Nine Things to Avoid Saying in Psychotherapy
Words are the vehicle of psychotherapy. Because they can be so powerful, it is important to choose our words carefully. Words can convey love, hope, strength, truth, balance and compassion, or they can convey doubt, fear, distrust, confusion and discouragement. Certain words or phrases therapists commonly use can undermine the effectiveness of the psychotherapeutic process, conveying unintended meanings, and causing resistance to therapy. Plenty of obvious words fit this category, such as name-calling, shaming words and words of defeat. Here, however, are the subtler ones:
1. “Just” – as in “he just wants attention.” This is a dirty little four-letter word in the counseling lexicography – unfair, shortsighted, and an overgeneralization. No one is ever just anything. Using just in a sentence implies that the answer is simple, that you have it figured out, and there is only one factor, which automatically rules out others. Human behavior is way too complex to think a person’s problem is the result of one factor. Narrowing the cause of any behavior or situation down to one phrase may sound astute and smart, but it tends not to lead to any solution.
For example, if a client is determined to be “just faking it,” how does that help determine the corrective? It may sound perceptive, but in and of itself it is not helpful. Why is he faking it? Why does he feel like he needs to fake it? Why and when did he start faking it? What is the payoff for faking it? What are some alternatives that would work besides faking it? Making a just statement is like wrapping up the behavior or situation in a nice bow, labeling it, and feeling satisfied that we know what is going on with the client. It has much the same effect as putting a diagnostic label on a client and thinking that explains what’s wrong with them.
2. “You need to …” is a directive initiated by the therapist that may sound authoritative, but unless clients can see the reason for it, they will just resist it. For example, when I hear, “You need to…,” I think, “The only things I need to do are eat, drink, breathe, and have shelter. So your telling me that I need to get a job or take care of myself or use better judgment does not motivate me.” In fact, it causes me to think of all of the reasons why I don’t need to do that, and who are you to be telling me what I need? Even if the client is not an oppositional person, that statement can bring out the stubborn side. On the other hand, if clients are told something would be beneficial and the reasons are outlined, they are more willing to take action.
3. In the same vein are the words, “should” or “shouldn’t.” There is a saying, “don’t should on people.” Should implies force from the outside that causes the person to make a change. Contrast this with people making changes because they see their value and can internally generate a reason – not because they’re being told by someone else what they have to do. Demands generally don’t work well. Initially they may cause someone to initiate a change, but further reinforcement is needed or the change will not hold.
4. Hard “whys” – There are two kinds of “whys.” One is the hard “why.” It is used as a shaming word, as in, “Why did you do that?” It implies that the person has some conscious reason or doing what they did. It also implies, “Why are you so stupid?” If a child knocks over a glass of milk, the parent may say, “Why are you so careless?” as if the child could give some insight about the core of his inadequacies. The child never knows the answer to “Why did you knock over the milk?” The most logical answer is “it was an accident.” What the parent wants in that situation is for the child to say, “I am bad, and I should not have done that.” Even if the child had the answer to the why, that does not tell us what is needed to correct it.
Soft “whys” are much better. These are said with a gentle, caring voice in the mode of “Why do you think that keeps happening to you?” which has a very different connotation. It is a mutual exploration for the answers, and also for the solution. An even better question to ask is “what?” as in “What’s going on? What’s up?” Soft whys or whats are joining questions, not blaming questions. They imply a sincere attempt to understand the nature of the problem, not just a way to blame or shame the person involved.
5. Hopeless – If counselors see situations as hopeless, then they have no business working with the client. Just because in this moment you can see no answer or way out of the situation does not mean that one does not exist. If we cannot give the client hope, then who can?
6. “What were you thinking?” This is especially used with adolescents. The problem with this is that given the recent research on the brain, they probably were not thinking. One reason is that under stress or the influence of alcohol or drugs, the amygdala (the fight-or-flight part of the brain) takes over, blocking the pre-frontal cortex (where the executive function resides) from operating, so the person literally is not thinking clearly in that state.
7. “Try” – Trying is not doing. If I ask you to close your eyes and try to open them, and you make an attempt to open your eyes but don’t, you have succeeded. You tried to open your eyes. Trying does not get you there. So you need to avoid negotiating with someone to try, because implied in the word is that they don't have to go all the way. That is different than breaking something down into smaller steps. Achieving small steps creates a sense of success.
8. “How does that make you feel?” Unfortunately, this phrase has caught on in the popular media. When anybody tries to mimic what goes on in therapy they always come up with the phrase, “And how does that make you feel?” Clients have caught on to this phrase, and it tends to have lost its meaning or impact. It is also a poor question, because it is a leading question that has a built-in assumption, and that is the situation made the client feel something. Maybe that is not the main way it was experienced. Equally the client could be asked, “What did that make you think?” or “What did that make you do? The best question is, “What was that like for you?” In this way the client can answer with a feeling, thought or behavior.
9. “We” – used in a condescending way, like “How are we doing today?” I always feel like saying, “I’m great; I’m not sure what your problem is.” We, however, can be a powerful word when used in the context of joining with a client to show them that they are not alone, or that they do not have to go it alone. For example, “We will get through this,” or “What do we need to do about this?” This is especially helpful in working with children and adolescents who have gotten in trouble. Rather than confronting them or challenging them, it is much more effective to join with them by saying, “We will figure this out and decide what we need to do.” This helps to de-stress the situation so that corrective action can take place.
Unconscious use of words can result in resistance in the client and put them on the defensive. This is especially true with children who take everything very concretely. Any time you get a reaction from the client you did not expect, ask them, “What do you hear me say?” and you may come up with more words to add to this list.
Jon Winder, LPC, author of Getting Unstuck: What to Do When You Don’t Know What to Do, Practical Guidance for Counselors