363 | Reducing Attrition by Preparing Parents for Resistance

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

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your source for centered and focused play therapy coaching.

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Hi,

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I'm Dr. Brenna Hicks,

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The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode,

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I am answering a question from Elliott in the UK.

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And I just want to give a little moment of shout out here.

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I am getting bombarded by emails from the UK lately.

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So,

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England,

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Ireland,

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Scotland,

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Wales,

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thank you for all of your

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Passion for CCPT and listening to the podcast and reaching out to me.

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And I think I've mentioned it before,

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but

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I was a student ambassador to those four countries

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a long time ago now,

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but

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represented the United States and was able to go over and spend quite a bit of time

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in those four countries.

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And they're some of my most incredible.

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Memories.

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I loved being over there.

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I'd love to go back.

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So if you all have connections for

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CCPT in those areas and you want to put me in touch with someone that I could

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do a conference or something over there,

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I'll come,

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I'll come hang out with you on the other side of the pond all day.

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So,

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you just,

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you make that happen and we'll,

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we'll make it happen.

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Anyway,

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Elliott,

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thank you for the email.

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Thank you to all of you that listen over there.

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I mean,

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obviously,

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thank you to those of you that listen all over the world in every country.

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I just feel like there's been

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a huge uptick in emails from

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England,

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Ireland,

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Scotland,

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Wales lately.

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So,

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I appreciate y'all.

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OK.

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This is

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about

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kids who

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say they don't want to come to sessions.

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And man,

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you want to talk about an uptick in stuff.

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I've had an uptick in emails from y'all and

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I've had an uptick in this particular topic.

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So,

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this is going to be a really helpful thing for us to talk about.

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Let me read parts of the email and then we will process together.

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I'm a child and adolescent counselor and I

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use child-centered play therapy with my younger clients.

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My question

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arises around a pattern that I've experienced a few times

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where the client shows strong resistance right from the initial session.

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Despite the parents' willingness that they attend.

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In these scenarios,

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the clients often express their displeasure at coming to the sessions.

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They sit quietly and don't engage.

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Say they're bored and ask how long left of the session,

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or tell me quite clearly how displeased they are about

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being there and how they don't want to come back.

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However,

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at the same time,

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the parents seem to be very keen about the start of therapy.

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I respond to the child appropriately by noticing and reflecting their feelings,

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generalizing,

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etc.

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etc.

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Fast forward 2 or 3 weeks,

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the client is kicking up a fussy tweak to come to therapy,

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and the parents give up fighting with their child and terminate the therapy.

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This has happened a few times,

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and I wonder how to work with this situation

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where the child is really resistant,

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yet the parents are really keen that their child receives therapy.

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All right,

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really helpful question.

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Thank you,

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Elliott.

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Basically,

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this comes down to a couple of things.

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The very first thing is setting expectations clearly with parents

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before a child even comes for the first time.

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So when we have that initial parent consultation,

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we sit down with them

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for that hour.

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We haven't even met the child yet.

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What we're doing

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is painting a picture of what's to come.

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We are also setting expectations

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and we're mitigating

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surprises and obstacles.

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Now,

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let me be clear,

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they're not surprises or obstacles from our perspective,

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but it's trying to put yourself in the position of the parent

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and saying,

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OK,

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what usually derails parents?

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What usually is a barrier or an obstacle?

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What surprises them?

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What catches them off guard?

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What are they usually unprepared for?

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You walk mentally through

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at

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A time you're not in front of parents,

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what is going to be an issue for them?

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And then you address those things purposefully and intentionally

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when you meet with them.

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So,

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you talk about the phases.

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You talk about how resistance

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is a very real part of therapy.

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You talk about resistance can happen at any point.

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You talk about what it might look like.

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Kids may say they don't want to come.

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Kids may refuse to get in the car.

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Kids may say they don't want to go back to the playroom.

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Kids may say that they hate this place and they hate me

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and they never want to see either of those two things again.

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And if you make me,

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I'm going to.

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They'll threaten,

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they will cry,

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they will yell,

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they will fight.

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You have to help parents understand

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this is part of the process.

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It's not a surprise to us.

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It doesn't catch us off guard.

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This is just like the initiation phase.

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This is just like the work phase.

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It's part of it.

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It doesn't manifest itself the same way every time,

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but it is absolutely a consistent factor in child-centered play therapy.

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So we have to be really clear before

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they even bring the child for the first time.

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These are some of the things that

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might and probably will happen.

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That's

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stage 1.

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Stage 2,

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here's what you need to do about it,

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if and when that does happen.

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Because

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it's not enough.

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I mean,

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it's a,

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it's a bulk of it

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to just let them know what's to come,

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because if you're prepared for something,

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it's not nearly as hard as if it catches you off guard.

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However,

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You also need to equip them with strategies.

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So

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if that does happen,

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here's what to say.

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Here's what to do.

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Here's how to handle that.

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And you actually give them scripts and templates to follow.

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It's your job to get them here.

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I will take over once they're here.

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It's your job to get them here.

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They don't have to want to be here.

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They don't have to want to go back to the playroom.

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They don't have to want to look at me or talk to me or acknowledge my presence.

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It's your job to get them here,

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and I'll take over.

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Here's what you say when they don't even want to get in the car.

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You really don't want to go see Miss Brenna today,

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but we have an appointment every day

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at 3 o'clock on Wednesday.

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So we're going to go to the appointment,

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but you know that you're in charge once you get there,

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and you can decide what happens

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once

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we get to the office.

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If you prepare parents ahead of time,

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not only for what they can expect,

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but also what to do and say.

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It is far easier for them.

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And

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the kids that resist from the very beginning,

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they're the kids that are struggling the most.

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They're the kids that are so highly anxious,

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that are so desperately in need of power and control.

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That are so close to the edge that if they step one toe over they're

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going to crack and they don't think that they can handle it if they crack.

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The kids that fight that hard from the very beginning.

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That indicates how desperately they need therapy.

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So you have to walk parents through that too.

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Look,

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some kids fight this really hard.

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Yours might be one of those kids that fights this really hard,

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and it might be a fight from the very first session.

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Kids that fight that hard that early on,

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that's an indication of how desperately they need this.

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So when you sign up for this and when you're all in on this,

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you have to stand your ground,

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you have to stand firm,

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you have to outwit,

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outlast,

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outplay.

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Because what happens in what you're describing 2 or 3 weeks,

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the client's kicking up a fuss,

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that's such a British phrase,

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by the way.

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We would not say that,

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but,

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but it's funny to me.

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As I'm saying it,

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I'm like,

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I would never say that.

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Kicking up a fuss.

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Parents give up fighting with their child.

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Well,

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you want to know what that communicates to me,

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and this is what you prepare parents for.

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Usually when kids

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are super anxious.

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They want all the control.

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Walk them through that

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connection.

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That's a very helpful connection for parents to have.

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So,

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huge levels of anxiety,

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huge need for control.

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What happens is the whole family walks around on eggshells around that kid.

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So the child has learned,

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all I have to do is escalate

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and I get my way.

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All I have to do is ramp up everything and I have control.

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All I have to do is up the ante,

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and I get what I want.

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So it's a conditioned pattern of behavior

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that everyone in the family

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gives in

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to the anxious child because giving in is easier than the fight,

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and it's easier than the child escalating

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and it's easier than everything ramping up.

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You have to walk parents through that and then you say,

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but what that does is it reinforces the anxiety.

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Because every time the child gets really anxious,

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they want to avoid.

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Their measure of control is,

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I will not do this.

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They're avoiding it because it scares them to death.

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So when someone in their life

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says,

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OK,

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you don't have to do that.

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Oh good.

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So my whole life,

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if I get really anxious and really overwhelmed

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and feel really incapable of handling something,

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I can just avoid it

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and then everything goes away.

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That reinforces anxiety.

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That reinforces the need to ramp and escalate

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and make everything a bigger deal to get your way.

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If we ever expect children

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to get to a point where their anxiety is managed

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and therefore their need for power and control is reduced,

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and therefore they have coping

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and therefore they can regulate themselves

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and therefore they can manage everyday life situations.

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We can't back out and just say,

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OK,

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never mind,

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every time they get

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overwhelmed by something.

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If you walk parents through those kinds of conversations.

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It is highly unlikely

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that they will give up and walk away.

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But all of this is front loaded work.

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I hope that y'all are hearing this.

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You can't do this once you're in the process.

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You're going to remind them

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in the process ad nauseam.

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Remember we talked about this.

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Remember we,

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remember we mentioned this.

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Remember that discussion that we had about this.

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Remember when I told you,

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you have to bring them back,

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7 + or minus 2.

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And when kids are resistant,

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00:10:01,049 --> 00:10:01,789
sometimes it's

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27 plus or minus 2.

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00:10:04,349 --> 00:10:05,349
Please hang on,

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please remember what I told you.

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Please listen to what I'm saying.

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So sometimes it's repeated and repeated and repeated.

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But the notion is,

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you can't introduce it.

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Once kids are already in the fight.

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It has to be something that you talked about before,

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00:10:22,770 --> 00:10:23,450
and then they're like,

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00:10:23,530 --> 00:10:23,849
oh yeah,

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00:10:23,960 --> 00:10:25,190
you told me this was going to happen.

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Oh yeah,

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00:10:26,250 --> 00:10:28,510
you told me that I needed to be prepared for this.

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Oh yeah,

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00:10:29,250 --> 00:10:32,090
you said that I needed to say this instead of that.

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That will help them hang on.

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They can't get caught off guard,

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and then you're trying to do damage control,

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you'll lose them.

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So,

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a lot of front loaded work.

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00:10:42,559 --> 00:10:45,380
This is why you need a template for your initial parent consult.

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00:10:45,590 --> 00:10:46,909
This is why you need scripts.

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00:10:47,150 --> 00:10:49,450
This is why you need to prepare ahead of time

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00:10:49,989 --> 00:10:51,380
so that you can ensure

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00:10:51,590 --> 00:10:52,570
that you are saying

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00:10:53,270 --> 00:10:54,489
everything that needs to be said

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00:10:54,630 --> 00:10:55,929
to set them up for success.

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00:10:56,070 --> 00:10:57,909
You don't ever want to bring someone on

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00:10:58,070 --> 00:10:59,570
and start working with a family

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00:10:59,830 --> 00:11:02,130
and then have them feel like it was a failure.

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00:11:03,599 --> 00:11:06,520
You're trying to set up every family to be successful,

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00:11:06,669 --> 00:11:07,539
and that means

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00:11:07,770 --> 00:11:09,599
get to a point of natural termination,

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00:11:10,039 --> 00:11:11,500
complete the entire process,

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00:11:11,669 --> 00:11:13,299
and feel comfortable along the way.

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00:11:14,159 --> 00:11:16,359
And that requires us to be very communicative,

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articulate,

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00:11:17,400 --> 00:11:18,039
intentional,

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00:11:18,080 --> 00:11:19,020
and purposeful

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00:11:19,239 --> 00:11:20,280
with what we say

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00:11:20,479 --> 00:11:23,080
when we first meet with them and help them understand what to expect.

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00:11:23,590 --> 00:11:23,710
So,

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00:11:23,750 --> 00:11:24,109
Elliott,

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00:11:24,190 --> 00:11:25,229
thank you so much for the question.

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00:11:25,270 --> 00:11:27,450
I hope that that is helpful for each and every one of you.

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00:11:27,669 --> 00:11:28,150
A really,

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00:11:28,270 --> 00:11:30,969
really difficult thing when a family

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00:11:31,229 --> 00:11:32,010
backs out

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00:11:32,270 --> 00:11:32,809
early

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00:11:32,909 --> 00:11:34,590
and when our attrition rates are high,

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00:11:34,650 --> 00:11:38,479
it almost always means that we need to change our initial parent consult process.

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So,

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hopefully that equips you with some thoughts of

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how to maybe improve that for yourselves.

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I love y'all.

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I hope you have a great week.

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We'll talk soon.

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Bye.

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Thank you for listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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For more episodes and resources,

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please go to www.playtherapypodcast.com.