Why We Need to Rethink Medicalised Language in Counselling and Psychotherapy
As counsellors and psychotherapists, the words we use matter - often more than we realise. We have a responsibility to create a therapeutic environment where clients feel safe, understood, and empowered. But what happens when the language we use does the opposite? When we talk about clients as if they’re “disordered” or that they have a “problem” that we can “fix”, we risk reinforcing harmful power dynamics before the first session even begins.
In my role at the Society, I’ve spent time reflecting on the language we use in therapy and how it shapes the therapeutic relationship. One framework that’s particularly helpful for me in thinking about this is the Power Threat Meaning Framework (PTMF). Developed as a challenge to more traditional diagnostic models, PTMF encourages us to move away from seeing people as inherently disordered and instead to view their experiences as meaningful responses to the threats and challenges they’ve faced in their lives.
Let’s take a step back and look at the power dynamics in therapy. The moment a client reaches out for help, there’s already a subtle power imbalance at play. The therapist is seen as the expert, the person with the knowledge, while the client is often positioned as someone in need of fixing. From my perspective, this dynamic - like most things - is largely driven by the language we use. If we refer to a client as having a ‘disorder’ or a ‘problem,’ we’re immediately placing them in a box - one where they’re the broken ones, and we’re the ones with the tools to fix them.
The PTMF encourages us to reframe this. Instead of asking, “What’s wrong with you?” we can ask, “What’s happened to you?”. This subtle shift in language makes a world of difference. It allows us to see the person sitting in front of us not as a collection of symptoms but as someone who has responded, in the best way they could, to the difficulties they’ve faced. Trauma, stress, loss - these aren't just events but experiences that shape the way people cope and respond. When we see clients through this lens, we stop pathologising them and start listening to their stories.
That said, it’s also important to acknowledge that diagnostic labels like ADHD, OCD, and PTSD etc are well-recognised and can be helpful for people. For some clients, these terms provide a sense of identity or relief - a way to understand their experiences and navigate the world as it exists for them; a way to relate to other people, and find support and advice easily. Similarly, for therapists, these labels can be a useful shorthand that will help with things like communication and planning, particularly when working across multidisciplinary teams.
With PTSD, for example, it's widely recognised by its medical name/description. We could debate whether to remove the ‘D’ and simply call it 'Post Traumatic Stress', but that still leaves room for discussion about how this term is understood by different people. Some clients might find power in diagnostic terms, while others might feel constrained by them. The key, as always, is to be flexible and to respect each person’s wishes regarding how they identify and perceive their experiences.
As therapists, it’s our job to listen, to understand how the client experiences these terms, and to work with them in a way that respects their perspective. After all, for some, having a label gives them a framework around which to seek support and to understand their challenges, and we should always honour their choices.
Still, even when these labels are useful, it’s important that we're aware of the broader power dynamics they can reinforce. Medicalised language, while often unintentional, reinforces the idea that mental health issues are innate defects that need correcting. But really, how often is someone’s anxiety, depression, or other emotional difficulty a reasonable, human reaction to their circumstances? The PTMF helps us view these reactions not as symptoms of disorder, but as responses to threat - responses that have meaning and are shaped by the power structures people have been exposed to.
For example, a young person who has experienced bullying might develop a range of coping strategies, including withdrawal or anxiety, as a response to the ongoing threat to their sense of safety. It’s not that they're inherently anxious or ‘broken’. Rather, they’ve developed behaviours in response to their experiences. By framing it this way, we validate their emotional responses, acknowledge the power dynamics at play, and give them agency in the therapeutic process.
In the therapy room, the language we use directly impacts how a client sees themselves. If we’re using medicalised terms, we might inadvertently be reinforcing a sense of powerlessness in them. They may feel that their issues are beyond their control, something to be fixed by someone else. But if we use language that reflects the understanding that their feelings and behaviours are responses to what they’ve been through, we empower them to see that they are capable of change and growth - not because they’re broken and need fixing, but because they’re resilient and capable of finding new ways to respond to life’s challenges.
The Power Threat Meaning Framework also invites us, as therapists, to reflect on the role of power in the therapeutic relationship. Power isn’t just about what happens in the therapy room; it’s also about the broader context of our clients’ lives. Who holds power over them in their day-to-day lives? What threats have they faced from those with more power? How have they made sense of these experiences? By considering these questions, we move away from a narrow focus on symptoms and instead explore the wider context of the client’s life, giving us a more holistic understanding of their experiences.
I know that most counsellors and psychotherapists are already working in ways that align with these principles; this is some fundamental stuff for us. We already challenge the traditional ‘doctor-patient’ model and have done for decades, especially as many of us are trained on Rogerian, person-centred principles, by creating therapeutic relationships built on empathy, trust, and mutual respect.
But as a profession, we need to go further, and be mindful of the increasingly medicalised language that finds its way into our parlance. We need to be more intentional about the language we use and how it impacts the people we work with. We need to continually challenge ourselves to think about power - not just in the therapeutic space but in the broader societal structures that shape our clients’ experiences.
Everything a person does, feels, or experiences has meaning, and we honour that meaning in our work. Our clients feel heard, understood, and empowered to make the changes they want in their lives - not because they’re ‘disordered’, but because they’re human. And isn't that all we are, at the end of the day?
