Bad Therapy: Master Therapists Share Their Worst Failures, the book
April 22, 2008
Bad Therapy: Master Therapists Share Their Worst Failures by Jeffrey A. Kottler and Jon Carlson was published by Brunner-Routledge in 2003. They interview 20 of what they call "master" psychotherapists some of whom I have heard of and some of whom I have not and ask them to describe a case of "bad" therapy which they conducted.
Some of the therapists made a distinction between "failed" therapy and "bad" therapy. All therapists, if they are honest, have cases where the therapy failed, but "bad" therapy implies more than just "failure". It implies that the therapist did something "bad" to cause the failure.
There also is a distinction between "bad" therapy and "unethical" therapy. Unethical therapy is blameworthy because the therapist intentionally misbehaved, and broke a code of ethics which they have promised to comply with and uphold. None of the therapists interviewed reported unethical therapy.
Bad therapy are the cases where the therapist blew it, bungled it, made mistakes which alienated the clients, and clients quit therapy feeling unhelped, disrespected, misunderstood, etc.
The most common cause of "bad" therapy is the treatment based on protocol or mental models in the therapist's head which he/she were hell bent on imposing on the client and the client's situation whether they were appropriate or helpful or not. Now days the debate is over "evidence based practice" vs. "client centered practice". The drive by a therapist to impose models of practice onto his/her work with clients is based on arrogance, narcissism, and insecurity. Rather than listening to clients and being responsive to the client's needs, concerns, and preferences, the therapist proceeds thinking that the therapist knows best leading to bad therapy.
It seems that most therapists mean well. They want to do good work and be helpful to clients, and they are saddened and embarrassed and sometimes feel guilty when they fail. A number of therapists say that they became humbler and were better able to learn from reflecting on their practice as they got older and had more experience.
Another thing which was apparent to me was the appreciation that good therapy is very very hard work. It takes an ability to be attentive and empathic in sustained ways with people who are emotionally distressed and often times with significant problems in functioning in important areas of their lives. I am struck how psychotherapy is marginalized, trivialized, and ridiculed in movies and popular culture and yet is soul saving and life saving in its mission and accomplishment. Perhaps psychotherapy gets marginalized because it makes people uncomfortable to think of our imperfection and difficulties in living our lives and achieving happiness as human beings.
Bad Therapy is not a great book. It probably holds little interest except for psychotherapists. I am somewhat disappointed with it and yet I find it interesting because it presents psychotherapists struggling with their own practice in helping people and that presentation puts a human face on the enterprise which is something of significant value as we strive to understand the practice of psychotherapy better. Kottler and Carlson and the 20 brave therapists who participated have made a contribution to the field for which I am grateful.
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