Types of Therapy Interfering Behaviors & How to Address Them

By Bernard Ramirez on May 16, 2024.

What are therapy-interfering behaviors?

Therapy-interfering behaviors (TIB), also known as treatment-interfering behavior, can hinder treatment progress and may manifest in various forms. Therapy-interfering behavior includes actions that impede the therapeutic process and prevent clients from deriving maximum benefit from therapy.

As described by Chapman and Rosenthal (2016), these behaviors can vary widely, ranging from intentional to unintentional, strategic to automatic. Examples include arriving late or missing sessions, not complying 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.

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 for managing therapy-interfering behaviors effectively while maintaining a supportive therapeutic environment.

What are some common types of therapy-interfering behaviors?

Let us delve into some of the behaviors that can impede the effectiveness of therapy (Chapman & Rosenthal, 2016):

Chronic self-judgment

Clients who consistently engage in self-criticism or negative self-talk during sessions may hinder progress. This behavior can impede the development of self-compassion and the exploration of underlying issues. Therapists must gently redirect clients towards more constructive self-reflection and self-compassion techniques, fostering a nonjudgmental 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 and behavioral practice 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, in some cases, miss the session completely. They may also 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 the exploration of 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 and colleagues (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.

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

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.
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.
Compromised safety and ethical concerns: Some therapy-interfering behaviors, particularly those involving safety risks, can have severe consequences for the client and therapist. Such behaviors may compromise the client's and others' physical safety, the therapist's professional integrity, and legal liability.
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 undermining the therapeutic process, 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 therapy sessions are not achieving desired outcomes is essential for clients and therapists. Despite consistent attendance and active participation, a lack of progress toward treatment goals may signal that sessions are ineffective. This could present as persistent symptoms, such as ongoing anxiety or depression, despite continued therapeutic efforts.

If a client expresses dissatisfaction with therapy or wants to quit therapy, these concerns should be explored promptly. Such feelings may arise from frustration over slow progress, disconnection from the therapist, or struggles with therapy-interfering behaviors. Addressing these issues can help realign the therapeutic process and foster a more supportive, productive environment.

Addressing therapy-interfering behaviors through dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT), a more specific form of cognitive behaviour therapy (CBT), is often applied to patients with borderline personality disorder. It has specific strategies and frameworks tailored to manage such behaviors effectively. Chapman and Rosenthal (2016) detail the application of dialectical behavior therapy to address therapy-interfering behavior.

DBT uses a comprehensive approach—combining mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance—to help clients build healthier coping mechanisms and improve therapy engagement. This approach allows therapists to address therapy-interfering behaviors effectively, creating a supportive environment for client growth.

DBT equips therapists to identify the root causes of TIB, such as emotional dysregulation, life-threatening behaviors, or maladaptive coping while providing clients with practical skills to navigate challenges. It emphasizes setting clear boundaries within the therapeutic relationship and fostering open communication to reduce disruptions, noncompliance, or avoidance of difficult topics.

Additionally, DBT enhances clients' self-awareness through tools like diary cards and behavioral chain analysis, helping them recognize patterns of TIB and adopt more constructive responses. By increasing insight and acceptance, clients are better prepared to engage meaningfully in therapy.

Ensuring effective communication with the patient as a therapist

In DBT, therapists prioritize effective communication to address therapy-interfering behaviors and foster a supportive environment. Maintaining open and transparent communication encourages collaboration and builds trust throughout the treatment process.

Therapists model effective communication through active listening, demonstrating empathy, and providing clear feedback and guidance. This approach empowers clients to engage fully in therapy, share their concerns, and set meaningful goals.

Additionally, therapists address TIB, such as missed sessions or avoidance, through assertive yet compassionate communication, ensuring the therapy process remains productive and focused on positive outcomes.

References

Chapman, A. L., & Rosenthal, M. Z. (2016). Managing therapy-interfering behavior. American Psychological Association.

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