IC04 Workshop 40 - The Use of Language in Psychotherapy - Richard Fisch, M.D.

Description:

Therapy is, inherently, a means of influencing a client, mostly verbally. This workshop will illustrate guidelines for making language more precise and effective in order to enhance the therapist's and client's goal of the therapy. Guidelines will be explained didactically, in a composite videotape of a clinical case and in dialogue with participants.

Educational Objectives:

1. To describe the importance of distinguishing between "the right thing to say" and the "effective thing to say."
2. To describe how to tailor therapeutic language to the individual client.

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Effective Use of Language in Therapy

• Language as a Therapeutic Tool

  • Therapy relies on precise and effective language.
  • Psychiatry training is shifting toward psychopharmacology, reducing psychotherapy education.
  • A session includes a video demonstration, a presentation, and Q&A.

• Working with Anxiety & Panic Attacks

  • Case study: A patient with flight-related panic attacks.
  • Symptoms: Sweating, racing heart, difficulty breathing, feeling trapped.
  • Addressing the root fear—loss of control and helplessness.

• Overcoming Anxiety

  • Common self-help methods: Breathing exercises, meditation, reassurance—often ineffective.
  • Encouraging clients to stop ineffective coping strategies.
  • Homework: Identify small signs of improvement and explore new approaches.

• Empowering Clients

  • Using questions to promote hope and self-awareness.
  • Example: A patient overcame a fear of freeway driving by shifting perspectives.

• Acceptance & Control

  • Encouraging clients to accept discomfort rather than fight it.
  • Exploring the paradox: Trying to suppress panic can strengthen it.
  • Using worst-case scenario thinking to reduce fear.

• Using Language to Enhance Therapy

  • Precision in speech influences therapy outcomes.
  • Techniques like embedded questions help clients accept new perspectives.
  • Encouraging clients to articulate how they would recognize improvement.

• Handling Non-Compliance

  • Differentiating legitimate vs. illegitimate reasons for non-compliance.
  • Avoiding direct urging, which can create resistance.

• Addressing Suicide Risks

  • Avoid implying that a client’s life is more valuable to the therapist.
  • Contracts are ineffective; hospitalization is often necessary.
  • Recognizing when a client’s words make the therapist anxious—an indicator of risk.

• Improving Relationships Through Language

  • Effective communication de-escalates conflict in couples and families.
  • Adapting language to fit the client’s values increases acceptance.
  • Avoiding inflammatory words like “why” and “should.”

• Cultural Sensitivity in Therapy

  • Adapting to clients’ communication styles and cultural backgrounds.
  • Respecting clients' language and personal expressions for better engagement.