Treatment-interfering behaviors are actions or ways of being that negatively impact the therapeutic relationship. In counseling and psychotherapy, the relationship between client and therapist is foundational to the success of therapy.
While practitioners trained in dialectical behavior therapy refer to these behaviors as Treatment-Interfering Behavior (TIB), other therapists also observe these in sessions but may not label them as such.
What Are Treatment-interfering Behaviors?
Treatment-interfering behaviors are not one-off interferences in an individual session. They are ongoing patterns of behavior. Some common examples of treatment-interfering behaviors are:
- Showing up late to sessions
- Not engaging with sessions by not answering any questions, shrugging, saying “I don’t know,” or blaming the therapist for problems.
- Canceling sessions at the last minute
- Consistently not engaging with the homework that the therapist has assigned
- Regularly threatening to quit therapy
- Not acknowledging that there is a problem or anything they would like to change about their life
- Blaming other people for problems in their life and talking about other people’s behavior instead of their own feelings
- Expecting the therapist to “fix” the client and offer solutions to their problems
- Lying about important things or changing a story that is significant in therapy
TIB can be either intentional or unintentional as well as strategic or automatic.[1] The treatment-interfering behavior can be related to therapy or completely unrelated; for example, the client may be in therapy to address social anxiety and then become so anxious and avoidant with the therapist that it impedes treatment. In contrast, the client may enter therapy because they are struggling with grief, and alcohol consumption is interfering with treatment by causing clients to arrive to a session under the influence or late.
How Can TIB’s Impact Treatment?
TIBs can affect treatment in a variety of ways. In DBT, these behaviors can directly prevent effective engagement in treatment[2] or lead to emotional or cognitive responses in the clinician that negatively impact treatment.
The way that treatment interfering behaviors impact treatment depends on the treatment modality the client is engaging with. For example; cognitive behavioral therapy (CBT) requires the client to engage in certain exercises between sessions. If a client’s friends and family are unsupportive of these exercises, it can impede the behavioral change that the client is aiming for. Similarly, if the clients themselves are displaying treatment-interfering behavior and not engaging with these exposure exercises, they may continue to avoid situations and stimuli and not make progress in their treatment.[2] In addition to slowing the client’s progress, it can cause the therapist to become frustrated and experience negative thoughts or associations with the client and furthermore negatively impact the therapeutic relationship.
For clients engaging with exposure therapy, treatment-interfering behaviors include avoidance on the part of the client or interference from family members with exposures. By not engaging with exposures, a client misses opportunities for corrective learning experiences, which is an essential part of exposure therapy.
Generally, though, in most therapy modalities, a lack of trust in the treatment process and in the expertise of the therapist can be the greatest interference – from both the clients and their loved ones. It is essential that trust and respect are built and that loved ones are supportive of the therapeutic process. A readiness to change is also essential because clients who remain in the pre-contemplation phase of change will have great difficulty engaging with therapy.
How Family Can Interfere With Treatment?
Parents and other family members can also contribute to treatment-interfering behavior, especially if family dynamics and relationships have contributed to the problem. As challenging as it may be, instead of remaining frustrated, angry, or resentful toward loved ones in therapy, it’s important that the family fully embrace the notion that their loved one is doing their best. To the close family of a client, it may seem at times as if they are “going around in circles” and not putting enough effort into recovery, relying too much on treatment, or not taking enough personal responsibility.
However, openly sharing these thoughts with the person in therapy or disparaging them in any way is likely to impede the therapeutic process. It is important for clients to engage with therapy primarily for themselves and not simply to please their loved ones.
All families are different and the reasons for entering therapy are different for every individual, so there is no one-size-fits-all approach to mitigating TIB. In some cases, family members who have directly contributed to the issues a person is in therapy to address may not feel ready to take responsibility for their role. It can be incredibly difficult for clients to change if the people closest to them are not supportive of the change or are unwilling to recognize its importance.
On the other hand, parents and family members can take too much responsibility for the struggles of the person in therapy without understanding the full picture. Taking on the role of responsible parent or caregiver when a client wants to build confidence in their own abilities and gain independence can be counterproductive and cause the client to fall into old patterns of behaviors that don’t align with their ideal self.
Taking time to listen non-judgmentally to the needs and desires of a loved one in therapy is crucial. Supporting their treatment and offering unconditional positive regard for their progress, even as it inevitably peaks and plumets, shows them that you care, that you can be relied upon for unbiased support, and that you respect the work they are doing in therapy.
If you or a loved one is struggling with anything you have read in this blog, please get in touch with Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.
References
[1] Chapman, A. L., & Rosenthal, M. Z. (2016). Managing therapy-interfering behavior: Strategies from dialectical behavior therapy. American Psychological Association.
[2] Davis, M. L., Fletcher, T., McIngvale, E., Cepeda, S. L., Schneider, S. C., La Buissonnière Ariza, V., Egberts, J., Goodman, W., & Storch, E. A. (2020). Clinicians’ perspectives of interfering behaviors in the treatment of anxiety and obsessive-compulsive disorders in adults and children. Cognitive behaviour therapy, 49(1), 81–96. https://doi.org/10.1080/16506073.2019.1579857
