Consider the following example;
A sixteen year old male is mandated to residential treatment for addiction. His file is read aloud at the weekly case consultation that all staff attend. Staff find out that this youth’s mandate comes after two years of escalating behaviour involving substance use, deteriorating relationships and criminal activity. He’s mandated to work on addiction, but staff aren’t surprised that he is attended as well by a diagnosis of Oppositional Defiant Disorder (ODD.) A murmur goes through the team. They’ve all seen this before. Staff work hard to maintain a safe therapeutic environment for all clients, and non-compliance can be difficult to manage without disrupting the milieu. With this in mind, the team has become understandably attuned to signs of non-compliance and people end up speaking a great deal about it in case consultations. The whole team is now on the lookout for ‘opposition’ and ‘defiance’ before the new youth arrives.
During his first week in treatment this youth struggles with the agency’s routines, he engages in constant boasting conversations with peers about drugs and violence, and he generally abrades against staff attempts to uphold rules and consistencies. Despite the initial effort to ‘meet this kid where he is’, his behavior naturally draws staff energy into increasing efforts to create compliance. However, the more the team cues this client, the more ‘oppositional’ he gets. Likewise, the more ‘oppositional’ he gets, the more consequences are delivered to him. By the end of the week this youth has exhausted all of the typical treatment interventions and is discharged (or discharges himself). And so, despite proclamations of being strengths-focused and client-centered, the team find themselves participating in the commonly experienced effect of traditional assessment and problem-naming: each observation they make confirms, brings forth and strengthens the diagnosis identified at intake.
Kelly Waters-Radcliffe, R. Psych
If we are surrounded by people who are invested in finding problems in us, it’s understandable that we might eventually become convinced. As the saying goes, we might begin to ‘live down to their expectations.’
The act of naming other people’s problems is a particularly important role of the helping professional (see this post for more), and one that we would do well to consider thoughtfully. Below are a few questions to consider as you engage in the practice of “naming” the problems that your clients are facing.
Is this (insert label, judgment or diagnosis) going to be helpful for this person?
Is it being done for their benefit or for *ours*?
Does it give us more or less room to be creative, curious and flexible in our approach?
Naming the problem that another person is dealing with is an act of power, granted to us through our roles as helping professionals.
We should wield it carefully.