How Being Bad Can Make You Better


Developing a culture of feedback in your practice

November/December 2007


Research now shows that a small group of clinicians—sometimes called "supershrinks"—obtain demonstrably superior outcomes in most of their cases, while others fall predictably on the less exalted sections of the bell-shaped curve. But thankfully, even mere mortals can significantly increase their therapeutic effectiveness by implementing the characteristics of these creme-de-la-creme therapists. How? The surprisingly simple answer is conveyed by Mae West's famous quip, "When I'm good, I'm very good, but when I'm bad I'm better." Granted, at first blush, these hardly seem like words for therapists to live by; but, as it turns out, they are.

Take the case of Matt, a twenty-something software wizard, frequently on the road, trouble-shooting customer problems. He loved his job. Even so, traveling had become an ordeal. For many, flying long ago lost its luster, but Matt had a personal problem that made flying unpleasant—an inability to urinate in public restrooms. At the outset, it caused only mild discomfort and was easily solved by repeated visits to the bathroom. In time, though, the problem began to cause intense apprehension before each trip, excruciating feelings of pressure in his bladder while on the plane, and hair-raising panic attacks sometimes. Hopeless and demoralized, the young man considered changing jobs. As a last resort, he decided to seek psychotherapy.

He liked his therapist and was glad that he could finally talk about his difficulty. In short…

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