I am ambivalent about the word “therapy”.

For me, it connotes the idea of something to be fixed and to be made better because there is something wrong, bad and diseased. That makes sense when talking about chemotherapy, or drug therapy, or physiotherapy.

Obviously, there many individuals who have experienced or currently has a mental health illness in which the appropriate word could be therapy, which denotes the act of medically caring for someone who is unwell. In this case, the word “therapy” may be apposite, especially when referring to pharmacological interventions. Although, even then, I am cautious about the idea of providing psychological therapy. In my experience, the best time to start talking therapy is not when a person has become mentally ill, but rather when they are stabilized and able to think and reflect safely in equilibrium. At this point, are they really different to the many people seeking a desire to lead their lives differently because there is a recognition that life could be lived better?

If this is the case, then word therapy does not seem to me to be the best word to describe this process. It is a misnomer to use this word to describe the desire for self-development. It also presupposes that there is something “wrong” with a person's life until this moment for desired change. I am little cautious about interpreting life in such black and white manner, and this seems to me to be a risk of the therapeutic process. In my mind, the relationship between the therapist and patient should be about knowing how to integrate rather than reject the past into a person's vision of a future better life. Living with our personal stories seems so much healthier to me than rejecting or suppressing our history.

Often what is discovered in the therapy process is that what worked when a person was a child, adolescent or young adult does not work so well when the individual is an adult. That is not to say that such behaviors are intrinsically bad; after all they served their purpose. It's just that the fit between the old behaviors and current life situation does not work. For many people entering therapy its about finding new ways to adjust and adapt to life changes and transitions. For example, I once worked with a family with a child who had obsessive compulsive disorder related to counting the number times she needed to breathe before starting a myriad of different tasks. What was interesting about this family, was that the parents and siblings all had their own separate mechanisms for dealing with moments of anxiety. For example, during the family consultation, everyone recognized what would happen when the mother was anxious. She would clean thoroughly every nook and cranny of the house in a whirlwind of industry, and it would be almost impossible to communicate with her. This is an example of a safety behavior which is triggered in moments of anxiety and designed to reduce the emotional tension.

Here is the point: from a therapy perspective one can see how all the family had uncommunicated anxieties and each individual had their own method for dealing with it. However, one consequence appeared to be that the child with OCD had been made the representative of the family's anxiety. Traditional therapy approaches would work with the pathologized child – which of course is indicated by the word therapy. But the question for me was how the family itself generated the necessary environment to perpetuate these safety behaviors in this particular chid. I wanted to focus on whole family rather than the child. In this case, the word I preferred using to describe my work with the family, was consultation. The work consisted of providing a safe context for them to explore all of their own anxiety behaviors and to make a decision about how important it was to focus on one child's specific behavior to the exclusion of everyone else's responses to anxiety. The consultation here was about allowing the family to make their own solutions that involved all the members.

And this is the heart of why I find the word therapy to be so challenging. Implicit in this word is the idea that I, as a psychologist, am able to fix someone else's problems. It seems to me, that at the very most I can offer guidance, counsel and consultation. Is it really possible for another person to be the expert of another individual's mind and consciousness.

I struggle with the notion of expertise. I have had many of years of training. I continue to read many books in psychology and neuroscience. I do have knowledge about mental health. But in a therapeutic context, it is possible for this very expertise to interfere in the opportunity afforded in that 50-minute session to really understand the person seeking support and help. This is a particular risk when someone comes to see me with the expectation that I can “fix” a problem in the process of therapy. It is those expectations that place me into the expert role, that I find challenging. It can be irresistible to be seen as an expert. After all, that is what most people want, and what they are paying for.

The family I described above expected me to start offering cognitive behavior therapy to the child with OCD. This would be a natural expectation. However, she had already received six months of CBT a year previously, and the OCD had migrated to different type of safety behavior. This gave me the opportunity to ask them to try a different and more solution-focused approach that got the family talking about their stories of being anxious. I was able to change their expectations about my role as a therapist, and was able to be more of a facilitator to the family's thinking and talking.

I do not think I would have been able to do this if I had been stuck with a more medicalized and fixed notion of therapy and its purpose. The question is what words are better to describe the psychological process of change in an individual or family. What words are better for describing the role of a therapist and the individuals they see? There is a neatness to the terms therapist, patient or client. It describes the roles and expectations clearly. However, that is exactly my discomfort and ambivalence to those words as well.