Words have power. They are impactful. They can contribute to stigma and divide humanity. To help fight stigma, change your language.
Have you ever been called a bitch? A creep? A whore? An idiot? Maybe someone said you were lazy or worthless or stupid. Words can hurt. Language has power. (Consider the power of your name spoken aloud… you immediately respond by answering or turning your head… the sound commands your attention and response.)
Furthermore, words are impactful… not only for the person being labeled, but for an entire group of people. They contribute to stigma while fueling biases. They divide humanity. Retard. White trash. Crazy. Junkie. N*****. Slut. Spic.
A while back, a colleague made a racial slur in my presence. He seemed unaware, so I gently corrected him; he immediately lashed back, calling me the “PC Police.” Not only did this person perceive the slur as perfectly acceptable, he seemed to have a negative perception of “political correctness.” It was a joke to him: “People need to stop being so sensitive!” (Um, no… maybe people need to stop being degrading to each other!)
Honestly, I have trouble understanding the negativity surrounding political correctness. Why strive for anything other than accuracy? (Especially knowing the power language holds.)
Why Language Matters: 4 Words/Phrases to Stop Saying
If you side against ignorance and want to end the stigma associated with mental illness, change your language. The following words or phrases contribute to stigma:
There are many negative connotations surrounding this word. Similarly, “alcoholic” can be demeaning. A person who is addicted to drugs or alcohol has a medical condition. Instead of calling them an addict (or junkie or tweaker or crackhead), say “individual with a substance use disorder.” Demonstrate the same empathy you would for a person who has cancer or MS or paralysis.
Don’t label a person who suffers from mental illness. They are more than the disorder they’re afflicted with. Calling someone “schizophrenic” or “borderline” or “bipolar” reduces them to an illness, not a person. It’s dehumanizing.
True, “mental retardation” used to be the diagnostic terminology for classifying individuals with lower IQs. Today, however, it’s mostly used as an insult. The American Psychiatric Association has eliminated the term as a classification; the correct term is “intellectual disability.”
This phrase suggests that the person who dies by suicide is criminal. Criminals commit crimes. An individual who dies by suicide should not be placed in the same category. Instead, say “died by suicide.” This demonstrates respect for both the individual and their loved ones.
Language has the power to influence and shape the world. You have power. Be a positive influence and choose to fight stigma instead of contributing to the toxicity.
A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more DESERVING lives.) “Junkies” don’t deserve second chances because #JunkieLivesDontMatter.
Disclaimer: If you happen to believe that addiction is a choice – “They’d quit if they really wanted to” or “They made the choice to use so they’re making the choice to die” – then scroll on to the next blog post. #JunkieLivesDontMatter
This article is inspired, in part, by an ignorant (not ill-intended) meme posted by a healthcare worker on social media.
The meme said,
“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”
Implication: A “junkie” doesn’t deserve a second chance at life. (#JunkieLivesDontMatter) They’re a waste of resources because they lack the willpower to stop using. A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)
If you believe it is screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re also a part of the movement: #JunkieLivesDontMatter
Many have joined the movement, as evidenced by the following social media posts:
“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”
“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”
“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”
“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”
“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”
“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”
“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”
Addiction & Stigma
According the the American Psychiatric Association,
Addiction is a scientifically proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing. (Note: This notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment. Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak… or a worthless junkie.)
Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.” #JunkieLivesDontMatter
To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment. Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.
Are you in therapy or have you sought counseling in the past? Are you currently practicing as a therapist or counselor? This article explores what makes a therapist effective (or not).
What Are the Characteristics of an Effective Therapist?
The American Counseling Association (ACA) established a code of professional ethics and values as a guide in practicing as an effective therapist. The ACA’s mission is “to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.”
Professional values include the following:
enhancing human development throughout the life span
honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts
promoting social justice
safeguarding the integrity of the counselor–client relationship
practicing in a competent and ethical manner
Ethics include autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity.
The ACA outlines professional values and ethics, but for the purpose of this article, I wanted to learn about current perceptions and views. Also, how do counselors exemplify the code in their practices? Using social media (Reddit and Quora) as a survey tool, I reached out to mental health professionals and therapy participants; I also browsed through older threads and posts on the topic.
I read about traits (like active listening and compassion) that are important to both therapy participants and clinicians. Additionally, I learned about negative experiences, which was disheartening. So what makes a good (or bad) clinician?
An effective therapist is someone who…
Is kind and compassionate
Puts a lot of thought into what they say
Educates their clients (coping skills, symptoms, stress management, etc.)
Reflects and validates feelings
Understands human behavior and mental disorders
Sets and adheres to healthy boundaries
Is genuine (and genuinely cares for their clients)
Has a wide range of techniques and a variety of tools
Is humble (and gives advice sparingly)
Creates a safe place for healing
Is knowledgeable (evidence-based practices, current research, etc.) and intelligent
Possesses emotional intelligence
Experiences and conveys empathy
Has a sense of humor
Recognizes and values other perspectives
Interestingly, a few responders took into account a therapist’s personal values and views (not just how they conduct themselves in a session). As a counselor, this resonated. For example, a therapist can’t be genuine if they’re empathetic with their clients, but rude or nasty otherwise. Being a counselor means fully embracing the code of conduct. Consider how it would feel to discover your therapist treats restaurant staff poorly or gets hammered and then drives. It would likely leave a bad taste in your mouth. A good clinician is a role-model. Furthermore, it’s important for a counselor to be emotionally stable and self-aware, which is something I’ll explore shortly.
Regarding professional development, it was noted by Lazar_Milgram (Reddit user) that a counselor must commit to “relearning,” meaning re-reading text books, literature, and research to prevent it from fading. As humans, we forget things. We need to go back to the original source of knowledge now and again. It’s not enough to go to grad school; a counselor must commit to a lifelong education. Along those lines, Lazara_Milgram reported that an effective counselor re-visits his/her failures. If we were unable to help a client for one reason or another, it’s worth it to review their file and our records, consult, and then learn from our mistakes.
On self-awareness, Reddit user Valirony, a marriage and family therapist, shared it’s important for a therapist to be aware of “[his/her] own existing issues and [be] either well-processed on those fronts and/or very capable of compartmentalizing the baggage that is less well-processed.”
To expand on this, consider the experience of emotional anguish. An empathetic person who has experienced a personal tragedy may consequently feel a desire to ease suffering in others. Naturally, they’re drawn to the counseling profession; but if their wounds haven’t healed, they lack the capacity to help their clients.
Sadly, some counselors enter the profession seeking to “fix” others as an attempt to compensate for being unable to face their own issues. In contrast, an effective therapist recognizes his/her limitations as a counselor, especially in the face of personal tragedy. They recognize when it’s their own “stuff” (and not the client) triggering a reaction. They leave the past where it belongs and carry little to no emotional baggage. This allows them to be fully present and engaged.
Valirony (Reddit user) also discussed constructive criticism. It’s essential for the effective therapist to remain open to constructive feedback in order to grow. Valirony explained, “I see a lot of defensiveness in some of my colleagues during consultation; I’m no saint and I feel defensive here and there, but I always take a look at that defensiveness for whatever it is in me that I need to change.” Defensiveness is a clue that something’s not right. On constructive feedback, Reddit user Lazar_Milgram suggested, “Embrace criticism – every criticism is a 50/50 package of perceptual information about you. 50% tells something about you and 50% tells something about client.” Providing it’s thoughtful and well-presented, criticism can inspire insight or provide a new way of looking at something.
Ann Veilleux, a private-practice psychotherapist and Quora user, identified emotional intelligence as a trait for effectiveness. “Intelligence comes to mind first, emotional intelligence certainly, a curiosity and interest in people [as] more [than] machines or plants.” Emotional intelligence is innate; it can’t be developed the way a skill can. Furthermore, a good clinician is curious, but their interest is attached to the well-being of their clients. Veilleux pointed out that an effective therapist must possess interest and ability – not one or the other – in order to sustain the level of investment therapy demands. It’s the “interest and ability to have intimate relationships with many people at the same time and not to tire of that.”
The Therapeutic Relationship
With regard to the client-counselor dynamic, an effective therapist recognizes that the relationship is central to the therapeutic process; it’s the key to healing and growth. A client must trust the counselor before they feel safe enough to share their pain or humiliation or guilt. Traits like warmth, humor, and transparency foster an honest and caring relationship. Counseling skills are important, but can only go so far without a trusting relationship.
To promote a supportive relationship, Reddit user RedYNWA suggested that counselors practice empathy without being overly emotional. RedYNWA described how they felt when their therapist cried in session. “I believe my topic brought up something personal for her. The minute she cried. I stopped talking, and changed the topic. I felt she was unable to hold my topic, and I felt a responsibility to ease her distress. It changed our relationship, I felt like the therapist, and it restricted my ability to divulge deep emotions. It was unintentional on her side. However, it destroyed the therapeutic relationship.”
In the above situation, a counselor’s emotional reactivity upset the balance of the therapeutic relationship. Unintentionally, the therapist sent a strong message. The message was that she was too fragile to hear her client’s pain. If the therapist can’t be strong, how can the client? A counselor who breaks that easily can’t be a source of unwavering support. It’s the client’s job to cry; the therapist’s job is to remain calm, to maintain a safe environment, and to instill hope.
I am acquainted with therapists (colleagues and former peers) who occasionally cry in sessions. Sometimes, it’s an instinctive reaction to hearing the horrors clients have gone through; the discrimination, the trauma, the abuse, and worse. There was a time I cried while facilitating a group, but it wasn’t related to anything being said. That morning, I had learned a former client died by suicide. He shot himself in the head. He was only 22. I felt vulnerable and self-conscious about crying in front of my clients. Later, my supervisor helped me to understand that crying can make a therapist seem more human and authentic, which has the potential to strengthen the counseling relationship while conveying empathy.
Some clients will feel closer to a therapist who cries; others will feel uncomfortable. There’s no right or wrong. Quora user Philippe Gross, Assistant Professor of Psychology at University of Hawaii, pointed out that even with all the right qualities, a therapist will not be a good fit with every client. When this happens, Gross stated that “an effective therapist should be able to recognize this soon and refer the client to a more appropriate therapist.”
One Reddit user and professional counselor, ForeverJung, touched on the importance of not getting caught up in their clients’ pain to the point it becomes their own (also known as vicarious trauma). It’s having “the ability to care deeply and then shut it off,” which can be difficult, especially for new counselors. ForeverJung also shared that an effective counselor must be able to listen, while at the same time “synthesizing data,” and then provide a constructive response that the client will be able to make sense of.
Redddit user blueybluel shared about a therapist they described as absolutely wonderful. “She was incredibly empathetic and patient with me, almost to a fault I felt like sometimes. But it really helped me a lot with my self-hatred, self sabotage and suicidal thoughts because for the first time ever, I was regularly associating with a person who was so soft with me. She genuinely thought I was a great person just the way I was, and that I didn’t have to accomplish and be perfect all the time just to have worth and to deserve to live.”
Similarly, Gatopajama (Reddit user) described positive interactions with their current therapist, who shares their odd sense of humor. “[My therapist] is serious when the topic calls for it, but usually a session with her feels very comfortable and laid back, like having coffee with a girlfriend. She also shares a little bit about herself sometimes (not in an inappropriate or TMI way) — it makes me feel like I’m talking to a real person and not a human psychology textbook. Plus, she’s got a gigantic bowl of moonsand in her office. Sometimes I plop that thing on my lap and play with it the whole hour to keep my hands busy if I’m trying to talk about something difficult.”
What are the Traits or Characteristics of an Ineffective Therapist?
While some traits (such as having a gigantic bowl of moonsand!) positively impact the counseling process, others contribute to nonproductive (or even harmful) therapy. When I elicited feedback on effectiveness, I learned about some horribly ineffective and disturbing practices.
An incompetent clinician lacks self-awareness and insight in addition to the required knowledge and skill. They may have entered the field for all the wrong reasons. They’re rigid and closed to new ways of thinking. Most importantly, they don’t listen to their clients. Ssdgmok, a Reddit user, described a bad clinician as “someone who talks about themselves each session, poor listening and ‘giving advice.’” Contrary to popular belief, a counselor’s role is not to advise the client. A therapist is more like a collaborative partner who leads the client to their own insights while providing the tools for change.
To give a personal example of a therapist who talked too much (although not about herself) and didn’t listen, I’ll use myself – but in the role of the client, not the clinician. I was in my late teens and it was one of my first experiences seeing a counselor (a middle-aged woman). The therapist had apparently just finished a session with a young woman who had attempted suicide. And the therapist proceeded to tell me all about it. Meanwhile, I was bursting with pain and self-doubt; and the therapist continued to talk about the client who had just left her office. She went on and on about how she couldn’t believe “that little girl” swallowed an entire bottle of Tylenol. It was like she didn’t hear a word I said, and I left feeling even worse. (Luckily, that experience didn’t poison my view of the profession or dissuade me from entering the field a decade later.)
A Reddit user shared about expressing thoughts of suicide to their therapist
Jwaggin “Therapist: Are you suicidal Me: Yea… Therapist: You hate your mom? Me: uhhh no Therapist:Well if you kill yourself your mom would be very hurt Me: uhhh ok (thanks for the guilt)”
If this happened, it’s clear that the therapist lacked not only empathy, but a basic understanding of mental illness. An effective therapist never shames or “guilts” a client. The client is already in pain (which is what brought them to therapy in the first place). Also, when a client says they’re suicidal, it’s the therapist’s responsibility to explore this with the client while ensuring the client’s safety. An effective therapist helps the client to identify what (if anything) would prevent them from killing themselves; the clinician won’t admonish the client for their hopelessness. To do so would be demeaning, with a disregard to human dignity.
Reddit user blueybluel shared, “When I told [the therapist] all my struggles, she seemed empathetic, but then got on this weird shtick of telling me to do homework of writing down things I like about myself, in an aggressive, demanding, pull yourself up by your bootstraps kind of way, and said, “Can you do that for me? By next week?” I canceled the next appointment and never saw her again.”
There’s no room for aggression in this profession. A good therapist is gentle; they don’t give orders. Instead, they explore, listen, and ask questions. It’s a respectful partnership between client and counselor.
After tragically losing their infant son, a Reddit user sought therapy
wonder-maker “I explained my situation about having lost my infant son in a tragic household accident. She asked me to wait a moment, got up, walked to the front desk, came back with a sticky note from the receptionist and told me to come back and see a different therapist at a later date, then refused to make eye contact with me. The next therapist said to my face ‘Boohoo, your kid died, get over it.'”
In the above example, the first therapist was a woman in her early 40s and the second was a male in his 60s. I’m disturbed by what happened to wonder-maker (Reddit user); and I’m horrified that these “helpers” are out there providing counseling services. The female therapist’s reaction could be explained by lack of experience or skill; alternatively, hearing about the accident could have triggered her (which is why self-awareness is so important). However, there is no excuse or explanation for what the male clinician said. You don’t have to be a therapist to feel empathy or compassion (but you do have to be a jerk to tell a grieving parent to “get over” the loss of a child).
In summary, there are many things that positively impact a counselor’s effectiveness, while opposite traits are related to incompetent practice. An effective counselor is an active listener, expresses empathy and compassion, and is genuine and transparent. They promote healing and self-exploration. The therapeutic relationship is also important. An effective clinician creates a safe environment for building trust while providing support. Additionally, to be effective, a therapist must commit to a lifelong pursuit of knowledge to learn new techniques and evidence-based practices, to understand how scientific developments will change the counseling profession, and to keep up-to-date on relevant research.
In contrast, a therapist who is uncaring, uninterested, and who doesn’t listen will never be effective. A counselor who constantly advises their clients or who shames their clients is incompetent and unethical. Furthermore, the absence of emotional intelligence greatly impacts a clinician’s counseling abilities.
Regarding personal values and lifestyle choices, there’s a gray area. Can a therapist who gossips or who abuses sleeping pills provide effective services? What about a marriage counselor who cheats on his wife? While a few therapy participants and mental health professionals emphasized the importance of a therapist’s personal integrity, most responders viewed effectiveness in the context of therapy alone.
Lastly, therapy participants who reported unproductive or even damaging experiences received services from therapists who did not adhere to the ACA code. Conversely, positive and effective experiences were related to ACA values.