LEARNING TO BE SPECIFIC AND DETAILED
One of my supervisors once told me, “Never ASSUME you know what the client means. Ask and analyze.”
As I was presenting the details of a case to another supervisor, he often would ask me to stop my presentation and to talk about the meaning to me of a client’s comment. He asked me to freely associate to the comment. From those intense, lengthy explorations, I learned about the riches contained in every comment… if we teach ourselves to think deeply about each one. Every comment represents a depth of understanding of our client and our own reactions, all of which can help us to help the client.
I once attended a staffing led by Karl Menninger. He stopped the presenter after each fact or sentence and invited the group of us therapists to bring out all the meanings we could think of for each fact or detail.
Another influence upon me was the writings of the famous analyst Theodore Reik, who wrote long involved treatises exploring his thoughts, which had been stimulated by a client’s single gesture or comment.
The Solution Focused therapist, Insoo Berg, developed detailed future scenarios with her clients. Carl Rogers reflected specific emotions, working to be accurate and empathic.
All of these supervisors and masters had a common message to understand the client, to achieve specific, detailed knowledge of the meaning of the client’s words and ideas, and to communicate with the client in specific language.
So, we see that everything the client does communicates all of herself or himself. Psychotherapy works best when the client experiences the therapist’s empathy and understanding, which in turn requires a depth of understanding. We need a specificity of knowledge about the client and clear thinking about what each client uniquely presents. Therefore, to repeat, never assume you know what the client means: ask, ask, and ask.
I mention these experiences precisely because I so often hear therapists not only fail in meeting this standard of specific, deep thinking, but almost going in the opposite direction. That is, I hear therapists use ambiguous, abstract buzz words as if the words had a specific meaning. These buzz words have different referents for different clients and families. So we can’t know exactly what the words mean to the client. We definitely can’t assume the client understands a buzzword when we use one ourselves.
And worse yet, when we as therapists use those words, we can assume our message to the client is that we will not think deeply, and we will not ask the client to think deeply; we will not probe the client’s experiences and connect them to his or her difficulties; we will condone moving to the surface of life experiences; and we will support the client’s dysfunctional defenses.
Buzzwords are imprecise words, purposely vague words. Therapists hear clients use these words, but they often do not find out their meaning to the client.
In contrast, jargon or argot means words with precise meaning which is esoteric, that is, known mainly to professionals. Psychology has an argot of hundreds of jargon-words, which help us define and describe what we are observing. Sometimes therapists use jargon with clients without explaining the meaning of the terms, which is also a problem.
Many buzzwords, such as “stress,” began as jargon, but have lost their specificity of meaning.
Some of the buzzwords are psychobabble; words that are pseudoscientific and have an air of being plausible and useful, but in the end the words are a way of revealing almost nothing specific.
Some of the most common such buzz words used in therapy include these:
Act out – It is used to mean hostile behavior, including hostile words. This has little to do with the precise meaning of the term. Acting out is a psychological defense in which the client expresses a conflict in action rather than in words. Acting out is an unconscious process, not necessarily connected with aggression. It is not a label for the manifest behavior, nor is it limited to aggression. Therapists should avoid the incorrect usage of this term and should rather describe the behavior of the client specifically. Thus, if the person is talking back or swearing, say the person is confrontational, talking back, defiant, swearing, or what have you. Calling it all “acting out” obscures the meaning and, besides, it is being used in a pejorative, often dismissive way.
Anal – It is used to mean overly organized or retentive (holding on to items which may not be useful). This bears little resemblance to the psychological meaning of psychosexual impulses and behaviors characteristic of the second year of life. It is almost always meant in a critical way.
Attention – This is almost always used pejoratively for a motive for behavior, to be paid attention to for attention’s sake. Attention-seeking is used to mean the attribution of a negative, almost frivolous or invalid motive for a person’s behavior, that is, to have someone notice. It is shockingly dismissive of the truth of the client’s behavior. I heard this term from a mother in a session as she dismissed her daughter’s feelings of being cast aside when the mother remarried, “Oh, she just wants attention.” Not an hour later, I heard the term used by a mother on a mystery show as she chose to dismiss her daughter’s allegation of sexual abuse against a family member as “Nothing but wanting attention.” Yet “attention” refers to necessary and normal interaction with important figures in one’s life, interactions which support sense-of-self and which provide essential positive reinforcement. Saying a child is attention-seeking actually misdirects us from probing into understanding the child’s legitimate needs. It implies the family should repudiate and reject the behavior rather than understanding the child’s needs and motives. It can be heart-breaking when a therapist lets this usage go or, worse, uses it herself or himself, such that a child’s bid for her mother’s love or an act expressing a need to be understood or validated is treated as nothing at all, merely, seeking attention. Don’t we all need to be attended to?
Attitude – This term is used to mean disagreeable behavior, talking back, or non-compliance. But which is it? It has become a vague global reference. In psychology, an attitude is a disposition toward some object or situation, that is, a belief and an emotion about something. Attitude tells us how someone thinks and feels about a thing. That is entirely a neutral term. The term should not be used to mean only a negative judgment of a person. When someone is described as having a “bad attitude,” the therapist should learn the detailed meaning of that statement. What did the person do? What about it is “bad?” “What behavior would be preferred?” “What will happen differently when that preferred behavior occurs?”
Can’t stand it – This is a vague statement of a strong negative reaction to an event or situation, a reaction that taxes a person. But this phrase avoids speaking to the actual emotions being experienced. Are they sadness, pain, anger, hurt, exhaustion, disappointment, disapproval, emptiness, resentment, irritation, etc.? Are they reminiscent of an unresolved past experience? Clinicians should ask what the client means when using this term.
Closure – Closure is used to mean a sense of being over an unpleasant experience in a way the person considers an acceptable or needed way to complete the experience. But the word covers up the process and mental work needed to attain that emotional outcome, namely a reduction in emotional response and emotional conflict regarding an experience. Seeking closure is actually a fantasy of how one hopes to feel given some psychological process by which the complex of thoughts and feelings attached to some event or person will be transformed. Again, ask the client what is meant by it, how to know when it is achieved.
Dealt with, deal with – This is used to mean coped, worked through, or processed. What does it mean to “deal with” something psychologically? Talk about it? Think about it? Confront someone? Come to a new understanding? Stand up to the situation? Cope effectively? Assert feelings? Feel at peace? The therapist should be looking at the process and not accept vague language. For example, if the therapist said, “You dealt with that effectively,” the therapist wasted an opportunity to reinforce a specific skill or coping strategy. It would be better to highlight and reinforce the new skills, saying, “You showed tact and thoughtfulness when you spoke with Johnny and tuned into his state of mind. Think how far you have come from when you used to scold him for this behavior and that didn’t work. But now you suppressed that urge and really worked to understand his feelings and it helped tremendously.”
Empower – The term is used loosely to mean to support client autonomy and self-determination, but generally we see the usage narrowed to encouraging the client to make a decision or take an action. E.g., “I empowered her to stand up for herself.” Now there is one vague and illogical, but all too common statement. The term derives from social, political, and economic processes that help groups of people gain control over their lives in the political arena by acting on the positions in which they believe; specifically, acting against a prevailing power structure. If the therapist means to engage the client to make decisions and follow through, such as to overcome dependency or to develop identity or to use assertiveness skills, then say just what the client does. To use the word ‘empower’ is to use much more vague language which focuses on the therapist’s actions and not the client’s demonstration of competencies, which can be reinforced. One can’t really empower someone! The client is demonstrating personal power. If the power is only given or permitted (by the one empowering), then it’s not true power. So when therapists say they empower the client, they would be advised to describe their intervention in more psychological terms, such as ‘used assertiveness training’ or ‘helped the client lay out pros and cons.’
Feel – “Feel” is too often misused to mean opinion or attitude rather than emotion. One should be clear whether she is asking “What is your emotional reaction to that?” or “What thoughts or opinions do you have about that?” When the client talks about a reaction, be clear whether the person has articulated an emotion or an opinion. Has the client given an affect or his/her theory of the situation? If we accept that, we have not asked the client to probe the self first, to come up with an accurate ‘theory’ based upon exploration of the facts and details of his or her reactions and emotions. When the client responds to a question of feeling by giving an opinion, the therapist might say, ‘Oh, that is your opinion about it, but what did you feel, your emotions?” “You are giving your notion of why that happened, but first let’s get all the thoughts and emotions out and come to an understanding of what it means.” This is a message about the level of specificity required in effective therapy. One of the most common statements in a therapy session is “What do you feel about that?” Unless we have taught the client that we mean, “What are the emotions you have in reaction to that?” then the answer is just as likely to be an opinion as an emotion. If we are looking for an emotion or an opinion, we need to be clear which.
Fight – Fight is a word that could mean difference of opinion, disagreement, argument, quarrel, or some kind of violence. Its meaning must be exactly specified. Using a word which better conveys the severity and intensity of the situation will help the client better differentiate amongst levels of conflict.
Handle it, can’t handle it – There are used to mean a capacity or incapacity to face a difficult situation. By what means does or did the client work through feelings about a situation? What coping or defense mechanisms are employed? What cognitive beliefs? “I handled it” does not tell us the strengths used. “I can’t handle it” does not tell us the emotions experienced. The command, “Handle it” and the similar phrase, “Get over it” completely underestimate the psychological work that needs to be done and how it is done. How can we help encourage successful coping if we do not specify the skills to use and put them into language?
Issue – This word as multiple meanings, such as, an unsolved problem, a difference of opinion, neurotic thinking, etc. It is often used to mean a statement that disagrees with another person or confronts the other person, as in “I have an issue with what you said.” “You have issues.” Better would be to say “I disagree” or “I disagree with what you are thinking” or “I am concerned with your thinking on that subject.” The word ‘issue’ ends up being critical and accusatory, while being meant purposely to be vague. “I have an issue with that” merely means I disagree. “You have an issue” means questioning the other’s position or thinking. If the word is meant to be critical, it leaves the recipient with no clarity about what to do, what the objection may be, or what changes may be desirable. Like “Handle it,” “You have issues” is yet another term that glibly implies the person should repudiate some thoughts, behavior, or opinion. Clinicians know that changing is more complex a process than that!
Let go, letting go – This is used to signify ending of responding to a loss or a painful experience or dashed hopes and expectations. This is especially vague, as it does not address how the person is to accomplish resolving the experience and what the outcome of that process may be. Is it a process of mourning? Adjusting expectations? What are the emotions the person must work through? What does it mean to say, “I let go of that”? It also violates normal processes of grief – it takes time and psychological work to recover; one cannot “let go.” So as with some other buzzwords, it is dismissive. Find out about the client’s emotional experiencing.
Listen – In today’s parenthood, “listen” is almost always used to mean comply or obey rather than to hear. If compliance is intended, the therapist will be more effective if words such as comply or obey are used. Furthermore, the word ‘hear’ might be meant when we communicate with someone with ADHD or a teen fiddling with a smart phone or hiding under a jacket. Or perhaps both hear and obey are meant. Get it straight.
Move on – Similar to “let go,” this term is used to mean leaving behind a conflictual or unpleasant situation or an injury. But the term obscures the underlying process, the emotions involved, the reasons the event was troubling.
Overreacting – This is mainly a critical term meaning to respond with excessive drama, emotion, or display. Saying someone is overreacting dismisses what the person is trying to express. Perhaps drama is the person’s way of showing the event had a major impact. Perhaps the person doesn’t expect to be heard otherwise. Or perhaps the reaction is based upon catastrophic beliefs or the reawakened memory of an old hurt. Clinicians should find out what is behind the reaction.
Process, Processed – When used as a verb, it means discussed, reviewed, and talked about. I think therapists use this to mean something much more, namely, coming to the point of understanding or insight, and then working through. The psychological processes involved are much richer than the term “process” implies. It would be more helpful to spell out the psychological work that has taken place. ‘Process’ can also mean a sequence of interactions in a session, each one stimulating the next, displaying the client’s patterns. This is jargon that has a useful meaning in a case conference, but little meaning in a therapy session. “Your interaction” or “The way each reaction followed from the one before” would have more meaning for the client.
Respect – Generally this is used to mean follow directives, comply, and speak courteously to. But the meaning is idiosyncratic; each person using the term means something different. One should always make sure to know what the client means by the term and the therapist should not use ‘respect’, but should use that more specific meaning.
Shut down – This term is used both to mean the client is not talking or the client is not sharing emotions. It could also mean having no feelings. The term has absolutely no psychological meaning or utility. Rather, the therapist should refer to the process behind the observation, namely, constriction, numbing, inhibition, resistance, suppression, blocking, anxiety, repression, etc.
Stress, stressed out – This term has an indeterminate meaning, but could refer to one’s reaction to a change or a group of events. If could just be used to mean a pile up of challenges and difficult things to do. Does it mean pressure, press of events, having too much to do, or deadlines? The term “stress” as defined by Hans Selye, who introduced it, has a scientific meaning in psychology of demand for adaptation that elicits adrenal hormones and causes wear and tear on the body. “Stressor” is the proper term for external events. Stress is about the body; stressor is about the environment. Any other use makes the terminology vague and unclear. Rather than use “stressed,” it is more helpful to refer to the underlying events and to explore the client’s reactions. “When you say you are stressed, let’s look at what events make you feel that way and just thoughts and feelings they stir up.”
Support – This term is so broadly used, I’m not sure of the meaning of the usage! Some people use it to mean agreement or backing the person up on what they believe and do. The broadest meaning is encouragement. Most often it is used to criticize what someone else is or is not doing to agree with, accept, or encourage one. Again, it is important to ask what the user of this term means by it and not to use it in therapy. The therapist uses terms that get at the specifics, such as, “So you think you are being criticized and you feel disappointed. You were hoping to have your idea encouraged rather than critiqued.”
In conclusion, “Never ASSUME you know what the client means. Ask and analyze.”
We can add that when a client uses a buzzword, never assume you understand what the client means. It’s an unconscious attempt to be vague. Probe for the meaning. Don’t let it go by.
Furthermore, never use a buzzword with a client or about a client. It shows a lack of incisive professional thinking. That is counter-productive because it condones the client being imprecise as well and supports avoidance, which then supports the client’s problems.
Lastly, besides the disservice done to the therapy and the client by using buzzwords and not asking for elaboration, the use of buzzwords does a significant disservice to the therapist as well. It prevents the therapist from developing, that is, from learning some of the hallmarks of good clinical work, such as
- How to describe the dynamics of the client’s behavior
- How to delve more deeply into the client’s emotions, cognitions, and memories
- How to perceive and describe deeper patterns
- How to explain the thinking behind our choice of interventions
- How to think incisively and with due complexity about therapy.
If you find a buzzword escaping your tongue before you can catch it, correct it. For example, “How did you handle that?” [Oops] “What was your thinking and feeling then?” Or “What did you do then? “ Or “What were your responses to that?”
For another example, “You say you are stressed out. That means different things to different people. So let’s make sure we fully understand how it is for you. “What is it like for you?” Or, “What feelings make you say that?”
For another example, “So you say you want him to show respect. Let’s make it crystal clear what that means to you, what he will be doing that you are looking for and can appreciate.” Follow up with, “What are the ways you will know it?” and then also “Ok, then also what behavior would you like to see less of?
We guide people to understanding how the assumptions behind their thinking can be examined, challenged, and changed. We guide people to understanding how past experiences shape their reactions so they can change. All this requires specificity and a detailed understanding of the individual. Our tool is language and we use it to communicate. So let’s not obfuscate the meaning – rather, let’s be clear, incisive, thorough, and detailed in our understanding. Never assume you know what the client means; ask, ask, ask.
© Don D Rosenberg, 2012