Triggering Boundaries

The confusions of therapy-speak point to broader linguistic challenges

Photo by Uday Mittal on Unsplash

There has been a bit of recent online kerfuffle around therapy-speak gone viral, triggering much concern.  One unhappy columnist holds that the overuse of words like trigger are “shoring up a culture of pathologizing everything or facilitating selfishness.”  Well then.

A slightly less alarmed (but still concerned) take asserts that triggered has come to mean “absolutely everything and therefore nothing,” that in therapy this term would be explored, specifically understood.    

Trigger after all refers to not an event or stimuli, but a lightning-fast psychological chain-reaction to such stimuli.  The word in common use becomes shorthand, an incident in search of a story.

It is used in 12-step and outpatient groups, in discussing relapse prevention for instance.  Groups are asked to discuss their triggers, to varying degrees of detail, the point being that each trigger is personally specific.  Yet it is used repetitively, as the individuality of the term is displaced. 

We use such placeholders all the time, so often that their complexity is overlooked or oversimplified.  We might assume a common understanding when there isn’t one.  “I know what ‘trigger’ means.” Do you, if you know little about the speaker?

This happens in therapy constantly, since we cannot investigate every single word and placeholders are inevitable. For instance we talk of patient and therapist “processing” feelings.  (Is this the same as “discussing”?)  I once tried to define “process” for a new patient and quickly stopped myself, so nonsensical did it sound; the patient was new and I was lost in translation. I had a sense of the word but not this particular patient.

Many patients dislike “process” because it is another overused term, a bit of a cliché, and has no personal significance for them yet; they come hoping for answers, to stop doing and feeling certain things.  But articulating those feelings is difficult for most newer patients.

Thus the tangle, of my wanting to know more about what cannot yet be articulated.  Welcome to my world, the patient might say, as I begin to feel and sense what cannot be expressed. Often this ties to the patient’s unspoken sense of inadequacy, in needing help in the first place, all part of the (here we go again) process.

Some patients tell me, “I wish I could set better boundaries.”  This implies there is an ideal way, though boundaries again occur relationally. Out of context it is simply a notion, a generic intent.

When someone says to a partner, “please don’t do X, or I’ll have to do Y,” they are making a move in a relational language game. Many patients have had to obey the moves of authority figures without inventing any of their own. They arrive hoping to follow mine. This is what leads to frustration and entrapment.

Language works like this, as common terms seek definition, or context in specific instances.

Unconscious has of course no one definition or “essence.”  It is an expression from within a certain psychological framing—Freudian, Kohutian, contemporary—such framing one of indirect observation and inference.  We do not directly view the whirring of the unconscious, as if looking through a microscope.

Yet the repetition of the word lends it a certain realness, a gravitas, blurring the background from whence it emerges. The background of therapy is the specific personalities and perspectives of participants. What does unconscious mean within this particular overlap of minds?

Our words and phrases are like the notes of a score.  In isolation they cease to be music.  Therapists help patients create a score of their own, the journey itself a kind of music, be it staccato, plucky, harmonious, or discordant, so often different from what was expected—to the point where we might fail to hear it is as music, listening only for certain notes.

I aim to speak simply with patients, notes we can both hear, in facilitating the music of affective intimacy.  It is remarkable what a long and arduous process that can be. Many early childhood contexts were abandoning or abusive, emotional expression discouraged or punished, notes smothered in the crib.  Spare emotional language sounds foreign, even dangerous.

A patient (or celebrity) who speaks of boundaries or triggers may be dodging and/or asserting themselves in a new way, like a beginner playing “Chopsticks.”

What of my anxiety or anger is being irritated, and why?  This last piece is missing in so much of our discourse.  We instantly know what is being said, and form strong opinions, forgetting we have our own way of hearing.

Jonah Hill seemed to be saying something in the now-infamous thread with Sarah Brady.  He said “boundary” repeatedly.  It was hard to know what this meant.  I kept wondering why it was hard to say, “it hurts or bothers me when you do that”? We can speak of the “proper” way to do things as a hedge against more vulnerable expression.

In other words we generalize as a way of hiding ourselves. Wittgenstein warned against the dangers of our craving for generalization.

Some patients intellectualize their dilemmas so that their words sound clipped from a textbook, inclusive of jargon from previous therapists!  “My parasympathetic nervous system got overheated” or “I pick abusive partners due to abandonment trauma.” To their mind these dry remarks say it all, though I fail to hear a story. It is a little like asking someone to stop by the grocery store to pick up “food.”

For most patients, language games of intimacy were never encouraged; there is no previously lived context for contrast or reference, so many honestly don’t know why I am honing in on specifics. Or they see it as another task, a pass/fail, as with so much early caregiver interaction. The danger of the “fail” is monumental.

It is like encountering a person raised in a culture of whistling and clapping rather than the speaking of phoneticized words.  They may not to our ears seem to understand or intelligibly speak to our non-understanding.  They simply clap louder. 

On social media the claps come loud and hard.  Of course online threads and posts are not therapy per se.  But we increasingly discuss therapy—plus addiction, depression, and other matters—in digitized arenas which tend to decontextualize.  To paraphrase McLuhan, the medium becomes the message.  

But the process of personalizing, of placeholders finding particulars occurs relationally, in the face of unknowns, uncertainty the cradle of relatedness, necessitating trust and inevitable risk, in co-creating the music backgrounding our dialogue—those fallibly spoken forms of life depending upon mutual listening, a heard presence, which I fear is of dwindling significance in our meta-spheres. 

In deeply listening to what we hear, we can hear our contributions and what we need to better understand what more might be said, asked, or considered, before rushing to the next bright and shiny thing.  Even in therapy this is often a challenge.