Viewpoint: What in the name of Narcissus is this?
Therapy Today, February 2026.

After negotiating space for my lunch on a train table with a young woman, I fell into conversation with her about the purpose of her books and laptop. She was a master’s student and having a tough time with her university’s administration, and her tutor in particular. In the half an hour or so of chatting she described him as a narcissist who gaslit her. She felt burnt out and angry that there was no safe space for her to go. I couldn’t be sure what she meant by these terms of so-called ‘therapy speak’, even though I’m a psychotherapist. They, and many other words and phrases from consulting rooms and diagnostic manuals, have percolated into the mainstream, and have been diluted or added to on the way.

Our new dialect of therapy speak seems to be everywhere – Margot (as I came to know my train friend as) is part of a generation that describes experiences and relationships in these psychological and emotional terms. She reflects how we have, more generally, become far more aware, and interested in, our minds and emotions, and that we want to attend to, and maybe prioritise, our wellbeing. This must be a good thing in a world that continues to create pain and suffering at a seemingly exponential rate. Margot’s way of thinking and talking advocates for a better understanding and acceptance for all our varied stories, and makes my profession far less of an aloof one than it was when I began to practise 20 years ago. 

However, therapy speak has no agreed upon dictionary or glossary to refer to, and its developing terms can mislead or even confuse others. I set up a Substack to offer a guide to many (now mainstream) terms in the hope that we can come to more of an understanding of them when used in conversations of all types. My understanding of ‘gaslighting’ turns out to be very different from Margot’s, and while her tutor certainly sounded deeply unpleasant to say the least, I was not sure that his behaviours would stack up to the meaning of a ‘narcissist’ that I know. 

Therapy speak isn’t entirely new of course. I came into adulthood in the early 1990s knowing very little about what mental health or ill health meant. I remember my mother’s reference to my potential ‘inferiority complex’ (a term of Alfred Adler) as a much younger sibling, and references to punishing ‘superegos’ (a term of Sigmund Freud), but these were rarefied concepts of readily dismissed ‘psychobabble’. My friends and I had no grasp of what terms like these really meant and only a privileged – or really unwell – few who went to therapy did. 

Psychotherapy was an aloof practice for a very long while, associated with its Freudian psychoanalytic form or Woody Allen films (‘patients’ lying on a couch describing their dreams), or maybe as Californian hippies ‘rebirthing’ or ‘primal screaming’ at the Esalen Institute. Most of us muddled through bad days, bad sleep and bad break-ups without deep enquiries into our inner worlds or analysis of the relational dynamics between ourselves and others. Maybe, more accurately, we kept such analysis private. 

‘Stressed’ was about as nuanced as many descriptions got in my teens. It described the reason my friend’s mother ‘went somewhere to rest’ (I later found out she was admitted to a psychiatric ward for depression), and it was also the reason for another friend’s sister’s admission to a hospital for her ‘stomach problems’ (a specialist ‘eating disorders service’ didn’t then exist). We now use many more words – accurate or not – to share, far more readily, the contents of our minds, the range of our feelings, emotions, bodily experiences and presentations, and the details of how our experiences play out. Much of this is online of course: in social media posts and TikTok reels, YouTube videos and Substacks, with all the likes and follows. 

The US critic Lauren Oyler’s biting 2024 essay ‘The power of vulnerability’ describes many of these personal outpourings as a ‘controlled release of intimate details’.¹ She notes a cultural emphasis on being ‘authentic’ and emotionally open – especially on social media platforms – that ultimately persuades us to present our vulnerabilities in a curated and performative way. She is concerned that when such self-disclosure becomes selfmarketing, it strays from being a genuine communication, nor, she suggests, could this be truly transformative for the person who shares their inner world. I worry that therapy speak runs the risk of us doing something similar too – pulling us away from what we may really mean to say – which is why I want us to take care about the terms that we use. 

When I told Margot I was a psychotherapist her face lit up with interest, and she shared her experiences of her own various talking therapies. The growth of therapy speak has tallied with the normalisation of what I do. Twenty years ago, when I began clinical work, revealing my profession usually clammed people up. Some clients would come to see me in secret, paying in cash for fear of a partner clocking their weekly outgoing. Others described me as a ‘work coach’ to their families or on their bank transfers. This was around the time the 2004 bestselling book Watching the English: the hidden rules of English behaviour was first published.² Written by Kate Fox, a social anthropologist, it discerned ‘the understatement rule’, where: ‘…a debilitating and painful chronic illness must be described as “a bit of a nuisance”; a truly horrific experience is “well, not exactly what I would have chosen”... an act of abominable cruelty is “not very friendly”, and an unforgivably stupid misjudgment is “not very clever”…’ 

While the understatement rule persists (to the amusement of my Dutch friends), the growth of therapy speak suggests another, opposite, cultural manner exists too, which is to ‘say it as it is’. Because we may be using ill-defined terms though, this might mean wrongly or overstating things, which is why I want us to take stock. These days many of my clients talk about their therapy with others and they no longer hide me, and may even introduce me to their families or friends if we meet accidentally. Some tell their work colleagues why they come in late on a Wednesday, or ask their flatmates to be scarce when we meet on Zoom. 

Interestingly Fox’s book landed on the shelves around the same time as a controversial one that hit a very different note: Therapy Culture: cultivating vulnerability in an uncertain age.³ Written by the Hungarian-Canadian sociologist Frank Furedi, he has a particularly loud voice among many critics of the ‘problematisation of everyday life’ that many see has escalated over the past two decades (also described by other thinkers as ‘therapism’). 

Furedi points to a cultural overemphasis on emotional vulnerability, and laments the medicalised treatment (via therapeutic interventions) of ‘normal’ human experiences such as grief, depression and anxiety. He contends that our ‘therapy culture’ has eroded traditional sources of meaning and authority such as religion, family and community, and argues that, ultimately, our sense of individual autonomy and personal responsibility has ebbed. His voice hums in the background of books published this year that challenge overdiagnosis of mental health problems. 

There are other ideas that reverberate through the therapy speak debate – two related ones are ‘semantic bleaching’ and ‘concept creep’. The former refers to words losing meaning, which happens naturally as language evolves. When I was a teenager ‘wicked’ meant ‘awesome’, and ‘queer’ was derogatory. Reluctantly I accept that ‘literally’ now most often means ‘figuratively’, as it did for the woman I overheard exclaim ‘I know! I literally died! Twice!’ 

I nod to the fact that therapy speak runs the risk of semantically bleaching the diagnostic meaning of certain illnesses. Overhearing ‘I’m OCD about cleaning the kitchen’ offends my client who cares for her daughter imprisoned in her bedroom for three years by her terror of contamination. Saying ‘I felt really depressed yesterday’ riles another who I often speak to on the phone from under her duvet because she can’t face seeing me online, let alone making the 10-minute walk to my consulting room. Fearful of adding more bleach to such words, some of my clients, and supervisees, are now reluctant to use them even in appropriate ways, just in case they are overdoing it. 

Meanwhile ‘concept creep’ concerns words that expand in meaning over a shorter period and tend to do so because of a more conscious desire for change. This phenomenon was originally outlined by Nick Haslam, a professor of psychology at the University of Melbourne, in 2016 in an oft-quoted paper, ‘Concept creep: psychology’s expanding concepts of harm and pathology’.⁴ He had noted a trend beginning in the 1980s in the social and psychology fields of the broadening definition, or ‘semantic inflation’, of six concepts: ‘mental disorder’, ‘abuse’, ‘addiction’, ‘bullying’, ‘prejudice’ and ‘trauma’.

Haslam thinks that these concepts are expanding both ‘horizontally’ and ‘vertically’. ‘Horizontal creep’ happens when a term absorbs qualitatively new phenomena, in the mode of metaphor. So, using the example of ‘bullying’, when I was in my primary school playground in the 1970s, it described children being nasty to other children. Now bullying easily refers to adults undermining adults in the workplace, or online trolling, and has grown to go beyond intimidating behaviours to ones that exclude, such as shunning or ‘ghosting’. 

‘Vertical creep’ refers to the absorption of less severe phenomena, and resembles hyperbole (or exaggeration) of the type Furedi doesn’t like, nor the US psychiatrist Allen Frances, who rails against the increase of psychiatric diagnostic terms^.5 So, using the example of bullying again, the term – in the workplace literature at least – now seems to include one-off acts or ones that weren’t intended to be bullying, but the subjective experience of the victim is emphasised instead. 

Haslam concedes such creep could be a good thing. It is surely good that we are alive to psychological harms and want to be thorough about including all potential targets of these. 

Without concept creep of trauma, we might have ignored the egregious effects of racial microaggressions, and without the creep of abuse to the financial realm, many domestic harms would be unrecognised and unsupported. Anxiety is also, appropriately, absorbing people’s debilitating concerns about the safety of our planet and our future on it. 

However, Haslam also has concerns that echo the Furedi and ‘therapism’ camps. He thinks that the loosening of the definitions of our harms runs the risk of entrenching a growing cultural cleave between ‘victims’ and ‘perpetrators’ or ‘the harmed’ and ‘the harmers’, or, what we see blowing up online all the time, the destructive fights between those clinging to being ‘right’ while insisting on others being ‘wrong’. 

I think Haslam is right to flag the point that it becomes easier to dig your heels in during a difference or conflict with the heft of a psychological (or pseudo-psychological) label. Statements that shut another person down, such as ‘I have boundaries so I can’t do x’ or ‘You are triggering me so I’m walking away’, will inevitably favour the subjective experience of its speaker, making it difficult or impossible for another to challenge. If this opportunity for reciprocity and communication evaporates, a conversational cul-de-sac is its residue. Of course, both of these suggested statements can be true, but now we can be confused as to when they are or when they aren’t, or when they are stated in error or as a deliberate means to avoid self-reflection. 

The inherent opacity of psychological terms used out of their original contexts notably played out when the Hollywood actor Jonah Hill’s ex-girlfriend Sarah Brady posted screenshots of some texts he sent to her in the summer of 2023.⁶ Online opinion split between those who supported his use of words such as ‘boundaries’ and ‘triggering’ as appropriate (especially as they came from a man who would not be expected to show his vulnerability), while others thought he used them to assert power and control over Brady, above anything else.⁷ Words that have no settled agreement among ‘lay’ users, such as ‘gaslighting’ or ‘trauma’, tend to reflect divisions and disagreements among researchers and clinicians too. 

The momentum of today’s increased interest in mental health and psychological functioning offers an opportunity for us all – including those who go to therapy – to think about the words we use more and reflect further on what we mean when we use them. Therapists have an opportunity to help clients do this, just as we should be making every effort to understand the meaning of all words we hear. This isn’t so much about ‘policing’ words used but exploring as to whether they are used to capture the meaning intended by them – or indeed if words not used (like ‘trauma’) should be used too.