Speaking of Psychology: The rise of ‘therapy speak,’ with Taisha Caldwell-Harvey, PhD, and Erin Parks, PhD

Do you think your ex is probably a narcissist? Do you worry that your boss is gaslighting you? In recent years, these words and others have entered the vocabularies of millions of Americans. Taisha Caldwell-Harvey, PhD, and Erin Parks, PhD, discuss the rise of “therapy speak,” what psychologists and other mental health professionals think about it, and how it’s changing the way many of us think about our friends, our family, our relationships and ourselves.

Taisha Caldwell-Harvey, PhD, who often goes by “Dr. Tai,” is the founder and CEO of The Black Girl Doctor, a virtual therapy practice that specializes in mental health and wellness for Black women. Before starting The Black Girl Doctor in 2017, Caldwell-Harvey earned a PhD in counseling psychology, completed a postdoctoral fellowship at the University of California, Irvine, and spent 7 years as a mental health consultant for the University of California system.

Erin Parks, PhD, is a clinical psychologist, researcher, and entrepreneur who specializes in evidence-based treatment for eating disorders. She's the cofounder and chief clinical officer of Equip, an online treatment program for eating disorders. Before founding Equip, she was the director of outreach and admissions at the UC San Diego Eating Disorders Center.

Kim Mills: Do you worry that your boss is gaslighting you? Do you think your ex is a narcissist? Are you considering setting some boundaries around your relationship with a difficult friend? In recent years, these terms—gaslighting, narcissism, boundaries and others—have become part of the vocabularies of millions of Americans. Therapy speak, it seems, is everywhere—changing the way many of us think about and talk about our friends, our family, our relationships, and ourselves.

So what’s behind this rise in therapy speak? What do psychologists and other mental health professionals think about it? What are some of the most common words popping up in movies, TV shows, news articles, social media, and elsewhere? And are these terms being used correctly or are misunderstandings cropping up when they make the leap from therapy to popular culture?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I’m Kim Mills.

We have two guests today. First is Dr. Taisha Caldwell-Harvey. Dr. Caldwell-Harvey is the founder and CEO of The Black Girl Doctor, a virtual therapy practice that specializes in mental health and wellness for Black women. Before starting The Black Girl Doctor in 2017, Dr. Caldwell-Harvey earned a PhD in counseling psychology, completed a postdoctoral fellowship at the University of California Irvine, and spent 7 years as a mental health consultant for the University of California system. She has published academic articles on wellness, career selection and achievement motivation.

Also with us is Dr. Erin Parks, a clinical psychologist, researcher and entrepreneur who specializes in evidence-based treatment for eating disorders. She’s the co-founder and chief clinical officer of Equip, an online treatment program for eating disorders. Before founding Equip, she was the director of outreach and admissions at the UC San Diego Eating Disorders Center. Dr. Parks and Dr. Caldwell-Harvey discussed the rise of therapy speak in an article in a recent issue of APA’s magazine Monitor on Psychology. 

Welcome to you both. Thank you for joining me.

Taisha Caldwell-Harvey, PhD: Thanks so much for having me.

Erin Parks, PhD: We’re excited to be here.

Mills: Why do you think we’re seeing this increase in therapy speak right now? Is this something new or have these concepts from psychology made their way into pop culture before?

Parks: I don’t know if it’s entirely new. I’m not sure if people remember in the '90s when all of a sudden everybody was codependent, a word that from the '70s, '80s and up until 1990 was a word that you only heard in psychology textbooks or in a therapist’s office. But then suddenly all of us were. But that being said, I was trying to think of other words from the '90s and that’s the only one I could think of. And now I feel like I can think of dozens of therapy speak.

Caldwell-Harvey: Yeah, that’s so interesting. I wonder—I feel like it has a lot to do with just how social media can spread information so fast, so before as it would’ve taken maybe a year for something to catch on at the level that it can catch on overnight now. Is that why we’re noticing that so many people are using these terms?

Mills: As psychologists, do you think this is a good thing? Mightn’t it indicate that the public is becoming more familiar with and maybe more comfortable with the concept of mental illness or mental disorders?

Caldwell-Harvey: Yeah, I really think that there is some good to it and I feel like as people, we really don’t like to sit in duality very much, but that is really what this is. I think there is some good and there is some bad and probably some very good and some very bad, and we’re just sitting at the intersection of all of that. But in terms of the representation or the good part, I feel like people are wanting language to talk about what’s going on with them internally instead of avoiding it. And so I love that about what’s happening.

Mills: Dr. Parks, do you agree?

Parks: I agree that there is good, there’s bad, and I think any of us who’ve been to a party recently might say there’s also the insufferable—the person who won’t stop using these every time. And it covers the whole spectrum. I’m glad that people have the term abuse, which was a term that was more often said in a clinical way and now people can recognize what it is. And there’s probably some harm being done by labeling every negative interaction you have as narcissistic or toxic or trauma. And so figuring out when are we using it for good? When are we using it to be insufferable and when is it actually harming us and our loved ones?

Mills: What about the idea I alluded to a minute ago, that maybe using this language is reducing stigma around mental illness. Do you see it working that way?

Parks: I think it can be, and it reminds me when WebMD first came out, and at first people were really concerned like, Oh, everyone’s going to think that they’re a doctor and they can diagnose themselves. But what it really did is enable us all to be better consumers of healthcare and also more knowledgeable about our own health. And I think the same thing might be true with therapy speak, that you don’t have to be in an office having one-to-one therapy to start learning a little bit about what’s going on with you. And that in and of itself starts to destigmatize it when it’s accessible to the lay person and not just something a professional says to you.

Mills: Dr. Caldwell-Harvey, do you think it’s reducing stigma or maybe making it worse because everybody’s throwing the words around?

Caldwell-Harvey: Yeah, I think it has the potential to do a little bit of both, and I’ve seen it do both. So I think there’s something really powerful when you come across a word that you haven’t heard before and it defines your experience. And that can be really destigmatizing. Now you can go in and seek care, you know what to Google and to research further about something that’s going on for you. But at the same time, there is this danger also around using words when they’re used in ways that aren’t necessarily accurate in particular. And so you have lots of people talking about being depressed and if they’re describing it in a way that it’s not actually what clinical depression looks like, the person that’s genuinely suffering with clinical depression is watching that and the public is watching that, and this is now their representation of what depression is.

And so my very painful experience could be minimized really easily and public perception of what I’m experiencing can be minimized. And now is there shame that I’m experiencing? Right? Because if this person can look so amazing online and talk about their depression in such a light way and I have depression and I’m struggling and I can’t get out of bed and I am having some significant challenges, there’s less compassion for me in the world, there’s less ability for me to understand my own challenges in a way that is helpful. And so again, I always think about again at the intersection of the duality, is the net more good? Is it more bad? And this one I’m concerned.

Parks: I even see it come up for me as a provider that there was a time when someone said, I experienced trauma or my dad’s a narcissist, and I probably was more likely to take it at face value. And now today when someone says, Oh, I have PTSD, I think I can feel the inner critic and skeptic in me that feels like I really need to verify and validate. And I think when I’m at my worst, that inner critic is unkind in its interpretation, if that makes sense. I almost start from a place of doubt instead of starting from a place of curiosity when I’m showing up at my worst.

Mills: Yeah, we had a guest, I think it was sometime last year, who was being treated for obsessive compulsive disorder and she wanted listeners to know that it’s painful to her when people say things like, Oh, I’m a little OCD. I mean, she really felt that this trivialized what she was going through. So I mean, I really think that mirrors what you’ve both just said.

Parks: We see it in eating disorders a lot too. It tends to be a disorder that people really think is a disorder of vanity or a disorder of choice instead of the way we think of other mental health disorders being either genetic or a combination of our environment and other risk factors. And I think that has a lot to do with people’s accessibility to diet culture and disordered eating. They’re like, Oh, I also restrict for a large period of time. I also have tried these unhealthy things before and thus I know what an eating disorder is. Some people are quick to say, I had an eating disorder when maybe what they really had was disordered eating. Same thing with I have OCD when what they really have is a personality that might have some particularities. And so I think the harm that can go with it is then it diminishes it for other people in the sense of like, well, I got over my eating disorder, so why are you still struggling with yours? When what you really had was disordered eating or an unhealthy relationship with food or living in our diet culture society.

Mills: One of the terms I hear a lot is people talking about codependency, Dr. Caldwell-Harvey, do you think that that’s something that people really understand or they’re just throwing it out there and mistaking what’s really going on in the relationship?

Caldwell-Harvey: Yeah, I think there’s probably a little bit of both. And I feel hesitant to criticize what somebody has come to know to be true in the way that it shows up in popular culture. And it’s just one of the things that I’ve been thinking about a lot about this topic, the epistemology, which is the study of how people come to know. And I think that is changing and that we really have to understand what is it that somebody believes to be true and why, and what do they believe as trusted sources?

And I think sometimes medical professionals are not the people for a particular communities or particular topics that are the trusted source for that group on what something is. And so I’m constantly trying to find a balance between just understanding what somebody is meaning by this. So if the culture has grasped onto this idea of what codependency is, I do think that obviously clinicians should be putting out educational resources at that explain clinical terms, but we also have this obligation to lean in and just understand what the culture defines as codependency and then use that to support people. And I feel like when we try to debate and combat, I don’t know that it’s going to get us to the end result that we’re looking for.

Mills: Another term that’s out there a lot these days is narcissism. And I’m just wondering, do either of you believe that people fully understand what that is? I mean, it is a diagnosable mental illness.

Parks: It is, and it has a very, very, very low base rate. I remember trying to teach psychology 101 and trying to find video examples of narcissism, and there’s not a ton of them. Whereas you could show here’s a video of someone in an assessment who had anxiety or have video of someone in an assessment with depression. But if you looked through social media, you would think that maybe one in 10 people are clinical narcissists based on how often it’s being used. And I think it goes a little bit to what Dr. Caldwell-Harvey is saying, is what are they getting out of using it? Is it empowering them to have a term that says this is a person who inherently how they behave is harmful to me, and so I am no longer in a relationship with them? It tends to be used a lot with exes, I feel like is where I see it a lot. And when is it creating permanent damage in a relationship?

Caldwell-Harvey: Yeah. Dr. Parks, I really agree with you, and I think in the relational aspect of people, when you label somebody with something that is so strong as something like narcissism, you then have a less likelihood of wanting to repair that relationship.

Parks: And it’s so final too. I think that you call someone you’re in a relationship with—whatever type of relationship—a narcissist, in some ways they’re using it accurately. They’re saying like, Hey, this is a core part of who you are and you can’t turn it off or it’s hard to turn it off. And what a damaging thing to say to someone if you ever wish to move the relationship beyond that point. But I would assume that very, very few people actually know what the clinical definition of a narcissist is, similar to how I think borderline gets thrown around a lot as well in a very inaccurate way.

Mills: We did a whole episode not long ago on borderline personality disorder. It is now the most listened to episode of the more than 230 episodes we have in our catalog. And I think people that do want to understand what these terms mean, and I think we spend a lot of time doing these podcasts to help people better understand, because I think people may be just throwing these words around as we just talked about narcissism, and somebody may be just self-involved, have a very strong ego. Does that make them a narcissist?

So what is this doing, do you think, to people’s relationships in the way that we interact with each other by just throwing out these psychological diagnoses at each other?

Parks: I think when you’re using them to get to know yourself and look inward, I’m glad people have a rich array of ways in which to learn more about themselves and their humanity. I think as soon as you’re starting to use these terms outward to put labels on other people or labels on other situations is when you are, I think more often than not, it could be harmful not just to the other person—so that other person might never know that you’re calling them a narcissist—but in what ways is it harming your ability to learn from whatever your interactions were with that person by saying, Hey, my ex was a narcissist, almost says I’m putting a hundred percent of blame onto them because they have something fundamental about them that they couldn’t act in a different way with me. 

Instead, if you’re like, well, that person was in a part of their life where they needed to make their job their whole life, and so they weren’t in a place to have a relationship, it allows for more nuance and a deeper understanding of what you could actually take away from that relationship. So I think it harms certainly the person who gets labeled, many of whom will never know, but it can also harm you because you don’t look at a deeper level of what you could have learned from a situation.

Caldwell-Harvey: Yeah, I agree. And I would add that I think I assume that most people aren’t trying to cause harm by using this language. They’re trying to do something helpful to explain their experience. And I think that’s the second category that I see as the negative side of this, which is assuming that your personal experience is so relevant to the greater discussion on this theory or this concept that it’s worthy of debate. And I talked in the other article just around imposter syndrome is a really good example. I more recently I’ve seen a lot of people sharing, I don’t have that. I have never experienced that in my life, and I’ve always been really confident. And I get it when someone hears what an imposter phenomenon is, some people get offended by it and they’re like, You’re not understanding, but contextual factors, all these things. I get it.

And I’m also thinking that’s very nice that that has been your experience, but because it’s your experience doesn’t mean that it is everybody’s experience. And what does that do? I think when it’s something like a theory, it feels like it’s not as harmful, but it actually can be really harmful. Nobody would walk around—I hope—and say, I’ve never had depression, I’ve always just been a very positive person. But you could really clearly see how damaging that could be to somebody who does experience depression. And so these other terms, I think people think they’re just engaging in helpful debate, but it can be really, really harmful. And we would never center the person who hasn’t had the experience in a discussion about something that is so serious as your mental health. And I think that that part is important. If it doesn’t apply to you, how did you become the center? And to really think about that when you’re talking about things.

Parks: I really like how you’re talking about how it gives people something to have a word for something. And yet sometimes this word becomes so reductive. And I think about that with borderline, even within clinicians in the eating disorder space, there’s a lot of comorbidity between eating disorders and borderline personality disorder in adults with eating disorders. And I started asking clinicians when I would see in the chart this patient as borderline, tell me more about what you mean. And they’d say, Oh, they self-harm. And other people would say, Oh, they have really bad emotional regulation. And other people would say they have no idea who they are, or other people would say, oh, they’re so annoying, and they get into fights with everybody. They love you and they hate you. You’d hear five different things. Everyone would describe it differently. And I’m like, wow. So by using this one term, we actually are being less communicative than we think we are. And how can we instead say, this person’s having difficulty regulating their emotions instead of this person has borderline, or is so borderline, if it’s being used in a more layman’s way.

Mills: Do you think that it’s creeping into treatment in a way that’s kind of harmful though? Are therapists fully understanding the terms that they’re using? Are they giving the tests that they should give in order to understand whether somebody actually has something like borderline, which is very hard to diagnose?

Parks: I don’t know if this is controversial, but I don’t think everybody knows the terms that they’re using in session. I think that there’s so much to know about the human experience. There are so many terms. Nobody finishes grad school knowing every single modality of treatment and getting to go in depth and everything. And I guess that’s why we call what we do practicing, but how do we make sure that there is time in our days to actually practice? Because I do think, especially for all of us who spend a decent amount of time online, these words do creep into our vocabulary both socially and professionally. And then are we sometimes misusing them? And does that harm the client?

Mills: How has this culture shift affected your clinical work? Dr. Caldwell-Harvey, why don’t you take that one?

Caldwell-Harvey: It’s an interesting question. I see my clients using the language more for sure. I like to stay up with technology, what’s happening on social media. So I do my best to keep one foot in, one foot out, but I do notice if I’m offline too long, people start saying things and I’m like, What are they talking about? But what I also notice is that I read a lot of books and memoirs, books that are trending that my clients follow and listen to. And a lot of memoirs I read, I’m so surprised at how much their therapist is quoted or not actually quoted, but the information that they’re learning in therapy is regurgitated in these books as advice coming from public figures. And I’m sometimes thinking, Ooh, your therapist probably needs a byline.

And so in that, sometimes I read things and I’m like, wow, that is a really remarkable personal description of something someone has gone through and how to use psychology and concepts and what you can learn in therapeutic move through something. And they just paint really powerful examples. And other times, I am horrified. That is a horrible example of how to apply this concept. And then I am listening to my clients coming in and they follow these people online. They’re following their advice.

And so in terms of my work, it’s really around, part of it is doing good clinical work, but being more attuned to having to lean in to what people are saying and really not make assumptions about what they believe to be true. And so a client can say, I am really getting into self-care, and I might make some assumptions before about what that means, but I really can’t make any assumptions. And I really have to say, tell me exactly what you’re doing. And I’ve had clients saying they’re doing laundry as their self-care. And I’m like, that’s not going to be it. That’s not going to work.

And again, I’m saying something a little bit more trivial, but I think a deeper root of it is people can genuinely start doing things like engaging in what I would call productive behaviors or taking care of your daily routine and thinking that they’ve done all they can do to care for themselves. And if I’m not careful and really breaking down what does it actually mean to rest? It’s literally one of the, probably for almost all of my clients, we’ve had conversations about defining what it means to rest and it not meaning what they believe it to mean based on their experience in culture. And I just think that’s just one example of the way it impacts clinical practice, but it also gives you stuff to talk about. So if there’s a trend, we can talk about it in session and talk through how it impacts them and how they’re interpreting it.

Mills: Do you find yourselves correcting clients then a fair amount when they start using these terms?

Caldwell-Harvey: I don’t. I really feel like if it’s something way off base that I think that there could be harm, I will. But I really just lean in and listen. I feel like correcting people can create a barrier to the relationship. And so again, my role as the therapist is to listen to what your understanding is and to help you navigate life that way. And so again, if there’s a big area where a redirection needs to happen, we’ll get there eventually. But otherwise, I’m just learning what you believe to be true.

Parks: I think for us, it comes up a lot in eating disorder treatment with trauma, and everyone will experience trauma in their life and not everyone will go on to develop PTSD. And while I’m glad that the word trauma is now in the public lexicon because people go through really traumatic things and forget to label it as such, that is a big deal that you got through that, that you survived, that you persevered. And when someone comes into treatment and they say they have PTSD, making sure all of our clinicians and myself know to give them the PTSD inventory, not so that we can say you did or didn’t experience trauma, but because the way you approach it, it’s going to be so vastly different. If they experience trauma and don’t have PTSD, then we might talk about it in our first couple of sessions while doing eating disorder treatment.

If they have PTSD, we’re going to work on grounding exercises first. We’re going to get them ready for when we’re going to formally do something like cognitive processing therapy alongside the eating disorder treatment. And so I think that’s where the harm comes in. Would never ever want to diminish someone’s trauma and say, well, actually no, you don’t have PTSD. They don’t need that correction. But what we do need to know as providers is how is that trauma experience affecting them? And the diagnostic criteria is not important for checking a box. It’s important for knowing how we’re going to begin our first several sessions of treatment.

Mills: Are there other terms out there that you’re running into that people are using and just sort of popular speech that have come from probably the DSM?

Parks: The one that drives me the most nuts is boundaries. I feel like everyone’s talking about boundaries and some people are using them correctly and other people use them incorrectly. And that’s where I do feel my desire to really want to correct. So I’ll hear the, I’m not talking to them because of boundaries or they did this and that was wrong because of boundaries and not recognizing that boundaries are something that you set for yourself versus impose on other people. I met with various levels of resistance when wanting to talk about what boundaries actually mean and when are you using them in a way that is helping to have the desired effect. No one says that they’re having boundaries because they want something bad to happen. They have a desired effect for why they’re setting boundaries, but when they’re not using them correctly, it’s just going to bring more relationship strife, more harm, more confusion. So boundaries is my word. That’s my trigger word. Trigger could be another word that people have.

Mills: Yeah.

Parks: Do you have a word Dr—oh, sorry.

Mills: No, no, go ahead. That’s a good question. Dr. Caldwell-Harvey. Do you have a word like that?

Caldwell-Harvey: Yeah, I think I brought this up before, but imposter phenomenon, imposter syndrome, really, it makes me very upset. I think the nuance is always missing in the assumption that it is completely internal when a lot of the research is telling us that, and it should be contextual factors in the environment that you’re in, social political environment does influence whether or not somebody experiences, has these types of feelings. But I think that that is missing from public understanding. And so there’s this, Oh, you’re just saying I lack confidence and it’s my fault, and I’m like, that is not what the theory says.

But then I also think about how a lot of the research is hidden behind paywalls and in academic journals that nobody reads. And so I also, and then like, well, how does somebody know that this has been studied on diverse populations? How would somebody know that? And so that I’m just left with, well, what can we do about this?

Mills: Well? What can we do? I mean, what can psychologists do to help people better understand the terms and use them properly?

Caldwell-Harvey: Yeah. One of the things that I really believe in is that we should be creating good content and doing that over debating existing content. So I see a lot of the times mental health professionals showing clips of people using something that in a way that we would say is wrong, and then creating this counter narrative debate. I think it’s entertaining, but it also I think could be shaming. When I think about the dynamic, it’s typically the person that they’re debating that has the ear of the public. And so I’m thinking, is this going to work in terms of what our end goal is, which is to help people align their language with something that is helpful and accurate? And so for us to saturate the market, I think is one thing we can do, with good content. So if they’re influencers, if they’re anybody creating content, if they look up a word, they should find us having written something about it in lay terms that they can understand. Everyone’s not going to do their research, but for those that do, it should be easily accessible in there.

Parks: For us, with a lot of the adolescents we work with, we talk about the word triggers. So there are things that are triggering and makes you want to use your eating disorder behaviors. And it can be understandably exhausting for parents if their teenager is calling every single thing they do triggering. And so that’s when we talk with the adolescent and we’re like, okay, tell us what you mean by the word. What are you trying to signal? When are you using the word triggering to say, it is really hard for me to resist my urge, versus I am definitely going to resist. I’ll be unable. I will restrict, I will binge, I’ll engage in one of my eating disorder habits. And so talking about when do you mean I’m uncomfortable versus when do you mean this is really making me want to use my eating disorder behavior?

And then why should you adjust your language because your parents want to help you, and they’re not going to be able to do that if we don’t add some nuance to it. I actually think of when my son was younger, anytime he felt something other than happiness or joy, he’d say he felt bored, but sometimes bored meant he was sad, sometimes bored meant he was angry, sometimes bored. And so it’s really about understanding why they’re using the word and how can we help expand their vocabulary so they can use the word they mean when they mean to use it.

Mills: Are there good resources out there that you would point people to? I’m asking for our listeners, and I get what you said, Dr. Caldwell-Harvey, that a lot of this is behind firewalls because it’s in academic literature, which people probably aren’t going to read anyway. But I mean, where’s a good place to go to really understand the lexicon?

Caldwell-Harvey: Yeah, good question. I mean, I think APA has been doing a really great job with putting out short-form articles on different topics. I think this podcast does a good job with that, and there are so many psychologists, influencers that are popping up creating great content. I’d be happy to just share some that are creating short-form videos talking about these topics. And so I think following someone with a mental health background in terms of education is really important, and I think it’s okay to listen to people who don’t, but to understand where you should actually be getting the content that informs your knowledge around something so serious as your mental health and mental illness.

Parks: I think I echo plus one every suggestion you just had, and I’ll add, I really like the influencers that combine the professional experience with the lived experience. I think sometimes when you’re watching just one or the other is where things get mixed and really maybe we can put in the show notes some of our favorite social media, some favorite influencers we all follow that we think do a good job with this.

Mills: Yeah, that would be very helpful. Well, this has been fascinating. I want to thank you both for joining me, and I hope we have helped our listeners better understand how to use psychological language more accurately going forward.

Parks: Thank you for having us.

Caldwell-Harvey: Yes, thank you. This has been a conversation that I feel like could continue on and on and on.

Mills: You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you’ve heard, please follow us and leave a review. For those of you who want to know more about psychology and the work of APA, you can join us as a supporter. You don’t have to be a psychologist. The benefits include a subscription to our award-winning magazine, Monitor on Psychology, as well as discounts on our books and other publications. So if psychology is your passion or if you just want to know more about the science, you can become a supporter by visiting at.apa.org/speakingopens in new window. That’s at.apa.org/speakingopens in new window. If you have comments or ideas for future podcasts, you can email us at speakingofpsychology@apa.org. Speaking of Psychology is produced by Lea Winerman.

Thank you for listening. For the American Psychological Association, I’m Kim Mills.