Bad Therapy

Bookstores around the country are filled with "how-to-do" therapy cookbooks.  Few of these books fulfill their promise of "teaching" the part-science, part-art of therapy.  Certainly the concept of "therapy" is a nebulous construct.  What exactly is therapeutic about therapy?  No one is really sure.  The book Bad Therapy by Kottler and Carlson is a unique offering into the "how to" do therapy literature; it is this, but it is also much more.

An implicit premise of "bad therapy" seems to be that students can learn about what to do (in therapy) by studying what not to do.  It is a clever approach, though knowing exactly what is bad therapy is difficult given the aforementioned idea that good therapy is so elusive to understanding. Each story in the book teaches a basic concept or skill central to "good" therapy through a story of mishap.  I found myself, notoriously fleeting of attention while reading, riveted to each story, trying like a detective to guess what the "mistake" was.  Sometimes right, sometimes wrong, I found myself learning or at least, reaffirming what I should know as a therapist.

What I like most about the book, however, is the "truth" uncovered by the different therapist's disclosures.

I dare say all therapists have bad sessions on occasion.  Some of us wonder if we are competent to do therapy, especially after an especially bad (perceived) mishap or interaction with a patient.  These fears are compounded by the fact that failures and mistakes are rarely discussed amongst colleagues, or in the literature.  Each perceived mistake is magnified and contrasted upon the backdrop of other's infallibility. Cognitively we know that others make mistakes too, but without seeing or discussing them, how can we be sure?

This type of book fills a very important niche in the pedagogical literature on psychotherapy.  Not only does it teach how to do therapy, but it also models the more human side to therapy: mistakes happen, therapists have insecurities, no one is perfect.

It also models the fact that, just as we want our patients to become more reflective in their lives, so to must we be reflective in our work. I'm sure that there are many therapists, either in practice or in training who believe that they are above mistakes or even, therapy, for themselves.  This "unawareness" has all the ingredients of disaster- though this type of therapist would likely not even recognize it.  To paraphrase Lao Tse, "the key to understanding is to first recognize ignorance" (at least this is what I keep telling myself).

I should add that in my all-too human "car-crash voyeurism" waited for a really juicy screw-up.  For better or worse, none really came; in fact some "mistakes" were somewhat lame.  Perhaps self-disclosure must have limits (these people still need to keep their jobs after all!). I recommend this book to all therapists, either in graduate school or out in the field. There are many household names (from our field) in this book.  It is nice to see that they are human too.

© 2003 Michael Sakuma
 

Michael Sakuma is Chair of the Psychology Department at Dowling College, Long Island, New York.