Ahead of his CPD on the subject, Paolo Assandri shares his dissertation, which focusses on therapeutic failure, and how opening the discussion on the subject can potentially be used in future research.
ABSTRACT
Although failure is unavoidable in therapists’ work, not much has been written about it. Even in psychosynthesis, therapeutic failure is an under-researched topic; in fact, there are no formal writings devoted to it. In light of this, the goal of this first psychosynthesis research devoted to therapeutic failure is to open a heartfelt and honest conversation on this topic within the Italian psychosynthesis psychotherapy community, in order to let failure out of the shadow and explore its potential for growth and learning as well as its harmful and pathogenic possible effects. More precisely this research focuses on psychosynthesis therapists’ experiences of perceived therapeutic failure. Considering the subjectivity of this topic, a phenomenological approach has been used and five experienced Italian therapists have been interviewed. Using Interpretative Phenomenological Analysis, three themes emerged from the data collected, showing that perceived therapeutic failure contains both a positive and negative aspect. This study shows that, besides having a detrimental impact on therapists’ sense of self in the aftermath, perceived therapeutic failure can promote therapists’ personal and transpersonal growth, if processed in an appropriate relational context. Since this is the first monographic study on therapeutic failure in psychosynthesis, further research on this topic is recommended.
INTRODUCTION
There is no such thing as the perfect therapist. All therapists, sooner or later, experience errors and failures. Despite the inevitability of such phenomena (Bugental, 1988; Guistolise, 1996), therapists prefer to focus on their successes and they rarely “publicly air the ‘dirty laundry’ of treatment failures” (Lampropoulos, 2011:1093). Speaking of one’s own failures can indeed be painful and admitting one’s fallibility can generate unpleasant and painful feelings (Dimidijian & Hollon, 2011). This may account for the relatively scarcity of material available on the topic of therapeutic failure (Lampropoulos, 2011). Also, within psychosynthesis, there are no formal writings devoted to this topic, even if the possibility of errors and mistakes is mentioned by some of its authors (Assagioli, 1966; Assagioli cited in Caldironi, 2004; Whitmore, 2004, Firman & Gila, 2010).
Given the very limited literature on this topic in psychosynthesis, the primary objective of this research is to open a sincere and honest dialogue on therapeutic failure among psychosynthesis therapists. Considering that psychosynthesis can be described as an inclusive psycho-spiritual model, which integrates and gives value to all human experiences (Firman & Gila, 2002), the purpose of this dialogue is to allow therapeutic failure to come out of the shadow and welcome it into psychosynthesis theory and practice. Furthermore, given psychosynthesis’s character of inclusivity (Assagioli, 1991), not only the “negative” side of therapeutic failure but also its potential for personal and transpersonal growth, will be investigated (Assagioli, 1966; Assagioli, 1991; Assagioli, 2007, Whitmore, 2004). By transpersonal, I mean those aspects and experiences that go beyond the ordinary human experiences and that are, as defined by Wilber, “’more than the personal, ‘personal plus’ ” (Wilber, 1996: xviii).
My motivation in conducting this research stems from the suicide of one of my clients. This experience, which I perceived as a significant therapeutic failure, had a huge impact on my life, even making me consider the possibility of abandoning my work as a therapist. This painful experience led me to ask myself several questions about therapeutic failure, especially when I realised that finding a shared definition of it was an impossible task, even between therapists with the same therapeutic training. Moreover, I also realised that that for many therapists, me included, sharing failures was hard, embarrassing and painful. Even supervision sessions did not feel safe enough. These reflections led me to want to know more about how other psychosynthesis therapists understand and cope with therapeutic failure. As a result of it, some questions emerged: is there in psychosynthesis a space to talk about therapeutic failure? How psychosynthesis therapists understand their failures? Can psychosynthesis support therapists in processing failure? But, above all, I wanted to know more about therapists’ humanity related to failure, in terms of imperfection, messiness, fears, feelings and emotions that therapeutic failure pushes therapists to get in touch with, because “…when we are most human we are in touch with our greatest potential for helping clients” (Wosket, 2011:109).
Given the above, this research can be considered a stepping-stone in relation to the topic of therapeutic failure. More precisely this dissertation will focus on perceived therapeutic failure, meaning the experience or set of experiences subjectively defined as failures by therapists. Its goal is not to define strategies to avoid or process failures and errors, but to open “some space for discussion and exploration of our regrets and sense of failure about our therapeutic practice” (Spellman & Harper, 1996:213). Being the first psychosynthesis monograph on therapeutic failure, this dissertation does not aspire to be exhaustive. On the contrary, its hope is to serve as an initial exploration of this important and underresearched topic, by bringing out doubts, questions, and contradictions that could become the subject of future research.
Given the subjective lens adopted, this dissertation will employ a qualitative and phenomenological investigation method. The dissertation consists of five chapters. Chapter one draws upon the literature in psychotherapy and counselling on therapeutic failure. Chapter two presents the thesis of this study, including the objectives of my work and the key research question. Chapter three presents a critical discussion of my methodological choices in conducting this research, including the tools used to collect data and the data-analysis method selected (Interpretative Phenomenological Analysis). Chapter four then presents the findings obtained from the analysis of the interviews. In this chapter three emerging superordinate themes are outlined: 1) “In the aftermath”: consequences of perceived therapeutic failure, 2) Processing perceived therapeutic failure, 3) The hidden gifts of perceived therapeutic failure. Finally, the last chapter outlines the conclusions drawn from this research, the possible implications at both theoretical and practical levels, the limits of the work and the recommendations for practitioners and for future research.
CHAPTER ONE: LITERATURE REVIEW
In this chapter, I will present a review of the counselling and psychotherapy literature on therapeutic failure. Since in psychosynthesis literature there is little material on this topic, this review will be based primarily on sources coming from other theoretical orientations. After outlining these various perspectives, I will discuss the reasons why therapeutic failure is such a difficult topic to address and why it is nonetheless crucial to talk about it.
Therapeutic failure in psychotherapy
In the middle of the last century, Eysenck (1952) expressed doubts that psychotherapy could have a beneficial effect on clients’ lives. His provocative comments kick-started a considerable amount of research on the efficacy of psychotherapy itself. Although many of these studies demonstrated its validity (Baskin et al., 2003; Lambert & Archer, 2006), psychotherapy also proved, in some cases, to be ineffective as an agent of change (Foa & Emmelkamp, 1983; Hynan, 1990; Kottler & Carlson, 2002). It even seems that psychotherapy had a detrimental effect on some clients’ conditions (Castonguay et al., 2010; Lilienfeld, 2007). According to a study by Lambert & Ogles (2004), about 8% of clients deteriorated as a result of the treatment itself. Psychotherapy is of course not devoid of error, and therapeutic failure seems to be an experience that, sooner or later, all therapists will face (Kottler & Blau, 1989; Guistolise, 1996; Weeks, Odell & Methven, 2005; Ben-Shahar & Shalit, 2016). Despite this awareness, therapeutic failure remains a topic that is rarely addressed (Lampropolous, 2011), and reticence to talk about it publicly is widespread amongst therapists (Lambert, 2013), and other health practitioners (Newman, 1996, Goldman, 2011).
Therapeutic failure in psychosynthesis
To date there are no psychosynthesis studies devoted to therapeutic failure. This could be due to several factors. One of them could be linked to the psychosynthesis idea that our pain, crisis and failures are learning opportunities, both on a personal and a transpersonal level (Assagioli, 1991; Whitmore, 2004; Assagioli; 2007). This idea could be misleading, as therapists may fail to adequately interrogate whether the deterioration of a client’s psychological state is indeed part of his or her Self-realization process or a result of misguided therapeutic interventions. This cavalier attitude could result in the denial of therapeutic mistakes and failures in clinical practice and omissions in the literature.
Another factor explaining this lacuna in the literature may relate to the “dualism” (Robertson, 1996:22), or “duality” (Whitmore, 2015), inherent in spiritual traditions. ‘Dualism’ here refers to a type of binary thinking where a positive polarity is pitched against a negative (e.g. body and soul). This dichotomising logic is apt to contaminate psychosynthesis (Robertson, 1996) to the extent that Higher and Lower unconscious are at times erroneously understood as two separate and polarized entities (Finotti, 2000; Firman & Gila, 2002), where the former is considered to be better than the latter. On the basis of this misconception, some psychosynthesis therapist and authors may tend to favour transcendence and peak experiences (Robertson, 1996) over ‘lower unconscious material’, which is then repressed as an “unacknowledged shadow” (ibid.,1996:22). Arguably, such a dynamic may apply to therapeutic failure.
While, to date, there are no psychosynthesis monographs devoted exclusively to this topic, various psychosynthesis authors (Assagioli cited in Caldironi 2004; Whitmore, 2004; Firman & Gila, 2010) have acknowledged in their writings that it is indeed possible for therapists to get it wrong. Assagioli himself (cited in Caldironi, 2004) argued that therapists’ choice of words can create pathology and symptoms, urging us to reflect on the possible iatrogenic effect of therapy. Firman and Gila (2010) state the assumption a therapist is always empathetic, caring and loving can cause empathetic failure and undermine the client-therapist relationship. Whitmore (2004) argues that therapists can make mistakes and experience failure. She also claims that “if we take responsibility for our mistake, acknowledge it and make amends in some way to clean up the mess we make, we are demonstrating a transformative way of being” (Whitmore, 2004:188), thus underlining the fact that the way we, as therapists, address our failures and errors can contribute to positive therapeutic outcome.
Is it possible to define therapeutic failure?
Over the past twenty years, health-care research and practice have been dominated by an emphasis on evidence-based treatments (Eddy, 2015) and the “… conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual clients” (Sacket et al., 1996: 71). Also within the fields of psychotherapy and psychology, researchers have tried to determine the efficacy of different treatment methods, seeking to reduce the risk of errors and of iatrogenic effect (Levant & Hasan, 2008; Norcross & Wampold, 2011). While the issue of defining psychotherapeutic failure has inevitably been raised in this type of inquiry, so far, little consideration has been given to the fact that many of the criteria used to define evidence-based psychotherapy treatments are rooted in a medical model that often does not translate well into the practice of psychotherapy (Clemens, 2002). This tension between the need to determine what does and does not work in psychotherapy and the inability of practitioners and researchers to provide categorical answers, spurred my initial exploration of the literature on therapeutic failure: is it possible to define therapeutic failure in psychotherapy? Or rather, is defining therapeutic failure a Sisyphean task destined to never be accomplished?
Based on the idea that psychotherapy as a relational process is both unpredictable and sloppy (Stern, 2004), various studies have shown that during psychotherapy, the client and therapist influence each other in unexpected ways (Norcross, 2002; Giusti & Marini, 2013). Bugental (1988) argues that the possibility of making mistakes is intrinsic to the therapeutic process itself insofar as what may be effective with one client may not be so with another. Therapeutic failure may occur even when the therapist has correctly followed protocols and administered the treatment deemed appropriate (Berger, 2001). For example, Koukopolous and Girardi (2005) point out that while some bipolar clients do not benefit from psychotherapy due to a failure to diagnose promptly or correctly, others who received correct diagnosis, appropriate treatment and displayed good motivation, did not benefit from therapy either (ibid.). Ultimately, research appears inconclusive in identifying which psychotherapeutic factors lead to therapeutic success or failure, especially because factors leading to recovery or otherwise are often external to the therapy itself (Asay & Lambert, 1999).
Defining therapeutic failure thus becomes extremely difficult within a post-modernist framework (Spellman & Harper, 1996; Weeks, Odell & Methven, 2005; Ben-Shahar & Shalit, 2016). While the traditional modernist conceptions of therapy clearly defined success and failure and indicated how to measure them (Spellman & Harper, 1996), post-modernism upsets these ideas, making them appear naive (ibid.). As Butler (1992: 20) argues, in this framework: “one practitioner’s success is another’s failure; there is no more consensus on damage than there is in any other therapeutic issue today”. Furthermore, every therapeutic approach can offer a different description of failure (Lampropoulos, 2011). For example, in CBT therapeutic failure may include dropouts, the absence of symptomatic improvement or relapse (Foa & Emmelkamp, 1983:15). In humanistic experiential therapy, it can be defined as the failure to develop a strong therapeutic relationship, the absence of symptomatic improvement, rejection of the organic experience, self-annihilation and disregard for oneself and one’s own experiences (Watson, 2011). In psychodynamic therapy, failure can occur in those cases where the client’s insight is little to none, even where there is symptomatic improvement (Gold & Stricker, 2011). In family therapy, it can refer to those therapeutic impasses that lead to a deterioration of the client’s condition or simply to the abandonment of any hope for change (Canevaro, 2014). Even within the same therapeutic approach, finding a definition of therapeutic failure can be an extremely difficult undertaking.
Why is it difficult to talk about therapeutic failure?
Formulating a definition of therapeutic failure is not the only difficult aspect of this topic. Talking about one’s own therapeutic failures is highly challenging inasmuch as it can be extremely difficult and painful (Dimidijian & Hollon, 2011; Lambert, 2013). Mistakes and failures are often regarded as “uninvited guests in the therapist’s’ office” (Butler, 1992:17).
This difficulty in sharing errors and failures seems connected to certain “myths” in relation to the psychotherapist profession (Pope, Sonne & Greene, 2006). These can be described as sets of unrealistic expectations with respect to both psychotherapy and the figure of the psychotherapist (Giusti & Marini, 2013). Pope, Sonne and Greene (2006) argue that these myths create an idealised version of psychotherapists, behind which therapists themselves can hide their mistakes and vulnerabilities, thus consequently feeding the silence surrounding uncomfortable topics such as sex, death, money and professional competition. For example, the myth according to which psychotherapeutic practice is characterised by the therapist’s positive feelings towards the client, contributes to creating an idealised image of the therapist whose actions are always motivated by altruistic motivations (ibid.). In order to protect this image, psychotherapists tend to deny their feelings of anxiety, fear, anger, excitement (ibid.) and the fantasies of domination and power (Guggenbuhl-Craig, 1998) that they may nurture towards clients. This denial contributes to the creation of taboos that can invalidate the clinicians’ ability to manage situations in which such feelings and fantasies are present (Giusti & Marini, 2013). I found especially interesting what Adams (2013) defines “the myth of the untroubled therapist”. According to this idea, therapists are supposed to be free of all the kinds of problems that clients bring to therapy (ibid.), thus creating a lot of expectations on therapists being somehow perfect. While reflecting on this myth, it became clear to me why therapists seldom talk about their failures: how can therapists disclose publicly their failures when they are supposed to be untroubled and perfect?
Another difficulty in talking about therapeutic failure is the attempt to protect the therapists’ theoretical reference model (Kaffman, 1987) and, consequently, their professional identity. Speaking of errors and failures can in fact provide a motive for criticising the therapeutic approach chosen by the therapist, thus demonstrating the fragility and vulnerability of both the theoretical model used and the therapists themselves (Emmelkamp & Foa, 1983). Furthermore, I think it is important to underline the fact that therapists, since they are human beings, can be subject to the same processes of denial, distortion, rationalisation and repression that they uncover in their clients (Hynan, 1990). For example, when therapists receive complaints, note deterioration in their clients or simply find themselves in difficulty, may try to mitigate their responsibility, justifying failure with explanations that lie outside of their responsibilities and therapeutic choices (ibid.), often attributing failure to organic causes or the client’s resistance (ibid.).
Talking about failure and errors can also trigger self-conscious emotions (Tangney, 2002) such as shame (Hahn, 2001; Ladany, Klinger & Kulp, 2011; Bidjerano, 2010) that can be extremely unpleasant and painful (Tangney, 1995). Errors and failures, even if only perceived, can cause what Ladany, Klinger & Kulp (2011) define as therapist shame, meaning “… an intense and enduring reaction to a threat to the therapist’s sense of identity that consists of an exposure of the therapist’s physical, emotional, or intellectual defects that occurs in the context of psychotherapy” (Ladany, Klinger & Kulp, 2011:308).
Furthermore, failures can lead to feelings of regret (Spellman & Harper, 1996), as a result of comparing how things ended up and how things should have been (Beazley, 2004). Failures can also generate self-doubt concerning therapeutic abilities and skills (Newman, 1996; Zhao & Wickman, 2015), thus undermining self-esteem (Herman, Leonardelli & Arking, 2002). Errors, mistakes and failings can also trigger self-criticism, and cause people to relate to themselves in judgemental, critical and cruel ways (Kelly, Zuroff & Shapira, 2009; Montero-Marin et al., 2016). Self-criticism can negatively affect people’s performance and capacity to achieve a goal (Powers et al., 2011).
Therapeutic failure therefore seems to compromise the professional sense of identity of the psychotherapists who are forced to face their own fallibility and vulnerability (Kottler & Blau, 1989). Failure also challenges the illusory narcissistic and grandiose fantasies, that are often present in therapeutic professions (ibid.). Ben-Shahar (2016) maintains that even just the idea of doing something about another person’s pain is a narcissistic belief and that “… a great deal of sense of worth stems from helping others” (Ben-Shahar, 2016: 155). Gabbard (2016) also stresses that the therapist’s narcissistic fantasies are often the cause of boundary violations, which are considered the main causes of therapeutic failures and iatrogenesis (Pepper, 1991).
I also believe it is important to mention that one of the reasons why therapeutic failure is a rarely addressed topic in the literature, is the importance attributed to “success” in the field of psychotherapy (Spellman & Harper, 1996). After all, as Goldman (2011) argues, who would choose to go to a healthcare professional who publicly admits to failing and making mistakes? Bianciardi and Telfener (1998) point out that for professional therapists, from a purely economic point of view, there seems to be no benefit in recognizing that therapeutic processes can be ineffective and/or harmful to clients.
Why is it important to talk about therapeutic failure?
Although, as I have previously outlined, there are several reasons why admitting mistakes and failures is difficult and painful, the literature seems to suggest numerous reasons why therapeutic failure should not be considered as “dirty laundry” (Lampropolous, 2011:1093) and hidden away.
Firstly, therapeutic failure can become an important source of learning (Edmondson, 2004; Goldman, 2011). Kottler and Carlson (2002) maintain that psychotherapists can learn a lot from processing their failures. According to the authors, therapeutic failure:
- promotes self-reflection. Failure provides therapists with the opportunity to understand what they could have done differently and make them more aware of their weaknesses and strengths.
- provides useful information. When working with a client, therapists can obtain more useful information about how therapy is going from errors and partial failures than from what they did right. This offers psychotherapists the possibility to modify any ongoing therapeutic choices that are not proving beneficial to the client.
- promotes flexibility. Failure helps therapists become more flexible and abandon ineffective, iatrogenic strategies in favour of those that are more useful to clients.
- teaches the value of patience. Failure shows that patience is a variable that allows the therapy to unfold. Therapy can only take place if the client and the therapist show patience to each other, also forgiving each other’s mistakes and inaccuracies.
- teaches the value of humility. Failure enables the therapist to recognise his narcissistic fantasies and accept his own weaknesses and imperfections. Schwartz and Flowers (2010) argue that the first big mistake therapists can make is not recognizing their limits.
In addition to the aforementioned teachings (Kotler & Carlson, 2002), recognising their failures and mistakes improves the therapist’s ability to enter in relationship with the client (Schwartz & Flowers, 2010). In fact, when psychotherapists admit their mistakes, they come into contact with their own humanity and “… when we are most human we are in touch with our greatest potential for helping others” (Wosket, 2011:109). As Rogers argues (cited in Baldwin, 1987), only if the therapist perceives himself as imperfect, with defects, can he leave his defensive position, aimed at protecting his illusory image of perfection, and help others. When the therapist shows his imperfection, the client can stop turning to the therapist as the only source of love and acceptance and can, instead, start looking for it within himself (Wosket, 2011). Bellows (2007) states that when therapists allow clients to be seen as imperfect, they encourage the development of a more realistic self, thus modelling self-acceptance and self-respect (Wilson, 2017).
Furthermore, as failure can trigger self-conscious emotions such as shame (Tangney, 2002), it is particularly important for therapists to share their failures (Spellman & Harper, 1996). Firstly, because sharing shame provoking experiences in a safe environment increases shame resilience, the ability to describe the experiences that cause shame and the capacity to understand, identify and name the shame, rather than internalizing and hiding it (Brown, 2006). Secondly, Pope, Sonne and Greene (2006) claim that sharing therapeutic failures with colleagues can strengthen the therapist’s sense of belonging to the therapeutic community itself, facilitating greater openness within the entire community to subjects that are considered taboo. Moreover, sharing one’s own experiences of shame in supervision, especially that in groups, can give a sense of liberation and re-establish self-esteem (Perret, 2017), thus satisfying one of the relational needs identified by Erskine, Moursund & Trautmann (1999); that of “mutuality, shared experiences, confirmation of personal experience” (Erskine, Moursund & Trautmann cited in Perret, 2017:44). Sharing experiences of failure also increases familiarity with this aspect of professional life, making it “more negotiable” (Kottler & Blau, 1989).
In conclusion, I agree with Casement when he claims that: “analysts and therapists do not so readily share their failures…more can be gained by all when some are prepared to do so” (Casement, 2002:225).
CHAPTER TWO: THESIS
Defining the key research question is a fundamental step in the design and implementation of a research project (Braud & Anderson, 1998; Robson, 2011), as it affects key research question affects all subsequent phases, including methodological choices (Robson, 2011). This chapter will outline the main objectives of my research and the questions I intend to explore, including the key research question.
As we have seen in the previous chapter, therapeutic failure is often perceived as a sensitive topic. Even though talking about this shared experience could be extremely important and fruitful for therapists (Kottler & Blau, 1989; Dimidijian & Hollon, 2011; Ben-Shahar & Shalit, 2016), the subject is rarely discussed and hardly addressed in psychotherapy literature (Lampropoulos 2011; Wosket, 2011). Specifically in relation to psychosynthesis, this lacuna may be linked to two primary factors. Firstly, the concept of ‘reframing’ pain, crisis and failures as learning opportunities, may at times be misused to gloss over therapeutic failure, diluting the sense of responsibility psychotherapists feel towards their therapeutic choices. Secondly, psychosynthesis’ differentiation between ‘higher and lower’ unconscious is apt to be misinterpreted as a moral hierarchy (Robertson, 1996), lead clinicians to repress of ‘Lower Unconscious’ material both in clients and in themselves. As mentioned in the previous chapter, therapeutic failure can be seen to pertain to this area of “unacknowledged shadow” (ibid., 22), which is likely to sabotage the effectiveness of therapy.
Indeed, therapeutic failure displays many of the attributes, associated in psychosynthesis with the shadow (Assagioli, 1966; Assagioli, 1991; Whitmore, 2004); if it is denied and hidden (Kottler & Carlson, 2002; Lampropolous, 2011), it can unconsciously affect therapists’ lives (Kottler & Blau, 1989; Ben-Shahar & Shalit, 2016). Furthermore, when in shadow, it contains a positive-negative polarity (Longstaffe, 1999; Assagioli cited in Firman & Gila, 2002), as it can be seen as a learning opportunity as well as a painful experience. Considering therapeutic failure as the shadow, it seems reasonable to assume that therapeutic failure also “… needs to be integrated into the client’s experience of well-being” (Whitmore, 2004: 20). Therefore, if we want to learn more about the growth potential of it as well as its iatrogenic and damaging characteristics, we must allow it ‘out in the open’. In fact, as long as it remains denied, suppressed and repressed and outside consciousness, it is impossible to sift its positive and negative traits and fully utilise what it can offer to psychosynthesis theory and clinical practice:
“Not only is the shadow not all bad, dirty and dangerous, containing gold and jewels as well, but we actually don’t know which will be the good bits and bad bits until they emerge into the light.” (Longstaffe, 1999)
The main objective of this dissertation is to start a conversation about therapeutic failure so that it can “emerge into the light” (ibid.). I believe that, at this stage, seeking to provide a definition or a psychosynthesis theory of therapeutic failure would be premature and excessively ambitious.
In other words, referring to one of psychosynthesis’ core concepts, that of disidentification (Whitmore, 2004; Assagioli, 2012; Firman, 2011), this research intends to help therapists question and examine their possibly unconscious identification with beliefs, feelings, fears, expectations, and meanings related to failure. Since we are dominated by what we identify with, and dominate and control what we disidentify from (Assagioli, 2012), this process will hopefully facilitate a progressive and conscious detachment from these otherwise undifferentiated aspects, which can at times obstruct or even sabotage the therapeutic relationship (Firman & Gila, 2010).
I would also like to point out that, in this study, the term therapeutic failure will not be used. Also, as pointed out in the previous chapter, considering that defining therapeutic failure in a post-modernist framework is a very difficult undertaking (Spellman & Harper, 1996), I will use the term perceived therapeutic failure (henceforth referred to as PTF). As mentioned earlier, by PTF I mean those experiences, or that set of experiences, that have been perceived as therapeutic failures, thus underlining the subjectivity inherent in the very definition of therapeutic failure (Brothers, 2016).
In light of the contents of this chapter, the key research question is as follows:
“How do psychosynthesis therapists understand and experience perceived therapeutic failure PTF?”
In addition to this main research question, and consistently with the psychosynthesis vision of life as a gym where one learns and grows (Assagioli cited in Morbidelli, 2009), this dissertation intends to investigate if and how PTF can be defined as “a source of discovery rather than an occasion for selfdefence” (Schon, 1983: 299). Therefore, I will explore different aspects related to PTF, such as how psychosynthesis therapists process their PTFs and how PTF can support their transpersonal development of the therapist.
Before presenting the methods used in this research, I would like to highlight that this study does not aspire to be exhaustive. Its aim is to be a springboard for exploration of this topic, hoping to bring out doubts, questions, and contradictions that could become the subject of future research.
CHAPTER THREE: METHODS
This chapter presents the methods that I chose to adopt for my research. It comprises a critical analysis and discussion of the methodological choices that I made, both on a theoretical and procedural level, to collect and analyse the data. It also includes a presentation of criteria of evaluation for this research and ethical issues.
Ontological Position and Epistemological Approach
This research starts from a relativistic ontological position (Willig, 2013), according to which the world “…is not the orderly, law-bound place that realists believe it to be” (ibid: 13). This is a contrasting position to the realist one, affirming that the world is composed of objects and phenomena, linked by a cause-effect relationship (ibid.). Since, as Butler (1992) and Brothers (2016) maintain, it is impossible to define therapeutic failure objectively, I believe that this position is better suited to the exploration of the multiplicity of psychosynthesis therapists’ experiences of PTF.
Based on an ontological position, I have chosen to use a phenomenological epistemological approach. According to it, every individual experience is unique and valid (ibid.). There is therefore no single valid reality but numerous “real” realities that derive from our subjective experience of a phenomenon as it appears to us (Irving, 2016). However, there are some critiques against it. Some, for example, highlight the impossibility of understanding another individual’s vision of the world (Ricolfi, 1997). Others state that the subjectivity of understanding makes the world impossible to know (ibid.). Despite these ideas, as mentioned in the previous chapter, since the aim of this study is to let PTF “emerge into the light” (Longstaffe, 1999), I consider this is the most suitable approach to allow participants’ beliefs, fears and doubts around PTF to come out in the open, without the pretence of finding shared definitions or theories about it.
Qualitative Research vs. Quantitative Research
As for the methodological approach, I chose to use the qualitative one for various reasons.
- Given the subjectivity inherent in the construct of PTF, then chose qualitative research because it is particularly suitable for the exploration of subjective experiences (Irving, 2016), which is a fundamental element of my key research question. Qualitative research, in fact, focuses on “…things that make us human – the tangled, messy and multifaceted aspect of experiences” (Eatough, 2012), like PTF.
- Since my research aims at opening a dialogue on PTF and not testing pre-existing theories, I considered qualitative research as the most appropriate approach to my key research question. Qualitative research, in fact, aims for an in-depth understanding of the research topic (Watkins, 2012), by means of identifying meanings, themes and connections between them (McLeod, 2011). It argues that the variables influencing social facts are complex, interconnected and difficult to measure (Ricolfi, 1997).
Collecting Data
Given my choice to use a qualitative approach, I chose to use in-depth semi-structured interviews, consisting of pre-prepared open-ended questions, which can be amended, depending on the interviewer-interviewee interaction (DiCicco & Bloom, 2006). My choice was based on two main reasons. Firstly, they allow the researcher to focus on certain previously carefully selected topics, thus facilitating the categorisation and analysis process compared to unstructured interviews (Gill et al, 2008). Secondly, in-depth semi-structured interviews are able “…to co-create meaning with interviewees by reconstructing perceptions of events and experiences” (DiCicco & Bloom, 2006:316), thus satisfying the objective of my research.
There are further reasons why I chose this kind of interview;
- Its conversational character (Robson, 2011), which helps the interviewee to be more willing and open to exploring the topics covered (Ricolfi, 1997), especially if sensitive (Cowles, 1988). That could be the case of PTF.
- The opportunity to amend interview schedule, following unforeseen aspects of the research topic, resulting from previous interviews (Smith, 1996). This could be the case of scarcely explored research topics (ibid.), such as PTF (Lampropoulos, 2011).
As for interview schedule (Appendix 1), seven main questions were defined thanks to my preliminary literature review, my previous training in clinical psychology and my exchanges with my academic tutor, peer students and trainers during MA seminars. General, broad questions were posed at the start of the interview (DiCicco-Bloom & Crabtree, 2006; Gill et al., 2008, Hefferon & Gil-Rodriguez, 2011) to put participants at ease and prepare them for more sensitive questions. (DiCicco-Bloom & Crabtree, 2006; Gill et al., 2008).
The one-hour interviews were conducted individually. The interviews were audio-recorded using two different digital audio-recorders, to minimise the risk of technical problems. They were then transcribed verbatim to enable analysis.
All participants were offered the possibility of being interviewed face-to-face or through videoconference platforms (e.g. Skype). Only one participant opted for an interview on Skype. Considering the sensitive nature of my research topic (Cowles, 1998; Sasso, Bagnasco & Ghirotto, 2016), in face-to-face interviews, participants could choose the interview location, to make them feel safe and at ease.
Participants
Choosing participants is very important, since their ability to provide information and offer insights on the topic is essential for research purposes (Braud & Anderson, 1998) Considering that the minimum number of participants for a Master’s level IPA research, that I chose as a data-analysis method and will explain later, is three and that the recommended number is from three to four (Smith, Flowers & Larkin, 2012), I decided to recruit five experienced psychosynthesis therapists. After consulting with two colleagues, I identified as “experienced” those psychosynthesis therapists with at least five years of professional experience and, therefore, with a sufficient number of client hours for having experienced a significant PTF.
Regarding sampling, IPA studies require a “fairly homogenous sample” (Smith, Flowers & Larkin, 2012:49) whose representatives are similar according to certain specific variables (ibid.). I therefore chose to involve psychosynthesis psychotherapists who, in addition to possessing the aforementioned characteristics, were trained and resident in Italy. Thus they would represent the Italian psychosynthesis psychotherapeutic community. Furthermore, Italian being my first language, I chose Italian participants to avoid misunderstandings that could result from interviewing English-speaking people. Additionally, I was aware that, being Italian myself, I would find difficulty identifying participants’ socio-cultural biases and assumptions, which could shape interviewees’ thoughts and definitions. In order to minimize this possibility, I decided to make my biases and assumptions around PTF explicit by keeping track of them on a reflective journal. Of these five participants, four were men and one, a woman. To recruit this sample, I sent 97 emails to psychosynthesis therapists, which I found on Internet search engines, especially Google.
Data Analysis
The data analysis process is aimed to make sense of the data collected and turn them into findings (McLeod, 2011, Robson, 2011). After considering different data-analysis methods (Breakwell, Smith & Wright, 2012), I decided to use Interpretative Phenomenological Analysis (henceforth referred to as IPA).
In IPA, the data-analysis procedure (see Appendix 3) consists of several stages, each requiring the task of interpreting the interview transcripts (Smith, Flowers & Larkin, 2012). This procedure is iterative because each stage must be seen and reviewed repeatedly, referring to the contents of the transcripts and to the resultant observations/reflections (ibid.). I therefore started my analysis by reading the transcripts of the interviews over and over (Smith, Flowers and Larkin, 2012) I wrote comments and notes from my readings in the right-hand margin. I subsequently grouped the notes, thus transforming them into emerging themes. They were “labelled” with concise phrases that were written in the left margin of the text (ibid.). In the next stage, For each transcript, I grouped the emerging themes in superordinate themes, according to conceptual similarities (ibid.) They were then compared and contrasted with each other, with the aim of seeking connections, similarities or diversities. From this cross-referencing, three superordinate main themes emerged. They were cyclically checked over and over again, in continuous relationship with the transcripts’ content. Thanks to this cyclic and iterative work (Smith & Osborn, 2004), I also managed to refine the main themes by cross-cutting the interviews, highlighting twelve sub-themes in total. At the end of this process, I organised the material into a coherent, narrative account, where I highlighted the sub-themes, integrating quotes (also named as “extracts” and “quotations” in this research) from the transcripts.
Criteria of Evaluation
In order to promote rigour (Jootun at al., 2009) throughout the dissertation, I chose to keep a reflective journal, given that each phase is characterized by subjectivity (Larkin, Watts & Clifton, 2006; Smith, Flowers & Larkin, 2012). This enabled me to understand how my beliefs, assumptions and biases could affect my research (Stiles cited in Etherington, 2004; Anderson, 2008). This journal also promoted transparency (Darawsheh, 2014) and confirmability, meaning “the degree to which the findings of the research study could be confirmed by other researchers” (Korstjens & Moser, 2018:121)
In order to ensure this research’s trustworthiness, the following strategies have been used: respect the criteria of credibility, transferability, dependability and confirmability (Lincoln & Guba, 1985).
- To improve dependability, namely the consistency and repeatability of the results (Guba, cited in Krefting, 1991), I chose to keep an audit trail, which comprises records and documents related to each research phase and which show methodological, theoretical and procedural choices (Baillie, 2015)
- To show transferability, meaning “the degree to which the results of qualitative research can be transferred to other contexts or settings with other respondents” (Korstjens & Moser, 2018:121), I wrote a rich and detailed description of settings and participants.
- To enhance credibility, I invited the interviewees to check their interviews and provide feedback on the accuracy of the data collected.
- To assess the consistency between the data and my interpretation, quotes from the interviews’ transcripts have been integrated in the following chapter, presenting the findings of my data analysis (Elliot et al., 1999). As for the translations into English of those quotes, I got confirmation from the Psychosynthesis Trust that I would not need a sworn translator.
- Scrutiny, discussion and feedback of the research projects by peers during MA seminars.
Ethical Issues
Before the research was undertaken, approval was received by the ethics board of the Psychosynthesis Trust (Appendix 5). This study was undertaken following the BPS (British Psychological Society) Code of Human Ethics (BPS, 2016) and the CNOP (Consiglio Nazionale degli Psicologi Italiani- National Board of Italian Psychologists) Code of Ethics (CNOP, 2018). The latter was used, since a substantial part of my research was carried out in Italy with Italian participants. Both codes provide ethical principles for conducting research with human participants (BPS, 2016, CNOP, 2018). These principles were respected as follows:
- To safeguard the autonomy and the agency of the participants, they were informed of their right to be able to withdraw at any time without prejudice. They were also given the opportunity to read the verbatim transcript of the interview and to access the study findings before submission. In addition, a week before our meeting, an email was sent to them containing the interview schedule. In this way they could familiarize themselves with the topic and decide whether or not to continue their participation in the research.
- The anonymity of the participants was safeguarded using codes (Smith, Harre & Van Langenhove, 1995) and omitting information that could identify either the respondents or persons mentioned during their accounts.
- All participants were sent a participant information sheet (PIS) containing detailed information concerning the nature, objectives and risks of the study. Written permission was given for participation in the research and audio recording of the interviews.
- To respect confidentiality, all of the interactive digital material relevant to the research was stored on a password-protected computer and all the analogical material in a locked cabinet.
- In order to minimize harm, intrusive questions were avoided as much as possible and the psychophysical state of the participants was monitored throughout the interview, with the intention to interrupt in case of severe distress. Participants were given the option to access appropriate psychological support, in the event that particularly painful and unpleasant memories and feelings emerged from giving their accounts of PTFs.
Throughout the duration of the research, not only during the planning and preliminary activities, the ethical implications of the research and the possible consequences were considered to ensure compliance with the previously mentioned ethical codes (BPS, 2016; CNOP, 2018).
CHAPTER FOUR: FINDINGS
In this chapter I will present the findings I obtained from my analysis of the interviews, using IPA (Smith, Flower and Larking, 2012). The findings are organised into three main super-ordinate themes “shared across the respondents’ data” (Fade, 2004:650), and twelve sub-themes (see Table 1)
The three overarching themes emerging from the data analysis (Smith, Flower and Larking, 2012) have been titled as follows:
- “In the aftermath”
- Processing PTF
- The hidden gifts of PTF
To show consistency between the data and my interpretation, I will include quotes taken from interviews’ verbatim transcripts (Elliot et al., 1999). Moreover, in order to respect participants’ confidentiality and anonymity, each of the five interviewees will be given a code (Smith, 1995): P1, P2, P3, P4 and P5.
Superordinate theme 1: “In the aftermath”
This superordinate theme refers to the profound emotional impact that PTF can have on therapists’ professional lives and their sense of professional identity, in the immediate aftermath of PTF. Given participants’ description of this as painful and unpleasant, analysis of the interviews led me to identify five interlinked and overlapping sub-themes, whose “golden thread” can be traced to the threat to self-esteem. They are: 1) Regret, 2) Self-doubt, 3) Self-Criticism (the Inner Critic), 4) the Narcissistic Wound, 5) Shame.
Sub-theme 1: Regret
All participants maintained that PTF caused regret. By regret, I mean an emotional and cognitive state, which can be perceived as unpleasant, even painful (Gilovich & Husted Medvec, 1995). It implies comparisons between the results of past choices with how things could have been and the wish that things had been different (Beazley, 2004).
All the participants pointed out that, in the aftermath of PTF, they asked themselves how and what they could have done to avoid this situation. Four of them maintained that regret was particularly intense in cases of dropouts, when clients had arbitrarily decided to terminate therapy, without giving the therapist the opportunity to negotiate closure of the therapeutic process. I was quite surprised by the way therapists described these situations; they sounded like lovers after being left by their partners with no explicit warning.
P3 affirmed that, in the days following a client’s unexpected drop-out, he often wondered what he could have done differently if he had identified the warnings signs:
“But there were some signs in retrospect that I could have read, but at that moment I didn’t interpret them … I didn’t read them. So, I spent days and weeks racking my brain; “Damn, if I had done this ….” if only I had understood it in that moment. And basically, it was … very, very intense. So, we’re talking about September, October, November and it was still there.”
Sub-theme 2: Self-doubt
Self-doubt is a “metacognitive representation of uncertainty about one’s abilities” (Zhao & Wickman, 2015:1). It can have numerous negative consequences on people’s self-perception, such as self-esteem (Hermann, Leonardelli & Arking, 2002). As it appears in previous research (Newman, 1996), self-doubt may be triggered by mistakes and failures, as it happened to three participants.
Speaking of a client who had aggressively expressed her disappointment with therapy and her desire to discontinue it, P5 stated that the client’s words had instilled in him the doubt that he wasn’t sufficiently technically prepared:
“Once a client told me that she was really disappointed, that I was wrong, that I hadn’t understood anything, that I was not good at all … that of course was really a painful change that had repercussions for me and really made me doubt if I had all the tools needed to work with”.
P1 declared that PTFs, besides questioning her assessment skills, led her to doubt the therapeutic value of the relationship with clients. This is confirmed by previous research, maintaining that people with self-doubt tend to be suspicious in relationships, even in those that can be considered stable and trustworthy (Murray et al., 2001).
”After this event, this trust, this hope was slightly undermined and so … actually … I started to ask myself: is our relationship good? In effect, is what passes as positive really as I believed it to be beforehand? Indeed, is the person able to take what I give him positively? That is, let’s say, that I asked myself a series of questions concerning the therapeutic relationship.”
Sub-theme 3: Self-Criticism (The Inner Critic)
All participants stated that PTFs had triggered a self-critical attitude. Self-criticism can be described as an “un-compassionate behaviour towards the self” (Montero-Marin et al., 2016:9). Occasionally, participants referred to self-criticism as the “inner critic sub-personality” (Whitmore, 2004) or as the psychoanalytical concept of “super-ego” (Assagioli, 1991:12).
P3 claimed that one of his PTFs had initiated for him, a series of thoughts and inner-talk, which sounded like “serious allegations”. It took some time to realise that he was under the attack of a strict “inner critic” sub-personality:
”At the very beginning I didn’t know what was happening. I just felt so bad. I kept telling myself that I was not good enough, that I should have given up. Then…you know…I stopped and looked at myself ‘in the mirror’… and I realised…I realised that these thoughts were glaringly obvious … that they were coming from my inner critic”.
The main element that seems to activate participants’ self-criticism is attributing their PTFs to errors that they should not have committed as experienced therapists (in terms of length of practice or previous professional experience with a specific client group). For example, P2 maintained that he should have managed the first interview with a client differently; given his previous professional experience with the type of pathology the client was suffering from:
“And I failed right on my home turf where … theoretically, where I had more experience!? I said to myself: ‘You should become a plumber and stop ruining people’s lives!’…Eventually I realised that those messages were coming from my super-ego”.
P3 points out that, in the experiences that are defined retrospectively as PTFs, the inner critic can be projected onto clients, thus attributing to them feelings and thoughts that have no way of being verified:
Sub-theme 4: The Narcissistic Wound
Three of the participants explicitly indicated that a PTF caused a “narcissistic wound”. By this, the interviewees meant the painful experience that they had when their PTFs revealed the fragility of their grandiose self-image. In fact, as P5 said, PTF “impacts one’s identity, hurts one’s pride”.” Narcissism is not used here as a pathological label. It refers to “…a fundamental need for affirmation, mirroring and respect for one’s own self” (Kohut cited in Walach, 2008) which everyone has. It can be considered then a spectrum whose range goes from psychotic to normal (Rothstein cited in Watson, Varnell & Morris, 1999).
P4 explicitly named the “narcissistic wound”, as a consequence of a lack of dis-identification from a subpersonality that expects perfection (“I must be the perfect therapist”) and is “dangerous and harmful”.
He argues that his identification with this sub-personality created a “narcissistic wound” when a specific PTF made him face the impossibility of being exactly as that sub-personality admonished him to be.
P2 explicitly talked about narcissism when he admitted that PTF made him face his fantasy of having to be a special therapist, (“I had to be the heir of Jung or Freud”, “I wanted to make believe that I was that handsome, cool dude”) and it made him feel fallible and imperfect when he failed to be that special therapist.
P3 explicitly named the term “therapeutic narcissism” when he pointed out that PTF put him in touch with his unattainable desire to adhere to a utopian model of the therapist:
“What I notice is that every time I experience a therapeutic failure there is a piece of me that confronts therapeutic narcissism. So every time, it’s a coming to terms, putting myself in front of a mirror reflecting that part of me which in that moment is feeding a narcissistic … An ideal… a desire to be something else other than what you are”.
Sub-theme 5: Shame
Three participants maintained that they experienced shame as a consequence of PTF. Shame is considered a self-conscious emotion, as it involves self-reflection or self-evaluation (Tangney, 2002).
One usually experiences shame when one fails to reach or maintain a standard of performance, flouts standards of moral conduct or does not respect social norms (ibid.). The most distinct aspect of shame is that it implies some kind of public exposure, thus linking shame to reputation (Jacquet, 2015).
P2 recalls a PTF with a client who didn’t return after the first interview and had been referred to him by an expert colleague:
“This made me feel very, very ashamed…. because of my pride. Initially I hid it a bit; I didn’t even speak about it in supervision because the fear essentially is that, when you don’t feel secure, the expert, the supervisor may say to you: “Look you’ve done something really serious. This really won’t do”.
P2 also mentioned his fear that the PTF with a client who was referred to him by a colleague had negative consequences in terms of a bad reputation, loss of confidence and impairment of the professional collaboration with his colleague:
“I felt I couldn’t talk about it. I was thinking that she…I told myself: ‘Damn! Now she thinks badly of me, she won’t refer clients, she will speak badly about me, I’ve made a bad name for myself …”
Superordinate theme 2: Processing PTF
The second superordinate theme indicates that consciously processing PTF is a complex, multifaceted and necessary task, leading therapists to the gradual integration of PTFs into their professional and personal life. Four sub-themes emerged from interviews. All of them refer, above all, to the relational context; in particular to individual or group supervision: 1) Importance of supervision, 2) Understanding the intra-psychic and relational dynamics, 3) Giving definition and meaning. Given the relational aspect involved in processing PTF and given the centrality of the clinician-client relationship in therapy (Ferrucci, 2005), in the next chapter the parallel between processing PTF and the therapeutic process, from a relational perspective, will be discussed.
Sub-theme 1: Importance of supervision
All participants highlighted the importance of supervision in integrating the experience of therapeutic failure. P1 defined it as “fundamental”. P2 maintained that it is precisely in supervision that “one talks about personal failures and listens to those of others”. P3 argued that supervision helped him considerably in the period immediately following PTF. P5 said that: “the more supervision one has, the more one has the chance to talk about one’s own mistakes”. However, P1 and P2 maintained that they needed several individual sessions with their supervisor before being able to share their PTFs in groups, thus showing that shame can be considered a significant obstacle in processing PTF.
P3 and P5 maintained that sharing their PTFs with colleagues helped them to put the therapeutic failure into perspective, helping them understand that experiencing failure is common to all psychotherapists.
P5 said that group supervision was particularly useful to him because, in those situations, “you can see that others also have difficulties”. P1 stated explicitly that sharing with her supervision group helped her soften the emotional impact of the PTF, especially because she realised that she was not the only one to have experienced a failure:
“Sharing the similar experiences of colleagues … this also helped me, because in any case these are things that happen. It also helped me to give it a bit more perspective”
Sub-theme 2: Understanding the intra-psychic and relational dynamics
Four of the five participants talked about the usefulness of understanding the intra-psychic and relational dynamics that led to a PTF.
P5 pointed out that understanding the counter-transference dynamics was useful in revealing the obstacles that had prevented him from working effectively with the client involved in a PTF:
“You know, the work on counter-transference has been the most useful: to see all the attitudes, fantasies, maybe even memories, habitual thoughts within me while I was working with that person, Understanding what happened between the two of us was very important because …because it does not feel as something useless…Understanding made a difference. I realised that I colluded with her and…understanding that…it made a difference. A huge difference.”
P5 also added that, while processing PTFs, it was particularly important to ask himself where he had made mistakes, thus taking responsibility for his own hypotheses, therapeutic choices and actions:
“First of all, it was important for me to take responsibility and … because, of course, there are two of you who fail. Naturally, the client also has his own responsibilities. But it was important to ask myself: What is my responsibility in all this? What did I do? Where was I lacking? What could I have done?”
Sub-theme 3: Giving definition and meaning
Three of the five participants highlighted the need to define PTF, not only emotionally but also cognitively. For P1, defining it was important because it allowed her to “see it, observe it, work on it”. P2 spoke about the need to also define his PTF in technical terms, highlighting the importance of his supervisors’ contribution; he had, in fact, given a partial definition on his own, which had not helped him in the process of elaboration and integration:
“However, you also need to understand it, to define the error both technically … and cognitively. It was important that supervision took that direction. I wanted to know what they thought of it …
I wanted to know their point of view on what had happened; I needed to understand. Also, together with the others …there, understanding together along with the others has always been important…”
P2 then added that it is not enough to define PTF to be able to process it. It is indeed necessary to give it a meaning, a perspective, inserting it into a psychosynthesis vision of the therapist’s growth and evolution as a human being (Alberti, 2012). In fact, Assagioli frequently referred to life as a great opportunity to learn, to grow, to wise up, as a gymnasium (Assagioli cited in Morbidelli, 2009):
“The failure followed by something makes sense … obviously psychosynthesis works well with this. Giving the failure a perspective, as it were. In fact, not just seeing:”You got this wrong, you have to improve, it’s better if you do this”… but making sense of it.”
Superordinate theme 3: The hidden gifts of PTF
The third super-ordinate theme describes how PTFs contributed to the discovery of hidden gifts. They have been described in this way, because, as all the participants have pointed out, PTFs have a strong evolutionary connotation and carry positive attributes often hidden behind the layer of unpleasant and painful feelings PTF provokes. This is probably the most explicitly transpersonal of the three superordinate themes. It shows, in fact, that painful experiences like PTF can help therapists “expand” beyond their personal limits and achieve a broader perspective on themselves. In reference to this superordinate theme, there are four sub-themes emerging from the interviews: 1) Suffering as an agent of change, 2) Transpersonal qualities, 3) ‘I-Self’ connection, 4) The value of experience.
Sub-theme 1: Suffering as an agent of change
Three of the five participants said that the suffering associated with PTFs had emotionally and psychologically enriched them both personally and professionally. P5 claimed that the more painful his PTFs were, the more they allowed him to reflect and learn. P5 believed that, for all those situations in which he managed to “escape from the hedonistic model in which the human being seeks pleasure and flees suffering”, he managed to understand the suffering from PTF as “an opportunity for learning in the school of life”. This is consistent with Assagioli’s conception of suffering as a means to “help the Soul to ascend and become free” (Assagioli, 2007:169)
P3 declared that the suffering resulting from PTF was an important evolutionary agent of change for him:
“[Suffering] is a facilitative agent – It is as if my field of consciousness is widening. Above all I take it positively … if it hurts, it happily hurts, right?”
P2 affirmed that suffering has a transpersonal aspect, when it is given an evolutionary connotation. P1 also affirmed that, in a transpersonal sense, suffering has a transformative aspect. She argues that PTF has allowed her to go “beyond” her personal experience of pain and strengthened her therapeutic presence:
“The first thing that came to my mind was the wound metaphor. That is, the wound must become an opening. So, it’s a door to somewhere else. I experience the transpersonal as the other, the elsewhere … The failure is like a wound; it’s something that indeed hurts you, maybe you’re left with a scar, which sometimes reopens and bleeds but it allows you to transform … if you know how to give it a meaning … it allows you to go beyond”.
Sub-theme 2: Transpersonal qualities
All participants stated that PTFs allowed them to come into contact with transpersonal qualities. Transpersonal qualities such as joy, courage, creativity and power, to name a few, can be defined as archetypal (Firman & Gila, 2002). Each of them is a principle which derives from the connection with Self and carries a unique energy (Whitmore, 2004), which. When the connection with Self is temporarily hindered, these qualities may be repressed/suppressed in the Higher unconscious; they can manifest into consciousness, when the connection with Self is re-established. They are transpersonal because they stretch individuals beyond their limits of their personal identification and allow human beings to overcome their feelings of being separated from others and from the universe (Schonfelder, 2013) Transpersonal qualities remind us that we are not just individuals, but we are part of something bigger.
P4 maintained that PTFs allowed him to form a relationship with humility, by which he means “intellectual honesty”. Contact with this transpersonal quality revealed to him the importance of always being attentive to and vigilant about what is actually occurring in the therapeutic relationship. According to P4 this was more important than demonstrating the validity of his therapeutic hypotheses, which, in fact, would only serve to reassure him that he is a good therapist:
“This experience has put me in touch with humility and for me humility is a synonym for honesty. Intellectual honesty… honesty … making reality the priority … who cares who’s right and who’s wrong!? The important thing is that we understand what happens. Otherwise I’ll just say I’m right and that’s it … but who does that help?”
P5 stated that, given the uncertainty of therapeutic work, PTF often put him in touch with humility, which is a transpersonal quality (Rosselli, 2017). In his opinion, a humble attitude is necessary “in a job that requires a lot of patience. Sometimes you can do it, sometimes not. It’s about accepting that you… that you always have a limited power and limited capacity… This is humility.”
P3 feels that PTF has put him in touch with many transpersonal qualities, such as compassion, understanding and gratitude.
Sub-theme 3: ‘I-Self’ Connection
Three of the participants stated that PTF had a profound transpersonal meaning for them, bringing them closer to their essence, to Self. This is consistent with the psychosynthesis idea that crisis, even the one following a PTF, can push one to do things that one would not do otherwise (Assagioli, 1991). Crisis can create unbalance, get the personality disorganised and destroy personality structures which were based on defensive mechanisms, thus giving one the opportunity to strengthen the I-Self connection, to become more authentic, to become more who one is, instead of operating from a survival personality (Firman & Gila, 1997).
P3 argues that PTF enables a further manifestation of the Self “through the chinks in the armour” of his professional identity and which PTF managed to crack:
“Failure gives the Self the possibility to emerge, to show itself a bit more. It is ever closer, increasingly manifesting itself…Through the chinks in the armour; it can express itself in a new way.”
P2 claimed that PTF allowed him to notice a more intense manifestation of the I-Self connection:
“For me it was like coming home. I always liked this psychosynthesis idea; going home. Failure brought me home in that situation where you are theoretically… in which you are a human being. Basically it brought me back to being … and to feel that is so beautiful!”
Sub-theme 4: The value of experience
Four of the participants talked about how experiencing PTF has made them more present as therapists and more credible in the client’s eyes. The psychosynthesis psychotherapist who experiences his own failures and accepts them lovingly, is able to convey to the client that it is possible to personally contemplate the vulnerability of being human. He then becomes a model of self-acceptance, thus showing that transformation happens by embracing it rather than fighting against it (Nannicini, 2011) .
P2 claims that experiencing PTF has put him in touch with his own vulnerability. He claims that on the one hand this makes him a more empathetic and sensitive therapist, and, on the other, allows the client to get closer; almost as if the client sensed the possibility to be able to trust him more:
“I think about that experience … I mean I think about what happened to me and in my opinion, people sense this. In the way that I sense it when someone tells me something that he did…something he experienced… or something that he has just read or theorised and no more!
That is… there is also a difference that can be felt. Perhaps clients trust me more … and maybe I would trust myself more now after experiencing that”.
CHAPTER FIVE: DISCUSSIONS AND IMPLICATIONS
In this chapter I will discuss the research findings outlined in the previous chapter, adding some personal reflections on my experience as a practitioner-researcher investigating a topic very close to my heart.
For most therapists, PTF is a painful experience which, by virtue of the distress it causes, risks being banished from consciousness as an unacknowledged shadow. Since, in psychosynthesis, shadow is said to contain a negative-positive polarity (Assagioli cited in Firman & Gila, 1997), my research has sought to empirically verify this theoretical assumption by focussing on therapists’ subjective experience of what they perceived as their therapeutic failures.
As we have seen in the previous chapter, all participants in my research confirmed that, while PTF can have a negative impact on therapists’ personal and professional lives, it can also offer a potential for learning. They also all agreed that, in order to appreciate what PTF can offer in terms of personal and transpersonal growth, it needs to be consciously processed within a suitable relational context.
In this dissertation, the painful aspects of the PTF’s polarity were explored in the first superordinate theme of the findings, “In the aftermath”. Here, a corollary of interlinked and overlapping sub-themes were identified (regret, self-doubt, self-criticism, narcissistic wounds and shame), whose common denominator is the threat to self-esteem that PTF poses for therapists. The correlation between self-esteem and narcissism (Neff, 2008), regret (Spencer, Josephs, and Steele, 1993), shame (Velotti et al., 2016) and self-doubt (Hermann, Leonardelli & Arking, 2002) is widely supported by psychological research. Furthermore, self-esteem is closely related to “self-concept” (Blascovich & Tomaka, 1991) and, given that “self-concept” provides a stable sense of self (Baumeister, 1999), it may be argued that PTF can, at a deeper level, constitute for therapists a veritable ‘existential threat’. This hypothesis is consistent with my findings, in that all participants described how PTF can trigger the fear of losing one’s professional, and maybe even personal, identity (“Who am I if I am not a good therapist?”).
In particular, the idea that PTF can pose an “existential threat” transpires from P3’s reference to PTF as a life-threatening, almost a near-death, experience. Indeed, the experience of therapeutic failure as ‘death’ may be considered an undercurrent running through the accounts of all the participants. In psychosynthesis parlance, we may say that PTF showed participants that their survival personality was in jeopardy, and the defence and coping mechanisms (Firman & Gila, 2002) used to protect themselves from the threat of non-being no longer worked. In other words, PTF forced them to confront their vulnerability and fallibility (Firman & Gila, 2010), urging them to embrace the imperfect nature of their humanity. In other words, it is possible to say that PTF undermined the illusory sense of stability provided by the survival personality, demanding that therapists outgrow its fallacies and limitations.
The “positive” side of PTF’s polarity has been presented in the third superordinate theme, “The hidden gifts of PTF”. All participants concurred that PTF offered them an opportunity for growth and learning, especially at a transpersonal level. They claimed that the suffering PTF had caused, had also spurred positive change. PTF had put them in touch with transpersonal qualities such as humility, which invigorated their I-Self connection. They also maintained that experiencing failure made them better therapists in that being in touch with their humanity, they were able to connect with clients in a more genuine and trustworthy way.
As practitioner/researcher, I experienced first-hand the humility and honesty of my respondents whose willingness to share such delicate aspects of themselves to benefit the therapeutic community as a whole, attests to the profound transformative potential of PTFs. As a clinician wrestling with PTF in his own life, listening to participants’ accounts was in itself a way to redeem the gifts inherent to the traumatic experience that initiated my quest. The privilege of witnessing not only my respondents’ struggles, but also the transpersonal development these struggles prompted, was very “healing” for me. While, integrating PTF requires on-going inner work, I have become increasingly aware that it has made me a more authentic, present and compassionate therapist. This realisation, however, has only been possible thanks to the authentic and honest interaction with others, and crucially with the participants in this research. This, to my mind, shows that getting in touch with the “hidden gifts of PTF” is very much a relational process.
The importance of the relational aspect in dealing with PTF is central to the second superordinate theme, “Processing PTF”, whose sub-themes all refer to a relational context. For all respondents, in fact, individual and group supervision was considered necessary to allow integration of PTF into their lives.
Given that psychosynthesis affirms the centrality of client-therapist relationship in therapy (Ferrucci, 2005; Firman & Gila, 2010; Millichamp, 2010; Nannicini, 2011), I think it is possible to identify a parallel between the inner work involved in integrating PTF and therapy. In fact, as with therapy, processing PTF requires a relational container, such as that provided by one-one or group supervision, or even by more informal exchanges with peers. In other words, in order to be consciously processed, PTFs needs to be “witnessed” within a supportive context. Here an attuned supervisor/peer can serve as a much needed, external unifying centre, whose non-judgemental attitude can help therapist elaborate and integrate their experience. Such a relationship may act as catalysts for therapists’ disrupted I-Self connection and, as a result, invigorate their I-Thou connection (Buber, 1958) with clients.
Besides the relational aspect, another key factor related to the second super-ordinate theme is the importance of disidentification (Assagioli, 1991; Assagioli, 2012) in processing PTF. Three participants highlighted the need to give a definition of their PTFs and four participants pointed out that understanding the intra-psychic and relational dynamics, which had caused their failures had been necessary. In both cases, they stressed the importance of identifying, and consequently, disidentifing from those experiences of failure, consistently with Assagioli’s idea that one can control what one disidentifies from (Assagioli, 2012). I would also add that all participants argued that this process happened during individual and group supervision, thus reinforcing the idea that processing PTF requires a relational component.
The research also shows how sensitive a subject, PTF is for therapist. I noticed that their sharing was often less inhibited, once I switched off the audio-recorders. I wonder if therapists perceived the recorder as an “open window” through which the entire global psychosynthesis community would get to know their failures. I also wonder if my attitude changed after I switched off the audio-recorder, thus allowing the participants to talk more freely.
Implications in clinical practice and in training
The interviews in this study provide a rich and coherent account of therapists’ experiences with PTF. In this section I will present the implications of the research findings in three areas: 1) Supervision, 2) Psychotherapy training 3) Clinical practice.
1. Supervision. Considering the importance attributed to supervision by participants, it is hoped that this study will be a reminder for supervisor of the extremely painful emotions PTF can trigger in their supervisees, and the profound negative impact it can have on their self-esteem. Furthermore, supervisors need to be aware that PTF can pose an “existential threat” to therapists, whose whole identity can be profoundly shaken by the experience. For these reasons, strategies apt to create a non-judgemental and compassionate space should be applied (Ladany, Klinger, & Kulp, 2011), especially in group supervision, where the importance of sharing PTF to tap into its inherent potential for growth and learning should be explicitly stressed (Hahn, 2001). In supervision, especially in groups and in training groups, it should be made clear that sharing experiences of failure increases familiarity with this aspect of professional life, thus making it “more negotiable” (Kottler & Blau, 1989). Furthermore, supervisors should assist supervisees in understanding the relational and intrapsychic dynamics at the root of PTFs, thus supporting their disdentication process (Assagioli, 2012).
2. Psychotherapy training. Numerous myths in relation to the psychotherapist profession (Adams, 2013; Pope, Sonne & Greene, 2006) contribute to keep PTF in the shadow. They also support therapists’ narcissistic fantasies and unrealistic expectations, which can result in regret, self-doubt, narcissistic wounds and shame when PTF is experienced (ibid.). For these reasons, psychotherapy training should support and promote a realistic idea of therapists, which includes imperfection, mistakes and failures (Brown, 2010). Psychotherapist in training should be invited to understand and deal with their PTFs with self-compassion (Neff, Hsieh & Dejitterat, 2005) and with a sympathetic approach. However, failures and mistakes should be neither justified nor promoted, as clients’ care and safety should always be of overriding importance in the therapeutic work (Guistolise, 1996).
3. Clinical practice: Therapists always invite clients to learn from their mistakes, but can they walk the talk? Considering that relationship is crucial to processing PTF we may conjecture that a parallel process may be at play, where therapists are exposed to the same challenges in supervision as their clients are in therapy. The vulnerability that therapists experience in the wake of a PTF, is a stark reminder of how exposed clients may feel in therapy and can therefore be used to foster therapist’s patience and compassionate understanding towards their clients. Like clients in the therapeutic relationship, therapist are also apt to feel intimidated by the power dynamic implicit in the supervisory relationship and may be faced with the same fear of judgment and rejection (Talbot, 1995).
In conclusion, my last reflection refers to a psychosynthesis concept, that of bifocal vision (Whitmore, 2004). If we imagine psychosynthesis as a bio-psycho-spiritual being on a path to Self-realization, I think that therapeutic failure can be seen as an invitation, not only to the single therapist but to the entire psychosynthesis community, to see the emerging purpose, which is hidden within it. I think that if psychosynthesis could explicitly integrate therapeutic failure in its theory even more than it presently does, psychosynthesis theory itself would expand its role as an authentic unifying centre for therapists, thus giving further support to their Self-realization process (Firman & Gila, 2010) both as practitioners and human beings.
Limitations and recommendations for future research.
One of the biggest limitations of this research is the size of its sample of participants, five in total, and their homogeneity, as they are all representatives of the Italian psychosynthesis psychotherapy community. Due to this, socio-cultural factors that might affect how therapists perceive and deal with therapeutic failure could not be adequately explored. Future research with a different population, e.g. the British psychosynthesis therapists, would open up a useful comparative dimension. Conducting a similar investigation with psychosynthesis therapist in training may also lead to the possibility of analysing how their perceptions of PTF may change in course of their career, introducing the role of experience as a variable in the research.
Given that, in IPA, the researcher plays an active role, engaging in a double hermeneutic (Smith, Flowers and Larkin, 2012), my recent experience with a significant PTF not only sparked my interest in the topic but inevitably coloured my approach in researching it. In fact, even though I made a conscious effort at self-reflexivity, regularly using a reflective journal, my beliefs, fears, feelings and biases may have nonetheless affected the research process. On one occasion for example, I caught myself redirecting the conversation when a participant displayed intense emotional arousal during his interview. This heightened emotional response was probably starting to bring to the surface the rawness of my own emotions, which, as interviewer, I felt I should keep at bay, lest they interfere with the participants’ narration.
Conclusions
In this dissertation I contended that PTF, with its corollary of self-doubt and self-criticism, narcissistic wounding, and shame is often treated by therapists as a threatening shadow, banished into the Lower
Unconscious of the profession. The aim of my research has been to redeem this shadow and illuminate both its painful, unsettling and “negative” aspect and its potential for growth for therapists. This is the first, but hopefully not the last, monographic study on PTF from a psychosyntehsis perspective. It is not meant to be an exhaustive compendium on the topic, but a stepping stone for further research.
I hope this research will have started ‘shedding some light’ on how psychosynthesis therapists process PTF, and contributed to spark an honest conversation on this fascinating and somewhat troubling experience all therapist face.
References
Adams, M. (2013) The myth of the untroubled therapist: private life, professional practice. London: Routledge. Alberti, A. (2012). Sulla Specificità della Relazione Terapeutica. Rivista di Psicosintesi Terapeutica. 25, pp. 9-28.
Anderson, L. (2008) Reflexivity. In: Thorpe, R. & Holt, R. (eds.) The Sage Dictionary of Qualitative Management Research. London: Sage. pp. 183-185.
Assagioli, R. (1966) Per l’Armonia della Vita. La Psicosintesi. Firenze: Istituto di Psicontesi
Assagioli, R. (1991) Comprendere la Psicosintesi. Roma: Casa Editrice Astrolabio.
Assagioli, R. (2007). Transpersonal Development. The Dimension Beyond Psychosynthesis. Forres: Smiling Wisdom.
Assagioli, R. (2012) Psychosynthesis: A collection of basic writings. Usa: Synthesis Center (Original work published 1965).
Asay, T.P. & Lambert, M.J. (1999) ‘The empirical case for the common factors in therapy: Quantitative findings’. In: Hubble, M.A., Duncan, L. & Miller, S.D. (eds.) The heart & soul of change: What works in therapy. Washington: American Psychological Association. pp. 23-55.
Baillie, L. (2015) Promoting and Evaluating Scientific Rigor in Qualitative Research. Art & Science Research Series. 29(46), pp. 36-42.
Baldwin, M. (1987) Interview with Carl Rogers On the Use of the Self in Therapy. Journal of Psychotherapy and the Family. 3(1), pp. 45-52.
Baskin, T.W., Tierney, S.C., Minami, T. & Wampold, B.E. (2003) Establishing specificity in psychotherapy: A meta-analysis of structural equivalence of placebo controls. Journal of Consulting and Clinical psychology. 71, pp. 979-993.
Baumeister, R.F. (ed.) (1999) The self in social psychology. Philadelphia: Psychology Press Taylor & Francis. Bayles, M. (2012) Is Physical Proximity Essential to the Psychoanalytic Process? An Exploration Through the Lens of Skype. Psychoanalytic Dialogues. 22(5), pp. 569-585.
Beazley, H. (2004) No Regrets: A Ten-Step Program for Living in the Present and Leaving the Past Behind. US: Wiley. Bellows, K. F. (2007). Psychotherapists’ personal psychotherapy and its perceived influence on clinical practice. Bulletin of the Meninger Clinic, 71(3), pp. 204–226.
Effective Self-Care and Resilience in Clinical Practice (p.44). Jessica Kingsley Publishers. Edizione del Kindle. Ben-Shahar, A.R. (2016)
Losing my religion? Psychotherapeutic practice as repetition compulsion of character rigidity. In: Ben-Shahar, A.R. and Shalit, R. (eds.) When Hurt Remains. Relational Perspectives on Therapeutic Failure. London: Karnac Books Ltd. Ben-Shahar, A.R. & Shalit, R. (eds.) (2016)
When Hurt Remains. Relational Perspectives on Therapeutic Failure. London: Karnac Books Ltd. Berger, V.W. (2001) The p-value Interval as an Inferential Tool. The Statician. 50(1), pp. 79-85.
Bianciardi, M. & Telfener, U. (1998) Ammalarsi di Psicoterapia. Milano: FrancoAngeli. Bidjerano, T. (2010) Self-Conscious Emotions in Response to Perceived Failure: A Structural Equation Model. The Journal of Experimental Education. 78, pp. 318-342.
Blascovich & Tomaka (1991) ‘Measures of Self Esteem’. In: Robinson, Shaver & Writghsman (eds.) Measures of Personality and Psychological Attitudes. pp. 115-127.
Braud, W. & Anderson, R. (1998) Transpersonal Research Methods for Social Science. Thousand Oaks: Sage Publications. Breakwell, G.M., Smith, J.A. & Wright, D.B. (2012) Research Methods in Psychology. 4th ed. London: Sage Publications British Psychological Society (2016) BPS Code of Human Research Ethics.
https://www.bps.org.uk/news-and-policy/bps-code-human-research-ethics-2nd-edition-2014 [accessed January 2018]
Brothers, D. (2016) Challenging the success-failure polarity in the therapeutic practice. In: Ben- Shaham, A.R. & Shalit, R. (eds.) When Hurt Remains. London: Routledge. pp. 5-13.
Brown, B. (2006) Shame Resilience Theory: A Grounded Theory Study on Women and Shame. Families in Society: The Journal of Contemporary Social Services. 87(1), pp. 43-52.
Brown, B. (2010) The gifts of Imperfection: let go of who you think you’re supposed to be and embrace who you are. Minnesota: Hazelden Publishing. Buber, M. (1958) I and Thou. [pdf]. http://teacherrenewal.wiki.westga.edu/file/view/I+and+Thou+1958.pdf [accessed 4 April 2018]
Bugental, F.T. (1988) What is “failure” in psychotherapy? Psychotherapy: Theory, Research, Practice, Training, 25(4), pp. 532-535
Butler, K. (1992) The Shadow Side of Therapy. The Family Therapy Newsletter. November/December, pp. 14-23.
Caldironi, B. (2004) L’uomo a tre dimensioni. Colloqui con Roberto Assagioli. Ravenna: Edizioni del Girasole. Canevaro, A. (2014) Drop-out e fallimento terapeutico sono la stessa cosa? Psicobiettivo. 34(1), pp. 15- 23.
Casement, P. (2002) Learning from our mistakes: beyond dogma in Psychoanaliysis and Psychotherapy: Psychoanalysis and Beyond. East Sussex: Routledge.
Castonguay, L.G., Boswell, J.F., Goldfried, M.R. & Hill, C.E. (2010) Training implications of harmful effects of psychological treatments. American Psychologists. 65(1), pp. 34-49.
Clemens, N.A. (2002) Evidence-Based Psychotherapy. Journal of Psychiatric Practice. 8(1), pp. 50- 53.
Consiglio Nazionale Ordine degli Psicologi Italiani (2018) Code of Ethics for the Psychologist. http://www.psy.it/national-board-of-italian-psychologists-code-of-ethics-for-the-psychologist [accessed 10 January 2018]
Cowles, K.V. (1988) Issues in Qualitative Research on Sensitive Topics. Western Journal of Nursing Research. 10(2), pp. 163-179.
Darawsheh, W. (2014) Reflexivity in research: Promoting rigour, reliability and validity in qualitative research. International Journal of Therapy and Rehabilitation. 21(12), pp. 560-568.
DiCicco-Bloom, B. & Crabtree, B.F. (2006) The qualitative research interview. Medical education. 40, pp. 314-321.
Dimidjian, S. & Hollon, S. (2011) What can be learned when empirically supported treatment fail? Cognitive and Behavioral Practice. 18, pp. 303-305.
Eatough, V. (2012) Introduction to Qualitative Methods. In: Breakwell, G.M., Smith, J.A. & Wright, D.B. (eds) Research Methods in Psychology. 4th ed. London: Sage Publishing.
Eddy, D.M. (2005) Evidence-Based Medicine: A Unified Approach. Health Affairs. 24(1), pp. 9-17.
Edmondson, A.C. (2004) Learning from failure in health care: frequent opportunities, pevasive barriers. Quality and Safety in Health Care. 13, pp. 3-9.
Elliot, R., Fischer, C.T. & Rennie, D.L. (1999) Evolving guidelines for publication qualitative research studies in psychology and related fields. British Journal of Clinical Psychology. 38, pp. 215-229.
Emmelkamp, P.M.G. & Foa, E.B. (1983) Failure Are a Challenge. In: Foa, E.B. & Emmelkamp, P.M.G. (eds.) Failures in Behavior Therapy. Us: John Wiley & Sons, pp. 1-9.
Erskine R.G., Moursund J.P. & Trautmann R.L., (1999) Beyond empathy. New York: Taylor & Francis. Etherington, K. (2004) Becoming a Reflexive Researcher. London: Jessica Kingsley Publisher.
Eysenck, H.J. (1952) The effects of psychotherapy: An evaluation. Journal of Consulting Psychology. 16, pp. 319-324.
Fade, S. ( 2004) Using interpretative phenomenological analysis for public health nutrition and dietetic research: a practical guide. Proceedings of the Nutrition Society. 63, pp. 647-653.
Ferrucci, P. (2005) Conversation with author. Capolona, Italy. 29 May.
Firman, J. & Gila, A. (1997). The Primal Wound. Albany: SUNY Press.
Firman, J. & Gila, A. (2002) A Psychology of the Spirit. Albany: SUNY Press.
Firman, J. & Gila, A. (2010). A Psychotherapy of Love. Albany: State of New York University Press.
Firman, D. (2011) A transpersonal Orientation: Psychosynthesis in the Counselor’s Office. Available at: https://appealpower.com/2016/02/07/a-transpersonal-orientation-psychosynthesis-in-thecounselors-office-by-dr-dorothy-friedman-ed-d/ [accessed 3 March 2017]
Foa, E.B. & Emmelkamp, P.M.G. (1983) Failures in Behavior Therapy. Us: John Wiley & Sons. Gabbard, G.O. (2016) Boundaries and Boundary Violations in Psychoanalysis. 2nd ed. USA: American Psychiatric Publishing.
Gill, P., Stewart, K., Treasure, E. & Chadwick, B. (2008) Methods of data collection in qualitative research: interviews and focus groups. British Dental Journal. 204(6), pp. 291-295.
Gilovich, T. & Husted Medvec, V. (1995) The Experience of Regret: What, When, and Why. Psychological Review. 102(2), pp. 379-395.
Giusti, E. & Marini, S. (2013) Iatrogenia in Psicoterapia. Roma: Sovera Multimedia srl.
Gold, J. & Stricker, G. (2011) Failures in Psychodynamic Psychotherapy. Journal of Clinical
Psychology: In Session. 67(11), pp. 1096-1105.
Goldman, B. (2011) Doctors make mistakes: Can we talk about it? https://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that [accessed 23 March 2018]
Guggenbuhl-Craig, A. (1998) Power in the Helping Professions. USA: Spring Publications.
Guistolise, P.G. (1996) Failure in the Therapeutic Relationship: Inevitable and Necessary? Transactional Analysis Journal. 26(4), pp. 284-288.
Hahn, W.K. (2001) The experience of shame in psychotherapy supervision. Psychotherapy. 38(3), pp. 272-283.
Hefferon, K. & Gil-Rodriguez, E. (2011) Interpretative phenomenological analysis. Methods. 24(10), pp. 756-759.
Hermann, A.D., Leonardelli, G.J. & Arkin, R.M. (2002) Self-Doubt and Self-Esteem: A Threat from Within. Personality and Social Psychology Bulletin. 28(3), 395-408.
Hill, C.E., Nutt-Williams, E., Heaton, K.J., Thompson, B.J. & Rhodes, R.H. (1996) Therapists retrospective recall impasses in long-term psychotherapy: A qualitative analysis. Journal of Counseling Psychology. 43(2), pp. 207-217.
Hynan, D.J. (1990) Client reasons and experiences in treatment that influence termination of psychotherapy. Journal of Clinical Psychology. 46, pp. 891-895.
Irving, L. (2016) Quantitative vs. Qualitative…or a mixed methods marriage? Research methods and dissertation I – Handouts, Master of Applied Positive Psychology and Coaching Psychology, University of East London.
Jacquet, J. (2015) Is Shame Necessary? New Uses for an Old Tool. Uk: Allen Lane Publishing.
Jootun, D., McGhee, G. & Marland, G.R. (2009) Reflexivity: promoting rigour in qualitative research. Research methods. 23(23), pp. 42-46.
Kaffman, M. (1987) Failures in family therapy: and then what? Journal of Family Therapy. 9, pp. 307- 328.
Kelly, A.C., Zuroff, D.C. & Shapira, L.B. (2009) Soothing Oneself and Resisting Self-Attacks: The Treatment of Two Intrapersonal Deficits in Depression Vulnerability. Cognitive Therapy Research. 33, pp. 301-313.
Korstjens, I. & Moser, A. (2018) Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice. 1, pp. 120-124.
Kottler, J.A. & Blau, D.S. (1989) The Imperfect Therapist. San Francisco: Jossey-Bass Inc Publishers.
Kottler, J.A. & Carlson, J. (eds.) (2002) Bad therapy: Master therapists share their worst failures. New York: Bruner-Routledge.
Koukopoulos, A. & Girardi, P. (2005) Fallimenti Terapeutici nei Pazienti Bipolari. Nuove Strategie. Roma: Giovanni Fioriti Editore.
Krefting, L. (1991) Rigor in Qualitative Research: The Assessment of Trustworthiness. The American Journal of Occupational Therapy. 45(3), pp. 214-222.
Ladany, N., Klinger, R. & Kulp, L. (2011) Therapist Shame: Implications for Therapy and Supervision.
In: L. Dearing & J. Tangney, ed., Shame in The Therapy Hour, 1st ed. American Psychological Association, pp. 307-322.
Lambert, M.J. & Ogles, B.M. (2004) The efficacy and effectiveness of psychotherapy. In: Lambert, M.J. (ed.) Bergin and Garfield’s handbook of psychotherapy and behavior change. New York: John Wiley & Sons, pp. 139-193.
Lambert, M.J. & Archer, A. (2006) Research findings on the effects of psychotherapy and their implication for practice. In: Goodheart, C.D., Kazdin, A. and Sternberg, R.J. (eds.) Evidence Based Psychotherapy. APA, Washington DC. Pp. 111-130.
Lambert, M.J. (2013) Outcome in Psychotherapy: The Past and Important Advances. Psychotherapy. 50 (1), pp. 42-51.
Lampropolous, G.K. (2011) Failure in Psychotherapy: An Introduction. Journal of Clinical Psychology. 67, pp. 1093-1095.
Larkin, M., Watts, S. & Clifton, E. (2006) Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology. 3, pp. 102-120.
Levant, R.F. & Hasan, N.T. (2008) Evidence-Based Practice in Psychology. Professional Psychology: Research and Practice. 39(6), pp. 658-662.
Lilienfeld, S.O. (2007) Psychological treatments that cause harm. Perspectives on Psychological Science. 2, pp. 53-70.
Lincoln, Y.S. & Guba, E.G. (1985) Naturalist Inquiry. Newbury Park: Sage Publications.
Lo Iacono, V., Symonds, P. & Brown, D.H.K. (2016) Skype as a Tool for Qualitative Research Interviews. Sociological Research Online. 21(2), pp. 1-15.
Longstaffe, J.A. (1999) Dark and Bright Shadow. http://two.not2.org/psychosynthesis/articles/shadow.htm [accessed 11 March 2018]
McLeod, J. (2011) Qualitative Research in Counselling and Psychotherapy. 2nd ed. London: Sage Publishing.
Millichamp, S. (2010) Psychosynthesis. In: Lowenthal, D. & House, R. (eds.) Critically Engaging CBT. Uk: Open University Press, pp. 67-76.
Montero-Marin, J., Gaete, J., Demarzo, M., Rodero, B., Serrano Lopez, L.C. & Garcia-Campayo, J. (2016) Self-Criticism: A Measure of Uncompassionate Behaviors Toward the Self, Based on the Negative Components of the Self-Compassion Scale. Frontiers in Psychology. 7, pp. 1-15.
Morbidelli, E. (2009) Cicli vitali e psicosintesi dell’età. Rivista di Psicosintesi Terapeutica. 20(10), pp. 9-47.
Murray, S.L., Holmes, J.G., Griffin, D.W., Bellavia, G. & Rose, P. (2001) The Mismeasure of Love: How Self-Doubt Contaminates Relationship Beliefs. Personality and Social Psychology Bulletin. 27, pp. 423-436.
Nannicini, A. (2011) Riflessioni sulle Specificità del Terapeuta di Psicosintesi. Rivista di Psicosintesi Terapeutica. 21-22, pp. 67-76.
Neff, K., Hsieh, Y. & Dejitterat, K. (2005) Self-compassion, Achievement Goals, and Coping with Academic Failure. Self and Identity. 4, pp. 263-287.
Neff, K. (2008) ‘Self-compassion: Moving beyond the pitfalls of a separate self-concept’. In: Bauer, J. & Wayment, H.A. (eds.) Transcending Self-Interest: Psychological Explorations of the Quiet Ego. Washington: APA Books. pp. 95-105.
Newman, M.C. (1996) The Emotional Impact of Mistakes on Family Physicians. Archives of Family Medicine. 5, pp. 71-75.
Norcross, J.C. (ed.) (2002) Psychotherapy relationship that work: Therapist Contributions and Responsiveness to Patients. Oxford: Oxford University Press.
Norcross, J.C. & Wampold, B.E. (2011) Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices. Psychotherapy. 48(1), pp. 98-102.
Pepper, R.S. (1991) When transference isn’t transference: Iatrogenesis and multiple role relations between practicing psychotherapists. Journal of Contemporary Psychotherapy. pp. 2-3.
Perret, V. (2017) Shame, the scourge of supervision. International Journal of Transactional Analysis. 8(2), pp. 41-48.
Pope, K.S., Sonne, J.L. & Greene, B. (2006) What therapists don’t talk about and why: understanding taboos that hurt us and our clients. 2nd ed. USA: American Psychological Association.
Powell, D.H. (1995) Lessons Learned from Therapeutic Failure. Journal of Psychotherapy Integration. 5(2), pp. 175-181.
Powers, T.A., Koestner, R., Zuroff, D.C., Milyavskaya, M. & Gorin, A.A. (2011) The effects of selfcriticism and self-oriented perfectionism on goal pursuit. Personality and Social Psychology Bulletin. 37(7), pp. 964-975.
Ricolfi, L. (1997) La Ricerca Qualitativa. Roma: La Nuova Italia Scientifica.
Robertson, C. (1996) Gateways and Pitfalls. Self & Society. 24(4), pp.19-23.
Robson, C. (2011) Real World Research: A Resource for Social Scientists and Practitioners- Researchers. 3rd ed. New Jersey: Wiley.
Rosselli, M. (2017) Psychopathology and Synthesis. Seminar. Psychosynthesis Trust, London. 29/30 April.
Rowley, J. (2012) Conducting research interviews. Management Research Review. 33(3-4), pp. 260- 271.
Rubin, H. & Rubin, I. (2005) Qualitative Interviewing: the Art of Hearing Data. 2nd ed. Thousand Oaks: Sage Publications.
Russell, G.I. (2015) Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy. Abingdon: Routledge.
Sackett, L., Rosenberg, W.M.C., Gray, A.M., Haynes, B. & Richardson, S. (1996) Evidence based medicine: what it is and what it isn’t. BMJ. 312, pp. 71.
Sasso, L., Bagnasco, A. & Ghirotto, L. (2016) La Ricerca Qualitativa. 2nd ed. Milano: Edra SpA.
Schon, D. (1983) The Reflective Practitioner: How Professionals Think in Practice. New York: Basic Books.
Schonfelder, C. (2013) La preghiera semplice di San Francesco. Un percorso psico-spirituale verso la pace. Rivista di Psicosintesi. 19, pp.13-17.
Schwartz, B. & Flowers, J.V. (2010) How to Fail as a Therapist. 2nd ed. Oakland: Impact Publishers.
Seitz, S. (2015) Pixilated partnership, overcoming obstacles in qualitative interviews via Skype: a research note. Qualitative Research. 16(2), pp. 229-235.
Smith, J.A., Harre, R. & Van Langenhove, L. (1995) Rethinking Methods in Psychology. London: Sage Publishing.
Smith, J.A. (1996) Beyond the divide between cognition and discourse: using interpretative phenomenological analysis in health psychology. Psychology of Health. 11, 261-271.
Smith. J.A. & Osborn, M. (2004) ‘Interpretative Phenomenological Analysis’. In: Breakwell, G.M. (ed.) Doing Social Psychology Research. Uk: The British Psychological Society and Blackwell Publishing Ltd. pp. 229-255.
Smith, J.A., Flowers, P. & Larkin, M. (2012) Interpretative Phenomenological Analysis. London: Sage Publications ( Original work published 2009).
Spellman, D. & Harper, D.J. (1996) Failure, mistakes, regret and other subjugated stories in family therapy. Journal of Family Therapy. 18, pp. 205-214.
Spencer, S.J., Josephs, R.A: & Steele, C.M. (1993) ‘Low self -esteem: the uphill struggle for selfintegrity’. In: Bauemeister, R. ( ed.) Self-esteem and the puzzle of low self-regard. New York: Plenum Press. pp. 21-36.
Stern, D.N. (2004) The Present Moment in Psychotherapy and Everyday Life. London: W.W. Norton & Company.
Talbot, N.L. (1995) Unearthing Shame in the Supervisory Experience. American Journal of Psychotherapy. 49(3), pp. 338-349.
Tangney, J. P. (1995) Shame and Guilt in Interpersonal Relationships. In: Tangney, J.P. and Fisher, K.W. (eds.) Self-conscious emotions: the psychology of shame, guilt, embarrassment and pride. New York: Guilford Press. pp. 114-142.
Tangney, J.P.(2002) Perfectionism and the Self-Conscious Emotions: Shame, Guilt, Embarrassment, and Pride. In: Flett, G.L. & Hewitt, P.L. (eds.) Perfectionism: Theory, research and treatment. Washington: American Psychological Association. pp. 199-215.
Thomson, S.B. (2011) Sample Size and Grounded Theory. Journal of Administration and Governance. 5(1), pp. 45-52.
Viglienghi, V. (2016) Orizzonti psicosintetici. Italy: Youcanprint.
Walach, H. (2008) Narcissism – The shadow of transpersonal psychology. Transpersonal Psychology Review. 12(2), pp. 47-59.
Watkins, D.C. (2012) Qualitative Research: The Importance of Conducting Research that Doesn’t Count. Health Promotion Practice. 13(2), pp. 153-158.
Watson, P.J., Varnell, S.P. & Morris, R.J. (1999) Self-Reported Narcissism and Perfectionism: an Ego- Psychological Perspective and the Continuum Hypothesis. Imagination, Cognition and Personality. 19(1), pp. 59-69.
Watson, J.C. (2011) Treatment failure in humanistic and experiential psychotherapy. Journal of Clinical Psychology. 67, pp. 1117-1128.
Weeks, G.R. Odell, M. & Methven, S. (2005) If only I had known: Avoiding common mistakes in couples therapy. New York: W.W. Norton & Company, Inc.
Whitmore, D. (2004) Humanistic theories in psychopathology. In: Miller, H.L. (ed.) The SAGE Encyclopedia of Theory in Psychology. Thousand Oaks: SAGE, pp. 438-441.
Whitmore, D. (2015) Promises and Pitfalls: The Spiritual and the Therapeutic Path. https://psychosynthesistrust.org.uk/diana-whitmore-promises-pitfalls-the-spiritual-and-the-therapeuticpath/ [accessed 13 July 2018]
Wilber, K. (1996) ‘Introduction’. In: Scotton, B.W., Chinen, A.B. & Battista, J.R. Textbook of transpersonal psychiatry and psychology. New York: Perseus Books Group.
Willig, C. (2013) Introducing qualitative research in psychology. Adventures in theory and method. Philadelphia: Open University Press.
Wilson, H. (2017) Modeling Imperfection and Developing the Imperfect Self. In Parry, S. (eds.)
Effective Self-Care and Resilience in Clinical Practice: Dealing with Stress, Compassion Fatigue, and Burnout. London; Jessica Kingsley Publishers Wosket, V. (2011) The Therapeutic Use of Self. London: Routledge (Original work published 1999).
Yourman, D.B. (2003) Trainee disclosure in psychotherapy supervision: the impact of shame. Journal of Clinical Psychology. 59(5), pp. 601-609.
Zhao, Q. & Wickman, A. (2015) Incremental Beliefs About Ability Ameliorate Self-Doubt Effects. SAGE Open. pp. 1-10.
Bibliography
Ackerman, S.J. & Hilsenroth, M.J. (2001) A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy. 38, pp. 171-185.
Adams, S. (2013) How to fail at almost everything and still win big: kind of the story of my life. London: Penguin Books.
Adichie, C.N. (2009) The Danger of A Single Story (video file) available from https://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story [accessed 21 February 2017]
Agostini, C. (2018) Conoscere la psicologia transpersonale: Storia, principi e protagonist della psicologia del future. Italia: Area51 Publishing.
Albee, G.W. (1998). Fifty years of clinical psychology: selling our soul to the evil. Applied and Preventive Psychology. 7, pp 141-167.
Alberti, A. & Favero, E. (2005). Teoria e Pratica della Diagnosi in Psicosintesi. Rivista di Psicosintesi Terapeutica. 11, pp. 11-70.
Alberti, A. (1994) Il Sé Ritrovato. Firenze: Giampiero Pagnini Editore.
Allodola, V.F. (2014) Metodi di ricerca qualitativa in Medical Education: approcci, strumenti e considerazioni di rigore scientifico. https://riviste.unimc.it/index.php/es_s/article/view/933 [accessed 10 March 2017]
Assagioli, R. (1965) L’equilibramento e sintesi degli opposti. Firenze: Istituto di Psicosintesi.
Assagioli, R. (1973). Le nuove dimensioni della psicologia: la terza, la quarta e la quinta forza.
Firenze: Istituto di Psicosintesi.
Assagioli, R. (1973) The Act of Will. New York: Penguin Books.
Assagioli, R. (1975) Principi e Metodi della Psicosintesi Terapeutica. Roma: Astrolabio.
Assagioli R. (1993) Psychosynthesis. A Manual of Principles and Techniques. London: The Aquarian Press.
Attig, T. (1991) The Importance of Conceiving of Grief as an Active Process. Death Studies. 15, pp. 385-393.
Bandura, A. (1982) Self-efficacy mechanism in human agency. American Psychologist. 37, pp. 122-147.
Bateman, A.W. & Fonagy, P. (2000) Effectiveness of psychotherapeutic treatment of personality disorder. British Journal of Psychiatry. 177, pp 138-143.
Bates, Y. (2006), Shouldn’t I Be Feeling Better By Now? Client Views Of Therapy. Baginstoke, UK: Palgrave.
Berglas, S. & Jones, E.E. (1978) Drug choice as a self-handicapping strategy in response to noncontingent success. Journal of Personality and Social Psychology. 36, pp. 405-417.
Berk, M. & Parker, G. (2009) The elephant on the couch: side-effects of psychotherapy. Australian and New Zealand Journal of Psychiatry. 43, pp. 787-794.
Besser, A. & Priel, B. (2011) Dependency, Self-Criticism and Negative Affective Responses Following Imaginary Rejection and Failure Threats: Meaning-Making Processes as Moderators or Mediators. Psychiatry. 74(1), pp. 31-40.
Binder, P., Holgersen, H. & Nielsen, G.H. (2010) What is a “good outcome” in psychotherapy? A qualitative exploration of former patients’ point of view. Psychotherapy Research. 20(3), pp. 285-294.
Bonacina, P. (2010). Manuale di Psicosintesi. Milan: XENIA Edizioni.
Braslow, M.D., Guerrettaz, J., Arkin, R.M. & Oleson, K.C. (2012) Self-Doubt. Social and Personality Psychology Compass. 6(6), pp. 470-482.
Brown, B. (2007) I thought it was just me (but it isn’t): making the journey from “What will people think?” to “I am enough”. London: Penguin Publishing Group.
Brown, B. (2010) The Power of Vulnerability (video file) available from https://www.ted.com/talks/brene_brown_on_vulnerability [accessed 14 February 2017]
Brown, B. (2015) Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. London: Penguin Books.
Brown, B. (2015) Rising Strong. New York: Spiegel & Grau.
Brown, J. (2015) Specifique Techniques Vs. Common Factors? Psychotherapy Integration and its Role in Ethical Practice. American Journal of Psychotherapy. 69 (3), pp. 301-316.
Brustein, M. (2013) Perfectionism: A guide for mental health professionals. New York: Springer Publishing Company.
Bugental, J.F.T. & Bugental, E.K. (1984) A fate worse than death: the fear of changing. Psychotherapy. 20, pp 543-549.
Burton, A. (1977) The Analysis of a Therapeutic Failure. Psychoanalytic Review. 63, pp. 587-614.
Calvi, E. & Gullotta, G. (1999) Il codice deontologico degli psicologi. Milan: Giuffrè.
Camic, P.M., Rhodes, J.E. & Hardley, L. (2003) Qualitative Research in Psychology: Expanding Perspectives in Methodology and Design. Washington: American Psychological Association.
Canevaro, A. (2014) Drop-out e fallimento terapeutico sono la stessa cosa? Psicobiettivo. 34(1), pp. 15- 22.
Cannon, M.D. & Edmondson, A.C. (2001) Confronting failure: antecedents and consequences of shared beliefs about failure in organizational work groups. Journal of Organizational Behavior. 22, pp. 167-177.
Carey, T.A., Kelly, R.E., Mansell, W. & Tai, S.J. (2012) What’s therapeutic about the therapeutic relationship? A hypothesys for practice informed by perceptual control therapy. The Cognitive Behaviour Therapist. 5, pp. 47-59.
Cassidy, E., Reynolds, F., Naylor, S. & De Souza, L. (2011) Using interpretative phenomenological analysis to inform physiotherapy practice: An introduction with reference to the lived experience of cerebellar ataxia. Psychotherapy Theory and Practice. 27 (4), pp. 263-277.
Castonguay, L.G., Boswell, J.F., Goldfried, M.R. & Hill, C.E. (2010) Training implications of harmful effects of psychological treatments. American Psychologists. 65(1), pp. 34-49.
Cipriani Cirelli, F. (2008) La ferita primaria. http://it.scribd.com/doc/27017699/PSICOSINTESI-n- 8-Ottobre-2007#page=14 [accessed 15 February 2017]
Cramer, P. (1998) Defensiveness and Defense Mechanisms. Journal of Personality. 55, pp. 880- 893.
Crouch, M. & Mckenzie, H. (2006) The logic of small samples in interview-based qualitative research.
Social Science Information. 45(4), pp. 483-499.
Daniels, M. (1988) The myth of self-actualization. Journal of Humanistic Psychology. 28, pp. 7-38.
Davidson, D. (1996) The Folly of Trying to Define Truth. Journal of Philosophy. 93(6), pp. 263-278.
Derlega, V.J., Margulis, S.T. & Winstead, B.A. (1987) A social-psychological analysis of self-disclosure in psychotherapy. Journal of Social and Clinical Psychology. 5(2), pp. 205-215.
De Witt, L. & Ploeg, J. (2006) Critical appraisal of rigour in interpretive phenomenological nursing research. Journal of Advanced Nursing. 55(2), pp. 215-229.
Douglas McKenna, D. & Davis, S.L. (2009) Hidden in Plain Sight: The Active Ingredients of Executive Coaching. Industrial and Organizational Psychology. 2, pp. 244-260.
Duncan, L. & Miller, S.D. (1999) The heart & soul of change: What works in therapy. Washington: American Psychological Association.
Fasolo, F. & Ponza, I. (1989) Cicatrici narcisistiche. Psichiatria Generale e dell’età evolutiva. 27, pp. 45-57.
Ferrucci, P. (2012). La Psicosintesi vista alla luce delle neuroscienze. Rivista di Psicosintesi Terapeutica. 26(1), pp. 9-31.
Finaly, L. & Ballinger, C. (2006) ‘Glossary’. In: Finlay, L. & Ballinger, C. (eds.) Qualitative Research for Allied Healt Professionals: Challenging Choices. Chichester: Whurr Publishers.
Finlay, L. (2009) Debating Phenomenological Research Methods. Phenomenology & Practice. 3(1), pp. 6-25.
Finotti, A. (2000) Sintesi degli opposti e psicoterapia. https://www.scuolapsicosintesi.com/sipt/2000/sintesi-degli-opposti-e-psicoterapia/ [accessed 15th February 2018]
Firman, J. & Russell, A. (1994) Opening to the Inner Child. Recovering Authentic Personality. Available at: http://synthesiscenter.org/articles/opening.pdf [accessed on 19th December 2016]
Firman, J. & Gila, A. (2007) Assagioli’s Seven Core Concepts of Psychosynthesis training. http://www.psychosynthesisresources.com/NieuweBestanden/Seven%Concepts.pdf [accessed 10 March 2017]
Firman, D. (2011) Transpersonal psychology: An introduction to psychosynthesis. https://www.psychologytoday.com/sites/default/files/attachments/42788/transpersonal-orientationdidi. pdf [accessed 12 May 2018]
Foa, E.B. & Emmelkamp, P.M.G. (1983) Failures in Behavior Therapy. Us: John Wiley & Sons
Forrester, R. (2013) How change happens:A theory of philosophy of history, social change and cultural evolution. Wellington: Best Publication Limited.
Frederickson, J. (2013) Co-creating change. Kansas City: Seven Leaves Press. Friedman, L. (1988) The Anatomy of Psychotherapy. New Jersey: The Analytic Press.
Gelso, C.J. & Carter, I.A. (1985) The relationship in counseling and psychotherapy: components, consequences and theoretical antecedents. The Counseling Psychologist. 13, pp.155-243.
Gelso, C.J. & Haves, J.A. (1998) The psychotherapy relationship: Theory, research and practice. New York: Wiley.
Germer, C. & Neff, K. (2013) Self-Compassion in Clinical Practice. Journal of Clinical Psychology. 69(8), pp. 1-12.
Gilbert, P., Clarke, M., Hempel, S., Miles, J.N.V. & Irons, C. (2004) Criticizing and reassuring oneself: AN exploration of forms, styles and reasons in female students. British Journal of Clinical Psychology. 43, pp. 31-50.
Gilbert, P. & Procter, S. (2006) Compassionate Mind Training for People with High Shame and Self- Criticism: Overview and Pilot Study of a Group Therapy Approach. Clinical Psychology and Psychotherapy. 13, pp. 353 – 379.
Gilbert, P. (2010) The compassionate mind (Compassion Focused Therapy). London: Constable & Robinson Ltd.
Goldberg, A. (2012) The Analysis of Failure. New York: Routledge.
Goldfried, M.R. (2013) What should we expect from psychotherapy? Clinical Psychology Review. 33, pp. 862-869.
Govier, T. (1993) Self-Trust, Autonomy, and Self-Esteem. Hypatia. 8(1), pp. 99-120.
Grasso, M. (2010) La relazione terapeutica. Bologna: Il Mulino.
Grof, S. (1985) Beyond the Brain: Birth, Death, and Transcendence in Psychotherapy. New York: Suny Press.
Grzegorek, J.L., Slaney, R.B., Franze, S. & Rice, K. (2004) Self-Criticism, Dependency, Self-Esteem, and Grade Point Average Satisfaction Among Clusters of Perfectionists and Non-perfectionists. Journal of Counseling Psychology. 51(2), pp. 192-200.
Guarino, S. The Repression of Sublime (n.d.) http://www.psicosintesi.it/sites/default/files/magazine_023_therepressionofsublime.pdf [accessed 15 February 2018]
Guggisberg Nocelli, P. (2011). La Via della Psicosintesi Una Guida Completa con una biografia di Roberto Assagioli. Firenze: L’UOMO Edizioni.
Gully, S.M, Payne, S.C., Kiechel Koles, K.L. & Whiteman, J.K. (2002) The Impact of Error Training and Individual Differences on Training Outcomes: An Attribute-Treatment Interaction Perspective.
Journal of Applied Psychology. 87(1), pp. 143-155.
Gutheil, T.G. & Gabbard, G.O. (1993) The concept of boundaries in clinical practice: Theoretical and risk management dimensions. American Journal of Psychiatry. 150, pp.188-196. Haley, J. (1969) The art of being a failure as a therapist. American Journal of Orthopsychiatry. 39(4), pp. 691-695.
Hall, R.C.H. & Resnick, P.J. (2008) Psychotherapy Malpractice: New Pitfalls. Journal of Psychiatric Practice. 14(2), pp. 119-121.
Hampton, L.P. (1984) Malpractice in Psychotherapy: Is there a Relevant Standard of Care. Case Western Reserve Law Review. 35, pp. 251-281.
Hartelius, G., Caplan, M. & Rardin, M.A. ( 2007) Transpersonal Psychology: Defining the Past, Divining the Future. The Humanistic Psychologist. 35(2), pp. 135-160.
Haugh, S. & Paul, S. (2008) The therapeutic relationship: perspectives and themes. Herefordshire: PCCS Books Ltd.
Havens, L. (1979) Explorations in the uses of language in psychotherapy: complex empathic statements. Psychiatry. 42, pp. 40-48.
Helkins, D., Hedstrom, L., Leaf, J. & Saunders, C. (1988) Toward a humanistic- phenomenological spirituality. Definition, Description, and Measurement. Journal of Humanistic Psychology. 28, pp. 5- 18.
Hendin, H., Pollinger Haas, A., Maltsberger, J.T., Szanto, K. & Rabinowicz, H. (2004) Factors Contributing to Therapists’ Distress After the Suicide of a Patient. American Journal of Psychiatry. 161, pp. 1442-1446.
Hoffman, S. & Horowitx, I. (1991) Treating the iatrogenically infantilized patient. American Journal of Psychotherapy. 1, pp. 279-283.
Hook, D. (2001) Therapeutic discourse, co-construction, interpellation, role-induction: psychotherapy as iatrogenic treatment modality? International Journal of Psychotherapy. 6(1), pp. 47-66.
Ivtzan, I., Lomas, T., Hefferon, K. & Worth, P. (2015). Second wave positive psychology: embracing the dark side of life. Oxon: Routledge.
Jacob, S.A. & Furgerson, S.P. (2012) Writing Interview Protocols and Conducting Interviews: Tips for Students New to the Field of Qualitative Research. The Qualitative Report. 17(6), pp. 1-10.
Jeffers, S. (2003) Embracing Uncertainty. Great Britain: Hodder and Stoughton.
Johnstone, M.J. & Kanitsaki, O. (2006) The ethics and practical importance of defining, distinguishing and disclosing nursing errors: A discussion paper. International Journal of Nursing Studies. 43, pp. 367-376.
Johnson, J., Panagioti, M., Bass, J., Ramsey, L. & Harrison, R. (2017) Resilience to emotional distress in response to failure, error or mistakes: A systematic review. Clinical Psychology Review. 52, pp. 19- 42.
Kapoor, A. (2006) Suicide: the effect on the counselling psychologist. Counselling at Work. pp. 10- 15.
Kendall, P.C., Kipnis, D. & Otto-Salaj, L. (1992) When clients don’t progress: influences on and explanations for lack of therapeutic progress. Cognitive Therapy and Research. 16(3), pp. 269-281.
Kidd, S. (2002) The role of qualitative research in psychological journals. Psychological Methods. 7(1), pp. 126-138.
Koch, T. (1994) Establishing rigour in qualitative research: the decision trail. Journal of Advanced Nursing. 19, pp. 976-986.
Kopala-Sibley, D.C., Zuroff, D.C., Hankin, B.L. & Abela, J.R.Z. (2015) The Development of Self- Criticism and Dependency in Early Adolescence and Their Role in the Development of Depressive and Anxiety Symptoms. Personality and Social Psychology Bulletin. 41(8), pp. 1094-1109.
Kuijpers, H.J., Van Der Heijden, F.M. & Tuinier, S. (2007) Meditation-induced Psychosis. Psychopathology, 40, pp. 461-464.
Ladany, N, Hill, C.E., Corbett, M.M. & Nutt, E.A. (1996) Nature, Extent, and Importance of What Psychotherapy Trainees Do Not Disclose to Their Supervisors. Journal of Counseling Psychology. 43(1), pp. 10-24.
Lambert, M., Harmon, C., Slade, K., Whipple, J. & Hawkins, E. (2005) Providing feedback to psychotherapists on their patients’ progress: clinical results and practice suggestions. Journal of Clinical Psychology. 61(2), pp. 165-174.
Lambert, M.J. (2010) Prevention of Treatment failure. Us: American Psychological Association. Langdridge, D. (2007) Phenomenological Psychology. Theory, Research and Method. Harlow: Pearson.
Leahy, R. (2001) Overcoming resistance in cognitive therapy. New York: The Guildford Press.
Lincoln, Y.S. & Guba, E.G. (1985) Naturalistic Inquiry. Thousand Oaks: Sage.
Linden, M. (2013) How to Define, Find and Classify Side Effects in Psychotherapy: From Unwanted Events to Adverse Treatment Reactions. Clinical Psychology and Psychotherapy. 20, pp. 286-296.
Lindolof, T.R. & Taylor, B.C. (2002) Qualitative Communication Research Methods. 2nd ed. Thousand Oaks: Sage Publications.
Lingiardi, L. & Maffei, C. (1997) I meccanismi di diffesa e la relazione medico-paziente. Milano: Franco Angeli Edizioni.
Lingiardi, L. (2002) L’alleanza terapeutica. Milano: Raffaello Cortina Editore.
Lingiardi L. & Madeddu, F. (2002) I meccanismi di difesa. Teoria, valutazione, clinica. Milano: Raffaello Cortina Editore.
Long, T. & Johnson, M. (2000) Rigour, reliability and validity in qualitative research. Clinical Effectiveness in Nursing. 4, pp. 30-37.
Lorenzini, R. & Scarinci, A. (2010) Errare “Umanum Est”. L’errore nella pratica psicoterapeutica. Roma: Alpes Italia.
Lyddon, W.J. & Weill, R. (1997) Cognitive psychotherapy and postmodernism: Emerging themes and challenges. Journal of Cognitive Psychotherapy. 11, pp.75-90.
Marchand, L. (2015) Shared presence: the heart of the therapeutic relationship. Families, Systems & Health. 33, pp. 283-284.
Maroda, K.J. (2010) Psychodynamic Techniques. Working with Emotion in the Therapeutic Relationship. New York: The Guildford Press.
Mash, E.J. & Hunsley, J. (1993) Assessment Considerations in the Identification of Failing Psychotherapy: Bringing the Negatives out of Darkroom. Psychological Assessment. 5 (3), pp. 292- 301.
Matua, G.A. & Van Der Wal, D.M. (2015) Differentiating between descriptive and interpretive phenomenological research approaches. Nurse Reseacher. 22(6), pp. 22-27.
McConnaughy, E.A., Diclemente, C.C., Prochaska, J.O. & Velicer, W.F. (1986) Stages of change in psychotherapy: a follow up report. Psychotherapy. 26, pp. 494-502.
McGregor, H.A. & Elliot, A.J. (2005) The shame of failure: examining the link between fear of failure and shame. Personality and Social Psychology Bulletin. 31(2), pp. 218-231.
Meissner, W.W. (1996) The therapeutic alliance. New Haven: Yale University Press.
Mitchell, S.A. & Aron, L. (1999) Relation Psychoanalysis. The Emergence of a Tradition. New York: The Analytic Press Hillsdale.
Nathanson, D.L. (1994) Shame and Pride: Affect, Sex and the Birth of the Self. USA: Norton Paperback.
Neenan, M. & Dryden, W. (2001) Learning from errors in rational emotive behaviour therapy. Uk: Whurr Pub Ltd.
Neff, K., Kirkpatrick, K. & Rude, S. (2007) Self-compassion and adaptive psychological functioning. Journal of Research in Personality. 41, pp. 139-154.
Neustadter, S.B. (2010) Understanding the motivation for suicide from a transpersonal perspective: research and clinical approaches. The Journal of Transpersonal Psychology. 42, pp. 61-88.
Norcross, J.C. (2011) Psychotherapy relationships that work: Evidence Based Responsiveness. Oxford: Oxford University Press.
Norcross, J.C., Koocher, G.P. & Garofalo, A. (2006) Discredited Psychological Treatments and Tests: a Delphi Poll. Professional Psychology Research and Practice. 37(5), pp. 515-522.
Oleson, K.C., Poehlmann, K.M., Yost, J.H., Lynch, M.E. & Arkin, R.M. (2000) Subjective
overachievement. Individual differences in self-doubt and concern with performance. Journal of Personality. 68, pp. 491-524.
Oliver, D.G., Serovich, J.M. & Mason, T.L. (2005) Constraints and Opportunities with Interview Transcription: Towards Reflection in Qualitative Research. Social Forces. 84(2), pp. 1273-1289.
Opdenakker, R. (2006) Advantages and Disadvantages of Four Interview Techniques in Qualitative Research. Forum: Qualitative Social Research. 7(4), pp. 392-405.
Packman, W.L., Cabot, M.G. & Bongar, B. (1994) Malpractice Arising From Negligent Psychotherapy: Ethical, Legal, and Clinical Implications of Osheroff v. Chestnut lodge. Ethics & Behavior. 4(3), pp. 175-197.
Pagano, P. (2009) Il modello medico in psicologia clinica. Rivista di Psicologia Clinica. 2, pp.242-253.
Parfitt, W. (2013) Psychosynthesis: Beyond the elements. London: PS Avalon.
Parry, S. (2017) Effective Self-Care and Resilience in Clinical Practice. London: Jessica Kingsley Publishers.
Persons, J.B. & Mikami, A.Y. (2002) Strategies for Handling Treatment Failure Successfully.
Psychotherapy : Theory/Research/Practice/Training. 39(2), pp. 139-151.
Petrik, A. & Cronin, T. (2014) Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken. The Australian Psychological Society. 49, pp. 283-286.
Pietkiwicz, I. & Smith, J.A. (2014) A Practical Guide to Using Interpretative Phenomenological Analysis in Qualitative Research Psychology. Psychological Journal. 20(1), pp. 7-14.
Pincus, A.L., Cain, N.M. & Wright, A.G.C. (2014) Narcissistic Grandiosity and Narcissistic Vulnerability in Psychotherapy. Personality Disorders: Theory, Research and Treatment. 5(4), pp. 439-443.
Piselli, A., Halgin, R.P. & Macewan, G.H. (2011) What went wrong? Therapists’ reflections on their role in premature termination. Psychotherapy Research. 21(4), pp. 400-415.
Ponterotto, J.G. (2005) Qualitative Research in Counseling Psychology: A Primer on Research Paradigms and Philosophy of Science. Journal of Counseling Psychology. 52(2), pp. 126-136.
Pope, K.S., Sonne, J.L. & Holroyd, J. (1993) Sexual Feelings in Psychotherapy: Explorations for Therapists and Therapists-in-training. 1st ed. Washington: American Psychological Association.
Pringle, P., Drummond, J., McLafferty, E., & Hendry, C. (2011) Interpretative phenomenological analysis: a discussion and critique. Nurse Research. 18(3), pp. 20-24.
Ravitz, P., McBride, C. & Maunder, R. (2011) Failures in Interpersonal Psychotherapy (IPT): Factors Related to Treatment Resistances. Journal of Clinical Psychology. 67, pp. 1129-1139.
Rizq, R. (2012) ‘There’s always this sense of failure’: an interpretative phenomenological analysis of primary care counsellors’experiences of working with the borderline client. Journal of Social Work Practice. 26(1), pp. 31-54.
Rizvi, S. (2011) Treatment Failure in Dialectical Behavior Therapy. Cognitive and Behavioral Practice. pp, 1-10.
Robertson, C. (1998) Psychosynthesis and its Shadow. http://www.aappsychosynthesis.org/resources/articles2/robertson.htm [accessed 12 December 2016]
Robinson, O.C. (2014) Sampling in Interview-Based Qualitative Research: A Theoretical and Practical Guide. Qualitative Research in Psychology. 11, pp. 25-41.
Rogers, C.R. (1970) On becoming a person. In: C.R. Rogers, La terapia centrata sul cliente. Firenze: Martinelli.
Roos, J. & Werbart, A. (2013) Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research. 23(4), pp. 394-418.
Rosselli, M. (2003) Psicosintesi e Psicopatologia. Sintesi. Studi di Psicoterapia Psicosintetica. 2, pp.45-54.
Rovetto, F. (2015) Psicologia Clinica, Psichiatria, Psicofarmacia, Psicofarmacologia. Uno spazio d’integrazione. Milano: FrancoAngeli s.r.l.
Safran, J.D. & Muran, J.C. (2000) Resolving therapeutic alliance rupture: Diversity and Integration.
Journal of Clinical Psychology. 56, pp.233-243.
Salmon, P. (2013) Assessing the quality of qualitative research. Patient Education and Counselling. 90, pp. 1-3.
Sanderson, C. (2015) Counselling Skills for Working with Shame. London: Jessica Kingsley Publishers.
Saunders, S.M. (1999) Client’s assistance of the affective environment of the psychotherapy session: Relationship to session quality and treatment effectiveness. Journal of Clinical Psychology. 55, pp.597-605.
Schultz, K. (2011) Being Wrong: Adventures in the Margin of Error. New York: Ecco.
Scott, S.M. (1997) The grieving soul in the transformation process. In: Cranton, P. (ed.) Transformative
Learning in Action: Insights from Practice. San Francisco: Jossey-Bass Publishers. pp. 41-50.
Scotton, B.W., Chinen, A.B. & Battista, J.R. (1996) Textbook of transpersonal psychiatry and psychology. New York: Perseus Books Group.
Semeraro, R. (2011) L’analisi qualitative dei dati di ricerca in educazione. The qualitative analysis of research data in education. Giornale Italiano della Ricerca Educativa. 4(7), pp. 97-106.
Settlage, J., Southerland, S.A., Smith, L.K. & Ceglie, R. (2009) Constructing a Doubt-Free Teaching Self: Self-Efficacy, teacher Identity, and Science Instruction Within Diverse Settings. Journal of Research in Science Teaching. 46(1), pp. 102-125.
Shenton, A.K. (2004) Strategies for Ensuring Trustworthiness in Qualitative Research Projects. Education for Infromation. 22, pp. 63-75.
Singer, M. & Lalich, J. (1996) Crazy Therapies: What are they? Do they work? San Francisco: Jossey-Bass Inc Pub.
Smith, J.A. (2004) Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology. 1(1), pp.39-54.
Smith, J.A. & Eatough, V. (2012) Interpretative Phenomenological Analysis. In: Breakwell, G.M.,
Smith, J.A. & Wright, D.B. (eds.) Research Methods in Psychology. 4th ed. London: Sage Publishing. pp. 439-461.
Sorensen, K. (2016) The Soul of Psychisynthesis: The Seven Core Concepts. Kentaur Publishing.
Sorensen, K. (2017) The balancing and synthesis of the opposites. https://kennethsorensen.dk/en/thebalancing- and-synthesis-of-the-opposites-by-robertoassagioli/#Balancing_Opposite_Poles_and_synthesis [accessed 6 March 2018]
Spath, P.L. (2003) Using failure mode and effects analysis to improve patient safety. Aorn Journal. 78(1), pp. 16-37.
Spinelli, E. (1989) The interpreted world: an introduction to phenomenological psychology. London: Sage.
Standal, S.W. (1954) The need for positive regard: A contribution to client-centered theory. Illinois: University of Chicago.
Starrs, C.J., Dunkley, D.M. & Moroz, M. (2015) ‘Self-criticism and Low Self-Esteem’. In: Wade, T. (ed.) Encyclopedia of Feeding and Eating Disorders. Singapore: Springer. pp. Stoeber, J., Hutchfield, J. & Wood, K.V. (2008) Perfectionism, self-efficacy, and aspiration level: differential effects of perfectionistic striving and self-criticism after success and failure. Personality and Individual Differences. 45, pp. 323-327.
Stone, M.H. (2006) Personality-Disordered Patients: Treatable and Untreatable. Arlington: American Psychiatric Publishing Inc.
Stuart, R.B. (1976) Trick or Treatment: How and When Psychotherapy Fails. Illinois: Research Press Publishers.
Stucke, T.S. & Sporer, S.L. (2002) When a Grandiose Self-Image Is Threatened: Narcissism and Self-Concept Clarity as Predictors of Negative Emotions and Aggression Following Ego-Threat. Journal of Personality. 70(4), pp. 509-532.
Strupp, H.H. (1980) Success and failure in time-limited psychotherapy further evidence (Comparison 4). Archives of General Psychiatry. 37, pp. 947-954.
Thomas, L. (1980) Dying as Failure. The Annals of the American Academy of Political and Social Science. 447, pp. 1-4.
Thomas, E. & Magilvy, J.K. (2011) Qualitative Rigor or Research Validity in Qualitative Research. Journal for Specialists in Pediatric Nursing. 16, pp. 151-155.
Town, J.M. (2013) Effectiveness and cost effectiveness of Davanloo’s Intensive Short-term Dynamic Psychotherapy: Does unlocking the unconscious make a difference? American Journal of Psychotherapy. 67, pp. 89-108.
Tsui, P. & Schultz, G.L. (1985) Failure of rapport: why psychotherapeutic engagement fails in the treatment of Asian clients. American Journal of Orthopsychology. 55, pp. 561-569.
Vaillant, G.E. (1994) Ego mechanisms of defense and personality psychopathology. Journal of Abnormal Psychology. 103, pp. 44-50.
Van Dijk, W.W., Zeelenberg, M. & van der Plight, J. (2003) Blessed are those who expect nothing: Lowering expectations as a way of avoiding disappointment. Journal of Economic Psychology. 24, pp. 505-516.
Vossler, A. & Moller, N. (2014) The Counselling and Psychotherapy Research Handbook. Thousand Oaks: SAGE Publications Ltd.
Wallach, M.A. & Wallach, L. (1983) Psychology’s sanction for selfishness: The error of egoism in theory and therapy. London: W H Freeman & Co.
Watson, J.C. (2011) Treatment Failure in Humanistic and Experiential Psychotherapy. Journal of Clinical Psychology. 67, pp. 1117-1128.
Wendt, D.C., Gone, J.P. & Nagata, D.K. (2015) Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses. The Counseling Psychologist. 43(3), pp. 334-358.
White, R.B. & Gilliland, R.M. (1975) Elements of Psychopathology: the mechanisms of defense. Michigan: Grune & Stratton.
Wierzbicki, M. & Pekarik, G. (1993) A Meta-Analysis of Psychotherapy Dropout. Professional Psychology: Research and Practice. 24 (2), pp. 190-195.
Will, A.J., Lavric, A., Croft, G.S. & Hodgson, T.L. (2007) Predictive Learning, Prediction Errors and Attention: Evidence from Event-related Potentials and Eye Tracking. Journal of Cognitive Neuroscience. 19(5), pp. 843-854.
Woodman, T., Akehurst, S., Hardy, L. & Beattie, S. (2010) Self-confidence and performance: A little self-doubt helps. Psychology of Sport and Exercise. 11, pp. 467-470.
Wright, P.M., Lichtenfels, P.A. & Pursell, E.D. (1989) The structured interview: Additional studies and a meta-analysis. Journal of Occupational Psychology. 62, pp. 191-199.
Zweig, C. & Abrams, J. (1991) Meeting the Shadow: The Hidden Power of the Dark Side of Human Nature. New York: TarcherPerigee.