Why is learning therapy hard?

In supervision, a supervisor lets us know when we made a mistake, so that next time we can make a better intervention that leads to healing. But it hurts to learn we made a mistake. Why? It’s not just because it hurts our self-esteem. When we make a mistake in therapy, we either cause or perpetuate the patient’s suffering. That is, our best attempt at loving the patient (psychotherapy) actually caused harm. The result? We feel guilt. And that’s why it’s hard to receive supervision. We learn that we hurt the patient when we were trying to heal him. 

Our task as supervisors and colleagues is to face reality: all of us make mistakes. We always will. All of us have hurt patients through our mistakes. All of us feel guilt. And this is painful.

Sometimes supervisors avoid this problem by just “being nice” and offering approval rather than genuine supervision. Sometimes as colleagues we sympathize and rationalize and say, “it wasn’t so bad.” We try to avoid the guilt that is inherent in learning psychotherapy.

We do this out of a false sense of compassion. Compassion comes from the Latin: to suffer with. If we try to erase painful reality of the mistake, we hope to erase the guilt, so there is nothing to suffer. But this is pseudo-compassion. Genuine compassion is facing reality together: “You made a mistake that hurt the patient. I have done this too. Let’s face this guilt together because it is a sign of your love for your patient. And let this guilt guide you in the learning so that next time you can do better work and repair the harm you did.”

Unlike in many fields, guilt is inherent in the learning of psychotherapy: our mistakes cause pain. As therapists, supervisors, teachers, and colleagues, our task in learning is to identify with each other as people whose mistakes cause suffering. If we can bear the guilt that comes when learning of our mistakes, that guilt, based on our love, can mobilize us to learn more, work harder, and become the best healers we can be. In other words, just like in life and in our love relationships, facing our guilt over the mistakes we make mobilizes us to engage in the act of repair. In our case, this loving act of repair is known as learning psychotherapy. 

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