When Helping Too Much Backfires: Prompt Dependency in Therapy

Helping your clients sounds like the right thing to do.

But sometimes… helping too much actually creates the opposite of what we want.

In this episode of MI for Change, we talk about prompt dependency — a concept familiar in ABA, but one that shows up in therapy, parent coaching, and leadership as well.

Prompt dependency happens when clients begin to rely on the therapist for answers, direction, or solutions… instead of developing the confidence to problem-solve on their own.

And often, it happens with the best intentions.

In this episode we explore:

• What prompt dependency actually looks like in therapy
• Why over-helping feels good to the therapist (even when it backfires)
• How giving answers too quickly blocks autonomy and confidence
• Why silence can be one of the most powerful clinical tools
• How Motivational Interviewing shifts us from directing to evoking

Because the real goal of therapy isn’t to be needed forever.

It’s to help clients realize they don’t need us as much as they thought.

Learn more about Motivational Interviewing and explore on-demand courses at www.drmonicagilbert.com

Join the MI Academy for practical training and resources — and enjoy an exclusive 15% off with code MIFORCHANGE at checkout.

📲 Connect with me on Instagram: @drmonicagilbert

Transcript

SPEAKER_00 0:07

Hello everyone and welcome to another episode of Am I for Change. This episode is going to be very interesting. So I hope that you stay for the entirety of it. And I hope that as always you find value in it. So Am I for Change is where we talk about the conversations that actually move people forward using motivational interviewing in real life, real sessions, and real leadership. And today we are going to talk about something that ABA therapists are very familiar with, and it's prompt dependency. We're going to emphasize when helping too much actually backfires. And that may seem as an oxymoron for a lot of us in the field. A lot of therapists working in the field, we're here to help clients. So, what do you mean helping them too much is actually going to backfire? And it actually does. It creates this prompt dependency that we will be going over. So I want you all to think about perhaps a client that you've been working with that is making progress. However, when they work with others or when they start applying the skills outside, or maybe when they go on a long vacation and they don't see you for a while, it's sort of like you're going back to day one. Nothing sticks, nothing generalizes. And sometimes they even freeze when you tell them exactly what to do. And again, it's you're asking them to come up with their own solutions, but how are they able to come up with these solutions if they've always relied on you? So this happens in good therapy, and this also happens in bad therapy. This happens in all therapy. And when clients have prompt dependency or when they are dependent on the therapist, this is not a problem of the client. This is not the client's fault. This is in some way the therapist. I don't want to say fault because I think we are kilted into a lot of things, but it is a faulty process. So it is a process that we've been using that where we haven't faded out, where we haven't really evoked the solutions from the clients. And instead, we are feeding them all the solutions. So of course they become dependent on us. And that's a very dangerous place to be because when we are ready to fade out session, which whether you are doing ABA therapy or you are supervising parent coaching, you are doing just one-on-one therapy, it's always important to fade out. You don't want to make the client rely on you, dependent on you, and not be able to generalize the skills that they have learned in therapy. So let's talk a little bit about what that prompt dependency really looks like and what we can do to, in some way, help them help our clients become more independent and need us less. So I know that for therapists, it is very reassuring to feel like we are the change agents in the client's life. Like a lot of our clients are like thankful because without us, they wouldn't be in the place that they're in. And I don't know about you, but whenever someone tells me that, a client or parent that I've been working on, whenever they they tell me something like, oh my gosh, you are wonderful and thank you so much for all this change. I always feel a little uncomfortable holding that. And I always want to give it back to them. And I always, you know, say thank you. Um, and I remind them that they have also been a key agent in this change process. And I think it's important for us to do that because again, you want them to become independent and not need us anymore, perhaps never need us again. That's really, or that really should be our goal as therapists. So sometimes we have the best intentions in mind, and we see this happen a lot with when we are giving a suggestion or advice, but the client is not ready to hear it. So they just either don't do it or they do the opposite or it just backfires. So, how do we unintentionally create this prompt dependency, even if we mean it's really comes from a place of help? So sometimes we are overprompting and over-explaining. I remember I used to work with this client, and he was probably the second client I ever worked with, about I don't know, 16, let's say 16, 17 years ago. And he was a 16-year-old that has been that had been receiving ABA for a while. Now, this was again a while ago. We didn't really talk a lot about prompt dependency in our field. We're fading out, and and our field is is very young. Um, back then it was younger, obviously. So I worked with this client and he was so compliant. Uh, you would ask him to do something and he would do it. He was six feet tall. I remember, you know, he was a big guy, um, but he was a teddy bear. He was the nicest thing ever. But really, that that prompt dependency got in the way of him being able to request his wants and needs independently, even when he wanted water, like visibly, you could see that he was tired and he wanted to drink water. And he would wait for you to prompt him to say water, even though he was able to say it himself. So the prompt dependency was actually not allowing him to communicate. It started as something that was meant to help him because he was completely non-vocal. Uh, but now he was relying too much on the therapist. So it took us a long, long, very, very long time to get him to become more independent. And after a lot of sessions, he was able to request water and food and things like that on his own, but we had to undo a lot of history, a lot of like learning history, um, because the previous therapist uh forgot to fade out. And again, it's not to say anything bad about that therapist, it happens. It happens a lot of the time. Um, that's why we have to program things with fidelity and we have to make sure that they're in phases and that every session is intentional. There's an intention behind every session. It can't just be a replication of the previous session. But, anyways, coming back to the prompt dependency, sometimes we over-prompt. And sometimes we're overexplaining, giving too much advice, a lot of reassurance. Other times we are jumping in too fast to fix the problem. I know that a lot of people have trouble staying in the silence, but so much comes from that. And when I say a lot of people, I mean me and a lot of people, even though I'm a therapist and I push myself to stay in the silence for some reason, it kind of feels awkward sometimes. But again, when we are doing therapy, when we are having a session with the client, it's not about us and our comfort level. It's about what they need. So I invite you all to stay in the silence. Even if you absolutely know what the solution is, it's not about you giving the client the solution. It's about the client learning how to come up with these solutions. If we are able to shift that goal in our mind, it makes all the difference. We're not there to give them the solution, we're there to evoke that solution from within them. So staying in the silence allows them to think, allows them to process. We know that everyone has different processing speeds. So just allow them to think about it a little bit. So not jumping into well, jumping into to fix the problem or the rescue or very quickly doing so, that can lead to prompt dependency. Asking leading questions. So leading questions are not the same as open-ended questions. Open-ended questions, you are asking a question and then you're leaving it open. That's why it's called open-ended question. And again, the intention matters because I'm sure that some people can say, well, I can ask an open-ended question and it can be a leading question. Absolutely. However, if in your mindset, instead of saying, I know the answer and I'm going to ask that to kind of trick them into it, if instead of that you're thinking, let me really figure out what's going on. Let me let me go in with curiosity, it makes the entire difference in that dialogue. The next way that unintentionally we we um create this prompt dependency is giving answers before they are able to again to even think about the question or the answer. Sometimes it may not even be a solution or an answer that sticks with them. So again, evoking is what we should be doing instead of just running to the rescue and and helping them through that. And I think that when we think about working with a child, it makes more objective sense. Think about a child who you are teaching how to say ball and you are showing them a ball. You're going to give them a chance to start modeling or imitating you when you are doing the vocal imitations of the word ball. And then once they're able to do it, we start shaping it. So again, it's waiting for the learner to take the lead and allowing them to start using those skills that we are teaching them and then fading out our prompts until they're able to do it independently and they don't need prompts anymore. So sometimes, again, running to the rescue and doing all these things that I just spoke about, it feels helpful even though it backfires. So, why does it feel helpful to the therapist if it actually backfires? So what's why are why are we getting like reinforced by that? Why is it? What is what is behind it? Well, first because it reduces the discomfort that the therapist has in the moment. Again, a lot of us going to sessions thinking that the spotlight is on us and we have to fix everything. And that's what makes us a competent professional. And it's not like that. It's not like that at all. So knowing how to prompt, how to fade, how to be intentional is session in sessions, that's what makes us a competent professional. So we don't have to have the solutions all the time. And again, this is all about hacking your brain and telling your brain that same thing. So if we go in with that mindset, we don't feel that discomfort in that moment where the parents, for example, in that parentrying session is lost for solutions. We don't feel awkward. We're just like, all right, let's let's figure it out together. Um, the other reason is that it creates short-term compliance, but not long-term change. So during that session, we are giving all this advice and we're overprompting the client. And it may seem like they're like, oh my gosh, yeah, this totally works. Thank you so much. So that's going to reinforce that same behavior that we have of overprompting them when we should really be fading away or allowing them to come up with these things. It teaches, you need me to do this instead of I can do this. So we like to teach, and this is going to sound a little bizarre, but I know that some people can totally uh see it like this. A lot of the times we as therapists, and this is just my theory, but I think that we came into this field because we we like to feel needed. We we like to feel like someone else is like, hey, can you help me with this? Right. Like that feeling of like I am able to use the skills that I have and everything else, my experience and all that to help this individual, that feels good. So sensory-wise, that just feels really reinforcing for us. That's why we're in this field. So we like to feel needed. And when a client is like, hey, I don't need you anymore because I have this, right? I think it takes a lot of us to be like, yes, this is, you know, I helped create this too, and this is what we want. So, how does motivational interviewing help with all of this? How does it help decrease this prompt dependency and allow our clients to become more independent? Well, the first thing is that we shifted from directing to evoking. Instead of us being the teachers, the trainers, the people. And if you're looking at the leadership role, which I'm I'm dabbing more into that leadership and MI, when we're looking at the leadership construct, it's the same way. Sometimes as a leader, and I can tell you this myself, I like to help employees, I like to help my staff, I like to help the admin team. And oftentimes I think that I help too much. And then they become dependent on me. Even if they have the right answer, they come to me and they're like, hey, I was thinking of doing this. I just wanted to bring it up to you. And I'm like, yeah, girl, why don't you just do it? Why are you coming to me? But I have to realize that I've created this. And this is me just being completely transparent with you guys. This is something that I'm dealing with now. I'm learning how to fade off more and more from from that from that dependency that I myself have created in my leadership role. So it's learning how to fade out because the reality is that it feels like a lot. It feels like a lot when everyone is relying on you. And honestly, a lot of the times they don't need me. They have better ideas than I can even come up with. So why are they coming to me? Well, because there is that prompt dependency. So even in that leadership role, instead from instead of coming in from that directing role, come in from that evoking role. Tell me some things that that we can do better in order to just have a better flow of therapists. Or what do you think we should do in terms of like the processes that we have on onboarding our clients? What are some things that you think we should tweak? And what are some things that perhaps you need help with? Or sometime, or some of the what are some things that are working and we should keep doing? So I have definitely shifted my questions and the way that I run the meetings with my staff because now I'm evoking that from them instead of always coming in here and directing and giving them solutions and and and looking for things and new processes and all that. And when you start doing that, you're you will feel a load taken off from you. And you may even feel a little odd that you're not worried all the time and that you're not bombarding with questions all the time, but you will start seeing how effective this is and how things will, people will figure it out at the end. Um, and of course, it's not to say that you're not going to be there to help, but you're not going to be there at the same magnitude. And that is really important, I think, for all leaders out there. So, again, how does motivational interviewing help? It helps from directing, shifting, directing to now evoking. It also helps change the expert mode to that collaborative mode. So you're always going to be the expert in whatever it is, but you don't always have to be that point of reference. People can look for other points of references as well. And instead of doing that, what they can do, instead of just relying on you, they can gather what they've seen and what they've learned and then collaborate with you. How beautiful, right? That partnership starts happening. It also shifts the here's what to do to what have you tried or what might work. Just like I was telling you all with that story about my own leadership journey. And again, this is me after 16 years of having my ABA company. And now that I've done all this uh motivational interview work and I'm shifting more into MI and leadership, is that I have noticed that my own leadership style is one that creates prompt dependency. So that's why I really wanted to come in here and talk about that prompt dependency because it's something that after, again, 16 years is that I start realizing. And I hope that you all or the people that are starting your leadership journey can learn about it now. So you don't have to, you know, go 16 years without learning about it and feeling stressed and feeling stuck. So again, we want to shift that and start act asking more open-ended questions and more evoking questions. That will allow that person to become more independent and less prompt-dependent on you. So some of the swaps that I want to leave you all with is instead of giving advice, provide reflections instead of prompts, open-ended questions, instead of reassurance, affirm autonomy. Problem solving shifted to problem solving with. So instead of I'm problem solving for, I'm problem solving with. So it's not like that mentality of like, if you don't give me a solution, then this is not working, right? Where we're it's okay to be a little ambivalent. We'll figure it out. Let's give it time. And this is also progress that's going to generalize when you're not in the room. And guess what? People will need you less. And that's actually a good thing, trust me. So again, um, just a few other, you know, summaries, a few other words. Prompt dependency isn't a client problem, it's a process problem. And when we help too quickly, we steal opportunities for confidence, autonomy, and real change. MI reminds us that our job isn't to be needed, it's to help clients realize they don't need us as much as they think. And again, that is a beautiful thing. So I hope you found value in this podcast, and I will see you guys next time. Thank you for joining me on today's episode of MI for Change. If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence. You can learn more at www.drmonicagilbert.com. Until next time, keep