Practical suggestions for therapists

Flags for potential adverse effects/early warning signs

Here are some situations you might encounter in your clinical work that could suggest therapy is going off-track. While it is not possible to describe how to manage specific situations, we have suggested some information that might be of use to you.

Client behaviour

  • a client is persistently late for or keeps missing their therapy sessions? Unfortunately my client would not commit to completing the agreed tasks we had agreed on as homework. - Therapist
  • a client doesn’t do the tasks we agreed within the previous session?
  • my client is hostile or aggressive towards me during sessions?
  • my client continually moves off at a tangent from the topic we are discussing?I think the client liked coming to therapy sessions so every time we reviewed his progress in achieving the goals we had initially set, he would identify a new problem to justify therapy sessions continuing. This occurred several times. - Therapist
  • I feel like I’m doing all the work within the session and my client isn’t contributing?I tried really hard with this client but I guess I learned that if I’m making more effort than the client is in therapy then maybe the client fears or rejects moving forward. - Therapist

Perhaps you might find these pages helpful – Therapeutic relationship, optimising the therapeutic experience and support structures (clinical supervision) 

Client complexity

  • my client appears to be deteriorating?
  • my client has previously had a negative experience of therapy?
  • I do not feel able to manage the level of complexity with which a client presents?The client’s difficulties were complex and numerous and I was an inexperienced therapist so it took ages to identify the issue which would work on. - Therapist
  • my client is struggle to tolerate the process of therapy; i.e. they dissociate or cut off, become significantly more anxious, other symptoms increase? My client had limited ego strength as well as little support in her everyday life which meant she struggled to tolerate the difficult emotions that came up in therapy. - Therapist
  • My client has experienced harmful therapy in the past?

Perhaps you might find these pages helpful – therapeutic relationship, optimising the therapy experience 

Improving & managing the therapeutic experience

  • strengthen the therapeutic relationship with my client?I believe my frustration with her just exacerbated her feelings of low self-esteem; clearly I didn’t mean to do this but it probably happened. - Therapist
  • ensure expectations for therapy are clear from the start?
  • manage the end of therapy, particularly if the client is reluctant to end?
  • prepare a client when I am going on annual or planned sick leave?My therapist had a scheduled back operation and was going to be off sick for a long time so she just ended my sessions. - Client
  • prevent negative outcomes?

Perhaps you might find these pages helpful – therapeutic relationship, optimising the therapy experience 

Professional development/safeguards

  • To make the most of my clinical supervision?
  • If my service or manager is asking me to see a particular client for therapy but I do not think they are ready for/suitable for/want to do undertake therapy?I should have considered whether she was suitable for psychodynamic psychotherapy from the start but because my manager referred the client to me I felt I had to offer the therapy despite my concerns. - Therapist
  • If I am not receiving sufficient or appropriate supervision?
  • If my client is particularly risky and there is insufficient professional support (or support from family and friends) available?

Perhaps you might find these pages helpful – support structures, good practice guidelines.