When Being a Therapist Means Saying You are Sorry

We all try to understand people. Counselors and personality experts use formal systems for the job. The therapist begins with lists of human characteristics, a bit like a Chinese menu – beef, chicken, pork. If you fall into one column or another, you are given the name at the top. Not fish or fowl, but introvert, extrovert, narcissist, schizophrenic, etc.

These systems all tend to put people into a box they fit imperfectly. We therefore add other words as qualifiers to make the label more precise. Kind of like saying a person is not merely “tall,” but “muscular,” or “slender” or also has “a winning smile.” Still, they are all generalizations and even the one with the dazzling teeth isn’t grinning all the time.

Our boxes are not made of corrugated cardboard or wood. They come from knowledge and experience, imagination and instinct. Without using them to “place” every person we meet, we’d be like small children, unable to make sense of people, neither responsive to their needs nor capable of securing our own.

On occasion the categorization strategies don’t come close to making the human world comprehensible. Not all labeled people and their motives are well-captured by name tags. They are more complex. Those individuals don’t quite think the way we do or feel the way we do, making our comprehension of their nature harder to achieve. Our effort at understanding another, too often based on how our own minds work (or we think they work) can fail. Therapists share this experience of failure with everyone else. Less often, we hope.

I’ve met only a few unique people in my life despite having more in-depth human encounters than most. These few burst any categories in which we place them. Usually, however, the boxes work well-enough or better. Indeed, many times they are spot-on.

Everyone outside the doctor’s office, however, is at risk of resorting to stereotypical, pejorative labels, condemning those who are different because they don’t understand them. The labeled crate becomes a confinement of accusation and punishment. Look around: nationalists of all countries transforming races and religions and different national groups into imagined monsters.

It makes the world less scary to do this. Life is simplified into one pile of good people and one pile of evil people. The individual doing the sorting is never in the evil stack.

Being a therapist means you must be humble and open to those who can be difficult to categorize and sometimes, just plain difficult. If you are over-matched by the task of grasping and managing the therapeutic relationship, maybe you should make a referral from the start. Usually, however, you don’t realize your understanding is flawed for a while. By then a referral will not be simple. No matter the desire to do good by the patient, your rejection is likely to sting or devastate. The client came to you for repair and you made him worse.

Some counselors will keep the same box and keep using their failed understanding to treat the person. Some try to jam the client’s body into a differently labeled container and still treat him, even when box #2 doesn’t work either. Most will try to learn more, be humble, and look for a right-sized carton or no box at all until things are clearer. None of these tacks is sure-fire, but I favored the last one when I was in practice, often with the help of a personality test.

The therapist in all such situations confronts his own limitations. He needs modesty before he can achieve mastery. He needs to acknowledge his errors. He needs to figure out what is best for the patient while keeping his brain from exploding a little from the frustration and the fear he won’t be able to handle things.

Not all of us can do this in therapy or in life, and no one does it all the time with those for whom we care and those we care about.

If you’ve read the black on white scribblings I seem to endlessly produce (to my own astonishment) you know I don’t offer too many simple answers. Like you, I keep trying to understand this thing called life that appears so simple on the surface and no one ever fully gets right.

Life is a squirmy creature. You believe she is in your grasp and one second later she wriggles away. You think you are the master of yourself until your lack of mastery can’t be ignored. People don’t fit into a carton, and life – of all things – oozes and leaps and bumps against any enclosure we attempt to put it in.

Our boxes, as essential as they are, can injure people around us and limit our own understanding: understanding of the complexities of our fellow-man and our ability to be understanding, comforting, and kind.

The irony is that our use of boxes puts us in a box, too.

The moral of this story is to acknowledge the artificiality of labeled cartons and know they are also needed to get through the day. And then, perhaps, drink a glass of wine and accept the universe as it is.

No wonder religious faith is so appealing. The idea of “giving control over” to a benign, all-powerful, all-knowing being is consoling for those who can. For others, myself included, the wine will have to do. And tomorrow you will find me, not at a wine bar again, but back at repairing and enlarging my boxes, fashioning some new ones perhaps, trying to make them work as well as they can.

To be our own best selves, therapists or not, at some point we awaken to the guidance so easy for every one of us to forget.

Each box should be labeled “Handle with Care.”


The top photo is called Box Loading and is the work of Surya Prekash, S.A. The second image features U.S. Troops Surrounded by Holiday Mail during World War II, ca 1944. It comes from the Smithsonian Institution. Both are sourced from Wikimedia Commons.

25 thoughts on “When Being a Therapist Means Saying You are Sorry

  1. ‘Being a therapist means you must be humble and open to those who can be difficult to categorize and sometimes, just plain difficult. If you are over-matched by the task of grasping and managing the therapeutic relationship, maybe you should make a referral from the start. Usually, however, you don’t realize your understanding is flawed for a while. By then a referral will not be simple. No matter the desire to do good by the patient, your rejection is likely to sting or devastate. The client came to you for repair and you made him worse.’

    My therapist recommended me taking a therapy break and only coming back to see her once I’ve gotten over my attachment to her…..which means I can never come back.

    Liked by 1 person

    • I’m sorry to hear this, Suzuki. Most therapists would try to provide a referral after making an attempt to work with the transferential issues. Simply ending things is not common, nor commonly recommended. I hope you try to find someone else.

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  2. Failing to find a “fit” between therapist and patient doesn’t have to mean that one or the other was “wrong” or “difficult.” But, I’ve always loved it when someone in a more “powerful” position admits to being just another human being after all.

    Liked by 4 people

  3. 🙂 Wine can seemingly help us cope with the randomness of life. I know you’ve said religion isn’t your thing, so would you be willing to consider another option of soul nourishment? I’m going to overstep and offer it unsolicited. 🙂 Yoga. Try it. Go to Spirit Rising Yoga in the Ravenswood area. Shabad is a psychotherapist in addition to being a wonderful teacher of Kundalini yoga. It may sound crazy, but it sure doesn’t sound any crazier than trying to forget our humanness with a light buzz.

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  4. Speaking of saying, “I’m sorry”, I’m sorry for being such a pest, here, but do you think that you might be able to toss out a few thoughts here on AADHD?

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    • I’ve written a bit about it somewhere on this blog, so if you search the posts you might find it, but there are tons of things on the net, and many books, too. Take care, Joseph.

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  5. Great blog. ‘Soft’ science means we admit our humanness and in doing so, we admit
    that being human is a work of creativity, Both pt and tx do best to sculpt the desired
    goals together. Step out of the labeling……ok to be wrong, even better, share perspectives
    refined through our perceived constructs.

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    • Thank you, Joanne. Your thoughtful comments are always gratefully received.

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    • Thank you, Joanne. My view is that the labels are usually useful in diagnosis and treatment if properly and carefully used. But, as I suggested, there is a downside. Your words are good advice for all therapists.

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  6. I had a therapist many years ago who seemed to need a therapist, himself. By that I mean that he was human and spent most of my session times, talking to me (aka venting) about his own troubles in his life. I felt as though we should have changed sides of the desk more often than not with me doing the billing to him. I say that with a fond chuckle, not disdain.

    I left this therapist as I was getting no help for myself and the reason that I went to him in the first place. The second therapist was much more willing to listen to my situation, issues and offer up questions whereby, I was sent out the door to figure it out and tell him what I had discovered. A clever method, no doubt.

    My third and final attempt at therapy involved a young woman who seemed to watch the clock, wanting to wrap up everything I had been saying, parrot it back to let me know that she had been listening then, tie a bow around it and give it back to me as though it was that simple. Maybe, it was?

    Those three therapists clearly were in need of help themselves as well. I hope that they got that help or, perhaps, they simply needed a glass or two of wine each evening.

    Thank you for this piece.

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    • You have the perfect name for someone who is reading my posts! Ponder life, indeed. All therapists have their issues, some just human, some more troubling. It is very important to keep from messing with your responsibility to your patient. If there is a next time, I hope you have better luck. Thanks, ponderinglifetoo.

      Liked by 1 person

      • I would hope that all therapists are human-feeling otherwise, it would feel almost impossible for patients to be able to relate and vice-versa. Besides, if they weren’t, I’d feel the need to prostate myself in front of them, unable to let out what was truly bothering me. 😉

        And, thank you again for the compliment as I am Pondering Life too. 🙂

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      • So sorry. I had a typo. That should have read “prostrate”, not “prostate” (ok, now I am chuckling at myself here. )

        Liked by 1 person

  7. “Life is a squirmy creature. You believe she is in your grasp and one second later she wriggles away. You think you are the master of yourself until your lack of mastery can’t be ignored. People don’t fit into a carton, and life – of all things – oozes and leaps and bumps against any enclosure we attempt to put it in.”

    ~ Oh, so true, Dr. Stein. We can spend a lifetime discovering who we truly are as individuals and never succeed. Knowing ourselves is true wisdom, Lao-tzu notes in his “Tao Te Ching.”

    Liked by 1 person

  8. I believe people can be a mixture of so many diagnosis’s, shadows of this and that, that it is hard to come up with a strick DMS-5 diagnosis. I have seen people’s diagnosis change many times. Sometimes upon admission, the patient is given an incorrect diagnosis and it stays with them regardless. (I am talking about mental health treatment centers.) Even medical diagnosis’s can be challenging. I have IBD and am being bounced back-and-forth between the two sub-categories and I do not know which one I have, but I am receiving treatment that presently seems to be working, which I guess is what counts. My doctors are trying and I appreciate this. Here’s to being human, Dr. Stein!

    Liked by 1 person

  9. Awesome article! Diversity awareness and cultural sensitivity in treatment are important factors, also. Male-female dyads, different ethnic dyads (including European Americans – also known as “white,” but I believe in using the ethnicity instead of the so-called skin color, and I believe that European Americans do have a culture), different religious dyads, old-young dyads, etc. It’s not easy for the therapist or the client have different ethnic backgrounds, cultural practices and beliefs, and gender differences – just to name a few diversity issues. But openness to discussing these differences and how it can affect the therapeutic alliance, the therapeutic outcome for the client, and the client’s struggles and triumphs in the world are important factors to consider in treatment. Our own biases as human beings can affect how we see others, no matter what arena we’re in – whether it is a therapeutic arena, whether we are the person of power in a company or in a therapeutic alliance, or whether we are the one seeking help in treatment or in a medical office or in the broader community, etc. An apology goes a long way, and a delineation of “expectations” may also be necessary to make the apology mean something to the client – in my humble opinion. Then again, sometimes the client’s expectations of therapists coupled with their particular disorders might make it more challenging for him or her to accept an apology or understand what appropriate expectations are in treatment. As a client, I’ve had great alliances with many therapists, and I’ve also had many not-so-great ones. The great ones occurred when the therapist understood our individual differences, explained his/her expectations and what I should be expecting (i.e, treatment goals), and wasn’t afraid to apologize for just being human from time to time. Heck, as a client, I’ve apologized to the therapist, too. We’re as human as the therapist and the boss and the other people in the world. We just live and operate differently, depending on many ecological and individual factors. This article reminded me of the importance of understanding our differences in the world, and our reactions to it. 🙂

    Liked by 1 person

    • Thank you, PP. Agreed on all points. The world is very full and in cutting it down to size, we inevitably lose something. You openness and thoughtfulness are admirable.

      Liked by 1 person

  10. Greetings Dr G
    I entered my therapist’s office in a box, all battered and mangled and damp from being dropped in a puddle or two and with a few corners chewed out – definitely had those labels: handle with care/she bites/use gloves/extreme caution necessary when opening this box/contents is toxic
    Now most therapist would have left me in that box and preferred to converse with me about the box and how I related to being in the box
    Fortunately my current therapist decided to break with tradition and hauled me out of the box, dusted off all those clingy polystyrene balls and plonked me down in a chair – I must admit I felt vulnerable and naked without my box, I missed it’s claustrophobic confines and its defining corners
    But the view out of the box was a lot more interesting
    And then both me and my therapist dived into the box like two fluffy kittens infected with a case of the deliciousness of curiosity and we started hauling out all the stuff that was hidden because I was sitting on it
    Now we use the box as a coffee table or something to rest out feet on, that’s how much importance that old box has in our therapy sessions
    It’s not the box or the labels that hold the secrets and so many therapists believe that they do
    What’s important is all the stuff inside the box that you’ve been sitting on for ages and ages, the stuff you’ve been making a nest out of
    It takes a strong, adventuresome therapist to see you sans box, the box doesn’t always accurately identify the contents, you read the labels and you’re scared off thinking there is a rabid beast inside that box when in actual fact there’s just a fluffy kitten inside that needs to learn how to play and be lion brave
    huggz, Dr G, your box-less bravery continues to hold my attention

    Liked by 2 people

  11. The richness of your prose is beyond praise, Rosie. I will remember your “box-less bravery” compliment for a long time. Thank you.

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