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“Where is the euphemism?” A college friend used to ask this question to point out the silliness of calling a toilet a bathroom. Euphemism in ordinary speech may be amusing, stilted, or polite, but in therapy it thwarts progress. Patients use euphemistic language for defensive purposes, such as to keep things polite and nice, avoid unpleasant feelings, or prevent deeper inquiry. It is important that therapists be prepared to challenge these avoidances and also that they not contribute their own. Here are my top three therapeutic euphemisms, terms that appear to offer acceptable, often mollifying explanations, but which usually disguise more than they convey: Stress, Frustration, and Control. That stress, frustration, and control are all significant matters in their own right only adds to their insidious usefulness as disguises.
Stress can be enormously important, but what does it actually mean? A patient says, “I’m stressed.” What is the patient actually experiencing? Is the person “stressed” from too much work or too little? Are the sources of stress external or internal? Is attention to external sources of stress hiding internal ones? Is the problem best understood as the very general “stress,” or is it one of coercion, hunger, traumatic loss, guilt, punishment fantasies, or something else? What more specific ideas or feelings is the word “stress” being used to steer clear of? No one gets better from discussing generalities; people need to understand (and be understood in) the particulars of their individual minds and situations.
Frustration, like stress, is often used both realistically and euphemistically. People really do get frustrated when they are unable to carry out an intention or find the answer to an important question. But usually the reason for mentioning “frustration” in therapy is an attempt to avoid acknowledging or feeling anger. And yet angry and murderous wishes and fantasies, and guilt and anxiety about them, are at the heart of many patients’ problems. Tiptoeing around the anger can be like leaving an abscess without lancing it. The pain and unpleasantness of addressing the anger is avoided, but the problem is left to fester and the patient continues to struggle. Patients’ use of the word frustration, however, can be seen as a great clue that they are trying, as well as they can, to talk about anger.
Control is a word that has many different meanings and connotations. It used to be predominantly a good thing, as in being able to keep control of one’s emotions or behavior in a difficult situation. More recently in both theraspeak and everyday language, it has lent itself to accusation: he’s so controlling! But most important here is how often it is used as an explanation when it actually explains very little. The therapist remarks that the patient wants to stay in control. Well, so do most people. More important are the questions of what, who, or how the patient wishes to control. Is the patient trying to control destructive impulses? Sexual ones? His uncomfortable feelings of envy or sadness? Toward his partner? The therapist? By rigidity of behavior or thought? By distraction? By seducing, restricting, or influencing other people? When the word control enters the therapeutic discussion, or the therapists mind, it will be useful if it is understood not as an explanation, but as a reminder to ask further questions.
It is important for a therapist to be kind, sensitive, and empathic. But relentless niceness has a downside. Patients need assistance to address their struggles with a tremendous variety of experiences, traumas, feelings, and wishes that are anything but nice. They need the therapist, tactfully, to help them overcome their defensive anxieties and avoidances. One important way of doing this is to explore or challenge patients’ use of euphemism. It is more helpful, and in that way kinder, to help a patient discover what the bland, vague, or overly sunny surface of his story is disguising. The key is to recognize that even as Stress, Frustration, and Control are often used as attempts to foreclose further inquiry, the very inclination to use them this way can become a great springboard to further questions and understanding.
(This article was published in the January, 2016 issue of Clinical Psychiatry News.)
