Labels In Mental Health: Friend Or Foe?
Written by Dr. Kiya Immergluck
As a counselor, I prefer not to label people. It is part of my job as a psychotherapist to come up with an accurate diagnosis for each person, but I often don’t emphasize that label directly with my clients.
Many times, a person comes to me who has identified with a superimposed label for years. They will tell me that they are Depressed or Bipolar or an Alcoholic because someone gave them that title long ago. Some report their diagnosis in a routine way. They describe themselves with a psychiatric label in the same way they might casually mention that they are “Italian.”
One powerful technique I often use with clients who habitually self-criticize is to stop and challenge their language. In the case of a person describing themselves disparagingly with a psychiatric label, I may point out: “You just told me that you are Bipolar as if that describes your essence as a human being. You may truthfully have that condition, but let’s come up with a better description of who you really are outside of that label!”
I am a great supporter of 12 Step Programs, but they aren’t suitable for everyone. One issue I have with AA is the insistence on a member continually and forever describing themselves by their addiction.
In a typical AA meeting, a person will introduce themselves to the group by saying:
“Hello, my name is Jane and I’m an Alcoholic.”
The group will respond:
Of course, there is a great rationale for continually making that declaration. It embodies the humble practice of never forgetting Step One: “We admitted we were powerless over alcohol and our lives had become unmanageable.”
If a client is deeply entrenched in their insistence that “drinking is NOT a problem and I can stop whenever I want to,” the eventual profound realization of their alcoholism may warrant a long period of daily reminders. “I AM an Alcoholic” may need to be their mantra for a very long time. This is a great example of when a label can be useful.
However, labels can sometimes be tied to shame and negative self-talk, both of which move us away from our mental health goals. A useful technique to curb negative labels is to ask a client to make simple, positive statements about themselves. I start by acknowledging that we all tend to minimize our good qualities. We create an imaginary pile of limiting adjectives and “Yeah buts” that we don’t say out loud. I help them create an entirely positive list of their strengths starting with the words “I am.” If they say “I’m SORT OF smart,” we stop and throw “sort of” in the negative adjective pile. Instead, the statement is simply: “I am smart.”
Sometimes we spend an entire session coming up with positive statements. I may ask them to think of something positive that a good friend might say about them (even if they don’t completely believe it yet)! We end up with a list of 10 statements. I ask them to read the list out loud AS IF they believed it: “I am kind,” “I am smart,” “I am hard-working,” etc… I give the client a copy to look at before the next session. This is another way that labels can actually promote mental health!
One of the joys I experience in my counseling work is the switch to more positive thinking that tends to happen when a client not only celebrates relief from a persistent problem, but is willing to drop the problem label when they describe themselves.
I’m not advocating a return to some form of denial. A person with a chronic condition will need to acknowledge it to themselves. The wonderful difference is the language around it. A person can mention that they are dealing with some form of mental illness without allowing it to define who they are.
Instead of saying “I am an Alcoholic,” a person might simply declare that they are dealing with that illness. I like when someone says “I am a Recovering Alcoholic.” They are admitting the problem without in any way using it as a label to define themselves.
Another useful technique that helps clients to remember to “emphasize the positive” is to revisit their list of positive “I AM” statements. Their homework is to notice every time they say to themselves something like: “I’m so stupid!” Then they declare two unrelated positive statements from their list. We add an element of humor by saying that the 2 positive statements don’t have to be remotely connected to the negative statement. For example, they notice saying “I’m stupid” and quickly add: “AND I’m pretty and a good dancer!” Sometimes a person will laugh! “Maybe I am stupid, but I am ALSO a cute dancer!”
When one of my clients has successfully transcended identifying with a problem, they have many options. Many choose to “graduate” with the understanding that they are always welcome to return for a “tuneup.” Others choose to concentrate on other issues that were buried under more pressing problems.
I love reaching the point of the counseling process when a person is ready to describe themselves using positive terminology without any emphasis on a psychiatric label. We are all so much more complex and wonderful than any label could encompass.
Dr. Kiya Immergluck, LCPC, LMFT, CADC
has happily worked at Urban Balance for more than 3 years and continues to enjoy her counseling work after more than 40 years in private practice.