The art of being a failure as a therapist.

Too much emphasis has been placed upon how to be successful as a therapist and too little has been written about how to fail. Twelve steps for failing in psychotherapy are described within the proper ideological framework, and it is argued that any therapist can achieve this end with proper training. What has been lacking in the field of therapy is a theory of failure. Many clinicians have merely assumed that any psychotherapist could fail if he wished. Recent studies of the outcome of therapy, however, indicated that spontaneous improvement of patients is far more extensive than was previously realized. There is a consistent finding that between fifty and seventy percent of patients on waiting list control groups not only do not wish treatment after the waiting list period but have really recovered from there emotional problems – despite the previous theories which did not consider this possible. Assuming that these findings hold up in further studies, a therapist who is incompetent and does no more than sit in silence and scratch himself will have at least a fifty percent success rate with his patients. How then can a therapist be a failure? The problem is not a hopeless one. We might merely accept the fact that a therapist will succeed with half his patients and do what we can to provide a theory which will help him fail consistently with the other half. However, we could also risk being more adventurous. Trends in the field suggest the problem can be approached in a deeper way by devising procedures for keeping those patients from improving who would ordinarily spontaneously do so. Obviously, merely doing nothing will not achieve this end. We must create a program with the proper ideological framework and provide systematic training over a period of years if we expect a therapist to fail consistently. An outline will be offered here of a series of steps to increase the chance of failure of any therapist. This presentation is not meant to be comprehensive, but it includes the major factors which experience in the field has shown to be essential and which can be put into practice even by therapists who are not specially talented. 1. The central pathway to failure is based upon a nucleus of ideas which if used in combination make success as a failure almost inevitable. Step A: Insist that the problem which brings the patient into therapy is not important. Dismiss it as merely a ”symptom” and shift the conversation elsewhere. In this way a therapist never learns to examine what is really distressing a patient. Step B: Refuse to directly treat the presenting problem. Offer some rationale, such as the idea that symptoms have ”roots,” to avoid treating the problem the patient is paying his money to recover from. In this way the odds increase that the patient will not recover, and future generations of therapists can remain ignorant of the specific skills needed to get people over their problems. Step C: Insist that if a presenting problem is relieved, something worse will develop. This myth makes it proper not to know what to do about symptoms and will even encourage patients to cooperate by developing a fear of recovery. Given these three steps, it seems obvious that any psychotherapist will be incapacitated, whatever his natural talent. He will not take seriously the problem the patient brings, he will not try to change that, and he will fear that successful relief of the problem is disastrous. One might think that this nucleus of ideas alone would make any therapist a failure, but the wiser heads in the field have recognized that other steps are necessary. 2. It is particularly important to confuse diagnosis and therapy. A therapist can sound ex-