How to harness the power of therapy-speak

When Joey Graziadei appeared in the title role of ABC’s The Bachelor in early 2024, contestants and fans alike praised the tennis pro for his "emotional intelligence" and empathy. Meanwhile, on Bravo’s Vanderpump Rules, the show’s stars argued over "boundaries" and "narcissistic tendencies."

If you are a psychologist looking to reality TV as a break from psychological concepts once largely relegated to textbooks, ivory towers, and one-on-one clinical work, you may be out of luck. Psychological terms are increasingly heard—maybe used accurately, maybe not—in viral TikTok videos, among friends conversing on public transportation, and in popular songs, too.

In one study that analyzed the 25 most popular rap songs at five points between 1998 and 2018, for instance, researchers found that top songs with references of suicide increased from 0% to 12%, songs with depression-related lyrics doubled from 16% to 32%, and songs including mental health metaphors grew from 8% to 44% (Kresovich, A., et al., JAMA Pediatrics, Vol. 175, No. 3, 2021opens in new window).

"Mental health language has always sort of seeped into colloquial speak. There was a time when people said ‘schizophrenic’ to mean changing your mind. People would use the term ‘OCD’ to mean you pay attention to detail," said Jessi Goldopens in new window, MD, a psychiatrist and chief wellness officer for the University of Tennessee System, which includes five campuses throughout the state. "So mental health-speak has always been there, but it’s amplified with a more emotionally aware generation to begin with, and one with more access to the words."

There are pros and cons to the trend, psychologists say. On the one hand, the public’s embrace of therapeutic concepts reflects an increased awareness around mental health issues, helps people find identity and community, and can make psychology more accessible in general. On the other hand, the terms are often misused and misinterpreted, can keep people stuck in self-diagnoses instead of seeking evidence-based solutions, and may minimize the pain of people with serious psychiatric illnesses.

"I love it and I hate it," said Taisha Caldwell-Harveyopens in new window, PhD, a clinical psychologist in Martinez, California, and founder of The Black Girl Doctor. "I love it because it could be a reflection of a deeper societal change where our emotional well-being and our psychological well-being are becoming more central to all of us and our narrative and how we see the world. And then that gets juxtaposed to this generation being subject to the most misinformation of any generation."

Psychologists, then, have an important role to play, Caldwell-Harvey and others say, in nudging the popular vernacular toward what’s most accurate—and empowering. Ohio-based clinical psychologist Lisa Damouropens in new window, PhD, puts it like this: "We should not underestimate the importance of our trained voices in helping the public share in our reassuring and evidence-based understandings of the human condition."

Most psychologists say the rise of therapy-speak is a net positive. For one, being able to put a nuanced word to a thought or feeling—without needing to earn a PhD—can strengthen a person’s relationship with themselves and others. Telling a partner you feel "victimized" or "betrayed," for example, gives your partner more information than saying you are "mad." Journaling about "grief" and "shame" can be more therapeutic than noting that you feel "bad."

"At root is the wish to understand one’s experience and to have a way to describe intense or unfamiliar emotions. So for the most part, I think it can be an effective way to try to communicate a subtle internal experience," said Damour, author of The Emotional Lives of Teenagersopens in new window and other books about teen mental health. "And being able to communicate about one’s inner world is an important part of finding emotional relief and feeling a sense of connection to others."

The omnipresence of mental health terminology is also an encouraging reflection of—and contributor to—the decreasing stigma around mental illness in the culture at large, psychologists say. One 2022 study showed, for instance, that adults with better "health literacy" had lower mental health stigma and less aversion to seeking help for mental health issues themselves (Fleary, S. A., et al., Health Literacy Research and Practice, Vol. 6, No. 4, 2022opens in new window).

Erin Parks, PhD, a clinical psychologist in Carlsbad, California, who cofounded Equip, a digital eating disorder treatment platformopens in new window, points to the term "abuse" as an example of how times have changed for the better.

"In previous decades, a lot of people who were in abusive situations didn’t have the term ‘abuse,’ and that made them more likely to blame themselves, to be confused by what was happening, and to overly internalize the experience as opposed to seeing it as a situation that they did not cause and that they need help escaping from," she said. "This is where language is so powerful."

[Related: Seven of the most frequently misused psychological terms]

Language is also powerful when it helps someone find a name—if not an entire community—for a way of thinking or behaving that they once thought was uniquely, and negatively, them. Nowhere is this effect clearer than in the explosion of social media content and communities around neurodivergent conditions like autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD), the latter of which has been hashtagged in more than 3.2 million videos on TikTok.

In one qualitative study published in 2023opens in new window, researchers found that adults who had been formally diagnosed with ADHD found online communities helpful to connect with others like them, swap coping skills, and learn vocabulary (like "rejection sensitivity dysphoria" to describe hypersensitivity to social exclusion and "executive dysfunction" to describe difficulty in impulse control, planning, and emotion regulation) for the things they had experienced but did not realize were connected to ADHD (Ginapp, C. M., et al., SSM: Qualitative Research in Health, Vol. 3, 2023opens in new window).

"Identity can be good for well-being," said Kostadin Kushlevopens in new window, PhD, a social psychologist and assistant professor at Georgetown University, where he leads the Digital Health and Happiness Lab. "It feels good to be part of a community. It feels good to be [around] similar people who understand you."

Even people whose mental health challenges do not warrant a clinical diagnosis can benefit from learning, and speaking, the language, Parks said. "It’s not gatekeeping. We’re not saying, ‘Well, only a therapist can tell you what it means to have insecure attachment.’ You can learn that in other ways, too," she said. "Everybody deserves access to information that can help them understand their life better and be happier or improve their relationships."

On the flip side, identifying with a particular diagnosis or psychological term that someone has found online or in pop culture can keep them stuck—particularly if they stop there rather than seeking more evidence-based information and support.

"When we use therapy terms to pathologize other people or pathologize ourselves, we can sometimes be very stuck in that thinking and forget that all of us are constantly evolving," Parks said. "When you give yourself that label, at best, maybe you use it as an excuse for why you engage in non-pro-health behaviors or non-pro-happiness behaviors. But at worst, you put yourself in a box that you feel like you can never get out of."

Similarly, psychological terms can also be misused—intentionally or not—to deepen divides in relationships. For example, if two friends disagree, they can work through it or agree to disagree. But if one friend mislabels the differing viewpoint as "gaslighting" or "invalidating a lived experience," a respectful truce is off the table. They think, "I don’t need to learn from this debate or discussion because they are gaslighting me," Parks said.

Even in the clinic, mental health jargon can get in the way of the therapeutic relationship as much as it can accelerate a patient’s progress. For example, if a patient tells Caldwell-Harvey their boss is a narcissist, Caldwell-Harvey must push for more. "I need so much more information about what’s going on, but they feel like they’ve told me the person is a narcissist, so there’s nothing more to know."

Perhaps the most discouraging thing about the proliferation of mental health terms is how regularly they are presented incorrectly. One report that evaluated 500 TikTok videos with the hashtags #mentalhealth or #mentalhealthtips found that 83.7% were misleading (for instance, delivered by a non-health care professional without that disclosure) and 14.2% included messages that could be damaging (like encouraging people to take a medication without consulting with a doctor). A whopping 100% of videos about ADHD were misleading, the health care professionals who coded the videos concluded (PlushCare Content Team, November 18, 2022opens in new window).

"With the advances of technology, anybody can share information about anything and everything, and there’s no direct relationship [between] the accuracy of what’s being shared" and how rapidly it spreads, Caldwell-Harvey said. "Knowledge is really powerful—and inaccurate information is really dangerous."

On a broader scale, mental health misinformation colors people’s views of what’s mental illness—and what’s a normal part of the human experience, Damour said. Now, any teen who is in an age-appropriate funk can self-diagnose depression, for example, or any freshman in college who feels awkward making new friends can chalk it up to social anxiety.

In a research paper out last year, Oxford University psychologists argued that mental health awareness efforts are leading some people to misinterpret mild distress as psychiatric problems, which then can become self-fulfilling. For example, if low-level anxiety is perceived as a disorder, someone might then avoid uncomfortable but necessary situations and exacerbate the anxiety (Foulkes, L., & Andrews, J. L., New Ideas in Psychology, Vol. 69, 2023opens in new window).

Kushlev, for one, worries about how institutions are contributing to this concern. "We need to be careful not to coddle people, our employees, our students too much and still challenge them to face those difficulties rather than always the solution being ‘you have such-and-such diagnosis; therefore, you’re exempt from this thing,’" he said. "Empathy and compassion don’t mean just not expecting anything from people."

"The professional view of human psychology is often a lot more reassuring than the TikTok view," Damour added. "Psychologists fully expect people to have good and bad days. We recognize that sadness and anxiety and frustration and anger are all part of what it means to be human. We also have a lot of evidence that we are good at treating true diagnoses. There’s a huge amount we can do to help people whose troubles have crossed the diagnostic threshold."

And for people who have crossed that threshold, hearing their diagnoses thrown around more casually can make their experience even more isolating. Andrew Wright, a 39-year-old writer in Detroit who has been hospitalized for suicidality, said he tried to connect with a friend who had mentioned suicidal thoughts—but then the friend backtracked. He has also had to explain to another friend who called herself "OCD" that the condition is, in fact, a lot more distressing than preferring the toilet paper to roll one way.

"There’s that split where ‘mental health’ is one thing—exercise, eat right, breathe right, take time for yourself, relax, go to therapy," Wright said. "And then there’s this other side of mental illness that is still not quite as freely spoken about," including addiction and self-harm. "It still has this [darker] underside."

Psychologists should be mindful of the power language has in clinical settings, academic settings, and more. Inclusive language that respects people’s individual and intersectional identities can help reduce bias and increase belonging. "This requires being open to continual learning and capacity building and remaining mindful that language may change," states APA’s Inclusive Language Guide, which was updated in 2023.

Meanwhile, psychologists can do their best to cut through the noise with the most accurate, up-to-date information rather than policing people’s language. Doing so ethically online means ensuring the content is rooted in scientific and professional knowledge; that psychologists consider how any content could affect viewers and patients; and that psychologists avoid breaching patient confidentiality, among other considerations, per APA’s social media policy (PDF, 662KB)opens in new window.

Traditionally, "there’s this secrecy around psychology, and I don’t think it’s helped us in terms of being seen as the experts," Caldwell-Harvey said. Not only should the profession be more open with sharing information, she said, but graduate students in particular should be empowered to take on that mission. After all, they’re always closest to the generation driving these linguistic shifts.

"Our graduate students have way more knowledge and information to be sharing about mental health online than the people who the public is listening to," Caldwell-Harvey said.

In clinical work, too, psychologists can make a difference—but not by correcting patients’ imperfect use of therapeutic terms. Rather, Damour and others recommend appreciating that patients are trying to communicate and asking them to tell more about what the words mean to them.

"Take what it is they’re describing seriously, while setting the question of diagnosis or terminology to the side because they’re always telling you something about what bothers them," she said. "It doesn’t feel useful to penalize them for not using the terminology correctly if at the heart of it they’re communicating about an experience that they’re struggling with. That’s what matters."

Tips for starting, or growing, an ethical social media presence
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