Sunday, October 19, 2014

Learner Therapist (49) … How much is a performance failure worth?

Torrey Orton
October 19, 2014

“A misunderstanding can be a good place to start….”

…I wrote to a prospective client 19 years ago in concluding my response to her justifiable irritation with my proposing to charge her for something she had not imagined was chargeable. I went on…

“I am sorry that we have a misunderstanding about fees, though on reflection I am not surprised. Please accept my apologies for my contribution to that misunderstanding.”

It has been a principle of mine to acknowledge mistakes, even perceived failures, in my professional life (and personal, too, often enough). In therapy, it seems to me essential to do so since relationship failures are the stuff of mental health matters and those failures often thrive on unacknowledged misdeeds by the more powerful over the less. Learning to acknowledge and ask for acknowledgment of perceived mistakes / failures is an essential capability outcome of useable therapeutic development. It cannot be learned when the pressure is on not to fail and not to acknowledge.

I concluded that

“The only charge for a service that has not been perceived to be rendered can be nothing at all.”

I have occasionally run into colleagues who explicitly counsel non-acknowledgment of perceived errors or missteps in therapy, and I gather my professional organisation counsels that as well (perhaps an infection of negligence suit paranoia in both cases?). It seems to me that counsel is a recipe for a paranoid process which is the enemy of professional development. The latter depends on conducting real practice undertaken for real purposes and discovering that my judgment failed the patient’s need(s) at a certain time. And the repair of failed efforts is usually a matter of slight adjustments of tone and timing, which can only be practiced in real time.

So I added that

“Therefore I am returning your cheque.”

One of my colleagues, my professional supervisor, has with reason proposed that I do not make mistakes. That I do what I thought best at the time and so they cannot be mistaken. An interesting line of approach since it recognised that I do do what I think best at the time, and not lightly so. Perhaps a call for more acknowledgement of successes?

And I closed with

“I look forward to working with you at any time you may find useful in the future.”

This may seem a strange offer, but I still feel it stands up to my understanding of best practice. This aspect has to do with not assuming that an error is a death notice to a relationship. I have insisted on making similar offers at times since then, even where the patient who bore my mistake(s) was more mistaken than I.

My founding assumption is that it is always my responsibility to ensure that all the relationship Ps and Qs are dotted and crossed. It is my capacity for relationship design and execution that is what patients are buying, and in that sense any mistake is mine first, even if it was theirs. When their mistake is unexpected or, the reverse, it is perfectly expected as a result of a design and /or implementation malfunction, it’s my mistake.

By the way, the cost was only $80 lost income. A small price.

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