The Therapist Who Can’t Be Wrong Is the Most Dangerous Person in the Room

How clinical certainty becomes a defense against doubt, mistakes, and the patient’s reality.

This is Part 6 of a 12-Part Series: The Hardest Things in Psychotherapy

The most dangerous therapist is one who can not admit mistakes.

Here is a pattern I’ve observed over many years— in colleagues, trainees and many in the mental health field and, honestly, in myself. It’s the overconfident clinician.

Certainty and over confidence make a clinician dangerous.

Who Is The Overconfident Clinician?

Overconfident clinicians are not typically malicious or incompetent. In fact, they are often talented, knowledgeable, skilled, maybe even charismatic. However…

Overconfident clinicians have stopped being genuinely uncertain. They believe they have a framework that takes into accounts all possibilities—and they quickly, and with certainty, greets new patients with an understanding or case formulation predetermined as correct.

They are the clinician who is rarely, if ever surprised.

Why Are They Dangerous?

They are dangerous because certainty applies theory to clinical understanding when it just doesn’t fit. Therapy become a formula—a math problem to be solved—where pigeonholing a person has consequences.

The history of psychiatry is filled with certainty, and with that certainty, so many errors.

• Freud told his patients their trauma was fantasy.
• There was the bad mothering theory as the cause of Schizophrenia.
• Patients are dismissed, being told their medical symptoms are “ in their head” a psychiatric disorder, often called somatization disorder when it reality it is an under recognized medical diagnosis.
• Too many patients with borderline personality disorder are often written off before a treatment has been tried.

This harm rarely comes from cruelty. It comes from a belief asserted without enough doubt.

When you feel certain, examine your own countertransference. The clinician who has stopped being surprised has started defending against something.

The clinician who has stopped being surprised has started defending against something. Don’t be the clinician who is rarely, if ever, surprised.

Therapeutic humility requires the ongoing willingness to be worried about what you don’t know. You can never really know a patients subjective experience without asking.

Uncertainty Is A Good Thing

The mind wants to settle so formulations prematurely can harden.

Your formulation is just a working hypothesis.Don’t treat it as a fact.

We feel relieved when certain and more anxious when sitting with doubt.

The more experience you have, the more seductive certainty becomes. It’s easy for typical pattern recognition to masquerade as the patient’s truth.

You do not need distrust your pattern recognition. Rather, it’s a practice of holding off on drawing conclusions until you can confirm your theory multiple times.

Sometimes, what a patient needs to hear from the clinician is: “I got that wrong. I missed it.”

No need to be defensive or overly self-critical. Just acknowledge, it’s my mistake, and reconsider what you have been saying, thinking, or doing.

Why Owning Your Mistakes Matters

Patients with trauma histories watch to see if their therapist can tolerate being wrong. Many patients have spent years with parents who always had the ONLY truth.

The therapist who can admit mistakes, and not wallow in them, humanizes the psychotherapy experience.

I find it helpful to remind myself that most patients are speaking the truth of their experiences. We need to listen and not let our overconfidence get in the way.

Doubt makes is easier to learn and to be taught new things—by our supervisors, by the literature, and by the patients who want to trust us. And patients trust us more when we can acknowledge what we don’t know.

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Robert E. Feinstein, MD

Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell



Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com

Owner & Founder Empathian LLC ( An Online Mental Health Education Company)

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