A Word of Caution Against Pathologizing

One of the principle ideals behind the concept of good therapy is that it should be non-pathologizing; that is, difficulties faced by clients should not be seen as intrinsic, inescapable diseases, nor should treatment focus on “healing” an issue in such a way. There are many reasons why a departure from pathologizing therapy is beneficial, both for the client and for the mental health professional (not to mention the field at large). But recently, psychotherapist Tammie Fowles published an op-ed piece that describes, if incidentally, a particularly important idea in the argument against pathologizing.

Fowles notes that all too often, approaches to therapy seek to internalize emotions, transforming knee-jerk reactions and emotional reflexes into complex ideas about what is wrong with the self. In this way, the experience of fear at the sight of someone being assaulted or the emotional reactions sustained during a store robbery might be turned on their head and used to reflect something maladaptive or insufficient within the client. Yet while the examination of why we react as we do has the potential to enlighten and heal, attributing our feelings to being a certain kind of person or having an emotional “script” that we follow based on some internal problem can not only disrupt the healing process, but can ignore the greater picture.

That greater picture, suggests Fowles, is that society as a whole is far from being perfect, and many of the more common challenges we face day to day are reflections of the society of which we’re a part. Pathologizing as a treatment modality, then, can sometimes make individuals responsible for those attributes of society that aren’t so positive. Though Fowles has many scathing points to make in her exploration of the modern face of therapy, this subtle nod towards a more proactive and realistic approach has been welcomed by many.



© Copyright 2009 by By John Smith. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Delly

    July 15th, 2009 at 7:04 PM

    love this perspective. keep up the good work Tammie

  • Therapistinstudy

    July 15th, 2009 at 7:24 PM

    I am a trainee student and I found this really fascinating. Is it important for a therapist to start the day like a blank sheet of paper emotionally? Is it more important to be aware of one’s state of mind and still be alert to our own responses. I have found it difficult on many occasions to be objective with a client when one has a personal issue through the day to deal with. Sometimes that problem could be the source of misdiagnosis or judgemental behavior. How does one stop our own knee jerk reactions from interfering?

  • Dru

    July 16th, 2009 at 3:37 AM

    Not sure I really catch the drift of this. Are you saying that we react to certain things in a way that we think we ought to react instead of in the way that we really may be feeling? Is that the script issue?

  • Tara

    July 16th, 2009 at 3:58 AM

    This makes a good point. Anything can set off a client, especially if it’s thru pathologizing. I enjoyed this article very much and found that it does make sense.

  • Laura P

    July 17th, 2009 at 11:55 AM

    Love to see the constsnt emergence of new ideas and the different ways that they are making their way into mainstream thought. Seems like good therapy is the perfect forum for that.

  • Jessica

    July 20th, 2009 at 2:10 AM

    I think it makes a lot of sense to avoid pathologizing. Sometimes in the early phase of one’s career it is difficult to stay off the pathologizing path. Experience definitely lends a hand with the objective.

  • Crystal

    March 11th, 2021 at 6:04 AM

    I’m trying to understand this theory. Are we saying that are reactions to trauma are normal but our coping mechanisms are where the mental illness comes from. Because I know a lot of people cannot understand why our initial responses are the way they are. I know most are from a survival standpoint and the abuser manipulating us and grooming us to react a certain way so they can continue the abuse. So our knee-jerk reaction to trauma is natural and genuine aka not wrong and need to understand that to heal? Someone please help me to understand this…

  • Kathleen

    February 13th, 2022 at 4:03 PM

    In other words, if you are a hammer, everyone looks like a nail to you.

  • Michael

    June 22nd, 2022 at 5:58 AM

    im struggling to understand this too….is it a case for understanding a clients issue(s) in a manner that its not always an internal / emotional source causing their/any situation to disrupt their life? a crude understanding might be to place their trauma/issue as an external objective for them to resolve and therefore not stigmatising their own intrinsic ability to deal with it?

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