The Rise of Therapy-Speak

Many people are celebrating the seemingly miraculous way in which social media helps destigmatize mental health and disseminate psychoeducation. But social media also seems to be a kind of petri dish for clinical terms and concepts to take on new forms and meanings, which then make their way back into the therapy room when clients come in with hashtag-inspired notions about themselves and others.

Somewhat ironically, this phenomenon has recently been garnering attention from prominent therapists active on social media. They’ve been calling out mainstream articles that encourage incorrect or flippant use of what’s been dubbed “therapy-speak.” They’re on a mission to caution clients about using words like gaslighting—Merriam-Webster’s 2022 Word of the Year—and narcissist whenever someone disagrees with them or prioritizes their own needs.

Matthias Barker is not one of those therapists. He’s a licensed clinical mental health counselor who has attracted 2.7 million TikTok followers and more than 400,000 Instagram followers by making it his personal mission to unpack psychological concepts for the general public, which often involves engaging in earnest, nuanced conversations about therapy-speak buzzwords.

Barker’s videos are polished and professional. If you stumbled on them without knowing his occupation, you might mistake him for a young CEO or Hollywood actor, but after a few seconds of listening to what he has to say, this impression would dissipate. It’s obvious that he’s a clinical insider who somehow embodies both the extraverted cool kid and the shy classroom introvert at the same time. If the popularity of his content is any indication, his knack for finding the nugget of clinical wisdom buried in therapy-speak—and for inviting viewers to rethink tired and misused concepts like codependence and gaslighting—has been hitting a cultural nerve.

Livia Kent: What’s your best guess about why laypeople with no clinical training are increasingly being drawn to therapy terms they hear about on social media?

Matthias Barker: I think people have always been drawn to clinical ideas; it’s just that social media has provided us with some creative ways to describe aspects of modern-day human suffering you won’t see in the DSM, words like imposter syndrome, triggers, and burnout. I get why clinicians are wary of the general public conflating these kinds of terms with actual diagnostic criteria, but if we get too caught up in protecting the purity of what we deem clinical content, we risk missing the underlying point: people are trying to communicate a part of their personal experience because they want help.

For instance, I’ve seen therapists get upset over the rampant use and misuse of the term gaslighting. Yes, clinicians use this word to characterize serious emotional abuse. But let’s remember that we got the word from a 1938 play: Gas Light. In it, a guy named Jack buys a house because he thinks jewels are hidden in the attic. When he sneaks up there at night, he has to turn up the gas lights to see, and because everything’s on a singular gas line, all the other lights in the house dim. He doesn’t want his wife finding out what he’s doing, so he convinces her that she’s imagining the lights dimming—that she’s crazy. Half the suspense of the play is whether the wife is going to find out what’s really going on and realize that she’s not losing her mind.

Not long ago, I shared a thought on social media about gaslighting. It was about how we all, unintentionally, might find ourselves in situations where we diminish others’ experiences. My suggestion was that we can unknowingly slip into minor forms of gaslighting. What I didn’t expect was the wave of backlash suggesting I was diluting the term’s clinical meaning. Many argued that by expanding the definition of gaslighting to incorporate other forms of experiencing dismissal, I was undermining the real trauma and abuse suffered by victims of classic narcissistic gaslighting.

I see their point. But my concern was that the term was becoming so caricatured and inflexible that it was basically becoming synonymous with villainy. The goal of my post wasn’t to downplay the severity of gaslighting. Instead, I hoped to broaden its application, allowing us to see ourselves, even just slightly, in a role that society has deemed unacceptable. I believed this approach was justified, especially since gaslighting, as a term, is most often used colloquially.

LK: Let’s say a client tells you they’re being gaslit by a partner, but you believe what they’re experiencing isn’t gaslighting. What do you say? Is it your job to correct their use of the word?

Barker: My first instinct is to ask myself whether what I’m doing is for the client’s benefit. If I’m correcting my client just to scratch an intellectual itch, because I’d prefer they use different words, that’s not best practice. So in your scenario, my first step would be to have the client tell me about their experience. What does it bring up for them? That’s the therapeutic content we’re there to explore.

Trauma expert and IFS trainer Frank Anderson says, “When we’re blaming outward, we’re not focusing inward.” Often, that’s a protective strategy for not having to engage with the emotional content underneath our most complex relationships. Terms like gaslighting and narcissism have the potential to fuel outward blame. Even actual diagnoses can fuel outward blame, like “all my problems have to do with my ADHD.” So when clients use these words to externalize blame, I take that as an opportunity to pivot toward a more internal journey.

LK: It sounds like you’re saying, “Hey, if clinical buzzwords bring people into the therapy room to do deeper work, what’s the problem?”

Barker: Well, I do understand the pushback. ADHD doesn’t mean anything if everyone has it who gets bored or distracted. Autism doesn’t mean anything if everyone who feels socially anxious has it. If something means everything, it means nothing. We have to draw boundaries around what things mean. The therapists on social media criticizing the overuse or misuse of clinical language are, I believe, trying to protect the experiences of their clients. Those who genuinely meet the criteria for a particular diagnosis, or are living with a certain type of suffering, deserve to have their experiences respected. In that sense, hashtagging or turning suffering into trendy entertainment does raise concerns.

LK: Let’s try another word that’s everywhere: trauma. Some people worry it’s so ubiquitous it doesn’t mean anything anymore.

Barker: That’s not just a problem created by the internet. This is an in-house problem as well: we don’t have an agreed upon threshold for trauma. On one end of the spectrum, you have people like Gabor Maté saying that every medical illness is related to trauma, and everyone suffers from trauma. On the other end, there are people like Paul Conti, who define trauma by its neurological impact—how certain brain regions are activated even in contexts that aren’t dangerous.

But even that threshold seems like a false summit to me, because people who have overwhelming experiences in childhood might not have an acute stress response or PTSD, but they might still respond to those experiences in ways that create self-reinforcing cycles of dysfunction. An example of that is being bullied in school and feeling like there’s something wrong with you because kids don’t like you. That narrative is carried into your later years and becomes a self-fulfilling prophecy, standing in the way of social connection, exacerbating loneliness, causing reclusiveness. That experience deeply shifted the trajectory of your life, so I’m comfortable calling it trauma.

LK: Well, I’m on board with your definition, but what if it’s in direct contrast to your client’s definition of trauma? What’s the conversation then?

Barker: Then the question becomes, what does the client want to do with the label? If they’re just wanting to describe their experience, I don’t think it matters what they call it. If they’re trying to use the label to justify some sort of action, like emancipating from a parent or taking custody away from a coparent, that’s where we need to nail down definitions.

LK: What are some more unfamiliar terms your clients are bringing into your therapy room to describe their experiences?

Barker: One thing I hear a lot is the word toxic: toxic parenting, toxic romantic relationships, toxic religion. People are saying they’re having some reaction to whatever they put toxic in front of, so my response is always, “What effect is that having on you?” I also hear zombieing, which is when someone, most likely an ex, keeps popping back into your life. Breadcrumbing is where someone leads you on but doesn’t really commit to you. There’s also ghosting, submarining, and benching.

LK: Do you feel you need to be up on all these terms as a therapist? Should our readers stay on top of what’s trending?

Barker: No. The only thing that matters is what about those words is meaningful to the client, what meaning they’re making of it.

LK: The psychoeducation you put out on social media is being voraciously consumed. How do you determine what to post about? Is it based on therapy words or concepts you see going viral?

Barker: I draw inspiration from a lot of sources, but when it comes to these buzzwords, my token move is to take a term, like in the gaslighting example, that people usually use to justify blame and villainize someone in their life; then I try to reveal how aspects of that label probably apply to all of us.

Sometimes I research ways that people describe something like breadcrumbing, and I go on an investigation: “Okay, what are the emotional experiences people have with this word?” If I can get a 3D picture of what the pain point is that people are trying to touch on, I can ask myself what clinical wisdom or experience would be relevant for them. I use the term as the top contour of my post—it’s what will attract people to it—then, I try to bring in new insights.

There’s a difference, though, in how we use these terms in public discourse versus clinical discourse. My social media posts are public discourse; I’m happy to play with and clarify how we use these terms there. In the therapy room, my emphasis is on honoring the wounds and experiences that are underneath the terms.

LK: These terms resonate widely online for a reason.

Barker: Precisely. The terms will evolve and change as time goes on, but the experience is what matters.