After negotiating space for my lunch on a train table with a young woman, I fell into conversation with her about the purpose of her books and laptop. She was a master’s student and having a tough time with her University’s administration, and her tutor in particular. In the half an hour or so of chatting she described him as a narcissist who gaslit her. She felt burnt out and angry that there was no safe space for her to go. I couldn’t be sure what she meant by these terms of so-called ‘Therapy Speak’, even though I’m a psychotherapist. They, and many other words and phrases from consulting rooms and diagnostic manuals have percolated into the mainstream, and have been diluted or added to on the way.
Our new dialect of Therapy Speak seems to be everywhere – Margot (as I came to know my train friend as) is part of a generation that describes experiences and relationships in these psychological and emotional terms. She reflects how we have, more generally, become far more aware, and interested in, our minds and emotions, and that we want to attend to, and maybe prioritise, our wellbeing. This must be a good thing, in a world that continues to create pain and suffering at a seemingly exponential rate. Margot’s way of thinking and talking advocates for a better understanding and acceptance for all our varied stories and makes my profession far less of an aloof one than it was when I began to practise twenty years ago.
However, Therapy Speak has no agreed-upon dictionary or glossary to refer to, and its developing terms can mislead, or even confuse others. In the posts that follow this one, I want to offer a guide of sorts in the hope that we can come to more of an understanding of some terms when we use them. My understanding of ‘gaslighting’ turns out to be very different from Margot’s, and while her tutor certainly sounded deeply unpleasant to say the least, I was not as sure that his behaviours would stack up to the meaning I know.
Therapy Speak isn’t entirely new of course. I came into adulthood in the early 90s knowing very little about what mental health or ill health meant. I remember my mother’s reference to my potential ‘inferiority complex’ (a term of Carl Jung) as a much younger sibling, and references to punishing ‘superegos’ (a term of Sigmund Freud), but these were rarefied concepts of readily dismissed ‘psychobabble’. My friends and I had no grasp of what terms like these really meant and only a privileged – or really unwell – few who went to therapy did.
Psychotherapy was an aloof practice for a very long while, associated with its Freudian psychoanalytic form or Woody Allen films (‘patients’ lying on a couch describing their dreams), or maybe as Californian hippies ‘re-birthing’ or ‘primal screaming’ at the Esalen Institute. Most of us muddled through bad days, bad sleep and bad break-ups without deep enquiries into our inner worlds or analysis of the relational dynamics between us and others. Maybe, more accurately, we kept such analysis to ourselves.
‘Stressed’ was about as nuanced as many descriptions got in my teens. It described the reason my friend’s mother ‘went somewhere to rest’ (I later found out she was admitted to a psychiatric ward for depression), and it was also the reason for another friend’s sister’s admission to a hospital for her ‘stomach problems’ (a specialist ‘eating disorders service’ didn’t then exist). We now use many more words – accurate or not – to share, far more readily, the contents of our minds, the range of our feelings, emotions, bodily experiences and presentations, and the details of how our experiences play out. Much of this is online of course: in social media posts and reels, You Tube videos, and substacks, with all the likes and follows.
The US critic Lauren Oyler’s biting 2024 essay ‘The power of vulnerability’ describes many of these personal outpourings as a ‘controlled release of intimate details’. She notes a cultural emphasis on being ‘authentic’ and emotionally open – especially on social media platforms – that ultimately persuades us to present our vulnerabilities in a curated, and performative way. She is concerned that when such self-disclosure becomes self-marketing, it strays from being a genuine communication, nor, she suggests, could this be truly transformative for the person who shares their inner world. I worry that Therapy Speak runs the risk of us doing something similar too – pulling us away from what we may really mean to say – which is why I want us to take care about the terms that we use.
When I told Margot I was a psychotherapist, her face lit up with interest, and she shared her experiences of her own various talking therapies. The growth of Therapy Speak has tallied with the normalisation of what I do. Twenty years ago, when I began clinical work, revealing my profession usually clammed people up. Some clients would come to see me in secret, paying in cash for fear of a partner clocking their weekly outgoing. Others described me as a ‘work coach’ to their families or on their bank transfers. This was around the time the best-selling book Watching the English: The Hidden Rules of English Behaviour was first published (2004). Written by Kate Fox, a social anthropologist, it discerned ‘the understatement rule’, where: “….a debilitating and painful chronic illness must be described as ‘a bit of a nuisance’; a truly horrific experience is ‘well, not exactly what I would have chosen’….. an act of abominable cruelty is ‘not very friendly’, and an unforgivably stupid misjudgement is ‘not very clever’….”
While the understatement rule persists (to the amusement of my Dutch friends), the growth of Therapy Speak suggests another, opposite, cultural manner exists too, which is to ‘say it as it is’. Because we may be using ill-defined terms though, this might mean wrongly or over-stating things, which is why I want us to take stock. These days, many of my clients talk about their therapy with others and they no longer hide me, and may even introduce me to their families or friends if we meet accidentally. Some tell their work colleagues why they come in late on a Wednesday or ask their flatmates to be scarce when we meet on zoom.
Interestingly, Fox’s book landed on the shelves around the same time as a controversial one, that hit a very different note: Therapy Culture: Cultivating Vulnerability in an Uncertain Age. Written by the Hungarian-Canadian sociologist Frank Furedi, he has a particularly loud voice amongst many critics of the ‘problematisation of everyday life’ that many see has escalated over the past two decades (also described by other thinkers as ‘therapism’).
Furedi points to a cultural over-emphasis on emotional vulnerability and laments the medicalised treatment (via therapeutic interventions) of ‘normal’ human experiences such as grief, depression and anxiety. He contends that our ‘therapy culture’ has eroded traditional sources of meaning and authority such as religion, family and community and argues that, ultimately, our sense of individual autonomy and personal responsibility has ebbed. His voice hums in the background of books published this year that challenge over-diagnosis of mental health problems.
There are other ideas that reverberate through the ‘Therapy Speak’ debate – two related ones are ‘semantic bleaching’ and ‘concept creep’. The former refers to words losing meaning, which happens naturally as language evolves. When I was a teenager, ‘wicked’ meant ‘awesome’ and ‘queer’ was derogatory. Reluctantly, I accept that ‘literally’ now, most often, means ‘figuratively’ as it did for the woman I overheard exclaim ‘I know! I literally died! TWICE!’
I nod to the risk that Therapy Speak runs the risk of semantically bleaching the diagnostic meaning of certain illnesses. Overhearing ‘I’m OCD about cleaning the kitchen’ offends my client who cares for her daughter, imprisoned in her bedroom for three years by her terror of contamination. Saying ‘I felt really depressed yesterday’ riles another who I often speak to on the phone from under her duvet because she can’t face seeing me online, let alone making the ten-minute walk to my consulting room. Fearful of adding more bleach to such words, some of my clients, and supervisees, are now reluctant to use them even in appropriate ways, just in case they are overdoing it.
Meanwhile, ‘concept creep’ concerns words that expand in meaning over a shorter period and tend to do so because of a more conscious desire for change. This phenomenon was originally outlined by Nick Haslam, a professor of psychology at the University of Melbourne, in 2016 in an oft-quoted paper ‘Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology’. He had noted a trend beginning in the 1980s, in the social and psychology fields of the broadening definition, or ‘semantic inflation’, of six concepts: ‘abuse’, ‘addiction’, ‘bullying’, ‘prejudice’, and ‘trauma’.
Haslam thinks that these concepts are expanding both ‘horizontally’ and ‘vertically’. ‘Horizontal creep’ happens when a term absorbs qualitatively new phenomena, in the mode of metaphor. So, using the example of ‘bullying’, when I was in my primary school playground in the 1970s, it described children being nasty to other children. Now, bullying easily refers to adults undermining adults in the workplace, or online trolling, and has grown to go beyond intimidating behaviours to ones that exclude, such as shunning or ‘ghosting’.
‘Vertical creep’ refers to the absorption of less severe phenomena, and resembles hyperbole (or exaggeration) of the type Furedi doesn’t like, nor the US psychiatrist Allen Frances who you will meet in Chapter 3, who rails against the increase of psychiatric diagnostic terms. So, using the example of bullying again, the term – in the workplace literature at least – now seems to include one-off acts or ones that weren’t intended to be bullying, but the subjective experience of the victim is emphasised instead.
Haslam concedes such creep could be a good thing. It is surely good that we are alive to psychological harms and want to be thorough about including all potential targets of these. Without concept creep of trauma, we might have ignored the egregious effects of racial microaggressions, and without the creep of abuse to the financial realm, many domestic harms would be unrecognised and unsupported. Anxiety is also, appropriately, absorbing people’s debilitating concerns about the safety of our planet and our future on it.
However, Haslam also has concerns that echo the Furedi and ‘therapism’ camps. He thinks that the loosening of the definitions of our harms runs the risk of entrenching a growing cultural cleave between ‘victims’ and ‘perpetrators’ or ‘the harmed’ and ‘the harmers’, or, what we see blowing up online all the time, the destructive fights between those clinging to being ‘right’ while insisting on others being ‘wrong’.
I think Haslam is right to flag the point that it becomes easier to dig your heels in during a difference, or conflict, with the heft of a psychological (or pseudo-psychological) label. Statements that shut another person down, such as ‘I have boundaries, so I can’t do x’ or ‘You are triggering me so I’m walking away’ will inevitably favour the subjective experience of its speaker, making it difficult, or impossible, for another to challenge. If this opportunity for reciprocity, and communication, evaporates, a conversational cul-de-sac is its residue. Of course, both statements can be true, but at the moment we can be confused as to when they are, or when they aren’t, or, when they are stated in error, or as a deliberate means to avoid self-reflection.
The inherent opacity of psychological terms used out of their original contexts notably played out when the Hollywood actor Jonah Hill’s ex-girlfriend Sarah Brady posted screenshots of some texts he sent to her in the summer of 2023. Online opinion split between those who supported his use of words such as ‘boundaries’ and ‘triggering’ as appropriate (especially as they came from a man who would not be expected to show his vulnerability), while others thought he used them to assert power and control over Brady, above anything else.
I want us to understand our popular Therapy Speak terms better, as well as learning about their interesting hinterlands that reflect how cultural responses to our minds and emotions have changed over time. I note some of the challenges and controversies that relate to them too. Words that have no settled agreement amongst ‘lay’ users such as ‘gaslighting’ or ‘trauma’, tend to reflect divisions and disagreements amongst researchers and clinicians too. This means I can’t offer any definitive terms, but I hope you ponder further about them as they are said to you, or when you use them yourself.
I want to harness the momentum of our increased interest in mental health and psychological functioning so that we can think about the words we use more, and reflect further upon our own, and others’ motivations, feelings and possible reasons for behaving in particular ways. We are living amongst an excess of mental ill-health, loneliness, disconnection, polarisation of beliefs and deep, chronic fears of our future. Now is the time to use our growing psychological insight to think more profoundly about how we tick, but also, and crucially, how we can have compassionate responses to our friends, partners and families as well as our wider communities and even our precious and beleaguered environment.
Next up, a look at ‘gaslighting’….