Do You Speak Therapist?

A list of common questions and phrases used in therapy – includes a free PDF printable version of this resource

By Cassie Jewell, M.Ed., LPC, LSATP

Therapists have their own unique (and purposeful) language. We may use jargon when talking to others in the field, but with our clients (and most likely, with other significant people in our lives), we are focused and thoughtful.

Therapy is a tool for self-discovery; as therapists, it’s important to know how to effectively employ this tool. (For example, a hammer, while a useful tool, would not be effective if someone used the handle to pound a nail instead of the head.) What we say and how we say it is powerful: open-ended questions, reflections, clarifications, etc.

The following is a list of questions/phrases I find myself using in individual therapy and group sessions to explore, empathize, empower, and motivate change, including a few versions of the “miracle question” (a question used in therapy that asks the client to imagine what their life would look like if, miraculously, all of their problems disappeared and everything was perfect).

Click below to access a printable PDF version of this list.


1. How are you feeling?

2. How does/did that make you feel?

3. What would happen if you gave yourself permission to feel your emotions?

4. What was that experience like for you?

5. When did you first notice that…

6. When did you first recognize that…

7. What are your current internal experiences and reactions?

8. I’m noticing that…

9. What I’m hearing is…

10. It sounds like…

11. I wonder if…

12. It makes a lot of sense hearing it from your perspective… and, I wonder what would happen if…

13. May I share some feedback with you?

14. Are you open to a suggestion?

15. Would you like to hear a different perspective?

16. May I share my observations?

17. Would you like to know more about [mental health topic]?

18. Some research indicates that __________, but other studies have found that __________.

19. Tell more about that.

20. Tell me what that was like for you.

21. Will you say more about that?

22. Can you speak to…

23. I’m not sure I understand.

24. Help me to understand.

25. Correct me if I’m wrong, but…

26. What am I missing? Something doesn’t quite match up…

27. Is there anything else I need to know?

28. Did I hear you correctly when you said…

29. May I pause you for a minute?

30. Can we return to what you said earlier about…

31. It looks like you shut down when I said __________. Can we talk about it?

32. You seem distracted today. Do you want to talk about something else?

33. Do you want to take a break from this topic?

34. What do you think __________ would say if they were here in this room with us?

35. If it was __________ in this situation, what advice would you give them?

36. What does __________ look like to you?

37. What does __________ mean to you?

38. What message did you hear when they said…

39. How would your life be different if you didn’t have…

40. Was there anything you could have done differently?

41. It sounds like you were doing the best you could with what you had at the time.

42. Honestly, I’m not sure how I would have reacted if in your shoes.

43. You’re the expert on you.

44. I wish I had the answer to that.

45. That’s a really good question. What do you think?

46. On the one hand __________, but on the other…

47. You say __________, but your actions…

48. I’m concerned that…

49. I can only imagine how __________ that was for you.

50. Can we explore this more?

Self-Care Strategies When Your Loved One Has an Addiction

Self-care is not a luxury; it’s necessary for survival when your loved one has a substance use disorder. By taking care of yourself, you gain the energy and patience to cope with your problems. Self-care promotes wellness and emotional intelligence; it puts you in a better space to interact with your loved one. Strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers.

By Cassie Jewell, M.Ed., LPC, LSATP

When your loved one has a substance use disorder (SUD), it can be overwhelming, distressing, and all-consuming. When we’re stressed, we forget to practice basic self-care, which in turn makes us even less equipped to cope with the emotional chaos addiction generates.  

In the book Beyond Addiction: A Guide for Families, the authors discuss the importance of self-care. This post reviews suggested strategies. (Side note: I strongly recommend reading Beyond Addiction if your loved one has an SUD or if you work in the field. This book will increase your understanding of addiction and teach you how to cope with and positively impact your loved one’s SUD by using a motivational approach. This is one of the best resources I’ve come across, especially for family members/significant others.)

Image by Pexels from Pixabay

Based on the premise that your actions affect your loved one’s motivation, taking care of yourself is not only modeling healthy behaviors, it’s putting you in a better space to interact with your loved one. Chronic stress and worry make it difficult to practice self-care. Self-care may even seem selfish. However, by taking care of yourself and thus reducing suffering, you gain the energy and patience to cope with your problems (and feel better too). Furthermore, you reduce the level of pain and tension in your relationships with others, including your loved one with a SUD. Self-care strategies include developing/building resilience, practicing distress tolerance, keeping perspective, and recognizing/managing your triggers. Therapy and/or support groups are additional options.

“An empty lantern provides no light. Self-care is the fuel that allows your light to shine brightly.”

Unknown

Resilience

The definition of resilience is “the capacity to recover quickly from difficulties” (Oxford Dictionary). Doctors Foote, Wilkens, and Kosanke wrote that having resilience is a way to “systematically reduce your vulnerability to bad moods, lost tempers, and meltdowns.” While you cannot “mood-proof” yourself entirely, resilience helps when facing life’s challenges, setbacks, and disappointments. To maintain resilience, one must practice at least the most basic self care practices, which are as follows:

  1. Eat well
  2. Sleep well
  3. Exercise enough
  4. Avoid mood-altering drugs (including alcohol)
  5. Treat illness (with prescribed medications, adequate rest, etc.)
Image by Irina L from Pixabay

Self-care is not something you can push in to the future. Don’t wait until you have more time or fewer obligations. Self-care is not a luxury; it’s a necessity. The authors of Beyond Addiction pointed out that self-care is something you have control over when other parts of your life are out of control. If you find it challenging to implement self-care practices, tap into your motivations, problem-solve, get support, and most of all, be patient and kind with yourself.

“Taking care of yourself is the most powerful way to begin to take care of others.”

Bryant McGill

Distress Tolerance

On tolerance, Doctors Foote, Wilkens, and Kosanke suggested that it is “acceptance over time, and it is a cornerstone of self-care.” Tolerance is not an inherent characteristic; it is a skill. And like most skills, it requires practice. However, it’s wholly worth the effort as it reduces suffering. By not tolerating the things you cannot change (such as a loved one’s SUD), you’re fighting reality and adding to the anguish.

Techniques for distress tolerance include distracting yourself, relaxing, self-soothing, taking a break, and creating positive experiences. (The following skills are also taught in dialectical behavior therapy (DBT), an evidence-based practice that combines cognitive behavioral therapy techniques and mindfulness. For additional resources, visit The Linehan Institute or Behavioral Tech.)    

Distract Yourself

  1. Switch the focus of your thoughts. The possibilities are endless; for you, this could mean reading a magazine, calling a friend, walking the dog, etc. The authors of Beyond Addiction suggested making a list of ideas for changing your thoughts (and keeping it handy).
  2. Switch the focus of your emotions. Steer your emotions in a happier direction by watching corgi puppies on YouTube, reading an inspirational poem, or viewing funny Facebook memes. The writers of Beyond Addiction suggested bookmarking sites in your Internet browser that you know will cheer you up.
  3. Switch the focus of your senses. This could mean taking a hot shower, jumping into a cold pool, holding an ice cube in your hand, walking from a dark room to one that’s brightly lit, looking at bright colors, listening to loud rock music, etc. Also, simply walking away from a distressing situation may help.
  4. Do something generous. Donate to your favorite charity, pass out sandwiches to the homeless, visit a nursing home and spend time with the residents, express genuine thanks to cashier or server, etc. By redirecting attention away from yourself (and directing energy toward positive goals), you’ll feel better. In Beyond Addiction, it’s noted that this skill is especially helpful for individuals who tend to ruminate. Also, it’s important to brainstorm activities that are accessible in the moment (i.e. texting a friend to let them know you’re thinking about them) that don’t take multiple steps (such as volunteering).
Image by congerdesign from Pixabay

Relax

“Body tells mind tells body…” Relaxing your body helps to relax your mind. It also focuses your thoughts on relaxing (instead of your loved one’s addiction). What helps you to relax? Yoga? A hot bath? Mindful meditation? (I recommend doing a mindful body scan; it’s simple and effective, even for the tensest of the tense, i.e. me.)

Soothe Yourself

In Beyond Addiction, self-soothing is described as “making a gentle, comforting appeal to any of your five senses.” A hot beverage. Nature sounds. A cozy blanket. A scenic painting. Essential oils. A cool breeze. A warm compress. A massage. Your favorite song. Find what works for you, make a list, and utilize as needed. Seemingly small techniques can make a big difference in your life by creating comfort and reducing out-of-control emotions.

Take A Break

“Taking a break” doesn’t mean giving up; it’s a timeout for when you’re emotionally exhausted. Learn to recognize when you need to step away from a situation or from your own thoughts. Find a way to shift your focus to something pleasant (i.e. a romantic movie, a nature walk, a day trip to the beach, playing golf for a few hours, traveling to a different country, etc.)

Image by Free-Photos from Pixabay

Create a Positive Experience

Doctors Foote, Wilkens, and Kosanke refer to this as “making it better,” not in the sense that you’re fixing the problem (or your loved one), but that you’re making the moment better by transforming a negative moment into a positive one. Suggested techniques include the following:

  1. Half-smile. Another mind-body technique, half-smiling tricks your brain into feeling happier.
  2. Meditate or pray. As explained in Beyond Addiction, “meditation or pray is another word for – and effective channel to – awareness and acceptance. Either one can open doors to different states of mind and act as an emotional or spiritual salve in trying moments.”
  3. Move. By moving, you’re shifting your focus and releasing energy. Stretch, run, play volleyball, chop wood, move furniture, etc.
  4. Find meaning. The authors of Beyond Addiction wrote, “Suffering can make people more compassionate toward others. Having lived through pain, sometimes people are better able to appreciate moments of peace and joy.” Suffering can also inspire meaningful action. What can you do to find meaning?
  5. Borrow some perspective. How do your problems look from a different viewpoint? Ask a trusted friend. You may find that your perspective is causing more harm than good.

Perspective

Perspective is “an understanding of a situation and your reactions to it that allows you to step back and keep your options open… [it’s] seeing patterns, options, and a path forward” (Beyond Addiction).

When Trish married Dave nearly 20 years ago, he rarely drank: maybe an occasional beer over the weekend or a glass of wine at dinner. After their fist daughter was born, his drinking increased to a few beers most nights. Dave said it helped him relax and manage the stress of being a new parent. By the time their second daughter was born several years later, his drinking had progressed to a six-pack of beer every evening (and more on weekends). Currently, Dave drinks at least a 12-pack of beer on weeknights; if it’s the weekend, his drinking starts Friday after work and doesn’t stop until late Sunday night.

Dave no longer helps Trish with household chores or yardwork as he did early in their marriage. He rarely dines with the family and won’t assist with the cooking/cleanup; he typically eats in front of the TV. Dave occasionally engages with his daughters, but Trish can’t recall the last time they went on a family outing, and it’s been years since they went on a date. Dave struggles to get out of bed in the mornings and is frequently late to work; Trish is worried he’ll get fired. They frequently argue about this. Dave is irritable much of the time, or angry. Most nights, he doesn’t move from his armchair (except to get another beer) until he passes out with the television blaring.

Trish is frustrated; she believes Dave is lazy and lacks self-control. When she nags about his drinking, he promises he’ll cut back, but never follows through. Trish thinks he’s not trying hard enough. She can’t understand why he’d choose booze over her and the kids; sometimes she wonders if it’s because she’s not good enough… maybe he would stop if she was thinner or funnier or more interesting?  At times she feels helpless and hopeless and others, mad and resentful; she frequently yells at Dave. She wonders if things are ever going to change.  

Image by Luis Wilker Perelo WilkerNet from Pixabay

A different perspective would be to recognize that Dave has an alcohol use disorder. He feels ill most of the time, which affects his mood, energy level, and motivation. He wants to cut back, but fails when he tries, which leads to guilt and shame. To feel better, he drinks. It’s a self-destructive cycle. If Trish understood this, she could learn to not take his drinking personally or question herself. Her current reactions, nagging and yelling, only increase defensiveness and harm Dave’s sense of self-worth. Alternative options for Trish might include learning more about addiction and the reasons Dave drinks, bolstering his confidence, and/or creating a supportive and loving environment to enhance motivation.

Triggers

In recovery language, a “trigger” is anything (person, place, or thing) that prompts a person with SUD to drink or use; it activates certain parts of the brain associated with use. For instance, seeing a commercial for beer could be triggering for a person with an alcohol use disorder.

You have triggers too. For example, if your loved one is in recovery for heroin, and you notice that a bottle of opioid painkillers is missing from the medicine cabinet, it could trigger a flood of emotions: fear, that your loved one relapsed; sadness, when you remember the agony addiction brings; hopelessness, that they’ll never recover. It’s crucial to recognize what triggers you and have a plan to cope when it happens.

Therapy and Support Groups

Lastly, therapy and/or support groups can be a valuable addition to your self-care regime. Seeing a therapist can strengthen your resilience and distress tolerance skills. Therapy may provide an additional avenue for perspective. (Side note: A good therapist is supportive and will provide you with tools for effective problem-solving and communication, coping with grief and loss, building self-esteem, making difficult choices, managing stress, overcoming obstacles, improving social skills/emotional intelligence, and better understanding yourself. A good therapist empowers you. A bad therapist, on the other hand, will offer advice and/or tell you what to do, disempowering you.)

Image by HannahJoe7 from Pixabay

Regarding support groups, there are many options for family members, friends, and significant others with a loved one who has a SUD, including Al-Anon, Nar-Anon, and Families Anonymous. Support groups provide the opportunity to share in a safe space and to receive feedback, suggestions, and/or encouragement from others who relate.


“I have come to believe that caring for myself is not self indulgent. Caring for myself is an act of survival.”

Audre Lorde

In sum, self-care is not optional; it’s essential for surviving the addiction of a loved one. Self-care enhances both overall wellness and your ability to help your loved one; in order words, take responsibility for your health and happiness by taking care of yourself.

For more information on how you can help your loved one, visit The Center for Motivation and Change.

What Counseling Has Taught Me (Part Two)

Learn to be more effective in your personal and professional life! This is the second installment of how counseling has led to a better understanding of people. Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others.

By Cassie Jewell, M.Ed., LPC, LSATP

This is the second installment of how counseling has led me to a better understanding of people. (In Part One, I discussed calmness, silence, active listening, partial truths, and hidden agendas.)

Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others. As a result, I’m more effective in my personal and professional life. I have a sense of peace and “okayness” in the world.

One thing I hadn’t previously considered was brought up by Quora user and mental health professional, G. Bernard (MA Counseling); he shared that counseling revealed the truth about change. “It has really reinforced that idea that people who want change will work harder to achieve it; those who are forced (legally, by parents, spouse etc.) probably won’t.” I agree with this 100%. People can’t be forced into change; and when they are, their efforts lack fortitude and it doesn’t last. Those who are internally motivated will fight for change, making it worthwhile and enduring.

Here are some additional truths and realizations that I gained through my counseling career.

What counseling has taught me (the second installment):

1. A new perspective

The DSM – Diagnostic and Statistical Manual (the “Bible” for mental health professionals) – uncovered a whole new world for me. Sure, I was familiar with mental illnesses like depression, PTSD, and anxiety before grad school. I took Abnormal Psych in college and even before that, I’d read books on schizophrenia, eating disorders, and other mental disorders. (Guess who did their middle school science project on schizophrenia? Me!) But my fleeting knowledge was laughable compared to what I found in the DSM; it provided me with information on every single diagnosable mental disorder. When I started working with clients, I was able to see how mental illness manifests in real life.

The more I learned (and saw), the more I was able to make sense of behaviors. Consequently, this led to me looking back on people I’ve encountered throughout the years. I realized how many of them had been struggling with a mental illness. (At the time, I probably just thought they were just a jerk, or acting inconsiderately.)

I also became more aware of the prevalence of severe mental illness and the way it presents in society. This led to increased tolerance and patience regarding behaviors I’d previous found annoying; I learned to recognize them for what they were.

Mental illness can easily be interpreted as something it’s not. By having an awareness, I’m more compassionate. Instead of judging, I observe. Someone who seems snobby may have social anxiety. That coworker who calls out sick every Monday may be struggling with addiction. A friend who never wants to go out anymore could be depressed.

Mental illness is everywhere if you know what to look for. I strive to give everyone the benefit of the doubt, which is better for my mental health.

2. Don’t give money to the homeless

I knew a client at a residential program with a talent for making clever signs. He’d use markers to write his message (“Will dance for food!”) on a piece of cardboard before grabbing his pail to hit the streets. He didn’t need the money; he received government benefits (funded by taxpayers). The money he earned panhandling funded his K2 habit or the occasional beer.

Many of the “homeless” people you meet are not homeless; they’re con men (or women) who make a profit on your sympathy. Most are either addicted to drugs/alcohol and/or severely mentally ill; they need treatment, not the crinkled dollar bill in your pocket. Giving your spare change isn’t helping that person. Instead, offer to buy a meal, give them a pair of socks, or hand them a bottle of water.

3. Telling someone what to do is not helpful

Giving advice rarely leads to lasting change.

There are a few different reasons why advice, no matter how well-meaning, isn’t helpful. Firstly, it doesn’t account for the person’s full experience or struggle; it could seem ignorant or insensitive. (For example, “Why don’t you just get a divorce?” is not helpful to a woman struggling with her husband’s infidelity; the problem is more complex than just getting a divorce. Children could be involved. Maybe she’s financially dependent on her husband. Maybe she’s still in love with him. Or maybe it’s against her religious beliefs.)

Advice also robs a person of the ability to solve their own problem. We need to learn to find solutions in life in order to grow and to be effective. If someone is always told what to do, they’re not going to learn to function independently.

Lastly, if advice is taken, and it works, the credit goes to the advice giver, not the taker. The results are less meaningful. Alternatively, if advice is taken and it doesn’t work, it becomes the advice giver’s fault. Advice deprives a person of being able to take full ownership of their actions.

If you own your decision and fail, the blame falls on you (helping you to grow as a person) or if you succeed, the triumph is yours alone. Either way, you’re better off finding your own solutions; this allows you to feel capable and you’ll become better at solving problems in the future.

4. The value of transparency and honesty

People like to know what’s happening and what to expect. I get better reactions from clients when I explain why I’m doing or saying what I am. I’m honest, and when I can’t be (or believe it would be inappropriate to do so), I tell clients exactly that. For example, if a client asks about my religion, I’d let them know I don’t feel comfortable sharing personal aspects of my life.

Personally, I prefer the company of others who are straightforward. I don’t like having to guess if someone is upset with me. I don’t like it when someone is nice to my face, but gossips when I’m not around. Those types of games are played by people who are insecure or who are attempting to manipulate you. Life is complicated enough. With me, you’ll know if your fly is down, and if you ask for my opinion, you’ll get it. (There’s much to be said for tact though!) Gentle truths are worth more than flattery. 

5. You can’t demand respect

It’s something that’s earned through words and actions, not freely given. Forced respect is not true respect; it’s fear or deception. And while I believe in treating everyone with respect, I don’t truly respect someone until I know what kind of person they are.

Furthermore, I’ve learned that if someone chooses to disrespect me, it’s not a threat. Respect is powerful, but disrespect? Feeble and pathetic. If someone is disrespectful, it won’t harm you or make you less of a person (unless you give it that control).

Throughout my career, I’ve been disrespected on many, many occasions by clients who don’t want to be in treatment (and even by colleagues with differing opinions). But my sense of self-worth is not dependent on how others treat me. As a result, disrespect from angry clients (or rude salespersons or drivers who cut me off, etc.) doesn’t faze me.

In sum, being a counselor is life-changing. I imagine many professions are to a degree, but I can’t picture any other job leading to such a deep understanding of humanity. Entering the mental health field is like having horrible vision and then finally getting glasses (except it happens over the course of years). I have an enhanced awareness of who I am along with an unforeseen sense of serenity. 

Every single client who’s shared a piece of their story has contributed to my awareness (and to my own personal growth), and I owe them each a gratitude. I’m more cautious in life, yes, but I’m also more compassionate. Instead of having high expectations, I have high hopes. I don’t attempt to control things I have no control over; and I don’t get angry over the decisions, views, or actions of others. Instead, I channel my energy into something more productive; I’m passionate and I’m an advocate. My beauty pageant answer to the stereotypical question is not “world peace”; it’s for everyone to have a deeper understanding of each other.

What insights have you gained from your chosen career? Please share in a comment!