Why “Therapy” is a Lousy, Misleading Name for What We Do
—by Dr. Jim Nolan
“Therapy” is, by definition, a “treatment” applied to relieve a condition or disorder.
We glibly use the term in the field of Psychology/Counseling, but there’s a problem.
We essentially appropriated the word from the medical industry. If you burn your hand, a nurse may apply a salve, or an ointment. If you break a bone, a physician sets it, wraps it, maybe puts it in a cast. They are actually TREATING the bone, or the burn. Strep throat? Amoxycillin is the “treatment.”
Psychology appropriated the term “Therapy”, as well as the concepts of “symptoms”, “treatment”, “treatment planning”, and “mental illness”, among others, from the medical industry. Probably to give themselves more credibility…It is kind of pathetic.
Re-Exploring the Terms:
Therapy. What gets called “Therapy” in the helping professions is often an intimate, intensive conversation, or relationship, between the helping professional and the “Client.” Maybe Art-Making is used, or maybe we teach breathing techniques. Usually, the idea is that the client wants to feel better, or have a better experience than they are currently having, in their life. No organ or identifiable disease is being “theraped”… Sorry—it is NOT therapy. It is relationship, guidance, an interactive process that helps the client move toward the life experience they would prefer to be having…
Symptoms. Symptoms are very often experiences that we do not want to have. They are not “symptoms” of some greater “disease.” Maybe they are recurrent, unhelpful thought patterns, or emotions/feelings that are uncomfortable. Maybe some relational patterns are not working the way the client wishes they would. Maybe the person is meeting legitimate emotional needs in unskilled ways, like drinking too much beer, smoking pot to avoid conflict, spending a lot of time online instead of interacting with their family, or doing their homework.
Treatment/Treatment Plan. These are often not diseases or illnesses. They do not really need a diagnosis, nor do they need to be “treated.” What the heck are we “treating” anyway? We’re talking, exploring, art-ing, discussing, strategizing.
There is no organ being “treated.”
Mental Illness. Even the DSM people know that “Mental Illness” is the wrong name for what we are talking about. Go read The Book of Woe, or Saving Normal to be disabused of the notion that we are working with “Mental Illness” here. Some people have suggested other terms for “Psychopathology” (which translates into “Disease of the Animating Spirit”, or some such nonsense.)
“Problems in living” is one that I like. Much “outpatient treatment” is really that. Client comes in with some problem(s) in their life, and they want to talk about it, or work on it somehow, in the hopes of coming to new understandings, developing new skills, finding previously unknown or unrecognized resources, and the like. Makes sense. But it is NOT treatment. It is closer to discovery, exploration, and problem solving…
Also, “treatment” suggests that the “healing” element, or process, or magic, is coming FROM the therapist, and applied TO the client. That is virtually entirely dismissive of the role the client has in changing elements in their lives to make it better. It’s the “Physician as God” model that my mom and her generation subscribed to…
Of course there are phenomena like what we currently call “Schizophrenia”, for example. Such an experience seems more complicated to me. There seems to be a very significant somatic, or biochemical consideration in such a diagnosis. That seems very different from “I don’t like my job, and I feel very down and pessimistic about it.” Or “I am in a relationship in which my needs are not being met, and it feels bad.” Or “My parents/kid/boss/neighbor is a pain in the ass, and I want to deal with the situation better.”
That is often what “comes into therapy.” That is NOT psychopathology, and the process of processing such incoming concerns is NOT “therapy.” Our calling it so may be an effort to raise ourselves and our processes in our own estimation, or that of our clients, but it would be more honest, and ethical, to name what we are REALLY doing.
Come up with your own words. But “I am doing psychotherapy” is probably among the least honest and most misleading ones you can come up with, in my mind…
“I am a psychologist, and I work with people to help them understand better what is going on in their lives so that they can make the best decisions possible (lifestyle, partners, jobs, nutrition, booze, spiritual practices, whatever)—decisions that are more likely to contribute to the life they envision for themselves. As an over-arching theme, they learn that they can empower themselves to make such changes, which, when understood, and embraced, can be a lifelong gift to themselves. I facilitate these processes of self-discovery. That’s what I do for a living…”
PS: Professionals who prescribe medications may feel differently about their work, and they should write an article about how THEY view what they are doing. I am not talking about them here, necessarily, except to the extent that they are also doing “Talk Therapy.”
Dr. Jim Nolan
Now taking clients (possibly…only a couple more, really…)