When any mental health professional is first getting started in their career, one of the things they need to do is find their therapeutic voice. That therapeutic voice can vary a lot from one professional to another, and there’s a tendency to settle into and get very comfortable with it. Some people will use more clichéd therapist-y statements and questions than others; I saw another blogger describe this as “shrinky stuff”. I’m thinking of things like: “How does that make you feel?” “What I hear you saying is…” “It sounds like you’re feeling…”
I decided early on in my mental health nursing career that I wanted to avoid using therapist-speak as much as I could. It just didn’t feel natural for me, and felt like it would be a barrier to bringing my genuine self into interactions. That was later reinforced when I later became a patient as well. Excessive therapist-speak it just seemed contrived. Of course it doesn’t mean that the therapist isn’t being genuine, but I just have a hard time getting past it.
There are certain things in particular that grate on my nerves, both when I hear colleagues doing them and when I’m the client on the receiving end. My biggest pet peeve? Empathic statements worded as simple reflections drive me absolutely bonkers.
What do I mean by this? Obviously empathy is a good thing, but there are different ways of demonstrating it. In psychiatrist Shawn Christopher Shea’s book Psychiatric Interviewing: The Art of Understanding, he described two different kinds of variance in empathic statement. One is level of intuition implied, ranging from reflecting back what the client said to getting deeper into underlying meaning. The other level is the degree of certainty vs. hesitancy with regards to knowing the client’s experience that the clinician uses in their empathic statements
At the bottom of the intuitiveness scale, you can get statements that are only a small step up from parroting back to the client what they just said. When a MH professional does with me, my reaction is to want to throw a chair at them. Sure, it conveys that they’ve listened on a superficial level, but when my friend pet parrot could do the same thing for free, it’s really not helpful. I know what I said. I don’t need to hear it again.
As a nurse, at times I’ve had nursing students tagging along with me. I’m terrible with students, because a) I can be kind of crotchety (okay, more than kind of), b) I get easily frustrated, and c) I tell them to knock it off with the simple empathic statements that they’ve been told in school that they should be using.
Also annoying is getting into the high end of the certainty scale. If high level intuited statement is used in conjunction with a high level of certainty, especially if they get it wrong, then it feels like I’m stuck with some jerk who feels the need to tell me what I’m feeling, while at the same time their head seems to be stuck firmly up arse.
I’ve never done psychodynamic therapy, but I did have a strongly psychodynamic-oriented psychiatrist the last time I was in hospital. I was punted over to him because I had repeatedly been telling the psychiatrist assigned to me for the first part of my hospitalization that he was a jerk, we had no therapeutic rapport, and he wasn’t helping me. “Telling” is perhaps too soft a word; there was yelling involved as well. So there I was, certified in hospital after a suicide attempt, and this psychoanalytic dodo bird who’d been newly assigned to me was asking me how I felt when my brother was born (I was three years old at the time), when I first had sex, and how I felt about sex. This is the initial interview. In hospital. Not the place for a Freudian sex-travaganza.
While there are some good ways to use therapist-speak, it’s not a good thing if it annoys the client. And I can’t be the the only crotchety one out there.
Have you had MH professionals who have used annoying versions of therapist-speak with you?
Originally published at http://mentalhealthathome.org on July 9, 2019.