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How to Manage Difficult Behavior in Therapy Sessions: 7 Proven Tactics

child taking plastic letter out of basket

The Surprising Impact of Challenging Behaviors

Every therapist can envision a highly effective therapy session. The child is excited to join you, easily becomes completely engaged in the activity, is motivated to work at it, and completes whatever task you introduce.

Before leaving, the child demonstrates a new skill. And better yet…in subsequent sessions, you either observe yourself or find out through a caregiver’s report that the child is implementing these new-found skills during his/her daily life!

Why shouldn’t this ideal scenario be the norm? After all, you know that you have the knowledge, you have the techniques, you have the experience, and you have wonderful materials, games, and toys. You are empathetic and caring, and you want what’s best for the child.

So…why in the world isn’t this child cooperating? Granted, all children and therapists can have an “off day;” however, sometimes, the child’s inappropriate behavior hijacks the session, bringing progress to a standstill.

What to do now?

Why is your Student Behaving Like This?

Before looking at solutions, it’s essential to understand that it’s unlikely the child is behaving this way to be intentionally disruptive or difficult. Rather, these behaviors probably indicate the child’s attempts to express his/her emotions and feelings, albeit inappropriately. Some of the common reasons behind these behaviors include:

Being tired…

Feeling hungry…

The activity is too easy or too difficult – either physically or mentally – which can lead to boredom or frustration…

The child is seeking control of the situation…

The child has learned to leverage this behavior for “personal gain” and is testing it out…

How can you Better Manage these Behaviors?

1. Pay Careful Attention to the Initial Evaluation

Before beginning with your new client, ask the caregiver three core questions:

  • How does your child relate to new people, in particular adults?
  • What is your child’s capacity to sustain attention on a task?
  • When your child becomes frustrated, what happens?

While you may feel that directly asking whether you should expect any “challenging behaviors” seems like an affront to parents, knowing what to expect in advance helps you react quicker and more effectively, leading to more productive sessions, which is what the parent wants!

2. Build Rapport

Rapport is probably the most critical facet of therapy. Without it, the therapist doesn’t stand much of a chance of being effective. With a child who poses more of a behavior challenge, it’s crucial to take extra time and care to establish rapport. You’ll see that your initial focus on that rapport, enhancing your relationship, will help reduce the frequency of challenging behaviors during subsequent sessions.

3. Ignore and Distract

Don’t think that, even when you develop a wonderful rapport with the child, you will be able to completely eliminate challenging behaviors. Inevitably, they will arise. Remember, when dealing with a difficult or disruptive outburst, not to “get into it with the child.” In other words, don’t take it personally, or too seriously, and avoid escalation.

Taking outbursts personally is a recipe for poisoning the therapeutic relationship. And escalating the conflict only serves to embolden the child to continue to utilize these outbursts inappropriately — either to vent frustration or avoid a difficult task. You need to remain sensitive to the child’s frustration, while not reinforcing the behavior — not so simple!

Another key is to resist the reflex to interrupt your forward movement with a child due to a challenging outburst. To the degree possible, ignore the outburst itself, distract attention from it by acknowledging and validating the child’s frustration, and then slightly modify the current activity or reassure him/her that a break is coming up very soon. Some children will find this easier if there is a visual timer in this case.

4. Positively Reinforce and Praise

Perhaps more effective than ignoring and distracting the child is ensuring that you use positive reinforcement and praise when the child is behaving appropriately. Although giving positive feedback doesn’t come naturally to everyone, research shows that it is more effective than a punitive reaction to negative or undesirable behaviors.

While it may seem obvious to praise good behavior or a learning or developmental achievement, it’s critical to praise your child for the little victories, such as paying careful attention to instructions, completing a task when asked, or calming down after an outburst.

5. Choose an Appropriate Challenge

Sometimes children are disruptive when the activity is too difficult, or bored when the activity is too easy. As a therapist, you need to find a challenge that is “just right”- an activity that is both challenging and achievable. If you choose an activity that is either too hard or too easy, tweak it to make it suitably engaging.

6. Allow for Some Choice and Compromise

At some point in the therapy, the child will be asked to engage in a task he/she just doesn’t want to do. To minimize the practically guaranteed non-compliance in following through with such a task, consider giving the child a choice between two options. However, ensure that both choices are consistent with the treatment plan.

For example, if you want the child to color, but he/she doesn’t have much tolerance for crayons, don’t ask if the child wants to color. Instead, ask the child, “when you color would you prefer a blue or red crayon?” Or “would you like to use a skinny or fat crayon?” If you want the child to wash up, and the child doesn’t like soap, ask the child which bar of soap he/she would prefer to use when washing up.

7. Be Patient

Sometimes you will work with a child whose progress is painfully slow. In such an instance it can be challenging to hide your frustration. Train yourself to be patient, not only because it is a virtue in and of itself, but because it will help keep your client progressing.

You May Think it’s an Option, But it Isn’t

If you are a seasoned therapist, you know by now that if you don’t quickly and effectively deal with your client’s disruptive behavior, it won’t disappear by itself. If left unchecked this behavior has the potential to invade future sessions, putting your effectiveness with this child at risk.

So learn these proven techniques until they become second nature, to bring the kid’s behavior back in line, so that your true greatness as a therapist will shine with every child, for your benefit and theirs!

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