Return of the …

Return of the ... : How to Vanquish The Recurring Monsters in Our Lives

A haunted house with a skeleton foot stepping on a pumpkin in front.

I have a confession: back when I was a vet tech I could be a little bit… judgmental. One of the things that would bring out my biggest judgmental feelings was when clients would stop doing something that worked because it worked and then when it would stop working because they stopped doing it, they would be upset, shocked, confused, and frustrated. 

Common scenarios included: 

  • “My cat’s infection started getting better so I stopped giving him the antibiotics but now the infection is coming back.”
  • “My dog’s anxiety went away after starting on fluoxetine so we took her off the fluoxetine and now she’s anxious again.”
  • “Why does my dog’s ear infection keep coming back? I used the ear wash and made sure that his ears were clean before I stopped using it. Do I have to keep cleaning his ears forever?”

I used to vent to my coworkers like, “How is it not obvious to them that the reason they were seeing improvement is because they were following through with the treatment protocol, and when they stopped doing the treatment protocol they stopped seeing improvement? It’s not rocket science! Just follow the freaking instructions already!”

But that’s the thing about youthful ignorance: everything seems more simple and straightforward than it actually is, and it’s easy to judge when you don’t understand all the contributing factors to behavior.

Becoming a behavior consultant and learning more about not just animal behavior, but also human behavior, gave me a new perspective and a whole lot more compassion towards humans when they do this. The more I learned and the more experience I gained, the easier it was for me to anticipate this and support clients through it rather than feeling frustrated when they did it. I thought I had a pretty good grasp on this whole “helping clients follow through with instructions” thing.

And then recently, I got a heaping serving of humble pie.

It's me, I'm the client

A few months ago I was diagnosed with bilateral plantar fasciitis and Achilles tendonitis. And I had let it get really severe before I even registered that it was a problem that I should probably see a doctor about. 

For me, this happened because I have so many other health issues that I feel like I’m constantly playing whack-a-mole with which one is the most urgent or needs the most attention and focus. And as soon as I get one thing under control, something else takes priority. Since chronic pain is a part of my regular existence, it was easy for me to ignore my foot pain until it became so bad that I was struggling to even walk to the bathroom or to the kitchen. Standing up to cook became an impossible task. So finally I realized I actually need to pay attention to it, and I went to the doctor.

My healthcare team gave me a combination of strategies to heal my feet. These included: 

  • Intrinsic foot muscle exercises 
  • Staying off my feet as much as possible and replacing my regular exercise options with chair yoga 
  • Daily use of a fascia release massager on my calves and feet
  • Applying Voltaren to the affected areas a few times a day
  • Wearing specific braces at night to keep my feet and ankles in the right position
  • And buying special shoes for both walking outside and around the house 

This plan felt really good for me and really sustainable. I loved the chair yoga routines and the foot exercises. The only thing that was really painful for me was having to have braces on at night and wear shoes during the day. Because for me, having things on my hands and feet drives me bonkers. It’s one of my sensory sensitivities. Rings and bracelets are a hard no for me, and I prefer to be barefoot whenever possible. If I have to wear shoes I’ll wear flip-flops as often as I can get away with it, and I’ll only wear closed-toed shoes if I absolutely have to.

So this was my routine for the past 2 and 1/2 months, and then one day I was in a hurry to let Miley outside, so I didn’t put my indoor shoes on. I just walked her straight to the back door. To my surprise, my feet didn’t hurt! I was able to walk normally with a smooth, even gait–no limping or hobbling whatsoever.

I was so excited! The prospect of getting to be barefoot again was unexpectedly relieving. I knew it was mildly annoying to always have things on my feet, but I didn’t realize how tired I had grown of it until I thought I didn’t have to do it anymore. 

So I did exactly what I used to judge all those clients for doing: I stopped doing the thing that works because it was working. And unsurprisingly, because I stopped wearing my supportive shoes, my feet got worse again. 

A few days ago I woke up, stood up, and felt a shooting pain up both heels. The sensation conjured up an image of one of those old-timey horror movie posters that says,  “Return of the…” in a bloody font, letting the audience know that even though they thought the monster had been vanquished, it has come back to terrorize them again. 

I felt crestfallen, resentful, trapped, almost panicky. The idea of having to go back to constantly having stuff on my feet made me want to cry. 

And that’s when I realized: even though I have been compassionate towards my clients who have stopped following through with the training plans I’d given them that had been working so well for them, I didn’t fully understand what they were experiencing that made them stop doing what was clearly working. I’d had compassion but not empathy.

Adherence fatigue is a thing

The mental health professions have a name for this phenomenon. It’s called adherence fatigue. What seems like a simple, quick task like giving a pill or cleaning out ears can be difficult to maintain for a long time–not because the task itself is hard or takes a lot of time and labor, but because it takes up cognitive space and requires maintained focus. It’s adding yet another thing to people’s mental to-do lists that they have to keep track of. It’s another spinning plate that they have to keep in the air. And when people are already overwhelmed by their day-to-day lives and all of the things that they already have to keep track of, adding one more plate for them to juggle can be the thing that causes it all to come crashing down.

Adherence fatigue is one of many reasons why it is so important to stay with your client for the whole journey rather than just sending them a comprehensive training plan and expecting them to do it on their own. It’s also why it’s so important to make their plan as simple, efficient, and sustainable as possible so that they can reach their goals with minimum effort and as quickly as is possible for all the learners involved. 

It’s also why we strongly recommend taking a descriptive approach through an enrichment framework–because a huge part of that approach is leveraging what they’re already doing and what advantages and resources they already have available to them, as well as harnessing undesirable behaviors to work for them rather than against them. Having people change how they’re doing what they’re doing to make it more impactful for them is far less cognitive load than adding new skills and routines to their already packed schedule.

We owe it to the learners in our care to take adherence fatigue seriously.

Vanquishing the adherence fatigue monster

Whether you’re a pet parent or a professional, the good news is that there are lots of things we can do to mitigate adherence fatigue and sometimes even get rid of it altogether.

First: simplify as much as possible, without compromising the efficacy of the plan or the welfare and well-being of the learners involved. The goal is to minimize the cognitive load as much as possible. 

  • What in the plan is unnecessary and can be removed all together? 
  • What in the plan can be broken down into smaller approximations? 
  • What in the plan can be deferred for later? 

Second: identify the pain point and address it.

  • Is there a barrier, no matter how small, to being able to complete the task consistently? 
  • Is there a gap in the instructions that makes it harder to do it effectively? 
  • Are there foundational skills that have been skipped?  
  • Is there an actual, physical pain point that makes doing the task uncomfortable? 

Finally: make sure needs are met. 

Nothing is sustainable when you’re running on empty all the time. You have to give from your overflow, not from the dregs of your empty cup. And caregiving is giving. Which means that for caregivers more than anyone else, self-care and meeting needs is critical. Tiffany recently wrote an excellent blog about how she uses crisis kits to take care of herself while taking care of her very special needs dog, Petey. I highly recommend that you read it and pay close attention to the part where she talks about the importance of somatic experience. Her crisis kit – and all of ours at Pet Harmony, for that matter – includes stimuli for all the senses to help us complete our stress response cycles and refill our cups.

For me, the answer to getting back on the foot care bandwagon was finding a new pair of indoor shoes that work much better for me. Believe it or not, they are flip-flops that are designed specifically for plantar fasciitis! They work better because they take much less effort to put on and take off, and there are much fewer contact points with my feet so they are generally much more comfortable for me to wear. 

Making that one change met all three criteria above: 

  • It simplified the plan because it takes less effort to put my indoor shoes on and take them off. 
  • It addressed the pain point of me feeling like I constantly had things enclosing my feet. 
  • It met my sensory needs by honoring my sensory processing sensitivity.

Remember: progress is not linear and we don’t get to control how long the journey is going to take, but what we can do is make the journey as pleasant and sustainable as possible. 

Here’s to harmony,

Emily

Now What?

If this article resonated with you and you’re realizing that you are experiencing adherence fatigue, reach out to the professional that you’re working with and ask for support. You can also use the tips in this article to try to support yourself better as well!

And as always, if the support you need is from a behavior professional, that’s what we do! We’re here for you and we’d love to work with you!

Copyright 2025 Pet Harmony, LLC. All Rights Reserved.

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Results are not guaranteed because behavior, human, canine, or otherwise, are not guaranteeable.

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Copyright 2025 Pet Harmony, LLC. All Rights Reserved.

Terms & ConditionsPrivacy Policy

Results are not guaranteed because behavior, human, canine, or otherwise, are not guaranteeable.

Leave a Reply

Your email address will not be published. Required fields are marked *