Mistakes that transform: Psychotherapists' perceptions of treatment mistakes that lead to therapeutic change

Barbara Sprayregen (1993)

This investigation was developed in order to explore the ambiguous notions of treatment mistakes and, especially, those particular errors that provide an opportunity for therapeutic change. Clinical mistakes have been viewed through the perspective of psychodynamic theories about the therapeutic relationship and the change process in therapy. A review of relevant literature determined that there is little clarity of articulation or understanding about treatment mistakes. An exploratory, qualitative research project was therefore designed in order to discover how experienced, psychodynamically oriented psychotherapists both think about and advantageously use treatment errors. The research design included a semi-structured format of conducting interviews. Theoretical ideas about mistakes, the therapeutic relationship, and the change process in therapy were elicited. Case vignettes about a circumscribed mistake which had been made and productively resolved with a client were obtained from eight subjects. Collected data was qualitatively analyzed and presented. Findings of the study indicated that a range of ideas exists about treatment mistakes and that such errors are viewed on a continuum which ranges from harmful mistakes to those that may be potentially useful for therapist and client. However, this multiform and complex group of mistakes is often denoted by the same word which is misleading. Furthermore, mistakes have been conceptualized as being interactive phenomena which are located within the dynamics of the therapeutic relationship. Treatment mistakes that become opportunities for therapeutic change have been perceived by the researcher as those particular types of errors which occur within the context of a "good" therapy and which are promptly recognized by therapists and integrated into the on-going treatment. Two forms of interactive mistakes were conceptualized: (1) mistakes involving the negotiation of closeness and distance within the therapeutic relationship; and, (2) mistakes consisting of intersubjective miscommunications between therapist and client. Furthermore, using such errors productively was perceived as being related to continually creating conditions of safety within the therapeutic relationship so that intersubjective differences may be identified and processed within the shared space of the therapeutic environment. Limitations of the investigation as well as its implications for research, theory, and clinical practice have been considered.