Brian Koehler wrote that “I like to reassure myself through Winnicott’s maxim-we succeed by failing
our patients-failing them in a way that is tolerable, acknowledged, and of
course, repaired (as the infant researchers, like my old teacher, Beatrice
Beebe, would say-disruption-repair cycles). However, this is not always
the case-countertransference is the best of teachers, but the worst of
I think a lot of the problem with how psychotic disorders are conceptualized has to do with mental heal workers not being able to follow this maxim. The dilemma is that if there really is a potential for a client to get better, but yet the client hasn’t been able to find the way to do that and the mental health worker hasn’t been able to show the client how to do that, then that means there is a failure in treatment. We have been inadequate to the task. In order to defend themselves from such charges of inadequacy, mental health workers instead theorize that the client has no potential for true recovery. This means no one has any grounds for criticizing the mental health worker or the treatment – after all, it is doing the best that is possible for such a “chronically ill” client! The problem of course is that the mental health worker and eventually the client are both likely to give up really trying as a result, if they believe this, and opportunities are for recovery are lost.
If we instead notice we have no reason to believe that full recovery is not possible (since others with very similar profiles have made such full recoveries) then we admit that the failure in any particular case may be due to inadequacies in our approach, and we can discuss that with the client and collaborate in reasonably hopeful explorations of other avenues toward recovery. A more humble mental health worker, yet also much more effective treatment, are the likely result.