How Reliable Are Online Reviews of Psychotherapists?

In a New York Times editorial, The Wrong Type of Talk Therapy, Keely Kolmes, Ph.D., a psychologist in California, wrote about the problems with online reviews for mental health professionals--problems that occur for both clients and psychotherapists.  Another informative article about this topic was on SFGATE.com, 2-Star Therapist? Why Online Reviews Give Psychiatrists Anxiety).

How Reliable Are Online Reviews of Psychotherapists?

How Are Online Reviews of Psychotherapists Different From Other Consumer Reviews?

As Dr. Kolmes points out in her editorial, reviewing your plumber or the wait staff at a restaurant is different from reviewing your psychotherapist.  As an example, she says that chances are if a patron at a restaurant had to wait a long time for a meal, there were probably other patrons who experienced the same thing.  

But this isn't necessarily the case for a client's relationship with a psychotherapist.  Not only is the therapeutic relationship unique and personal, but what might not work well for one client would work very well for another.  What might annoy one client would be considered wonderful by another.  

Online Reviews of Psychotherapists and Mental Health Confidentiality Laws
As Dr. Kolmes points out, whereas plumbers and restaurant owners can respond to online reviewers, psychotherapists cannot due to confidentiality laws.  Psychotherapists are ethically and legally bound to maintain clients' confidentiality, so they cannot respond to online reviews whether they are positive or negative--even when the client provides their full name as the reviewer.  

So, anyone who reads a review of a psychotherapist online, who might not know that a therapist is not allowed to respond to the reviewer, might think that the therapist isn't interested in responding.

Reliability of Online Reviews of Psychotherapists or Other Mental Health Practitioners

Generally, there is a negativity bias with most reviews.  People are more likely to write negative reviews than positive reviews, so what appears online often isn't reflective of what most clients seeing a particular psychotherapist think of the therapist.

Also, there's often a "back story" to these reviews that online reviewers don't provide, so people who are reading the reviews often don't have the full story.

For instance, if the client came for a consultation for a particular type of therapy and the therapist assessed that the client isn't a candidate for this therapy, the reviewer might not reveal that the therapist explained the reasons and offered other services or offered to provide another referral (see my article: EMDR is a Transformative Therapy For Trauma, But There Are a Few Exceptions).

This is also true of rave reviews, which can be an over-idealization of the psychotherapist, or represent an erotic transference (see my article:  Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist).

Once again, the point is--whether the review is positive or negative--it is very subjective and personal.

How Online Reviews Are Harmful to Current and Prospective Clients

Many clients who post online reviews of psychotherapists use their names on the social media site without considering that their post is now available for everyone to see--including current and future employers.

While it's true, as Dr. Kolmes points out, that anyone can erase a review, there's no telling how many people have already seen the review.  An employer who is considering hiring a job candidate and who sees a ranting review might be concerned that this person might rant about them online too.  They might also be concerned that this person might lack good judgment or have little in the way of impulse control and, as a result, they shouldn't hire him or her. 

Prospective clients who rely on online reviews of psychotherapists--whether these reviews are positive or negative--are often getting a skewed view, as I mentioned earlier.

How Online Reviews Are Harmful For Psychotherapists

Whether or not a psychotherapist has a website, most private practice professionals are listed on online sites--whether they want to be listed or not.  These sites also encourage consumers to write reviews with no guidelines for how a review of a mental health professional is different from other reviews.   

A few negative reviews, whether they are justified or not, could ruin a psychotherapist's professional reputation, and the psychotherapist has little recourse since s/he cannot respond to the review due to confidentiality laws.

Medical Doctors and Dentists Are Also Getting Online Reviews and Taking Action

Within the last few months, I looked up the addresses for my eye doctor and my dentist, two professionals that I have seen for many years.  I consider them both to be top notch, dedicated professionals who go above and beyond for their patients.  This is why I was surprised and dismayed to see negative reviews for seemingly petty issues.  

In one case, a patient gave the doctor a negative review because she didn't like the way the doctor's biller interacted with her.  Based on what she wrote, it didn't seem like a major issue, but this patient gave the doctor the negative review.  

According to Dr. Kolmes, some doctors are taking action, based on advice from an organization called Medical Justice, by asking patients to sign an agreement that the doctor has control over any Web posting mentioning their practice.  Presumably, the idea is that it would allow the doctor to respond to a patient's negative review without violating confidentiality laws.  I'm not an attorney, but whether these agreements are legal is an open question in my mind.

Other Options to Online Reviews

Legal issues aside, I could foresee many problems if psychotherapists adapted the type of agreement that some doctors are using, and even more problems if psychotherapists actually responded to negative reviews, including damaging the therapeutic relationship.

I suppose one could argue that if the client is posting negative reviews--rather than speaking to the client directly--the therapeutic relationship might already be ruined.  But if a psychotherapist responds to an online review, it would surely be the final nail in the coffin for their relationship.  

I believe that it's a good idea for psychotherapists to ask clients for feedback from time to time to find out how they are feeling about the therapy.

If clients are encouraged to provide their therapist with ongoing feedback, it might reduce the likelihood that clients will feel they have no other option but to write a review online.  They would know that their therapist wants to hear and discuss the client's feedback.  

Beyond the momentary satisfaction that a client might get from writing a negative review, it usually doesn't accomplish much for the reviewer.  Many reviewers end up regretting their negative reviews when their anger has subsided.  It also doesn't resolve the problem between the client and the therapist. 

But if the client knows that s/he can discuss problems openly, it would open up an ongoing dialogue between the client and the therapist where, unlike an online review that the therapist might or might not see, they could actually work out any problems.  

This probably won't resolve problems for people who aren't clients, for instance--people who come for a one-time appointment or a consultation and never see the therapist again.  These people aren't clients until after the consultation when they decide to work together.  But for people who are actually clients, it might be a viable solution.

How to Communicate Your Dissatisfaction With Your Psychotherapist

Unfortunately, many people don't know how to communicate when something is bothering them about their psychotherapist or in their therapy (see my articles: Asking For What You Need in Therapy and  How to Talk to Your Psychotherapy About Something That's Bothering You in Therapy).

Some people, who feel too uncomfortable communicating anything negative to their therapists leave therapy prematurely (see my article: When Clients Leave Therapy Prematurely).

But there's a real missed opportunity when people hold back communicating their dissatisfaction directly to the therapist or leave therapy without ever saying anything.  This is especially true for people who were unable to communicate anything negative when they were growing up or who were not believed.

While no one enjoys hearing negative comments, psychotherapists are trained not to take criticism personally.  Also, when the problem is resolved between the client and the therapist, this is often helpful to the work and helps improve the therapeutic relationship (see my article: Ruptures and Repairs in Psychotherapy).

Getting Recommendations For Psychotherapy From Medical Doctors or From Friends

Rather than relying on online reviews, which are often unreliable, asking their doctor or a trusted friend for a recommendation for a therapist would be better.  

Although it would not be a good idea to see the same psychotherapist that a close friend is currently seeing, you could contact a therapist that your friend saw in the past.  This is especially helpful if your friend saw this therapist over time (rather than relying on an online review from someone who saw a therapist once or twice).  Also, you know your friend and know his or her judgment about these issues.  You can also ask your friend questions.

You might also want to meet with a few psychotherapists until you find someone that you feel comfortable with over time (see my article below about how to choose a psychotherapist).

Getting Help in Therapy

If you have been trying to resolve an emotional problem on your own without success, you could benefit from seeking help in psychotherapy (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to work through your unresolved problems so that you can lead a more fulfilling life (see my article: How to Choose a Psychotherapist).

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Parallel Losses For the Psychotherapist and the Client

Loss and grief are an unfortunate part of life, and it's one of the reasons why many people come to therapy (see my articles: Who Are You After Your Parents Die?,  Grief: The Emotional Impact of Losing Both of Your Parents and Coping With Grief).  There are often times in psychotherapy when the psychotherapist and the client are going through parallel losses.  In fact, this phenomenon occurs more often than most people would think (see my article: The Psychotherapy Session: A Unique Intersubjective Experience).

Parallel Losses For the Psychotherapist and the Client

This parallel process between the psychotherapist and client often benefits the therapeutic work because, through her empathy, the therapist has more to give to the client because she is going through a similar process.

In order for this process to be healing for the client, the therapist must be trained and skilled at being able to experience the client's suffering while, at the same time, dipping into her own experience briefly without getting lost in her experience.  

The psychotherapist's focus must be mainly on the client and, while their experiences might be similar in some ways, the therapist can't assume that the client's experience is exactly the same as the therapist's experience.

From my own experience as a psychotherapist and from what colleagues have told me about their experiences, it's often the case that a client comes to therapy at the same time that a therapist is having a similar experience.

Depending upon the psychotherapist's theoretical orientation, the therapist probably won't share her loss with the client, especially if it will impinge on their work, because the therapy is focused on the client and not the therapist.

There might be times when it is therapeutic for the therapist to share a similar personal experience with the client, but only if it is in the service of furthering their work together.

Let's take a look at how this parallel process between therapist and client shows up in therapy in the following fictional vignette:

Fictional Vignette: Parallel Losses For the Psychotherapist and the Client

Lois

Lois began therapy because her mother, who had advanced Alzheimer's, was rapidly decompensating both physically and mentally.  

Parallel Losses For the Psychotherapist and the Client

Her mother began showing signs of dementia about 10 years before.

Until recently, the decline had been slow and her mother still knew Lois and Lois' siblings.  But a month prior to Lois starting therapy, her mother was becoming increasingly confused and no longer recognized Lois and other family members.

The doctor at the skilled nursing facility where Lois' mother lived told Lois and her siblings that her mother's condition was worsening, and they discussed the treatment plan, including advanced directives.

Lois and her mother were close, and it was excruciating for Lois to see her mother deteriorate over time.  Prior to the dementia, her mother had been very sharp and active, so it was especially difficult for Lois to watch the mother she knew slowly disappear.

She found support at an Alzheimer's support group, but she found her visits to see her mother increasingly difficult.

Knowing that her mother's life would soon be coming to an end, Lois knew that she would need more than her support group.  She needed the one-on-one support of a psychotherapist.

From the first therapy session, Lois felt understood and cared about by her therapist (see my article: The Creation of the "Holding Environment" in Therapy).

In addition to helping Lois cope with emotional pain of watching her mother decompensate due to Alzheimer's disease, the therapist also provided Lois with practical information. 

Lois felt fortunate that she found a psychotherapist who was so knowledgeable about loss, grief and the practical issues involved with having a family member who has dementia.

Little did Lois know that her psychotherapist also had a mother who was suffering with advanced Alzheimer's disease, and they were both going through a parallel process.

Lois' therapist wondered if it would be therapeutically beneficial for her to disclose to Lois that she was also going through a similar situation.  But she sensed, based on things that Lois told her, that Lois needed something different from her at this point in time--she needed to feel that her therapist was outside the world of Alzheimer's disease, nursing homes and hospitals.

As a result, her therapist decided that there would be no therapeutic benefit to disclosing her personal situation to Lois, so she kept it to herself.  She didn't want to impinge on Lois' experience.

Even though her therapist didn't disclose her personal situation to Lois, Lois felt that her therapist was present with her in a way that she had never felt before with her other therapists--as if her therapist really understood what Lois was going through--and this was healing for Lois.

Two months before Lois' mother died, her therapist called her to let her know that she would have to cancel their next two appointments because she had a loss in her family.  

When they resumed work together, Lois expressed her condolences to her therapist.  She didn't ask if the person who died was close to her therapist because she already felt overwhelmed by her own emotions.  Sensing that Lois didn't want to know, her therapist didn't divulge that her mother had just died from complications of Alzheimer's.

When Lois got the call from the nursing home that her mother died the night before, she was grief stricken.  All along she was grieving for the changes in her mother.  Somehow, she thought that, since she anticipated her mother's death.  She knew she would be upset, but she didn't think she would be so upset.

After their father died a few years earlier, Lois' siblings looked to her for advice because she was the oldest, and now it was no different with their mother's death.  They looked to her for guidance and emotional support, so Lois was glad to have her weekly therapy sessions so she could get her own emotional support from her therapist.

Lois resumed her therapy sessions a week after her mother died, and she was relieved to feel enveloped in the caring and empathetic environment that her therapist created for her (see my articles: Why is Empathy Important in Psychotherapy? and The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).  

Parallel Losses For the Psychotherapist and the Client

She could feel her therapist's attunement to her, and there were times in her sessions when she felt she didn't even need to talk.  It was enough to be there and feel her therapist's empathy.  

Aside from her advanced clinical training and experience, her therapist also had her own therapy that she relied on for her support through the grief process.  

Her therapist had many years of experience helping clients to cope with grief.  As she listened to Lois talk about her feelings, she recognized the parallel experiences between them.  She sensed the similarities as well as the differences in their relationships with their mothers and their experiences of grief.

Just as Lois found these therapy sessions to be healing, her therapist also had an internal experience of how healing these sessions were for herself.

Conclusion

It's not unusual for a psychotherapist and client who are working together in therapy to be having a parallel experience--whether it's about loss, happy experiences, personal relationships or any other experiences.

Most of the time, if the psychotherapist is skilled, experienced and can contain her own experiences with appropriate boundaries, the client can benefit from going through this parallel experience with the therapist--whether the client knows about the parallel experience or not.

There are times when even the most skilled psychotherapists must be aware of their own limitations and not take on certain clients because they are aware that they have a particular emotional vulnerability to whatever the client is going through and the therapy wouldn't be beneficial for the client.  Usually these instances are more the exception than the rule.

The therapist usually makes a decision on a case-by-case basis, depending upon the client's needs and the therapist's comfort level with disclosure, whether or not to disclose her own experience.  For instance, in substance abuse treatment, therapists often reveal their own history with substance abuse because this is an accepted practice in substance abuse treatment.

Psychotherapists' disclosure is a topic where there are many different views.  While the therapist is expected to be genuine and no longer expected to be a "blank screen" with her client, the decision to disclose personal information or not must be viewed in light of whether it would be of therapeutic benefit to the client and not solely for the therapist's benefit.

Getting Help in Therapy

Whether or not to start therapy can be a challenging decision (see my articles: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent and Psychotherapy and Beginner's Mind).

Finding a licensed mental health professional who is right for you is a process (see my articles: How to Choose a Psychotherapist).

When you and your psychotherapist are a good match, you can benefit from your work together in ways that might exceed your expectations (see my article: The Benefits of Psychotherapy).

The healing process in therapy can lead to emotional breakthroughs and a more fulfilling life.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

See my other articles about Psychotherapy: My Articles About Psychotherapy.

The Psychotherapy Session: A Unique Intersubjective Experience

Over time, people who are in therapy come to appreciate the uniquely private space of the therapy room.

The Therapy Session: A Unique Intersubjective Experience

Considering how busy most people are these days, other than their therapy sessions, many people don't take the time to reflect on what's going on in their lives and to get objective feedback.

For many people, the psychological insights that they have about themselves occurs in their therapy sessions.

The Privacy of the Therapy Session
In recent times, privacy has been eroded to such an extent that there are few (if any) other places where someone can come in and say whatever is on his or her mind in an accepting, objective, nonjudgmental private place.

Making Connections Between the Present and the Past in Therapy 
It's also a unique environment where an experienced therapist is trained to help clients to make possible connections between what is going on now and the past, and to begin to understand the many different aspects of themselves.

Most people don't feel immediately comfortable divulging a lot of private information about themselves at first.  It takes time to build a relationship with a therapist and to establish a rapport.

The Therapeutic "Holding Environment"
The attuned therapist creates a comfortable, secure environment for the client where the client feels heard and cared about (see my article:  The Attuned Therapist Creates a Therapeutic Holding Environment).

During the initial therapy sessions, it's important for the client and the therapist to each assess if they are a good "match" to continue to work together.  There aren't any specific steps for the client to determine this.  Mostly, I recommend that clients trust their intuition.

The Therapy Session: A Unique Intersubjective Experience

For the therapist, it's important that she work within the scope of her knowledge and skills.  So, if a client is looking for a therapist with a particular specialty, it's important for the therapist to reveal whether or not this is one of her specialties.

When it's a good match, over time, clients develop a comfort level where they feel they can talk about anything with their therapist.

Of course, there will be times when clients will feel ashamed to talk about certain topics, but it's important to remember that most experienced therapist have heard just about everything and, most likely, won't be shocked by what clients say.

Having a compassionate, skilled therapist and the time and place to talk about whatever is on a person's mind is a very freeing experience that is rare.

Many people, who are in therapy, look forward to attending their therapy sessions because it's such a unique experience where they have their therapists undivided attention and the time is dedicated to them.

Unconscious Communication:  The Intersubjective Space Between Therapist and Client
Clients and therapists often talk about getting into a particular intersubjective space that is unique to their particular therapeutic relationship (see my article:  The Psychotherapist's Empathic Attunement).

Within this intersubjective space, there is a form of unconscious communication between client and therapist that is particular to that client-therapist dyad.

As a result, there is more being communicated than the words that are being spoken.

There is also a latent communication that therapists, who are trained to work with unconscious communication, experience on a felt sense level.

Many clients will often talk about how they also sense this unconscious communication that is part of the intersubjective space between client and therapist.

Although there is always unconscious communication between people who are together, the unconscious communication between therapist and client is more focused than it would be between two other people and it usually develops over time.

When there is a good match between a therapist and client, it's not unusual for a therapist to intuitively sense what a client is about to say or for a client to sense what a therapist is about to say.

This is because this unconscious communication is "in the air" between them.

Choosing a Therapist
Thinking of the first session as a consultation is a good way to approach that first session.

Not only are you talking about your problems in a broad way, you're also getting a sense for whether you feel comfortable with the therapist.

You might not be able to tell in the first session, but after the a few sessions, you usually get a sense as to whether it's a good match.

For more information about how to choose a therapist, see my article:  How to Choose a Psychotherapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, see my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Psychotherapy: Ruptures and Repairs Between You and Your Therapist

In the last two blog articles, I discussed transference in psychotherapy in the context of the erotic and the idealized transference( Psychotherapy and the Erotic Transference and Psychotherapy and the Positive Transference). I also mentioned "ruptures" in treatment and discussed this briefly. 

In this post, I would like to focus on the effect of ruptures in treatment and how they can be repaired so that the therapeutic relationship between therapist and client can be preserved and, in many cases, even thrive after a rupture.

Psychotherapy: Ruptures and Repairs in Therapy

What are Ruptures in Psychotherapy?
In any long-term psychotherapy, there are bound to be treatment ruptures. Usually, these ruptures occur when the therapist unwittingly commits an empathic failure with the client. Even the most empathic psychotherapist will, at times, either misunderstand what a client is saying or give a response that is less than empathic. This is usually not intentional. It's a mistake.

When a client, especially a client who might be emotionally fragile, feels that his or her therapist has been either insensitive or doesn't hear or understand what the client is saying, the client often experiences this as a rupture in treatment. 

Sometimes these ruptures are small, as when a therapist forgets a particular small detail of a client's history and this becomes obvious to the client. And sometimes, these ruptures can be big, and I'll give an example of this later on.

Whether the rupture is perceived by the client as big or small is determined by many factors, including the strength of the therapeutic relationship at the time of the rupture, how fragile the client is feeling what the therapist actually did or said and so on

If the therapeutic alliance is strong and there haven't been many ruptures in the past, clients can overlook a therapist's mistake, especially if the client knows that this was a mistake. 

However, if the client and therapist have just begun to work together or if there have been frequent ruptures or if the client has a personal family history where he or she was neglected or abused, any kind of empathic failure can lead to a big rupture between client and therapist.

If there are egregious offenses by the therapist, like sexual boundary crossings or other serious offenses, this not just a rupture. This is a serious ethical and legal breach, and that's not what I'm referring to in this article.

How Can Ruptures Be Repaired?
If we consider that in most long-term psychotherapy treatments there will be inevitable and unintentional empathic failures or mistakes on the part of the therapist, how can these empathic failures be addressed and repaired so that the rupture doesn't lead to the failure of the treatment?

The most important part of repairing a rupture in treatment is for the therapist to be able to acknowledge that he or she made a mistake. Except for the most narcissistic psychotherapists, most therapists can and will do this. Even if it wasn't originally perceived as a "mistake" by the therapist, once the client feels misunderstood or not heard, the therapist needs to acknowledge and take responsibility for it.

Almost any rupture, if it's not egregious, can be repaired in treatment if the therapist acknowledges that he or she either made a mistake or failed the client in some way. For most clients, the acknowledgement on the part of the therapist that there was a mistake or the client was hurt in some way is often enough to repair the treatment.

Ruptures in Therapy Can Be Repaired

Many clients have grown up in homes where their parents never owned up to mistakes they made, so the experience of having the therapist take responsibility for an empathic failure can be reparative in itself, especially if the client feels that the therapist's acknowledgement is heartfelt.

Even Experienced and Skilled Therapists Can Commit Unintentional Empathic Failures:
I remember early on when I was training to be a psychotherapist at a psychoanalytic institute, my peers and I were very concerned about making mistakes in treatment. As therapists in training, most of us feared that our inexperience could lead to irreparable damage to clients.

In the context of a discussion about empathic failures, one of our instructors, who was much admired, told us a story about a rupture in treatment due to an empathic failure that he had committed with a client. 

Before I discuss what the empathic failure was, I should mention that not only was this instructor much-admired by the psychoanalytic trainees and faculty, but most of the trainees had a strong idealizing transference for him, which relates to my prior blog post.

Most of us, at the time, were very surprised that someone of his talent and skill could make such a mistake. This is another example of the effects of the idealizing transference between students and instructors.

Our instructor was well aware of this and he used the story he told us not only to show that ruptures can be repaired in treatment but in his humility, to show that even seasoned and skilled therapists can make mistakes in treatment. He didn't want us, as therapists in training, to be so afraid of making a mistake that we would be too self conscious with clients, which would have, in and of itself, interfered with treatment.

His main point in telling us about a mistake that he made was: While it's not great to make mistakes with clients, in most cases, it's not so much about the mistake that leads to the rupture-- it's more about how the therapist handles the mistake and repairs the rupture.

To that end, he told us about a time when he forgot about a client's appointment and he left the office. The client had been coming to treatment for a few years, and he had a great deal of difficulty trusting people, including his therapist.

During these sessions, the client often talked about wanting more from the therapist in terms of being more like friends rather than client and therapist. Since this would be an ethical breach of the treatment frame, the therapist explained, as gently and tactfully as possible, that this wasn't possible and explained the reasons why.

Most clients would understand that the client-therapist relationship, albeit caring and, at times, intense, is still a professional relationship. However, some clients, for a variety of reasons (sometimes, due to a history of neglect or abuse), want more from the therapist and it's up to the therapist to preserve the safety of the therapeutic relationship and the treatment to maintain the treatment frame.

All of this is to say that, even after a few years of treatment where the client came multiple times per week and kept his appointments, the therapy sessions were often rocky because the client wanted a more personal relationship with the therapist and, in some ways, he felt deprived that the therapist would not give in to his wishes.

So, in a nutshell, that's the background of the case, and you can picture many sessions where the client attempted to get the therapist to break the treatment frame and the therapist was holding the line for the sake of the client's emotional safety, although the client didn't realize it at the time.

One day, the therapist received a call from his young daughter's school that his daughter was sick and he needed to pick her up from school. At the time, the therapist had a very busy schedule that included a full-time private practice; being an instructor and supervisor at the psychoanalytic institute; involvement in various professional committees, and so on.

Tired, distracted and focused on his concerns about his daughter, he left the office completely forgetting about the client's appointment. He picked up his daughter, brought her home, and called the pediatrician. Fortunately, it turned out to be only a cold, and his daughter went right to sleep.

Relieved that his daughter didn't have a major illness, the therapist began to relax after a busy, stressful day. It was only then that he realized that he had forgotten about his client, something that had never happened to him before in his many years of practice.

Being very concerned, he called the client to apologize, but the client was too upset to accept the apology. He didn't tell the client that he had to pick up his daughter. It would have been too hurt for a client, who wanted more of a personal relationship from his therapist, to feel that the therapist's daughter took precedence over him. He simply apologized and told the client that he was called away from the office, he forgot about his appointment, and he was deeply sorry.

As an aside, one could speculate as to whether there was an unconscious wish on the part of the therapist to avoid dealing with this client on this particular day. While this might have been a factor, if and when that occurs, it's up to the therapist in this situation to do some self-analysis to explore this question.

In any case, the client was unable to accept the therapist's apology immediately. In fact, he focused on this empathic failure and the rupture in the treatment for about two months in every session. They were unable to move beyond this problem and it consumed the client's thoughts. Not only was the client very angry, but he was very deeply hurt that the therapist forgot about him.

This empathic failure fed right into his worst fear that the therapist really didn't care about him and he wasn't important to the therapist which, of course, was not the case at all. However, for a client who grew up with emotional neglect, he was very sensitive to any kind of empathic breach. In many ways, he was always vigilant and suspecting that this would happen because he found it difficult to trust people. So, in terms of empathic failures, this couldn't have happened to a more emotionally fragile client.

The therapist knew the client was unconsciously"testing" him. The therapist needed to withstand the client's anger and hurt to show the client he cared about him. 

After a few months of the client venting his anger and hurt and, together with the therapist, making connections to how this empathic failure triggered his history of emotional neglect, over time, the client and therapist were able to repair their relationship.

What's more, the relationship was more than just repaired to its former state, it was actually enhanced. 

Over time, the client was able to see that his therapist actually did care about him a great deal and that the empathic failure was an unintentional mistake. He realized that his therapist was human and he let go of some of his idealization (much as I and the other psychoanalytic trainees did on the day when our instructor told us this story).

Feeling cared about, over time, the client stopped demanding that the therapist be his friend. He realized that it was enough that the therapist was compassionate and cared about him.

As psychotherapists in training back then, we were much relieved to hear that, even a therapist who was known to be highly skilled, could make such a mistake. It served to take a lot of pressure off us, and I've always remembered this story.

For most clients, a sincere and caring apology can go a long way to repairing a rupture in treatment. And, in many cases, the reparative experience is more important than the rupture.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 or email me.