It is no secret that Western medicine has actively contributed to the harm inflicted on historically marginalized and vulnerable communities. And, despite the very nature of the profession, psychology is far from immune from this shameful past. Lest we forget, sexual orientation was pathologized in the Diagnostic and Statistical Manual of Mental Disorders up until the mid-1970s.
Certainly no initiative could ever compensate for this history. To begin to chart a new path forward for the field, however, the APA generated inclusive language guidelines for the first time in its history. The goal of these guidelines are to help clinicians develop awareness about the ways in which the terms they use may perpetuate things like racism, ableism, heterosexism, and change their language to be more inclusive.
As APA Chief Diversity Officer Dr. Maysa Akbar put it, “Those committed to effecting change must acknowledge language as a powerful tool that can draw us closer together or drive us further apart. Simply put, words matter.”
While all healthcare fields ought to take note of this initiative, inclusivity is afforded unique importance in behavioral medicine. In therapy, vulnerability is paramount for progress. If you want your clients to trust you, you have to make it possible for them to trust you. Trust is not built simply from the absence of discrimination, but from the repeated presence of signs of safety. And safety starts with fostering a sense of belonging.
So, what exactly do these guidelines spell out for us clinicians? APA’s recommendations can be summarized by these three components:
Person-first language
Use language that emphasizes the person and not their disorder, disability, or condition. Using descriptors that precede a client’s personhood is to imply that that descriptor is the defining feature of your client. For example, referring to someone with substance use disorder as an “addict” centers this person’s relationship to substances as the primary piece of information that others should know about that person.
You might be thinking “Of course! I already do this!” but don’t scroll past this one just yet. Here are some examples of person-first language that have been slower to enter the clinical lexicon and that may require concerted effort on your part:
- Instead of “homeless person”, it is more inclusive to say “person without housing”
- Instead of “elderly people”, it is more inclusive to say “older adults” or “people above the age of 65”
- Instead of “special needs”, it is more inclusive to say “person with a disability”
- Instead of “victim”, it is less stigmatizing to say “person who experienced…”
Gender diversity and sexual orientation
First things first: remember not to conflate the two. Gender and sexual orientation describe two completely different elements of a person’s identity, and both are important to label accurately.
When it comes to gender identity, it is always good practice to ask your client directly what pronouns they use. You might even disclose your pronouns first before asking your client to share. When doing so, steer clear of using the term “preferred” pronouns, which implies choice in gender identity.
Here are some other key things to note:
- Instead of “birth sex” or “born male/female”, say “sex assigned at birth”
- Instead of “transgendered”, which implies that transgender identity is something done TO a person, say “a person who is transgender”
- Replace “he/she” (i.e., which might appear in any paperwork you ask your client to complete), with “they” or “everyone” or “folks”
Behavioral specificity
In many cases, language becomes stigmatizing when we don’t say exactly what we mean. Surprisingly, being direct with your word selection can actually help decrease the odds of using pejorative language inadvertently. The APA guidelines include a list of phrases that have a culturally appropriative origin, such as “spirit animal” and “getting gypped”. Using shorthand phrases can come at a cost.
Clinically, behavioral specificity is important, too. The guidelines are clear: use language that says just what you mean. For instance…
- Instead of “committed suicide” or “completed suicide,” which frames suicide as a crime or an achievement, say that someone “died by suicide”.
- Instead of “nonconsensual sex”, it is important to name this as “rape”
If, by this point, you’re thinking “Ok, I get why this is important, but this all just sounds too difficult to remember”, a perspective change might be in order. Weigh this perceived inconvenience with the pain your clients have experienced from years of invalidating language that erases their experience. And, remember, give yourself permission to slip up and stumble over your words. The most important thing is to keep going and learn from your mistakes. Bit by bit, we can make our field a more welcoming, inclusive space for all who need our help.
