VT Works

If you’ve ever traveled on a commercial flight, surely you’re familiar with the term rapid decompression (sometimes referred to as the sudden change in cabin pressure) as spoken by a flight attendant whose pre-flight message about the whole thing seems to be “it is horrible, but don’t worry”. Yeah, OK. With any luck, reading this blog post is as close as you will ever come to one, which is great news because it seems they are an undesirable experience. For those who are not familiar, our friends at Wiki describe it as “is an unplanned drop in the pressure of a sealed system, such as an aircraft cabin or hyperbaric chamber, and typically results from human error, material fatigue, engineering failure, or impact, causing a pressure vessel to vent into its lower-pressure surroundings or fail to pressurize at all.” 

Translation: be anywhere else when this happens.

The therapy room may present challenges that feel the same in terms of emotional challenges. No one is depriving us of oxygen or asking us to brace for the next 12 minutes while they do all they can to prevent a 30,000-foot plummet, although there may be days it feels that way on the inside. Challenging sessions can take their toll, moments can be tough, especially when working with patients who seem interested in how many different ways they can poke a hole in our well-planned sessions. 

In recent weeks, I’ve been contacted by a few therapists asking how to handle difficult patients. While I’m inclined in those moments to share stories of my own challenges or even to compare notes on some of my own epic failures, instead I lean on a more sophisticated answer: channel your inner child.  No, I’m not suggesting you throw something across the room or lay on the floor kicking and screaming, not in the slightest; I’m saying recognize your patient is programmed to expect a negative reaction to their behavior, and when it comes, it will likely add fuel to their attention-seeking tank. So maybe the answer is not resistance. Maybe the answer is to listen to what they are really saying. 

I have written in the past about the importance of trying something different, of changing the channel, and of the power of finding the unexpected. It is honestly my best answer to how to manage the difficult patients: Don’t Be Like Every Other Grownup!

As of this moment, there are quite a few challenging kiddos on my schedule. They come in with the baggage of their school day, the baggage of their homework war, the baggage of a life spent trying to catch up. Some act out, some huff and puff, and one even enjoys seeing if someone will chase him when he runs out the door. There is not a one size fits all type answer, but since I’ve been asked, here are some ideas to try that tend to work well for me:

• Sit On The Floor While Your Patient Stands – I cannot emphasize enough how powerful this is. Read any book you can find on body language, non-verbal communication, or positions of dominance. As a general rule, placing your body into a higher position demonstrates dominance and provides a natural advantage. Kids pick up on this just like adults do. Meet them at their eye level, or even better, take a less dominant position. Your body language is so incredibly important when working with challenging kiddos. Remember, this is not a competition. They are here to get better and to feel better about themselves, and when they win, you win.
• Make Everything A Question – this is a skill I learned as a parent of young children way back when. There’s a great series of books on “Parenting with Love and Logic” by Foster Cline that demonstrates the power of giving children choices rather than commands. In short, ask them what they think, if they are ready to get started, if they like what they just did, and most importantly if they will help you to figure out this new activity. That simple statement removes the perception of judgment from the equation and creates a problem to work on together.
• Talk Straight/Not Down – this one is pretty self-explanatory. Think of that one person in your life that always knows the answer, always believes they have the best ideas, and always seems to find a way to make other people insignificant. You know that pit you feel in the bottom of your stomach when you think of that person? Don’t be the reason a patient gets the same feeling when working with you. Talk to them like a teammate, not a struggling child, and watch their demeanor change.
• Failure Has To Be An Option – don’t beat yourself up too much if you have a session where nothing works. We have all been there. Anyone who has been in a committed relationship for longer than five minutes knows those moments when nothing will appease your spouse; the same principle seems to apply here. The best thing you can do is evaluate the session once it’s complete, figure out what you’d like to do differently next time, and make changes accordingly.

I wish you all every success in those challenging moments, and if all else fails, remember the words of Winnie the Pooh…

“You are braver than you believe, stronger than you seem, and smarter than you think”.

There will always be a next time.