Dear Ethics Consult,
I’ve been licensed and in private practice for just over a year now. I have several clients who seem to be falling into the same pattern in their therapy, one that has come up since before I was licensed. We’ll set a goal together. They work on the goal well enough through a few sessions, and then for various reasons, they fail.
I do my level best to patch them up again, restoring their confidence and their hope for the future—and then the cycle repeats. Am I doing something wrong? I love being a therapist, but I’m worried that my clients aren’t getting better. Am I in the wrong line of work?
— A Little Afraid to Hear the Answer
Dear A Little Afraid,
I highly doubt you’re in the wrong line of work. Your struggle sounds quite common and normal, and if it is what I think it is, it’s a struggle precisely because you’re so invested in serving your clients well.
Let’s address the most straightforward ethical component of your concern here first: Are your clients getting better? This is something you should be regularly assessing, and if you lose faith that clients are likely to benefit from continued treatment, you shouldn’t continue treatment. I’m a fan of outcome measurement instruments, which are imperfect but better than nothing.
All that said, I suspect that your clients are benefiting from their work with you, even in the presence of this pattern you’re seeing. I could be wrong about all of this, but try this on for size: I suspect you’re not letting clients fail hard enough.
It’s tough to watch someone we care about fail to do something, especially when they’ve tried to do that thing because they think it’ll make their life better. It’s particularly hard when we’ve been the one trying to help them do that thing. When we see their pain and sadness around that failure, we naturally want to relieve them of those feelings, and help them restore their faith in themselves.
So we comfort. We shift responsibility for the failure to external factors. We help clients focus on the future.
And it works! They move past the failure, and set new goals, often without doing a reasonable post-mortem on why the last ones weren’t met. Was the goal too optimistic? Did it rely on things the person can’t control? Did they encounter some practical barriers along the way? These questions are not discussed, because to discuss them would be to focus on the failure instead of the next success. And the cycle starts again.
Except that their pain over failing to meet their goals can be tremendously useful, if we—and they—are willing to let it be.
Some questions to consider as you move forward are: Do you meaningfully examine client failures with them? What about their frustrations at what they surely also see as a repeating pattern?
Perhaps more sensitively, what is their failure like for you? Is it different the second, third, or fifth time you experience the same thing with the same client? Does their failure, and their distress over it, suggest to you that you’re failing as a therapist? If so, that would go a long way to explaining this pattern. Is it their lack of tolerance for failure, or yours, that is preventing these failures from being useful?
I say all of this from a place of camaraderie, not judgment. I’ve failed a lot in things I cared about. I’ve written books that flopped, started businesses that failed, and had couples in my practice who ultimately didn’t make it despite all of our best efforts. The consequences of each of these and many other failures are tangible and lasting, and the sadness that results can be overwhelming.
At the same time, it’s not our job to save clients from that sadness. This has been perhaps the hardest thing for me to learn as a professional, and it’s the reason why this work can be at once so emotionally draining and so freeing. We don’t rescue clients from their distress—we walk with them through it.
We allow their pain to be a guide. If we want it to be helpful, we have to be okay with it being in the room in the first place.
You say that your clients are not meeting their goals for “various reasons,” which suggests that you experience those reasons as either unimportant or overwhelming. Either way, I suspect that your clients would benefit from staring those reasons in the face, naming them out loud, and investigating why they keep winning. It will be hard, and they—and you—can do it.
Dr. Ben Caldwell
Ethics Consult is for informational purposes only, and does not constitute medical, legal, or ethical advice. To protect confidentiality, case examples may include fictionalized elements. This column is not a substitute for an individual ethical or legal consultation. Every situation is different; if you are in need of ethical or legal guidance, please seek the advice of your professional liability insurer, attorney, professional association, or other qualified professional. If you submit a letter to Ethics Consult, you are agreeing to let Pollen Magazine use that letter in part or in full, and you agree that we may edit your letter for length, clarity, or confidentiality purposes.
If you would like to submit a question to Ethics Consult, send an email to firstname.lastname@example.org.