Scaffolding In Therapy (Timing, Pacing, Context of When To Use Interventions/Skills)

TLDR (Too Long, Didn’t Read)

• Theoretical orientation, modalities, and interventions are great to be skilled and experienced atAND timing, pacing, education and context of when to use and the rationale behind using an intervention is even more important

• If you push a client too far or use interventions that are not appropriate yet for the client, a rupture is more likely to occur

  • A rupture is a break in the connection, trust, or collaborative process between a therapist and a client.

  • It can be as small or subtle as as a misunderstanding or disagreement to more direct such as a conflict, a client feeling invalidated or dismissed

• Experiment and try things out 

• Be curious (don't assume) and ask the client and yourself what is happening in session in the moment 

• Focus on deliberate practice

  • AKA focus on structured, repetitive rehearsal of specific clinical skills to improve performance, rather than just accumulating experience.

  • It involves breaking down skills into small components, practicing with feedback from a trainer or supervisor, and making micro-adjustments (e.g. role plays over and over)

• Consider:

  • Why am I interrupting the client?

  • Why I am talking?

  • Why am I still talking? Am I doing this for myself and my discomfort or the clients?

  • If I waited 20 seconds before trying this intervention, what would happen?

  • Is the client adequately prepared for this intervention?

  • Would withholding do more harm than good?

  • Is the client new to therapy or has the client been to therapy before?

  • Is there a cultural component to consider with the client?

  • Am I assuming or mind reading in session rather than being curious and asking questions? Etc. 

Individual Therapy

• Scaffolding in Dialectical Behavioral Therapy (DBT) therapy involves breaking down complex behavioral and emotional skills into manageable, sequential steps, allowing clients to master foundational skills (e.g., mindfulness) before tackling harder ones (e.g., emotion regulation). 

  • “In order for us to help you with your emotion regulation when you get overwhelmed, let’s work on building a strong foundation first. One of the strong foundational skills I teach clients is mindfulness.”

  • “I could be wrong, but I’ve noticed that you tend to perhaps be impatience with growth and healing in sessions and that you take a large leap instead of small steps toward your goals. Would be open to doing things in a more manageable way so that it’s sustainable toward long term growth and change?”

• Attuning to the client and assessing what intervention to use next in session

  • Trying a mindfulness skill with the client and noticing they are trying to do mindfulness perfectly. Instead of continuing with the practice in silence, interrupting them and letting them know doing mindfulness perfectly isn’t possible. It’s simply noticing the present moment and to provide education that ruminative self talk should be expected for most clients.

• The therapist provides high support initially, gradually removing it as the client gains competency and independence, often using techniques like "I do, we do, you do".  

  • This helps build self efficacy (self esteem, self worth, self love) and in turn helps the client feel more empowered and independent

  • Being more of a teacher and providing lots of psychoeducation and role plays initially.

  • Then as the client practices outside of session, talking less and providing less education and having them bring up issues and topics

Couples/Dyadic Therapy

• Bill Doherty’s concept of "scaffolding an intervention" is a core craft skill in couples therapy that structures sessions to ensure there is "no intervention before its time," allowing for a gradual, non-aggressive approach to client challenges. 

• As a technique focused on timing and sequence, scaffolding helps therapists avoid premature, overly aggressive interventions by breaking down complex therapeutic moments into manageable, safe steps. 

• Wait, watch and wonder

  • Trying an intervention with a couple/dyad and waiting, watching and wondering how it might land and adjusting it as needed