In my more than 20 years as a therapist, I have encountered many clients deeply struggling with their past actions; very few of their stories, however, touched me as deeply as Sophie’s, that of a resilient and hardworking nurse whose life came to a halt over one single mistake. As we met regularly, I witnessed Sophie transform from the person riddled with guilt to someone who embraced his fallibility and forgiving himself. This article will recount Sophie’s story, describe the therapeutic process we followed, and underscore the central messages that emerged from our work together.
The Accident
It was a typical busy day in the emergency room when Sophie made the kind of mistake she’d worry about for months. A patient with severe stomach pain had come in, and somewhere in the flurry of quickly giving medicine to alleviate the pain, Sophie had erroneously given the patient a much higher dose of morphine than they were meant to get. The patient wasUnable to breathe for a moment, but the on-duty doctor had managed to stabilise them quickly.
While the patient survived without any lasting damage, the mistake felt deeply unsettling for Sophie. She had always considered herself to be meticulous and conscientious about patient care, and this seemed to throw into question everything she believed about herself as a clinician.
The Burden of Regret
When Sophie first entered my office, she was obviously burdened with guilt. She seemed to shrink into her chair, averted her eyes, and barely audibly said she thought she might have caused a fatal car crash. ‘I don’t have a clue how I can gain back the confidence that I will drive safely again.’
This is an entirely appropriate response from Sophie, who is not alone in being a patient-care provider to make such an error. The culture of medicine tends to emphasise perfection, and that doesn’t leave much room for human slip-ups. These pressures can lead to severe psychic consequences in the event of error, as they sometimes do.
Her experience of guilt also went deeper than one single instance of failure: thinking that she had betrayed not only her patient but also her coworkers, her career, her future nursing career, and even her own ‘image’ as a nurse.
The Healing Process
Understanding the Feelings
Our first step was to create a safe space where Sophie could express her feelings freely with no judgment. I encouraged her to recount her experiences of guilt, embarrassment and anxiety in vivid detail. This expression of feelings provided her with an outlet to prevent those feelings from being pushed away, boarded up and buried inside. Left unchecked, such feelings will undoubtedly exacerbate over time into serious mental health problems.
Thought Adjustment
Following weekly meetings, we began to collaborate to reframe her thinking around the incident. We explored the distinction between guilt and shame – guilt refers to the feeling for a specific behaviour, whereas shame refers to the feeling about oneself. Sophie’s shame was eliciting self-directed anger by making her see herself as deeply flawed or ‘not good enough’, rather than the mistake as a singular event.
We used similar cognitively based behavioural therapies to update these maladaptive styles of thinking. ‘I can’t do anything right, I’m a terrible nurse’ became something like ‘I’m competent overall. Sure, I made an error today, just like anybody else makes mistakes.’
Understanding the Situation
What was important now was to examine the conditions that had led to the error. Sophie explained to me that she had been picking up overtime shifts because there were never enough staff hired and she had been very worried on the day of the mistake. While this still didn’t make her error acceptable, by highlighting the difficult working conditions in the health system, the explanation provided a way for Sophie to understand that the mistake wasn’t as much a reflection of her inadequacy as a worker as it was the brutality of the working conditions that made it more likely to happen.
Mindfulness and Kindness to Oneself
In terms of navigating her anxiety and depression, I taught her mindfulness techniques (such as learning to pay attention to what is happening in the moment, instead of ruminating on past blunders) and also taught her how to cultivate kindness to herself (adapted from Dr Kristin Neff’s research on self-compassion), so that, on a given day, she’d be kind to herself in the same way she’d treat a friend or co-worker if they had a similar issue.
Asking for Help
Sophie had shut herself off initially due to embarrassment, and was also isolating herself from her colleagues. We helped her reach out to her very supportive network again – her friends and work fellows, and realised that just talking about her situation with trustworthy colleagues not only helped reduce her feeling of isolation, it also led to discussions about common issues at work.
Personal Development and Improvement
Once Sophie was learning to sit with and adjust to her feelings of guilt, we then turned our attention to the lessons that could be learned from what had happened. She became very motivated to try to make things safer in the department, and helped to come up with better safety rules, enough to be able to offer to share her story as part of the hospital’s training programme to avoid errors.
The Pivot Moment
It was about three months into our therapy before Sophie arrived for a meeting in a very different spirit. She had stopped a colleague from making a similar error with the medication. ‘I realised that being a bit more careful as a result of my error actually enabled me to do my job better in some respects.’ She had a first glimmer of pride since our first meeting.
This was a turning point for Sophie: ‘It was the first time that I thought about my experiences in a good way, and realised they made me a better human being and a better worker.’
The Journey to Forgiving Yourself
It’s hardest to let yourself off the hook, as she points out. ‘It’s easier for someone else to forgive you than to accept forgiveness.’ To move on from a major misstep at work – as is the case with many in the health professions – can also be a slow process with a few main components:
Fallibility and ‘humanity’: When Sophie rebelled at being required to redistribute the chocolate chips, he told her means making mistakes. He discussed how even the most talented person is fallible, and the key is to handle and learn from those errors.
Involving leadership (Apology): There were no complications and the patient made a good recovery, but Sophie tried to personally apologise. With her boss, she drafted a letter to the patient expressing remorse and outlining the steps they would undertake to avoid this same mistake in the future. Acknowledging the mistake had helped Sophie.
Zeroing in on Progress: Hospital procedures had gotten better, and this was in large part due to Sophie’s involvement. Having been given a hard lesson, she now returned it to the world, as good as new.
Daily Exercise of Positive Statements: Through planned statements we gave the patient power and confidence. Here are some examples of our daily positive statements given to Sophie to boost her confidence and boost her skills: I am a valuable member of the medical team I learn and improve from the experiences I make I play sound in my communication I give immediate information when needed with clear concise words Live in the moment Is not that bad, actually can be worse I must first gain my patients’ trust than ask any questions
Record Keeping: Sophie began to write down her achievements with the patients, the successes, positive words. It’s a great way to begin to look at the bright elements: ‘I’ve helped so many people in a positive way because of my job.’
Key Takeaways
What I learnt from Sophie can help any medical worker, and perhaps anyone who has ever felt bad about something and wondered how to make up for it.
just one mistake – even a big one – shouldn’t be taken to mean anything about one’s general impression The language is common parlance: a single error shouldn’t define someone or make them seem worse at what they do generally.
In These Failures Are Not You (2020), lack of talent and its connection to failure is characterised as something that ‘isn’t you’ – an allusion, of course, to Woody Allen’s poignant vignette Seventh Avenue Frog (2004), about a man who is prey to ‘a nearly universal anxiety’: the fear of being mistaken for someone he isn’t.
What keeps the plaintiff awake night after night is the paranoid delusion that he resembles ‘the policeman who beat my head open in 1954’, or the likes of corrupt businessman Maurice Lebsche. One mistake needn’t undermine a consummate professional – just recall ‘fat finger’ Friday in 2010, when the Dow Jones dropped by more than 9 per cent basically due to a human typo.
While the issue is understood as a ‘human error’ in the specific case of the Dow Jones, this epistemically neutral idiom masks what might be better understood as a problem of talent. Stephen Jeston, an academic improvisation ensemble leader at the Royal Conservatoire of Scotland, conceded as much in an interview with researchers at the prestigious Royal College of Music in London in 2018.
Jeston remarked: We hear, “We’re going to play that boring old piece again – we need you to play it from memory.”
The musician’s mind retorts: “No – I don’t care what piece we play – I won’t remember.” Our attitude toward classical music face challenges on two fronts: from outside and from within.
Context is All: Sometimes coming to understand the reasons behind a mistake will help clarify things – even if that still doesn’t make the mistake itself okay.
Social support is vital: when we feel a mistake is unforgivable, it can be very helpful to talk to people we know and trust, and to hear their supportive responses.
Growth Mindset: framing errors as learning opportunities provides a more fertile bed for positive growth. Don’t let mistakes get you down.
Self-Compassion Is Important: Be kind to yourself and understand your emotions.
Professional Advocate: in the medical hospital setting, the ability to describe, analyse and learn from errors helps create a safer and higher-quality experience for patients.
Conclusion
And when the final session of our therapy drew to a close, the Sophie who sat in front of me was a remarkable transformation from the sullen young woman I had first encountered. She stood up a little straighter, spoke more freely about her experiences, and had rediscovered her passion for nursing.
‘I never thought I’d say this,’ Sophie told me during our final session. ‘But I’m actually glad that I went through this – it’s made me a better nurse, a nicer person.
Sophie’s approach from intense guilt to self-forgiveness to a stronger sense of self is an inspiring illustration of resilience. Her example highlights how crucial it is to create a systemic buffer that allows for individuals to admit, discuss, learn and heal when the fault is their own: an organisational culture in healthcare and elsewhere that encourages dialogue, openness, learning and improvement from what occurred.
Sophie’s case inspires me. I am a psychotherapist and I’ve seen the true power of therapy and what it can do for people. Working with individuals during the most challenging times in their lives, to help them on their way, to be better, to see themselves, and to know what they want in their lives can be a gift.
Asking for help takes courage, not a lack of it. Your fumbles and bumbles do not define who you are. With the right support and kindness towards self, you can recover and grow.