A Good Therapist Doesn’t Have to Know Everything: The Importance of Admitting Your Intellectual Limitations to Clients

To me, few things are harder to tolerate than my own ignorance; I hate admitting that I don’t know something. And my disdain even stretches to my knowledge, or lack thereof, in fields in which no one else would call me an expert. Since I’ve associated so much of my self-worth with being “the smart one,” my limited knowledge fosters two states, respectively: obsession and demoralization.

For whatever reason (I can’t trace my memories back that far), I developed the notion that love equates with expertise and recognition. So, you may be able to imagine how my core belief can interfere with my job. Additionally, our culture tends to over-value quick reasoning, or what psychologist Daniel Kahneman calls System 1 Thinking, whereby a pundit arrives at a solution within seconds of hearing the problem. And although studies on human cognition persist in evincing the increased likelihood of poor judgment, we still mostly honor the ones with a razor sharp wit.

Yet, while quick-thinking is a positive quality in emergency rooms and other fast-paced environments, it’s more detrimental (on average) than deliberation, System 2 Thinking, in the others, especially in therapy. There are some clinicians, particularly the humanistic ones, who argue against diagnosing in general, noting our innate capacity to prefer to maintain our initial perspectives; the human mind, according to them, falls in love with its stories. So, they assert that they should never be crystalized, as would be the case with an official diagnosis. Over time, their conclusions, at least partially, effected the phrase “provisional diagnosis,” whereby therapists cultivate stories resting on tentative foundations. But, despite that check on our power, many of us still find ourselves desperately clinging, as though expertise fades with each passing mistake.

Like many others in our field, I’ve struggled with imposter syndrome, which fosters a need for constant reinforcement and the difficulty with tolerating even moderate mistakes. If my story were wrong, then what sort of expert could I actually be? Who would want to see me for treatment? Who could accept my conclusions? Like any other endeavor entailing a clientele, therapy is a business and, as such, requires self-promotion. Since most of us are competing with other practitioners, we try our best to stand out from the crowd, essentially peacocking. And in New York City, where people are constantly shopping for therapists, none of us want to be left behind.

Thus, I help my clients quickly form intricate stories that make sense to them, and love the subsequent recognition for their conceptions. But, as the history of sophistry indicates, an apparently genuine story or argument isn’t necessarily true. So, I’m often stuck between two choices: appearing knowledgable or being vulnerable, wondering if an admission of error will cause a client to abruptly end treatment. And while I still struggle with feeling like an imposter, I remind myself that the stories weaved with my clients are only partial truths (sometimes, not even that), mere attempts to get at the heart of their distress. I’m right about some things, but wrong about others. And I’ve come to accept why diagnoses are only provisional concepts that are ungeneralizable. One example is of Delusional Disorder, wherein we diagnose a client who’s telling apparently absurd tales with a disorder that implicitly disputes their claims. But, what if I’m wrong and he’s right about some conspiracy hatched at work in order to terminate him? And what if the overly competitive individual whom I’ve diagnosed with Narcissistic Personality Disorder is truly a part of a cutthroat environment?

We have to keep asking these types of questions if we are the experts we purport to be. For, an expert holds on to her view, but remains open to losing it, or she’d require a diagnosis granted to many of those with delusions. But, our environment, and our careers, will still foster worry. If you admit your mistakes, some clients will leave, especially the ones searching for an authority figure to resolve their problems on their behalf, but others will value your courage, interpreting it to indicate your concern for their health while also smashing the illusion of their intellectual inferiority.

In the end, what matters most is not precision regarding their problems’ sources (at least not initially), but consideration of the individuals who present with them. Carl Rogers, the prominent humanistic psychologist noted, “True empathy is always free of any evaluative or diagnostic quality,” meaning that our diagnoses often inform our perceptions of moral character, sometimes causing us to solely blame the client for her distress. And even though, as the expert, you’re supposed to know more about her sorrow from a clinical standpoint, you don’t have to know everything.

I have a tendency to jump to conclusions and, at times, make false theoretical assumptions of my clients’ motivations; sometimes, I’m right, and at others, I’m wrong. However, what they appreciate most seems to be my willingness to listen and reinterpret my stance. Most of the time, clients aren’t seeking out a therapist who knows them better than they know themselves; they’re simply looking for someone who will care enough to help them discover the deeper aspects of their inner worlds.

Physicist Richard Feynman wrote:

It is in the admission of ignorance and the admission of uncertainty that there is a hope for the continuous motion of human beings in some direction that doesn’t get confined, permanently blocked, as it has so many times before in various periods in the history of man.

And, I maintain that the admission of uncertainty engenders the hope for the continuous motion of the human relationship, constantly evolving and growing, with its interlocutors learning from their mistakes and teaching one another about their admissibility.