Practice management
Refusal Pattern Tracker
Log each client refusal across sessions until the pattern — not just the frustration — becomes readable.
When a client consistently refuses suggestions, the single session is not where the answer lives. The pattern across sessions is. This log captures what was suggested, how the refusal arrived, what the therapist did, and what followed — session by session — until the structure of the refusal becomes visible as clinical information rather than an ongoing obstacle.
Complete this within thirty minutes of each session while the details are fresh. After four entries, review all of them together before adjusting your clinical approach. The pattern is almost always there. It is just invisible inside a single hour.
Refusal Pattern Tracker
Session date: Session number with this client:
The suggestion made
Write out the suggestion as specifically as possible — the actual wording if you remember it, or a close paraphrase:
What was the clinical rationale for offering this suggestion at this point?
How the client refused
Check all that apply:
( ) Direct verbal refusal (“No,” “I don’t want to,” “That won’t work”)
( ) Apparent agreement in session, no follow-through by next session
( ) Deflection — changed the subject without addressing the suggestion
( ) Objection — gave a specific reason it was not possible
( ) Silence or minimal response
( ) Missed the session following the suggestion
( ) Other:
The client’s actual words, if you remember them:
Timing in the session
When in the session did you make the suggestion?
( ) First 15 minutes ( ) Middle third ( ) Final third ( ) Right at close
What was happening in the session just before you offered it?
Your response to the refusal
What did you do immediately after the client refused?
Did you restate the suggestion, adjust it, or drop it?
( ) Restated as-is ( ) Adjusted or simplified ( ) Dropped it ( ) Explored the refusal ( ) Other:
What followed
What happened in the remainder of the session after the refusal?
Did the client seem more engaged, more withdrawn, or unchanged after the refusal exchange?
( ) More engaged ( ) More withdrawn ( ) Unchanged ( ) Hard to read
Pattern notes (complete after 4 or more entries)
What kinds of suggestions get refused most consistently?
At what point in the session do refusals most often occur?
What does the client’s refusal style tell you about what they need the work to look like?
Hypothesis: what function does this client’s refusal appear to serve in the therapeutic relationship?
( ) Protection — the suggestion felt unsafe or exposed
( ) Control — the client reasserts agency in a relationship that feels prescriptive
( ) Communication — the refusal signals something about the suggestion or the relationship
( ) Other:
What has the client accepted, even partially, that you can build on?
Generated with Rapport7 — rapport7.com