Should Therapists Admit to Making Mistakes in Therapy?
Curt and Katie chat about what therapists can do to effectively navigate their own mistakes in the therapy room. We look at what constitutes a mistake in therapy, the types of mistakes that therapists make, and considerations on how to address mistakes. This is an ethics continuing education podcourse.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about how modern therapists can navigate making mistakes
When therapists make mistakes, clients can prematurely terminate treatment or fail to meet their goals. Most research on effective therapy looks at factors that minimize the therapist’s tendency to make mistakes, rather than what to do when they happen. However, focusing on the effectiveness of handling mistakes is one of the factors that clinicians can actually control. This workshop focuses on how effectively handling mistakes made by therapists and the mental health system can lead to better outcomes for clients.
What should therapists do when they make a mistake?
“I definitely feel like there is an element to [making mistakes] where I like the humanity of it. I hate making mistakes. But I like the humanity and the conversations that happen and the deepening of the relationship most of the time.” – Katie Vernoy, LMFT
- Looking at the humanity of the therapist
- It is important to define what is actually a mistake
- Looking at where mistakes can happen within treatment
- Mistakes can be defined based on the definition of success
What types of mistakes do therapists make in therapy?
- Incorrect or mismatched treatment without adjustment
- Treatment failures happen for many different reasons – what is a mistake versus a work in progress?
- Mistakes can be based on the individual client or therapist factors and the focus of the therapist in the therapeutic work and relationship
When should therapists admit mistakes?
“A lot of the complaints that [the CAMFT ethics committee] end up seeing…[are] where just a clinician making a relationship repair sort of action would have just prevented a whole lot of bigger feelings developing.” – Curt Widhalm, LMFT
- Consideration of whether admitting the mistake will harm the client
- Going beyond “non-malfeasance”
- Exploring how clients like to handle a mistake
- Paying attention to therapist’s own preferences or bias
- Understanding when and how to take responsibility for what you’ve done as a therapist
- Avoiding the impact on the client that they believe that they have made the mistake
- Making sure therapists are resourced when they engage in this process
What are the systemic errors in mental health treatment?
“Overall, as a field, we still tend to blame a lot of failed psychotherapy on patients.” – Curt Widhalm, LMFT
- Taking a global view to therapy can allow for seeing the other elements and systems
- Recognizing the limits of what therapists can do to solve clients’ concerns, including due to agency policies
- Harm caused by the profession and professional associations (statements made, research completed, etc.)
Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide
Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!
Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.
You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/should-therapists-admit-to-making-mistakes-in-therapy
Continuing Education Approvals:
When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.
CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Contacting Curt: curt@therapyreimagined.com
References mentioned in this continuing education podcast:
American Psychological Association Council of Representatives (2021). Apology to People of Color for APA’s Role in Promoting, Perpetuating, and Failing to Challenge Racism, Racial Discrimination, and Human Hierarchy in U.S. Retrieved from https://www.apa.org/about/policy/racism-apology
Gazzola, N., & Iwakabe, S. (2022). Psychotherapy failures: to err is human. Counselling Psychology Quarterly, 35(4), 719-723.
Knox, S., Miller, C., Twidwell, R. E., & Knowlton, G. (2023). Client perspectives on psychotherapy failure. Psychotherapy Research, 33(3), 298-315.
Małus, A., Konarzewska, B., & Galińska-Skok, B. (2018). Patient’s failures and psychotherapist’s successes, or failure in psychotherapy in the eyes of a psychotherapist. Archives of Psychiatry and Psychotherapy, 3, 31-41.
Medau, I., Jox, R. J., & Reiter-Theil, S. (2013). How psychotherapists handle treatment errors–an ethical analysis. BMC medical ethics, 14(1), 1-9.
Mizock, L., & Lundquist, C. (2016). Missteps in psychotherapy with transgender clients: promoting gender sensitivity in counseling and psychological practice. Psychology of Sexual Orientation and Gender Diversity, 3(2), 148.
Wampold, Bruce E; Imel, Zac E (2015) [2001]. The great psychotherapy debate: the evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.
*The full reference list can be found in the course on our learning platform.
Relevant Episodes of MTSG Podcast:
Dual Relationships – Pros and Cons
It’s the Lack of Thought That Counts: Ethical Decision Making in Dual Relationships
Why Is Therapy Taking So Long? The causes and solutions for therapeutic drift
What Can Therapists Do When Clients Don’t Get Better?
Is BPD a Genuine Diagnosis or a Dismissive Label?
It’s NOT a Chemical Imbalance, An Interview with Dr. Kristen Syme
Liability Hot Potato: Defensive Therapy practices that give clients inadequate care
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:15
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.
Katie Vernoy 0:47
Once again, hop over to moderntherapistcommunity.com or one CE once you’ve listened well.
Curt Widhalm 0:54
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, Katie Vernoy. And this is the podcast for therapists about the things that we do in our profession, the things that we do in our sessions, and many other things. And this is another one of our CE eligible episodes. Listen at the beginning and the end of the episode or check out our show notes over at mtsgpodcast.com for how you can get some CEs for this episode. This episode is dealing with mistakes, and kind of how they happen, what we do in response to them, should we even admit to them, and kind of all the different levels within therapy as far as how mistakes can end up happening even beyond just what you do as a clinician or what happens in your therapy room. So starting off with just kind of maybe the first question here is, Katie, I’m assuming you’ve made some mistakes in therapy I have. I know. I like to, in my mind, reframe them as learning opportunities or opportunities to get back to Alright, what are we actually working on here? But do you admit when you make mistakes clients?
Katie Vernoy 2:13
Most of the time, I think I do. I think our conversation will be much more nuanced than a yes or a no answer. But I definitely feel like there is an element to this where I like the humanity of it. I hate making mistakes. But I like the the humanity and the conversations that happen and the deepening of the relationship most of the time. Certainly there are definitely I said a lot of certainly and definitely, you can tell like this is this is my feeling around mistakes. There are definitely times when mistakes have really harmed the relationship. And I’ve lost a client. Not frequently, but you know, I’ve been 21 years. So I do believe that there are going to be times that this for everyone that you make a mistake that hurts the relationship sufficiently that you lose a client. I don’t like those. But I am a human. And I feel like that’s part of my charm is being a human and having those teachable moments where we can admit mistakes and repair and all that good stuff. So so yes, I’m mostly admit my mistakes. How is how’s that for the answer?
Curt Widhalm 3:28
I’ll admit, maybe that was a little bit of an unfair question to start with, because it’s a fair question later. But I think in order to get to that question, we first have to define: What is a mistake?
Katie Vernoy 3:42
Yeah, I think that’s always where I want to start. Because I think it’s something a mistake is not necessarily a mistake, if it works out really well, right. I know I’ve talked in in different parts of our, you know, different episodes. And if I remember which ones they are, I’ll try to put them in the show notes. But I think there’s that element of I’ve said something a little bit unfiltered or a little bit sharper than I mean to. And there’s probably a confirmatory bias here, but it seems like when that happens, best intervention in the session.
Curt Widhalm 4:18
So I’m gonna start with as a 2018, article by Malus, Konarzewska, and Galińska-Skok, and this is from the Archives of Psychiatry and Psychotherapy. And to start with what is a mistake, we have to maybe look at what is therapeutic success. And some of this is going to be largely determined by your therapeutic school of thought. For example, early psychoanalysis, so we’re talking about Freud here, you know, his idea of what success was is the patient’s ability to love and work or in German leaving in arbeiten.
Katie Vernoy 5:06
That’s an interesting measurement of success. I actually don’t I don’t hate that
Curt Widhalm 5:11
More contemporary psychodynamic psychotherapist evaluate the efficacy of their work using terms like insight and personality change. The behavior therapists might look at the ability to accomplish something that was previously not accomplished. Other definitions might include the reduction of therapeutic symptoms or something like that. Where if we get into the common factors, kinds of things of Wampold et all we’re going to look at things like, Did the client reach the goals that the client set out to reach? So depending on your school of thought, that’s gonna give you a little bit of an idea first and foremost of like, where you should go. And that helps us to then further get to where you don’t get there does that…
Katie Vernoy 5:58
Or you don’t want to go.
Curt Widhalm 5:59
Or where you don’t want to. Now, I should probably say at this point that we’ll give some some credit to feedback informed treatment here. But this is not a feedback informed treatment episode. This is almost more philosophical in like, where some of the mistakes can end up happening, because…
Katie Vernoy 6:18
Oh, I love it. I love philosophy.
Curt Widhalm 6:21
Because within the schools of thoughts, if I’m a CBT therapist, and I look at the psychoanalysts, and they don’t reach the goals that I set out for them, it’s very easy for me to be like everything that you’re doing is a mistake. So part of this does come back to that, you know, wonderful, like, here’s therapeutic alliance sort of stuff. They get on the same page as your client as far as what you’re working for here. But part of setting yourself up for success is the ability to set the path together.
Katie Vernoy 6:56
Yeah, and we have a whole bunch of episodes on that. So we’ll definitely link to some of those in the show notes over at mtsgpodcast.com.
Curt Widhalm 7:04
So the school of thought that you have is then going to also talk about kind of the techniques that you employ. And some of the good treatment planning interventions that you end up doing should give you some guidance on what interventions that you should do when. But I think within this, we have to kind of talk about that there are different levels of mistakes that can end up happening. And the first one here that we’re going to talk about is just whether or not treatment is correct in the first place.
Katie Vernoy 7:41
Yeah, I think the biggest mistakes here are ones that probably won’t be admitted, which is like the sexual orient change, sexual orientation change efforts, things where it’s just bad treatment. But I think, which I don’t, I don’t think our modern therapists are going to be doing. But there’s also this this kind of mismatched treatment where I have either mischaracterized, misdiagnosed, whatever it is what’s going on with you, I I set out on a treatment that’s supposed to address what you bring you’re bringing in, and I’ve missed the mark. And so I think that’s, that’s a mistake, that can be a pretty tough one. But but when I look at therapeutic mismatches, whether it’s an intervention or a whole modality that doesn’t seem to line up for the client, I kind of classify that not as a mistake, but more of a failed experiment, an opportunity to continue to differentiate what is actually there, what’s not there, what’s going to align for the client, what’s going to not align for the client. I think if I kept doubling down on No, this treatment should work. Keep trying it. That feels very much like a mistake. But I guess we’re still in this place of Is it a mistake? Or is it kind of a failed experiment or work in progress? How do we how do we want to distinguish that? Does it matter, I guess, if we distinguish mistake versus work in progress.
Curt Widhalm 9:12
So, I’m going to refer to an article this is called ‘Psychotherapy failures: to err is human’ by Gazzola and Iwakabe. This is 2022 Counseling Psychology Quarterly. And in talking about psychotherapy treatments, they say: despite the consistent positive outcome findings in psychotherapists best intentions in their efforts to help clients, psychotherapy simply does not work in all cases. In fact, five to 10% of adult clients deteriorate during psychotherapy. Although not exclusively due to treatment failures per se. Almost 20% of clients terminate their therapy prematurely. Some studies report that 20 to 30% of clients do not return after the first session and half terminate after two sessions. And while it’s possible that people benefit from things, considerable proportion of participants in things like CBT, are not actually better at the end of treatment, despite CBT being held as the gold standard of treatment for many things, including some of the studies that examined things like depression and dysthymia, which I think most of us are going to say, Yeah, CBT approach is usually pretty straightforward with those kinds of things.
Katie Vernoy 10:29
Yeah.
Curt Widhalm 10:30
And so the authors here are positing that there’s a lot of reasons for treatment failures, but the approach of just kind of doing what’s a gold standard, because it’s a gold standard, doesn’t necessarily mean that we’re matching the correct treatments to clients who are presenting to us. And so this is something that we’ve talked recently about things like doing a good enough job during the intake to ensure that, here’s, here’s the right treatment plan, that we’re making sure that we agree on the right cause of things. We’ve had a number of episodes where we’ve at least made mention, if not fully dived deeply into things like depression has, like a million different causes.
Katie Vernoy 11:18
Yeah, yeah.
Curt Widhalm 11:19
And, you know, you can CBT the hell out of like, have a different perspective on like, poverty, and then you won’t be depressed any more.
Katie Vernoy 11:29
Yeah, yeah, I think there’s we’ll definitely link to Dr. Kristen Symes episode in our show notes. Because that the it’s not It’s Not a Chemical Imbalance episode really speaks to that. I think part of it, this is really our perspective, right? As clinicians, if we aren’t keeping our minds open or active, or whatever the right word is, and really continuing to look and not just kind of check boxing our way through treatment, I think we can get in trouble. And so I think we need to be able to do a better job with a differential diagnosis or case conceptualization, so that we continue to assess. But I go back to the question of, let’s say, I try CBT. And it doesn’t work. Is that a mistake? Or is that a work in progress? Because I think to me, there’s that element of, okay, we tried this, it didn’t work, let’s move on, is that admitting a mistake are just continuing to, continuing the treatment forward.
Curt Widhalm 12:28
And this is part of why I point out how many people don’t return after a session or two is, sometimes those clients that stick around for quite a while, we have the privilege and the opportunity of time to be able to say, hey, you know, things aren’t working, let’s reevaluate, and all of the all of the wonderful things that like fit people would say, and the things that, you know, alright, we have time let’s, let’s reevaluate what our goals are. But when we’re looking at premature dropout, we have to really make sure from the very beginning that All right, we’ve got to ask the right questions to make sure that we’re even going down the right path in the first place.
Katie Vernoy 13:11
Well, I think setting the stage as well for those conversations, because I think, in the first session, by and large, maybe not every single client, but my my goal in every first session is to say, we’re going to try stuff, and there are going to be times when it may not line up for what’s best for you. There might be times where you feel like I’m addressing something that’s not quite right for you. And so this is us working together, I want to collaborate on what we’re actually doing. So if you feel like I’m going in the wrong direction, let me know. Now that is obviously a treatment orientation of, you know, very attachment based, very relationship based, but I think I think it’s a good idea for most folks to open that pathway to have a conversation. So it isn’t a mistake. It’s a work in progress. But I I don’t want to belabor that point. I think we’ve got to it, but I think there’s that element of the mistake is not bringing in the feedback. And the mistake is in doubling down on something because it’s a gold standard. It should work. And so to me, I think I think we’ve successfully addressed kind of the mismatch treatment or the wrong treatment. Is there anything else in that type of mistake that we want to look at…
Curt Widhalm 14:26
No.
Katie Vernoy 14:26
…before we go into the other areas.
Curt Widhalm 14:28
Because I think a lot more of what is in clinicians control falls within this next category of things that this is also from that “Psychotherapy failure: to areas human’ by Gazzola and Iwakabe, and this is talking about the individuals involved. And that, you know, it’s a complex process. This is something where there’s been a lot written as far as common factors, but a lot of manualized treatment in and of itself is trying to minimize the variability in the clinician factors from person to person in order to make sure that it’s the treatment that works. And, you know, a lot of the common factors work around this ends up being like, okay, that’s not always true. And…
Katie Vernoy 15:21
Well, and you can’t minimize a lot of things about different people. I mean, we’re just going to show up differently, you know, in all different ways. So it’s, it’s sometimes it’s a fool’s errand, but I think it also in being so manualized doesn’t necessarily align with the client in front of you.
Curt Widhalm 15:36
Right. So there’s two parts of this, there’s the therapist individual factors, and there’s the client individual factors. And always the joke of like: How many therapists does it take to change a light bulb? Just one, the lightbulb has to want to change itself. That we tend to make a lot more of the individual factors on the client side of things end up becoming important here. And a lot of times that can show up in a lot in different ways for therapists as far as well, what kinds of mistakes are we making? You know, you’ve shared with me stories of like, Alright, I have told a client, like, I’m gonna challenge you more. And then…
Katie Vernoy 16:22
Yeah.
Curt Widhalm 16:23
…it’s like you challenge them, and then things kind of go sideways. And it’s like, well, I did what I said I was gonna do like, is that, in fact, a mistake?
Katie Vernoy 16:31
Yeah, yeah. Well, I think it’s something where when we’re looking at the individual factors of the client, it can feel very positive. And I think it is good to understand your client. But I’m thinking about our Humor in Psychotherapy episode, like, there’s also what’s different about us and how we might do an intervention that could both positively and negatively impact the client. And so I think it it’s interesting, because I guess I’m just reinforcing your point about the us more being more focused on the client factors. But what do you mean, specifically, when you’re talking about the clinician factors? Because I have my idea, what I was just saying, but like, it seems like there’s more to it than just that. And that’s something that that I think, by and large clinicians are maybe not as good at.
… 17:20
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Curt Widhalm 17:22
So I’m gonna start with a list here. And this one is going to start from a very specific article, but I think that this applies in a lot of other areas. This is from Psychology of Sexual Orientation and Gender Diversity, 2016, ‘Missteps in psychotherapy with transgender clients: promoting gender sensitivity in counseling and psychological practice’ by Mizock and Lundquist, and they identify therapy mistakes, therapy missteps with transgender clients. Things such as education burdening: relying on the client to educate the psychotherapist on transgender issues. Gender inflation: overlooking other important aspects of a transgender client’s life beyond gender. Or on the other end gender narrowing: which is applying preconceived restrictive notions of gender onto those clients. Gender avoidance: lacking any focus on issues of gender. Gender generalizing: making assumptions in psychotherapy that all transgender individuals are the same. Gender repairing: act in psychotherapy, as if the transgender identity of the client is a problem to fix. Gender pathologizing: stigmatizing transgender identity as a mental illness to be treated. Or gatekeeping, which is focusing on the psychotherapist role in controlling access to gender affirmative medical resources. Now, a lot of this in this article is focused on just work with transgender clients. But I think in any kind of work, we can still make the mistakes such as education burdening. Having our class have to be the ones who teach us about things. Having, you know, kind of the inflation aspect of overlooking other important aspects of a client’s life. Or narrowing, like I’m only going to focus on this very specific thing that you came in for it, I’m gonna ignore everything else. Or avoidance not even like focusing on the issues that clients are coming in with in the first place. So these are mistakes that can happen with any kinds of clients here. And I think that, you know, especially when it comes to mistakes, like education burdening, this is particularly something that I hear from, you know, the therapists that we hear back from a lot of the clients that like, I just don’t want to have to teach you about my culture in order to be able to get help and that leads, you know, to all the kinds of systemic problems that end up happening here.
Katie Vernoy 19:51
Well, as you were reading, I was like, ah, you know what this sounds like? Every single episode when we ask somebody, what do therapists get wrong? It’s by and large the same thing. It’s the education burdening, it’s over focusing on the problem, it’s under focusing on the problem. Like it’s, it’s, it’s pretty universal. I think it’s great that you found that that article, I think it’s important to recognize that it was specific to trans. But I, and I’m going to link to the whole section on special populations that we, because it’s not knowing what you don’t know. And it’s avoiding the things that you feel less comfortable about, or zooming in, to kind of feel like you’ve addressed it and not paying attention to the the human in front of you. That is, that is a great list. And I think we’ve had those conversations, probably 200 times on the podcast.
Curt Widhalm 20:44
Right. So these are mistakes that really are on the therapist’s end of things. And I think things that are transtheoretical, that no matter what theory that you’re coming from, you can get overly focused on any aspect or you can become overly avoidant on things. And it’s being able to get feedback from other people, as far as your case conceptualization and continued ongoing supervision or consultation or those kinds of things. And doing your own work to help clients just beyond kind of like, I’m going to show up, and I’m going to respond. But really understanding kind of where you come from is the fix to that. But at the core of this comes, these are the kinds of mistakes that we can make that are beyond things that are a little bit, I guess simpler, easier to point out. Things like forgetting your client’s name and calling them the wrong name. Or not showing up to the session, you know, having remembered what you talked about in the last session, or even
Katie Vernoy 21:53
Or coming late or you know, just all the things that we can often do when we’re burned out or when we’re overwhelmed or have too many clients. Like there’s a lot of stuff as humans that we can do that are not so specific to the client in front of us, right. But but when we’re burdening our client, or we’re not knowing what we don’t know about our client, I think that takes it a step further. Certainly, I think that coming late, forgetting a session, calling your client the wrong name. I’ve done that before. It’s not a fun mistake to make. You know, all the different pieces. I think there’s that element of those are not good, too. I think they’re more common, and people kind of get a little bit more compassion around them. It’s like, oh, yeah, you were just too tired or Oh, you’re human. It’s okay. And, and I think there’s a lot of reassurance when we make those kinds of mistakes. Whereas when we are are burden burdening a client who is different from us, I feel like there’s less compassion from the profession, which in some ways is good, some ways bad, but I think it’s, it’s definitely a mistake we should talk about when we’re looking at whether or not you admit it, and how you do so if you decide to admit it.
Curt Widhalm 23:04
Well, that’s a great transition here. And going kind of back to the question at the top of the episode where this is timely is Do you admit when you make mistakes?
Katie Vernoy 23:17
I still I still stand by that previous answer, which is like, by and large, I probably do. I want to assess how the the mistake has impacted the client. Probably the beginning part is going to Was it a mistake? It feels like a mistake to me. Was it a mistake? And kind of framing it not like oh, my gosh, I’m so sorry, I did this horrible thing. But like, Hey, I noticed something, it felt like a little bit of a mismatch. How did you take that in? I think there’s that element of still keeping it in a more of a curious place. I don’t necessarily know like, oh my gosh, but like, if I’ve double booked a session, or I’ve called somebody the wrong name, or I’ve done something where it was an obvious oopsie, I do definitely say, my bad, you know, like, this is this was my problem. I did this, I’m sorry. Let me make amends, or let me try to reconnect and make a repair. But I think when there’s you know, a bias of mine or a lack of knowledge or those types of things by and large, I also admit those and try to talk about them. But those are a little bit more delicate, I think require a little bit more of a decision making process.
Curt Widhalm 24:27
So, I want to get into that decision making process and this is coming out of 2013 article called “How psychotherapists handle treatment errors–an ethical analysis” by Medau, Jox and Reiter-Theil. This gets into my favorite part of things, ethics, ethics decision making. But it really kind of comes around question that’s been around in healthcare and psychotherapy kind of discussions for a very long time. They started out by pointing out to 1979, empirical research by Charles Bosk that talks about errors and whether or not the management in surgery and how those things should be handled. And then they kind of took some of those ideas and applied them to psychotherapy. And they point to the trend in the field of a shift to a more patient centered approach has refocused attention on patient autonomy. And autonomy is one of the main healthcare principal ethics as defined by Beauchamp and Childress. And in particular, the patient’s right to truth in these discussions. So, when it comes to things like admitting whether or not a mistake has been made, at face value, with the trend in our field, it seems like yeah, we should make it known: hey, we’ve made a mistake. Here’s kind of the background of it. But what if admitting those mistakes causes further harm to the client. And this comes to what many people identify as possibly the highest form of healthcare ethics, which is non malfeasance, which is do no harm. So, for example, if you are somebody who’s working with severe mental illness, or you’re working with somebody who is in a very heightened emotional states, and is kind of engaged in very black and white thinking. I’m thinking of some of the autistic clients that I’ve worked with that, in particular moments, I’ve admitted, like, hey, that didn’t go as planned. And then due to features of the client’s presentation, ends up being something that is just referred to as you are a failure for everything, because you made that one mistake. So, you talk about this nuance in how you decide, can you go in, like, all right, in some cases, it makes sense to make admit mistakes, hey, double booked a session, like there’s no getting around that one, you’re not bringing two different clients into the office at the same time. But when you do make a mistake with clients with severe mental illness or other types of presentations, where admitting it could actually cause more harm. What’s your thought process as far as Okay, on one side, these are the ones that we admit. And on the other side, here’s what my thinking is.
Katie Vernoy 27:35
I feel like it doesn’t go to a all or nothing answer. Because I still stand by at times something is a mistake, and something is not. And so it’s, it’s challenging. Like for a client that’s going to feel very betrayed or harmed, or overgeneralize that now you’ve done everything, I can’t trust you forever. I think that addressing the misstep, misalignment, mistake, whatever the right word is with delicacy makes sense. But if they’re coming at me as this is a mistake. And I say, Well, no, it’s not. And here’s why. Whether I believe it’s a mistake or not, I feel like that becomes adversarial. And so I, you know, or if I say, No, it is a mistake, or yes, I’m so sorry. It was a mistake. Like, to me, I think getting into black or white in that. I don’t know if it’s harmful to the client, necessarily. It’s certainly harmful to the relationship, and it might be harmful to me. And so I think it’s that element of, can I have a a kind of a regulation, you know, emotions regulation conversation to bring us down to, what is it that you’re feeling here? What’s going on here? And then getting to a place of whether it’s wise mind or just a calmer conversation from a place of connection, and talking about what happened. And potentially apologizing or saying, like, yeah, it seems like I wasn’t with you right there, or whatever it is, and, and praising them for bringing it up and being able to talk through it. But I think that there’s there’s an element that eventually I get to Yeah, it seems like there was a mismatch there. I’m sorry about that in some way, even with clients who were are highly upset. Now, that doesn’t always work. And so maybe there are times when making a mistake, and admitting it was harmful to the relationship such that I lost the client or whatever. But to me, it feels like there is a place to go where you dive into the relationship to get to a place of wow, this is what happens when humanity shows up in the room and you know, we’re not meeting each other or whatever it is. I don’t know I don’t I don’t know that I’m getting to a black or white answer here. But like to me it’s it’s always going to initially what is in the relationship right at this moment, and then exploration and then taking responsibility for what was mine.
Curt Widhalm 30:10
It’s interesting that I haven’t shared this article with you to read beforehand on this episode, I would say that you’re pretty far along the way that is recommended in not only this article, but also Beauchamp and Childress and Lindsay, who’s another healthcare ethicist principlist sort of thing. And without, you know, just reading all of the article here, there is some differences in approaches between Beauchamp and Childress, and Lindsay. But some of these approaches, kind of point out that as principles of our professions, like our ethics codes, they don’t really have any guiding aspects as far as what you do when mistakes are made.
Katie Vernoy 30:56
Yeah.
Curt Widhalm 30:57
I mean, at least as far as our American ones go, because they do point out that, like the medical code of ethics of the European Federation of professional psychological associations did adopt the Lindsay approach. As far as looking at things like that, we need to consider things like respect, competence, responsibility, and integrity, and not just rely on non-malfeasance as being kind of the far superior of the base principle ethics.
Katie Vernoy 31:24
Yeah.
Curt Widhalm 31:25
And while this does tend to push us more towards Yes, we should admit to mistakes. What is recommended is that the first thing that we have to ask and look for is what is our patient’s preferred way of dealing with an error. And I think that in being able to look at that helps us in our decision making process, and especially in those established relationships, we can start to tease out like, Okay, here’s the ones we’re like, Hey, I double booked a session or I laughed at an inopportune time in session, I thought you were making a joke, and, you know, things that are relationship repair sorts of things that you do more in the moment. But when it does come to bigger things, in helping to look at, let’s take, for example, complex PTSD, where a mistake in a relationship might have a much higher impact on a client than it might with somebody who’s presenting with a much different diagnosis.
Katie Vernoy 32:32
Sure.
Curt Widhalm 32:33
So in being able to evaluate that some clients in those mistakes that are made by the therapist are going to need it delivered a lot more tenderly. It’s going to need to be something that ends up becoming a lot deeper relational work. I mean, I’ve made mistakes with clients before where it’s just like, they’re like, oh, it’s refreshing to see even a professional kind of make a mistake from time to time, that takes some pressure off of me. Whereas other people might take it much more to their core. But once you are able to identify kind of what’s the patient’s preferred way of dealing with an error, you have to evaluate what the therapist reasons for their preferred course of action in the light of the two existing principle based ethical approaches. So this gets into that ethical decision making model. Like, all right, am I avoiding talking about this mistake because it has the potential to harm the client? Is that the only way that I’m looking at this? And I’m ignoring like, oh, but this takes away client autonomy? Am I acting paternalistically By making this decision for the client? is a question that we need to ask ourselves.
Katie Vernoy 33:49
Yes. And I, as you were talking, I was also thinking about the conversation we had about defensive therapy practices. I feel like there’s also that element of have we done mental gymnastics saying this will cause harm, when in fact, I think it’s about protecting, you know, liability, or how I feel about myself as a professional or all of those things. I mean, I think we can talk ourselves, we’re really good at reframing things. And we can talk ourselves into I’m not addressing this because it could harm the client or because maybe it wasn’t a mistake or whatever. And so to me, if I’m hearing you properly, it’s it’s understanding the client and then understanding your motivations. Is that what you’re saying? It’s like, what’s going on with the client and how they want to deal with an error or how they typically deal with an error and then also understanding yourself. Is that what we’ve said so far?
Curt Widhalm 34:37
I’m really glad you were listening to me and able to boil that down into much more concise language.
Katie Vernoy 34:43
Well, and the thing that I was thinking about and how the client deals with errors, I think that is very clinically rich, right? I mean, I think about if the client has no, is perfectionistic or has no ability to really allow themselves to have mistakes, and either gives you a ton of a ton of compassion and grace, or is perfectionistic about how you’re approaching things. I mean, that is just, that’s beautiful. It’s like almost I would purposely make a mistake to be able to have that conversation with the client to be able to really talk about how does that feel? And how do you get to a place where you can hold both that I am a therapist that you that you appreciate working with, and I’m flawed? And what does that mean about you and how you can hold yourself? Like I think that understanding the client’s typical way of dealing with errors, I think is clinically rich. But the other piece, and maybe this is the next step is really understanding how they view the situation and making sure they feel completely heard. Because the agreement about whether it’s a mistake or not part of it is what is the client see and making sure they feel validated in their perspective.
Curt Widhalm 35:56
And this is really one of the main differences between Beauchamp and Childress, and Lindsay is while both value patient’s autonomy as kind of the the or the highest sorts of things. When it comes to the second listed principle ethic where Beauchamp and Childress go to non maleficence. And many clinicians will hide behind this as like…
Katie Vernoy 36:21
Yeah
Curt Widhalm 36:22
…do no harm, don’t don’t take any action that could cause any harm. Where Lindsay diverges is into I will take responsibility for an error, apologize and express my regret. Responsibility. And I think that that is…
Katie Vernoy 36:36
Yeah.
Curt Widhalm 36:37
…it is missing in a lot of ethics discussions is, I mean, Beauchamp and Childress are great. Like, there’s a reason that they are the core of what we’ve been doing for, you know, 50ish years at this point, like…
Katie Vernoy 36:51
Yeah.
Curt Widhalm 36:52
But what I think happens in non maleficence, is it allows for us to do some of those mental gymnastics to kind of, like, alright, I don’t, it’s what the manual said, you know, the manual said, I should do that, you obviously were not ready for that. But I, that was the next step in the manual. Like, there’s no responsibility in that. And I think that that’s really what takes ethics into, and when we do take responsibility for these things, when you’re, we’re talking about like, Okay, we’ve admitted these mistakes and the positive client reactions to them. That’s really where we see a lot of this come in. And some of the trainings that I’ve been to throughout my career, and a lot of them have, you know, fancy names, like, what the master therapists do, or something like this. And a lot of it just boils down to, how do you handle things when they’re going sideways, or not in a predicted sort of way, or when mistakes happen. And some of these workshops have a practicum component to it, where you just roleplay with other therapists, bad therapy sessions, and how to scramble and pick up for them.
Katie Vernoy 38:06
That sounds like fun.
Curt Widhalm 38:07
It sounds like fun, and it’s just kind of like, Alright, here’s a stranger that has been sitting down the road from me for the last hour listening to this, and they’re gonna bring in their most difficult case that I have no background on, it’s just going to start with like, I’m going to quit therapy, you suck as a therapist, and then that’s just where you pick up.
Katie Vernoy 38:29
I think for me, the reason why this has become such a, I think, a skill set for me, and and I could be wrong, there might be some clients that are like, you totally messed up, and you didn’t handle it properly. And I fully admit that, that that’s, you know, in different stages of my career, that’s probably the case. But I spent a lot of time as a supervisor and manager in a really high intensity program, having parents come to me and tell me how much everybody had messed up, you know, I’d messed up. My my supervisors, my clinicians had messed up, like everybody had messed up. And so getting to a place of really being able to sit with, all right, I’m with a very activated person who’s very upset, feels very whether it’s betrayed or disappointed or frustrated or angry. And I just need to sit with this and be a human in the room to get to What happened here? And what is their perspective on it? What is, what did they want as as their solution to this? And oftentimes, it really was, I want to be heard, I want you to respect that something happened here. And if there is a fix, I want you to fix it. Right? Like you did this thing or your clinician did this thing. I need you to fix it. And so often when I was you know, the the supervisees that would come in and say the parent is really mad at me, and it’s horrible and oh my gosh, and what do I do? And other people go back: Well, you have to say a boundary and you have to do this and do all these things. And I’m just sitting here going like they’re getting caught in this rigidity around, I need to do the right thing. I can’t admit wrong, they’re defensive, or they’re upset or they don’t understand. And it really is just being human. And honestly, they were like, well, what if they want this? And what if they want that? And so often, it was just like, they just wanted to be heard. I mean, sometimes they wanted to change a clinician, or sometimes they want to do something else. But oftentimes, it was like they wanted to be heard. They wanted their grievances to be respected, and potentially a small repair.
Curt Widhalm 40:40
And I think, you know, as I sit on the ethics committee for the California Association for Marriage and Family Therapist, a lot of the complaints that we end up seeing, I think, not not all of them, like there’s some definite ones that don’t fall into this, but like, where just a clinician making a relationship repair sort of action would have just prevented a whole lot bigger feelings developing. Maybe shifting this back to some of the clinical discussion sorts of things too. One of the articles is I’ve been looking at in preparation for this episode is called ‘Client perspectives on psychotherapy failure.’ This is by Knox, Craig Miller, Twidwell and Knowlton in Psychotherapy Research 2023. And this is a small sample size 13 clients were interviewed about failed psychotherapy. But a lot of this ends up being where, without really being able to do some of the relationship repair kinds of things, or talking about mistakes, can leave clients feeling like they’re the ones who have failed. And so again, it comes back to responsibility sorts of things. Like, you know, we can talk about therapy, interfering behaviors. Yeah, there’s things that some clients do that make it to where they don’t have to talk about the reason that they’re in therapy. Those are clinically rich discussions to have. But there’s also things that just like through our errors, and hiding behind the guise of professionalism, whether it’s conscious or not, ends up just being like, here’s, here’s the blame to the clients, you know, they’re taking that on on their own. And this can show up at all points in treatment, whether it’s pre treatment, you know, even just like getting set up for the first session. Like if you’re late or beyond the timeline that you promised that you would deliver paperwork to somebody. Oh, as a client, I’m not important enough for your attention, that ends up being something that could be re-validating some of the reasons that they’re approaching therapy in the first place.
Katie Vernoy 43:03
So much of this is being able to sit with yourself as a human. And I think there are times in my life, I’m not going to talk about quote, unquote, other people, I’ll just talk to about myself, there are times in my life, when I’ve felt nervous in what I was doing in session, or I felt like there was a relationship that was especially important, and I didn’t feel like I was doing it right, or those types of things. And in those moments of insecurity, I feel like I was less able to do this. I was less able to sit and say, okay, whatever you’ve got, I’m gonna listen, I’m going to take that in, and I’m going to be able to have a conversation with you. And do the thing that I think we do a lot as therapists, which is I’m going to listen to all that you have. And maybe other people would walk out of the room and never come back. But I’m going to keep coming back, I’m going to keep saying you are are worthy of my time and attention, you are worthy of my respect. And I’m going to listen and try to understand you in the best way that I can. And I think when I’m feeling, when I have my own stuff, or when I’m feeling insecure, that is harder to do. I think as therapists we probably have some skills to fake it until we get back to that space. But I think going back to what you said earlier, this is why we have to do our own work. We have to be able to sit with hard things. And we and I honestly believe we have to be able to sit with the stuff that’s in the relationship. And for me, I’m an attachment long term therapist. And so a lot of what ends up happening in the long term is relationships. So clearly, I love that stuff. And when you’re meeting with a client for six sessions, 10 sessions, you’re gonna have a relationship with them, but it’s different than a client that you’ve had for 10 years. I mean, it just it’s, it has to be. And so I think there’s there’s some therapists that this maybe a little bit more challenging for if they do a lot of really short term therapy.
Curt Widhalm 45:04
So I’m gonna go back to Małus, Konarzewska, and Galińska-Skok. This is the 2018 article ‘Patient’s failures and psychotherapist’s successes, or failure in psychotherapy in the eyes of a psychotherapist.’ And they talk about that, kind of what you’re saying here, that more experienced clinicians are probably going to have a lot more of these kinds of interactions with clients and are going to be more prone to analyze some of the response, the responsibility as falling on the therapists themselves. But overall, as a field, we still tend to blame a lot of failed psychotherapy on patients.
Katie Vernoy 45:52
Yeah. Yeah.
Curt Widhalm 45:54
You know, I think that part of this, again, comes down to school of thought. It might come down to your license type, as far as, you know, being able to address things in the correct way. And, you know, I’ve been a podcast host for a minute or two now. And…
Katie Vernoy 46:11
Just a minute or two.
Curt Widhalm 46:12
Just reflecting on my own experience of this, the more that I end up researching for my clients, the more that I end up researching for being a podcast host, being an educator, the more that I take kind of that global view with clients and am upfront with it when, you know, parents call me and say, you know, here’s a problem that is happening with our child. And here’s what their response to it is. Hey, here’s the thing that’s happening, you know, between student and teacher. Okay, are we just going to focus on your child’s response to it like, what’s going on with the teacher? Are you doing your job as parents there? That look more systemically at contributions to why somebody might be seeking therapy in the first place. These are more global approaches to things, you know, I mentioned earlier, like, you can’t CBT your way out of poverty. You’d, you know, you can do humanistic things about, you know, war. But that’s not going to solve that there’s war that’s contributing to this in the first place. Like some of those mismatched sorts of things. And I’ve taken a lot more of the approach of like, the boundary pushing that you’re talking about, which is, I recognize the limits of what I can do, and therefore I’m going to encourage and help advocate in the places that we can’t do that within our room. And I think that that’s something that taking this more global approach with the experience that we have later in our career is not something that’s necessarily encouraged. And a lot of times what I hear from early career clinicians is, it’s actively discouraged, based…
Katie Vernoy 46:15
Oh, interesting.
Curt Widhalm 47:59
Based on No, you are a fill in the blank theory therapist. You don’t do that because of the theory.
Katie Vernoy 48:08
Hmm. Yeah, it really ties your hands doesn’t it? Like it makes it so if you’re boxed in to something, and I can understand that early career clinicians need some boxing in to to, you know, kind of get beyond the threshold of do no harm. But so much of what I see therapy being as effective, and this is going back to Wampold, but like the relationship and how you show up in the relationship, I feel like there’s more teaching of that that is really critical than particular treatment orientation, or strict rules about how we function. I think that creates more liability for supervisors and trainers because we’re saying show up as a human, learn how to show up as a human and make mistakes, like, nobody wants that kind of liability on their license. But I feel like that’s what we have to do to really effectively train new clinicians. Is teach them to be okay being themselves in the room, and using those pieces to be able to support the relationship.
… 49:17
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Curt Widhalm 49:17
This came up in a discussion that I recently had with a early career clinician that was talking about, they had a client that had had an IEP meeting an Individualized Education Plan meeting. And so they, the clinician had made mention to the parents about the IEP meeting, they spent a couple of minutes talking about it and what kind of structures were being put in place for the student at the school. And this clinician was then talking with their clinical supervisor about, here’s what’s going on with this case, and the supervisor told them stop doing case management. Your job is therapy and the clinician was consulting with me for something else and I was like, because I really just kind of out of line? Like it was like, two or three minutes out of, you know, conversation in the hallway leading out of the office at the end of a session. Like it wasn’t, you know, like a major focus of session. And, and so part of getting to looking at, you know, some of the mistakes that can be made is, I don’t know, treating people like they’re part of a global complex interaction of systems might be one that I’m okay with people making, but oftentimes what we have to look at, and this isn’t just me rambling, but getting to a point where sometimes especially in agency work, it’s being able to talk about the limitations of the agency in…
Katie Vernoy 50:52
Yeah.
Curt Widhalm 50:53
…what a clinician is able to do for somebody and being able to process some of the feelings around that. Hey, yes, there are these problems. Unfortunately, we can’t do that here. Here’s referrals for those things.
Katie Vernoy 51:08
That makes me think about kind of the, more broadly about the profession and the mistakes that the profession has made. And the fact that as clinicians, sometimes we have clients that walk into the room, and they’ve been harmed by the profession as a whole. Maybe this is going a little bit too broad.
Curt Widhalm 51:29
No, this is exactly where I wanted you to go.
Katie Vernoy 51:32
All right. All right. We got there, we got to where we wanted to go. But I think there’s this element of whether it’s about psychotherapy, whether it’s about society, I think these broad systems making mistakes. I don’t think we have to take the blame for society and societal wrongs. We, I think it’s good to acknowledge them and talk about them. But as a profession, I feel like there is potentially some responsibility to say, yeah, as a profession, we effed up. We we did wrong here. And I understand how this has harmed you as a client. And let’s figure out how we can make this a different experience. But to me, knowing that that’s happened, or that that’s part of the clients experience isn’t necessarily the first thing you’re going to hear when they walk in the room. And maybe it is. I always ask about previous experiences in therapy, or if they’ve done therapy before, how they understand therapy, but I think there’s that element of as a profession, we’ve done some pretty awful things.
Curt Widhalm 52:34
And it’s easy to kind of look at things from a state of presentism. You know, the placing today’s moral values on things in the past, like, it does not justify the first one that I’m about to say here. Like…
Katie Vernoy 52:50
Just to be clear, you’re saying this is awful.
Curt Widhalm 52:54
In today’s, you know, world, it’s very easy to be like how the eff did the a the American Psychiatric Association classify homosexuality as a mental disorder for as long they did?
Katie Vernoy 53:06
Yeah. I mean, society, it makes sense based on society at the time, but that doesn’t justify it.
Curt Widhalm 53:13
It doesn’t justify it. And, you know…
Katie Vernoy 53:15
It’s actually really awful.
Curt Widhalm 53:16
But the reason that I point out presentism is it’s easy to look 50-60 years back and be like, yeah, mistakes were made. And as a profession, we’re good now. Right? And…
Katie Vernoy 53:31
That seems a little bit too dismissive.
Curt Widhalm 53:33
It is, and this is highlighted by things like the 2021 American Psychological Associations Council of Representatives statement, the statement called ‘Apology to People of Color for APA’s Role in Promoting, Perpetuating, and Failing to Challenge Racism, Racial Discrimination, and Human Hierarchy in U.S.’ And this was adopted by the APA Council of Representatives on October 29, 2021.
Katie Vernoy 54:01
Oh, my gosh, that that recently?
Curt Widhalm 54:03
That recently.
Katie Vernoy 54:04
Oh, I was thinking, Oh, yeah. Like this is in the 60s. No, no, this was two years ago.
Curt Widhalm 54:12
Yes. So we’ll include links to it in me to all of that at least provide our reference list, but links to what we can in our show notes and our references for the CE course here. And I think it’s just kind of, especially with like, this statement, I think it maybe got overshadowed a little bit in all of the COVID sort of stuff. This is a lengthy statement. I don’t know maybe it’s just kind of like when we’re talking about mistakes and we’re talking about mistakes as a profession. We’re talking about, you know, the impacts that things like you know, the APA’s roll in the contribution to some of these race sorts of things. I’ve heard enough thoughts and prayers sorts of statements
Katie Vernoy 54:58
Yeah.
Curt Widhalm 54:59
…from even organizations, you know, our membership organizations, really, it’s not just saying, Hey, I made a mistake, but at any level, whether it’s the mismatch treatment, whether it’s mistakes made in session, whether it’s the professional level things, it’s the follow through on these kinds of things, that really ends up becoming how we evaluate psychotherapy mistakes.
Katie Vernoy 55:28
Yeah, I think when apologies, whether it’s person to person or what you’re talking about, kind of at a at a an agency or organization level, when it is performative, or checkbox, or, I’m sorry, that you feel this way. You know, the things that are like I’m, I’m doing the bare minimum to accept the tiniest bit of responsibility. And I am going to state that this was wrong, and that is sufficient, I think feels pretty awful. And I think we’ve had a lot of that over the last several years that I think people are tired of. And so I mean, when I’m thinking about bringing this down into the treatment room, so to speak, the clinical relationship. I feel like there’s a need to talk through the humanity of it. Obviously get educated, be able to perform differently in the in the environment and and even potentially push back on the norms of the profession. I know that we’ve got some conversations around decolonizing therapy, we have some different things that are also coming down the pipe that will be really, I think, rich conversations about this. But when we’re talking about taking action, do you do you have something more specific in mind that you’re thinking about?
Curt Widhalm 56:57
Well, some of the things that I like about this APA statement is they put in some action steps they are going to do and…
Katie Vernoy 57:07
Oh, good.
Curt Widhalm 57:08
Once again, this is a 2021 statement. But one of the things that they talked about, the APA will engage in a comprehensive audit of all of its EDI and other antiracism related activities, including ethnic representation of governance leaders, and central office staff policies, practices and procedures currently underway in use to include how psychologists of color will have access to the results of the audit, and its intended impact on society to be concluded by the February 2022 meeting of the Council of Representatives. So I liked that they’re putting specific things in with deadlines that that end up taking, alright, we’re going to comprehensively go through things. Long statement here. But one of the things that they talk about is going through all old APA publications and changing things like the term minority to person of color. So taking steps, albeit way later than any….
Katie Vernoy 58:05
Yeah, for sure. Way later.
Curt Widhalm 58:08
But, you know, I think when it comes to professional organization type things, it’s looking at kind of where the fractures in our, in our professions lie. Associations that are afraid of losing members, because…
Katie Vernoy 58:27
They still are tied to old, old treatments that don’t work, or they’re, they’re putting their own values and morals on to their clients. And they don’t see that as a problem, or whatever it is, right. Like I think there’s there’s a lot of there are not, a lot of clinicians that need to be confronted about mistakes that they’re making. And I think associations are only sustainable if they have members. And so they worry about losing any member even if that member is doing harm, which is unfortunate. And that’s a broad generalization. I don’t think that’s necessarily completely true. But that is a concern.
Curt Widhalm 59:02
Right.
Katie Vernoy 59:03
So when we’re talking about these organizations that potentially are now seeing the harm in the past and trying to rectify things, all of that stuff. I want to bring it back down to individual clinicians. Because I think that there are folks who have been harmed by these things in our profession. What do you see, or I can talk about mine if that if you don’t have an immediate thought, but what do you see as a way that this might come up in session and that clinicians can actually navigate our professions wrongs with their clients.
Curt Widhalm 59:37
So when it comes to some of the larger organization sorts of things, you know, I’m imagining a scenario where a client is like, Hey, I just saw this APA thing where they made a statement about this thing and that does not take into consideration clients like me, and it, you know, I’ve heard you talk about, you know, APA sort of stuff before, are you a member? And is that what you believe? You know, that in my scenario here, what I’m imagining is like the perfect client, like…
Katie Vernoy 1:00:12
Yeah, that’s gonna bring it up, bring it up in a very, very specific way. Sure.
Curt Widhalm 1:00:16
Right. But we do have ethical responsibilities to know what is currently happening in our profession. And that includes following some of these professional organizations to know what some of these statements are. And being able to look at this. In this perfect ideal sort of scenario there’s the, the not taking responsibility, things that could happen. Oh, I didn’t know about that. There’s the making clients educate you about it, which is, tell me more about your feelings and about how people like you might be affected by this. You might be able to be like, I didn’t actually hear about that. Let me look into it. But then you have to have the responsibility of following up with it.
Katie Vernoy 1:01:00
Yeah, for sure.
Curt Widhalm 1:01:02
Is even as involved in professional organizations, as you and I have been, we don’t always agree with what even the organizations that we’ve been involved with have said or not said, at certain points in history. Part of going through the decision making model in how to happen, in how to handle those things, is something that in the moment is like, What is my patient’s preferred way of hearing something from me? Now, most of my patients, when I pause for too long to kind of collect my thoughts are like: Just say what you’re thinking, like…
Katie Vernoy 1:01:43
I’ve had that happen, too. That’s hilarious. Yeah, they’re like just say it. And usually I, you know, how I just I don’t actually stay silent. I say, like, well, I’m trying to decide. They’re, like, just say, Katie.
Curt Widhalm 1:01:54
And, you know, a big piece of that is many of the clients that I’ve had that experience with are longer term clients, where they’ve known me to be able to speak my mind and not, you know, make things so soundbite-y or…
Katie Vernoy 1:02:11
Yeah.
Curt Widhalm 1:02:11
…you know, politically correct in how they’re stated. But being able to say, like, look, my first reaction is this. And, you know, I, you know, can maybe see why they’re making a statement like this, but I can see how it doesn’t apply to you. And that’s not representative of the work that we’re doing together. Or if it, I can imagine a scenario where I just flat out disagree with them. Like…
Katie Vernoy 1:02:37
Yeah.
Curt Widhalm 1:02:38
Part of this really does come within this has been an hour of talking about relational factors.
Katie Vernoy 1:02:44
Yeah.
Curt Widhalm 1:02:45
And relationship work and honesty and authenticity, which are things that I personally value. And I think, you know, if we’re talking about especially Lindsay’s kind of approach within healthcare ethics, there should be maybe more of a professional guidance on this. You know, sometimes we have these calls to action that, you know, we we work on things in the background, and it takes us quite a while from when we identify something, I’m talking about the work that Katie and I do, to actually getting some fruition of this out on the back end, you know, we, we lobbied for years on getting Medicare and it finally came out, like. So, but I think that there can be more professional guidance on like, here’s what responsibility means when it comes to how we interact with patients. It’s… You’ve got to look.
Katie Vernoy 1:03:36
Oh, I just was, like, trying to make sure that that when before you finished I said this. Because I’m gonna I want this on the record. So as a CAMFT member, I’m talking to an ethics committee member saying, Maybe we should add some of this mistake decision making guidance into the CAMFT ethics code.
Curt Widhalm 1:03:55
So this is one…
Katie Vernoy 1:03:58
This is advocacy in action, friend. Advocacy in action.
Curt Widhalm 1:04:01
I was I was actually, you know, kind of wondering like, Does this need to be in the ethics code? Or is this just something that needs to be talked about in an ethical way?
Katie Vernoy 1:04:14
All right.
Curt Widhalm 1:04:15
So, I actually want to hear from our audience on this. As far as, you know, if you’re hanging out with us, there’s lots of ways to get in touch with us, but reach out to us on our social media or send us an email. We’ll include how to get to us in our show notes over at mtsgpodcast.com. But I would love to hear your thoughts on you know, when it comes to responsibility, are we being taught enough? And is this something where in order to to help stop this where it is and make the next generation of clinicians and education better? I want more input.
Katie Vernoy 1:04:55
All right, all right. So he’s not just taking it from me folks. Let’s let’s make sure that send send emails, we’ll we’ll put it in our show notes. And you can tell Curt: yes, we want this in the ethics code, or no, we don’t.
Curt Widhalm 1:05:09
So just to kind of summarize, a lot of this stuff boils down to relationship sorts of things. It’s, it’s how you handle the relationship. It’s how you consider the other person that you’re in a relationship with and the things that they prefer when it happens, that mistakes come up.
Katie Vernoy 1:05:27
And I think it’s doing your own work so that you can actually sit in the discomfort. I know that a lot of what we’ve talked about in the past and have heard is therapists are fairly conflict avoidant. And so I think this is smoothing it out and sitting with it, which makes it a little bit less of a conflict, but it is taking this head on and making sure that you’re actually being in the process with your client versus trying to deflect or ignore or defend.
Curt Widhalm 1:05:58
Listen at the end of the episode for how you can get your CE information. And if you want to support us, that’s one of the ways that you can do it. We always appreciate when you do that. Other ways you can support us is please consider becoming a patron or supporting us through Buy Me a Coffee. And until next time, I’m Curt Widhalm with Katie Vernoy.
… 1:06:19
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Katie Vernoy 1:06:20
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.
Curt Widhalm 1:06:35
Once again, that’s moderntherapistcommunity.com.
Announcer 1:06:39
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SPEAK YOUR MIND