Eventually every therapist will make a mistake -- forget something important, be late, forget to return a call -- something. It will happen because it must, because we are human and part of the therapeutic process is learning to accept both one's own and the other's humanness. Some patients will stubbornly hold on to demands for perfection and not forgive even the most minor slips. As the therapist, I have to be willing to stay with it and apologize for the mistake and listen to the patient's hurt and anger while also trying to help them see that life has gone on, that the relationship is not over and that there is room for forgiveness. It helps that I remember my own feelings when I discovered my analyst was not perfect. It's never easy to be caught in one's own errors and lapses, though with practice, over the years, it does get less anxiety provoking to listen to and deal with a patient's anger and disappointment.
As a therapist, it is important that I not act out any hurt or anger caused by the patient. This means that the patient can say what happened and that the effect was that she were hurt or inconvenienced or whatever. And that there will not be retaliation. I have to sit on my own all-too human urges to defend myself, not always an easy task.
The most frequent situation that I encounter is a patient forgetting the check or bouncing a check. Often that patient expects that I will be angry or disappointed or make her feel bad for her mistake. I calmly tell them that the bounced check must be replaced and include whatever fee my bank charges., Or I tell them to please mail a check to me that day after the session. I might also express curiosity about what might have led to this behavior -- how it reflects some unspoken feelings about our work or might reflect a recurring destructive pattern. This one is hard for most patients to consider — it was just an accident, they say. Gently I ask if maybe there was also some feeling - of resentment or anger - that might also be part of this forgetting. And we go on.
We build trust by showing up, listening, being willing to receive the patient's feelings, even the ugly ones. By being willing to not act out. And by reflecting on our own behavior and willing to acknowledge mistakes.
And the patient's responsibility? To show up and be willing to talk, not just about the things that are comfortable, but also the things which are dark or ugly or scary or angry.
If both therapist and patient are willing, these things can be worked through. There are times that no amount of mea culpas will appease some patients and they leave -- usually they have been ready to leave since starting, and/or they have a history of being failed by therapists and have no insight into their role in the process. We fail sometimes.
All of this is far easier to write than to live.