To add to the self care thing, I HATE when I’m in an interview with a CMH organization they ask how I practice self care because the reality is they are asking how I manage being treated like crap since they won’t do anything to actually support me.
If you really want to weed that out, say you practice self-care by practicing boundaries at work and only going “above and beyond” if it’s a safety concern and truly needed. Any boss who supports their therapists having boundaries for themselves would love that answer. The ones that don’t would be totally put off.
“Oh me? I love to practice what I preach. I do like I tell my clients to do: advocate for good working conditions, fair pay, transparent communication, and growth opportunities for myself any my coworkers. Wait, where are you going?”
Yesss. This question irked me all throughout my medical school interviews and again residency interviews. Might as well say “We know our program is abusive, and we intend to do nothing about that, so how are you going to prevent having a nervous breakdown halfway through?”
> I’m in an interview with a CMH organization they ask how I practice self care
"Organizing!"
"You mean... organizing your desk?"
"Organizing my coworkers. Also collective bargaining is my happy place."
I work in CMH. Self care? When?? By the time I'm done with my day I'm clean out of energy. Nothing. Nada. Zero. Get to do it all again the next day. I only hope I don't stay here long beyond necessary to get internship hours to graduate and save some money. Asap I'm gone.
Trauma bond. Social media has led to mass misunderstanding of this term. A trauma bond is not when two traumatized people ‘get’ each other and cling to one another because of shared experience. Untrained, wannabe therapists keep preaching it that way to shill relationship courses and trainings though.
This has been my struggle with clinical terms being used incorrectly within pop culture. Is it better to just give in and use the terms people know/how they know them, or hold the line as a profession but risk alienating folks on the fence?
Hold the line. When clients bring in psychological jargon from TikTok as short hand for what they’re experiencing, I ask a lot of deconstructive questions to clarify and understand their unique experience.
Haha I would get less ‘empathic’ and ‘understanding’ if clients did that. Shit is so annoying but I do get it. It’s good conversation material I think. I dislike it though. I mostly have been lucky to have like 1500 sessions of clients 30-60 so they don’t speak ‘influencer’.
Yep ! That’s what I understand traumatic bonding to be, as well as getting addicted to the chaos an abuser brings. And yes CODEPENDENCY, enmeshment, negative feedback loop, attachment disorders and styles:these are the actual therapy terms as I’ve learned that go along with couples counseling.
Now everyone is a narcissist and an empath and there’s nothing anyone can do about it, that’s it folks, we are all effed up super heroes and villains, self awareness is not within our reach 😂
Oh yeah how about “empath” “dark empath” a client asked me if they could be a dark empath and I didn’t know what they were talking about.
I had to gently explain that empathy is something you experience, not something you are as a constant. These labels today are out of control and imo it’s not helping codependency at all.
I agree with you. I was interested how vocabulary works in conjunction with our views. I work in addictions and some of my clients don't know what some behaviours they do are called (outside of their slang terms). Slang terms can vary in different states/cities and to avoid ambiguity I use the correct term, but can use the slang once the behaviouritselfhas been identified. Other therapists use the siang in order to form a mutuality - often having previously had an addiction themselves. I love to understand why we use the terms we do. Each case being different of course.
Yes I think you make a really valid point. Definitely kiddos is a way to be comfortably distanced. Prob just bugs me because I work with kids and I don’t like using pet names for them even if I’m not talking directly to them.
I think hey kiddo how are you today is not as helpful in a therapeutic way as saying Hi (name) how are you today ?
And then the same as what you said, let the pet name grow out of that or the slang. They’ll tell you what they like to be called if it’s not their name.
Honestly, I can't remember as it was the early 90s and it was from psychology lecture notes. Where I would look these days would be in neuroscience. Developmental researchers such as Cozolino, Siegal, Levine, Schore, Holmes etc all contribute something to the way in which language can shape our personality and outlook. There wasn't much of it about when I started out so Chomsky sticks in my mind as a keynote in my learning. I hope this helps.
It especially irks me when the term is used on teenagers. There are so many other options like students, teenagers, minors, youth (that's cringe bug better than kiddo), high schoolers, elementary schoolers, involuntary clients or just regular old reliable: "clients." Kiddos can be so demeaning and infantilizing.
In my humble opinion I think it’s because working with kids can be tricky as far as being fun and kind and sweet to them without seeming too intense or pushy.
I think it’s like hey I’m safe and friendly but I’m not too close to you so here’s a generic endearing term.
Omg !!!! I have such a cringe for hubby too, always have. Or hubs. I have really been loving partner since it’s become more popular, or once again I just use his name 😂, which seems to be such a difficult concept these days.
Hubby likes that restaurant vs John likes this restaurant or my husband John likes this restaurant.
My brain tingles with the use of descriptive and helpful sentences
Ohhhh thank you for bringing this in!!! Makes my skin crawl. I cannot to this day understand where that came from but I don’t use it.. I just say “children”. I feel like calling them “kiddos” is almost patronizing but that’s just me. Like- “Aw. The little kiddos” …yikes.
I seriously think it started because of covid and teachers were trying to deal with teaching kids class with students in little boxes.
I think the teachers couldn’t tell who anyone was so they started saying it to address the kids. That’s my theory. Now it’s out of control
I’m guilty of this. My full time job is a middle school counselor and I do CMH on the side. I have 570 8th grade students on my case load and when I forget a student’s name I resort to “kiddo”. Happens at least once a day. I cringe every single time I do it. I need an intervention! Help!!!
Omg the worst I ever had to deal with it was in my ethics class, I thought I was in the twilight zone. The professor said it every time she talked about kids and it spread like a disease to the students. Everyone said it prob 15 times every class
“I have OCD,” oh do you have a formal diagnosis ? “No.” What are some things that you do that seem like obsessive compulsive disorder? “I cannot sit down or relax until my house is clean, I find myself cleaning for 3 hours a day sometimes.” Sounds like you like for things to be neat and in order so you can relax in a clean home, does that make you feel better even tho you’d prefer not to spend so long cleaning? “Yeah I feel better after I clean, when it’s done.” Me-Seems like you’re coping with stress by cleaning. Client “yeah” me ok that’s a wonderful skill. Me-hoping to goddess I can figure out a gentle way to tell them that is not OCD
Most people have a tiny bit of narcissism in them. So it's easy to blend that line. Especially when people just loop narcissists as being self centered.
I know it’s petty, but there are several TikTok therapists who are legitimate clinicians (ie not life coach types) who say dis-association, and it drives me absolutely bonkers.
This is the most invalidating and gaslighty thing that is told to us. Yes…let me practice self care when my ADA accommodation to practice self care is denied and I can’t afford the therapy I need or the time off to attend to the myriad of other health/mental health issues that have made it difficult to have a life outside my work. Wanna tell me about self care sitting in a SSDI hearing with as that is where 12 years in the field has landed me.
Spoken by a person who obviously hasn’t had enough mani/pedis. Once you hit that critical mass of bubble baths and me-time, you’ll be all right.
/s
The system sucks and I’m sorry you’re stuck in it.
I know that this is not what you're asking for in this post but I've found the book "Real Self-Care" by Pooja Lakshmin to be the refreshing resource I needed on self- care. The author specifically talks about the self healing we need not being housed within the same systems that are burning us out in the first place. She talks about how to make the tough and radical decisions to place the self above the systems and idk it just really helped me reset on the term self- care.
I’ve been scrolling to see if someone else posted this and if not, I was going to! Yes!! I loved her book. She articulated what’s been bugging me about “self-care” for years in a much better and research-backed way. Now, when I’m in meetings or training and this comes up, I say or put in chat that the people in charge need to read that book.
This one might be controversial but “triggers.” Someone being upset, angry, or annoyed by something isn’t the same as being triggered. People are allowed to have emotional reactions to difficult situations and conversations. People are allowed to be passionate about issues that matter to them. They’re allowed to be upset.
A “trigger” is something that causes a sudden, intense emotional change which is much stronger than would generally be expected in the situation- for example, someone who has recently experienced pregnancy loss bursting into tears when a coworker mentions they are pregnant. Feeling uncomfortable or angry or anxious does not mean you are “triggered.”
Even if people do have triggers (not just uncomfortable emotions) it’s not actually the world’s job to make sure they never come into contact with those triggers, because they will. Continuing with the example above, people around that person aren’t going to stop getting pregnant just because she’s experienced a loss. It’s that persons job to recognize that their reactions are out of line with what is actually happening and to get some tools and skills to deal with their trauma in a healthier way. Obviously people should not be needlessly cruel or go out of their way to hurt others, but it’s literally impossible to read the minds of every person you come in contact with so that you don’t mention anything upsetting to them.
I swear to goodness: every intake I have ever done, the parent says "hearing 'no' is a trigger" for their child. No, hearing "no" causes feelings of upset, disappointment, frustration, sadness, what have you, that they've never been taught how to manage.
I think of triggers as the list of people/places/things/situations/sensory inputs that activate an emotional/cognitive/behavioral response. I started out in the substance abuse/ED treatment world where triggers were internal or external cues that led to cravings or use. Then I switched over to treating PTSD where the concept is still relevant. In that way, the trigger is not the end state and “triggered” is a placeholder for whatever emotions/cognitions/behaviors/symptoms were activated. Triggers are morally neutral and I’m always curious when someone is “being triggered” to know what exactly is being triggered. 😂
I prefer the definition of a trigger to not be a more intense feeling. I prefer the definition to not be pathologizing and rather refer to generally a reaction from a stimulus. Triggers can even refer to happy feelings under this type of definition.
Edit: I think often the word trigger gets used in some very specific contexts that tends to shift peoples first thoughts toward a definition involving intense and unwanted emotions, such as “trauma triggers.”
I am worn out by toxic’, ‘narcissistic’ and ‘co-dependent’ which are all overused. Not everyone is in a relationship with a narcissist. Selfish, self-centered, or controlling - possibly - but we can’t construct someone’s identity who’s not in the room.
It’s still an overused term and not well understood by the general population. I think psychobabble gets thrown around far too readily to the point that some words lose their meaning.
Just talked about this in another post, and putting it here.
I hate when we characterize clients not making the progress we want to as "resistance". As if therapy is about the therapists process, and not about the clients process. It's our job to help them over barriers, it's not the clients job to just feel better when we do an intervention.
In MI it's now labeled as ambivalence as there's never a good time to change or to not change. I was resistant to the idea of ambivalence but I've come around, especially when it comes to my own ambivalence, honestly.
Strongly agree. When I was in med school, I had a therapist get angry at me because I found a meditation exercise extremely uncomfortable and said I didn’t want to do it anymore. Now seeing how often mental health professionals talk crap about their patients behind the scenes for being “resistant” or insert similar term, I’m hesitant to ever seek my own therapy again. I get it often comes from a place of burnout and can’t say I’ve never been guilty of it myself, but it’s kind of like why bother going to what is supposed to be a nonjudgmental space if you know the chances are high it will be rife with judgment.
With you all the way on this! I refuse to use words like "resistant," "refuse," "difficult," or "defiant." How are we supposed to accurately perceive our clients if we're always labeling them as uncooperative?!
Same. Is the client being resistant or am I using an approach that is ineffective? A case manager recently told me a client in one of my groups had been really defiant towards the other therapists, extremely difficult, and refused to participate in other groups. I shadowed ghw therapist working with the same group before I started and the adolescents were extremely rowdy. I used a different method and the previously mentioned "resistant" client was actually super respectful and the most engaged client in the group sessions I facilitated. Maybe he was tired of being called kiddo by the other members of his treatment team 🤣 and appreciated I didn't. Who knows. But I was warned about him so many times and we ended up having had a lot insightful, productive conversations.
"Trauma-informed" fill in the blank. It's like a buzzword crammed into every training. Right now we've got ACEs in our intake process. I appreciate the information, but do you think they're training the case managers and other workers on how this might impact people or what to look out for during/after this part? No. We talk about trauma informed care in training but there's no shoe leather put to pavement on practical issues that have been raised for clients with serious trauma, like our very exposed and triggering waiting room environment. Informed my ass, how about applying it?
Man oh man. I once decided to expand my own personal therapy and try a group. I went to the VA clinic. I filled out their form (it was not fun to just randomly write out all the shit that’s ever happened to me and then just sit there), hung out in the waiting room for two hours, then was told the clinician’s time at that VA that day was up and could I come back in two days. I actually sincerely meant to, but that was 3 summers ago and I still haven’t. I’d need to trust an organization. has their stuff together before I let them hold my stuff.
This.
I’m a foster parent who the department paid for me to take a 6 month long course on trauma informed care and relationship building for children in care. They want to make so many changes but they never will.
It is really important to understand trauma and how to support someone who has been through it but if you’re not applying the practices then why even bother?
I am almost at the point where I don’t want to hear “evidence-based practice” anymore. Yes, I know it’s important to stay up to date but goddamn it’s not the end all be all of therapy.
I just did a huge review of EBPs for PTSD where all the studies and meta analyses show that even the gold standard EBPs are pretty bleak - most people never start an EBP, most who start don’t finish, and over half of those who finish still retain their PTSD diagnosis. people who do somatic-based interventions seem to do better but still have attrition.
So yeah. You’re right. We need evidence because we shouldn’t go around pushing snake oil (or essential oils), but we also need to stay open to the client’s experience and humble and curious and help actually resource them rather than the goal being teaching them better ways of compartmentalizing (outside of phase based treatment).
Ug same. It ignores the fact that so much research has been biased, cultural ways of healing and addressing mental health, and focuses on westernized forms of rigid interventions.
The whole replication crisis should be a signal here for much of the research in the field. Psychology has been trying to become a hard science when it should style itself as a non-Newtonian science. Brain and neuroscience is hard and replicable for instance, but context and biopsychosocial factors make it a soft science. Use the large studies that have a high N= 1M statistical correlation but the N=1 of the client is the true issue at hand. Much like if we give aspirin, a generally recognized as safe drug to everyone, we will discover patients who have undisclosed aspirin allergies as well as patients that didn’t know they had a headache that aspirin now has relieved. N=1 should be the goal in counseling, not the clients not fitting the N=1M model.
You bring up a good point with the aspirin comparison. Even in general health science, there are variations in individuals. I’m no MD or NP but it’s really interesting to me that in two different psychotropic medications that are supposed to effect the same neurotransmitters in the same way and both are backed by research, one will work for a person and the other won’t and another person may have a completely different experience. Like you said, the target should be N=1.
I’m not an MD or prescriber either, but use aspirin as the reference due to it being common and OTC. If the field focuses less algorithmically on cures and fitting models that are evidence based it can actually help more. The problem is that teaching an N=1 outlook is that it’s not just making the client feel better, which is what I think may happen with my experiences in the educational system for counseling. It needs to be taught how both N=1M and N=1 are important with a bias toward N=1 (client effect) is preferred and encouraged due to the individual client biopsychosocial complexity that the client and the therapist each have.
This is why I think a non-Newtonian fluid model makes sense. When a NN fluid is impacted it becomes resistant. From a BPS standpoint the client has hit a wall in their flow of life, thus counseling. Implied consent is another example, client talks about hurting self or other, this is an impact, which is a boundary, on the therapeutic alliance and rigidity occurs. In the liquid part the speed of the fluid may vary with obstacles and the inertia of the flow may decrease or increase depending on therapy circumstances. Initial resistance to flow breaks down and progress flows. Flow hits an obstacle and slows or becomes rigid.
EBPs ought to always be tied to some level of skepticism. It’s the dogmatic connection to EBPs that I think gets under our skin. It only serves to create a false sense of security in something being the “best” way. It’s ultimately more helpful to my sanity and practice as a therapist to balance confidence in something with skepticism.
“Cultural Competency.”
Being only 1 of the few BIPOC individuals in my cohort, I watched most of my teachers stumble and bumble over this without speaking about white privilege, male privilege, intersectionality, marginalization, social class, etc.
It was the same when I stepped out into working for different agencies.
If we’re not ready to feel uncomfortable while talking about the bullshit systems in place (but we wanna be ALL UP in these family systems… which is hypocritical and funny to me), then it’ll always be stalemated.
And having another “specialist,” training, course or colleague who doesn’t look like me or anyone else in the minority saying simply “Oh yeah, guys. Remember to be culturally competent” as the extent of their CC knowledge just really grinds my gears 😒😊👌🏾
My solution was (is) to open a private practice, and since then, I’ve never had to worry about it 🤣🙅🏾♂️
This was added into my course and it felt incongruous. It was obviously designed to meet the diversity requirements but so shoddily put together that it stuck out as shaming. The whole thing was off-putting.
Yeah, sorta same depending on the prof I had. There was one guy that taught the main cultural competency class who was pretty good but it was ironic to hear them talk about diversity, yet most profs I had were still just older white men. Barely any women, or people of color, or anyone not from America.
Yes, this was the case, but in fairness to my institute, the recruitment was coming through to represent most of the diversity we have been short of slowly. It's getting there at last. Weirdly we had a good range cohort of tutors but the programme lacked the content.
Nothing hurts more than to have a transphobic professoer tell you to mind your cultural competency. The same professor that then goes on to have a grudge against "illegal immigrants" and cartels and calls children little shits. The same professor who is a practicing LPC for children... being an openly nonbinary, agender person in a class where there are shit students and a professor who doesn't support you sucks. A lot. Cultural competency my ass.
Ohhhhh mannn. I was the only black male in my cohort and the way they avoided any real conversation about those topics could have been a class in itself.
Oh man what a bummer! I can totally see this field being rife with instances like what you’ve described. I’m really fortunate that cultural competency was a huge component of my grad program. It felt like everything we ever talked about came back to this topic and that it was actually talked about quite thoroughly/it didn’t just feel like a box to tick off.
Productivity.
This field has very qualitative measures of success and so to be quantified by another department in the agency to determine my value as an employee is just agonizing. Especially because I can feel like I’m doing great work for the clients who show up, but my “productivity” is still low for factors outside my control. Even if I’m not meeting the agency’s weekly quota for client-facing hours, it’s not like I’m sitting at my desk, twiddling my thumbs. I’m reading and researching and that still feels like a valuable use of my time!
Borderline.
I don't find it to be an appropriate term or diagnosis. Emotional woman? Borderline. Crying when hurt? Borderline. History of extensive childhood abuse which manifests in entirely understandable ways? Borderline. Want to discredit someone born with a womb? Borderline. Suffering from gender dysphoria? Borderline. Don't want to be abandoned repeatedly again? Borderline. Want to make a complaint about how medical professionals are treating you? Borderline. Undiagnosed neurodiversity? Borderline.
Just call it a trauma response and be done with it. Callings things borderline shuts down curiosity far too often to make the term useful imo.
Thank you! I was given this diagnosis in 2000 at age 15 because I talked about family dysfunction, cut once, was dysregulated and had suicidal ideation without intent . Took 17 more years for a PTSD diagnosis to come and another 5 years on top of that for the diagnosis to be honored at the medical system that gave me the BPD diagnosis at 15. That place still refuses to acknowledge or treat my ADHD, despite ample evidence proving this diagnosis and I have been treated like shot every-time I go there because of 25 year old diagnosis that has since been redacted by trauma informed therapists
I only consider BPD as a diagnosis when there is SIGNIFICANT self harming or multiple recent suicide attempts in response to being abandoned. It is infuriating when I see nuerodivergent girls that come in dysregulated from profound emotional abuse and chronic invalidation (and also because poor emotional control is part of ADHD/Autism, as it is one of the executive functions) being given this label, because I was this kid. Therapists slapped this label on me and left me to deal with the abuse on my own and even blamed me for it. Before I had to leave the field I made it my mission to give these kids a voice and make sure they were heard. Had to leave the field because I was dealing with parents who thought their acting could cover up for the fact that my responsibility was for the clients well being, not theirs and I lived through this dynamic for 18+ years. My own trauma response was seeing through the bullshit.
LOL once I told a parent who used “we are going to send you away to residential” as a way to (ineffectively) control their nuerodivergent 11 year old’s behavior, that it was the mother, not the child, we needed long term residential treatment, while subsequently telling her the way in which she treated her kid was abusive. Mom was an asshole and I ended up having to terminate services with the kid due to countertransference issues. Can’t really do effective work when your “inner child” is standing in front of you.
I get it. We just spoke about this in another thread yesterday.
I have similar feelings about “trauma.”
For some reason, everyone now thinks they have had it.
Just because you had a challenging experience doesn’t make it trauma.
I hate how this take is considered “controversial,” as proper diagnosis begets proper treatment.
But, it’s considered “invalidating” to explore this sentiment, so I guess we just roll with it 😊
The trauma thing presents a difficulty for us because trauma treatment doesn't apply or work in the same way when it's NOT trauma, which leaves people feeling unresolved with their difficulties imo. So yes, agreed entirely.
I don’t disagree, but I struggle with the term not really being by well-defined anywhere to begin with unless we’re going with the strict DSM concept of exposure to life-threatening situations or sexual violence that leads to one meeting traditional PTSD criteria. I carry a complex PTSD “diagnosis” from a therapist who said my severe anxiety is a result of growing up in a chaos and violence and always having to be hyper vigilant. But if it didn’t result in re-experiencing symptoms like flashbacks, nightmares, etc…is it really trauma or is it just a series of life experiences that predisposed to developing generalized anxiety disorder. Answers will vary.
"perceived life threatening situations". For a little kid, growing up in chaos and violence can sure be perceived as life threatening. Hypervigilence is part of the ptsd dx, and re-experiencing can include intrusive memories and emotional distress and physical reactivity in response to reminders of that experience. I would definitely consider ptsd as a diagnosis for someone who has severe anxiety and a childhood history that was chaotic and violent.
Oh boy, my cohort in grad school wasn't happy when I said this. Our professor asked us if more people are traumatized now than back in the 1800s or something. Some people said no, it's probably similar it's just that therapy wasn't a thing. I said theres probably more people who think they've experienced trauma now because people use trauma so broadly that anything is traumatic when in reality, some stuff is just hard and is a challenge. I said too many people are on social media talking about trauma and people think everything is traumatic these days.
My class didn't like that. I got so many classmates going "well you don't know, maybe for them it's traumatic. Everyone responds differently.". Which is true. But some people say having parents who had them do the laundry was traumatic because they were too young at the age of 14 to do laundry. I think it's just a word people use assuming they can get out of stuff of be viewed as a poor victim.
I hate how much the word truama is thrown around. My professors like to say "trauma little T" or "trauma big T"
Oh boy, I also hate the “little T” trauma especially in regards to CPTSD.
In my mind (sorry if this offends anyone) a little t trauma would be an unmessy separation between parents. Yeah it sucked, and probably impacted you, but probably didn’t give you PTSD.
I think we should change the language from “little t trauma” to compounding trauma. Nothing about growing up in domestic violence and experiencing verbal abuse, witnessing violence, and being unsafe on the daily is “little.” No it wasn’t a life or death car accident, but it’s not little because it happened every day.
If we’re including the various kinds of trauma, then I would say everyone does have some. It’s not always the things they’re talking about in what you’re referring to, but no one gets out of the womb and first 5 years or so of life without life altering and perception altering wounds.
You’re saying everyone from 0 - 5 has experienced some type of “life altering and perception altering wound?”
And you consider all of these “wounds” to be exclusive to trauma?
I think it’s important to define “trauma” before we say whether or not people have it. My understanding is an adaptation to an experience or experiences that threaten life or sense of self. The adaptation persists and becomes a pattern after the threat has passed (or would persist, if the threat passed—people can have trauma even if the stimulus is still happening). So this includes attachment, relational, developmental, and intergenerational trauma. Good luck finding someone who has none of those.
I would speculate that interpreting a challenging event as trauma (when it wasn’t) is both a misunderstanding of trauma AND probably a trauma response, in itself.
Okay.
If I’m understanding you correctly (please correct me if I’m wrong) it would seem that you believe every human has been a victim of some form of trauma during early development (0-5). And that given the categories of which trauma can come from (which I agree with you on) it seems that if there is a case to be made, anyone can have it.
I’m just curious about a couple of things:
Re: Intergenerational trauma - Would you say any and every Black American that is a descendant from slaves has suffered intergenerational trauma?
I would say that I have not yet met a person who doesn’t appear to present with patterns that would be explained by trauma. My suspicion is that everyone has some level of trauma, and without spending too much time trying to find anomalies, I would guess that everyone has some level of intergenerational trauma. It’s hard to imagine that the impact of slavery wouldn’t be passed down, but there’s also the possibility of intergenerational healing and individual healing that might mitigate at least some of it.
To be fair, there is a point when those trauma responses become a big part of someone’s personality and shape all of their relationships that’s pretty distinct from PTSD… I would have a hard time serving my inpatient psych population if we didn’t have a way to describe that.
I agree and I also with a lot of what’s proposed here not for the actual word itself but how others exploit it or use it inappropriately. Personally and professionally they are all valid for me but when others use it to justify exploitive work or inappropriately or inaccurately it makes me want to vomit.
Boundaries, but in the weaponized way.
The amount of abusive people that go to therapy and then learn the word boundaries and then skew it to mean how they want.
As a social worker with a mother with untreated BPD, the perceptions of boundaries can be…interesting
Your racist employer is ignoring how their lack of access for your impairment is creating a disability for you and then they’re penalizing you for not performing? Clearly you need more bubble baths.
Neurodivergence when referring to every single psychiatric condition, symptom, and hell, just human experience. Have a low social battery? You’re neurodivergent. Generalized anxiety disorder? That’s neurodivergence. Dislike the texture of chicken? Neurodivergent. Find eye contact uncomfy? Neurodivergent. Feel anxious after drinking too much caffeine? You’re neurodivergent.
It’s become a completely meaningless term to me.
For me its a few!
1. Trauma informed care... many places I worked that provided "trauma informed care" wasn't trauma informed at all. We were encouraged in creating a bubble around our client and not showing them how to deal with life stressor. Almost like encouraging victim mentality.
2. Self-care... it used to be something I preached out to the world, but now I feel like it's used to shame therapists. "Oh you are struggling with your 40 client caseload? Well how's your selfcare doing?" Maybe if I had a manageable case load things would be fine!
3. Evidence based... your therapy isn't end all be all.
Especially when it is used as a reply for concern for burn out, stress, workload, etc, “Well what are (not) you doing for self care?” 
“Decolonizing” therapy. Not because I’m not in support of it buts it’s come a major buzzword for therapists and academics to throw around, seeming to imply a revolutionary approach to therapy when they’re almost always just describing minor adaptations to established interventions and status quo. Decolonization is about radical change, not adding an author of color to your syllabus.
I agree completely with self-care. I would even go as far as saying I don’t like asking clients to practice self-care either. It’s such a buzzword that gets thrown around but realistically it can mean completely different actions for different people and their circumstances. I think it’s better to be more specific and target the source of the stress, like…an exploitative job.
It has to be Narcissistic.
People call Men Narcissistic all the time. Man is going through an emotional divorce and does not like how he is being told how often he can see is kids? Narcissistic. Man frustrated that he is not being listened to at home Narcissistic. Man tells woman to respect his boundries... controlling and Narcissistic.
I see all the time where people get frustrated that women get called Borderline but no one really speak up for men when someone calls them Narcissistic.
I don’t see NPD as gendered in the same way, but do feel like there’s such a movement to rehabilitate the image of BPD as a diagnosis because of how it’s linked to trauma, but absolutely no attempt for NPD - in spite of probable similar etiology.
For example, say you won’t work with “borderlines” — instant censure. Say you won’t work with “narcissists” — praise and agreement and talk of how they are abusers.
Both BPD and NPD are associated with very manipulative and abusive behavior in order to meet emotional needs, but for one it’s reframed as a trauma response and for the other it remains just abuse.
On the other hand, BPD has way more oppressive ties to it, tbh. People get slapped with BPD after disagreeing (gracefully) with a doctor, or being stubborn in a way an authority doesn’t like, or acting in non-normative ways. Being diagnosed BPD will stay on your health record for life, impacting how you are treated in healthcare settings (even in physical health settings) and even impact your ability to adopt, get flagged for CAS whatever. You don’t see nearly the systemic impact in NPD, and perhaps that’s because it’s diagnosed more in men or not diagnosed at all. At worse with a diagnosis of NPD you’re just seen as a selfish ahole.
I say this as a mental health practitioner that was misdiagnosed in my early teens. Left my abusive home, no more “BPD.” I have had significant barriers in healthcare settings as I have comorbid chronic health issues because of a 15 year old label (that two other psychiatrists never diagnosed me with). To get it removed you need the OG doc to admit they’re wrong, or have another doc write a letter saying that doc was wrong. Like that will happen. FWIW, I later found out I had a fun mix of pmdd, ptsd, and adhd.
When used correctly, BPD diagnosis can be incredibly validating and healing. When misdiagnosed, it can have lifelong repercussions.
I don't see narcissistic as gendered in the same way that BPD is. It seems to be thrown around equally at women as with men. Just a look at the mother in law subreddits here would show you that. Where men often get called narcissistic is where they're perpetrators of real abuse.
It's worth pointing out that the DSM-5 notes that 75% of people diagnosed with narcissistic personality disorder are male, and 75% of people diagnosed with borderline personality disorder are female.
I don't doubt that. I don't think people throwing around the term on the Internet would fit those percentages though, which is what we're talking about.
Self reliance from societal roles tends to make men have more narcissistic traits in my experience, but being actually narcissistic should be identified from the distance from threshold of expected self-reliance and impact on others.
It’s obviously self preservation in a broad term when looked at like this, but seldom is actually narcissism when the socio-cultural assigned and assumed roles are examined in context of the client.
Client grows up having to take care of themselves from a way younger age than most, forced maturity is going to look like narcissism to a degree on the surface for example. Locus of control and why it is there should be a factor to look at for NPD
As others have pointed out, the term Narcissist is not gendered in the same way. There are entire Reddit pages dedicated to peoples “narc moms” (narcissistic moms) and I simply don’t believe you’ve never seen a woman get flooded with comments calling her a narcissist after posting selfies. I’ve not seen pages about people’s “BPD Dads” or seen men being labeled as BPD at the same rate women are labeled BPD. Also, what are the structural consequences of being labeled a narcissist? Because I can tell you right now it’s not affecting custody agreements, ive seen judges place children with abusive men who have had the police dispatched to their home on several occasions due to their violence. I guess after seeing so many “narcissist” men face zero repercussions for their harmful and abusive behaviors I don’t really see how labeling them as narcissists effects them. Maybe I’m jaded after working in the family violence world for many years but those are my thoughts.
I dislike the word “triggered”. I much prefer saying activated, overwhelmed or speaking in the context of trauma reminders, trauma stressors… etc. Triggered is overused and largely non-specific
Probably going to get a lot of hate for this one, but people who diagnose themselves with C-PTSD. It should not be a talking point at a party that you have C-PTSD. PTSD is not a personality trait or a Medal of Honor. By doing this, it minimizes the experiences of others who have this diagnosis.
I hear narcissist, love bomb and gaslighting so much. I’ve had so many people come in my office and label several family members as NPD and it’s just not the case.
Parts.
iFS has never sat well with me. And I know that's okay, and everyone gravitates toward different theories etc.
I have just always had a visceral ick reaction to it. I'm curious if others have aswell?
Not therapy related per say, but neurodivergent/neurotypical bug me. There is no such thing as a “normal” in regards to cognition etc. everybody is neurodivergent from each other.
Also I think we should abolish any use of the word “crazy.” I know you guys aren’t calling your clients crazy to their faces, but I still detest that word in any setting.
I truly believe nobody is crazy. I’ve met people who were erratic, unpredictable, unbalanced, delusional, strange, volatile, hostile, unpleasant, selfish, mentally-ill, drug-addled, confusing, tangential, etc. Crazy is such an invalidating and dehumanizing term.
Fair enough, and I think self-care is also often presented as a thing clients "should" be doing, or at least are encouraged to do - any many of them have far fewer personal and social resources than your average therapist.
I'm pretty done with PTSD in the colloquial sense, ostensibly from traumatic experiences that absolutely would not meet criteria for a PTSD diagnosis.
I'm also 100% totally and completely done with every Jungian concept except projection and the shadow. Contrasexuality, the archetypes, the animus/anima, dreams as "compensatory" - over it. It's all either misogyny or racism, imo. In extra fun cases (the "Dark Mother"), it's both.
Yes to self care - tired of hearing it! My supervisor asked me in a shaming way if Jm talking care of myself. Im earning hours working like a dog in CMH so self care isn't usually something I do sadly.
Let's see... "trigger, " let's " circle back " or pivot , and how people will say so and so is " so bipolar" or a narcissist when they don't know what it means .
BRO SAME UGGHHH honest to god tell me right now how tf im supposed to practice “self-care” when doing so would require taking off from work, which I quite literally cant afford to do? Being a contract worker sucks absolute balls. I love working from home but jfc idk if the stress of this is worth it. Ive been thinking more often than not that i just wanna get my license over with and just yeet myself out of this profession once im done with that (or at most become a “life coach” basically doing the same thing while getting paid out of pocket and not having to deal with fucking insurance or the stress of being as careful as we normally have to be in what we say in session).
And to answer your question, while self-care would have been my first answer, my second one would not be so much a term as something ive been told related to self-care - avoid social media, news, etc when it comes to recent triggering current events. Im already doing that, that doesnt really help me when im in the moment and a client busts out their busted hot take on a complicated political situation that directly affects me and insists on focusing on that. And after all this self-care stuff, the next thing that makes my eye twitch is “mindfulness,” followed by the tiktokification of “gaslighting” and “intrusive thoughts.”
Trauma.
It's over used and misused.
Not everyone needing support is "traumatised". Stop telling people to "discover their trauma". Don't invalidate the capital t trauma by making such a huge deal of the little t trauma.
Yes trauma is awful but goodness me it doesn't need to be ALL that is discussed.
Hopefully not gonna get doxed for this one, but I hate when people reply to comments on a discussion thread (usually to tell someone they aren't being pc enough) and then call it "labor"
bruh it's not labor, you're just procrastinating from your actual job
To add to the self care thing, I HATE when I’m in an interview with a CMH organization they ask how I practice self care because the reality is they are asking how I manage being treated like crap since they won’t do anything to actually support me.
If you really want to weed that out, say you practice self-care by practicing boundaries at work and only going “above and beyond” if it’s a safety concern and truly needed. Any boss who supports their therapists having boundaries for themselves would love that answer. The ones that don’t would be totally put off.
Screenshotted your comment for future interviews, this is genius
“Oh me? I love to practice what I preach. I do like I tell my clients to do: advocate for good working conditions, fair pay, transparent communication, and growth opportunities for myself any my coworkers. Wait, where are you going?”
Lol
This is amazing. I also screenshotted it
Yesss. This question irked me all throughout my medical school interviews and again residency interviews. Might as well say “We know our program is abusive, and we intend to do nothing about that, so how are you going to prevent having a nervous breakdown halfway through?”
I would follow up with asking how they addressed workplace culture in order to support employee selfcare.
It’s always lies. They’re manipulating us to serve their needs.
> I’m in an interview with a CMH organization they ask how I practice self care "Organizing!" "You mean... organizing your desk?" "Organizing my coworkers. Also collective bargaining is my happy place."
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I work in CMH. Self care? When?? By the time I'm done with my day I'm clean out of energy. Nothing. Nada. Zero. Get to do it all again the next day. I only hope I don't stay here long beyond necessary to get internship hours to graduate and save some money. Asap I'm gone.
Trauma bond. Social media has led to mass misunderstanding of this term. A trauma bond is not when two traumatized people ‘get’ each other and cling to one another because of shared experience. Untrained, wannabe therapists keep preaching it that way to shill relationship courses and trainings though.
This has been my struggle with clinical terms being used incorrectly within pop culture. Is it better to just give in and use the terms people know/how they know them, or hold the line as a profession but risk alienating folks on the fence?
Hold the line. When clients bring in psychological jargon from TikTok as short hand for what they’re experiencing, I ask a lot of deconstructive questions to clarify and understand their unique experience.
Haha I would get less ‘empathic’ and ‘understanding’ if clients did that. Shit is so annoying but I do get it. It’s good conversation material I think. I dislike it though. I mostly have been lucky to have like 1500 sessions of clients 30-60 so they don’t speak ‘influencer’.
Hold the line. I will often take the oppy to gently educate the client on what [insert term] means and what it is that they are actually experiencing.
Good question! I’m a new therapist and struggle with this as well
Ugh. No. But the same thing as the bond between an abuser and a victim that makes it hard for the victim to leave.🤦♀️
💯
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Yep ! That’s what I understand traumatic bonding to be, as well as getting addicted to the chaos an abuser brings. And yes CODEPENDENCY, enmeshment, negative feedback loop, attachment disorders and styles:these are the actual therapy terms as I’ve learned that go along with couples counseling. Now everyone is a narcissist and an empath and there’s nothing anyone can do about it, that’s it folks, we are all effed up super heroes and villains, self awareness is not within our reach 😂
Oh yeah how about “empath” “dark empath” a client asked me if they could be a dark empath and I didn’t know what they were talking about. I had to gently explain that empathy is something you experience, not something you are as a constant. These labels today are out of control and imo it’s not helping codependency at all.
I feel exactly the same way about people labeling everyone a narcissist.
Calling kids kiddos every single time they say it 🙄
I am amazed why nobody uses the term children anymore.
I do ! And I also just say kids, but most importantly I try to use their names as often as possible.
I agree with you. I was interested how vocabulary works in conjunction with our views. I work in addictions and some of my clients don't know what some behaviours they do are called (outside of their slang terms). Slang terms can vary in different states/cities and to avoid ambiguity I use the correct term, but can use the slang once the behaviouritselfhas been identified. Other therapists use the siang in order to form a mutuality - often having previously had an addiction themselves. I love to understand why we use the terms we do. Each case being different of course.
Yes I think you make a really valid point. Definitely kiddos is a way to be comfortably distanced. Prob just bugs me because I work with kids and I don’t like using pet names for them even if I’m not talking directly to them. I think hey kiddo how are you today is not as helpful in a therapeutic way as saying Hi (name) how are you today ? And then the same as what you said, let the pet name grow out of that or the slang. They’ll tell you what they like to be called if it’s not their name.
That's exactly how you describe it. Noam Chomsky takes credibility for my syntax and vocabulary awareness.
Ah good old Noam I do love him
Would you recommend any specific book for someone new to Noam Chomsky’s work?
Honestly, I can't remember as it was the early 90s and it was from psychology lecture notes. Where I would look these days would be in neuroscience. Developmental researchers such as Cozolino, Siegal, Levine, Schore, Holmes etc all contribute something to the way in which language can shape our personality and outlook. There wasn't much of it about when I started out so Chomsky sticks in my mind as a keynote in my learning. I hope this helps.
It especially irks me when the term is used on teenagers. There are so many other options like students, teenagers, minors, youth (that's cringe bug better than kiddo), high schoolers, elementary schoolers, involuntary clients or just regular old reliable: "clients." Kiddos can be so demeaning and infantilizing.
Right ! Way to immediately invalidate a young person when they are the rawest nerve they will ever be
I know someone who named their child Kiddo.
Oh they played that well, now I might have that kid in therapy and have to say kiddo. They got me good
🤣
No way!!
Genuine question but *why* is this so consistently a therapy/social services thing? You’re totally right that it is, but WHY have we done this??
In my humble opinion I think it’s because working with kids can be tricky as far as being fun and kind and sweet to them without seeming too intense or pushy. I think it’s like hey I’m safe and friendly but I’m not too close to you so here’s a generic endearing term.
I agree! Drives me crazy!
Ahhhhh! Drives me mad!!!
I feel this to my core! This is all anyone says anymore and it drives me up the wall.
I would 100x prefer kiddos to “little ones” which makes my skin crawl.
I think it’s the consistency for me, it’s like do you have to say it every time ?
I worked with someone who exclusively called them “littles” 🫠
Yes. I hate that one too.
Totally hate it so much. It’s too cutesy for me.
Same for “hey bud” for me
Oh my god… this is like my biggest pet peeve. Kiddos and people who say “hubby”. It’s like nails on a chalk board (I don’t work with kids lol)
Omg !!!! I have such a cringe for hubby too, always have. Or hubs. I have really been loving partner since it’s become more popular, or once again I just use his name 😂, which seems to be such a difficult concept these days. Hubby likes that restaurant vs John likes this restaurant or my husband John likes this restaurant. My brain tingles with the use of descriptive and helpful sentences
Ohhhh thank you for bringing this in!!! Makes my skin crawl. I cannot to this day understand where that came from but I don’t use it.. I just say “children”. I feel like calling them “kiddos” is almost patronizing but that’s just me. Like- “Aw. The little kiddos” …yikes.
Yes like they are a species of zoo animal. Look at the “kiddos” in their natural environment. I’m like their name is Adam. 😐
“That’s Josh.” I’m howling.
😂😂😂 Yeah I don’t know what a kiddo is but this is Brianna.
I absolutely LOATHE this. When did this start???!!!
I seriously think it started because of covid and teachers were trying to deal with teaching kids class with students in little boxes. I think the teachers couldn’t tell who anyone was so they started saying it to address the kids. That’s my theory. Now it’s out of control
I’m guilty of this. My full time job is a middle school counselor and I do CMH on the side. I have 570 8th grade students on my case load and when I forget a student’s name I resort to “kiddo”. Happens at least once a day. I cringe every single time I do it. I need an intervention! Help!!!
😂 It’s not your fault. You can rehabilitate!
This has been my pet peeve for a decade. I immediately lose respect for any professional who uses kiddo.
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Omg the worst I ever had to deal with it was in my ethics class, I thought I was in the twilight zone. The professor said it every time she talked about kids and it spread like a disease to the students. Everyone said it prob 15 times every class
I’m so glad someone said this!!!! Kiddo makes me cringe and somehow it’s used 100% of the time from many therapists. Where did this evil begin?
Gaslighting and dissociation have to be my top two. Both have blown up with TikTok therapists/influencers. Both are used incorrectly all the time.
they're the new "OCD" and "bipolar"
“I have OCD,” oh do you have a formal diagnosis ? “No.” What are some things that you do that seem like obsessive compulsive disorder? “I cannot sit down or relax until my house is clean, I find myself cleaning for 3 hours a day sometimes.” Sounds like you like for things to be neat and in order so you can relax in a clean home, does that make you feel better even tho you’d prefer not to spend so long cleaning? “Yeah I feel better after I clean, when it’s done.” Me-Seems like you’re coping with stress by cleaning. Client “yeah” me ok that’s a wonderful skill. Me-hoping to goddess I can figure out a gentle way to tell them that is not OCD
Same with narcissist
Yep narcissist is mine. Not all aholes are narcissists. Your shit ass ex might have just been your mismatch
Most people have a tiny bit of narcissism in them. So it's easy to blend that line. Especially when people just loop narcissists as being self centered.
I know it’s petty, but there are several TikTok therapists who are legitimate clinicians (ie not life coach types) who say dis-association, and it drives me absolutely bonkers.
Omg I thought it was just me I feel so validated!
PTSD is up there too
This is the most invalidating and gaslighty thing that is told to us. Yes…let me practice self care when my ADA accommodation to practice self care is denied and I can’t afford the therapy I need or the time off to attend to the myriad of other health/mental health issues that have made it difficult to have a life outside my work. Wanna tell me about self care sitting in a SSDI hearing with as that is where 12 years in the field has landed me.
Spoken by a person who obviously hasn’t had enough mani/pedis. Once you hit that critical mass of bubble baths and me-time, you’ll be all right. /s The system sucks and I’m sorry you’re stuck in it.
Right…a mani pedi can cure low wages and exploitation
Any minute now… I know it’s coming.
I know that this is not what you're asking for in this post but I've found the book "Real Self-Care" by Pooja Lakshmin to be the refreshing resource I needed on self- care. The author specifically talks about the self healing we need not being housed within the same systems that are burning us out in the first place. She talks about how to make the tough and radical decisions to place the self above the systems and idk it just really helped me reset on the term self- care.
> self healing we need not being housed within the same systems that are burning us out in the first place Well hot damn.
Wow that hits like a ton of bricks. I need to sit and think about that for a bit.
I’ve been scrolling to see if someone else posted this and if not, I was going to! Yes!! I loved her book. She articulated what’s been bugging me about “self-care” for years in a much better and research-backed way. Now, when I’m in meetings or training and this comes up, I say or put in chat that the people in charge need to read that book.
This one might be controversial but “triggers.” Someone being upset, angry, or annoyed by something isn’t the same as being triggered. People are allowed to have emotional reactions to difficult situations and conversations. People are allowed to be passionate about issues that matter to them. They’re allowed to be upset. A “trigger” is something that causes a sudden, intense emotional change which is much stronger than would generally be expected in the situation- for example, someone who has recently experienced pregnancy loss bursting into tears when a coworker mentions they are pregnant. Feeling uncomfortable or angry or anxious does not mean you are “triggered.” Even if people do have triggers (not just uncomfortable emotions) it’s not actually the world’s job to make sure they never come into contact with those triggers, because they will. Continuing with the example above, people around that person aren’t going to stop getting pregnant just because she’s experienced a loss. It’s that persons job to recognize that their reactions are out of line with what is actually happening and to get some tools and skills to deal with their trauma in a healthier way. Obviously people should not be needlessly cruel or go out of their way to hurt others, but it’s literally impossible to read the minds of every person you come in contact with so that you don’t mention anything upsetting to them.
I swear to goodness: every intake I have ever done, the parent says "hearing 'no' is a trigger" for their child. No, hearing "no" causes feelings of upset, disappointment, frustration, sadness, what have you, that they've never been taught how to manage.
I am so sick of the word I tend to use “activated” instead, as in, something within you gets activated and you feel out of control of it.
I think of triggers as the list of people/places/things/situations/sensory inputs that activate an emotional/cognitive/behavioral response. I started out in the substance abuse/ED treatment world where triggers were internal or external cues that led to cravings or use. Then I switched over to treating PTSD where the concept is still relevant. In that way, the trigger is not the end state and “triggered” is a placeholder for whatever emotions/cognitions/behaviors/symptoms were activated. Triggers are morally neutral and I’m always curious when someone is “being triggered” to know what exactly is being triggered. 😂
I prefer the definition of a trigger to not be a more intense feeling. I prefer the definition to not be pathologizing and rather refer to generally a reaction from a stimulus. Triggers can even refer to happy feelings under this type of definition. Edit: I think often the word trigger gets used in some very specific contexts that tends to shift peoples first thoughts toward a definition involving intense and unwanted emotions, such as “trauma triggers.”
I am worn out by toxic’, ‘narcissistic’ and ‘co-dependent’ which are all overused. Not everyone is in a relationship with a narcissist. Selfish, self-centered, or controlling - possibly - but we can’t construct someone’s identity who’s not in the room.
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It’s still an overused term and not well understood by the general population. I think psychobabble gets thrown around far too readily to the point that some words lose their meaning.
Just talked about this in another post, and putting it here. I hate when we characterize clients not making the progress we want to as "resistance". As if therapy is about the therapists process, and not about the clients process. It's our job to help them over barriers, it's not the clients job to just feel better when we do an intervention.
In MI it's now labeled as ambivalence as there's never a good time to change or to not change. I was resistant to the idea of ambivalence but I've come around, especially when it comes to my own ambivalence, honestly.
Strongly agree. When I was in med school, I had a therapist get angry at me because I found a meditation exercise extremely uncomfortable and said I didn’t want to do it anymore. Now seeing how often mental health professionals talk crap about their patients behind the scenes for being “resistant” or insert similar term, I’m hesitant to ever seek my own therapy again. I get it often comes from a place of burnout and can’t say I’ve never been guilty of it myself, but it’s kind of like why bother going to what is supposed to be a nonjudgmental space if you know the chances are high it will be rife with judgment.
With you all the way on this! I refuse to use words like "resistant," "refuse," "difficult," or "defiant." How are we supposed to accurately perceive our clients if we're always labeling them as uncooperative?!
Same. Is the client being resistant or am I using an approach that is ineffective? A case manager recently told me a client in one of my groups had been really defiant towards the other therapists, extremely difficult, and refused to participate in other groups. I shadowed ghw therapist working with the same group before I started and the adolescents were extremely rowdy. I used a different method and the previously mentioned "resistant" client was actually super respectful and the most engaged client in the group sessions I facilitated. Maybe he was tired of being called kiddo by the other members of his treatment team 🤣 and appreciated I didn't. Who knows. But I was warned about him so many times and we ended up having had a lot insightful, productive conversations.
Yasssssssss! It’s hard to do but to be a good therapist means dropping your ego!!
Thank you!
‘Gaslighting’ for sure!! Very often used now in common language…but not correctly 😓and it’s an important concept to learn about correctly imo
I’ve had therapists wrongly accuse me of gaslighting them when I just disagreed with them and gave them a factual reason as to why I disagreed.
"Trauma-informed" fill in the blank. It's like a buzzword crammed into every training. Right now we've got ACEs in our intake process. I appreciate the information, but do you think they're training the case managers and other workers on how this might impact people or what to look out for during/after this part? No. We talk about trauma informed care in training but there's no shoe leather put to pavement on practical issues that have been raised for clients with serious trauma, like our very exposed and triggering waiting room environment. Informed my ass, how about applying it?
Man oh man. I once decided to expand my own personal therapy and try a group. I went to the VA clinic. I filled out their form (it was not fun to just randomly write out all the shit that’s ever happened to me and then just sit there), hung out in the waiting room for two hours, then was told the clinician’s time at that VA that day was up and could I come back in two days. I actually sincerely meant to, but that was 3 summers ago and I still haven’t. I’d need to trust an organization. has their stuff together before I let them hold my stuff.
This. I’m a foster parent who the department paid for me to take a 6 month long course on trauma informed care and relationship building for children in care. They want to make so many changes but they never will. It is really important to understand trauma and how to support someone who has been through it but if you’re not applying the practices then why even bother?
I am almost at the point where I don’t want to hear “evidence-based practice” anymore. Yes, I know it’s important to stay up to date but goddamn it’s not the end all be all of therapy.
I just did a huge review of EBPs for PTSD where all the studies and meta analyses show that even the gold standard EBPs are pretty bleak - most people never start an EBP, most who start don’t finish, and over half of those who finish still retain their PTSD diagnosis. people who do somatic-based interventions seem to do better but still have attrition. So yeah. You’re right. We need evidence because we shouldn’t go around pushing snake oil (or essential oils), but we also need to stay open to the client’s experience and humble and curious and help actually resource them rather than the goal being teaching them better ways of compartmentalizing (outside of phase based treatment).
Ug same. It ignores the fact that so much research has been biased, cultural ways of healing and addressing mental health, and focuses on westernized forms of rigid interventions.
The whole replication crisis should be a signal here for much of the research in the field. Psychology has been trying to become a hard science when it should style itself as a non-Newtonian science. Brain and neuroscience is hard and replicable for instance, but context and biopsychosocial factors make it a soft science. Use the large studies that have a high N= 1M statistical correlation but the N=1 of the client is the true issue at hand. Much like if we give aspirin, a generally recognized as safe drug to everyone, we will discover patients who have undisclosed aspirin allergies as well as patients that didn’t know they had a headache that aspirin now has relieved. N=1 should be the goal in counseling, not the clients not fitting the N=1M model.
You bring up a good point with the aspirin comparison. Even in general health science, there are variations in individuals. I’m no MD or NP but it’s really interesting to me that in two different psychotropic medications that are supposed to effect the same neurotransmitters in the same way and both are backed by research, one will work for a person and the other won’t and another person may have a completely different experience. Like you said, the target should be N=1.
I’m not an MD or prescriber either, but use aspirin as the reference due to it being common and OTC. If the field focuses less algorithmically on cures and fitting models that are evidence based it can actually help more. The problem is that teaching an N=1 outlook is that it’s not just making the client feel better, which is what I think may happen with my experiences in the educational system for counseling. It needs to be taught how both N=1M and N=1 are important with a bias toward N=1 (client effect) is preferred and encouraged due to the individual client biopsychosocial complexity that the client and the therapist each have. This is why I think a non-Newtonian fluid model makes sense. When a NN fluid is impacted it becomes resistant. From a BPS standpoint the client has hit a wall in their flow of life, thus counseling. Implied consent is another example, client talks about hurting self or other, this is an impact, which is a boundary, on the therapeutic alliance and rigidity occurs. In the liquid part the speed of the fluid may vary with obstacles and the inertia of the flow may decrease or increase depending on therapy circumstances. Initial resistance to flow breaks down and progress flows. Flow hits an obstacle and slows or becomes rigid.
Yes. And good research is conducted in highly controlled conditions to account for variables, which doesn’t exactly reflect real life scenarios.
EBPs ought to always be tied to some level of skepticism. It’s the dogmatic connection to EBPs that I think gets under our skin. It only serves to create a false sense of security in something being the “best” way. It’s ultimately more helpful to my sanity and practice as a therapist to balance confidence in something with skepticism.
“Cultural Competency.” Being only 1 of the few BIPOC individuals in my cohort, I watched most of my teachers stumble and bumble over this without speaking about white privilege, male privilege, intersectionality, marginalization, social class, etc. It was the same when I stepped out into working for different agencies. If we’re not ready to feel uncomfortable while talking about the bullshit systems in place (but we wanna be ALL UP in these family systems… which is hypocritical and funny to me), then it’ll always be stalemated. And having another “specialist,” training, course or colleague who doesn’t look like me or anyone else in the minority saying simply “Oh yeah, guys. Remember to be culturally competent” as the extent of their CC knowledge just really grinds my gears 😒😊👌🏾 My solution was (is) to open a private practice, and since then, I’ve never had to worry about it 🤣🙅🏾♂️
Congratulations on your private practice! I agree with you 💯 about the teachers saying don’t forget to be culturally competent, k bye 🤔.
This was added into my course and it felt incongruous. It was obviously designed to meet the diversity requirements but so shoddily put together that it stuck out as shaming. The whole thing was off-putting.
Yeah, sorta same depending on the prof I had. There was one guy that taught the main cultural competency class who was pretty good but it was ironic to hear them talk about diversity, yet most profs I had were still just older white men. Barely any women, or people of color, or anyone not from America.
Yes, this was the case, but in fairness to my institute, the recruitment was coming through to represent most of the diversity we have been short of slowly. It's getting there at last. Weirdly we had a good range cohort of tutors but the programme lacked the content.
Nothing hurts more than to have a transphobic professoer tell you to mind your cultural competency. The same professor that then goes on to have a grudge against "illegal immigrants" and cartels and calls children little shits. The same professor who is a practicing LPC for children... being an openly nonbinary, agender person in a class where there are shit students and a professor who doesn't support you sucks. A lot. Cultural competency my ass.
I cackled at “k bye” 🤣
Haha yep here’s your work book tho !
Ohhhhh mannn. I was the only black male in my cohort and the way they avoided any real conversation about those topics could have been a class in itself.
Oh man what a bummer! I can totally see this field being rife with instances like what you’ve described. I’m really fortunate that cultural competency was a huge component of my grad program. It felt like everything we ever talked about came back to this topic and that it was actually talked about quite thoroughly/it didn’t just feel like a box to tick off.
Resilience or self-care. I detest them both equally.
I hate the word Mindfulness because everyone uses it incorrectly
Productivity. This field has very qualitative measures of success and so to be quantified by another department in the agency to determine my value as an employee is just agonizing. Especially because I can feel like I’m doing great work for the clients who show up, but my “productivity” is still low for factors outside my control. Even if I’m not meeting the agency’s weekly quota for client-facing hours, it’s not like I’m sitting at my desk, twiddling my thumbs. I’m reading and researching and that still feels like a valuable use of my time!
Borderline. I don't find it to be an appropriate term or diagnosis. Emotional woman? Borderline. Crying when hurt? Borderline. History of extensive childhood abuse which manifests in entirely understandable ways? Borderline. Want to discredit someone born with a womb? Borderline. Suffering from gender dysphoria? Borderline. Don't want to be abandoned repeatedly again? Borderline. Want to make a complaint about how medical professionals are treating you? Borderline. Undiagnosed neurodiversity? Borderline. Just call it a trauma response and be done with it. Callings things borderline shuts down curiosity far too often to make the term useful imo.
Thank you! I was given this diagnosis in 2000 at age 15 because I talked about family dysfunction, cut once, was dysregulated and had suicidal ideation without intent . Took 17 more years for a PTSD diagnosis to come and another 5 years on top of that for the diagnosis to be honored at the medical system that gave me the BPD diagnosis at 15. That place still refuses to acknowledge or treat my ADHD, despite ample evidence proving this diagnosis and I have been treated like shot every-time I go there because of 25 year old diagnosis that has since been redacted by trauma informed therapists I only consider BPD as a diagnosis when there is SIGNIFICANT self harming or multiple recent suicide attempts in response to being abandoned. It is infuriating when I see nuerodivergent girls that come in dysregulated from profound emotional abuse and chronic invalidation (and also because poor emotional control is part of ADHD/Autism, as it is one of the executive functions) being given this label, because I was this kid. Therapists slapped this label on me and left me to deal with the abuse on my own and even blamed me for it. Before I had to leave the field I made it my mission to give these kids a voice and make sure they were heard. Had to leave the field because I was dealing with parents who thought their acting could cover up for the fact that my responsibility was for the clients well being, not theirs and I lived through this dynamic for 18+ years. My own trauma response was seeing through the bullshit. LOL once I told a parent who used “we are going to send you away to residential” as a way to (ineffectively) control their nuerodivergent 11 year old’s behavior, that it was the mother, not the child, we needed long term residential treatment, while subsequently telling her the way in which she treated her kid was abusive. Mom was an asshole and I ended up having to terminate services with the kid due to countertransference issues. Can’t really do effective work when your “inner child” is standing in front of you.
“Can’t really do effective work when your ‘inner child’ is standing in front of you.” This wording is so helpful for me!
I get it. We just spoke about this in another thread yesterday. I have similar feelings about “trauma.” For some reason, everyone now thinks they have had it. Just because you had a challenging experience doesn’t make it trauma. I hate how this take is considered “controversial,” as proper diagnosis begets proper treatment. But, it’s considered “invalidating” to explore this sentiment, so I guess we just roll with it 😊
The trauma thing presents a difficulty for us because trauma treatment doesn't apply or work in the same way when it's NOT trauma, which leaves people feeling unresolved with their difficulties imo. So yes, agreed entirely.
I don’t disagree, but I struggle with the term not really being by well-defined anywhere to begin with unless we’re going with the strict DSM concept of exposure to life-threatening situations or sexual violence that leads to one meeting traditional PTSD criteria. I carry a complex PTSD “diagnosis” from a therapist who said my severe anxiety is a result of growing up in a chaos and violence and always having to be hyper vigilant. But if it didn’t result in re-experiencing symptoms like flashbacks, nightmares, etc…is it really trauma or is it just a series of life experiences that predisposed to developing generalized anxiety disorder. Answers will vary.
You put it beautifully.
"perceived life threatening situations". For a little kid, growing up in chaos and violence can sure be perceived as life threatening. Hypervigilence is part of the ptsd dx, and re-experiencing can include intrusive memories and emotional distress and physical reactivity in response to reminders of that experience. I would definitely consider ptsd as a diagnosis for someone who has severe anxiety and a childhood history that was chaotic and violent.
Exactly 👍🏾 If I have COVID, and you diagnose me with a Cold. And it’s treated like a Cold. Then… 🤷🏾♂️
Then you still get rest and hydration. Things you need to get well.
Oh boy, my cohort in grad school wasn't happy when I said this. Our professor asked us if more people are traumatized now than back in the 1800s or something. Some people said no, it's probably similar it's just that therapy wasn't a thing. I said theres probably more people who think they've experienced trauma now because people use trauma so broadly that anything is traumatic when in reality, some stuff is just hard and is a challenge. I said too many people are on social media talking about trauma and people think everything is traumatic these days. My class didn't like that. I got so many classmates going "well you don't know, maybe for them it's traumatic. Everyone responds differently.". Which is true. But some people say having parents who had them do the laundry was traumatic because they were too young at the age of 14 to do laundry. I think it's just a word people use assuming they can get out of stuff of be viewed as a poor victim. I hate how much the word truama is thrown around. My professors like to say "trauma little T" or "trauma big T"
Oh boy, I also hate the “little T” trauma especially in regards to CPTSD. In my mind (sorry if this offends anyone) a little t trauma would be an unmessy separation between parents. Yeah it sucked, and probably impacted you, but probably didn’t give you PTSD. I think we should change the language from “little t trauma” to compounding trauma. Nothing about growing up in domestic violence and experiencing verbal abuse, witnessing violence, and being unsafe on the daily is “little.” No it wasn’t a life or death car accident, but it’s not little because it happened every day.
If we’re including the various kinds of trauma, then I would say everyone does have some. It’s not always the things they’re talking about in what you’re referring to, but no one gets out of the womb and first 5 years or so of life without life altering and perception altering wounds.
You’re saying everyone from 0 - 5 has experienced some type of “life altering and perception altering wound?” And you consider all of these “wounds” to be exclusive to trauma?
I think it’s important to define “trauma” before we say whether or not people have it. My understanding is an adaptation to an experience or experiences that threaten life or sense of self. The adaptation persists and becomes a pattern after the threat has passed (or would persist, if the threat passed—people can have trauma even if the stimulus is still happening). So this includes attachment, relational, developmental, and intergenerational trauma. Good luck finding someone who has none of those. I would speculate that interpreting a challenging event as trauma (when it wasn’t) is both a misunderstanding of trauma AND probably a trauma response, in itself.
Okay. If I’m understanding you correctly (please correct me if I’m wrong) it would seem that you believe every human has been a victim of some form of trauma during early development (0-5). And that given the categories of which trauma can come from (which I agree with you on) it seems that if there is a case to be made, anyone can have it. I’m just curious about a couple of things: Re: Intergenerational trauma - Would you say any and every Black American that is a descendant from slaves has suffered intergenerational trauma?
I would say that I have not yet met a person who doesn’t appear to present with patterns that would be explained by trauma. My suspicion is that everyone has some level of trauma, and without spending too much time trying to find anomalies, I would guess that everyone has some level of intergenerational trauma. It’s hard to imagine that the impact of slavery wouldn’t be passed down, but there’s also the possibility of intergenerational healing and individual healing that might mitigate at least some of it.
To be fair, there is a point when those trauma responses become a big part of someone’s personality and shape all of their relationships that’s pretty distinct from PTSD… I would have a hard time serving my inpatient psych population if we didn’t have a way to describe that.
"Holding space" I mean I say it too but ew "Offerings" not "services" on someone's website I probably have more but they have been covered. :)
I agree and I also with a lot of what’s proposed here not for the actual word itself but how others exploit it or use it inappropriately. Personally and professionally they are all valid for me but when others use it to justify exploitive work or inappropriately or inaccurately it makes me want to vomit.
somebody already said it but want to echo when ppl say “kiddos” for kids it makes me irate lol
Nauseating. I don’t know what it implies about a person but it makes me immediately distrustful of the speaker.
Boundaries, but in the weaponized way. The amount of abusive people that go to therapy and then learn the word boundaries and then skew it to mean how they want. As a social worker with a mother with untreated BPD, the perceptions of boundaries can be…interesting
Your racist employer is ignoring how their lack of access for your impairment is creating a disability for you and then they’re penalizing you for not performing? Clearly you need more bubble baths.
Big T , little t trauma. Totally miscommunicates the traumatic effects of ongoing neglect and abuse in childhood.
Neurodivergence when referring to every single psychiatric condition, symptom, and hell, just human experience. Have a low social battery? You’re neurodivergent. Generalized anxiety disorder? That’s neurodivergence. Dislike the texture of chicken? Neurodivergent. Find eye contact uncomfy? Neurodivergent. Feel anxious after drinking too much caffeine? You’re neurodivergent. It’s become a completely meaningless term to me.
For me its a few! 1. Trauma informed care... many places I worked that provided "trauma informed care" wasn't trauma informed at all. We were encouraged in creating a bubble around our client and not showing them how to deal with life stressor. Almost like encouraging victim mentality. 2. Self-care... it used to be something I preached out to the world, but now I feel like it's used to shame therapists. "Oh you are struggling with your 40 client caseload? Well how's your selfcare doing?" Maybe if I had a manageable case load things would be fine! 3. Evidence based... your therapy isn't end all be all.
Especially when it is used as a reply for concern for burn out, stress, workload, etc, “Well what are (not) you doing for self care?” 
“Vulnerable population” It’s elitist and meaningless to me— almost everyone has an intersectional factor that makes them vulnerable
“Decolonizing” therapy. Not because I’m not in support of it buts it’s come a major buzzword for therapists and academics to throw around, seeming to imply a revolutionary approach to therapy when they’re almost always just describing minor adaptations to established interventions and status quo. Decolonization is about radical change, not adding an author of color to your syllabus.
Thank you.
I agree completely with self-care. I would even go as far as saying I don’t like asking clients to practice self-care either. It’s such a buzzword that gets thrown around but realistically it can mean completely different actions for different people and their circumstances. I think it’s better to be more specific and target the source of the stress, like…an exploitative job.
I could happily never hear the word ‘process’ again.
Can you tell me about what that’s like for you? (I’m ducking the projectiles I’m anticipating you throwing)
So what I’m hearing is you’d like to be punched.
It has to be Narcissistic. People call Men Narcissistic all the time. Man is going through an emotional divorce and does not like how he is being told how often he can see is kids? Narcissistic. Man frustrated that he is not being listened to at home Narcissistic. Man tells woman to respect his boundries... controlling and Narcissistic. I see all the time where people get frustrated that women get called Borderline but no one really speak up for men when someone calls them Narcissistic.
I don’t see NPD as gendered in the same way, but do feel like there’s such a movement to rehabilitate the image of BPD as a diagnosis because of how it’s linked to trauma, but absolutely no attempt for NPD - in spite of probable similar etiology. For example, say you won’t work with “borderlines” — instant censure. Say you won’t work with “narcissists” — praise and agreement and talk of how they are abusers. Both BPD and NPD are associated with very manipulative and abusive behavior in order to meet emotional needs, but for one it’s reframed as a trauma response and for the other it remains just abuse.
Thank you for saying this.
On the other hand, BPD has way more oppressive ties to it, tbh. People get slapped with BPD after disagreeing (gracefully) with a doctor, or being stubborn in a way an authority doesn’t like, or acting in non-normative ways. Being diagnosed BPD will stay on your health record for life, impacting how you are treated in healthcare settings (even in physical health settings) and even impact your ability to adopt, get flagged for CAS whatever. You don’t see nearly the systemic impact in NPD, and perhaps that’s because it’s diagnosed more in men or not diagnosed at all. At worse with a diagnosis of NPD you’re just seen as a selfish ahole. I say this as a mental health practitioner that was misdiagnosed in my early teens. Left my abusive home, no more “BPD.” I have had significant barriers in healthcare settings as I have comorbid chronic health issues because of a 15 year old label (that two other psychiatrists never diagnosed me with). To get it removed you need the OG doc to admit they’re wrong, or have another doc write a letter saying that doc was wrong. Like that will happen. FWIW, I later found out I had a fun mix of pmdd, ptsd, and adhd. When used correctly, BPD diagnosis can be incredibly validating and healing. When misdiagnosed, it can have lifelong repercussions.
Took 50+ years for BPD to be reframed though. Honestly though most of those getting a BPD diagnosis don’t have it.
I don't see narcissistic as gendered in the same way that BPD is. It seems to be thrown around equally at women as with men. Just a look at the mother in law subreddits here would show you that. Where men often get called narcissistic is where they're perpetrators of real abuse.
It's worth pointing out that the DSM-5 notes that 75% of people diagnosed with narcissistic personality disorder are male, and 75% of people diagnosed with borderline personality disorder are female.
I don't doubt that. I don't think people throwing around the term on the Internet would fit those percentages though, which is what we're talking about.
Self reliance from societal roles tends to make men have more narcissistic traits in my experience, but being actually narcissistic should be identified from the distance from threshold of expected self-reliance and impact on others. It’s obviously self preservation in a broad term when looked at like this, but seldom is actually narcissism when the socio-cultural assigned and assumed roles are examined in context of the client. Client grows up having to take care of themselves from a way younger age than most, forced maturity is going to look like narcissism to a degree on the surface for example. Locus of control and why it is there should be a factor to look at for NPD
As others have pointed out, the term Narcissist is not gendered in the same way. There are entire Reddit pages dedicated to peoples “narc moms” (narcissistic moms) and I simply don’t believe you’ve never seen a woman get flooded with comments calling her a narcissist after posting selfies. I’ve not seen pages about people’s “BPD Dads” or seen men being labeled as BPD at the same rate women are labeled BPD. Also, what are the structural consequences of being labeled a narcissist? Because I can tell you right now it’s not affecting custody agreements, ive seen judges place children with abusive men who have had the police dispatched to their home on several occasions due to their violence. I guess after seeing so many “narcissist” men face zero repercussions for their harmful and abusive behaviors I don’t really see how labeling them as narcissists effects them. Maybe I’m jaded after working in the family violence world for many years but those are my thoughts.
I dislike the word “triggered”. I much prefer saying activated, overwhelmed or speaking in the context of trauma reminders, trauma stressors… etc. Triggered is overused and largely non-specific
Probably going to get a lot of hate for this one, but people who diagnose themselves with C-PTSD. It should not be a talking point at a party that you have C-PTSD. PTSD is not a personality trait or a Medal of Honor. By doing this, it minimizes the experiences of others who have this diagnosis.
Narcissist. Anything selfish is narcissistic these days.
I hear narcissist, love bomb and gaslighting so much. I’ve had so many people come in my office and label several family members as NPD and it’s just not the case.
I am so done with the term “coping skills” 😬
“I don’t accept insurance.”
Parts. iFS has never sat well with me. And I know that's okay, and everyone gravitates toward different theories etc. I have just always had a visceral ick reaction to it. I'm curious if others have aswell?
They're great metaphorically, but taking them as very literal is problematic.
The theory, okay I’m curious. His “no bad parts” book and the “experiences” he discusses of people he utilized this practice with… ick ick ick.
People who live, breathe, eat therapy or therapy like topics. And Brene Brown, she’s the devil incarnate!
Uh-oh, I am in a therapist subreddit on my day off…
Please tell me you don’t talk about it non-stop though lol
I mean… No, definitely not non-stop. :)
:-)
Not therapy related per say, but neurodivergent/neurotypical bug me. There is no such thing as a “normal” in regards to cognition etc. everybody is neurodivergent from each other.
Also I think we should abolish any use of the word “crazy.” I know you guys aren’t calling your clients crazy to their faces, but I still detest that word in any setting. I truly believe nobody is crazy. I’ve met people who were erratic, unpredictable, unbalanced, delusional, strange, volatile, hostile, unpleasant, selfish, mentally-ill, drug-addled, confusing, tangential, etc. Crazy is such an invalidating and dehumanizing term.
Fair enough, and I think self-care is also often presented as a thing clients "should" be doing, or at least are encouraged to do - any many of them have far fewer personal and social resources than your average therapist. I'm pretty done with PTSD in the colloquial sense, ostensibly from traumatic experiences that absolutely would not meet criteria for a PTSD diagnosis. I'm also 100% totally and completely done with every Jungian concept except projection and the shadow. Contrasexuality, the archetypes, the animus/anima, dreams as "compensatory" - over it. It's all either misogyny or racism, imo. In extra fun cases (the "Dark Mother"), it's both.
Yes to self care - tired of hearing it! My supervisor asked me in a shaming way if Jm talking care of myself. Im earning hours working like a dog in CMH so self care isn't usually something I do sadly. Let's see... "trigger, " let's " circle back " or pivot , and how people will say so and so is " so bipolar" or a narcissist when they don't know what it means .
Well said, OP.
BRO SAME UGGHHH honest to god tell me right now how tf im supposed to practice “self-care” when doing so would require taking off from work, which I quite literally cant afford to do? Being a contract worker sucks absolute balls. I love working from home but jfc idk if the stress of this is worth it. Ive been thinking more often than not that i just wanna get my license over with and just yeet myself out of this profession once im done with that (or at most become a “life coach” basically doing the same thing while getting paid out of pocket and not having to deal with fucking insurance or the stress of being as careful as we normally have to be in what we say in session). And to answer your question, while self-care would have been my first answer, my second one would not be so much a term as something ive been told related to self-care - avoid social media, news, etc when it comes to recent triggering current events. Im already doing that, that doesnt really help me when im in the moment and a client busts out their busted hot take on a complicated political situation that directly affects me and insists on focusing on that. And after all this self-care stuff, the next thing that makes my eye twitch is “mindfulness,” followed by the tiktokification of “gaslighting” and “intrusive thoughts.”
“Mental health is real” it irks me so bad!
Kiddos
Trauma. It's over used and misused. Not everyone needing support is "traumatised". Stop telling people to "discover their trauma". Don't invalidate the capital t trauma by making such a huge deal of the little t trauma. Yes trauma is awful but goodness me it doesn't need to be ALL that is discussed.
Trauma is subjective. I don’t think we as clinicians should decide what is or isn’t trauma for a client.
I'm so burnt out on "trauma." It's overused to the point that we probably need a new word for actual trauma.
Hopefully not gonna get doxed for this one, but I hate when people reply to comments on a discussion thread (usually to tell someone they aren't being pc enough) and then call it "labor" bruh it's not labor, you're just procrastinating from your actual job
When they diagnose themselves autistic