The growing popularity of teletherapy, while an extremely welcome development, has presented a whole range of challenges for therapists. Often the most difficult is how to react when children misbehave during the session.
When things don’t go as planned, it is important to understand the reasons behind the child’s difficult behavior. It’s possible that the child is tired or hungry, and is acting out her emotions. Or perhaps she is learning how she can leverage her behavior to drive favorable outcomes for herself. Or maybe it’s just boredom or frustration.
Whatever the reason, such behaviors are destined to mitigate the productivity of the online therapy session. It is therefore imperative to have strategies and tactics in place, so you’re always ready to handle any contingency.
How Can You Manage These Behaviors?
1. Pay Careful Attention to the Initial Evaluation
Before the initial session, ask the caregiver these three core questions:
How does your child interact with new people, adults in particular?
What is your child’s ability to maintain attention to a task?
When frustration sets in, then what happens?
While you may think that such pointed questions regarding the child’s “challenging behavior” seem like an affront to parents, advance notice of what to expect will enable you to react more quickly and effectively, resulting in more productive sessions, which is what the parent wants.
Keep in mind that establishing rapport between therapist and child is dependent on those first impressions. So, it is critical to create additional space for a client that you suspect may be more challenging. And that initial rapport will yield heavy dividends later on by helping to reduce the frequency of challenging behaviors throughout the therapy.
2. Build Rapport
Rapport is arguably the most crucial component of therapy. Without it, chances of the therapy being effective are greatly reduced. With children who pose behavior challenges, you must take additional time and provide extra care to establish rapport. You neglect this at your peril. Because without it, you will not only experience the expected misbehaviors, but the absence of rapport will likely exacerbate the situation.
3. Ignore and Distract
But don’t fool yourself. Having a wonderful rapport with the child won’t prevent you from experiencing those obnoxious behaviors from time to time. Inevitably, they will surface. Just remember that, when dealing with a disruptive outburst, “don’t get into it with the child.” In other words, don’t take it personally, or too seriously, and avoid escalation.
Taking the outburst as a personal affront will escalate the situation. And escalation only emboldens the child to continue using the outbursts inappropriately — either to vent frustration or avoid a difficult task. The trick is to remain sensitive to the child’s frustration, while not reinforcing the inappropriate behavior — easier said than done!
What’s more, you need to resist the impulse to halt your forward movement with a child because of the outburst. As much as possible, ignore the outburst itself, distract the child’s attention from it by acknowledging and validating his frustration, and then slightly tweak the current activity or reassure him that shortly there will be a break.
4. Positively Reinforce and Praise
Many times, even more effective than ignoring and distracting the child is positive reinforcement and praise when the child is behaving appropriately. Although you may feel uncomfortable with it, positive reinforcement more effectively motivates a child than does a punitive reaction to undesirable behaviors.
While it comes quite naturally to extend praise for significant accomplishments, it’s not as obvious how important it is 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 the disruption is due to despair when the activity is too difficult, or boredom when the activity is not challenging enough. You need to find a challenge that is “just right” — an activity that will require effort while at the same is achievable. If you went too high or too low, tweak the activity to be suitably engaging.
6. Allow for Some Choice and Compromise
At one point or another, your client will be asked to engage in a task she just doesn’t want to do. To reverse the practically guaranteed non-compliance, consider giving the child a choice between two options.
But make sure that both choices are consistent with the treatment plan. For example, if you want the child to color, but she doesn’t like crayons, don’t ask if she wants to color. Ask, “when you color would you prefer a blue or red crayon?” Or “would you like to use a skinny or fat crayon?”
7. Be Patient
Sometimes you will find that the child’s progress is tortuously slow. When this happens, it can be practically impossible to hide your frustration. Embrace this unsolicited character development opportunity. Train yourself to be patient, which is a virtue in itself. However, in this instance, the benefit is much greater: your client’s continued progress.
It’s Not Really an Option
Although in the heat of the moment it may be difficult to remember, you must know that challenging behaviors are, generally, unrelated to the therapy itself. At the same time, they can’t be ignored. You need to do the best you can when these uninvited problems show up at your session’s door, even if you weren’t specifically trained to address them.
If you are an experienced therapist, by now you know that if you don’t deal with these disruptions quickly and effectively, they won’t disappear by themselves. And if left to continue unchecked they have the potential to disrupt and impair future sessions, putting your clinical effectiveness with this child at risk.
So learn and practice these proven techniques until they become second nature, to bring the kid’s behavior back in line. When you do, your true greatness as a therapist will shine with every child, for your benefit and theirs!