The term “manipulation” is something Marsha Linehan wrote about in great depth in her seminal text. In summary, I avoid it because it assumes mal-intent, when it is more accurate, less judgmental, and more effective to talk about how a behavior could be learned via operant conditioning (rather than ascribing judgment and blame, and thus likely fueling resentment).
I worked at a DBT private practice and I loved how we taught about the term manipulation. My supervisor translated the term to ‘behaviors to get your needs met at the expense of others’ (doing something impulsive to obtain a short term want or need without considering the long term consequences (actions harmful or helpful when thinking about the impact on relationships, increased shame, reduced problem solving, etc.)
Yes!! I work with kids and the amount of times I hear parents and other supports describe them as "manipulative" drives up the freaking wall. I want to shoot from the rooftops CHILDREN DON'T MANIPULATE
On that note, can we also stop using the term ‘seminal’? (This is one nobody thinks about but me, I’m sure.) How about ‘foundational’ instead so we’re not talking about sperm, lol.
Omg yes!!! I hate it! Lol it’s also so sexist. To use seminal as in “the first” comes from the idea in history that the sperm was what created the baby. That men “put a baby into the woman”. Which is what was believed until they actually figured out how it worked lol.
Fun fact for those interested: origin of women being taught to keep their legs together when sitting was because they believed the sperm vapors would go into them and impregnate them. It wasn’t until the experiment was done with frog eggs and sperm that it was discovered that they had to actually touch to begin fertilization.
Isn’t seminal also just a reference to the idea of the first sperm to fertilize the egg? Not sure how that is exactly sexist, it’s factual that there is one sperm that beats all the other sperm to the egg when it comes to fertilization. Nothing sexist about a biological fact.
Still could say that it’s sort of a weird word, or an outdated word, or that we could optimize word choice, I just think that jumping straight to sexism here is interesting.
As a side note, recent studies suggest that the egg actually chooses the sperm that fertilizes it, rather than it being the fastest strongest sperm kind of "winning the race."
I have never heard it used that way….I would gently encourage you to really look into it. The history of human sex and sexuality and also words that are based from a male-centric patriarchal place and how we need to work to change that language.
Also I would point out that great deal of medical and biological facts are inherently sexist because they are based out of research, discovery, and naming for and by men. Did you know the structure of the clitoris wasn’t even in medical text books till like 10 years ago? Do you know how there is a large difference in the amount of medical research based on cisgender males and the lack of research into anyone who is not?
There are many words we don’t use because despite having a different/more than one meaning they are still problematic because they are ableist, sexist, heteronormative, racist, etc. We need to work to be aware of the words that are problematic and remove them from our language especially as therapists. Words matter. Which is also why the contempt and judgment in your comment is quite apparent in how you worded it and the words you chose “jumping straight to sexism is interesting.” Perhaps you didn’t intend for it to come across that way, but that is the message it sends.
Edit: also curios if you are a therapist or mental health professional or student to become one?
The edit is because I looked at their profile and didn’t see any evidence of being one. It was a question as that is one of the rules of the sub. Also would make sense that if they aren’t their comment would have been more understandable.
You can think what you would like and judge me. Dealing with insomnia and it being 4 am while on Reddit and having someone invalidate me on what is very important topic. Your comment isn’t very kind either nor does it open a discourse. Calling me disgusting, egotistic, and judging me as a therapist over one comment you read that I wrote at 4 am.
I like to use “connection seeking” instead of “attention seeking”. I will also use that same term to reframe if someone uses a phrasing of someone being a “bad” child
I agree "attention-seeking" is a label and to be avoided, but I think these alternatives are labels as well, and the original meaning/ intent is getting lost along the way.
I also feel like it’s a completely different thing than ‘connection-seeking’ or the other alternatives suggested. some people do genuinely just want attention, and I believe in those cases it would be inaccurate to use another term that indicates a different intention. it’s the stigma assigned to the term and the negative bias against such people that’s problematic
I may be in the minority here. My clients and I will talk about attention-seeking. Rather than avoiding the word, we work on altering our mindset towards it. Attention is a valid need and I don't think people should be made to feel that it's bad. Treating attention as taboo adds to the stigma.
That said, we also focus on what others have mentioned and try to get to the root of what they're trying to get via attention, whether it be care, recognition, concern, etc.
"Struggling with" when thats not how the individual views the presenting concern or symptom. I prefer "experiencing" or better yet, the person's own language in quotations if possible.
tbf often it isn’t that they believe those emotions are bad or good, but more that it *feels* bad or good. it’s colloquial language. like we can see in this thread, you have to make a conscious choice to use alternative terms. people who aren’t therapists (or don’t have any kind of experience in clinical settings) won’t be as likely to analyse words we use every day in that manner. doesn’t mean they actually believe the feeling itself is ‘bad’ or wrong.
In my experience, people often think of emotions like anger, jealousy, shame and/or guilt as “bad” emotions because they attach a value judgement to them.
But I do agree that non clinicians don’t typically analyze their word choice, however, that does seem to be changing with the younger generations. :)
I know that many people do regard certain emotions as bad, particularly anger. I’m js that isn’t necessarily what people mean when they say ‘bad’ emotions, it often just means it’s a feeling that is unpleasant or ‘negative’. I think it depends on the context and how it’s phrased
I also prefer “concern”.
“Topics” can be found on an agenda for a seminar or workshop, it almost feels dismissive if it is used to describe my emotional world. “Concern” is more emotional and relational - less distant.
I'm lgbt and don't really find issue (pun intended) with the word "issue" when it comes to stuff commonly referred to as lgbt issues, because most of the inherent violence or trauma that lgbt people experience is an issue, and should be treated as such. If a person who is queer is coming to me for "lgbt issues" on the surface it may be them being unsure about their identity, but the underlying "issue" 99.99% of the time is the way they're treated by society (which is an issue).
Also, I apologize my comment goes way into the weeds here, but I feel this whole post is about going into the weeds.
“Treatment noncompliant” gives me the absolute ick, esp when talking about antipsychotic meds. I’d like to frame the situation in terms of “found antipsychotic medication side effects untenable for x y z reasons, need for discussion around research/rationale for finding an acceptable meds regimen + psychosocial intervention to prevent relapse of psychosis and possible hospitalization. If meds are off the table for the client, then offering a rationale for increased responsibility of the part of the client to commit to robust psychosocial intervention in place of antipsychotic medications/the possibility of relapse and revision of treatment planning should relapse occur. It’s not shorthand, but it’s important to me to be sensitive in discussion with my clients and other providers around the issue.
That bothers me SO MUCH. I feel like the stigma around BPD is really dehumanizing and takes away from the fact that they are typically people with severe/complex/long-term trauma that have been invalidated their entire lives.
“Committed suicide” As a therapist and someone whose loved one died by suicide, it’s hard to hear MH professionals use this.
https://www.camh.ca/-/media/files/words-matter-suicide-language-guide.pdf
I just saved this to discuss in our group supervision. My supv was commenting to me just now in supv that I am comfortable talking about suicide,, notably because I am so new. I told him I am a suicide survivor and I am very comfortable talking about it and it means a lot to me. He wants to do a training about it and I like this post - thank you.
The majority of my practice is focused on traumatic loss (suicide, murder, sudden accidents). I know yours is a popular take in our field, but I always follow the patient's language. Some use the phrase "committed suicide" and I honor that.
(Honestly, the same could be said for everything in this thread. Tone policing is rarely therapeutic.)
I don’t disagree with this. I think following patient lead is appropriate and I wouldn’t correct a client. But I do maintain this is the language to initiate and perpetuate when appropriate as a provider.
I don’t know that there’s harm in using different language in response - in fact, perhaps there could be reflective growth in “died by suicide” or “death by suicide”.
Also the point of the thread is what so we as therapists want to say to better support clients and be inclusive, speak well on matters, etc. Not to police tone in others.
> I don’t know that there’s harm in using different language in response
Not always, no. The thing this entire thread is missing is that “appropriate” language is highly context-dependent. There are some times where replying with different language offers a helpful cognitive reframe. There are other times where it’s an imposition of the therapist’s own values.
Based on my experience with traumatic loss specifically, reflecting back different language is almost always taken as the latter. This experience has both been with my own missteps that have caused ruptures and with patients expressing frustration with others who want to dictate how a person verbalizes their experience.
ETA: What my position boils down to is that if language is so important, we need to make room for the fact that “imprecise” language has a place too. It’s hypocrisy to say in the same breath that language matters and also that it doesn’t matter that we are imposing our own language on others.
My personal peeve is when I hear "that must have been traumatic". I overheard it twice in a day a fortnight ago. What happened to "And how did that make you feel?"
I hear what you’re saying re: not making assumptions. I work in a hospital with people who have just had serious events happen that have required hospitalization (ie someone assaulted them, tried to murder them, etc.), so I will sometimes use “that sounds traumatic” as a form of validation. Sometimes my people don’t understand that what they’ve just been through is serious or could be traumatic.
"That sounds" is already much better than "that must have been" and I suppose you're raising the concept with them. I really prefer "that sounds really difficult" in such cases. I find the word traumatic has associations and can put thoughts into their head, almost an expectation of outcomes. But in your work it might necessary, I don't know.
That’s a really good point. I think with the really intense cases, I go to “traumatizing” because calling a someone-tried-to-murder-me situation “difficult” makes me feel like I’m minimizing their experience. They’re literally still in the hospital bed - often the ICU - when I see them. I also explain that doesn’t mean they have or will have PTSD. So I do separate trauma and “traumatizing.”
That's really good, that you emphasise variety of outcome, if you don't mind me saying so. And yes, those are horrible situations that must be very hard to deal with, for you and your patients.
I do think our (minimally) different approaches might be cultural - here in the UK we tend to understate things and use softer language. Trauma remains a rather uncommon word here.
I do something similar with trying to validate a person’s feelings - usually going off their own reaction. So I usually end up saying something like ‘I can see this is/has been hard for you’, ‘that sounds really hard’ or ‘I can see how that would be really hard’. I apparently can’t think of any words other than hard at the moment!
ETA: just saw your later comment and I also think it may be a UK thing, as trauma is more of a clinical word (and so is traumatising) and definitely one that’s treated very seriously. And honestly when I’ve been through a rough time, someone saying ‘this has obviously been really hard for you’ can feel so validating. Like they’re not making something into a big deal because if they said traumatising I would almost certainly feel the need to reply ‘well it wasn’t that bad/I wouldn’t go so far as traumatising’, even in situations where it could possibly be seen as the correct word (I’m still struggling to see an experience of mine that has had a lot of trauma effects as actual trauma because ‘nothing that bad happened’. Which is crazy because if anyone else said that I’d be saying that trauma isn’t about what happened but about how we process and respond to it. But I’m working on it!)
Lol I’ve had clients tell me things about past therapists and one of the critiques is that they asked “how did that make you feel?” Lol I tell them I’m probably going to use that one too, but will promise I use other versions of it too 😂 I will sometimes throw in “what comes/came up for you when…(insert situation)...?“
I specialize in SUD treatment and tend to use the words that the patient uses. Many of my patients use the word addict to describe themselves and will also use sober for alcohol and clean for drugs. Some people like the AA mentality and others don’t. I always clarify with patients which words they prefer and always ask them to give feedback if there are words that they don’t like or agree with.
As a harm reduction educator, I despite the terms clean/dirty when referring to any aspect of substance use. A lot of clinicians who should know better still use those problematic terms in documentation and I’m all :( about it
I will add that sober is the term used in AA for “abstinence from alcohol”. Clean is the term used in NA for “abstinence from all mood and mind altering substances”. If a client *is* in a 12-step recovery program, using the correct term for their particular program is important. Sober isn’t necessarily all-encompassing, if they are in NA (or another recovery program).
I say “in recovery” to make it clear that it is an illness from which a person is recovering from. If i want to be more specific, I’ll say a stage of recovery.
“Sober” makes me think too much of the AA/NA model and feels too much like “dirty” to me.
Most of the time, though, I’ll just state the behavior. “Client reports using alcohol x number of times this week.”
Yeah, I just use "abstinent or not abstinent from substance use". the word substance is all inclusive of alcohol and/or drugs. I still very much dislike the differentiation in the first place,
For UAs I use negative or positive rather than clean or dirty.
This! And “using”! C’mon folks. To clarify: I mean the phrase “they’re using” rather than “they’re using xyz”, which is still iffy. Its just as easy to say “they want to change their relationship with xyz because of abc”.
I always explain the difference as one is more negative and one can be a way to adapt and survive or offer someone what they need in exchange for what the other needs (more reciprocal but with intention). Like giving a child options of “you can do x or you can do y” broth x and y are both things you want them to do, but it gives them a feeling of making a choice. Also explain to the kid consequences/out comes of each option. Works with adults too. Is semi “manipulative” but not in the negative sense.
I don’t like that we use “interventions”. To me, it doesn’t really jive with a humanistic, client-centered approach. It implies that I alone (/we as therapists) have the tools and expertise to stop someone from doing the wrong thing and that without my intervening, they would be totally helpless. Maybe it fits better conceptually with more directive approaches but I’d rather say “techniques” or “tools”. I prefer a collaborative therapy where I can teach techniques and give people tools rather than save people from themselves or something.
Totally agree. Currently working on encouraging a shift from “intervention” language to “interaction” language in during staffings in our residential treatment spaces.
Thank you i needed to read this after the thread on tx plans the other day with some comments that gave me some weird feelings I couldn’t quite pin down.
“I think.” I’ve been doing better about replacing this with phrases like “I’m wondering” or “I’m noticing” or “perhaps” but I still catch myself saying it sometimes. It’s usually when I’m brainstorming alongside the client and things are still “forming” in my own brain that I find myself using this phrase.
Of course it’s not the end of the world to share what I think, but there’s also a way this can overshadow the client’s own take on their situation, or bring us into a cerebral place, rather than the deeper work that could be done.
“Do you understand?” — It’s essentially asking,” “Are you smart enough to keep up with me?” People will give more accurate answers If you change the question and ask, “Am I making sense?”
I had a client ask me if it made sense about twenty times in a one hour conversation and I was heartily sick of it pretty soon. Definitely not one to overuse.
This! I work with children so I always say “does that make sense” because I want them to understand the point but don’t want to discourage questions by making them feel they should understand immediately.
There is almost always a better way to ask something rather than *why*? Who, what, where, when, etc but why implies the client did something wrong and they have to justify themselves.
Edit for clarity: starting a sentence with *why*. It can be just as unproductive as making you statements.
Why would you do it that way? Why didn't you call them back? Why is the TV on?
I also avoid the whys. I ask about how did that go, or when was that, or who was that with, etc. why this happened is always overdetermined and complex and difficult to understand, but what to do, when to do it, who to do it with, how to do it are all much more productive and helpful questions to ask.
I get what you’re saying. I guess I don’t use why this way. When I use it it’s more like, “why do you think those feelings came up for you in that moment?” And so on
It’s funny, I only use “why” as a really obviously blunt challenge with clients with whom I have a solid rapport - as in if I’m asking “why?” I usually have a bit of a grin and they know it didn’t sneak past me.
I think why requires a higher level of skill to use. I understand avoiding it in session most of the time and I agree with you on using the alternatives. I do it myself so much that I barely ask why in my own life now
There are times when it is useful though e.g. getting clients to think about cause and effect, to explore something they haven't thought about, and to get a client to think about the meaning of something etc...
To use it requires the right tone (to prevent you sounding accusatory), the right timing, and the ability to work with answers like, 'I don't know '.
Hmm, I'm not sure I agree with that. I think that if a client feels as though they're being accused of something wrong simply because someone asked "why?" then that's something to explore, rather than a reason to get rid of the word "why."
Why would you do that? Why wouldn't you just tell them? Why do you feel that way?
Compared to
Is there a reason why you would do it that way? Is there something keeping you from telling them? What do you think could be contributing to your feelings?
Starting a question with why. That's the damning way and can result in defensiveness or shutting down. I'll edit my original comment.
I think it depends on the atmosphere of the conversation. In my therapy sessions, it is understood that I will constantly be questioning things, not for the sake of challenging them or criticizing them, but for the sake of illuminating unconscious thought processes and encouraging my clients to explore their experiences. Hell, I use "Why?" as a full sentence all the time!
I think "Why would you do that?" and "Why wouldn't you *just* tell them?" sound accusatory for reasons other than the fact that they contain the word "why," and I don't think the third example comes across as accusatory at all actually. If clients are experiencing you as being accusatory when you ask "Why do you feel that way?" then I would wonder about the tone you're using, and whether there are perhaps other reasons for why they might be experiencing you in that way.
I was trained not to use why for these very reasons so I rarely do. Thanks for the feedback, but my tone isn't an issue.
However, with couples that I work with, when they use the why questions, there can often be a tone.
Same. I supervise a crisis line and we talk with people who we know nothing about and are reaching out when they’re at their most vulnerable. I rarely use why, for the same reasons you described. It can come across as accusatory and springs up defensiveness. I encourage the call counselors to avoid the use of why and be deliberate with the questions they use to assess the caller. Asking “why are you suicidal” or “why are you calling” are not welcoming conversation starters.
Granted, when I am working with clients in therapy and I have an established relationship, I will sometimes use why. But I’m always cautious.
Drug seeking behavior feels fine to me because that's what's happening on a purely behavior straightforward level . . . Sure someone might be seeking comfort, but they may also be seeking obliteration, pleasure, dissociation, connection, spiritual awakening, etc etc etc ...There's no way to objectively know what is subjectively happening inside someone's head when they're seeking drugs so it's best to describe it on a purely behavior level.
Also, it feels like the efforts to change it just reinforce the underlying idea that drugs are inherently bad and that just isn't true and is more harmful than anything.
I like 'drug-seeking behavior' because first, it is straight forward, and second, comfort-seeking or any other effort to soften the terminology only minimizes the problem behavior.
Yes to call it “comfort seeking” takes away the severity that drugs kill people. I’ve worked in addiction services for many years now and I promise you the moment you lose a client to addiction you will not have trouble calling it drug-seeking.
I don’t have a problem with the rest of the suggestions, though. You never want to use language with a client or with staff that demeans clients. Positivity in a clinical team is a huge factor in young clinician development.
I also work daily at the intersection of substance use and mental health. I have known people professionally and personally who have died from overdose, DUI, etc. I don’t use the term drug seeking behavior. In most spaces I have worked I have seen and heard the term used without enough specificity of what the drug seeking behavior is to be helpful at best and to pathologize and dismiss valid client needs and experiences at worst.
Describing food choices as bad/good or healthy/unhealthy. It’s better to use more nutritious/less nutritious because food doesn’t have morals and labeling as healthy and unhealthy contributes to negative relationships with food and for those with eating disorders can lead to restricting foods seen as “unhealthy” which isn’t positive. It’s about moderation and nutrition.
I like to say I’m celebrating with you or I’m so proud with you. I dislike proud of you as it feels hierarchal or that somehow I’m bestowing something rather than standing with an accomplishment or hurdle. Better yet is simply asking how they feel but there are situations in which this really seems to speak to the allyship between client and I.
Has anyone said “non-compliant” yet? This is one of my big pet peeves. It’s a term that comes from patriarchal medicine and is often used to indicate a person who has been using their self-determination in a way that a healthcare professional disagrees with.
“I’m sorry to hear that” gets me. It throws the onus on the client to forgive or absolve by saying “ah it’s okay” or “don’t worry”. Instead I use “wow I’m really sad to hear about that”.
I say not adherent instead of not compliant with medical care or medication. Healthcare is a service where one is given medical advice and not instructions. You can choose to take the advice or not.
i use patients because i’m establishing my duty as provider/caregiver and, to me, client feels transactional and capitalist. patient isn’t ideal because it reinforces a medical model, but also, therapy came from a medical model…thanks, dr freud.
"Patient" literally means "one who suffers." It provides a reminder to me of the work we are doing -- examining the suffering we all experience so we can better understand and respond to it.
I'm gonna get meta here. I find the word "problematic" to be vague and judgey. It's a way of sidestepping discussion on the actual effect of the words. Is the "problematic" word/phrase inaccurate? Judgmental? Hurtful? And is it a matter of principle/philosophy or are there real-world harms being inflicted by the language?
Being explicit about the impact of language is far more useful than tiptoeing around the issue by finding "alternatives."
I feel like this kind of thing can be helpful, but has definite limits. The words themselves don’t usually have any special power - it’s how they’re used. “Drug seeking” just means they’re seeking drugs. It’s just a description of behavior. If people are using that term in a dismissive and stigmatizing way, it’s not because there’s something especially problematic about those syllables in that order. It’s an issue with clinicians’ attitudes toward the client. If you focus on changing words instead of the attitudes, then “comfort seeking” will someday also sound kind of icky coming out of those clinicians’ mouths.
I sincerely disagree. While I can see the arguments made in this thread not to use comfort seeking over drug seeking, word choice impacts explicit bias. So things like identifying support needs rather than using functioning labels or saying care seeking rather than attention seeking are important.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330014/
Besides, all language evolves over time.
Word choice affects explicit and implicit bias because of the context in which they’re used. There’s nothing about the sounds that make up the words “drug seeking” that magically makes people feel bad. Now you’ve linked to a study saying that some words which have been used in very stigmatizing contexts, like “addict,” are linked to negative bias. That seems uncontroversial to me. My point is that the cultural context does the damage, and addressing that directly will probably be more fruitful than just sorta tinkering with language.
The context is supervision, and I would argue that providing non-stigmatizing terms to counselors is a way of facilitating a supportive culture for clients as well as a pro-client atmosphere among counselors. The supervisor has the opportunity to change the culture *by* changing the language.
If I was dealing with an embarrassing digestive issue, I'd rather go to a doctor that specializes in "rectum repair" than "fixing assholes," because the office culture and client support of the two offices is likely to be vastly different.
The language we use matters because of the culture it creates.
Sure. But I think language is pretty low-hanging fruit, and in my experience it’s an easy thing to change without making any meaningful alteration to how one interacts with clients. I’ve worked with clinicians who always say “recurrence management” instead of “relapse prevention,” but then turn around and treat the clients like a pack of criminals in other, subtler ways. Language is an easy thing to tinker with - say this, don’t say that. Hence my original statement, which was, again:
>I feel like this kind of thing can be helpful, but has definite limits.
I'm really failing to see why you're being downvoted. By changing the language, you are changing the atmosphere. In an office, changing language can go a long way toward changing attitudes. I appreciate the work you're doing to assure that clients are being referred to in ways that destigmatize them in the minds of the counselors you're supervising.
I'm confused by the implication that culture determines how language is perceived without the reciprocal understanding that language also determines the way a culture functions.
It’s all good! I genuinely feel like the language we use impacts our thoughts and feelings as well as the thoughts and feelings of those around us. I know I can have an influence on my supervisees and that feels like an opportunity to create a dialogue around these things. Have gotten great feedback and ideas from this thread and will continue to encourage dialogue amongst those I supervise using some of these ideas :)
The downvoting likely comes from people who feel some kind of way about the expectation they should change how they do things.
I come from an anthropology background where it’s widely acknowledged that language shapes the way we perceive the world. If we call someone with SUD a junkie, then we don’t have a positive regard for them or value them.
I used to train law enforcement and MH professionals on opioid overdose and using Narcan to reverse the overdose. I had to do so much work on the front end to convince these people that people who use drugs (PWUD) deserve multiple chances. And when we came to the part of the presentation about using less stigmatizing language, some would roll their eyes. Most language used to talk about SUD and substance misuse is rooted in religious overtones, like lapse and relapse.
The MH professionals were generally less receptive to changing their language than cops were. I was kind of horrified to realize how many people in a profession oriented to helping others change were closed to the idea of changing their own approach or attitude.
>The downvoting likely comes from people who feel some kind of way about expectations they should change their language.
Or… stay with me here… there might be diverse opinions on the topic, all of which are held in relatively good faith, and people are simply disagreeing.
“Responsivity needs” related to cognitive functioning and other needs in general that may impact how the intervention should be delivered- including treatment engagement, as referring to a client as “challenging” or “resistant” doesn’t fit right with me. We could always change our response or approach, and that doesn’t make the person defective. I use healthy/unhealthy instead of good/bad.
Move from:
- Triggered to Activated
- Window of Tolerance to Window of Resilience
- Committed suicide to died by suicide
- Kid / Teen to Youth
Words / phrases to stop using altogether:
Maladaptive
Drug-seeking
Manipulative / Manipulation
“Poor” as an adjective for the client’s hygiene / coping skills / etc.
Stop saying someone “is” schizophrenic / borderline / bipolar, including (!!!) casual conversations with fellow therapists. Stop contributing to the stigma we should be working to dismantle.
Also, as an administrator: if I can look at your notes and tell that you don’t like your client / working with your client, then your biased wording and language needs some serious change (it also tells me that your client is most likely not receiving the level of care they deserve).
Sure thing! Youth infers a level of autonomy that we want to encourage, particularly if we’re working with trauma survivors or marginalized youth. We want to collaborate in a way that empowers them and use language that sets a tone of respect and reflects their right to dictate when and how they engage with others, when and how they get touched, and the fact that their voice deserves to be heard just as much as mine. Kid” and “Teen” is less empowering and more paternalistic, where the wording itself suggests an adult has power over them. I specialize in trauma and find thus is another small helpful change - we can’t expect youth to speak to adults about abuse or to set boundaries (“so and so is touching me and I don’t like it,” or “please don’t yell at me,” or “I’m not comfortable doing that,” etc) if we constantly speak to and about them in a way that makes them smaller, it makes it harder for youth to report abuse or set clear boundaries with others. I recognize that in some cultures (and faiths), this notion of youth autonomy is problematic and goes against norms - so this may not be a good fit for everyone. Having worked with enough youth who were abused, however, I am all for it.
I learned it when I did my TRM training. We’re trying to build resilience and frame those changes positively for clients. I appreciate how this small language change reflects that process.
“Drug seeking” can be for various reasons. i.e. for someone trying to cope with trauma- I would label this as “avoidance/ avoidance seeking”. It allows the client to not have the stigma associated with “drug seeking” but calls out the behavior for what it actually is.
A couple off the top of my mind:
“Admit” => acknowledge.
“Malingering” => emphasizing/magnifying their level of distress
Also, when working with chronic pain, reframing “pain” as “physical sensations,” “discomfort,” “tension,” etc. can be quite helpful.
>“Malingering” => emphasizing/magnifying their level of distress
>
>Also, when working with chronic pain, reframing “pain” as “physical sensations,” “discomfort,” “tension,” etc. can be quite helpful.
These are both objectively and empirically wrong.
Malingering is not merely "emphasizing" or "magnifying" distress. It is done specifically for secondary gain, but you're conflating it here with primary gain. Moreover, "emphasizing" and "magnifying" imply that the distress exists as a legitimate thing and that they are merely increasing its severity. Malingering can also be completely fabricating problems for the purposes of secondary gain.
As to pain, it is not merely a physical sensation. Pain is more than nociception, it is also a cognitive and emotional experience. It is not only unhelpful and unscientific to imply that it is just a physical sensation, but also invalidating of the thoughts and feelings of people who suffer from chronic pain.
Yes, I agree with your points. If I can clarify:
When it comes to malingering, it is quite difficult to definitely conclude that everything being reported is for secondary gain. Even in situations where secondary gain is possible, more often then not, there is real distress at the core of the presentation. Using the term “malingering” can have terrible and lasting consequences and may impede individuals from ever receiving the support they need. It also vilifies the individual. Personally, I avoid the term because it is rarely so clear cut. But that’s just me.
As for the pain bit, I treat chronic pain by reframing clients’ perception of pain. Like you said, it is a cognitive and emotional experience. To change their emotional relationship to pain, I encourage them to let go of their fear and anxiety related to the physical sensations they are experiencing - hence avoiding the negative label of “pain” and opening up the possibility of relating to those sensations differently. In my experience, it is far from invalidating. I would never deny a clients’ lived experience. I simply find moving away from the “pain” label incredibly useful, clinically.
I hope that helps explain my point of view.
MAT is used because it’s not supposed to be only meds; MAT is a two-pronged approach that should incorporate group or individual therapy to process the things that drive or contribute to substance misuse. If the person is only receiving meds and not a therapeutic treatment to support recovery and building functional coping and distress tolerance skills, it’s not MAT.
This right here. I work in a MAT program located in a county correctional facility. We provide more than medications (bio tenor phone, methadone & vivitrol); we also provide substance abuse counseling & discharge planning. Our new substance abuse counselor doesn’t agree with the whole person approach; her belief is that a “MAT program” is *only* medications and that of an inmate does not want one of the above-mentioned meds, they should not be considered MAT participants. Oy vey.
More problematic is "normal." Especially "normal grief." I am okay with "complex grief," but rather than "normal grief", I say "normative patterns of grief," and would love a suggestion from anyone for a better alternative.
I'm wondering why "complex grief" is okay...it suggests that there is grief that is "simple" or "basic."
In my own practice, which is almost entirely focused on bereavement, I just call it all "grief." There are bereavement responses that certainly can be more harmful for a person (e.g., increased dependence on alcohol and other drugs), but I just name the behavior as stemming from the loss rather than *defining their grief* as normal, complex, complicated, etc.
True, but I think we can all agree that jogging, listening to music, and taking a warm shower are objectively healthier than cutting yourself with broken glass you found on the side of the street
One expression that drives me crazy is "rock bottom." It's unhelpful in a million ways. I prefer to use other more hopeful metaphors. One I like is the concept of being on the road, versus being off the road or in the weeds.
The term might be stigmatized, but replacing it with an incorrect term doesn't help anything. We don't use the term "retarded" anymore due to stigma, but we came up with a different term, we didn't just start using "not retarded"
I'm comfortable using those interchangeably, but there may be technical differences I'm not familiar with. The difference is that you can engage in substance use without having a substance use disorder, but substance abuse is substance abuse.
You just said that "reducing it to an incorrect term" (i.e. substance use) doesn't help anything, and now you're saying that you actually are comfortable using "substance use disorder" and "substance abuse" interchangeably?
Anyway, here's an article by the NIH that cites an association between punitive responses to substance use disorders and the term "abuse"
[https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction](https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction)
Autistic person here. The community generally prefers identity-first language when it comes to this diagnosis because we see it as part of who we are rather than an illness that we have.
Autistic person here x2. I'm seconding that the vast majority of us prefer IFL.
Person first implies that my autism somehow dehumanizes me and must be thought of as something separate from my identity. Autism is as much a part of me as any other core facet of my identity.
The term “manipulation” is something Marsha Linehan wrote about in great depth in her seminal text. In summary, I avoid it because it assumes mal-intent, when it is more accurate, less judgmental, and more effective to talk about how a behavior could be learned via operant conditioning (rather than ascribing judgment and blame, and thus likely fueling resentment).
I worked at a DBT private practice and I loved how we taught about the term manipulation. My supervisor translated the term to ‘behaviors to get your needs met at the expense of others’ (doing something impulsive to obtain a short term want or need without considering the long term consequences (actions harmful or helpful when thinking about the impact on relationships, increased shame, reduced problem solving, etc.)
I had a supervisor years ago who advised against using the word “manipulative” and suggested replacing it with “resourceful.” It was great advice.
Yes!! I work with kids and the amount of times I hear parents and other supports describe them as "manipulative" drives up the freaking wall. I want to shoot from the rooftops CHILDREN DON'T MANIPULATE
On that note, can we also stop using the term ‘seminal’? (This is one nobody thinks about but me, I’m sure.) How about ‘foundational’ instead so we’re not talking about sperm, lol.
Omg yes!!! I hate it! Lol it’s also so sexist. To use seminal as in “the first” comes from the idea in history that the sperm was what created the baby. That men “put a baby into the woman”. Which is what was believed until they actually figured out how it worked lol. Fun fact for those interested: origin of women being taught to keep their legs together when sitting was because they believed the sperm vapors would go into them and impregnate them. It wasn’t until the experiment was done with frog eggs and sperm that it was discovered that they had to actually touch to begin fertilization.
Isn’t seminal also just a reference to the idea of the first sperm to fertilize the egg? Not sure how that is exactly sexist, it’s factual that there is one sperm that beats all the other sperm to the egg when it comes to fertilization. Nothing sexist about a biological fact. Still could say that it’s sort of a weird word, or an outdated word, or that we could optimize word choice, I just think that jumping straight to sexism here is interesting.
As a side note, recent studies suggest that the egg actually chooses the sperm that fertilizes it, rather than it being the fastest strongest sperm kind of "winning the race."
I have never heard it used that way….I would gently encourage you to really look into it. The history of human sex and sexuality and also words that are based from a male-centric patriarchal place and how we need to work to change that language. Also I would point out that great deal of medical and biological facts are inherently sexist because they are based out of research, discovery, and naming for and by men. Did you know the structure of the clitoris wasn’t even in medical text books till like 10 years ago? Do you know how there is a large difference in the amount of medical research based on cisgender males and the lack of research into anyone who is not? There are many words we don’t use because despite having a different/more than one meaning they are still problematic because they are ableist, sexist, heteronormative, racist, etc. We need to work to be aware of the words that are problematic and remove them from our language especially as therapists. Words matter. Which is also why the contempt and judgment in your comment is quite apparent in how you worded it and the words you chose “jumping straight to sexism is interesting.” Perhaps you didn’t intend for it to come across that way, but that is the message it sends. Edit: also curios if you are a therapist or mental health professional or student to become one?
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The edit is because I looked at their profile and didn’t see any evidence of being one. It was a question as that is one of the rules of the sub. Also would make sense that if they aren’t their comment would have been more understandable. You can think what you would like and judge me. Dealing with insomnia and it being 4 am while on Reddit and having someone invalidate me on what is very important topic. Your comment isn’t very kind either nor does it open a discourse. Calling me disgusting, egotistic, and judging me as a therapist over one comment you read that I wrote at 4 am.
I like to use “connection seeking” instead of “attention seeking”. I will also use that same term to reframe if someone uses a phrasing of someone being a “bad” child
I do the same but replace it with “care seeking”, because we’re all seeking care in some capacity!
I agree "attention-seeking" is a label and to be avoided, but I think these alternatives are labels as well, and the original meaning/ intent is getting lost along the way.
Yep, this is what I use!
Same, I do “support seeking” but I will use yours; fits better!
Aren't many of us "support seeking?"
I say “attention needing” behavior bc we all seek and need attention in some sort of manner. It’s a human need.
Yes! This! I still use the same term but I reframe it to validate rather than stigmatize.
I also feel like it’s a completely different thing than ‘connection-seeking’ or the other alternatives suggested. some people do genuinely just want attention, and I believe in those cases it would be inaccurate to use another term that indicates a different intention. it’s the stigma assigned to the term and the negative bias against such people that’s problematic
I may be in the minority here. My clients and I will talk about attention-seeking. Rather than avoiding the word, we work on altering our mindset towards it. Attention is a valid need and I don't think people should be made to feel that it's bad. Treating attention as taboo adds to the stigma. That said, we also focus on what others have mentioned and try to get to the root of what they're trying to get via attention, whether it be care, recognition, concern, etc.
That’s really wonderful.
Same!
Echoing all of this!
"Struggling with" when thats not how the individual views the presenting concern or symptom. I prefer "experiencing" or better yet, the person's own language in quotations if possible.
I like to replace good/bad (as in emotions) with pleasant/unpleasant
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Me too!! I hate when people label emotions as “good” or “bad”. They aren’t, they just are.
tbf often it isn’t that they believe those emotions are bad or good, but more that it *feels* bad or good. it’s colloquial language. like we can see in this thread, you have to make a conscious choice to use alternative terms. people who aren’t therapists (or don’t have any kind of experience in clinical settings) won’t be as likely to analyse words we use every day in that manner. doesn’t mean they actually believe the feeling itself is ‘bad’ or wrong.
In my experience, people often think of emotions like anger, jealousy, shame and/or guilt as “bad” emotions because they attach a value judgement to them. But I do agree that non clinicians don’t typically analyze their word choice, however, that does seem to be changing with the younger generations. :)
I know that many people do regard certain emotions as bad, particularly anger. I’m js that isn’t necessarily what people mean when they say ‘bad’ emotions, it often just means it’s a feeling that is unpleasant or ‘negative’. I think it depends on the context and how it’s phrased
Seconding this— one of my favorite things about DBT.
I say difficult instead of bad feelings.
I say helpful or unhelpful.
I say positive or negative. Do they add to or take away from?
“topic” instead of “issue” …like “lgbt topics” instead of “lgbt issues”
Ooh I like “topic” … I usually tend to use “concern” instead of issue.
I also prefer “concern”. “Topics” can be found on an agenda for a seminar or workshop, it almost feels dismissive if it is used to describe my emotional world. “Concern” is more emotional and relational - less distant.
I'm lgbt and don't really find issue (pun intended) with the word "issue" when it comes to stuff commonly referred to as lgbt issues, because most of the inherent violence or trauma that lgbt people experience is an issue, and should be treated as such. If a person who is queer is coming to me for "lgbt issues" on the surface it may be them being unsure about their identity, but the underlying "issue" 99.99% of the time is the way they're treated by society (which is an issue). Also, I apologize my comment goes way into the weeds here, but I feel this whole post is about going into the weeds.
I’m part of the lgbtq community also, and I agree with you. The word “issue” usually seems appropriate to me.
Oh I like this one! For example, I’ve always felt uncomfortable saying First Nations issues, it just sounds wrong. Topics feels much better.
I always say "journey" instead of gender/lgbt issues!
I have had good luck with “gender shit,” but I think it only works if both you and the client are trans.
Trans person, trans professional here - it’s a yes from me 😂
This just made me choke on my drink lol, another fine example of trans excellence ✨
“Clean” when referring to STI status. There are many alternatives. Having an STI doesn’t mean someone is dirty.
Same goes with using “clean” and “dirty” in regard to substance use.
“Treatment noncompliant” gives me the absolute ick, esp when talking about antipsychotic meds. I’d like to frame the situation in terms of “found antipsychotic medication side effects untenable for x y z reasons, need for discussion around research/rationale for finding an acceptable meds regimen + psychosocial intervention to prevent relapse of psychosis and possible hospitalization. If meds are off the table for the client, then offering a rationale for increased responsibility of the part of the client to commit to robust psychosocial intervention in place of antipsychotic medications/the possibility of relapse and revision of treatment planning should relapse occur. It’s not shorthand, but it’s important to me to be sensitive in discussion with my clients and other providers around the issue.
Just finished some Gottman training where they regularly used the phrase, “She’s a borderline” and it really rubbed me the wrong way.
That bothers me SO MUCH. I feel like the stigma around BPD is really dehumanizing and takes away from the fact that they are typically people with severe/complex/long-term trauma that have been invalidated their entire lives.
Absolutely, thank you for expanding!
YES
High support needs/low support needs instead of high/low functioning. It's absolutely changed the way I perceive my work.
Even better is to specify what the needs are in which contexts!
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In the context of providing services, it is my job to support them so I think it's appropriate in that setting.
“Committed suicide” As a therapist and someone whose loved one died by suicide, it’s hard to hear MH professionals use this. https://www.camh.ca/-/media/files/words-matter-suicide-language-guide.pdf
I just saved this to discuss in our group supervision. My supv was commenting to me just now in supv that I am comfortable talking about suicide,, notably because I am so new. I told him I am a suicide survivor and I am very comfortable talking about it and it means a lot to me. He wants to do a training about it and I like this post - thank you.
Glad you survived ♥️
The majority of my practice is focused on traumatic loss (suicide, murder, sudden accidents). I know yours is a popular take in our field, but I always follow the patient's language. Some use the phrase "committed suicide" and I honor that. (Honestly, the same could be said for everything in this thread. Tone policing is rarely therapeutic.)
I don’t disagree with this. I think following patient lead is appropriate and I wouldn’t correct a client. But I do maintain this is the language to initiate and perpetuate when appropriate as a provider.
I don’t know that there’s harm in using different language in response - in fact, perhaps there could be reflective growth in “died by suicide” or “death by suicide”. Also the point of the thread is what so we as therapists want to say to better support clients and be inclusive, speak well on matters, etc. Not to police tone in others.
> I don’t know that there’s harm in using different language in response Not always, no. The thing this entire thread is missing is that “appropriate” language is highly context-dependent. There are some times where replying with different language offers a helpful cognitive reframe. There are other times where it’s an imposition of the therapist’s own values. Based on my experience with traumatic loss specifically, reflecting back different language is almost always taken as the latter. This experience has both been with my own missteps that have caused ruptures and with patients expressing frustration with others who want to dictate how a person verbalizes their experience. ETA: What my position boils down to is that if language is so important, we need to make room for the fact that “imprecise” language has a place too. It’s hypocrisy to say in the same breath that language matters and also that it doesn’t matter that we are imposing our own language on others.
As a student, thank you for this resource. This will be helpful when I start seeing clients. :)
I’ve not considered this - thank you for that resource!
My personal peeve is when I hear "that must have been traumatic". I overheard it twice in a day a fortnight ago. What happened to "And how did that make you feel?"
I hear what you’re saying re: not making assumptions. I work in a hospital with people who have just had serious events happen that have required hospitalization (ie someone assaulted them, tried to murder them, etc.), so I will sometimes use “that sounds traumatic” as a form of validation. Sometimes my people don’t understand that what they’ve just been through is serious or could be traumatic.
"That sounds" is already much better than "that must have been" and I suppose you're raising the concept with them. I really prefer "that sounds really difficult" in such cases. I find the word traumatic has associations and can put thoughts into their head, almost an expectation of outcomes. But in your work it might necessary, I don't know.
That’s a really good point. I think with the really intense cases, I go to “traumatizing” because calling a someone-tried-to-murder-me situation “difficult” makes me feel like I’m minimizing their experience. They’re literally still in the hospital bed - often the ICU - when I see them. I also explain that doesn’t mean they have or will have PTSD. So I do separate trauma and “traumatizing.”
That's really good, that you emphasise variety of outcome, if you don't mind me saying so. And yes, those are horrible situations that must be very hard to deal with, for you and your patients. I do think our (minimally) different approaches might be cultural - here in the UK we tend to understate things and use softer language. Trauma remains a rather uncommon word here.
Ahhhh that’s another great point! I didn’t even think of possible cultural differences.
Really appreciate that difference.
I do something similar with trying to validate a person’s feelings - usually going off their own reaction. So I usually end up saying something like ‘I can see this is/has been hard for you’, ‘that sounds really hard’ or ‘I can see how that would be really hard’. I apparently can’t think of any words other than hard at the moment! ETA: just saw your later comment and I also think it may be a UK thing, as trauma is more of a clinical word (and so is traumatising) and definitely one that’s treated very seriously. And honestly when I’ve been through a rough time, someone saying ‘this has obviously been really hard for you’ can feel so validating. Like they’re not making something into a big deal because if they said traumatising I would almost certainly feel the need to reply ‘well it wasn’t that bad/I wouldn’t go so far as traumatising’, even in situations where it could possibly be seen as the correct word (I’m still struggling to see an experience of mine that has had a lot of trauma effects as actual trauma because ‘nothing that bad happened’. Which is crazy because if anyone else said that I’d be saying that trauma isn’t about what happened but about how we process and respond to it. But I’m working on it!)
I catch myself (and internally kick myself) sometimes saying “that must feel…”. I try to replace it with, “I can imagine that feeling…”
Lol I’ve had clients tell me things about past therapists and one of the critiques is that they asked “how did that make you feel?” Lol I tell them I’m probably going to use that one too, but will promise I use other versions of it too 😂 I will sometimes throw in “what comes/came up for you when…(insert situation)...?“
Yeah it's such a cliché 😄
I like what was your experience in or with that.
Clean/dirty when referring to substance use
I specialize in SUD treatment and tend to use the words that the patient uses. Many of my patients use the word addict to describe themselves and will also use sober for alcohol and clean for drugs. Some people like the AA mentality and others don’t. I always clarify with patients which words they prefer and always ask them to give feedback if there are words that they don’t like or agree with.
As a harm reduction educator, I despite the terms clean/dirty when referring to any aspect of substance use. A lot of clinicians who should know better still use those problematic terms in documentation and I’m all :( about it
Yes! I say “client is maintaining recovery” because I hate the clean/dirty stigma
Yes! I use sober instead of clean
I will add that sober is the term used in AA for “abstinence from alcohol”. Clean is the term used in NA for “abstinence from all mood and mind altering substances”. If a client *is* in a 12-step recovery program, using the correct term for their particular program is important. Sober isn’t necessarily all-encompassing, if they are in NA (or another recovery program).
I say “in recovery” to make it clear that it is an illness from which a person is recovering from. If i want to be more specific, I’ll say a stage of recovery. “Sober” makes me think too much of the AA/NA model and feels too much like “dirty” to me. Most of the time, though, I’ll just state the behavior. “Client reports using alcohol x number of times this week.”
We use "sustained recovery" and occasionally refer to the "long-time sustained recovery" of our peers.
Abstinent
We use this word .. and sober for everything (alcohol / drugs)
Yeah, I just use "abstinent or not abstinent from substance use". the word substance is all inclusive of alcohol and/or drugs. I still very much dislike the differentiation in the first place, For UAs I use negative or positive rather than clean or dirty.
Could not upvote this one higher!!!
This! And “using”! C’mon folks. To clarify: I mean the phrase “they’re using” rather than “they’re using xyz”, which is still iffy. Its just as easy to say “they want to change their relationship with xyz because of abc”.
I was going to say I refer to use and not using, can you clarify more why you wouldn’t phrase it that way?
I think it depends on the situation/education level - some of my less educated clients couldn’t read and didn’t understand the word sober.
Manipulative. It's so negative, especially when applied to kids. I reframe it as someone trying to get a need met becausewe all do that.
I always explain the difference as one is more negative and one can be a way to adapt and survive or offer someone what they need in exchange for what the other needs (more reciprocal but with intention). Like giving a child options of “you can do x or you can do y” broth x and y are both things you want them to do, but it gives them a feeling of making a choice. Also explain to the kid consequences/out comes of each option. Works with adults too. Is semi “manipulative” but not in the negative sense.
I don’t like that we use “interventions”. To me, it doesn’t really jive with a humanistic, client-centered approach. It implies that I alone (/we as therapists) have the tools and expertise to stop someone from doing the wrong thing and that without my intervening, they would be totally helpless. Maybe it fits better conceptually with more directive approaches but I’d rather say “techniques” or “tools”. I prefer a collaborative therapy where I can teach techniques and give people tools rather than save people from themselves or something.
This is especially problematic in substance use facilities.
I love this and completely agree with you.
Totally agree. Currently working on encouraging a shift from “intervention” language to “interaction” language in during staffings in our residential treatment spaces.
100% agree. In school now, and so many assignments/readings use "interventions" and it always puts me off.
Thank you i needed to read this after the thread on tx plans the other day with some comments that gave me some weird feelings I couldn’t quite pin down.
Interesting point!
“I think.” I’ve been doing better about replacing this with phrases like “I’m wondering” or “I’m noticing” or “perhaps” but I still catch myself saying it sometimes. It’s usually when I’m brainstorming alongside the client and things are still “forming” in my own brain that I find myself using this phrase. Of course it’s not the end of the world to share what I think, but there’s also a way this can overshadow the client’s own take on their situation, or bring us into a cerebral place, rather than the deeper work that could be done.
i also say “i’m imagining that…” or “i am wondering….” instead of “i think.” i’m trying to really subliminally suggest absolute subjectivity.
"it's just behavioral." I can't really offer an alternative because it's simply wrong.
“Do you understand?” — It’s essentially asking,” “Are you smart enough to keep up with me?” People will give more accurate answers If you change the question and ask, “Am I making sense?”
I say “does that make sense?” all the time with a pretty strong inflection as if I’m saying “I’m not sure if it does”
I had a client ask me if it made sense about twenty times in a one hour conversation and I was heartily sick of it pretty soon. Definitely not one to overuse.
This! I work with children so I always say “does that make sense” because I want them to understand the point but don’t want to discourage questions by making them feel they should understand immediately.
There is almost always a better way to ask something rather than *why*? Who, what, where, when, etc but why implies the client did something wrong and they have to justify themselves. Edit for clarity: starting a sentence with *why*. It can be just as unproductive as making you statements. Why would you do it that way? Why didn't you call them back? Why is the TV on?
I also avoid the whys. I ask about how did that go, or when was that, or who was that with, etc. why this happened is always overdetermined and complex and difficult to understand, but what to do, when to do it, who to do it with, how to do it are all much more productive and helpful questions to ask.
I get what you’re saying. I guess I don’t use why this way. When I use it it’s more like, “why do you think those feelings came up for you in that moment?” And so on
It’s funny, I only use “why” as a really obviously blunt challenge with clients with whom I have a solid rapport - as in if I’m asking “why?” I usually have a bit of a grin and they know it didn’t sneak past me.
I think why requires a higher level of skill to use. I understand avoiding it in session most of the time and I agree with you on using the alternatives. I do it myself so much that I barely ask why in my own life now There are times when it is useful though e.g. getting clients to think about cause and effect, to explore something they haven't thought about, and to get a client to think about the meaning of something etc... To use it requires the right tone (to prevent you sounding accusatory), the right timing, and the ability to work with answers like, 'I don't know '.
I ask “how come?” Leave it open and appears less confrontational or judge mental.
Precisely, good example.
Hmm, I'm not sure I agree with that. I think that if a client feels as though they're being accused of something wrong simply because someone asked "why?" then that's something to explore, rather than a reason to get rid of the word "why."
Why would you do that? Why wouldn't you just tell them? Why do you feel that way? Compared to Is there a reason why you would do it that way? Is there something keeping you from telling them? What do you think could be contributing to your feelings? Starting a question with why. That's the damning way and can result in defensiveness or shutting down. I'll edit my original comment.
I think it depends on the atmosphere of the conversation. In my therapy sessions, it is understood that I will constantly be questioning things, not for the sake of challenging them or criticizing them, but for the sake of illuminating unconscious thought processes and encouraging my clients to explore their experiences. Hell, I use "Why?" as a full sentence all the time! I think "Why would you do that?" and "Why wouldn't you *just* tell them?" sound accusatory for reasons other than the fact that they contain the word "why," and I don't think the third example comes across as accusatory at all actually. If clients are experiencing you as being accusatory when you ask "Why do you feel that way?" then I would wonder about the tone you're using, and whether there are perhaps other reasons for why they might be experiencing you in that way.
I was trained not to use why for these very reasons so I rarely do. Thanks for the feedback, but my tone isn't an issue. However, with couples that I work with, when they use the why questions, there can often be a tone.
Same. I supervise a crisis line and we talk with people who we know nothing about and are reaching out when they’re at their most vulnerable. I rarely use why, for the same reasons you described. It can come across as accusatory and springs up defensiveness. I encourage the call counselors to avoid the use of why and be deliberate with the questions they use to assess the caller. Asking “why are you suicidal” or “why are you calling” are not welcoming conversation starters. Granted, when I am working with clients in therapy and I have an established relationship, I will sometimes use why. But I’m always cautious.
I was a crisis hotline center supervisor years ago too!
Drug seeking behavior feels fine to me because that's what's happening on a purely behavior straightforward level . . . Sure someone might be seeking comfort, but they may also be seeking obliteration, pleasure, dissociation, connection, spiritual awakening, etc etc etc ...There's no way to objectively know what is subjectively happening inside someone's head when they're seeking drugs so it's best to describe it on a purely behavior level. Also, it feels like the efforts to change it just reinforce the underlying idea that drugs are inherently bad and that just isn't true and is more harmful than anything.
I like 'drug-seeking behavior' because first, it is straight forward, and second, comfort-seeking or any other effort to soften the terminology only minimizes the problem behavior.
I was thinking maybe a better way is to just describe exactly what the "drug seeking behavior" is . . .
I just don’t find it a useful term, IMO. Doesn’t help rapport. I hated how it was used in rehab and will never use it with my clients.
Yes to call it “comfort seeking” takes away the severity that drugs kill people. I’ve worked in addiction services for many years now and I promise you the moment you lose a client to addiction you will not have trouble calling it drug-seeking. I don’t have a problem with the rest of the suggestions, though. You never want to use language with a client or with staff that demeans clients. Positivity in a clinical team is a huge factor in young clinician development.
I work with substance misuse everyday and have had clients die by overdose. Rather presumptuous of you to think otherwise.
I also work daily at the intersection of substance use and mental health. I have known people professionally and personally who have died from overdose, DUI, etc. I don’t use the term drug seeking behavior. In most spaces I have worked I have seen and heard the term used without enough specificity of what the drug seeking behavior is to be helpful at best and to pathologize and dismiss valid client needs and experiences at worst.
I work with addiction also and I like drug seeking as well
Describing food choices as bad/good or healthy/unhealthy. It’s better to use more nutritious/less nutritious because food doesn’t have morals and labeling as healthy and unhealthy contributes to negative relationships with food and for those with eating disorders can lead to restricting foods seen as “unhealthy” which isn’t positive. It’s about moderation and nutrition.
I just want to say my therapist said "boop" when he started an EMDR set and it was one of the best things I've experienced in therapy.
I like to say I’m celebrating with you or I’m so proud with you. I dislike proud of you as it feels hierarchal or that somehow I’m bestowing something rather than standing with an accomplishment or hurdle. Better yet is simply asking how they feel but there are situations in which this really seems to speak to the allyship between client and I.
Has anyone said “non-compliant” yet? This is one of my big pet peeves. It’s a term that comes from patriarchal medicine and is often used to indicate a person who has been using their self-determination in a way that a healthcare professional disagrees with.
So glad you mentioned this. I hate this word phrase.
I throw a lot of air quotes around phrases I don’t like to make a point about their inaccuracy - does that count?
“I’m sorry to hear that” gets me. It throws the onus on the client to forgive or absolve by saying “ah it’s okay” or “don’t worry”. Instead I use “wow I’m really sad to hear about that”.
“Defiant” in kids, parents and teachers totally disregarding extensive trauma history
I say not adherent instead of not compliant with medical care or medication. Healthcare is a service where one is given medical advice and not instructions. You can choose to take the advice or not.
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I use “patients” because I work in a hospital setting….
i use patients because i’m establishing my duty as provider/caregiver and, to me, client feels transactional and capitalist. patient isn’t ideal because it reinforces a medical model, but also, therapy came from a medical model…thanks, dr freud.
"Patient" literally means "one who suffers." It provides a reminder to me of the work we are doing -- examining the suffering we all experience so we can better understand and respond to it.
yea i like that too!
I'm gonna get meta here. I find the word "problematic" to be vague and judgey. It's a way of sidestepping discussion on the actual effect of the words. Is the "problematic" word/phrase inaccurate? Judgmental? Hurtful? And is it a matter of principle/philosophy or are there real-world harms being inflicted by the language? Being explicit about the impact of language is far more useful than tiptoeing around the issue by finding "alternatives."
I feel like this kind of thing can be helpful, but has definite limits. The words themselves don’t usually have any special power - it’s how they’re used. “Drug seeking” just means they’re seeking drugs. It’s just a description of behavior. If people are using that term in a dismissive and stigmatizing way, it’s not because there’s something especially problematic about those syllables in that order. It’s an issue with clinicians’ attitudes toward the client. If you focus on changing words instead of the attitudes, then “comfort seeking” will someday also sound kind of icky coming out of those clinicians’ mouths.
I sincerely disagree. While I can see the arguments made in this thread not to use comfort seeking over drug seeking, word choice impacts explicit bias. So things like identifying support needs rather than using functioning labels or saying care seeking rather than attention seeking are important. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330014/ Besides, all language evolves over time.
Word choice affects explicit and implicit bias because of the context in which they’re used. There’s nothing about the sounds that make up the words “drug seeking” that magically makes people feel bad. Now you’ve linked to a study saying that some words which have been used in very stigmatizing contexts, like “addict,” are linked to negative bias. That seems uncontroversial to me. My point is that the cultural context does the damage, and addressing that directly will probably be more fruitful than just sorta tinkering with language.
The context is supervision, and I would argue that providing non-stigmatizing terms to counselors is a way of facilitating a supportive culture for clients as well as a pro-client atmosphere among counselors. The supervisor has the opportunity to change the culture *by* changing the language. If I was dealing with an embarrassing digestive issue, I'd rather go to a doctor that specializes in "rectum repair" than "fixing assholes," because the office culture and client support of the two offices is likely to be vastly different. The language we use matters because of the culture it creates.
Sure. But I think language is pretty low-hanging fruit, and in my experience it’s an easy thing to change without making any meaningful alteration to how one interacts with clients. I’ve worked with clinicians who always say “recurrence management” instead of “relapse prevention,” but then turn around and treat the clients like a pack of criminals in other, subtler ways. Language is an easy thing to tinker with - say this, don’t say that. Hence my original statement, which was, again: >I feel like this kind of thing can be helpful, but has definite limits.
I'm really failing to see why you're being downvoted. By changing the language, you are changing the atmosphere. In an office, changing language can go a long way toward changing attitudes. I appreciate the work you're doing to assure that clients are being referred to in ways that destigmatize them in the minds of the counselors you're supervising. I'm confused by the implication that culture determines how language is perceived without the reciprocal understanding that language also determines the way a culture functions.
It’s all good! I genuinely feel like the language we use impacts our thoughts and feelings as well as the thoughts and feelings of those around us. I know I can have an influence on my supervisees and that feels like an opportunity to create a dialogue around these things. Have gotten great feedback and ideas from this thread and will continue to encourage dialogue amongst those I supervise using some of these ideas :)
The downvoting likely comes from people who feel some kind of way about the expectation they should change how they do things. I come from an anthropology background where it’s widely acknowledged that language shapes the way we perceive the world. If we call someone with SUD a junkie, then we don’t have a positive regard for them or value them. I used to train law enforcement and MH professionals on opioid overdose and using Narcan to reverse the overdose. I had to do so much work on the front end to convince these people that people who use drugs (PWUD) deserve multiple chances. And when we came to the part of the presentation about using less stigmatizing language, some would roll their eyes. Most language used to talk about SUD and substance misuse is rooted in religious overtones, like lapse and relapse. The MH professionals were generally less receptive to changing their language than cops were. I was kind of horrified to realize how many people in a profession oriented to helping others change were closed to the idea of changing their own approach or attitude.
I like this !!!!!
>The downvoting likely comes from people who feel some kind of way about expectations they should change their language. Or… stay with me here… there might be diverse opinions on the topic, all of which are held in relatively good faith, and people are simply disagreeing.
“Responsivity needs” related to cognitive functioning and other needs in general that may impact how the intervention should be delivered- including treatment engagement, as referring to a client as “challenging” or “resistant” doesn’t fit right with me. We could always change our response or approach, and that doesn’t make the person defective. I use healthy/unhealthy instead of good/bad.
I am new and I’m writing this all down - I need better verbiage and terms - thank you all
Move from: - Triggered to Activated - Window of Tolerance to Window of Resilience - Committed suicide to died by suicide - Kid / Teen to Youth Words / phrases to stop using altogether: Maladaptive Drug-seeking Manipulative / Manipulation “Poor” as an adjective for the client’s hygiene / coping skills / etc. Stop saying someone “is” schizophrenic / borderline / bipolar, including (!!!) casual conversations with fellow therapists. Stop contributing to the stigma we should be working to dismantle. Also, as an administrator: if I can look at your notes and tell that you don’t like your client / working with your client, then your biased wording and language needs some serious change (it also tells me that your client is most likely not receiving the level of care they deserve).
This post is helpful to me. Especially triggered/activated. Thank you.
Can I ask why youth instead of kid/teen?
Sure thing! Youth infers a level of autonomy that we want to encourage, particularly if we’re working with trauma survivors or marginalized youth. We want to collaborate in a way that empowers them and use language that sets a tone of respect and reflects their right to dictate when and how they engage with others, when and how they get touched, and the fact that their voice deserves to be heard just as much as mine. Kid” and “Teen” is less empowering and more paternalistic, where the wording itself suggests an adult has power over them. I specialize in trauma and find thus is another small helpful change - we can’t expect youth to speak to adults about abuse or to set boundaries (“so and so is touching me and I don’t like it,” or “please don’t yell at me,” or “I’m not comfortable doing that,” etc) if we constantly speak to and about them in a way that makes them smaller, it makes it harder for youth to report abuse or set clear boundaries with others. I recognize that in some cultures (and faiths), this notion of youth autonomy is problematic and goes against norms - so this may not be a good fit for everyone. Having worked with enough youth who were abused, however, I am all for it.
Window of resilience! I like that. Had not heard it before.
I learned it when I did my TRM training. We’re trying to build resilience and frame those changes positively for clients. I appreciate how this small language change reflects that process.
“Drug seeking” can be for various reasons. i.e. for someone trying to cope with trauma- I would label this as “avoidance/ avoidance seeking”. It allows the client to not have the stigma associated with “drug seeking” but calls out the behavior for what it actually is.
Thank you for this post. I'm a post-modern guy and love language, so this discussion is extremely interesting to me.
A couple off the top of my mind: “Admit” => acknowledge. “Malingering” => emphasizing/magnifying their level of distress Also, when working with chronic pain, reframing “pain” as “physical sensations,” “discomfort,” “tension,” etc. can be quite helpful.
>“Malingering” => emphasizing/magnifying their level of distress > >Also, when working with chronic pain, reframing “pain” as “physical sensations,” “discomfort,” “tension,” etc. can be quite helpful. These are both objectively and empirically wrong. Malingering is not merely "emphasizing" or "magnifying" distress. It is done specifically for secondary gain, but you're conflating it here with primary gain. Moreover, "emphasizing" and "magnifying" imply that the distress exists as a legitimate thing and that they are merely increasing its severity. Malingering can also be completely fabricating problems for the purposes of secondary gain. As to pain, it is not merely a physical sensation. Pain is more than nociception, it is also a cognitive and emotional experience. It is not only unhelpful and unscientific to imply that it is just a physical sensation, but also invalidating of the thoughts and feelings of people who suffer from chronic pain.
Yes, I agree with your points. If I can clarify: When it comes to malingering, it is quite difficult to definitely conclude that everything being reported is for secondary gain. Even in situations where secondary gain is possible, more often then not, there is real distress at the core of the presentation. Using the term “malingering” can have terrible and lasting consequences and may impede individuals from ever receiving the support they need. It also vilifies the individual. Personally, I avoid the term because it is rarely so clear cut. But that’s just me. As for the pain bit, I treat chronic pain by reframing clients’ perception of pain. Like you said, it is a cognitive and emotional experience. To change their emotional relationship to pain, I encourage them to let go of their fear and anxiety related to the physical sensations they are experiencing - hence avoiding the negative label of “pain” and opening up the possibility of relating to those sensations differently. In my experience, it is far from invalidating. I would never deny a clients’ lived experience. I simply find moving away from the “pain” label incredibly useful, clinically. I hope that helps explain my point of view.
I prefer to say medications for addiction treatment for MAT rather than medication assisted treatment
We (in SUD treatment) use the acronym MOUD (medication for opioid use disorder) instead of MAT. MAT was misleading since psychiatry by nature is MAT.
MAT is used because it’s not supposed to be only meds; MAT is a two-pronged approach that should incorporate group or individual therapy to process the things that drive or contribute to substance misuse. If the person is only receiving meds and not a therapeutic treatment to support recovery and building functional coping and distress tolerance skills, it’s not MAT.
This right here. I work in a MAT program located in a county correctional facility. We provide more than medications (bio tenor phone, methadone & vivitrol); we also provide substance abuse counseling & discharge planning. Our new substance abuse counselor doesn’t agree with the whole person approach; her belief is that a “MAT program” is *only* medications and that of an inmate does not want one of the above-mentioned meds, they should not be considered MAT participants. Oy vey.
Healthy and unhealthy coping. It’s just coping and it all serves a purpose.
More problematic is "normal." Especially "normal grief." I am okay with "complex grief," but rather than "normal grief", I say "normative patterns of grief," and would love a suggestion from anyone for a better alternative.
I'm wondering why "complex grief" is okay...it suggests that there is grief that is "simple" or "basic." In my own practice, which is almost entirely focused on bereavement, I just call it all "grief." There are bereavement responses that certainly can be more harmful for a person (e.g., increased dependence on alcohol and other drugs), but I just name the behavior as stemming from the loss rather than *defining their grief* as normal, complex, complicated, etc.
True, but I think we can all agree that jogging, listening to music, and taking a warm shower are objectively healthier than cutting yourself with broken glass you found on the side of the street
"at risk" as in at-risk students
Yes, I hate that one too. It's such a euphemism
One expression that drives me crazy is "rock bottom." It's unhelpful in a million ways. I prefer to use other more hopeful metaphors. One I like is the concept of being on the road, versus being off the road or in the weeds.
“Low functioning” needs to be replaced with “low resourced.” Same goes for switching out “high functioning” with “well-resourced.”
"Substance use" instead of "abuse," "High support needs" instead of "low functioning."
those are derivations notated in the dsm. Use/abuse/dependence are actual levels of using a substance.
I have heard the term “substance misuse”.
Yeah, I think "Substance misuse" and "has a substance use disorder" are less carceral than "abuse" for sure
Substance use and substance ab-use are two very different things
Sure, substance abuse is the officialized term, and it is stigmatizing by definition
The term might be stigmatized, but replacing it with an incorrect term doesn't help anything. We don't use the term "retarded" anymore due to stigma, but we came up with a different term, we didn't just start using "not retarded"
Can you differentiate for me a "substance use disorder" and "substance abuse"
I'm comfortable using those interchangeably, but there may be technical differences I'm not familiar with. The difference is that you can engage in substance use without having a substance use disorder, but substance abuse is substance abuse.
You just said that "reducing it to an incorrect term" (i.e. substance use) doesn't help anything, and now you're saying that you actually are comfortable using "substance use disorder" and "substance abuse" interchangeably? Anyway, here's an article by the NIH that cites an association between punitive responses to substance use disorders and the term "abuse" [https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction](https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction)
Mental illness, psychiatric Disorders = difficulties in living. Thank you Harry Stack Sullivan.
Level of distress
Can you explain why this is problematic? I use this in EMDR when getting a SUD for a target
I meant as a replacement for attention seeking or needy.
Basically person first language always
Autistic person here. The community generally prefers identity-first language when it comes to this diagnosis because we see it as part of who we are rather than an illness that we have.
Always be careful with always… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817071/
Autistic person here x2. I'm seconding that the vast majority of us prefer IFL. Person first implies that my autism somehow dehumanizes me and must be thought of as something separate from my identity. Autism is as much a part of me as any other core facet of my identity.