Tag Archives: support

Buzzwords Versus Meaningful Words

Therapy Gems ©

Buzzwords Versus Meaningful Words

Buzzwords I: Common Buzzwords, Psychobabble, and Vague Jargon in Therapy

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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 of my supervisors, 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 free associate to the comment.  From those intense, lengthy explorations, I learned that if we teach ourselves to think deeply about each bit of client ‘material,’ we find the riches contained in every detail and anecdote. 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 the famous psychoanalyst, 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.  Again, that was a lesson in the wealth of meaning in client communications.

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.

One of my supervisors, the co-founder of Solution Focused Brief Therapy, Insoo Berg, developed detailed future scenarios with her clients. Carl Rogers reflected specific buzzword1emotions, working to be accurate and empathic.

All of these supervisors and masters had a common message for our understanding of the client, namely, 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. Delve into the meaning.

ON BUZZWORDS

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 buzzwords as if the words had a specific, conventional, consensual meaning.  These buzzwords 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 of them ourselves.

And worse yet, when we as therapists use those words frequently, 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 consistently 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 partially 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 meanings which are esoteric, that is, known mainly to professionals in a specific discipline.  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.  That is also a problem.

Many buzzwords, such as “stress,” began as jargon, but have lost their specificity of meaning as they have passed into popular usage. Eventually, words such as stress acquire a vague or general popular meaning.  Then therapists may use such words in their buzzword status rather than as professional jargon.

Some of the buzzwords are psychobabble, words which are pseudoscientific and always were, and which have an air of being plausible and useful.  But in the end the words are a way of revealing almost nothing specific.

This paper is a compendium of common buzzwords. First, we’ll discuss clarification as a way to underscore the point that buzzwords may block effective care.

CLARIFICATION

The most used of all therapeutic tools is the technique of “clarification,” meaning asking probing questions with the aim of gaining a more in-depth understanding of the client’s cognitions, emotions, motivations, and actions, and those memories which shape behavior. We ask CLARIFYING questions which are different from what may be used in common conversation. We may ask, “What do you mean by that?” “Tell me more about it.” “What comes to mind about _____?”  “When you think of that, what emotions go with that?”  “When you remember that, what do you think or say about yourself?”  “What emotions do you have now?”  “When you stopped talking, what came to mind?”  “Are you saying ______?”

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CLARIFICATION gives depth and color to the client’s material.
The magnified anecdote shows us the details and truth in the story.

In common conversation, we may ask, “Why did you say that?” “What do you mean?”  “Explain that.”  As I think about those questions, they usually aim to promote a discourse or to challenge a point.  In contrast to our motives in common conversation, therapy is not meant to be a back-and-forth discourse, to be persuasive, or defeat the client’s point.  Clarification is meant to direct the client to self-understanding or to gather data about the client’s dysfunctional reaction patterns.

In contrast, buzzwords are not meant to clarify. They are more likely to obscure.  We may intend to use words which are intentionally vague in order to soften a message.  When we de-enervate the message in order to be less objectionable, we are not communicating clearly.

For example, let’s say the client has just said, “Two days ago, I was fired from my job for being late again, so I spent the next day in bed and didn’t have any motivation to move the entire day.” Then the therapist said, “That really stressed you out. You just didn’t know how to handle it.”   The client answered, “It sure did.  Right.”   Where do we go now?

The use of the buzzwords “stressed out” and “handle it” obscured the possibility of significant meaning in the client’s statement. Let’s use CLARIFICATION instead of buzzwords.   Let’s say the client has just said, “Two days ago, I was fired from my job for being late again, so I spent the next day in bed and didn’t have any motivation to move the entire day.”   Then the therapist said, “First, let’s go over what happened with the firing and then what happened yesterday.”  Cl: “When I got to the office to punch in, the HR Manager was right by the clock.  She said I was late for the third time and that holds up the assembly line.  ‘Violation of company policy.’  ‘You’re suspended for two weeks.’ I argued I was only 15 minutes late and there was traffic.  She said, ‘You’re supposed to plan for that like everyone else.’  Under my breath, I called her a name.  So she said, ‘That shows you just don’t get it, do you?  Get your things and I’ll escort you out.  You are fired.’  So I called her something nasty, kind of loudly, and she said, ‘That’s it!  Leave the building, now, and we’ll mail your stuff to you.’”

When the therapist tries to empathize without CLARIFYING the story, he or she not only could be way off base, but could be condoning psychopathology. Plus, a marvelous learning opportunity has been missed.  What riches are hidden in this story!  What memories or attitudes regarding authority figures could have been discovered?  Did the client use provocation as a response to feeling small and embarrassed or guilty or ashamed?  Instead of mending his ways, he became defensive and challenging, behaviors which will not work in too many social situations and which have roots we can understand.  What memories may have shaped his perception of the manager and his choice of defenses?

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CLARIFICATION is essential in a variety of therapies. For instance, originally a method in psychoanalysis used to gather insights needed in order to make an INTERPRETATION, CLARIFICATION is used in cognitive therapy in order to extract the client’s automatic thoughts and dysfunctional beliefs from his or her experiences. In Solution Focused Brief Therapy, the therapists may seek to learn about an exception to the problem and then use clarifying questions in order to develop the story in detail.  Clarification is used in counseling generally in order to get a clearer sense of the client’s emotions.  Buzzwords and psychobabble fail to help clarify and, therefore, fail to lead to a rich understanding.

COMMON BUZZWORDS

Some of the most common such buzzwords used in therapy include these:

Act out, acting out – It is used to mean hostile behavior, including hostile words and tantrums. 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.  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.  For example, I recently received a call from a TV reporter asking me to comment on what parents can “to help their acting out children.”  This statement could have a variety of meanings.  It turns out he meant what can parents do to help children who often act aggressively as a result of a mental disorder.  By helping him ask a more specific question, I had the specificity needed to answer the question.

In another example, a 14 year-old with an Attachment Disorder kicked his mother when he felt criticized. He could not articulate how criticisms feel like statements that he is unlovable and cannot be kept, that he will be abandoned.  So his kicking rejects the statement, rejects to author of so painful and hurtful a statement, and demonstrates his inner hurt.  It gets back at the person who threatened his existence.  If we mean he “acted out” his feelings in the sense of expressing all those reactions through kicking, that is close to the meaning of the term.  If we use it only to refer to kicking as hostile behavior, that is using the term as a buzzword.  The former shows insight and attunement, the latter does not.

Take, for example, a 10 year-old girl with an Attachment Disorder whose first action was to walk briskly into the consulting room and, after the therapist sat down at the desk, to come up close enough to touch her hip against the therapist’s arm, and to say, “You’re my new therapist forever. What will be doing on that computer?”  This is acting out – she was showing through action her rapid, indiscriminate, superficial connecting with another.  But this was approach behavior, not hostile action.  The example shows further that “acting out” should not be used merely as a term for aggressive behavior.

Anal – It is used to mean overly organized or retentive (holding on to items which may not be useful) or retentive of feelings and thoughts. This usage 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, namely, 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.

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This superficial view of behavior obscures the deeper need behind the behavior – love, connection, approval, attachment.

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 TV 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.   Therapists are supposed to use empathy and understanding, not dismissiveness, as a tool for change. 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 buzzwords5need to be understood or validated is treated as nothing at all, merely, seeking attention.  Don’t we all need to be attended to?  What is the deeper need the client is showing?

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 an entirely 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?”  The use of the term attitude to mean negative behavior should never go unexamined.

Can’t stand it – This is a vague statement of a strong negative reaction to an event or situation, a reaction which 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, loss, aloneness, frustration, 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 way to complete or to ‘resolve’ that 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 and how to know when it is achieved.

Closure is an end result. But what is the process? For therapy, the word ‘RESOLUTION’ is a better jargon term with the following referents.

  • Memories of the experience cause no significant distress or impairment.
  • The person is relatively comfortable talking about it.
  • The memories are experienced as part of history, as something from the past, rather than as something vividly and emotionally present.
  • The person conceptualizes the event narrative with language suggesting mastery, survival, forgiveness, successful coping, personal effectiveness, or pulling through.

So when the therapist refers to an experience as resolved or unresolved, he or she has in mind specific elements and, in the latter case, techniques to help move towards resolution.

Dealt with, deal with – This is used to mean coped, worked through, or processed. “I can deal with it” may be true, i.e., the person can think about it without impairment, or an untrue statement meant to discourage discussion of the event or memory or situation. “I can’t deal with” is ambiguous, suggesting feeling overwhelmed, easily upset, unable to accept. 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 restraint, tact, and thoughtfulness when you spoke with Johnny and tuned into his state of mind empathically.  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.”  So “deal with it” is not an expression a therapist ought to use.

“Deal with” is also used in another way, saying “I can’t deal with that.” What does it mean?  Tolerate? Face the emotions?  Feel overwhelmed? I have heard therapists say something from a class of possible statements such as, “You didn’t deal with the feelings from your divorce.”  What does it mean?  Anything from “You have felt depressed over the sense of loss” on one side to “You have been resentful over how it ended and you’ve been acting hostile and obstructive as a result.”   The escape frombuzzwords6.jpg specificity in using a buzzword such as “deal with” is virtually anti-therapeutic.

Empower – The term is used loosely to mean to support client autonomy, assertiveness, 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.  Furthermore, by focusing on one action, the therapist has contradicted the very possibilities of the term itself – namely, the possibility of becoming empowered as a person, that is, autonomous and self-determining.   She is taking credit, which is anti-empowering.

The term derives from social, political, and economic processes which 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 upon the client’s demonstration of competencies which can be reinforced.

In a sense, 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 personal 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’ or ‘highlighted the expression of personal authority’ or ‘the client used assertiveness skills such as non-reactively stating her bottom line position.’

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 or a judgment.  Has the client given an affect or his/her theory of the situation?  If we accept the vague use of “feel,” 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 for you.”  “ You are coming up with your judgment of the situation before we have explored your emotions and the meaning of it.  Let’s hold off on that judgment and explore it first.” 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 it is that we seek.

Fight – For therapy, fight is a word which 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.  Many clients overstate a disagreement by calling it a fight.  Others understate violence by calling it a fight.  To me, a fight means an upsetting, vociferous, non-violent conflict in which hostile, critical words are expressed.  An argument is a step down.  Hitting or pushing is a step up in severity.  A therapist who finds out the details of the event and labels the event correctly is better positioning the participants to understand the dynamics and learn to change.

Handle it, can’t handle it – [Also look to the paragraph about “deal with” above.] 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 which 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 – When I hear the word, “Issue” used in a statement in therapy or in a case conference or even when a therapist is referring to her own internal challenges, I hear buzzwords7.jpgthe person intentionally softening the statement and presenting an intentionally vague picture. This word “issue” has multiple meanings, such as, an unsolved problem, a difference of opinion, neurotic thinking, etc. It is often used to mean a statement which 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.  Itbuzzwords8.jpg is also meant to mean “You seem irrational or disturbed.”  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 which 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, disappointments, 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.

buzzwords12.pngOverreacting – 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 or understood 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 – “Process” has two meanings. 1) When used as a verb, it means discussed, reviewed, or talked about.  I think therapists use this to mean something much more, namely, coming to the point of understanding or insight, then working it through.  [See the discussion of “closure” above.] The psychological processes involved are much richer than the term “process” implies.  It would be more helpful to spell out the psychological work which has taken place.

2) ‘Process’ can also mean a sequence of interactions in a session, each one stimulating the next, displaying the client’s patterns. This is jargon which has a useful meaning in a case conference, but little meaning in therapy.  “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, complying, speaking courteously to another. 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.  Asking a child to “respect” a parent would give the child no map as to the desired behaviors  — compliance, obedience, fear, mutuality, thoughtfulness, valuing, validating.  Furthermore, the range of behaviors could be so broad that the child would have difficulty approximating what is expected.  The same problem occurs quite frequently in couples counseling.  “You don’t respect me” is more a statement of feeling and judgment and not much of a guide to improvement.  The meaning could be an indictment of the partner as ego centric, a statement about feeling dismissed, a statement about feeling alone and not valued or not appreciated, or any number of others meanings.  Therapists should be getting a specific list of the meanings behind such a statement and of the desired behaviors.

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 buzzwords13behind the observation, namely, constriction, flattening of emotion, numbing, inhibition, resistance, suppression, blocking, anxiety, repression, etc.  ‘Shut down’ is a way of characterizing the behavior in vague terms which does not permit us to know the underlying process.  If a client is told he is shutting down, what is he supposed to do with that?

Space, as in “I need more space.” – Also, “I feel smothered [engulfed].” This is not a term therapists are likely to use, but it is one they will hear.  What could this mean?  I want to break up?  I am not comfortable with you?  We are becoming close more quickly than I can trust? I have avoidant attachment style, so increasing closeness makes me anxious?  I feel my independence is compromised?  I have made plans to separate?  I don’t want an exclusive relationship?  You are too demanding?  When this phrase comes up, it is important to clarify the meaning.

Stress, stressed out – This term has an indeterminate meaning, but could refer to one’s reaction to a change or a group of events. It 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?buzzwords14.jpg  The term “stress” as defined by Hans Selye, who introduced it to medicine, has a scientific meaning in psychology of demand for adaptation which 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.”  Rather than reflect “You are so stressed,” better would be “Having to react to a loss and then to financial troubles leaves you scared and interrupts your sleep.  You seem to be blaming yourself, and those thoughts make you depressed.”  You can see that getting away from the buzzword leads to more possibilities, such as exploring automatic thoughts, interpreting the defense of turning against self, or reviewing the entire process around the client’s reaction to the loss.

Support – This term is so broadly used that 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 then not to use it in therapy.  The therapist uses terms which 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.”

CONCLUSION

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 could be an unconscious attempt to be vague or is overtly dismissive.  It could have a referent for the client which is not shared in the therapist’s mind.

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 it 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

  1. how to describe the dynamics of the client’s behavior
  2. how to delve more deeply into a client’s emotions, cognitions, and memories (clarification)
  3. how to perceive and describe deeper patterns (insight)
  4. how to explain the thinking behind our choice of interventions
  5. 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.  Never assume the client knows what you mean; explain, explain, explain in clear language.

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© Don D Rosenberg, Version 1.0 2012, Version 1.1 2017

The Lingering Effects of Teasing and Bullying:

I. Traumatic Impacts

Bully pic 1I asked Howard, a 60 year-old man with a history of depression, about the social shyness for which he sought my help. Then, he told me the story of how he had been teased and bullied years before.

“When I was in the fifth grade, we moved from a neighborhood where I’d grown up the first 10 years f my life. I had friends and felt pretty good about myself. One of the fastest runners in the school, I could hit a baseball far for a 10 year-old. In retrospect, I guess I felt very equal to my friends. It was back at a time when kids had free run of the neighborhood from the library about half mile away to the big park across a busy street to a neighborhood shopping strip a few blocks away where there was a popular deli. My father used to take me there for breakfast before we would go for an outing on a Saturday. Or give me ten dollars and a list of things to buy from the bakery counter and bring home.

“Then we moved up to a more affluent area where the kids were way more sophisticated than where I had grown up. They dressed in the latest clothes, knew all the latest popular music, even knew how to dance. The athletic boys knew how to play basketball. There was no basket in the play ground at my old school, and I didn’t know anything about the game.

“So, I remember being teased by the popular kids for what we would now call being a nerd. How being clever turned into a bad thing puzzled me completely. My clothes didn’t fit in; I was ashamed of that. Someone teased me for my facial features, which were ordinary, I guess. I have to admit that a couple of years later I joined in picking on another kid for his looks. I guess we knew we were being cruel for no good reason. No, I didn’t have one particular villain. Just that there were several kids who had nothing to do with me except to say derogatory things. That hurt.

“But there was this one kid, Billy, a real troublemaker, who took everything one step farther. He was scary. He ended up in a reform school. That’s what they called it in those days, you know, for the dangerous kids. If one kid would only go so far as to say I was a bookworm – an old term for nerd, I guess – Billy went further, knocking the books out of my hand. Once, he knocked them into a puddle. If a kid might just say my nose was too big, that Billy put his palm over my face and pushed me. He always took it farther than anyone else. If some one said something about my clothes, he’d pull me by a shirt, ripping off a button, or yank the back of my collar until I fell. A real piece of work. We was a mediocre athlete, but he liked to show off that he had the best looking girlfriend or the biggest entourage. So, he would come by the school yard, but not right after school. Later. So, I got to play baseball or learn basketball. I knew to clear out by 4:30 or so, if I remember right, and keep out of his way.

“I tried so hard to excel at what seemed important there. Like learning to dance. Spending hours learning to dribble and shoot baskets and field baseballs. I got some cool clothes – one of the kids who befriended me showed me how to pick.

“But I became a follower, and did not have the same level of self-esteem as in the old neighborhood. I became self-conscious, I always worried about my impression on others. I still am. That was not part of my thinking before moving there. So, then I got to be shy in the sense of afraid to approach people. I thought they would feel I was a bother. I defined myself as unpopular. That’s what I was. My friends could criticize me and I’d take it; I’d think there actually was something wrong with me which I had to fix. As time went on, my distance from the popular kids became a universe; so I just thought of myself as part of the unpopular and different group.

“Even over four decades later, what stands out most immediately from those days is the memory of the ‘lowlights!’ I mean the various teasing comments. I can remember a lot of good things, but the unpleasant stuff is what comes up in my mind first.

“It was not just the kids. My three most immediate memories of high school are a teacher of Spanishbully pic 2 mocking me on the first day. It seems the teacher from the previous year must have said to her that I was good in Spanish and I raised my hand a lot. So a source of self-worth by being smart got put down on the first day in her class when she said in a critical way which was, I am sure, meant to put me down, “Oh, Howard ______, I heard about you, yes, Howard _______, I heard about you.”

“I remember feeling now there was almost nothing I could do to be accepted anymore. An English teacher made fun of me in class for a silly mistake on a test. I guess being a good student gets you blasted when you screw up. And a physics teacher did the same. I had winged it on a test – my fault for not studying more – and got a very poor grade. But the teacher didn’t have to announce it in class. I spent a week feeling two feet tall.

“After that, I felt equally bad when I aced a test and set a curve. Like no one would like me for that.”

“Fortunately, the skills I had shown when we moved to the neighborhood, which included spending hours practicing and a determination to master skills, helped me a lot. In my mind, getting near perfect grades in physics, a compulsion with me the rest of that year, showed up the teacher. Of course, that’s how the bullied think, that any future performance is in some kind relationship to the teasing. Proving you are better than they say. Or confirming you are as bad as they say. Now, it dawns on me the teacher probably felt reinforced by my improvement; she could get the impression that, if you mortify the kid, then he’ll do better!

Howard concluded, “I’ve been reasonably successful. But still I am afraid to approach people for fear of what they may say. Still I wonder if someone will sting me about my hair, of which there is obviously so much less, or my features or my clothes. So I pay too much attention to trying to impress people with my sports car, my bold colored clothes, art work, my upscale address, being in shape, playing great golf, trying to fit in. It’s a battle that can never be won. Each day that feels good and I think I am something special runs into the next when I am low and have to prove myself. So I’m depressed.”

Brittany told a different story.   At 56, she told the story of events 40 years before. More emotional than Howard, she was too upset to get into all the details. “I was slow to mature. So already when I was 13 or 14, I was noticed for being different, the outsider. But then the acne came. All kids got it in those days. Is it my imagination or it way less prevalent today? Look,” she said, pointing to her face, “pock marks. Lots of them. That’s why I wear a lot of make up.”

“The boys would call me names I won’t repeat. The girls, well, some took pity, which made me feel worse somehow. A few understood. There just wasn’t much you could do for it. Antibiotics. Washes. Visits to the dermatologist. Didn’t help all that much.

“Then there were the girls – nowadays we would call them ‘Mean Girls.’ Wow. They were brutal. I also had big cystic pimples on my back and the girls could see that in the locker room. They said and did things to make me feel contaminated, like it would infest them. I still can’t stand being looked at too much.

In fact, Brittany did far more to compensate than her story suggested. She developed an obsession bully pic 3with her appearance and a ritual compulsion to armor herself with medications, makeup, scarves, and a hairdo which would mask her scarring as much as possible. She had to get up an extra hour early in the morning in order to go through the ritual. Spontaneity was forbidden in her world.

These stories came to mind when I read a Chicago Tribune article, “The debilitating scars of bullying” by Candy Shulman (February 8, 2015)*.   Her brave disclosures demonstrate the inner experience of someone being teased. She notes that some years later, the bullied continue to think about the mistreatment while the bully often remembers nothing of his or her behavior.

Shulman’s story mirrors the stories of Howard and Brittany*. Particularly noteworthy is how the object of teasing and bullying develops a mindset that she is being bullied and has to protect herself from it even when it is no longer happening. Shulman thinks of it as a victim mind set.

She also points out how bullying shapes social perception and expectations. For example, she mentioned the expectation of hurt and loss, behaviors engendered by her childhood bully, which generalize to new situations later in life and throughout adulthood.

Similarly, Howard and Brittany spent their adult lives continuing to stave off teasing and trying to achieve a feelings of acceptance, feelings of which they had felt deprived during adolescence. Each forecast a likelihood that new situations and new people would treat them in the same humiliating and hurtful ways as they had experienced in adolescence. They compensated in ways they imagined would fend off attacks. This is classic avoidance behavior – continue to react as if the assault is coming even after the threat no longer occurs. We carry the threat around mentally and act as unremitting victims.

One of the most extreme reactions to bullying is to identify with the perceived violence of it and then to perpetrate violence upon the self or upon others. That makes the news. Suicidal thinking and suicidal actions as a result of bullying are amongst the strongest of reactions to it. Completed suicides attributed to bullying are often reported by the media. Mass shootings by teens and young adults are often explained as associated with chronic bullying. They have led to a movement to shift the attitudes of educators from overlooking bullying or rationalizing it to the expectation they will prevent it or stop it.

But one in five children report being bullied. Sometimes, the damage may be significant enough tobully pic 4 shape lives, as we see with Howard, Brittany, and Ms Shulman.

In these days, one can cyber-bully, namely, leave teasing or hurtful comments on the Internet or in a chat or email or on Facebook. The cruel words do not vanish, but remain visible. Rather than delivering teasing in person, the comments can be hurled from a safe distance.   I wonder if that makes it easier to issue teasing. I wonder if the words are more impactful when on the Internet.

bully pic 5Another example comes to mind. Jesse* was 16 when his mother brought him to see me. It was March. He went to school for sophomore year for about two weeks back in September. Since then he had not been back to school. This was before schools had to have programs for children who were unable to go to school due to illness or, in Jesse’s case, emotional problems.

I had previously treated a number of children with school phobia, a form of separation anxiety in which the child is afraid to be away from parents or home. Often the child fears some dire event may take place when he or she is away or the parent may leave the family.

With Jesse, we found no evidence for school phobia. He was depressed, sad, and soft-spoken. He showed little emotion overall. A behavioral analysis of his problem with school showed that he feared two situations. 1) If kids in the hallways were loud, the noise startled him. He expected a fight would break out. He assumed it would become violent, and he could be hurt in the melee. While he had seen fights, he had never actually been harmed. 2) If he walked into class and anyone was already in the room, he expected to be watched and judged. He thought the other kids would think he was strange. He would feel embarrassed. He then thought that he would be singled out to be victimized. The escape from social situations due to the fear of being judged by others is a symptom of a mental disorder known as Social Phobia.

That particular situation in class had actually never happened. However, he had often been teased by an older brother. So the memory of that teasing was being generalized to the school setting. Furthermore, Jesse believed his father sided with his brother. So Jesse generalized that school employees – teachers and administrators – would not protect him. He expected they would join in the negative behavior. So in his world, there was no protection except to avoid the situation and hide at home. In his belief system, he had defined himself as a vulnerable victim.

At home, he did not feel entirely safe. His imagined fears made him anxious even there. But he felt relief that as a result of his avoidance no new episodes of harm could occur.

In order to motivate him, Jesse’s father took a stance many parents might take. In hopes of motivating the young man, Father admonished him, told him that at this rate he would not amount to anything, and said high school should be a good time in life. To Jesse, however, these efforts confirmed his feeling of being misunderstood, unprotected, and not measuring up to other children. In contrast to Father, Jesse’s mother tried to comfort him. She pleaded with him to go to school. She felt helpless to motivate him. As a result, many days would pass when she said nothing about his avoidance. When she backed off, Jesse experienced what we call intermittent negative reinforcement, namely, the relief that he could stay home while the unpleasant interactions in the family would not occur that day. Such avoidance behavior is remarkably stable and long-lasting.

bully pic 6Jesse’s mother had gone to school to complain to the Assistant Principal. However, the latter did not give her and Jesse a sense that the young man could be protected. Rather, the school threatened the family with repercussions for their son’s truancy.

In contrast to school phobia, Jesse presented with Social Phobia and school avoidance, failure to attend school due to a fear of the school setting or of other children. He had experienced some teasing, and he had witnessed bullying.

Can one be affected vicariously by witnessing bullying? Yes, indeed. Jesse projected himself into the shoes of kids he witnessed being bullied. He imagined what it would be like if that happened to him. He felt terrified by his thoughts. He imagined the helplessness that he felt standing by as a witness would be magnified if he were the actual victim. By remaining on the periphery of his school mates, he had few ties at school to motivate him to go just for positive social interactions with friends.

Whereas Howard’s and Brittany’s stories show the lasting effects of teasing and bullying, Jesse’s story shows the impact at the time it is happening. It even shows how witnessing others being bullied can affect bystanders. The story demonstrates how difficult it can be for parents to select an effective strategy to manage the situation.

The good news here is that Howard and Brittany had compensated effectively. So for them, the task in therapy was to help them desensitize the memories, change beliefs about themselves, and free themselves to experience contemporary life as it is, not as an echo of the past. In contrast, the therapeutic task for Jesse was more challenging. Namely, he did not have the successful life experiences Howard and Brittany could use in order to shift their thinking. He had limited emotional and family resources.   Furthermore, the changes needed to help him were not going to be mainly internal changes as we saw with Howard and Brittany. Jesse actually had to overcome inertia, avoidance, and fear and start going to school. In school, he would need a more positive set of experiences so that he would experience positive reinforcement for going rather than negative reinforcement for staying home. Also, both of his parents would need to learn more effective strategies for managing the situation.

And they did. While Jesse participated in a program of reprocessing his fears, Mother was willing tobully pic 7 participate in a graduated program in which Jesse dressed for school and she drove him to the school, then home, without going in. When his anxiety at that subsided, she could escort him to the door, then home. After a few days of that, she escorted him through the hallway to the office. Later, she stood by the office and watched him walk through the hall on his own, even when other kids were present. Meanwhile, we reprocessed the fear of walking into a classroom and rehearsed going into class. Eventually, Jesse managed to go and to sit through a class. He used some tools we had discussed and practiced, including some 3 X 5 cards on which we wrote statements to help him cope, such as, “I can sit quietly. After one minute, when I look around, I see no one is paying attention to me.” “My prime job is listening to the teacher.” The following September, Jesse was going to school full days. We had rehearsed strategies for having his parents interrupt any negative interactions with his brother, and family life became more pleasant for everyone in the home.

As a psychotherapist, I come into the picture after the damage has been profound. The treatment approach is to desensitize memories and experiences of teasing and bullying, overcome avoidance, increase skills to manage the situation, shift thinking from victimhood and defectiveness to assertiveness and adequacy, re-design family interactions, and enlist supports from school personnel. In a follow-up essay, we will discuss some ways for parents to work with children to prevent or stop teasing and bullying before damage occurs, before psychotherapy may be required.

*Reference for the Schulman story:

http://www.chicagotribune.com/news/opinion/commentary/ct-bully-bullies-anxiety-panic-attack-perspec-0208-jm-20150205-story.html?dssReturn

*Note: The names and details of the stories of Howard, Brittany, and Jesse have been altered in order to substantially disguise the identities of real individuals.