Psychotherapy: Empathic Failures, Great & Small

There is no fun in psychiatry. If you try to get fun out of it, you pay a considerable price for your unjustifiable optimism. ~ Harry Stack Sullivan

            Despite the quote above, Harry Stack Sullivan seems to have a great deal of optimism about the human condition.  He does not believe that our emotional lives are fixed in the first few years of our lives, but created in every moment of our lives.  That is hopeful.  As a therapist, my goal is to enter into relationship with people, join them in that journey of their life, and hopefully help co-create a new reality.  There is nothing more meaningful and humbling than when this occurs.   Sullivan is also the person that points out that as therapists, part of the therapeutic process is recovering from a series of empathic failures on our part as we attempt to connect with our clients. 

            From the moment when the client enters our office for the first time, we attempt to get to know them and their situation.    We try to not overwhelm them by spending too much time on the intake paperwork.  We try to communicate our best understanding of what the client is dealing with and what he or she may be feeling.  In subsequent sessions, we sometimes forget small details of the client’s story and that may feel like a failure to the client who wants to be understood and remembered.  At times, we may presuppose a client is feeling one thing and not be attuned enough to them to realize that they feel something else.  These little failures on the part of the therapist can create small set-backs in the therapeutic process, but Sullivan suggests that the process of therapy is the recovery of the therapeutic relationship from such failures.  I am not an expert in Sullivan’s theory of Interpersonal Psychiatry, but I would imagine that when we begin to recover from such empathic failures in therapy, it helps us to be better equipped to deal with them outside of therapy and even be more tolerant when they occur.  Life is full of little disappointments and the ability to not define any relationship by those moments seems critical to the survival of relationships and authentic happiness.

            Then there are those OTHER moments.  From time to time, our emotional reactions or our misjudgments as therapists result in us having a huge lapse in empathy and completely missing our clients.  In 15 years of doing therapy, my experience has been that after my early years of training, these larger lapses in empathy were fairly rare.  When they occur, however, they often result in clients leaving therapy altogether.  This is one of the most difficult things to deal with as a therapist.  There are some therapists who tend to blame their clients for “lack of readiness to enter therapy” and there may be times when that is true, but as therapists we have to admit that sometimes we mess up.  I am not talking about the gross misuse of a client or horrible bending of the therapeutic boundaries, but the failure to connect with our clients in way that is meaningful. (The client may be fully justified in leaving, especially if the miss is egregious or happens a number of times.)  Many times these types of failures occur when we, as therapists, fail to keep our own emotions and relational “baggage” out of the therapy with another person.  Therapy is about the person in front of us and not about us.  A good therapist must have gone through some process (like their own therapy or another self-reflective experience) to maximize his or her ability to avoid these big empathic misses. 

            Each empathic miss, large or small, becomes an opportunity to learn.  It is a chance to learn more about our clients and more about ourselves.  The therapeutic process at its best is an interaction of two people for the benefit of one of them.  The therapeutic process is co-created by therapist and client and it is the therapist who needs to always be mindful of the process and tending to the client.  We are obviously not perfect at this.  Some are obviously better than others (and some are really bad), but the good therapist recognizes these failures, seeks supervision, does the hard work of introspection, and continues to seek to be better.  Our clients help us and help themselves when they realize that there is a process and that the process is co-created.  Conversation and connection create the holy space for both of us.