Psychologists have a problem with words.
First, we have words like ‘attachment.’ ‘Attachment’ means something very specific in the context of developmental psychology. Grounded in ‘attachment theory,’ attachment refers to an evolved process that keeps infants oriented to caregivers, using them as a place to retreat to when they’re frightened and as a secure base for exploration. Virtually all babies form attachments with those close to them, although those attachments differ qualitatively in their style and functioning.
The problem with words like ‘attachment’ is how we use them in everyday life. We talk about parents being attached to their children, and we mean ‘love.’ We are attached to our pets, our homes, and our jobs. Everyday usage causes confusion when psychologists are talking about attachment theory, for example, because laypeople, and especially students, think they know what psychologists mean because they know the word ‘attachment.’ Most developmental psychologists would say that babies are attached to their parents but that parents are not attached (in a technical sense) to their babies. Parents love and care for their babies. They don’t use them as secure bases.
An example: I remember a friend being deeply hurt when a family therapist said that some of her adopted daughter’s behaviors were due to ‘attachment problems.’ The therapist, I am sure, did not mean that the daughter did not love her mom. She meant that the child’s abandonment and chaotic life in crowded orphanages had resulted in an insecure attachment pattern that she brought to her current relationships.
What the mother heard was that her daughter didn’t love her.
It was a good clinical insight but a poor choice of words.
Words matter.
A Case in Point
Miscommunications by clinicians who use technical words that mean something very specific to them and assume that their clients understand those words, in the same way, can have more serious implications than hurt feelings.
An older friend was being interviewed in her rehab center about how she was coping with mobility issues. She had moved from her condo in a retirement community into a small supported care room. They were trying to decide whether she was ready to move back home.
The therapists asked: “Do you think you are at risk for self-harm?”
When my friend asked what they meant, they said: “Do you think you might hurt yourself?” She answered “Oh yes! That’s what I’m most worried about going back to my own place. That’s why I asked to come here.”
This was a case of cultural miscommunication. The therapists were asking something specific: Are you at risk for suicide or for purposely hurting yourself? For a psychologist, that’s what ‘self-harm’ is. Rephrasing it as ‘hurting yourself’ apparently meant the same thing to them.
To my friend, ‘hurting yourself’ meant something quite different. She is very afraid of falling. When living alone, she is scared that no one would know she has fallen and hurt and she won’t get help when she needs it. She was afraid of falling and hurting herself.
That’s what children mean when they say they ‘hurt themselves’: I fell off my bike. I skinned my knee. It’s what parents say to kids: Don’t hurt yourself with that.
Laypeople, in everyday speech, refer to hurting themselves as an accident. Mental-health professionals do not. ‘Self-harm’ and ‘hurting yourself’ are less technical words that they use to describe what the literature calls ‘non-suicidal self-injury‘ or thoughts and actions associated with suicide. It refers to intentional behavior.
In the example of my friend, the failure to communicate was cleared up quickly, as she began talking about her fear of falling. But this screening interview was used to make an important decision about her life. Other people might have been less chatty.
A Failure to Communicate
Language usage can be even more problematic. One of my advisees had immigrated from northern Africa. As a young child, her town had been overrun with genocidal conflict. She had lost many family members, watched her mother be killed, and fled with her father as a political refugee to the United States. As a college student, she began experiencing nightmares, difficulty concentrating, and flashbacks.
I had recommended that she seek help in the mental health counseling center. She did, but returned blisteringly angry. She told me they had said she was ‘crazy’ and had a ‘mental illness.’ When we talked more, it turns out they had not. What they did was use a technical term — ‘post traumatic stress disorder’ — to explain her symptoms to her. They were trying to be comforting. What the counselor had meant was that this young woman had coped with her horrific childhood experiences. Now that she was older and in a safe place, some of those memories were resurfacing. That’s why she was having nightmares and odd memories pushing into her regular day. Working through those experiences would help her integrate them and allow her to cope with them better.
To the therapist, PTSD was a short-hand explanation of what my advisee was experiencing and why. That is not what my advisee heard. By hearing that she had a ‘disorder’ she felt she was being told she was ill — broken. She said she would never go back because she was afraid that they would treat her as ‘disordered.’ (After we talked through what PTSD was, she did eventually receive counseling.)
Words mean one thing to the speaker. Another thing to the hearer.
Communication means we need to make sure we are all using our words in the same way. I think that’s particularly hard for psychologists and other professionals who use technical words frequently in their work. Psychology as a discipline has a particularly tough time with this because we both adopt everyday words into our technical jargon, and our technical jargon is adopted into everyday life.