Power in Psychotherapy: The Power to Name

[Mary S]

I first encountered the phrase “the power to name” about ten years ago when reading  (the then-current edition of) Poe and Vasquez, Ethics in psychotherapy and counseling: A practical guide.  My recollection from that book was that “the power to name” seemed like something rather mystical. So I was glad to find an elaboration in Zur’s article (under item #3. Professionalism Power: Societal Respect For The Healer’s Role  in the section types of Power in Psychotherapy). He describes this as follows:

“Power to name: The authority to label, name and diagnose is another form of power that therapists have over their clients. This also involves the power to suggest or interpret unconscious or conscious motivations. As part of the therapists' authority to name or label mental illnesses is the enormous power to define that which is normal and that which is not. As will be articulated below, the power to define what is normal gives therapists social power and control and is reserved to very few others in our society.”

He elaborates under the heading “The power to name” in the section How Therapists Create Power Advantage, which I recommend reading.

I’d like to add an additional perspective. Namely, I became aware many years ago (I can’t find a reference, but I know this is not original to me) that all too often when we have a name for something, we feel we understand it but don’t really understand it. So the power to name brings with it the power to feel we understand when we don’t. And this is in turn the power to close doors to understanding. It can also be the power of denial (that we don’t understand). It can be the power to stuff into boxes. It can easily be applied unintentionally. This occurs in therapy in diagnosing clients (as “labeling” them, as Zur points out), but also in labeling clients’ feelings or motivations.

Thus therapists (and also clients) need to be very, very cautious in using the power to name.

[Eve B]

Just because they're therapists doesn't mean their diagnosis is accurate, and clients can always get 2nd and 3rd opinions, right?  I still think the public sees the therapist as much a quack as a healer.  Isn't there also power from the client's side in labeling the therapist with names like 'shrink' or 'mental manipulator'?  Therapists can only gain power from us if we allow them, but yeah, it's tricky once you start opening up to them.

[Sylvester McMonkey McBean]

thanks mary for sharing this link.  i'm definitely curious to have a read through it.  

although my T does not usually give a DSM diagnosis or a label, he will suggest or interpret both conscious and unconscious motivations of mine.  there are times where i find myself in disagreement with his interpretations and i am sure a T would put that down to me being resistant, but for me it is probably more of a reaction to the power-play that i may be sensitive to that is playing out with my T.     

[Mary S]

2 hours ago, Eve B said:

Just because they're therapists doesn't mean their diagnosis is accurate, and clients can always get 2nd and 3rd opinions, right?

Things may have changed since I have tried therapy, but the following were common when I tried it:

1. More often than not the therapist would not tell the client the diagnosis.

2. If using insurance for therapy, the insurance company wouldn't pay for two therapists unless there was a different diagnosis -- so if a client was dissatisfied with the diagnosis and tried another therapist to get a second opinion, and the opinion turned out to be the same, the insurance would not pay for the second opinion.

3. Many therapists had standard diagnoses that they gave most clients -- then what they actually did was to engage in what seemed to be snap judgments (not backed up by evidence, even if I asked or disagreed).

Also, in my case, since coping with personal attention was the problem I was going to therapy for help with, the idea of seeing another therapist was really a big deal -- being asked lots of questions for a second opinion would be a real ordeal for me.

[Mary S]

In my first post on this thread, I said,

"... I became aware many years ago (I can’t find a reference, but I know this is not original to me) that all too often when we have a name for something, we feel we understand it but don’t really understand it. So the power to name brings with it the power to feel we understand when we don’t. And this is in turn the power to close doors to understanding. It can also be the power of denial (that we don’t understand). It can be the power to stuff into boxes. It can easily be applied unintentionally. This occurs in therapy in diagnosing clients (as “labeling” them, as Zur points out), but also in labeling clients’ feelings or motivations.

Thus therapists (and also clients) need to be very, very cautious in using the power to name. "

I found what seems to be an example of this “give it a name and you feel you understand it” phenomenon in another website of Ofer Zur. At  http://www.zurinstitute.com/therapy.html , he said,

“I see most depressions as depletion, most anxieties as overwhelm, phobias as being out of control and panic as the psyche's cry for help”.

I am not in love with DSM classifications, but at least they have the virtue that you can find the criteria written down somewhere and decide for yourself whether or not they fit your experience of reality. But if a therapist says, “Your problem is depletion,” (or “overwhelm” or “being out of control”), or  “Your psyche is crying for help,” what can you do? Maybe Zur believes he understands you, but I would just find these labels unhelpful – and in fact, counterproductive. For me, these are examples of the therapist behaviors that produce the “unintended gaslighting” effect, that seem to give the message that the therapist does not consider my own perception of the reality I experience as worth taking seriously.

(To his credit, Zur does say later on the same page, “I will do whatever is clinically appropriate, is likely to help clients and is acceptable to and discussed and agreed to by clients.” My experience is that most therapists do not care to discuss with clients what is likely to be helpful, and do not restrict themselves to what clients agree to.)

Edited June 11, 2017 by Mary S
correct typo