Copyright © New Therapist
By Tom Strong
We talk a lot about our assumptions as therapists, but what about those of our clients? How, in this media-saturated age, can we work with the understandings clients have developed regarding their concerns - understandings often presented as diagnostic labels? As a constructionist therapist I twitch inwardly any time I'm presented with a one reality view of what I am to work on. So, it is quite a challenge to have a diagnostic label plunked down before me by a client who is "certain" of what I want to get curious about.
Labels have an uncanny way of packaging life experience; they set in motion cues that, for clients, have them track what dissatisfies them about their lives. The certainties are part of what a modern scientistic view of the world uses to seduce an understandably anxious and desirous-of-certainty clientele. The metaphors are directly borrowed from the classificationist views of biology and the engineering views of applied science. Describing things in symptom terms sounds a bit like naming trees by their leaves and bark. Still, there is often a deeply felt sense of relief for many when a formerly inchoate and troubling experience "finds a handle".
A constructionist therapist wonders: why exclusively this label, and what other possible descriptions could fit alongside that which has so uniformly represented a client's presenting concerns?
I have come to see labels as verbal ports of entry into client experience. Ask how they became the best fitting description for a client's plight and an important story emerges, one with other, less constraining plotlines, if explored. Ask about what gets left out of the story shaped by the use of that label, and there's rich potential for multiple understandings where a singular one prevailed. Ask further about how the label portrays a client's wishes for the future and both of you are facing a conversational black hole if the label is your reference point: the only thing you can talk about is the absence of something that has compellingly "explained" the client's experience. Inside a label, however, are many experiences that simply don't fit the totality of who clients are and what they do; sort of like stretching a tight corset over too big a frame.
Of course, adopting a stance that says the client has things wrong is a recipe for disaster. What I'm proposing is an inquisitive process that adds to the meanings clients start from. There's little poetry in a language of objectively verifiable symptoms, so we start there. Symptoms are but one way of portraying an experience as complicated and particular (to a client) as "depression". My use of quotes around such a label is in no way intended to diminish the significance of that way of describing a client's experience, but there's so much more missing from such a catch-all word. The meanings of any label can be collaboratively explored for their adequacy, much in line with this quote from transcultural psychiatrist, Laurence Kirmayer, "the sufferer is a poet in search of metaphors adequate to express his predicament". What then, metaphorically, can further highlight not only the qualities of personal experience implicit in the concern brought to therapy, but can elaborate on the sense that this experience is not in keeping with the preferred flow of how a client wants to live life?
My point in sharing all this is that labels can be presented to us as tight meanings, as if our clients' experiences have been definitively defined. But, there's a problem with labels in this regard: the label a client presents to us has not fostered problem-resolution, or our assistance would not be sought. So, I'm suggesting we "unpack" and "poetize" a label for such things as: how thoroughly it "fits" for the client; exploring together other meanings that add "fitting" nuances to what the label tried to capture in its totality, and jointly seeing what those nuances generate in terms of preferred possibilities for clients.
Tom Strong is an Assistant Professor in the Education Program (Counselling Specialisation) at the College of Arts, Social and Health Sciences, University of Northern British Columbia, Canada.