How labels can help and not help
This is a long look at labels in easy language. Spending some time to understand how labels work can help keep us all calmer. The headings below are:
We Can All Talk; Special Words; Specialists; Kinds of Help; Labels and Paying the Helpers; Labels and Proof Treatment Works; Examples of Labels; How Labels Don't Help Relationships; Labelling Relationships?; Labels for Help and Helpers; Inviting Others In; and Who Wrote This (it was Nick Child).
We Can All Talk
People like to talk about everything. Especially we like to talk about relationships and troubles. To do this we use words. We like to have a name for things. We make names up. We read them in the papers. We hear professionals use them. We all experience and know something about relationships. In our own language at least, we should only need ordinary words to talk about them. Professionals almost always use weird words and abbreviations. |
Try this
If you're
looking at a label for what's troubling you, talk through what the hopes
and fears are, the good and bad things, about that label. Make two
lists to help you be clearer.
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Special Words
Specialists deal with uncommon things that most people don't come across. Most people don't need names for things they don't come across. Specialists may need special names for the uncommon things they deal with.
Mechanics know about the insides of cars, doctors know about the insides of the human body, lawyers know about legal rules and the insides of courts. Most of us don't come across these things. Most of us don't know the special names of parts of cars, of internal organs or diseases, nor of finicky laws and legal procedures.
We call in specialists to mend our car, treat our illness, and to make our marriage and house purchase legal and to handle wills and offences against us. We like them to tell us details, but often it goes over our heads. We trust that they know what they're doing. We're just pleased to get the help and get on with our lives.
Do we need special words for the insides of our minds? It's not so easy to answer that question. We want to say that our minds our ours - only we can know and say what's in them. But they also seem to have a life of their own - moods, creativity, dreams, mixed motives, unexpected slips and outbursts, forgotten or blocked memories, and unconscious or even supernatural experiences.
Psychoanalysts especially offer long and deep exploration beyond what we are conscious of. And anyone might see how the brain is an astonishing computer - what's on the conscious screen is a very small part of what else is going on in the unconscious 'mind' of its hard drives. Psychoanalysts and IT consultants are entitled to some specialist terminology too.
Specialists deal with uncommon things that most people don't come across. Most people don't need names for things they don't come across. Specialists may need special names for the uncommon things they deal with.
Mechanics know about the insides of cars, doctors know about the insides of the human body, lawyers know about legal rules and the insides of courts. Most of us don't come across these things. Most of us don't know the special names of parts of cars, of internal organs or diseases, nor of finicky laws and legal procedures.
We call in specialists to mend our car, treat our illness, and to make our marriage and house purchase legal and to handle wills and offences against us. We like them to tell us details, but often it goes over our heads. We trust that they know what they're doing. We're just pleased to get the help and get on with our lives.
Do we need special words for the insides of our minds? It's not so easy to answer that question. We want to say that our minds our ours - only we can know and say what's in them. But they also seem to have a life of their own - moods, creativity, dreams, mixed motives, unexpected slips and outbursts, forgotten or blocked memories, and unconscious or even supernatural experiences.
Psychoanalysts especially offer long and deep exploration beyond what we are conscious of. And anyone might see how the brain is an astonishing computer - what's on the conscious screen is a very small part of what else is going on in the unconscious 'mind' of its hard drives. Psychoanalysts and IT consultants are entitled to some specialist terminology too.
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Specialists
Even if the specialists we go to for personal and relationship help have special words for what's in our minds, they need to talk straightforwardly with us to build a good working relationship. Mystification is not good for trust. You should feel able to ask about anything and feel the answer is clear and genuine - even if it is "I don't know". Psychiatrists are even more specialist doctors than ordinary doctors. They have built up huge systems of labels for emotional and behaviour "disorders". People feel the disorders are like illnesses in that they can't help having them. To have them labeled helps the sufferer feel better by validating the problem as recognised by other people, that it's taken seriously. The label gives sympathy and hope that someone else can understand or help take the problem away. Labels may be needed to access treatment or other benefits. |
Kinds of Help
But emotional and behavioural problems are often not so clearly the same as physical illnesses. They are not so clearly things that can be taken away by treatments. Or the treatments for them involve the person with the disorder being helped to make changes themselves.
For these emotional and behavioural troubles, it's a paradox. People need special help, but in the end it is about us helping ourselves after all!
Some say that it would be better not to label this kind of thing in the first place. There's a lot to be said for that, but it still can leave the troubled person unhelped. A label can help you and the helpers know where to go for help.
Labels and Paying the Helpers
Once you have used up your own ideas, and those of your friends and family, reliable help is usually going to cost someone some money to provide it. Well, would you do that kind of work for nothing?!
If you are suffering and you need help, but can't pay for it yourself, then the government or organisations who are going to pay for the help need some way to manage how it's paid for. The NHS in the UK is based on the idea that everyone has an equal right to good medical treatment - however much tax they pay or not. If you can't help being ill, then it's fair that you get treatment whoever you are. If you have health insurance, the insurance company will only pay the professional if there is an acceptable label for what you've got and the treatment has been accepted as effective. But remember that some problems don't fit the medical model so well.
Remember too that the government has to answer to the tax-payer, and the tax-payer is always keen to pay less not more in taxes. The same person might both demand more NHS or other government services and also fight tooth and nail to pay less taxes! Insurance companies also have to watch how much they pay out because otherwise it means customers have to pay in more. Voluntary organisations work hardest to provide social help free or cheap - persuading charitable giving, fund-holders, and local government to pay for what volunteers can't provide. Even there, the voluntary organisation has to prove that what it's doing is effective. Labels help all of this process of getting funding.
So a major reason why professionals want to assess and label your problem is that this helps them to get paid for their work so you don't have to pay so much or at all.
But emotional and behavioural problems are often not so clearly the same as physical illnesses. They are not so clearly things that can be taken away by treatments. Or the treatments for them involve the person with the disorder being helped to make changes themselves.
For these emotional and behavioural troubles, it's a paradox. People need special help, but in the end it is about us helping ourselves after all!
Some say that it would be better not to label this kind of thing in the first place. There's a lot to be said for that, but it still can leave the troubled person unhelped. A label can help you and the helpers know where to go for help.
Labels and Paying the Helpers
Once you have used up your own ideas, and those of your friends and family, reliable help is usually going to cost someone some money to provide it. Well, would you do that kind of work for nothing?!
If you are suffering and you need help, but can't pay for it yourself, then the government or organisations who are going to pay for the help need some way to manage how it's paid for. The NHS in the UK is based on the idea that everyone has an equal right to good medical treatment - however much tax they pay or not. If you can't help being ill, then it's fair that you get treatment whoever you are. If you have health insurance, the insurance company will only pay the professional if there is an acceptable label for what you've got and the treatment has been accepted as effective. But remember that some problems don't fit the medical model so well.
Remember too that the government has to answer to the tax-payer, and the tax-payer is always keen to pay less not more in taxes. The same person might both demand more NHS or other government services and also fight tooth and nail to pay less taxes! Insurance companies also have to watch how much they pay out because otherwise it means customers have to pay in more. Voluntary organisations work hardest to provide social help free or cheap - persuading charitable giving, fund-holders, and local government to pay for what volunteers can't provide. Even there, the voluntary organisation has to prove that what it's doing is effective. Labels help all of this process of getting funding.
So a major reason why professionals want to assess and label your problem is that this helps them to get paid for their work so you don't have to pay so much or at all.
Labels and Proof Treatment Works
If you pay for it yourself, it's up to you how much evidence you want of whether it will work. Lots of "alternative" methods may work well for those that use them. But they haven't been proven to work objectively enough for NHS or insurance companies to pay for yet. In the NHS, the government wants to know that the very expensive professional services it provides are being used for those in real need. They also want to know that these expensive services are actually going to cure or help the disorder. To research the question of what works, it is easiest to give the problem a label so that it can be defined and then different treatments scientifically tested out. Labels also help more constructive research on a problem - defining it means you can find out what goes with it, what's perhaps helping to cause it that can be changed to prevent the problem. Science can be very effective with physical causes and treatments. It's not so good when things aren't so simple or general. For relationships too we know that emotional and behavioural problems are worse when people are stressed, abused, ignored, unsupported or poor. But these things are not so easily changed by general measures like clean water supply or vitamin supplements can in medicine. Personal and relationship problems require more particular help that those involved take part in creating. They may need political action too. Alternative methods too tend not to separate the labeled problem so much from the person who has it. That makes scientific proof harder. |
Why not personalise
your label? Talk with Jimmy about choosing his own more lively label or
name
for his problem, as if it had a personality behind it. Thinking about
how "Sneaky Poo" tricks you works better than the official label
"Encopresis" does.
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Examples of Labels
An example of a label that is often very helpful to a person and their family is: "Aspergers Syndrome". There is no known treatment or cure for AS - and people who have it wouldn't want that anyway. But this label immediately helps understand a wide range of troubles that the AS person faces. It leads into lots of ways they can live lives more easily and to the full.
Examples of labels that are often used for a wide range of troubles and do not mean anything very clear or helpful are: "Depression" and "ADHD". It's not that the people are not really upset and troubled. It's just that the label in itself doesn't often lead (as it does in physical medicine) to anything simple or so lastingly helpful.
How Labels Don't Help Relationships
This kind of medical style label or diagnosis goes with the idea that the problem can be removed, and usually removed by someone else. The surgeon operates, the doctor prescribes pills. You hope the labeled problem can be detached from you. Medical problems are very strongly thought of as being attached to an individual person and their body.
The main trouble with labeling any problems that are not so easily detached from the person or people who have them is that the label becomes attached to the individual. The people around use it too. It grows on you and the people around you, while the person grows smaller and feels defeated under it.
You might end up kind of becoming the labeled problem. Instead of John who has appendicitis, or who has mental illness, or who has not got much money, John becomes "the appendicitis in bed 3" or "a schizophrenic" or "a waster".
Then you or your family or social group get lumped in together - "a case for ECT" "a social work case" "youths on the streets" "mental patients are dangerous" "foreigners take our jobs". The label leads to prejudice and stigma. Professionals may not take time to go behind the label either. These attitudes and this disinterest adds another layer of trouble to the original one.
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Labeling Relationships?
The thing about relationships is that they are the most constant and important thing in our lives, but they are the least easy to label. If a person is too unique and complex for labels and not helped by them anyway, two or more people in a relationship are even more so. Labeling relationships is much harder. In fact it's pretty well not done. Maybe we should try it out more than we have? What about a scale of "overorganised problem solving styles" through to "disorganised problem solving styles" as a way of describing families? (Click here for more on this idea.) But if you do label relationships, it doesn't usually say too much from anyone's point of view about how things are for the people in the relationship. For example, you may be "married" but as for individuals, every marriage is different, at least if you're wanting to work with the people about anything. People and relationships just must have personal individualised help designed with them and for them. |
Labels for Help and Helpers
Now there most definitely are labels for people who help individuals with emotional and behavioural problems. Mostly they are called counselors or psychotherapists. These labels too are confusing, not least because there are a thousand different kinds of counseling and psychotherapy! That's because their work is not so definable (as doctors for example).
Just because they don't agree on how to do the job doesn't mean that what they all do - listening and talking - is not a valid professional service. All the many methods and trainings strive to set high standards of qualification and continuing learning. Feel free to ask about your counselor or therapist's training, experience and supervision.
Even counseling and psychotherapy with individuals still depends on a relationship - the relationship between the client and the counselor. Many clients and therapists say that emotional and behavioural problems are anyway to do with that individual's relationships - past, present and possible.
Naturally trust in counselors and therapists requires confidentiality. But confidentiality can mean that the other people in the client's life are not just shut out of the room - they are not even thought about as active influences and resources to work with. If the work focuses on the bad past relationships that seem to have caused the problems, then this excludes even more the usefulness of the person's own resources and present "system".
Some research shows that some of the best and lasting help for some problems is relationship help - eg Couple therapy where one person has severe depression (click here). Increasingly ways of working - even with individual clients - focus on their own solutions, strengths and resilience and on the resources for support and help that they already might find around them "at home".
Now there most definitely are labels for people who help individuals with emotional and behavioural problems. Mostly they are called counselors or psychotherapists. These labels too are confusing, not least because there are a thousand different kinds of counseling and psychotherapy! That's because their work is not so definable (as doctors for example).
Just because they don't agree on how to do the job doesn't mean that what they all do - listening and talking - is not a valid professional service. All the many methods and trainings strive to set high standards of qualification and continuing learning. Feel free to ask about your counselor or therapist's training, experience and supervision.
Even counseling and psychotherapy with individuals still depends on a relationship - the relationship between the client and the counselor. Many clients and therapists say that emotional and behavioural problems are anyway to do with that individual's relationships - past, present and possible.
Naturally trust in counselors and therapists requires confidentiality. But confidentiality can mean that the other people in the client's life are not just shut out of the room - they are not even thought about as active influences and resources to work with. If the work focuses on the bad past relationships that seem to have caused the problems, then this excludes even more the usefulness of the person's own resources and present "system".
Some research shows that some of the best and lasting help for some problems is relationship help - eg Couple therapy where one person has severe depression (click here). Increasingly ways of working - even with individual clients - focus on their own solutions, strengths and resilience and on the resources for support and help that they already might find around them "at home".
Inviting Others In
But it is strange that there are not many kinds of helper who invite in the several people who are involved in relationships with each other, people who are often actually living or working with each other every day. One of our main aims at RU is to raise the profile of this kind of help, to help you understand what they're good at and why, and point you to where you can find them. For those therapists who think about the active place of wider systems around their clients, and who actively invite others to be part of the sessions, the word most often used is "systemic". By now you won't be surprised to learn that this label "systemic" also has a confusing range of meanings! |
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Some of the names under which you will find explicitly relationship help are: Couple Counselling or Couple Therapy, Family Counselling, Family Mediation, Systemic Psychotherapy, and Family Therapy. You might find these services in the NHS or Health Centres or other statutory (government funded) services. But they are rare and hard to access. You will also rarely find independent practitioners in the non-statutory sectors - search for them through Google for your area. RU aims to highlight the issue of raising the profile and the number of these services and their accessibility.
Bigger non-statutory sector organisations that provide, or can direct you to, these kinds of relationship help are: Relate (in England and Wales), Relationships Scotland, and AFT.
Who Wrote This
Nick Child wrote this section on Labels. No claim is made for originality - thousands have written about these things but using much more complex language. This is Nick's attempt to demystify it so at least he can understand it. He was a child and family psychiatrist. He wrote lots about demystifying the theory and practice of medicine, psychiatry, psychotherapy and philosophy. You can read more about that on his website www.forallthat.com.
Bigger non-statutory sector organisations that provide, or can direct you to, these kinds of relationship help are: Relate (in England and Wales), Relationships Scotland, and AFT.
Who Wrote This
Nick Child wrote this section on Labels. No claim is made for originality - thousands have written about these things but using much more complex language. This is Nick's attempt to demystify it so at least he can understand it. He was a child and family psychiatrist. He wrote lots about demystifying the theory and practice of medicine, psychiatry, psychotherapy and philosophy. You can read more about that on his website www.forallthat.com.