Matt Smith, LCMHC, LCASA, NCC on Nov 30, 2021
Words matter, and they especially matter in therapy.
Those of us who work in the mental health community generally know this to be true. As therapists, we know that our words hold the potential to humanize and normalize the concerns our clients bring with them to therapy.
But there are certain words we commonly use in the mental health community that often have the opposite effect: they pathologize, stigmatize and alienate.
In most cases, I believe we use such terms unreflectively, not maliciously; we simply don’t consider the message our words may be sending to our clients. Or our egos get the better of us and we opt for terminology that serves to establish us as “the experts” in the room. God knows I’ve dropped an academic term or two with my most intelligent clients. (They’re always impressed, I assure you.)
Certainly, we’d all do well to reflect more on the words we hear ourselves using in session. In the meantime, here are five words I’ve eliminated from my therapist lexicon, and I think you should too.
Ask yourself: can you think of a word that sounds any colder or more clinical than “mechanism”? If so, you should probably stop using that word too. Sure, our clients often talk of their “coping mechanisms,” but no one ever said you have to follow suit. When my clients refer to their “mechanisms,” I see it as an opportunity to introduce a term that highlights their strengths, like coping skills, or their inherent ingenuity in the face of trying circumstances, like coping strategies. Changing just one word can itself be a kind of mini intervention.
I completed my counseling internship at an outpatient substance abuse facility where seasoned clinicians would throw around the b-word almost daily. Why was so and so visibly angry in group today? “She’s a borderline.” Why wouldn’t she follow instructions during class time? “Oh, you didn’t know? She’s a borderline.”
Not “She may feel unsafe expressing herself in a more vulnerable way.” Not “She’s likely distrustful of authority figures given her past trauma.” Nope, just “She’s a borderline,” as if that one word conveys all anyone would ever need to know about the person.
My objection to the term isn’t fundamentally about the pseudoscientific way we define all personality disorders. No, my bigger gripe with “borderline” is the lazy, reckless way we tend to use it, effectively erasing the unique story and interesting aspects of the person to whom we assign it. What a shame that is for our clients—and for us.
Okay, I realize we can’t stop using the indefinite article in the mental health community. But there’s one way we often use this word that’s just inexcusable.
Consider the statement I shared above—“She’s a borderline.” You already know how I feel about that last word, but truth be told, it’s the “a” in that statement that I find most insulting and infuriating. All by itself, that one little letter sends the message that the person is their illness. We use “a” in this way a lot in the mental health community— “She’s a narcissist,” “He’s an addict”—and it’s something we need to stop.
Medical professionals would never say, “He’s an AIDS” or “She’s a stage-4 cancer.” So, what makes it acceptable for us to speak of our patients in such callous, condescending terms?
Is it just me or does it seem like half the general population is “narcissistic” these days? My clients throw this word around more than almost any other psychological term, and I think I know why. Somehow the mental health community has created the impression that narcissism is a common condition. Spoiler alert: It’s not. Fact is, narcissistic personality disorder is incredibly rare. But you’d never know it listening to our clients casually label parents, partners, bosses and colleagues as clinical narcissists.
Sure, I realize when many of us use the word “narcissistic” we’re using it descriptively; we don’t mean “NPD.” But our clients and the general population seldom recognize the difference. So, when “narcissistic” finds its way into my sessions, I’ll often highlight the differences between the adjective and the clinical disorder. At minimum, this helps to show clients that I take diagnoses and diagnosing seriously. I want them to know, if only implicitly, that I don’t reduce my therapy clients—and them in particular—to clinical labels, much less one as hackneyed as narcissistic.
Before all the memes got started—and definitely before Don Jr. wrote a book with the word as its title—“triggered” was a useful term within the mental health community. And this is definitely still the case for many. But more and more, I find the word can be distracting for clients. As in, I’ve had more than a couple of my therapy clients outwardly mock my use of the word in recent years. Don’t get me wrong, I’m here for some client-therapist repartee, but I’m slowly noticing myself moving on from “triggered” and “triggers,” unless my clients use them first.
As therapists, we draw much of our diction from the zeitgeist, and rightly so. But I think we do well to guard against an over-reliance on tired terminology, especially the kind that stigmatizes rather than normalizes.