“Hi, I’m Kennedy, I’m an alcoholic!”
But Kennedy hadn’t drunk a drop since high school. He was now 33 and had come to see me not about drinking, but for help with relaxing while flying. I asked him about his alcoholic ‘status’.
“Well, I’m really a recovering alcoholic.” Like many people, Kennedy had been led to believe that an alcoholic is never recovered but can only ever be recovering.
So it appeared that Kennedy had himself fundamentally flagged as having alcoholism rather than as having conquered alcoholism.
And we can understand that it may seem safer to adopt this mindset as a kind of protection against tipping back into alcohol abuse once more.
But framing your whole identity around some diagnosis can be really damaging.
Language can shape our expectations, and our expectations can powerfully shape and prime our experiences. And if we therapists ourselves are not careful, we can make it worse for our clients.
Where is the real you in all of this?
The language of identity is tricky.
When someone has a cold, and gets over it, they are ‘cured’. But when someone has cancer and gets over it, they are said to be ‘in remission’. This implies that it is the state of being cured that is temporary.
In one piece of research (1) a group of cancer survivors who considered themselves cured did better than a group who thought themselves to be ‘in remission’. The ‘cured’ group were happier, stronger, experienced less pain and functioned better socially.
So it seems that how a patient sees their disease (or even whether they consider it a disease at all, as with alcoholism and depression) can have big implications for how they experience their diagnosis.
Whether someone considers depression or alcoholism a disease which is part of who they are (an attitude strongly encouraged by the pharmaceutical industry) or something that is not integral to their identity and therefore can be mastered can make a lot of difference.
Anyone can contract cancer and fare badly with it, no matter what their attitude. However, there is evidence to show that those who don’t see cancer as who they are fare better than those who come to identify themselves exclusively as ‘cancer patient’. (2)
So what therapy techniques might we gently use to help clients feel that they are more than their ‘condition’?
Here’s 3 therapy techniques that help your clients transcend their labels.
1) Tip One: Frame the condition as a behaviour or temporary current state
You are depressed, you have depression, therefore you are a depressive!
The thinking then goes something like this: Well, If I’m a ‘depressive’ then even when I’m not feeling depressed I still sort of am really! The depression is just biding its time to come back and reclaim its position as head of the household, leader of my life and sole occupier of my soul.
Be mindful of language when discussing your client’s condition.
Kennedy: “I am an alcoholic.” (whole identity)
Me: “So you used to drink and it was a problem back then.” (past, not who he is essentially)
The aim is not to minimize the client’s experience but to gently lead them to a place where they feel stronger than their condition. Which leads us to tip two…
2) Tip Two: Refer to ‘it’ not ‘you’
How does the anorexia convince you that you are too fat?
How does the depression make you view the future?
How does smoking con you into taking it back again when you’ve finished with it?
Not ‘you the smoker’, but ‘it the smoking’.Talk about 'it' instead of 'you' to separate problem behaviour from core identity. #therapytipsClick To Tweet
3) Tip Three: Look at life beyond the label
Someone who has constructed (with the help of others) their identity around being ‘a smoker’, or ‘a depressive’ or ‘co-dependent’ or ‘bipolar’ can come to feel as if there is nothing else.
Of course, when treating someone to help them overcome or live better with some problem or difficulty, you do need to ask and talk about it, and so do they. But I think we also need to take great care to avoid deepening their sense of ‘this is who I am’.
I talked to a man who’d smoked 40 cigarettes a day for thirty years starting when he was twelve years old (and he now looked 112!) about his life when he was still eleven.
He imagined, and even half recalled, what it was like to get up in the morning with all kinds of other stuff on his mind other than cigarettes. From this we were able to go on to speak about a future where cigarettes simply had no place.
You might talk to someone who has been depressed about what they do ‘normally’ when they are feeling fine or okay, or what they would do once the depression has gone away.
Kennedy too was and is so much more than someone who used to have a problem with drink.
Labels can be very useful, but they can also shape how we feel, and squeeze and limit our expectations. Labels stick – but they can also be unpeeled.
- See: S. Carson, E. J. Langer, and A. Flodr, ‘Remission vs. cure: the effects of labels on health and well-being’ (awaiting publication).
- See: Sarit Ahavah Golub, ‘Optimism, Pessimism, and HIV Risk Behavior: Motivation or Rationalization?’ Harvard University, 2004 (PhD dissertation).
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