On language, power and the psychologist’s ego

Psychologists are always banging on about power. Our profession has a history of engaging in coercion and abuse. Some, shamefully, have been involved in torture in more recent times. We have been involved in terrible treatments for ‘mental disorder’ and ‘crimes’ such as having children out of wedlock. Most of us are aware of this and try not to act in ways which could be perceived as abusive. It sounds easy, but actually it’s very difficult. In mental health, we still detain people against their will. We tell them they have to take medication to be discharged. We still restrain. We detain them again if they don’t abide by the conditions of their discharge. Psychologists are rarely involved in the process of detention and lots of us seem to find this a relief. If I had to detain someone against their will I would probably find it a real ethical dilemma.

 

So in that sense, psychology is separated from the power typically granted to those who work in the psychiatric system. In recent years, we have questioned ourselves and our profession more closely. We now conduct research following the acquisition of ethical approval. We ask people what they want from therapy and try not to force it upon them. We encourage (there’s another blog to be written on this) ‘service user’ involvement, which essentially means that the people who use our services get to have a say in who is recruited to work in them and how those services operate. Increasingly, we as a profession treat the folk who come and see us as ‘experts’ – we generally know nothing of the reality of their lives unless they tell us, and we try to get into their worlds rather than simply applying our own notions of what we think their reality is. All these things are good, as long as they remain genuine and don’t end up being tokenistic and mechanistic. But there is one area in which we continue to uphold the power vested in us by our education and qualifications and that is in the language we use.

 

Most professions use their own lingo. Engineers have theirs, web designers have theirs, and, god knows, lawyers have theirs. Languages, in my opinion, have two functions: to create an identity and to exclude others. This is the case for all languages – the bilingual family may choose to speak their native language at home in order to keep it alive and to retain a connection with their culture. They may also use that language when they are out and wish to pass comment on someone without that person understanding them. In psychology, we have our own language; ‘psychspeak’, as I term it. Here are some examples of psychspeak, along with some handy definitions, and, where appropriate, a small explanation of why they wind me up so much. Incidentally, I didn’t know many of these until i began clinical psychology training. I am still terrible at knowing the lingo. I get the concepts and I can apply them, but I don’t talk the talk. Partly this is because I put no effort into learning it, and that probably tells you much about how much I value it. In any case, for your enjoyment:

 

Anxiety-provoking: something which makes you worried. But why? No-one says ‘joy-inducing’. There’s no need to say an exam is anxiety-provoking (what an inefficient use of syllables). Exams worry you. That’s fine. It’s normal.

Authentic: genuine. Often applied to therapists. As in, you should be authentic with the people you see clinically. What this means is ‘be yourself’. Why we need a term for this I don’t quite know. I mean, we do work with people. We generally have quite good people skills. We’re not actors. We rarely have to pretend to be something we’re not. There’s no reason to turn it into a honed skill when it’s actually about confidence and accepting yourself.

Anxiety: worried. Nervous. Frightened. In the real world, people use words like ‘worried’. ‘Anxiety’ is a clinical word. It exists in our clinical categories. The people who see us don’t generally have a good knowledge of our jargon. Why not use terms they use? I AM in psychology and I never say I’m anxious. I’m worried, I’m nervous, I’m apprehensive, I’m uncomfortable. Don’t dress it up just because you can. It’s not the mark of being a better therapist.

Affirmation: agreeing. I mean, REALLY.

Validating: accepting. As in ‘I validated her anger that her husband had had an affair’.

Overwhelming: too much. Now this is a word used in everyday life, obviously. But we apply this to EVERYTHING.

Flow: things you enjoy doing. Normal things, like reading and running and knitting.

Safety behaviour: Something you do to avoid an unpleasant feeling. A bit like avoiding having a row when you hate having rows.

Hypothesis: an idea I, as a therapist, have for the reasons behind your behaviour. Hypothesis. Is there a more appalling way to say ‘an idea’? How do you think that makes the person in the other chair feel? Do you realise how patronising it sounds? If a psychologist used that term with me I’d give them short shrift.

Shared understanding: telling someone else what you think.

Narrative: story

Affect: mood.

Thickening: adding detail. Thus, ‘thickening the narrative’ means ‘making the story more detailed’.

Family system: family, oddly.

Restructure: change

Reframe: thinking about it differently. Therefore, ‘My friend didn’t talk to me in the shop because they find me boring’ becomes ‘they didn’t talk to me because they didn’t see me’.

Appraisal: judgement. interestingly, ‘negative’ appraisals are generally spoken about more than ‘positive’ ones, though of course psychology is often based on the assumption that something is ‘wrong’.

Cognitive biases: errors in thinking. I’m never quite sure who decides what makes something an ‘error’, though.

Maladaptive cognitions: incorrect thoughts. There is an implied judgement here which makes me uncomfortable.

Maladaptive behaviours: behaving n ways I think you shouldn’t. See above.

Insight: often, seeing things the way I see them. So someone might believe they see angels. and that these angels are real. This might be termed a ‘lack of insight’. If they later agree that the angels were imagined, that might be considered ‘insightful’. This always assumes that the professional, who presumably doesn’t believe in angels, is correct. But what if you do believe in angels? How then do you think about the person who sees them?

Psychologically-minded: thinking the same way we do. Psychologists are terrible for this. Often we demand psychological-mindedness before we see someone. How, pray, will they develop it if we don’t try to help them?

Behavioural activation: doing things. Not special things, just the things that you’ve stopped doing. Getting out of bed, for example. Going for walks. Washing up.

Schema: your way of thinking.  So a self-sacrificing schema might mean you act like a bit of a martyr.

Externalise: express. As in, ‘externalise your anger’.

Rupture: damaged. Often used in the context of relationships. Thus a ‘therapeutic rupture’ means ‘I’m not getting on well with my psychologist’ (although of course, it’s almost always the psychologist who will speak of a therapeutic rupture.

Attachments: relationships. Good, bad, often complex. But, nevertheless, relationships, plain and simple.

 

This isn’t grousing for no good reason. As I said, language holds much power and in psychiatric systems, the people who come and see us rarely have much power. It is ethically wrong to use complex words needlessly. More than that, it might severely limit the extent to which they can work with you. Many of the people we see will have found school difficult or might have had learning difficulties. They might have been humiliated and belittled by parents or teachers. If we use these words, words they quite possibly won’t understand, what are we doing? In some case, we’re probably reminding them of times they didn’t understand something and were made to feel stupid for it. I would hate it if I ever did something which made someone who had come to see me for help stupid. Is it necessary to use complex language? Rarely. Does it make therapy more effective? Probably not.  Having a therapist who is on your side and who tries to understand is what helps. I would suggest that having one who uses words you understand aids that process.

 

So why do we continue to use jargon? Perhaps to give ourselves a professional identity, though I reckon it’s more the latter. If we speak a language only we understand, we can claim an expertise. I’m not saying we don’t have any expertise – I haven’t spent ten years getting to this stage to claim I don’t know anything – but it’s one thing to have knowledge and another to make it unnecessarily apparent. I came into psychology to try to do a good job; not to massage my own ego. But it’s seductive. Being Dr? Getting published? Being a senior member of a mental health team? Knowing something about how you might be able to help damaged people? All enormously gratifying. But that kind of gratification is dangerous: once you get sucked into it it can be terribly hard to escape. And once you are working to gratify yourself, what happens to your previously noble intentions? Nobility and egotism can rarely coexist. Sadly, I’m not as noble as I’d like to be and I’m not immune to feelings of gratification. But really, if there is a way to truly enter the world of the person who comes to see you in despair and desperation and to leave your own need to be applauded at the door, we, as therapists, have a duty to find it. And for me, that begins with language.

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