You’d think that, given the amount of time, energy, resources, and money (if paying out of pocket) spent, everyone in therapy must all be such ardent clients keen on dissecting the profound depths of their minds, tackling every homework with zeal, practicing every intervention strategy learned religiously, and reflecting on the discussions between sessions with intense passion. Although it is true that therapy can be rewarding, it is only contingent upon the efforts clients are first willing to put into the progress to become vulnerable and to delve into often sensitive, challenging, and distressful behaviors, feelings, and thoughts.
Sounds very tough, does it not? You can imagine why it would invoke in many clients reflexive behaviors to ward off all attempts to address the emotional threat concomitant to the therapeutic progress. Otherwise known as therapy-interfering behaviors (TIBs), these behaviors serve to protect us from approaching more painful issues, even in the “safe” context of therapy. Paradoxically, these behaviors also function as interference to our therapeutic and personal growth. Some of the common categories of such self-sabotaging behaviors include motivational deficits, skills deficits, environmental contingencies, avoidance coping, problematic thinking patterns, and problematic environments and life stressors (Chapman, 2016). The list can go on to echo many different behaviors in therapy. Some of more common red flags include the following:
#1: You Avoid Talking about Difficult Topics, especially Ones that Make You Feel Poorly about Yourself
Habits of avoidance are rampant in our lives. Sometimes avoidance can be healthy and adaptive, as there may be distressing issues too overwhelming for us when immediately confronted; however, in the long run, constant avoidance becomes maladaptive when you grow accustomed to using it every single time a sensitive topic comes up. We all want to sound and feel like wonderful people. It is only human nature to want to feel good about ourselves so one of the primary strategies I see clients use is sharing only the “good news” (e.g., “I ate more salads this week!”) while neglecting conveniently to tell me about their perceived “latest failures” (e.g., “I drunk-texted my ex and had another big fight with them again”). A memorable example was a new client who, one day during our phone call, expressed wanting to make losing weight a goal as they have been struggling with obesity. “Sure, can you tell me more about what we can do to support you?” I inquired. After a brief pause, they responded with a curt “no” and hung up, leaving me bewildered and worried. They continued to respond to administrative contacts, but dismissed all other attempts to gently invite them back to therapy to work on what has obviously been a painful subject for them, despite being the one to self-trigger. Although I had been warned about their trouble with maintaining relationships, it was still jarring to see how the warning manifested in the way it did before my very eyes as such a poignant example of TIB.
#2: You Hide Your True and/or Immediate Feelings and Thoughts about Therapy
This behavior stems from an aversion to confrontation. In therapy, especially for new clients, sometimes it can be particularly difficult to be completely honest about their impressions in sessions. As you and your therapist work to build a rapport, sometimes you may find yourself feeling uncomfortable about the direction of therapy, a statement that was said, or a technique utilized in session. It can be incredibly powerful and contribute significantly to strengthening the therapeutic relationship if you can feel more encouraged and safer to share your impressions to have an open discussion with your therapist, but it is more common for us to be hesitant as we would feel guilty about possibly hurting the latter’s feelings, leaving a poor impression, or causing the therapy relationship go awry. It is human nature to be antipathetic to perceived “confrontations,” which is why even therapists themselves do it when they’re in therapy. Therefore, like one of my counsellor clients, rather than sharing the fact that you do not like homework as it reminds you of things that overwhelm you or that you feel uncomfortable of being challenged to expose yourself to the trigger, you decide to suppress, ignore, or worse…
#3: You become “Resistant” to the Treatment Plans and Start Engaging in Maladaptive Behaviors
It is perfectly normal to have the occasional time when you do not complete homework, be late, be too tired to engage in work in sessions, or miss appointments – after all, life happens and we deal with it. There will also be times when things become hard for you outside of sessions that led you to relapse or return to some maladaptive habits that initiated you to therapy in the first place. It is understandable that we are not perfect and we can work around the fact that progress may not always be a linear, upward trend. However, if you start to fall silent too frequently because of perceived stress, become distracted so easily that you could not focus in session, or always ask to end therapy early, it may reflect a latent attempt to avoid therapy. The more you do it, the easier it becomes for you to do so as you become accustomed to this negative reinforcement that takes away the discomfort of having to deal with the more difficult aspects of therapy, such as the feelings triggered by the work in session.
#4: You Use Each Session Solely to Deal with the Latest Crisis and Avoid Returning to/Addressing the Primary Goals
Hey, like I said before, I get that life happens and you may be one of those people who has to deal with more drama and hassles than your average peers (think the Netflix series my clients have been raving to me about, Maid). Sharing the latest crises as part of the “weekly report” can be helpful to certain clients to receive support for their stressors. We all want an empathetic listener to validate our experiences and help us process our upset, and there are certainly moments when lending a patient ear can be incredibly reassuring and supportive to the therapeutic progress; however, when it becomes a weekly occurrence and no longer a phenomenon, it is likely a manifestation of either an unconscious or even intentional act of avoidance to address the more paramount problems at hand: a classic case of TIB!
#5: You have the mindset: “I’m okay when nothing bad happens!”
“Oh, I think I’m okay now! I think I’m cured!” A new client announced happily in our seventh session. She presented with screaming fits when she feels threatened and thinks she might get attacked by fast-moving objects.
“Okay, um, how so?” I was curious. This client has been having tremendous difficulty with psychoeducation in sessions by being constantly confused about the function of fight-or-flight responses and how her symptoms are related to PTSD.
“Because I’ve just been staying at home! I only scream when I get scared but I haven’t been screaming because I’m not scared when I’m okay.” She said proudly. “Do I still need therapy when nothing is happening? Does that also mean I can get my insurance money now if I’m all better?”
I could just see her claims lawyer writhing in agony and the elation of the insurance company at this profound revelation…
After I regained my composure from the incredulous mind-scream, I began another round of psychoeducation and functional analysis that ended with me showing her a short YouTube news video to give her
the shock therapy she needs so that she can realize the extent of her impairments a gentle reminder of the symptoms she still needs to improve on. Unfortunately, this case is not uncommon. Sometimes it is hard to even be aware of your own TIB, especially in face of temptation of positive reinforcement afforded by mere comfort, avoidance, and sheer blissful ignorance. Granted, to be fair, the client’s position does have a small point because, in an ideal world, we’re all okay when nothing is wrong/happens. However, in the real world, the importance of prevention and maintenance – and, in this case, treatment – often eludes laypeople. Why do I have to eat a healthy diet when I’m not fat? Why do I need a physical exam when I’m not sick? For this client, because she has become complacent with the perceived safety, her motivation had quickly waned and she began indulging in the false belief that she is all better as long as nothing goes wrong to trigger her.
TIB as a wonderful source of exploration
Not to encourage you to start drinking in session, stirring up weekly drama, and fighting with your therapist so that you can have some material to work on in sessions, but, under the hands of a competent therapist, a sporadic – and UNINTENTIONAL – dose of TIB can provide a rich fodder that spurs your progress, especially when therapy has become stagnant. If you recognize any of the signs listed here, perhaps it is time to learn to trust your mental-health professional and start examining your TIB. Hope you can give the both of us a chance to try to tackle this issue together. I look forward to see how I may be of service 🙂
Chapman, A.L. (2016). Managing therapy-interfering behavior: Strategies from dialectical behavior therapy. American Psychological Association.