When any mental health professional is first getting started in their career, one of the things they need to do is find their therapeutic voice. That therapeutic voice can vary a lot from one professional to another, and there’s a tendency to settle into and get very comfortable with it. Some people will use more clichéd therapist-speak statements and questions than others; I saw another blogger describe this as “shrinky stuff”. I’m thinking of things like: “How does that make you feel?” “What I hear you saying is…” “It sounds like you’re feeling…”
I decided early on in my mental health nursing career that I wanted to avoid using therapist-speak as much as I could. It just didn’t feel natural; it seemed like it would be a barrier to bringing my genuine self into interactions. That was later reinforced when I later became a patient as well. Excessive therapist-speak it just seemed contrived. Of course, it doesn’t mean that the therapist isn’t being genuine; I just have a hard time getting past it.
Empathic statements
Certain things in particular grate on my nerves, both when I hear colleagues doing them and when I’m the client on the receiving end. My biggest pet peeve? Empathic statements worded as simple reflections drive me absolutely bonkers.
What do I mean by this? Obviously, empathy is a good thing, but there are different ways of demonstrating it. In psychiatrist Shawn Christopher Shea’s book Psychiatric Interviewing: The Art of Understanding (affiliate link), he described two different kinds of variance in empathic statements. One is the level of intuition implied, ranging from simple reflection to getting deeper into underlying meaning. The other level is the degree of certainty vs. hesitancy with regards to conveying understanding of the client’s experience.
At the bottom of the intuitiveness scale, you can get statements that are only a small step up from parroting back to the client what they just said. When a mental health professional does this with me, my reaction is to want to throw a chair at them. Sure, it conveys that they’ve listened on a superficial level, but when my friend Beckie’s pet parrot Peanut could do the same thing for free, it’s really not helpful. I know what I said. I don’t need to hear it again.
As a nurse, at times I’ve had nursing students tagging along with me. I’m terrible with students, because a) I can be kind of crotchety (okay, more than kind of), b) I get easily frustrated, and c) I tell them to knock it off with the simple empathic statements that they’ve been told in school that they should be using.
Making assumptions
Also annoying is getting into the high end of the certainty scale. If a high level intuited statement is used in conjunction with a high level of certainty, especially if they get it wrong, then it feels like I’m stuck with some jerk who feels the need to tell me what I’m feeling, while at the same time their head seems to be stuck firmly up arse.
Psychoanalytic dodo bird
I’ve never done psychodynamic therapy, but I did have a strongly psychodynamic-oriented psychiatrist the last time I was in hospital. I was punted over to him because I had repeatedly been telling the original psychiatrist assigned to me that he was an asshole, we had no therapeutic rapport, and he wasn’t helping me. “Telling” is perhaps too soft a word; there was yelling involved as well.
So there I was, certified in hospital after a suicide attempt, and this psychoanalytic dodo bird who’d been newly assigned to me was asking me how I felt when my brother was born (I was three years old at the time), when I first had sex, and how I felt about sex. This is the initial interview. In hospital. Not the place for a Freudian sex-travaganza.
While there are some good ways to use therapist-speak, it’s not a good thing if it annoys the client. And I can’t be the only crotchety one out there.
Have you had MH professionals who have used annoying versions of therapist-speak with you?
The post Psychotherapy Alphabet Soup: CBT, DBT, ACT, and More provides an overview of a variety of different therapeutic approaches.
Luckily, that particular annoyance has not happened to me. I did have one marriage counselor with long blonde hair who dressed in pink and advised me in front of my husband to act more “cute and helpless” to diffuse tension. Wtf? She said i should learn to play up my feminine role to see if that would bring back our romance, since that was one of the things i was complaining about. I thought she was nuts.
Privately however, she told me she thought he was impossible and I should leave him.
I was very confused.
Oh dear lord…
Oh gawwwddd yes! I’ve definitely had those experiences…which admittedly only put me in a state where I’d get a kick out of saying what I thought they wanted to hear just to get the look on their face of “damn I’m a good therapist. I really broke through to her” simply because…it was entertaining (also great avoidance, also I was much younger and unsure how to receive help)
Gotta take entertainment where we can!
Urgh yes! I don’t actually remember a whole bunch of my therapy days thanks to a very selective memory but what still sticks with me is just the look and unending silence! I would sit down and she wouldn’t say a word…. just looking at me until i felt so uncomfortable i just said something stupid. I was so young at the time so didn’t really know how to open up, and there was zero help.
Ugh, that sounds yucky!
I’ve been in one form of therapy or another since I was roughly 25. I’m now 59. That’s 34 years of therapy (on and off). The MH worker that uses ‘therapy speak’ doesn’t retain me as a client for long. That sort of pablum tends to annoy me and exacerbate my anger ‘issues’ and the relationship is usually quickly terminated. I asked one such therapist why she thought that sort of stuff was helpful and she didn’t know what to say, I totally threw her. I guess patients aren’t supposed to question the ‘method’, right? I know HOW I feel, I don’t need some outsider asking me that question. I want some tools to use to combat how I feel or deal with it more effectively. And if some idiot had ever asked me about how I felt about the births of my siblings or my sex life, I think I’d have gotten up and walked out. That stuff isn’t relevant in the context of my own interpretation of my mental illness. I do allow that it has it’s place in context of helping get to the heart of why my illness gets as bad as it does now and then. But once dealt with, I expect the therapist to stop pursuing that avenue of inquiry. Pushing those sorts of questions just seems like unhealthy interest on their part somehow.
Pablum is exactly the right word for it!
And I agree, if something isn’t an issue for the client, the therapist fixating on it starts to get just plain weird.
“Tell me more” after I just got done using all the words I had to say. I used to get so frustrated with that. Im not sure why, but it was sooo unhelpful! That particular therapist used to do that all the time.
Ugh, so annoying!
Right?!
Ugh, no offense to Peanut, but I’ve had therapists like that before.
Lol
I’ve never been in therapy, but did train to be a therapist, and always found therapist speak to be absolutely ridiculous. I only use it jokingly with my family and friends; never used it when I was a student therapist. Offering sympathetic phrases like “wow, that sounds like it was a tough situation,” praise for what they did well, asking guiding questions to help see situations from other perspectives, and actually helping them develop tools they could use ended up being the most successful. Then again, I worked with adults with intellectual disabilities, so being more direct and heavy handed was necessary.
There’s definitely a lot to be said for directness.
I certainly have come across this issue. I know everyone is different and each person wants something different out of a therapist, and I’m sure that makes it very hard for mental health professionals! It took me several tries to find a therapist that was a good match for me in both speak and process. If people tell me they think therapy isn’t working, I always encourage them to try another one. It’s so important to find the right match!
Definitely!
I am thrilled I read this before closing up shop this evening. OMG! Therapist-Speak… I never even knew there was a term for it before up until I read this.
I have had two therapists since my diagnosis back in 08/2015. The first one gave me more anxiety by talking with her. I literally mean, I would have anxiety before even walking in her office because of the way she spoke to me.
The one I have now… I have been debating whether or not to change entirely because of 1. She’s 20 something and I could be her mother. 2. She speaks to me as if I’m her age and there have been times when I’ve brought up things that are rather sensitive to me, and she has giggled. WTF???? 3. She speaks to me as if I’m a college buddy of hers.
Don’t get me wrong… I don’t hold the age thing over her head, everyone needs to start off somewhere… But, I don’t feel as if she has been helping me over the last year now.
I really loathe thinking about having to find a new therapist in order to find the right fit per se, but I can’t see me getting any better with the one I have at current. I’m not her friend!
Hmm giggling at inappropriate times is not a good thing…
Not at all. I could understand if I was speaking of a situation that I threw some humor into, but still… Unappropriate still.
I had a therapist who was very well meaning but kept asking, “well did you communicate that to said person?” As if I hadn’t thought of that. Well, if it were that easy, I wouldn’t be here would I? I felt less and less and validated and became bitter and angry, then stopped going. There’s a lot to be said for repetition and applying the same strategies to every situation: it doesn’t work that way!!!
Yes!
My first therapist essentially spoke in riddles, and I just didn’t get it at all – maybe because I’m an avoidant. “What your wife is talking about here, Andrew, is Andrewness. She needs more Andrewness.”
Andrewness.
WTH.
Oh my…
I’ve lucked out with my first therapist. There is no therapist-speak like that.
That’s good 🙂
“What does that feel like in your body?” and “How does that make you feel?” are two of my pet peeve therapist-speak statements! To give my therapist credit, however, she has loosened up considerably and can now pretty much say “SkinnyHobbit, we both know that’s bullshit” when I’m off making excuses for people who’ve harmed me.
How nice and refreshing!
She sometimes swears too, and it always cracks me up haha!