20 Therapy Today/www.therapytoday.net/March 2013 Debate The language of healthcare Rosemary Rizq warns that the language we use to describe and report what we do can begin to dictate how we work with our clients Illustration by Annabel Wright It was at this point that I started to think seriously about the language and terminology that are increasingly deployed in our public services. And the more I thought about it, the clearer it became to me that there is a vocabulary out there, a lexicon created largely by the evidence-based movement (or perhaps the evidence-based regime), that is now essential, if not obligatory, for those working in the health professions. We’re all familiar with this language. I suspect we’re all using it. Let me give you some typical examples: patient choice and patient wellbeing; competence frameworks; evidence- based interventions; risk assessment, world class commissioning, best practice or positive practice; outcome- led services, payment by results; and even ‘NICE-compliant therapies’. The problem I have with these by now very familiar terms is that they have been welded together into a discourse that has become the only language available to health professionals and academics working in the public sector. It’s a language that is taken extremely seriously. It’s a language that is required, certainly within academic circles, in order to get papers published, to win promotion and to get grant applications approved. It’s also a language used by managers and commissioners in the NHS to get funding for services. Most of all, it’s a language that is applied to those people who are referred to us for psychological help, to label their problems, prescribe the appropriate ‘interventions’ and deine the desired ‘outcomes’. It’s a language that I think we can safely say deines success. Richard Rorty, I want to start by telling you about a recent experience in an NHS service. This service became an expanded IAPT service some years ago and moved into rather smart new premises. Its staf now enjoy a pleasant reception area, an open-plan oice with plenty of desks and telephones and use of a large number of individual clinical rooms. Each of these rooms is equipped with a whiteboard on the wall, for use by therapists and their clients during sessions. On this particular day, as I walked past a room, I noticed a phrase written on the whiteboard. It said: ‘Dysfunctional thought: my husband is dead.’ I’m not really concerned at this point with the iner points of what appears to be a particularly telling piece of cognitive behavioural therapy. I just want to share with you my response as a human being – which was simply one of baled incredulity. Is the client’s thought, ‘My husband is dead’, really dysfunctional? As a (presumably) bereaved client, should she really not think about the fact that her husband is dead? Should she not remember her husband, not feel loss, sadness, grief or fury? Should she not remember that this was probably the most signiicant relationship in her life? Perhaps she shouldn’t be making her therapist feel uncomfortable by grieving? Perhaps she should just get over it: get back to work, become a productive, preferably employed member of society’? (Indeed, according to the new DSM-5 criteria, 1 if the grieving spouse has not got rid of her ‘dysfunctional thought’ within two weeks, her doctor will now be able to diagnose a major depressive disorder and treat her with drugs.)