What I Learned from 55 Years of Being Wrong

I’ll tell you something most psychiatrists won’t admit: my own analysis was a complete waste of time.

I went through the whole thing. Years on the couch. Classical psychoanalysis, four days a week, with a well-credentialed analyst who said very little and charged quite a lot. I did everything you’re supposed to do. I free-associated. I explored my dreams. I waited for the breakthrough.

It never came.

And for a long time, I thought that meant something was wrong with me. That I was resistant. That I hadn’t gone deep enough. It took years — and a lot of clinical experience of my own — to realize the truth: it wasn’t me. It was the method. Or at least, it was the wrong method for me.

That realization changed everything about how I practice.

The Gift of Getting It Wrong

When you’ve been doing this for fifty-five years, you accumulate a very long list of things you used to believe that turned out to be incomplete, misguided, or flat-out wrong. Early in my career, I believed insight was the whole game. If the patient understood their patterns, change would follow naturally. It sounded elegant. It was also, in many cases, nonsense.

I used to think insight was the engine of change. It took me years to realize that insight without action is just a very expensive form of procrastination.

— Dr. John S. Tamerin

I watched brilliant, self-aware patients understand themselves perfectly and change nothing. They could narrate their dysfunction with extraordinary precision. They just couldn’t stop doing it.

That failure — my failure, not theirs — pushed me to evolve. To integrate behavioral approaches. To pay attention to habits, not just histories. To care less about being theoretically elegant and more about being practically useful.

Sacred Cows and Dead Horses

Psychiatry is full of sacred cows. I’ve slaughtered a few in my time, usually after riding them too long myself.

The blank-screen analyst who never reveals anything personal? I tried that. It made my patients feel like they were talking to furniture. Now I share when it serves the work. I laugh in session. I tell stories. I’m a person in the room, not a mirror.

The fifty-minute hour that ends mid-sentence? I understand the theory. But when someone is in the middle of a genuine breakthrough, stopping because a clock says to is a form of malpractice that no one talks about. I’m flexible with time. Not infinitely, but enough.

The idea that the therapist shouldn’t give advice? That one drove me crazy even as a trainee. A patient is about to make a catastrophic decision and you’re supposed to sit there and explore their feelings about it? I give advice when it’s warranted. Clearly. Directly. And I own it.

The best therapist I could have been at thirty is not the best therapist I can be now. If your approach hasn’t changed in twenty years, you haven’t been paying attention.

— Dr. John S. Tamerin

What Fifty-Five Years Teaches You

Here’s what I know now that I didn’t know when I started:

Humility is not optional. The moment you think you’ve figured a patient out is usually the moment you’ve stopped seeing them clearly. People are more complicated than any theory. The good clinicians are the ones who stay curious.

The relationship is the treatment. I can prescribe the right medication and use the right technique, and none of it matters if the patient doesn’t feel safe enough to be honest with me. Trust isn’t a precondition for therapy. It is the therapy.

Speed matters. Not rushing — but not wasting time either. The old model of spending years circling the issue was, in many cases, a failure of nerve. Good therapy should move. Not recklessly. But with purpose and momentum.

Most patients already know what’s wrong. They come in thinking they need someone to explain themselves to them. Usually, they need someone to confirm what they already suspect and help them do something about it.

Every patient teaches you something. I am not exaggerating when I say I learn from every single person who walks into my office. Sometimes they teach me about a pattern I hadn’t considered. Sometimes they teach me that an approach I loved doesn’t work. Sometimes they teach me about courage, simply by showing up.

The Analyst Who Couldn’t Grow

I’ve known colleagues who found their theoretical home in their thirties and never left it. They practice the same way at seventy that they did at thirty-five. Same techniques. Same assumptions. Same reading list.

I don’t judge them. But I do think they’re missing something. The field has changed. The patients have changed. The culture has changed. If you’re practicing the same way you did thirty years ago, you’re not being consistent — you’re being rigid.

The best compliment a patient ever gave me wasn’t about a breakthrough or a cure. It was this: “You’re different from other therapists I’ve seen. You actually seem like you’re still learning.”

I am. Every single day.

Why This Matters to You

You might be reading this and thinking: what does a psychiatrist’s career arc have to do with me?

Everything.

Because when you’re choosing someone to sit across from — someone to trust with the most private parts of your life — you want someone who has been humbled. You want someone whose certainty comes from experience, not from textbooks. You want someone who has been wrong enough times to know the difference between confidence and arrogance.

I’ve been wrong more times than I can count. That’s not a confession. That’s a qualification.

Still Growing

At my age, most psychiatrists have retired or settled into a comfortable routine. I’m doing neither. I still see patients. I still think about cases when I’m not in the office. I still change my mind when the evidence tells me I should.

If you’re looking for a therapist who has all the answers, I’m not your guy. But if you’re looking for someone who has spent fifty-five years learning how to ask the right questions — and who isn’t done yet — then we should talk.