Diagnostic Labels and the Therapeutic Relationship
The relationship between the therapist and client is a subject I feel very passionate about! We use labels to try to understand something, or to communicate about our experience. Sometimes people come in and repeat to me what other therapists have told them, they may have a page full of western mental health diagnosis' or they might say, “I am a rigid psychopath”. The latter refers to labels given to holding patterns back in the time of Wilhelm Reich. These holding patterns also lead to personality traits, or what Reich called “character structure”. While still respecting Reich's very important work, I no longer uses these labels in this way. However many practitioners still do.
The holding patterns are the subject of other articles, but today I want to talk about how a client would come to own such a label and if it could have any value to them. Often clients will read a book and label themselves, and, although they may be trying to understand their experience, this may be an intellectual exercise, an idea they have in their head based on someone else’s experience or knowledge. The problem is that the label doesn't describe what actually happens. The labeling can be limited in that the person may not really know, kinesthetically, what it means. It can also limit the wisdom of the body, the mind, and the emotions’ ability to have new experiences, obfuscating the change process.
Therapy is co-created between the client and the practitioner. While a therapist needs to have a solid theoretical groundwork that guides how she understands what happens in the sessions, its function is to provide a map for the work. I hope to use my knowledge in a way that provides a structure for understanding the therapy rather than dictates the client’s experience. I am aware that I cannot assume to understand the experience of another. Therefore we need to stay in constant communication, exploring and bringing into awareness what is happening for the client in their mind, body, and emotions each step of the way. This information helps the client to see how they do whatever it is they do in their life, and gives me information to guide the session. Awareness of what we do internally, how we structure our energy, and how it affects our thought patterns, feelings and behaviors, is a large part of what creates change.
A big reason that I employ physical exercise that can be provocative in groups and in sessions, is to open the system and help the client to explore beyond their normal experience and holding patterns. The things that come up during the session define where we go next. A recent group session encouraged members to explore what happens in their body under certain conditions. For example, if you have “been left by someone you love”, or if you have “been falsely accused”. How do you respond? We explored the attitudes “I can do it” and “I will not let them them get me”. Members were able to perceive their reactions in their bodies, the posture and the muscular and breathing patterns that ensued. They were able to identify the familiar attitudes that they personally carry through life, recalling the memories that created these reaction patterns. We walked around the room exaggerating the posture of this attitude and were able to see how the attitude was received by others and how we were affected by others’ attitudes. These type of exercises create a solid foundation of experience to recognize reactions going on within themselves and in their dynamics with others that had, until now, been out of full conscious awareness.
We are constantly exploring and tuning in so that clients have a way of recognizing when they are reacting to old belief systems and patterns based on past experience rather than what may actually be happening in the here and now. Along with other preparation provided in the therapy, this self-awareness can set the stage for new experience and different reaction patterns.
On the contrary, if I were just to tell you what (I perceive) you do, what the clinical name is for it, and how you may have come to it, this could, in the best case scenario, be a great relief to you because it can normalize your experience and give you some self-understanding. But even if it accurately describes your reaction patterns it would be limiting because if it remains an idea or a concept, you will not have the awareness to know HOW it is triggered, the mind-body awareness to know WHEN it is being employed, or the compassion for your system that will help you to change it in the moment. You may end up believing you are a victim of your physiology, clinging to the label rather than encouraging and allowing the innate knowledge of the system to find its way to a new repose. It is so important to realize that reactions come from experiences, and even though they then become patterns, this is not who we are at the core. When we identify with the reaction patterns and the labels we use to describe them we are very likely to reinforce the problem and to become stuck.
We have created a mental health system where labels are important for identifying the problem and for reimbursement purposes, but it is essential to not let that lock the client and practitioner into a way of working that 1) gives the practitioner power over the client by assuming he knows more about the problem than the client; 2) limiting the exploration of the problem and the treatment process based on the label and the idea that we are our labels 3) causes the client to identify with the label and the past experience rather than use it to facilitate change. We must be creative in the work and seek to find the deeper wisdom of the situation at hand.
by Aylee Welch, LICSW