Feature

Several years ago psychologist Donna Davenport, PhD, of Texas A&M University, was working with a couple she considered "very religious" to help the wife through her inhibited sexual desire.

During one session, Davenport said, "having sex with…" and the couple's faces froze. "We're not comfortable with words that 'devalue' the act," Davenport recalls them saying. Interested, Davenport asked them how the term "making love" differed from "having sex." The wife disclosed that as a child, her uncle abused her, telling her he needed to teach her about "sex"so that she could know how to please her husband later.

Since the incident, the woman had compartmentalized her memories of the incident as "sex," but considered her marital intimacy "making love."

Davenport apologized for having not paid more attention to her word choice. The couple's understanding of Davenport's regret was the first step in a breakthrough that allowed Davenport to help the wife open up about her past and learn to increase her comfort level during sex.

"The treatment took a much more productive turn, but it wouldn't have happened if I hadn't apologized and shown a willingness to respect their word choice," she says.

Davenport is one of many psychologists who see the advantages in admitting a mistake, according to a recent study by psychologist Caroline Burke, PhD, of Carleton College, and her colleagues. The study of 82 APA members and fellows found that all of the survey participants had apologized to a client at some point for transgressions like being late to a session or failing to provide promised feedback, generally with positive results.

"The survey reported some variability in thinking when apology is warranted," Burke says. "And a significant number of responders from the survey suggested that it is quite simply the right thing to do."

Burke presented the results at APA's 2005 Annual Convention in Washington, D.C.

Modeling behavior

Davenport, who uses a feminist theoretical orientation, considers apologies to be especially beneficial as a means of modeling responsible behavior.

"You can't hide behind your role," Davenport says. "It's a moral and ethical issue."

By making apologies, psychologists can show their humanity and willingness to take responsibility for their actions, she says.

For situations such as when a psychologist is late or distracted, Davenport recommends that psychologists offer the same types of apology that they would in nonclinical settings, such as acknowledging their error and pledging to pay closer attention to their actions in the future. She adds that the apology should be brief and serve as a transition into resuming the work of therapy.

For more grievous mistakes, such as when a psychologist exploits or misuses power, like when he or she fails to give a client notice that a session is cancelled, Davenport believes the psychologist should obtain consultation to examine his or her own issues in addition to offering a lengthier, heartfelt apology.

However, psychoanalyst Arnold Goldberg, MD, who wrote an article evaluating the place of apology in psychoanalysis and psychotherapy in the International Review of Psycho-Analysis, (Vol. 14, No. 3, pages 409-417),suggests that holding a blanket policy for making apologies is not in every client's best interest.

"It is naïve…to suggest that an apology will have a lasting, meaningful effect," says Goldberg, who uses both psychoanalytic and psychodynamic theoretical orientations. "It's nice to apologize-it may matter-but it doesn't have much more impact than if a barista at Starbucks apologizes for screwing up your order."

Instead, Goldberg explores what he calls the transference of the situation, or what contributed to his making the error.

"Each and every case needs to be evaluated in its own right…[but] if you don't understand why the mistake happened, you miss the point," he says.

Reservations

Indeed, the nature of their clients' personality, temperament and therapeutic issue can influence psychologists' decision to apologize, says Burke.

"Apologies are not always helpful," she says. "They can shut down the process...and if a client has issues with overapologizing or other concerns, the psychologist has to think through what it means to say 'I'm sorry' to that client."

In her survey, she found that nearly a quarter of the psychologists who had apologized had, at times, later regretted doing so. In most of those cases, the regret was the result of the psychologist's failure to consider the individual client. Psychologists in the study explained that regret by saying, for instance, "I need to be careful when working with Axis II-especially borderline clients," and "The patient took my apology as a furthering of her privilege."

For example, a few years ago Davenport inadvertently apologized for saying the wrong name of a relative to a client who had borderline narcissistic personality disorder. For the rest of the session, the patient kept returning to her apology.

"She saw my regretting a mistake as an opportunity to assume a position of power," Davenport says.

Burke hopes that her study bolsters psychologists' awareness of apologies as cultural response.

"Apologies are generally a good thing," she says. "But psychologists should proceed with caution. Culturally polite behavior seems to not always be the best course of action."

One psychologist who agrees with Goldberg's assertions is Mark Kunkel, PhD, of the University of West Georgia, who says he would rather collaborate with his patients to understand the way they make meaning of his mistakes-such as forgetting pertinent details or his own tardiness-than apologize.

"Of course I commit lapses," he says. "But what I try to do as a therapist is work collaboratively with those lapses rather than view them as a problem of mine that I have to deal with by apologizing at the expense of the relationship [with the client]."

To do so, Kunkel-who works from a psychodynamic orientation-encourages his patients to search within their past to find experiences that recall his error, such as other times they have felt let down and to come to understand what he calls, "the symbolic manifestation of these past experiences"in the present.

His methodology allows his client's therapeutic issues to emerge and be understood, he says.

Indeed, Goldberg notes: "Apologies are complicated things-minor mishaps are a dime a dozen in therapy. But if you just throw out apologies you might miss the meaning in your actions and the client's reactions."