Therapists' experiences of therapeutic mistakes

Introduction: In contrast to the extensive literature on related areas such as therapeutic boundaries, alliance and ruptures, little empirical research has been conducted on therapeutic mistakes. Existing research based predominantly on case studies and observations have focused on systems for categorising mistakes. Empirical research on therapeutic mistakes has focused on supervisors’ and clients’ perspectives. This study is the first to explore therapists’ experiences of therapeutic mistakes.

Method: Seven psychological therapists were interviewed using semi-structured interviews on their experience of therapeutic mistakes in therapy sessions. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Initially, individual transcripts were analysed separately, resulting in a number of themes for each participant. A group analysis was then conducted across participants, yielding super-ordinate themes and sub-themes, based on their psychological relatedness.

Results: A seven-stage process was identified across participants’ accounts (including participants’ experience of before the session, in the session, the emergence of a problem, in the midst of the problem, ‘The aftermath’, making sense and ‘How I’m left’), detailing the experiential themes for participants at each stage. Some of the main themes that emerged were a sense of ‘something brewing’, feeling criticised by their client or self-criticism, relief and recovery, reflecting on roles and responsibility and pre-occupation with the mistake. Four key findings were presented including participants’ complex constitution of mistakes, the role of emotion in participants’ experiences of mistakes, participants’ on-going meaning making process and participants’ experience of mistakes as an interpersonal negotiation. The findings also suggested a difference between how participants constituted mistakes in principle (more aligned with the literature on boundary transgressions and categorisations of mistakes) and the mistakes they shared in their accounts (which reflected more ordinary and minor mistakes, e.g. administrative errors or sharing an interpretation that was not well received).