Power of De-Pathologizing Clients' Struggles

As a clinician and educator, it has long been my passion to promote the idea of a strengths-based approach to treating clients.  Rather than focusing on what’s “wrong” with them and attempting to fit them into a neat diagnostic package, I am far more interested in what’s “right” about them.  How did they survive? How are their current “symptoms” actually the inevitable, creative coping strategies that they mastered in order to be safe in the world? And what do their coping strategies teach us about their resilience as they endured and navigated pain in the past?

Recently, I began seeing a new client who really hit home the importance of the strengths- based perspective.  She had been in and out of therapy many times before finding the courage to start treatment with me.  In the first session, after some initial ice breaking and “joining,” she reached into her pocketbook and pulled out a large piece of paper. “Here,” she said, “I figured you would want this.  It’s a list of all the diagnoses I’ve been given in recent years.” And after pausing, she added, “It’s who I am.”  It was quite a long list!  It was such a poignant moment because with some degree of resignation and defeat, it seemed as if her entire sense of self had become defined by those diagnoses.

When I asked her to give a voice to her tears she said, “No one, ever, has asked about my strengths.

After thanking her for the trust and courage it took to share the list, she actually seemed shocked when I let her know that I wasn’t really interested in those diagnoses and instead wanted to talk about her strengths. I asked her to tell me about three of her strengths and after a moment of confusion, she started to cry. When I asked her to give a voice to her tears she said, “No one, ever, has asked about my strengths. I’m realizing that years ago I stopped focusing on the possibility that there was anything good about me.  I assumed I was just all of these diagnoses.”  When I asked her what she wanted to do with the list she smiled and said, “Tear it up!”  And from a place of renewed strength she asked, “Maybe we can make a new list?  Maybe at some point we can come up with good stuff that I can put on the list instead?”

Although I understand that diagnosing a client helps us better “understand” their presentation and their symptoms, this client reminded me how diagnoses can put a “glass ceiling” on the extent to which clinicians and clients alike believe in a client’s capacity to grow, heal, or change.  When clinicians focus too much on diagnoses they can become an all-encompassing way for clients to define who they are. I believe it’s imperative to help clients understand they are more than their trauma, and more than the manifestations of their pain. When we invite clients to identify and celebrate their resilience, creativity, intelligence, cleverness, courage and strengths, we are highlighting internal resources rather than impediments.  We are helping to shift them from “I’m bad” to “Something bad happened to me.”  Ultimately, this approach can move clients through and beyond PTSD and help plant the seeds for post-traumatic growth.

So the next time you’re sitting across from a client, challenge yourself to notice what’s right about them, and use the session to process and celebrate those strengths and abilities. Pay attention to the impact it has on your client and on you, and know that you’ve taken an important step towards shattering that glass ceiling.



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