Practice in Action: Loaded Words Matter

The words we choose shape far more than conversation—they shape emotions, treatment, documentation, and even access to care.

In this episode, Paul Wagner and Ray Christner explore how language influences the way clients experience their struggles and how clinicians document those experiences. They discuss the growing trend of using highly charged clinical terms like trauma, PTSD, narcissist, abuse, and hostage to describe everyday situations, and why that language can unintentionally increase emotional distress instead of helping people move forward.

They also examine the opposite problem: clinicians softening documentation so much that important functional impairments disappear from reports, potentially affecting insurance coverage, disability determinations, educational services, and medical necessity.

You’ll learn practical strategies for challenging inflated language without invalidating clients, writing balanced documentation that captures both strengths and impairments, and using words that promote clarity, accuracy, and effective treatment.

Whether you’re a therapist, psychologist, counselor, educator, or simply interested in how language shapes mental health, this conversation offers practical insights you can use immediately.

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To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at: 

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“Be well, and stay psyched"

Transcript

SPEAKER_00 1:01

Hello and welcome to the Psych2 Practice Podcast, your one-stop for practical and useful clinical information, masterful insights from experts in the field, and a guide to daily living. I'm your host, Paul Wagner, and joining me as always. Great Chris her. And, you know, kind of a bit of a revisit to a general topic, but wanting to really get a bit more specific here. If you've been a longtime fan of the show, uh, you know that we have the uh well are now condensed words, words, words episode, but kind of stemming from words matter. It's where words really matter, and it's not the words that matter the most. And wanting to kind of add a little bit to that and getting a bit more specific here for today.

SPEAKER_01 1:34

Yeah. And I think maybe moving in a little bit of a clinical direction from where our other episodes were. And, you know, really, you know, I think two pieces that I think we I want to cover tonight. And one is this kind of growing tendency to an idea that I don't know if this is the technical term, but this idea of language inflation. Like so where we hear people using either clinical or extreme terms, things like being a hostage or abuse or trauma or narcissist or whatever, but using them in a way that we're just describing just everyday experiences and kind of the impact. And then kind of a pendulum swing. And on the other end, really want to talk about clinician language and talking about kind of a move where I'm starting to see and seeing some ramifications of the avoidance of using difficult clinical language and reports and notes. And really, while I think important to talk about strength-based approaches, doing them in a way where avoiding using words that might be necessary to create medical necessity or to get services. And so I want to talk about maybe both ends of that today.

unknown 2:58

Yeah.

SPEAKER_00 2:58

And, you know, maybe starting in this uh first idea of like the really strong, like uh, you know, overly evocative language. And actually, Brett, you before as we're getting ready, you kind of shared a little bit of like what one of the reasons why this episode came into being. And do you mind kind of sharing a little bit of that story so we can kind of use it maybe? Yeah.

SPEAKER_01 3:17

So so this has kind of come up a lot. Uh in but what really kind of prompted me. So I mean, I think two things in 24 hours kind of happened, but the one that really got me on this inflation was somebody I see for therapy who came in and was was quite heightened, um, you know, definitely angry, some some anxiety that was going on. And it was all over a sish situation at work. And the the wording that they used was that their boss held them hostage the night before. And then there's a lot of other language that went in there that, you know, it was torture, it was, you know, very kind of heavy words. And you know, one of the things that in that was like the more the language got big, the more the emotions got intense and deep, and almost, for lack of a better word, kind of a cognitive spiral that was happening. And it, you know, and so part of the intervention for me that night was kind of getting in there and and I'm gonna use the word challenge, but but really kind of addressing the language and kind of going like, let's let's kind of talk about what that means, like that though those wording. And what was real interesting was at the more we kind of went through it, I saw this real calming that kind of happened. And it made me think, like, you know, when we hear people use these this language inflation, uh, if we're not therapeutically challenging it, and that continues to be the way they describe situations, are we doing a disservice in not addressing it? And and I think we have to do it in a very kind of cautious way, because I think it can uh it could feel being dismissed as well. But yeah, so I mean that that was really the the main piece and you know, kind of working through that situation. And then, you know, I I it was interesting. Like after I was like, wow, we should do it, we should kind of focus this as an episode. I started going through and just looking at language, you know, like so I some of the ones that I had was people saying, you know, uh this this meeting at work traumatized me today. Um and I hate meetings in general, but but again, big language. Um, you know, my parents abused me because they grounded me. My teacher's response gave me PTSD. Even things like, you know, oh, I'm so OCD, where we're really using a diagnosis to describe a a behavior. And in this case, the person said that mainly because like they were cleaning up after themselves, not a bad, I wish I did more of that some days. Or the other one I came up with was like everyone in my life is a narcissist, uh, was another one.

SPEAKER_00 6:11

So yeah, I'm like, what's your thoughts? Yeah, I mean, I I think this comes up, I I mean, not even just in session, but I want that to be the focus. But I think it's prevalent everywhere. And the the one, I guess, maybe deviation from session I want to talk about is I'm a part of a decent number of online groups surrounding mental health topics. And some of them are on the clinician side, some of it on like the diagnostic side. And I think more of like the if it's a support group, I hear a lot of really charged language. And so even if this idea like of, you know, if we're doing like a narrative storytelling in a way, how all of a sudden, you know, sharing that, and then someone chimes in with that idea of like, you know, I don't know how you can put up with that, you know, I would never go back there. Or, you know, oh, you know, that that's criminal how they treated you. And like, and, you know, I think, you know, in in attempts to validate, we inflate, or and, you know, sometimes it becomes, you know, a bit of a soapbox. And um, I think those platforms can be wonderful, but I think that they can also be, they can really charge experiences that might not be as beneficial or might not warrant it in a way. And I think, you know, clinicians at times, but I'm speaking personally, I know I've been in a position where I have to catch myself to not validate some of those experiences, and you know, not kind of saying, like, yeah, no, like that sounds. Whoa, before I go on, you know, if I were to say, yeah, that sounds awful. And even if I'm trying to soften, are they walking out of there, you know, and saying, like, yeah, and you know, my my therapist told me that I was I was gonna help hostage and you know how awful that was, versus if we're not addressing it directly in a way. And so I do think it's something of being having to be mindful and intentional with, but also it's not something we just wanna like, oh well, I I'm just gonna mirror the language, but sometimes mirroring is not just enough, but we actually have to be a bit more direct with it.

SPEAKER_01 8:00

Yeah, I I'm glad you brought that up. I guess I wasn't even thinking about the the way we may unintentionally reinforce that language. And and again, I I think it's a balance. Like I, you know, I I've done a lot of kind of reflecting on like why does why do people go that route? Like, why do they use that language? Like I tend not to, I try not to talk like that. I do sometimes. But you know, some things, like one is it I think social media has contributed because there's a lot of sound bites that use that language, like people who I think are influencers who are trying to get dramatic effect. Like, I mean, that's what they do. But then it puts it in our vernacular, right? It puts it in our everyday language, like we've heard it so many times. But then when we say I was held hostage, we're not really thinking about what that means. It becomes, I think, reflexive that we hear it so much.

SPEAKER_00 9:00

And the thought as you were sharing it, even just this most recent time, it's almost an incomplete like simile or metaphor. Yeah, yeah. Where like we're we're missing the use of it as a comparison tool versus it being, you know, we're making a declarative statement of what the experience was. And so if it's like, you know, I was locked in, it was almost like I had OCD in this moment, still not crazy about it, but now we're, you know, we're using it as a circumstantial moment versus you know, uh an attribute that we're assigning to ourselves of, you know, my OCD. It's the difference there, and even the hostage, you know, and last night I felt like I was held hostage. I know it wasn't, but like it was like there was a difference there versus it again, similarly like or as elements of that comparatively to a declarative statement in that sense.

SPEAKER_01 9:49

Oh, I I think that I I mean I think that matters so much. I mean, I think that that that you you know I I I think I probably have said at some point in my life, wow, I really felt like hostage in that situation. I I think that like I that's we hear that kind of language in some level. I do think that you're right. I think that saying it in a way that it describes the elevation of the experience, making a kind of a kind of a metaphor of sorts is much different than I was held hostage. Like I think our brain, well, I know our brain processes it differently. Like it just does. And that's where I think understanding this means so much because our our brains are designed to process that language. And it yeah, it just elevates. And then what does that do to us emotionally?

SPEAKER_00 10:45

Yeah. And I'm almost thinking of it as like a it's it's not the accurate usage of it, but like, you know, and the functional attribution error in a way of you know, we're we're creating this attribution statement or declarative statement versus it being, you know, circumstantial and trying to just build awareness of the circ the the impact of the circumstance. And so, but instead of circumstance, it's comparative comparison in a in a sense. And so how easy it is to fall into those, you know, it makes a good story, you know, and whether we're if we're emulating what we hear or it's just you know, like you know, our vernacular has changed and it's it's adding some of this in, but also I think we're sh as much as we're adding in concepts, we're shortening down how we disperse it. You know, I can think about short-form content.

SPEAKER_01 12:06

Yeah.

SPEAKER_00 12:07

And so how do I capture this experience? I was held hostage. Right. You know, I don't need to elaborate on, you know, there's a lot that needs to be elaborated, but you know, I get my message across in that. Not thinking about how we sit with it and our interpretation experience, especially when we ruminate on it.

SPEAKER_01 12:24

Yeah. And I mean, even to the extent when we when we use those kind of that language, like that, how does it impact us wanting to like in that situation to go back to work the next day? Like, I mean, it's you know, if if that's what I I felt, that that's going to create a whole other emotional experience. And in in this case, it did that for that individual. Yeah. So I I I do, I think there's like the social media piece. I I like that you mentioned that kind of the the error kind of in thinking because I I looked at it as kind of an emotional reasoning, like we're really, or maybe a desire for validation. We want people to know how tough it was for us. And and I think that's okay. Like, I mean, I think there's but I think there's a better way to to do it. Uh and you know, and I and again, I think it's also we see this this idea that therapeutic language just enters this every day. And that and that's not a new uh issue. You know, I mean it's it's interesting. I I I'm doing this uh this presentation on intellectual disabilities. And one of the things that I'm I'm doing with it is uh researching the the history of diagnosis and um you know the fact that you know uh imbecile and idiot were the the clinical diagnoses of the of the time. Now, today we use them very different. Uh and the reason those uh diagnose names changed was because people started using them in everyday language as insults. And then, you know, doesn't sound better, but we went to moron as the the the next kind of term. And then we use terms like mental retardation, and you know, now we see that that's kind of gone. But that's the danger, I think, of what we do, something that was clinical, and and it's it's interesting. I want to give a history lesson today, but I could get into it. But but like the whole idea of of idiot and imbecile, which even when I say them out loud, I kind of go, oh, that's a little cringe to to doing that, because that's you know where I'm at in in kind of my life. But when you read why they chose those terms and the real clinical reason, it was actually quite smart and maybe even a little elegant for a lack of a better word. But we we bastardize terms by how we use them. And and I see that happening now with so many things, you know. I I I can't tell you how many times in a week that somebody uses TISM, um, which drives me insane. Like it's like it I get a reaction out of that. Um so yeah, I I just think that it can go kind of all over the place. So I I guess when we uh when we hear this, before we kind of go to the second phase of this, I guess how how do you respond? Like, so I yeah, I kind of have my approach now that I use when I hear extreme language, and and it's similar to what I even do with people in my life who use extreme language. But like, so if you have somebody that comes in and they use some of these charged kind of words, what's your approach? That depends.

SPEAKER_00 15:39

But but I would say oftentimes where I hear the language coming the most, and a lot of my clients will hear me kind of. I I kind of one of the consistent things is I try to define my role. Like before I'm like, hey, you know, I'm here to challenge you, or you know, you know I'm here to like, you know, give giving my perspective or you know, shifting this thought, whatever that may be. But it's just kind of a an acknowledgement of like, hey, I'm gonna push. And to the point where a lot of my clients are like, I know, I'm ready, you know. Oh, yeah, I know, I'm ready. You know, the here we go. Like it's go, it can almost kind of be a like a dialogue back and forth. But even that action, I think, helps prime them for, all right, you know, there's I'm I'm gonna be challenged. And either I I I need to feel strongly enough to defend myself and defend why this is accurate, or I want to be open to hearing kind of what what my insight or what my take is there. And I think a lot of times I look for patterns that present themselves in our in our session. So um that was an absolute statement. I was like, is there a way you can break, you know, bring that back? And we're just make it conditional. And so if it's like, you know, like oh, like, you know, she's never gonna understand. Hey, I'm gonna challenge you. All right, like that's absolute. Is there a different and so like being able to kind of building awareness? And I think through that, like that's just a bit of the rapport that I build. But oftentimes working to catch some of those really intense statements. Now, as far like I don't, I'm sure it has, but I can't think of any recent time when like that, you know, I've been held hostage or torture.

SPEAKER_01 17:16

Yeah.

SPEAKER_00 17:17

But you know, I have had that like, you know, like hey, if if this doesn't work out, I guess there's always the option and off in my own, like, whoa. Right. And like, so like even like using I can use straight kind of a calling out and not I want to almost say like with a bit of a a humor element to it, but I'm like, whoa, hey, where are you at? Right now, and they're like, okay, you and then it's like, you know, okay, like well, what do you mean? Like, and like we can kind of get into those types of conversations where I'm asking for elaboration and I'm asking for them to kind of stop and like not just use the intense short language, but rather clarify it for me. And we don't need to like, you don't need to write me a novel, but leave me understanding with clarity what it means. And that's where then I again I also like the active, like the active listening element of reflecting back in my own way. I'm like, all right, does it does this sound right? You know, I'll kind of give that. Yeah, that's about right. And and oftentimes, but it is that it's not just a validation through, you know, back to your comment of like I was held host hostage. And if I was like, that sounds awful. Like it's it's not a validation, it's a reflection and a reframing of what I'm hearing in that way. So um, I I would say those are some of the ways that I find myself doing it. And it is, and it's not trying to downplay and trying to say, hey, hey, you're overreacting. Like that's that right. So I want it to be activating enough, but I also want it to feel like what they're what we're talking about still is functional and we have direction we can move from it versus it just being an intense statement that just kind of is uh an anchor that pulls them down and keeps them stuck in the situation or moment and we're not really able to move on from it.

SPEAKER_01 18:57

Yeah. It's yeah, I I I kind of use the the simple phrase in my head is this idea of don't correct, but explore is kind of really my like my summary of it when I kind of deal deal with it. And like so, I mean I guess I using the example I gave, you know, my my response, you know, I I tend to say kind of the same things over and over, I think. But I yeah, I I I kind of said when that came up, I went, wow, like this situation has you using some big words, not big words like long words, but like big words, like, wow, this was really tough. Tell me about like that, let's let's talk about that experience. Like, I'm just curious about that piece of it. Can you can we kind of talk through what makes those words right? And then, of course, kind of listening and then then moving into kind of like okay, so like it I get it. This this sucked. This was a this was a terrible situation. Can we try different words to see how that that impacts? And like I'm just just curious, like when I hear hostage in my mind, it brings up bad news clips. It brings up like there's a lot of things when I hear that word. And so I'm just curious like how that reacts with you. And so, you know, we basically, long story short, was like, you know, kind of going through and just you know, hitting on different ways. And yeah, I think we kind of landed somewhere on, you know, man, my my boss was a real asshole. And it he was disrespectful for not giving me a heads up and telling me I had to stay. And why there was that reaction was I had other things I wanted to do, and I respect my job enough not to walk out. Because at the end of the day, and I and I think we landed in somewhere of like as a hostage, yeah, I probably could never leave. I did have the choice to walk out. Now there was a consequence to that choice, but but as you know, I'm kind of giving the reader's digest version of an hour conversation, but essentially we work through it to come up with some alternate language. And then I said, like, when you say it now, when you say say it in that way, what's the emotion? And she's like, Yeah, I'm still pissed off. Like, it just shouldn't have happened. I'm like, hey, but we can do something with pissed off. Like, we can do like, what do you think you should do? Like, I think, you know, it wouldn't be inappropriate to talk to human resources at your job. That if somebody called off four hours earlier, you shouldn't have had a five-minute notice that you need to stay an extra two hours. Like, that is disrespectful. Like, I'm we're good with that. So I that's kind of how I go through. I I look at it as I'll use things like, wow, those are big words. Like, let's let's talk through. What's that word mean to you? Those kind of questions and reframing. So my goal is not to correct like I wouldn't say, well, you weren't, you're no, you aren't a hostage, or that's not being traumatized. Like, I think I have had people say, Yeah, I've had people tell me that it gets us nowhere. It just creates a defense. I think so. This explore, I think is important kind of to me.

SPEAKER_00 22:12

And and one more piece, like not every circumstance, but I think a lot of them, when it is a bit of that experience where someone's describing something, um, I oftentimes I think also try to then talk about does the intensity like when you're saying like you could walk out, there's a consequence, but you could. I like it, it's kind of that, what's the moment after? Right. So we're stuck in that moment of like I'm being told this, and it's just like I can like really just stay in that, like, this is messed up, you know, I I didn't have a choice. It's like, what's the moment after that? You know, what's the opportunity or what's the circumstance? And even if it's, you know, I'm thinking of like some anxiety, like, no, no, no, no, I can't do that. I you know, no way I could do that. Like it's I'd lose my mind. I would I'm just I can't think of a direct example, but it's like, like eventually we wouldn't feel that stressed. Like we would like, you know, if we would there'd you'd be laying in bed that night, and it might have been awful, like terrible, like it just did not go any way or shape form you wanted it to. At the end of the night, you're laying in bed. You know, and it's like we we can recover, we can heal, like we can be, we can, you know, be resilient. So it is also not trying to be dismissive, but I think also trying to to make it uh making that moment where it becomes they become stuck a bit more, uh I think the word I'm looking for is transitory in a way where we We can go back to prior, what happened before, we can then digest that moment, but then we need to be able to move forward from it and not just stay stuck because I think that's where that's not functional. That's not helping us out in the moment, is just making us resentful of someone we're gonna have to work with, you know, keep ongoing until we decide to make a change.

SPEAKER_01 23:49

Yeah. And I and I think that you know at the end of the day, our goal is, you know, it really isn't to minimize the person's reaction or kind of suffering for lack of a better word. But our goal is to help the person describe that suffering or reaction more accurately. And and I think that's like, and and and that's always the the piece. It's not to say, you know, listen, what happened to this individual? It it was it, I would have been mad. Like, I mean, I would have been pretty angry myself. I don't want to, I don't want to minimize, but getting to a point where they could process the information and do something with that. Where when it was heightened hostage language, we couldn't get anywhere. It was just, it was this cognitive cyclone that was just not, she couldn't get out of. And when we reframed it, then we made progress, then we had solutions, we had some options while still validating the emotion. And I think that it is the balance we do have to kind of continue.

SPEAKER_00 25:02

Absolutely.

SPEAKER_01 25:03

So let's talk about the second one. And this one's maybe a little, I don't know if it's trickier, but the you know, so my 24-hour period, I had one situation of that we just talked about, and the second was I did an evaluation on someone who essentially lost all of their benefits. Um insurance, social security, disability, because they were audited and records that were were requested, the the notes that the therapist had written and the reports that were written were written in a very strength-based approach, which I'm not discounting as a good a good thing in some ways, but it was written in such a way that the audit found that the person didn't have a functional impairment that would require those that level of support. I will tell you when I saw them for the evaluation, that is not the case. Uh, this is an individual who has definitely some some things that are impacting their ability to be able to work and uh other things. And so it got me again kind of thinking about you know, the words that we use clinically, and you know, I I this idea of pendulum swing, you know, I I think for historically mental health has done uh a lot of disservice. And you know, we we really had this very deficit-based mindset with mental health for so many years. And um, I'm glad, and and I see see in my 30 years, I've seen such a a great change from that. But I think my concern and why I wanted to bring this up is I think we've moved uh in some ways so far on the other end that there are ramifications that can happen. So I mean, so it's interesting. The day I had this case was the same day that the Supreme Court ruled on a death penalty case for an individual with an intellectual disability that they were going to execute. And part of the reason that they it went clear to the Supreme Court was the language that was used. I mean, our words could have life or death consequences, right? So so that's where it kind of got me thinking. So yeah, I just it was interesting. So I mean, I I think clinically we have this intention of kindness, and we should, and I think we should do that, but I don't think we should go so far that there's a consequence where we may reduce a person's ability for support or things of that nature. And again, my head started going all over. Like I was like, wow, what if this clinician gets audited? Could the insurance company say, wow, your notes don't reflect that there's medical necessity? And you know, so I don't know, thoughts that you have.

SPEAKER_00 28:08

And I I think one of the initial thoughts, and it's more so, I guess, in what I hear pop culture-wise, is this uh the sayings of like, you know, everyone needs therapy or everyone could benefit from therapy. Um, you know, I and I don't think I necessarily disagree with that, but if we're looking at what's the way in which, you know, the majority of individuals access therapy through insurance, then we need to have that identified impairment, we need to have that medical necessity, we need to to justify the reasoning for the services that are there. And really uh, I'm gonna pick on better help for a moment just because uh they're in a lot of my podcast shirts. And just like hearing the the stories and the descriptions that, you know, the individuals I'm listening to, you know, as entertainers, um, and usually I believe that there's an element of like a personal note to it. It's you know, that from them, like they'll they'll mention it in other uh contexts that they're in therapy. But they talk about like, you know, if it's like, oh, you know, we were we went over this and like this is why everyone, every listener, you know, could really benefit. And I do think there's this social, like this pop culture-ish element of like, you know, therapy is like a haircut, you know, everyone could benefit from a haircut, you know, you're looking, you know, you're just kind of get refining, like, you know, you're just refining areas and like, well, I'd love that. That's not necessarily the system we're in.

SPEAKER_01 29:30

Yeah.

SPEAKER_00 29:30

And I think that that can get conflated at times. And so when you're when you're describing that, like especially the strength-based piece, like there's elements of like, it sounds very much like it's I want, you know, I want the people I'm working with to feel good, but I'm I'm probably not accurately representing them in a way.

SPEAKER_01 29:46

Right.

SPEAKER_00 29:47

And I I go back to even my statement earlier of how we as clinicians can potentially reinforce certain things. And even if we are in in the session using language of like, you know, if we're not acknowledging issues or concerns, and actually, you, you know, uh before we started this ray, you took like three times, I think, for me to really comprehend the question fully. But yeah, you know, ultimately it was kind of this like, would I get offended, you know, if talking about ADHD and talking about it as an impairment and talking about the deficits that, you know, it creates and the impact. And I think my response was like, I think, like, you know, and it was very accurate, very well framed. Like, I don't know that that does it, you know, justice, but like, you know, it's I'd want more, I want to lean more into it rather than less. And like that softness of like, you know, oh, hey, you know, the they have a hard time with focus.

unknown 30:33

Yeah.

SPEAKER_00 30:34

Everyone can have a hard time with focus. You know, if it's, you know, you know, we see an impairment where they're not able to complete this on or where they're struggling to complete it on time and consistently missing due dates to the point where they're potentially losing their job.

unknown 30:48

Right.

SPEAKER_00 30:48

All right, you know, hey, like that that is something that we can really kind of identify and making it, what are we looking to change? You know, if struggling with focus, you know, is that really going to be it versus I don't want you to lose your job because of this impairment. Right. And being able to differentiate there. Right.

SPEAKER_01 31:05

And and I think that we know we we've moved to the point that identifying that we all have deficits or challenges or impairments as a bad thing. And I I think this is where the neurodivergence movement has been brilliant, is that it is okay that we have the these differences, but these differences can be severe. And and that's okay. It doesn't discount the strengths that someone has. And I still think we need to really talk about those strengths with people, but how we how we discuss it, it again, it does have kind of implications. And you know, going back to your kind of better help kind of thing, you know, I think it's interesting. I've been lately reading research on iatrogenesis, this idea that you know, we don't like to talk about it, but but our interventions that we do can be harmful to some people. That, you know, we we as clinicians uh want to believe that we help everybody, but there is a percentage of people in therapy that get worse. So I don't know that everybody needs therapy is an accurate statement. I think therapy is wonderful for a lot of people, but for some people it's not. And being able to recognize that will make us better clinicians. Uh I have had people that I've seen for therapy and they didn't get better. And I and I kind of said, I think you coming here is actually making it so much in your presence that it's not not helping. And I, you know, I I tell everybody that I see kind of part of my disclosure is yes, there's a possibility that there is a side effect. Like when I hear therapists say there's no side effect to therapy, no, there is like research has uh shown it, but there's also great benefit. But we we do need to talk about both sides of those coins, but but yeah, so the back to the wording. Uh Alice, I I I think we have to avoid stigmatizing that. I think that's that's important. I think you know, uh watching in in a way where if we're writing a note and everything is negative, yeah, that's not the we shouldn't be doing that either. Um, you know, we really uh don't need to use pathologizing language, but we do need that to talk in a functional way. So I mean, you know, eligibility decisions for uh insurance reimbursement, for uh certain services for uh special education in school, uh they're based on terms like functional impairment, educational impact, disability-related needs. Like these are the terms that legally we we look at. Limitations to or limitations in major life activities, I think is one. So, you know, for me, I again I think we have to talk about strengths. I'm not trying to get away from that. We've made great progress, but I think also using language that describes the situation and how it impacts, you know, I'll I'll give one line out of the report that affected this individual. Um, and and I'm just gonna call the individual Sarah for lack of a better uh name. But uh the the actual line in the re in the note was Sarah experiences some challenges with attention, but demonstrates many strengths. That was part of the assessment statement. What are some challenges? What what yeah, we have some challenges, but many strengths. That sounds good, but when you're trying to determine is this person able to maintain employment or whatever, as an aside, I actually did call this clinician and just kind of said, hey, like I just want you to know, like, this is kind of what's going on. And and unfortunately, this person's you know paying for an evaluation to try to appeal the decision. And and we talked a little bit about language, and and you know, I I kind of said, um, doing something, yes, we can talk about Sarah has many strengths related to how she socializes with individuals and and communicates her interests. However, she shows significant, uh clinically significant attention deficits that impair her ability to complete tasks, to independently or independent work production, and to academically perform across settings. Again, accurate.

SPEAKER_00 35:44

So again, just some some wording things. And, you know, I think we as clinicians need to be cautious about when we like a client. And almost if there can almost be this experience of like when during our documentation, how like, you know, if we like the client or not, really I think needs to take a backseat to that accuracy of information because if it becomes like, I don't want to be mean. And again, it's not mean, but because like some of these terms are being brought in, like, you know, going from like the you know, the the clinical term idiot to the now it's a an insult. Certain language, we might then be like, oh, well, like, you know, but you know, or even I even know if I'm thinking of some of the sessions, like I was like, they did it really, really well. That doesn't mean impairments aren't present. It's just they were effective in that session.

SPEAKER_01 36:35

Right. Absolutely. That's and that's important to document.

SPEAKER_00 36:39

And and the way we document that doesn't mean that there's the absence of any impairments, unless unless that is truly accurate. But yeah, you know, letting there be both. And I'm reminded of it was our podcast episode with Dr. Jobs um or David Jobs on the CAMS model of surrounding suicidality. And I part of his assessment was what are the reasons uh for living and what are the reasons for dying? And kind of in the conversation I remember him sharing, he's like, you know, if we increase the reasons for living, that doesn't decrease suicidality. It's only when we start to decrease the reasons for dying. And really, uh when you're talking about the strengths as well as the functional impairment, like that's kind of the both. It's like we we want to increase the strengths, but it's really in our ability to decrease the impairments or decrease the impact of the impairments or improving uh capacity of coping or adapting to them that's going to be what reduces the impairment or improves living quality of life.

SPEAKER_01 37:36

Yeah, I it's yeah, so for for me, I mean, kind of bouncing off that, I I I write using a kind of a four-part formula for myself. Like so when I write, I describe the strength, I describe the difficulty, so what's not working, I describe the impact. What is the person telling me their lived experiences with these challenges? And then I describe the path forward. Like so, when I'm in my notes, in my assessment, like like the assessment part of my therapy notes, as well as if I'm writing a psychological report, those are what I think of. And and I'll just kind of give a wording. And this this is actually I just kind of pulled it the other day because I was working with a kid about reading, uh, doing an evaluation. And the report from the school said Michael is struggling with reading. That is literally the quote. And in my report, I wrote, Michael demonstrates strong verbal comprehension and curiosity. However, significant deficits in phonological processing interfere with the accurate and fluency of his reading. These difficulties affect classroom performance and independent learning. With intensive structured literacy intervention and appropriate accommodations, meaningful progress would be expected. Real different. Real different. Yeah.

unknown 40:32

Yeah.

SPEAKER_01 40:33

And I, you know, when I do trainings about report writing, one of the quotes that I say often and is on one of my slides is that if we rate hope without honesty, all we're doing is providing reassurance. If hope with honesty, we will start providing intervention and support. So we have so it's you know, the strengths are the hope, but the honesty is what really is the impact that we're seeing. Again, we can make it sound positive, but we don't want it to not to minimize the the difference.

SPEAKER_00 41:11

Very well. So with that, we we hope you enjoy this episode. We'll be back in two weeks. But until then, be well, stay psyched.