Bad Therapy

Master Therapists Share Their Worst Failures

Jeffrey A. Kottler, Jon Carlson

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135954048
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Bad Therapy offers a rare glimpse into the hearts and mind's of the profession's most famous authors, thinkers, and leaders when things aren't going so well. Jeffrey Kottler and Jon Carlson, who include their own therapy mishaps, interview twenty of the world's most famous practitioners who discuss their mistakes, misjudgements, and miscalculations on working with clients. Told through narratives, the failures are related with candor to expose the human side of leading therapists. Each therapist shares with regrets, what they learned from the experience, what others can learn from their mistakes, and the benefits of speaking openly about bad therapy.

Chapter 1 The Thing Is

Jeffrey A. Kottler

DOI: 10.4324/9780203890219-2

When I first greeted Frances in the waiting room, I couldn't help but notice that she was already in the middle of a conversation: However, she was alone. “… granddaughter isn't usually that bad. I think her mother knows this. I've told her so many times….”

“Hi Frances,” I said, far more cheerfully than I felt.

She glanced up for a second, then brushed by me as she walked into my office and planted herself in a chair. She continued the conversation with me even though I was beyond her view, still standing at the door.

Frances was a big woman who walked very, very slowly. She was probably in her mid-70s although her dyed brown hair and carefully applied makeup made her look ageless to me—like the prototypical grandmother. I'd rather not confess this so early, but there is no doubt that she reminded me of the worse characteristics of my own grandmother; she was controlling, meddling, and an expert at instilling guilt. To this day, I am still occasionally startled into shame because I haven't called my grandmother lately—she died over 10 years ago.

“It's not like I haven't warned her,” Frances continued, actually looking at me for the first time. I couldn't remember who she was supposed to be warning, but I knew it was hopeless to ask for clarification. She usually just ignored me.

I sighed, but mostly to myself. This was how our conversations usually started. Frances was so desperate for someone to listen to her that as soon as she heard my footsteps approaching the door, she'd launch into her litany of complaints. I guess she figured we could cover more ground that way. She wanted to suck every second of my attention she could.

In some ways, this was the easiest case I had ever handled. There were no debilitating symptoms I had to address, no emergency situation or crisis that had to be resolved. So far as I knew, Frances hadn't yet declared a goal that she wanted to work toward. It seemed that all she wanted to do was talk, and have someone, anyone, even someone she paid, to listen to her. It seemed like a simple enough assignment.

However, I became a therapist in the first place because I like to talk. At the very least, I enjoy some friendly, or even spirited, dialogue. After having spent a half-dozen sessions together, it quickly became apparent this old lady was not going to let me get a single word in. Believe me: I tried.

Well, I noticed that I'm doing it again, the it being that I'm blaming Frances for being an uncooperative, difficult client instead of recognizing that I was being a lousy therapist. In my own defense, let me say that even by my own exacting standards, I am actually quite a skilled practitioner. I even help people most of the time, and it doesn't take that long. But true confession time: this was just about the worst session I ever did, and I've had my share of doozies.

Let's see. There was the time I got so mad at a young woman who wouldn't dump her abusive boyfriend that I fired her in a moment of frustration, told her not to come back because I couldn't help her. She looked at me with complete despair and then left without a word. When I later called to apologize, she refused to speak with me ever again. I hope she got better care elsewhere.

Then there was the woman who decided to control our first interview by challenging my qualifications. Rather than going with the flow, I decided to fight back. I was feeling threatened but didn't realize it at the time. Within the first 15 minutes, I surrendered, telling her I didn't think we were a good match and that she should find someone else, someone “better qualified.” Okay, so I tend to pout a little.

Once I told her to leave, she refused to do so, claiming that I was the only one who could help her (if I'd had a supervisor on this case, I would have told him or her that this was a brilliantly executed paradoxical directive). It took another hour to pry her out of the chair. She was so angry with me she spent the next 3 days leaving threatening messages on my answering machine, talking until she filled up the tape. Then she started sending me presents ordered from the shopping channel, accompanied by cryptic notes that announced that maybe the enclosed item would help me to recover from my problems. I was certainly curious to see what was inside, but not enough to open them. Could have been a bomb.

It's nice to reminisce, I know, but back to Frances. What made this session so memorably awful is that there was really very little I had to do to help her: just listen compassionately; show her some respect and empathy; make her feel cared for.

Because she wasn't meeting my expectations as a good client—she was neither interesting, entertaining, or even in obvious pain—I didn't feel she was deserving of my full attention. I don't need that much from my clients, but I like them to change, to do it quickly, and then to be grateful (but not too grateful). Frances, however, was boring and she rambled a lot. She'd go off on a rant as if I wasn't even in the room. When I'd interrupt her with some brilliant interpretation, she'd ignore me. This really hurt my feelings, not to mention my sense of competence. So I'd pout.

During this one particularly bad session, Frances had been going on for some time about how her daughter was such an inadequate mother because she wouldn't handle things exactly the same way that Frances would. I must say that I was not only feeling spectacularly bored, but also angry. It was as if she were my own father scolding me because I wasn't bringing up my son right.

For a variety of reasons, I decided I'd had quite enough of this stuff. I hadn't been listening to her anyway for the previous several minutes, having enjoyed an elaborate fantasy about where I wanted to visit for my next trip. What the heck—she wouldn't let me talk anyway so I might as well leave the room in my head. At one point, I even pictured myself tiptoeing out of the door and returning about the time our session was over. She'd probably never notice I was gone, I complained to myself.

Finally, I'd had enough. I had to do something. It seemed ridiculous that I was being paid to just sit there. Didn't she know how smart and insightful I was? Couldn't she realize how much I could help her, if only she'd let me say something?

“Frances,” I interrupted her in voice that was hoarse from underuse. “… got an A- on his paper but this mother never said. …”

“Frances,” I tried again, this time loud enough to startle her. This saintly grandmother looked at me with a wounded expression and I started to feel terribly guilty, not because I had so rudely interrupted but because I had long ago stopped listening to her altogether. This gave me a brilliant idea.

“Look,” I said in a more moderate tone, “I need to say a few things to you. Can you listen for a minute?”

She crossed her arms and waited, but I could tell she was irritated with me. I noticed her glance at the clock as if to remind me that whatever I had to say, it had better be quick because she had a lot more ground to cover. I had been dying for this opportunity and now that it was finally here, I was feeling hesitant, thinking maybe I should just slip back into my accustomed role. “Look,” I said, starting again, “you have so much to say. You always have so much to say. But the thing is …” I stopped for a second to gather my courage. “The thing is … it's … um … it's …” and then with a rush, I blurted out: “It's really hard for me to listen to you.”

I looked at Frances to see how she was taking this. It was time to confront her, to tell her that she was tough to listen to because she was so self-absorbed, because she rambled so much, because she talked and talked but never listened. I had a pretty good idea this might be the source of her troubles in other relationships—with her husband, her daughter, and a few of her bridge partners. But there was no reaction at all.

I told her all this, and more. I used immediacy to share with her how I felt pushed away from her, finding it impossible to get close. I interpreted her fears of intimacy. I pointed out her lack of social skills. I confronted her resistance to looking at underlying issues. I even reflected what I sensed was her anger toward me at that moment. And I did it all in 5 minutes because I could see her foot tapping impatiently.

Frances looked at me and cocked her head, which seemed to be asking me if I was done. Was I sure there was nothing else I wanted to say? I smiled warmly at her and gestured back that she could respond now. As yet, she hadn't said a word, although I could see her lips pressed tight from the effort to restrain herself. I nodded again, indicating that I was truly done. I'd said what I had to say, what I'd wanted to say for weeks. “Go on,” I prompted her, “what do you think?”

“What do I tink?” she repeated in her faint East European accent, “I tink that daughter of mine had better change her ways or there's gonna be serious trouble in that house.” Then she was off again.

Incredibly, she didn't seem to have heard a single word I'd said. It was as if I were invisible, as if she were just renting my office as a place to rant and complain and whine.

Okay, I'm doing it again. I'm blaming Frances for being so difficult and ornery and uncooperative. I did such a poor job of conducting this session (and managing the case) that even now I refused to accept responsibility for our predicament. It was all her fault because she was ungrateful. Besides, she probably had some kind of brain disorder or attention deficit, or maybe hearing loss.

I became so frustrated and unappreciated that I spent the rest of the session retreating back into my fantasy. At the appointed moment when the session was over, I returned to announce it was time to stop. This presented its own challenges since Frances would continue talking to me as I escorted her out the door. Sometimes I'd find myself standing in the waiting room alone, realizing she was still in her chair jabbering away. Once I'd get her in the waiting room, as I closed the door, I'd hear her continuing to speak to me through the solid wood.

What Made This Session so Bad

Like so much of therapy—for both participants—a lot of the action takes place on the inside. Perhaps I could be forgiven (or forgive myself) for mistimed confrontations designed more for my own amusement than to help my client. Frankly, I'm pretty certain that Frances treated my clumsy interventions more as an annoyance than anything else. But what haunts me the most to this day was the extent to which I surrendered my compassion.

The really scary thing about this case is that I seemed to have helped Frances anyway (or something did). Her family members provided ongoing reports about how much easier she was to deal with lately. Although Frances would never have admitted it directly, even she mentioned on occasion that she enjoyed coming to our one-way conversations. When I think about how little of myself I actually gave to this woman, I still feel ashamed.

I failed this client, and myself, by being unwilling to remain present with her. She was challenging to spend extended time with; certainly she rambled a lot; mostly, though, she was just plain scared and this was the only way she knew how to keep things together, by focusing on others, trying to control family members, and keep me as far away as possible.

Bad therapy, to me, is not only determined by the outcome, that is, whether the client leaves a satisfied customer (as Frances did). It is also not defined by how good I feel about a session (whether I think I did a good job), nor is it a function totally of our joint assessment of how well we did together since, after all, this relationship does represent a collaboration. I'd love to buy the idea that it is the client who does the work, the one who determines whether therapy is successful or not, but that lets me off the hook. There are times when I really do a lousy job because I'm not present, because I'm lazy, because I do or say stupid things. If I have a good enough relationship with the person, I can usually recover and get things back on track as I seemed to have done with Frances.

Some would say that I'm too hard on myself, that I take too much responsibility for the outcomes, and to that, I plead guilty. But it's not something I care to change. As much as I would like to shift most of the responsibility onto my clients for their work, I also accept that I have a choice about how much I want to give, how hard I want to try, how inventive I want to be, how determinedly I want to work. Perhaps I am deluding myself about having more power than is possible for a mortal being, but that's how I do this job, and this is the price I pay.

So, what did I do that was so utterly putrid, so unworthy of my professional capabilities? Let me name them.

1. I felt disrespectful and judgmental toward my client. She had hired me to understand her and instead I blamed her for being the way she was. Clients come to see us in the first place because they can't work things out on their own, nor can they find useful help from their friends and family.
2. I became lazy. I gave up. I surrendered to my boredom. I took the easy way out and cruised. I refused to remain present, with her, and instead only pretended to listen, and to care.
3. I tried to “punish” Frances for failing to entertain me, for not letting me talk, for ignoring me, for not letting me help the way I wanted to. Rather than engaging her at the level that she was at, I needed her to move more quickly. I became restless and impatient.

Even this exaggerated self-condemnation is continued evidence of my need to suffer for my sins. If truth be told, on the larger scale of things, this was hardly the disaster I am making it seem. It is because this incident was so ordinary, so apparently harmless, that I remember it as my worst session and selected it as the one to write about. It shows me at a time when I functioned most ineffectively, operating on auto-pilot. I was feeling burned out, dispirited, and tired of practicing. Not only with Frances, but with others, I would periodically leave the room in my head.

Ever since this episode, I've been curious as to how often other practitioners escape their sessions in fantasy. Just as interesting to me is where they go. To make lists? Relive a pleasant trip? Plan an adventure? Lapse into sexual fantasy? I'd guess that somewhere between 30 and 50% of the time (depending on the client and the issues discussed), most therapists have left their sessions for a period of time. This happens for a number of reasons:

1. Boredom. We get tired of the routines. We have heard similar stories before. The client is repeating him or herself for the umpteenth time.
2. Threat. What is being presented is a little too close to home. It triggers our own issues. It stirs up things that we would prefer would be left alone.
3. Personal stuff. There are things going on in our lives that haunt us. It is difficult to concentrate on what is going on because we are upset about something. We are feeling angry, misunderstood, confused, or aroused by a relationship. We are mulling over something that we want to do, and how we want to do it. We are undergoing some personal trauma, transition, or crisis.
4. Laziness. We just don't feel like investing the hard work that is needed to remain focused. It is just so easy to drift off, to get into our own stuff, to let our concentration waver. Sometimes we are just plain depleted and tired.

With Frances, I wasn't there for her much at all. I just presented a shell that nodded occasionally, inserted a few uh-huhs, and spent most of the hour lost in my own fantasies of driving sports cars, climbing rock walls, undressing attractive women I'd seen that day, and reliving all the things I wish I'd said a little better to people I had been with earlier. I also counted the dots on the ceiling tiles, trying to estimate how many were in the room, and played imaginary piano notes with my right hand.

Is this all understandable? Sure. Forgivable? Most definitely. But for my clients’ and students’ sake it's important for me to remember this mediocrity so I don't settle for such laziness again.

What Others Might Learn

1. It isn't just when you do something dramatically stupid or graceless that you become a bad therapist, but also when you demonstrate benign neglect.
2. Being intensely self-reflective and self-critical has its benefits in promoting continued growth and learning, but also s...

Table of contents

• Cover Page
• Half-title Page
• Title Page
• Copyright Page
• Table Of Contents
• About the Authors
• Preface
• Acknowledgments
• Introduction The Good, the Bad, and the Ugly: Parameters of Bad Therapy
• 1. JEFFREY A. KOTTLER: The Thing Is
• 2. JON CARLSON: Stories Without Endings
• 3. PEGGY PAPP: A Public Humiliation
• 4. ARNOLD A. LAZARUS: A Huge Dose of Humility
• 5. VIOLET OAKLANDER: If I Learned Something, Then I Can Forgive Myself
• 6. RICHARD SCHWARTZ: The Critical Parts of Me
• 7. WILLIAM GLASSER: I Can't Wait Until You Leave
• 8. STEPHEN LANKTON: Speaking the Client's Language
• 9. FRANCINE SHAPIRO: I Need to Have Safeguards in Place
• 10. RAYMOND CORSINI: Don't Get Stuck With One Approach
• 11. JOHN GRAY: Being in Bad Therapy
• 12. FRANK PITTMAN: I Take a Lot of Risks
• 13. SAM GLADDING: I Zigged When I Should Have Zagged
• 14. SUSAN M. JOHNSON: I Felt Quite Helpless
• 15. PAT LOVE: Listening to My Inner Voice
• 16. ART FREEMAN: We're Not as Smart as We Think We Are
• 17. JOHN C. NORCROSS: 50 Minutes of Pure Hostility
• 18. LEN SPERRY: Letting Things Get Personal
• 19. SCOTT D. MILLER: I Should Have Known Better
• 20. MICHAEL F. HOYT I Was Blind at the Time
• 21. RICHARD B. STUART: I Expect Too Much
• 22. MICHELE WEINER-DAVIS: Struck by a Bolt of Lightning—Again!
• 23. Some Common Themes and Lessons Learned
• References