Critical Incidents in Psychotherapy

The critical-incident technique was used to obtain a list of 52 critical incidents defined by the behavior of patients who create special difficulties for psychotherapists. The critical incidents could be divided into four major categories: threat of harm, criticism of the therapist or of the therapy, occurrence of a major life crisis, and attempts by the patient to seek friendship or seduction. Twenty-one experienced psychiatrists rated the importance and the frequency of occurrence of each of the 52 critical incidents. Ten third-year psychiatric residents also rated the incidents. For almost every incident the inexperienced psychiatrists rated the incident as less important and more frequent than did the experienced psychiatrists. Implications for the training and supervision of psychotherapists are discussed.