When Should You Adapt Your Therapeutic Approach?
In the dynamic landscape of mental health treatment, adapting therapeutic methods is sometimes necessary. We've gathered insights from ten mental health professionals, including Psychotherapists and a Clinical Director, on what can trigger a change in their approach. From responding to evolving client needs to pivoting when safety is a concern, these experts share their reasons for adjusting treatment mid-course.
- Respond to Evolving Client Needs
- Assess Patient's Mental Health Dynamics
- Adapt to Client's Unique Progress
- Follow the Journey of Self-Discovery
- Reevaluate Approach After No Improvement
- Identify Patterns of Disengagement
- Overcome Resistance with Flexibility
- Attune to Trauma Client's Needs
- Pivot Approach When Safety Is Concerned
- Change Approach for Lack of Progress
Respond to Evolving Client Needs
As a therapist, I adapt my approach mid-treatment in response to:
- Changes in clients' needs or circumstances
- Shifts in their goals and priorities
- Feedback they provide
By being flexible and attuned to these changes, I can refine my approach to better support clients' growth and success. This collaborative process ensures a personalized and effective treatment plan. I am always open to adjusting the strategy to meet clients' evolving needs. Supporting a strong alliance is at the heart of a dynamic and supportive therapeutic relationship.
Assess Patient's Mental Health Dynamics
It is really important to understand a patient's mental health care dynamics to improve therapeutic outcomes. When we need to change our approach, it's always important to assess a variety of different things. These items can include: a patient being more influenced by social forces than biological; if they require more meaning-making in one's life; if they have many inner resources that we can pull from together; and if they require more of a need to be more present in their life by increasing awareness.
In addition, a patient's treatment needs may need to examine their thoughts as more of a path to change their behaviors; a patient's need to increase more personal responsibility; their increased needs to cultivate greater clarity to their reality to reorient their attitudes; and one's needs to increase more emotional or cognitive regulation skills to learn about specific triggers to increase their coping abilities.
As mental health professionals, we need to adapt to a patient's desire to explore more about one's self, address their long-term and recurrent issues, and provide routine guidance for their current life challenges. The transformation process begins with the acknowledgment of where we both stand in the treatment together.
Adapt to Client's Unique Progress
Adaptability should be a core pillar of your practice, not an afterthought. Your therapeutic approach is simply a means to an end—a tool to help your client thrive—so adjust it whenever necessary to serve their needs.
This means treating each session as a collaborative experiment, where you're constantly assessing and responding to your client's unique reactions and progress.
How do you do this? Pay attention to subtle cues: shifts in their language, unexpected reactions, or evolving patterns in their thoughts and behaviors.
By being flexible and attuned to these signals, you create a therapeutic experience that places your client’s needs over your preference for a specific approach.
Follow the Journey of Self-Discovery
When clients set out on a self-discovery journey, no one knows where it will go. Our curiosity will start a conversation, and a thought or trigger will take us down a new path. Often, we discover a deep belief that is subconsciously directing our lives. Then we set off to shift that belief to a new pattern of thought and possibilities, and revisit our goals.
Reevaluate Approach After No Improvement
In my 30+ years as a psychotherapist, I have had the honor of partnering with many amazing adults struggling with managing their mental health. I have humbly learned that each person's journey of understanding the sources of their mental health difficulties and working with them toward improved health and well-being is their own unique journey. I have found that partnering with each individual person to identify and design effective approaches and goals is crucial to effective psychotherapy. However, in general, if there are no positive changes or improvements in their mental health after a significant amount of time consistently participating in counseling, it's important to consider different therapeutic approaches that could be more effective and helpful.
Identify Patterns of Disengagement
I adapt my approach mid-treatment whenever I recognize behavioral patterns of disengagement. This can look like clients showing up late to sessions, increased cancellations or rescheduling, having no agenda for sessions, emotional disconnection in conversations, and a lack of questions and concerns after sessions. We must also be trained to identify behaviors that support the misuse of therapy, such as consistent redirection of topics to avoid thoughts or feelings, viewing the therapist as a 'friend' instead of a professional, or ignoring treatment goals or therapy homework. When I witness any of the behaviors listed, I inquire about direct feedback, review their treatment plan with them, and use motivational interviewing techniques to help clients identify the 'why' in their treatment.
Overcome Resistance with Flexibility
I believe that we adapt our therapeutic approach when we see that our client is resistant to the method we are usually, for the most part, successful with. There is a moment of frustration that can go one of two ways: you either become frustrated to the point where your client feels it and disengages, or you choose to channel that frustration to understand why you are frustrated. Slowly taking the time to separate those feelings to understand that this frustration comes from a deep need to help your client, and now with a clear mind, to figure out and find another therapeutic approach that can better support your client. Therapy is not a one-size-fits-all, and it's an opportunity for a therapist to become more flexible and open-minded for the sake of a client's well-being.
Attune to Trauma Client's Needs
Working with trauma requires flexibility in therapeutic approach. I attune to my clients' needs in the moment. Do we need this session to focus on strategies to self-regulate and manage daily stressors or trauma cues? Or do we need this session to process the traumatic event—to rewrite the narrative or make new meaning of the event? I trust my clients to bring what they find most valuable in our time together, and I adjust my approach to best serve them.
Pivot Approach When Safety Is Concerned
As a practicing licensed therapist, I tend to see numerous signs that warrant pivoting my approach mid-treatment; I will outline two here.
The first occurrence that would necessitate shifting my modality or approach would be if new information comes to light indicating that continuing the current course would be detrimental to the client's well-being and/or safety. Let's say that I have been seeing a client biweekly for about four months, focusing on boundaries and communication in her relationship. The game plan changes to crisis management when she discloses that her current romantic relationship is actually fraught with physical abuse, not 'harmless verbal spats' as previously reported. While still employing trauma-focused interventions, the priority becomes immediate safety planning. My mindset immediately becomes far more logistical and strategic to assess immediate safety needs and consult with colleagues to ensure a thorough plan. Not every instance is this high-stakes, but precarious situations involving safety and well-being happen frequently.
The second reason I would change my therapeutic approach would be if the client is not committed to interventions they themselves have requested. If my client has a desire to work on managing their Body Dysmorphic Disorder by working through an evidence-based BDD workbook, I would oblige, especially if she's been honing her coping skills for regulating emotions and distress tolerance. If I notice a habitual inability to complete the reading and assignments that she commits to, I will have a non-judgmental conversation about whether she is ready to do this work. I normalize feeling overwhelmed or unprepared. We may need to take a step back and reassess what could be hindering progress despite her genuine effort, like impaired executive functioning skills (i.e., prioritizing, time management, etc.) that indicate ADHD, for example.
I have found that it is human nature for us to think we have solved a problem by discussing it repeatedly. In the words of poet Brianna Wiest, 'You cannot think your way into the life you want; you have to act your way into the life you want.' Whether in groups, with couples, or individuals, the choice to step past the Contemplation stage of change into Action is crucial. I assure clients that taking small, incremental steps toward goals is okay. It's my job to meet them where they are.
Change Approach for Lack of Progress
As a supervisor of student trainees and teacher of doctoral-level clinicians, the question of when to adjust treatment or consider referring out is a common one. In a nutshell, changes to the therapeutic approach should occur with either lack of progress or change in presentation. For example, if a client comes in with a crisis situation, then you will clearly address the crisis first and foremost, which is likely to adjust your approach. Alternatively, if you have been seeing a client for a while and there have been no notable changes to their daily functioning or movement towards their treatment goals, that is a really good indicator that the approach you are utilizing may not be meeting the client's needs best at this moment.
