Types of Therapy Interfering Behaviors & How to Address Them

Introduction to Therapy Interfering Behaviors

Therapy-interfering behaviors can hinder treatment progress and may manifest in various forms. These behaviors include arriving late or missing sessions, being non-compliant with therapy assignments, avoiding topics, or being overly critical of the therapist. Addressing them involves fostering open communication to understand the underlying reasons behind such behaviors.

Therapists can collaboratively set realistic goals, emphasize the importance of consistency, and explore any barriers to engagement. Implementing behavioral contracts or utilizing motivational interviewing techniques can help increase commitment. Therapists must remain non-judgmental, empathetic, and flexible, adjusting strategies to accommodate clients' needs and preferences.

Encouraging accountability while maintaining a supportive environment can empower clients to actively participate in their therapy journey actively, enhancing the likelihood of positive outcomes.

Definition of a therapy-interfering behavior

Therapy-interfering behavior (TIB) encompasses actions that impede the therapeutic process and hinder clients from deriving maximum benefit from therapy. These behaviors, as described by Chapman and Rosenthal (2016), can vary widely, ranging from intentional to unintentional, strategic to automatic. They may include chronic lateness or noncompliance with treatment, ineffective expression or inhibition of emotions during sessions, overly passive or aggressive interpersonal interactions with the therapist, and more.

TIB can sometimes directly relate to the client's presenting problem, such as when social anxiety manifests in anxious and avoidant behavior toward the therapist. Other times, it may involve behaviors unrelated to the treatment focus, like flirtatiousness or excessive self-disclosure. Regardless of the manifestation, any behavior inhibiting therapeutic progress can be considered TIB.

Clinicians must recognize and address these behaviors with compassion and curiosity, utilizing tools and strategies to manage them effectively while maintaining a supportive therapeutic environment.

What are some common types of therapy-interfering behaviors?

According to Chapman and Rosenthal (2016), TIB encompasses a spectrum of actions that can impede the effectiveness of therapy. Let us delve into some of these behaviors and explore their impact on the therapeutic process:

Chronic self-judgment

Clients who consistently engage in self-criticism or negative self-talk during sessions may hinder progress. This behavior can impede self-compassion development and hinder the exploration of underlying issues. Therapists must gently redirect clients towards more constructive self-reflection and self-compassion techniques, fostering a non-judgmental therapeutic environment.

Hopeless rumination

Clients with generalized anxiety may engage in repetitive and hopeless rumination, fixating on negative thoughts and scenarios. This behavior can prevent them from engaging in productive therapeutic work and finding relief from their symptoms. Therapists can employ cognitive-behavioral techniques to challenge irrational thoughts and promote problem-solving skills, empowering clients to break free from the cycle of rumination.

Lateness and disorganization

Clients who struggle with time management or organizational skills may frequently arrive late to sessions or have difficulty organizing their thoughts during therapy. This behavior can disrupt the therapeutic process and limit the time available for meaningful work. Therapists can work collaboratively with clients to develop strategies for better time management and organization, such as setting reminders or creating schedules, to improve session effectiveness.

Emotional inhibition

Some clients may struggle to express their emotions openly during therapy, either due to fear of judgment or past conditioning. This behavior can hinder progress by preventing exploring deeply rooted feelings and experiences. Therapists can create a safe and supportive environment, encouraging clients to gradually explore and express their emotions at their own pace and facilitating emotional processing and healing.

Conflict avoidance

Clients who avoid addressing conflicts or uncomfortable topics during therapy may hinder progress by avoiding essential therapeutic work. This behavior can prevent the resolution of underlying issues and inhibit personal growth. Therapists can gently encourage clients to explore and address conflicts, providing support and guidance as they navigate challenging conversations and fostering constructive communication and conflict resolution skills.

How do therapy-interfering behaviors affect treatment?

Hogan et al. (2019) discuss how TIB can impact treatment, particularly in remotely managed therapy sessions. These behaviors, which disrupt the therapeutic relationship, vary in intent and can be overt or covert. Examples include homework noncompliance, missing sessions, and frequently switching therapy focus. These behaviors hinder effective engagement in treatment and may reflect avoidance or disagreement with the treatment approach.

As cited in their example, TIB can significantly impact the effectiveness of treatment in several ways:

1. Disruption of therapeutic alliance: Therapy-interfering behaviors can strain the therapeutic relationship between the client and therapist. For instance, frequent interruptions or missed sessions can erode trust and commitment, hindering collaboration toward treatment goals.
2. Impairment of treatment progress: Behaviors like homework noncompliance or frequent topic-switching can disrupt the continuity of therapy and impede progress toward therapeutic goals. When clients fail to engage in assigned tasks or consistently shift the focus of treatment, it becomes challenging for therapists to address underlying issues effectively.
3. Compromised safety and ethical concerns: Some therapy-interfering behaviors, particularly those involving safety risks, can have severe consequences for the client and therapist. For example, answering work-related calls while driving or operating heavy machinery during sessions, as described in the case vignette, poses significant safety hazards and raises ethical concerns. Such behaviors may compromise the client's and others' physical safety, the therapist's professional integrity, and legal liability.
4. Reduced therapeutic effectiveness: Ultimately, therapy-interfering behaviors can diminish the overall effectiveness of treatment and impede the achievement of therapeutic outcomes. When clients engage in behaviors that undermine the therapeutic process, such as avoiding sessions or withholding information, it becomes challenging for therapists to address their needs adequately and facilitate meaningful change.

How can you tell if therapy sessions aren't working?

Recognizing when sessions do not yield desired outcomes is crucial for clients and therapists. Firstly, a lack of progress toward treatment goals despite consistent attendance and active participation may indicate sessions are not practical. This could manifest as persistent symptoms or behaviors associated with the client's condition, such as ongoing anxiety or depression, despite ongoing therapy interventions.

Secondly, if therapy-interfering behaviors persist or worsen over time, it could signal that the therapeutic process is not working optimally. These behaviors, such as consistently missing sessions, avoiding topics, or displaying resistance to therapeutic techniques, hinder the client's ability to engage fully in therapy and disrupt the therapeutic alliance.

Additionally, communication breakdowns between the client and therapist may indicate ineffective sessions. This could involve difficulties expressing thoughts and emotions, misunderstandings about treatment approaches, or feeling unheard or invalidated by the therapist. Compelling communication is vital for fostering a supportive and collaborative therapeutic environment.

Furthermore, if the client expresses dissatisfaction with the therapy process or voices a desire to quit therapy altogether, exploring the reasons behind these sentiments is essential. Clients may feel discouraged by a lack of progress, disillusioned with therapy-interfering behaviors, or disconnected from their therapist. Addressing these concerns promptly can help salvage the therapeutic relationship and adjust the treatment approach accordingly.

Using dialectical behavior therapy (DBT) to address therapy-interfering behavior

In the book "Why People Get in Their Own Way," Chapman and Rosenthal (2016) detail the application of dialectical behavior therapy (DBT) to address therapy-interfering behavior. DBT therapists have specific strategies and frameworks tailored to manage such behaviors effectively. These strategies include recognizing and anticipating client therapy-interfering behaviors, establishing clear boundaries, and employing DBT principles to address underlying issues contributing to these behaviors.

Through a comprehensive approach that combines mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance skills, DBT helps clients develop alternative coping mechanisms and enhance their engagement in therapy. This targeted application of DBT principles enables therapists to navigate and address therapy-interfering behaviors skillfully, fostering a conducive therapeutic environment for client growth and progress.

DBT offers a multifaceted approach to address therapy-interfering behaviors (TIB). Firstly, DBT equips therapists with a robust framework to identify and understand the underlying causes of TIB, whether they stem from emotional dysregulation, life-threatening behaviors, interpersonal conflicts, or maladaptive coping mechanisms. By targeting core areas such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance, DBT provides clients with practical skills to manage and navigate challenging situations more effectively.

Moreover, DBT emphasizes establishing clear boundaries and expectations within the therapeutic relationship. Therapists are trained to communicate these boundaries assertively while also fostering a supportive and validating environment for clients to express themselves. This helps minimize instances of TIB such as session disruptions, noncompliance with homework assignments, or avoidance of difficult topics.

DBT also enhances clients' self-awareness and insight into their thoughts, emotions, and behaviors. Through techniques such as diary cards, behavioral chain analysis, and validation strategies, clients learn to recognize patterns of TIB and explore alternative responses. By increasing awareness and acceptance of their experiences, clients are better equipped to make informed choices and actively engage in the therapeutic process.

Ensuring effective communication with the patient as a therapist

Effective communication with patients is essential for therapists to navigate sessions successfully and address TIB. In DBT, therapists are trained to maintain open and transparent communication channels with their clients, fostering a supportive therapeutic environment.

An example of an effective communication model is active listening, where therapists attentively engage with patients to understand their thoughts, feelings, and experiences. By actively listening, therapists can demonstrate empathy and validation, central components of DBT and effective sessions.

Moreover, therapists should encourage open dialogue and collaboration, inviting patients to express their concerns, preferences, and goals for therapy. This collaborative approach empowers patients to participate actively in their treatment process and enhances therapeutic engagement.

In addition, therapists must model effective communication by providing clear explanations, feedback, and guidance throughout sessions. Therapists can set a positive example for patients by modeling effective communication skills and facilitating constructive interactions.

Furthermore, therapists should be vigilant for signs of therapy-interfering behaviors, such as missed sessions or avoidance, and address these issues promptly through assertive yet compassionate communication. By addressing therapy-interfering behaviors proactively, therapists can prevent potential disruptions to the therapy process and promote positive treatment outcomes.

Benefits of addressing behaviors that interfere during treatment

Addressing behaviors interfering during treatment yields several benefits for the therapist and the patient. We have listed the benefits it may bring by addressing TIB:

1. Promotes effective therapy: Addressing interfering behaviors ensures that therapy sessions remain productive and focused on addressing the patient's needs, facilitating progress and growth.
2. Strengthens therapeutic alliance: By addressing these behaviors with sensitivity and understanding, therapists demonstrate their commitment to the patient's well-being, fostering trust and rapport in the therapeutic relationship.
3. Reduces dropout rates: Proactively addressing interfering behaviors decreases the likelihood of patients quitting therapy prematurely, ensuring they receive the full benefits of treatment and reducing the risk of relapse.
4. Develops healthy coping mechanisms: Therapists help patients develop healthier coping mechanisms and adaptive strategies to manage challenges effectively by addressing maladaptive behaviors.
5. Empowers patients: Addressing interfering behaviors allows patients to take an active role in their treatment, promoting a sense of agency and ownership over their recovery journey. This empowerment can lead to increased motivation and engagement in therapy.

Address therapy-interfering behaviors with Carepatron

Carepatron is comprehensive mental health practice management software that offers tools and features to effectively manage therapy-interfering behaviors. Its intuitive interface and customizable workflows allow therapists to document and track these behaviors across sessions, ensuring quality care.

Carepatron's telehealth platform allows therapists to conduct virtual sessions seamlessly, providing timely intervention and support when therapy-interfering behaviors arise. This fosters accountability and progress in therapy.

The platform prioritizes data security and compliance, providing peace of mind for both therapists and clients. Its robust encryption protocols and adherence to industry standards protect sensitive patient information. Carepatron also offers comprehensive support and resources to help therapists navigate challenging situations effectively. From educational materials on managing therapy-interfering behaviors to responsive customer support, Carepatron equips therapists with the tools and knowledge needed to deliver high-quality care.

Carepatron's combination of mental health practice management software and telehealth platform makes it the ideal solution for addressing therapy-interfering behaviors.

Take the next step towards better patient care, and sign up for Carepatron today!

References

Chapman, A. L., & Rosenthal, M. Z. (2016). Why people get in their own way. American Psychological Association EBooks, 3–17. https://doi.org/10.1037/14752-001

Hogan, J., Boykin, D., Schneck, C. D., Ecker, A. H., Fletcher, T. L., Lindsay, J. A., & Shore, J. H. (2019). Clinical lessons from virtual house calls in mental health: The doctor is in the house. The Psychiatric Clinics of North America, 42(4), 575–586. https://doi.org/10.1016/j.psc.2019.08.004