Is Your Therapist a Model of Certainty?

The effect of a therapist’s personality on treatment outcomes is significant (Del Re et al., 2021). The size of the effect varies according to the setting and situation (Johns et al., 2013). Which traits are best for the therapy are not always obvious. For example (Delgadillo et al, 2020, Heinonen & Nissen-Lie, 2019), therapists who are too agreeable, too open, too nervous, and too certain are likely to have poorer treatment outcomes than their counterparts in many settings. I’m particularly interested in therapists who are too certain.

Some therapists don’t know how to play with ideas, so they either do not provide ideas or they provide them as pronouncements. These therapists may be certain, let's say, that your mother was a narcissist or your roommate is borderline, or else they go along with your impressions of people without introducing the possibility that you might be wrong, especially when you base your estimations on your emotions. They may treat you like you are the final authority on yourself, or they treat you like they are the final authority on you. Psychotherapy becomes a process of labeling and categorizing and cancelling other people and parts of oneself rather than a process of discovering things together.

Underlying this certainty that either the therapist is always right or that you are always right, there seems to be the ancient morality that Nietzsche described: I am (or, you are) a good person so whatever I (or you) do must be good. All therapists are occasionally susceptible to this way of thinking, and it’s especially tempting to take advantage of the fall guys implicit in most therapies. Instead of the therapist and patient exploring the immediate sources of the conflicts that arise between them, they are all too quick to blame the patient’s parents. Even if the parents dropped the ball regularly, a therapy that blames them becomes just another exercise in self-righteous faultlessness, albeit with a new idealized object and a new set of unmet needs.

The opposite of self-righteous certainty is psychological-mindedness, the awareness, as Walt Whitman put it, that “I contradict myself; I contain multitudes.” I’ve tried to reduce the concept to just three words: “maybe it’s me.” When the patient and therapist collude to ignore the patient’s dissatisfactions with the relationship, the therapist is enacting self-righteousness and not psychological-mindedness.

The more self-righteous people are, including therapists, the more prone they are to interpreting obstacles and conflicts as transgressions. It’s easy to see this on both sides of the political spectrum in contemporary politics, where certainty can translate into self-righteousness and the villainization of others.

You can’t always tell how self-righteous your therapist is. But respectful complaints can actually lead to insight—these may be about their tone of voice, their chitchatting on your dime, or the implications of what they said on how they see you. A therapist who explores complaints with an open mind will be one who is also less likely to cast your life story with the stock figures of a cartoonish melodrama and, more importantly, less likely to treat some parts of yourself as holy and some parts as wicked.

Good therapists welcome complaints, because they set the stage for improving the therapy or they open a window into how peculiar some of your expectations may be. Good therapists want to know how you are experiencing them, and they want to collaborate around distinguishing which conflicts are primarily the result of their own doing and which are illustrative of your own idiosyncrasies. Good therapists start with the assumption that they did something wrong, since they believe that making a mistake isn’t fatal to a relationship (because no one is perfect).

Proverbs 12:1 teaches us that “whoever hates to be corrected is stupid.” Therapists who hate to be corrected in training reveal the extent of their self-glorification, as do those who don’t wonder about every move they make whether it might have been an error. But such therapists may invent conspiracies involving your parents, and they may invent sins involving the parts of yourself you disown. These therapists sermonize on good and evil, and they invite their patients to adopt an equally sanctimonious approach to others.

It’s a short journey from insisting that one’s emotions and perspectives are valid to demonizing those who doubt their appropriateness to any given situation. That doubt is at the heart of effective psychotherapy, which wonders if maybe you are responding in some characteristic pattern that is not good for you instead of accurately reading the current situation. A therapist who is open to either possibility, as demonstrated by exploring the conflicts that arise in the therapy itself can help you learn to tell the difference, but that requires a therapist who isn’t already certain of their own innocence.

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If history has taught us anything, it’s that the greatest crimes of humanity, including genocide and slavery, rest on sanctimony, the idea that anyone who stands in the way of God’s work must be the devil—or if not God, some other perfect, pure ideal. It’s also true of many of our lesser crimes. Self-righteousness—certainty about one’s own goodness and correctness—can lead to demonizing others and has no place in psychotherapy.