Becoming Better At Failing

Many young colleagues approach me for guidance as they venture out into their careers as a therapist. I thought I would share my experience in avoiding your patient's improvement and - which is most feared of all - your patient's recovery. 


Here is a Twelve Step Program that will almost certainly guarantee dynamic failure as a therapist: 

1. There is a central pathway to failure based upon combining the following foundational ideas. Combine them from the start to guarantee inevitable failure. 
1. Insist with authority that the problem which brings the patient to therapy is not important. 
2. Consistently refuse to directly treat the presenting problem.
3. Assert that if the presenting problem is relieved, something worse will develop.
2. Diagnose more, treat less. That's the beauty of labeling your patients with the scientific lingo of the medical community that will make you sound like an expert. Even better, you will never risk success in treatment is you stick to diagnoses!
3. Use one method of treatment. Doesn't matter what problem. Schools - not tools. If your patients don't behave according to the method, you can always declare them as "treatment-resistant" or even better "untreatable".
4. Cling to an ambiguous, ill-defined theory of what you should do as a therapist to bring about therapeutic change. It would also be un-therapeutic to give directives for change because there is a substantial risk that your patients might follow them and change.
5. Only years of therapy will every really change a patient. Make that clear from the start.
6. Offer repeated warnings about spontaneous, patient-driven improvements. Point out the possibility of psychotic breaks, mood dysregulation and relapse on substances if they improve without your guidance.
7. Definitely focus on the past. It can't be changed and it will reliably decrease your patient's mood.
8. Center your work about your patient perceives as his faults and past failures. Subtly increase guilt to resolve guilt by ongoing "treatment"- can you think of a more sustainable business model?
9. This technique is underutilized since the advent of Cognitive Behavioral Therapy: Ignore your patients' reality and dive into their infancy, their relationship with their mother and their fantasy life. And don't forget to interpret their dreams.
10. Avoid the poor, avoid  patients who ask too many questions. Both inquisitive minds and people with limited financial resources are much more difficult to distract from progress with insightful conversations.
11. Your continuing refusal to define the goals of therapy is essential. Can you imagine what would happen? One could actually raise the question whether goals have been achieved. That's a no-go for failure. In the same line - avoid evaluating the results of therapy at all costs. 
12. Always deal with your patient alone, being at the interface of family and society dramatically increases your patients' risk for recovery. 

To sum this up into a more memorable slogan, here are the Five B's to abide to as a successful failure-oriented therapist: 

• Be Passive 
• Be Inactive 
• Be Reflective 
• Be Silent 
• Beware 

> Irony/sarcasm off. 

This is based on "The Art of Being a Failure as a Therapist" by Jay Haley
Read more of him. Try to stand on the shoulder of giants.