One of the beautiful things about therapy is the possibility it possesses. I have had the pleasure of witnessing growth right before my eyes as folks come to understand themselves on a deeper level. I am fortunate enough to have highly motivated clients who show up consistently, ready to hit the ground running and offer me the chance to point out incongruencies or patterns of behavior that can help them become better versions of themselves. But I have a secret to share with you—sometimes just showing up to session isn’t enough.

The difference between good therapy and bad therapy is work. As a therapist it is my job to help clients meet goals. My work consists of treatment planning and figuring out what objectives a client must meet to achieve their goals. Therapeutic goals can be evident within the first session with some clients through coming to understand what is troubling them and their current list of symptoms. Sometimes, with others, it takes a few sessions to really figure out what they’re working towards.

For clients who believe simply showing up to therapy is what will “cure” them of their issues, it become imperative that I take time in session discuss the intricacies of therapy as well as Treatment Interfering Behavior™ (TIB). TIB is “any behavior that is incompatible or directly interferes with a person’s ability to participate in treatment successfully” (per the Saint Louis Behavioral Medicine Institute, St. Louis, MO, An Affiliate of Saint Louis University Health Sciences Center). But to take that definition even further, “A TIB is not defined by a person’s intention, but the outcome of the behavior”.

What this looks like in sessions is like this—I’ll have a super motivated client show up. We will begin developing a therapeutic relationship. Our conversations will stay mostly at surface level and when I attempt to go deeper, they will resist. They will freely acknowledge that they want to be in therapy, but don’t really possess a greater goal than attending sessions. They may also frequently miss appointments, show up late to appointments, and effectively make no effort to change how they operate within their world.

Here a few examples of TIBs;

  • Does not acknowledge having a problem.

  • Does not adequately or consistently acknowledge the problem’s severity or its impact on others.

  • Does not identify clear goals for treatment.

  • When discussing the nature of the problem or the treatment plan, argues with the therapist, dismisses the things they say, or lectures them.

  • Attempts to change the focus of sessions to issues not on the treatment plan.

  • Has difficulty explaining the treatment plan or the rationale behind it.

  • Has difficulty answering questions in a timely fashion (e.g., provides information not relevant to the question, provides too much detail, does not respond).

  • Is frequently late or does not show up for treatment sessions.

  • Has difficulty following the treatment plan (e.g., does not complete therapy assignments, doesn’t take medication as prescribed)

  • Provides information to the treatment team that is either inaccurate, misleading, or inconsistent (e.g., does not adequately report difficulties, reports different things to different staff members, leaves out critical details)

So, in essence, a client’s job is to not just show up to session but to take what we discuss in session and apply to their lives. It isn’t enough to identify a feeling but to figure out how to integrate the knowledge gained about said feeling into their daily life. It also isn’t enough to only think about therapy in the therapeutic setting. A true measure of success is implementing change in significant ways so that you can grow and develop as a person. If a client cannot successfully conceptualize why they are in therapy, then it becomes difficult to measure progress. That isn’t to say that it is all on the client to come up with these goals—sometimes psychoeducation by a therapist can enlighten a client to discover what they want to focus on in sessions.

So, what if a person shows up to therapy but isn’t ready to make a change? I like to confront my clients and acknowledge that they seem unwilling to make a change. We hold space for that phenomenon and explore what is holding them in their current pattern and the costs and potential benefits of making a change. Because I take a humanist approach to therapy I try to honor where my client finds themselves in any given moment. A discussion such a this can serve as a catalyst for change, or it can be an opportunity to allow a client to make an informed decision on how to proceed with therapy. Sometimes client choose to commit to a certain goal, other times they terminate services.

If you have been feeling stuck in life perhaps now is the time to begin your therapeutic journey.

Monet David, MS, LPC

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