Having a session go “flop” or “go wrong” is a challenging, albeit common scenario. It’s useful to reflect on the context in which this occurs and think about what we can do when this happens.
Firstly, it is important to recognise that in part this challenge occurs because we have a plan. That is to say we had a direction we wanted the session, and indeed the therapy, to go in and this challenge presents when things don’t go this way. Taking a directive approach in therapy has a number of advantages. It allows us to work directly on the child’s challenges and enables us to teach the child and family some new skills. This approach is often efficient and works well in the context of the time limited context we often find ourselves working in.
There are, however, some challenges of taking a directive approach. Usually working in this way means we have content we want to cover and our focus on this can mean that we miss important cues about where the client is at. We might miss opportunities to explore their current feelings or our relationship with them. We might go too fast or too slow or push them too quickly into areas they are not yet ready to explore. Often when this happens we begin to feel like the therapy is “not working” or the client is being “resistant”. For many of us the uncomfortable anxiety this creates makes it even harder for us to be present with our clients and focus on what is happening in the room.
Finding the balance between working in a directive way and still remaining present in the room so that you can process what is happening in the moment can be challenging. It can be particularly challenging when you are working with children and families. The complexity of working with a family, all of whom can be at different developmental levels, have their own states of readiness, and different goals for therapy, is important to recognise. As therapists we have to try to hold each of the family members in mind as well as understand what is happening between them.
It’s in this context that we often have this experience of our session not going to plan. Sometimes this happens because the plan is just that, it’s our plan, rather than one the child and family feels wedded to. This is important to keep in mind and highlights the need for developing a shared understanding and goals. Establishing this early in therapy and continuing to have these conversations throughout is essential.
Even when shared goals have been established sometimes our sessions don’t go to plan. We might, for example, choose a task that is not developmentally appropriate for the child or try to introduce something that the family doesn’t see the relevance of. Perhaps most concerningly though we might be asking the child and family to explore something when they are not ready to do so. This can result in anxiety, which may manifest in the child withdrawing, becoming flooded or engaging in challenging behaviour.
Other times sessions don’t go to plan because there is something else that is coming up for the child or family. This becomes their focus during the session and when this is not clear we can find ourselves pulling in opposing directions. It might be a parent who has faced a new challenge with their child and feels this needs to be prioritised, or a child who is concerned about missing a special event at school in order to attend therapy. These events have the potential to quickly derail a session if, as therapists, we remain so focussed on our session plan that we don’t acknowledge what is happening and alter our session accordingly.
When a session doesn’t go to plan there are some helpful ways of responding that can support you to prioritise your engagement with the family and keep moving forward therapeutically. Noticing what is happening in the room is the first key step when a session is not going to plan. This means both noticing what is happening for the child and family as well as noticing what is happening for you. Tuning in to what a child and parent are saying and, perhaps more importantly, what they are not saying, will often give you some important information about what is happening. Notice children’s and parent’s facial expressions and behaviours and get curious about what these might mean, particularly if they don’t match with what is being said. It’s ok to ask directly about this, saying something like “I can see you are here with me however you seem distracted. What sort of thoughts are coming up for you right now?”
Noticing what is happening for you in the room is also crucial. As therapists we so frequently get caught up in our thoughts about how the session should be going and this often takes us away from what is happening in the moment. For example, if I repeatedly have thoughts about needing to introduce the idea that we can face our fears, then I’m likely to feel worried about this and continually try to direct the session towards this topic. Often when we have this experience we become less focus on the child or family we are working with and are more likely to miss what is happening for them. Taking a step back and trying to notice both what is happening for you and for the family is an ideal way to begin when a session doesn’t go to plan.
Working authentically with children and families means modelling what we teach them and taking a breath and pausing when sessions don’t go to plan is a wonderful way of doing this. Staying regulated ourselves means that we are in a better position to notice what is happening for the family and for ourselves and can begin to think this through. Often I’ll take a breath and name that it is feeling hard or that it’s not going how I thought it would. Doing so gives us a valuable pause and invites the family to name their experience too.
Part of the reason that pausing is so essential is that often when sessions don’t go to plan there is a tendency for us to speed up rather than slow down. Often the speeding up is fuelled by thoughts about needing to make the session ‘therapeutic’ or address a particular topic or issue. In reality though moving more quickly has the opposite effect, preventing us from understanding what the challenge is and compromising our rapport with the child and family. Slowing down allows us to model regulation for the child and family and offers them an opportunity to see you problem solve the situation.
Sometimes when we work in a directive way we minimise the value of what is happening within the room. We can readily forget that often what happens in the room is a reflection of what the child and family might be working through. This is particularly true for therapists who have little experience working with less directive therapeutic approaches. It is important to get curious about how what is happening in the room might relate to the challenges faced by the child and family. For example, a child who moves quickly between tasks and whose conversation jumps from one topic to another may feel anxious and confused at home and part of the work might be about helping the family to provide more containment. Supervision, by its very nature, provides a distance that often allows us to see this more clearly so if you are struggling to answer this question try discussing this with a supervisor or trusted colleague.
While planning for sessions can be incredibly helpful it is essential that we hold our plans loosely and remain mindful of what is happening in the room. So next time a session doesn’t go to plan try to sink into it and see it as an opportunity rather than a threat. You might be pleasantly surprised about where it takes you.
If you are keen to see our loose session plan and case note template you’ll find it in our free resources or by clicking here.
Dr Fiona Zandt, Clinical Psychologist
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Our shared resources and posts are aimed at providing ideas for qualified professionals and are not a substitute for appropriate training and ongoing supervision.