We are used to saying that the client is responsible for his psychotherapy. But even in the presence of other objective circumstances, we are also to a certain extent responsible for the outcome of treatment. You must have the courage and determination to voice your mistakes, wrong ideas, ill-timed and poorly executed interventions. Each of us periodically makes the wrong diagnosis, rushes or, on the contrary, slows down progress, and makes an unforgivable mistake. Research says that a third of clients leave after the initial consultation, and half quit after the second meeting. And few psychotherapists know the true reasons for this. Other clients, not seeing positive changes, continue for an average of ten more sessions before deciding that psychotherapy is not benefiting them. 10-20% of clients will feel worse, especially those experiencing grief, traumatic stress, and dissociative disorder. To support ourselves, we come up with excuses: delegating all responsibility to the client: “He is not motivated” rationalization: “Sometimes things get worse before improvement” support from colleagues: “This is resistance” seeing success in everything: “He did not return because he solved his problem for once” do not count on much: “If he continues to walk, then he receives a certain benefit” accuse the client of denial: “He is much better, he just doesn’t understand it” refer to insurmountable external circumstances: “I am powerless when the client has such a severe problem life situation" to consider the client unprepared for change: "Time must pass for him to understand that it is time to decide on something." It happens that we are unable to help a client. And admitting this is very difficult. Jeffrey A. Kottler gives us some examples of really bad psychotherapy to support us. “American actress Judy Garland’s psychotherapist usually held two sessions a day with her and prescribed her the best medications that were supposed to relieve her of insomnia and loneliness, as well as reduce her levels of depression and anxiety. (She died of a drug overdose.) The therapist of Brian Wilson, the founder, songwriter and producer of the popular group The Beach Boys, who followed him everywhere for a year, insisted that all the songs Brian wrote during that period include a thank you note. therapist as a co-author of these songs, and asked Brian for a million dollars for treatment. My “favorite hero” is Marilyn Monroe’s therapist, who may well be the man who killed her by prescribing her a lethal dose of barbiturate. (He was the last person to see her alive.) In addition, he forced Marilyn Monroe, who was suffering from depression, to be at his beck and call, supplying her with unlimited quantities of Nembutal, Seconal and chloral hydrate. He also demanded that she buy him a house not far from where she lived, explaining that he must be ready to quickly come to her aid at any time.” The errors in these examples are obvious, but there is no agreement on what exactly causes such negative results. And the range of opinions is very wide. Someone pays attention to how the client behaves outside the office, whether he sees understanding from the specialist and how his condition changes. But for others, it is important whether the psychotherapist is in control of the situation, how he demonstrates compassion and empathy, how flexible and free he is in relationships, the accuracy of diagnosis and the degree of his own arrogance and self-esteem. At the same time, many were very lenient about their mistakes, not recognizing them as poor psychotherapy and signs of insufficient qualifications, if they made amendments to their actions taking into account previously made mistakes. Some experts evaluate effectiveness based on the client’s feelings, others rely on their own opinion. Can it be considered a success if the client is satisfied when there is clearly no change, or when the client is dissatisfied but those around him say that his condition has improved significantly? That's why