Deconstructing 'Psychobabble'

I'm happy to be invited by Talia to post on her blog. As an introduction, here's an article that will give you some insight into my beliefs about the therapy process.

Deconstructing 'Psychobabble' and the Myths of the Psychotherapy Process

My clinician colleagues might look askance at the above title. Some would raise a condescending eyebrow. But my professional field, mental health counseling or psychotherapy, is plagued by the same barriers to clarity as the legal profession. We have all experienced legalese that required us to hire an attorney for interpretation. While important to have a language to communicate with members of our profession, I believe we do our patients a disservice when we “mystifying” the process of counseling by using psychobabble.

But what is my Diagnosis??

In over seventeen years of working with patients on their mental health, one of the greatest gifts I’ve given them is telling them that they are not “nuts” or “crazy.” OK, now my fellow therapists are cringing! But the reality is that that is often a patient’s biggest fear - they have begun to think of themselves as crazy. Normal people wouldn’t be having these symptoms or crazy thoughts! What serves to perpetuate this is the counseling field’s reliance on a medical diagnostic process. Mental health diagnoses are mostly categorized by “disorders.” And these diagnoses have made their way into popular culture - talk shows, magazines and blogs. For instance, the latest diagnosis du jour is bipolar disorder. I hear adolescents call each other “Bipolar!” as an epithet. In my professional experience, very few people in the general population truly suffer from bipolar disorder. All people, especially adolescents, experience mood swings. We have become too fond of categorizing each other in this way.

In my practice, I take time in an initial session with a patient to explain the diagnostic rationale. Since we often work within an insurance system that requires us to give patients a diagnosis to justify treatment and to receive reimbursement, it is a necessity. Unless a patient has definite signs and symptoms of, say, a depressive disorder, I almost always rely on a diagnostic category of “adjustment disorders.” Most of life’s stressors - problems in a primary relationship, work stress, health concerns, loss, etc. require some adjustment. It’s a normal life process to adapt to those stressors or learn effective ways to cope. People can readily understand this label and are less frightened or confused by it.

Do I have to come see you 3 times a week and lay on a couch??

The scene in a movie of a patient lying on a couch in a therapist’s office has become a cliché and one of the many misrepresentations in the media of the psychotherapy process. Many portrayals have us believing that every therapist is a bespectacled man with a goatee furrowing his brow and asking, “How does that make you feel?” I can honestly say that I’ve never asked a patient that question!

Because of some of these inaccurate depictions, it is important for the patient who is new to counseling to feel comfortable and have some understanding of the process. We are all more at ease if we have some knowledge of what is expected of us in new situations. It is perfectly acceptable to ask your therapist questions about the process - “How often will I see you?” “What will we talk about?” Any therapist who is unwilling to at least address your questions or who makes you feel uncomfortable is not doing his/her job.

Repression, Projection, Rationalization, oh my!

The terms I learned in graduate school to describe how the human psyche works are not very useful to the lay public. But they have made their way into the general public’s database. Who hasn’t turned on a talk show and heard a “talking head” counselor use the above buzzwords? If describing to a patient what is taking place in say, projection, is helpful to that patient’s understanding of their behaviors, I might use that word in a therapy session. When the patient is misplacing their anger or “projecting” that anger onto the wrong person, it might be helpful for them to understand the process. But just throwing around the jargon is not productive.

Obviously, there are times in counseling that explaining a patient’s subconscious processes isn’t helpful or warranted. Often this can result in the patient over thinking their role and can be counterproductive. But mystifying the process can be equally counterproductive.

Accessibility

The overall point is that the psychotherapy/counseling process should be accessible. Until quite recently, the subject of mental health counseling was taboo, shrouded in shame and secrecy. Thanks to the same media that often gets it wrong, the general public has a much clearer understanding of mental illness and counseling. It has become much more acceptable to seek counseling and to discuss it openly. My concern is that by using “psychobabble” and perpetuating myths about the process, we professionals continue to throw up barriers for people who need our services.

Nancy L., LISW, LICDC