Martin, D. (2007). Treatment goals of adult mental health patients: Aliterature review. Dissertation Abstracts International, 68 (4-B), 2670.Stiles, W.B., Gordon, L.E., & Lani, J.A. (2002). Session evaluation and thesession evaluation questionnaire. In G.S. Tryon (Ed.), Counseling basedon process research: Applying what we know (pp. 325-343). Boston:Allyn and Bacon.Stone, M. (1985). Negative outcome in borderline states. In D. T. Mays &C. M. Franks (eds.), Negative outcome in psychotherapy and what to doabout it. New York: Springer.Strean, H. S., & Freeman, L. (1988). Behind the couch: Revelations of apsychoanalyst. New York: Wiley.Teyber, E. (2000). Interpersonal process in psychotherapy (4 th ed.).Belmont, CA: Wadsworth/Thompson Learning.Tryon, G. S., & Winograd, G. (2002). Goal consensus and collaboration.In J. Norcross (Ed.), Psychotherapy relationships that work: Therapistcontributions and responsiveness to patient needs, 109-125. New York:Oxford University Press.Uebelacker, L. A., Battle, C. L., Friedman, M A., Cardemil, E V., Beevers,C. G., & Miller, I. W. (2005). Treatment goals of depressedinpatients and outpatients. Unpublished.17 Continuing Psychology Education Inc.

FAMOUS THERAPIST ERRORSTEST – FAMOUS THERAPISTERRORS6 Continuing Education hoursRecord your answers on the Answer Sheet (click the“NAADAC/CAADAC/CAADE Answer Sheet” link onHome Page and either click, pencil or pen your answers).Passing is 70% or better.For True/False questions: A = True and B = False.1. Therapist-induced failures can be minimized ifissues are detected early given counselor honestand objective self-analysis.A) True B) False2. Almost always, one specific reason to which weattribute unsuccessful therapy explains the entiretruth.A) True B) False3. Peggy Papp learned it is inappropriate to decideahead of time on a treatment method before evenmeeting the family and hearing their story.A) True B) False4. Violet Oaklander resolved that children cannotmanage a lot of expression of feelings all at onetime as adults can.A) True B) False5. Susan Johnson resolved that being empathic ratherthan judgmental with the client can facilitatetherapy.A) True B) False6. Excessive therapist self-disclosure can cause theclient to feel bored, ignored, and minimized andlead to client terminating therapy.A) True B) False7. Eliciting active client participation in thedevelopment of treatment goals has not been found toincrease commitment to goals and the probabilityof goal-attainment.A) True B) False8. Symptom relief appears to be the most importantclient reported goal across clinical settings but itis not the most frequently indicated goal.A) True B) False9. A common therapist-client interactive variableleading to therapy-failure is the practitioner’sattitude of “I’ve seen it all before.”A) True B) False18 Continuing Psychology Education Inc.This course, Famous Therapist Errors, is approved for 6continuing education contact hours by the NationalAssociation of Alcoholism and Drug Abuse Counselors(NAADAC) Approved Education Provider Program(NAADAC Provider # 438), the CaliforniaAssociation of Alcoholism and Drug AbuseCounselors (CAADAC Provider # 1S-07-397-1013),and the California Association for Alcohol and DrugEducators (CAADE Provider # CP40 909 H 1113).10. The most common causes of therapist-clienttherapy process failure are unresolvedtransference experiences or dependencyissues.A) True B) False11. An indication of __________ is highly suggestedwhen both therapist and client agree that there hasnot been an apparent change.A) counterresistanceB) therapy failureC) countertransferenceD) poor anger-control12. Studies have shown that the two most significantfactors in differentiating good from bad therapyare __________.A) the fee and client punctualityB) therapist assertiveness and utilization of humorC) depth or power of the therapy and how smoothlythings proceedD) confrontation and mirroring13. Gerald Corey learned from personal experiencehow group members often discount their innerreactions and relinquish their power in orderto __________.A) be heard in the groupB) seek justification for a group leader’s mistakeC) criticize other group membersD) be more assertive14. William Glasser disclosed that one of his therapeuticweaknesses was __________.A) to not listen effectivelyB) to avoid confrontationC) to be impatient and push client faster than expectedD) to lack empathy15. Arnold Lazarus believes that bad or ineffectivetherapy occurs when therapists __________.A) lack empathy and compassionB) do not hear their clientC) do not employ empirically supported techniqueswhen relevantD) all of the above

FAMOUS THERAPIST ERRORS16. Raymond Corsini believes that the idealtherapist ____________.A) utilizes only one therapeutic methodB) maintains a fair sliding fee scaleC) has a working knowledge of many therapeuticsystemsD) limits confrontational communication17. To Richard Schwartz, good therapy essentialsinclude _____.A) being more aware of our inner thoughts, feelingsand various partsB) monitoring variables that appear to be slowing thetherapy processC) avoiding placing all the blame on client when theprocess is not going wellD) all of the above18. Therapist resistance, countertransference, andblockages are manageable through _________.A) relaxation procedureB) avoidance behaviorC) self-awareness, self-monitoring, personalcounseling, and supervisionD) stress reduction techniques19. Admitting and learning from therapy errors canassist therapists in _____________.A) promoting reflective thoughtB) enhancing flexibilityC) reinforcing humilityD) all of the above20. Reflecting upon and understanding therapeuticerrors is deemed __________.A) not advised by respected practitionersB) relevant because it may lead to improvementC) rarely worthwhileD) hazardous in the long-termPlease transfer your answers to the Answer Sheet(click the “NAADAC/CAADAC/CAADE AnswerSheet” link on Home Page and either click, pencilor pen your answers, then fax, mail, or e-mail theAnswer Sheet to us). Do not send the test pages toContinuing Psychology Education Inc.; you maykeep the test pages for your records.Press “Back” to return to“NAADAC/CAADAC/CAADE Courses” page.Copyright © 2011 Continuing Psychology Education Inc.19 Continuing Psychology Education Inc.