I am a lousy therapist.

When I saw this statement in a comment from a respected colleague on an Internet forum I reacted with skepticism: What makes him think he’s lousy as a psychotherapist, and what gives him the authority to judge anyway? Then my head started spinning with questions.

Who can determine the quality of a psychotherapist? Can we really judge our own competence? Did criticism of the colleague above by others contribute to his statement, or did he determine this himself? How often has any of us criticized the psychotherapy abilities of others? How often have others criticized our abilities? Can the patient accurately judge, or will the patient’s feelings toward the psychotherapist interfere with accurate assessment? “I like her, therefor she’s a great psychotherapist.”

What determines the ability of a psychotherapist? Popularity with patients? Success? Can we assume that a speedier cure suggests a better psychotherapist? Boredom? Falling asleep during sessions? Dislike for patients? Can one develop a dislike for doing psychotherapy but remain good at it?

How lousy must you be to justify abandoning the profession? What constitutes good enough? How many lousy psychotherapists continue to practice anyway, and how much harm results?

How many lousy psychotherapists can fall back on another skill? The colleague above used the statement to explain his decision to restrict his practice to medication management. Similarly, psychologists can walk away from psychotherapy to focus on testing, but likely the vast majority of psychotherapists have no such an easy alternative practice.

Is it the psychotherapist or the psychotherapy one judges as lousy? Could a lousy narrative psychotherapist excel at gestalt therapy? Could a lousy family systems psychotherapist excel at an Adlerian approach?

I will conclude one thing: The colleague above demonstrated tremendous integrity in making such a choice (but I still do not believe him).

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